Chapter 22: Legal Implications in Nursing Practice Nursing School Test Banks

Potter & Perry: Fundamentals of Nursing, 6th Edition

MULTIPLE CHOICE

1. The client has an order for intramuscular (IM) morphine sulfate as needed for pain. A nurse accidentally administers an incorrect dosage of the morphine sulfate to the client. Which source of law best addresses this situation?

a.

Civil law

b.

Criminal law

c.

Common law

d.

Administrative law

ANS: a

a. Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Generally, violations of civil laws cause harm to an individual or property, and damages involve payment of money. Administering an incorrect dosage of morphine sulfate would fall under civil law because it could cause harm to an individual.

b. Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment).

c. Common law is created by judicial decisions made in courts when individual legal cases are decided (e.g., informed consent).

d. Administrative law is created by administrative bodies, such as State Boards of Nursing when they pass rules and regulations (e.g., the duty to report unethical nursing conduct).

REF: Text Reference: p. 407

2. On admission to the hospital, a terminal cancer patient says he has a living will. This document functions to state the clients desire to:

a.

Receive all means of technical assistance and equipment used to prolong his life

b.

Have his wife make decisions regarding his care

c.

Be allowed to die without life-prolonging techniques

d.

Have a lethal injection administered to relieve his suffering

ANS: c

c. A living will is an advance directive, prepared when the individual is competent and able to make decisions, regarding that persons specific instruction about end-of-life care. Living wills allow people to specify whether they would want to be intubated, treated with pressor drugs, shocked with electricity, and fed or hydrated intravenously.

a. A living will specifies what interventions the client does not want, so that his or her life will not be prolonged.

b. If his wife had power of attorney, she would be able to make decisions regarding the clients care.

d. Assisted suicide, such as a lethal injection, is not a function of a living will. A living will defines a clients wishes for withholding of treatment that would prolong his or her life.

REF: Text Reference: p. 409

3. A junior nursing student prepares to give her client an injection. What standard of care applies to the student nurses conduct when providing care normally performed by a registered nurse (RN)? The student is held to:

a.

A standard of care of an unlicensed person

b.

The same standard of care as an RN

c.

A standard similar to but not the same as the staff nurse with whom she is assigned to work

d.

No special standard of care because her faculty member is responsible for her conduct

ANS: b

b. Student nurses are expected to perform as professional nurses (i.e., as an RN would in providing safe client care).

a. Students are not working in the same capacity as an unlicensed person and therefore are not compared with the standard of an unlicensed person.

c. This is not a true statement. Staff nurses may serve as preceptors, but that does not excuse the student from performing at the level of a RN.

d. If a client is harmed as a direct result of a nursing students actions or lack of action, the liability for the incorrect action is generally shared by the student, instructor, hospital or health care facility, and the university or educational institution.

REF: Text Reference: p. 418

4. The nurse has just obtained a license to practice and is determining whether individual malpractice insurance is necessary. Which of the following is the most important factor in a nurses deciding whether to carry malpractice insurance?

a.

The amount of the malpractice insurance provided by the employer

b.

The evaluation of whether the nurse works in a critical area of nursing where clients have higher morbidity and mortality rates

c.

The time frames and individual liability of the employers malpractice coverage

d.

The nurses knowledge level of Good Samaritan laws

ANS: c

c. It would be important to know the time frames of the employers malpractice coverage. In other words, is the nurse covered only during the times he or she is working within the institution? It would be important to know the individual liability, meaning if sued, what financial responsibility would the nurse have?

a. The amount of the malpractice insurance provided by the employer is not the most important factor in deciding whether to carry private insurance. Generally, the employers malpractice insurance coverage is much greater than private insurance coverage.

b. The area of nursing in which the nurse is employed is not the most important factor in deciding whether to carry malpractice insurance. Lawsuits can occur anywhere.

d. The nurse should be aware of Good Samaritan laws, but this would not be sufficient coverage for most nursing practice. Therefore it is not the most importance factor in determining whether to purchase private malpractice insurance.

REF: Text Reference: p. 418

5. An unconscious client with a head injury needs surgery to live. His wife speaks only French, and the health care providers are having a difficult time explaining his condition. Which of the following is the most correct answer regarding this situation?

a.

Two licensed health care personnel should witness and sign the preoperative consent indicating their hearing an explanation of the procedure given in English.

b.

