Legal Dimensions of Nursing Practice

Patient Self-Determination Act

HCW must give patients info regarding advance directives, living will, & health care durable power of attorney

What is the purpose of accreditation for health care organizations?

Indicates institution has a standard of quality that goes beyond the minimum required for licensure

Who is Florence Nightingale? What does her theory include (7); which is still relevant today?

Nightingale was the founder of modern nursing. Her theory includes: (1) Care that emphasizes health maintenance and restoration (2) Improved Sanitation (3) Improved Nutrition (4) Therapeutic environment (5) Empathetic care (6) Confidential care (7) Care through vital assessment All the elements in her theory are still relevant today.

HIPAA

Protects patient from disclosure of private health information including demographic info; past, present, future health condition; tx; financial info

When is delegation to a CNA or LPN acceptable?

The nurse must actually do the nursing process (Assessment, Nursing Diagnosis & prioritization, Planning goals and interventions, Implementing interventions, and Evaluating care)

A client states that the client's recent fall was caused by his scheduled antihypertensive medications being mistakenly administered by two different nurses, an event that is disputed by both of the nurses identified by the client. Which measure should the nurses prioritize when anticipating that legal action may follow? a) Document the client's claims and the events surrounding the alleged incident. b) Consult with the hospital's legal department as soon as possible. c) Consult with practice advisors from the state board of nursing. d) Enlist support from nursing and nonnursing colleagues from the unit.

a

A nurse asks a coworker about the condition of the nurse's next-door neighbor, who has been admitted to the unit. If the coworker shares the neighbor's client information with the nurse, the coworker could be held liable for committing which act? a) Invasion of privacy b) Negligence c) Assault d) Defamation of character

a

A nurse witnesses a traffic accident and dresses the open wounds sustained by a child. Later, in the hospital, the child develops complications from an infection in the wound. The family holds the nurse responsible for the complications and attempts to file a lawsuit. Which statement is true regarding how the Good Samaritan law applies to this case? a) The Good Samaritan law will provide legal immunity to the nurse. b) The Good Samaritan law will not protect the nurse because the nurse did not accept compensation. c) The Good Samaritan law is not applicable to health care workers. d) The Good Samaritan law will provide absolute exemption from prosecution.

a

A nurse working on a busy medical-surigcal unit does not take the vital signs of client who is preparing for discharge but instead documents the same vital signs obtained for this client earlier in the morning. For which tort would the nurse be potentially liable? a) Fraud b) False imprisonment c) Battery d) Assault

a

A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the dosage of atenolol to 12.5 mg. However, because the physician is late for another visit, the physician requests that the nurse write down the order for the physician. What should be the appropriate nursing action in this situation? a) The nurse should ask the physician to come back and write the order. b) The nurse should write the order and implement it. c) The nurse should inform the client of the change in medication. d) The nurse should remind the physician later to write the work order.

a

Action has been taken against a nurse's license based on a claim that the nurse acted outside of nursing's scope of practice. The nurse's attorney determines that the nurse needs more education about the purpose of the board of nursing when the nurse makes which statement? a) "The rules made by the board of nursing don't reflect my practice." b) "The board of nursing exists to protect the safety of the public." c) "The board of nursing is established by state legislation." d) "Board of nursing rules keep unlicensed people from practicing nursing."

a

After reporting to work for a night shift, the nurse learns that the unit is understaffed because two RNs called out sick. As a result, each nurse on the unit must provide care for four acute clients in addition to the nurse's regular clients. Which statement is true for this nurse when working in understaffed circumstances? a) The nurse is legally held to the same standards of care as when staffing levels are normal. b) Understaffing constitutes an extenuating circumstance that creates a temporarily lower expectation for care for the nurse. c) The nurse must document that float staff, nurses on overtime, and part-time staff were contacted in an effort to fill the gaps in care. d) The nurse is legally obliged to refuse to provide care when understaffing creates the potential for unsafe conditions.

a

During the orientation to the hospital, the staff development educator discusses unit and institutional-based policies. What is the source of the practice rules that result in unit and institutional-based policies? a) Health care institution b) Federal legislation c) State legislation d) Board of nursing

a

Having recently completed a specialty nursing program in neonatal care, a nurse is now preparing to leave the medical unit and begin providing care in the hospital's neonatal intensive care unit (NICU). The nurse has completed which process of credentialing? a) Certification b) Licensure c) Accreditation d) Validation

a

Nurse practice acts are examples of which type of laws? a) Statutory laws b) Constitutional laws c) Administrative laws d) Common laws

a

Nurses are occasionally asked to witness a testator's (person who makes the will) signing of a will. Which guideline is true regarding a nurse's role in witnessing a testator's signature? a) Witnesses to a signature do not need to read the will. b) Witnesses do not need to observe the signing of the will and can sign it at a later time. c) A beneficiary to a will is allowed to act as a witness. d) A single witness is sufficient for a will.

