Legal & Ethical Issues in Nursing, 6th edition by Ginny Wacker Guido Test Bank

Legal & Ethical Issues in Nursing, 6th edition by by Ginny Wacker Guido

Email: richard@qwconsultancy.com

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 01 Question 1 Type: MCSA A nurse would like to advocate for a modification of the state’s nursing practice act and believes the best strategy is to contact the persons with authority to write and change this statutory law. Whom should the nurse contact?

1. State board of nursing 2. State governor 3. State legislature 4. State nursing association Correct Answer: 3 Rationale 1: State boards of nursing are involved in the implementation and enforcement of the nurse practice act but not charged with writing the law.

Rationale 2: Governors may appoint members of those on the state board of nursing, but are not involved in writing nursing practice acts.

Rationale 3: State legislative bodies create and pass the individual nursing practice acts (statutory laws) and create state boards of nursing or state boards of nurse examiners (state administrative agencies) to implement and enforce those acts.

Rationale 4: State nursing associations may promote or seek to change nurse practice acts, but they cannot do so independently.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.1 Define the term law and describe four sources from which law is derived, including constitutional, statutory, administrative, and judicial (decisional) law.

Question 2 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

A patient brought suit against a hospital for injuries sustained in a fall. The case went to trial and the jury found for the hospital. Can the patient take this same suit and evidence to another trial court in hopes of a different decision?

1. No, because of the doctrine of res judicata 2. Yes, stare decisis allows retrial 3. Yes, because of the doctrine of precedent 4. No, this is a landmark decision Correct Answer: 1 Rationale 1: Res judicata means “a thing or matter settled by judgment” and applies when a legal dispute has been decided by a competent court of jurisdiction. This doctrine prevents the same parties in the original lawsuit from retrying the same issues involved in the first lawsuit.

Rationale 2: Stare decisis means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system.

Rationale 3: The doctrine of precedent means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system. Landmark decisions signify that precedent is changed by the current court decision.

Rationale 4: Landmark decisions signify that precedent is changed by the current court decision.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.2 Compare and contrast the doctrines of precedent (stare decisis) and res judicata.

Question 3 Type: MCSA The circumstances of a lawsuit cause it to be under the jurisdiction of more than one court. In this case, the nurse expects that which court will have the greatest personal jurisdiction?

1. Federal Supreme Court 2. Federal district court 3. State supreme court Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. State trial court Correct Answer: 1 Rationale 1: The federal Supreme Court is the highest court in the country and its decisions will affect all citizens.

It passes across all state and federal district boundaries, thus having the highest impact on people.

Rationale 2: Federal district courts are the first of the three levels of federal courts. They are not the courts with widest jurisdiction.

Rationale 3: The state supreme court is the final authority for state issues, unless a federal issue or constitutional right is involved.

Rationale 4: A state trial court is often the first court to hear legal disputes. It does not hold the widest jurisdiction.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.3 Define and give an application of jurisdiction and a landmark decision.

Question 4 Type: MCSA Several state nursing associations are working together in an attempt to change a constitutional law. These associations should ask for which action on this law?

1. Repeal 2. Expansion 3. Amendment 4. Redefinition Correct Answer: 3 Rationale 1: Statutory laws can be repealed, but constitutional laws cannot.

Rationale 2: Statutory laws and administrative bodies can be expanded, but constitutional laws cannot.

Rationale 3: Constitutional law is a system of fundamental laws or principles for the governance of a nation, society, corporation, or other aggregate of individuals. It is the highest form of statutory law and is changed only by amendment.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Administrative bodies may be redefined, but constitutional laws cannot.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.4 List four ways in which laws can be changed.

Question 5 Type: MCSA An emergency department patient was injured while attacking his neighbor with a knife. After treatment the patient was arrested and charged with battery and assault. Which classification or type of law would determine the case against this defendant?

1. Criminal law 2. Civil law 3. Private law 4. Constitutional law Correct Answer: 1 Rationale 1: Criminal law is appropriate in this case because the act against the neighbor was of a nature that was offensive and harmful.

Rationale 2: Civil law is concerned with the rights and privileges of a citizen.

Rationale 3: Private law is synonymous with civil and common law and is not the law of most importance in this case.

Rationale 4: Constitutional law is a system of fundamental laws and principles for the governance of a nation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.5 Define classifications of law, including common, civil, criminal, public, and private law.

Question 6 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Type: MCSA A person who was injured in a motor vehicle accident sued the driver to recover hospital costs. Which type of law would be enforced in this situation?

1. Tort law 2. Public law 3. Constitutional law 4. Procedural law Correct Answer: 1 Rationale 1: Tort law is the only option that has a process for allowing the determination of damages and compensation for damages in this case scenario. Tort laws govern wrongful acts that are harmful to an individual.

Rationale 2: Public law is the branch of law concerned with the state in its political capacity. There is no information in this scenario to indicate that a criminal offense occurred.

