2101 Final - Legal Principals in Nursing

A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells the client that diapers will be used next time the urinal is used improperly. Which of the following torts is the AP committing? a. assault b. battery c. false imprisonment d. invasion of privacy

A By threatening the client, the AP is committing assault. The AP's threat could make the client become fearful and apprehensive.

A patient falls out of bed because the nurse did not raise the side rails. Which action did the nurse commit? a. Felony b. Assault c. Battery d. Negligence

ANS: D Negligence is conduct that falls below the generally accepted standard of care of a reasonably prudent person. A felony is a serious offense that has a penalty of imprisonment for greater than a year or possibly even death such as practicing nursing without a license. Assault is any intentional threat to bring about harmful or offensive contact with another individual. Battery is any intentional touching without consent.

A nurse is caring for a client who is about to undergo an elective surgical procedure. The nurse should take which of the following actions regarding consent? (Select all that apply) a. Make sure the surgeon obtained the client's consent b. Witness the client's signature on the consent form. c. Explain the risks and benefits of the procedure. d. Describe the consequences of choosing not to have the surgery. e. Tell the client about alternatives to having the surgery.

A, B It is the nurse's responsibility to verify that the surgeon obtained the client's consent and that the client understands the information the surgeon gave them. It is the nurse's responsibility to witness the client's signing of the consent form, and to verify that they are consenting voluntarily and appear to be competent to do so. The nurse also should verify that the client understands the information the surgeon has provided.

The nurse is caring for a patient who refuses to cooperate for a dressing change. The nurse tells the patient that he or she will tie the patient down if the patient does not hold still. Which action did the nurse commit? a. Assault b. Unintentional tort c. Battery d. Felony

ANS: A Assault is an intentional threat toward another person that gives that person a reasonable fear of harmful contact. No actual contact is required for an assault to occur. An example of an assault in nursing practice is to threaten to restrain a patient for an x-ray procedure when the patient has refused consent. Battery is intentional offensive touching without consent or lawful justification. Negligence is an unintentional tort. A felony is a serious offense that results in significant harm to another person or society in general, like misusing controlled substances.

When a nurse suspects child abuse or neglect, which action must the nurse take? a. Report it to the proper legal authority. b. Inform the parents that their actions are illegal. c. Call the security department to handle the problem. d. Prevent the parents from seeing the child during hospitalization.

ANS: A Health care providers are required to report incidents such as child, spousal, or elder abuse; rape; gunshot wounds; attempted suicide; and certain communicable diseases. Health care providers are provided legal immunity if the report is made in good faith. Not reporting suspected child abuse or neglect can cause a nurse to be liable in civil or criminal legal actions. It is not the nurse's responsibility to inform the parents of illegal activity or to prevent the parents from seeing the child. The nurse is responsible for reporting the suspected abuse, not call security to handle the problem.

A nurse is maintaining precise records regarding the dispensing, wasting, and storage of a drug that is securely locked. Which drug is the nurse administering? a. Routine medication b. Controlled substance c. Over-the-counter medication d. Substance not requiring an order

ANS: B Controlled substances are securely locked away, and only authorized personnel have access to them. Maintain precise records regarding the dispensing, wasting, and storage of controlled substances. There are criminal penalties for the misuse of controlled substances. Routine and over-the-counter drugs are not controlled substances. Controlled substances required an order by a licensed physician or in some states advanced practice nurses.

Only one nurse was scheduled to care for 12 postsurgical patients with a nursing assistant. The nurse is concerned for the safety of the patients and the nursing license. What is the most appropriate first step in this situation? a. Contacting the nursing supervisor and documenting the action b. Refusing to care for the patients without appropriate help and leaving c. Contacting the State Board of Nursing and documenting the action d. Contacting the hospital administrator on call to complain and documenting the action

ANS: A If a nurse is assigned to care for more patients than is reasonable for safe care, he or she should notify the nursing supervisor. If the nurse is required to accept the assignment, he or she must document this information in writing and provide the document to nursing administrators. Although documentation does not relieve a nurse of responsibility if patients suffer harm because of inattention, it shows that the nurse attempted to act appropriately. Refusing to care for the patients without appropriate help and leaving could be regarded as abandonment. Complaining to the administrator is not the first step, nor is calling the Board of Nursing.

