Legal implications in nursing practice

A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which statements regarding a breach of duty apply to this situation? Select all that apply. 1 Failure to document a change in assessment data 2 Failure to provide discharge instructions 3 Failure to follow the six rights of medication administration 4 Failure to use proper medical equipment ordered for patient monitoring 5 Failure to notify a health care provider about a change in the patient's condition

1, 5 The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.

The nurse notes that an advance directive is on a patient's medical record. Which statement best describes an advance directive guideline? 1 A living will allows an appointed person to make healthcare decisions when the patient is in an incapacitated state. 2 A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3 The patient cannot make changes in the advance directive once admitted to the hospital. 4 A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

2 A living will does not assign another individual to make decisions for the patient. A durable power of attorney for healthcare is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.

The nurse has been falsely accused of providing inadequate care to a patient by another nurse. The nurse has received praise in the past for providing quality care to the patients. Which tort does this indicate? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy

2 Because the nurse has received praise in the past for providing quality care to patients, the implication is that the nurse provides quality care. Another nurse accusing this nurse of providing inadequate patient care is indicative of slander, which occurs when one person speaks falsely about others. Libel refers to written defamation of character. Malpractice refers to actions performed below the standard of care. Invasion of privacy refers to unwanted intrusion into the patient's personal affairs.

The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act (HIPAA)? 1 Discussing patient conditions in the nursing report room at the change of shift 2 Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3 Posting medical information about a patient on a message board in the patient's room 4 Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3 Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment, which violates the Health Insurance Portability and Accountability Act (HIPAA)

In which situations is the nurse allowed to use physical restraints? Select all that apply. 1 The patient is extremely irritated. 2 The patient has suicidal ideation. 3 The healthcare provider has given a written order. 4 The patient is potentially dangerous to other patients. 5 The patient's family members have asked to restrain the patient

3, 4 The nurse can use physical restraints on a patient only if the healthcare provider has given an order to do so or to ensure the safety of other patients. If the patient is irritated, the nurse should use other measures of restraining the patient, such as counseling. Patients exhibiting suicidal ideation should be monitored closely and should receive psychotherapy. The nurse should not restrain the patient just because family members have asked the nurse to do so.

A patient who is hospitalized with chronic illness is depressed and demands to go home. The nurse applies a physical restraint and administers medication to the patient. What does this nursing intervention indicate? 1 The nurse is following Good Samaritan laws. 2 The nurse may be charged with malpractice. 3 The nurse is guilty of invading the patient's privacy. 4 The nurse may be charged with false imprisonment.

4 Patients cannot be forced to stay in the hospital against their will, because this constitutes false imprisonment. Good Samaritan laws help protect health care professionals from charges of negligence in providing emergency care. In this case, the patient is not restrained during emergency care, so the nurse is not following Good Samaritan laws. Malpractice is professional negligence, in which the nurse does not provide standard care for the patient. Applying physical restraints does not indicate that the nurse is providing substandard care. Using restraints to stop the patient from going home does not indicate that the nurse is invading the privacy of the patient.

The nurse is floated to work on a nursing unit where the assignment is beyond the nurse's capability. Which is the best nursing action to take first? 1 Call the nursing supervisor to discuss the situation. 2 Discuss the problem with a colleague. 3 Leave the nursing unit and go home. 4 Say nothing and begin work.

1 Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

The nurse is sued for failure to monitor a patient appropriately after a procedure. Which statements are correct about this lawsuit? Select all that apply. 1 The nurse represents the plaintiff. 2 The defendant must prove injury, damage, or loss. 3 The person filing the lawsuit has the burden of proof. 4 The plaintiff must prove that a breach in the prevailing standard of care caused an injury. 5 The nurse is a witness.

3, 4 The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage. Thus, the plaintiff has the burden of proof. The nurse is the defendant, not a witness.

A patient suffering from cardiac arrest is brought to the hospital. The patient previously underwent a coronary artery bypass graft (CABG) and angioplasty, and the patient has been chronically ill since then. The patient has requested in writing that not to be resuscitated in case of emergency. What is the term for this request? 1 Living will 2 Implied consent 3 Informed consent 4 Power of attorney

1 Living wills are written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. Implied and informed consents are types of consent that are given by a patient (or guardian) in case of surgery or treatment. A power of attorney is a legal document that designates a person of the patient's choice to make health care decisions on behalf of the patient when the patient is no longer able to do so.