Rationale 3: Constitutional law is a system of fundamental laws or principles for the governance of a nation, society, corporation, or other aggregate of individuals. The purpose of a constitution is to establish the basis of a governing system.

Rationale 4: Procedural law concerns the process and rights of the individual charged with violating substantive law, and does not apply to this situation.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.5 Define classifications of law, including common, civil, criminal, public, and private law.

Question 7 Type: MCSA An emergency department nurse has agreed to testify as an expert witness in a lawsuit involving a child. The opposing attorney questions the nurse's qualifications as a pediatric nurse. Which type of law does this scenario reflect?

1. Due process of law 2. Private law Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. Substantive law 4. Procedural law Correct Answer: 4 Rationale 1: Due process of law applies only to state actions and not to actions of private citizens.

Rationale 2: Private law is synonymous with civil or common law.

Rationale 3: Substantive law concerns the specific wrong, harm, or duty that caused the lawsuit or an action to be brought against an individual.

Rationale 4: Procedural law concerns the processes and rights of the individual charged with violating substantive law, and includes questions of admissibility of evidence and qualifications of expert witnesses.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.6 Distinguish between substantive and procedural law, and state why each is important to professional nursing practice.

Question 8 Type: MCMA A nurse is scheduled to appear before the state board of nursing in regard to action against the nurse's license.

Which occurrences would violate due process of law?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The time of the hearing was changed without adequate notice to the nurse.

2. The nurse was told the meeting was in regard to a complaint about the agency where the nurse was employed.

3. Other nurses involved in the situation leading to the action were not similarly summoned before the board.

4. The nurse was suspended by her private employer pending outcome of this action.

5. A snow storm forced postponement of the board meeting until next month.

Correct Answer: 1,2 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The nurse must be given adequate notice of changes in the hearing schedule or due process of law is violated.

Rationale 2: The nurse must be given proper information about the purpose of the meeting or due process of law is violated.

Rationale 3: Each nurse’s participation in this situation is individual. Other nurses may not have committed actionable offenses. If their actions were equally as actionable, this would violate the equal protection of the law concept, not due process of law.

Rationale 4: Due process of law applies only to state actions, not to that of private citizens.

Rationale 5: As long as the nurse has adequate notice of this postponement, due process of law is not violated.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.7 Discuss due process and equal protection of the law.

Question 9 Type: MCSA A county-supported hospital elects to limit surgical procedures for morbid obesity to male patients. Female patients receive pharmacologic therapy, counseling, and instruction for diet and exercise, but are excluded from operative procedures. Under which legal concept is this illegal?

1. Res judicata 2. Due process of law 3. Stare decisis 4. Equal protection under the law Correct Answer: 4 Rationale 1: Res judicata means “a thing or matter settled by judgment” and prevents the same parties in the original lawsuit from retrying the same issues involved in the first lawsuit.

Rationale 2: Due process of law ensures that fair procedures are followed in enforcing rules.

Rationale 3: The doctrine of precedent, or stare decisis, means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Equal protection under the law holds that all similarly situated persons will be affected similarly.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.7 Discuss due process and equal protection of the law.

Question 10 Type: MCSA In which case would the judge serve both as a fact-finder and determiner of questions of law?

1. Trial by jury is waived by both sides.

2. The jury asks the judge to address both types of questions.

3. The case is so complex that the jury is unable to decide the question.

4. The attorneys for the plaintiff agree to such a condition.

Correct Answer: 1 Rationale 1: Only in the case where there is no jury does the judge address and answer both questions of law and fact.

Rationale 2: The jury is seated to determine questions of fact and cannot ask the judge to assume that responsibility.

Rationale 3: Determining questions of fact is the responsibility of the jury.

Rationale 4: The attorneys for the plaintiff cannot make this determination.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.8 Differentiate between questions of law and questions of fact in trial settings, and give an example of both.

Question 11 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

During a jury trial, the presence of a nurse–patient relationship is questioned. What kind of question is this and who would determine it?

1. Fact to be determined by the judge 2. Law to be determined by the jury 3. Law to be determined by the judge 4. Fact to be determined by the jury Correct Answer: 4 Rationale 1: Judges determine law.

Rationale 2: The jury determines fact.

Rationale 3: The presence of a nurse–patient relationship is determined by the evidence and therefore is a fact and not a law.

Rationale 4: The nurse–patient relationship constitutes a determination as to whether a relationship existed. This is determined by the evidence and therefore is a fact. Facts are determined by the jury.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.8 Differentiate between questions of law and questions of fact in trial settings, and give an example of both.

Question 12 Type: MCMA A patient says, “I was told my back pain is the result care I received when I was in the hospital a year ago. How long do I have to file a lawsuit?” Which statements made by the nurse are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “A general rule is 2 years from the time you knew what caused your injury.”

2. “State laws differ on the statute of limitation for personal injury.”

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. “It is too late if you knew you had back pain right after the fall.”

4. “You should move to Washington because their statute of limitation is longer.”

