Chapter 23: Legal Implications in Nursing PracticeTest Bank ALL ANSWERS 100% CORRECT FALL- EDITION GUARANTEED GRADE A+

A newly hired experienced nurse is preparing to change a patient’s abdominal dressing and hasn’t done it before at this hospital. Which action by the nurse is best? a. Ask another nurse to do it so the correct method can be viewed. b. Check the policy and procedure manual for the agency’s method. c. Change the dressing using the method taught in nursing school. d. Ask the patient how the dressing change has been recently done. ANS: B The Joint Commission requires accredited hospitals to have written nursing policies and procedures. These internal standards of care are specific and need to be accessible on all nursing units. For example, a policy/procedure outlining the steps to follow when changing a dressing or administering medication provides specific information about how nurses are to perform. The nurse being observed may not be doing the procedure according to the agency’s policy or procedure. The procedure taught in nursing school may not be consistent with the policy or procedure for this agency. The patient is not responsible for maintaining the standards of practice. Patient input is important, but it’s not what directs nursing practice. DIF: Apply REF: 297 OBJ: List sources for standards of care for nurses. TOP: Planning MSC: Safe and Effective Care Environment 2. A new nurse notes that the health care unit keeps a listing of patient names in a closed book behind the front desk of the nursing station so patients can be located easily. What action is most appropriate for the nurse to take? a. Move the book to the upper ledge of the nursing station for easier access. b. Talk with the nurse manager about the listing being a violation of the Health Insurance Portability and Accountability Act (HIPAA). c. Use the book as needed while keeping it away from individuals not involved in patient care. d. Ask the nurse manager to move the book to a more secluded area. ANS: C The privacy section of the HIPAA provides standards regarding accountability in the health care setting. These rules include patient rights to consent to the use and disclosure of their protected health information, to inspect and copy their medical record, and to amend mistaken or incomplete information. This document limits who is able to access a patient’s record. It establishes the basis for privacy and confidentiality about patients in any manner. The book is located where only staff would have access. It is not the responsibility of the new nurse to move items used by others on the patient unit. The listing is protected as long as it is used appropriately as needed to provide care. There is no need to move the book to a more secluded area. DIF: Apply REF: 299 OBJ: Describe the legal responsibilities and obligations of nurses regarding the following federal statutes: Americans with Disabilities Act (ADA), Emergency Medical Treatment and Active Labor Act(EMTALA), Health Insurance Portability and Accountability Act of 1996 (HIPAA), and the Patient Self-Determination Act (PSDA). TOP: Implementation MSC: Safe and Effective Care Environment 3. A 17-year-old patient, dying of heart failure, wants to have his organs removed for transplantation after his death. What action by the nurse is correct? a. Prepare the organ donation form for the patient to sign while he is still oriented. b. Instruct the patient to talk with his parents about his desire to donate his organs. c. Notify the physician about the patient’s desire to donate his organs. d. Contact the United Network for Organ Sharing after talking with the patient. ANS: B An individual over age 18 may sign the form allowing organ donation upon death. In this situation, the parents would need to sign the form because the teenager is under age 18. The nurse cannot allow the patient to sign the organ donation document because he is younger than age 18. The physician will be notified about the patient’s wishes after the parents agree to donate the organs. The nurse caring for the patient does not contact the United Network for Organ Sharing. A transplant coordinator will be the liaison for this organization. DIF: Apply REF: 299 OBJ: Define legal aspects of nurse-patient, nurse–health care provider, nurse-nurse, and nurse-employer relationships. TOP: Implementation MSC: Safe and Effective Care Environment 4. An obstetrical nurse comes across an automobile accident. The patient seems to have a crushed upper airway, and while waiting for emergency medical services to arrive, the nurse makes a cut in the trachea and inserts a straw from her purse to provide an airway. The patient survives and has a permanent problem with his vocal cords, making it difficult to talk. Which statement is true regarding the nurse’s performance? a. The nurse acted appropriately and saved the patient’s life. b. The nurse acted within the guidelines of the Good Samaritan Law. c. The nurse took actions beyond those that are standard and appropriate. d. The nurse should have just stayed with the patient and waited for help. ANS: C An obstetric nurse would not have been trained in performing a tracheostomy or a cricotomy, and doing so would be beyond what she has been trained or educated to do. The nurse did not do what another nurse would have done in the same situation. The nurse is not protected by the Good Samaritan Law because she acted outside of her scope of practice and training. The nurse should have acted within what she was trained and educated to do in this circumstance, not just stay with the patient. DIF: Understand REF: 300 OBJ: Explain the legal concept of standard of care. TOP: Implementation MSC: Safe and Effective Care Environment 5. A nurse performs cardiopulmonary resuscitation (CPR) on a 92-year-old with brittle bones and breaks a rib during the procedure, which then