A group of nurses makes a list of patients who require organ transplantation. Which patient would be given priority for organ transplantation? 1 The patient who is most critically ill 2 The patient who is a very young age 3 The patient who will pay more for the intervention 4 The patient who lives in close proximity to the healthcare center

1 The patient who is most critically ill or is unstable would be given priority, because receiving the organ transplant can save the patient's life. Young patients would not be given priority for receiving an organ transplant, because they are relatively stable. Being partial toward the patient who is willing to pay more for the intervention is unethical and biased. Giving preference for an organ transplant to a patient who lives in close proximity is inappropriate, because other patients may require it more based on their health condition.

A graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which statements below indicate the new graduate understands ways to remain involved professionally? Select all that apply. 1 "I am thinking about joining the health committee at my church." 2 "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3 "I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing." 4 "Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses." 5 "Nurses should take direction from physicians in the hospital setting."

1, 2 Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees at all levels of their career, not just when they have experience. Nurses have a powerful voice in the legislature.

The nurse is working the night shift in an emergency room. The nurse receives a patient who is violent toward the staff. The patient is uncooperative and hysterical. The nurse decides to use restraints on this patient. Which are indications for using restraints? Select all that apply. 1 There is a written order from the healthcare provider. 2 The patient is hysterical. 3 All other less restrictive interventions are unsuccessful. 4 The patient may harm other patients. 5 The nurse and three other nurses agree on restraining

1, 3, 4 The Centers for Medicare and Medicaid Services and The Joint Commission have stipulated that the nurse may apply restraints only when absolutely necessary. Restraints are allowed when the patient poses a danger to other residents, all other means of restriction have failed, and there is a written directive from a healthcare practitioner. It is against the law and unethical to restrain a patient who is hysterical. The nurse cannot restrain any patient without orders from the healthcare provider, even with the agreement of three other nurses.

Which essential criteria are used to establish nursing malpractice? Select all that apply. 1 The nurse owed a duty to a patient. 2 The nurse followed the instructions given for a patient. 3 The nurse did not follow an ordered intervention for a patient. 4 The nurse conveyed appropriate discharge instructions to the patient. 5 The nurse's failure to carry out the duty caused an injury to the patient.

1, 3, 5 If the nurse owed a duty to a patient, did not perform the given duty, and if failure to perform that duty caused injury to the patient, then the nurse could be liable for nursing malpractice. Following the given instructions for a patient and conveying appropriate discharge instructions are both examples of good and ethical nursing practice. These actions would not make the nurse liable for nursing malpractice.

Which actions, if performed by a registered nurse, would result in both criminal and administrative sanctions against the nurse? Select all that apply. 1 Taking or selling controlled substances 2 Refusing to provide healthcare information to a patient's child 3 Reporting suspected abuse and neglect of children 4 Applying physical restraints without a written physician's order 5 Administering the wrong medication to the patient

1, 4 The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a healthcare provider based on Joint Commission and Medicare guidelines. Refusing to provide healthcare information to a patient's child, reporting suspected abuse and neglect of children, and administering the wrong medication to a patient would not result in both criminal and administrative sanctions against the nurse.

The nurse has failed to obtain informed consent before performing a procedure on a patient. Which type of torts result from this nursing action? Select all that apply. 1 Assault 2 Battery 3 Negligence 4 False imprisonment 5 Libel

2, 3 Negligence is performing an action that falls below a standard of care. Failure to obtain informed consent is an act of negligence. Assault refers to an action that places a person within harmful or offensive contact without consent. Battery is any intentional touching without consent. Because the nurse has failed to obtain informed consent, doing any intervention on the patient would be considered as battery. False imprisonment is the unjustified restraint of a person without legal warrant. Failure to obtain informed consent would not result in assault or false imprisonment. Libel is written defamation of character.

The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. Which would probably cover the nurse in this situation? 1 The nurse's automobile insurance 2 The nurse's homeowner's insurance 3 The Good Samaritan laws, which grant immunity from suit if there is no gross negligence 4 The Patient Care Partnership, which may grant immunity from suit if the injured party consents

3 The Good Samaritan law holds healthcare providers immune from liability as long as they function within the scope of their expertise. Automobile and homeowner insurance would not cover the nurse in this situation. The Patient Care Partnership may grant immunity from suit if the injured party consents, which is not the case in this scenario.