5. “In some cases it depends if the injury was due to trauma or disease.”

Correct Answer: 1,2,5 Rationale 1: The “discovery rule” is a general guideline stating that patients have 2 years from the time that they knew or should have known of the injury to file a personal injury lawsuit. This is a fact that the nurse would be justified in providing to a patient.

Rationale 2: State laws differ widely on statutes of limitations. This is a fact that the nurse would be justified in providing to a patient.

Rationale 3: The nurse is not prepared to determine if it is “too late” to file this suit and should not make this statement.

Rationale 4: The statute of limitation of the state in which the injury occurred would apply.

Rationale 5: Some courts have distinguished between traumatic injury cases and diseases cases. This is a fact and the nurse would be justified in providing this information to the patient.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.11 Describe statutes of limitation, their significance, and their purposes.

Question 13 Type: MCMA An employee asks for time off to be a juror in a case before the state appellate court. The unit is very busy and this employee’s absence would affect patient care. How should the nurse manager respond to this request?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Give the employee the time off because jury service is required upon subpoena.

2. Refuse the request and refer the employee to the personnel department for review of the employee manual.

3. Insist that the employee contact the county clerk to request release from jury duty.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. Ask the employee more questions about the request.

5. Tell the employee that service as a juror for this case is not required.

Correct Answer: 4,5 Rationale 1: The nurse manager should not give this employee time off.

Rationale 2: There is no need for this employee to review the employee manual.

Rationale 3: This employee does not need to contact the county clerk.

Rationale 4: The nurse manager should ask questions to gain additional information before responding further to this request.

Rationale 5: State appellate courts have no jurors.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 1.10 Explain the functions of the trial courts, appellate courts, and supreme courts at both the state and federal levels.

Question 14 Type: MCMA A nurse has been called to testify in a case that will be tried in family court. The nurse anticipates that the case will involve one of which situations?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Adoption 2. Estate division 3. Child abuse 4. Divorce 5. Child custody Correct Answer: 1,4,5 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Adoptions are under the jurisdiction of family court.

Rationale 2: Wills and estates are under the jurisdiction of probate courts.

Rationale 3: Criminal matters are under the jurisdiction of criminal courts.

Rationale 4: Divorces are under the jurisdiction of family court.

Rationale 5: Child custody is under the jurisdiction of family court.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.9 List two types of jurisdictions, giving the definition and an example of each.

Question 15 Type: MCMA A nurse reads that a case involving the care provided in a hospital will be reviewed by the United States Supreme Court. The nurse suspects that which situations could have occurred?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The case involves a constitutional issue.

2. Two lower federal courts have reached different conclusions in the case.

3. The hospital involved is a military hospital.

4. The care in question included the suspicion of premeditated homicide.

5. The patient involved in the case was an undocumented alien.

Correct Answer: 1,2,3 Rationale 1: The U.S. Supreme Court reviews cases in which constitutional issues have been decided.

Rationale 2: The U.S. Supreme Court reviews cases in which two or more lower courts have reached different conclusions.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Typically the care in a civilian hospital would be under the jurisdiction of state courts. Cases involving military, veterans’, or other federally funded health centers are frequently settled in federal courts. This may result in Supreme Court review.

Rationale 4: The question of premeditated homicide would not change the jurisdiction to the federal system.

Rationale 5: The citizenship status of the patient involved in the case would not determine if the case was under federal jurisdiction.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 1.10 Explain the functions of the trial courts, appellate courts, and supreme courts at both the state and federal levels.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 02 Question 1 Type: MCMA A lawsuit has been filed against the hospital for terminating an employee for excessive tardiness and absenteeism.

The defendant’s attorney has contacted nurses who worked with this employee to testify in the case. Which statements would best support the defendant’s case?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I didn’t work the same shift.”

2. “The employee called in sick on several consecutive Fridays.”

3. “She often asked me to cover for her while she took her kids to school.”

4. “She was never late or absent during the 6 months I worked with her.”

5. “Her absences affected the work flow on our unit.”

Correct Answer: 2,3,5 Rationale 1: This statement is rather neutral, gives little information about the case, and would not support either side.

Rationale 2: This case exemplifies a pattern of absenteeism that supports the hospital’s case (the defendant) against the employee.

Rationale 3: The defendant in this case is the hospital. This statement indicates that there may be a pattern of tardiness.

Rationale 4: This statement supports the case of the employee who filed the suit who is the plaintiff in this action.

Rationale 5: This statement supports the defendant hospital’s allegation of excessive absenteeism.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 2.1 List and explain the purpose of the six procedural steps in the trial process.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 2 Type: MCMA A nurse is served with a summons alerting him that he has been named in a malpractice lawsuit. What information can the nurse learn from this summons?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Names of any other defendants in the case 2. Name of the plaintiff in the case 3. Expected length of the trial 4. Date to appear before the court 5. Breaches in standards of care, injuries, or damages alleged by the defendant Correct Answer: 1,2,4 Rationale 1: The summons will list other defendants named in the complaint.

