Chapter 23 Legal Implications in Nursing Practice
What should the nurse do to avoid malpractice and the resulting professional negligence? Select all that apply. 1 Strictly follow the given standards of care. 2 Regularly update current nursing knowledge. 3 Properly document all assessments and interventions. 4 Avoid explaining medical procedures to patients. 5 Complete health documentation at the end of the shift.
1, 2, 3 As a rule, nurses should follow given standards of care to avoid malpractice. Regularly updating current nursing knowledge keeps nurses well informed of the latest medical knowledge and techniques and health care policies and laws. Properly documenting all assessments, interventions, and evaluations is necessary for future reference and communication with other healthcare team members. Nurses should clearly explain medical procedures to patients and obtain consent when necessary. Health documentation should be completed at the right time to ensure timely communication to other healthcare team members and to avoid negligence.
The nurse is caring for a patient who recently had coronary bypass surgery. Which legal sources of standards of care should the nurse use to deliver safe healthcare? Select all that apply. 1 Information provided by the nurse manager 2 Policies and procedures of the employing hospital 3 State Nurse Practice Act 4 Regulations identified in The Joint Commission's manual 5 The American Nurses Association standards of nursing practice
2, 3, 4, 5 Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.
A nursing student is learning about the role of the State Board of Nursing. Which are functions of the State Board of Nursing? Select all that apply. 1 Provides for the rights of patients and protects employees 2 Gives nursing home residents the right to be free of restraints 3 Can suspend the license of the nurse who violates licensing provisions 4 Licenses all registered nurses in the state in which they practice 5 Has to follow due process before revoking or suspending a license
3, 4, 5 The State Board of Nursing can suspend or revoke a license if the nurse's conduct violates provisions in the licensing statute. The State Board of Nursing is the governing body and issues licenses to all registered nurses in the state in which they practice. The State Board has to follow due process before revoking or suspending a license; nurses must be notified of the charges against them and be given an opportunity to defend themselves in a hearing. The rights of patients and protection of employees were formulated under the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The right of residents of registered nursing homes to be free of restraints was granted by the Federal Nursing Home Reform Act (1987).
A woman who is a Jehovah's Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The healthcare provider ordered two units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood. What is the nurse's responsibility? 1 Obtain a court order to give the blood. 2 Coerce the husband into giving the blood. 3 Call security and have the husband removed from the hospital. 4 Abide by the husband's wishes and inform the healthcare provider.
4 Adult patients such as those who are Jehovah's Witnesses are able to refuse treatment for personal religious reasons.
A patient is brought to the hospital after a motor vehicle accident. Which law makes it mandatory for the healthcare facility to provide emergency care to patients before transferring them to other hospitals? 1 Good Samaritan Law 2 Mental Health Parity Act 3 Americans with Disabilities Act 4 Emergency Medical Treatment and Active Labor Act
4 The Emergency Medical Treatment and Active Labor Act states that a patient who is brought to the emergency room of any hospital should be stabilized before being transferred. The Good Samaritan Law protects people who provide help or first aid to victims with good intention. The Mental Health Parity Act forbids health plans from placing lifetime or annual limits on mental health coverage. The Americans with Disabilities Act protects the rights of people with physical or mental disabilities.
The nurse is assessing a postsurgical patient who is in acute pain. The patient is not willing to change position for x-rays. The nurse tells the patient that a sedative injection will be administered if the patient does not cooperate for the procedure. Which tort is indicated? 1 Assault 2 Battery 3 Invasion of privacy 4 False imprisonment
1 Assault places an apprehensive patient within harmful or offensive contact without consent. In this case, the nurse is threatening to give sedative injections if the patient does not cooperate with the procedure. This is an example of an assault on the patient. Battery is intentional touching without consent. Invasion of privacy refers to the unwanted intrusion into the private affairs of the patient. False imprisonment is an intentional tort in which a patient is restrained without a legal warrant.
Which is an example of statutory law? 1 Americans with Disabilities Act 2 Laws about the patient's right to refuse treatment 3 Laws about acquiring informed consent from the patient 4 Laws about the need to report unethical nursing conduct to the State Board of Nursing
1 Americans with Disability Act is the statutory law passed by the United States Congress. Laws about the patient's right to refuse treatment and acquiring informed consent from the patient are examples of common law in nursing. These laws are made in courts when individual legal cases are decided. Laws about the need to report unethical nursing conduct to the State Board of Nursing are a type of regulatory law. These laws reflect decisions made by administrative bodies when they pass rules and regulations.
