Nursing Law Exam

An Emergency Department nurse has agreed to testify as an expert witness in a lawsuit involving a child. The opposing attorney questions the nurse's qualifications as a pediatric nurse. Which type of law does this scenario reflect?

"qualifying as an expert witness" OR An expert witness explains highly specialized technology or skilled nursing care to the jurors, who typicall don't know nursing. pg. 37-40

A patient has just discovered that a surgical error made 3 years ago was responsible for the loss of the patient's leg. How does the discovery rule relate to statutes of limitation in this case?

According to the discovery rule, pateints have 2 years frm the time that they knew or should have known of the injury to file a personal injury lawsuit in the majority of states. The time frames vary according to state law. It would have to be determined whether or not the patient "should have known" to see if the patient could file suit.

A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status?

All 50 states require reporting of AIDS cases without the patient's consent, to the CDC or to the state health department for epidemiological purposes. The states are divided, though on whether the reporting is anonymous or entails more descriptive demographics.

The nurse comes upon a motor vehicle accident with injury and stops to help. What should be the nurse's first action?

Ask the injured people for permission

Hospital policy states that a registered nurse must cosign all charts that licensed practical nurses complete. What is the effect of this policy on the registered nurse?

Because the registered nurse must cosign the charts that LPNs complete, they are then responsible for the information on those charts. It is important that the registered nurse agrees with, understands, and is checking what they sign before they sign it. If they were to be named in a lawsuit the registered nurse would be responsible for the information on the chart.

The hospital policy and procedure manual states that medications should be charted immediately after administration. The nurse routinely charts the medications as they are being prepared for administration. What does this practice reflect?

Breech of duty owed the pateint Showing a deviation from the standard of care owed the patient malpractice or professional neglience

A nurse was scheduled to appear before the state board of nursing in regard to action against the nurse's license. The place of the meeting was changed and the nurse was not notified. What legal concept was violated in this situation?

Change of Venue/notice requirement OR due process of law

The nursing student began a case study paper by writing, " J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital." What is the significance of this statement?

Confidentiality

Which action could result in the nurse being charged with conversion of property?

Conversion of property arises when the health care practitioner interferes with the right to possession of the patient's property, either by intermeddling or by dispossessing the person of the property. For example, searching a patient's suitcase and removing prescription drugs from the patient's possession or taking the patient's care keys or clothes without a just cause. However, if there adequate justification of the action, the practitioner may be free from liability. For example, taking the car keys to prevent a confused, disoriented person from driving is permissible.

A county-supported hospital elects to limit surgical procedures for morbid obesity to male patients. Female patients receive pharmacologic therapy, counseling, and instruction for diet and exercise, but are excluded from operative procedures. Under which legal concept is this illegal?

Discrimination according to Civil Rights act of 1964, which protects against discrimination. OR equal protection of the law

The jury in a professional negligence trial is provided information regarding nursing practice standards. What is this jury considering?

Duty of Care OR The jury is considering duty owed the patient. The second aspect of duty is the scope of care that the must be delivered. The standard of care owed is that of the reasonably prudent nurse under similar circumstances as determined by expert testimony, published standards, and common sense.

A nursing student reports that her grandmother served as a nurse in World War II. At the end of the war, her grandmother was licensed as a nurse, even though she never graduated from nursing school. Which type of exemption from licensure does this reflect?

Grandfather clause

What is the basic purpose of the state board of nursing?

Grants legal permission to a qualified individual or entity to perform designated skills and services in a jurisdiction in which such practice would be illegal without a license. Ensures enforcement of nurse practice acts (and rules and regulations). Accountable to the legislators for professional nursing within a given jurisdiction. • Govern their individual operation and administration • Approve or deny approvals to schools of nursing •Examine and license applicants • Review licenses, grant temporary licenses, and provide for inactive status for those already licensed • Regulate specialty practice • Discipline those who violate provisions of the licensure law

Which type of licensure protects the title "nurse" as well as professional actions associated with nursing?

Mandatory Licensure

What is the single most critical factor in determining whether a particular nurse acted with reasonable care in a given situation?

Nurses judgement in a particular situation is a critical factor in determining whether or not she acted with reasonable care OR a.Open and trusting nurse-patient relationship b. Patients and their families who are treated honestly, openly, and respectfully and who are apprised of all facets of treatment and prognosis are not likely to sue c. Communicating in a caring and professional manner has been shown to be a major reason why more people do not sued despite adequate grounds for a successful lawsuit

Several state nursing associations are working together in an attempt to change a constitutional law. How is constitutional law changed?

Nursing associations may lobby to attempt to influence decisions made by officials in the government, who are most often legislators or members of regulatory agencies. Constitutional amedments may be proposed by either two-thirds of both houses of the US congress or by a national convention. This convention can be assembled at the request of the legislatures of at least two-thirds of the several states. To become part of the Constitution, amendments must then be ratified either by approval of the legislatures of three-fourths of the states or ratifying conventions held in three-fourths of the states. Congress has discretion as to which method of ratification should be used. Any amendment so ratified becomes a valid part of the constitution, provided that no state "shall be deprived of its equal Suffrage in the senate," without its consent.

