Chapter 23

Question 1

As a registered nurse, you have a legal and ethical obligation to do which of the following?

a. Delegate responsibility to others
b. Show up for work on time
c. Advocate for patients
d. Respect the wishes of patients no matter what

Answer 1

C: The American Nurses Association Code of Ethics (2001), as well as many state Nursing Practice Acts, require nurses to serve as patient advocates. A patient’s diagnosis, extent of illness, treatments, pain, and the institutional nature of hospitals often result in patients becoming passive recipients of care instead of active participants. Nurses have the obligation to advocate for patients, especially those who are unable to do so for themselves, helping them communicate their wishes to the health care team, being vigilant in protecting their safety, and sometimes even in protecting their legal rights. NEGLIGENCE AND NURSING ADVOCACY

Question 2

A patient’s son has medical power of attorney and has arrived at the patient’s bedside to discuss care options with her. The patient has just been dialyzed, has not received any pain medication, and is rational in her decision making. The patient’s son decides that she should not receive any more dialysis treatments due to the acute state of her illness, the discomfort that she has suffered, and her inability to care for herself. The patient disagrees. Which decision should be followed?

a. The patient’s son
b. The patient
c. Both, and the hospital ethics committee should convene and decide
d. Neither, this is a legal decision and should be done by a court of law

Answer 2

B: Even though the patient has given her son legal power of attorney over her health care decisions, if she is competent and disagrees with her agent’s (her son’s) wishes or decisions, her decisions are the ones that prevail. FALSE IMPRISONMENT

Question 3

A student nurse has learned that Good Samaritan laws were enacted to protect the health care professional from legal liability. The student nurse asks a nurse educator about when the Good Samaritan laws would not be applicable. Which of the following would a nurse educator give as an example of care rendered that does not fall under Good Samaritan laws?

a. A doctor who delivers a baby during a football game
b. A nurse who sets a broken leg while hiking in the mountains
c. An EMT who, upon their arrival at the accident, intubates an accident victim who stopped breathing and who was forcibly thrown onto their vehicle
d. A nurse who stops to help at the scene of a water-skiing accident

Answer 3

C: Some of the components of care given under the Good Samaritan laws are care that is rendered in an emergency situation (the nurse at the water-skiing accident or the nurse who set the broken leg while hiking) when the health care worker is not being paid. (The fact that the EMT intubated the patient who was thrown on their vehicle indicates that the EMT arrived in response to a call. If the EMT was passing by and just happened to see the accident and either had not been called or was off-duty, then the care would fall under the Good Samaritan laws.) The doctor who delivers a baby during a football game also rendered care under the Good Samaritan law. GOOD SAMARITAN LAWS

Question 4

A patient has an advance directive that indicates no CPR should be performed under any circumstance. When the nurse enters the patient’s room and finds that he has coded, the nurse immediately begins CPR. The nurse is at risk for which of the following?

a. Negligence c. Assault
b. Battery d. Licensure

Answer 4

B: Failing to honor a patient’s advance directive (living will, medical power of attorney, or durable medical power of attorney) puts caregivers at risk for charges of malpractice via battery. An example of negligence would be not honoring a patient’s wish to be resuscitated, and licensure may be revoked or suspended due to certain acts (or failure to act) depending on the circumstances and outcomes involved. TABLE 23-2 SELECTED TORTS

Question 5

A student asks a nurse educator about what part of the law tort law deals with. The nurse educator responds that tort law is concerned with:

a. torts and pies, and always being correct.
b. always being correct and failure to show up for jury duty.
c. failure to show up for jury duty and touching people when they do not want to be touched.
d. touching people when they do not want to be touched and always being correct.

Answer 5

C: Law.com (2010) has defined tort as a civil wrong for which injury occurs to another. Examples of torts include failure to show up for jury duty (failure to comply with a public duty), touching people when they do not want to be touched (battery, which is a type of tort charge), and denial of a person’s rights. TORT LAW

Question 6

A new nursing graduate is working on a unit project regarding patient care and GI treatments. While interviewing a patient, who has been incessantly complaining about his lack of daily bowel movements (complete with graphic details about the type and consistency), the new nursing graduate tells the patient that if he is not quiet she will give him an enema he will never forget. This is an example of:

a. invasion of privacy. c. assault.
b. battery. d. defamation.

