Chapter 23 Legal Implications in nursing

Question 1

Nurse Practice Acts

Answer 1

e. Describe and define the legal boundaries of nursing practice within each state.

Question 2

Regulatory law

Answer 2

H.Reflects decisions made by administrative bodies

Question 3

Common Law

Answer 3

F. Judicial decision made in courts when individual legal cases are decided.

Question 4

Criminal Law

Answer 4

B. Prevent harm to society and provide punishment for crimes.

Question 5

Felony

Answer 5

C. A crime of serious nature that has a penalty of imprisonment for grater than 1 year or even death.

Question 6

Misdemeanor

Answer 6

G. Less serious crime that has a penalty of a fine or imprisonment for less that 1 year.

Question 7

Civil Laws

Answer 7

D. Protect the rights of individual persons within our society and encourage fair and equitable treatment.

Question 8

Standards of Care

Answer 8

A. The legal guidelines for nursing and provide the minimum acceptable nursing care.

Question 9

Americans with Disabilities Act

Answer 9

It protects the rights of people with disabilities. It also is the most extensive law on how employers must treat health care workers and patients infected with HIV.

Question 10

Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer 10

The EMTALA states that when a pt comes to the emergency dept or hospital, an appropriate medical screening occurs within the hospitals capacity. If an emergency exists, the hospital is not to discharge or transfer pt until the conditions stabilizes.

Question 11

Mental Health Primary Act

Answer 11

• forbids health plans from placing lifetime or annual limits on metal health coverage that are less generous than those placed on medical or surgical benefits.

Question 12

Patient Self Determination Act

Answer 12

requires health care institutions to provide written information to pt concerning their rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.

Question 13

Living Wills

Answer 13

are written documents that direct treatment in accordance with a pt’s wishes in the event of terminal illness or condition.

Question 14

Durable Power of Attorney for Health Care

Answer 14

is a legal document that designates a person or persons of one’s choosing to make health care decisions on his or her own behalf.

Question 15

Uniform Anatomical Gift Act

Answer 15

An individual older that the age of 18 years has the right to make an organ donation; the person needs to make the gift in writing with his or her signature.

Question 16

Health Insurance Portability and Accountability Act of 1996 (HIPPA)

Answer 16

provides rights to pts (protects individuals from losing their health insurance when changing jobs by providing portability) and protects employees. It also establishes the basis for privacy and confidentiality.

Question 17

The Joint Commission’s specific guidelines for the use of restraints are:

Answer 17

• Restraints should only be used to ensure the physical safety of the resident or other residents.
• Restraints should only be used when less restrictive interventions are not successful.
• Restraints should be only used on the written order of a physician which includes a specific episode with start and end times.

Question 18

Licensure

Answer 18

• The board of Nursing licenses all RNs in the state in which they practice and can suspend or revoke a license if a nurse’s conduct violates provisions in the licensing statute based on administrative law rules that implement and enforce the statute.

Question 19

Good Samaritan laws

Answer 19

Good Samaritan laws encourage health care professionals to assist in emergencies, limit liability, and offer legal immunity for nurses who help at the scene of an accident.

Question 20

Public Health laws

Answer 20

PHL provide protection of the public’s health, advocating for the rights of people, regulating health care and health care financing, and ensuring professional accountability for the health care provider.

Question 21

Uniform Determination of Death Act

Answer 21

requires irreversible cessation of circulatory and respiratory functions or that there is irreversible cessation of all the functions of the entire brain, including brain stem

Question 22

Physician assisted suicide

Answer 22

Stature that stated that a competent individual with a terminal disease could make an oral or written request for medication to end his or her life in a humane and dignified manner.

Question 23

tort

Answer 23

Civil wrong made made against a person or property

Question 24

Assault

Answer 24

Any intentional threat to bring about harmful or offensive contact.

Question 25

Battery

Answer 25

Any intentional touching without consent.

Question 26

False imprisonment

Answer 26

Unjustified restraining of a person without legal warrant.

Question 27

Invasion of Privacy

Answer 27

The release of a patient’s medical information to an unauthorized person.

Question 28

Slander

Answer 28

When one person speaks falsely about another person.

Question 29

Libel

Answer 29

Written defamation of character.

Question 30

Negligence

Answer 30

Conduct that falls below the standard of care.