An institutional review board must be contacted to give their emergency advice on the situation.

c.

A friend of the family could act as an interpreter, but the explanation could not provide details of the clients accident, because of confidentiality laws.

d.

The health care team should continue with the surgery after providing information in the best manner possible.

ANS: d

d. In emergency situations, if it is impossible to obtain consent from the client or an authorized person, the procedure required to benefit the client or save a life may be undertaken without liability for failure to obtain consent. In such cases, the law assumes that the client would wish to be treated.

a. Telephone consents usually require two witnesses. This is not the case in this situation.

b. In an emergency, it is not necessary to contact the institutional review board. Doing so would take up valuable time.

c. A family member or acquaintance that is able to speak a clients language should not be used to interpret health information. An official interpreter must be available to explain the terms of consent (except in an emergency situation).

REF: Text Reference: p. 416, Text Reference: p. 417

6. A physician asks a family nurse practitioner to prescribe a medication that the nurse practitioner knows is incompatible with the current medication regimen. If the nurse practitioner follows the physicians desire, which of the following is the most correct answer?

a.

The nurse practitioner will be liable for the action.

b.

Good Samaritan laws will protect the nurse.

c.

If the nurse practitioner has developed a good relationship with the client, there will probably not be a problem.

d.

This type of situation is why nurse practitioners should have malpractice insurance.

ANS: a

a. A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client.

b. Good Samaritan laws will not protect the nurse in this situation. Good Samaritan laws are for providing care at the scene of an accident. The nurse should refuse to administer the medication when he or she knows it is wrong.

c. Developing a good relationship with the client is important but will not protect the nurse from legal liability for providing incompetent care.

d. Having malpractice insurance is not the answer, as it does not protect the client from harm. The nurse practitioner should refuse to administer the medication.

REF: Text Reference: p. 419

7. A registered nurse interprets a scribbled medication order by the attending physician as 25 mg. The nurse administers 25 mg of the medication to a client, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who would ultimately be responsible for the error?

a.

Attending physician

b.

Assisting resident

c.

Pharmacist

d.

Nurse

ANS: d

d. A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. The nurse should clarify the order with the physician if unable to read the order.

a. The attending physician could be included in a lawsuit, but the nurse would be ultimately responsible for the error.

b. The assisting resident would not be ultimately responsible for the error. The assisting resident did not carry out an inaccurate order.

c. The pharmacist could be included in a lawsuit, but the nurse would ultimately be responsible for the error because the nurse was the individual who carried out an inaccurate order.

REF: Text Reference: p. 419

8. Because of an influenza epidemic among nursing staff, a nurse has been moved from the eye unit to a general surgical floor. The nurse recognizes that he is inexperienced in this specialty. The nurses initial recourse is to:

a.

Politely refuse to move, take a leave-of-absence day, and go home

b.

Ask to work with another general surgery nurse

c.

Fill out a report noting his dissatisfaction

d.

Notify the state board of nursing of the problem

ANS: b

b. Nurses who float should inform the supervisor of any lack of experience in caring for the types of clients on the nursing unit. They also should request and be given orientation to the unit. Asking to work with another general surgery nurse would be an appropriate action.

a. A nurse who refuses to accept an assignment may be considered insubordinate, and clients will not benefit from having fewer staff available.

c. A nurse can make a written protest to nursing administrators, but it should not be the nurses initial recourse.

d. Notifying the state board of nursing should not be the nurses initial recourse. The nurse should first notify the supervisor and request appropriate orientation and training. If problems continue, the nurse should attempt using the usual chain of command within the institution before contacting the state board of nursing.

REF: Text Reference: p. 419

9. The nurse recognizes that issues concerning death and dying may influence nursing practice. Which of the following is true concerning the legalities of death and dying issues?

a.

Passive euthanasia is illegal in all states.

b.

Assisted suicide is a constitutional right.

c.

Organ donation must be attempted if it will save the recipients life.

d.

Feedings may be refused by competent individuals who are unable to feed themselves.

ANS: d

d. Competent clients have the right to refuse treatment. This includes lifesaving hydration and nutrition.

a. This is not a true statement. Furthermore, physician-assisted suicide is legal in the state of Oregon.

b. In 1997 the Supreme Court ruled that no fundamental constitutional right exists to assisted suicide.

c. Organ donation does not have to be attempted to save a recipients life.

