Quiz On e Prior to surgery, the nurse checks to ensure that the patient has signed an informed consent form. Which ethical principle is the nurse supporting? Answer: Autonomy The nurse is conflicted about the harmful effects of an intervention that also will have a beneficial effect for the patient. Which ethical consent gives direction to the nurse? Answer: Double Effect The hospital is forming an ethics committee. Which concept should be central to that committee’s function?
Answer: The committee should act to provide guidelines for potential problems An ethical dilemma has arisen in regard to a patient who has been declared incompetent and who has left no advance directive. Which model is likely to be of best use to the ethics committee reviewing the case? Answer: Patient benefit The nurse tells a patient that an immunization “will not hurt at all” when the nurse is aware
that the injection will be painful. Which ethical principle pr inciple has the nurse most clearly violated? Answer: Veracity A group of nurses wishes to improve the ethics of the care of their group provides. What is the first step this group should take to reach their goal? Answer: Explore their individual values and beliefs The nurse bases individual i ndividual nursing practice upon commitment to quality patient care and understanding of the nursing role. Under which broad classification of ethical theory does this fail? Answer: Deontological theories The nurse advises a pa tient to have surgery because, “the doctor knows what is best for you.” The nurse is most likely li kely following which ethical principle? Answer: Paternalism
The hospital has a well-designed, fully functioning ethics committee. What ethical debate topics, concerning the entire social network rather than an individual patient, might now i s addressed by this committee? Answer: Duplication of services The ethics committee is reviewing a case in which the patient is competent. Which model is likely to be of best use to the ethics committee reviewing the case? Answer: Autonomy Ethics as a discipline differs from law in which way? Answer: Ethics focuses on the individual, rather than society as a whole The nurse is experiencing conflict as the values and ethics expressed by co workers do not match the nurse’s values and ethics. What should this nurse consider when thinking about
these differences? Answer: Ethics and values may change over time The nurse makes practice decisions based upon each patient’s unique characteristics, the
relationship between the patient and the nurse, and the most humanistic course of action in the particular case circumstance. Which branch of ethics does this reflect? Answer: Situational The ethics committee is reviewing a case in which there are broad social issues in i n question. Which model is likely to be of best use to the ethics committee reviewing the case? Answer: Social Justice QUIZ 2 The hospital administration asks nursing services to assume housekeeping duties from midnight until 6. Nurses are fearful that this is the first step to shifting complete 24 hour per day responsibilities for housekeeping duties to nursing services……etc?
Answer: Slippery slope thinking The student nurse is writing an essay on the development of A NA’s code of ethics for nurses with interpretative statements. Which info should be included? Answer: The document expresses nursing’s own understanding of its commitments to society.
In nursing school, the student learns that the nurse should always consider the possible outcomes of any nursing action taken. What ethical concept does this consideration support? Answer: Therapeutic jurisprudence The nurse believes that a physician’s order is contrary to the accepted standard of care and
could potentially harm the patient. What should the nurse do? Answer: Question the physician regarding the order Which change would be helpful in assisting nurses to cope with moral distress? Answer: Encouraging free discussion of ethical concerns The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments. The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying? Answer: Rights protection model Un rest on the nursing unit has progressed to moral outrage among the nursing staff. Which statement made by the nurse manager to the chief nursing officer indicates understanding of the issue? Answer: We may experience turnover in staff positions if this tension continues The hospital is developing an ethics committee. In planning this committee, the group should consider that they are most likely to be asked to consider which type of ethical dilemma? Answer: Conflicts in basic human rights The nurse intends to lobby the state legislature to write a new code of ethics for the nurses in the state. Is this an appropriate idea? Answer: No, professional nursing organizations write the code of ethics for nurses The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years. During the review, revi ew, the nurse begins to cry and tells the manager, “I just can’t do this anymore. I can’t sleep……etc
Answer: Moral distress
The health care team is involved in a situation in which there are two equally undesireable options. One of these options must be chosen and applied to the situation. What term describes this situation? Answer: Ethical Dilemma The nurse provides info about treatment options to a patient who has been diagnosed with diabetes mellitus. What patient advocacy model is this nurse using? Answer: Values-based decision model ?
