Legal Implications in Nursing Practice

1. Which source of law best addresses a situation where nurse accidentally administers an incorrect dosage of morphine sulfate to the client?

1.
Civil law
2.
Criminal law
3.
Common law
4.
Administrative law

ANS: 1

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. Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). Common law is created by judicial decisions made in courts when individual legal cases are decided (i.e., informed consent). Administrative law is created by administrative bodies, such as state boards of nursing when they pass rules and regulations (i.e., the duty to report unethical nursing conduct)

DIF: A REF: 326 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

2. What standard of care applies to the student nurse’s conduct when providing care normally performed by a registered nurse (RN)?

1.
The same standard of care as an RN
2.
A standard of care of an unlicensed person
3.
No special standard of care because her faculty member is responsible for her conduct
4.
A standard similar to but not the same as the staff nurse with whom she is assigned to work

ANS: 1

Student nurses are expected to perform as professional nurses (i.e., as an RN would in providing safe client care). Students are not working in the same capacity as an unlicensed person, and therefore are not compared to the standard of an unlicensed person. No special standard of care because her faculty member is responsible for her conduct is not a true statement. Staff nurses may serve as preceptors, but that does not excuse the student from performing at the level of an RN. If a client is harmed as a direct result of a nursing student’s actions or lack of action, the liability for the incorrect action is generally shared by the student, instructor, hospital or health care facility, and university or educational institution.

DIF: A REF: 333 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

3. Which of the following is the most important factor in a nurse deciding whether or not to carry malpractice insurance?

1.
The nurse’s knowledge level of Good Samaritan laws
2.
The amount of malpractice insurance provided by the nurse’s employer
3.
The time frames and individual liability of the employer’s malpractice coverage
4.
The evaluation of whether the nurse works in a critical area of nursing where clients have higher morbidity and mortality rates

ANS: 3

It would be important to know the time frames of the employer’s malpractice coverage. In other words, is the nurse only covered during the times he or she is working within the institution? It would be important to know the individual liability. For example, if sued, what financial responsibility would the nurse have? 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. The amount of malpractice insurance provided by the employer is not the most important factor in deciding whether to carry private insurance. Generally, the employer’s malpractice insurance coverage is much greater than private insurance coverage. The area of nursing in which the nurse is employed is not the most important factor in deciding whether or not to carry malpractice insurance. Lawsuits can occur anywhere.

DIF: A REF: 334-335 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

4. An unconscious client with a head injury needs surgery to live. His wife only speaks 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?

1.
An institutional review board needs to be contacted to give their emergency advice on the situation.
2.
The health care team should continue with the surgery after providing information in the best manner possible.
3.
A friend of the family could act as an interpreter, but the explanation could not provide details of the client’s accident, because of confidentiality laws.
4.
Two licensed health care personnel should witness and sign the preoperative consent indicating they heard an explanation of the procedure given in English.

ANS: 2

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. In an emergency, it is not necessary to contact the institutional review board. In doing so, it would take up valuable time. A family member or acquaintance that is able to speak a client’s 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). Telephone consents usually require two witnesses. This is not the case in this situation.

DIF: A REF: 333 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

5. 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 physician’s desire, which of the following is the most correct answer?

1.
Good Samaritan laws will protect the nurse.
2.
The nurse practitioner will be liable for the action.
3.
This type of situation is why nurse practitioners should have malpractice insurance.
4.
If the nurse practitioner has developed a good relationship with the client, there will probably not be a problem.

ANS: 2

A nurse carrying out an inaccurate or inappropriate order may be legally responsible for any harm suffered by the client. 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. Having malpractice insurance is not the answer, as it does not protect the client from harm. The nurse practitioner should refuse administering the medication. Developing a good relationship with the client is important, but will not protect the nurse from legal liability for providing incompetent care.

DIF: A REF: 327 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

6. 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?

