Chapter 3: Nursing Practice and the Law—Answers and Rationales

1. Which of the following laws govern nursing practice? A. Statutory laws B. Common laws C. Administrative laws D. Constitutional laws

A Page: 36 Feedback A. This is correct. Statutory laws are those created by various legislative bodies, such as state legislatures. Laws that govern nursing practice are statutory laws. B. This is incorrect. Common laws develop out of the judicial system, as court decisions set precedent for other decisions. C. This is incorrect. Administrative laws are developed by administrative agencies such as federal or state governments. D. This is incorrect. The U.S. Constitution is the foundation for American law, defining the power of the government and protecting the rights of citizens.

9. An RN enters a patient's room to place an indwelling urinary catheter, as ordered by the health-care professional. The client is alert and oriented and tells the RN he wants to leave the hospital now and not receive further treatment. Which of the following actions by the RN would be considered false imprisonment? A. The RN tells the client he is not allowed to leave until the physician has released him. B. The RN asks the client why he wishes to leave. C. The RN asks the client to explain what he understands about his medical diagnosis. D. The RN asks the client to sign an against medical advice discharge form.

A Page: 41 Feedback A. This is correct. Verbal or physical detainment of a client who desires to leave the institution is false imprisonment. B. This is incorrect. Asking the client why he wishes to leave is not false imprisonment and may provide additional information. C. This is incorrect. Asking a client to explain what he or she understands about the medical diagnosis will ensure the client has all the information needed to make an informed decision. D. This is incorrect. Asking a client to sign the against medical advice discharge form is not false imprisonment.

2. Which of the following categories does a violation of the nurse practice act fall under? A. Juvenile B. Felony C. Misdemeanor D. Tort

B Page: 37 Feedback A. This is incorrect. A juvenile offense is when an individual under the age of 18 breaks a law. The age limit varies by state. B. This is correct. A felony offense is the most serious category and includes such offenses as homicide and nurse practice act violations. C. This is incorrect. A misdemeanor offense includes lesser offenses, such as traffic violations. D. This is incorrect. A tort is a type of civil offense.

6. As an RN stands in line for the cafeteria cashier, he overhears the staff in front of him talking about a client the RN took care of earlier in the week. The client's room number is mentioned along with the diagnosis and prognosis. Which of the following actions should the RN take? A. Join in the conversation in case the RN is assigned to care for the client in the future. B. Remind the staff members that they are in a public location and sharing this information is a breach of the Health Insurance Portability and Accountability Act (HIPAA). C. Correct a statement made by one of the staff members. D. Ignore the conversation,

B Page: 39 Feedback A. This is incorrect. Discussing a client's private health information in a public setting where it can be overheard is a breach of confidentiality. B. This is correct. HIPAA protects the privacy of health information and preserves confidentiality. Discussing a client's health information in a public place where it can be overheard is a breach of HIPAA. C. This is incorrect. Discussing a client's private health information in a public setting where it can be overheard is a breach of confidentiality. D. This is incorrect. The RN should protect the client's privacy by stopping the conversation. Allowing the conversation to continue is a breach of HIPAA and could result in liability for the organization.

7. Which of the following is a potential benefit to social media? A. Sharing the fun side of nursing by posting a video of nurses singing and dancing in the hallways of the hospital while on duty B. Connecting with clients to keep up with their health status C. Connecting with the public to encourage healthy behaviors D. Sharing pictures of interesting clinical experiences with friends

C Page: 40 Feedback A. This is incorrect. Although encouraging potential students to enter the field of nursing would be a benefit, it is important to avoid sharing anything that could be viewed as unprofessional conduct. B. This is incorrect. Nurses must be extremely cautious not to intentionally or inadvertently expose a client's personal health information. C. This is correct. Encouraging health benefits and connecting with the public are potential benefits to social media. D. This is incorrect. Posting pictures of clinical experiences can potentially expose private client health information.