The nurse notes that the healthcare unit keeps a listing of the patient names at the front desk in easy view for healthcare providers to more efficiently locate the patient. Which does this action violate? 1 Mental Health Parity Act (MHPA) 2 Patient Self-Determination Act (PSDA) 3 Health Insurance Portability and Accountability Act (HIPAA) 4 Emergency Medical Treatment and Active Labor Act (EMTALA)

3 The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) requires patient information to be protected from unnecessary publication. The Mental Health Parity Act (MHPA) addresses the needs of the mental health patient, the Patient Self-Determination Act (PSDA) addresses a patient's right to refuse treatment and formulate advance directives, and the Emergency Medical Treatment and Active Labor Act (EMTALA) ensures appropriate screening and stabilization of the patient in an emergency setting.

A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy? 1 Inform the patient's spouse about the disease. 2 Do not inform the patient or the family members about the disease. 3 Obtain permission from the patient to inform the patient's spouse about the disease. 4 Obtain informed consent from the spouse to reveal the illness to the patient.

3 Hepatitis B is a sexually transmitted disease, and the patient may be unwilling to reveal the information about the disease to the spouse. Thus, the nurse should request consent from the patient to let the spouse know about the illness. The patient's spouse should not be informed about the illness without the patient's consent. The nurse should abide by the patient's right to be informed about the disease. The nurse must obtain the patient's consent to inform family members about the disease. Obtaining informed consent from the spouse to reveal the illness to the patient is an inappropriate nursing action. Test-Taking Tip: Do not choose responses that violate confidentiality of patient health care information, even to spouses. The patient must be the one to give consent for anyone else to gain access to healthcare information. You could think of this point as the legal extension of patient-centered care.

A patient who has tested positive for human immunodeficiency virus (HIV) tells the nurse, "I feel helpless. My boss fired me because I'm HIV positive." Which is the best response by the nurse? 1 "Don't worry. You're protected by Good Samaritan laws." 2 "Don't lose hope. Take this as an opportunity to spend time with your family." 3 "I understand your feelings, but I think you should concentrate on your health now." 4 "You should approach a lawyer. You're protected by the Americans with Disabilities Act."

4 The Americans with Disabilities Act protects the rights of people with physical or mental disabilities as well as the rights of patients who have tested positive for human immunodeficiency virus (HIV). Therefore, the nurse would recommend that the patient speak to a lawyer. Good Samaritan laws help protect health care professionals from charges of negligence in providing emergency care but do not provide protection for HIV-positive patients. Asking the patient to take the opportunity to spend time with family is not appropriate, because the patient may lose hope of fighting for his or her rights. It is also not appropriate to recommend that the patient overlook this violation of rights and concentrate on his or her health.

The healthcare provider has asked for a postmortem examination on a patient. Under which circumstances can a healthcare provider make the decision to perform an autopsy? Select all that apply. 1 The patient was terminally ill. 2 The patient's autopsy reports are required for medical research. 3 The patient had an adverse drug effect that caused death. 4 The patient's death occurred under suspicious circumstances. 5 The patient died within 1 hour of being admitted to the hospital.

4, 5 The healthcare provider can decide to conduct an autopsy only if the patient's death occurred under suspicious circumstances or the patient died within 1 hour of being admitted to the hospital in order to determine the exact cause of death. Because the cause of death is known in a terminally ill patient, an autopsy need not be done for this patient. An autopsy cannot be done for research purposes, unless the patient or the caregivers have given their consent. In cases in which an adverse drug reaction has been identified as the cause of death in the patient, an autopsy is not required.

