NU371 Week 8 PrepU: Legal Issues
A nurse overhears another nurse say to a client, "If you do not stop spitting, I'm going to leave you outside in your wheelchair so that you miss your dinner." What is the most appropriate response by the nurse who overhears this conversation? "Could you clarify for me whether you were joking with the client?" "I think you need to review therapeutic communication techniques." "Your verbal threats to the client are legally considered assault." "I will have to report you for unprofessional behavior toward a client."
"Your verbal threats to the client are legally considered assault." o Assault is conduct that makes a person fearful and produces a reasonable apprehension of harm. The nurse's behavior in legal terms is assault.
Which client of a forensic nurse has most likely been found not guilty but mentally ill (not guilty by reason of insanity) following the commission of a serious crime? A client with a history of mental illness who is serving a lengthy term in a federal prison A client who has been released into the community with strict limits on activity A client who is being held involuntarily in a secure psychiatric setting A client who is receiving care involuntarily on a community hospital's psychiatric unit
A client who is being held involuntarily in a secure psychiatric setting o Individuals found not guilty of a crime but mentally ill are normally held in a secure psychiatric setting, not a community hospital, prison, or in the community.
A nurse working in a coronary care unit resuscitates a client who had expressed wishes not to be resuscitated. Which tort has the nurse committed? Libel Assault Battery Slander
Battery o The nurse has committed battery by unlawfully carrying out a procedure that the client had refused. Battery is an assault and includes negligent touching of another person's body or clothes or anything attached to or held by that other person. Assault is the threat of touching another person without the person's consent. Defamation of character in spoken words is called slander. Libel is defamation of character in written words.
When staff members physically control the client and move him or her to a seclusion room, what form of restraint is being implemented? Mechanical Short term Human Long term
Human o Human restraint is when staff members physically control the client and move him or her to a seclusion room. A mechanical restraint is a device, usually ankle or wrist restraints, fastened to a bed frame to curtail the client's physical aggression. Long- and short-term restraint refers to the time frame for the use of the restraint.
A client reveals in a therapy session that the client has thought about killing a neighbor. What is the therapist's obligation regarding this revelation? The therapist must evaluate the threat and notify authorities if it meets credibility criteria. The therapist must notify authorities and the potential victim. The therapist must keep the comment confidential, because the disclosure is protected by therapist-client confidentiality. The therapist must meet with an ethics committee to determine the course of action.
The therapist must notify authorities and the potential victim. o As a result of the Tarasoff decision, it is mandatory in most (but not all) states to report any clear threats that psychiatric clients make to harm specific people. Psychiatrists, psychotherapists, and other mental health care providers must warn authorities (if specified by law) and potential victims of possible dangerous actions of their clients, even if the clients protest.
The nurse is initiating isolation precautions for a client who has chronic Clostridium difficile infection. What should the nurse be sure to include with these precautions? rrecognize that this type of infection requires droplet precautions include a N95 respirator mask for health care staff entering the room be sure that there are gloves of various sizes and gowns for use remind others to use a mask when caring for this client
be sure that there are gloves of various sizes and gowns for use o All health care workers and visitors should don a gown and gloves prior to entering the client's room. These bacteria are not transmitted by droplet. An N95 respirator mask is not required for this client.
The nurse is planning an education for new nurses on psychiatric units. Which topic should be given priority? neglect assault breach of confidentiality battery
breach of confidentiality o Psychiatric nurses know well the problem of stigma for those with a mental illness. The Code of Ethics for Nurses ensures the alleviation of stigma and discrimination toward those with mental illness. In the United States, RNs also know the importance of protecting a client's personal health information. In the United States, HIPAA (Health Insurance Portability and Accountability Act) requires healthcare workers to protect and keep private health information of clients and outlines penalties for any violations. Mental health and substance abuse records are even more protective. Breach of confidentiality then, occurs when a nurse shares this information with another without the client's consent. Assault is an act that results in fear that one will be touched without consent. Battery involves nonconsensual touching of another person. Neglect is the failure to do what is deemed reasonable in a situation.