A nurse completes an occurrence report. Which is the best way for the nurse to document this occurrence? a. "Patient found lying on right side on floor. No noted injuries, patient stated, 'I slipped on a wet spot on the floor. I don't think I am injured.'" b. "Patient slipped on a wet spot on the floor. No noted injuries, physician notified." c. "Patient in too much of a hurry and was walking too fast and fell. Was not injured. Patient instructed to slow down and not be in such a hurry. Health care provider notified." d. "Patient fell while going outside to smoke. Patient denied any injuries. Health care provider notified. Patient counseled."

ANS: A Objectively record the details of the event and any statements the patient makes. An example is as follows: "Patient found lying on floor on right side. Abrasion on right forehead. Patient stated, 'I fell and hit my head.'" Patient slipped on wet spot and patient fell while going outside should not be charted unless the nurse actually observed the event; otherwise, chart what found: Patient lying on floor. Patient in too much of a hurry includes subjective assumptions and statements; assigning blame or fault is inappropriate when completing the report.

A patient died from suspicious circumstances. What should the nurse do next? a. Notify the coroner. b. Notify the newspaper. c. Chart what the nurse thinks happened. d. Chart opinions from the health care staff.

ANS: A State statutes specify that, when there are reasonable grounds to believe that a patient died as a result of violence, homicide, suicide, accident, or death occurring in any unusual or suspicious manner, you need to notify the coroner. Notifying the newspaper would break confidentiality. Charting must be objective and factual, not what the nurse thinks happened or opinions.

To establish the elements of malpractice against a nurse, which must be proved by the patient? a. The patient must have been harmed as a result of the injury. b. The patient must have paid for the health care services. c. The patient must show evidence of malicious intent. d. The patient must demonstrate personal accountability.

ANS: A To establish the elements of malpractice, the patient or plaintiff must prove the following: (1) the nurse defendant owed a duty to the patient, (2) the nurse breached that duty, (3) the patient was injured because of the nurse's breach of duty, and (4) the patient has accrued damages as a result of the injury. The patient paying, showing evidence of malicious intent, and demonstrating personal accountability are not elements of malpractice.

A nurse is about to administer a medication and notices that the physician's or primary health care provider's order looks incorrect regarding the amount of the medication. What should the nurse do? (Select all that apply.) a. Notify the physician or health care provider. b. Do not carry out the order. c. Document the suspicion that the dosage is incorrect. d. Administer the medication. e. Notify the supervisor or nurse manager.

ANS: A, B, E Nurses are responsible for carrying out medical treatment unless the physician's or health care provider's order is in error, violates hospital policy, or is harmful to the patient. Therefore it is imperative to assess all orders and, if they appear to be erroneous or harmful to the patient, to obtain further clarification from the physician or health care provider. Do not carry out the order if there is a risk that harm will come to your patient; therefore do not administer the medication. Inform the nurse manager or the nursing supervisor. The nurse does not document suspicions or opinions, just objective, factual information.

A nurse wants to follow the American Nurses Association's Social Media Policy (2011). Which actions should the nurse take? (Select all that apply.) a. Never name or describe a patient. b. Never have a blog. c. Never post an image of the patient. d. Never disparage a fellow employee. e. Never report breaches of privacy.

ANS: A, C, D The American Nurses Association has developed a Social Media Policy (2011), which recommends that when using social media sites, a nurse should never name or describe a patient, never post an image of a patient, and never disparage a fellow employee or employer. In addition, the professional nurse has an obligation to report breaches of privacy and confidentiality. Never having a blog is not a recommendation.