Rationale 2: The person bringing the suit, or the plaintiff, will be named in the complaint summons.

Rationale 3: A complaint summons is notification that the lawsuit exists and demands that the defendants appear before the court. The length of time of the trial is not indicated on this summons.

Rationale 4: A date to appear, which may change as proceedings progress, is listed on the original complaint summons.

Rationale 5: Allegations are made by the plaintiff in the case.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.1 List and explain the purpose of the six procedural steps in the trial process.

Question 3 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

In which case might a default judgment be entered?

1. The defendant did not respond to the complaint and would otherwise have been shown to have liability.

2. The defendant did not respond to the complaint.

3. The plaintiff did not respond to the complaint.

4. The plaintiff did not respond to the complaint and would otherwise have been shown to have liability.

Correct Answer: 2 Rationale 1: If the defendant does not respond, liability is assumed and does not have to be shown or proven.

Rationale 2: Default judgments are entered when a defendant does not respond to the complaint by the plaintiff.

Rationale 3: The plaintiff has initiated the complaint, so a response is not necessary.

Rationale 4: The plaintiff is the person bringing the complaint, so a judgment is not entered against the plaintiff in a case.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.1 List and explain the purpose of the six procedural steps in the trial process.

Question 4 Type: MCSA The attorney for a nurse named in a malpractice case recommends that the case go to a prelitigation panel. What rationale would the attorney offer the nurse for this recommendation?

1. These panels ensure that there is a controversy or fact question for the court.

2. Using such a panel negates the need for a full jury trial.

3. Such panels shorten the time between filing and conclusion of the lawsuit.

4. Questioning of witnesses is not conducted under oath and is more informal.

Correct Answer: 1

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The sole purpose of a prelitigation panel is to determine facts and whether there is indeed an actual controversy.

Rationale 2: Jury trials often proceed after a panel review and are not negated.

Rationale 3: In states that use this type of panel, lawsuits are often extended by 6 to 12 months.

Rationale 4: While it is an informal process, this informality is not the primary reason for using prelitigation panels.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2.2 Examine alternate means of resolving controversies, including alternate dispute resolution, mediation, arbitration, and prelitigation panels.

Question 5 Type: MCSA A nurse named in a malpractice case may wish to avoid the expense of a trail by going to arbitration. What is another rationale for using this process?

1. There is no need to have attorney representation.

2. Arbitration is not binding, so if the parties do not like the outcome, nothing is lost.

3. Witnesses do not testify under oath and are easier to obtain.

4. There is no formal record made of the arbitration process.

Correct Answer: 4 Rationale 1: Both sides have legal counsel during arbitration.

Rationale 2: The decision of the arbitrator is binding.

Rationale 3: Arbitration is a formal process where sworn testimony is heard.

Rationale 4: Arbitration is an alternative dispute resolution method. No formal record is made of the arbitration process. This allows the proceedings to be confidential.

Global Rationale: Cognitive Level: Analyzing Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2.2 Examine alternate means of resolving controversies, including alternate dispute resolution, mediation, arbitration, and prelitigation panels.

Question 6 Type: MCMA Depositions will be taken of witnesses in a wrongful termination suit filed against the hospital by a former employee. Which information should the attorneys provide to the witnesses that will be deposed?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The testimony provided is sworn testimony.

2. Witnesses being deposed will be questioned by their attorney.

3. Once the testimony is recorded no changes can be made to the record.

4. The witness may refer to notes during the disposition.

5. The deposition will be taken in a courtroom with a judge in attendance.

Correct Answer: 1,4 Rationale 1: The deposing witness is under oath during the entire deposition. Once the deposition is reviewed and signed by the witness it becomes sworn testimony.

Rationale 2: The attorney for the deposing party does not take an active part in the deposition. Questions will be asked by the opposing attorney.

Rationale 3: The witness will be allowed to review and make minor changes such as for typographical errors. No substantive changes to the record can be made.

Rationale 4: The witness may bring medical records, notes, and literature sources to the deposition, and may refer to them as needed during the deposition.

Rationale 5: Depositions are often taken in an attorney’s office. A judge is not present.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2.3 Distinguish between traditional depositions, court reporter–recorded depositions, and the more modern videotaped depositions, stating the advantages and challenges of each of these methods.

Question 7 Type: MCSA A nurse has agreed to participate in a videotaped deposition in a malpractice case. What does this indicate?

1. The nurse is testifying as an expert witness.

2. The nurse's testimony can be presented in court, even though the nurse is unavailable for the trial date.

3. The nurse is afraid testimony will adversely affect employment opportunities.

4. The plaintiff's attorney believes the nurse is a liability for personal trial appearance, but will be credible on tape.

Correct Answer: 2 Rationale 1: There is no indication that this nurse is testifying as an expert witness.

Rationale 2: Taped depositions are frequently reserved for witnesses who will not be present for the actual trial.

