Chapter 14 Legal

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Chapter 14 Legal
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2011-02-02 21:55:51
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  1. Which of the following questions would not be expected from the risk manager after an incident reportis filed?
    A. Who is negligent?
    B. What can be done to prevent the same kind of error?
    C. Are there any other policies or equipment needed to prevent the error from occurring again?
    D. What are the conditions that led up to the error?
    A.Rationale: Incident reports are often reviewed by an agency risk managementcommittee, which decides whether to investigate the incident further. Nurses maybe required to answer such questions as: what they believe precipitated theaccident, how it could have been prevented, and whether any equipment should beadjusted.
    (this multiple choice question has been scrambled)
  2. A nurse documents in the client’s chart that the physician is incompetent because he did not respondpromptly to the nurse’s call regarding the client. This is an example of
    :a. Battery.
    b. Slander.
    c. Assult.
    d. Libel.
    Rationale: Libel is defamation by means of print, writing, or pictures. Slander isdefamation by the spoken word, stating unprivileged or false works by which areputation is damaged. Unprofessional conduct includes incompetence or grossnegligence, conviction for practicing without a license, falsification of clientrecords, illegally obtaining, using, or possessing controlled substances. Accordingto the Code of Ethics for Nurses, nurses are responsible for retaining theirprofessional boundaries.
  3. A nurse is taking care of a client who is well known in the community and is running for public office.The nurse overhears a phone conversation between the client and an associate which revealsinformation that will put the client/candidate in an unfavorable light with the voting public. The nursecalls the local news station with the information that was overheard. This is an example of:
    a. An intentional tort.
    b. A serious misdemeanor.
    c. A felony.
    d. An unintentional tort.
    Rationale: This is an example of slander which is an intentional tort. Inthis case, the nurse gave the information on purpose and with intent toharm the client’s reputation. Unintentional torts do not require intent. Amisdemeanor is an offense that is committed in violation of criminal law.A felony is a serious crime such as murder.
  4. A primary care provider prescribes one tablet, but the nurse accidentally administers two. Afternotifying the primary care provider, the nurse monitors the client carefully for untoward effects of whichthere are none. Is the client likely to be successful in suing the nurse for malpractice
    ?a. No, because the client was not harmed
    .b. No, because the nurse notified the physician
    .c. Yes, because a breach of duty exists.
    d. Yes, because foreseeability is present.
    a.Rationale: All elements such as duty, foreseeability, causation, harm/injury,and damages much be present for malpractice to be proven. The nurse is alicensed professional responsible for individual actions. Notifying the primary careprovider does not exempt the nurse from liability. Since it is apparent the standardof practice was not performed, a breach of duty does exist. Violation/ omission ofthe standard of practice resulted in an excessive dosage. Therefore, foreseeabilityis present; however, no harm occurred to the client.
  5. The new home health care agency has developed a unique format to send data to other health careproviders. This is a violation of which of the following four areas of the Health Insurance Portability andAccountability Act?
    a. Standardized numbers for identifying provider
    sb. Privacy rule which sets standards defining appropriate disclosure of protected health information
    c. Electronic transfer of information among organizations
    d. Security rule which provides for a uniform level of protection of all health information
    Rationale: Instead of each health provider using its own electronic format totransact claims HIPAA implements a national uniform standard to simplify suchtransactions.
  6. A nurse knows that their neighbor has just been admitted to the hospital. The nurse has a password tolook up the information on the neighbor. This would be a violation of which of the following four areas ofthe Health Insurance Portability and Accountability Act?
    A. Electronic transfer of information among organizations
    B. Security rule which provides for a uniform level of protection of all health information
    C. Standardized numbers for identifying providers
    D. Company rule which sets standards defining appropriate disclosure of protected health information
    C.Rationale: If the nurse is not assigned to care for their neighbor the nurse has nolegal right to the health care information.
    (this multiple choice question has been scrambled)
  7. A client’s relative is angry with the nurse when visiting and seeing that the client has been restrained.The relative states that the client is being falsely imprisoned. False imprisonment is what type of law?
    a. Contract
    b. Criminal
    c. Tort
    d. Statutory
    Rationale: A criminal law deals with actions against the safety and welfare of thepublic. A contract law involves the enforcement of agreements among privateindividuals or the payment of compensation for failure to fulfill the agreements.Tort law defines and enforces duties and rights among private individuals that arenot based on contractual agreements. Laws enacted by any legislative body arestatutory laws.
  8. A nurse who deliberately delivers a lethal dose of medication to a client has violated a ________ law.
    a. Tort
    b. Common
    c. Criminal
    d. Civil
    Rationale: A common law evolves from court decisions. A criminal law dealswith actions against the safety and welfare of the public. A civil law is the body oflaw that deals with relationships among private individuals. Tort law defines andenforces duties and rights among private individuals that are not based oncontractual agreements.
  9. Nurses work with implied consent from a client when the client:(Select all that apply.)Note: Credit will be given only if all correct choices and no incorrect choices are selected.
    a. Turns off the light and goes to sleep
    .b. Walks out of the room
    .c. Turns onto his back to receive an injection
    .d. Asks for more information about NGT insertion.
    a.Rationale: There are two types of consent: express and implied.Express consent may be either an oral or written agreement. Usually, themore invasive a procedure and/or the greater the potential for risk to theclient, the greater the need for written permission. Implied consent existswhen the individual’s nonverbal behavior indicates agreement. Forexample, clients who position their bodies for an injection or cooperate withthe taking of vital signs infer implied consent. Consent is also implied in amedical emergency when an individual cannot provide express consentbecause of physical condition.
  10. A nurse is asked to sign an informed consent. The nurse signs as a witness. Which of the following doesthe nurse's signature NOT confirm?
    select all that apply