In which situation is an occurrence-based policy most beneficial to the nurse?

Occurrence-based insurance policies cover the nurse for any injuries arising out of incidents that occurred during the time the policy was in effect (policy period). This hold true even if the subsequent lawsuit is filed after the policy has expired and the policy was not renewed by the policy holder. •This may be most useful particularly in cases involving children, neonates, and conditions that arise months to years after the triggering event.

A patient brought suit against a hospital for injuries sustained in a fall. The case went to trial and the jury found for the hospital. Can the patient take this same suit and evidence to another trial court in hopes of a different decision?

Once the verdict is known, the losing side may move for a new trial. If the motion is granted, the entire trial is repeated before a new jury panel. If it is denied, the judgment becomes final and the losing side may appeal to the proper appellate court if there are legal grounds for such an appeal.

A person who was injured in a motor vehicle accident sued the driver to recover hospital costs. What type of law would be enforced in this situation?

Special damages, which account for all losses and expenses incurred as a result of the injury OR tort law involves compensation to thsoe worngfully injured by others' actions. tort law is a type of civil law

From where does the state's power to license nurses derive?

State board of nursing/ State board of nursing examiners Or Nurse practice act

Which nurse action is appropriate according to the American Nurses Association's stance on assisted suicide and active euthanasia?

The ANA opposes the movement and nurses participation either in assisted suicide or active euthanasia because they violate the ethical traditions embodied in the Code of Ethics for nurses. If nurses are asked directly by patients to assist with their suicide they must refuse. Instead, look beyond the request to what the patient may actually be saying. They may have a greater need for pain control or for someone to talk to about their fears of a terrible death. As a nurse you should: •Procure about alternative medication options •Supply forms for advanced directives •Allow the patient to speak to a chaplain, representative of their faith, or social worker. •Ensure the patient knows someone cares

How should the nurse proceed when caring for a suit-prone patient?

The nurse should then attempt to react on a more human or personal basis such as expressing satisfaction with the patients cooperation, showing empathy and concern with their suffering and setbacks and repeating needed information to keep patients less fearful of unknown treatments and procedures. An atmosphere of attentiveness, caring, and patience may help prevent the suit-probe patient form filing future lawsuits

A nurse brings suit against the hospital after being terminated for excessive absenteeism. Who is the plaintiff in this lawsuit?

The nurse. A plantiff believes he or she may have a valid cause of action against another individual so he or she initatites the lawsuit.

A person desires to bring suit for injuries sustained while hospitalized. What is this person's legal burden of proof?

The burden of proof refers to the obligation of a party to prove its allegations at a trial. Answer: the person's burden of proof would be to provide evidence and prove that the hospital was responsible for the injuries sustained by the pt.

The charge nurse has delegated a task to another staff member. Who assumes accountability for the task?

The charge nurse: delegation is the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome b. "However if it can be shown that the team leader/nurse manager tasks appropriately and had no reason to believe that the individual to whom the task was delegated was anything but competent to perform the task the delegator will be judged to have no personal liability. But the opposite is also true. The nurse manager must be aware of the nurses skills, knowledge and competencies.

The nurse is reviewing a professional liability policy for the time period the policy is in effect. Under which section of the policy should this nurse look?

The declarations section OR The "coverage Period" section

A nurse has agreed to participate in a videotaped deposition in a malpractice case. What does this indicate?

This means that the nurse is under oath, potentially unable to appear in court but it may be that the attorneys want a positive representation in court and they feel that this may be one reason that the attorneys want to obtain a statement. Anything this nurse says in a sworn statement- deposition videos are often obtained for witnesses that will not be present for the actual trial or potentially they are outside of the jurisdiction of the court or who may be unavailable during the time of the trial hearing may choose to have their deposition videotaped. A deposition is a witness's sworn statement made outside the court that is admissible as evidence in a court of law. Depositions are taken of a witness, who is questioned by the attorney representing the opposing side of the controversy. The deposition's purpose is to assist the opposing counsel for the court case by revealing potential testimony from witnesses before the trial. A newer concept in taking depositions is to videotape the witness during the entire deposition rather than to record the deposition through a court reporter. If the witness giving the deposition has a pleasing personality and appears to be caring and compassionate on tape, playing of this type of deposition in court mimics the personal effect of live appearance. It is the option of the deposing parties (and their counsel) to choose this type of deposition. (An error that physicians and nurses frequently make during depositions is in giving too much information).

Standards of care exist for a number of reasons. What is their most basic purpose?

To protect and safeguard the public as a whole.

A person is arrested and charged with battery and assault after attacking a neighbor with a knife. What classification or type of law would determine the case against this defendant?

Tort law- intentional law. Battery and Assault are intentional torts- tort law is a type of civil law

Why is proving proximate harm cause important in the outcome of a professional negligence suit?

