Question 1

To establish the elements of malpractice against a nurse,which must be proved by the patient?

Accepted Answer

To establish the elements of malpractice,the patient or plaintiff must prove the following: (1)the nurse defendant owed a duty to the patient,(2)the nurse breached that duty,(3)the patient was injured because of the nurse's breach of duty,and (4)the patient has accrued damages as a result of the injury.The patient paying,showing evidence of malicious intent,and demonstrating personal accountability are not elements of malpractice.

Question 2

A registered nurse is caring for a patient 2 days after a colon resection.The patient called for assistance to go to the bathroom.Instead of waiting for help,the patient decided to get up without help.The patient fell but was not injured.After contacting the patient's primary health care provider,which action should the nurse take next?

Accepted Answer

When there is a deviation from the standard of care,such as a patient or visitor falls or an error is made,a nurse makes specific documentation of the event or incident in the form of an occurrence/incident report.The nurse should complete an occurrence report when anything unusual happens that could potentially cause harm to a patient,visitor,or employee.Just because the patient was not injured does not mean the report can be neglected.The health care provider orders follow-up care or treatment when necessary,not the nurse.The ethics committee is involved in ethical dilemmas,not occurrence/incident reports.

Question 3

The nurse is caring for a patient who refuses to cooperate for a dressing change.The nurse tells the patient that he or she will tie the patient down if the patient does not hold still.Which action did the nurse commit?

Accepted Answer

Assault is an intentional threat toward another person that gives that person a reasonable fear of harmful contact.No actual contact is required for an assault to occur.An example of an assault in nursing practice is to threaten to restrain a patient for an x-ray procedure when the patient has refused consent.Battery is intentional offensive touching without consent or lawful justification.Negligence is an unintentional tort.A felony is a serious offense that results in significant harm to another person or society in general,like misusing controlled substances.

Question 4

A registered nurse was accused of patient abandonment when the nurse became angry,quit the job,and left the hospital before the end of the shift.This is an example of violating legal standards/guidelines set by which organization?

Accepted Answer

Nurse Practice Acts permit the State Board of Nursing to set rules,regulations,and guidelines that specifically define the standard of care in nursing practice.An example is the guidelines that define patient abandonment.The State Department of Health,the Joint Commission,and the National League for Nursing do not set the legal rules and regulations for patient abandonment.

Question 5

Which behavior is the best way for a nurse to avoid being liable for malpractice?

Accepted Answer

The best way to avoid being liable for malpractice is to give nursing care that meets the generally accepted standard of care.In a malpractice lawsuit the law uses nursing standards of care to measure nursing conduct and determine whether the nurse acted as any reasonably prudent nurse would act under the same or similar circumstances.Purchasing insurance,not sharing last name,and not delegating tasks are not appropriate behaviors to avoid malpractice.

Question 6

A nurse completes an occurrence report.Which is the best way for the nurse to document this occurrence?

Accepted Answer

Objectively record the details of the event and any statements the patient makes.An example is as follows: "Patient found lying on floor on right side.Abrasion on right forehead.Patient stated,'I fell and hit my head.'" Patient slipped on wet spot and patient fell while going outside should not be charted unless the nurse actually observed the event; otherwise,chart what found: Patient lying on floor.Patient in too much of a hurry includes subjective assumptions and statements; assigning blame or fault is inappropriate when completing the report.

Question 7

Which patient would the nurse consider to be competent to give informed consent?

Accepted Answer

Even though an emancipated minor has not achieved the legal age of consent,he or she may give consent for procedures and treatment.If a patient is unconscious,you need to obtain consent from a person legally authorized to give consent on his or her behalf.A patient who is legally incompetent needs to have the consent of a legal guardian,which is determined through a legal proceeding.A person who is drunk cannot fully understand the procedure and cannot sign the consent form.

Question 8

A nurse wants to follow nursing standards of care.Which document should the nurse follow?

Accepted Answer

The health care facility's written procedure manual is defined as a standard of care.Standards of care are defined by the following: (1)State Nurse Practice Acts,(2)state and federal hospital licensing laws and accreditation rules,(3)professional and specialty organizations,and (4)written policies and procedures of the nurse's health care facility.Brochures are not standards of care.World Health Organization and Department of Health and Human Services are not state or federal hospitals or professional and specialty organizations for nurses.

Question 9

Which chart entry by a nurse would require follow up?

Accepted Answer

Do not document in the nurses' notes that an occurrence report was completed.All the other entries are accurate.Objectively record the details of the event and any statements
the patient makes.At the time of the event,always assess the patient thoroughly,and then contact the health care provider to examine him or her.

Question 10

An RN suffers from chronic back pain that was the result of an injury suffered when pulling a patient up in bed.The nurse is addicted to pain medication and has recently been accused of stealing narcotics.This is an example of which violation of the law?

Accepted Answer

A felony is a serious offense that results in significant harm to another person or society in general.Felony crimes may carry penalties of monetary restitution,imprisonment for greater than 1 year,or death.Examples of Nurse Practice Act violations that may carry criminal penalties include practicing nursing without a license and misuse of controlled substances.A misdemeanor is a crime that,although injurious,does not inflict serious harm.Torts are civil wrongful acts or omissions against a person or a person's property that are compensated by awarding monetary damages to the individual whose rights were violated.Malpractice is an example of negligence,sometimes referred to as professional negligence.The law defines nursing malpractice as the failure to use the degree of care that a reasonable nurse would use under the same or similar circumstances.