QUIZ 3 During a jury trial, the presence of a nurse-patient relationship is questioned. What kind of question is this and who would determine it? Answer: Fact to be determined by the judge A person who was injured in a MVA sued the driver to recover hospital costs. What type of law would be enforced in this situation? Answer: Tort Law The circumstances of a lawsuit cause it to be under the jurisdiction of more than one court. In this case, which court has the greatest personal jurisdiction? Answer: Federal supreme court In which case would the judge serve both as a fact finder and determiner of questions of law? Answer: Trial by jury is waived by both sides A patient has just discovered that a surgical error made 3 years ago was responsible for the loss of the patient’s leg. How does the discovery rule relate to statutes of limitation in this case? Answer: The time of the statute of limitation may start at the time of discovery A nurse was scheduled to appear before the state board of nursing in regard to action against the nurse’s license. The place of the meeting was changed and the nurse was not notified. What
legal concept was violated in this situation? Answer: Due process of law
A county-supported hospital elects to limit surgical procedures for morbid obesity to male patients. Female patients receive pharmacological therapy, counseling, and instruction for diet and exercise, but are excluded from operative procedures. Under which legal concept is this illegal? Answer: Equal protection under the law An emergency department nurse has agreed to testify as an expert witness in a lawsuit involving a child. The opposing attorney questions the n urse’s qualifications as a pediatric nurse. Which type of law does this scenario reflect? Answer: Procedural Law Which group or persons has authority to write statutory law such as nurse practice acts? Answer: State legislature The probate court has the right to hear cases concerning wills and estates. Which kind of jurisdiction is this? Answer: Subject matter A person is arrested and charged with battery and assault after attacking a neighbor with a knife. What classification or type of law would determine the case against this defendant? Answer: Criminal Law An employee asks for time off to be a juror in a case before the state appellate court. How should the nurse manager respond to this request? Answer: Ask more questions, as state appellate courts have no jurors The jury in a professional negligence trial is provided information regarding nursing practice standards. What is this jury considering? Answers: Questions of fact A patient brought suit against a hospital for injuries sustained in a fall. The case went to trial and the jury found for the hospital. Can the patient take this same suit and evidence to another trial court in hopes of a different decision? No, because of the doctrine of res judicata
QUIZ 4 A person desires to bring suit for injuries sustained while hospitalized. What is this person’s legal burden of proof? Answer: To show that an incident occurred and resulted in injury In which case might a default judgment be entered? Answer: The defendant did not respond to the complaint The nurse is involved as an expert witness in a civil court case where life support was withdrawn and the patient expired. Which level of evidence is expected for this case? Answer: clear and convincing evidence A nurse brings suit against the hospital after being terminated for excessive absenteeism. Who is the plaintiff in this lawsuit? Answer: The nurse bringing the suit Which statement best describes the rule regarding expert testimony in nursing malpractice cases? Answer: Whether expert testimony is needed is decided on a case by case basis after analyzing the facts of the case Arbitration may be preferred by some individuals rather than conducting an expensive trial. What is another reason for favoring arbitration? Answer: There is no formal record made of the arbitration process What is true regarding testimony given at a deposition? Answer: It is sworn testimony and may not be altered at trial Why are prelitigation panels used in medical malpractice cases? Answer: these panels ensure that there is a controversy or fact question for the court Which person would best qualify as an expert in a nursing malpractice case filed because of failure of a unit nurse to recognize the early signs and symptoms of respiratory arrest? Answer: A critical care nurse who holds a BS in nursing and cortication from the American Association of Critical care nurses.
Criminal charges have been brought against a nurse who made a medication error that resulted in a child’s death. Which level of evidence is expected in this case?
Answer: Evidence beyond a reasonable doubt What is the major ethical concern of an expert witness? Answer: The expert witness must stay objective and unbiased in the work What is the purpose of cross examination of witnesses that occurs at trial? Answer: The process gives the opposing counsel an opportunity to question and refute a witness’s testimony.
A nurse has agreed to participate in a videotaped deposition in a malpractice case. What does this indicate? Answer: The nurse’s testimony can be presented in court, even though the nurse is unavailable
for the trial date What is the role of lay witnesses in a trial? Answer: These witnesses tell only what has transpired from their perspective
QUIZ 5 The hospital nursing group establishing standards of care for a newly organized patient care unit is looking for external sources for these standards. Where should these nurses look? Answer: Professional journals and nursing textbooks What does the court consider in determining the nurse’s legal li ability for standards of care?
Answer: Professional education, experience, and specific conduct The hospital nursing group establishing standards of care for a newly organized patient care unit is looking for internal sources for these standards. Where should these nurses look? Answer: Hospital policy and procedures manual Standards of care exist for a number of reasons. What is their most basic purpose? Answer: To protect and safeguard the public as a whole
Which scenario reflects the “two schools of thought” doctrine?
Answer: Nurses on one unit vary in their choice of ways to deliver quality care. How can health care best ensure that all of its practitioners meet current standards of care? Answer: Create clearly written easily updated policy and procedure manuals. In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor? Answer: The individual’s status as a professional
The hospital nursing group has reviewed external standards of care to establish standards of care for newly organized patient care unit. These external sources serve to set which level of standards of care? Answer: National The hospital policy and procedure manual states that medications should be charted immediately after administration. The nurse routinely charts the meds as they are being prepared for administration. What does this practice reflect? Answer: A violation of hospital policy and procedure The nurse holds national certification as a wound care specialist and works in a small, rural hospital. What standards of skill and care applies to this nurse’s practice?
Answer: It should be the same as that of an average nurse who also holds national would care certification What is the single most critical factor in determining whether a particular nurse acted with reasonable care in a given situation? Answer: How the nurse’s conduct compares to that of nurses with similar background and
experience The survivors of a patient who unexpectedly died in a hospital brought suit for wrongful death against the hospital and two nurses…..What is the most likely outcome of this suit?
