Chapter 3: Nursing Practice and the Law, NCLEX - Legal & Ethical, Nursing Jurisprudence: Legal and Ethical Considerations NCLEX Practice Quiz, Legal and Ethical Issues in Nursing, NCLEX Questions-Ethical and Legal Issues, NCLEX STYLE REVIEW QUESTIONS...
A confused client who fell out of bed because side rails were not used is an example of which type of liability? A. Felony B. Assault C. Battery D. Negligence
Answer: D. Negligence
Misdemeanor
a lesser crime with a penalty of a fine of less than 1 year in prison (petty theft)
Obtaining informed consent is the responsibility of A. The physician B. The RN manager C. The nurse D. The CNA
A. The physician Rationale: The physician is RESPONSIBLE for obtaining an informed consent.
. Even though the nurse may obtain the client's signature on a form, obtaining informed consent is the responsibility of the: A. Client B. Physician C. Student nurse D. Supervising nurse.
Answer: B. Physician
Legal Issues in Nursing Practice: Controlled Substances
1) Proper handling and documenting of controlled substances and following FDA guidelines 2) Report controlled substance abuse in the work setting.
Threat against a patient or a coworker:
Assault
Contributory and Comparative Negligence
Hold injured person accountable for their fault in the injury.
The primary care provider wrote a do-not-resuscitate (DNR) order. The nurse recognizes that which applies in the planning of nursing care for this client? 1. The client may no longer make decisions regarding his or her own health care. 2. The client and family know that the client will most likely die within the next 48 hours. 3. The nurses will continue to implement all treatments focused on comfort and symptom management. 4. A DNR order from a previous admission is valid for the current admission
Answer: #3 Rationale: A DNR order only controls CPR and similar life-saving treatments. All other care continues as previously ordered. Competent clients can still decide about their own care (including the DNR order.)
Intentional Torts
3 common elements 1.will full act. 2.intend to bring about the consequenses. 3.must be causation.
Defenses
Arguments in support of or used for justification.
Cause-In-Fact
The breach of duty caused the injury: a direct cause-and-effect relationship.
autonomy
freedom to make decisions that affect self and to take action for self
Defenses Against Quasi-Intentional Torts
Defamation and Invasion of property, Consent, Truth, Privilege, Required Disclosure
Nurse Educator
For those who enjoy sharing their knowledge with others.
Disclosure Statues
State statues create mandatory reporting requirements in several areas.
Certified Nurse Midwife
Trained in the dual disciplines of nursing and mid-wifery.
Two Unintentional Torts
1) Negligence 2) Malpractice
Proximate Cause
Determines how far liability extends.
Unavoidable Accident
When nothing other than accident could have caused the patient's injury.
assault
unwanted contact with client that causes that causes client fear
18 or older
what age may a client choose to donate organs
Which nursing actions could result in malpractice? Select all that apply 1. Learns about a new piece of equipment 2. Forgets to complete the assessment of a client 3. Does not follow up on client's complaints. 4. Charts client's drug allergies 5. Questions primary care provider about an illegible order
Answer: 2 and 3 Rationale: Standards of practice require a complete assessment. A nurse needs to be sure the client's needs have been met. They both can impact client safety and do not follow standards of care.
The most important factor in providing nursing care to clients in a specific ethnic group is: A. Communication B. Time orientation C. Biological variation D. Environmental control
Answer: A. Communication
The dominant value orientation in North American society is: A. Use of rituals symbolizing the supernatural. B. Group reliance and interdependence C. Healing emphasizing naturalistic modalities D. Individualism and self-reliance in achieving and maintaining health.
Answer: D. Individualism and self-reliance in achieving and maintaining health.
If review of this patient's record revealed that she had never consented to the eye surgery, of which intentional tort might the surgeon have been guilty? A) assault B) battery C) invasion of privacy D) false imprisonment
B) battery
11. A health-care provider orders an injection for a pediatric patient. The patient's legal guardian refuses to allow the nurse to administer the medication. The nurse proceeds to administer the injection. Which action has the nurse committed? A. Assault B. Battery C. Invasion of privacy D. False imprisonment
B. Battery
Nurse Practice Acts
Based on police power of state, designed to protect public from unsafe practitioners.
National and Local Standards of Care
Based on reasonableness and are the average degree of care. Skill and diligence exercised by members of the same profession.
Which of the following statements characterizes criminal law? Criminal law applies to conduct that violates a person's rights. Criminal law involves an offense against an individual. Criminal law applies to conduct that is detrimental to society. The purpose of criminal law is to restitute the victim.
Criminal law applies to conduct that is detrimental to society. Criminal law is concerned with offenses against society in general. Civil law deals with personal rights. 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. Civil law applies to conduct that is detrimental to an individual.
Common Reasons for Board Investigations
Negligent, sexual relations, abusive behavior, substance abuse, physical or mental impairment.
Locality Rule
Professional organizations establish standards that are national in scope.
Products Liability
Refers to the liability of a manufacturer, processor, nonmanufacturing seller for injury to a person's property by a product.
Advanced Practice Nursing
Regulated by state law. Are permitted to prescribe medications.
Legal Issues in Nursing Practice: Short Staffing
Respondeat Superior - letting superior know there is a problem Corporate Liability
School Health Nursing
The school nursing clinical focus area is for those who want a more active leadership role in school nursing.
False Imprisonment
The unjustifiable dention of a person without legal basis to confine the person
Criminal Laws
Written to prevent harm to society and provide punishment for crimes. *Felony or Misdemeanor*
informed consent
a legal protection of client rights to choose type of care desired and make own decisions
Malpractice
addresses a professional, unreasonable lack of skill or care by a professional.
negligence
duty, breech of duty, injury occurred, proximate cause, actual loss or damage are all examples of
private and civil law- contract law
examples of law between nurse and client/employer or client agency
justice
fair, equitable and appropriate treatment, resources are distrubted to all
Endorsement
state grant of license to individual nurse licensed in another state.
nonmaleficence
to do no harm, either intentional or unintentional
veracity
to tell the truth to promote trust between client and nurse
general consent, surgical procedure, anesthesia
what three types of consents
Legal Issues in Nursing Practice: Use of Assistive Personnel
1) Must delegate appropriately, according to the person's licensure or certification, job description, and training. 2) Must know about the person's knowledge level, skill level, and competency check off status before delegating.
3 Types of Liability
1) Personal Liability 2) Supervisor Liability 3) Corporate Liability
The nurse places an aquathermia pad on a client with a muscle sprain. The nurse informs the client the pad should be removed in 30 minutes. Why will the nurse return in 30 minutes to remove the pad? A. Reflex vasoconstriction occurs. B. Reflex vasodilation occurs. C. Systemic response occurs. D. Local response occurs.
Answer: A. Reflex vasoconstriction occurs. If heat is applied for 1 hour or more, blood flow is reduced by reflex vasoconstriction. Vasoconstriction is the opposite of the desired effect of heat application
The nurse is working with parents of a seriously ill newborn. Surgery has been proposed for the infant, but the chances of success are unclear. In helping the parents resolve this ethical conflict, the nurse knows that the first step is: A. Exploring reasonable courses of action B. Collecting all available information about the situation C. Clarifying values related to the cause of the dilemma. D. Identifying people who can solve the difficulty.
Answer: B. Collecting all available information about the situation.
Trying questionable and experimental forms of therapy is a behavior that is characterized of which stage of dying? A. Anger B. Depression C. Bargaining D. Acceptance
Answer: C. Bargaining
Which factor is least significant during assessment when gathering information about cultural practices? A. Language, timing B. Touch, eye contact C. Biocultural needs D. Pain perception, management expectations
Answer: C. Biocultural needs Cultural practices do not influence biocultural needs because they are inborn risks that are related to a biological need and not a learned cultural belief or practice.
The best explanation of what Title VI of the Civil Rights Act mandates is the freedom to: A. Pick any physician and insurance company despite one's income B. Receive free medical benefits as needed within the county of residence C. Have equal access to all health care regardless of race and religion D. Have basic care with a sliding scale payment plan from all health care facilities
Answer: C. Have equal access to all health care regardless of race and religion
8. A nurse is caring for a patient who suffered a stroke. The patient's daughter brings a DNR and the power of attorney documents to the hospital. What is the purpose of the DNR? A. Document the terminal nature of the client's condition B. Allow an alternative to the universal standing order to provide cardiopulmonary resuscitation to all clients C. Provide an opportunity for the client, family, and caregivers to discuss the nature of the client's condition and the best possible course of action if the client has a cardiac arrest D. Provide legal protection for nurses who believe a client should not be resuscitated
B. Allow an alternative to the universal standing order to provide cardiopulmonary resuscitation to all clients
When witnessing the client's signature during informed consent, it is most important for the nurse to make which assessment? A) does the client understand the procedure? B) does the client have any questions? C) does the client give consent voluntarily? D) is the client about to write the name?
C) does the client give consent voluntarily?
Scope of Practice Issues
The actions or duties of a given profession. It refers to the legally permissable boundaries of practice and is defined by statue, rule, or a combination.
Felony
a crime of a serious nature: rape, theft, kidnap, murder
9. A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to identify a situation that represents an example of invasion of client privacy. Which situation, if identified by the student, indicates an understanding of a violation of this client right? a. Performing a procedure without consent b. Threatening to give a client a medication c. Telling the client that he or she cannot leave the hospital d. Observing care provided to the client without the client's permission
9. D- Invasion of privacy occurs with unreasonable intrusion into an individual's private affairs. Performing a procedure without consent is an example of battery. Threatening to a give a client a medication constitutes assault. Telling the client that the client cannot leave the hospital constitutes false imprisonment.
A nurse discovers that a primary care provider has prescribed an unusually large dosage of a medication. Which is the most appropriate action? 1. Administer the medication 2. Notify the prescriber 3. Call the pharmacist. 4. Refuse to administer the medication.
Answer #2 Rationale: The nurse should call the person who wrote the order for clarification. Administering the medication is incorrect because knowing the dose is outside the normal range and not questioning it could lead to client harm and liability for the nurse.
Which statement is correct? A. Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD). B. A second trimester abortion can be given without state involvement. C. Student nurses cannot be sued for malpractice while in a nursing clinical class. D. Nurses who get sick and leave during a shift are not abandoning clients if they call their supervisor and leave a message about their emergency illness.
Answer: A. Consent for medical treatment can be given by a minor with a sexually transmitted disease (STD). Anyone, at any age, can be treated without parental permission for an STD infection. The client is "advised" to contact sexual partners but is not "required" to give names. Permission from parents is not needed, based upon current privacy laws.
The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of: A. Assault B. Battery C. Invasion of privacy D. Neglect
Answer: B. Battery
What should the nurse do when planning nursing care for a client with a different cultural background? The nurse should: A. Allow the family to provide care during the hospital stay so no rituals or customs are broken B. Identify how these cultural variables affect the health problem C. Speak slowly and show pictures to make sure the client always understands D. Explain how the client must adapt to hospital routines to be effectively cared for while in the hospital
Answer: B. Identify how these cultural variables affect the health problem Without assessment and identification of the cultural needs, the nurse cannot begin to understand how these might influence the health problem or health care management.
The distribution of nurses to areas of "most need" in the time of a nursing shortage is an example of: A. Utilitarianism theory B. Deontological theory C. Justice D. Beneficence
Answer: C. Justice Justice is defined as the fairness of distribution of resources. However, guidelines for a hierarchy of needs have been established, such as with organ transplantation. Nurses are moved to areas of greatest need when shortages occur on the floors. No floor is left without staff, and another floor that had five staff will give up two to go help the floor that had no staff.
A document that lists the medical treatment a person chooses to refuse if unable to make decisions is the: A. Durable power of attorney B. Informed consent C. Living will D. Advance directives
Answer: D. Advance directives
The nurse reviews a patient's medical record and sees that tube feedings are to begin after a feeding tube is inserted. In recent past experiences the nurse has seen patients on the unit develop diarrhea from tube feedings. The nurse consults with the dietitian and physician to determine the initial rate that will be ordered for the feeding to lessen the chance of diarrhea. This is an example of what type of direct care measure? Preventive Controlling for an adverse reaction Consulting Counseling
Controlling for an adverse reaction Anticipating the need to start the feeding at a slower rate is an example of controlling for an adverse reaction, which in this case would be a harmful or unintended effect (diarrhea) of therapeutic intervention.
The nursing diagnosis readiness for enhanced communication is an example of a(n): Risk nursing diagnosis. Actual nursing diagnosis. Health promotion nursing diagnosis Wellness nursing diagnosis.
Health promotion nursing diagnosis A patient's readiness for enhanced communication is an example of a health-promotion diagnosis because it implies the patient's motivation and desire to strengthen his health.
Nurse allows a staff member to draw blood for lab. Is this a violation of HIPAA?
NO.
A nurse assesses a 78-year-old patient who weighs 240 pounds (108.9 kg) and is partially immobilized because of a stroke. The nurse turns the patient and finds that the skin over the sacrum is very red and the patient does not feel sensation in the area. The patient has had fecal incontinence on and off for the last 2 days. The nurse identifies the nursing diagnosis of risk for impaired skin integrity. Which of the following goals are appropriate for the patient? (Select all that apply.) Patient will be turned every 2 hours within 24 hours. Patient will have normal bowel function within 72 hours. Patient's skin will remain intact through discharge. Patient's skin condition will improve by discharge.
Patient will have normal bowel function within 72 hours. Patient's skin will remain intact through discharge. The skin remaining intact is an appropriate goal for the patient's at-risk diagnosis. A return of normal bowel functioning is also appropriate since it indicates removal of a risk factor. Turning the patient is an intervention; skin condition improving by discharge is a poorly written goal that is not measurable.
The nurse enters a patient's room, and the patient asks if he can get out of bed and transfer to a chair. The nurse takes precautions to use safe patient handling techniques and transfers the patient. This is an example of which physical care technique? Meeting the patient's expressed wishes Indirect care measure Protecting a patient from injury Staying organized when implementing a procedure
Protecting a patient from injury A common method for administering physical care techniques appropriately includes protecting you and your patients from injury, which involves safe patient handling. Transferring a patient is a direct care measure. Organization is an aspect of physical care but not an example of this nurse's action. Although meeting patient needs is important, it is not a physical care technique.
In the following examples, which nurses are making nursing diagnostic errors? (Select all that apply.) The nurse who listens to lung sounds after a patient reports "difficulty breathing" The nurse who considers conflicting cues in deciding which diagnostic label to choose The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema The nurse who identifies a diagnosis on the basis of a single defining characteristic
The nurse assessing the edema in a patient's lower leg who is unsure how to assess the severity of edema The nurse who identifies a diagnosis on the basis of a single defining characteristic When the nurse assesses edema without knowing how to assess the severity, the nurse fails to validate her assessment findings of edema, either by using a scale to measure the severity or by asking a colleague to validate her findings. In identifying a diagnosis on the basis of a single defining characteristic, the nurse prematurely closes clustering, which can lead to an inaccurate diagnosis. By listening to lung sounds after the patient reports 'difficulty breathing' the nurse validates findings to make an accurate diagnosis. The nurse interprets cue clusters to make an accurate diagnosis when considering conflicting cues to make a diagnosis.
Review the following list of nursing diagnoses and identify those stated incorrectly. (Select all that apply.) Acute pain related to lumbar disk repair Sleep deprivation related to difficulty falling asleep Constipation related to inadequate intake of liquids Potential nausea related to nasogastric tube insertion
cute pain related to lumbar disk repair Sleep deprivation related to difficulty falling asleep Potential nausea related to nasogastric tube insertion Acute pain related to lumbar disk repair uses a medical diagnosis as a related factor. Sleep deprivation related to difficulty falling asleep uses a clinical sign rather than a treatable etiology such as 'excess noise in environment.' Potential nausea related to nasogastric tube insertion uses a diagnostic study as the etiology. None of the etiologies can be managed or treated by nursing intervention.
statutory laws
nurse practice acts, guardianship, informed consent, living wills, abuse reporting, sexual harrassment, good samaritan all fall under these laws
living will or health care proxy
two types of advance directives are
When the nurse described the client as "that nasty old man in 354," the nurse is exhibiting which ethical dilemma? A. Gender bias and ageism B. HIPAA violation C. Beneficence D. Code of ethics violation
Answer: A. Gender bias and ageism Stereotyping an "old man" as "nasty"is a gender bias and an ageism issue. The nurse is verbalizing a negative descriptor about the client.
To respect a client's personal space and territoriality, the nurse: A. Avoids the use of touch B. Explains nursing care and procedures C. Keeps the curtains pulled around the clients bed D. Stands 8 feet away from the bed, if possible.