•Proximate cause attempts to determine how far the liability of the defendant extends for consequences following negligent activity. •Proximate causes build on foreseeability. •Ex. Medical professional are not responsible for patients getting in a car accident after taking a med that makes them drowsy unless they failed to warn them of the side effects.

The patient has tested positive for a gene associated with breast cancer. Can this patient be denied life insurance based upon this finding?

Yes. The patient can be denied life insurance as well as disability insurance and long term care insurance policies. The Genetic Information Nondiscrimination Act of 2008 (GINA) protects Americans from being treated unfairly by health insurers and employers, not life insurance.

The cardiac telemetry unit nurses repeatedly cautioned a patient not to leave the floor because input from telemetry monitors is limited to that area. The patient went to the cafeteria and suffered a fatal dysrhythmia. What is the nurses' best defense in the negligence lawsuit brought for the patient's survivors?

a. Assumption of risk. Pt knew risks of going off unit and proceeded with the action anyways.

A patient refused to ambulate postoperatively and subsequently developed bilateral pneumonia, causing his hospital stay to be lengthened. After discharge, the patient filed a lawsuit claiming his primary nurse was negligent in allowing him to develop pneumonia. What is the nurse's best defense in this case?

a. Contributory & comparative negligence: hold plaintiff at fault if they had any part in the adverse consequences. (failure to follow prescribed treatment) b. Assumption of risk: plaintiffs are partially responsible for consequences if they understood the risks involved when they proceeded with the action.

As a result of shared medical decision making a patient undergoes a surgical procedure, which results in paralysis. What must the patient prove to bring a successful malpractice suit based on informed consent? Choose all answers that are correct.

a. Duty on the part of the healthcare provider to know of a risk or alternative treatment. b. Duty on the part of the healthcare provider to disclose the risk or alternative treatment c. Breach of duty to disclose d. If healthcare occurs in state where the reasonable pt standard is used, a reasonable person in the plaintiff's position would not have consented to treatment if he or she had known of the outstanding risk e. Undisclosed risk caused harm or harm would not have occurred if an alternative treatment plan was selected f. Plaintiff suffered injuries for which damages can be assessed.

Which scenario best reflects indirect supervision of a nursing assistant?

a. Indirect Supervision occurs when the delegator is easily contactable, but does not directly oversee the interventions or activities being performed

The state board of nursing has brought action against a nurse's license based upon violation of a regulation. What is true about this scenario?

•When deciding which standards of care apply, courts can consider ERROR IN JUDGEMENT RULE and TWO SCHOOL OF THOUGHT DOCTORINE •Error in judgment rule: allows the court to evaluate the standards of care given a patient even if there was an honest error in judgment, including an error in the diagnosis. What the court evaluated is the care given and whether that care met the prevailing standards, not whether the judgment was correct •Two schools of thought doctrine: supports the nurse who chooses among alternative means of delivering quality health care. In this instance, the court evaluated the standards of care given when the nurse chooses among the alternative modes of treatment. •Violations of standards open nurses to possible disciplinary action by the board.

Which option reflects assignment in nursing?

Direct supervision: provided when the delegator is actually present, observes, works with, and directs the person who is being supervised

A growing body of research supports linkages between the educational status of nurses and which outcomes? Select all that are discussed in the textbook.

-patient mortality rates -patient failure-to-rescue rates • Ensure that nurses are competent to care for specialty patients • Ensure nurses are competent to perform management roles • Ensure nurses can function as quality nursing educators • Better ensure that nurses are lifelong learners and that they remain competent, whatever their role or field in nursing • State boards of nursing will have a better benchmark upon which to renew licenses

A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation?

.• May be covered by employer but coverage will most likely be insufficient • Most hospital insurance policies do not have supplementary payments for the nurse-defendant, which means that if the nurse incurs additional expenses in investigating the claim or lose days of work defending the claim, then he/she must cover the expenses out of pocket

In which case might the state deny a patient's right of refusal for medical treatment?

1. Preservation of life if the patient does not have an incurable or terminal disease -transitioning out of anesthesia post-op -arrhythmias following an MI 2. protection of minor dependents 3. Protection of the public's health

The nurse has been sued for defamation after charting that the patient is a prostitute. What is the nurse's best defense in this case?

? Defamation concerns wrongful injury to another's reputation. It involves written or oral communication to someone other than the person defamed of matters concerning a living person's reputation. When a nurse charts, they should be careful to only chart when a person exhibits unusually behavior, and chart exactly the behavior perceived rather than conclusory statements such as this patient is a prostitute. The nurse's best defense in this case is truth. The nurse can prove the truth of this defamatory statement (that this women is a prostitute). In order for it to be considered defamation, a statement must be false and must subject a person to public hatred, contempt, and ridicule or impeach the person's honesty, integrity or virtue. b. Privilege: mandate to report persons with certain diagnoses/diseases or those suspected of abusing others c. Disclosure statutes: reporting communicable diseases (venereal diseases if the prostitute has one)

Upon entering a patient's room to complete discharge instructions the nurse discovers the patient in tears. The business office has stated that the patient cannot leave until someone pays a portion of the hospital bill. What should the nurse do?