1.
Attending physician
2.
Assisting resident
3.
Pharmacist
4.
Nurse

ANS: 4

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. The attending physician could be included in a lawsuit, but it would be the nurse who is ultimately responsible for the error. The assisting resident would not be ultimately responsible for the error. The assisting resident did not carry out an inaccurate order. The pharmacist could be included in a lawsuit, but it would be the nurse who is ultimately responsible for the error because the nurse was the individual who carried out an inaccurate order.

DIF: A REF: 327 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

7. A nurse is being asked to move from the eye unit to a general surgery floor where she in inexperienced in this specialty due to an influenza epidemic among the nursing staff. She is aware of her inexperience. The nurse’s initial recourse is to:

1.
Fill out a report noting her dissatisfaction
2.
Ask to work with another general surgery nurse
3.
Notify the State Board of Nursing of the problem
4.
Politely refuse to move, take a leave-of-absence day, and go home

ANS: 2

Nurses who float should inform the supervisor of any lack of experience in caring for the type of clients on the nursing unit. They should also request and be given orientation to the unit. Asking to work with another general surgery nurse would be an appropriate action. A nurse can make a written protest to nursing administrators, but it should not be the nurse’s initial recourse. Notifying the state board of nursing should not be the nurse’s initial recourse. The nurse should first notify the supervisor and request appropriate orientation and training. If problems continue, the nurse should attempt the usual chain of command within the institution before contacting the state board of nursing. A nurse who refuses to accept an assignment may be considered insubordinate, and clients will not benefit from having less staff available.

DIF: A REF: 335-336 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

8. There are issues concerning death and dying may influence nursing practice which the nurse recognizes. Concerning the legalities of death and dying issues, which of the following is true?

1.
Passive euthanasia is illegal in all states.
2.
Assisted suicide is a constitutional right.
3.
Organ donation must be attempted if it will save the recipient’s life.
4.
Feedings may be refused by competent individuals who are unable to self-feed.

ANS: 4

Competent clients have the right to refuse treatment. This includes life-saving hydration and nutrition. This is not a true statement. Furthermore, physician-assisted suicide is legal in the state of Oregon. In 1997 the Supreme Court ruled that there is no fundamental constitutional right to assisted suicide. Organ donation does not have to be attempted to save a recipient’s life.

DIF: A REF: 330 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

9. The Joint Commission (TJC) sets standards of care, in which an institution is required to have:

1.
Limits of professional liability
2.
Educational standards for nurses
3.
A delineated scope of practice for health professionals
4.
Written nursing policies and procedures for client care

ANS: 4

The TJC requires that accredited hospitals have written nursing policies and procedures. Standards of care help define the limits of professional liability. The TJC does not require an institution to have limits of professional liability. Nurse practice acts establish educational requirements for nurses. 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.

DIF: A REF: 326 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

10. In the event that a nursing license is revoked, which of the following is correct?

1.
The hearings are usually held in court.
2.
Due process rights are waived by the nurse.
3.
Appeals may be made regarding the decisions.
4.
The federal government becomes involved in the procedures.

ANS: 3

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. Hearings for suspension or revocation of a license do not occur in court but are usually conducted by a hearing panel of professionals. Due process must be followed. They do not have to be waived by the nurse. Some states, not the federal government, provide administrative and judicial review of such cases after nurses have exhausted all other forms of appeal.

DIF: A REF: 330 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

11. Which one of the following actions is an example of an unintentional tort?

1.
Restraining a client who refuses care
2.
Taking photos of a client’s surgical wounds
3.
Leaving the side rails down and the client falls and is injured
4.
Talking about a client’s history of sexually transmitted diseases

ANS: 3

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. Restraining a client who refuses care would be an example of assault and battery. Taking photos of a client’s surgical wounds without the client’s permission is an example of invasion of privacy. Talking about a client’s history of sexually transmitted diseases would fall under the category of invasion of privacy. Personal information should be kept confidential.