Answer 6

C: Threatening to touch (or treat) another person without his consent is a definition of assault. By threatening to give the patient “an enema he will never forget” if he is not quiet, the new nursing graduate has threatened to give a treatment (enema) against his will. Battery is the actual act of giving the enema (treatment), and defamation is the act of giving intentionally false information, communication, or publication such as making a statement that could cause a patient to lose his job. TABLE 23-2 SELECTED TORTS

Question 7

A nursing instructor asks a student to name the four elements required to provide proof of liability. Which response by the student would indicate that further teaching is needed?

a. Obligation created by law, contract, or standard practice that is owed to the professional by the complainant
b. Breach of this obligation either by omission or commission
c. Physical, emotional, or financial harm to the complainant
d. Proof that the breach of obligation caused the complainant harm

Answer 7

A: Providing proof of liability (or fault) in malpractice or negligence cases requires the following four factors: obligation created by law, contract, or standard practice that is owed to the complainant (patient) by the professional (not the other way around); a breach of this obligation either by omission or commission; physical, emotional, or financial harm to the complainant; and proof that the breach of obligation caused the complainant harm. NEGLIGENCE AND MALPRACTICE

Question 8

A nurse has heard that a fellow nurse at another hospital was charged with assault on a patient. The nurse asks the nurse manager whether assault is the same as battery. The nurse manager explains that assault differs from battery in that it:

a. is the act instead of the threat being done without permission.
b. is the threat instead of the act being done without permission.
c. concerns being offensive without permission.
d. concerns the thought without the act or the threat.

Answer 8

B: Assault concerns the threat to touch (or treat) another person without her permission, while battery is the actual act of touching or treating another person without her permission. ASSAULT AND BATTERY

Question 9

A nurse trained in another country is seeking licensure in the United States. While becoming familiar with the American legal system, the nurse learns that there are three types of public laws that include which of the following?

a. Constitutional, governmental, and criminal
b. Criminal, constitutional, and administrative
c. Criminal, tort, and administrative
d. Administrative, governmental, and civil

Answer 9

B: Public laws define a citizen’s relationship with the government. Three types of these laws are criminal, constitutional, and administrative. PUBLIC LAW

Question 10

You are conducting an in-service and ask the participants to identify the law that is concerned with the protection of the rights of citizens. Which response by the participants would be correct?

a. Tort c. Administrative
b. Civil d. HIPAA

Answer 10

C: Administrative law deals with the protection of the rights of citizens. An example is the Civil Rights Act of 1964, which prohibits forms of discrimination in the workplace. Civil law deals with how people relate to each other in everyday matters; it encompasses both tort and contract law. HIPAA is a type of federal administrative law and is concerned with the protection of medical information. FEDERAL

Question 11

Using a whiteboard to organize nursing assignments per shift or to provide patients information about their practitioner or diagnosis is a violation of which of the following?

a. Civil law c. HIPAA
b. Tort law d. OSHA

Answer 11

C: The Health Insurance Portability and Accountability Act (HIPAA) was enacted to safeguard medical information. Some previous methods for patient care organization fall under what is now considered to be HIPAA violations because they provide a means for others to access private information about patients’ care. Examples of HIPAA violation include the use of whiteboards to organize shift assignments and nursing organizational charts (used to organize patient treatments, diagnoses, etc.). If used, they must be destroyed when they are no longer needed. FEDERAL

Question 12

A student nurse has heard about something called the Nurse Licensure Compact. When the student asks a nurse educator, the nurse educator explains that the Nurse Licensure Compact is a:

a. plan for all nurses to need only one license with a large annual fee.
b. project of the National Council of State Boards of Nursing.
c. type of specialized organizational tool used in licensure and NCLEX exams.
d. spinoff of EEOC legislation.

Answer 12

B: The Nurse Licensure Compact is a project of the National Council of State Boards of Nursing and is an agreement among states to allow nurses to be multistate licensed (without applying for a new license) in those states that have agreed to this practice (no extra large fee involved). STATE

Question 13

A nurse entrepreneur is working with an attorney to develop a contract for a health care-related business that is being started. The attorney explains to the nurse entrepreneur that, according to contract law, an agreement must contain which of the following in order to be legal?

a. Agreement between two people that states what the first party must do
b. Agreement between two people in which a fee was paid up front
c. Mutual understanding of the obligations that the contract imposes on each party
d. Must be a written document

Answer 13

C: Contract law regulates certain transactions between individuals, legal entities, and/or businesses. For a contract to be considered legal, it must contain certain elements such as a mutual understanding of the terms and obligations that the contract imposes on each party (not just the first party) to the contract, and an agreement between two or more legally competent individuals/parties stating what each must or must not do. It can be either oral or written. CONTRACT LAW

Question 14

There is a going-away party for one of the nurses, who has been promoted to a managerial position in another hospital that is part of the same health care organization. Photographs have been taken of nurses around the unit as a way for the nurse to remember fellow colleagues. If patients are inadvertently photographed and no consent for this is obtained, this is an example of:

a. assault. c. invasion of privacy.
b. battery. d. defamation.