Question 31

Malpractice

Answer 31

Referred to as professional negligence; below the standard of care.

Question 32

Informed consent

Answer 32

Person’s agreement to allow something to happen based on disclosure of risks, benefits, and alternatives.

Question 33

The scope of nursing practice is legally defined by:

1. State Nurse practice Acts
2. Professional nursing organizations
3. Hospital policy and procedure manuals
4. Health care providers in employing institutions

Answer 33

*1, Rationale: Determines the legal boundaries within each state.

Question 34

A student nurse who is employed as a nursing assistant may perform any functions that:

1. Have been learned in school
2. Are expected of a nurse at that level
3. Are identified in the position’s job description
4. Require technical rather than professional skill

Answer 34

3, Rationale: Need to perform only those tasks that appear in the job description for a nurses aide or assistant.

Question 35

A confused patient who fell out of bed because side rails were not used is an example of which type of liability?

1. Felony
2. Battery
3. Assault
4. Negligence

Answer 35

4. Rationale: Conduct that falls below the standards of care.

Question 36

The nurse puts restrains on a patient without the patient’s permission and without a physician’s order. The nurse may be guilty of:

1. Battery
2. Assault
3. Neglect
4. Invasion of Privacy

Answer 36

1. Rationale: Unintentional touching without consent.

Question 37

In a situation in which there is insufficient staff to implement competent care, a nurse should:

1. Organize a strike.
2. Refuse the assignment.
3. Inform the patients of the situation
4. Accept the assignment but make a protest in writing to the administration.

Answer 37

4. Rationale: Need to follow the institution’s policies and procedures on how to handle these situations and use the chain of command.

Question 38

Identify the four criteria needed to establishing nursing malpractice.

Answer 38

• The nurse (defendant) owed a duty to the patient (plaintiff)
  *The nurse did not carry out that duty.
  *The patient was injured.
  The nurse’s failure to carry out the duty caused the injury.

Question 39

Briefly explain the process that a nurse needs to follow when a staffing assignment is unreasonable

Answer 39

*Nurses should inform their supervisor and make a written protest to nursing administration. A copy of the this document should be kept.

Question 40

Identify what the nurse’s responsibility is when he or she “floats” to another nursing unit.

Answer 40

the nurse needs to inform the supervisor of any lack of experience in caring for the type of patients on the unit. The nurse also needs to request an orientation to the unit.

Question 41

What is the nurse’s responsibility with physicians’ orders?

Answer 41

Nurses must follow physician’s orders unless they believe the orders are in error or will harm the patients. If there is any controversy with the order the nurse needs to also inform the supervising nurse or follow the established chain of command.

Question 42

Risk management is:

Answer 42

*a system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs.

Question 43

Identify the purpose of the occurrence (incident) report.

Answer 43

*The occurrence (incident) report provides a database for further investigation in a further attempt to determine deviations from standards of care; corrective measures are needed to prevent recurrence and to alert risk management to potential claim situation.

Question 44

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits?

A. Family member
B. Surgeon
C. Nurse
D. Nurse Manager

Answer 44

B
Rationale:
The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.

Question 45

A woman who is a Jehovah’s Witness has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 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?
A. Obtain a court order to give the blood
B. Coerce the husband into giving the blood
C. Call security and have the husband removed from the hospital
D. Abide by the husband’s wishes and inform the health care provider

Answer 45

D.
Rationale
Adult patients such as those who are Jehovah’s Witnesses are able to refuse treatment for personal religious reasons.

Question 46

6. The nurse notes that an advance directive is on a patient’s medical record. Which statement represents the best description of an advance directive guideline the nurse will follow?

A. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state.
B. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state.
C. The patient cannot make changes in the advance directive once admitted to the hospital.
D. 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.

Answer 46

B.
Rationale:
A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.

Question 47

7. A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nursing manager because this action is a violation of which act?

A. Mental Health Parity Act
B. Patient Self-Determination Act (PSDA)
C. Health Insurance Portability and Accountability Act (HIPAA)
D. Emergency Medical Treatment and Active Labor Act

Answer 47

C.
Rationale:
The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.

Question 48

8. Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? (Select all that apply.)

