Chapter 7- Legal Responsibilities for Practice My Nursing Test Banks

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Chapter: Chapter 7: Legal Responsibilities for Practice

Multiple Choice

1. Which of the following statements accurately reflects an element of the crisis surrounding liability insurance in the United States?

A) Professional liability insurance does not provide coverage when the nurse assists in an emergency.

B) Malpractice insurance premiums are not affordable for nurses in independent advanced practice and traditional nursing roles.

C) Laws in some states are being amended to restrict the monetary liability of any party according to the percentage of responsibility.

D) Nurses are being named in fewer lawsuits, but the judgments being awarded are larger.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5

Page and Header: 259, Liability Insurance

Feedback: Laws in some states are being amended to restrict the monetary liability of any party according to the percentage of responsibility. Liability laws continue to be a major concern for nurses, because nurses are being named in an increasing number of suits, although the total number is still low. Nursing liability insurance tends not to be expensive and it provides coverage in emergency situations.

2. The law requires that a person give voluntary and informed consent for medical treatment. Which of the following statements accurately describes this legal obligation?

A) It is the responsibility of the nurse to obtain informed consent.

B) Informed consent must be obtained in the form of written documentation.

C) A blanket consent for any procedures deemed necessary is usually considered adequate consent for specific procedures.

D) The courts do not accept the clients medical condition alone as a valid reason for withholding information when seeking consent.

Ans: D

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 266, Consent for Medical Treatment

Feedback: Courts do not accept the patients medical condition alone as a valid reason for withholding complete and accurate information when seeking consent. Obtaining consent is not normally a nursing responsibility. Verbal consent and implied consent may have legal standing and blanket consent is insufficient to cover any and every procedure.

3. A nurse working in a hospital setting is accused of malpractice. Which statement accurately represents a legal element of this type of negligence?

A) Malpractice is present only if a breach of duty was the cause of the harm.

B) When the harm is not clear and needs to be proved in court, the legal term res ipsa loquitur is used.

C) Breach of duty is clearly defined as the expression of malicious intent.

D) A breach of duty is a failure to act as a prudent professional according to standards of care designated by the federal government.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 252, Display 7.1

Feedback: One of the essential elements of malpractice is a breach of duty by the professional. When the harm is so clear and the responsibility for the harm so straightforward that it does not need to be proved in court, the legal term res ipsa loquitur is used. Breach of duty is not synonymous with malicious intent. The standards by which breach of duty is evaluated are not defined by the federal government.

4. An attorney representing a client in a malpractice case attends a deposition. What might occur in this proceeding?

A) A sworn, verbatim record is made by a court reporter.

B) A settlement is made out of court.

C) A legal proceeding presided over by a judge takes place in a courtroom.

D) Damages are awarded to the plaintiff.

Ans: A

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9

Page and Header: 281, Discovery

Feedback: A deposition is a formal proceeding in which each attorney has an opportunity to question a witness outside of court, and a sworn verbatim record is made by a court reporter. A deposition is not the usual venue for a settlement or the awarding damages. A trial, not a deposition, is a legal proceeding presided over by a judge that takes place in a courtroom.

5. A nurse is called to testify as an expert witness in a malpractice suit. Which of the following guidelines contains prudent advice for this nurse?

A) Volunteer as much information as possible when explaining medical procedure.

B) Use medical jargon as appropriate to describe the treatment provided by the defendant.

C) Pause during the testimony to allow your attorney to object if appropriate.

D) Discuss your testimony with the opposing attorney before the court date.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 10

Page and Header: 282, Display 7.4

Feedback: A nurse who is testifying should listen carefully to the entire question before answering and pause to let your attorney object if appropriate. The nurse should not offer additional information voluntarily or use medical jargon unless it is necessary. Testimony is not discussed with the opposing attorney prior to a court date.

6. A nurse is aware that the nurse practice act in her state provides the legal framework for her scope of practice. A nurse practice act is an example of

A) common law.

B) constitutional law.

C) enacted law.

D) judicial law.