Which essential criteria are used to establish nursing malpractice? Select all that apply. 1 The nurse owed a duty to a patient. 2 The nurse followed the instructions given for a patient. 3 The nurse did not follow an ordered intervention for a patient. 4 The nurse conveyed appropriate discharge instructions to the patient. 5 The nurse's failure to carry out the duty caused an injury to the patient.
1, 3, 5 If the nurse owed a duty to a patient, did not perform the given duty, and if failure to perform that duty caused injury to the patient, then the nurse could be liable for nursing malpractice. Following the given instructions for a patient and conveying appropriate discharge instructions are both examples of good and ethical nursing practice. These actions would not make the nurse liable for nursing malpractice.
Which actions, if performed by a registered nurse, would result in both criminal and administrative sanctions against the nurse? Select all that apply. 1 Taking or selling controlled substances 2 Refusing to provide healthcare information to a patient's child 3 Reporting suspected abuse and neglect of children 4 Applying physical restraints without a written physician's order 5 Administering the wrong medication to the patient
1, 4 The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a healthcare provider based on Joint Commission and Medicare guidelines. Refusing to provide healthcare information to a patient's child, reporting suspected abuse and neglect of children, and administering the wrong medication to a patient would not result in both criminal and administrative sanctions against the nurse.
The nurse is caring for a 6-year-old child with hypovolemic shock. The child is a Jehovah's Witnesses. The child needs an immediate blood transfusion, but the child's parents refuse to provide consent. Which would be the most appropriate action? 1 Administer blood to the child. 2 Administer intravenous fluids. 3 Provide oral hydration and nutrition. 4 Seek court order for blood transfusion.
1 Jehovah's Witnesses is a cultural and religious group that refuses blood transfusions based on their religious beliefs. According to the Durable Power of Attorney for Health Care (DPAHC) document, the court will grant an order allowing hospitals and healthcare providers to treat children of Christian Scientists or Jehovah's Witnesses who have denied consent for treatment of their minor children. Therefore, to save the life of the child it is most appropriate for the health care provider or nurse to administer blood to the child. Refusing a blood transfusion in the case of hypovolemic shock would most likely result in the death of the child. Administering only intravenous fluids may not help, because the child is in hypovolemic shock. Oral hydration and nutrition will not be sufficient to resuscitate a child who has had severe blood loss. The court will allow the healthcare providers to resuscitate the child; thus the medical personnel need not seek or wait for court orders.
The nurse wraps and ties a cloth to prevent bleeding from the site of injury for a patient who is a victim of a traffic accident. The patient is taken to the hospital and presents with signs of infection. Which action will be taken against the nurse? 1 The nurse will not face any action. 2 The nurse will be given a warning for gross negligence. 3 The nurse will face liable charges for not getting an informed consent. 4 The nurse will be sued for not obtaining orders from the primary healthcare provider before intervening.
1 The nurse has wrapped a cloth to control bleeding in the patient, thus providing appropriate care at the accident site. The nurse cannot be blamed for the patient's infection, because the infection could be due to many reasons. The nurse has not shown gross negligence in this case. The nurse does not need informed consent in the case of a life-saving emergency, nor does the nurse need an order from the healthcare provider before intervening in this case.
The nurse is explaining the Americans with Disabilities Act (ADA) to a patient with human immunodeficiency virus (HIV). Which information should the nurse include? Select all that apply. 1 People with HIV who are asymptomatic also come under the category of disabled people. 2 People with HIV have the right to decide whether to disclose their infection. 3 Healthcare workers have the choice to not treat patients who are HIV positive. 4 Healthcare professionals who are HIV positive can also choose to decide whether to disclose their infection. 5 The motive of ADA is to provide equal opportunities for people with disabilities.
1, 2, 4, 5 According to the Americans with Disabilities Act (ADA), asymptomatic human immunodeficiency virus (HIV) is considered a disability. This act gives the HIV-infected individuals the opportunity to decide whether to disclose their disability. Healthcare providers may choose not to disclose the fact that they have HIV. This act aims at removing any discrimination and providing equal opportunities for people with disabilities. Healthcare workers cannot discriminate against HIV-positive patients.
The nurse is learning about the legal implications in nursing practice. Which statements are true about the various sources of law? Select all that apply. 1 Civil laws protect the rights of individuals in the society. 2 Common law presents decisions made by administrative bodies. 3 Criminal laws protect society by providing punishment for crimes. 4 Criminal laws are passed to protect society from nursing negligence. 5 Regulatory law reflects decisions made by administrative bodies when they pass rules.