    a. The signature is authentic
    .b. The nurse has sufficiently explained the surgery
    .c. The client appears competent to give consent.
    d. The client gave consent voluntarily.
    Often, the nurse is asked to obtain a signed consent form.The nurse is not responsible for explaining the procedure but for witnessingthe client’s signature on the form. The nurse’s signature confirms threethings:The nurse advocates for the client by verifying that the client receivedenough information to give consent. If the client has questions or if thenurse has doubts about the client’s understanding, the nurse must notifythe health provider. Again, the nurse is not responsible for explaining themedical or surgical procedure. In fact, the nurse could be liable for givingincorrect or incomplete information or interfering with the client-providerrelationship.
  11. A primary care provider’s orders indicate that a surgical consent form needs to be signed. Since thenurse was not present when the primary care provider discussed the surgical procedure, whichstatement best illustrates the nurse fulfilling the client advocate role?
    a. “Remember that you can change your mind and cancel the procedure.”
    b. “What were you told about the procedure you are going to have?"
    c. “The doctor has asked that you sign this consent form.”
    d. “Do you have any questions about the procedure?”
    Rationale: “What were you told about the procedure you are going tohave?" provides more information from the client in his or her own words.This is the best answer because the nurse is assessing the client’s level ofknowledge as a result of the discussion with the primary care provider.Based on this assessment, the nurse may initiate other actions (e.g.,call the primary care provider if the client has many questions). In “Thedoctor has asked that you sign this consent form”, the nurse is notassessing if the client received enough information to give consent. “Doyou have any questions about the procedure?” is one way to assess theclient’s level of knowledge regarding the procedure. However, it is not thebest approach because it is a closed-ended question, asking for only a “yes” or “no” response. The statement “Remember that you can changeyour mind and cancel the procedure” is true; however, the nurse shouldfirst verify if the client received enough information to give consent. Afterthe assessment, this statement may be appropriate but the assessmentneeds to be done first.
  12. A nurse disclosed a drug addiction to the supervisor of the unit. Which of the following is an exampleof a requirement in a diversion program?
    a. The nurse enters a supervised treatment program for six weeks
    .b. The nurse’s practice is closely supervised with no access to the controlled substance medicationson the unit
    .c. The nurse’s license is revoked.
    d. The nurse continues to work under the same conditions with a random drug screen administeredweekly.
    Rationale: In many states, impaired nurses who voluntarily enter a diversionprogram (sometimes called a peer assistance program) do not have their nursinglicense revoked if they follow treatment requirements. Their practice, however, isclosely supervised within specific guidelines (e.g. working on a general nursingunit versus critical care area, no overtime, work only day shift, not allowed toadminister or have access to narcotics).
  13. A client was discharged after having an a 1-day surgery on her gallbladder. The nurse discharging theclient failed to give her oral or written discharge instructions. This failure to carry out the provision ofdischarge instructions could result in charges of
    :a. Malpractice
    b. Negligence
    c. Assault
    d. Battery
    Rationale: Failing to provide discharge instructions is a form ofmalpractice. The nurse should document in the client’s chart thatdischarge instructions were given verbally, the client expressedunderstanding of the discharge instructions, and/or a copy of thedischarge instructions were given to the client or caregiver.
  14. The client has been diagnosed with a hospital acquired infection. The client has been noting the handhygiene practices of the health care providers and is going to bring ___________ charges against thehospital staff
    .a. Malpractice
    b. Felony
    c. Negligence
    d. Breach of duty
    Rationale: Negligence is misconduct or practice that is below the standardexpected of an ordinary, reasonable, and prudent person. Such conduct placesanother person at risk for harm. Both nonmedical and professional persons can beliable for negligent acts. Malpractice must meet six elements to be proven, and allmay not be met in this case. A felony is a serious crime such as murder. Abreach of duty applies to a specific situation that the standard of care was notobserved.
  15. Two nursing students are riding the bus home after a stressful day of clinical. They are discussing theevents of the day and laughing about the blood alcohol level of the school’s basketball coach admittedafter an accident. The client was never mentioned by name but common personal details about theclient allowed everyone sitting near the students to know what the name of their client was. Thestudents could be charged with:
    a. Defamation
    .b. Slander
    .c. Invasion of privacy.
    d. Libel.
    Rationale: Defamation is communication that is false, or made with acareless disregard for the truth, and results in injury to the reputation of aperson. Both libel and slander are wrongful actions that come under theheading of defamation. Libel is defamation by means of print, writing, orpictures. Writing in the nurse’s notes that a physician is incompetentbecause he didn’t respond immediately to a call is an example of libel.Slander is defamation by the spoken word, stating unprivileged (notlegally protected) or false words by which a reputation is damaged. Aninvasion of privacy has occurred by public disclosure of private fact. Privateinformation is given to others who have no legitimate need for thatinformation.

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