Which patient would the nurse consider to be competent to give informed consent? a. A 27-year-old unconscious patient b. A 16-year-old emancipated minor c. A 43-year-old patient who is drunk d. A 33-year-old patient who has been declared legally incompetent

ANS: B Even though an emancipated minor has not achieved the legal age of consent, he or she may give consent for procedures and treatment. If a patient is unconscious, you need to obtain consent from a person legally authorized to give consent on his or her behalf. A patient who is legally incompetent needs to have the consent of a legal guardian, which is determined through a legal proceeding. A person who is drunk cannot fully understand the procedure and cannot sign the consent form.

As part of the admission process the nurse asks if the patient has an advance directive. The patient doesn't know for sure. What is the nurse's best response? a. It is autopsy permission. b. It is a living will. c. It is informed consent. d. It is an organ donation card.

ANS: B Many times the decision regarding lifesaving treatment is in writing in the patient's living will or advance directive. Living wills are documents instructing the health care provider to withhold or withdraw life-sustaining procedures in a patient who is terminally ill. Advanced directives are not an organ donation card, nor informed consent, nor autopsy permission.

Which situation will enable a nurse to use restraints? a. To punish a patient b. To ensure the patient's safety c. To retaliate against poor behavior d. To ensure staff convenience

ANS: B Regulations set the standard that all patients have the right to be free from seclusion and physical or chemical restraints except to ensure the patient's safety in emergency situations. The standards specifically prohibit restraining patients for staff convenience, punishment, or retaliation.

A clinic nurse stopped at an automobile accident to assist. There was one victim who was not breathing. The nurse provided CPR at the scene, but the victim died. The victim's family sued the nurse. Which will provide the best protection to the nurse in this case? a. Clinic's malpractice insurance policy b. Good Samaritan Law c. State Board of Nursing d. Institute of Medicine

ANS: B The Good Samaritan Law protects the nurse because CPR is within a nurse's scope of practice. Although Good Samaritan Laws provide immunity to the nurse who does what is reasonable to save a person's life, if the nurse performs a procedure for which he or she has no training, the nurse will be liable for any injury resulting from that act. Therefore, provide only care that is consistent with your level of expertise. The insurance policy, state boards of nursing, and Institute of Medicine do not provide protection to the nurse under the Good Samaritan Law.

Which behavior is the best way for a nurse to avoid being liable for malpractice? a. Purchasing quality malpractice insurance coverage on a yearly basis b. Practicing nursing that meets the generally accepted standard of care c. Not sharing his or her last name with patients and families d. Not delegating any tasks to unlicensed assistive personnel

ANS: B The best way to avoid being liable for malpractice is to give nursing care that meets the generally accepted standard of care. In a malpractice lawsuit the law uses nursing standards of care to measure nursing conduct and determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances. Purchasing insurance, not sharing last name, and not delegating tasks are not appropriate behaviors to avoid malpractice.

An RN has been caring for a patient. The nurse received an erroneous order for a medication. The primary health care provider has a reputation for impatience and irritability. Knowing this health care provider's nature, which action by the nurse would be most appropriate? a. Clarify the order with the pharmacy. b. Ask the patient to remember. c. Clarify the order with the primary health care provider. d. Ask another nurse to look at the order to try to clarify it.

ANS: C A nurse will assess all physician or health care provider orders, and if the nurse determines they are erroneous or harmful, obtain clarification from that physician or health care provider. Calling pharmacy, asking the patient, and asking another nurse are not the best ways to handle erroneous orders.

Which task can a nurse safely delegate to a student nurse who is working as a nursing assistant? a. Distributing medications to patients b. Administering insulin injections c. Collecting intake and output data d. Assessing patients

ANS: C During the time when a student nurse works as an employee of a health care facility, perform only tasks that appear in a job description for a nurse's aide or nursing assistant. For example, even if a student nurse has learned how to administer intramuscular medications, do not perform this task as a nurse's aide.

Which information indicates the nurse has an accurate understanding of the State Nurse Practice Act? a. It is a federal senate bill. b. It is a law enacted by the federal government. c. It is a statute enacted by state legislature. d. It is a judicial decision.

