CH 7 LEGAL DIMENSIONS Flashcards
1.
Which of the following aspects of nursing would be most likely defined by legislation at a state level?
A)
The differences in the scope of practice between registered nurses (RNs) and licensed practical nurses (LPNs).
B)
The criteria that a nurse must consider when delegating tasks to unlicensed care providers.
C)
The criteria that clients must meet in order to qualify for Medicare or Medicaid.
D)
The process that nurses must follow when handling and administering medications.
A
Feedback:
The scope of practice defines the parameters within which nurses provide care, and is established by state legislation, most commonly in the form of a Nurse Practice Act. The criteria and due process for delegation in the clinical setting is addressed by a state board of nursing. Qualification criteria for programs such as Medicare and Medicaid are established by federal legislation, while the process for safe and appropriate medication administration is defined and monitored by a state board of nursing.
2.
During a clinical placement on a subacute, geriatric medicine unit, a student nurse fed a stroke client some beef broth, despite the fact that the client’s diet was restricted to thickened fluids. As a result, the client aspirated and developed pneumonia. Which of the following statements underlies the student’s potential liability in this situation?
A)
The same standards of care that apply to a registered nurse apply to the student.
B)
The student and the nursing instructor share liability for this lapse in care.
C)
The patient’s primary nurse is liable for failing to ensure that delegated care was appropriate.
D)
The student’s potential liability is likely negated by the insurance carried by the school of nursing.
A
Feedback:
Despite the fact that their knowledge and skills are still under development, nursing students are held to the same standards of care as registered nurses. Consequently, primary liability does not lie with the student’s instructor or the patient’s primary nurse. Insurance may be carried by the school of nursing, but this does not negate the student’s legal responsibility to provide care at a high standard.
3. A nurse is arrested for possession of illegal drugs. What kind of law is involved with this type of activity? A) Civil B) Private C) Public D) Criminal
D
Feedback:
Criminal law concerns state and federal criminal statutes, which define criminal actions such as murder, manslaughter, criminal negligence, theft, and illegal possession of drugs. Civil law, also called private law, includes laws relating to contracts, ownership of property, and the practice of nursing, medicine, pharmacy, and dentistry. Public law is law in which the government is involved directly.
4. A lawyer quotes a precedent for punishment of a crime committed by the defendant in a trial. What is court-made law known as? A) Public law B) Statutory law C) Common law D) Administrative law
C
Feedback:
The government provides for a judiciary system, which is responsible for reconciling controversies. It interprets legislation at the local, state, and national levels as it has been applied in specific instances and makes decisions concerning law enforcement. A body of law known as common law has evolved from these accumulated judiciary decisions. Common law is thus court-made law, and most law involving malpractice is common law.
5. A client is suing a nurse for malpractice. What is the term for the person bringing suit? A) Plaintiff B) Defendant C) Litigator D) Witness
A
Feedback:
A lawsuit is a legal action in a court. Litigation is the process of bringing and trying a lawsuit. The person or government bringing suit against another is called the plaintiff. The one being accused of a crime or tort (defined later) is called the defendant. The defendant is presumed innocent until proved guilty of a crime or tort.
6. A nurse is providing client care in a hospital setting. Who has full legal responsibility and accountability for the nurse’s actions? A) The nurse B) The head nurse C) The physician D) The hospital
A
Feedback:
In modern practice, nurses assess and diagnose clients and plan, implement, and evaluate nursing care. Full legal responsibility and accountability for these nursing actions rest with the nurse.
7. What type of law regulates the practice of nursing? A) Common law B) Public law C) Civil law D) Criminal law
C
Feedback:
Civil laws regulate the practice of nursing. A law is a standard or rule of conduct established and enforced by the government, chiefly to protect the rights of the public. Private law, also called civil law, regulates relationships among people and includes laws related to the practice of nursing.
8. What is the legal source of rules of conduct for nurses? A) Agency policies and protocols B) Constitution of the United States C) American Nurses Association D) Nurse Practice Acts
D
Feedback:
Nurse Practice Acts are examples of statutory law, enacted by a legislative body in keeping with both the federal constitution and the applicable state constitution. They are the primary source of rules of conduct for nurses. Standards of practice, which differ from rules of conduct, are made by agency policies and protocols and by the American Nurses Association.
