CH 7 LEGAL DIMENSIONS

Question 1

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.

Answer 1

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.

Question 2

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.

Answer 2

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.

Question 3

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

Answer 3

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.

Question 4

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

Answer 4

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.

Question 5

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

Answer 5

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.

Question 6

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

Answer 6

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.

Question 7

7.
What type of law regulates the practice of nursing?
A)
Common law
B)
Public law
C)
Civil law
D)
Criminal law

Answer 7

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.

Question 8

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

Answer 8

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.

Question 9

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

Answer 9

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.

Question 10

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.

Answer 10

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.

Question 11

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

Answer 11

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.

Question 12

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

Answer 12

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.

Question 13

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

Answer 13

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.

Question 14

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

Answer 14

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.

Question 15

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

Answer 15

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.

Question 16

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

Answer 16

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).

Question 17

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

Answer 17

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.

Question 18

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

Answer 18

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.

Question 19

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

Answer 19

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.

Question 20

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.

Answer 20

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.

Question 21

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

Answer 21

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.

Question 22

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.

Answer 22

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.

Question 23

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.

Answer 23

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.

Question 24

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.

Answer 24

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.

Question 25

25.
A nurse fails to administer a medication that prevents seizures, and the client has a seizure. The nurse is in violation of the Nurse Practice Act. What type of law is the nurse in violation of?
A)
Criminal
B)
Federal
C)
Civil
D)
Supreme

Answer 25

C

Feedback:
Malpractice cases are generally the kind of civil cases that involve nurses.

Question 26

26.
A baccalaureate-prepared nurse is applying for a nurse practitioner position. The nurse is:
A)
Well educated and can perform these duties
B)
Able to practice as a nurse practitioner
C)
Educated to practice only with pediatric patients
D)
Practicing beyond his scope according to licensure

Answer 26

D

Feedback:
A nurse without an advanced practice license is not able to practice beyond his or her scope in accordance with the Nurse Practice Act.

Question 27

27.
When the nurse inserts an ordered urinary catheter into the client’s urethraafterthe client has refused the procedure, and then the client suffers an injury, the client may sue the nurse for which type of tort?
A)
Battery
B)
Assault
C)
Invasion of privacy
D)
Dereliction of duty

Answer 27

A

Feedback:
Battery is the actual carrying out of such threat (unlawful touching of a person’s body). A nurse may be sued for battery if he or she fails to obtain consent for a procedure.

Question 28

28.
A group of nurses working in a long-term care facility fails to keep the narcotic medications in a secure location. The nurses also fail to count the medications before and after each shift, as indicated by the institution’s policies and procedures. These failures may result in what type of disciplinary action?
A)
Action against the nurses’ licenses
B)
Action against the facility’s state license
C)
Action against the state regulating body
D)
Action against the pharmacist’s license

Answer 28

A

Feedback:

In institutions, most controlled substances must be kept secure and monitored closely in accordance with institutional and state regulations. Failure to do so may lead to disciplinary action against the nurse’s license.

Question 29

29.
Which of the following statements accurately describes an aspect of the credentialing process used in nursing practice? Select all that apply.
A)
Credentialing refers to the way in which professional competence is ensured and maintained.
B)
Accreditation is the process by which the state determines that a person meets minimum requirements to practice nursing.
C)
Certification grants recognition in a specified practice area to people who meet certain criteria.
D)
Legal accreditation of a school preparing nursing personnel by the state Board of Nursing is voluntary.
E)
Once earned, a license to practice is a property right and may not be revoked without due process.

Answer 29

A, C, E

Feedback:

Credentialing refers to the way in which professional competence is ensured and maintained. Licensure is the process by which a state determines that a candidate meets certain minimum requirements to practice in the profession and grants a license to do so. Certification is the process by which a person who has met certain criteria established by a nongovernmental association is granted recognition in a specified practice area. State accreditation is a legal requirement; legal accreditation of a school preparing nursing personnel by the state Board of Nursing should not be confused with voluntary accreditation. Once earned, a license to practice is a property right and may not be revoked without due process. This includes notice of an investigation, a fair and impartial hearing, and a proper decision based on substantial evidence. According to the National Council of State Boards of Nursing, a mutual recognition model of nurse licensure exists that allows a nurse to have one license in his or her state of residency, and to practice in other states (both physically and electronically) as well, subject to each state’s practice law and regulation, unless otherwise restricted.

Question 30

30.
According to HIPPA regulations, which of the following is a client right regarding the client’s medical record? Select all that apply.
A)
To see the health record
B)
To copy the health record
C)
To make additions to the health record
D)
To cross out sections of the health record
E)
To restrict certain disclosures of the health record

Answer 30

A, B, E

Feedback:

According to HIPAA, clients have a right to see and copy their health record; to update their health record; to get a list of the disclosures a health care institution has made independent of disclosures made for the purposes of treatment, payment, and health care operations; to request a restriction on certain uses or disclosures; and to choose how to receive health information. The client may not make additions, cross out sections, or destroy the health record.

