Week 3- Chapter 7- Legal Issues

Question 1

Which province in Canada does not have a set of common laws?
a. British Columbia.
b. Ontario.
c. Quebec.
d. Newfoundland.

Answer 1

C

Question 2

Which of the following has the highest standard of proof associated with it?
a. Common law.
b. Criminal law.
c. Negligence law.
d. Malpractice law.

Answer 2

ANS: B
The standard of proof of criminal actions is higher than that of actions involving other liability, and penalty options in criminal sanctions generally include jail time. In criminal law, people are presumed to be innocent until proven guilty.

Question 3

Athena, a registered nurse (RN), has been operating an abortion clinic in one of the city’s impoverished neighbourhoods. Athena is at risk for professional sanctions involving which behaviour?
a. Negligence.
b. Misconduct.
c. Incompetence.
d. Conduct unbecoming a member of the profession.

Answer 3

D
Professional sanctions and disciplinary actions generally arise from three unacceptable behaviours: (1) misconduct, (2) incompetence, and (3) conduct unbecoming a member of the profession. Misconduct is unacceptable behaviour within the scope of the profession’s practice; incompetence is a failure to meet minimum generally accepted standards; and conduct unbecoming a member of the profession is behaviour outside a profession’s practice that may bring the profession into disrepute. Because Athena is practising outside the scope of her RN practice, she is at risk for sanctions involving conduct unbecoming a member of the profession.

Question 4

A person in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Canadian Charter of Rights and Freedoms (1982) requires that employers:
a. Make reasonable accommodations for persons who are disabled.
b. Allow modified job expectations for persons recovering from alcoholism.
c. Hire disabled individuals before hiring other qualified, nondisabled persons.
d. For purposes of employment, treat homosexuals and bisexuals as disabled.

Answer 4

ANS: A
The Canadian Charter of Rights and Freedoms (1982) outlines many of the provisions that prohibit discrimination in the workplace on the basis of national origin or ethnicity, race, religion, age, colour, gender, sexual orientation, or mental or physical disability.

Question 5

A staff nurse who was fired for reporting client abuse to the appropriate state agency files a whistle-blower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistle-blower suit claiming retaliation include which of the following?
a. The nurse had previously reported the complaint, in writing, to hospital
administration.
b. The nurse had threatened to give full details of the client abuse to local media
sources.
c. The nurse was discharged after three unsuccessful attempts at progressive
discipline had failed.
d. The nurse had organized, before filing the complaint, a work stoppage action by
fellow employees.

Answer 5

ANS: A
An employer cannot fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law. Nurses may be affected by a variety of laws that require reporting, and many statutes provide provisions to protect whistle-blowers from reprisals or retaliatory actions by employers or others as a result of the reporting. The intent is to advance the protection of the public and those who take action to safeguard it.

Question 6

The nurse manager organizes an orientation for new staff members. As part of the orientation the nurse manager reviews the unit’s policy and procedure manual, which is a part of which type of law?
a. Employment law.
b. Common law.
c. Written law.
d. Legislated law.

Answer 6

ANS: B
Basic employment law is found in common law and includes a duty for employees to follow legitimate employer commands related to their work. These commands may take the form of a manager’s direct request and are also contained within institutional rules, policies, and procedures.

Question 7

To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process in which people attempt to identify potential hazards and:
a. Compensate for previous injuries.
b. Eliminate these risks before anyone else is harmed.
c. Supersede the need for staff members to file incident reports.
d. Discipline staff members who have been involved in previous incident reports.

Answer 7

B

Question 8

A colleague asks you to give her your password access so that she can view her partner’s health care record. This request violates the patient’s right to:
a. Privacy.
b. Confidentiality.
c. Undue authorization of treatment.
d. Protection against slander.

Answer 8

ANS: A
Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient’s affairs, which in the medical context, extends to protection against public disclosure of private facts about the patient to the public.

Question 9

The chart of a patient who has undergone abdominal surgery indicates that one set of vital signs were taken at 7 minutes after surgery; the next set were completed 10 hours after surgery. This level of assessment illustrates which element of malpractice?
a. Breach of duty owed the patient.
b. Foreseeability.
c. Causation.
d. Injury or damage.

Answer 9

ANS: A
The element of malpractice that is depicted in the example is a breach of the duty owed, as evidenced by failure to monitor vital signs of a surgical patient regularly.

Question 10

A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks to a patient with a history of previous sexual abuse. The patient sues, claiming malpractice. Which of the following conditions would probably not apply in this situation?
a. Injury.
b. Causation.
c. Breach of duty.
d. Breach of duty of care owed.

Answer 10

ANS: A
By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behaviour violates usual standards of care. If further distress can be directly linked to the remarks, then causation is established. Because of the physical nature of injury, it may not be possible to establish injury in the suit.

Question 11

As a charge nurse you counsel your RN staff member that he has satisfied his duty of care by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for:
a. Professional negligence.
b. Assault.
c. Avoidance.
d. Murder.

Answer 11

ANS: A
Negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child’s condition.

Question 12

The parents of a toddler, who dies after being brought to the emergency room, launch a lawsuit claiming that the failure of nurses to pursue concerns related to their son’s deteriorating condition contributed to his death. The senior nurse executive is viewed as:
a. A global respondent.
b. Vicariously liable.
c. Performing a frivolous action.
d. Being under the element of causation.

Answer 12

ANS: B
According to the concept of vicarious liability, employers are accountable for the negligence of their employees; the rationale is that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.

Question 13

Which of the following demonstrates a movement away from a culture of blame and liability to one in which a systematic approach is used to enhancing patient safety?
a. Avoiding harmful misrepresentation while assisting patients to understand their
health record.
b. Apology letters to patients who experienced an adverse event inadmissible in a
court of law.
c. Encouraging full disclosure of adverse events with patient identification
information removed.
d. Instituting monthly meetings of a risk management review committee.

