Practice Questions, Chapter #23

A nurse forgets to put the call light within the client's reach and then leaves the room. The client reaches for it and falls out of bed. The nurse could be charged with which of the following? A. Assault B. Battery C. Negligence D. Criminal Intent

C. Negligence

Mr. Nick Barber, a 47-year-old professor, is a trauma patient who sustained injuries when he was crossing the street on campus. He was struck by a fast-moving car that failed to stop at a stop sign. He was rushed to the emergency department and then to surgery to repair his injuries. After surgery he was transferred to the medical-surgical unit for postsurgical management. Brad is the nursing student assigned to Mr. Barber. Currently Mr. Barber is resting quietly in his room with his wife present. 1. Mr. Barber has a durable power of attorney for health care (DPAHC). This document means that Mr. Barber has expressed in written form that he does not wish to be sustained on life support. True False 2. Brad carries Mr. Barber's laboratory requisition slip to the laboratory in the basement of the hospital. He folds the paper so Mr. Barber's information is not visible to others in the halls and elevators. Brad is protecting Mr. Barber's _______________. 3. The driver of the car who struck Mr. Barber is guilty of which unintentional tort? Homicide Manslaughter Negligence Assault Battery

1. Answer: B Rationale: The DPAHC is a legal document that designates a person or person of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf. A living will is a written document of the patient's wishes in which the patient declares what he or she wants in the event of a terminal illness or condition. 2. Answer: Confidentiality Rationale: Confidentiality protects private patient information once it has been disclosed in health care settings. Privacy is the right of patients to keep personal information from being disclosed. 3. Answer: C Rationale: The driver of the car that struck Mr. Barber is guilty of negligence since running the stop sign is conduct that falls below a standard of care.

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

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A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says, "I don't understand what the bid deal is. As my instructor, you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor? A. "You are expected to perform at the level of a professional nurse." B. "You are expected to perform at the level of a nursing student." C. "You are practicing under the license of the nurse assigned to the patient." D. "You are expected to perform at the level of a skilled nursing assistant."

A. "You are expected to perform at the level of a professional nurse."

The nurse hears a physician say to the charge nurse that he doesn't want that same nurse caring for his patients because she is stupid and won't follow his orders. The physician also writes on his patient's medical records that the same nurse, by name, is not to care for any of his patients because of her incompetence. What component(s) of defamation has the physician committed? (Select all that apply). A. Slander B. Invasion of privacy C. Libel D. Assault E. Battery

A. Slander C. Libel

An elderly adult fell at home and fractured a hip, which requires surgical repair. After admittance to the emergency department, the client was given sedation for pain before a surgical permit was signed. What is the best action necessary to obtain consent? A. The physician should have the client's wife sign the consent form. B. Since the client has been medicated, the nurse should thoroughly explain the consent form to the client. C. The physician should wait until the effects of the medication wear off and have the client sign. D. This would be considered an emergency situation and consent would be implied.

A. The physician should have the client's wife sign the consent form.

A nurse is caring for a patient who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (Select all that apply.) 1. Information provided by the head nurse 2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission's manual 5. The American Nurses Association standards of nursing practice

Answer: 2,3,4,5. All of these sources govern the legal standards of care and are individualized by State and agency. Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.

Which of the following statements indicate that the new nursing 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 completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

Answer 1, 2, 3. 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 to be involved in decision making. Nurses have a powerful voice in the legislature.

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 of the following 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

Answer 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.

A woman has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood 2. Coerce the husband into giving the blood 3. Call security and have the husband removed from the hospital 4. More information is needed about the wife's preference and if the husband has her medical power of attorney

Answer 4. Adult patients such as those with specific religious objection are able to refuse treatment for personal religious reasons but there needs to be clear directions on who can make the decision.

You are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action? 1. Give the family the record 2. Discuss the issues that concern the family with them 3. Call the nursing supervisor 4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information

Answer 4. Family members do not have the right to private personal health information without the consent of the patient. Confidentiality protects private patient information once it has been disclosed in health care settings.

A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans with Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed

Answer 4. The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.

Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.) 1. Taking or selling controlled substances 2. Refusing to provide health care 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. Completing an occurrence report on the unit

Answer: 1, 4. The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be

You are floated to work on a nursing unit where you are given an assignment that is beyond your 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 your work

Answer: 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.

A nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? 1. A living will allows an appointed person to make health care 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.

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

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

Answer: 2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complic

A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply.) 1. The nurse does not need any representation. 2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury. 5. The burden of proof is always the responsibility of the nurse.

Answer: 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.

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient 2. Instruct the mother on safe handling of a 2-year-old child 3. Contact a child abuse hotline 4. Discuss this story with a colleague

Answer: 3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

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 of these actions describes a violation of 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 the 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

Answer: 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.

A client comes to the clinic and is found to have an STD (sexually transmitted disease). The client states to the nurse, "Promise you won't tell anyone about my condition." the nurse, according to the Health Insurance Portability and Accountability (HIPAA) of 1996, must do which of the following? A. Honor the client's wishes B. Communicate only necessary information C. Not disclose any information to anyone D. Respect the client's privacy and confidentiality

B. Communicate only necessary information

A 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. What 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 law, which grants 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

Answer: 3. The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.

A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act? 1. Patient Protection and Affordable Care Act (PPACA) 2. Patient Self-Determination Act (PSDA) 3. Health Insurance Portability and Accountability Act (HIPAA) 4. Emergency Medical Treatment and Active Labor Act

Answer: 3. The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.

A student nurse employed as a nursing assistant may perform care A. As learned in school B. Expected of a nurse at that level C. Identified in the hospital's job description. D. Requiring technical rather than professional skills.

C. Identified in the hospital's job description.

A 17-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? A. Prepare the organ donation form for the patient to sign while he is still oriented. B. Instruct the patient to talk with his parents about his desire to donate his organs. C. Notify the physician about the patient's desire to donate his organs. D. Contact the United Network for Organ Sharing after talking with the patient.

B. Instruct the patient to talk with his parents about his desire to donate his organs.

Which of the following client cannot legally give consent? A. A married 14-year-old girl. B. A 70-year-old man who is alert and oriented but unable to write his name. C. A 40-year-old client who has been sedated. D. A 50-year-old woman who cannot stop crying during explanation.

C. A 40-year-old client who has been sedated.

You are about to administer an oral medication and you question the dosage. You should A. Administer the medication B. Notify the physician. C. Withhold the medication D. Document that the dosage appears incorrect.

C. Withhold the medication

A client is to undergo an invasive procedure by a physician. The client is questioning some of the terminology in the consent form. Which of the following is the best response by the nurse? A. "You should have asked your physician when he was in here." B. "I'll explain whatever you don't understand." C. "Just sign the form, and I'll make sure your physician talks to you before he begins the procedure." D. "I'll call your physician back in the room to answer your questions."

D. "I'll call your physician back in the room to answer your questions."

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? A. An unintentional tort B. Assault C. Invasion of privacy D. Battery

D. Battery

Which of the following can be delegated to an UAP? A. Giving pain medication. B. Reporting to the doctor for an abnormal laboratory result. C. Inserting an IV catheter. D. Checking oral temperature.

D. Checking oral temperature.

The nurse understands the implications of the Patient Self-Determination Act. This legislation requires that: a. Clients designate a power of attorney b. DNR orders for clients meet a standard criterion c. Organ donation is required on death, if possible d. Information be provided to the client regarding rights for refusal of care

d. ~ The Patient Self-Determination Act requires health care institutions to provide written information to clients concerning the clients rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.

The nurse is working with a client who has been diagnosed with acquired immunodeficiency syndrome (AIDS). On the way downstairs in the elevator, the nurse shares the clients name and diagnosis with a co-worker. Unknown to the nurse, a friend of the client also is on the elevator and hears the entire story. The nurse who shared the information may be held liable for: a. Slander b. Assault c. Malpractice d. Invasion of privacy

a. ~ A nurse can be held liable for slander if he or she shares private client information that can be overheard by others.