Question 31

31.
A nurse explains the informed consent form to a client who is scheduled for heart bypass surgery. Which of the following are elements of this consent form? Select all that apply.
A)
Disclosure
B)
Organ donation
C)
DNR orders
D)
Comprehension
E)
Competence

Answer 31

A, D, E

Feedback:
Every person is granted freedom from bodily contact by another person, unless consent is granted. In all health care agencies, informed and voluntary consent is needed for admission (for routine treatment), for each specialized diagnostic procedure or medical or surgical treatment, and for any experimental treatments or procedures. Elements of informed consent include disclosure, comprehension, competence, and voluntariness.

Question 32

32.
Which of the following nursing actions would be considered a violation of HIPPA regulations? Select all that apply.
A)
A nurse ambulates a client through a hospital hallway in a hospital gown that is open in the back.
B)
A nurse shoves a confused, bedridden client into bed after he made several attempts to get up.
C)
A nurse inadvertently administers the wrong dose of morphine to a client in the ICU.
D)
A nurse uses a client’s chart as a sample teaching case without changing the client’s name.
E)
A nurse reports the condition of a client to the client’s employer.

Answer 32

A, D, E

Feedback:

HIPPA regulations exist to protect patient privacy. Answers A, D, and E are examples of violations of HIPPA. Shoving a patient is battery and inadvertently administering the wrong dose of a medicine is negligence. A person fraudulently misrepresenting himself or herself to obtain a license to practice nursing is considered fraud.

Question 33

33.
The nursing student asks the nurse for an example of a “never event.” Which example provided by the nurse best answers the nursing student’s question?
A)
The client scheduled for a cholecystectomy has a total abdominal hysterectomy.
B)
The client receives preoperative medication before signing the informed consent.
C)
The client receives a medication and develops a rash on the trunk of the body, itching, and dyspnea.
D)
The client fails to receive a regularly scheduled medication.

Answer 33

A

Feedback:
A “never event” is an extremely rare medical error that should never occur. The performance of the wrong surgery on a client is an example of a never event. The other examples are examples of incidents or variances, events that occur out of the ordinary that result in, or have the potential to result in, harm to a client, employee, or visitor.

Question 34

34.
The nurse reports a nursing colleague on the unit who is lethargic and verbally responding in a slow manner. What is this an example of?
A)
Whistle-blowing
B)
Collective bargaining
C)
Delegating nursing care
D)
Ensuring adequate staffing

Answer 34

A

Feedback:
Whistle-blowing is when the nurse reports unsafe practice environments. Impaired nurses threaten the safety of clients in the clinical setting, as does inadequate staffing. Nurses may delegate or assign tasks involved in the delivery of nursing care to individuals as long as the individual has sufficient knowledge and skill to perform the assigned task. Collective bargaining is a legal process in which representatives of organized employees negotiate with employers about work conditions.

Question 35

35.
The nurse is accused of malpractice by a client. List the order in which the steps of the litigation process will occur (use all options).
1) The basis for the claim is determined to be appropriate and timely with all elements of liability present.
2) All parties named as defendants (nurses, physicians, health care agency), as well as insurance companies and attorneys, work toward a fair settlement.
3) Trial takes place; both sides present their evidence and arguments.
4) The case is presented to a malpractice arbitration panel. The panel’s decision is either accepted or rejected, in which case a complaint is filed in trial court.
5) Pretrial discovery activities occur: review of medical records and depositions of plaintiff, defendants, and witnesses.
6) The defendants contest allegations.
A)
2, 3, 4, 1, 5, 3
B)
1, 2, 4, 6, 5, 3
C)
1, 2, 3, 4, 5, 6
D)
2, 6, 5, 3, 1, 4

Answer 35

B

Feedback:

The steps involved in malpractice litigation are as follows: 1. The basis for the claim is determined to be appropriate and timely; all elements of liability are present (duty, breach of duty, causation, and serious damages). 2. All parties named as defendants (nurses, physicians, health care agency), as well as insurance companies and attorneys, work toward a fair settlement. 3. The case is presented to a malpractice arbitration panel. The panel’s decision is either accepted or rejected, in which case a complaint is filed in trial court. 4. The defendants contest allegations (argue that there is no basis for alleging deviation from the appropriate standard of care or for proving causation and damages). 5. Pretrial discovery activities occur: review of medical records and depositions of plaintiff, defendants, and witnesses. 6. Trial takes place; both sides present their evidence and arguments. 7. Decision or verdict is reached by the judge and/or jury. 8. If the verdict is not accepted by both sides, it may be appealed to an appellate court.