Chapter 45: Legal Issues My Nursing Test Banks

Chapter 45: Legal Issues

Multiple Choice

Identify the choice that best completes the statement or answers the question.

____ 1. A pregnant 15-year-old girl presents to the emergency department (ED) of the local private hospital. She has been transported by her mother and appears to be in active labor. The girl is crying uncontrollably and says she is scared and experiencing painful contractions. Her mother states, We dont have any money or insurance, but this hospital is closer than the public hospital, and she needs help now. What is the first step that the ED staff should take?

1)

Arrange for an ambulance to transport her to the nearest public hospital.

2)

Explain to the girl and her mother that the hospital only accepts patients who can pay the hospital bill.

3)

Examine her to determine if her condition is stable or if she requires immediate medical attention.

4)

Inform her mother that she will need to transport her daughter to the nearest public hospital.

____ 2. For the patient with no healthcare coverage who is seeking medical care, the emergency department staff members decide whether to provide care or transport to a public facility based on which law, enacted by Congress in 1986 and updated in 2003?

1)

Health Care Quality Improvement Act (HCQIA)

2)

Patient Self-Determination Act (PSDA)

3)

Newborns and Mothers Health Protection Act (NMHPA)

4)

Emergency Medical Treatment and Active Labor Act (EMTALA)

____ 3. A patient tells you that chart entries made by the nurse from the previous day indicate he was uncooperative when asked to ambulate. He says this is not true and asks his record be corrected. You understand that, if what he says is accurate, he has the right to have the documentation error corrected based on which of the following regulations?

1)

Americans with Disabilities Act (ADA)

2)

Patient Self-Determination Act (PSDA)

3)

Health Insurance Portability and Accountability Act (HIPAA)

4)

Health Care Quality Improvement Act (HCQIA)

____ 4. Upon initial assessment of a 75-year-old patient, you identify bruises and scratches on the patients arms, legs, and trunk in various stages of healing. You notify your supervisor when you suspect the patient may be a victim of physical abuse. You are complying with which of the following state laws?

1)

Good Samaritan Law

2)

Mandatory Reporting Law

3)

Nurse Practice Act

4)

Nursing Standards of Practice

____ 5. Nursing codes of ethics support which of the following?

1)

Patients can receive emergency treatment regardless of their ability to pay.

2)

Nurses will educate patients about advance directives.

3)

Nurses with HIV must disclose their condition to their employer.

4)

Patients have the right to dignity, privacy, and safety.

____ 6. The charge nurse in a progressive care unit assigns the care of a patient receiving hemodialysis to a newly hired licensed practical nurse (LPN) without checking to see that the nurse has been determined competent to care for hemodialysis patients. The LPN is in orientation and, does not inform the charge nurse that she does not have experience with this type of patient. The actions of the charge nurse would be considered to be which of the following?

1)

Malpractice

2)

Incompetence

3)

Negligence

4)

Abandonment

____ 7. In which of the following circumstances might the nurse defer obtaining informed consent for care and treatment of a patient?

1)

The patient is confused and cannot understand or sign the consent form.

2)

The patient is brought to the emergency department in cardiac arrest; no family is present.

3)

The surgeon requests that the patient be sent to the surgical suite before you get the consent form signed.

4)

An unconscious patient is admitted to your unit; he is alone.

____ 8. A 4-year-old child is brought to the emergency department by his mother. He has a large bruise in his left chest and multiple contusions on his face. His mother tells you her boyfriend intentionally pushed the child down the stairs in anger. The child appears to be in a great deal of pain. Which of the following four correct items should the nurse to do first?

1)

Notify the nursing supervisor of the suspected physical abuse.

2)

Complete a physical assessment of the child.

3)

Obtain an order for pain medication.

4)

Notify Child Protective Services of the suspected abuse.

____ 9. You are caring for an alert, oriented 47-year-old patient who is recovering from abdominal surgery. The patient becomes angry and upset and says, Im leaving this hospital. Remove my IV and surgical drains or I will do it myself. In order to keep him from removing his lines and leaving the hospital, you apply bilateral wrist restraints until you can contact the physician for an order for patient restraint. This is an example of which of the following?

1)

Assault and battery

2)

A felony

3)

False imprisonment

4)

A quasi-intentional tort

____ 10. A registered nurse forgot to put the side rails up for a confused patient. The patient fell out of bed and fractured his hip. The patient sues and wins a judgment (award) for $2 million. The nurse has an occurrence policy with double limit coverage of $3 million/$10 million that covered the time period when the incident occurred. The statement that best describes the nurses situation is that her insurance policy will:

1)

Not cover her.

2)

Pay $4 million.

3)

Pay $2 million.

4)

Pay 75% of the $2 million

____ 11. A registered nurse administers the wrong medication to a patient. She does not notify anyone of the error and documents that the correct medication was administered. The nurse was reported to the state board of nursing. Which of the following actions can the state board of nursing take against the nurse in this situation?

1)

Disciplinary action against the nurses license to practice

2)

Criminal misdemeanor charges against the nurse

3)

Medical malpractice lawsuit against the nurse

4)

Employment release from the institution

Multiple Response

Identify one or more choices that best complete the statement or answer the question.