? In this question, the business office has stated that the patient cannot leave until someone pays a portion of the hospital bill. That is considered false imprisonment; the unjustifiable detention of a person without legal warrants to confine the person. Therefore, unless there is legal warrant, the patient is free to leave. Although I didn't find a definitive answer in the book, as a nurse I would notify my nurse manager immediately and even physician to prevent false imprisonment charges.

A physician reported a case of possible nursing negligence to the state board of nursing. What action will be taken by the board?

A board hearing is scheduled, and the nurse is entitled to a clear statement of the charges, the right to question and produce witnesses, the right to an attorney, and the right to a fair determination based on the evidence presented. • For minor violations, the nurse may receive a warning or reprimand • Continued violations may result in probation of temporary suspension of licensure • Various disciplinary actions may be taken, depending on the severity of the violation oPrivate reprimand or censure oPublic reprimand or censure oProbation oSuspension of licensure oRefusal to renew licensure oRevocation of licensure oImposition of a fine

Which scenario is a quasi-intentional tort rather than an intentional tort?

A tort becomes quasi-intentional when intent is lacking, but there is a violational action and direct causation -More than mere negligence is involved, but the intent that is necessary for an intentional tort is missing Defamationa and invasion of privacy

What was the major impetus for more stringent delegation and supervision rules and regulations as they are applied today?

By the mid-1990s, a nursing shortage had again shifted the nursing model to a multilevel staff, with a return of the need for delegation and supervision In the case Nursing home, Inc vs Department of Health and Human Services a nursing home was held liable for inadequate practices and procedures in monitoring ventilator- dependent patients. In this case, a professional had delegated the task of suctioning a VDP to a nurses aide- after suctioning the patient the aide failed to make sure that the ventilator was back on the patient and the patient died. The professional did not check to make sure that this task was completed correctly.

Under a claims-made insurance policy, for which claim is the nurse protected?

Claims-made policies provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period or during an uninterrupted extension of that policy period

What is the main purpose of documentation in the medical record?

Communication. 1) assist in planning and evaluating patient care and recommending a patient's continuing treatment 2) document the course of the patient's care including response to treatment and patient cares 3) protect legal interests of the patient, healthcare facility and healthcare providers 4) provide data for use in continuing education and in research.

Which scenario best reflects direct supervision of a nursing assistant?

Direct Supervision is provided when the delegator is actually present, observes, works with, and directs the person who is being supervised

A patient, injured at work, was seen by the factory occupational nurse. The nurse treated the wound and instructed the patient to get a tetanus antitoxin injection at the county health department. The patient failed to follow instructions, developed tetanus, and subsequently filed a suit against the nurse. What is the most likely result of the ensuing trial?

Due to the patient's failure to follow direction, he is considered 51% more at fault and will lose the ensuing trial. This is by means of comparative negligence defense, which is also a type of defense that holds injured parties accountable for their fault in the injury.

During a jury trial, the presence of a nurse-patient relationship is questioned. What kind of question is this and who would determine it?

Duty owed the patient. Determined by: Expert testimony, published standards, common sense about scope of practice OR duty-owed. The nurse=patient relationship (one person depending on the other for quality, competent care) actually forms the basis of the duty-owed concept. Most cases have not concerned themselves with this portion of the nursing duty element because a showing of hospital employment usually is considered sufficient in providing that a duty is owed the patient. The court would determine this.

The patient presents to the Emergency Department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers?

Emergency consent protects healthcare workers who provide care to a patient that collapses in the ED. Patients must not be able to make their wishes known, and a delay in providing care would result in the loss of life or limb. The healthcare provider has no reason to know or believe that consent would not be given were the patient able to deny consent.

A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report?

Fill out the form as though it is discoverable. Do not include language that admits liability. Do not mention in the patient's chart that the incident report form was completed. It should be a check-off list, with a limited area for a brief, written description of the occurrence.

The nurse is involved as an expert witness in a civil court case where life support was withdrawn and the patient expired. Which level of evidence is expected for this case?

For a civil court case, clear and convincing evidence is used. (also called standard of proof. Levels of Evidence or standard of proof that is presented at trial often depends upon the type of case being tried; what is necessary to convince the judge that a given proposition is true and to "minimize the risk of erroneous (mistaken) decision". Preponderance of the evidence is based on the probable truth or accuracy of the evidence presented, not the amount of evidence. Judge must be persuaded that facts are more probable one way or the other. This level of evidence remains subjective. Used in civil court cases. Clear and convincing evidence is the intermediate standard of evidence, proof that a fact is highly probable. Highest level of proof that can be applied in a civil court case and is generally the standard of proof seen in cases involving withdrawal of life-sustaining treatment. Proof beyond a reasonable doubt highest level of evidence and standard in criminal cases.

