Chapter 23 EAQ
A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The healthcare provider ordered two 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. What is the nurse's responsibility? Obtain a court order to give the blood. Coerce the husband into giving the blood. Call security and have the husband removed from the hospital. Abide by the husband's wishes and inform the healthcare provider.
Abide by the husband's wishes and inform the healthcare provider. Rationale Adult patients such as those who are Jehovah's Witnesses are able to refuse treatment for personal religious reasons.
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? Call the nursing supervisor to discuss the situation. Discuss the problem with a colleague. Leave the nursing unit and go home. Say nothing and begin work.
Call the nursing supervisor to discuss the situation. Rationale 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 patient who has developed a pulmonary embolism after abdominal surgery is immediately transferred to another hospital. Which law has been broken in this case? Mental Health Parity Act Americans with Disability Act Patient Self-Determination Act Emergency Medical Treatment and Active Labor Act
Emergency Medical Treatment and Active Labor Act Rationale According to the Emergency Medical Treatment and Active Labor Act, patients who have an emergency condition should not be discharged or referred to another hospital unless the condition stabilizes. Pulmonary embolism is a life-threatening condition, and according to this law the patient should not be transferred to another hospital unless the condition is stabilized. According to the Mental Health Parity Act, health insurance companies should not place lifetime or annual limits on mental health coverage, and the coverage should be as generous as coverage for medical or surgical care. The Americans with Disability Act prevents discrimination against persons with disabilities and ensures equal opportunities in employment, state and local government services, public accommodations, commercial facilities, and transportation. According to the Patient Self-Determination Act, health care institutions should provide written information to patients about their rights to make decisions regarding treatment.
A patient is brought to the hospital after a motor vehicle accident. Which law makes it mandatory for the healthcare facility to provide emergency care to patients before transferring them to other hospitals? Good Samaritan Law Mental Health Parity Act Americans with Disabilities Act Emergency Medical Treatment and Active Labor Act
Emergency Medical Treatment and Active Labor Act Rationale The Emergency Medical Treatment and Active Labor Act states that a patient who is brought to the emergency room of any hospital should be stabilized before being transferred. The Good Samaritan Law protects people who provide help or first aid to victims with good intention. The Mental Health Parity Act forbids health plans from placing lifetime or annual limits on mental health coverage. The Americans with Disabilities Act protects the rights of people with physical or mental disabilities.
A homeless man enters the emergency department seeking health care. The healthcare provider indicates that the patient needs to be transferred to the city hospital for care. Which law does this action most likely violate? Health Insurance Portability and Accountability Act (HIPAA) Americans with Disabilities Act (ADA) Patient Self-Determination Act (PSDA) Emergency Medical Treatment and Active Labor Act (EMTALA)
Emergency Medical Treatment and Active Labor Act (EMTALA) Rationale The Emergency Medical Treatment and Active Labor Act (EMTALA) requires that in an emergency situation the patient must be stabilized before a transfer is appropriate. Health Insurance Portability and Accountability Act (HIPAA) addresses privacy issues, the Patient Self-Determination Act (PSDA) addresses a patient's right to refuse treatment and formulate advance directives, and the Americans with Disabilities Act (ADA) deals with equal access for all individuals.
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? Mental Health Parity Act (MHPA) Patient Self-Determination Act (PSDA) Health Insurance Portability and Accountability Act (HIPAA) Emergency Medical Treatment and Active Labor Act (EMTALA)
Health Insurance Portability and Accountability Act (HIPAA) Rationale 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.
The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply. Nursing notes can be illegible as long as the nurse can read them. Nursing notes should be maintained properly. Nursing records should be properly preserved. Institutions should maintain complete nursing records. Only basic duties should be recorded in nursing records.
Nursing notes should be maintained properly. Nursing records should be properly preserved. Institutions should maintain complete nursing records. Rationale Nursing notes are important, because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly, complete nursing records should be properly preserved, because they may be required to show what care was provided. Basic nursing duties as well as advanced nursing care should be recorded in the nursing records.
A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy? Inform the patient's spouse about the disease. Do not inform the patient or the family members about the disease. Obtain permission from the patient to inform the patient's spouse about the disease. Obtain informed consent from the spouse to reveal the illness to the patient.