REF: Text Reference: p. 409

10. As per the standards of care of the Joint Commission on Accreditation of Healthcare Organizations (JCAHO), an institution is required to have:

a.

Limits of professional liability

b.

Educational standards for nurses

c.

A delineated scope of practice for health professionals

d.

Written nursing policies and procedures for care

ANS: d

d. The Joint Commission on Accreditation of Healthcare Organizations requires that accredited hospitals have written nursing policies and procedures.

a. Standards of care help define the limits of professional liability. The Joint Commission on Accreditation of Healthcare Organizations does not require an institution to have limits of professional liability.

b. Nurse Practice Acts establish educational requirements for nurses.

c. Nurse Practice Acts define the scope of nursing practice. The rules and regulations enacted by the state board of nursing define the practice of nursing more specifically. The American Nurses Association has developed standards for nursing practice that delineate the scope, function, and role of the nurse and establish clinical practice standards.

REF: Text Reference: p. 407

11. Under specific circumstances that are outlined in the states nurse practice act, a nurses license may be suspended or revoked. In the event that a nursing license is revoked, which of the following is correct?

a.

The hearings are usually held in court

b.

Due process rights are waived by the nurse

c.

Appeals may be made regarding the decisions

d.

The federal government becomes involved in the procedures

ANS: c

c. Because a license is viewed as a property right, due process must be followed before a license can be suspended or revoked. Due process means that nurses must be notified of the charges brought against them and that the nurses have an opportunity to defend against the charges in a hearing.

a. Hearings for suspension or revocation of a license do not occur in court but are usually conducted by a hearing panel of professionals.

b. Due process must be followed. They do not have to be waived by the nurse.

d. Some states, not the federal government, provide administrative and judicial review of such cases after nurses have exhausted all other forms of appeal.

REF: Text Reference: p. 411

12. In the course of practice, a nurse may be liable for actions that constitute an unintentional tort. Which one of the following is an example of an unintentional tort?

a.

Restraining a client who refuses care

b.

Taking photos of a clients surgical wounds

c.

Leaving the side rails down and the client falls and is injured

d.

Talking about a clients history of sexually transmitted diseases

ANS: c

c. An unintentional tort is an unintended wrongful act against another person that produces injury or harm. An example of an unintentional tort would be leaving the side rails down, and the client falls and is injured.

a. Restraining a client who refuses care would be an example of assault and battery.

b. Taking photos of a clients surgical wounds without the clients permission is an example of invasion of privacy.

d. Talking about a clients history of sexually transmitted diseases would fall under the category of invasion of privacy. Personal information should be kept confidential.

REF: Text Reference: p. 414

13. The nurse must be aware of individuals who are able to given consent for procedures and treatments. Which one of the following individuals may legally give informed consent?

a.

A 16-year-old for her newborn child

b.

A sedated 42-year-old client

c.

The friend of an 84-year-old married client

d.

A 56-year-old who does not understand the proposed treatment plan

ANS: a

a. An emancipated minor, one who is younger than 18 years but who is a parent, may legally give informed consent for the care of her newborn. An emancipated minor can also be someone younger than 18 years who is legally married.

b. A person who has been sedated cannot legally give informed consent. Consent should be obtained before a sedative is administered.

c. If the 84-year-old client were unable to give consent, then the clients wife would be the person legally authorized to do so on the clients behalf. For a friend to be legally able to give consent, he or she would have to possess power of attorney or legal guardianship of the client.

d. If a client does not understand the proposed treatment plan, the nurse must notify the physician or nursing supervisor and must make certain that clients are informed before signing the consent.

REF: Text Reference: p. 416

14. A client is to have a surgical procedure tomorrow morning. and the nurse has gone into the room to obtain the consent form. The nurses signature as a witness on an informed consent indicates that the client:

a.

Fully understands the procedure

b.

Agrees with the procedure to be done

c.

Has voluntarily signed the form

d.

Has authorized the physician to continue with the treatment

ANS: c

c. The nurses signature witnessing the consent means that the client voluntarily gave consent, that the clients signature is authentic, and that the client appears to be competent to give consent.

a. It is the physicians responsibility to make sure the client fully understands the procedure. If the nurse suspects that the client does not understand, the nurse should notify the physician.

b. The nurses signature does not indicate that the client agrees with the procedure, but that the client has voluntarily given consent and is competent to do so. Clients also have the right to refuse treatment, which also is signed and witnessed.

d. The nurses signature does not verify that the client has authorized the physician to continue with treatment. It verifies only that the consent was given voluntarily, the client is competent to give consent, and the signature is authentic.