DIF: A REF: 332 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

12. Which one of the following individuals may legally give informed consent?

1.
A 16-year-old for her newborn child
2.
A sedated 42-year-old preoperative client
3.
The friend of an 84-year-old married client
4.
A 56-year-old who does not understand the proposed treatment plan

ANS: 1

An emancipated minor, one who is below the age of 18 but who is a parent, can legally give informed consent for the care of her newborn. An emancipated minor can also be someone below the age of 18 who is legally married. A person who has been sedated cannot legally give informed consent. Consent should be obtained before a sedative is administered. If the 84-year-old client were unable to give consent, then the client’s wife would be the person legally authorized to do so on the client’s behalf. In order 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. 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.

DIF: A REF: 332-333 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

13. When a nurse signs as a witness on an informed consent form, she is indicating that the client:

1.
Fully understands the procedure
2.
Agrees with the procedure to be done
3.
Has voluntarily signed the consent form
4.
Has authorized the physician to continue with the treatment

ANS: 3

The nurse’s signature witnessing the consent means that the client voluntarily gave consent, that the client’s signature is authentic, and that the client appears to be competent to give consent. It is the physician’s responsibility to make sure the client fully understands the procedure. If the nurse suspects the client does not understand, the nurse should notify the physician. The nurse’s 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 is also signed and witnessed. The nurse’s signature does not verify that the client has authorized the physician to continue with treatment. It only verifies that the consent was given voluntarily, the client is competent to give consent, and the signature is authentic.

DIF: A REF: 332 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

14. A nurse who is working with clients who have DNR (do not resuscitate) orders knows that these orders:

1.
Are legally required for terminally ill clients
2.
May be written by the physician without client consent if resuscitation is futile
3.
Are maintained throughout the client’s stay in either an acute care or a long-term care facility
4.
Follow nationally consistent standards for implementation of client interventions

ANS: 2

If the client is unable, and there is no surrogate available to give consent, the DNR order can be written but only if the physician is reasonably medically certain that the resuscitation would be futile. A DNR order is not legally required for terminally ill patients.. DNR orders are not necessarily maintained throughout the client’s stay because a client’s 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. There is no nationally consistent standard for DNR implementation. States have their own statutes regarding DNR orders.

DIF: A REF: 328-329 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

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

1.
Clients designate a power of attorney
2.
DNR orders for clients meet standard criteria
3.
Organ donation is required upon death, if possible
4.
Information be provided to the client regarding rights for refusal of care

ANS: 4

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. The Patient Self-Determination Act does not require clients to designate a power of attorney. The Patient Self-Determination Act does not require that DNR orders meet standard criteria. The Patient Self-Determination Act does not require organ donation upon death. It is the client’s decision whether he or she wants to participate in organ donation.

DIF: A REF: 328 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

16. The newly enacted Health Insurance Portability and Accountability Act (HIPAA) of 2003 requires:

1.
Insurance coverage for all clients
2.
Policies on how to report communicable diseases
3.
Limits on information and damages awarded in court cases
4.
Safeguards to protect written and verbal information about clients

ANS: 4

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 there are reasonable safeguards to protect written and verbal communications about clients. 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. HIPAA does not require policies on how to report communicable diseases. It does require safeguards to protect written and verbal information about clients. HIPAA does not require limits on information and damages awarded in court cases.

DIF: A REF: 329 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

17. A client is told by his nurse that he has to take the medications, including an injection. The client refuses the medications, but continues to have them administered by the nurse. This action is an example of the intentional tort of:

1.
Assault
2.
Battery
3.
Malpractice
4.
Invasion of privacy

ANS: 2

Battery is any intentional touching without consent. An example of battery is a nurse who gives a medication after the client has refused. Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. Malpractice is negligence committed by a professional such as a nurse or physician. This case is not an example of malpractice. Invasion of privacy is where the client has unwanted intrusion into his or her private affairs. This case is not an example of invasion of privacy.