Ans: C

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 246, Enacted Law

Feedback: Enacted law includes all bills passed by legislative bodies; nurse practice acts in the various states are examples of enacted law at the state level. A nurse practice act is not an example of constitutional law or common law. Judicial law consists of decrees or judgments from the courts.

7. The federal Health Insurance Portability and Accountability Act (HIPAA) of 1996 addresses patient rights within the healthcare system. Which of the following actions may constitute a violation of HIPAA?

A) A nurse identifies a patient whom he recently cared for on his Facebook page.

B) A nurse completes a charting entry without providing her initials after the entry.

C) A nurse inserts a central venous catheter without the consent of the patient.

D) A nurse makes a crude comment to a patient while providing morning hygiene.

Ans: A

Client Needs: A-1

Cognitive Level: Evaluation

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 248, Rights and Responsibilities in Healthcare

Feedback: HIPAA specifically addresses matters related to patient privacy and confidentiality. Identification of a patient by a nurse would be considered a violation of confidentiality. Failing to sign documentation is not a contravention of HIPAA. Making inappropriate comments and performing interventions without consent are both serious violations of professionalism, but these are less likely to be addressed by HIPAA.

8. The risk manager at a large, university hospital has become aware that there may be a discrepancy between a longstanding protocol on one of the hospital units and the nurse practice act of the state. Which of the following statements regarding the legal standing of institutional policies is most accurate?

A) Institutional policies do not have legal standing.

B) Institutional policies supersede enacted law but do not supersede common law.

C) Established policies may be considered common law by a court

D) Discrepancies between policies and legislation are usually resolved by professional associations such as a board of nursing.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 249, Institutional Policies, Protocols, and Procedures

Feedback: Established agency policies may be considered the standard of practice for that agency and, therefore, common usage (common law) by the court, and may become important as a basis for legal decisions. However, policies do not normally have the power to supersede enacted laws. Discrepancies are ultimately the jurisdiction of the courts, not professional associations.

9. Nursing practice is subject to a wide variety of laws and regulations. Which of the following actions is the clearest violation of criminal law?

A) A nurse left a patients bed in a raised position and the patient subsequently fell.

B) A nurse withheld opioids from a patient and then sold them.

C) A nurse left the unit before her replacement had arrived.

D) A nurse applied restraints to a patient in alcohol withdrawal without first obtaining an order.

Ans: B

Client Needs: A-1

Cognitive Level: Evaluation

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 251, Criminal Law and Nursing

Feedback: Thefts and the sale of controlled substances are not only violations of professional standards but also crimes. Abandoning patients, performing interventions without orders, or committing an action that leads to injury are most often violations of civil law.

10. On a night shift, a nurse who provides care in an inpatient psychiatric setting admitted a patient with a recent history of violence but placed the patient in a two-bed room. The patient subsequently attacked and injured the other patient in the room. Which of the following principles will be considered in the courts determination of liability?

A) The nurse may be held liable if institutional factors are not noted to have contributed to the situation.

B) The nurse is exempt from liability if institutional protocols specify that room allocation is a nursing responsibility.

C) The nurse may be held liable provided the action was a crime.

D) The nurse may be held liable if the action constituted a violation of the standard of care.

Ans: D

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 4

Page and Header: 254, Personal Liability

Feedback: A violation of the standard of care is likely to create a situation of legal liability for a nurse. The violation need not be a crime, however. Institutional factors and protocols do not negate the nurses potential liability

11. Mrs. Howe, age 59, had a bilateral mastectomy with axillary node dissection and was discharged home 2 days later with drains in situ. Contrary to the nurses predischarge teaching, Mrs. Howe attempted to remove one of her drains independently once output ceased, resulting in pain, tissue trauma, and bleeding. Mrs. Howe claims that her injuries were the result of negligence by the nurses on the unit. How would the court apply the principle of comparative negligence in this case?

A) The court would determine what proportion of the patients injuries was the result of her own actions.

B) The court would compare Mrs. Howes actions with those of a reasonable person.

C) The court would determine whether it was medically appropriate to discharge Mrs. Howe with her drains still in situ.