Which option reflects one of the more convincing arguments for the nurse having individual malpractice insurance?

Individual coverage is the broadest type of coverage and is specific to the individual policyholder. This type of policy covers the nurse on a 24-hour basis, as long as actions fall within the scope of professional nursing practice. This is tailed to meet the needs of the individual nurse. No matter what the merit of the case, it is costly. There are numerous fees that go along with the lawsuit and few nurses can sustain such financial strain without insurance. • Defending against a lawsuit is costly (most convincing arguments!) • Nurses who have professional liability insurance are not "targets" and are not sued more frequently than nurses who choose not to have individual professional liability insurance coverage • Professional liability insurance is relatively inexpensive • The assurance of adequate protection should a lawsuit be filed • Having one's own professional liability insurance does not automatically trigger an employee indemnity lawsuit • The fact that professionals assume accountability for their own actions or omissions • Malpractice insurance premiums are currently a tax-deductible business expense

What is the role of lay witnesses in a trial?

Law witnesses etablish fact at the trial level, stating for the judge and jury exactly what transpired; define for the judge exactly what happened They are allowed to testify only facts and may not draw conclusions or form opinoins Law witnesses are patients, pateint's family members, nurses not named in the lawsuit, interdisciplinary staff membres

Which group or person has authority to write statutory law such as nurse practice acts?

Legislative bodies pass the individual nurse practice acts (satutory laws) and create state boards of nursing or state boards of nurse examiners (state adminstrative agencise). The state boards implement and enforce the state nurse practice act by writing rules and regulations for the enforcement of the statutory law and by conducting investigations and hearings to ensure the law's continual enforcement.

The laboratory notifies the nursing unit that a substantial amount of test data was mistakenly recorded on the wrong patient's medical record two days ago. Who has the authority to alter the patient's record?

Never alter a record at someone else's request. Only the lab has the authority to alter the patient's record administratvie staff or the primary health care provider should correct such substantive errors.

An out-of-state caller becomes irate when the nurse cannot provide information over the telephone about a hospitalized friend. The caller says, "If you know what is good for you, you had better tell me." Has a civil assault occurred?

No, threatening over the phone is no present ability to commit a harm, thus no tort has been committed. (not present to commit harm to you)

What is assured once an adult patient executes a living will?

Nothing. A living will is a directive from a competent individual to medical personnel and family members regarding the treatment they wish to receive when they can no longer make the decisions for themselves. Typically there is no legal enforcement of the living will and medical practioners may choose to abide by wishes or ignore them as they see fit. Language is usually broad and vague.

The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review?

Nurse Practice Acts: protect the public at large, define the practice of nursing, give guidance within the scope of practice issues, and set standards for the nursing profession

The health care facility has sponsored a continuing education offering on emergency management of pandemic influenza. At lunch, a nurse is overheard saying, "I'm not going to take care of anyone that might have that flu." What is true of this statement?

Nurse has a right to refuse patients that conflict with cultural values or religious beliefs, BUT •The ability of the health care professionals to provide care is greater than that of the public, thus increasing the obligation to provide care.' •Health care professionals have assumed the risk of care for these individuals based on their choice of profession dedicated to the care of the sick. •Members of this profession should be available in times of emergency, as the profession is part of a social contract with the public. This latter reason is also consistent with the ANA's code of ethics for nurses.

The patient has just been admitted to the intensive cardiac care unit. Who should assess and document the patient's nursing needs?

Nurse who took report on the patient. Nurse who was "assigned to that patient. (working on the CVICU)

Why are prelitigation panels used in medical malpractice cases?

Prelitigation panels are a separate mechanism for ensuring the appropriateness of causes of actions. Ensure that there is actually a controversy. They exist to prevent against frivolous lawsuits and expedite the trial process. Sometimes malpractice suits can take 3-6 years after the injury and often this process expedites it to 6-12 months.

In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor?

Professional Judgement- Courts expect nurses and healthcare providers to use their professional judgement before blindly following written policy and procedures OR There are internal standards (set by institutions) and standards can be specified to specialty practice areas.

In a professional liability insurance policy which person or group is considered the policyholder?

Professional liability insurance protects nurses against lawsuits that arise from real or alleged errors or omissions, including negligence, in the course of delivering nursing care in clinical settings. A policy holder is the insured party or the person who owns the insurance plan

Criminal charges have been brought against a nurse who made a medication error that resulted in a child's death. Which level of evidence is expected in this case?

Proof beyond a resonable doubt. Civil law: no fine or imprisonment; injured parties collect money damages from the individuals who have harmed them. The most important area of law to the nurse is tort law (a form of civil law) that involves compensation to those wrongfully injured by others' practices; normally involved in medical malpractice claims Criminal law: conduct that is offensive or harmful to society as a whole, crimes viewed as offenses against the state rather than against individuals The same action by a given individual may be the basis for both a civil lawsuit and a criminal wrong. For example: if a nurse removes a ventilator-dependent patient from a ventilator and the pt. dies, the state board of nursing may revoke the nurse's license to practice nursing (a criminal action), and the family may file a wrongful death suit (a civil suit) against the nurse. Answer: For a criminal charge, proof beyond a reasonable doubt is required

The plaintiff was injured by a defective intravenous catheter. In order to win a product liability case, what must the plaintiff prove first?