DIF: A REF: 331 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

18. A nurse who is working with a client who has been diagnosed with AIDS reveals the client’s name and diagnosis with a co-worker on the way downstairs in an elevator. Unknowingly, a friend of the client that happens to be sharing the elevator and hears the entire story. The nurse who shared the information may be held liable for:

1.
Slander
2.
Assault
3.
Malpractice
4.
Invasion of privacy

ANS: 1

A nurse can be held liable for slander if he or she shares private client information that can be overheard by others. 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. 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. Invasion of privacy occurs when 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.

DIF: A REF: 331 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

19. A nurse stealing narcotics from an acute care nursing unit is guilty of a:

1.
Civil offense
2.
Criminal offense
3.
Common law offense
4.
Administrative law offense

ANS: 2

Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). A felony is a crime of a serious nature that has a penalty of imprisonment for greater than 1 year or even death. A misdemeanor is a less serious crime that has a penalty of a fine or imprisonment for less than 1 year. An example of criminal conduct for nurses is misuse of a controlled substance. Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Common law is created by judicial decisions made in courts when individual legal cases are decided (i.e., informed consent). Administrative law is created by administrative bodies, such as state boards of nursing, when they pass rules and regulations.

DIF: A REF: 326 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

20. The case of a nurse accused of unethical nursing conduct will be heard by the state board of nursing. This is an example of:

1.
Civil law
2.
Criminal law
3.
Common law
4.
Administrative law

ANS: 4

Administrative law is created by administrative bodies, such as state boards of nursing when they pass rules and regulations such as unethical nursing conduct. Civil laws protect the rights of individual persons within our society and encourage fair and equitable treatment among people. Criminal laws prevent harm to society and provide punishment for crimes (often imprisonment). Common law is created by judicial decisions made in courts when individual legal cases are decided.

DIF: A REF: 330 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

21. Which of the following statements made by a nursing student regarding responsibility for provided care requires immediate follow-up by the nursing instructor?

1.
“I’m not held to the same standards as a licensed RN.”
2.
“I am required to provide the safest, appropriate care I am capable of.”
3.
“My clinical instructor is ultimately responsible for the care I provide.”
4.
“No one expects nursing students to provide care on the level as an experienced RN.”

ANS: 3

Student nurses are expected to perform as professional nurses, that is, as an RN would in providing safe, appropriate client care. The clinical instructor is responsible for proper instruction, supervision, and guidance but the student is responsible for their own acts. The remaining options do reflect misconceptions, but the issue of responsibility has priority.

DIF: C REF: 333 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

22. The nurse is having difficulty reading the prescribed dosage on a handwritten order for a pain medication. The most appropriate action to ensure the client’s safety and to minimize legal issues is for the nurse to:

1.
Ask another RN to confirm the order
2.
Request the pharmacist to interpret the order
3.
Call the health care provider to clarify the order
4.
Consult a current drug book to determine the normal dosage range

ANS: 3

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 prescriber if unable to read the order. Although asking others to interpret the order may appear prudent, it is ultimately the nurse’s responsibility if a medication error is made. Although the drug book may provide a normal range it does not aid in determining definitively what the order intended.

DIF: A REF: 336 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

23. The legal basis for a nurse to provide emergency treatment without consent to a client incapable of informed consent is:

1.
Such care is clearly a nursing responsibility
2.
To fail to provide such care is nursing negligence
3.
It is presumed that the client would want the emergency treatment
4.
Health care providers have an obligation to provide emergency treatment

ANS: 3

In emergency situations, if it is impossible to obtain consent from the client or an authorized person, the law assumes that the client would wish to be treated. Providing appropriate nursing care is a nursing responsibility, and failure to do so is negligence.

DIF: C REF: 332 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

24. An experienced pediatric nurse is reassigned to an adult oncology floor because of staffing issues and immediately recognizes a lack of experience in this specialty. Which of the following nursing actions shows a lack of professionalism?