ANS: C Nurse Practice Acts are examples of statutes enacted by state legislatures to regulate the practice of nursing. Common laws are based on judicial decisions or case law precedent. An example of a judicial decision that guides health care practice is Roe v. Wade, but not the nurse practice act. An example of a federal statute that affects health care practice is the Americans with Disabilities Act, but not the nurse practice act. The nurse practice act is a state law, not a federal senate bill.

A registered nurse was accused of patient abandonment when the nurse became angry, quit the job, and left the hospital before the end of the shift. This is an example of violating legal standards/guidelines set by which organization? a. The State Department of Health b. The Joint Commission c. The State Board of Nursing d. The National League for Nursing

ANS: C Nurse Practice Acts permit the State Board of Nursing to set rules, regulations, and guidelines that specifically define the standard of care in nursing practice. An example is the guidelines that define patient abandonment. The State Department of Health, the Joint Commission, and the National League for Nursing do not set the legal rules and regulations for patient abandonment.

A nurse wants to follow nursing standards of care. Which document should the nurse follow? a. World Health Organization guidelines b. National League for Nursing brochure c. Health care facility's written procedure manual d. Department of Health and Human Services guidelines

ANS: C The health care facility's written procedure manual is defined as a standard of care. Standards of care are defined by the following: (1) State Nurse Practice Acts, (2) state and federal hospital licensing laws and accreditation rules, (3) professional and specialty organizations, and (4) written policies and procedures of the nurse's health care facility. Brochures are not standards of care. World Health Organization and Department of Health and Human Services are not state or federal hospitals or professional and specialty organizations for nurses.

Which information indicates the nurse has an accurate understanding of when the institution's malpractice insurance covers the nurse? a. While driving to work b. While driving home from work c. While tending to people in the neighborhood d. While working within the scope of employment

ANS: D If a nurse works for a health care institution, generally the institution's insurance will cover the nurse during employment. Malpractice insurance usually provides nurses with an attorney, payment of those fees, and payment of any judgment or settlement if a patient sues a nurse for medical malpractice. If a nurse provides care on a voluntary basis outside the health care facility, hospital-provided malpractice insurance would not cover the nurse. The nurse will need to carry additional insurance. Driving to and from work is not malpractice.

A registered nurse is caring for a patient 2 days after a colon resection. The patient called for assistance to go to the bathroom. Instead of waiting for help, the patient decided to get up without help. The patient fell but was not injured. After contacting the patient's primary health care provider, which action should the nurse take next? a. Nothing; the patient was not injured. b. Call the ethics committee. c. Submit an incident report. d. Insist that the patient have a radiograph done.

ANS: C When there is a deviation from the standard of care, such as a patient or visitor falls or an error is made, a nurse makes specific documentation of the event or incident in the form of an occurrence/incident report. The nurse should complete an occurrence report when anything unusual happens that could potentially cause harm to a patient, visitor, or employee. Just because the patient was not injured does not mean the report can be neglected. The health care provider orders follow-up care or treatment when necessary, not the nurse. The ethics committee is involved in ethical dilemmas, not occurrence/incident reports.

A nurse must ask a family member to consider an organ donation. In which order should the nurse contact the individuals? a. Spouse b. Parent c. Guardian d. Grandparent e. Adult son or daughter f. Adult brother or sister a. a, c, e, f, b, d b. a, e, f, b, d, c c. a, e, b, f, d, c d. a, b, e, f, d, c

ANS: C You approach individuals in the following order to consider organ or tissue donations: (1) spouse, (2) adult son or daughter, (3) parent, (4) adult brother or sister, (5) grandparent, and (6) guardian.