1, 3, 5 Civil laws protect the rights of individuals in the society and provide fair treatment in case of civil violations. Criminal laws protect society by providing punishment for crimes. These punishments are defined by municipal, state, and federal legislations. Regulatory laws are administrative laws and hence reflect decisions made by administrative bodies when they pass rules. Common law results from judicial decisions made in court when individual cases are decided. Civil laws are passed to protect society, such as in the case of nursing negligence.
A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which statements regarding a breach of duty apply to this situation? Select all that apply. 1 Failure to document a change in assessment data 2 Failure to provide discharge instructions 3 Failure to follow the six rights of medication administration 4 Failure to use proper medical equipment ordered for patient monitoring 5 Failure to notify a health care provider about a change in the patient's condition
1, 5 The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.
A terminally ill patient does not want to be resuscitated if complications arise. Which document would record the patient's wishes regarding treatment? 1 Nurse's records 2 Living will 3 Health care proxies 4 Durable powers of attorney
2 A living will contains the decisions about medical procedures a patient would undergo or not undergo when terminally ill or in a vegetative state. The nurse's records are written documents maintained by the nurse about the daily care provided to the patient. Health care proxies or durable powers of attorney are legal documents that designate a person to make decisions on the patient's behalf. These documents are used when the patient is no longer capable of making decisions.
The nurse has been falsely accused of providing inadequate care to a patient by another nurse. The nurse has received praise in the past for providing quality care to the patients. Which tort does this indicate? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy
2 Because the nurse has received praise in the past for providing quality care to patients, the implication is that the nurse provides quality care. Another nurse accusing this nurse of providing inadequate patient care is indicative of slander, which occurs when one person speaks falsely about others. Libel refers to written defamation of character. Malpractice refers to actions performed below the standard of care. Invasion of privacy refers to unwanted intrusion into the patient's personal affairs.
The surgical nurse is collecting the necessary documents to obtain a patient's informed consent before a surgery. In which instance should the nurse refrain from obtaining informed consent? 1 The patient voices no concerns regarding the surgery. 2 The patient was administered morphine. 3 The patient's family members are not present. 4 The surgery is associated with risk for severe complications.
2 Informed consent is usually obtained when the patient is alert, is able to understand and process information, and can make decisions. Morphine may cause drowsiness, preventing the patient from making informed decisions. Even if the patient voices no concerns or has no questions, the consent form still needs to be presented and explained to the patient. Presence of family members is not necessary for giving informed consent unless the patient is unable to do so for any reason. Every surgery is associated with risks, which are explained in the associated documentation, so this is not a valid reason for not obtaining an informed consent.
A student nurse who has not been trained to administer medications is assisting a registered nurse while caring for various patients in the general ward. Which intervention by the student nurse may result in a malpractice lawsuit? 1 Collecting the vital signs of a patient 2 Administering a subcutaneous injection 3 Checking the body mass index of a patient 4 Assisting the registered nurse with an enteral nutrition feeding
2 Student nurses should not perform tasks if they are unprepared because their actions can cause harm to patients. Administering a subcutaneous injection without proper preparation may lead to patient harm and expose the student nurse to a malpractice orientation phase. The student nurse can collect vital signs, because this does not cause harm to the patient and is within the scope of practice for a student nurse. Checking the patient's body mass index is within the scope of practice for a student nurse. The student nurse can assist the registered nurse while providing enteral nutrition. Because this is done under the supervision of a licensed professional, the nurse will not face a malpractice lawsuit.
A patient dies after receiving care from the nurse. In what circumstance would the nurse be legally protected by the Good Samaritan Act? 1 The nurse provides standard care in the hospital setting, but the patient cannot be saved due to severe injury. 2 The nurse provides emergency care outside the hospital, performing a procedure for which the nurse has been trained. 3 The nurse performs an emergency procedure that is normally outside the nurse's scope of practice because no one else is available at the scene. 4 The nurse does not provide care at the scene but puts the patient in a car heading to the hospital.
2 The Good Samaritan Act protects health care professionals from charges of negligence in providing emergency care outside of the hospital setting, assuming the health care provider is qualified to provide the care. The Good Samaritan Act does not protect the nurse within the hospital setting, where standard procedures can be followed. The Good Samaritan Act may not protect the nurse if performing a procedure for which the nurse is not qualified or trained. The Emergency Medical Treatment and Active Labor Act emphasizes that in case an emergency arises, the patient should not be shifted but should receive immediate quality treatment.