Answer: B. Explains nursing care and procedures
Which statement about loss is accurate? A. Loss is only experienced when there is an actual absence of something valued. B. The more the individual has invested in what is lost, the less the feeling of loss. C. Loss may be maturational, situational, or both. D. The degree of stress experienced is unrelated to the type of loss.
Answer: C. Loss may be maturational, situational, or both.
The nurse notes that an advance directive is in the client's medical record. Which of the following statements represents the best description of guidelines a nurse would follow in this case? A. A durable power of attorney for health care is invoked only when the client has a terminal condition or is in a persistent vegetative state B. A living will allows an appointed person to make health care decisions when the client is in an incapacitated state. C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. D. The client cannot make changes in the advance directive once the client is admitted into the hospital.
C. A living will is invoked only when the client has a terminal condition or is in a persistent vegetative state. Rationale: A living will directs the client's healthcare in the event of a terminal illness or condition. A durable power of attorney is invoked when the client is no longer able to make decisions on his or her own behalf. The client may change an advance directive at any time.
A nurse checks a physician's order and notes that a new medication was ordered. The nurse is unfamiliar with the medication. A nurse colleague explains that the medication is an anticoagulant used for postoperative patients with risk for blood clots. The nurse's best action before giving the medication is to: Have the nurse colleague check the dose with her before giving the medication. Consult with a pharmacist to obtain knowledge about the purpose of the drug, the action, and the potential side effects. Ask the nurse colleague to administer the medication to her patient. Administer the medication as prescribed and on time.
Consult with a pharmacist to obtain knowledge about the purpose of the drug, the action, and the potential side effects. When a nurse performs a new or unfamiliar procedure, such as giving a new medication, it is important to assess personal competency and determine if new knowledge or assistance is needed. The nurse's best action is to check with the pharmacist about the medication. Having another nurse check the dosage is appropriate if the nurse is still uncertain about the medication. Once the nurse feels prepared, the medication is administered as prescribed. You never ask a colleague to give a medication to a patient to whom you are assigned.
A nurse is preparing for change-of-shift rounds with the nurse who is assuming care for his patients. Which of the following statements or actions by the nurse are characteristics of ineffective handoff communication? This patient is anxious about his pain after surgery; you need to review the information I gave him about how to use a patient-controlled analgesia (PCA) pump this evening. The nurse refers to the electronic care plan in the electronic health record (EHR) to review interventions for the patient's care. During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient. The nurse gives her patient a pain medication before report so there is likely to be no interruption during rounding.
During walking rounds the nurse talks about the problem the patient care technicians created by not ambulating the patient Creating a culture of blame does not support questioning, which is needed for good handoff communication. Talking about the patient's anxiety during handoff is patient centered and thus appropriate, referring to the EHR to review interventions ensures that essential information is included, and administering a pain medication before the report allows the nurse to be organized and uninterrupted during rounds.
A nurse is starting on the evening shift and is assigned to care for a patient with a diagnosis of impaired skin integrity related to pressure and moisture on the skin. The patient is 72 years old and had a stroke. The patient weighs 250 pounds and is difficult to turn. As the nurse makes decisions about how to implement skin care for the patient, which of the following actions does the nurse implement? (Select all that apply.) Review the set of all possible nursing interventions for the patient's problem Review all possible consequences associated with each possible nursing action Consider own level of competency Determine the probability of all possible consequences
Review the set of all possible nursing interventions for the patient's problem Review all possible consequences associated with each possible nursing action When making decisions about implementation, reviewing all possible interventions and consequences and determining the probability of consequences are necessary steps. The nurse is responsible for having the necessary knowledge and clinical competency to perform an intervention, but this is not part of the decision making involved.
The following nursing diagnoses all apply to one patient. As the nurse adds these diagnoses to the care plan, which diagnoses will not include defining characteristics? Risk for aspiration Acute confusion Readiness for enhanced coping Sedentary lifestyle
Risk for aspiration A risk diagnosis does not have defining characteristics, but instead risk factors. Risk factors are the environmental, physiological, psychological, genetic, or chemical elements that place a person at risk for a health problem.
In which of the following examples is a nurse applying critical thinking attitudes when preparing to insert an intravenous (IV) catheter? (Select all that apply.) Following the procedural guideline for IV insertion Seeking necessary knowledge about the steps of the procedure from a more experienced nurse Showing confidence in performing the correct IV insertion technique Being sure that the IV dressing covers the IV site completely
Seeking necessary knowledge about the steps of the procedure from a more experienced nurse Showing confidence in performing the correct IV insertion technique Seeking necessary knowledge about the steps of the procedure shows humility. The nurse recognizes that she needs clarification from a senior colleague. Another example of a critical thinking attitude is confidence. In this case confidently inserting an IV line allows the nurse to convey expertise and a sense of calm, leading the patient to trust the nurse. Following policy and procedure is an example of following standards of care, not of a critical thinking attitude. Making sure that the dressing is covered is a step in following good standards of IV care but is not a critical thinking attitude.
As part of their right to refuse treatment, patients may prepare advance directives specifying what life-saving treatments they do or do not wish to receive. When determining the legality of an advance directive, the nurse should know the applicable _______ laws. Federal State County Local
State State laws vary on the legalities of the various forms of advance directives, so the nurse needs to know the applicable state laws.
Which of the following are examples of data validation? (Select all that apply.) The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. The nurse asks the patient if he is having pain and then asks the patient to rate the severity. The nurse observes a patient reading a teaching booklet and asks the patient if he has questions about its content. The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement. The nurse asks the patient to describe a symptom by saying, "Go on."
The nurse assesses the patient's heart rate and compares the value with the last value entered in the medical record. The nurse obtains a blood pressure value that is abnormal and asks the charge nurse to repeat the measurement. Validation involves comparing data with another source. By asking the patient about pain and then having it rated the nurse collects two assessment findings. The nurse asking an open-ended question about the patient's understanding of the booklet is not data validation. Telling the patient to go on; is back channeling.
A nurse manager is conducting an employee evaluation for a new employee. Which employee behavior best indicates that the nurse is providing patient-centered care? The nurse shares his or her own personal problems in order to obtain the patient's trust and to show empathy with the family. The nurse avoids raising the patient's anxiety by chatting about pleasant topics before unpleasant procedures. The nurse clarifies patients' reasons for refusing medications without becoming defensive. The nurse avoids upsetting patients by not bringing up health care issues that might upset the patient.
The nurse clarifies patients' reasons for refusing medications without becoming defensive. Providing patient-centered care involves clarifying patients' reasons for refusing medications. Refraining from discussing own concerns demonstrates a patient-centered approach. The nurse displays patient-centered care by attempting to talk the patient through anxiety-laden procedures. Avoiding discussing health issues does not display a patient- centered approach.
A nurse from home health is talking with a nurse who works on an acute medical division within a hospital. The home health nurse is making a consultation. Which of the following statements describes the unique difference between a nursing care plan from a hospital versus one for home care? The goals of care will always be more long term. The patient and family need to be able to independently provide most of the health care. The patient's goals need to be mutually set with family members who will care for him or her. The expected outcomes need to address what can be influenced by interventions.
The patient and family need to be able to independently provide most of the health care. A community-based health care setting such as home health must work with patients and their families to set goals and outcomes that ultimately lead to a plan that allows them to provide the majority of care themselves. Goals of care will not always be more long term; goals will be short term and long term, depending on the patient's condition. Mutually setting goals with caregiving family members is true for any health care setting. The statement "The expected outcomes need to address what can be influenced by interventions" is incorrect; the outcomes allow you to direct your evaluation of care.
A nurse is assigned to a patient who has returned from the recovery room following surgery for a colorectal tumor. After an initial assessment the nurse anticipates the need to monitor the patient's abdominal dressing, intravenous (IV) infusion, and function of drainage tubes. The patient is in pain, reporting 6 on a scale of 0 to 10, and will not be able to eat or drink until intestinal function returns. The family has been in the waiting room for an hour, wanting to see the patient. The nurse establishes priorities first for which of the following situations? (Select all that apply.) The family comes to visit the patient. The patient expresses concern about pain control. The patient's vital signs change, showing a drop in blood pressure. The charge nurse approaches the nurse and requests a report at end of shift.
The patient expresses concern about pain control. The patient's vital signs change, showing a drop in blood pressure. Pain control is a priority, because it is severe and affects the patient's ability to rest after surgery and be able to perform necessary activities. A change in vital signs is a priority, and the change could be related to the patient's pain. However, because of the nature of surgery, the nurse has to reassess for any bleeding, which lowers blood pressure. Attending to the family is important to lend the patient needed support, but it is not the initial priority. Finally the nurse must attend to urgent patient needs before completing a report.
The nurse is documenting several aspects of an assessment conducted on a patient newly admitted to the hospital with a suspected myocardial infarction. Which of the following is considered objective data? The patient states, "I feel like an elephant is standing on my chest." The patient is diaphoretic, pale, hypotensive, and tachycardic The patient states, "This is the worst pain I have had in my life." The patient states, "I have pain under the breastbone in my chest."
The patient is diaphoretic, pale, hypotensive, and tachycardic Objective data is the type of data that the nurse will collect through observation of the patient. It is measurable, and often called signs. The patient statements of a feeling of an elephant standing on the chest, severe pain, and pain under the breastbone are all examples of subjective data.
The nurse is planning care for an 8-year-old patient who had undergone a tonsillectomy yesterday and is having difficulty increasing fluid intake postoperatively due to incisional pain. Which of the following is an appropriate patient goal? The patient will consume 1000 ml within 24 hours. Provide the patient with small sips of favorite liquids. Encourage the patient to take prescribed pain medications. Apply an ice collar to the patient's throat if desired.
The patient will consume 1000 ml within 24 hours. A goal is a statement of what is to be accomplished. It should be stated in terms of what the patient will do rather than what the nurse will do. The statement "the patient will consume 1000 ml of fluid within 24 hours" is a goal. The statements regarding providing sips of liquids, administering pain medications and ice collars are nursing interventions, not goals.
Quasi-Intentional Torts
Invasion of privacy, defamation
Personal Liability
Nurse's responsibility and accountability for her own actions or inaction.
The code of ethics for nurses is composed and published by: A. The national league for Nursing B. The American Nurses Association C. The Medical American Association D. The National Institutes of Health, Nursing division.
Answer: B. The American Nurses Association The ANA has established widely accepted codes that professional nurses attempt to follow.
Child Health Nursing
Assessment and management of children with chronic health conditions and their families.
Truth
Is a valid defense to defamatory statements.
The client's right to refuse treatment is an example of _________ laws.
civil
Four ways to legally protect myself?
1) Know my state laws affecting nursing practice. 2) Follow my state's nursing practice act rules and regulations. 3) Deliver sage, competent nursing care. 4) Develop and use your critical thinking abilities and skills.
Legal Issues in Nursing Practice: Discharge Instructions
1) Write out the directions in simple, layperson's terms 2) Be consistent with the doctor's written discharge order.
Ethnocentrism is the root of: A. Biases and prejudices B. Meanings by which people make sense of their experiences. C. Cultural beliefs D. Individualism and self-reliance in achieving and maintaining health.
Answer: A. Biases and prejudices
When action is taken on one's prejudices: A. Discrimination occurs B. Sufficient comparative knowledge of diverse groups is obtained. C. Delivery of culturally congruent care is ensured. D. People think/know you are a ******* for being prejudiced.
Answer: A. Discrimination occurs
Which statement about an institutional ethics committee is correct? A. The ethics committee is an additional resource for clients and healthcare professionals. B. The ethics committee relieves health care professionals from dealing with ethical issues. C. The ethics committee would be the first option in addressing an ethical dilemma. D. The ethics committee replaces decision making by the client and health care providers.
Answer: A. The ethics committee is an additional resource for clients and healthcare professionals.
Transcultural nursing implies: A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate B. Working in another culture to practice nursing within their limitations C. Combining all cultural beliefs into a practice that is a non-threatening approach to minimize cultural barriers for all clients' equality of care D. Ignoring all cultural differences to provide the best generalized care to all clients
Answer: A. Using a comparative study of cultures to understand similarities and differences across human groups to provide specific individualized care that is culturally appropriate Transcultural care means that by understanding and learning about specific cultural practices the nurse can integrate these practices into the plan of care for a specific individual client who has the same beliefs or practices to meet the client's needs in a holistic manner of care.
Janie wants to call an ethics consult to clarify treatment goals for a patient no longer able to speak for himself. She believes his dying is being prolonged painfully. She is troubled when the patient's doctor tells her that she'll be fired if she raises questions about his care or calls the consult. This is a good example of: A) ethical uncertainty B) ethical distress C) ethical dilemma D) ethical residue
B) ethical distress
Articulation with Medical Practice Acts
Each state has a nurse practice act and a medical practice act.
Initiating The Lawsuit
It is rare to have a single plaintiff or a single defendant.
Saying something about someone that you know is false:
Malice
Content
May be oral, implied or apparent.
Release
Maybe signed during the process of settling a claim to prevent any and all future claims arising from the same incident.
Clinical Nurse Leader
Position created to improve quality of patient care and engage highly skilled clinicians in out-comes-based practice and quality improvement in response to national reports that highlighted poor patient outcomes.
Malpractice
Professional negligence.
court of law
communication of clients and health care workers cannot be shared with others outside health care team for example __ unless clients consents
incident report
communication tools that provide information to risk managers to liability, and identify problems and solutions to prevent incident.
Negligence
conduct lacking in due care.
A attorney charged a nurse with manslaughter because she poisoned her patient with a lethal medication. What type of law is this?
criminal law
14. A nurse is caring for a patient who has colon cancer. The interprofessional team met to discuss some changes in the patient's plan of care. The nurse discusses the changes with the patient's daughter before discussing anything with the patient. Which did the nurse violate? a. The Patient Care Partnership b. The Fifth Amendment c. The American Disabilities Act d. Health Insurance Portability and Accountability Act
d. Health Insurance Portability and Accountability Act
Nurse Practice Act
is the single most important piece of legislation for nurses.
fidelity
remain faithful to ethical principles and ANA code of ethics for example researching a question the client may have
beneficence
to act in best interest of others to contribute to the well-being of others, advocacy, promote good, prevent harm or evil
Develop nursing care standards and lobbying for better laws affecting nursing practice and patient care.
Member/Leader of a Professional Nursing Organization
A patient outcome statement or goal is (select all that apply): Specific to the patient Given a time frame for completion Indicative of an increase of the problem Realistic for the patient
Specific to the patient Given a time frame for completion Realistic for the patient
Legal Issues in Nursing Practice: HIV/AIDS
1) Maintain confidentiality of HIV infected clients and peers. 2) May fire a nurse who refuses to work with a client with AIDS.
Legal Issues in Nursing Practice: Living Wills and Health Care Surrogates
1) Patient Self-Determination Act - living will or advanced directive 2) Living Wills - patient or surrogate must bring in documentation and instruct MD 3) Durable Power of Attorney or Health Care Surrogates
Two Major Legal Focuses of the R.N.
1) Protect my clients' rights 2) Protect myself from legal liability
Legal Issues in Nursing Practice: Abortion Issues
1) Roe vs. Wade: Right to an abortion. 2) Casey - Required 24 hours wait time before having an abortion
Appeals
1. Based on error of law during trial. 2. Appellate level or state intermediate court level. 3. State supreme court or highest level court 4. Federal Court.
Supervisor Liability
Liability of the employer when the employee makes an error in the workplace
Immunity
Some states have enacted statutes that confer immunity from suit in certain circumstances, such as good samaritan statutes.
yes but must be documented in medical record
may clients waive the right to informed consent
battery
purposeful touching without that clients consent
Malpractice involves substandard care and the following four criteria:
1) The nurse (defendant) owed a duty to the patient (plaintiff) 2) The nurse did not care out that duty. 3) The client was injured 4) The nurse's failure to carry out the duty are is both the actual and proximate causes of the injury.
1. The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report? a. The client fell out of bed b. The client climbed over the side rails c. The client was found lying on the floor d. The client became restless and tried to get out of bed.
1. C- The incident report should contain the client's name, age, and diagnosis. The report should contain a factual description of the incident, any injuries experienced by those involved, and the outcome of the situation. The correct option is the only one that describes the facts as observed by the nurse. Options 1, 2, and 4 are interpretations of the situation and are not factual information as observed by the nurse.
Good Samaritan Laws
Encourage people to render aid in emergency situations.
The nurse's partner/spouse undergoes exploratory surgery at the hospital where the nurse is employed. Which practice is most appropriate 1, Because the nurse is an employee, access to the chart is allowed. 2. The relationship with the client provides the nurse special access to the chart. 3. Access to the chart requires a signed release form 4. The nurse can ask the surgeon to discuss the outcome of the surgery.