9. A nurse moves from Ohio to Missouri. Where can a copy of the Nurse Practice Act in Missouri be obtained? A) Ohio State Board of Nursing B) Missouri State Board of Nursing C) Federal government nursing guidelines D) National League for Nursing
B
Feedback:
Each state has a Nurse Practice Act that protects the public by broadly defining the legal scope of nursing practice. A copy of the Nurse Practice Act for the state in which a nurse practices can be obtained from that state’s board of nursing. Neither the federal government nor the National League for Nursing has copies of nurse practice acts.
10.
Which of the following best describes voluntary standards?
A)
Voluntary standards are guidelines for peer review, guided by the public’s expectation of nursing.
B)
Voluntary standards set requirements for licensure and nursing education.
C)
Voluntary standards meet criteria for recognition, specified area of practice.
D)
Voluntary standards determine violations for discipline and who may practice.
A
Feedback:
Voluntary standards are developed and implemented by the nursing profession itself. They are not mandatory but are used as guidelines for peer review. The organizations that set standards are guided by society’s need for nursing and by the public’s expectations of nursing.
11.
Which of the following accreditations is a legal requirement for a school of nursing to exist?
A)
National League for Nursing Accrediting Commission
B)
American Association of Colleges of Nursing accreditation
C)
State Board of Nursing accreditation
D)
Educational institution accreditation
C
Feedback:
State laws are enacted to ensure that schools preparing nursing practitioners maintain minimum standards of education. This is legal accreditation. Accreditation by voluntary agencies is not required for a school to exist.
12. Which of the following is the most frequent reason for revocation or suspension of a nurse’s license? A) Fraud B) Mental impairment C) Alcohol or drug abuse D) Criminal acts
C
Feedback:
A nurse’s license may be suspended or revoked for fraud, deceptive practices, criminal acts, previous disciplinary action by other state boards, negligence, physical or mental impairments, or alcohol or drug abuse. The most frequent reason is alcohol or drug abuse.
13. A nurse does not assist with ambulation for a postoperative client on the first day after surgery. The client falls and fractures a hip. What charge might be brought against the nurse? A) Assault B) Battery C) Fraud D) Negligence
D
Feedback:
A tort is a civil wrong committed by a person against another person or his or her property. Negligence, an unintentional tort, occurs when a person fails to exercise reasonable care in the performance of his or her duties. In this situation, the nurse did not initiate proper precautions to prevent patient harm and is subject to the charge of negligence.
14. A client refuses to have a pain medication administered by injection. A nurse says, “If you don’t let me give you the shot, I will get help to hold you down and give it.” With what crime might the nurse be charged? A) Assault B) Battery C) Negligence D) Defamation
A
Feedback:
Assault and battery are intentional torts. Assault is a threat or attempt to make bodily contact with another person without that person’s consent. Threatening to forcibly administer an injection after the patient has refused it is assault. Battery is an assault that is carried out and includes willful, angry, and violent or negligent touching of another person’s body, clothes, or anything attached to or held by that other person. Negligence is defined as performing an act that a reasonably prudent person under similar circumstances would not do or, conversely, failing to perform an act that a reasonably prudent person under similar circumstances would do. Defamation is an intentional tort in which one party makes derogatory remarks about another that diminish the other party’s reputation.
15. Two nurses are discussing a client’s condition in an elevator full of visitors. With what crime might the nurses be charged? A) Defamation of character B) Invasion of privacy C) Unintentional negligence D) Intentional negligence
B
Feedback:
Certain acts by nurses could constitute invasion of privacy, including talking about patients in public areas, such as elevators. This violates federal law. In this case, the nurses would not be charged with defamation or negligence.
16. A lawsuit has been brought against a nurse for malpractice. The client fell and suffered a skull fracture, resulting in a longer hospital stay and need for rehabilitation. What does the description of the client and his injuries represent as proof of malpractice? A) Damages B) Causation C) Duty D) Breach of duty
A
Feedback:
Liability involves four elements: duty (obligation to use care and follow standards), breach of duty (failure to follow standards of care), causation (the failure to follow standards of care resulted in the injury), and damages (the actual harm or injury resulting to the patient).
17. A nurse has been named as a defendant in a lawsuit. With whom should the nurse discuss the case? A) Colleagues B) Reporters C) Plaintiff D) Attorney
D
Feedback:
The nurse should only discuss the case with the attorney representing him or her and/or the institution. Recommendations for the nurse as defendant include not discussing the case with anyone at the employing agency (except the risk manager), the plaintiff, the plaintiff’s lawyer, anyone testifying for the plaintiff, or reporters.