Answer: Find the nurses since they followed hospital policy and procedures
The hospital nursing group establishing standards of care for a newly organized patient care unit..external sources to look for? Answer: Professional journals and nursing textbooks A lawsuit is brought against a nurse in a rural hospital. The nurse replies that the standard of care for rural nurses is different from that for nurses working in large urban facilities. Is this a defensible position? Answer: No nurses in rural settings must meet the same standards as those practicing in large urban areas
QUIZ 6 An out of state caller becomes irate when the nurse cannot provide info over the phone about a hospitalized friend. The caller says “if you know what is good for you, you had better…etc
Answer: No, the caller is out of state and cannot reach the nurse A defendant invokes the locality rule as justification for a lower standard of patient care. How does the locality rule support this claim? Answer: The locality rule holds the professional to a standard of care in a given geographic area, rather than the national standard of care. Which scenario is a quasi-international tort rather than an intentional tort? Answer: The physician accuses the nurse of incompetence in front of the patient’s family A nurse is leaving the parking lot at the hospital and carelessly runs over a patient who was just discharged. Ironically, the nurse has been assigned to care for that patient that day. If the patient sues this nurse, which statement is true? Answer: The nurse can be held liable for negligence but not malpractice The registered nurse who works in the obstetrics department is walking by the emergency department waiting room when a person cries out, “Help me, my mother is not breathing.”
Does this nurse have a duty to assist? Answer: Yes, the general duty of care exists to help in times of crisis or imminent harm
The court is establishing liability in a case in which several actions cause the plaintiff’s injury. Which test of causation would be most useful in this case? Answer: Substantial factor test How should the nurse proceed when caring for a suit prone patient? Answer: Give the same compassionate, competent care that all patients receive Which action could result in the nurse being charged with conversion of property? Answer: Removing the patient’s car keys against his or her will Upon entering a patient’s room to complete discharge instructions the nurse discovers the
patient in tears. The business office has stated that the patient cannot leave until someone pays a portion of the hospital bill. What should the nurse do? Answer: Continue preparations for discharge, comforting the patient as much as possible Why is providing proximate harm cause important in the outcome of a professional negligence suit? Answer: It determines how far the liability extends for consequences following negligent actions Punitive damages of one million dollars were awarded to the family of a patient who died following a nursing medication error. What is true of these punitive damages? Answer: These damages are awarded to set an example to other nurses The health care facility has sponsored a continuing education offering on emergency management of pandemic influenza. At lunch a nurse is overheard saying, “I’m not going to take care of anyone that might have the flu” What is true?
Answer: This statement is a breach of the Code of Ethics for Nurses. After 3 years of uneventful employment, the nurse made a medication error that resulted in patient injury. What hospital response to this event is ethical? Answer: The hospital was supportive and assistive as the nurse coped with this event
QUIZ 7 In caring for a 6 year old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that ….etc
Answer: Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities. In which case would the manufacturer of a drug designated as unavoidably unsafe be held liable for injuries to a patient receiving the drug? Answer: If the physician was not warned of risks by the manufacturer A week after stopping to assist at an injury accident, the nurse receives a check for 100 from the patient’s family as a thank you for the care provided. What is the best description of the
effect? Answer: This gift may change the nurse’s care to fee for service changing Good Samaritan
protection Which scenario demonstrates apparent consent? Answer: Showing his or her conduct that he or she agrees to the treatment The nurse comes upon a motor vehicle accident with injury and stops to help. What should be the nurse’s first action?
Answer: Ask for permission to help When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patent was confined to bed. What is the nurse’s best defense for applying restraints? Answer: Self defense The plaintiff was injured by a defective IV catheter. In order to win a product liability case, what must the plaintiff prove first? Answer: The intravenous catheter was sold to him
A patient refused to ambulate postoperatively and subsequently developed bilateral pneumonia, causing his hospital stay to be lengthened. After discharge, the patient filed a lawsuit claiming his primary nurse was negligent in allowing him to develop pneumonia. What is the nurse’s best defense in this case? Answer: The patient’s conduct contributed to his complications A patient became confused and used a pocket knife to threaten others. The nurse confiscated the knife. What is the nurse’s best defense for this action?
Answer: Necessity The nurse has been sued for defamation after charting that the patient is a prostitute. What is the nurse’s best defense in this case?
Answer: Prove that the statement is true
QUIZ 8 What is assured once an adult patient executes a living will? Answer: The health care providers who abide by the document cannot be charged with criminal negligence associated with the patient’s death
Which nurse action is appropriate according to the ANAs stance on assisted suicide and active euthanasia? Answer: The nurse declines the patient’s request to help with the suicide plan In which instance can a 13 year old patient give consent for treatment? Answer: If the child is consenting to treatment for a venereal disease The nurse is preparing a patient for a procedure. The patient has signed a consent form, but states “I don’t really know anything about this procedure. I wonder if there is something else I
could do instead? What should the nurse proceed? Answer: Stop the preparation as the patient can revoke consent at any time
A nursing faculty has included a requirement that students participate as research subjects as a part of their course grade. Does this requirement meet the guidelines for research participant’s
rights? Answer: No, the individual must be given the choice to participate or not The patient has tested positive for a gene associated with breast cancer. Can this patient be denied life insurance based upon this finding? Answer: Yes there is currently no legislation prohibiting this denial In which instance is the performance of non emergency treatment for a minor permissible without parental consent? Answer: the state has a family consent doctrine and an adult sister signs the form The patient presents to the ED with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent? Answer: Implied In which case might the state deny a patient’s right of refusal for medical treatment?
