Question 1

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?

Accepted Answer

In some cases,information about a scientific discovery or a major medical breakthrough or an unusual situation is newsworthy.In this case,anyone seeking information needs to contact the hospital's public relations department to ensure that invasion of privacy does not occur.It is not the nurse's responsibility to decide independently the legality of disclosing information.The nurse does not have the right to allow the cameraman access to the neonatal unit.This would constitute invasion of privacy.The physician has no responsibility regarding this situation and cannot allow the cameraman on the unit.It is not the nurse's responsibility to find out how the pictures are to be used.This is a task for the public relations department.

Question 2

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?

Accepted Answer

The Joint Commission requires accredited hospitals to have written nursing policies and procedures.These internal standards of care are specific and need to be accessible on all nursing units.For example,a policy/procedure outlining the steps to follow when changing a dressing or administering medication provides specific information about how nurses are to perform.The nurse being observed may not be doing the procedure according to the agency's policy or procedure.The procedure taught in nursing school may not be consistent with the policy or procedure for this agency.The patient is not responsible for maintaining the standards of practice.Patient input is important,but it's not what directs nursing practice.

Question 3

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?

Accepted Answer

Slander occurred when the physician spoke falsely about the nurse,and libel occurred when the physician wrote false information in the chart.Both of these situations could cause problems for the nurse's reputation.Invasion of privacy is the release of a patient's medical information to an unauthorized person such as a member of the press,the patient's employer,or the patient's family.Assault is any action that places a person in apprehension of a harmful or offensive contact without consent.No actual contact is necessary.Battery is any intentional touching without consent.

Question 4

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?

Accepted Answer

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 5

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?

Accepted Answer

The risks associated with the use of restraints are serious.A restraint-free environment is the first goal of care for all patients.Many alternatives to the use of restraints are available,and the nurse should try all of them before notifying the patient's health care provider.The situation states that the patient is touching the items,not trying to pull them out.At this time,the patient's well-being is not at risk.The nurse will have to check on the patient frequently and then will determine if the health care provider needs to be informed of the situation.Restraints can be used (1)only to ensure the physical safety of the resident or other residents,(2)when less restrictive interventions are not successful,and (3)only on the written order of a health care provider.The health care provider needs to know the situation but also needs to know that all approaches possible have been used before writing an order for restraints.Allowing the patient to pull out any of these items could cause harm to the patient.

Question 6

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?

Accepted Answer

The nurse has a duty to report this situation to protect the children.Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action.The person making the report has legal immunity if the report is made in good faith.Talking with the parents is not mandated by law.There is no obligation to tell the parents that they will be reported to authorities.There is no obligation for the nurse to take pictures of the children.

Question 7

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

Accepted Answer

Clear,concise,and timely communication is essential whenever charting in the patient's medical record occurs.Nursing students are not permitted to receive verbal orders.Documentation regarding communication with the health care provider must contain what was communicated by the nurse and the health care provider,orders if given,date,time,and identification of who is documenting the situation.

Question 8

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?

Accepted Answer

Certain criteria are necessary to establish nursing malpractice.In this situation,although harm was caused,it was not because of failure of the nurse to perform a duty according to standards the way other nurses would have performed in the same situation.The nurse would have had to have done the procedure correctly,or the patient most likely would not have survived without any residual problems such as brain damage.The fact that the patient sustained injury as a result of age and physical status does not mean the nurse breached any duty to the patient.The nurse would need to make sure the defense attorney knew that the cardiopulmonary resuscitation (CPR)was done correctly.Without intervention,the patient most likely would not have survived.The prosecution would try to prove that a breach of duty had occurred,which had caused injury,not that cardiopulmonary resuscitation was done correctly.The defense team,not the prosecution,would explain the correlation between brittle bones and rib fractures during CPR.

Question 9

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?

Accepted Answer

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 10

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?

Accepted Answer

An official interpreter must be present to explain the terms of consent if a patient speaks only a foreign language.A family member or acquaintance who speaks a patient's language should not interpret health information.Family members can tell those caring for the patient what the patient is saying,but privacy regarding the patient's condition,assessment,etc.,must be protected.There is no way that the nurse can know that the family member is translating exactly what the nurse is saying.Privacy must be ensured and accurate information must be provided to the patient.After consent is obtained for treatment,the health care provider would be notified because little can be done without consent.The health care provider needs to have the translator available during the history and physical,as well as at other times,but the first step is to get a translator to obtain informed consent because this is not an emergency situation.Using hand gestures and medical equipment is inappropriate when communicating with a patient who does not understand the language spoken.Certain hand gestures may be acceptable in one culture and not appropriate in another.The medical equipment may be unknown and frightening to the patient,and the patient still doesn't understand what is being said.

Question 11

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?

Accepted Answer

Malpractice insurance provided by the employing institution covers nurses only while they are working within the scope of their employment at that institution.It is always wise to find out if malpractice insurance is provided by a secondary place of employment,in this case,the pharmacy,or the nurse should carry an individual malpractice policy to cover situations such as this.

Question 12

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?

