Chap 12: Nursing and the Law: What Are the Rules?

A patient tells the LPN/LVN, "I want you to bring my medical record so I can read it. I know HIPAA gives me the right to see it." The LPN/LVN should

explain that the request will be made to the RN, who will follow agency policy.

How should an LPN/LVN explain the term accountability to a student nurse?

"Accountability is assuming personal responsibility for one's nursing actions."

The instructor tells a student nurse, "You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I'm assigning you to a complex nursing situation. I expect you to function without asking for assistance." The most appropriate response from the student nurse would be

"I cannot accept the assignment. Complex nursing situations are beyond my abilities."

How do you best respond to a teenage neighbor who thinking about becoming an LPN/LVN "become it only takes a year and isn't hard like real nursing"?

"Surprise! Surprise! An LPN (or LVN) is a different level of nursing. You will have to learn a great deal of medical information and nursing care skills in a short period of time. Even as a student you will be held to the legal standard of a licensed nurse.''

Which of the following is true regarding informed consent?

A patient is informed that he or she has the right to revoke consent at any time

. Individual A has worked as an LPN/LVN for a year. The agency where she works discovers that the registration document she presented at the time she was hired was altered to remove the name of the rightful registrant and show her name instead. What are the possible outcomes of this situation? (Select all that apply.) a. The state board of nursing, when notified, will charge the nurse with fraud and deceit. b. The agency will terminate the employment of the individual. c. The agency will notify all patients for whom the individual cared to determine injury. d. The individual will be arrested for misrepresentation. e. The individual's license to practice will be revoked.

ANS: A, B

Nurse A is assigned to care for a patient with diabetes who is being regulated on new types of insulin. The patient performs most of her own care and rarely uses the call bell to summon the nurse. The nurse knows this and leaves the patient unobserved most of the shift. Just before change of shift report, the aide reports that she cannot rouse the patient. The patient enters a vegetative state as the result of brain damage related to severe hypoglycemia. Which, if any, of the four elements needed to prove malpractice are present? (Select all that apply.) a. Duty b. Breach of duty c. Damages d. Proximate cause e. No elements are present

ANS: A, B, C, D

In the following list, identify the instances of possible malpractice. (Select all that apply.) a. The nurse accidentally administers an excessively large dose of a prescribed medication, and the patient becomes comatose. b. The nurse runs a red light en route to work and causes an auto accident in which three people are seriously injured and one dies. c. The nurse notes the patient's poor capillary return distal to a cast, becomes busy and does not report it, and the patient later loses limb function. d. The nurse discusses a patient's condition in a disparaging way in a hospital elevator and is overheard by the patient's husband.

ANS: A, C

Which statements are accurate with regard to a living will? (Select all that apply.) a. An attorney is required to draft a living will. b. Living wills are recognized as legal documents in Canada. c. A living will does not let the person select someone to make decisions for them. d. Living wills are recognized as legal documents in 47 states in the United States, the District of Columbia, and Guam. e. The living will is filled out by the individual and witnessed by a person who will benefit by the death of that individual. f. A living will is a legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill.

ANS: C, D, F

How will you answer the lawyer's questions when asked to give testimony during a legal action?

Be specific, answering "yes," or "no" whenever possible, without adding details

Which of the following is an example of breach of duty?

The LPN/LVN does not perform duties according to the standard of care.

The patient tells the nurse, "I want to make sure that my daughter can make health care decisions for me in the event I'm unable to make decisions for myself. What do I need to do?" The nurse should advise the patient that he or she needs to execute a/an

durable medical power of attorney.

The Nurse Practice Act of state X expressly states that blood products may be administered only by physicians, registered nurses, and physician assistants. Under what conditions can an LPN/LVN administer a unit of packed red cells?

Never; LPN/LVNs cannot administer packed cells

To function within the scope of the law, the nurse must know that the legal duties and functions of the nurse in a given state are determined by the

Nurse Practice Act of the state.