Prove there has been a sale of the prodcut rather than a mere delivery of a service. Products liability does not exist if there is no sale of a product.

An employee asks for time off to be a juror in a case before the state appellate court. How should the nurse manager respond to this request?

State appellate courts do not rehear the entire trial but base their decisions on evidence as presented in a record of the trial hearing. There are NO WITNESSES, NEW EVIDENCE OR JURORS. (p. 44) (However, in other cases, when jury duty was necessary, the nurse manager must allow the employee the time off. This is required by law. Make sure to let the employer know well in advance, as soon as you receive your summons OR The employer must grant time off to serve jury duty, however unless the employee is a government employee, employers are not generally required to pay salaries during the time the employee is serving jury duty.

The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, "I'll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot." What action should be taken by the nurse?

Stop the team and inform the physicain that informed consent in lacking. Patient is unaware of amputation above the knee. Nurses have an obligation to inform the primary health care provider that informed consent is lacking. Contacting both the immediate supervisor and the primary health care provider can do this. It is the nurse's legal duty to investigate the situation. The nurse must first review the paperwork with an open min to the possibility that the paperwork could be wrong and the oral comments of the patient correct. If the paperwork does not match what the patient is saying, the nurse has the duty to contact the physician and explain the issue. Also, all efforts to correct the situation must be noted in the patient's record.

The probate court has the right to hear cases concerning wills and estates. Which kind of jurisdiction is this?

Subject-matter jourisdiction- which refers to the court's competency to hear and to determine a given case within a particular class of cases. For example, a court may have jurisdiction only in cases that involve probate matters (wills and estates), family matters (adoptions, divorces and child custody), or criminal matters.

What does the court consider in determining the nurse's legal liability for standards of care?

The court considers what a reasonable prudent nurse with like experiences and education would do in under the similar conditons in the same community OR Six elements that assist in determining whether an action is negligence or malpractice: 1.The injury is treatment-related or caused by a dereliction of professional skill 2.Expert evidence is required to determine whether the appropriate standard of care was breached 3.The act or omission involved an assessment of the patient's condition 4.The incident occurred in the context of the health care provider-patient relationship or was within the scope of activities a hospital or other care facility is licensed to perform 5.The injury occurred because the patient sough treatment 6.The act of omission was unintentional

The circumstances of a lawsuit cause it to be under the jurisdiction of more than one court. In this case, which court has the greatest personal jurisdiction?

The court nearest to ther preson's residence (court situated in county of defendant would have personal jurisdiction over defendant; court situated in county of plantiff would also have personal jourisdiction over parties to lawsuit). Basic concept is whether the courts have vested interest in you and a right to make binding decisions over you. OR personal jouristiction refers to the power of a given court regarding a particular perosn. The federal constitution gives guidance for overlapping cases. THe federal courts ahve original jouristiciton over admiralty cases, crimes involving bankruptcy and patient lass. The U.S. constitution gives the U.S. Supreme Court jourisdiction over cases "involving ambassadors, other public ministers and counsuls and those in which a state is named a party"

A nurse brings suit against the hospital after being terminated for excessive absenteeism. Who is the defendant in this lawsuit?

The hospital. A defendant is the answering party, who ansers to the plantiff

Which person would best qualify as an expert in a nursing malpractice case filed because of failure of a postanesthesia care unit nurse to recognize the early signs and symptoms of respiratory arrest?

The minimum credential for a nurse expert witness is current licensure to practice professional nursing within a state or territory, Other criteria for selection include total lack of involvement with the defendants either as an employee or consultant, clinical expertise in the area of nursing at issue, certification in the clinical area if possible, and recent continuing or formal education relevant to the specialty of nursing at issue. Ideally, the expert witness should also have earned graduate degrees and authored publications in nursing. (p. 67) A nurse anesthetist would be a good expert in this case.

The nurse has a strong religious conviction against elective sterilization procedures. When seeking employment, how should the nurse handle this belief?

The nurse does not have to bring this up during the employment process but if the situation presents itself, the nurse should know that under the civil rights act your employment cannot be affected due to religious beliefs- so you should be sure to inform your nurse manager and request that you not be assigned to such a case following employment. According to the Code of Ethics for Nurses

The nurse is preparing a patient for a procedure. The patient has signed a consent form, but states, "I don't really know anything about this procedure. I wonder if there is something else I could do instead?" How should the nurse proceed?

a. Obligated to inform the primary health care provider that informed consent is lacking. Can be done by contacting the immediate supervisor and the primary health care provider.