a

Nurses practicing in a critical care unit must acquire specialized skills and knowledge to provide care to the critically ill client. These nurses can validate this specialty competence through what process? a) Certification b) Accreditation c) Licensure d) Litigation

a

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? a) Breach of duty b) Causation c) Damages d) Duty

a

Which action constitutes battery? a) An older adult client refuses an intramuscular injection, but the nurse administers it. b) The nurse threatens to restrain a client if the client does not take a medication. c) While bathing a client behind pulled curtains, two nurses discuss a different client. d) The nurse tells a client that the client cannot leave the hospital because the client is seriously ill.

a

Which scenario is an example of certification? a) A nurse who demonstrates advanced expertise in a content area of nursing through special testing b) A graduate of a nursing education program who passes NCLEX-RN c) An education program that meets standards of the National League for Nursing d) A hospital that meets the standards of the Joint Commission

a

While at a coworker's house, a nurse discusses with the coworker a client whom the nurse suspects of physically abusing the client's child. The next day, the client is moved to another nursing unit after a surgical procedure and comes under the care of the coworker, who is also a nurse. The coworker confronts the client about the alleged physical abuse. The client is shocked and angered by the accusation and denies it categorically. What would be the charge if the client were to file a suit? a) The first nurse could be charged with slander. b) The second nurse could be charged with libel. c) No charges are valid because the revelation took place during off-duty hours and off-site. d) No charges are valid because both nurses are involved in the client's care.

a

While walking down the hall, a nurse manager overhears a staff member telling a client, "If you don't stay in this chair and stop wandering, I'm going to tie you to it." The nurse manager pulls the staff member aside and discusses what was said. The nurse manager intervenes because the staff member's statement is which type of tort? a) Assault b) Battery c) False imprisonment d) Invasion of privacy

a

Beneficence

a nurse's actions should promote good

Libel

a published false statement that is damaging to a person's reputation; a written defamation

Which elements are necessary to prove malpractice? Select all that apply. a) Duty b) Breach of duty c) Causation d) Damages e) Disclosure

a,b,c,d

Legal safeguards are in place in the nursing practice to protect the nurse from exposure to legal risks as well as to protect the client from harm. What are examples of legal safeguards for the nurse? Select all that apply. a) The nurse obtains informed consent from a client to perform a procedure. b) The physician is responsible for administration of a wrongly prescribed medication. c) The nurse educates the client about The Patient Care Partnership. d) The nurse executes physician orders without questioning them. e) The nurse documents all client care in a timely manner. f) The nurse claims management is responsible for inadequate staffing leading to negligence.

a,c,e

The nurse attorney provides an educational session to the nursing staff on acts of negligence. Which responses by the staff would indicate to the attorney that the staff can accurately identify acts of negligence? Select all that apply. a) "I can be charged with negligence if I apply a heating pad to the client's skin and the client suffers a superficial or first-degree burn." b) "I can be charged with negligence if I follow the policy for administering insulin and the client has a reaction to it." c) "I can be charged with negligence if I am following the standards of care for my specialty, which is ambulatory nursing." d) "When I am using a new piece of equipment for the first time, I must make sure I know how to properly operate it." e) "I can be charged with negligence if I notify the health care practitioner about a change in a client's status but do not follow up or document.

a,e

Which process evaluates and recognizes educational programs as having met certain standards? a) Accreditation b) Credentialing c) Licensure d) Certification

a--Accreditation is the process by which an educational program is evaluated and recognized as having met certain standards

The nurse is providing care to a client whose condition has progressively declined. The nurse assesses and makes appropriate interventions as well as notifies the health care provider. Despite the nurse's efforts, the client expires. What element of liability has the nurse demonstrated? a) Duty b) Breach of duty c) Causation d) Damages

a--Duty refers to an obligation to use due care. The nurse assessed the client and made appropriate interventions and notifications.

During the admission assessment of a client with a suspected mandibular fracture, the client discloses to the nurse that the injury results from the client's spouse hitting the client. Which action should the nurse prioritize when responding to this disclosure? a) Reporting the abuse to the appropriate authorities b) Ensuring that the client's statement is confirmed by another nurse c) Performing an assessment to confirm the client's statement d) Informing the client of the client's right to keep this information private

a--Nurses have a legal and ethical obligation to report cases of abuse. The nurse's obligation to report abuse legally supersedes the client's right to privacy.

