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Chapter 05: Legal Issues
MULTIPLE CHOICE
1.Which province in Canada does not have a set of common laws?
| a. | British Columbia |
| b. | Ontario |
| c. | Quebec |
| d. | Newfoundland |
ANS: C
Canada’s common law system is derived from the English common law system. The system is structured with courts that have different levels of authority. Moreover, the decisions of higher courts govern those of lower courts, and decisions of courts at the same level are governed by consistency in subsequent rulings on similar matters. Quebec’s legal system is slightly different from those of the rest of Canada, and most of its provincial laws are limited to and contained within a single written civil code based on the French civil code. Quebec does not have a set of common laws like the rest of Canada, and court decisions related to Quebec provincial laws are often restricted to how courts interpret the civil code.
DIF:Cognitive Level: UnderstandREF:Page 71
TOP: Nursing Process: Assessment
2.Which of the following has the highest standard of proof associated with it?
| a. | Common law |
| b. | Criminal law |
| c. | Negligence law |
| d. | Malpractice law |
ANS: B
The standard of proof of criminal actions is higher than that of actions involving other liability, and penalty options in criminal sanctions generally include jail time. In criminal law, people are presumed to be innocent until proven guilty.
DIF:Cognitive Level: UnderstandREF:Page 72
TOP: Nursing Process: Assessment
3.Athena, a registered nurse (RN), has been operating an abortion clinic in one of the city’s impoverished neighbourhoods. Athena is at risk for professional sanctions involving which behaviour?
| a. | Negligence |
| b. | Misconduct |
| c. | Incompetence |
| d. | Conduct unbecoming a member of the profession |
ANS: D
Professional sanctions and disciplinary actions generally arise from three unacceptable behaviours: (1) misconduct, (2) incompetence, and (3) conduct unbecoming a member of the profession. Misconduct is unacceptable behaviour within the scope of the profession’s practice; incompetence is a failure to meet minimum generally accepted standards; and conduct unbecoming a member of the profession is behaviour outside a profession’s practice that may bring the profession into disrepute. Because Athena is practising outside the scope of her RN practice, she is at risk for sanctions involving conduct unbecoming a member of the profession.
DIF:Cognitive Level: AnalyzeREF:Page 73
TOP: Nursing Process: Assessment
4.A person in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Canadian Charter of Rights and Freedoms (1982) requires that employers
| a. | make reasonable accommodations for persons who are disabled. |
| b. | allow modified job expectations for persons recovering from alcoholism. |
| c. | hire disabled individuals before hiring other qualified, nondisabled persons. |
| d. | treat, for purposes of employment, homosexuals and bisexuals as disabled. |
ANS: A
The Canadian Charter of Rights and Freedoms (1982) outlines many of the provisions that prohibit discrimination in the workplace on the basis of national origin or ethnicity, race, religion, age, colour, gender, sexual orientation, or mental or physical disability.
DIF:Cognitive Level: UnderstandREF:Page 81
TOP: Nursing Process: Implementation
5.A staff nurse who was fired for reporting client abuse to the appropriate state agency files a whistle-blower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistle-blower suit claiming retaliation include which of the following?
| a. | The nurse had previously reported the complaint, in writing, to hospital administration. |
| b. | The nurse had threatened to give full details of the client abuse to local media sources. |
| c. | The nurse was discharged after three unsuccessful attempts at progressive discipline had failed. |
| d. | The nurse had organized, before filing the complaint, a work stoppage action by fellow employees. |
ANS: A
An employer cannot fire an employee who, in good faith, reports what is believed to be a violation of a law, rule, or state or federal law. Nurses may be affected by a variety of laws that require reporting, and many statutes provide provisions to protect whistle-blowers from reprisals or retaliatory actions by employers or others as a result of the reporting. The intent is to advance the protection of the public and those who take action to safeguard it.
DIF:Cognitive Level: UnderstandREF:Page 75
TOP: Nursing Process: Implementation
6.The nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the unit’s policy and procedure manual, which is a part of which type of law?
| a. | Employment law |
| b. | Common law |
| c. | Written law |
| d. | Legislated law |
ANS: B
Basic employment law is found in common law and includes a duty for employees to follow legitimate employer commands related to their work. These commands may take the form of a manager’s direct request and are also contained within institutional rules, policies, and procedures.
DIF:Cognitive Level: UnderstandREF:Page 80
TOP: Nursing Process: Implementation
7.To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process in which people attempt to identify potential hazards and
| a. | compensate for previous injuries. |
| b. | eliminate these risks before anyone else is harmed. |
| c. | supersede the need for staff members to file incident reports. |
| d. | discipline staff members who have been involved in previous incident reports. |
ANS: B
Risk management involves taking proactive steps to identify and eliminate risks and liability.