Answer 13

B

Question 14

You volunteer at a community clinic. A 17-year-old girl claims to have a diagnosis of a sexually transmitted infection and presents with Chlamydia. The team leader at the clinic advises that:
a. The age of legal consent is 18; therefore, no treatment can be delivered.
b. The teen is underage and should be referred to the family general practitioner.
c. Care can be provided as long as consent is voluntary and information about
treatment and options is provided.
d. Treatment is provided as long as telephone consent is obtained from a parent or
legal guardian.

Answer 14

ANS: C
All provinces and territories have a legal age for consent; in general, this age is 18. However, minors seeking treatment can provide their own consent. An explanation and the patient’s understanding of the proposed treatment or procedure to be performed, the expected results, and the health condition it addresses must be discussed with the patient before it is performed.

Question 15

Which level of government is most responsible for hospitals and health care? a. Local.
b. Provincial.
c. National.
d. International.

Answer 15

B

Question 16

Which of the following is a publicly funded national health care program in Canada?
a. Blue Cross.
b. Hospital Insurance Program.
c. Medicare.
d. Social assistance.

Answer 16

C

Question 17

Which of the following is an unregulated health care worker?
a. Pharmacist.
b. Occupational therapist.
c. Practical nurse.
d. Care aide.

Answer 17

D

Question 18

Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with:
a. Privacy.
b. Confidentiality.
c. Veracity.
d. Informed consent.

Answer 18

A
Privacy may be defined as the right of the individual to determine when, how, and to what extent he or she will release personal information. Privacy protection includes protection against unwarranted intrusion of the patient’s affairs.

Question 19

To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except:
a. Notifying staff of changes to policies related to medication administration.
b. Scheduling and staffing to ensure safe care.
c. Delegating in accordance with practice acts.
d. Supervising the practice of the physician.

Answer 19

D

Question 20

Which of the following is the least restrictive in governing health care occupations? a. Association.
b. College.
c. Registration. d. Certification.

Answer 20

C

Question 21

Sally observes a colleague reading the chart of a patient who is not assigned to him. She approaches him and inquires why he is reading the chart. His reply is he has a similar diagnosis in one of my patients and “I want to see if this information could help me care for my patient.” Sally is concerned there is a breach of patient confidentiality and informs her nurse manager of the incident. The term used to describe Sally’s reporting this situation is:
a. Duty of care.
b. Negligence.
c. Duty to report.
d. Ethical dilemma.

Answer 21

ANS: C
Some recent nursing regulations impose new statutory duties on nurses to report other nurses or health care providers to their registration bodies where concern exists that a professional is dangerous to the public or demonstrates sexual misconduct. Of concern here is an individual health care provider’s fitness to practise and the protection of the public.

Question 22

The term negligence includes which aspects of the following? (Select all that apply.)
a. Is a common type of unintentional tort.
b. Duty to care was breached.
c. There was reasonable foreseeability.
d. May be legally actionable.

Answer 22

ANS: A, B, C, D
Negligence is a common type of unintentional tort and requires that there be an existent duty to care that was breached in a particular way by a person who was expected to uphold a standard of care, and who could reasonably foresee that their actions might result in a wrongful act or injury. Depending on circumstance it may be legally actionable.

Question 23

Nurses cannot refuse to work under what circumstances? (Select all that apply.)
a. It is a usual scope of practice.
b. Employer has inadequate supports.
c. Endangers another person.
d. Places nurse in overtime.

Answer 23

ANS: A, C
Occupational health and safety legislation gives employees the right to refuse to work where that work, including the operation of equipment, machines, or devices, poses a danger to themselves or others. Health care workers cannot refuse to work where refusal would directly endanger the life, health, or safety of another person.

Question 24

Battery is termed which of the following? (Select all that apply.)
a. Intentional tort.
b. Intent to touch without consent.
c. Unintentional tort.
d. Exceeds consent given.

Answer 24

ANS: A, B, D
Failure to obtain informed consent before performing an act on a patient, or where an act exceeds the consent given, results in what is termed a battery in tort law and takes place when someone intentionally touches another without consent.

Question 25

Nurses who commit wrongful actions include which of the following? (Select all that apply.)
a. Criminal liability.
b. Have no liability.
c. Professional sanctions.
d. Ensures compliance.

Answer 25

ANS: A, C, D
The consequences faced by nurses who perform wrongful actions fall into four basic categories: criminal liability, civil liability, professional sanctions, and employment ramifications. Nurses do not have an option to not have liability insurance; it is a requirement of the College of Nurses.

Question 26

One of your staff nurses asks for your advice because a patient refuses to sign a consent form for surgery. The patient says that he will not sign because he does not understand the nature of the surgery. You advise that: (Select all that apply.)
a. Consent must not be coerced.
b. The patient has a right to choose not to consent.
c. The patient must sign the consent because the doctor wants him to sign.
d. Witnessing the signing of a consent from is related only to the voluntary nature of
the signature.

Answer 26

A, B, D

Question 27

With regard to nursing practice, nurse managers are held responsible for: (Select all that apply.)
a. Practising within legal guidelines established under provincial or territorial law and nurse practice acts.
b. Ensuring that nursing staff members under their supervision are currently licenced to practice.
c. Referring all errors in nursing judgement to state discipline boards.
d. Ensuring that physicians are properly licenced to provide care on patient care units.

Answer 27

ANS: A, B
Nurses are responsible for knowing legal and nurse practice acts and for practising according to them. Managers are responsible for monitoring staff practice and ensuring that nursing staff members hold current, valid licensure.