A client is being prepared for an elective surgical procedure and the consent form has not been signed. Who should the nurse have obtain consent for the procedure? a) The health care provider performing the surgical procedure b) The client's family or significant other c) The perioperative nurse d) The nursing supervisor

a--Obtaining informed consent is the responsibility of the person who will be performing the diagnostic or treatment procedure or the research study

An RN is working on a medical-surgical unit with a licensed practical/vocational nurse (LPN/LVN). Which action by the RN is considered negligent if injury results from this action? a) Asking the LPN/LVN to teach a new diabetic client how to administer insulin b) Calling the health care provider about abnormal lab results c) Obtaining vital signs on a newly admitted client d) Delegating oral medication administration to the LPN/LVN

a--Teaching is not in the current scope of practice for a LPN/LVN, and thus the RN's delegation of this task to the LPN/LVN could be considered negligence.

A client newly diagnosed with congestive heart failure has a prescription for digoxin. The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care? a) The nurse withholds the medication and notifies the health care practitioner. b) The nurse administers the medication and reassesses the client after 30 minutes. c) The nurse withholds the medication, retakes the heart rate, and gives the medication at a later time. d) The nurse administers the medication after reviewing the client's serum potassium level.

a--digoxin should be withheld if BPM is <60

A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged? a) Libel b) Slander c) Negligence d) Malpractice

b--slander is spoken false statements libel is PUBLISHED false statements

A client has a prescription for amoxicillin 500 mg P.O. every 8 hours. The nurse administers the medication via the intravenous route. Based on the nurse's action, the client develops complications and has an increased length of stay. The client files a lawsuit against the facility and the nurse. Which legal action has the nurse's attorney identified that meets the criteria for the client's lawsuit? a) Negligence b) Malpractice c) Assault d) Battery

b--failing to perform (or performing) an act that causes harm to a client

Which are examples of a nurse appropriately protecting a client's privacy? Select all that apply. a) During a bed bath, the nurse exposes the client's upper torso while washing the client's face. b) With the client's permission, the nurse explains the client's diagnosis to the client's spouse. c) The nurse questions the client about the client's social life even though it does not affect care planning. d) The nurse moves the client from the emergency department waiting room to a private area to collect assessment data. e) Because the facility is a teaching facility, the nurse allows a nursing student to photograph a client for a care plan.

b,d

Battery

assault that is carried out; "beat"

A client being discharged from the hospital asks the nurse, "When I go visit my family out of state, should I take my living will with me, or do I need a new one for that state?" Which is the most appropriate response by the nurse? a) "A living will can only be used in the state in which it was created." b) "Take it with you. It is recognized universally in the United States." c) "As long as your family knows your medical wishes, you will not need it." d) "We have it on file here, so any hospital can call and get a copy."

b

A client with end-stage renal disease decides against further treatment and requests a "Do Not Resuscitate" (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. The charge nurse appropriately identifies that nurse has committed: a) defamation. b) battery. c) assault. d) fraud.

b

A nurse and the facility have been named as defendants in a malpractice lawsuit. In addition to the nurse's attorney, whom else would be appropriate for the nurse to talk with about the case? a) A colleague b) The agency's risk manager c) The plaintiff's lawyer d) The local press

b

A nurse enters the client's room and finds the client lying on the floor experiencing a seizure. After stabilizing the client, the nurse informs the physician. The physician advises the nurse to prepare an incident report. What is the purpose of an incident report? a) To determine the nurse's fault in the incident b) To evaluate the quality of care provided and assess the potential risks for injury to the client c) To provide information to local, state, and federal agencies d) To evaluate the immediate care provided by the nurse to the client

b

A nurse fails to communicate a change in the client's condition to the physician. Which element related to proving malpractice has been met? a) Duty b) Breach of duty c) Proximate cause d) Damages

b

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? a) Assault b) Battery c) Libel d) Slander

b

An HIV-positive client discovers that the client's name is published in a research report on HIV care prepared by the client's nurse. The client is hurt and files a lawsuit against the nurse. Which offense has the nurse committed? a) Unintentional tort b) Invasion of privacy c) Defamation of character d) Negligence of duty

b

The client being admitted to the oncology unit conveys wishes regarding resuscitation in the event of cardiopulmonary arrest. The nurse advises the client that it would be in the client's best interest to obtain which document? a) A will b) A living will c) Proof of health care power of attorney d) A proxy directive

b

Which is true of the Occupational Safety and Health Act? a) It requires nurses to report abuse of infants, children, and adults of all ages. b) It helps to reduce workforce injuries and illness in the workplace. c) It establishes an information clearinghouse for nurses who engage in unprofessional conduct. d) It protects nurses who are recovering from drug or alcohol addiction or have communicable diseases.