The nurse is caring for a 6-year-old child with hypovolemic shock. The child is a Jehovah's Witnesses. The child needs an immediate blood transfusion, but the child's parents refuse to provide consent. Which would be the most appropriate action? 1 Administer blood to the child. 2 Administer intravenous fluids. 3 Provide oral hydration and nutrition. 4 Seek court order for blood transfusion

1 Jehovah's Witnesses is a cultural and religious group that refuses blood transfusions based on their religious beliefs. According to the Durable Power of Attorney for Health Care (DPAHC) document, the court will grant an order allowing hospitals and healthcare providers to treat children of Christian Scientists or Jehovah's Witnesses who have denied consent for treatment of their minor children. Therefore, to save the life of the child it is most appropriate for the health care provider or nurse to administer blood to the child. Refusing a blood transfusion in the case of hypovolemic shock would most likely result in the death of the child. Administering only intravenous fluids may not help, because the child is in hypovolemic shock. Oral hydration and nutrition will not be sufficient to resuscitate a child who has had severe blood loss. The court will allow the healthcare providers to resuscitate the child; thus the medical personnel need not seek or wait for court orders.

A patient is abusive and rude with the student nurse. The student nurse documents that the patient is uncooperative and shows symptoms of alcohol withdrawal. As a result the patient will be transferred to a different floor. Which is the best classification of this nurse's error? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy

1 Libel is documentation of false entries or defamation of character. The nurse is offended by the patient's behavior, so the nurse documents signs of alcohol withdrawal, even though this is not indicated by rude behavior alone. Slander is oral defamation of character. The nurse is documenting the report, but not verbalizing it, so this is not considered slander. Malpractice is negligence of a professional role. This nursing action does not indicate negligence. Invasion of privacy typically involves releasing a patient's private information without the patient's consent. The nurse has not violated the patient's privacy in this instance.

What should the nurse do to avoid malpractice and the resulting professional negligence? Select all that apply. 1 Strictly follow the given standards of care. 2 Regularly update current nursing knowledge. 3 Properly document all assessments and interventions. 4 Avoid explaining medical procedures to patients. 5 Complete health documentation at the end of the shift.

1, 2, 3 As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other healthcare team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence. Test-Taking Tip: Another way to evaluate a choice is to ask yourself the question, "Would it be right to...?" So for the option "Avoid explaining medical procedures to patients," you would ask, "Would it be right to avoid explaining medical procedures to patients?" Certainly not! So you can eliminate that choice.

An 8-year-old girl is brought to the emergency room with severe abdominal pain. The nurse has to get consent before medical treatment can begin. The parents of the child are divorced and the mother has custody. The patient is accompanied by her mother, father, and sister, the latter aged 19 years old. What information should be provided before the patient's guardian gives consent? Select all that apply. 1 A complete explanation of the procedure or treatment 2 Names and qualifications of the people performing the treatment 3 The exact number of days required for complete cure and treatment 4 A description of possible adverse effects or side effects of the treatment 5 An explanation that once the guardian signs the consent, treatment must be given

1, 2, 4 The patient or the patient's guardian should give consent only after receiving information about the procedure or treatment. The information should also include the names of the people who will be treating the patient and the possible side effects of the treatment or procedure. The nurse should also inform the guardian that she can later refuse treatment even if she initially signed consent. It is not practical for the nurse to anticipate the exact number of days required for a cure, and such information is not provided before the guardian gives consent.

Which is an example of statutory law? 1 Americans with Disabilities Act 2 Laws about the patient's right to refuse treatment 3 Laws about acquiring informed consent from the patient 4 Laws about the need to report unethical nursing conduct to the State Board of Nursing

1 Americans with Disability Act is the statutory law passed by the United States Congress. Laws about the patient's right to refuse treatment and acquiring informed consent from the patient are examples of common law in nursing. These laws are made in courts when individual legal cases are decided. Laws about the need to report unethical nursing conduct to the State Board of Nursing are a type of regulatory law. These laws reflect decisions made by administrative bodies when they pass rules and regulations.

A nursing student is learning about the standards of care for nursing. Which should the student do to maintain high nursing standards? Select all that apply. 1 Learn about the Nurse Practice Act in the state. 2 Follow updates in laws and policies practiced. 3 Read current nursing literature in specified practice areas. 4 Avoid using procedures given by the employment agency. 5 Understand current legal issues affecting nursing practice.

1, 2, 5 The Nurse Practice Act defines the scope of nursing practice, and all nurses should be aware of the particular laws in their respective states. Laws and policies can change with time, so keeping current with them is important. Reading current nursing literature in specified practice areas keeps the nurse up to date with the latest nursing knowledge; ignorance of such updates is not an acceptable excuse for malpractice. Understanding current legal issues affecting nursing practice is important; doing so helps the nurse practice in a fashion that avoids legal problems. Nurses should follow procedures given by the employment agency. STUDY TIP: If you are a visual learner, take notes and make study note cards using different colors of ink for different information. For instance, use blue for definitions, green for legal information, and red for clinical information.