Answer: the patient has an illness that poses a threat to public health if left untreated What is the major problem associated with charting by exception? It may not provide enough information to support trending of the patient’s condition. 100%
The laboratory notifies the nursing unit that a substantial amount of test data was mistakenly recorded on the wrong patient’s medical record two days ago. Who has the authority to alter the patient’s
record? Only administrative staff or the patient’s primary physician 100%
Which statement best explains the importance of electronic medical record use?
Patient care is improved. 100% A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report? Include only the facts and the nurse’s observations in the incident report. 100%
The nursing student began a case study paper by writing, “ J.P., a 65 -year-old Asian male, was admitted to the intensive care unit at Southwest Hospital.” What is the significance of this statement?
It violates Health Insurance Portability and Accountability Act regulations. 100% When President Clinton signed the Health Insurance Portability and Accountability Act in 19 96, many provisions concerning confidentiality of medical records became law. What were o ther provisions of this act? Choose all that apply.
An antifraud and abuse program 100% The patient brings suit against a health care provider. How does this action affect the confidentiality of the patient’s medical record?
The record becomes discoverable by all parties to the suit. Which ethical principle supports the argument that all newborns should be screened for HIV?
Beneficence 100% What is the main purpose of documentation in the medical record?
It is used to communicate patient condition to the health care team. 100% Hospital policy states that a registered nurse must cosign all charts that licensed practical nurses complete. What is the effect of this policy on the registered nurse?
It places the RN in the position of endorsing and authenticating the entries made in the charts cosigned. The patient demands to see the actual medical record of a hospitalization that occurred one year ago. How should the hospital handle this request?
Have the patient come to the hospital to review the original record. 100%
The parents of a 17-year-old who is receiving substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider?
Only release information if the patient has signed consent to do so. A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status?
All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department.
The limits of liability on an insurance policy are $1,000,000 fo r each claim, $4,000,000 aggregate. A nurse is charged in a serious situation in which five separate lawsuits have been filed. What is t he most the insurance company will likely pay in this situation?
$1,000,000 100% The nurse is reviewing a professional liability policy for the time period the policy is in effect. Under which section of the policy should this nurse look?
Declarations 100% As a part of a malpractice case, the hospital has decided to bring an indemnity claim against a nurse. What is the implication to the nurse?
The nurse will have to pay monetary damages to the hospital if the hospital wins the claim. 100% In which situation is an occurrence-based policy most beneficial to the nurse?
A nurse who had insurance coverage during 20 years of practice, but is now retired and no longer has an active policy 100% Under a claims-made insurance policy, for which claim is the nurse protected?
Claims that are filed for incidents during the active period of the policy 100% A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit ? Not necessarily, it depends upon the hospital’s insurance policy and what it covers. 100%
A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation?
The nurse can be held personally responsible for all damages assessed. What elements does the insurance company that offers professional liability insurance verify under the exclusion portion of the policy? Choose all correct answers.
Licensure of the insured 100% Which type of insurance is generally the most pre ferable for the most nurses?
Occurrence-based 100% How has the present legal environment affected the frequency with which nurses are named in suits for malpractice?
Frequency is greater than 15 years ago.
In a professional liability insurance policy which person or group is considered the policyholder?
The nurse who purchases the policy 100% The hospital-employed nurse volunteered to assist with physical examinations for athletes at the local high school. How does this situation affect the nurse’s malpractice insurance?
The nurse is very likely not covered by any malpractice insurance. A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit ?
Not necessarily, it depends upon the hospital’s insurance policy and what it covers. The patient decides to discontinue standard medical treatment for diabetes mellitus and to rely on diet and herbal medications for blood sugar control. Which statement, made by the nurse, is most appropriate?
Why did you decide to make this change? What is the most important driving force behind the movement for multistate licensure?
Advancing technologies, especially telehealth and telephone triage 100% Which situation is probable grounds for disciplinary action against a nurse’s license?
The nurse made a false statement on the licensure application. 100% A growing body of research supports linkages between the educational status of nurses and which outcomes? Select all that are discussed in the textbook.
Lower patient mortality rates When President Clinton signed the Health Insurance Portability and Accountability Act in 1996, many provisions concerning confidentiality of medical records became law. What were other provisions of this act? Choose all that apply.
An antifraud and abuse program The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse, what is the status of the nurse’s license?
Only the state in which the nurse holds licensure can act to suspend or revoke that license. What is the basic purpose of the state board of nursing?
To establish a means of protecting the public at large
The nurse has a strong religious conviction against elective sterilization procedures. Whe n seeking employment, how should the nurse handle this belief?
Be up front and discuss the issue during the employment interview. The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review?
State Nurse Practice Act 100% What is the basic purpose of the state board of nursing?
To establish a means of protecting the public at large Which type of licensure protects the title “nurse” as well as professional actions associated with
nursing?
Mandatory The home health nurse discovers that a homebound cancer patient is using marijuana to control nausea from chemotherapy. What advice should the nurse give t his patient?
Under certain circumstances, patients can claim exemption from the law against possession of marijuana. From where does the state’s power to license nurses derive?
Police power within the state The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor?
Report the concerns to the state board of nursing. 100% The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse’s practice?
There is no problem as the practice requirements are the same. 100% The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges?
The individual hospital
The patient requires a controlled substance for the treatment of pain. What is true of the advanced nurse practitioner’s role in independently prescribing this medication?
