Nursing Delegation, Setting Priorities, And Making Patient Care Assignments 2nd Edition by Patricia Kelly – Test Bank

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Sample Questions Posted Below

Chapter 5: Legal Aspects of Patient Care and Delegation

MULTIPLE CHOICE

1.A constitution is a set of basic laws that specifies the power of different parts of the government. Listed below are some of the functions of a constitution. Which is not correct?

ANS: C

A constitution is a set of basic laws that delineates the powers of different branches of a government and how these branches (or segments) relate to one another. Constitutions have the authority to: 1) make laws; 2) interpret laws; and 3) implement laws.

PTS:1DIF:KnowledgeTOP:Sources of Law

2.Public law consists of a number of different types of laws and duties. Which of the following is not correct regarding public law?

ANS: D

Public law defines a citizen’s relationship with the government and is comprised of three types of law. These three types of law are: 1) administrative law; 2) constitutional law; and 3) criminal law.

PTS: 1 DIF: Comprehension TOP: Public Law

3.Nurse Practice Acts are examples of which type of law?

ANS: C

Nurse Practice Acts are state-based administrative laws that govern how nursing is performed in that state. Under Nurse Practice Acts, state boards of nursing are given the authority to define the practice of nursing within specific guidelines and parameters specified by the legislature; mandate required preparation for the practice of nursing; and discipline members who deviate from the rules for nursing practice in the state.

PTS: 1 DIF: Comprehension TOP: State

4.How many states have joined the Nurse Licensure Compact?

ANS: B

The Nurse Licensure Compact is an agreement among member states to allow nurses licensed in one state to practice in other states which are part of the agreement, without obtaining an additional license. This is a project of the National Council of State Boards of Nursing and currently there are 23 states who have joined this agreement at the time of this publication.

PTS: 1 DIF: Knowledge TOP: State

5.Which of the following is not correct regarding tort law?

ANS: D

Tort law is defined as a negligent or intentional civil wrongdoing resulting out of a contract or statute that causes injury to another person in some way. As a result of this wrongdoing, the injured party may sue the wrongdoer for damages (The Lectric’ Law Library’s Lexicon on Tort, 2008). Some other characteristics of tort law include the: 1) denial of an individual’s legal right; 2) failure to comply with a public duty; and 3) failure to perform a private duty that results in harm to another. Examples of tort include malpractice, neglect, or assault and battery.

PTS: 1 DIF: Application TOP: Tort Law

6.Nurse X has an order to give Patient W an enema as a prep for his GI procedure tomorrow. Patient W has refused the enema, but Nurse X says that he really needs it and she will give it to him regardless of his wishes so that he can have his procedure tomorrow. By threatening to give Patient W this enema, Nurse X is guilty of which type of tort?

ANS: A

A number of different types of torts can be found in health care-related situations. When a nurse or individual threatens to do an action, such as Nurse X threatening to give Patient W an enema regardless of his wishes, she is guilty of assault (threat to touch another person in an offensive manner without that person’s permission.). If Nurse X actually gave the enema to Patient W then she would be guilty of battery (touching of another person without that person’s consent). Defamation pertains to intentionally giving information, communication, or publication that may cause the loss of a person’s reputation.

PTS: 1 DIF: Application TOP: Tort Law

7.Listed below are some identified clinical locations for nursing malpractice cases from the Professional Negligence Law Reporter (July 2001 – July 2002). Which is not necessarily correct?

ANS: B

The Professional Negligence Law Reporter provides an account of negligence cases over a specific period of time. From July 2001 through July 2002, forty-seven nurse malpractice cases were identified in nine locations (settings). Some of these include: 1) hospital-medical-surgical—thirteen cases; 2) urgent care facility—one case; 3) emergency room—five cases; 4) recovery room—two cases; 5) maternity-obstetrics—ten cases; and 6) nursing home—nine cases. Costco is not considered a clinical setting and is not listed in the Professional Negligence Law Reporter during this period even though occasionally some health-related services may occur there such as flu shots.

PTS: 1 DIF: Comprehension TOP: Negligence and Malpractice

8.Good Samaritan Laws exist to protect health care professionals from legal liability for actions administered in an emergency situation. Which of the following is not correct regarding Good Samaritan Laws?