Question 11

Which task can a nurse safely delegate to a student nurse who is working as a nursing assistant?

Accepted Answer

During the time when a student nurse works as an employee of a health care facility,perform only tasks that appear in a job description for a nurse's aide or nursing assistant.For example,even if a student nurse has learned how to administer intramuscular medications,do not perform this task as a nurse's aide.

Question 12

Which information indicates the nurse has an accurate understanding of the State Nurse Practice Act?

Accepted Answer

Nurse Practice Acts are examples of statutes enacted by state legislatures to regulate the practice of nursing.Common laws are based on judicial decisions or case law precedent.An example of a judicial decision that guides health care practice is Roe v.Wade,but not the nurse practice act.An example of a federal statute that affects health care practice is the Americans with Disabilities Act,but not the nurse practice act.The nurse practice act is a state law,not a federal senate bill.

Question 13

A student nurse must pass the NCLEX before practicing as a registered nurse.NCLEX stands for __________ Examination.

Accepted Answer

To be licensed in a state,a nurse must have a passing score on the National Council Licensure Examination (NCLEX)to obtain the initial license and meet the educational requirements set by the state.Nursing Council of Licensing,Nightingale Code,and Nursing Code examinations do not exist to practice as a nurse.

Question 14

An RN has been caring for a patient.The nurse received an erroneous order for a medication.The primary health care provider has a reputation for impatience and irritability.Knowing this health care provider's nature,which action by the nurse would be most appropriate?

Accepted Answer

A nurse will assess all physician or health care provider orders,and if the nurse determines they are erroneous or harmful,obtain clarification from that physician or health care provider.Calling pharmacy,asking the patient,and asking another nurse are not the best ways to handle erroneous orders.

Question 15

A patient is confused and is attempting to get out of the hospital bed.The nurse is tired after working for more than 10 hours and is concerned for the patient's safety.What is the best action that the nurse should take to prevent the patient from harm?

Accepted Answer

Asking a family member to sit with the patient is the best answer because it does not restrain the patient physically or chemically.The Joint Commission has set guidelines for the use of restraints in hospitals.These regulations set the standard that all patients have the right to be free from seclusion and physical or chemical restraints except to ensure the patient's safety in emergency situations.The standards specifically prohibit restraining patients for staff convenience,punishment,or retaliation.

Question 16

A clinic nurse stopped at an automobile accident to assist.There was one victim who was not breathing.The nurse provided CPR at the scene,but the victim died.The victim's family sued the nurse.Which will provide the best protection to the nurse in this case?

Accepted Answer

The Good Samaritan Law protects the nurse because CPR is within a nurse's scope of practice.Although Good Samaritan Laws provide immunity to the nurse who does what is reasonable to save a person's life,if the nurse performs a procedure for which he or she has no training,the nurse will be liable for any injury resulting from that act.Therefore,provide only care that is consistent with your level of expertise.The insurance policy,state boards of nursing,and Institute of Medicine do not provide protection to the nurse under the Good Samaritan Law.

Question 17

Which example demonstrates a breach of confidentiality and a violation of the Health Insurance Portability and Accountability Act (HIPAA)of 1996?

Accepted Answer

Although HIPAA does not require such things as soundproof rooms in hospitals,it does mandate that nurses and health care providers avoid discussing patients in public hallways and provide reasonable levels of privacy in communicating with and about patients in any matter.Issues of disclosure,privacy,and confidentiality are important concerns when working with patients or peers infected with blood-borne illnesses such as human immunodeficiency virus (HIV)or acquired immunodeficiency virus (AIDS),hepatitis,and sexually transmitted illnesses.Providing continuity of care,giving reports,talking to the health care provider,and providing information to the nursing assistant do not violate HIPAA.

Question 18

What is the nurse's best proof against malpractice?

Accepted Answer

Documentation of nursing care is the only record of what actually was done for a patient and will serve as proof that a nurse acted reasonably and safely.Nursing notes written at the time of the event,are seen as better evidence of the facts of the event than any one person's memory.Nurses' notes written carelessly and without regard to detail or hospital standards of documentation do not reflect well on the health care provider's credibility or appearance of accountability to a judge or jury.

Question 19

As part of the admission process the nurse asks if the patient has an advance directive.The patient doesn't know for sure.What is the nurse's best response?

Accepted Answer

Many times the decision regarding lifesaving treatment is in writing in the patient's living will or advance directive.Living wills are documents instructing the health care provider to withhold or withdraw life-sustaining procedures in a patient who is terminally ill.Advanced directives are not an organ donation card,nor informed consent,nor autopsy permission.

Question 20

Only one nurse was scheduled to care for 12 postsurgical patients with a nursing assistant.The nurse is concerned for the safety of the patients and the nursing license.What is the most appropriate first step in this situation?

Accepted Answer

If a nurse is assigned to care for more patients than is reasonable for safe care,he or she should notify the nursing supervisor.If the nurse is required to accept the assignment,he or she must document this information in writing and provide the document to nursing administrators.Although documentation does not relieve a nurse of responsibility if patients suffer harm because of inattention,it shows that the nurse attempted to act appropriately.Refusing to care for the patients without appropriate help and leaving could be regarded as abandonment.Complaining to the administrator is not the first step,nor is calling the Board of Nursing.

Quiz 5: Legal Principles in Nursing