Some states allow advanced nurse practitioners to prescribe controlled substances. What is the one care component NOT common in the independent practice of a certified nurse midwife?
Management of postpartum complications 100% The advanced nurse practitioner is routinely addressed as “doctor” by clinic patients. What is the best
way for the nurse to handle this mistake?
Be certain patients are aware that the nurse is not a physician. 100% A nursing student’s grandmother relates a time in the 1920s when medications were selected based
upon the recommendation of a nurse who lived in the neighborhood. How is this possible?
Prior to 1938, most medications were over-the-counter and nurses were instrumental in their choice. 100% Which option reflects a change that may occur in the roles of advanced practice nurses?
Development of a new category to include clinical nurse specialists and advanced nurse practitioners Clinical nurse specialists in hospital settings are more likely to be sued for malpractice than staff nurses for which reason?
They assume greater legal liability by virtue of their specialty credentials. 100% Fein v. Permanente Medical Group is important as the case defined the standard of care for the advanced practice nurse. How was that standard of c are defined?
The advanced nurse practitioner standard of care 100% The advanced nurse practitioner believes that he should spend as much time with each patient as the patient desires. Does this practice raise ethical challenges?
Yes, if this practice makes other patients wait past their own appointment times. 100% Which factor was primary in driving the establishment of the advanced nurse practitioner role?
The physician shortage of the late 1960s The advanced nurse practitioner is considering changing malpractice insurance carriers. What should the nurse consider prior to making this change?
The expanding role of the advanced nurse practitioner has increased the number of lawsuits filed. 100% Which advanced nurse practitioner role is authorized by nurse practice acts, medical practice acts, and allied health laws?
Nurse anesthetist A patient who is well known to be violent arrives by ambulance at the Emergency Department for care of a laceration. What action should be taken?
Use a buddy system when providing care. 100% The nurse cited “intolerable working conditions” as the reason for resignation. In order to claim
constructive discharge, what must the nurse prove?
The employer deliberately created the work condition to force the nurse to resign. 100% How does the doctrine of respondent superior alter the liability of the nurse for negligent conduct?
It makes the nurse liable to the employer. The hospital acts to revoke the clinical privileges of a physician who has repeatedly refused to respond to emergency calls from nursing staff. Under which doctrine is this action advisable?
Corporate liability 100% Which nurse would be most likely to be protected under the Age Discrimination Employment Act of 1967?
A 45-year-old nurse who was fired after complaining about a new policy 100% In an effort to attract clinic physicians, the hospital has agreed to provide a nurse to work in the physician’s office. The nurse will work under the direction and supervision of the physician whose clinic
is housed with the hospital building. Which doctrine most closely describes the conditions in which this nurse is working?
Borrowed servant 100% Which legal doctrine cannot apply to a nurse’s practice as a private duty nurse?
Respondeat superior The nurse says, “I’m not spending my money and my time off to go to continuing education.” How
should this statement be interpreted in relation to the duty owed the employer?
As unreasonable. Staying current is a duty the nurse owes to the employer. 100%
The hospital has outsourced housekeeping services to an independent contractor. A patient, who was injured in a fall on wet flooring, brings suit against the company. Does the hospital also hold liability?
Perhaps, secondary to the doctrine of ostensible authority. The female nurse works in a nursing home where many of the patients are military service veterans. She discovers that a male nurse with whom she works makes $2.80 per hour more than she makes. In which situation could this be legal under affirmative action?
The male nurse’s yearly evaluations are better t han the female nurse’s. A patient who is well known to be violent arrives by ambulance at the Emergency Department for care of a laceration. What action should be taken?
Use a buddy system when providing care. A nurse calls the newspaper and reports that circumstances surrounding several deaths in the local hospital are suspicious and that a cover-up is in action. The subsequent article identifies the nurse by name and the nurse is fired. Is the nurse protected under the whistleblower law?
No, the allegations should have been made to the appropriate authorities.
The plaintiff was awarded monetary damages from the hospital in a suit resulting from a nurse’s
negligence. Under which principle is it possible for the hospital to sue the nurse to recover the amount of the damages?
Indemnification 100% The nurse and immediate supervisor have a personal conflict. The supervisor warns the nurse that the hospital is an employment-at-will institution. What does that indicate?
The nurse can be dismissed at any time, without cause. 100% Which person would be the best choice for a mediator in a contract dispute between a nurse and a hospital?
A consultant from outside the hospital The court found a nurse manager liable for failure to warn. Which option reflects a failure to warn scenario?
The nurse manager did not tell a potential employer that a former employee was asked to resign for incompetence. Changes have been made to the employee handbook. What must occur for this document to constitute a contract?
The employee must continue to work after the manual takes effect. A work dispute has gone to arbitration. The nurses involved in the dispute are unhappy with the decision made by the arbitrator. Do the nurses have to abide by the decision?
Yes, unless both parties agreed in advance that the decision is not binding Which situation is NOT an exception to the statute of frauds principle? A “handshake” agreement to sell a one-acre parcel of land 100% The hospital’s risk management team has identified a potential hazard to patient safety. What should be the team’s next action?
Eliminate the hazard before anyone else is harmed. The news reports that a person “contracted over the telephone” to kill another person. Under contract
law is that a correct statement?