Answer: #3 Rationale: The only person entitled to information without written consent is the client and those providing direct care. The nurse has open access to information regarding assigned clients only.
Which criterion is needed for someone to give consent to a procedure? A. An appointed guardianship B. Unemancipated minor C. Minimum of 21 years or older D. An advocate for a child
Answer: A. An appointed guardianship A guardian has been appointed by a court and has full legal rights to choose management of care.
Legal Issues in Nursing Practice: Surrogate Pregnancy Contracts and Adoption
Surrogacy contracts are legal, but may not be enforceable
List Examples of Negligence:
1) Leaving a patient in a wet bed 2) Not turning every 2 hours 3) Meds to the wrong patient 4) Giving too many doses of a med 5) Incorrect surgical site 6) Seeing a downward trend of vitals and doing nothing
11. An 87-year-old woman is brought to the emergency department for treatment of a fractured arm. On assessment, the nurse notes old and new ecchymotic areas on the client's chest and legs and asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he arrives home from work. What is the most appropriate nursing response? a. "Oh really I will discuss this situation with your son" b. "Let's talk about the ways you can manage your time to prevent this from happening" c. "Do you have any friends that can help you out until you resolve these important issues with your son?" d. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay.
11. D- The nurse must report situations related to child or elder abuse, gunshot wounds and other criminal acts, and certain infectious diseases. Confidential issues are not to be discussed with nonmedical personnel or the client's family or friends without the client's permission. Clients should be assured under a legal obligation. Option 1, 2, and 3 do not address the legal implications of the situation and do not ensure a safe environment for the client.
A primary care provider prescribes on tablet, but the nurse accidentally administers two. After notifying the primary care provider, the nurse monitors the client carefully for untoward effects of which there are none. Is the client likely to be successful in suing the nurse for malpractice? 1. No, the client was not harmed 2.No, the nurse notified the primary care provider 3. Yes, a breach of duty exists 4. Yes, foreseeability is present
Answer: 1 Rationale: All elements such as duty, foreseeability causation, harm/injury and damages must be present for malpractice to be proven.
Cultural awareness is an in-depth self-examination of one's: A. Background, recognizing biases and prejudices. B. Social, cultural, and biophysical factors C. Engagement in cross-cultural interactions D. Motivation and commitment to caring.
Answer: A. Background, recognizing biases and prejudices. Cultural awareness is an in-depth examination of one's own background, recognizing biases and prejudices and assumptions about other people.
Ethical dilemmas often arise over a conflict of opinion. Once the nurse has determined that the dilemma is ethical, a critical first step in negotiating the difference of opinion would be to: A. Consult a professional ethicist to ensure that the steps of the process occur in full. B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. C. List the ethical principles that inform the dilemma so that negotiations agree on the language of the discussion. D. Ensure that the attending physician has written an order for an ethics consultation to support the ethics process.
Answer: B. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma Each step in the processing of an ethical dilemma resembles steps in critical thinking. The nurse begins by gathering information and moves through assessment, identification of the problem, planning, implementation, and evaluation.
In most ethical dilemmas, the solution to the dilemma requires negotiation among members of the health care team. The nurse's point of view is valuable because: A. Nurses have a legal license that encourages their presence during ethical discussions. B. The principle of autonomy guides all participants to respect their own self-worth. C. Nurses develop a relationship to the client that is unique among all professional health care providers. D. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about client care.
Answer: C. Nurses develop a relationship to the client that is unique among all professional health care providers When ethical dilemmas arise, the nurses point of view unique and critical. The nurse usually interacts with clients over longer time intervals than do other disciples.
Miss Mary, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value
Answer: C. Prizing a value.
The nurse is providing patient education for a patient newly diagnosed with diabetes mellitus. When the nurse teaches the patient how to administer insulin, the nurse is demonstrating which phase of the nursing process? Diagnosis Planning Evaluation Interventions
Interventions A nurse providing patient education on self-administration of insulin is demonstrating the intervention phase of the nursing process. Teaching patients is not an example of diagnosis, planning, or evaluation.
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? Assault Negligence Slander Malpractice
Malpractice Malpractice in the failure to meet a legal duty that results in harm to another. Slander in malicious or untrue spoken words about another person or property.Negligence is the commission or omission of an act that a reasonably prudent person would have done in a similar situation that leads to harm to another person.Assault is an intentional threat to cause bodily harm to another.
Which steps does the nurse follow when he or she is asked to perform an unfamiliar procedure? (Select all that apply.) Seeks necessary knowledge Reassesses the patient's condition Collects all necessary equipment Delegates the procedure to a more experienced staff member Considers all possible consequences of the procedure
Seeks necessary knowledge Considers all possible consequences of the procedure You require additional knowledge and skills in situations in which you are less experienced. When you are asked to administer a new procedure with which you are unfamiliar, follow the three choices: seek necessary knowledge, collect necessary equipment, and consider all possible consequences of the procedure. Collecting necessary equipment and considering potential consequences is needed for any procedure.
LPN/LVNs need to know what they can and cannot do within their scope of practice. They would need to refer to: Interstate compact ANA The Nurse Practice Act of their licensing state Their employing institution
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 in a legal agreement that allows multistate practice of nursing.ANA is involved in developing standards of care for nursing practice. The employing institution may limit further the scope of practice for an LPN/LVN, but it is for that institution only.
The nurse makes the following statement during a change of shift report to another nurse. "I assessed Mr. Diaz, my 61-year-old patient from Chile. He fell at home and hurt his back 3 days ago. He has some difficulty turning in bed, and he says that he has pain that radiates down his leg. He rates his pain at a 6, but I don't think it's that severe. You know that back patients often have chronic pain. He seems fine when talking with his family. Have you cared for him before?" What does the nurse's conclusion suggest? The nurse is making an accurate clinical inference. The nurse has gathered cues to identify a potential problem area. The nurse has allowed stereotyping to influence her assessment. The nurse wants to validate her information with the other nurse.
The nurse has allowed stereotyping to influence her assessment. The nurse is applying a stereotype about patients with back pain. An accurate clinical inference would not include the nurse's opinion. The cues suggest that the patient has acute pain, which the nurse is rejecting. Validation would involve having another nurse also assess the patient for pain.
Injury
The plantiff must demonstrate that some type of physical, financial or emotion injury resulted from the breach of duty owed to the patient.
Reciprocity
agreement between states to recognize license of other state.
proximate cause
reasonably close causal connection between nurse conduct and resulting injury example of negligence
Legal Issues in Nursing Practice: Good Samaritan Law
refers to someone who renders aid in an emergency to an injured person on a voluntary basis. Don't go beyond basic first aide.
nurse practice act
scope of practice for nurse in specific state, guidelines, education, examination, that board of registration in nursing to oversee implementation
Consent
A nurse cannot be liable for invasion of privacy if allowed access to patients property.
When caring for a terminally ill client, it is important for the nurse maintain the client's dignity. This can be facilitated by: A. Spending time to let clients share their life experiences B. Decreasing emphasis on attending to the client's appearance because it only increases their fatigue C. Making decisions for clients so they do not have to make them D. Placing the client in a private room to provide privacy at all times
Answer: A. Spending time to let clients share their life experiences A. Spending time to let clients share their life experiences enables the nurse to know clients better. Knowing clients then facilitates choice of therapies that promote client decision making and autonomy, thus promoting a client's self-esteem and dignity.
Nurses are bound by a variety of laws. Which description of a type of law is correct? A. Statutory law is created by elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA). B. Regulatory law includes prevention of harm for the public and punishment for those laws that are broken. C. Common law protects the rights of the individual within society for fair and equal treatment. D. Criminal law creates boards that pass rules and regulations to control society.
Answer: A. Statutory law is created by elected legislature, such as the state legislature that defines the Nurse Practice Act (NPA). Statutory law is created by legislature. It creates statues such as the NPA, which defines the role of the nurse and expectations of the performance of one's duties and explains what is contraindicated as guidelines for breach of those regulations.
A client's family member says to the nurse, "The doctor said he will provide palliative care. What does that mean?" The nurse's best response is: A. "Palliative care is given to those who have less than 6 months to live." B. "Palliative care aims to relieve or reduce the symptoms of a disease." C. "The goal of palliative care is to affect a cure of a serious illness or disease." D. "Palliative care means the client and family take a more passive role and the doctor focuses on the physiological needs of the client. The location of death will most likely occur in the hospital setting."
Answer: B. "Palliative care aims to relieve or reduce the symptoms of a disease." The goal of palliative care is the prevention, relief, reduction, or soothing of symptoms of disease or disorders without effecting a cure.
A bioethical issue should be described as: A. The physician's making all decisions of client management without getting input from the client B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy. C. The withholding of food and treatment at the request of the client in a written advance directive given before a client acquired permanent brain damage from an accident. D. After the client gives permission, the physician's disclosing all information to the family for their support in the management of the client.
Answer: B. A research project that included treating all the white men and not treating all the black men to compare the outcomes of a specific drug therapy. The ethical issue was the inequality of treatment based strictly upon racial differences. Secondly, the drug was deliberately withheld even after results showed that the drug was working to cure the disease process in the white men for many years. So after many years, the black men were still not treated despite the outcome of the research process that showed the drug to be effective in controlling the disease early in the beginning of the research project. Therefore harm was done. Nonmaleficence, veracity, and justice were not followed.
Cultural competence is the process of: A. Learning about vast cultures B. Acquiring specific knowledge, skills, and attitudes C. Influencing treatment and care of clients D. Motivation and commitment to caring.
Answer: B. Acquiring specific knowledge, skills, and attitudes Cultural competence is the process of acquiring specific knowledge, skills, and attitudes that ensure delivery of culturally congruent care.
To be effective in meeting various ethnic needs, the nurse should: A. Treat all clients alike. B. Be aware of client's cultural differences. C. Act as if he or she is comfortable with the client's behavior. D. Avoid asking questions about the client's cultural background.
Answer: B. Be aware of client's cultural differences.
When providing care to clients with varied cultural backgrounds, it is imperative for the nurse to recognize that: A. Cultural considerations must be put aside if basic needs are in jeopardy. B. Generalizations about the behavior of a particular group may be inaccurate. C. Current health standards should determine the acceptability of cultural practices. D. Similar reactions to stress will occur when individuals have the same cultural background.
Answer: B. Generalizations about the behavior of a particular group may be inaccurate.
Most litigation in the hospital comes from the: A. Nurse abandoning the clients when going to lunch B. Nurse following an order that is incomplete or incorrect C. Nurse documenting blame on the physician when a mistake is made D. Supervisor watching a new employee check his or her skills level
Answer: B. Nurse following an order that is incomplete or incorrect The nurse is responsible for clarifying all orders that are illegible, unreasonable, unsafe, or incorrect. The failure of the nurse to question the physician about an order creates an area of liability on the nurse's part because this is perceived as a medical action and not the role of the nurse to write orders. Some RNs do have prescriptive privileges based upon advanced degrees and certification. Therefore the nurse who cannot correct the order must document that the physician was called and clarification or a new order was given to correct the unclear or illegible one that was currently on the chart. Phone calls, follow-up, and lack of follow-up by the physician should also be documented if there is a problem with getting the information in a timely manner. The nurse must show the sequence of events of a situation in a clear manner if there is any conflict or question about any orders or procedures that were not appropriate. Assessments and documentation of the client's status should also be included if there is a potential risk for harm present. Contact of the staff's chain of command should also be specifically stated for the proof of the responsibilities being followed according to hospital policy.
When a client is confused, left alone with the side rails down, and the bed in a high position, the client falls and breaks a hip. What law has been broken? A. Assault B. Battery C. Negligence D. Civil tort
Answer: C. Negligence Knowing what to do to prevent injury is a part of the standards of care for nurses to follow. Safety guidelines dictate raising the side rails, staying with the client, lowering the bed, and observing the client until the environment is safe. As a nurse, these activities are known as basic safety measures that prevent injuries, and to not perform them is not acting in a safe manner. Negligence is conduct that falls below the standard of care that protects others against unreasonable risk of harm.
A client who had a "Do Not Resuscitate" order passed away. After verifying there is no pulse or respirations, the nurse should next: A. Have family members say goodbye to the deceased. B. Call the transplant team to retrieve vital organs. C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. D. Call the funeral director to come and get the body.
Answer: C. Remove all tubes and equipment (unless organ donation is to take place), clean the body, and position appropriately. The body of the deceased should be prepared before the family comes into view and say their goodbyes. This includes removing all equipment, tubes, supplies, and dirty linens according to protocol, bathing the client, applying clean sheets, and removing trash from the room.
When helping a person through grief work, the nurse knows: A. Coping mechanisms that were effective in the past are often disregarded in response to the pain of a loss B. A person's perception of a loss has little to do with the grieving process. C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur. D. Most clients want to be left alone.
Answer: C. The sequencing of stages of grief may occur in order, they may be skipped, or they may recur. Grief is manifested in a variety of ways that are unique to an individual and based on personal experiences, cultural expectations, and spiritual beliefs. The sequencing of stages or behaviors of grief may occur in order, they may be skipped, or they may recur. The amount of time to resolve grief also varies among individuals.
Besides the Joint Commission on Accreditation of Healthcare Organizations (JACHO), which governing agency regulates hospitals to allow continued safe services to be provided, funding to be received from the government and penalties if guidelines are not followed? A. Board of Nursing Examiners (BNE) B. Nurse Practice Act (NPA) C. American Nurses Association (ANA) D. Americans With Disabilities Act (ADA)
Answer: D. Americans With Disabilities Act (ADA) If the hospital fails to follow ADA guidelines for meeting special needs, the facility loses funding and status for receiving low-income loans or reimbursement of expenses. ADA protects the civil rights of disabled people. It applies to both the hospital clients and hospital staff. Privacy issues for persons who are positive for human immunodeficiency virus (HIV) have been one issue in relationship to getting information when hospital staff have been exposed to unclean sticks. The ADA allows the infected client the right to choose whether or not to disclose that information.
Which activity would not be expected by the nurse to meet the cultural needs of the client? A. Promote and support attitudes, behaviors, knowledge, and skills to respectfully meet client's cultural needs despite the nurse's own beliefs and practices B. Ensure that the interpreter understands not only the language of the client but feelings and attitudes behind cultural practices to make sure an ethical balance can be achieved C. Develop structure and process for meeting cultural needs on a regular basis and means to avoid overlooking these needs with clients D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized
Answer: D. Expect the family to keep an interpreter present at all times to assist in meeting the communication needs all day and night while hospitalized It is not the family's responsibility to assist in the communication process. Many families will leave someone to help at times, but it is the hospital's legal obligation to find an interpreter for continued understanding by the client to make sure the client is fully informed and comprehends in his or her primary language.
A client is hospitalized in the end stage of terminal cancer. His family members are sitting at his bedside. What can the nurse do to best aid the family at this time? A. Limit the time visitors may stay so they do not become overwhelmed by the situation. B. Avoid telling family members about the client's actual condition so they will not lose hope. C. Discourage spiritual practices because this will have little connection to the client at this time. D. Find simple and appropriate care activities for the family to perform
Answer: D. Find simple and appropriate care activities for the family to perform. It is helpful for the nurse to find simple care activities for the family to perform, such as feeding the client, washing the client's face, combing hair, and filling out the client's menu. This helps the family demonstrate their caring for the client and enables the client to feel their closeness and concern. a. Older adults often become particularly lonely at night and may feel more secure if a family member stays at the bedside during the night. The nurse should allow visitors to remain with dying clients at any time if the client wants them. It is up to the family to determine if they are feeling overwhelmed, not the nurse.
Which statement would best explain the role of the nurse when planning care for a culturally diverse population? The nurse will plan care to: A. Include care that is culturally congruent with the staff from predetermined criteria B. Focus only on the needs of the client, ignoring the nurse's beliefs and practices C. Blend the values of the nurse that are for the good of the client and minimize the client's individual values and beliefs during care D. Provide care while aware of one's own bias, focusing on the client's individual needs rather than the staff's practices
Answer: D. Provide care while aware of one's own bias, focusing on the client's individual needs rather than the staff's practices Without understanding one's own beliefs and values, a bias or preconceived belief by the nurse could create an unexpected conflict or an area of neglect in the plan of care for a client (who might be expecting something totally different from the care). During assessment values, beliefs, practices should be identified by the nurse and used as a guide to identify the choices by the nurse to meet specific needs/outcomes of that client. Therefore identification of values, beliefs, and practices allows for planning meaningful and beneficial care specific for this client.