ANS: A

Good Samaritan Laws are laws that exist to provide protection for health care professionals who provide care in emergency situations where they are not being paid for their services or assigned as emergency workers. For example, an off-duty nurse who stops at the scene of a rollover accident on the highway to render service on her way from work is covered under the Good Samaritan Laws. Conversely, the EMT who arrives at the scene of the same rollover accident who provides care, but is working his shift, is not covered by Good Samaritan Laws.  Other characteristics of Good Samaritan Laws are that the care provided did not recklessly or intentionally cause harm or injury, and that the health care worker is not paid for his or her services.

PTS:1DIF:Knowledge

TOP: Resources for Safe, Legal, and Ethical Nursing Practice

9.Listed below are some of the reasons nurses document. Which is not necessarily correct?

ANS: C

Documentation is an important part of professional nursing practice and helps provide evidence of the nurse’s actions for the patient. Documentation is a professional responsibility for all health care professionals. Some reasons nurses document include: 1) compliance with accreditation criteria and professional nursing standards; 2) accurate data needed to plan the patient’s care in order to ensure continuity of care; 3) a resource for review, quality improvement, reimbursement, education, research, and protection for nurses, other health care professionals and the organization (not only the hospital); and 4) documented legal record to protect the patient, organization, and nursing and medical providers.

PTS: 1 DIF: Comprehension TOP: Documentation

10.DeLaune & Ladner (2011) identified a nursing checklist that can be used to assist nurses with understanding what is expected from documentation and what reviewers are looking for when they review a chart. Which of the following is not correct regarding reviewing a chart for effectively documented information?

ANS: C

Documentation provides a legal record of patient care to protect the patient, organization, and nursing/medical practitioners. DeLaune & Ladner’s (2011) nursing checklist for documentation provides a good foundation to assist nurses in understanding what reviewers are looking for when they review a chart for specific nursing-related information. Some of the items on this checklist include: 1) can the assessment data that triggered the nursing diagnosis be identified?; 2) when the defining characteristics of a specific nursing diagnosis are compared to the patient’s presenting signs and symptoms, is there supporting evidence?; 3) were critical questions asked during the patient interview?; and 4) did the nurse use the data obtained from both the interview and physical assessment in establishing the diagnosis? While ensuring that all charges documented are reasonable, and that nothing seems out of line are both important tasks, these actions are related more to fiscal concerns and are not listed in DeLaune & Ladner’s checklist.

PTS:1DIF:AnalysisTOP:Documentation

11.FLAT charting is an acronym that pertains to ways in which a nurse can protect himself or herself while charting. Which of the following is not correct regarding FLAT charting techniques?

ANS: D

The acronym FLAT stands for factual (what you see, not what you think you may see); legible (no erasures, with corrections made with a single line drawn through the error and initialed); accurate (complete, state exactly what you saw and what occurred—i.e., what color was the drainage?); and timely (should be completed as soon after the occurrence as possible). It is used to assist nurses with remembering how and what to chart to protect themselves, their patients, and the health care organization from potential liability.

PTS:1DIF:KnowledgeTOP:Documentation

12.Whistleblowing in health care occurs when an individual “blows the whistle” and reports an unsafe situation. Some suggestions for nurses who may choose to be whistleblowers in health care-related situations are listed below. Which is not necessarily correct?

ANS: B

Sometimes nurses choose to “blow the whistle” on unsafe or unethical practices occurring in health care situations (Vonfrolio, 2006). There can be professional consequences for these actions and not all states offer whistleblower protection. Advice for nurses who may be considering being a whistleblower includes: 1) avoid being confrontational when discussing the issue with management; exhaust all internal remedies before taking matters out of house; 2) consider reporting your concerns about quality of care to the Joint Commission (not the Institute of Medicine or Robert Wood Johnson Foundation); 3) keep a personal diary of events after the incident is reported; 4) document the incident and keep a copy for yourself; 5) send a typed complaint to the Director of Nursing or anyone in another department with a stake in the case; and 6) seek the support of your colleagues, as nurses should band together to protect patients from unethical, incompetent, or unsafe care.

PTS:1DIF:ApplicationTOP:Ethical Behavior

13.The duty to do good to others and to maintain a balance between benefits and harms is the definition of the ethical principle of __________.