A nurse exits the room of a confused client without raising the side rails on the bed. The failure to raise the side rails would constitute which element of liability related to malpractice? causation breach of duty damages duty
breach of duty o Breach of duty is failing to meet the standard of care, and in this case, it was the failure to execute and document the use of appropriate safety measures. Causation is the failure to use appropriate safety measures, which results in injury to the client. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Damages refers to the actual harm or injury that the client incurs.
How may drugs be prescribed and dispensed? by trade name only by generic name only by prescription by generic or trade name
by generic or trade name o Drugs may be prescribed and dispensed by generic name or by trade name.
A nurse is deciding whether to report a suspected case of child abuse. Which criterion is the most important for the nurse to consider? incompatibility between the child's history and the injury inappropriate parental concern for the degree of injury inappropriate response of the child to the injury absence of parents to question about the injury
incompatibility between the child's history and the injury o Incompatibility between the history and the injury is the most important criterion on which to base the decision to report suspected child abuse. For example, the child may have a skull fracture but the parents state that the child fell off of the sofa. The other criteria also may suggest child abuse but are less reliable indicators.
A nurse discusses the HIV-positive status of a client with other colleagues. The client can sue the nurse for which violation? false imprisonment defamation of character professional negligence invasion of privacy
invasion of privacy o The client can sue the nurse for invasion of privacy. Disclosing confidential information to an inappropriate third party subjects the nurse to liability for invasion of privacy, even if the information is true. Defamation of character includes false communication that results in injury to a person's reputation. Prevention of movement or unjustified retention of a person without consent may be false imprisonment. Negligence is an act of omission or commission.
A nurse is overheard in the hospital cafeteria making false, derogatory comments about a client. The nurse is guilty of: invasion of privacy. assault. libel. slander.
slander. o Slander is oral defamation of character. Libel is written defamation of character. Assault is a threat or attempt to make bodily contact with another person without that person's consent. Invasion of privacy involves a breach in keeping client information confidential.
A nurse is explaining the rights and responsibilities of a child with a developmental disorder to the parents of 7-year-old diagnosed with a learning disorder. The child is attending a public school. The parents demonstrate understanding when they make which statements? Select all that apply. "We should not have to pay for any of the services he receives." "We have the right to review any of his records related to his schooling." "Our child should have an individualized education plan for his education." "Our child's IQ will be the determining factor for the services he needs." "His needs should be evaluated every year."
"We should not have to pay for any of the services he receives." "We have the right to review any of his records related to his schooling." "Our child should have an individualized education plan for his education." o A child with a developmental disorder attending public school has certain rights and responsibilities. These include an individualized education plan, parental access to all school records, evaluation every 3 years or sooner, and free provision of services. Children cannot be placed in or out of a program based on IQ alone.
Which is the most important reason for psychiatric nurses to understand law, legislation, and legal processes that relate to professional nursing practice? Because these activities are included in the Nursing Code of Ethics. Because doing so gives the nurse guidelines by which to use seclusion and restraint appropriately, when needed. Because only by lobbying can psychiatric nurses have an impact on the delivery of services on a national level. Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients.
Because doing so gives the nurse the ability to provide quality care that will safeguard the rights and safety of clients. o Nurses practice under the Code of Ethics and the Scope of Practice. Nurses must learn to value, respect, and develop knowledge about laws, legislation, and the legal processes that regulate, impede, and facilitate professional nursing practice.
Prescription practices of primary health care providers for controlled substances are monitored by which agency? World Health Organization (WHO) Food and Drug Agency (FDA) U.S. Pharmacopeia (USP) Drug Enforcement Agency (DEA)
Drug Enforcement Agency (DEA) o The Drug Enforcement Agency is responsible for monitoring prescription practices for controlled substances of the primary health care provider. The FDA monitors all drug development. The USP organization sets standards for the identity, strength, quality, and purity of medicines, food ingredients, and dietary supplements manufactured, distributed and consumed worldwide. The World Health Organizations represents the entire world and does not monitor controlled substances of primary health care providers.