A professional nurse committed to the principle of autonomy would be careful to? A) provide the info. and support a patient needed to make decisions to advance one's own interest. B) treat each patient fairly, trying to give everyone his or her due. C) keep any promises made to a patient or another professional caregiver D) keep any promises made to a patient or another professional caregiver D) avoid causing harm to a patient.
A) provide the info. and support a patient needed to make decisions to advance one's own interest.
4. What criteria are outlined in the Patient Self-Determination Act? Select all that apply. A. All clients need to be informed in writing of their rights to accept or refuse treatment while they are competent. B. All clients need to provide the name of a healthcare surrogate before receiving care. C. Nurses have an obligation to provide patients with the names of individuals who can act as durable power of attorneys D. Nurses need to recognize the role culture and spiritual beliefs have in a patient's decision-making process
A. -All clients need to be informed in writing of their rights to accept or refuse treatment while they are competent. D. -Nurses need to recognize the role culture and spiritual beliefs have in a patient's decision-making process
The scope of Nursing practice is legally defined by: A. State nurses practice acts B. Professional nursing organizations C. Hospital policy and procedure manuals D. Physicians in the employing institutions
Answer: A. State nurses practice acts.
What are the stages of dying according to Elizabeth Kubler-Ross? A. Numbing; yearning and searching; disorganization and despair; and reorganization. B. Accepting the reality of loss, working through the pain of grief, adjusting to the environment without the deceased, and emotionally relocating the deceased and moving on with life. C. Anticipatory grief, perceived loss, actual loss, and renewal. D. Denial, anger, bargaining, depression, and acceptance.
Answer: D. Denial, anger, bargaining, depression, and acceptance.
The nurse reporting suspected child abuse is legally operating under which cope? A) good samaritan B) duty to disclose C) discretionary powers D) expert witness
B) duty to disclose
The healthcare provider asks the nurse to assist in obtaining informed consent for a procedure from the client. Which action does the nurse take to obtain informed consent form the client who is declared mentally incompetent? A) contact the client's next of kin to obtain consent. B) consult with the client's psychiatrist to determine if the client is able to sign the form. C) contact the client's legal guardian or health care surrogate. D) have the client's health care provider obtain informed consent from the client.
C) contact the client's legal guardian or health care surrogate.
A home health nurse who performs a careful assessment of the home of a frail elderly patient to prevent harm to the patient is acting in accordance with which of the principles of bioethics? A) autonomy B) beneficence C) justice D) fidelity E) nonmaleficence
E) nonmaleficence
Elements of Negligence
1. Duty. 2. Breach of duty. 3.Causation. 4. Injury.
Causation
2 factors:1. cause-in-fact 2. proximate cause
Newly hired nurses in a busy suburban hospital are required to read the state Nurse Practice Act as part of their training. Which topics are covered by this act? Select all that applies. A) violations that may result in disciplinary action. B) clinical procedures. C) medication administraiton D) scope of practice E) delegation policies F) medicare reimbursement
A) violations that may result in disciplinary action. D) scope of practice
Successful ethical discussion depends on people who have a clear sense of personal values. When many people share the same values it may be possible to identify a philosophy of utilitarianism, with proposes that: A. The value of people is determined solely by leaders in the Unitarian church. B. The decision to perform a liver transplant depends on a measure of the moral life that the client has led so far. C. The best way to determine the solution to an ethical dilemma is to refer the case to the attending physician. D. The value of something is determined by its usefulness to society.
Answer: D. The value of something is determined by its usefulness to society. A utilitarian system of ethics proposes that the value of something is determined by its usefulness.
The registered nurse (RN), who is supervising a group of nurses at a health clinic, overhears a nurse telling a patient, "If you do not stop shouting, I am going to give you an injection." The RN immediately intervenes and tells the nurse this action can lead to which accusation? Delegation Breach of confidentiality Assault Respondeat superior
Assault Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Breach of confidentiality is revealing health care information to those not involved with the care of the patient. Delegation involves giving someone else authority to act for another. Respondeat superior attributes the acts of the employees to their employer.
What type of interview techniques does the nurse use when asking these questions, "Do you have pain or cramping?" "Does the pain get worse when you walk?" (Select all that apply.) Active listening Open-ended questioning Closed-ended questioning Problem-oriented questioning
Closed-ended questioning Problem-oriented questioning The nurse's technique is to ask a closed-ended question using a problem oriented approach. The patient gives a specific answer to broaden the nurse's knowledge about the character of his pain.
Necessity
Can interfere with patient's property rights to prevent injury.
What must be est. to prove that malpractice or negligence has occurred in this case? A) the surgeon who performed the procedure called the nurse's action pure negligence, saying that the patient could have been saved. B) the fact that this patient should not have died, she was a vibrant grandmother of 10 who had walked three quarters of a mile the morning of her surgery and had sung in her church choir the day before. C) the nurse intended to harm the patient and was willfully negligent. D) then nurse had a duty to monitor the patient's vital signs, failed to do so, the patient died, and it was Jean's failure to do her duty that caused the patient's death.
D) then nurse had a duty to monitor the patient's vital signs, failed to do so, the patient died, and it was Jean's failure to do her duty that caused the patient's death.
Battery
The offensive, unauthorized touching
court
who can rule a client incompetent
Standard Issues: In Every Contract
1. Law of state in which performance occurs dictates some requirement requirements. 2. Assumes basically equal bargaining positions. 3. Provisions can't violate law or equity. 4. Most contract will have an arbitration clause.
Tort
A civil wrong
Protecting patient rights, participating in healthcare decisions, getting adequate education. Lobby for new laws and protections for patients.
Advocate
In a situation in which there is insufficient staff to implement competent care, a nurse should: A. Organize a strike B. Inform the clients of the situation C. Refuse the assignment D. Accept the assignment but make a protest in writing to the administration.
Answer: A. Organize a strike
A student nurse who is employed as a nursing assistant may perform any functions that: A. Have been learned about in school B. Are expected of a nurse at that level C. Are identified in the positions job description D. Require technical rather than professional skill.
Answer: C. Are identified in the positions job description.
Standards
Authoritative statement promulgated by a profession by which the quality of practice, service or education can be evaluated.
Which of the following nursing orders is written correctly for the diagnosis of: Acute pain r/t deep vein thrombosis m/b redness, swelling, warmth, positive Homans'? Assess level of pain. Complete bed rest with right leg elevated on two pillows at all times. Monitor lab values. Assess vital signs.
Complete bed rest with right leg elevated on two pillows at all times. This nursing order includes what to do, when, and how often.
Assault
Creates in a person the fear that he/she is about to be touched in an offensive, insulting or injurous manner.
The nurse notices a patient dx w/ major depression crying in the day room. The nurse puts her hand over the patient's shoulder and states, "Let's talk about it." Which of the following ethical principles describes the nurse's action? A) Autonomy B) Veracity C) Nonmaleficence D) Beneficence
D) Beneficence
Scope of Practice
Is the actions or duties of a given profession. It refers to the legally permissible boundaries of practice and is defined by statute, rule, or a combination.
Written statement about someone:
Libel
Legal Issues in Nursing Practice: Organ Donation
Person's Driver's License or Required Request Laws - Ask Family
A nurse is talking with a patient who is visiting a neighborhood health clinic. The patient came to the clinic for repeated symptoms of a sinus infection. During their discussion the nurse checks the patient's medical record and realizes that he is due for a tetanus shot. Administering the shot is an example of what type of preventive intervention? Tertiary Direct care Primary Secondary
Primary An immunization is an example of a primary prevention aimed at health promotion.
Civil Law
Protects the rights of the individual in our society; encourages fair and equitable treatment among people
Philosophy
State why and action is performed,
Standard of Care
That degree of care, skill and diligence exercised by similar practitioners in similar cirumstances.
Statute of Limitations
The period of time within which a lawsuit my be filed.
Trespass
Unlawful interference with another's possession of land may be either intention or negligent.
Conversion of Property
When a health care practitioner interferes with the right to possession of the patient's property, either by searching or removing property.
accountability
being answerable to self and others for ones actions includes concept of responsibility.
Which outcome allows you to measure a patient's response to care more precisely? The patient's wound will appear normal within 3 days. The patient's wound will have less drainage within 72 hours. The patient's wound will reduce in size to less than 4 cm (1 ½ inches) by day 4. The patient's wound will heal without redness or drainage by day 4.
he patient's wound will reduce in size to less than 4 cm (1 ½ inches) by day 4. An outcome must have terms describing quality, quantity, frequency, length, or weight to allow for precise measurement. The statement "The patient's wound will reduce in size to less than 4 cm (1 ½ inches) by day 4" identifies a specific wound size, which indicates a degree of healing. The outcome statements concerning the wound appearing normal and having less drainage are vague and not measurable. The statement "The patient's wound will heal without redness or drainage by day 4" has more than one outcome.
couurt appointed guardian
if pt. is incompetent this person is appointed to make the decisions
ethics
knowledge of what is right or wrong, like advocacy, accountability, developed by ANA
malpractice
negligence by a professional, failure to carry out or perform duties that result in injury to another, acting outside of scope of practice
private or civil law - tort law
negligence/malpractice, slander/libel, invasion of privacy, false imprisonment are examples of this type of law
breech of duty
nurse falis to complete duty including commission(nurse did) or omission(nurse failed to do)
living will
outlines medical treatment client wishes to refuse if client is unable to communicate
false imprisonment
prohibiting a client from leaving a health care facility with no legal justification
negligence
unintentional failure to act as a reasonable person in similar circumstance would act that results in injury to another.
treatment, surgery, risks, benefits, alternatives
what are five conditions obtaining consent
mental capacity, voluntarily done, client understands treatment and information provided
what are the three requirements except in emergencies or unresponsive for informed consent
do not place in medical record or make reference to it
what is done to incident report after completion.
Alternative Liability
when 2 or more manufacturers commit separate wrongful or unreasonable acts.
public health department
who do rns and docs report specific communicable disease to
Two types of Torts
1) Intentional Tort - Willful 2) Unintentional Tort - Mistakes
A malpractice case is won by the plaintiff when:
1) It is determined that the standard of care that any reasonable and prudent nurse in a similar setting with the same credentials would deliver, has been violated or omitted. 2) Nurse violated policy and/or procedures
Due Process
1. A clear statement of the allegations. 2.A notice of the time and place of the hearing, disciplinary conference, or other proceeding. 3. A right to legal counsel or to consult with legal counsel. 4. A presention of one's on witnesses and evidence. 5. A cross-examination of the state's witnesses and challenge of state's evidence. 6. A full hearing before the board. 7. A written record. 8. A judicial review of the board's decision.
Once Filed
1. Defendant notifies attorney, files answer. 2. If no response is filed on behalf of defendant, a default judgment is rendered for plaintiff. 3. If required, alternative dispute resolution is held (prelitigation review). 4. Iowa does not require such review.
Elements of Negligence
1. Duty owed to the patient. 2. Breach of the duty owed to the patient. 3. Foreseeability. 4. Causation. 5. Injury. 6. Damages.
Lay Witness
1. Establishes facts. 2. Can only testify to facts, not give opinions. 3. Has direct connection with the case.
Expert Witness
1. Explains highly specialized technoloy or skilled nursing care. 2. Requires clinical expertise, knowledled, advanced education, objectivity.
12. The nurse calls the health care provider (HCP) regarding a new medication prescription because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the HCP, and the medication is due to administered. Which action should the nurse take? a. Contact the nursing supervisor b. Administer the dose prescribed c. Hold the medication until the HCP can be contacted d. Administer the recommended dose until the HCP can be located
12. A- If the HCP writes a prescription that requires clarification, the nurse's responsibility is to contact the HCP. If there is no resolution regarding the prescription because the HCP cannot be located or because the prescription remains as it was written after talking with the HCP, the nurse should contact the nurse manager or nursing supervisor for further clarification as to what the next step should be. Under no circumstances should the nurse proceed to carry out the prescription until obtaining clarification.
5. The nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing clear liquid, in the antecubital area. Which is the most appropriate action by the nurse? a. Call security b. Call the police c. Call the nursing supervisor d. Lock the co-worker in the medication room until help is obtain
5. C- Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Option 4 is an inappropriate and unsafe action.
A nurse working on a medicine nursing unit is assigned to a 78-year-old patient who just entered the hospital with symptoms of H1N1 flu. The nurse finds the patient to be short of breath with an increased respiratory rate of 30 breaths/min. He lost his wife just a month ago. The nurse's knowledge about this patient results in which of the following assessment approaches at this time? (Select all that apply.) A problem-focused approach A structured comprehensive approach Using multiple visits to gather a complete database Focusing on the functional health pattern of role-relationship
A problem-focused approach The nurse should use a focused approach initially to determine the patient's respiratory status. However, to gather an admission assessment, multiple visits are needed because of the patient's age and level of physical distress. A structured comprehensive approach is not appropriate for this acute situation. Eventually the nurse will want to assess the patient's role-relationship health pattern because of his wife's death. But it is not appropriate at this time.
Patient doing cocaine & using cocaine during her pregnancy. She asks you not to tell anyone b/c her husband is unaware of it. (select all that applies) A) yes. she has the right for confidentiality B) share the info w/ the doctor only C) yes. record on patient's record. D) mother would be separated from the mom
A) yes. she has the right for confidentiality B) share the info w/ the doctor only
What technique(s) best encourage(s) a patient to tell his or her full story? (Select all that apply.) Active listening Back channeling Validating Use of open-ended questions Use of closed-ended questions
Active Listening, Back Channeling, Use of open ended questions Active listening allows the patient to speak and shows the nurse's respect for what he or she has to say. Back channeling reinforces interest in what the patient has to say and shows the nurse's desire to hear the full story. Using open-ended questions encourages the patient to tell his or her story and actively describe his or her health status. Validation simply confirms accuracy of data collected. Closed-ended questions do not encourage storytelling.
When does implementation begin as the fourth step of the nursing process? During the assessment phase Immediately in some critical situations After the care plan has been developed After there is mutual goal setting between nurse and patient
After the care plan has been developed Implementation begins after the nurse has developed the plan of care. Even in emergent situations a nurse assesses a situation quickly, considers options, and then implements nursing measures. Goal setting is part of planning.
Although the client refused the procedure, the nurse insisted and inserted a nasogastric tube in the right nostril. The administrator of the hospital decides to settle the lawsuit because the nurse is most likely to be found guilty of which of the following? 1. An unintentional tort 2. Assault 3. Invasion of Privacy 4. Battery
Answer #4 Rationale: Battery is the willful touching of a person without permission. Another name for an unintentional tort is malpractice. This situation is an intentional tort because the nurse executed the act on purpose.
A health care issue often becomes an ethical dilemma because: A. A client's legal rights coexist with a health professional's obligation. B. Decisions must be made quickly, often under stressful conditions. C. Decisions must be made based on value systems. D. The choices involved do not appear to be clearly right or wrong.
Answer: D. The choices involved do not appear to be clearly right or wrong.
2. A nurse graduated from an associate degree nursing program two years ago. The nurse is brought before the State Board of Nursing for offering to give physicals for $25.00 to children who needed them for or summer camp. What charge can the State Board of Nursing apply to the nurse? A. Misdemeanor B. Felony C. Tort D. Larceny
B. Felony
Before consulting with a physician about a patient's need for urinary catheterization, the nurse considers the fact that the patient has urinary retention and has been unable to void on her own. The nurse knows that evidence for alternative measures to promote voiding exists, but none has been effective, and that before surgery the patient was voiding normally. This scenario is an example of which implementation skill? Cognitive Interpersonal Psychomotor Consultative
Cognitive Thinking and anticipating how to approach implementation involve a cognitive implementation skill. The nurse considers the rationale for an intervention and evidence in nursing science that supports that intervention or alternatives.
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 is: Assault Harm Malpractice Negligence
Harm 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 to another person.
A federal regulation that came into effect April 14, 2003 has impacted the health care field regarding privacy of a patient's health information. This regulation is the: Joint Commission on Accreditation of Healthcare Organizations Patient Self-Determination Act Patient's Bill of Rights Health Insurance Portability and Accountability Act
Health Insurance Portability and Accountability Act The Health Insurance Portability and Accountability Act of 1996 (HIPAA) came into effect on April 14, 2003 to safeguard a person's health information. It sets rules and limits on who can look at and receive health information. The Patient's Bill of Rights is the list of things that patients have the right to do or refuse to do. The Patient Self-Determination Act requires that institutions maintain written policies and procedures regarding advance directives, the right to accept or refuse treatment, and the right to participate fully in health care-related decisions. The Joint Commission on Accreditation of Healthcare Organizations (JCAHO) is an organization that accredits health care facilities.
