Chapter 45 - NCLEX Questions
For the patient with no healthcare coverage who is seeking medical care, the emergency department staff members decide whether to provide care or transport to a public facility based on which law, enacted by Congress in 1986 and updated in 2003? A) Health Insurance Portability and Accountability Act (HIPAA) B) Patient Self-Determination Act (PSDA) C) Newborns' and Mothers' Health Protection Act (NMHPA) D) Emergency Medical Treatment and Active Labor Act (EMTALA)
D) Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale: The intent of the Emergency Medical Treatment and Active Labor Act (EMTALA) is to ensure public access to emergency services regardless of ability to pay. The EMTALA prohibits "patient dumping," which is transferring indigent or uninsured patients from a private hospital to a public hospital without appropriate screening and stabilization. An exception is made if a hospital does not have the capability to stabilize a patient or if the patient requests a transfer. However, the hospital has to ensure that the patient is released to or transported with proper medical personnel.
A registered nurse on active duty in the army is licensed in the state of Texas. She is assigned to work as a nurse in the military hospital located in Nevada. The nurse will: A) need to obtain a license through the endorsement process. B) need to obtain a license through the mutual recognition process. C) not need to obtain a new license in the state of Nevada. D) not need a license for Nevada if she gets a guest license from the state of Texas.
C) not need to obtain a new license in the state of Nevada. Rationale: A nurse who works for the federal government does not need a new license to work in other federal government facilities.
Mutual recognition in nursing benefits which of the following individuals? A) A registered nurse whose primary state of residency is in a compact state and wants to work in a different compact state B) A registered nurse who lives is in a compact state and wants to work in another compact state C) A registered nurse whose primary state of residency is in a non-compact state, but who works in a compact state D) A nursing student who wants to work in a hospital and is attending a university to obtain a bachelor's degree in nursing
A) A registered nurse whose primary state of residency is in a compact state and wants to work in a different compact state Rationale: The nurse whose state of residency is in a compact state can work in any other state that is a member of the nurse licensure compact without obtaining a new license. It is not enough that the nurse lives in a compact state; it has to be the nurse's state of residency.
A registered nurse administers the wrong medication to a patient. As a result, the patient suffers an injury that requires a longer hospital stay. The patient can sue the hospital under the doctrine of which of the following? A) Battery B) False imprisonment C) Vicarious liability D) Statute of limitations
C) Vicarious liability Rationale: Vicarious liability is also known as substituted liability, wherein another party is responsible for the negligence or malpractice of another person.
For which of the following examples of conduct by nurses would the American Nurses Association recommend disciplinary action by state boards of nursing? Select all that apply. A) Committing a medication error B) Taking excessive sick time or personal leave C) Restraining a patient without obtaining informed consent D) Failing to report a person practicing nursing without a license
A) Committing a medication error C) Restraining a patient without obtaining informed consent Rationale: The American Nurses Association (ANA) recommends that the following unprofessional conduct result in disciplinary action: violation of the nursing practice act or rules, fraud, deceit, criminal activity, negligence, risk to clients, physical or mental incapacity, disciplinary action by another jurisdiction, incompetence, and unethical conduct. State boards of nursing enforce the requirements of nursing practice by establishing disciplinary actions for unprofessional conduct, including negligence. Restraining a patient without informed consent is considered false imprisonment, which is an intentional tort. Medication administered in error might be the grounds for liability in a nursing lawsuit. However, the error when unintentional is not necessarily the basis for disciplinary action. Nurses must report the unauthorized practice of nursing. Excessive use of sick time and personal leave may result in disciplinary action by the manager but would not warrant action by the state board.
The nurse's legal role in obtaining written consent from a patient for any treatment or procedure includes which of the following? Select all that apply. A) Determining that the elements of a valid informed consent are in place B) Explaining to the patient the treatment and potential complications before he signs the consent C) Communicating the patient's needs for more information to the provider who will perform the procedure D) Evaluating whether the patient's provider has adequately explained the treatment and options before the patient signs the consent
A) Determining that the elements of a valid informed consent are in place C) Communicating the patient's needs for more information to the provider who will perform the procedure Rationale: As a nurse, your legal role regarding written consent is to collaborate with the provider who will perform the procedure. You may witness a patient's signature on the consent form, but you are not legally responsible for explaining the treatments and options nor for evaluating whether the physician has adequately explained them. You must, however, determine that the elements of a valid informed consent are in place, communicate the patient's need for more information to the physician, and provide feedback to the physician if the patient wishes to change her consent.