REF: Text Reference: p. 416

15. In working with clients who have DNR (do not resuscitate) orders, the nurse recognizes that these orders:

a.

Are legally required for terminally ill clients

b.

May be written by the physician without client consent if resuscitation is futile

c.

Are maintained throughout the clients stay in an acute or long-term facility

d.

Follow nationally consistent standards for implementation

ANS: b

b. If the client is unable, and no surrogate is available to give consent, the do-not-resuscitate (DNR) order can be written but only if the physician is reasonably medically certain that the resuscitation would be futile.

a. A DNR order is not legally required for terminally ill patients.

c. DNR orders are not necessarily maintained throughout the clients stay because a clients condition may warrant a change in DNR status. The attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities.

d. No nationally consistent standard exists for DNR implementation. States have their own statutes regarding DNR orders.

REF: Text Reference: p. 410

16. The nurse understands the implications of the Patient Self-Determination Act. This legislation requires that:

a.

Clients designate a power of attorney

b.

DNR orders for clients meet a standard criterion

c.

Organ donation is required on death, if possible

d.

Information be provided to the client regarding rights for refusal of care

ANS: d

d. The Patient Self-Determination Act requires health care institutions to provide written information to clients concerning the clients rights under state law to make decisions, including the right to refuse treatment and formulate advance directives.

a. The Patient Self-Determination Act does not require clients to designate a power of attorney.

b. The Patient Self-Determination Act does not require that DNR orders meet standard criterion.

c. The Patient Self-Determination Act does not require organ donation on death. It is the clients decision whether he or she wants to participate in organ donation.

REF: Text Reference: p. 409

17. The nurse is investigating legislation that may have an effect on nursing practice. The nurse finds that the newly enacted Health Insurance Portability and Accountability Act (HIPAA) of 2003 requires:

a.

Insurance coverage for all clients

b.

Policies on how to report communicable diseases

c.

Limits on information and damages awarded in court cases

d.

Safeguards to protect written and verbal information about clients

ANS: d

d. The Health Insurance Portability and Accountability Act (HIPAA) requires all hospitals and health agencies to have specific policies and procedures in place to ensure that reasonable safeguards protect written and verbal communications about clients.

a. HIPAA does not require insurance coverage for all clients. It limits the extent to which health plans may impose preexisting condition limitations and prohibits discrimination in health plans against individual participants and beneficiaries based on health status.

b. HIPAA does not require policies on how to report communicable diseases. It does require safeguards to protect written and verbal information about clients.

c. HIPAA does not require limits on information and damages awarded in court cases.

REF: Text Reference: p. 411

18. The nurse enters the room and tells the client that he has to take the medication, including an injection. The client refuses the medication, but the nurse continues to administer the medications. This action is an example of the intentional tort of:

a.

Assault

b.

Battery

c.

Invasion of privacy

d.

Malpractice

ANS: b

b. Battery is any intentional touching without consent. An example of battery is a nurse giving a medication after the client has refused.

a. Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary.

c. Invasion of privacy exists when the client has unwanted intrusion into his or her private affairs. This case is not an example of invasion of privacy.

d. Malpractice is negligence committed by a professional such as a nurse or physician. This case is not an example of malpractice.

REF: Text Reference: p. 413

19. The nurse is working with a client who has been diagnosed with acquired immunodeficiency syndrome (AIDS). On the way downstairs in the elevator, the nurse shares the clients name and diagnosis with a co-worker. Unknown to the nurse, a friend of the client also is on the elevator and hears the entire story. The nurse who shared the information may be held liable for:

a.

Slander

b.

Assault

c.

Malpractice

d.

Invasion of privacy

ANS: a

a. A nurse can be held liable for slander if he or she shares private client information that can be overheard by others.

b. Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. The nurse in this situation has not committed assault.

c. Malpractice is negligence committed by a professional such as a nurse or physician. Nursing malpractice results when care falls below the standard of care. This case is not an example of malpractice.

d. Invasion of privacy exists if the client has unwanted intrusion into his or her private affairs. This case is not an example of invasion of privacy. This instance falls under the category of defamation of character.

REF: Text Reference: p. 414

Copyright 2005 by Mosby, Inc. All rights reserved.

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