The nurse is caring for a patient who is in early stages of cardiac failure. The patient tells the healthcare provider and the nurse that he wishes to end his life without any suffering as soon as possible. Which would be the most appropriate action? 1 Assist the patient in suicide as per his wish. 2 Explain to the patient that his life can be extended. 3 Ask the patient's family to make decisions regarding the patient's death. 4 Ask the patient to wait for court orders regarding the decision.
2 The patient does not have end-stage cardiac failure; thus medical interventions would be of help for the patient to extend his life. Assisted suicide violates the Code of Ethics for nurses, is illegal in most states, and is not appropriate in a patient with a nonterminal disease. Becausethe patient could be managed by means of drugs and other medical interventions, there is no need for the patient's family to make decisions concerning the patient's death.
The nurse has failed to obtain informed consent before performing a procedure on a patient. Which type of torts result from this nursing action? Select all that apply. 1 Assault 2 Battery 3 Negligence 4 False imprisonment 5 Libel
2, 3 Negligence is performing an action that falls below a standard of care. Failure to obtain informed consent is an act of negligence. Assault refers to an action that places a person within harmful or offensive contact without consent. Battery is any intentional touching without consent. Because the nurse has failed to obtain informed consent, doing any intervention on the patient would be considered as battery. False imprisonment is the unjustified restraint of a person without legal warrant. Failure to obtain informed consent would not result in assault or false imprisonment. Libel is written defamation of character.
The nurse is learning about nursing malpractice. Which statements should the nurse consider as good nursing practice? Select all that apply. 1 Nursing notes can be illegible as long as the nurse can read them. 2 Nursing notes should be maintained properly. 3 Nursing records should be properly preserved. 4 Institutions should maintain complete nursing records. 5 Only basic duties should be recorded in nursing records.
2, 3, 4 Nursing notes are important, because they contain evidence needed to understand the care received by a patient. The notes should be legible to all people, not just the nurse. Similarly, complete nursing records should be properly preserved, because they may be required to show what care was provided. Basic nursing duties as well as advanced nursing care should be recorded in the nursing records.
When witnessing a patient giving informed consent prior to undergoing surgery, which actions should the nurse perform? Select all that apply. 1 If the patient refuses to sign the consent, leave the situation as it is. 2 Confirm that the patient has understood the information about the surgery. 3 Inform the healthcare provider if the patient refuses to undergo the surgery. 4 Sign the consent form as a witness, once the patient voluntarily gives consent. 5 Ask a nursing student to witness the informed consent if the nurse is busy.
2, 3, 4 The patient needs to understand the surgical procedure and voluntarily give consent, so the nurse should enquire about the patient's understanding and answer any questions. If the patient refuses to undergo the surgery, the nurse should inform the healthcare provider, so any harmful consequences of refusal can be explained to the patient. The nurse's signature witnessing the consent means that the patient voluntarily gave consent, that the signature is authentic, and that the patient appears to be competent to give consent. If the patient refuses to sign the consent in spite of repeated explanations, this rejection should be documented, signed, and witnessed. Due to the legal nature of the document, a nursing student should not be asked to witness informed consent forms.
The hospital administrators warn the nurse about being negligent while providing patient care. Which is the most appropriate reason for the warning? 1 The nurse has threatened a patient with the use of physical restraints to control the patient. 2 The nurse has published the wrong assessment findings of a patient in a scientific journal. 3 The nurse has given an excessive dose of hepatotoxic drug to a patient with liver failure. 4 The nurse has informed the spouse about the patient's disease without the patient's consent.
3 Giving an excessive dose of hepatotoxic drug to a patient with liver failure is an example of a negligent act by the nurse. Threatening the patient with the use of physical restraints is an example of assault by the nurse, not a negligent act. Publishing the wrong assessment findings of a patient in a scientific journal is an example of defamation of character tort (libel) but is not considered as negligence in providing care. Informing the spouse regarding the patient's diagnosis without the patient's consent is an example of invasion of privacy; it is not considered an act of negligence.
A patient has just been diagnosed with hepatitis B. Which is the most appropriate nursing action to avoid invasion of privacy? 1 Inform the patient's spouse about the disease. 2 Do not inform the patient or the family members about the disease. 3 Obtain permission from the patient to inform the patient's spouse about the disease. 4 Obtain informed consent from the spouse to reveal the illness to the patient.