punctures a lung. The patient recovers completely without any residual problems and sues the nurse for pain and suffering, and for malpractice. What key point will the prosecution attempt to prove? a. The CPR procedure was done incorrectly. b. The patient would have died if nothing was done. c. The patient was resuscitated according to policy.d. Patients with brittle bones might sustain fractures when chest compressions are done. ANS: A Certain criteria are necessary to establish nursing malpractice. In this situation, although harm was caused, it was not because of failure of the nurse to perform a duty according to standards the way other nurses would have performed in the same situation. The nurse would have had to have done the procedure correctly, or the patient most likely would not have survived without any residual problems such as brain damage. The fact that the patient sustained injury as a result of age and physical status does not mean the nurse breached any duty to the patient. The nurse would need to make sure the defense attorney knew that the cardiopulmonary resuscitation (CPR) was done correctly. Without intervention, the patient most likely would not have survived. The prosecution would try to prove that a breach of duty had occurred, which had caused injury, not that cardiopulmonary resuscitation was done correctly. The defense team, not the prosecution, would explain the correlation between brittle bones and rib fractures during CPR. DIF: Understand REF: 302 OBJ: List the elements needed to prove negligence. TOP: Implementation MSC: Safe and Effective Care Environment 6. A recent immigrant who does not speak English is alert and requires hospitalization. What is the initial action that the nurse must take to enable informed consent to be obtained? a. Ask a family member to translate what the nurse is saying. b. Notify the health care provider that the patient doesn’t speak English. c. Request an official interpreter to explain the terms of consent. d. Use hand gestures and medical equipment while explaining in English. ANS: C An official interpreter must be present to explain the terms of consent if a patient speaks only a foreign language. A family member or acquaintance who speaks a patient’s language should not interpret health information. Family members can tell those caring for the patient what the patient is saying, but privacy regarding the patient’s condition, assessment, etc., must be protected. There is no way that the nurse can know that the family member is translating exactly what the nurse is saying. Privacy must be ensured and accurate information must be provided to the patient. After consent is obtained for treatment, the health care provider would be notified because little can be done without consent. The health care provider needs to have the translator available during the history and physical, as well as at other times, but the first step is to get a translator to obtain informed consent because this is not an emergency situation. Using hand gestures and medical equipment is inappropriate when communicating with a patient who does not understand the language spoken. Certain hand gestures may be acceptable in one culture and not appropriate in another. The medical equipment may be unknown and frightening to the patient, and the patient still doesn’t understand what is being said. DIF: Apply REF: 302 OBJ: Discuss the nurse’s role in witnessing the informed consent process. TOP: Implementation MSC: Safe and Effective Care Environment 7. A pediatric oncology nurse floats to an orthopedic trauma unit. What actions should the nurse manager of the orthopedic unit take to enable safe care to be given by this nurse? a. Provide a complete orientation to the functioning of the entire unit. b. Determine patient acuity and care the nurse can safely provide.c. Allow the nurse to choose which meal time she would like. d. Assign nursing assistive personnel to assist her with care. ANS: B Nurses who float need to inform the supervisor of any lack of experience in caring for the type of patients on the nursing unit. They also need to request and receive an orientation to the unit. Supervisors are liable if they give a staff nurse an assignment that he or she cannot safely handle. Before accepting employment, learn the policies of the institution regarding floating, and have an understanding as to what is expected. A basic orientation is needed, whereas a complete orientation of the functioning of the entire unit would take a period of time that would exceed what the nurse has to spend on orientation. Allowing the nurse to choose which meal time she would like is a nice gesture of thanks for the nurse, but it does not enable safe care. Having nursing assistive personnel may help the nurse complete basic tasks such as hygiene and turning, but it does not enable safe nursing care that she is ultimately responsible for. DIF: Apply REF: 304 OBJ: Define legal aspects of nurse-patient, nurse–health care provider, nurse-nurse, and nurse-employer relationships. TOP: Implementation MSC: Safe and Effective Care Environment 8. While recovering from a severe illness, a hospitalized patient states that he wants to change his living will, which he signed nine months ago. Which response by the nurse is most appropriate? a. “Check with your admitting health care provider whether a copy is on your chart.” b. “Have you talked with your attorney recently about a living will?” c. “Your living will can be changed only once each calendar year.” d. “Let me check with someone here in the hospital who can assist you.” ANS: D Each health care facility has personnel who are familiar with the state laws and can assist the patient in revising a living will. They may be in the admissions or risk management department. Checking with the health care provider about the presence of a living will on the char