ANS: D

The ethical principle of beneficence is defined as the duty to do good to others and to maintain a balance between benefits and harms. An example of beneficence would be when a nurse provides all patients, including those who are terminally ill, with caring attention and information. Nonmaleficence is the principle of doing no harm. Justice pertains to the principle of fairness that occurs when an individual is given what he or she is owed, deserves, or can legitimately claim. Veracity pertains to the principle of truth telling.

PTS:1DIF:KnowledgeTOP:Ethical Behavior

14.Some methods for organizations to reduce their risk of liability are listed below. Which is not necessarily correct for organizations?

ANS: A

There are some defined methods and strategies for organizations, nurses, and other health care providers to follow to reduce their risk of liability. Some of these strategies for organizations include: 1) consider a shared governance model of nursing practice to empower nursing decision making and delegation in clinical practice; 2) provide standards for ongoing supervision and periodic licensure/competency verification and evaluation of all staff; and 3) provide documentation of routine maintenance for all patient care equipment. Making frequent walking rounds to assure quality patient outcomes after delegation is a nursing strategy to assist in the reduction of risk liability, not necessarily an organizational strategy.

PTS: 1 DIF: Comprehension TOP: Risk Management Programs

15.Reasons an organization’s professional malpractice liability insurance may fail to cover a nurse’s actions are listed below. Which is not necessarily correct regarding organizational professional malpractice liability insurance?

ANS: B

The question of whether a nurse should carry his or her own professional malpractice insurance in addition to that provided by the employer has been a topic of debate. Organizational malpractice liability insurance generally covers the nurse except in certain situations such as: 1) may not cover if the insured intentionally injures another party; 2) may not cover if the insured fails to comply with organizational policies and procedures; and 3) may not be enough especially if the nurse is named individually in addition to the organization, and it might behoove the nurse to consider carrying additional individual malpractice insurance.

PTS: 1 DIF: Application TOP: Malpractice/Professional Liability Insurance

16.Some examples of common monetary awards for health care malpractice awarded in jury trials by juries are listed below. Which is not necessarily correct?

ANS: D

Medical malpractice cases can be settled out of court or can go to trial where they are subject to the decision of the jury. Some examples of monetary awards by jury trial in health care cases include: 1) vision loss—$8 million; 2) wrongful death (pulmonary embolism)—$5 million; 3) microcephaly in newborn—$17 million; and 4) brachial plexus injury—$13.3 million (not $52 million).

PTS: 1 DIF: Comprehension TOP: Common Monetary Rewards

17.LaDuke (2000) has identified some strategies for nurses when consulting and/or collaborating with an attorney. Which of the following is not correct regarding LaDuke’s strategies?

ANS: B

Nurses who are considering consulting or collaborating with an attorney should be aware of certain aspects of the nurse-attorney relationship and work toward being clear up front about what they need and expect. LaDuke (2000) has provided some excellent advice for nurses who may be considering consulting or working with an attorney. They are: 1) retain a legal specialist (not a generalist); 2) set your own course (insist on a collaborative relationship for the duration of the case, not merely letting the attorney do all the decision making without a collaborative relationship); 3) keep costs sensible (know what your fees will be, how you will be billed, and whether a retainer fee is required); and 4) examine everything in writing (everything needs to be explained clearly by your attorney and all examined in written form).

PTS: 1 DIF: Application TOP: Nurse – Attorney Relationship in a Lawsuit

18.When Nurse J insists that all patients receive consent for all procedures, allows her patients to make choices regarding their care, and respects their rights as a person, under which ethical principle is she acting?

ANS: C

The ethical principle of autonomy is the respect for an individual’s right to self-determination and respect for individual liberty. When Nurse J insists that all patients receive consent for all procedures, allows her patients to make choices regarding their care, and respects their rights as a person, she is acting under the principle of autonomy. Beneficence is the duty to do good to others and maintain a balance between benefits and harms. Nonmaleficence is the duty to do no harm, and veracity is the obligation to tell the truth.

PTS:1DIF:KnowledgeTOP:Ethical Behavior

19.Patient O has been talking with Nurse N and has disclosed some confidential personal information regarding his health and personal behaviors. He has asked that Nurse N not tell anyone what he has just revealed and Nurse N agrees. Under which ethical principle has Nurse N acted through this promise?