3 Hepatitis B is a sexually transmitted disease, and the patient may be unwilling to reveal the information about the disease to the spouse. Thus, the nurse should request consent from the patient to let the spouse know about the illness. The patient's spouse should not be informed about the illness without the patient's consent. The nurse should abide by the patient's right to be informed about the disease. The nurse must obtain the patient's consent to inform family members about the disease. Obtaining informed consent from the spouse to reveal the illness to the patient is an inappropriate nursing action.
The home health nurse notices significant bruising on a 2-year-old child's head, arms, abdomen, and legs. The patient's mother describes the child's frequent falls. Which is the best nursing action for the home health nurse to take? 1 Document the findings and treat the child. 2 Instruct the mother on safe handling of a 2-year-old child. 3 Contact a child abuse hotline. 4 Discuss this story with a colleague.
3 Nurses are mandated reporters of suspected child abuse. Significant bruising on a 2-year-old child's head, arms, abdomen, and legs possibly indicate child abuse. It is not enough to document the findings, instruct the mother on safe handling of the child, or discuss the story with a colleague.
The nurse notes that the healthcare unit keeps a listing of the patient names at the front desk in easy view for healthcare providers to more efficiently locate the patient. Which does this action violate? 1 Mental Health Parity Act (MHPA) 2 Patient Self-Determination Act (PSDA) 3 Health Insurance Portability and Accountability Act (HIPAA) 4 Emergency Medical Treatment and Active Labor Act (EMTALA)
3 The privacy rule of the Health Insurance Portability and Accountability Act (HIPAA) requires patient information to be protected from unnecessary publication. The Mental Health Parity Act (MHPA) addresses the needs of the mental health patient, the Patient Self-Determination Act (PSDA) addresses a patient's right to refuse treatment and formulate advance directives, and the Emergency Medical Treatment and Active Labor Act (EMTALA) ensures appropriate screening and stabilization of the patient in an emergency setting.
A student nurse is gossiping with colleagues about a patient's many romantic relationships. The registered nurse warns the student nurse about talking about the patient's personal life in a public place. The nurse's warning is intended to prevent which error? 1 Assault 2 Libel 3 Invasion of privacy 4 Defamation of character
3 The registered nurse reprimands the student nurse for speaking in public about the patient's private life, because it is an invasion of the patient's privacy. Assault is intentional bodily harm caused by the perpetrator, but gossiping does not cause physical harm to the patient. The nurse is not committing libel, which is written defamation of character. Defamation of character is defined as making false public statements about a person, but there is no indication that the nurse is making false statements, just that the information is private.
Following an accident at a job site, a patient's employer contacts the hospital and asks the nurse about the patient's condition to determine the patient's likelihood of returning to work in the future. Which is the best response by the nurse to the employer? 1 "You need to speak to the primary healthcare provider." 2 "We can send the patient's medical records for your reference." 3 "The patient is doing well and will definitely be able to return to work." 4 "You will have to get the patient's permission to receive any related information."
4 According to the Health Insurance Portability and Accountability Act (HIPAA) of 1996, the patient's information should be kept confidential and the patient's privacy should be respected. Patient-related information should not be divulged to anybody without the patient's permission. Therefore, the nurse should ask the employer to seek the patient's permission to receive any patient-related medical information, including information about the feasibility of a patient returning to work. The primary healthcare provider is also not authorized to divulge patient information without the patient's consent. Providing the patient's medical records to others is a violation of HIPAA.
A patient who is hospitalized with chronic illness is depressed and demands to go home. The nurse applies a physical restraint and administers medication to the patient. What does this nursing intervention indicate? 1 The nurse is following Good Samaritan laws. 2 The nurse may be charged with malpractice. 3 The nurse is guilty of invading the patient's privacy. 4 The nurse may be charged with false imprisonment.
4 Patients cannot be forced to stay in the hospital against their will, because this constitutes false imprisonment. Good Samaritan laws help protect health care professionals from charges of negligence in providing emergency care. In this case, the patient is not restrained during emergency care, so the nurse is not following Good Samaritan laws. Malpractice is professional negligence, in which the nurse does not provide standard care for the patient. Applying physical restraints does not indicate that the nurse is providing substandard care. Using restraints to stop the patient from going home does not indicate that the nurse is invading the privacy of the patient.