b

Which situation is an example of battery that the nurse may witness while performing duties at the health care facility? a) Telling the client that the client may not leave the hospital b) Performing a surgical procedure without getting consent c) Taking the client's photograph without consent d) Witnessing a procedure done on a client without the client's consent

b

Which statement about laws governing the distribution of controlled substances is true? a) When a nurse misuses controlled substances in the workplace and gets help, the nurse will not be charged with a criminal act. b) Nurses are responsible for adhering to specific documentation about controlled substances. c) Substance use is not treatable. d) The nurse is only at risk if diverting medication from the client; a nurse using the nurse's own personal drugs is not at risk.

b

A nurse is called to a deposition for a malpractice charge that has resulted in the death of a client. As the chart is reviewed, the prosecuting attorney questions the nurse about several defaming comments written in the medical record about the client. What charges can be filed against the nurse due to these comments? a) Malpractice b) Slander c) Libel d) Negligence

c

A client admitted to a mental health unit has exhibited physical behaviors that put the client and others at risk. The nurse applies four-point restraints on the client without obtaining a physician's order or the client's consent. The nurse is at risk of being accused of which action? a) Slander b) Negligence c) Battery d) Malpractice

c

A client is unhappy with the health care provided and informs the nurse that the client is leaving the facility. The client has not been discharged by the physician. The nurse finds that the client has dressed and is ready to go. What should the nurse's action be in this situation? a) The nurse should have the client restrained and call the physician. b) The nurse should let the client go because the nurse cannot do anything. c) The nurse should call and inform the nursing supervisor of the situation. d) The nurse should warn the client that the client cannot come to the hospital again.

c

A nurse is caring for a client following endotracheal intubation. Before applying soft wrist restraints to prevent the client from pulling out the endotracheal tube, what is the most appropriate action of the nurse? a) Sedate the client. b) Get written consent. c) Obtain a medical order. d) Notify the family.

c

A nurse is providing care to an older adult client. The client has been alert and independent with ambulation but now is exhibiting some confusion along with being unsteady when getting out of bed and walking. The nurse fails to report and document this change in status. No safety measures are taken and the client falls while getting out of bed to use the bathroom and fractures a hip. The client is experiencing significant pain from the fractured hip and requires surgery to repair the fracture. The nurse is sued for malpractice. Which action reflects the element of causation in this case? a) Responsibility to report changes in status b) Failure to document and report the change c) Lack of safety measures implemented with status change d) Fractured hip, pain, and need for surgery

c

Nurses complete incident reports as dictated by the agency protocol. What is the primary reason nurses fill out an incident report? a) To document everyday occurrences b) To document the need for disciplinary action c) To improve quality of care d) To initiate litigation

c

Professional regulations and laws that govern nursing practice are in place for which reason? a) To limit the number of nurses in practice b) To ensure that practicing nurses are of good moral standing c) To protect the safety of the public d) To ensure that enough new nurses are always available

c

Which nursing student would most likely be held liable for negligence? a) A nursing student performs a dressing change using sterile technique and documents the presence of necrotic tissue in the wound. b) A nursing student reports that insulin was not administered to the client by the nurse on the previous shift. c) A nursing student administers medication to a resident while working as an unlicensed assistive personnel (UAP) at a local nursing home. d) A nursing student completes an incident report after administering a medication to a client who then experienced an adverse reaction to the medication.

c

During a nursing shift, which events warrant completion of an incident report? Select all that apply. a) A nurse reports that a client is crying and distraught over a diagnosis of metastatic cancer. b) An intravenous antibiotic was administered 2 hours late because the IV site infiltrated. c) A visitor slipped and fell in the hallway, but was not injured. d) A client falls while being transferred from the bed to the chair. e) A registered nurse asks an unlicensed assistive personnel (UAP) to feed a client.

c,d

A nursing student administers an overdose of a narcotic to a client and the client arrests. When discussing the incident with nursing faculty, which statements made by the student indicate the need for further teaching? Select all that apply. a) "I realize that I am held to the same standards as a registered nurse." b) "I have also put the nursing faculty at risk with my action." c) "I am glad I am a student because nursing faculty will be blamed, not me." d) "I should have informed you that I felt unprepared for my assignment." e) "I cannot be held liable because this is only my second time at this facility."

c,e

When the nurse informs a client's employer of the client's autoimmune deficiency disease, the nurse is committing the tort of: a) breach of contract. b) assault. c) invasion of privacy. d) battery.

c--A loss of privacy occurs if others obtain unauthorized information about someone from a nurse.