A physician asks a family nurse practitioner to prescribe a medication that the nurse practitioner knows is incompatible with the current medication regimen. If the nurse practitioner follows the physicians desire, which of the following is the most correct answer? a. The nurse practitioner will be liable for the action. b. Good Samaritan laws will protect the nurse. c. If the nurse practitioner has developed a good relationship with the client, there will probably not be a problem. d. This type of situation is why nurse practitioners should have malpractice insurance.

a. ~ A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client.

The nurse must be aware of individuals who are able to given consent for procedures and treatments. Which one of the following individuals may legally give informed consent? a. A 16-year-old for her newborn child b. A sedated 42-year-old client c. The friend of an 84-year-old married client d. A 56-year-old who does not understand the proposed treatment plan

a. ~ An emancipated minor, one who is younger than 18 years but who is a parent, may legally give informed consent for the care of her newborn. An emancipated minor can also be someone younger than 18 years who is legally married.

The client has an order for intramuscular (IM) morphine sulfate as needed for pain. A nurse accidentally administers an incorrect dosage of the morphine sulfate to the client. Which source of law best addresses this situation? a. Civil law b. Criminal law c. Common law d. Administrative law

a. ~ Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Generally, violations of civil laws cause harm to an individual or property, and damages involve payment of money. Administering an incorrect dosage of morphine sulfate would fall under civil law because it could cause harm to an individual.

The nurse enters the room and tells the client that he has to take the medication, including an injection. The client refuses the medication, but the nurse continues to administer the medications. This action is an example of the intentional tort of: a. Assault b. Battery c. Invasion of privacy d. Malpractice

b. ~ Battery is any intentional touching without consent. An example of battery is a nurse giving a medication after the client has refused.

In working with clients who have DNR (do not resuscitate) orders, the nurse recognizes that these orders: a. Are legally required for terminally ill clients b. May be written by the physician without client consent if resuscitation is futile c. Are maintained throughout the clients stay in an acute or long-term facility d. Follow nationally consistent standards for implementation

b. ~ If the client is unable, and no surrogate is available to give consent, the do-not-resuscitate (DNR) order can be written but only if the physician is reasonably medically certain that the resuscitation would be futile.

Because of an influenza epidemic among nursing staff, a nurse has been moved from the eye unit to a general surgical floor. The nurse recognizes that he is inexperienced in this specialty. The nurses initial recourse is to: a. Politely refuse to move, take a leave-of-absence day, and go home b. Ask to work with another general surgery nurse c. Fill out a report noting his dissatisfaction d. Notify the state board of nursing of the problem

b. ~ Nurses who float should inform the supervisor of any lack of experience in caring for the types of clients on the nursing unit. They also should request and be given orientation to the unit. Asking to work with another general surgery nurse would be an appropriate action.

A junior nursing student prepares to give her client an injection. What standard of care applies to the student nurses conduct when providing care normally performed by a registered nurse (RN)? The student is held to: a. A standard of care of an unlicensed person b. The same standard of care as an RN c. A standard similar to but not the same as the staff nurse with whom she is assigned to work d. No special standard of care because her faculty member is responsible for her conduct

b. ~ Student nurses are expected to perform as professional nurses (i.e., as an RN would in providing safe client care).

On admission to the hospital, a terminal cancer patient says he has a living will. This document functions to state the clients desire to: a. Receive all means of technical assistance and equipment used to prolong his life b. Have his wife make decisions regarding his care c. Be allowed to die without life-prolonging techniques d. Have a lethal injection administered to relieve his suffering

c. ~ A living will is an advance directive, prepared when the individual is competent and able to make decisions, regarding that persons specific instruction about end-of-life care. Living wills allow people to specify whether they would want to be intubated, treated with pressor drugs, shocked with electricity, and fed or hydrated intravenously.

In the course of practice, a nurse may be liable for actions that constitute an unintentional tort. Which one of the following is an example of an unintentional tort? a. Restraining a client who refuses care b. Taking photos of a clients surgical wounds c. Leaving the side rails down and the client falls and is injured d. Talking about a clients history of sexually transmitted diseases

c. ~ An unintentional tort is an unintended wrongful act against another person that produces injury or harm. An example of an unintentional tort would be leaving the side rails down, and the client falls and is injured.