A patient who has tested positive for human immunodeficiency virus (HIV) tells the nurse, "I feel helpless. My boss fired me because I'm HIV positive." Which is the best response by the nurse? 1 "Don't worry. You're protected by Good Samaritan laws." 2 "Don't lose hope. Take this as an opportunity to spend time with your family." 3 "I understand your feelings, but I think you should concentrate on your health now." 4 "You should approach a lawyer. You're protected by the Americans with Disabilities Act."
4 The Americans with Disabilities Act protects the rights of people with physical or mental disabilities as well as the rights of patients who have tested positive for human immunodeficiency virus (HIV). Therefore, the nurse would recommend that the patient speak to a lawyer. Good Samaritan laws help protect health care professionals from charges of negligence in providing emergency care but do not provide protection for HIV-positive patients. Asking the patient to take the opportunity to spend time with family is not appropriate, because the patient may lose hope of fighting for his or her rights. It is also not appropriate to recommend that the patient overlook this violation of rights and concentrate on his or her health.
An 8-year-old girl is brought to the emergency room with severe abdominal pain. The nurse has to get consent before medical treatment can be started. The parents of the child are divorced, and the mother has custody. The patient is accompanied by her mother, father, and elder sister, who is 19 years old. Who should sign the consent form of the patient? 1 The patient's father 2 The patient's sister 3 The patient herself 4 The patient's mother
4 When the patient is a minor, consent is given by parents or guardians. In this case, the parents are divorced, so the consent is given by the parent who has custody of the child, the mother.
A patient was rushed to the emergency department and then to surgery to repair injuries sustained in a hit-and-run car accident. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that the patient has a durable power of attorney for health care (DPAHC). How should the nurse interpret this information? Select all that apply. 1 The patient can decide which medical procedures not to undergo. 2 The patient has designated a person who is solely responsible for making financial decisions when the patient is unable. 3 The patient has expressed in written form the wish not to be sustained on life support. 4 The patient has designated a person who makes healthcare decisions when the patient is not able to make decisions. 5 The patient has designated a person who is solely responsible for making healthcare decisions according to the patient's wishes.
4, 5 A healthcare proxy, or durable power of attorney for healthcare (DPAHC), is a legal document that designates a person or persons of one's choosing to make healthcare decisions when patients can no longer make decisions on their own behalf. This designated person also makes healthcare treatment decisions based on the patient's wishes. A living will is a written document of the patient's wishes regarding measures to be taken in the event of a terminal illness or condition.
A patient is abusive and rude with the student nurse. The student nurse documents that the patient is uncooperative and shows symptoms of alcohol withdrawal. As a result the patient will be transferred to a different floor. Which is the best classification of this nurse's error? 1 Libel 2 Slander 3 Malpractice 4 Invasion of privacy
1 Libel is documentation of false entries or defamation of character. The nurse is offended by the patient's behavior, so the nurse documents signs of alcohol withdrawal, even though this is not indicated by rude behavior alone. Slander is oral defamation of character. The nurse is documenting the report, but not verbalizing it, so this is not considered slander. Malpractice is negligence of a professional role. This nursing action does not indicate negligence. Invasion of privacy typically involves releasing a patient's private information without the patient's consent. The nurse has not violated the patient's privacy in this instance.
A patient suffering from cardiac arrest is brought to the hospital. The patient previously underwent a coronary artery bypass graft (CABG) and angioplasty, and the patient has been chronically ill since then. The patient has requested in writing that not to be resuscitated in case of emergency. What is the term for this request? 1 Living will 2 Implied consent 3 Informed consent 4 Power of attorney
1 Living wills are written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition. Implied and informed consents are types of consent that are given by a patient (or guardian) in case of surgery or treatment. A power of attorney is a legal document that designates a person of the patient's choice to make health care decisions on behalf of the patient when the patient is no longer able to do so.
Hospital administrators have warned the healthcare team about invasion of a patient's privacy. Which could have been the reason for this warning? 1 The nurse read text messages on the patient's cell phone. 2 The health care provider asked the nurse to catheterize the patient. 3 The nurse published a report on the patient's condition without his or her consent. 4 The healthcare team provided cardiopulmonary resuscitation (CPR) without the family's consent.
1 Privacy refers to the patient's right of keeping personal information from being disclosed. Reading text messages on the patient's cell phone is an invasion of the patient's privacy. The healthcare provider asking the nurse to catheterize a patient is an example of collaborative care by the healthcare team. Publishing a report on the patient's condition without consent is a breach of confidentiality. Confidentiality protects the patient's information once it has been disclosed in the healthcare setting. According to the health care law in the United States, cardiopulmonary resuscitation (CPR) should be provided to the patient when required unless the patient has given a Do Not Resuscitate (DNR) order. Consent need not be obtained from the family when providing CPR.