____ 1. Which of the following are examples of invasion of privacy by nurses? Choose all that apply.

1)

Searching a patients belongings without permission

2)

Reviewing the plan for patient care in the lunchroom

3)

Discussing healthcare issues for an unconscious patient with his power of attorney

4)

Releasing patient health information to local newspaper reporters

____ 2. While you are admitting an adult patient, he asks you whether he should create an advance directive. To provide him adequate information to make an informed decision, you should tell the patient which of the following? Choose all that apply.

1)

If he is unable to communicate, his family may make changes to his advance directive.

2)

Once he signs an advance directive, no further care will be provided to him.

3)

He may change his advance directive by telling his physician or by making changes in writing.

4)

An advance directive will ensure he gets as much or as little care as he wishes.

____ 3. What do negligence and malpractice have in common? Choose all that apply.

1)

Negligence and malpractice are unintentional torts.

2)

Negligence and malpractice are felonies.

3)

Malpractice is the professional form of negligence.

4)

Negligence and malpractice involve the intent to do harm to a patient.

____ 4. You are caring for a patient with renal failure. His morning laboratory results reveal an abnormal potassium level of 6.8. This value is more elevated than on the previous day, when the level was within normal limits. You page the patients physician, but he does not return your call right away. You become busy with another patient and forget to notify the physician again and fail to mention the critical laboratory value to the oncoming nurse during shift report. Which of the following does this scenario illustrate? Choose all that apply.

1)

Failure to implement a plan of care

2)

Failure to evaluate

3)

Malpractice

4)

Failure to assess and diagnose

Completion

Complete each statement.

1. The American Nurses Association (ANA) believes nurses should not participate in active euthanasia (and assisted suicide) because such acts violate ____________________.

A. the Patient Self-Determination Act

B. civil laws

C. the Good Samaritan laws

D. the Code of Ethics for Nurses

Other

1. Prioritize the following guidelines for nursing practice in order of specificity (14).

A. ____ State laws

B. ____ Institutional policies and procedures

C. ____ Federal laws

D. ____ State nurse practice acts

Chapter 45: Legal Issues

Answer Section

MULTIPLE CHOICE

1. ANS: 3

When a client comes to the ED requesting examination or treatment for an emergency medical condition (including labor), the hospital must provide stabilizing treatment; the client cannot be transferred until she is stable.

PTS: 1 DIF: Moderate REF: V1, p. 1111

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

2. ANS: 4

The intent of the Emergency Medical Treatment and Active Labor Act (EMTALA) is to ensure public access to emergency services regardless of ability to pay. The EMTALA prohibits patient dumping, which is transferring indigent or uninsured patients from a private hospital to a public hospital without appropriate screening and stabilization. An exception is made if a hospital does not have the capability to stabilize a patient or if the patient requests a transfer.

PTS: 1 DIF: Difficult REF: V1, p. 1111

KEY: Client need: SECE | Cognitive level: Recall

3. ANS: 3

The Health Insurance Portability and Accountability Act (HIPAA) Privacy Rule of 2004 provides comprehensive protection for the privacy of protected health information (confidentiality of patient records). In addition, patients have the right to see and copy their medical records and to reconcile incorrect information.

PTS: 1 DIF: Moderate REF: V1, p. 1111

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Comprehension

4. ANS: 2

Under state mandatory reporting laws, nurses must report to designated authorities (e.g., Adult Protective Services) suspected physical, sexual, emotional, or verbal abuse or neglect by healthcare workers or family members. In general, nurses who fail to report suspected abuse or neglect may be held criminally or civilly liable.

PTS: 1 DIF: Moderate REF: V1, p. 1113

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application

5. ANS: 4

In the Patient Bill of Rights, patients have the right to dignity, privacy, and safety. Although they are not laws, nursing codes of ethics specify ethical duties of the nurse to the patient as related to corresponding patient rights. Although patients do have a right to receive emergency medical care regardless of their ability to pay, this is not part of the nursing code of ethics. Likewise, a nurses role is to educate patients about advance directives; this is a goal supported by nursing organizations but is not part of the code of ethics.

PTS: 1 DIF: Moderate REF: V1, p. 1114

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

6. ANS: 3

Negligence is the failure to use ordinary or reasonable care or the failure to act in a reasonable and prudent (careful) manner. It is negligent to assign a nurse to care for a patient without verifying the nurse has training, experience, and clinical competence in caring for such patients.

PTS: 1 DIF: Moderate REF: V1, p. 1119

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

7. ANS: 2

Informed consent is the necessary authorization by the patient for any and all types of care and must be written and signed by the patient or the person legally responsible for the patient for hospital admission and for invasive or specialized treatments or diagnostic procedures. Written consent is not necessary in an emergency if experts agree that there was an immediate threat to life or health. It is the physician responsible for the care of the patient who has the duty to obtain informed consent from the patient.