An RN suffers from chronic back pain that was the result of an injury suffered when pulling a patient up in bed. The nurse is addicted to pain medication and has recently been accused of stealing narcotics. This is an example of which violation of the law? a. Misdemeanor b. Tort c. Malpractice d. Felony

ANS: D A felony is a serious offense that results in significant harm to another person or society in general. Felony crimes may carry penalties of monetary restitution, imprisonment for greater than 1 year, or death. Examples of Nurse Practice Act violations that may carry criminal penalties include practicing nursing without a license and misuse of controlled substances. A misdemeanor is a crime that, although injurious, does not inflict serious harm. Torts are civil wrongful acts or omissions against a person or a person's property that are compensated by awarding monetary damages to the individual whose rights were violated. Malpractice is an example of negligence, sometimes referred to as professional negligence. The law defines nursing malpractice as the failure to use the degree of care that a reasonable nurse would use under the same or similar circumstances.

Which example demonstrates a breach of confidentiality and a violation of the Health Insurance Portability and Accountability Act (HIPAA) of 1996? a. Giving a report to the oncoming nurse in a conference room b. Discussing a patient's diagnosis with the patient's health care provider c. Providing patient information to the nursing assistant caring for the patient d. Sharing with other nurses in the cafeteria that a patient is HIV positive

ANS: D Although HIPAA does not require such things as soundproof rooms in hospitals, it does mandate that nurses and health care providers avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any matter. Issues of disclosure, privacy, and confidentiality are important concerns when working with patients or peers infected with blood-borne illnesses such as human immunodeficiency virus (HIV) or acquired immunodeficiency virus (AIDS), hepatitis, and sexually transmitted illnesses. Providing continuity of care, giving reports, talking to the health care provider, and providing information to the nursing assistant do not violate HIPAA.

A patient is confused and is attempting to get out of the hospital bed. The nurse is tired after working for more than 10 hours and is concerned for the patient's safety. What is the best action that the nurse should take to prevent the patient from harm? a. Restrain the patient with wrist restraints. b. Place the patient with a belt restraint in a chair. c. Sedate the patient with medication. d. Ask a family member to sit with the patient.

ANS: D Asking a family member to sit with the patient is the best answer because it does not restrain the patient physically or chemically. The Joint Commission has set guidelines for the use of restraints in hospitals. These regulations set the standard that all patients have the right to be free from seclusion and physical or chemical restraints except to ensure the patient's safety in emergency situations. The standards specifically prohibit restraining patients for staff convenience, punishment, or retaliation.

Which chart entry by a nurse would require follow up? a. 0815 Patient found on floor. b. 0816 Patient assessed and helped back to bed. c. 0818 Physician notified of incident. d. 0820 Occurrence report completed.

ANS: D Do not document in the nurses' notes that an occurrence report was completed. All the other entries are accurate. Objectively record the details of the event and any statements the patient makes. At the time of the event, always assess the patient thoroughly, and then contact the health care provider to examine him or her.

What is the nurse's best proof against malpractice? a. The nurse supervisor's memory of the event b. Recorded documentation written carelessly c. The nurse's memory of the event d. Recorded documentation of nursing care

ANS: D Documentation of nursing care is the only record of what actually was done for a patient and will serve as proof that a nurse acted reasonably and safely. Nursing notes written at the time of the event, are seen as better evidence of the facts of the event than any one person's memory. Nurses' notes written carelessly and without regard to detail or hospital standards of documentation do not reflect well on the health care provider's credibility or appearance of accountability to a judge or jury.

Which action is the nurse required by law to perform when a patient is admitted? a. Notify the family. b. Notify the attorney. c. Ask how payment will be made. d. Ask about advance directives.

ANS: D The Patient Self-Determination Act (1991) requires health care institutions to inquire whether a patient has created an advance directive, give patients information on advance directives, and document whether a patient states that he or she has an advance directive. Notifying the family and attorney is breaking confidentiality. Asking how payment will be made is not required by law and is not the responsibility of the nurse.