Rationale 3: The video will be played as a part of the trial procedures, so there would be no difference in its effect on employment opportunities.

Rationale 4: There is no indication that this nurse will be a liability for personal trial appearance.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.3 Distinguish among traditional depositions, court reporter–recorded depositions, and the more modern videotaped depositions, stating the pros and cons of each of these methods.

Question 8 Type: MCSA Which person would best qualify as an expert in a nursing malpractice case filed because of failure of a postanesthesia care unit nurse to recognize the early signs and symptoms of respiratory arrest?

1. The director of clinical pharmacy who holds a doctoral degree in clinical pharmacology 2. A staff nurse who works on the general medical unit and has recently earned a BS in nursing.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The director of nursing at the hospital who holds an MSN in nursing administration 4. A critical care nurse who holds a BS in nursing and certification from the American Association of Critical Care Nurses (AACN) Correct Answer: 4 Rationale 1: Simply holding an advanced degree does not indicate expert knowledge in postanesthesia care.

Rationale 2: The staff nurse does not have experiential knowledge of postanesthesia unit care.

Rationale 3: Simply holding an advanced degree and being in a leadership roll does not indicate expert knowledge in postanesthesia care.

Rationale 4: The expert witness is an individual who is highly specialized in the field relevant to the case. In this scenario, recognizing respiratory arrest signs and symptoms are patient care aspects that should be well known to the critical care nurse. Therefore, this individual would be best able to discuss the patient care standards of practice. The individual's education and certification in a specialty add further evidence of expert skills and knowledge.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.4 Distinguish between lay and expert witnesses and their roles in the trial process.

Question 9 Type: MCSA Which statement best describes the rule regarding expert testimony in nursing malpractice cases?

1. Expert testimony is always required in nursing malpractice suits, and the injured party cannot win his or her case without expert testimony being presented.

2. Whether expert testimony is needed is decided on a case-by-case basis after analyzing the facts of the case.

3. Expert testimony should be presented whenever there is reason to suspect that the jury will decide in favor of the injured party if expert testimony is not presented.

4. The jury is permitted to decide, based on all the evidence submitted, whether expert testimony is needed.

Correct Answer: 2 Rationale 1: The likelihood of one side of a case winning or losing should not be the determining factor in whether to present expert testimony.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Expert testimony is used to help the jury make conclusions that may involve facts or scientific information that is more than common knowledge. Use of expert testimony is considered on a case-by-case basis.

Rationale 3: The likelihood of one side of a case winning or losing should not be the determining factor in whether to present expert testimony.

Rationale 4: The decision to use expert testimony is not made by the jury but by the legal representation of both parties in the case.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2.4 Distinguish between lay and expert witnesses and their roles in the trial process.

Question 10 Type: MCMA A nurse has been called as a lay witness in a malpractice lawsuit. What information should be provided to the nurse regarding this testimony?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Lay witnesses testify to what others have said about the incident under question.

2. The testimony should include opinion on the appropriateness of care provided.

3. These witnesses tell only what has transpired from their perspective.

4. Lay witnesses may answer hypothetical questions for the jury.

5. The lay witness must have a direct connection to the case.

Correct Answer: 3,5 Rationale 1: Witnesses must tell only what they saw or know, not what was told to them by others.

Rationale 2: Lay witnesses can testify only to the facts and may not draw conclusions or form opinions.

Rationale 3: Testimony is a presentation of factual information that an individual can relay relevant to his or her own perspective.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Lay witnesses can testify only to the facts and may not draw conclusions. Therefore, they cannot answer hypothetical questions.

Rationale 5: Nurses may be called to serve as a lay witness to describe for the jury what, when and how a particular event occurred. The nurse must have a direct connection to the case in order to provide this information.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 2.4 Distinguish between lay and expert witnesses and their roles in the trial process.

Question 11 Type: MCSA The nurse is involved as an expert witness in a civil court case where life support was withdrawn and the patient expired. Which level of evidence is expected for this case?

1. Voir dire evidence 2. Preponderance of evidence 3. Evidence beyond a reasonable doubt 4. Clear and convincing evidence Correct Answer: 4 Rationale 1: Voir dire refers to jury selection, not levels of evidence.

Rationale 2: Preponderance of evidence is based on the probable truth or accuracy of the evidence presented, the evidence remains subjective, and the judge or jury must be persuaded that the facts are more probable one way than another way.

Rationale 3: Evidence beyond a reasonable doubt is the highest level of evidence and is generally the standard required in criminal cases.

Rationale 4: For most courts, clear and convincing evidence is the highest level of proof that can be applied in a civil case and is generally the standard of proof seen in a withdrawal of life-sustaining measures cases.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.5 Examine levels of evidence and state which level is most appropriate in criminal and civil court cases.

Question 12 Type: MCSA Criminal charges have been brought against a nurse who made a medication error that resulted in a child's death.

Which level of evidence is expected in this case?