A. Taking or selling controlled substances
B. Refusing to provide health care information to a patient’s child
C. Reporting suspected abuse and neglect of children
D. Applying physical restraints without a written physician’s order

Answer 48

A & D
Rationale:
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 health care provider based on Joint Commission and Medicare guidelines.

Question 49

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 of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)?

A. Discussing patient conditions in the nursing report room at the change of shift
B. Allowing nursing students to review patient charts before caring for patients to whom they are assigned
C. Posting medical information about the patient on a message board in the patient’s room
D. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

Answer 49

C
Rationale:
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.

Question 50

The 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 of the following statements regarding a breach of duty apply to this situation? (Select all that apply.)
A. Failure to document a change in assessment data
B. Failure to provide discharge instructions
C. Failure to follow the six rights of medication administration
D. Failure to use proper medical equipment ordered for patient monitoring
E. Failure to notify a health care provider about a change in the patient’s condition

Answer 50

A & E
Rationale:
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.

Question 51

11. A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws?
    A. Health Insurance Portability and Accountability Act (HIPAA)
    B. Americans with Disabilities Act (ADA)
    C. Patient Self-Determination Act (PSDA)
    D. Emergency Medical Treatment and Active Labor Act (EMTALA)

Answer 51

D
Rationale:
The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate.

Question 52

12. You are the night shift nurse and are caring for a newly admitted patient who appears to be confused. The family asks to see the patient’s medical record. What is the first nursing action to take?
    A. Give the family the record
    B. Give the patient the record
    C. Discuss the issues that concern the family with them
    D. Call the nursing supervisor

Answer 52

C
Rationale:
Family members do not have the right to private personal health information without the consent of the patient. Establishing a therapeutic relationship with the family and exploring their concerns gives you the information you need to determine how to best address their concerns.

Question 53

13. A home health nurse notices significant bruising on a 2-year-old patient’s head, arms, abdomen, and legs. The patient’s mother describes the patient’s frequent falls. What is the best nursing action for the home health nurse to take?
    A. Document her findings and treat the patient
    B. Instruct the mother on safe handling of a 2-year-old child
    C. Contact a child abuse hotline
    D. Discuss this story with a colleague

Answer 53

C
Rationale:
Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

Question 54

A new graduate nurse is being mentored by a more experienced nurse. They are discussing the ways nurses need to remain active professionally. Which of the statements below indicates the new graduate understands ways to remain involved professionally? (Select all that apply.)
A. “I am thinking about joining the health committee at my church.”
B. “I need to read newspapers, watch news broadcasts, and search the Internet for information related to health.”
C. “I will join nursing committees at the hospital after I have several years of experience and better understand the issues affecting nursing.”
D. “Nurses do not have very much voice in legislation in Washington, DC, because of the shortage of nurses.”

Answer 54

A & B
Rationale

Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees at all levels of their career, not just when they have experience. Nurses have a powerful voice in the legislature.

Question 55

15. You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. What is the best nursing action to take first?
    A. Call the nursing supervisor to discuss the situation
    B. Discuss the problem with a colleague
    C. Leave the nursing unit and go home
    D. Say nothing and begin your work

Answer 55

A.
Rationale:
Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

Question 56

A nurse is caring for a pt who recently had coronary bypass surgery. Which are legal sources of standards of care the nurse uses to deliver safe health care? (select all that apply)
A. Information provided by the head nurse
B. Policies and procedures of the employing hospital
C. State nurse practice act
D. Regulations identified in the Joint commission’s manual
E. The American Nurses association standards of practice

Answer 56

B,C, D. E
Rationale: Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care

Question 57

A nurse is sued for failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? (Select all that apply)
A. The represents the plaintiff.
B. The defendant must prove injury, damage, or loss.
C. The person filing the lawsuit has the burden of proof.
D. The plaintiff must prove that a breach in the prevailing stands of care caused an injury.

Answer 57

C & D

Rationale: the pt as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the pt injury or damage.

Question 58

A 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. What would probably cover the nurse in this situation?
A. The nurse’s auto ins.
B. The nurse’s homeowner ins.
C. The good Samaritan laws, which grant immunity from suit if there is no gross negligence.
D.The patient care partnership, which may grant immunity from suit if the injured party consents.

Answer 58

C

Rationale: The GSL, which grant immunity from suit if there is no gross negligence.