Punitive damages of one million dollars were awarded to the family of a patient who died following a nursing medication error. What is true of these punitive damages?

a. Punitive (or exemplary) damages may be awarded if there is malicious, willful, or wanton misconduct b. The plaintiff must show that the defendant acted with conscious disregard for his/her safety c. Punitive damages are usually considerable and are awarded to deter similar conduct in the future

In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do?

a. Report to immediate supervisor and the treating physician. Document all information in pt's chart. If fail to report can be held liable for subsequent injuries.

When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse's best defense for applying restraints?

a. Self-defense and defense of others: if pt is combative and threat to self and others nurse is justified in restraining the patient without order for restraints.

In which instance is the performance of nonemergency medical treatment for a minor permissible without parental consent?

a.Dx & tx of infectious, contagious, or communicable diseases. b.Dx & tx of drug dependency, drug addiction, or any condition directly related to drug usage c.When obtaining birth control devices d.With tx during a pregnancy as long as the care concerns the pregnancy e.With medical care for a child

Which statement best explains the importance of electronic medical record use?

increases accurate recordings of facts and allows for prompt charting. With EMRs, documentation is readily available and easy to retrieve, review, and amend as needed. Data can be viewed and edited by all members of the health care team on site or at a remote location. a.Increases accurate recording of facts and allows for prompt charting. b.Most systems prompt the nurse if a portion of the nursing process is omitted c.Necessary test and laboratory results can be instantly available

The nurse holds national certification as a wound care specialist and works in a small, rural hospital. What standard of skill and care applies to this nurse's practice?

national standards, internal standards, specialist standards, and specialist standard of care. THE SAME FOR ALL!

A lawsuit is brought against a nurse in a rural hospital. The nurse replies that the standard of care for rural nurses is different from that for nurses working in large urban facilities. Is this a defensible position?

no, due to national standards of care. Patients have the right to quality care everywhere. However, internal standards of care for the institution are taken into consideration.

The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse, what is the status of the nurse's license?

she is expected to follow the guidelines of each state- if she loses licensure in 1 state I believe she losses it in all of the states? "The states of residence acts against the license per se, using probation, suspension, or revocation as its mechanisms of action and the remote state acts against the practice privilege granted by the compact by limiting or stopping the practice with a cease and desist order. The effects of both states are essentially the same • The compact ensures that the nurse is properly licensed in the state of residence or "home state" • Other states where the compact is in effect and where the nurse practices but does not live are called remote states • The state of residence acts against the license per se, using probation, suspension, or revocation as its mechanisms of action, and the remote state acts against the practice privilege granted by the compact by limiting or stopping the practice with a cease-and-desist order • Nurses could be required to bear the cost of investigation and disciplinary proceedings in all states involved with the incident

What is the most important driving force behind the movement for multistate licensure?

technology- telehealth- allows nurses to provide care across multiple states

Unlicensed personnel are not licensed by the state in their own right. Why is it that these persons can perform delegated tasks?

these UAP are able to practice because the "practice on the license of the delegator. Remember that only those with a license are at risk to lose it." •These persons work under the auspices and license of the institution, not the professional nurse •The organization must ensure sufficient staffing so that professional staff members may appropriately delegate patient care tasks •There should be an institutional mechanism for consistent and adequate orientation and training of UAPs: oPatient care responsibilities should be well delineated, and UAPs must be taught when to inform other personnel of patient data or untoward happenings oNurses should know that they have a responsibility for safe delegation of tasks (within scope of practice of UAP), appropriate follow-up, and to inquire about expected outcomes •Supervision is one of the keys to ensuring that proper delegation with UAPs results in positive and competent patient care

The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor?

• A written complaint should be filed with the state board of nursing by an individual, a health care agency, or a professional organization • The complaint is screened and an investigation is initiated, if appropriate • Board hearing is scheduled, nurse is entitled to a clear statement, produce a witness, attorney, and a fair determination

Which situation is probable grounds for disciplinary action against a nurse's license?

• Conviction of a felony or crime involving moral turpitude (an action contrary to justice, honesty, modesty, or good moral principles) • Use of fraud or deceit in obtaining licensure • Violation of the provisions of the nurse practice act • Aiding or abetting any unlicensed person with the unauthorized practice of nursing • Revocation, suspension, or denial of licensure to practice nursing in another jurisdiction • Habitual use of, or addiction to, alcohol or drugs • Unprofessional conduct that is likely to deceive, defraud, or injure the public or patients • Lack of fitness by reason of physical or mental health that could result in injury to the public or individual patients

As a part of a malpractice case, the hospital has decided to bring an indemnity claim against a nurse. What is the implication to the nurse?

• Indemnity claims are those brought by the employer for monetary contributions from the nurse whose actions or failure to act caused the original patient injury. The hospital policy will not cover the nurse nor will it pay for his/her legal representation.

Which situation supports the charge of malpractice against a professional nurse?