Obtain permission from the patient to inform the patient's spouse about the disease. Rationale 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.
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)? Discussing patient conditions in the nursing report room at the change of shift Allowing nursing students to review patient charts before caring for patients to whom they are assigned Posting medical information about a patient on a message board in the patient's room Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
Posting medical information about a patient on a message board in the patient's room Rationale 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)
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? The nurse's automobile insurance The nurse's homeowner's insurance The Good Samaritan laws, which grant immunity from suit if there is no gross negligence The Patient Care Partnership, which may grant immunity from suit if the injured party consents
The Good Samaritan laws, which grant immunity from suit if there is no gross negligence Rationale 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 wraps and ties a cloth to prevent bleeding from the site of injury for a patient who is a victim of a traffic accident. The patient is taken to the hospital and presents with signs of infection. Which action will be taken against the nurse? The nurse will not face any action. The nurse will be given a warning for gross negligence. The nurse will face liable charges for not getting an informed consent. The nurse will be sued for not obtaining orders from the primary healthcare provider before intervening.
The nurse will not face any action. Rationale The nurse has wrapped a cloth to control bleeding in the patient, thus providing appropriate care at the accident site. The nurse cannot be blamed for the patient's infection, because the infection could be due to many reasons. The nurse has not shown gross negligence in this case. The nurse does not need informed consent in the case of a life-saving emergency, nor does the nurse need an order from the healthcare provider before intervening in this case.
The nurse is preparing to give cardiopulmonary resuscitation (CPR) to a patient with cardiac arrest. The healthcare provider orders the nurse and code team to avoid resuscitating the patient. Which is the most appropriate reason for this? The patient is unlikely to benefit from CPR. The patient does not have a written order for CPR. The patient has given a Do Not Resuscitate (DNR) order. The patient's family has not yet given the consent to resuscitate the patient.
The patient has given a Do Not Resuscitate (DNR) order. Rationale According to the healthcare law in the United States, cardiopulmonary resuscitation (CPR) is to be given to all appropriate patients unless the patient has given a Do Not Resuscitate (DNR) order. CPR has been known to be very effective in reviving patients with cardiac arrest. There is no written order required for performing CPR; performing CPR is based on the patient's condition. The healthcare provider or the nurse need not obtain consent from the patient's family to give CPR.
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 be started. The parents of the child are divorced, and the mother has custody. The patient is accompanied by her mother, father, and elder sister, who is 19 years old. Who should sign the consent form of the patient? The patient's father The patient's sister The patient herself The patient's mother
The patient's mother Rationale When the patient is a minor, consent is given by parents or guardians. In this case, the parents are divorced, so the consent is given by the parent who has custody of the child, the mother.
The nurse is evaluating the need for the use of restraints when managing a patient with delirium. Which conditions must be met before the nurse may use restraints? Select all that apply. The patient is improving. The patient refuses to undergo a necessary procedure. The safety of the patient is at risk. There is a written order from a health care provider. Less restrictive patient interventions have failed.
The safety of the patient is at risk. There is a written order from a health care provider. Less restrictive patient interventions have failed. Rationale Restraints are not always recommended and should be used only in select cases. The three conditions that must be met before the use of restraints include 1) their use is necessary to ensure the safety of the patient or other patients, (2) A provider order is written with a start and end time and reviewed according to institution policy, and (3) all other attempts to provide for patient safety have failed. When the patient is improving, there is typically no need for restraints. Patients have the right to refuse investigations and procedures, and the nurse cannot restrain them for doing so. Such restraint may be considered false imprisonment.
The nurse is studying the Emergency Medical Treatment and Active Labor Act. What is the meaning of the term patient dumping? Transferring a patient from a private to a public hospital on patient's request Transferring a patient from a private to a public hospital after the patient is stabilized Transferring a patient from a private to a public hospital on consent of the healthcare provider Transferring a patient from a private to a public hospital without appropriate screening and stabilization
Transferring a patient from a private to a public hospital without appropriate screening and stabilization Rationale Patient dumping refers to transferring a patient from a private to a public hospital without appropriate screening and stabilization. The Emergency Medical Treatment and Active Labor Act was established to reduce the incidence of patient dumping. According to this act, patients can be transferred from a private to public hospital on their own request, after being stabilized, or by consent of a healthcare provider.