1.
Politely declining the assignment
2.
Filling out a report noting her dissatisfaction
3.
Asking to work with another oncology nurse
4.
Notifying the state board of nursing of the problem

ANS: 1

A nurse who refuses to accept an assignment may be considered insubordinate, and clients will not benefit from having less staff available. This is an unprofessional attempt to resolve the problem. Asking to work with another oncology nurse, sending a written protest, and notifying the state nursing board would be appropriates action, and so are not examples of unprofessional behavior.

DIF: C REF: 335 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

25. Although a nurse may not agree, the nurse recognizes that a terminally ill client has the legal right to:

1.
Seek passive euthanasia in some states
2.
Sign an organ donor pledge statement
3.
Refuse DNR (do not resuscitate) status
4.
Refuse treatment in the form of food and water

ANS: 4

Competent clients have the right to refuse treatment. This includes life-saving hydration and nutrition. Physician-assisted suicide is legal in the state of Oregon, and it is legally a client’s decision to declare a DNR status or to sign an organ donor card.

DIF: A REF: 328 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

26. Which of the following statements best reflects a nurse’s understanding of the proper critical thinking process regarding the need for personal malpractice insurance?

1.
“The state’s Good Samaritan laws protect me outside of the hospital.”
2.
“I work in a very low risk area of nursing, so I don’t really have a need.”
3.
“The hospital carries its own malpractice insurance, so I don’t need extra.”
4.
“Lawsuits can occur years after the event, so I carry my own liability insurance.”

ANS: 4

The employing institution’s insurance only covers nurses while they are working within the scope of their employment. Because nurses are professionals and it is often difficult to separate their private lives from their professional skills, nurses need to consider purchasing individual professional liability insurance, even if the employing institution has coverage. It would be important to know the time frames of the employer’s malpractice coverage. The nurse may be only covered during the times he or she is working within the institution. Good Samaritan laws have a narrow scope and would not cover many nursing activities. Although it is true that some areas of nursing have a higher potential for liability claims, all areas have risk. The hospital’s insurance may not cover all potential expenses and may not be applicable in all liability situations.

DIF: C REF: 334-335 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

27. Which of the following statements made by a nurse puts the nurse at risk for assault of the client?

1.
“You will be sorry if you don’t agree to take this medication.”
2.
“You can’t refuse this medication if you really want to feel better.”
3.
“I’ll be so disappointed in you if you don’t take your medication.”
4.
“I’ll tell your son you aren’t cooperating if you don’t take your medication.”

ANS: 1

Assault is any intentional threat to bring about harmful or offensive contact. No actual contact is necessary. Threatening to tell a family member may be a breech of confidentiality; the remaining options are examples of unnecessary pressuring of the client.

This case is not an example of invasion of privacy.

DIF: C REF: 331 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

28. Which of the following statements made by a nurse shows the best understanding regarding the requirements of the Health Insurance Portability and Accountability Act (HIPAA) of 2003?

1.
“I’m always careful to close the door when taping or listening to the unit’s shift report.”
2.
“The nursing assistants know to hand me the vital signs sheet and not just put it on the medication cart.”
3.
“I called the radiology department to tell them I would be faxing the client information they requested.”
4.
“The client’s niece called to see how she slept last night, but I told her I couldn’t share that with her over the phone.”

ANS: 3

The Health Insurance Portability and Accountability Act (HIPAA) requires all hospitals and health care agencies to have specific policies and procedures in place to ensure that there are reasonable safeguards to protect written and verbal communications about clients. By notifying the receiver of an impending client-oriented fax, the nurse has taken a reasonable measures to ensure it is seen by only the appropriate individuals. Although the remaining options deal with safeguards, the potential for a breech in client confidentiality is not as great in those scenarios.

DIF: C REF: 331 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

29. Which of the following statements made by a nurse reflects the best understanding of the legal safeguards of a DNR (do not resuscitate) order?