The nurse is caring for a patient who is extremely irritable and agitated. The nurse first transfers the patient forcefully to an isolated room to avoid disturbing other patients in the ward. The nurse then sedates the patient by giving a morphine injection. Which torts has the nurse committed? Select all that apply. 1 Assault 2 Battery 3 False imprisonment 4 Invasion of privacy 5 Defamation of character

2, 3 The nurse has committed battery and false imprisonment. Battery is intentional touching without the patient's consent. The nurse gives a morphine injection without requesting consent. This is indicative of battery. Transferring the patient to an isolated room indicates false imprisonment. The tort of false imprisonment refers to the unjustified restraint of a person without legal warrant. Assault is an action that places an apprehensive patient within harmful or offensive contact without consent. Threatening the patient to give the injection is an example of assault. Invasion of privacy refers to the unwanted intrusion into the personal matters of the patient. Defamation of character is the publication of false statements about a person that could damage a person's reputation.

The nurse is teaching a group of patients about the Health Insurance Portability and Accountability Act of 1996 (HIPAA). Which statements regarding privacy and confidentiality are true? Select all that apply. 1 All persons can view the medical records of a patient. 2 Nurses should help organizations protect a patient's right to confidentiality. 3 Nurses have the right to discuss a patient's health information in public places. 4 Privacy is the right of patients to keep personal information from being disclosed. 5 Patients have the right to consent to the disclosure of their protected health information.

2, 4, 5 In the privacy section of the Health Insurance Portability and Accountability Act of 1996 (HIPAA), the standards regarding accountability in the health care setting are discussed. Nurses should help organizations protect the patient's rights to confidentiality, which includes protecting private information. Privacy is the right of patients to keep personal information from being disclosed. HIPAA provides patients the right to consent to the use and disclosure of their protected health information, to inspect and copy their medical records, and to amend mistaken or incomplete information. The law limits who is able to access a patient's record; such records are not widely accessible. The law stipulates that nurses and health care providers must avoid discussing a patient's health information in public places. Test-Taking Tip: Even if you think you are unfamiliar with the specific material, use your best judgment or common sense to evaluate each option. For this question, you could eliminate the two choices that do not support patient privacy (allowing all persons to view a patient's medical record and discussing a patient's health information in a public place), which would give you the answer!

Following an accident at a job site, a patient's employer contacts the hospital and asks the nurse about the patient's condition to determine the patient's likelihood of returning to work in the future. Which is the best response by the nurse to the employer? 1 "You need to speak to the primary healthcare provider." 2 "We can send the patient's medical records for your reference." 3 "The patient is doing well and will definitely be able to return to work." 4 "You will have to get the patient's permission to receive any related information."

4 According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the patient's information should be kept confidential and the patient's privacy should be respected. Patient-related information should not be divulged to anybody without the patient's permission. Therefore, the nurse should ask the employer to seek the patient's permission to receive any patient-related medical information, including information about the feasibility of a patient returning to work. The primary healthcare provider is also not authorized to divulge patient information without the patient's consent. Providing the patient's medical records to others is a violation of HIPAA.

A patient was rushed to the emergency department and then to surgery to repair injuries sustained in a hit-and-run car accident. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that the patient has a durable power of attorney for health care (DPAHC). How should the nurse interpret this information? Select all that apply. 1 The patient can decide which medical procedures not to undergo. 2 The patient has designated a person who is solely responsible for making financial decisions when the patient is unable. 3 The patient has expressed in written form the wish not to be sustained on life support. 4 The patient has designated a person who makes healthcare decisions when the patient is not able to make decisions. 5 The patient has designated a person who is solely responsible for making healthcare decisions according to the patient's wishes.

4, 5 A healthcare proxy, or durable power of attorney for healthcare (DPAHC), is a legal document that designates a person or persons of one's choosing to make healthcare decisions when patients can no longer make decisions on their own behalf. This designated person also makes healthcare treatment decisions based on the patient's wishes. A living will is a written document of the patient's wishes regarding measures to be taken in the event of a terminal illness or condition.