Administrative/Clinical/Education Track
Prepares students.
Clinical Nurse Specialist
Provide a range of care in speciality areas.
When a nurse properly positions a patient and administers an enema solution at the correct rate for the patient's tolerance, this is an example of what type of implementation skill? Interpersonal Cognitive Collaborative Psychomotor
Psychomotor Psychomotor skills require the integration of cognitive and motor activities to ensure safe intervention.
Two Schools of thought doctrine
Supports the nurse who chooses among alternative means of providing quality care.
A charge nurse is evaluating the performance of a staff nurse. Which activity best demonstrates expert thinking, rather than novice thinking? The nurse focuses on own actions. The nurse follows clear-cut rules. The nurse considers options before acting. The nurse relies on step-by-step procedures.
The nurse considers options before acting. A nurse who assesses and considers different options for intervening before acting is demonstrating expert thinking. Novice thinking is characterized by focusing on one's own actions, following clear-cut rules, and relying on step-by-step procedures.
The registered nurse, employed by the risk management department of a hospital is giving an inservice class on social media to nursing employees. Which one of these statements should be included in this class? Posts are private and accessible only to the intended recipient. Once content has been deleted, it is no longer accessible. No harm is done if patient information is disclosed only to the intended recipient. The nurse should not refer to a patient, even by nickname or room number.
The nurse should not refer to a patient, even by nickname or room number. The nurse should never refer to a patient on social media, even by nickname or room number. Social media posts are not considered private and are not always accessible only to the intended recipient. Even deleted content is accessible at times on social media. Disclosing any patient information is a harmful act, even if it is disclosed only to the intended recipient.
Strict Liability
The plantiff claims that the product is unreasonably dangerous due to a defect in the manufacturing process when used as intended or used for another reasonable foreseeable purpose, or inadequate warning lables or instructions.
morals
personal philosophy of what is right or wrong,
Three nursing roles related to legal issues.
1) Advocate 2) Risk Manager 3) Member/Leader of Nursing Professional Organization
7. The nurse has made an error in a narrative documentation of an assessment finding on a client and obtains the client's record to correct the error. The nurse should take which action to correct the error? a. Documenting a late entry into the client's record b. Trying to erase the error for space to write in the correct data c. Using whiteout to delete the error to write in the correct data d. Drawing one line through the error, initialing and dating, and then documenting the correct information.
7. D- If the nurse makes an error in narrative documentation in the client's record, the nurse should follow agency policies to correct the error. This includes drawing one line through the error, initializing and dating the line, and then documenting the correct information. A late entry is used to document additional information not remembered at the initial time of documentation. Erasing data from the client's record and the use of whiteout are prohibited
6. Three nursing students are in the elevator and overhear another staff nurse, discussing a neighbor who was hospitalized last night for liver failure. The nurse told his colleague that a mutual friend told him that the neighbor was "known for liking his brandy." A family member was in the elevator and also overheard the conversation. What charges may be brought against the nurse by the patient and/or family: A. Slander B. Libel C. Malpractice D. Breach of confidentiality
A. Slander
5. A nurse is caring for a patient who is receiving chemotherapy. The nurse assessed the patient's port and found it was blocked and started a peripheral line to administer the chemotherapy. The medication infiltrated and caused permanent nerve damage to the patient's arm. The patient filed a malpractice suit against the nurse. How will the nurse's actions be evaluated? Select all that apply A. Policies and Procedures of the institution B. Patient' Self-Determination Act C. Standards of Practice of the nursing organization D. Physician Expert
A. -Policies and Procedures of the institution C. -Standards of Practice of the nursing organization
As an advocate for the client, the nurse must make sure that "safe, effective care" is given in conformity with the A. Nurse Practice Act (NPA). B. American Nursing Association (ANA) C. National Council for Lisensure Examinations D. State Board of Licensure
A. Nurse Practice Act (NPA).
The philosophy sometimes called the code of ethics of care suggests that ethical dilemmas can best be solved by attention to: A. Relationships B. Ethical principles C. Clients D. Code of ethics for nurses.
Answer: A. Relationships. The ethic of care explores the notion of care as a central activity of human behavior. Those who write about the ethics of care advocate a more female biased theory that is based on understanding relationships, especially personal narratives.
The nurse notices that a colleague's behaviors have changed during the past month. Which behaviors could indicate signs of impairment? Select all that apply 1. Is increasingly absent from the nursing unit during the shift. 2. Interacts well with others 3. "Forgets" to sign out for administration of controlled substances. 4. Offers to administer prn opiates for other nurse's clients 5. Is able to say "no" to requests to work more shifts.
Answer: 1, 3, 4 Rationale: Interacting with others (versus isolating self from others) and setting limits on the number of hours working are positive behaviors and not indicative of possible impairment. The other options are warning signs for impairment
A nursing student is employed and working as an unlicensed assistive personnel (UAP) on a busy surgical unit. The nurses know that the UAP is enrolled in a nursing program and will be graduating soon. A nurse asks the UAP if he has performed a urinary catheterization on clients while in school. When the UAP says yes, the nurses asks him to help her by doing a urinary catheterization on a post surgical client. What is the best response by the UAP? 1. "Let me get permission from the client first." 2. "Sure, which client is it?" 3. "I can't do it unless you supervise me." 4. "I can't do it. is there something else I can help you with."
Answer: 4 Rationale: A sterile invasive procedure that places the client at significant risk for infection is generally outside the scope of practice of a UAP. Even though the UAP is a nursing student, the agency job description should be followed.
The client's right to refuse treatment is an example of: A. Statutory law B. Common law C. Civil laws D. Nurse practice acts
Answer: B. Common law.
The nursing theorist who developed transcultural nursing theory is A. Dorothea Orem B. Madeleine Leininger C. Betty Newman D. Sr. Callista Roy
Answer: B. Madeleine Leininger Madeleine Leininger developed the theory on transcultural theory based on her observations on the behavior of selected people within a culture.
A registered nurse arrives at work and is told to "float" to the ICU for the day because the ICU is understaffed and needs an additional nurse to care for the clients. The nurse has never worked in the ICU. Which of the following is the most appropriate nursing action? A. refuse to float in the ICU B. call the hospital lawyer C. call the nursing supervisor D. report to the ICU and identify tasks that can be safely performed
Answer: D Rationale - floating is acceptable and legal practice. The nurse floated to a unit until will be given orientation; be assigned to care for stable patients or those with conditions similar to her training experience.
Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.
Answer: C. Assess the client's point of view and prepare to articulate this point of view. Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.
Disparities in health outcomes between the rich and the poor illustrates: a (an) A. Illness attributed to natural, impersonal, and biological forces. B. Creation of own interpretation and descriptions of biological and psychological malfunctions. C. Influence of socioeconomic factors in morbidity and mortality. D. Combination of naturalistic, religious, and supernatural modalities.
Answer: C. Influence of socioeconomic factors in morbidity and mortality. Disparities in health outcomes between the rich and the poor illustrate the influence of socioeconomic factors in morbidity and mortality. Social factors such as poverty and lack of universal medical insurance compromise the health status of the poor and unemployed.
In the United States, access to health care usually depends on a client's ability to pay for health care, either through insurance or by paying cash. The client the nurse is caring for needs a liver transplant to survive. This client has been out of work for several months and does not have insurance or enough cash. A discussion about the ethics of this situation would involve predominantly the principle of: A. Accountability, because you as the nurse are accountable for the well being of this client. B. Respect of autonomy, because this client's autonomy will be violated if he does not receive the liver transplant. C. Ethics of care, because the caring thing that a nurse could provide this patient is resources for a liver transplant. D. Justice, because the first and greatest question in this situation is how to determine the just distribution of resources.
Answer: D. Justice, because the first and greatest question in this situation is how to determine the just distribution of resources Justice refers to fairness. Health care providers agree to strive for justice in health care. The term often is used during discussions about resources. Decisions about who should receive available organs are always difficult.
The dominant values in American society on individual autonomy and self-determination: A. Rarely have an effect on other cultures B. Do have an effect on health care C. May hinder ability to get into a hospice program D. May be in direct conflict with diverse groups.
Answer: D. May be in direct conflict with diverse groups. The dominant value in American society of individual autonomy and self-determination may be in direct conflict with diverse groups. Advance directives, informed consent, and consent for hospice are examples of mandates that may violate client's values.
The scope of Nursing Practice, the established educational requirements for nurses, and the distinction between nursing and medical practice is defined by: A. Statutory law B. Common law C. Civil law D. Nurse practice acts
Answer: D. Nurse practice acts
The nurse is obligated to follow a physician's order unless: A. The order is a verbal order B. The physician's order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client.
Answer: D. The order is an error, violates hospital policy, or would be detrimental to the client.
The nurse practice acts are an example of civil law. A. True B. False
Answer: False Rationale: Nurse practice acts fall under Statutory law
Review the following nursing diagnoses and identify the diagnoses that are stated correctly. (Select all that apply.) Anxiety related to fear of dying Fatigue related to chronic emphysema Need for mouth care related to inflamed mucosa Risk for infection
Anxiety related to fear of dying Risk for infection The diagnosis Anxiety related to fear of dying is stated correctly, with the related factor being the patient's response to a health problem. Risk for infection is a risk factor for an at-risk diagnosis. In all cases the related factor or risk factor is a condition for which the nurse can implement preventive measures. Fatigue related to chronic emphysema is incorrect since chronic emphysema is a medical diagnosis. Need for mouth care related to inflamed mucosa is not a NANDA-I approved nursing diagnosis.
A nurse ans. a patient's call light and finds the patient on the floor by the bathroom door. After calling for assistance and examining the patient for injury, the nurse helps the patient back to the bed and then fills out an incident report. Which statements accurately describe aspects of this procedure? select all that applies. A) an incident report is used as disciplinary action against staff members. B) an incident report is used as a means of identifying risks. C) an incident report is used for quality control D) the facility manager completes the incident report. E) an incident report makes facts available in case litigation occurs. F) filling of an incident report should be documented in the patient record.
B) an incident report is used as a means of identifying risks. C) an incident report is used for quality control E) an incident report makes facts available in case litigation occurs.
The nursing instructor discusses perioperative care. Which statement best describes informed consent? A) informed consent is required for every invasive procedure done in the hospital. B) informed consent is obtained before major invasive (surgical) procedures. C) informed consent is implied when the client signs the admission papers. D) informed consent is not necessary for surgical or invasive hospital procedures.
B) informed consent is obtained before major invasive (surgical) procedures.
The nurse puts a restraint jacket on a client without the client's permission and without the physicians order. The nurse may be guilty of assault. A. True B. False
B. False Rationale: Battery is physical in nature. Assault is a threat.
A student nurse who is employed as a nursing assistant may perform any functions that she taught in school. A. True B. False
B. False Rationale: You may only perform functions that you are licensed to perform while on the job.
Standard of care
Basis for analysis of nursing care in negligence action.
Touching someone without consent:
Battery
Nurses agree to be advocates for their patients. Practice of advocacy calls for the nurse to: A. Seek out the nursing supervisor in conflicting situations B. Work to understand the law as it applies to the client's clinical condition. C. Assess the client's point of view and prepare to articulate this point of view. D. Document all clinical changes in the medical record in a timely manner.
C. Assess the client's point of view and prepare to articulate this point of view. Rationale: Nurses strengthen their ability to advocate for a client when nurses are able to identify personal values and then accurately identify the values of the client and articulate the client's point of view.
Miss Magu, an 88-year old woman, believes that life should not be prolonged when hope is gone. She has decided that she does not want extraordinary measures taken when her life is at its end. Because she feels this way, she has talked with her daughter about her desires, completing a living will and left directions with her physician. This is an example of: A. Affirming a value B. Choosing a value C. Prizing a value D. Reflecting a value
C. Prizing a value
7. A nurse is caring for a patient who was admitted with a subarachnoid hemorrhage. The healthcare provider orders state that neurological assessments need to be preformed every 30 minutes. The nurse forgets to perform the assessments on two different occasions. An action that can lead to a malpractice suit would be: A. Assessing the patient more than once per shift. B. Explaining the patient's current condition to the family. C. Holding the next dose of sedation in order to perform a neurological assessment. D. Altering the time the assessments were performed
D. Altering the time the assessments were performed
5. A nurse and his girlfriend witness a motor vehicle accident. The calls 911 and pulls over to the side of the road. The nurse assesses the victim and determines that he is unconscious. His girlfriend says, "This guy can't give you permission to help him; maybe you should just leave him alone." The nurse explains that he has implied consent. When is implied consent assumed? A. At the time a person sees a physician or nurse by appointment in the office or clinic setting B. When a person arrives in the operating suite for a surgical procedure. C. On the person's admission to the hospital unit. D. If the person is treated at the scene of an accident
D. If the person is treated at the scene of an accident
A nurse reviews data gathered regarding a patient's pain symptoms. The nurse compares the defining characteristics for acute pain with those for chronic pain and in the end selects acute pain as the correct diagnosis. This is an example of the nurse avoiding an error in: Data collection. Data clustering. Data interpretation. Making a diagnostic statement.
Data interpretation In the review of data, the nurse compares defining characteristics for the two nursing diagnoses and selects one based on the interpretation of data. Making a diagnostic statement is incorrect because the nurse has not included a related factor.
The nurse is obligated to follow a physicians order unless: A. The order is a verbal order B. The order is illegible C. The order has not been transcribed D. The order is an error, violates hospital policy, or would be detrimental to the client
D. The order is an error, violates hospital policy, or would be detrimental to the client.
Guideline
Describes a recommended course of action.
Self Defense And Defense of Others
Justifiable to protect from harm.
A patient signals the nurse by turning on the call light. The nurse enters the room and finds the patient's drainage tube disconnected, 100 mL of fluid in the intravenous (IV) line, and the patient asking to be turned. Which of the following does the nurse perform first? Reconnect the drainage tubing Inspect the condition of the IV dressing Improve the patient's comfort and turn onto her side. Obtain the next IV fluid bag from the medication room
Reconnect the drainage tubing The priority is to reconnect the drainage tube. This can be done quickly and prevents fluid loss and reduces risk of infection spreading up into the tube. Next the nurse turns the patient for comfort. With 100 mL of fluid remaining, the nurse has time to perform these tasks. The nurse can inspect the IV dressing last, after going to obtain the next IV fluid bag.
Legal Issues in Nursing Practice: Floating BRN Policy
Responsibility when Floating 1) Inform charge (lead) nurse of your capabilities/competencies. Don't go beyond them. 2) Legally you cannot refuse to float
Verbally saying something about a person that is damaging to them:
Slander
health care proxy( durable power of attorney
appoints someone family or friend to make health care decisions if client is unable
yes participating
may a client who committed himself in mental health still capable of health care decisions
minor married, emancipated minor, or STD or pregnancy
informed consent for minors is obtained from parent or legal guardian unless -
statutory law
laws enacted by legislative branch of government, regulatory agencies are established
Licensure
legal process by which an authorized authority (usually a state) grants a qualified person.
civil tort
malpractice is filed as this
administrative laws
rules and regulations of a state board of nursing fall under these laws
Scope of Duty
standard of care
Res Ipsa Loquitor
the thing speaks for itself. Must prove 3 elements.
A nurse identifies several interventions to resolve the patient's nursing diagnosis of impaired skin integrity. Which of the following are written in error? (Select all that apply.) Turn the patient regularly from side to back to side. Provide perineal care, using Dove soap and water, every shift and after each episode of urinary incontinence. Apply a pressure-relief device to bed. Apply transparent dressing to sacral pressure ulcer.
turn the patient regularly from side to back to side. Apply a pressure-relief device to bed. The statements 'Turn the patient regularly from side to back to side' and 'Apply a pressure-relief device to bed' do not provide specific guidelines for the frequency or type of intervention. The other two options identify specific intervention methods.
Licensure by Examination
when state does not grant license by waiver or endorsement; applicant must take exam to be licensed in state.
When the attorney representing the pt's family calls Jean and asks to talk with her about the case so that he can better understand her actions, how should Jean respond? A) "I'm sorry, but I can't talk with you. You'll have to contact my attorney." B) Answer the attorney's questions honestly and make sure that he understand her side of the story. C) appeal to the attorney's sense of compassion and try to enlist his sympathy by telling him how busy it was that morning. D) "Why are you doing this to me? This could ruin me!"
A) "I'm sorry, but I can't talk with you. You'll have to contact my attorney."
All of the following are crucial needs of the dying client except: A. Control of pain B. Preservation of dignity and self-worth C. Love and belonging D. Freedom from decision making
Answer: D. Freedom from decision making
Family friend call about patient concerned about patient and you tell them. Is this a violation of HIPAA?