Answer 14

C: Consent must always be obtained for any photographs or use of statements made by patients or to disclose confidential information about a patient. Assault deals with the threat to touch another person against their will, and battery is the actual act of touching or treating another person against their will. Defamation (including libel and slander) is concerned with intentionally giving false information that may cause the loss of a person’s reputation. TABLE 23-2 SELECTED TORTS

Question 15

A nurse educator informs the class that the reasonable person standard is:

a. it takes a reasonable man to maintain a good relationship.
b. reasonable men tend to have reasonable children and make good partners.
c. used to demonstrate a breach of duty.
d. used by state Boards of Nursing to evaluate the male-female ratios according to clinical position.

Answer 15

C: The reasonable person standard is used by courts when dealing with cases of potential negligence and malpractice to show what a “reasonable nurse would do” in a given situation. Reviewing the organization’s policies and procedures, evidence from the state’s Nurse Practice Act, and the use of expert witnesses to the standard of nursing practice in that community are all examples of aspects of the reasonable person standard. NEGLIGENCE AND MALPRACTICE

Question 16

A nurse is doing some charting and needs a tool that will help with legal protection. The nurse remembers that one useful tool is the acronym FLAT, which stands for:

a. factual, legible, accountable, and timely.
b. factual, legal, accurate, and time frame.
c. fully accountable, legitimate, accurate, and truthful.
d. foresight, legitimate, accountable, and timely.

Answer 16

A: The acronym FLAT is a tool that can be used by nurses to remind themselves what points must be covered in charting to help protect them legally. FLAT stands for factual, legible, accurate, and timely. The old adage that “if it isn’t written, it didn’t happen” still holds true, and FLAT is one way to remind nurses what needs to be written and how. SKILLFUL COMMUNICATION

Question 17

A nurse manager wishes to implement a risk management program because it:

a. helps protect hospitals from bioethical problems.
b. has an emphasis upon quality improvement and protection from financial liability.
c. can be combined with quality management goals; hence, there is no need for specially trained people.
d. may investigate nurses who do not practice according to evidence-based practice.

Answer 17

B: Risk management programs in hospitals are set up to investigate and correct system problems that may contribute to errors in patient care or to employee injury. They have an emphasis upon quality improvement and the protection of the institution from financial liability. Ethics departments/programs deal with bioethical problems and dilemmas. While risk management personnel may reside within a quality management/improvement department, they are specially trained in risk prevention and are able to focus on identifying risk behaviors and correcting problems RISK MANAGEMENT PROGRAMS

Question 18

A group of newly hired nurses ask a nurse manager if they should carry malpractice insurance. The nurse manager tells them that there are a number of good reasons for nurses to carry their own malpractice insurance. Which of the following would not be included?

a. Their institution’s insurance may not cover them if they fail to comply with its policies and procedures.
b. Nurses are being named individually in lawsuits.
c. Their institution may fail to cover them if they acted outside the scope of their employment.
d. Nurses are being considered easy targets for lawsuits.

Answer 18

D: Some reasons why nurses may consider carrying their own malpractice insurance include the fact that an employer’s liability coverage may not protect them if it is found they acted outside their scope of employment (i.e., UAP who started an IV) or failed to comply with facility policies and procedures. In addition, nurses are being named individually as defendants more frequently, and it would behoove a nurse to be assured of a sound defense independent of their employer. MALPRACTICE/PROFESSIONAL LIABILITY INSURANCE

Question 19

A nurse is asking a more senior nurse for suggestions regarding consulting and collaborating with an attorney. Which combination of suggestions by the senior nurse for consulting and collaborating with attorneys would be correct?

a. Choose an attorney from the yellow pages and keep costs sensible.
b. Be attentive and do not set your own course.
c. Retain a specialist and do not notify your carrier of a possible liability until you are sure.
d. Weed through the writing and set your own course.

