Deck 71: Legal Implications in Nursing Practice

Question 1

An obstetrical nurse comes across an automobile accident.The patient seems to have a crushed upper airway,and while waiting for emergency medical services to arrive,the nurse makes a cut in the trachea and inserts a straw from her purse to provide an airway.The patient survives and has a permanent problem with his vocal cords,making it difficult to talk.Which statement is true regarding the nurse's performance?

A) The nurse acted appropriately and saved the patient's life.
B) The nurse acted within the guidelines of the Good Samaritan Law.
C) The nurse took actions beyond those that are standard and appropriate.
D) The nurse should have just stayed with the patient and waited for help.

Answer 1

C
An obstetric nurse would not have been trained in performing a tracheostomy or a cricotomy,and doing so would be beyond what she has been trained or educated to do.The nurse did not do what another nurse would have done in the same situation.The nurse is not protected by the Good Samaritan Law because she acted outside of her scope of practice and training.The nurse should have acted within what she was trained and educated to do in this circumstance,not just stay with the patient.

Question 2

A new nurse notes that the health care unit keeps a listing of patient names in a closed book behind the front desk of the nursing station so patients can be located easily.What action is most appropriate for the nurse to take?

A) Move the book to the upper ledge of the nursing station for easier access.
B) Talk with the nurse manager about the listing being a violation of the Health Insurance Portability and Accountability Act (HIPAA).
C) Use the book as needed while keeping it away from individuals not involved in patient care.
D) Ask the nurse manager to move the book to a more secluded area.

Answer 2

C
The privacy section of the HIPAA provides standards regarding accountability in the health care setting.These rules include patient rights to consent to the use and disclosure of their protected health information,to inspect and copy their medical record,and to amend mistaken or incomplete information.This document limits who is able to access a patient's record.It establishes the basis for privacy and confidentiality about patients in any manner.The book is located where only staff would have access.It is not the responsibility of the new nurse to move items used by others on the patient unit.The listing is protected as long as it is used appropriately as needed to provide care.There is no need to move the book to a more secluded area.

Question 3

A nursing student in the final term of nursing school is overheard by a nursing faculty member telling another student that she got to insert a nasogastric tube in the emergency department while she was working as a nursing assistant.What advice is best for the nursing faculty member to give to the nursing student?

A) "Just be careful when you are doing new procedures and make sure you are following directions by the nurse."
B) "Review your procedures before you go to work, so you will be prepared to do them if you have a chance."
C) "The nurse should not have allowed you to insert the nasogastric tube because something bad could have happened."
D) "You are not allowed to perform any procedures other than those in your job description even with the nurse's permission."

Answer 3

D
When nursing students work as nursing assistants or nurse's aides when not attending classes,they should not perform tasks that do not appear in a job description for a nurse's aide or assistant.The nursing student should always follow the directions of the nurse,unless doing so violates the institution's guidelines or job description under which the nursing student was hired.The nursing student should be able to safely complete the procedures delegated as a nursing assistant,and reviewing those not done recently is a good idea,but it has nothing to do with the situation.This option does not address the situation that the nursing student acted outside the job description for the nursing assistant position.The focus of the discussion between the nursing faculty member and the nursing student should be on following the job description under which the nursing student is working.

Question 4

A patient with sepsis as a result of long-term leukemia dies 25 hours after admission to the hospital.A full code was conducted without success.The patient had a urinary catheter,an intravenous line,an oxygen cannula,and a nasogastric tube.What question is priority for the nurse to ask the family before beginning postmortem care?

A) "Do you want to assist in bathing your loved one?"
B) "Is an autopsy going to be done?"
C) "To which funeral home do you want your loved one transported?"
D) "Do you want me to remove the lines and tubes before you see your loved one?"

Question 5

A nurse performs cardiopulmonary resuscitation (CPR)on a 92-year-old with brittle bones and breaks a rib during the procedure,which then punctures a lung.The patient recovers completely without any residual problems and sues the nurse for pain and suffering,and for malpractice.What key point will the prosecution attempt to prove?

A) The CPR procedure was done incorrectly.
B) The patient would have died if nothing was done.
C) The patient was resuscitated according to policy.
D) Patients with brittle bones might sustain fractures when chest compressions are done.

Question 6

A patient's condition is slowly deteriorating.What actions should the nurse take to provide the best care possible?

A) Allow the nursing student to receive verbal orders from the physician in the room while the nurse is in the medication area down the hall.
B) Document the patient's status changes in the medical record in a timely manner.
C) Document that the health care provider has been notified of the specific patient status, including date and time that messages were left.
D) Check the chart for frequent orders.
E) Omit charting what the health provider's response is to notification of the patient's status change.

Question 7

A nurse notices that his neighbor's preschool children are often playing on the sidewalk and in the street unsupervised and repeatedly takes them back to their home and talks with the parent available,but the situation continues.What immediate action by the nurse is mandated by law?

A) Talk with both parents about safety needs of their children.
B) Contact the appropriate community child protection agency.
C) Tell the parents that the authorities will be contacted shortly.
D) Take pictures of the children to support the overt child abuse.

Question 8

A nurse works full-time on the oncology unit at the hospital and works part-time on weekends giving immunizations at the local pharmacy.While giving an injection on a weekend,the nurse caused injury to the patient's arm and is now being sued.How will the hospital's malpractice insurance provide coverage for this nurse?