Which of the following is your legal guideline for all you can do as an LPN/LVN

State board of nursing

The instructor tells an SP/VN, "You have functioned at a substandard level of clinical performance recently. Now you have a chance to redeem yourself. I'm assigning you to a complex nursing situation. I expect you to function without asking for assistance." What is the most accurate assessment of the instructor's action?

The instructor is accountable for making an unsafe patient care assignment.

Which situation most clearly illustrate negligence

The nurse forgot to lower the patient's bed after completing colostomy care, and the patient fell when he tried to get out of bed

What is the nurse's responsibility regarding an improper medical order that, if carried out, may harm a patient?

The nurse must go directly to the physician and, if necessary, refuse to carry out the order.

A new LPN/LVN passes the NCLEX-PN examination and obtains licensure in state X. The LPN/LVN wishes to work in a state other than state X but is unsure of how to proceed. Which statement provides sound advice in this situation?

The nurse should contact the state board of nursing of the state in which she wishes to work to determine whether they have multistate licensure with state X.

A nurse is found liable for battery. What does this mean?

The nurse, without consent, touched the patient in a way that caused harm.

Which statement is true regarding durable medical power of attorney and living wills?

They allow patients a voice about medical interventions after they are incapable of acting.

An example of battery is

a patient who refuses to be suctioned and is suctioned anyway after refusal.

A nurse who angrily tells a patient, "If you don't go to sleep, I'm going to give you an injection," can be accused of

assault.

With regard to HIPAA implementation, the LPN/LVN who is newly employed at a health care agency should

be aware that each agency may interpret HIPAA provisions somewhat differently.

The nurse discusses the patient's condition on the phone with the patient's brother. On learning this, the patient is upset, saying he has not spoken with his brother for years and does not want his brother to know anything about his condition. The nurse has

breached confidentiality.

A resident asks an LPN/LVN, "What is meant by the practical/vocational nurse's standard of care in a long-term care agency?" The LPN/LVN should respond, "The practical/vocational nurse who provides care for residents in a long-term care agency must implement care that is consistent with

care that an ordinary, prudent LPN/LVN with the same education and experience would perform in similar circumstances."

An example of a criminal action committed by a nurse is

discontinuing a ventilator without a physician's order.

Patient A, who has Alzheimer's disease, wanders and is often noisy and intrusive. The patient has a prn order for haloperidol (Haldol) IM for assaultive behavior. At report, the LPN/LVN charge nurse explains that staffing is poor and she is unable to provide the supervision the patient needs. She directs the medication nurse to administer the patient's prn haloperidol q4h during the shift. This action constitutes

false imprisonment.

The term used to describe a competent patient's agreement to have a surgical procedure after the physician explains the procedure, the desired outcome, possible complications, and possible alternative treatment is

informed consent.

Civil law is concerned with

intentional and unintentional torts.

A nurse damages a physician's reputation through false written communication without the physician's permission. This is an example of

libel

The student nurse caring for a patient with a large decubitus ulcer photographs the ulcer without obtaining permission from the patient. The patient developed the ulcer while being cared for at home by her physician husband. The student plans to give the patient's history and use the photograph in a paper she is writing. The instructor explains to the student that this action is unacceptable and could result in a court action for

libel.

A legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill is known as a(n) ____________________.

living will The living will is a legal document that describes the kind of medical or life-sustaining treatments the person would want if seriously or terminally ill.

A risk management strategy a nurse can use to prevent being named in malpractice lawsuits is

maintaining good relationships with patients and families.

Legally, student practical/vocational nurses are held to the level of performance

of the LPN/LVN.

The LPN/LVN does not perform duties according to the standard of care.

record all interventions performed and patient instruction given.

A nursing student is assigned to care for a patient who requires several technical procedures. The student was busy and did not prepare in advance for the assignment. In preconference, the student is unable to describe the care to be given. The instructor would be justified in

sending the student off duty and turning the patient's care over to staff.

A nurse damages a patient's reputation by verbalizing private information about the patient to a third party. This is an example of

slander.

An example of statutory law is

the Nurse Practice Act