D) The court would decide if the nurses on the postsurgical unit are legally obliged to teach patients.

Ans: A

Client Needs: A-1

Cognitive Level: Evaluation

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 4

Page and Header: 257, Limits on a Patients Claim to Negligence

Feedback: In the application of comparative negligence, the courts determine what percentage of injury resulted from a patients negligence and what part rested with the nurse, and reduce the damage award accordingly. The court would also likely examine the patients actions in light of those of a reasonable person, but this is not a direct application of the concept of comparative negligence. The court would not likely focus on the appropriateness of the patients discharge or the nurses abilities to teach patients.

12. Mr. Yamata was recently admitted to the hospital after a fall in which he suffered a fracture of his femoral head. Over the past 2 days, he has begun to refuse care. Which of the following factors is most significant in the determination of Mr. Yamatas legal competence to refuse care?

A) Mr. Yamata was recently diagnosed with early-stage Alzheimer disease.

B) Mr. Yamata defers most of his important decisions to his oldest son.

C) Mr. Yamata has previously expressed a preference for complementary and alternative therapies.

D) Mr. Yamata attempted to transfer to the commode independently, despite the nurses instructions to the contrary.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 267, Competence to Give Consent

Feedback: Cognitive ability is an important consideration in the determination of competence. The patients preference of alternative therapies, his previous reckless behaviors, and his deference to his son are not factors that would significantly affect his legal competence.

13. An 80-year-old woman has been admitted to the emergency department after a sudden loss of consciousness and computed tomography indicates a serious ischemic stroke. The patients son is adamant that the patient would not want thrombolytic therapy. The son would have the right to refuse this treatment on his mothers behalf if

A) there is a reasonable belief that such a treatment would not result in improved outcomes for the patient.

B) a durable power of attorney for healthcare names the son as a healthcare proxy.

C) the son is able to show evidence that his mother was legally incompetent prior to her stroke.

D) there is unanimity among other immediate family members.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 270, Durable Power of Attorney for Healthcare

Feedback: A durable power of attorney for healthcare (DPOA-Healthcare) is a document that legally designates a substitutionary decision maker, should the person be incapacitated. This document may also be referred to as designating a healthcare proxy. Previous disabilities, the agreement of other family members and a low likelihood of benefit are not factors that confer legal rights for surrogate decision-making.

14. A nurse who works in the emergency department of a large, urban hospital often provides care for patients who must be temporarily restrained for their own protection. Which of the following measures lessens the chance that the nurse will be faced with a false imprisonment suit?

A) Utilize physical restraints whenever possible and chemical restraints only as a last resort.

B) Use the least restrictive means possible to restrain patients.

C) Delegate the management of confused and aggressive patients to unlicensed care personnel.

D) Have all patients sign blanket consent when admitted.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 8

Page and Header: 275, False Imprisonment

Feedback: Any time patients pose a danger to themselves or others, the law requires that the least restrictive means available be used to protect patients and others. Physical restraints are not usually preferable to chemical restraints and neither method exempts the nurse from potential liability. It would be inappropriate to delegate the care of patients who pose a danger and blanket consent does not have legal standing.

15. Despite the fact that all nurses face the potential risk of being named in a lawsuit there are measures that nurses can take to significantly reduce this risk. Which of the following measures has the greatest potential to prevent a malpractice claim?

A) Complete continuing competence requirements on time

B) Carry adequate liability insurance that provides comprehensive coverage

C) Avoid interacting with clients or patients without a witness

D) Maintain a high-quality standard of nursing care

Ans: D

Client Needs: A-1

Cognitive Level: Application

Difficulty: Easy

Integrated Process: Nursing Process

Objective: 8

Page and Header: 278, Maintaining Excellent Standards of Care

Feedback: There are many actions that nurses can take to prevent lawsuits. Paramount among these is maintaining a high standard of care. Insurance does not necessarily prevent claims, but rather mitigates the consequences of these claims. It is normally unnecessary to avoid one-on-one interaction with patients and clients and continuing competence requirements do not necessarily prevent lawsuits.

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