• Malpractice, sometimes referred to as professional negligence, is a specific term that addressed a professional standard of care as well as the professional status of the caregiver. Any professional misconduct, unreasonable lack of skill, or fidelity in professional or judiciary duties. • Malpractice is the failure of a professional person to act in accordance with the prevailing professional standards or failure to foresee consequences that a professional person, having the necessary skills and education, should foresee. • Most common categories of malpractice among nurses are the failure to: o Follow standards of care o Use equipment in a responsible matter o Communicate o Document o Assess and monitor o Act as a patient advocate • Standards of care are referenced in malpractice cases against nurses to show they breached the duty of care owed to the patient. Six elements must be shown in malpractice lawsuits: 1. Duty owed the patient-Incorporates both the obligation as well as the level of the obligation ex. Failing to monitor the patient 2.Breach of duty owed the patient-Involves showing a deviation from the standard of care owed to the patient ex. Failing to report a change in patient status 3.-Foreseeability-The concept that certain events may reasonably be expected to cause specific outcomes ex. Failing to report another health care provider's incompetence 4.Causation-The injury caused to the patient must be a direct result of the breach of duty owed to the patient and may be subdivided into cause-in-fact and proximate cause Ex. Failing to provide for the patient's safety 5.Injury- Involves some type of physical, financial, or emotional harm that occurred as a result of the breach of duty owed the patient ex.Allowing a patient to be burned 6.Damages -Failing to question an inappropriate medical order Can be subdivided into four categories: General damages-Using equipment incorrectly Special damages-Failing to follow ordered treatments . Emotional damages- Failing to provide patient education and discharge instructions Punitive or exemplary damages- Acting in a manner that wholly disregards the patient's safety

In which instance can a 13-year-old patient give consent for treatment?

• The emergency doctrine applies—the need for treatment is too urgent for a parent to be contacted and asked to give consent • The child is an emancipated (no longer under parent's control and regulation and who are managing their own financial affairs) or mature minor (between the ages of 14 and 17 who is able to understand the nature and consequences of the proposed therapy and who independently makes his or her own decisions on a daily basis) •The law recognizes the minor as having the ability to consent to the therapy

What is the major ethical concern of an expert witness?

• The nurse often only gets to review medical records and other reports that comprise the written record of the occurrence or event, and they have to presume that they are all accurate. • How does one proceed if the records and reports clearly show that the interventions were inappropriate or that the minimal standard of care was barely completed by those involved in the incident • What obligations does the expert witness have to disclose such finding to the attorney representing the defendants? • The nurse knows that nursing is not an exact science and that human factors often intervene so how does one begin to explain these unexpected outcomes in a way that does not create liability or prejudice a patient who should be compensated for untoward outcomes. • You have to tell the "whole truth" not just the truths that will help your client.

Which statement best describes the rule regarding expert testimony in nursing malpractice cases?

• To testify as an expert in a health care malpractice lawsuit, a witness must be practicing health care in a field that involves the same type of care or treatment and must have knowledge of the accepted standards of care. o A physician can testify against a nurse if they are familiar with nursing standards of care. o The role of an expert witness is explained highly specialized technology or skilled nursing care to the jurors. o Expert testimony is required when conclusions by a jury depend on facts and scientific info that is more than common knowledge. o The nurse must have expertise in the specific of the care in question o Minimum requirement: current licensure to practice professional nursing within a state or territory. o Other requirements total lack of involvement with the defendants either as an employee or consultant, clinical expertise in the area of nesting at issue, certification in the clinical area if possible, and recent CEUs to the specialty of nursing at issue. o It's the role of the judge to decide whether an expert witness is qualified for the specific case.

The charge nurse is aware that some staff nurses routinely "short-cut" assessment activities for long-term patients. In case of a negative patient outcome related to this practice, does the charge nurse hold any liability?

• Yes: team leaders/nurse-managers have a duty to ensure that staff members under their supervision are practicing in a competent manner Yes Page 373. "Effective discipline is a vital part of the nurse manager's/nurse leaders role in supervision and delegation. ...they need to assist persons to perform at their best, improving in areas in which their performance requires improvement and ensuring an acceptable level of competent productivity of the unit."

The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient's death. Does the preceptor hold any liability in this case?

•No: if it can be shown that the team leader/nurse-manager delegated tasks appropriately and has no reason to believe that the individual to whom the task was delegated was anything but competent to perform the task, the delegator will be judged to have no personal liability oTeam leaders/nurse-managers are not liable merely because they have a supervisory function oThe doctrine "knew or should have known" becomes a legal standard in delegating tasks to licensed or unlicensed individuals whom one supervises a. According to the rule that the RN delegator should know the competencies of the professional that they are delegating to and should also be responsible and accountable for their actions the preceptor can hold some of the liability. b. "The ANA scope of practice mandates that the nurse assigns or delegates tasks based on the individual needs of the patient, THE COMPLEXITY OF THE TASK, the predictability of the outcome and the abilities of the staff person to whom the task is being delegated." Page 374