A client has been in the emergency department for 3 hours for treatment of a migraine headache. Care has been delayed due to a multicasualty car accident. The client gets up to go to the bathroom unattended, faints, and suffers a subdural hematoma. The family threatens to sue for malpractice. Which element of malpractice will be the most difficult for the attorney to prove? a) Duty b) Breach of duty c) Causation d) Damages

c--Typically, causation is the most difficult component of malpractice to prove. Causation asks the question, "Did the nurse's actions directly cause the damages?"

A client was admitted to a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which legal term describes the case? a) Misdemeanor b) Felony c) Tort d) Fraud

c--tort: people are liable for the consequences for their actions, whether intentional or not misdemeanor--minor wrongdoing felony--major wrongdoing, typically involving violence

A client is brought to the emergency department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? a) The nurse informs the family about advance directives. b) The nurse informs the family about the living will. c) The nurse ensures that the client signs the consent form. d) The nurse ensures that the client's family signs the consent form.

d

A client who is scheduled for hernioplasty needs clarification regarding the procedure. The nurse calls the physician at the client's insistence. The physician, who is in a bad mood, is overheard telling the client that the nurse does not know anything. Which legal tort has the physician committed? a) Libel b) Battery c) Assault d) Slander

d

A registered nurse who has an associate degree would like to obtain a baccalaureate degree in nursing. The nurse works full time and has several family obligations and would like to find a program that fits into that lifestyle. What is the nurse's priority question about an educational program? a) How much does it cost? b) Is it online? c) What is the NCLEX pass rate? d) Is the program accredited?

d

A student nurse is assisting an older adult client to ambulate following hip replacement surgery when the client falls and reinjures the hip. Who is potentially responsible for the injury to this client? a) The student nurse b) The nurse instructor c) The hospital d) The student nurse, the nurse instructor, and the hospital

d

The nurse attempts to notify a health care provider about a client's elevated temperature but does not get a response. Which statement, if documented by the nurse, would indicate that the nurse is following proper protocol for nursing documentation? a) 1300: Client temperature elevated. Telephoned health care provider 3 times. As usual, health care provider did not respond. b) 1300: Client temperature elevated. Health care provider paged, but did not respond. Administered acetaminophen without an order because I knew this health care provider does not return calls. c) 1300: Client temperature elevated. Telephoned health care provider's service several times with no response. Will notify nursing supervisor during rounds. d) 1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified.

d

Which statement made by the nurse providing care to a group of clients indicates that the nurse requires further education regarding negligence? a) "Please avoid bringing fresh fruit to a client with neutropenia." b) "I am going to assess for collateral circulation before preforming an arterial blood gas (ABG)." c) "I am going to auscultate breath sounds every 8 hours on a client receiving enteral feedings." d) "I don't need to assess distal pulses on a client after a femoral arteriography."

d

Which is an example of an unintentional tort? a) Nurses discuss a client's laboratory values in the elevator. b) A nurse tells a client that the client cannot leave the hospital until the client pays the bill. c) A nurse threatens to restrain a client if the client does not stop talking. d) A nurse gives the client a medication, and the client has an adverse reaction to it.

d--An unintentional tort occurs when the nurse does not intend harm, but harm occurs

A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse? a) Discuss the case with the plaintiff to ensure understanding of each other's positions. b) If a mistake was made on a chart, change it to read appropriately. c) Be prepared to tell your side to the press, if necessary. d) Do not volunteer any information on the witness stand.

d--The nurse on the witness stand should be polite, but not volunteer any information.

What is informed consent?

permission granted in the knowledge of the possible consequences

Litigation

process of lawsuit

Malpractice

rendering professional services which results in injury, loss, or damage; professional negligence; 4 elements must be present to prove: (1) Duty--to pt (2) Breach of duty (3) Causation--failure to perform duty caused injury (4) Damages--pt was injured

Slander

the action or crime of making a false spoken statement damaging to a person's reputation

Assault

threat or an attempt to make bodily contact with another person without that person's permission

Veracity

truthfulness, accuracy

Tort

wrong committed by a person against another person or that person's property; can be intentional or unintentional