No, contracts must fulfill a lawful purpose. The nurse takes a position working in a clinic and receives a sign-on bonus. After having worked for one month the nurse charges that she never signed a contract with the clinic and therefore can leave for a different, higher-paying job without returning the bonus. What is true about this situation?
The contract was accepted when the nurse showed up for work. The contract between a nurse and a hospital delineates the nurse’s salary, benefits package, and when the job will begin. The contract does not state that the nurse must provide quality care. What is the term used to describe the quality expectation?
implied terms The unit policy is that the nurse with the least seniority is required to float to understaffed units. Is this the best policy?
No, generally the most capable and efficient person should be floated. Which situation reflects consideration in contract law?
The nurse agrees to work for specific wages. Mandatory overtime raises ethical issues about patient and nurse safety. How does voluntary overtime affect these issues?
It requires nurse managers to be vigilant concerning safety.
Which strategy is most effective in ensuring that nurses floated to other areas of the hospital are qualified to work in those units?
Cross training staff to various units 100% Which situation reflects legal termination of a contract?
The facility accepts the nurse’s letter of resignation. 100% The nurse takes a position working in a clinic and rece ives a sign-on bonus. After having worked for one month the nurse charges that she never signed a contract with the clinic and therefore can leave for a different, higher-paying job without returning the bonus. What is true about this situation?
The contract was accepted when the nurse showed up for work. 100% The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient’s death. Does the preceptor hold any liability in this case?
No, since the new nurse has a license, all liability is retained by the new nurse. Which option reflects assignment in nursing?
The charge nurse divides the patient load into one team for each staff nurse who works the shift. 100% The nurse is searching for information about nurses’ responsibility and accountability for of tasks . All
but one of the following answers are correct. Where should this nurse NOT look for this information?
State medical association bylaws 100% The registered nurse has delegated the task of ambulating a patient who has a history of unexpected falls to two nursing assistants. The patient appears to ambulate without assistance, but m ust be ambulated with two assistants in case of another unexpected fall. What is the most important aspect of delegating this task?
The aides understand the importance of walking with the patient. Which scenario best reflects indirect supervision of a nursing assistant?
The nurse is easily contactable by pager but is not present in the care environment. 100% A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient’s vital signs?
The registered nurse who has worked on this unit for 8 months Unlicensed personnel are not licensed by the state in their own right. Why is it that these persons can perform delegated tasks?
They work under the auspices and licensure of the institution, not the professional nurse. Which scenario best reflects direct supervision of a nursing assistant?
The nurse and the nursing assistant work together to provide care to a team of six patients. 100% What was the major impetus for more stringent delegation and supervision rules and regulations as they are applied today? A major nursing shortage 100% The hospital has recently eliminated all nursing assistant positions and has replaced them with unlicensed assistive personnel (UAP) to provide patient care. How should the professional nursing staff work with these new employees?
Continue to delegate and supervise them as they did with the nursing assistants. The charge nurse is aware that some staff nurses routinely “short -cut” assessment activities for long -
term patients. In case of a negative patient outcome related to this practice, does the charge nurse hold any liability?
Yes, the charge nurse has a duty to ensure staff competency. 100% The unit is extremely busy when the physician orders that a urinary catheter be inserted in a patient. The patient’s assigned nurse is new, has seen the procedure done, but has never done it independently.
How should the charge nurse handle this situation?
The charge nurse should assist the new nurse with the procedure. 100% The nurse has recently assumed the position of chief nurse in a long-term care facility with a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities?
Establish a formal discipline plan to be used when standards of care are not followed. 100% Which scenario meets the Civil Rights Act of 1991 definition of quid pro quo sexual harassment?
Submission to, or rejection of, sexual conduct as a basis for employment decisions 100% Which impairments are covered by the Americans with Disabilities Act?
Either physical or mental impairments 100% In passing the Americans with Disabilities Act of 1990, Congress attempted to combine disability with Equality 100% which other legal concept? Which person best meets the criteria as a “member of a protected class” in a quid pro quo sexual
harassment lawsuit?
A staff nurse as compared to his or her supervisor 100% The nurse who has worked at a hospital for five years suffers a disability secondary to a work-r elated accident and requests accommodation. Does the nurse’s new position have to provide the sam e salary as the old position? No, but the nurse’s seniority should be considered in salary negotiations.
Discrimination against which group of persons necessitated the Americans with Disabilities Act?
Those living with HIV/AIDS 100% The employee has requested the employer provide a reasonable accommodation. What does this request entail?
Needed and realistic modifications in the workplace 100% Which person qualifies under the Americans with Disabilities Act?
A person who is a recovering alcoholic The nurse is concerned about the potential of sexual harassment in her workplace. Which standard should this nurse investigate before making a decision about whether an activity is sexual harassment or not?
Reasonable woman standard for hostile work environment sexual harassment An employee has requested special accommodations secondary to a disability. The hospital refuses, citing undue hardship. What must be present for t hat refusal to be upheld?
The accommodation would be very difficult to implement. The nurse manager requests that a job applicant who has a physical disability receive a medical examination prior to assignment to a work station. Is this examination legal?
Only if all other applicants for similar positions are subjected to the same examination A nurse who has an obvious physical disability applies for a staff nurse position. Which question, asked by the nurse recruiter, is legal? “Are you able to fulfill the requirements of this job?”