Answer 19

D: In the event that a nurse is named as a defendant in a malpractice case, LaDuke (2002) has the following suggestions for consulting and collaborating with an attorney: keep costs sensible (expenses should be explained up front and sometimes a retaining fee is paid), be attentive (read the documents your attorney provides), set your own course (insist on a collaborative relationship with your attorney for the duration of your case), retain a specialist (professional malpractice, professional disciplinary proceedings, and employment disputes require the expertise of a specialist in those areas), DO notify your insurance carrier as soon as you are aware of a real or potential liability issue and weed through the writing (your attorney needs to explain all facts and options). NURSE/ATTORNEY RELATIONSHIP

Question 20

A nurse with 20 years of OB-GYN experience was asked to float to the ER. She refused. Was she correct in this decision and why?

a. Correct. If she did this once, she might be expected to float on a regular basis.
b. Incorrect. She felt she had enough seniority to not have to float.
c. Incorrect. She just did not want to float.
d. Correct. With her lack of experience, she felt she could not safely care for her patients.

Answer 20

D: Sometimes nurses find they are in conflict with their hospital/facility’s expectations and standard of care. Being asked to float to another unit, particularly a specialized one such as an ER, when one has no experience in that area, can put patients at risk and their safety in jeopardy. By refusing to float to the ER, the experienced OB-GYN nurse is advocating for the ER patient’s rights and safety. When refusing to comply with a request or assignment such as this, the nurse would be wise to work through the hospital/facility chain of command and notify the supervisor of their patient safety concerns. NEGLIGENCE AND NURSING ADVOCACY

Question 21

A nurse is sexually harassed by one of the Chief Residents on the unit. After experiencing several months of this harassment, the nurse files a complaint with the union representative. The attorney for the hospital informs the union representative that the hospital was unaware of the sexual harassment. Which of the following statements is accurate in terms of the hospital’s liability?

a. Lack of knowledge of the sexual harassment does not eliminate the hospital’s liability.
b. The hospital is not liable because the nurse should have reported the first incident of sexual harassment.
c. Liability for the sexual harassment would only exist if the nurse was sexually harassed by another nurse.
d. The hospital is not liable because the nurse should have filed the complaint in the office of EEOC before involving the union representative.

Answer 21

A: The hospital has the responsibility for providing each employee with a safe environment in which to work and reasonable treatment and behavior from other health care providers with whom the employee must interact. Lack of knowledge of the sexual harassment does not eliminate the hospital’s liability. CIVIL LAW

Question 22

A nurse has received several summons to appear for jury duty. The nurse does not respond to the summons and throws them in the trash. The nurse is in violation of which of the following?

a. Contract law c. Criminal law
b. Tort law d. Federal law

Answer 22

B: A tort can be denial of a person’s legal right, failure to comply with a public duty, or failure to perform a private duty that results in harm to another. By ignoring a summons to appear for jury duty, the nurse is in violation of a tort law. TORT LAW

Question 23

Angry at a classmate, a nursing student spreads a rumor that the classmate is HIV positive. The nursing student can be charged with which of the following?

a. Assault c. Slander
b. Battery d. Libel

Answer 23

C: By spreading a false rumor about the classmate, the nursing student can be charged with slander. The slanderous rumor has the potential of defaming the classmate’s character. TABLE 23-2 SELECTED TORTS

Question 24

A patient in the emergency department has a cardiac arrest, and a lawsuit is filed alleging that the triage nurse failed to appreciate acute cardiac symptomatology. The nurse’s action or inaction is an example of which of the following?

a. Negligence c. Ignorance
b. Invasion of privacy d. Malpractice

Answer 24

D: The triage nurse’s failing to appreciate the acute cardiac symptomatology can be considered malpractice. The term malpractice refers to a professional’s wrongful conduct in the discharge of his professional duties or a failure to meet standards of care for the profession, which results in harm to another individual entrusted to the professional’s care. As a triage nurse in the ER, the nurse should have been knowledgeable of the implications of the patient’s cardiac symptoms. TABLE 23-4 NURSING MALPRACTICE CASES

Question 25

A nurse is assigned to six acutely ill patients. The nurse is very careful with administering all medications and treatments accurately and safely to all clients. Legally, which of the following should the nurse be most concerned with?

a. Hear no evil, see no evil, speak no evil.
b. Haste makes waste.
c. If it wasn’t charted, it wasn’t done.
d. A bird in the hand is worth more than two in the bush.

Answer 25

C: The nurse would be most concerned with the phrase, “If it wasn’t charted, it wasn’t done.” Accurate and timely charting is one of the best ways to avoid a lawsuit. Without charting that is factual, legible, accurate, and timely, there is no proof that the nurse provided care that meets professional standards. REAL WORLD INTERVIEW