Accepted Answer

Each health care facility has personnel who are familiar with the state laws and can assist the patient in revising a living will.They may be in the admissions or risk management department.Checking with the health care provider about the presence of a living will on the chart has nothing to do with the patient's desire to change the living will.The question states that the patient wants to change his living will.Asking whether he has talked to his lawyer recently is a closed-ended question that passes the responsibility to someone else,that is,the attorney,and does not address the patient's current desire to change the living will.It is the nurse's responsibility to find an appropriate person in the facility to assist the patient.A living will can be changed whenever the patient decides to change it,as long as the patient is competent.

Question 13

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?

Accepted Answer

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 14

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?

Accepted Answer

Nurses who float need to inform the supervisor of any lack of experience in caring for the type of patients on the nursing unit.They also need to request and receive an orientation to the unit.Supervisors are liable if they give a staff nurse an assignment that he or she cannot safely handle.Before accepting employment,learn the policies of the institution regarding floating,and have an understanding as to what is expected.A basic orientation is needed,whereas a complete orientation of the functioning of the entire unit would take a period of time that would exceed what the nurse has to spend on orientation.Allowing the nurse to choose which meal time she would like is a nice gesture of thanks for the nurse,but it does not enable safe care.
Having nursing assistive personnel may help the nurse complete basic tasks such as hygiene and turning,but it does not enable safe nursing care that she is ultimately responsible for.

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?

Accepted Answer

An individual over age 18 may sign the form allowing organ donation upon death.In this situation,the parents would need to sign the form because the teenager is under age 18.The nurse cannot allow the patient to sign the organ donation document because he is younger than age 18.The physician will be notified about the patient's wishes after the parents agree to donate the organs.The nurse caring for the patient does not contact the United Network for Organ Sharing.A transplant coordinator will be the liaison for this organization.

Question 16

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?

Accepted Answer

Although nursing students are not employees of the health care agency where they are having their clinical experience,they are expected to perform as professional nurses would in providing safe patient care.Different levels of standards do not apply.Nursing students,just as nurses,provide safe,complete patient care,or they don't.No standard is used for nursing students other than that they must meet the standards of a professional nurse.The nursing instructor,not the nurse assigned to the patient,is responsible for the actions of the nursing student.

Question 17

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?

Accepted Answer

Nurses follow health care providers' orders unless they believe the orders are in error or may harm patients.Therefore,the nurse needs to assess all orders.If an order seems to be erroneous or harmful,further clarification from the health care provider is necessary.If the health care provider confirms an order and the nurse still believe that it is inappropriate,the nurse should inform the supervising nurse or follow the established chain of command.The supervising nurse should be able to help resolve the questionable order,but only the health care provider who wrote the order or a health care provider covering for the one who wrote the order can change the order.Harm to the infant could occur if the medication dosage was too high.The nurse cannot change an order.Giving the amount calculated to be correct would not be what another nurse would do in the same situation.Although the pharmacy is an excellent resource,only the health care provider can change the order.

Question 18

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?

Accepted Answer

Examples of an occurrence include an error in technique or procedure such as failing to properly identify a patient.Institutions generally have specific guidelines to direct health care providers how to complete the occurrence report.The report is confidential and separate from the medical record.The nurse is responsible for providing information in the medical record about the occurrence.It is also best for the nurse to discuss the occurrence with nursing management only.The risk management department of the institution also requires complete documentation.The fact that an occurrence report was completed is not documented in the patient's medical record.No discussion of why the omission in procedure occurred should be documented in the patient's medical record.Errors should be discussed only with those who need to know such as the health care provider,appropriate administrative personnel,and risk management.

Question 19

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?

Accepted Answer

An autopsy or postmortem examination may be requested by the patient or the patient's family,as part of an institutional policy,or if required by law.Because the patient's death occurred as a result of long-term illness,not under suspicious circumstances,and more than 24 hours after admission to the hospital,whether to conduct a postmortem examination would be decided by the family,and consent would have to be obtained from the family.The nurse needs to know the policy to follow regarding removal of lines when an autopsy is to be done.Asking about bathing the deceased patient is a valid question but is not priority,because the nurse needs to know the protocol to follow if an autopsy is to be done.Finding out which funeral home the deceased patient is to be transported to is valid but is not priority,because other actions must be taken before the deceased patient is transported from the hospital.Removal of lines and tubes is not a decision made by the family if an autopsy is to be done.The nurse must first check the protocol to be followed.

Question 20

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?

Accepted Answer

The ethical doctrine of autonomy ensures the patient the right to refuse medical treatment.Living wills are written documents that direct treatment in accordance with a patient's wishes in the event of a terminal illness or condition.With this legal document,the patient is able to declare which medical procedures he or she wants or does not want when terminally ill or in a persistent vegetative state.Each state providing for living wills has its own requirements for executing the health care proxy or durable power of attorney for health care (DPAHC).This is a legal document that designates a person or persons of one's choosing to make health care decisions when the patient is no longer able to make decisions on his or her own behalf.This agent makes health care treatment decisions based on the patient's wishes.Cardiopulmonary resuscitation (CPR)is an emergency treatment provided without patient consent.Health care providers perform CPR on an appropriate patient unless a do not resuscitate (DNR)order has been placed in the patient's chart.The statutes assume that all patients will be resuscitated unless a written DNR order is found in the chart.Legally competent adult patients can consent to a DNR order verbally or in writing after receiving appropriate information from the health care provider.Differences among the states have been noted regarding advance directives,so the patient should check state laws to see if a state will honor an advance directive that was originated in another state.

Quiz 23: Legal Implications in Nursing Practice