The nurse applies to a faith-based hospital. Another applicant who is of the same faith supported by the hospital is hired instead. Is this seen as discrimination under ADA?
No, employers may offer preference to individuals of the same religion. Which scenario meets the Civil Rights Act of 1991 definition of hostile environment sexual harassment?
Submission to sexual innuendos, remarks, and physical acts that alter the conditions of the employee’s employment, creating an abusive workplace Which situation meets the criteria of sexual favoritism or preferential treatment?
A nurse is awarded a position after having an affair with a supervisor.
CHAPTER 9 What is the major problem associated with charting by exception? It may not provide enough information to support trending of the patient’s condition. When President Clinton signed the Health Insurance Portability and Accountability Act in 1996, many provisions concerning confidentiality of medical records became law. What were other provisions of this act? Choose all that apply. An antifraud and abuse program The nursing student began a case study paper by writing, “ J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital.” What is the significance of this statement? It violates Health Insurance Portability and Accountability Act regulations. The patient demands to see the actual medical record of a hospitalization that occurred one year ago. How should the hospital handle this request? Have the patient come to the hospital to review the original record. The laboratory notifies the nursing unit that a substantial amount of test data was mistakenly recorded on the wrong patient’s medical record two days ago. Who has the authority to alter the patient’s record? Only administrative staff or the patient’s primary physician Which ethical principle supports the argument that all newborns should be screened for HIV? Beneficence Hospital policy states that a registered nurse must cosign all charts that licensed practical nurses complete. What is the effect of this policy on the registered nurse? It places the RN in the position of endorsing and authenticating the entries made in the charts cosigned. Which statement best explains the i mportance of electronic medical record use? Patient care is improved. The parents of a 17-year-old who is receiving substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider? Only release information if the patient has signed consent to do so. A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status? All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department.
CHAPTER 10 As a part of a malpractice case, the hospital has decided to bring an indemnity claim against a nurse. What is the implication to the nurse? The nurse will have to pay monetary damages to the hospital if the hospital wins the claim.
The limits of liability on an insurance policy are $1,000,000 for each claim, $4,000,000 aggregate. A nurse is charged in a serious situation in which five separate lawsuits have been file d. What is the most the insurance company will likely pay in this situation? $1,000,000 The hospital-employed nurse volunteered to assist with physical examinations for athletes at the local high school. How does this situation affect the nurse’s malpractice insurance? The nurse is very likely not covered by any malpractice insurance. A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit ? Not necessarily, it depends upon the hospital’s insurance policy and what it covers. The nurse believes that her need for individual malpractice insurance is decreased because she practices in a smalltown home health agency. What is true about this situation? Home health care is an area in which the risk of lawsuit is higher than in many other practice areas. The nurse is reviewing a professional liability policy for the time period the policy is in effect. Under which section of the policy should this nurse look? Declarations Which type of insurance is generally the most preferable for the most nurses? Occurrence-based A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation? The nurse can be held personally responsible for all damages assessed. Under a claims-made insurance policy, for which claim is the nurse protected? Claims that are filed for incidents during the active period of the policy What elements does the insurance company that offers professional liability insurance verify under the exclusion portion of the policy? Choose all correct answers. Licensure of the insured
CHAPTER 11 The nurse has a strong religious conviction against elective sterilization procedures. When seeking employment, how should the nurse handle this belief? Be up front and discuss the issue during the employment interview. The patient decides to discontinue standard medical treatment for diabetes mellitus and to rely on diet and herbal medications for blood sugar control. Which statement, made by the nurse, is most appropriate? Why did you decide to make this change? Which situation is probable grounds for disciplinary action against a nurse’s license? The nurse made a false statement on the licensure application. The home health nurse discovers that a homebound cancer patient is using marijuana to control nausea from chemotherapy. What advice should the nurse give this patient? Under certain circumstances, patients can claim exemption f rom the law against possession of marijuana. The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor? Report the concerns to the state board of nursing. What is the basic purpose of the state board of nursing?
To establish a means of protecting the public at large The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review? State Nurse Practice Act From where does the state’s power to license nurses derive? Police power within the state The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse, what is the status of the nurse’s license? Only the state in which the nurse holds licensure can act to suspend or revoke that license. Which type of licensure protects the title “nurse” as well as professional actions associated with nursing? Mandatory CHAPTER 12 The advanced nurse practitioner is routinely addressed as “doctor” by clinic patients. What is the best way for the nurse to handle this mistake? Be certain patients are aware that the nurse is not a physician. Fein v. Permanente Medical Group is important as the case defined the standard of care for the advanced practice nurse. How was that standard of care defined? The advanced nurse practitioner standard of care Which factor was primary in driving the establishment of the advanced nurse practitioner role? The physician shortage of the late 1960s Which advanced nurse practitioner role is authorized by nurse practice acts, medical practice acts, and allied health laws? Nurse anesthetist Clinical nurse specialists in hospital settings are more likely to be sued for malpractice than staff nurses for which reason? They assume greater legal liability by virtue of their specialty credentials. The advanced nurse practitioner is considering changing malpractice i nsurance carriers. What should the nurse consider prior to making this change? The expanding role of the advanced nurse practitioner has increased the number of lawsuits filed. The patient requires a controlled substance for the treatment of pain. What is true of the advanced nurse practitioner’s role in independently prescribing this medication? Some states allow advanced nurse practitioners to prescribe controlled substances. What is the one care component NOT common in the independent practice of a certified nurse midwife? Management of postpartum complications The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges? The individual hospital The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse’s practice? There is no problem as the practice requirements are the same.