11. A postop nurse is caring for a client after knee replacement. She discovers the consent was not signed before the surgery. Which of the following charges could be filed? A. False imprisonment B. Libel C. Battery D. Malpractice

C Page: 43 Feedback A. This is incorrect. False imprisonment occurs when an individual wishes to leave a facility but is detained by physical or verbal means. B. This is incorrect. Libel occurs when an individual says something that damages the reputation of another. C. This is correct. Battery occurs when an individual is touched without consent. Performing surgery without a signed consent is battery. D. This is incorrect. Malpractice occurs when duties requiring specialized education are not fulfilled, resulting in harm and injury to the patient.

5. An RN comes upon a serious motor vehicle accident that has just occurred and no first responders are on the scene. One car has been flipped upside down and she can see the driver still in the car. The RN decides to stop and help. She knows she is protected from civil liability as long as she does which of the following? A. Acts in an ordinary, reasonable, and prudent professional manner B. Assures that information obtained is not communicated to anyone else C. Does not make any verbal comments that could lead to economic harm D. Fails to meet the established standards of practice

A Page: 39 Feedback A. This is correct. The Good Samaritan Law protects trained professionals from civil lawsuits when they provide assistance in an emergency situation as long as they behave in a manner that is ordinary, reasonable, and prudent. B. This is incorrect. Confidentiality laws require nurses to ensure they do not communicate private client information to anyone who does not have a need to know. However, these laws do not protect professionals helping in emergency situations. C. This is incorrect. A quasi-intentional tort occurs when verbal comments lead to economic harm or damage the reputation of another. This does not protect the nurse from civil lawsuits when helping someone in an emergency situation. D. This is incorrect. A failure to meet established standards of practice for someone to whom a duty to care is owed would be negligence. However, this does not describe an emergency situation when a nurse offers to help voluntarily.

10. Which of the following is a recommendation for avoiding charges of negligence and false imprisonment for confused clients? A. Carefully assess and document client status. B. Ensure all patient information is closed and the nurse has signed out of the computer before leaving the computer station. C. Keep careful notes while providing care so that documentation later in the day is accurate. D. Discuss safety needs with clients.

A Page: 42 Feedback A. This is correct. Careful assessment and documentation of client status is an essential component of good nursing practice. B. This is incorrect. Protecting client information by signing out of computers is good practice to protect client health information, but it does not protect a nurse against charges of negligence or false imprisonment. C. This is incorrect. Documentation should occur as soon as patient assessment and care has occurred. D. This is incorrect. Discussing safety needs with clients, their families, and the health-care team is one way nurses can protect themselves from charges of negligence and false imprisonment. However, if the client is confused, discussing safety needs with only the client is not enough.

15. An RN is writing reminders for good documentation for the nurses on her staff. The purpose is to ensure nursing documentation is legally credible. Which of the following is a recommendation she should include in the reminders? A. Use shortcuts in documentation. B. Only use approved abbreviations. C. Documentation should be subjective. D. Document after care is provided.

B Page: 47 Feedback A. This is incorrect. Shortcuts in documentation should be avoided. B. This is correct. Only approved abbreviations should be used in documentation. C. This is incorrect. Documentation should be objective and appropriate. D. This is incorrect. Documentation should be completed at the time care is provided.

3. A registered nurse (RN) administered a patient's morning insulin as the breakfast tray arrived at 0800. The RN performed a complete assessment at the same time. Then, the RN got busy with her other patients and did not check on the patient until 1400. At that time, she found the patient unresponsive with a blood glucose of 23. Both the breakfast and lunch tray were at the bedside untouched. Which of the following could the RN be charged with? A. Quasi-intentional tort B. Misdemeanor C. Negligence D. Juvenile offense

C Page: 38 Feedback A. This is incorrect. A quasi-intentional tort is voluntary speech that inflicts economic harm or damages a reputation. B. This is incorrect. A misdemeanor is a lesser criminal offense, such as a traffic violation. C. This is correct. Negligence is the failure to act in a reasonable, ordinary, and prudent manner, causing harm to someone who is owed the duty to care. D. This is incorrect. A juvenile criminal offense is an act committed by someone under the age of 18.

14. Two RNs are discussing the benefits of professional liability insurance. Which of the following is a reason for an RN to have a professional liability insurance policy? A. No expense is involved in frivolous lawsuits. B. If a nurse is found guilty of malpractice, the institution cannot sue the nurse. C. Liability policies may also cover charges of libel, slander, assault, and HIPAA violations. D. Only doctors are sued for malpractice.