DIF: Cognitive Level: Understand REF: Page 84 TOP: Nursing Process: Planning
8.Nurses are often “floated” to other patient care areas in health care organizations. One means of ensuring that such nurses are qualified to work in those areas is
| a. | employing additional staff to assist with orientation processes. |
| b. | cross-educating staff members with regard to other areas of the institution. |
| c. | transferring clients to units where the staffing pattern is optimal. |
| d. | orienting staff members to all patient care areas as part of their general orientation to the institution. |
ANS: B
Nurses should be floated to units as similar as possible to their own to decrease the potential for liability. Cross-training, a proactive approach to temporary staffing problems, reduces the potential for liability.
DIF:Cognitive Level: ApplyREF:Page 86
TOP: Nursing Process: Implementation
9.A colleague asks you to give her your password access so that she can view her partner’s health care record. This request violates the patient’s right to
| a. | privacy. |
| b. | confidentiality. |
| c. | undue authorization of treatment. |
| d. | protection against slander. |
ANS: A
Privacy refers to the right to protection against unreasonable and unwarranted interference with the patient’s affairs, which extends, in the medical context, to protection against public disclosure of private facts about the patient to the public.
DIF: Cognitive Level: Understand REF: Pages 85-86 TOP: Nursing Process: Evaluation
10.The chart of a patient who has undergone abdominal surgery indicates that one set of vital signs were taken at 7 minutes after surgery; the next set were completed 10 hours after surgical. This level of assessment illustrates which element of malpractice?
| a. | Breach of duty owed the patient |
| b. | Foreseeability |
| c. | Causation |
| d. | Injury or damage |
ANS: A
The element of malpractice that depicted in the example is a breach of the duty owed, as evidenced by failure to monitor vital signs of a surgical patient regularly.
DIF:Cognitive Level: ApplyREF:Page 83, Table 5-2
TOP: Nursing Process: Assessment
11.A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks to a patient with a history of previous sexual abuse. The patient sues, claiming malpractice. Which of the following conditions would probably not apply in this situation?
| a. | Injury |
| b. | Causation |
| c. | Breach of duty |
| d. | Breach of duty of care owed |
ANS: A
By virtue of employment, the nurse owes a duty of care to the patient; this care has been breached by a nurse, who would be expected to know that this behaviour violates usual standards of care. If further distress can be directly linked to the remarks, then causation is established. Because of the physical nature of injury, it may not be possible to establish injury in the suit.
DIF:Cognitive Level: ApplyREF:Pages 82-83
TOP: Nursing Process: Implementation
12.As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child’s physician of his concerns about deterioration in the child’s status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for
| a. | professional negligence. |
| b. | assault. |
| c. | avoidance. |
| d. | murder. |
ANS: A
Negligence can be asserted when there is failure to do what a reasonable and prudent nurse would do in the same situation. In this situation, the charge nurse might have advocated further for the patient in light of the evident seriousness of the child’s condition.
DIF:Cognitive Level: AnalyzeREF:Page 83 | Page 87
TOP: Nursing Process: Implementation
13.The parents of a toddler who dies after being brought to the emergency room launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son’s deteriorating condition contributed to his death. The senior nurse executive is viewed as
| a. | a global respondent. |
| b. | vicariously liable. |
| c. | performing a frivolous action. |
| d. | being under the element of causation. |
ANS: B
According to the concept of vicarious liability, employers are accountable for the negligence of their employees; the rationale is that the employee could not have been in a position to have caused the wrongdoing unless hired by the employer.
DIF:Cognitive Level: UnderstandREF:Page 73
TOP: Nursing Process: Assessment
14.Which of the following demonstrates a movement away from a culture of blame and liability to one in which a systematic approach is used to enhancing patient safety?
| a. | Avoiding harmful misrepresentation while assisting patients to understand their health record |
| b. | Apology letters to patients who experienced an adverse event inadmissible in a court of law |
| c. | Encouraging full disclosure of adverse events with patient identification information removed |
| d. | Instituting monthly meetings of a risk management review committee |
ANS: B
New legislation in Canada prevents apology letters to patients for adverse events being entered into evidence in courts to substantiate wrongdoing and legal liability; this is one step signalling a movement away from a culture of blame and liability to one in which a systematic approach is used to enhance patient safety.