YES.
Who's responsible of wrong medication by physician order?
both the nurse and doctor
Failure to raise a side rail up is considered which malpractice?
breach of duty
Legal Issues in Nursing Practice: Patient Rights
1) Invasion of Privacy 2) Confidentiality 3) Informed consent 4) Right to Refuse Treatment
Seven Employment Issues - Anti-Discrimination Laws
1. Civil Rights Act of 1964 2. Sexual Harassment of 1980 3. Age Discrimination Act of 4. American's with Disabilities Act of 1992 and 1995 5. Family & Medical Leave ACT of 1993 6. Occupational Safety & Health Act of 1970 7. Mental Health Parity Act of 1996
Discovery of Evidence
1. Interrogatories: questions and written answers required. 2.Depostions taken: sworn testimony taken of prospective witnesesses. 3. Requist for production of documents. 4. Request for independant medical examination of plaintiff. 5. Subpoenas issued to compel witnesses, if needed. 6. Pretrial conference or hearing held. 7.Settlement discussion initiates, case may be settled.
Trial Process
1. Jury is selected (voir dire). 2.Opening statements: first plaintiff, then defendant. 3. Plaintiffs case is presented, with cross-examination by defendant. 4. Defendate's case is presented, with cross examination. 5.Motion is filed for directed verdict against plaintiff. Closing statements are made. 6. Jury instructions are given. 7. Jury deliberates. 8. Verdict is decided and announced.
Execution of Judgment
1. Payment of damages. 2. Specific performance or injunction. 3. Impriosoment or fine of defaulting party
Pleadings and Pretrial Motions
1. Plaintiff files complaint. 2. Defendant files answer. 3. Either side may file motion to dismiss lawsuit. 4. Both sides may file motion to dismiss lawsuit. 5. Both sides may file counterclaims. 6.Either side may file amended or supplemented. 7. Pleadings 8. Either side may file motion for judgment based on pleadings.
Complaint is Filed
1. documents describes nature of injury and basis for case. 2. In competent juridiction: that is, court appropriate to hear the case. 3. Maybe where plaintiff and/or defendant reside, may be where injury occured.
10. Nursing staff members are sitting in the lounge taking their morning break. An unlicensed assistive personnel (UAP) tells the group that she thinks that the unit secretary has acquired immunodeficiency syndrome (AIDS) and proceeds to tell the nursing staff that the secretary probably contracted the disease from her husband, who is supposedly a drug addict. Which legal tort has the UAP violated? a. Libel b. Slander c. Assault d. Negligence
10. B- Defamation is a false communication or a careless disregard for the truth that causes damage to someone's reputation, either in writing (Libel) or verbally (slander). An assault occurs when a person puts another person in fear of a harmful or an offensive contact. Negligence involves the actions of professionals that fall below standard of care for a specific professional group
The nurse is assessing the character of a patient's migraine headache and asks, "Do you feel nauseated when you have a headache?" The patient's response is "yes." In this case the finding of nausea is which of the following? An objective finding A clinical inference A validation A concomitant symptom
A concomitant symptom A concomitant symptom is a symptom that occurs along with a primary symptom. The finding is subjective based on patient self-report. There is no clinical inference since the nurse is not trying to find the meaning of the findings. The patient is reporting nausea, but there is no validation or confirmation with another source.
A state attorney decides to charge a nurse with manslaughter for allegedly administering lethal medication. This is an example of what type of law? A) public law B) private law C) civil law D) criminal law
D) criminal law
1. A nurse was caring for a patient who reported syncopal episodes. The nurse placed the call bell in reach, and instructed the patient not to get out of bed without assistance. The patient forgot to call the nurse and got out of bed to go to the bathroom. The patient fell and broke a hip. The patient is now suing for negligence. What needs to be considered to constitute a negligence claim? Select all that apply A. Duty B. Breach of duty C. Spontaneous duty D. Harm
A.- Duty B.- Breach of duty D. -Harm
3. A nursing student is preparing for the NCLEX. Which of the following activities should the nurse perform several days prior to taking the examination? Select all that apply. A. Pack a bag of items that may be needed during the test. B. Map out the route to the exam site. C. Eat a diet high in fats and carbohydrates. D. Decrease fluids to prevent needing to go to the bathroom during the exam.
A.- Pack a bag of items that may be needed during the test. B. -Map out the route to the exam site.
The RN employed in a medical center in a large metropolitan area was asked to resign after consistently failing to report changes in client status to the health care provider. The RN subsequently applied for a staff nurse position in another hospital. Which action is best for the nurse manager to take when the new employer asks for a reference? A) consult an attorney B) inform the potential employer that the nurse resigned C) inform the new employer about occurrences D) ignore the request for reference
C) inform the new employer about occurrences
When signing a form as a witness, your signature shows that the client: A. Is fully informed and is aware of all consequences. B. Was awake and fully alert and not medicated with narcotics. C. Was free to sign without pressure D. Has signed that form and the witness saw it being done
Answer: D. Has signed that form and the witness saw it being done Your signature as a witness only states that the person signing the form was the person who was listed in the procedure.
Bereavement may be defined as: A. The emotional response to loss. B. The outward, social expression of loss. C. Postponing the awareness of the reality of the loss. D. The inner feeling and outward reactions of the survivor
Answer: D. The inner feeling and outward reactions of the survivor.
On the morning before surgery, the client signs an operative consent form. Soon afterward, the client tells the nurse that the client does not want the surgery. Which action does the nurse take first? A) notifies the health care provider of the client's decision. B) informs the client the decision has delayed the operating room schedule. C) encourages the client to discuss reasons for canceling the surgery D) asks the client's family to encourage the client to have the surgery
C) encourages the client to discuss reasons for canceling the surgery
A nursing student asks the charge nurse about legal liability when performing clinical practice. Which statement regarding liability is true? A) students are not responsible for their acts of negligence resulting in patient's injury. B) student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse. C) hospitals are exempt from liability for student negligence if the student nurse is properly supervised by an instructor. D) most nursing programs carry group professional liability making student personal professional liability insurance unnecessary.
B) student nurses are held to the same standard of care that would be used to evaluate the actions of a registered nurse.
A nurse approaches the nurse manager to ask for a raise. After some discussion about why the nurse feels a raise is warranted, the nurse manager suggests they discuss the raise further over dinner. The nurse refuses, and the nurse manager replies, "No dinner, no raise." Which action does the nurse take first? A) immediately document the incident B) immediately report the incident to the supervisor C) immediately inform the nurse manager that the nurse does not want to go out to dinner. D) immediately contact the nurse's family
C) immediately inform the nurse manager that the nurse does not want to go out to dinner.
12. After administering an incorrect dosage of a medication the nurse realizes that too little medication was given to the client. The nurse then administers a second dose in order to give the correct dosage. What should the nurse do? Select all that apply: A. Report the error B. Explain what happened to the patient C. Document that the correct medication was administered D. Chart both times the medication was administered
C. Document that the correct medication was administered
4. A patient was brought to the emergency department by two police officers. The patient was combative and verbally abusive. After waiting for over an hour, the patient tells the nurse he is leaving. The nurse removes Larry's clothes from the room, leaving him only in his underwear. The nurse may be charged with: A. Cruel and unusual punishment B. Slander and libel C. False imprisonment D. Assault and battery
C. False imprisonment
Negligence
Conduct that falls below the standard of care: "Failure to use that degree of care that an ordinarily CAREFUL and PRUDENT person would use under the same or similar circumstances."
The student nurse discusses causes of malpractice suits with the instructor. The instructor intervenes if the student include which occurrence as an example of malpractice? A) failure to warn a potential employer of an RN's incompetence. B) failure to staff a unit adequately C) failure to ensure that nurses are practicing in a competent manner D) failure to document within 30 minutes after a change in the client condition
D) failure to document within 30 minutes after a change in the client condition
The nurse understands that risk management, within the context of managed care, focuses on which principle? A) educate clients about managing risk factors that would predispose to certain health conditions. B) teach employees how to take risks safely in their personal and professional lives. C) propose risk taking activities for the institution that will enhance its public image D) prevent and minimize institutional and treatment factors that could lead to legal liability.
D) prevent and minimize institutional and treatment factors that could lead to legal liability.
9. A nurse is caring for a patient who has diabetes and gangrene of the lower left extremity. The nurse accompanies the surgeon when he explains that he will perform a below-the-knee amputation that will remove the infection. He states that the patient will receive antibiotics, and go home in a few days. After the surgeon leaves, the nurse brings in the consent forms and asks the patient explain what the surgeon said. The patient states, "Oh, he is going to remove the infection and give me antibiotics and then I can go home. I feel so much better now because my other doctor told me they were going to cut off my leg!" What should the nurse do next? A. Ask the patient to sign the consent form B. Draw a picture of a below-the-knee amputation for the patient C. Tell the patient that she did not hear what her doctor told her D. Call the surgeon and explain the situation to him
D. Call the surgeon and explain the situation to him
13. A high school graduate who wants to be a nurse is looking online at different programs in the state. The graduate knows that in order to practice nursing it is necessary to pass the NCLEX-RN. What is the basic qualification required for licensure? A. The individual must complete a minimum of 12 months of study from a program. B. The individual must graduate from a school located within their state of residence C. The individual must provide documentation of citizenship D. The individual must graduate from an approved nursing program
D. The individual must graduate from an approved nursing program
Which of the following factors puts an older adult at risk for physical, emotional, and financial abuse? Select all that apply. Decrease in strength and mobility Increase in independence Isolation Declining mental ability
Decrease in strength and mobility Declining mental ability
Breach of Duty owed to the Patient
Deviation from the standard of care owed to the patient.
Once a nurse is licensed, he or she can apply to another state for licensure by: Applying to take the NCLEX® examination in that state Interstate compact Endorsement Following the nurse practice act
Endorsement A nurse can apply for a license in another state by endorsement if all licensing criteria have been met for that state.The NCLEX® examination is a national licensure exam. It is not necessary to take it again. Interstate compact is a legal agreement among certain states that allows multistate practice of nursing as long as the nurse has a license in his or her home state. The Nurse Practice Act lists a nurse's scope of practice for the different licensure.
A nurse is working in a neonatal intensive care unit (NICU) where a premature baby (26 weeks gestation) is facing respiratory disorders, numerous infections, and a brain hemorrhage. The parents want every measure to be taken to keep their baby alive, but several members of the health care team are advocating removal of life support. The nurse believes there are several ethical issues involved in this case. What step should the nurse take first when facing an ethical dilemma? Gather as much information as possible about the situation Identify the options available in this situation Act in a fair and equitable manner for all involved Evaluate the actions taken using ethical principles
Gather as much information as possible about the situation The nurse should clarify the ethical dilemma by gathering as much information as possible about the situation. This compares with the assessment phase of the nursing process and is the first step in the ethical decision making model. Most ethical dilemmas have multiple options, which should all be considered, but gathering additional data must be the first step. Making a decision and acting in a fair and equitable manner must take place, but gathering additional data is the first step. Evaluating the actions taken is the last step of the ethical decision making model.
Malpractice Insurance
Get "occurrence" policy. Covers acts occurring while policy was active.
Objectives
Goals that give direction to what must be accomplished.
Ethical Issues and Tort Law
Health Care providers have a legal duty to provide care to patients, based on legal duty and ethical responsibilities.
A nurse assesses a patient who comes to the pulmonary clinic. "I see that it's been over 6 months since you've been in, but your appointment was for every 2 months. Tell me about that. Also I see from your last visit that the doctor recommended routine exercise. Can you tell me how successful you have been following his plan?" The nurse's assessment covers which of Gordon's functional health patterns? Value-belief pattern Cognitive-perceptual pattern Coping-stress-tolerance pattern Health perception-health management pattern
Health perception-health management pattern The nurse is attempting to learn about the patient's self-report of health practices, clinic appointments, and exercise plan designed to improve his health.
Which of the following are examples of collaborative problems? (Select all that apply.) Nausea Hemorrhage Wound infection Fear
Hemorrhage Wound infection Hemorrhage and wound infection are collaborative problems, actual or potential physiological complications. Nurses typically monitor for these to detect changes in a patient's status. 'Nausea' and 'fear' are both NANDA-I approved nursing diagnoses.
A patient is admitted to the hospital with a sacral wound that has a foul odor, purulent drainage, and necrotic tissue in the center. It measures 4 cm in circumference by 2 cm deep. Select the most appropriate nursing diagnosis. Risk for infection Impaired skin integrity Chronic pain Impaired peripheral circulation
Impaired skin integrity The collected data all show that there is an impaired skin integrity.The data show that an infection is already present and so the diagnosis needs to be actual and not risk for. More data would need to be collected to know if the patient has pain. Impaired peripheral circulation -More assessment data would need to be collected, so it is not the most appropriate at this time.
A nurse is reviewing a patient's list of nursing diagnoses in the medical record. The most recent nursing diagnosis is diarrhea related to intestinal colitis. This is an incorrectly stated diagnostic statement, best described as: Identifying the clinical sign instead of an etiology. Identifying a diagnosis based on prejudicial judgment. Identifying the diagnostic study rather than a problem caused by the diagnostic study. Identifying the medical diagnosis instead of the patient's response to the diagnosis.
Identifying the medical diagnosis instead of the patient's response to the diagnosis. In this example intestinal colitis is a medical diagnosis and thus an incorrect diagnostic statement.
Using Maslow's hierarchy of needs, select the nursing diagnosis with the highest priority. Deficient knowledge Acute pain Risk for impaired skin integrity Imbalanced nutrition
Imbalanced nutrition The lack of nutrition falls in the base of Maslow's, therefore being of the highest importance. Whenever there is risk, it is not the main priority in the plan of care, but the result of another problem. Pain is a result of another problem and falls in Maslow's level of safety and security. Knowledge deficit is generally a result of another problem and falls in Maslow's level of safety and security
Your patient has returned from surgery and has a history of smoking. The physician has orders for the use of incentive spirometry (IS) every 2 hours. The patient asks why he has to do IS so often. You teach your patient about the importance of breathing deeply, to clear any secretions and its prevention of pneumonia. This teaching is an example of: A nursing diagnosis An outcome statement Implementation of a nursing intervention The nursing process
Implementation of a nursing intervention Correct Teaching is the implementation of a nursing intervention or physician order. A nursing diagnosis is an identified problem. An outcome statement is what you want to see your patient do or how they improve. The nursing process is a 6-step process in which teaching is only one step.
A patient tells the nurse during a visit to the clinic that he has been sick to his stomach for 3 days and he vomited twice yesterday. Which of the following responses by the nurse is an example of probing? So you've had an upset stomach and began vomiting—correct? Have you taken anything for your stomach? Is anything else bothering you? Have you taken any medication for your vomiting?
Is anything else bothering you? A probing question encourages a full description without trying to control the direction of the patient's story. It requires further open-ended statements. Confirming an upset stomach and vomiting is an example of summarizing findings. The questions about medications taken are examples of closed-ended questions that control the patient's response and do not ensure a full objective view from the patient.
Setting a time frame for outcomes of care serves which of the following purposes? Indicates which outcome has priority Indicates the time it takes to complete an intervention Indicates how long a nurse is scheduled to care for a patient Indicates when the patient is expected to respond in the desired manner
Indicates when the patient is expected to respond in the desired manner The time frame indicates when you expect a response to your nursing interventions. Time frames help to organize priorities but do not indicate which problem is most important. Time frames for outcomes are not used to gauge the time it takes to complete interventions, and they are unrelated to a nurse's work schedule.
The nurse is planning care of a patient with difficulty breathing due to a medical diagnosis of COPD. Which of the following should the nurse determine is the priority nursing diagnosis? Knowledge deficit regarding use of inhaler Sleep pattern disturbance Spiritual distress Ineffective airway clearance
Ineffective airway clearance Airway clearance is a high priority physiological need and should take priority over non-physiological, basic needs. Knowledge deficit, sleep pattern disturbance, and spiritual distress are all important needs, but physiological needs should be the priority of care.
The nurse is caring for a patient who is scheduled for surgery. Prior to 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? Patient's Bill of Rights Accountability statement Informed consent doctrine Confidentiality statement
Informed consent doctrine An informed consent doctrine is a person's agreement to allow a particular treatment based on full disclosure of the facts needed to make an intelligent decision. The patient's Bill of Rights is a list of rights of the patient that includes the right of an informed consent. Accountability is the responsibility of the nurse as part of the care to be given to the patient. Confidentiality is the responsibility of the nurse as part of the care to be given to the patient.
Assumption of Risk
Injured parties are responsible for consequences if they understood the risks involved when they proceeded with the action.