C Page: 48 Feedback A. This is incorrect. Even in a frivolous lawsuit, if a patient fails to incur damages, but hopes to collect on a settlement, nurses incur expenses. B. This is incorrect. When a nurse has been charged with and found guilty of malpractice, the employing institution may sue the nurse to recoup damages. C. This is correct. Assault, HIPAA violations, libel, slander, and property damage may be covered in professional liability insurance policies. D. This is incorrect. Any professional health-care worker, including nurses, may be charged with malpractice.

13. An RN's client with terminal pancreatic cancer asks questions about a do not resuscitate order. Which of the following statements should be included in the RN's teaching to the client? A. When a heart ceases to beat, the client is pronounced clinically dead. B. Physicians must write do not resuscitate (DNR) orders. C. A DNR order can be written after the health-care provider has discussed it with the client and family. D. A DNR requires a court decision.

C Page: 49 Feedback A. This is incorrect. When a heart ceases to beat, the client is in cardiac arrest and this is commonly when CPR is initiated. B. This is incorrect. In many states, nurse practitioners and physician assistants may also write DNR orders. C. This is correct. Clients may request a DNR order, but they need to be fully informed of all the ramifications of the decision. Therefore, the health-care provider will consult with the client and family before the order is written. D. This is incorrect. A DNR may require a court decision if a legal dilemma has arisen. However, in general DNRs can be written by the health-care provider after consulting with the client and family.

4. Which of the following is true of malpractice? A. Malpractice occurs when a professional shares information about a patient that could damage that patient's reputation. B. Malpractice is a serious criminal offense. C. Malpractice is a minor criminal offense. D. Malpractice is a negligent act by an individual whose duties require specialized education.

D Page: 38 Feedback A. This is incorrect. A quasi-intentional tort occurs when someone makes a verbal statement that damages another's reputation. B. This is incorrect. Malpractice is a civil offense. C. This is incorrect. Malpractice is a civil offense. D. This is correct. Malpractice occurs when duties requiring specialized education are not fulfilled, resulting in harm and injury to the patient.

8. There are several pitfalls that should be avoided when using social media of any type. For example, a nurse or student could be found guilty of libel in which of the following scenarios? A. Snapping a selfie with a patient B. Posting a positive review of the hospital where the student completed clinicals C. Creating a closed online forum where students can discuss clinical experiences without providing client information D. Complaining about her nurse preceptor on social media, discussing the preceptor's unprofessional characteristics.

D Page: 41 Feedback A. This is incorrect. Taking and posting a picture with a patient may present a breach of confidentiality, but would not specifically indicate libel. B. This is incorrect. Posting a positive review would not damage the organization's reputation and therefore is not considered to be libel. C. This is incorrect. Students should be very careful not to expose any potentially identifiable client information; however, as the forum is closed, it is not specifically indicative of libel. D. This is correct. Statements about individuals encountered in one's professional or educational life that could damage that person's reputation may be slander or libel and can be prosecuted as quasi-intentional torts.

12. Which of the following should be included in a discussion of advance directives with new nurse graduates? A. According to the Patient Self-Determination Act, nurses are required to inform clients of their right to create an advance directive. B. The advance directive designates an individual who will make financial decisions for the client if he or she is unable to do so. C. A living will designates who will make health-care decisions for an individual in the event the individual is unable or incompetent to make his or her own decisions. D. The advance directive designates a health-care surrogate who will make known the client's wishes regarding medical treatment if the client is unable to do so.

D Page: 50 Feedback A. This is incorrect. The Patient Self-Determination Act does not specify who should discuss advance directives with clients. B. This is incorrect. Advance directives describe an individual's treatment wishes in case of a serious accident or illness. C. This is incorrect. The living will outlines the client's wishes regarding life-prolonging medical treatment in the event he or she is unable or incompetent to make his or her own decisions. D. This is correct. One function of the advance directive is to appoint a health-care surrogate who will make known the client's wishes for medical treatment to the medical and nursing team if the client is unable to do so.