Which are appropriate actions for protecting clients' identities? Select all that apply. Ensure that clients' names on charts are visible to the public. Have conversations about clients in private places where they cannot be overheard. Place light boxes for examining X-rays with the client's name in private areas. Orient computer screens toward the public view. Document all personnel who have accessed a client's record.
Have conversations about clients in private places where they cannot be overheard. Place light boxes for examining X-rays with the client's name in private areas. Document all personnel who have accessed a client's record. o Documenting all personnel who have accessed a client's record, placing light boxes for examining X-rays with the client's name in private areas, and having conversations about clients take place in private where they cannot be overheard are useful strategies to limit casual access to the identity of clients and health informatics. Orienting computer screens toward the public view and visibly displaying clients' names on charts are incorrect, as these are breaches of patient confidentiality.
Which actions should the nurse perform to limit casual access to the identity of clients? Select all that apply. Making the names of clients on charts visible to the public Keeping record of people who have access to clients' records Placing fax machines, filing cabinets, and medical records in areas that are off-limits to the public Posting information linking a client with diagnosis, treatment, and procedure on whiteboards Obscuring identifiable names of clients and private information about clients on clipboards
Keeping record of people who have access to clients' records Placing fax machines, filing cabinets, and medical records in areas that are off-limits to the public Obscuring identifiable names of clients and private information about clients on clipboards o Obscuring identifiable names of clients and private information about clients on clipboards; placing fax machines, filing cabinets, and medical records in areas that are off-limits to the public; and keeping record of people who have access to clients' records are required under the Health Insurance Portability and Accountability Act (HIPAA), which is legislation that attempts to limit casual access to the identity of clients. Posting information linking a client with diagnosis, treatment, and procedure on whiteboards and making the names of clients on charts visible to the public are violations of HIPAA, as these activities allow casual access to the identity of clients.
DNA fingerprinting is based in part on recombinant DNA technology and in part on those techniques originally used in medical genetics to detect slight variations in the genomes of different individuals. These techniques are used in forensic pathology to compare specimens from the suspect with those of the forensic specimen. What is being compared when DNA fingerprinting is used in forensic pathology? The haplotypes The triplet code The chromosomes The banding pattern
The banding pattern o Banding patterns are analyzed to see if they match. Four bases—guanine, adenine, cytosine, and thymine (uracil is substituted for thymine in RNA)—make up the alphabet of the genetic code. A sequence of three of these bases forms the fundamental triplet code used in transmitting the genetic information needed for protein synthesis. The small variation in gene sequence (termed a haplotype) is thought to account for the individual differences in physical traits, behaviors, and disease susceptibility. Chromosomes contain all the genetic content of the genome.
v\Which guidelines define and regulate what the nurse may and may not do as a professional? standards of care state legislature nurse practice act facility policies and procedures
nurse practice act o Each state legislature has enacted a nurse practice act. These statutes outline the legal scope of nursing practice within a particular state. State boards of nursing oversee the statutory law. State legislatures create boards of nursing within each state; the state legislature itself doesn't regulate the scope of nursing. Facility policies govern the practice within a particular facility. Nurse practice acts set educational requirements for the nurse, distinguish between nursing practice and medical practice, and define the scope of nursing practice in that state. Standards of care, criteria that serve as a basis for evaluating the quality of nursing practice, are established by federal organizations, accreditation organizations, state organizations, and professional organizations.
The nursing instructor is talking to a class of nursing students about the American's with Disabilities Act, and persons having various disabilities that have the right to education in the least restrictive environment. The nursing instructor asks the students, "what is the reason for the least restrictive environment?" Which example should the student nurse choose? placement options budget factors availability of space unique needs
unique needs o Least restrictive environment means the individual cannot be restricted to an institution when he or she can be successfully treated according to the client's needs, and stay in the community. Budget factors, placement options, and availability of space are not factors related to The American's with Disabilities Act.