Under specific circumstances that are outlined in the states nurse practice act, a nurses license may be suspended or revoked. In the event that a nursing license is revoked, which of the following is correct? a. The hearings are usually held in court b. Due process rights are waived by the nurse c. Appeals may be made regarding the decisions d. The federal government becomes involved in the procedures

c. ~ Because a license is viewed as a property right, due process must be followed before a license can be suspended or revoked. Due process means that nurses must be notified of the charges brought against them and that the nurses have an opportunity to defend against the charges in a hearing.

The nurse has just obtained a license to practice and is determining whether individual malpractice insurance is necessary. Which of the following is the most important factor in a nurses deciding whether to carry malpractice insurance? a. The amount of the malpractice insurance provided by the employer b. The evaluation of whether the nurse works in a critical area of nursing where clients have higher morbidity and mortality rates c. The time frames and individual liability of the employers malpractice coverage d. The nurses knowledge level of Good Samaritan laws

c. ~ It would be important to know the time frames of the employers malpractice coverage. In other words, is the nurse covered only during the times he or she is working within the institution? It would be important to know the individual liability, meaning if sued, what financial responsibility would the nurse have?

A client is to have a surgical procedure tomorrow morning. and the nurse has gone into the room to obtain the consent form. The nurses signature as a witness on an informed consent indicates that the client: a. Fully understands the procedure b. Agrees with the procedure to be done c. Has voluntarily signed the form d. Has authorized the physician to continue with the treatment

c. ~ The nurses signature witnessing the consent means that the client voluntarily gave consent, that the clients signature is authentic, and that the client appears to be competent to give consent.

A registered nurse interprets a scribbled medication order by the attending physician as 25 mg. The nurse administers 25 mg of the medication to a client, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who would ultimately be responsible for the error? a. Attending physician b. Assisting resident c. Pharmacist d. Nurse

d. ~ A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. The nurse should clarify the order with the physician if unable to read the order.

The nurse recognizes that issues concerning death and dying may influence nursing practice. Which of the following is true concerning the legalities of death and dying issues? a. Passive euthanasia is illegal in all states. b. Assisted suicide is a constitutional right. c. Organ donation must be attempted if it will save the recipients life. d. Feedings may be refused by competent individuals who are unable to feed themselves.

d. ~ Competent clients have the right to refuse treatment. This includes lifesaving hydration and nutrition.

An unconscious client with a head injury needs surgery to live. His wife speaks only French, and the health care providers are having a difficult time explaining his condition. Which of the following is the most correct answer regarding this situation? a. Two licensed health care personnel should witness and sign the preoperative consent indicating their hearing an explanation of the procedure given in English. b. An institutional review board must be contacted to give their emergency advice on the situation. c. A friend of the family could act as an interpreter, but the explanation could not provide details of the clients accident, because of confidentiality laws d. The health care team should continue with the surgery after providing information in the best manner possible.

d. ~ In emergency situations, if it is impossible to obtain consent from the client or an authorized person, the procedure required to benefit the client or save a life may be undertaken without liability for failure to obtain consent. In such cases, the law assumes that the client would wish to be treated.

The nurse is investigating legislation that may have an effect on nursing practice. The nurse finds that the newly enacted Health Insurance Portability and Accountability Act (HIPAA) of 2003 requires: a. Insurance coverage for all clients b. Policies on how to report communicable diseases c. Limits on information and damages awarded in court cases d. Safeguards to protect written and verbal information about clients

d. ~ The Health Insurance Portability and Accountability Act (HIPAA) requires all hospitals and health agencies to have specific policies and procedures in place to ensure that reasonable safeguards protect written and verbal communications about clients.

As per the standards of care of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an institution is required to have: a. Limits of professional liability b. Educational standards for nurses c. A delineated scope of practice for health professionals d. Written nursing policies and procedures for care

d. ~ The Joint Commission on Accreditation of Healthcare Organizations requires that accredited hospitals have written nursing policies and procedures.