CHAPTER 13
The hospital acts to revoke the clinical privileges of a physician who has repeatedly refused to respond to emergency calls from nursing staff. Under which doctrine is this action advisable? Corporate liability Which legal doctrine cannot apply to a nurse’s practice as a private duty nurse? Respondeat superior The female nurse works in a nursing home where many of the patients are military service veterans. She discovers that a male nurse with whom she works makes $2.80 per hour more than she makes. In which situation could this be legal under affirmative action? The male nurse’s yearly evaluations are better than the female nurse’s. How does the doctrine of respondeat superior alter the liability of the nurse for negligent conduct? It makes the nurse liable to the employer. The nurse cited “intolerable working conditions” as the reason for resignation. In order to claim constructive discharge, what must the nurse prove? The employer deliberately created the work condition to force the nurse to resign. The hospital has outsourced housekeeping services to an independent contractor. A patient, who was injured in a fall on wet flooring, brings suit against the company. Does the hospital also hold liability? Perhaps, secondary to the doctrine of ostensible authority. A patient who is well known to be violent arrives by ambulance at the Emergency Department for care of a laceration. What action should be taken? Use a buddy system when providing care. The nurse says, “I’m not spending my money and my time off to go to continuing education.” How should this statement be interpreted in relation to the duty owed the employer? As unreasonable. Staying current is a duty the nurse owes to the employer. The plaintiff was awarded monetary damages from the hospital in a suit resulting from a nurse’s negligence. Under which principle is it possible for the hospital to sue the nurse to recover the amount of the damages? Indemnification The nurse and immediate supervisor have a personal conflict. The supervisor warns the nurse that the hospital is an employment-at-will institution. What does that indicate? The nurse can be dismissed at any time, without cause. CHAPTER 14 The news reports that a person “contracted over the telephone” to kill another person. Under contract law is that a correct statement? No, contracts must fulfill a lawful purpose. Mandatory overtime raises ethical issues about patient and nurse safety. How does voluntary overtime affect these issues? It requires nurse managers to be vigilant concerning safety. Which situation reflects consideration in contract law? The nurse agrees to work for specific wages. The court found a nurse manager liable for failure to warn. Which option reflects a failure to warn scenario? The nurse manager did not tell a potential employer that a former employee was asked to resign for incompetence. The contract between a nurse and a hospital delineates the nurse’s salary, benefits package, and when the job will begin. The contract does not state that the nurse must provide quality care. What is the t erm used to describe the quality expectation? implied terms
Which person would be the best choice for a mediator in a contract dispute between a nurse and a hospital? A consultant from outside the hospital Changes have been made to the employee handbook. What must occur for this document to constitute a contract? The employee must continue to work after the manual takes effect. The nurse takes a position working in a clinic and receives a sign-on bonus. After having worked for one month the nurse charges that she never signed a contract with the clinic and therefore can leave for a different, higher-paying job without returning the bonus. What is true about this situation? The contract was accepted when the nurse showed up for work. A work dispute has gone to arbitration. The nurses involved in the dispute are unhappy with the decision made by the arbitrator. Do the nurses have to abide by the decision? Yes, unless both parties agreed in advance that the decision is not binding The unit policy is that the nurse with the least seniority is required to float to understaffed units. Is this the best policy? No, generally the most capable and efficient person should be floated. CHAPTER 15 The registered nurse has delegated the task of ambulating a patient who has a history of unexpected falls to two nursing assistants. The patient appears to ambulate without assistance, but must be ambulated with two assistants in case of another unexpected fall. What is the most important aspect of delegating this t ask? The aides understand the importance of walking with the patient. Unlicensed personnel are not licensed by the state in their own right. Why is it that these persons can perform delegated tasks? They work under the auspices and licensure of the institution, not the professional nurse. What was the major impetus for more stringent delegation and supervision rules and regulations as they are applied today? A major nursing shortage The nurse has recently assumed the position of chief nurse in a long-term care facility w ith a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities? Establish a formal discipline plan to be used when standards of care are not followed. A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient’s vital signs? The registered nurse who has worked on this unit for 8 months The hospital has recently eliminated all nursing assistant positions and has replaced them with unlicensed assistive personnel (UAP) to provide patient care. How should the professional nursing staff work with these new employees? Continue to delegate and supervise them as they did with the nursing assistants. The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient’s death. Does the preceptor hold any liability in this case? No, since the new nurse has a license, all liability i s retained by the new nurse. The nurse is searching for information about nurses’ responsibility and accountability for of tasks. All but one of the following answers are correct. Where should this nurse NOT look for this information? State medical association bylaws The charge nurse is aware that some staff nurses routinely “short-cut” assessment activities for long-term patients. In case of a negative patient outcome related to this practice, does the charge nurse hold any liability? Yes, the charge nurse has a duty to ensure staff competency.