A nurse saw a coworker steal drugs from a locked cabinet. The supervisor notices the missing drugs and has a good idea who is responsible for the theft. The supervisor asks if the nurse saw anything out of the ordinary. Which professional value reflects a nurse's duty to tell the truth? autonomy veracity beneficence nonmaleficence
veracity o Veracity is the nurse's duty to tell the truth in all professional situations. Autonomy refers to a client's right to self-determination. Beneficence is the duty to do good for the clients assigned to the nurse's care. Nonmaleficence is the duty to do no harm to the client.
The health care provider is in a client's room doing an assessment. The health care provider walks out of the room and says to the nurse, "I have prescribed furosemide 40 mg orally twice daily for 5 days. Enter the prescription into the computerized order entry system for me." What is the best response by the nurse? "I will put the order in the computer order entry system and give the furosemide once it arrives from the pharmacy." "I will need to let the charge nurse know about the order so it can be entered in the computerized order entry system." "I will find you a computer that is not being used so you can enter the order into the computerized order entry system." "I will get the furosemide from the floor stock right now and give it to the client." "I will call the pharmacy and have them send the furosemide right away."
"I will find you a computer that is not being used so you can enter the order into the computerized order entry system." o The nurse cannot give the furosemide right away because the prescription needs to be put in the computerized order entry system first. This is not an emergency. The correct response is to have the health care provider put the prescription in the computerized order entry system because it is not an emergency. Verbal orders are for emergencies only. The charge nurse does not need to know about the prescription. The charge nurse does not need to put the order in the computerized order entry system. The nurse assigned to the client is responsible for the client's care. The nurse can call the pharmacy right away to have the furosemide sent, but the prescription needs to be entered first. The pharmacy will not send the medication, because it is not an emergency, without an order first. The nurse should not put the prescription in the computerized order entry system. The health care provider needs to put the prescription in the computerized order entry system. Verbal orders are for emergencies only.
The nurse has provided preoperative instructions to a client scheduled for surgery at an ambulatory care center. Which statement, made by the client, would indicate that further instruction is needed? "The physician will update my family after the procedure and provide specific discharge instructions." "My medical records will be sent to the ambulatory care center prior to my surgery." "If I do not follow the instructions, my surgery could be cancelled." "The nurse will explain the details of the surgery before I sign a consent."
"The nurse will explain the details of the surgery before I sign a consent." o Further instruction would be needed to clarify that the physician, not the nurse, explains the details of the surgery and obtains voluntary consent for the procedure. It is correct that preoperative instructions must be followed prior to surgery for the safety of the client, medical records are present for review prior to surgery, and the physician speaks with the family following the procedure and provides instructions for discharge.
The nurse used a secure access code to obtain a morphine 2 mg/ml vial from the computerized automated dispensing cabinet (ADC). Before exiting the system, the nurse is prompted to count the remaining vials. The nurse counts 10 remaining vials, but the system reads 9 remaining vials. What is the next action by the nurse? Administer the medication then contact the pharmacy to report the discrepancy. Change the number on the ADC to read 10 remaining vials. Ask another nurse to assist with following the procedure to resolve the discrepancy. Remove the extra vial and ask another nurse to witness the waste.
Ask another nurse to assist with following the procedure to resolve the discrepancy. o Morphine is a controlled substance. Federal law requires an accurate record for each controlled substance administered to prevent diversion and misuse. Accurate counts of vials are an important part of maintaining this accurate record. In the event of a discrepancy, the nurse should ask another nurse to act as a witness and follow the facility procedure for resolving a discrepancy. Resolving the discrepancy is a priority and should happen before medicating the client. The nurse should not change the number or waste the extra vial because this will not maintain an accurate record of the controlled substance administration as required by law.