1. Preponderance of evidence 2. Clear and convincing evidence 3. Discovery evidence 4. Evidence beyond a reasonable doubt Correct Answer: 4 Rationale 1: Preponderance of evidence is based on the probable truth or accuracy of the evidence presented, the evidence remains subjective, and the judge or jury must be persuaded that the facts are more probable one way than another way.

Rationale 2: For most courts, clear and convincing evidence is the highest level of proof that can be applied in a civil case.

Rationale 3: Discovery is not a level of evidence.

Rationale 4: Evidence beyond a reasonable doubt is the highest level of evidence and is generally the standard required in criminal cases.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 2.5 Examine levels of evidence and state which level is most appropriate in criminal and civil court cases.

Question 13 Type: MCSA A nurse has been called to testify in a malpractice lawsuit. Which information should the attorney provide about the process of cross-examination?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Cross-examination allows the nurse to ask questions of the opposing counsel.

2. During this process opposing counsel will try to refute the nurse’s testimony.

3. Cross-examination is a process to ensure that both attorneys question all witnesses.

4. This process allows opposing counsel to explain the meaning of the nurse’s testimony.

Correct Answer: 2 Rationale 1: Attorneys do the questioning in a trial, not the parties to the lawsuit.

Rationale 2: Cross-examination of a witness is a specific strategy by the opposing attorney to discredit or negate the witness's testimony.

Rationale 3: While both attorneys have the option to question all witnesses, they are not required to do so.

Rationale 4: Attorneys do not explain testimony, but rather ask questions to support their client’s case.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2.6 Enumerate the trial process, including the purposes and steps of the various stages in the process.

Question 14 Type: MCMA A patient has filed a lawsuit alleging that negligence by a nurse resulted in permanent injury to his legs. At trial what is this person’s burden of proof?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. That the nurse intended to injure the patient 2. That the alleged incident actually occurred 3. That the nurse being charged was improperly trained and supervised 4. That the incident caused the plaintiff’s injury 5. That the plaintiff recognized the injury within days of discharge Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 2,4 Rationale 1: The patient does not have to prove that the nurse intentionally meant to injure the patient.

Rationale 2: The plaintiff must prove that the incident being discussed actually did occur.

Rationale 3: While training and supervision may be part of the information brought to trial it is not part of the required burden of proof.

Rationale 4: The plaintiff must prove that his injury was caused by the incident he claims occurred.

Rationale 5: The statute of limitations is not a matter of days. This is not part of the plaintiff’s burden of proof.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2.6 Enumerate the trial process, including the purposes and steps of the various stages in the process.

Question 15 Type: MCSA A nurse has agreed to serve as an expert witness in a jury trial. What is this nurse’s major ethical concern?

1. Ability to stay objective and unbiased in the work 2. Fulfilling the obligation to "fill in the blanks" in the medical record 3. To explain that unexpected outcomes sometimes occur in health care 4. To make a logical and fair decision at trial Correct Answer: 1 Rationale 1: The expert witness has task of being objective and unbiased and conveying these qualities to the judge and jury.

Rationale 2: The expert witness must guard against "filling in the blanks" of the medical record with information that is not present.

Rationale 3: While unexpected outcomes do occur in health care, it is not the expert witness's role to explain that at trial.

Rationale 4: The judge or jury makes the decision at trial.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 2.7 Discuss some of the ethical issues facing the expert witness.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 03 Question 1 Type: MCMA Which statements would the nurse evaluate as correctly identifying difference between ethics and law?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Ethics applies to conduct and actions, and the law applies to motive and attitude.

2. Ethics focuses on the individual whereas law focuses on society as a whole.

3. Ethics are externally determined.

4. Law relies heavily on judicial enforcement.

5. Ethics can change situationally, but laws are static and unchangeable.

Correct Answer: 2,4 Rationale 1: Both ethics and the law apply to conduct, actions, and motive. Attitude is more associated with ethics.

Rationale 2: Ethics, like values, is individualistic and is subject to philosophical, moral, and individual interpretations. The law focuses on rules and regulations that guide society in a formal and binding manner.

Rationale 3: Ethics describes conduct or principles that are internalized.

Rationale 4: The legal system, including the judicial branch, is founded on rules and regulations that guide society in a formal and binding manner.

Rationale 5: Ethical values are subject to philosophical, moral, and individual interpretations and may change as the person grows and develops. Laws are more formal, but can also be changed.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3.2 Distinguish law from ethics.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 2 Type: MCSA The nurse bases individual nursing practice upon commitment to quality patient care and understanding of the nursing role. Under which broad classification of ethical theory does this fall?

1. Applied theories 2. Utilitarian theories 3. Deontological theories 4. Teleological theories Correct Answer: 3 Rationale 1: Applied ethics analyzes specific, controversial moral issues and is not a broad category of ethics that serves as a basis for daily decisions.

Rationale 2: Utilitarian theory states that what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people. Following utilitarian principles will not always support providing excellent nursing care to an individual.