The legal criterion against which the nurse's conduct is compared to determine whether a negligent act occurred is called: A) standard of care. B) intentional tort. C) vicarious liability. D) an advance directive.
A) standard of care. Rationale: The standard of care measures what a reasonable, prudent nurse would have done in the same or similar circumstances. To be successful in a malpractice lawsuit, the plaintiff must prove that the standard of care was breached, in addition to the other elements of malpractice.
A 67-year-old man has been admitted to the hospital for a surgical procedure. During the admission process, the nurse asks whether he has a living will or a durable power of attorney. The patient asks, "What is a living will?" The best response by the nurse would be which of the following? A) "A living will and a durable power of attorney are both advance directives." B) "A living will states your wishes regarding future healthcare if you become unable to give instructions." C) "A living will identifies a person who will make healthcare decisions in the event you are unable to do so." D) "I will tell a case manager that you would like additional information."
B) "A living will states your wishes regarding future healthcare if you become unable to give instructions." Rationale: Generally, there are two types of advance directives: a living will and a durable power of attorney. A living will is a directive that declares the patient's wishes should the patient become unable to give instruction. A durable power of attorney identifies a person who will make healthcare decisions in the event the patient is unable to do so. Simply saying a living will and durable power of attorney are both advance directives is broadly stated and does not give as much information to the patient.
A nurse carried her own professional liability, a claims-made policy, from May 1, 2011, until April 30, 2012. She did not renew her professional liability policy, but purchased the tail coverage because she was starting law school on July 15, 2012, and did not plan to work as a nurse. A malpractice lawsuit was filed against her on July 3, 2012, arising out of an incident that occurred in December 2011. The plaintiff won the lawsuit. The statement that best describes the nurse's situation is that her insurance policy will A) not cover her. B) cover her. C) cover her only if she is working as a nurse. D) cover her if she renews her policy within 3 months.
B) cover her. Rationale: A claims-made policy covers claims that were made and reported during the policy period. The purchase of the tail insurance extended the coverage of the policy. If the nurse had not purchased the tail insurance, she would not have been covered.
A registered nurse's primary state of residency is Utah, a compact state. She wants to practice nursing in the state of Nevada, which is a non-compact state. The nurse A) should retake the NCLEX-RN examination for practice in Nevada. B) must apply for licensure by compact endorsement. C) can practice under the mutual recognition agreement. D) must request a permissive license from the Utah Board of Nursing
B) must apply for licensure by compact endorsement. Rationale: The mutual recognition model of nursing applies to states that have entered into the compact agreement. The agreement does not extend to those states that have not entered into the compact agreement (Nevada).
A patient tells you that chart entries made by the nurse from the previous day indicate he was uncooperative when asked to ambulate. He says this is not true and asks that his record be corrected. You understand that if what he says is accurate, he has the right to have the documentation error corrected based on which of the following regulations? A) Americans with Disabilities Act (ADA) B) Patient Self-Determination Act (PSDA) C) Health Insurance Portability and Accountability Act (HIPAA) D) Health Care Quality Improvement Act (HCQIA)
C) Health Insurance Portability and Accountability Act (HIPAA) Rationale: The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule of 2004 provides comprehensive protection for the privacy of protected health information (confidentiality of patient records). In addition, patients have the right to see and copy their medical records and to reconcile incorrect information.
A nurse may be convicted of false imprisonment for which behavior? A) Putting the patient in fear of being harmed B) Touching the patient without his/her consent C) Putting a patient in restraints to prevent him from leaving D) Yelling and screaming at the patient for trying to get out of bed without assistance
C) Putting a patient in restraints to prevent him from leaving Rationale: False imprison is restraining a patient against his/her wishes. This violates the patient's autonomy. Assault is putting the patient in fear of being harmed, such as yelling, screaming, and making threats. Touching a patient without his consent is battery.
Two student nurses in the elevator are discussing the HIV-positive status of a client. One of the clients' family members is in the elevator and overhears the conversation between the student nurses. Which of the following statements is true? A) The state board of nursing can discipline the students' license. B) The client can sue the student nurses for slander and libel. C) The students have violated the Health Insurance Portability and Accountability Act. D) The students have violated the Emergency Medical Treatment and Active Labor Act.
C) The students have violated the Health Insurance Portability and Accountability Act. Rationale: The students have released the client's protected personal information to a third party without the patient's consent and to those who do not have a medical or business need to know. This is a HIPAA violation.