A nurse reports a medication error and monitors the patient, who suffers no ill effects. Which element is lacking to prove nursing malpractice? Duty of care Breach of duty Injury Standard of care
Injury Since there is no injury, then malpractice cannot be proven. Breach of duty, duty of care, and standard of care are not relevant elements in this case.
Legal Issues in Nursing Practice: Abandonment of Patients
It's considered abandonment if you do not follow through with the accepted assignment by severing the patient and RN relationship.
On a medical unit, several patients are being treated for Hepatitis B infection. One of the patients contracted Hepatitis B through using infected needles associated with heroin use. Another of the patients contracted Hepatitis B through a blood transfusion following a car accident. Several of the employees on the unit treat the patient who used heroin rudely and delay their attention to the patient's requests. The nurse intervenes and reminds the staff to use which ethical principle? Justice Nonmaleficence Beneficence Autonomy
Justice Justice describes providing patients with the same diagnosis and health care needs the same care. By delaying attention to the patient's requests and treating the patient rudely, the staff is not using the principle of justice. Nonmaleficence is the duty to do no harm. Beneficence is frequently described as "the doing of good." Autonomy means that individuals have the right to determine their own actions and the freedom to make their own decisions.
When caring for patients, the nurse knows that part of the ethical principles include all patients having the same right to nursing interventions. This principle is: Autonomy Nonmaleficence Justice Beneficence
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.
A 58-year-old patient with nerve deafness has come to his doctor's office for a routine examination. The patient wears two hearing aids. The advanced practice nurse who is conducting the assessment uses which of the following approaches while conducting the interview with this patient? (Select all that apply.) Maintain a neutral facial expression Lean forward when interacting with the patient Acknowledge the patient's answers through head nodding Limit direct eye contact
Lean forward when interacting with the patient Acknowledge the patient's answers through head nodding Leaning forward shows that the nurse is aware and attending to what the patient is saying. The use of head nodding regulates the interaction and makes it easier for the patient to know the nurse's responses to his comments. A neutral expression does not express warmth or immediacy, which is needed to establish a positive relationship. Good eye contact communicates the nurse's interest in what the patient has to say.
Licensure
Legal process by which an authorized authority (usually a state) grants a qualified person permission to preform designated skills and service in a defined jurisdiction.
A recent graduate of a nursing program has accepted a position in a long term care unit. The nurse can use which strategy to reduce the risk of malpractice suits? Carry malpractice insurance Request supervision for all care Not sign his or her name in patient records Maintain good relationships with patients and families
Maintain good relationships with patients and families Maintaining good relationships with patients and families does reduce the risk of malpractice suits. Carrying malpractice insurance does not reduce the risk of a malpractice suit. Requesting supervision for all care provided is not feasible in many situations and does not reduce the risk of malpractice suits. Not signing patient records can actually increase the risk of lawsuits, as failure to document is considered a category of negligence that results in malpractice lawsuits.
Corporate Liability
Must hire, supervise and maintain qualified, competent and adequate staff; maintain equipment; and maintain a safe work setting.
Malpractice
Negligence by a professional.
A nurse is providing patient teaching for a patient undergoing chemotherapy. The nurse is explaining that the chemotherapy will cause some unpleasant side effects, such as nausea and hair loss. In this situation, the nurse is using which ethical principle? Beneficence Nonmaleficence Autonomy Justice
Nonmaleficence Nonmaleficence involves the duty to do no harm. Although the patient will experience nausea and hair loss (harm), the treatment will eventually produce good for the patient. Beneficence is frequently defined as the "doing of good." Autonomy means that individuals have the right to determine their own actions and the freedom to make their own decisions. Justice means that the same care is provided to patients with similar diseases and health care needs.
The nurse in a geriatric clinic collects the following information from an 82-year-old patient and her daughter, the family caregiver. The daughter explains that the patient is "always getting lost." The patient sits in the chair but gets up frequently and paces back and forth in the examination room. The daughter says, "I just don't know what to do because I worry she will fall or hurt herself." The daughter states that, when she took her mother to the store, they became separated, and the mother couldn't find the front entrance. The daughter works part time and has no one to help watch her mother. Which of the data form a cluster, showing a relevant pattern? (Select all that apply.) Daughter's concern of mother's risk for injury Pacing Patient getting lost easily Daughter working part time Getting up frequently
Pacing Patient getting lost easily Getting up frequently Pacing, getting lost, and hyperactivity are a cluster of defining characteristics that point to the diagnostic label of wandering
The nurse writes an expected-outcome statement in measurable terms. An example is: Patient will be pain free. Patient will have less pain. Patient will take pain medication every 4 hours. Patient will report pain acuity less than 4 on a scale of 0 to 10.
Patient will report pain acuity less than 4 on a scale of 0 to 10. Answer 4 is measurable because it is the only outcome statement that allows the nurse to obtain an actual measure of the patient's pain. The patient being pain free is a goal; the patient having less pain is written vaguely, and the patient taking pain medication every 4 hours is an intervention.
During the review of systems in a nursing history, a nurse learns that the patient has been coughing mucus. Which of the following nursing assessments would be best for the nurse to use to confirm a lung problem? (Select all that apply.) Family report Chest x-ray film Physical examination with auscultation of the lungs Medical record summary of x-ray film findings
Physical examination with auscultation of the lungs Medical record summary of x-ray film findings The family cannot provide information to reveal that the cough is a lung problem. A chest x-ray film is not a nursing assessment; if a previous chest x-ray film had been performed, the nurse could review that report to confirm a lung problem.
Doctoral Programs
Prepare nurses for careers in health administration, clinical research, and advanced clinical practice.
A nurse checks a patient's intravenous (IV) line in his right arm and sees inflammation where the catheter enters the skin. She uses her finger to apply light pressure (i.e., palpation) just above the IV site. The patient tells her the area is tender. The nurse checks to see if the IV line is running at the correct rate. This is an example of what type of assessment? Agenda setting Problem-focused Objective Use of a structured database format
Problem-focused The nurse saw the inflammation and gathered additional information to determine if a problem existed with the IV site. The data were not all objective; the patient's report of tenderness is subjective. Setting an agenda is an interview technique. The nurse was not using a structured format for her assessment.
Advanced Practice Nursing
RN, graduate degree level as either a Clinical Specialist, Nurse Anesthetist, Nurse-Midwife, or Nurse Practioner
Defense Against Negligent Torts
Release, Contributory or Comparative negligence, Assumption of risk, Unavoidable accident, Defense of the fact, immunity statue.
Genetics Nursing
Specialty that focuses on providing nursing care to individuals, families and communities with known genetic conditions or birth defects.
Legal Issues in Nursing Practice: Physician Interaction
The RN must assess orders to see if they are in the client's best interest; the person writing the order is legally authorized to give directions to the RN; and the order is applicable to statures, regulations and agency policies.
The nurse enters a patient's room and finds that the patient was incontinent of liquid stool. The patient has recurrent redness in the perineal area, and there is concern that he is developing a pressure ulcer. The nurse cleanses the patient, inspects the skin, and applies a skin barrier ointment to the perineal area. She calls the ostomy and wound care specialist and asks that he visit the patient to recommend skin care measures. Which of the following describe the nurse's actions? (Select all that apply.) The application of the skin barrier is a dependent care measure. The call to the ostomy and wound care specialist is an indirect care measure. The cleansing of the skin is a direct care measure. The application of the skin barrier is a direct care measure.
The call to the ostomy and wound care specialist is an indirect care measure The cleansing of the skin is a direct care measure. The call to the ostomy and wound care specialist is an indirect care measure involving collaborative care. Cleansing the skin is an independent direct care measure. Applying the skin barrier is an independent nursing measure involving direct care.
Foreseeability
The concept that certain events may reasonably be expected to cause specific results.
Privilege
The disclosure is to protect public or private interests recognized by law.
Standard of Care
The level or degree of quality considered adequate by a given profession.
Nursing Informatics
To focus on more knowledge and skill in information management.
Qualified Privilege
When person making statement, otherwise defamatory, has a legal duty to do so.
Defense of the Fact
When there is no connection between the patient's injury and any action by the health care provider.
Collective and Alternative Liability
When there's cooperation among several manufacturers in a wrongful activity, and all the wrongdoer's actions result in an inadequate industry-wide standard of safety.
treatment
what is the prority issue for co-worker substance abuse
Five Intentional Torts
1) Assault 2) Battery 3) Invasion of Privacy (publishing photos, disclosing confidential information) 4) Defamation of Character (false statements that result in damage to a person's reputation) 5) False Imprisonment
13. The nurse employed in a hospital is waiting to receive a report from the laboratory via the facsimile (fax) machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photograph. Which is the most appropriate nursing action? a. Call the police b. Cut up the photograph and throw it away c. Call the nursing supervisor and report the incident d. Call the laboratory and ask for the individual's name who sent the photograph
13. C- Ensuring a safe workplace is a responsibility of an employing institution. Sexual harassment in the workplace is prohibited by state and federal laws. Sexually suggestive jokes, touching, pressuring a co-worker for a date, and open displays of or transmitting sexually oriented photographs or posters are examples of conducts that could be considered sexual harassment by another worker. If the nurse believes that he or she is being subjected to unwelcome sexual conduct, these concerns should be reported to the nursing supervisor immediately. Option 1 is unnecessary at this time. Options 2 and 4 are inappropriate initial actions.
3. The nurse has just assisted a client back to bed after a fall. The nurse and health care provider have assessed the client and have determined that the client is not injured. After completing the incident report, the nurse should implement which action net? a. Reassess the client b. Conduct a staff meeting to describe the fall c. Document in the nurse's notes that an incident report was completed. d. Contact the nursing supervisor to update information regarding the fall
3. A- After a client's fall, the nurse must frequently reassess the client because potential complications do not always appear immediately after the fall. The client's fall should be treated as private information and shared on a "need to know" basis. Communication regarding the event should involve only the individuals participating in the client's care. An incident report is a problem-solving document; however, its completion is not documented in the nurse's notes. If the nursing supervisor has been made aware of the incident, the supervisor will contact the nurse if status update is necessary.
Damages
4 types: General, Special, Emotional, Punitive.
4. The nurse arrives at work and is told to report (float) to the intensive care unit (ICU) for the day because the ICU is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the ICU. The nurse should take which action first? a. Call the hospital lawyer b. Refuse to float to the ICU c. Call the nursing supervisor d. Identify tasks that can be performed safely in the ICU
4. D- Floating is an acceptable legal practice used by hospitals to solve understaffing problems. Legally, the nurse cannot refuse to float unless a union contract guarantees that nurses can work only in a specified area or the nurse can prove the lack of knowledge for the performance of assigned tasks. When encountering this situation, the nurse should set priorities and identify potential areas of harm to the client. The nursing supervisor is called if the nurse is expected to perform tasks that he or she cannot safely perform. Calling the hospital lawyer is a premature action.
6. A hospitalized client tells the nurse that a living will is being prepared and that the lawyer will be bringing the will to the hospital today for witness signatures. The client asks the nurse for assistance obtaining a witness to the will. Which is the most appropriate response to the client? a. "I will sign as a witness to your signature." b. "You will need to find a witness on your own.' c. "Whoever is available at the time will sign as a witness for you." d. "I will call the nursing supervisor to seek assistance regarding your request."
6. D- Living wills, also known as natural death acts in some states, are required to be in writing and signed by the client. The client's signature must be witnessed by specified individuals or notarized. Laws and guidelines regarding living wills vary from state to state, and it is the responsibility of the nurse to know the laws. Many states prohibit any employee, including the nurse of a facility where the client is receiving care, from being a witness. Option 2 is nontherapeutic and not a helpful response. The nurse should seek the assistance of the nursing supervisor.
A primary care provider's orders indicated that a surgical consent form needs to be signed. Since the nurse was not present when the primary care provider discussed the surgical procedure, which statement "best" illustrates the nurse fulfilling the client advocate role? 1. "The doctor has asked that you sign the consent form." 2. "Do you have any questions about the procedure?" 3. "What were you told about the procedure you are going to have?" 4. "Remember that you can change your mind and cancel the procedure."
Answer: #3 Rationale: This is the best answer because the nurse is assessing the client's level of knowledge as a result of the discussion with the primary care provider. Based on this assessment, the nurse may initiate other actions (call the primary care provider if the client has any questions)
Following a motor vehicle crash, a nurse stops and offers assistance. Which of the following actions are most appropriate? Select all that apply 1. The nurse needs to know the Good Samaritan Act for the state. 2. The nurse is not held liable unless there is gross negligence 3. After assessing the situation, the nurse can leave to obtain help. 4. The nurse can expect compensation for helping. 5. The nurse offers to help but cannot insist on helping.
Answer: 1,2,5 Rationale: The nurse is subject to the limitations of state law and should be familiar with the Good Samaritan laws in the specific state. Gross negligence would be described by the individual state law. Unless there is another equally or more qualified person present, the nurse needs to stay until the injured person leaves. The nurse should ask someone else to call or go for additional help. The same client rights apply at the scene of an accident as well as those in the workplace.
Culture strongly influences pain expression and need for pain medication. However, cultural pain: A. May be suffered by a client whose valued way of life is disregarded by practitioners. B. Is more intense, thus necessitating more medication. C. Is not expressed verbally or physically D. Is expressed only to others of like culture.
Answer: A. May be suffered by a client whose valued way of life is disregarded by practitioners. Nurses need not assume that pain relief is equally valued across groups. Cultural pain may be suffered by a client whose valued way of life is disregarded by practitioners.
The nurse practice acts are an example of: A. Statutory law B. Common law C. Civil law D. Criminal law
Answer: A. Statutory law
OSHA
who do we report to for unsafe working condition
Duty Owed to the Patient
2 elements to duty 1) Legal duty 2) scope of duty.
Top Complaints Leading to Malpractice Claims
1. OB 2. ER 3. Orthopaedics 4. Failure to diagnose (missed diagnosis)
8. Which identifies accurate nursing documentation notations? Select all that apply a. The client slept through the night b. Abdominal wound dressing is dry and intact without drainage c. The client seemed angry when awakened for vital sign measurement d. The client appears to become anxious when it is time for respiratory treatments e. The client's left lower medial leg wound is 3 cm in length without redness, drainage, or edema
8. A, B, E- Factual documentation contains descriptive, objective information about what the nurse sees, hears, feels, or smells. The use of inferences without supporting factual data is not acceptable because it can be misunderstood. The use of vague terms, such as seemed or appears is not acceptable because these words suggest that the nurse is stating an opinion.
When an older nurse complains to a younger nurse that nurses just aren't ethical anymore, which reply reflects the best understanding of moral development? A) "behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop" B) "I don't agree that nurses were more ethical in the past It's a new age and the ethics are new!" C) "Ethics is genetically determined... it's like having blue or brown eyes. Maybe were evolving out of the ethical sense your generation had." D) "I agree! It's impossible to be ethical when working in a practice setting like this!"
A) "behaving ethically develops gradually from childhood; maybe my generation doesn't value this enough to develop"
A student nurse begins a clinical rotation in a long term care facility and quickly realizes that certain residents have unmet needs. The student wants to advocate for these residents. Which statements reflect a correct understanding of advocacy? Select all that applies. A) advocacy is the protection and support of another's rights. B) patient advocacy is primarily done by nurse. C) patients with special advocacy needs include the very young and the elderly, those who are seriously ill, and those with disabilities. D) Nurse advocates make good health care decisions for patients and residents. E) nurse advocates do whatever patients and residents want. F) effective advocacy may entail becoming politically active.
A) advocacy is the protection and support of another's rights. C) patients with special advocacy needs include the very young and the elderly, those who are seriously ill, and those with disabilities. F) effective advocacy may entail becoming politically active.
The nurse reviews informed consent with a group of nursing students. Which conditions must the informed consent meet to be valid? (select all that applies) A) there is adequate disclosure B) the nurse explains the procedure to the client C) the informed consent is given voluntarily D) the client has the opportunity to rescind. E) the client has sufficient comprehensions. F) the client is under the influence of morphine
A) there is adequate disclosure C) the informed consent is given voluntarily E) the client has sufficient comprehensions.