Rationale 3: Deontological theories derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed. The nurse makes a commitment to excellence of patient care.

Rationale 4: Teleological theories derive norms or rules for conduct from the consequences of actions.

Teleological principles do not support excellence in individual care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.1 Compare and contrast the different ethical theories that underlie ethical nursing practice.

Question 3 Type: MCSA The hospital ethics committee has decided to move to the relational ethics framework for decision making. What change should the committee members expect from this framework shift?

1. Decisions made will be more practical and action oriented.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. The number of options for discussion will be reduced.

3. Use of other ethical theories and guidelines will be eliminated.

4. The impact of the environment on the decision will be reduced.

Correct Answer: 1 Rationale 1: Relational ethics moves decisions into the context of the environment in which these decisions are made, creating more "practical action-oriented" ethics.

Rationale 2: Relational ethics is not meant to reduce the amount of options discussed.

Rationale 3: Relational ethics is not meant to eliminate other ethical theories and guidelines.

Rationale 4: Relational ethics moves decision making into the context of the environment in which the decisions are made.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.1 Compare and contrast the different ethical theories that underlie ethical nursing practice.

Question 4 Type: MCSA The nurse advises a patient to have surgery because, “The doctor knows what is best for you." The nurse is most likely following which ethical principle?

1. Respect for others 2. Paternalism 3. Justice 4. Fidelity Correct Answer: 2 Rationale 1: Respect for others acknowledges the right of individuals to make decisions and to live or die based on those decisions.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Paternalism is allowing someone else to make a decision for another and allows no collaboration in the decision-making process. In this scenario the nurse is encouraging the patient to let someone else (the physician) make treatment decisions.

Rationale 3: Justice states that people should be treated fairly and equally. Nothing in this scenario demonstrates use of justice.

Rationale 4: Fidelity is keeping one's promises or commitments. Nothing in this scenario demonstrates fidelity.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 5 Type: MCSA A group of nurses wishes to improve the ethics of the care their group provides. What is the first step this group should take to reach their goal?

1. Request that all dilemmas be presented to the Hospital Ethics Committee for resolution.

2. Explore their individual values and beliefs.

3. Seek others' input rather than relying on their own ethical determinations.

4. Explore the values and beliefs of the physicians with whom they work.

Correct Answer: 2 Rationale 1: While the opinion of others and seeking support by hospital ethics committees to aid in the resolution of ethical dilemma can be helpful, it is not the first logical step in these nurses’ work.

Rationale 2: Understanding one’s ethics and values is the first step in understanding the ethics and values of others and in assuring the delivery of appropriate and ethical nursing care.

Rationale 3: A relying primarily on the ethical determinations of others is not a means to promote the ethics for a group of health care providers.

Rationale 4: At some point the nurses will need to consider the ethics and values of those with whom they work.

This is not the first logical step in the process being undertaken.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 6 Type: MCSA Prior to surgery, the nurse checks to ensure that the patient has signed an informed consent form. Which ethical principle is the nurse supporting?

1. Beneficence 2. Veracity 3. Autonomy 4. Fidelity Correct Answer: 3 Rationale 1: Beneficence states that the actions one takes should promote good.

Rationale 2: Veracity concerns truth telling.

Rationale 3: Autonomy is the right to choose what will happen to one's own person. Being informed about the benefits and risks of surgery through informed consent is a direct reflection of the principle of autonomy.

Rationale 4: Fidelity is keeping one's promises or commitments.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 7 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The nurse tells a patient that an immunization "will not hurt at all" when the nurse is aware that the injection will be painful. Which ethical principle has the nurse most clearly violated?

1. Veracity 2. Beneficence 3. Justice 4. Autonomy Correct Answer: 1 Rationale 1: Veracity concerns truth telling. This nurse knowingly was not truthful with this patient, thereby violating the ethical principle of veracity.

Rationale 2: Beneficence states that the actions one takes should promote good.

Rationale 3: Justice states that people should be treated fairly and equally.

Rationale 4: Autonomy addresses personal freedom and self-determination.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 8 Type: MCSA The nurse makes practice decisions based upon each patient's unique characteristics, the relationship between the patient and the nurse, and the most humanistic course of action in the particular case circumstance. Which branch of ethics does this reflect?

1. Virtual ethics 2. Duty ethics 3. Utilitarian ethics 4. Situational ethics Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 4 Rationale 1: Virtual ethics emphasizes development of good character and habitually performing in this quality character mode.

Rationale 2: Duty ethics derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed.

Rationale 3: Utilitarian ethics declares that what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people.

Rationale 4: Situational ethics takes into account the unique characteristics of each individual, the caring relationship between the person and the caregiver, and the most humanistic course of action given the circumstances.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.1 Compare and contrast the different ethical theories that underlie ethical nursing practice.