The nurse is unable to find the health record (chart) for a client who has arrived for a clinic visit. Which is the best action by the nurse? Begin a new medical record with all client identifiers to document the current visit and merge this document into the medical record later. Call one of the client's other healthcare providers to request that a copy of the medical records for the client be sent to the clinic. Advise the client that the appointment will have to be rescheduled due to the fact that the medical record cannot be located. Document the information about the visit on paper, and transcribe these notes into the client's medical record once it is located.
Begin a new medical record with all client identifiers to document the current visit and merge this document into the medical record later. o Documentation is an essential and legal component of providing care to clients. Information must be documented as it is collected. The nurse should not send the client away without the client getting the care that was to be provided. Therefore, the nurse creates a new record that contains all the client's appropriate identifiers so this can be added to the client's primary medical record when it is located. The nurse should be truthful about the missing records and should avoid transcribing notes whenever possible to avoid data errors. Another healthcare provider's records are not a substitute for the health record specific to this clinic. Requesting records from another provider would only be appropriate if relevant to the client's current reason for the visit and if the client consented to the transfer of this information.
The nurse is providing care to a client who had orthopedic surgery. The nurse has medicated the client for pain. However, the client reports that the pain is unrelieved. The nurse takes no further action regarding assessment and intervention for the client's pain. The nurse does not notify the surgeon regarding the client's pain. The nurse's failure to take further action represents which element of liability in this case? Breach of duty Damages Causation Duty
Breach of duty o Breach of duty is the failure to assess, intervene, or notify the health care provider regarding the client's condition. It does not meet the expected standard of care. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nurse-client relationship. Causation is when the failure to meet the standard of care caused injury. Damages are the harm or injury to the client.
Which of the following is a legally safe rule of documentation? Sign entries only at the end of a shift. If an error occurs, obliterate the documentation. Include complaints in the chart documentation. Chart objectively and accurately.
Chart objectively and accurately. o Charting must be done objectively and accurately. Entries should be signed throughout the shift. Complaints should not be documented in the chart. Errors should not be obliterated from the documentation.
The nurse is providing care to a woman who has just given birth to a healthy term neonate. The woman's partner arrives and asks about the neonate's status. Which action by the nurse would be appropriate? Answer the partner's questions honestly and without hesitation. Tell the partner that no information can be shared with him or her at this time. Ask the partner for identification first before sharing any information. Check the medical record for written client approval with whom to share information.
Check the medical record for written client approval with whom to share information. o In maternal and newborn health care, information is shared only with the client, legal partner, parents, legal guardians, or individuals as established in writing by the client or the child's parents. This law promotes the security and privacy of health care and health information for all clients. Therefore, the nurse needs to check the medical record for written documentation that allows the partner to have this information. Any other action would be inappropriate.
The nurse obtains a unit of blood for the client, Donald D. Smith. The name on the label on the unit of blood reads Donald A. Smith. All the other identifiers are correct. What action should the nurse take? Check with the blood bank first and then administer the blood with their permission Administer the unit of blood Ask the client if he was ever known as Donald A. Smith Refuse to administer the blood
Refuse to administer the blood o To ensure a safe transfusion, all components of the identification must be correct. The nurse should refuse to administer the blood and notify the blood bank about the discrepancy. The blood bank should then take the necessary steps to correct the name on the label on the unit of blood.
A nurse at the health care facility cares for several clients. Some of the clients may require end-of-life care. Which case may require the service of a coroner? The client was diagnosed with acute renal failure. The client did not have any recent medical consultation. The client was being administered oxygen therapy. The client is elderly with a history of hypertension.
The client did not have any recent medical consultation. o The services of a coroner may be needed in a case where the client did not have any recent medical consultation. A coroner is a person legally designated to investigate deaths that may not be the result of natural causes. Death following a diagnosis of acute renal failure, administration of oxygen therapy, or a history of hypertension does not call for the services of a coroner.