While caring for an 8-year-old patient, the nurse finds that the child appears scared of the parents and has bruises on the soles of the feet and on the back. Which laws obligate the nurse to report suspected abuse to law enforcement authorities? 1 Public health laws 2 Good Samaritan Act 3 Mental Health Parity Act 4 Failure to act laws
1 The nurse observes that the child is scared of the parents and has bruises on unexpected places of the body such as soles of the feet and back. The bruises indicate that the child is facing abuse, so the nurse is obligated by public health laws to report the abuse to higher officials. The Good Samaritan Act protects health care professionals from charges of negligence in providing emergency care outside the hospital. The Mental Health Parity Act forbids health insurance policies from placing lifetime or annual limits on mental health coverage. Failure to act laws require health care professionals to provide emergency care if they are qualified to do so, but these laws do not require the report of abuse.
A group of nurses makes a list of patients who require organ transplantation. Which patient would be given priority for organ transplantation? 1 The patient who is most critically ill 2 The patient who is a very young age 3 The patient who will pay more for the intervention 4 The patient who lives in close proximity to the healthcare center
1 The patient who is most critically ill or is unstable would be given priority, because receiving the organ transplant can save the patient's life. Young patients would not be given priority for receiving an organ transplant, because they are relatively stable. Being partial toward the patient who is willing to pay more for the intervention is unethical and biased. Giving preference for an organ transplant to a patient who lives in close proximity is inappropriate, because other patients may require it more based on their health condition.
The nurse is caring for a surgical patient in the preoperative area. The nurse witnesses the patient's informed consent for the surgical procedure. Which statements are true regarding informed consent? Select all that apply. 1 It must be signed while the patient is free from mind-altering medications. 2 It can be witnessed by the nurse or nursing student. 3 It may be withdrawn at any time. 4 It must be signed by patients age 16 and older. 5 It is usually obtained by the healthcare provider and not the nurse.
1, 3, 5 An informed consent must be signed while the patient is free from mind-altering medications and after the patient has received all information necessary to make an informed decision. In most situations, the healthcare provider, not the nurse, obtains informed consent, because the nurse does not perform surgery or direct medical procedures. Signed consent must be witnessed by the nurse, but never by a nursing student because of the legal nature of the document. Informed consent may be withdrawn at any time before the procedure and must be signed by patients age 18 and older. A parent or guardian's signature is required for minors.
The nurse notes that an advance directive is on a patient's medical record. Which statement best describes an advance directive guideline? 1 A living will allows an appointed person to make healthcare decisions when the patient is in an incapacitated state. 2 A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3 The patient cannot make changes in the advance directive once admitted to the hospital. 4 A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
2 A living will does not assign another individual to make decisions for the patient. A durable power of attorney for healthcare is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.
The occupational nurse is speaking to a patient who has started a new job after working for a company for 6 months. The patient is worried about losing health insurance. Which advice should the nurse give to the patient? 1 "You should not have left the job." 2 "Don't worry. You will not lose insurance coverage." 3 "You should apply for your new health plan as soon as possible." 4 "I am not able to help you. Please consult with the health law advocate."
3 According to the Health Insurance Portability and Accountability Act (HIPAA), employees can change jobs without losing health coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group coverage. In this scenario, the patient has worked for only 6 months. Therefore, the patient will lose health insurance coverage on taking a new job. The nurse should advise the patient to apply for a new health plan in the new company as soon as possible. The nurse should not judge the patient's decision to leave the job. Taking a new job is the patient's decision, which the nurse should respect. The group coverage from the previous job would be lost, because the patient has worked for fewer than 6 months. The nurse should know about all healthcare laws, so asking the patient to consult a healthcare advocate is an inappropriate nursing behavior.
The nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. Which would probably cover the nurse in this situation? 1 The nurse's automobile insurance 2 The nurse's homeowner's insurance 3 The Good Samaritan laws, which grant immunity from suit if there is no gross negligence 4 The Patient Care Partnership, which may grant immunity from suit if the injured party consents
3 The Good Samaritan law holds healthcare providers immune from liability as long as they function within the scope of their expertise. Automobile and homeowner insurance would not cover the nurse in this situation. The Patient Care Partnership may grant immunity from suit if the injured party consents, which is not the case in this scenario.