A) It will provide coverage as long as the nurse followed all procedures, protocols, and policies correctly.
B) The hospital's malpractice insurance covers this nurse only during the time the nurse is working at the hospital.
C) As long as the nurse has never been sued before this incident, the hospital's malpractice insurance will cover the nurse.
D) The hospital's malpractice insurance will provide approximately 50% of the coverage the nurse will need.

Question 9

A patient has just been told that he has approximately six months to live and asks about advance directives.Which statements by the nurse give the patient correct information?

A) "You have the right to refuse treatment at any time."
B) "If you want certain procedures or actions taken or not taken, and you might not be able to tell anyone at the time, you need to complete documents ahead of time that give your health care provider this information."
C) "You will be resuscitated at any time to allow you the longest length of survival."
D) "You might want to think about choosing someone who will make medical decisions for you in the event that you are unable to make your desires known."
E) "We will get someone who knows the state's guidelines to assist you in setting up your living will."
F) "If you travel to another state, your living will should cover your wishes."

Question 10

A confused patient with a urinary catheter,nasogastric tube,and intravenous line keeps touching these needed items for care.The nurse has tried to explain to the patient that he should not touch these lines,but the patient continues.What is the best action by the nurse at this time?

A) Apply restraints loosely on the patient's dominant wrist.
B) Try other approaches to prevent the patient from touching these care items.
C) Notify the health care provider that restraints are needed immediately to maintain the patient's safety.
D) Allow the patient to pull out lines to prove that the patient needs to be restrained.

Question 11

The nurse hears a physician say to the charge nurse that he doesn't want that same nurse caring for his patients because she is stupid and won't follow his orders.The physician also writes on his patient's medical records that the same nurse,by name,is not to care for any of his patients because of her incompetence.What component(s)of defamation has the physician committed?

A) Slander
B) Invasion of privacy
C) Libel
D) Assault
E) Battery

Question 12

A recent immigrant who does not speak English is alert and requires hospitalization.What is the initial action that the nurse must take to enable informed consent to be obtained?

A) Ask a family member to translate what the nurse is saying.
B) Notify the health care provider that the patient doesn't speak English.
C) Request an official interpreter to explain the terms of consent.
D) Use hand gestures and medical equipment while explaining in English.

Question 13

A pediatric oncology nurse floats to an orthopedic trauma unit.What actions should the nurse manager of the orthopedic unit take to enable safe care to be given by this nurse?

A) Provide a complete orientation to the functioning of the entire unit.
B) Determine patient acuity and care the nurse can safely provide.
C) Allow the nurse to choose which meal time she would like.
D) Assign nursing assistive personnel to assist her with care.

Question 14

A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier.The nursing student says,"I don't understand what the big deal is.As my instructor,you are there to protect me and make sure I don't make mistakes." What is the best response from the nursing instructor?

A) "You are expected to perform at the level of a professional nurse."
B) "You are expected to perform at the level of a nursing student."
C) "You are practicing under the license of the nurse assigned to the patient."
D) "You are expected to perform at the level of a skilled nursing assistant."

Question 15

A 17-year-old patient,dying of heart failure,wants to have his organs removed for transplantation after his death.What action by the nurse is correct?

A) Prepare the organ donation form for the patient to sign while he is still oriented.
B) Instruct the patient to talk with his parents about his desire to donate his organs.
C) Notify the physician about the patient's desire to donate his organs.
D) Contact the United Network for Organ Sharing after talking with the patient.

Question 16

While recovering from a severe illness,a hospitalized patient states that he wants to change his living will,which he signed nine months ago.Which response by the nurse is most appropriate?

A) "Check with your admitting health care provider whether a copy is on your chart."
B) "Have you talked with your attorney recently about a living will?"
C) "Your living will can be changed only once each calendar year."
D) "Let me check with someone here in the hospital who can assist you."

Question 17

A nurse gives an incorrect medication to a patient without doing all of the mandatory checks,but the patient has no ill effects from the medication.What actions should the nurse take after reassessing the patient?

A) Notify the health care provider of the situation.
B) Document in the patient's medical record that an occurrence report was filed.
C) Document in the patient's medical record why the omission occurred.
D) Discuss what happened with all of the other nurses and staff on the unit.
E) Continue to monitor the patient for any untoward effects from the medication.
F) Send an occurrence report to risk management after completing it.

Question 18

The nurse calculates the medication dose for an infant on the pediatric unit and determines that the dose is twice what it should be.The pediatrician is contacted and says to administer the medication as ordered.What is the next action that the nurse should take?

A) Notify the nursing supervisor.
B) Check the chain of command policy for such situations.
C) Give the medication as ordered.
D) Give the amount calculated to be correct.
E) Contact the pharmacy for clarification.

Question 19

Conjoined twins are in the neonatal department of the community hospital until transfer to the closest medical center.A photographer from the local newspaper gets off the elevator on the neonatal floor and wants to take pictures of the infants.What initial action should the nurse take?

A) Escort the cameraman to the neonatal unit while a few pictures are taken quietly.
B) Tell the cameraman where the hospital's public relations department is located.
C) Ask the cameraman to wait while permission is obtained from the physician.
D) Ask the cameraman how the pictures are to be used in the local newspaper.

Question 20

A newly hired experienced nurse is preparing to change a patient's abdominal dressing and hasn't done it before at this hospital.Which action by the nurse is best?

A) Ask another nurse to do it so the correct method can be viewed.
B) Check the policy and procedure manual for the agency's method.
C) Change the dressing using the method taught in nursing school.
D) Ask the patient how the dressing change has been recently done.