ANS: B

The ethical principle of fidelity pertains to the duty to keep one’s promise. When Nurse N agreed to keep Patient O’s personal information private and confidential, he was following the principle of fidelity. Veracity pertains to truth telling and autonomy pertains to an individual’s right to self-determination and respect for individual liberty. Nonmaleficence is the duty to do no harm.

PTS:1DIF:ApplicationTOP:Ethical Behavior

20.Some methods that nurse managers can use for creating an ethical workplace are listed below. Which is not necessarily correct?

ANS: B

Nurse managers can work to develop and maintain an ethically responsible workplace. Some methods and strategies that can be used by nurse managers to develop and enhance ethically responsible behaviors include: 1) training programs in ethics and social responsibility; 2) having nurses refer to the ANA (American Nurses Association) code of ethics (not AMA, which is the American Medical Association); 3) written organizational codes of conduct; and 4) widespread communication in the hospital to reinforce ethically and socially responsible behavior.

PTS:1DIF:ApplicationTOP:Ethical Behavior

MULTIPLE RESPONSE

1.Which of the following are examples of an intentional or unintentional tort that can be seen in health care?

ANS: A, C, E, F

Torts are intentional or unintentional civil wrongs that arise out of a contact or statute where one party causes injury to another. Examples of torts that can be seen in health care (of which nurses need to be aware) include: 1) negligence; 2) false imprisonment (not all imprisonment); 3) battery; 4) malpractice; and 5) defamation.

PTS: 1 DIF: Analysis TOP: Tort Law

2.Which of the following must be present in order to prove liability or fault in malpractice and negligence cases?

ANS: A, C, D, E

Negligence and malpractice are two types of tort law where proof of liability or fault is required. Four elements must be present in order for proof of liability or fault to be found. They are: 1) duty or obligation created by law, contract, or standard practice that is owed to the complainant by the professional; 2) breach of this duty which has caused the complainant harm or injury; 3) harm which can be physical, emotional, or financial to the complainant; and 4) proof that the breach of duty caused the complainant harm or injury.

PTS: 1 DIF: Analysis TOP: Negligence and Malpractice

3.Health care organizations can be liable for actions other than nurse-related ones. Some of these are listed below. Which are correct?

ANS: B, D, E, F

Health care organizations can be found liable for actions other than those provided by nurses and other health care professionals. Some of these noted in the Professional Negligence Law Reporter from July 2001 to July 2002 include: 1) failure to adequately train personnel in fall prevention (not failure to train patients); 2) failure to provide a safe environment; 3) failure to provide timely lab services; 4) failure to instruct and train personnel regarding the handling of jaundice in newborns; 5) allowing unlicensed persons to administer IV medications; and 6) failure to enforce policies to adequately handle emergencies.

PTS: 1 DIF: Analysis TOP: Negligence and Malpractice

4.Knowledge and ability to safely practice as a nurse are requirements for all nurses. Which of the following is not correct regarding the six rights of medication administration?

ANS: C, F

Medical errors contribute to cases of malpractice and other types of torts in health care. Licensed practicing nurses should have the knowledge to safely practice as a nurse in their state. Medication errors are some of the more common medical errors noted; hence a good working knowledge of the “six rights” of medication administration is recommended. These six rights are: 1) right patient; 2) right medication; 3) right time; 4) right dose; 5) right route; and 6) right documentation.

PTS: 1 DIF: Application TOP: Negligence and Malpractice

5.Some methods to decrease the risk of liability for nursing are listed below. Which items are correct?

ANS: A, B, E

There are a number of different ways in which health care organizations and nurses can work to decrease their risk for liability. For nurses, some of these methods and techniques include: 1) treat all patients and families with respect and kindness; 2) take appropriate actions to meet the patients’ nursing needs; and 3) maintain current professional standards of care and the facility’s policy and procedure for administering care and reporting incidents. Ways for organizations to decrease their risk of liability include: 1) develop physical, mental, and verbal “no abuse” policy to be followed by all professional and nonprofessional health care staff; 2) provide administrative support for supervisors and staff who delegate, assign, monitor, and evaluate patient care; and 3) consider applying for magnet status.

PTS: 1 DIF: Analysis TOP: Risk Management Programs