A student nurse must pass the NCLEX® before practicing as a registered nurse. NCLEX® stands for __________ Examination. a. Nursing Council of Licensing b. Nightingale Code of Licensure c. Nursing Code of Licensure d. National Council Licensure

ANS: D To be licensed in a state, a nurse must have a passing score on the National Council Licensure Examination (NCLEX) to obtain the initial license and meet the educational requirements set by the state. Nursing Council of Licensing, Nightingale Code, and Nursing Code examinations do not exist to practice as a nurse.

A nurse is caring for a competent adult client who tells the nurse, "I am leaving the hospital this morning whether the doctor discharges me or not." The nurse believes that this is not in the client's best interest, and prepares to administer a PRN sedative medication the client has not requested along with the schedules morning medication. Which of the following types of tort is the nurse about to commit? a. assault b. false imprisonment c. negligence d. breach of confidentiality

B Administering a medication as a chemical restraint to keep the client from leaving the facility against medical advice is false imprisonment, because the client neither requested nor consented to receiving the sedative.

A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, the nurse was found asleep in a chair in the break room not during a break time. Which of the following actions should the nurse take? a. Alert the American Nurse Association b. Fill out an incident report c. Report the observation to the nurse manager on the unit d. Leave the nurse alone to sleep

C Any nurse who notices behavior that could jeopardize client care or could indicate a substance use disorder has a duty to report the situation immediately to the nurse manager.

A nurse in a surgeon's office is providing preoperative teaching for a client who is scheduled for surgery the following week. The client tells the nurse that he will prepare his advance directives before he goes to the hospital. Which of the following statements made by the client should indicate to the nurse an understanding of advance directives? A. "I'd rather have my brother make decisions for me, but I know it has to be my wife." B. "I know they won't go ahead with the surgery unless I prepare these forms." C. "I plan to write that I don't want them to keep me on a breathing machine." D. "I will get my regular doctor to approve my plan before I hand it in at the hospital."

C The client has the right to decide and specify which medical procedures he wants when a life-threatening situation arises.

A nurse observes an assistive personnel (AP) reprimanding a client for not using the urinal properly. The AP tells the client that diapers will be used next time the urinal is used improperly. Which of the following torts is the AP committing? a. Assault b. Battery c. False imprisonment d. Invasion of privacy

a. Assault

A nurse is caring for a client who is about to undergo an elective surgical procedure. The nurse should take which of the following actions regarding informed consent? (Select all that apply.) a. Make sure the surgeon obtained the client's consent. b. Witness the client's signature on the consent form. c. Explain the risks and benefits of the procedure. d. Describe the consequences of choosing not to have the surgery. e. Tell the client about alternatives to having the surgery.

a. Make sure the surgeon obtained the client's consent. b. Witness the client's signature on the consent form.

A nurse is caring for a competent adult client who tells the nurse, "I am leaving the hospital this morning whether the doctor discharges me or not." The nurse believes that this is not in the client's best interest, and prepares to administer a PRN sedative medication the client has not requested along with the scheduled morning medication. Which of the following types of tort is the nurse about to commit? a. Assault b. False imprisonment c. Negligence d. Breach of confidentiality

b. False imprisonment

A nurse in a surgeon's office is providing preoperative teaching for a client who is scheduled for surgery the following week. The client tells the nurse that "I plan to prepare my advance directives before I come to the hospital." Which of the following statements made by the client should indicate to the nurse an understanding of advance directives? a. "I'd rather have my brother make decisions for me, but I know it has to be my wife." b. "I know they won't go ahead with the surgery unless I prepare these forms." c. "I plan to write that I don't want them to keep me on a breathing machine." d. "I will get my regular doctor to approve my plan before I hand it in at the hospital."

c. "I plan to write that I don't want them to keep me on a breathing machine."

A nurse has noticed several occasions in the past week when another nurse on the unit seemed drowsy and unable to focus on the issue at hand. Today, the nurse was found asleep in a chair in the break room not during break time. Which of the following actions should the nurse take? a. Alert the American Nurses Association. b. Fill out an incident report. c. Report the observations to the nurse manager on the unit. d. Leave the nurse alone to sleep.

c. Report the observations to the nurse manager on the unit.