DIF:Cognitive Level: UnderstandREF:Page 85
TOP: Nursing Process: Assessment
15.You volunteer at a community clinic. A 17-year-old girl claims to have a diagnosis of a sexually transmitted infection and presents with Chlamydia. The team leader at the clinic advises that
| a. | the age of legal consent is 18; therefore, no treatment can be delivered. |
| b. | the teen is underage and should be referred to the family general practitioner. |
| c. | care can be provided as long as consent is voluntary and information about treatment and options is provided. |
| d. | treatment is provided as long as telephone consent is obtained from a parent or legal guardian. |
ANS: C
All provinces and territories have a legal age for consent; in general, this age is 18. However, minors seeking treatment can provide their own consent. An explanation and the patient’s understanding of the proposed treatment or procedure to be performed, the expected results, and the health condition it addresses must be discussed with the patient before it is performed.
DIF:Cognitive Level: ApplyREF:Page 82
TOP: Nursing Process: Implementation
16.Which level of government is most responsible for hospitals and health care?
| a. | Local |
| b. | Provincial |
| c. | National |
| d. | International |
ANS: B
Most matters of health care and hospitals fall under provincial jurisdiction.
DIF:Cognitive Level: UnderstandREF:Page 70
TOP: Nursing Process: Assessment
17.Which of the following is a publicly funded national health care program in Canada?
| a. | Blue Cross |
| b. | Hospital Insurance Program |
| c. | Medicare |
| d. | Social assistance |
ANS: C
Medicare is Canada’s publicly funded national health care program.
DIF:Cognitive Level: UnderstandREF:Page 70
TOP: Nursing Process: Assessment
18.Which of the following is an unregulated health care worker?
| a. | Pharmacist |
| b. | Occupational therapist |
| c. | Practical nurse |
| d. | Care aide |
ANS: D
Regulated health care workers include nurses, pharmacists, and occupational therapists. They conduct reserved health care–related actions authorized by licencing. Unregulated health care workers include care aides and certain therapists or counsellors.
DIF:Cognitive Level: UnderstandREF:Page 71
TOP: Nursing Process: Assessment
19.Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.’s statements reflect concern with
| a. | privacy. |
| b. | confidentiality. |
| c. | veracity. |
| d. | informed consent. |
ANS: A
Privacy may be defined as the right of the individual to determine when, how, and to what extent he or she will release personal information. Privacy protection includes protection against unwarranted intrusion on the patient’s affairs.
DIF:Cognitive Level: ApplyREF:Page 77
TOP: Nursing Process: Assessment
20.To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except
| a. | notifying staff of changes to policies related to medication administration. |
| b. | scheduling and staffing to ensure safe care. |
| c. | delegating in accordance with practice acts. |
| d. | supervising the practice of the physician. |
ANS: D
Legally, the nurse manager is accountable to nursing practice standards, standards for nurse administrators, and hospital policies and procedures.
DIF:Cognitive Level: UnderstandREF:Page 83
TOP: Nursing Process: Assessment
21.Which of the following is the least restrictive in governing health care occupations?
| a. | Association |
| b. | College |
| c. | Registration |
| d. | Certification |
ANS: C
Registration is the least restrictive regulation that governs health care occupations and may require individuals simply to register with a designated employer to obtain membership; registration also offers the least regulatory protection to the public.
DIF:Cognitive Level: UnderstandREF:Page 72
TOP: Nursing Process: Assessment
MULTIPLE RESPONSE
1.One of your staff nurses asks for your advice because a patient refuses to sign a consent form for surgery. The patient says that he will not sign because he does not understand the nature of the surgery. You advise that (Select all that apply.)
| a. | consent must not be coerced. |
| b. | the patient has a right to choose not to consent. |
| c. | the patient must sign the consent because the doctor wants him to sign. |
| d. | witnessing the signing of a consent from is related only to the voluntary nature of the signature. |
ANS: A, B, D
Consent must be voluntary and not coerced; the patient must understand what he is signing, must have legal capacity, and must understand the consequences of refusal. Witnessing the signing of a consent form means attesting to the voluntary nature of the patient’s signature.
DIF:Cognitive Level: AnalyzeREF:Page 82
TOP: Nursing Process: Implementation
2.With regard to nursing practice, nurse managers are held responsible for (Select all that apply.)
| a. | practising within legal guidelines established under provincial or territorial law and nurse practice acts. |
| b. | ensuring that nursing staff members under their supervision are currently licenced to practice. |
| c. | referring all errors in nursing judgement to state discipline boards. |
| d. | ensuring that physicians are properly licenced to provide care on patient care units. |
ANS: A, B
Nurses are responsible for knowing legal and nurse practice acts and for practising according to them. Managers are responsible for monitoring staff practice and ensuring that nursing staff members hold current, valid licensure.
DIF:Cognitive Level: UnderstandREF:Page 71 | Page 81
TOP: Nursing Process: Implementation
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