1.
“All family members need to agree before a DNR order can be written.”
2.
“All terminally ill clients are ultimately required to be declared a DNR status.”
3.
“The DNR order on the terminally ill client in Room 45 needs reviewed today.”
4.
“If the client’s family can’t be located, the physician will write the DNR order.”

ANS: 3

DNR orders are not necessarily maintained throughout the client’s stay because a client’s condition may warrant a change in DNR status. To ensure client safety, the attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities. If there is no living will or durable power of attorney appointed, members of the family will be consulted regarding a DNR order. Although not all family members need to agree, an order will usually not be written if some family members express strong opposition to the status change. If no family can be located, the attending physician has the legal right to write the order. There is no legal requirement for a terminally ill client to be required to assume DNR status.

DIF: C REF: 328-329 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

30. Which of the following statements made by a nurse reflects a lack of understanding regarding a DNR (do not resuscitate) order?

1.
“All family members need to agree before a DNR order can be written.”
2.
“All terminally ill clients are ultimately required to be declared a DNR status.”
3.
“The DNR order on the terminally ill client in Room 45 needs reviewed today.”
4.
“If the client’s family can’t be located the physician will write the DNR order.”

ANS: 1

If there is no living will or durable power of attorney appointed, members of the family will be consulted regarding a DNR order. Although not all family members need to agree, an order will usually not be written if some family members express strong opposition to the status change. DNR orders are not necessarily maintained throughout the client’s stay because a client’s condition may warrant a change in DNR status. To ensure client safety, the attending physician must review the DNR orders every 3 days for hospitalized clients or every 60 days for clients in residential health facilities. If no family can be located, the attending physician has the legal right to write the order. There is no legal requirement for a terminally ill client to be required to assume DNR status.

DIF: C REF: 328-329 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

31. Which of the following statements made by a nurse shows a lack of understanding regarding the Uniform Anatomical Gift Act?

1.
“A client must be 21 to give consent to be an organ donor.”
2.
“All clients admitted to the hospital are asked about becoming an organ donor.”
3.
“We have a form here on the unit that must be signed to show a client’s informed consent to be an organ donor.”
4.
“In our state, you can check the back of a client’s driver’s license to verify whether they are an organ donor.”

ANS: 1

An individual who is at least 18 years of age has the right to make an organ donation (defined as a “donation of all or part of a human body to take effect upon or after death”). Donors need to make the gift in writing with their signature. In many states, adults sign the back of their driver’s license, indicating consent to organ donation. In most states, required request laws mandate that at the time of admission to a hospital, a qualified health care provider has to ask each client older than 18 whether he or she is an organ or tissue donor.

DIF: C REF: 329 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

32. The nurse is heard stating to another staff member that, “the client in Room 54 is such a whiner; you would think she was dying.” This nurse is liable of:

1.
Libel
2.
Slander
3.
Malpractice
4.
Invasion of privacy

ANS: 2

Defamation of character is the publication of false statements either verbally or in writing that result in damage to a person’s reputation. Slander occurs when one verbalizes the false statement. Libel is the written defamation of character, whereas invasion of privacy occurs when the client has unwanted intrusion into his or her private affairs. Malpractice is negligence committed by a professional such as a nurse or physician. Nursing malpractice results when care falls below the standard of care.

DIF: A REF: 332 OBJ: Comprehension

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

33. Which of the following nursing statements reflects the best understanding of the importance of appropriate nursing documentation regarding risk management?

1.
“If the client isn’t compliant, I’m sure to put that in my notes.”
2.
“I’m always careful to document any changes in the client’s condition.”
3.
“My notes are the proof that I provided the client with effective, appropriate care.”
4.
“When there is a lawsuit, the nursing notes are the first thing the attorney looks at.”