Which statements best describe a consent form? Select all that apply. 1 It may be signed by an emancipated minor. 2 It protects the healthcare facility but not the healthcare provider. 3 It signifies that the patient understands all aspects of the procedure. 4 It signifies that the patient and family have been told about the procedure. 5 It must be signed by the patient or responsible party at the healthcare facility, and consent may not be obtained by phone or fax.
1, 3 An emancipated minor may sign a consent form. The consent form signifies that the patient understands all aspects of the procedure. The document protects the surgeon and the healthcare facility in that it indicates that the patient knows and understands all aspects of the procedure. Only in the cases of underage children or unconscious or mentally incompetent people must a family member be aware of the procedure. The consent may be obtained by fax or phone with appropriate witnesses.
The nurse is learning about negligence in unintentional torts. Which actions would the nurse consider as common acts of negligence? Select all that apply. 1 Failure to follow orders 2 Failure to perform malpractice 3 Failure to document monitoring 4 Failure to follow policies and guidelines 5 Failure to explain the risks of a surgery to a patient
1, 3, 4 Failure to follow orders is an act of negligence because it is the duty of the nurse to follow all given orders. Documentation of monitoring is one of the best practices to prevent legal issues and is important to communicate with other healthcare team members. Policies and guidelines are created in accordance with laws and regulations, so they should be followed. Malpractice is professional negligence and should be avoided. Explaining the risks of a medical procedure to a patient is not the nurse's responsibility.
A surgeon obtains patient consent for an appendectomy. While operating, the surgeon also removes the patient's gall bladder. This mistake could be classified as which type of tort? 1 Assault 2 Battery 3 False imprisonment 4 Defamation of character
2 Torts are intentional or unintentional mistakes that are infringements of civil law. Removing the gall bladder without consent may be considered battery because the surgeon's actions go beyond the scope of the patient's original consent, which was only for the appendectomy. Assault involves the intentional threat of bodily harm, but there is no indication the surgeon meant to harm this patient by removing the gall bladder. Forcing the patient to stay in the hospital even if the patient is unwilling would indicate false imprisonment. Making false, damaging statements about a patient would indicate defamation of character.
The nurse attends to a trauma patient who has been transferred from the intensive care unit (ICU). The nurse finds out that the ICU nurse provided a detailed explanation on the patient's condition to the family without consent from the patient. The ICU nurse also gave the patient a steroid shot even though the patient refused the medication. Which torts would the ICU nurse be guilty of? Select all that apply. 1 Malpractice 2 Battery 3 Invasion of privacy 4 Negligence 5 Defamation of character
2, 3 Battery is any intentional touching without consent. Giving a steroid injection to a patient after the patient has rejected an invasive procedure is considered battery. Malpractice occurs when health care delivered falls below a standard of care expected. The patient's privacy has been invaded when the healthcare provider informs the patient's family of the patient's present medical condition without consent. Negligence is conduct that falls below a standard of care. Defamation of character is the publication of false statements that damage a person's reputation.
The nurse attends to a patient who sustained injuries when crossing the street. The patient was hit by a car that failed to stop at a stop sign. The patient was rushed to the emergency department and then to surgery to repair injuries. After surgery, the patient was transferred to the medical-surgical unit for postsurgical management. The healthcare provider informs the nurse that patient confidentiality should be strictly maintained. What should the nurse interpret from this? Select all that apply. 1 The nurse should respect that the patient has the right to keep personal information from being disclosed. 2 The nurse should avoid discussing the patient's medical reports in public areas with other healthcare professionals. 3 The nurse should not disclose information about a procedure to the patient. 4 The nurse must protect any private information about the patient, once it has been disclosed in healthcare settings. 5 Message boards where daily nursing care information is posted in the patient's room cannot contain information revealing the patient's medical condition.
2, 4, 5 Confidentiality means that nurses and all healthcare providers must avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any manner. Confidentiality protects private patient information once it has been disclosed in healthcare settings. Privacy is the right of the patient to keep personal information from being disclosed. Patient have the right to get every possible detail before undergoing a particular procedure. Message boards used in patient's hospital rooms to post daily nursing care information can no longer contain information revealing the patient's medical condition.
The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which action violates the Health Insurance Portability and Accountability Act (HIPAA)? 1 Discussing patient conditions in the nursing report room at the change of shift 2 Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3 Posting medical information about a patient on a message board in the patient's room 4 Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared
3 Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment, which violates the Health Insurance Portability and Accountability Act (HIPAA)