15. A nurse is looking at the healthcare provider orders for a patient. The healthcare provider ordered a medication to be administered intravenously via a bolus. The nurse knows that this medication should not be given through this route and calls the healthcare provider for clarification. The healthcare provider tells the nurse to give the medication. What action should the nurse take next? A. Hold the medication and notify a supervisor B. Hold the medication and call another healthcare provider in the same facility C. Administer the medication as ordered D. Administer the medication and document the healthcare provider's response
A. Hold the medication and notify a supervisor
6. What actions should a nurse initiate if named in a lawsuit? Select all that apply. A. Respond to the complaint. B. Never sign a document without showing it to an attorney or legal representative C. Maintain a file of all meetings and conversations D. Withhold information that may be incriminating to you
A. -Respond to the complaint. B. -Never sign a document without showing it to an attorney or legal representative C. -Maintain a file of all meetings and conversations
Ethical principles for professional nursing practice in a clinical setting are guided by the principles of conduct that are written as the: A. American Nurses Association's (ANA's) Code of Ethics B. Nurse Practice Act (NPA) written by state legislation C. Standards of care from experts in the practice field D. Good Samaritan laws for civil guidelines
Answer: A. American Nurses Association's (ANA's) Code of Ethics This set of ethical principles provides the professional guidelines established by the ANA to maintain the highest standards for ideal conduct in practice. As a profession, the ANA wanted to establish rules and then incorporate guidelines for accountability and responsibility of each nurse within the practice setting.
A client has recently been told he has terminal cancer. As the nurse enters the room, he yells, "My eggs are cold, and I'm tired of having my sleep interrupted by noisy nurses!" The nurse may interpret the client's behavior as: A. An expression of the anger stage of dying B. An expression of disenfranchised grief C. The result of maturational loss D. The result of previous losses
Answer: A. An expression of the anger stage of dying In the anger stage of Kubler-Ross's stages of dying, the individual resists the loss and may strike out at everyone and everything, in this case, the nurse.
Which of the following is not included in evaluating the degree of heritage consistency in a client? A. Gender B. Culture C. Ethnicity D. Religion
Answer: A. Gender
1. A nurse was called before the State Board of Nursing. The nurse had been in practice for over six years, had her license suspended because an audit of her continuing education credits showed that she had not met the mandatory course requirements. The Board of Nursing has the ability to do this based on: A. Case law B. Administrative law C. Civil law D. Statutory law
B. Administrative law
The parents of an adult child have just been informed that the client will die shortly. The parents do not wont the nurse to discuss the situation with the client. The nurse states, "I will be truthful." The nurse's action is based on which ethical concept? A) beneficence B) autonomy C) veracity D) nonmaleficence
C) veracity
10. A nurse on a busy medical-surgical unit reports for a scheduled shift after working a double shift yesterday. At the end of this day, two nurses call in, and the nurse manager tells the nurse that he needs to stay and cover the next shift. The nurse may refuse to accept an assignment if: A. He is being asked to care for too many difficult clients B. He believes his assignment is unsafe C. He is being asked to work overtime D. He believes there are not enough nurses to work with him
C. He is being asked to work overtime
The nurse asks a patient, "Describe for me your typical diet over a 24-hour day. What foods do you prefer? Have you noticed a change in your weight recently?" This series of questions would likely occur during which phase of a patient-centered interview? Setting the stage Gathering information about the patient's chief concerns Collecting the assessment Termination
Collecting the assessment The nurse is focusing on the patient's nutritional status and asking specific questions to assess his diet history.
Defenses Against Intentional Torts
Consent, Self-defense, Defense of Others, Necessity
Two nurses are having a discussion at the nurses' station. One nurse is a new graduate who added, "Patient needs improved bowel function related to constipation" to a patient's care plan. The nurse's colleague, the charge nurse says, "I think your diagnosis is possibly worded incorrectly. Let's go over it together." A correctly worded diagnostic statement is: Need for improved bowel function related to change in diet. Patient needs improved bowel function related to alteration in elimination. Constipation related to inadequate fluid intake. Constipation related to hard infrequent stools.
Constipation related to inadequate fluid intake. Constipation related to inadequate fluid intake is an accurate NANDA-I approved nursing diagnosis with an appropriate etiology. Need for improved bowel function related to change in diet is a goal with an etiologic factor. Patient needs improved bowel function related to alteration in elimination is a goal with a diagnostic statement. Constipation related to hard infrequent stools is a nursing diagnostic label with a clinical sign.
Legal Issues in Nursing Practice: Death and Dying
Euthanasia - Legal in Oregon 1m
A patient has been in the hospital for 2 days because of newly diagnosed diabetes. His medical condition is unstable, and the medical staff is having difficulty controlling his blood sugar. The physician expects that the patient will remain hospitalized at least 3 more days. The nurse identifies one nursing diagnosis as deficient knowledge regarding insulin administration related to inexperience with disease management. What does the nurse need to determine before setting the goal of "patient will self-administer insulin?" (Select all that apply.) Goal within reach of the patient The nurse's own competency in teaching about insulin The patient's cognitive function Availability of family members to assist
Goal within reach of the patient The patient's cognitive function goal must be realistic and one that the patient has cognitive and sociocultural potential to reach. The nurse's competency does not influence the patient's goal. However, it may mean that the nurse must consult with a diabetes educator or a more qualified nurse before beginning instruction.
A patient who visits the allergy clinic tells the nurse practitioner that he is not getting relief from shortness of breath when he uses his inhaler. The nurse decides to ask the patient to explain how he uses the inhaler, when he should take a dose of medication, and what he does when he gets no relief. On the basis of Gordon's functional health patterns, which pattern does the nurse assess? Health perception-health management pattern Value-belief pattern Cognitive-perceptual pattern Coping-stress tolerance pattern
Health perception-health management pattern The nurse assesses the patient's understanding of his therapy and level of adherence. She also assesses his health practices.
Secondary sources of information include (select all that apply): Medical record Patient Physician Spouse or close relative
Medical record Spouse or close relative
Following the gathering of subjective and objective data, performing a health history and a physical assessment, the nurse sets up a plan of care. The first step is to identify the problem with a(n): Medical diagnosis Nursing intervention Nursing diagnosis Evaluation
Nursing diagnosis The nursing diagnosis is the title or label given to an identified problem and is the first step is a patient's plan of care.A medical diagnosis is the problem identified by the physician upon admission.Nursing intervention is the action used to meet the goal of the plan of care.Evaluation is the last step in the plan of care to see if the interventions are working or need to be changed.
n experienced nurse would best demonstrate collegiality with a novice nurse by which of the following behaviors? Allowing the novice plenty of independence to "get his feet wet" Overlooking mistakes to avoid embarrassing the novice nurse Asking a nursing instructor on the unit to take students elsewhere so the novice nurse can complete assigned tasks. Offering to serve as a mentor to the novice with mutually agreed on goals.
Offering to serve as a mentor to the novice with mutually agreed on goals. A nurse would best demonstrate collegiality with a novice nurse by offering to serve as a mentor to the novice. Allowing the novice to "get his feet wet" does not display behavior that supports another nurse. Overlooking mistakes does not serve as a positive role model. Asking students to leave does not demonstrate welcoming behavior.
A patient has been in the hospital for 2 days because of newly diagnosed diabetes. His medical condition is unstable, and the medical staff is having difficulty controlling his blood sugar. The physician expects that the patient will remain hospitalized at least 3 more days. The nurse identifies one nursing diagnosis as deficient knowledge regarding insulin administration related to inexperience with disease management. Which of the following patient care goals are long term? Patient will explain relationship of insulin to blood glucose control. Patient will self-administer insulin. Patient will achieve glucose control. Patient will describe steps for preparing insulin in a syringe.
Patient will achieve glucose control. It will take time for the patient who is medically unstable to achieve glucose control. Explaining the relationship of insulin to blood glucose control and self-administering insulin are short term goals and should be met before discharge. Describing steps for preparing insulin in a syringe is not a goal but an outcome statement for the goal that the patient will self-administer insulin.
During the implementation step of the nursing process, a nurse reviews and revises the nursing plan of care. Place the following steps of review and revision in the correct order: Review the care plan. Decide if the nursing interventions remain appropriate. Reassess the patient. Compare assessment findings to validate existing nursing diagnoses.
Review the care plan. Decide if the nursing interventions remain appropriate. After reassessing a patient, the nurse reviews the care plan and compares assessment data to validate the nursing diagnoses and determine whether the nursing interventions remain the most appropriate for the clinical situation. If the patient's status has changed and the nursing diagnosis and related nursing interventions are no longer appropriate, the nurse modifies the nursing care plan.
Provide safe care environment for patients. If risks are noticed, analyze and correct the issue. Look at trends inincident reports to identify the problems in the organization.
Risk Manager
The patient has a central venous line. The registered nurse (RN) delegates changing the sterile dressing over the line to a nursing assistant. The nursing assistant does not understand sterile technique and contaminates the dressing. An infection develops in the patient. The nurse manager discusses the action of the RN. Which statement is correct regarding the nurse's action? The nursing assistant is guilty of malpractice. The nurse is responsible for the acts delegated. The hospital cannot be held responsible for the act of its employees. No harm came to the patient, so a malpractice suit cannot be claimed.
The nurse is responsible for the acts delegated. The registered nurse is responsible for delegating appropriately. It is not appropriate to delegate a skill requiring sterile technique and assessment of a central line site to a nursing assistant. It is not within the nursing assistant's scope of practice to perform central line dressing changes. The hospital is responsible for the acts of its employees under the concept of respondeat superior. Harm was caused by this act, since the patient did develop an infection, so a malpractice suit can be claimed.
A nurse gathers the following assessment data. Which of the following cues form(s) a pattern suggesting a problem? (Select all that apply.) The skin around the wound is tender to touch. Fluid intake for 8 hours is 800 mL. Patient has a heart rate of 78 and regular. Patient has drainage from surgical wound. Body temperature is 101° F (38.3° C). Patient asks, "I'm worried that I won't return to work when I planned."
The skin around the wound is tender to touch. Patient has drainage from surgical wound. Body temperature is 101° F (38.3° C). These form a pattern of a problem with wound healing. Fluid intake of 800 mL in 8 hours and having a heart rate of 78 are normal findings. The patient indicating some worry about not returning to work when planned may suggest a problem, but more cues are needed to see a pattern that would allow the nurse to clearly identify the problem.
A nurse is on duty in the emergency room when the nurse is notified that a school bus has been struck by a train. Immediately the nurse reports to the triage area and begins the task of determining the severity of injuries, so that the most critical patients receive care first. Which ethical theory is the nurse putting into action? Utilitarianism Act deontology Rule deontology Virtue ethics
Utilitarianism Utilitarian ethics states that "what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people." By triaging the patients according to the severity of the injury, the nurse will be able to save the lives of more patients, thus doing the greatest good for the greatest number of people. Act deontologists determine the right thing to do by gathering all the facts and then making a decision. Rule deontologists emphasize that principles guide our actions. Virtue ethics are tendencies to act, feel, and judge that develop through appropriate training but come from natural tendencies.
private and civil law
law that applies relationships between private individuals
Waiver
state can waive some requirements but require applicant to meet other requirements.
will, advanced directives or donor card, or by family at time of death
what documents show consent of organ donor
homicide, suicide, inflicted injury such as gunshot or stabbing or abuse to police
what type of injuries are reported to police
supervisor
who do you report to fo co-worker substance abuse
health care provider performing trx, surgery, or procedure
who is responsible for informed consent
Ethics
Protect patient from incompetent practitioners.
patient bill of right
client intitled to confidentiality and informed consent are a part of
Credentials
proof of qualifications, usually in written form
2. A nurse is caring for an elderly patient. The patient falls and injures herself. Which of the following actions should the nurse take to decrease his/her liability? Select all that apply. A. Document the incident carefully on the designated form provided by the institution. B. Chart the facts surrounding the client's fall, condition, and follow-up care. C. It is not necessary to document anything about the fall. D. Report the incident to the next shift during report.
A.- Document the incident carefully on the designated form provided by the institution. B. -Chart the facts surrounding the client's fall, condition, and follow-up care. D. -Report the incident to the next shift during report.
2. A client is brought to the emergency department by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? a. Obtain a court order for the surgical procedure b. Ask the EMS team to sign the informed consent c. Transport the victim to the operating room for surgery d. Call the police to identify the client and locate the family.
2. C- In general, there are two situations in which informed consent of an adult client is not needed. One is when an emergency is present and delaying treatment for the purpose of obtaining informed consent would result in injury or death to the client. The second is when the client waives the right to give informed consent. Option 1 will delay emergency treatment, and option 2 is inappropriate. Although option 4 may be pursued, it is not the best action
The nurse completed the following assessment: 63-year-old female patient has had abdominal pain for 6 days. She reports not having a bowel movement for 4 days, whereas she normally has a bowel movement every 2 to 3 days. She has not been hospitalized in the past. Her abdomen is distended. She reports being anxious about upcoming tests. Her temperature was 37° C, pulse 82 and regular, blood pressure 128/72. Which of the following data form a cluster, showing a relevant pattern? (Select all that apply.) Vital sign results Abdominal distention Age of patient Change in bowel elimination pattern Abdominal pain No past history of hospitalization
Abdominal distention Change in bowel elimination pattern abdominal pain The presence of abdominal pain, distention, and a change in bowel elimination pattern forms a cluster, suggesting an elimination problem
A nurse informs the patient's health care provider that the patient is refusing potentially life saving surgery. In this situation, which ethical principle is the nurse using? Beneficence Nonmaleficence Autonomy Justice
Autonomy Using the principle of autonomy allows individuals to have the right to determine their own actions and make their own choices. Calling the health care provider to report the patient's refusal of surgery demonstrates the nurse's use of autonomy to guide practice. Beneficence is frequently described as "the doing of good." Nonmaleficence is the duty to do no harm. A description of justice includes patients with the same diagnosis and health care needs receiving the same care.
3. A registered nurse returning from vacation is a passenger on a flight from Los Angeles to New York. The flight attendant requests the help of a nurse or physician if one is on board. The nurse approaches the flight attendant and asks if she can assist. What statement in the Good Samaritan Act protects the nurse as a licensed healthcare provider? A. The provider may administer care any time. B The provider is covered if he/she administers the same level of care as a paramedic. C. The provider is covered if he/she administers the level of care that any other prudent individual with the same education would provide D. The provider may perform care outside the scope of his/her scope of practice if he/she knows how to perform the required procedure
C. The provider is covered if he/she administers the level of care that any other prudent individual with the same education would provide
A patient has the nursing diagnosis of nausea. The nurse develops a care plan with the following interventions. Which are examples of collaborative interventions? Provide frequent mouth care. Maintain intravenous (IV) infusion at 100 mL/hr. Administer prochlorperazine (Compazine) via rectal suppository. Consult with dietitian on initial foods to offer patient. Control aversive odors or unpleasant visual stimulation that triggers nausea.
Consult with dietitian on initial foods to offer patient. Providing frequent mouth care and controlling outside stimulation that triggers nausea are independent interventions. Maintaining an IV infusion and administering the rectal suppository are dependent interventions.
Occupational Health
Focus on providin nursing care in the workplace and often are responsible for health of staff take preventative action to avoid illness and promote health education.
Which of the following outcome statements for the goal, "Patient will achieve a gain of 10 lbs (4.5 kg) in body weight in a month" are worded incorrectly? (Select all that apply.) Patient will eat at least three fourths of each meal by 1 week. Patient will verbalize relief of nausea and have no episodes of vomiting in 1 week. Patient will eat foods with high-calorie content by 1 week. Give patient liquid supplements 3 times a day.
Give patient liquid supplements 3 times a day. Patient will verbalize relief of nausea and have no episodes of vomiting in 1 week. The statement 'Patient will verbalize relief of nausea and have no episodes of vomiting in 1 week' is not singular. The statement 'Give patient liquid supplements 3 times a day' is an intervention.
"Ambulate the patient three times a day at 0900, 1400, 1900 as tolerated" is an example of: Nursing order Nursing diagnosis Patient goal Evaluation
Nursing order This statement is an example of an intervention that has been made more specific to the patient, which is a nursing order.A nursing diagnosis is a NANDA-approved statement that identifies a specific problem. A patient goal is a statement that includes what the patient needs to do to make changes in the problem. Evaluation is the review of the plan of care to see what revisions are necessary to the plan of care.
A nurse is orienting a new graduate nurse to the unit. The graduate nurse asks, "Why do we have standing orders for cases when patients develop life-threatening arrhythmias? Is not each patient's situation unique?" What is the nurse's best answer? Standing orders are used to meet our physician's preferences. Standing orders ensure that we are familiar with evidence-based guidelines for care of arrhythmias. Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation. Standing orders minimize the documentation we have to provide.
Standing orders allow us to respond quickly and safely to a rapidly changing clinical situation. Standing orders are preprinted documents containing orders for the conduct of routine therapies, monitoring guidelines, and/or diagnostic procedures for specific patients with identified clinical problems. They are common in critical care settings and other specialized practice settings in which patients' needs change rapidly and require immediate attention.