ANS: 3

The nurse’s documentation is often the evidence of care received by a client and serves as proof that the nurse acted reasonably and safely. The remaining options are not incorrect but do not identify the primary importance to the nurse.

DIF: C REF: 336 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

34. Which of the following statements reflects a nurse’s need for further instructions regarding an incident report?

1.
“I hope this incident report will help determine a way to help prevent falls.”
2.
“Risk management will want to review the incident report on the client’s fall.”
3.
“I put the incident report on the client’s fall in his chart as soon as I was finished.”
4.
“I need to review the guidelines before I fill out this incident report regarding the client’s fall.”

ANS: 3

The report is confidential and separate from the medical record. The remaining options reflect an understanding about incident reports.

DIF: C REF: 336 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

35. Regarding hours worked and frequency of errors, recent research has shown that nurses working more than 12.5 hours per shift and more than a 40-hour week are:

1.
Reporting more physical illnesses than those working only 40 hours per week
2.
Three times more likely to commit an error in nursing judgment related to client care
3.
Experiencing more physical injuries than those working only 40 hours per week
4.
Experiencing signs of emotional ‘burn out’ more frequently than those working only 40 hours per week

ANS: 2

Results showed that nurses who worked shifts lasting 12.5 hours or more had a three times greater likelihood of making an error. Overtime increased the odds of making at least one error regardless of length of original shift scheduled. The remaining options are not supported by research data.

DIF: C REF: 335 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

36. While working as a nursing assistant, a nursing student is asked to reinsert a Foley catheter by the RN. Which of the following reflects the most appropriate initial student response to the request?

1.
Notify the nursing supervisor of the inappropriate request.
2.
Tell the RN that she can only perform as a nursing assistant.
3.
Agree to perform the task but with the supervision of the RN.
4.
Jointly read the nursing assistant job description with the RN.

ANS: 2

When students work as nursing assistants or nurses’ aides, they should not perform tasks that do not appear in a job description for a nurses’ aide or assistant. The remaining options do not appropriately address the immediate situation.

DIF: C REF: 333-334 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

MULTIPLE RESPONSE

1. Which of the following statements is true regarding the implications of the nurse’s signature as a witness for a client’s consent? (Select all that apply.)

1.
Client signed voluntarily.
2.
The signature is authentic.
3.
Client appears to be competent.
4.
Client appears knowledgeable about the procedure.
5.
The nurse has discussed the possible risks of the procedure.
6.
The nurse has discussed possible post procedure nursing care.

ANS: 1, 2, 3, 4

The nurse’s signature witnessing the consent means that the client voluntarily gave consent, that the client’s signature is authentic, and that the client appears to be competent to give consent. When nurses provide consent forms for clients to sign, nurses must ask the clients if they understand the procedure for which they are giving consent. If clients deny understanding or you suspect they do not understand, notify the physician or nursing supervisor. Nursing care post procedure should be discussed but is not inferred by a nurse’s signature as a witness. Discussing possible risk factors is the physician’s responsibility.

DIF: C REF: 332-333 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment

2. When documenting notification of the primary health care provider concerning a client whose condition is deteriorating, the nurse must be sure to include which of the following? (Select all that apply.)

1.
Client’s wife at bedside.
2.
Client rating pain at 3 out of 10 at 0920.
3.
Client asking to have wife called to come to hospital.
4.
Dr. Smith notified of client’s pain rating of 8 out of 10 at 0900.
5.
Client administered 2 mg morphine sulfate IV every 5 minutes for two doses.
6.
Client ordered morphine sulfate 2 mg IV every 5 minutes until pain relief is achieved.

ANS: 2, 4, 5, 6

The nurse must be certain to document that the physician was notified and his or her response, nursing action in follow-up of orders, and the client’s response. The remaining options are not relevant to the proper documentation of the situation.

DIF: C REF: 336 OBJ: Analysis

TOP: Nursing Process: Implementation

MSC: NCLEX® test plan designation: Safe, Effective Care Environment