18. Which of the following is the nurse’s best legal safeguard? A) Collective bargaining B) Written or implied contracts C) Competent practice D) Patient education
C
Feedback:
Competent practice is the nurse’s most important and best legal safeguard. Each nurse is responsible for making sure his or her educational background and clinical experience are adequate to fulfill the nursing responsibilities described in the job description. Collective bargaining, written or implied contracts, and/or patient education do not provide the best legal safeguard.
19. A nurse has taken a telephone order from a physician for an emergency medication. The dose of the medication is abnormally high. What should the nurse do next? A) Administer the medication based on the order B) Question the order for the medication C) Refuse to administer the medication D) Document concerns about the order
B
Feedback:
The nurse should question any physician order that is ambiguous, contraindicated by normal practice (such as an abnormally high medication dose), or contraindicated by the client’s present condition. The nurse should not administer the medication, refuse to administer the medication without contacting the physician, or document concerns about the order without doing anything further.
20.
A client gets out of bed following hip surgery, falls, and re-injures her hip. The nurse caring for her knows that it is her duty to make sure an incident report is filed. Which of the following statements accurately describes the correct procedure for filing an incident report?
A)
The physician in charge should fill out the report.
B)
The names of the staff involved should not be included.
C)
The reports are used for disciplinary action against the staff.
D)
The report should contain all the variables related to the incident.
D
Feedback:
An incident report, also called a variance or occurrence report, is used by health care agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor. The nurse responsible for a potentially (or actually) harmful incident or who witnesses an injury is the one who fills out the incident form. This form should contain the complete name of the person or people involved and the names of all witnesses; a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident. These reports are used for quality improvement and should not be used for disciplinary action against staff members.
21. An on-duty nurse discovers that her colleague is pilfering medicines. According to the Nurse Practice Acts, what should the nurse do? A) Keep silent and overlook the incident B) Inform the local police station C) Discuss this incident with the colleague D) Report the incident to the supervisor
D
Feedback:
According to the Nurse Practice Acts, the nurse should report the incident to the supervisor. Laws are enacted to regulate the practice of nursing and may be used to decide upon an appropriate action. Discussing the incident with a colleague may alarm the nurse who is pilfering medicines and she may become cautious. The nurse should not overlook the incident because pilfering of medicines is an offense. Calling local police may lead to undue interference.
22.
A client who has undergone resection of the intestine is on a liquid diet with a nasogastric tube in place. He refuses the food tray with regular food that comes to his room and insists that a physician be called. The nurse insists that it is the right food and makes the client take it. The client develops complications and has to be re-operated upon. How is negligence determined in this situation?
A)
The nurse did not call the physician when the client asked.
B)
The nurse did not realize the importance of the tube.
C)
The dietary department sent the wrong diet for the client.
D)
The nurse insisted the patient have the solid food.
B
Feedback:
Negligence is defined as harm that occurs because the person did not act reasonably. In this case, the nurse did not realize that the client was on a nasogastric tube, and should consequently have been on liquid feeds after intestinal surgery; as a result, the patient developed complications. The acts of not calling the physician and insisting the patient have food do not amount to negligence. The dietary department sending the wrong food is unrelated to the nurse.
23.
A home care nurse is caring for a quadriplegic client who needs regular position changes and back massages. A gentleman identifying himself as a family friend inquires if he can be of any help to the family. What should be the nurse’s response be?
A)
The nurse should ask the gentleman to talk to the family directly.
B)
The nurse should invite the gentleman to learn the caring techniques.
C)
The nurse should state that the family does not need any help.
D)
The nurse should refer the gentleman to the local social worker.
A
Feedback:
The nurse should ask the gentleman to talk to the family directly. Revealing information about the client’s care is a violation of the client’s privacy. The nurse should not invite the gentleman for a learning session because it would be a breach of the client’s right to privacy. Referring him to a social worker is not an appropriate choice.
24.
A client is admitted with symptoms of psychosis. The nurse hurries to the client’s room when she hears the client calling for help. She finds the client lying on the ground. The nurse assists the client back to the bed and performs a thorough assessment. The nurse informs the physician and completes the incident report. Which of the following statements should the nurse document in the incident report?
A)
The client was trying to lower the side rails.
B)
The client was found lying on the floor.
C)
The client was trying to get out of the bed.
D)
The client was not aware that he had fallen.
B
Feedback:
An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. All of the details given in the incident report should be accurate and not assumed. Accurate and detailed documentation helps to prove that the nurse acted reasonably or appropriately in the circumstance. The nurse should document that the client was found lying on the floor. The other statements are assumptions and should not be included in the incident report.