PTS: 1 DIF: Moderate REF: V1, p. 1126

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

8. ANS: 2

Although the nurse must report to designated authorities (Child Protective Services) suspected physical abuse, the primary responsibility of the nurse in this situation is to evaluate the patients physical condition and extent of his injuries in order for appropriate medical treatment to be provided. Pain medication should not be administered prior to a thorough physical assessment. The nurse should always notify the nursing supervisor if any outside agencies may need to be contacted.

PTS: 1 DIF: Moderate

REF: V1, p. 1123; critical thinking item requires synthesis of previously acquired knowledge | V1, p. 1129; critical thinking item requires synthesis of previously acquired knowledge

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Analysis

9. ANS: 4

False imprisonment involves an intentional or willful detention of a patient without consent or authority to do so. Restraining a patient without consent is another form of civil false imprisonment. Competent patients have a right to leave an institution, even if it is harmful to their health. Whenever possible, have the person sign a form stating that he is aware that he is leaving against medical advice.

PTS: 1 DIF: Moderate REF: V1, p. 1118

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

10. ANS: 3

An occurrence policy will cover those claims that occurred during the time the policy was in effect. However, the policy will pay up to $3 million per claim; because the amount awarded does not exceed this, the nurse is covered.

PTS: 1 DIF: Difficult REF: V1, pp. 1129-1130

KEY: Nursing process: Analysis | Client need: SECE | Cognitive level: Analysis

11. ANS: 1

The state board of nursing is empowered to initiate disciplinary action against the nurses license for professional misconduct. The board does not bring criminal charges or sentence the nurse to jail; that is the parameter of the state prosecutor and judge. A patient or the person harmed can bring medical malpractice lawsuits against the nurse.

PTS: 1 DIF: Moderate

REF: V1, pp. 1116-1117; ESG, Chapter 45, Box 45-3: Actions, Behaviors, or Omissions that Constitute Unprofessional Conduct

KEY: Nursing process: Assessment | Client need: SECE | Cognitive level: Application

MULTIPLE RESPONSE

1. ANS: 1, 2, 4

Invasion of privacy violates a persons right to be free from unwanted interference in her private affairs, such as occurs in discussing patient matters in a public setting; searching patients private items without their permission; and releasing private information to the public. A durable power of attorney is a document empowering a person selected by the patient to make healthcare decisions in the event that the patient is unable to do so. It is permissible to discuss pertinent issues related to the welfare of the patient with the person holding a power of attorney.

PTS: 1 DIF: Easy REF: V1, p. 1119

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

2. ANS: 3, 4

Advance directives include living wills and durable powers of attorney. A living will establishes the patients wishes regarding future healthcare should he become unable to give instructions. A patient may specify actions in a living will that are not supported by family members, such as a desire for a do not resuscitate order, or for as much or as little care as he wishes. A person may change or revoke an advance directive at any time. Changes and written revocation should be signed and dated and shared with the patients physician. Even without an official written change, orally expressed direction to the physician generally has priority over any statement made in an advance directive as long as the patient is able to decide for himself and can communicate his wishes.

PTS: 1 DIF: Moderate REF: V1, pp. 1111-1112

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Application

3. ANS: 1, 3

Rationale: Negligence and malpractice are unintentional tortsnurses can be negligent without intending to do harm. Negligence is simply the failure to use ordinary or reasonable care as dictated by the standards of practice and/or by what a reasonable and prudent nurse would do in the same or similar circumstances. Intent is not an element of negligence. When a nurse or other licensed professional healthcare provider is negligent and fails to exercise ordinary care, it is called malpractice. Malpractice is the professional form of negligence.

PTS: 1 DIF: Moderate REF: V1, p. 1119 | V2, p. 1062

KEY: Client need: SECE | Cognitive level: Analysis

4. ANS: 1, 2, 4

Failure to implement a plan of care and failure to evaluate are two of the most common causes of nursing malpractice claims. The above scenario represents a failure to follow standards of care, failure to communicate, and failure to document, which are in the category of failure to implement a plan of care. It also represents a failure to report a significant change in the patients condition, which is part of the category offailure to evaluate. The nurse did assess the potassium level and recognize that it was too high.

PTS: 1 DIF: Difficult REF: V1, pp. 11231124 | V2, p. 1064

KEY: Nursing process: Interventions | Client need: PHSI | Cognitive level: Application

COMPLETION

1. ANS:

D

The ANA defines assisted suicide, a form of active euthanasia, as providing a patient the means to end his life, with full knowledge of the patients intentions to do so. The ANA believes that participation in active euthanasia violates the Code of Ethics for Nurses and the ethical traditions of the profession.

PTS: 1 DIF: Moderate REF: V1, p. 1114; not stated outright in the chapter

KEY: Nursing process: Planning | Client need: SECE | Cognitive level: Recall

OTHER

1. ANS:

C, A, D, B

Institutional policies and procedures are usually more specific and detailed than standards set by professional organizations. State nurse practice acts identify the minimum level of nursing care for a specific patient in specific situations. Standards in nurse practice acts are set forth in statutes and enforced by authority granted by the state. Federal laws, both constitutional and statutory, affect nursing practice in the most general terms.

PTS: 1 DIF: Moderate REF: V1, pp. 1110-1115

KEY: Nursing process: Interventions | Client need: SECE | Cognitive level: Analysis

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