Question 9 Type: MCMA A patient is prescribed medication for the treatment of cancer. The nurse is concerned that administering this medication may have a harmful effect on the patient. Which conditions would help the nurse decide that it is ethical to administer the medication through the application of the concept of double effect?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The medication has been proven effective in the treatment of cancer.

2. The nurse is administering the medication to achieve treatment of the cancer.

3. The harmful effect must not occur in order for the medication to be successful in treating the cancer.

4. The benefits of using this medication are more likely to occur than are the undesired actions of the medication.

5. The patient must agree to accept the possibility of undesired effects of the medication.

Correct Answer: 1,2,3,4 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: One of the conditions that must be present for the concept of double effect to be used is that the action itself must be “good” or at least morally indifferent.

Rationale 2: One of the conditions that must be present for the concept of double effect to be used is that the nurse must intend only the good effect of the action.

Rationale 3: In order for the concept of double effect to be useful the undesired effect must not be the means of attaining the good effect.

Rationale 4: A proportional or favorable balance between the desirable and the undesirable effects of the action must exist for the concept of double effect to be pertinent.

Rationale 5: While teaching about undesired effects is part of patient education and the patient retains the right to refuse the medication this is not a part of the concept of double effect.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 10 Type: MCSA An ethical dilemma has arisen in regard to a patient who has been declared incompetent and who left no advance directive. Which model is likely to be of best use to the ethics committee reviewing the case?

1. Autonomy 2. Patient justice 3. Patient benefit 4. Social justice Correct Answer: 3 Rationale 1: The autonomy model facilitates decision making for the competent patient.

Rationale 2: Patient justice is not a model used by ethics committees.

Rationale 3: The patient benefit model uses substituted judgment and facilitates decision making for the incompetent patient.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: The social justice model considers broad social issues and is accountable to the institution.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.4 Discuss the importance and role of hospital ethics committees and ethics grand rounds.

Question 11 Type: MCSA The hospital is forming an ethics committee. Which concept should be central to that committee's function?

1. Most of the committee's work should involve short-term ethical issues.

2. The overriding concern of the committee should be protection of the hospital.

3. Members should be limited to medical staff.

4. The committee should act to provide guidelines for potential problems.

Correct Answer: 4 Rationale 1: Ethical dilemmas can be both short-term and long-term. There is no restriction on ethics committees to focus primarily on short-term issues.

Rationale 2: Protection of the hospital should not be the ethics committee’s primary concern. This committee is concerned about the provision of ethical care to the patient.

Rationale 3: Ethics committees should be broad based, including members from a variety of professions and services.

Rationale 4: Ethics committees can (1) provide structure and guidelines for potential problems, (2) serve as an open forum for discussion, and (3) function as a true patient advocate by placing the patient at the core of the committee discussions.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 3.4 Discuss the importance and role of hospital ethics committees and ethics grand rounds.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 12 Type: MCMA The hospital has a well-designed, fully functioning ethics committee. What ethical debate topics, concerning the entire social network rather than an individual patient, might now be addressed by this committee?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Do-not-resuscitate orders 2. Autonomy 3. Duplication of services 4. Informed consent 5. Effects of managed care on patient well-being Correct Answer: 3,5 Rationale 1: A do-not-resuscitate order is an issue focused on an individual patient or health care organization.

Rationale 2: Autonomy is a broad-based ethical theory that the committee would use to guide decision making. It is not a specific topic of discussion.

Rationale 3: Duplication of services is a topic that concerns the entire social network of provision of health care and is a much broader topic than the typical individual concerns addressed by maturing committees.

Rationale 4: Informed consent is an ethical concern directed at the individual health care organization and is not a broad based issue that affects larger populations.

Rationale 5: The impact of managed care on patient well-being is the kind of broad-based, societal issue that can be addressed by a well-developed mature ethics committee.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.4 Discuss the importance of hospital ethics committees and ethics grand rounds.

Question 13 Type: MCMA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Which nursing actions would exemplify cardinal virtues as seen by Plato and other virtue ethicists?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse has developed the reputation of making wise decisions.

2. The nurse advocated for the patient’s right to autonomy against a physician who is paternalistic.

3. When asked to work overtime shifts, the nurse always complies.

4. The nurse always puts the good of the unit before personal well-being.

5. The nurse treats all people working on the unit fairly and equally.

Correct Answer: 1,2,5 Rationale 1: Wisdom in a cardinal virtue as described by Plato and other virtue ethicists.

Rationale 2: This action took courage on the part of the nurse which is one of the cardinal virtues as described by Plato and other virtue ethicists.

Rationale 3: This is an example of fortitude, but is not always wise, so a cardinal virtue is not demonstrated.

Rationale 4: This is an example of generosity, but is not always wise nor does it evidence self-respect. This is not an example of a cardinal virtue.

Rationale 5: This is an example of justice which is a cardinal virtue as described by Plato and other virtue ethicists.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3.1 Compare and contrast the different ethical theories that underlie ethical nursing practice.

Question 14 Type: MCMA A nurse is frequently tardy to work causing other nurses to have to change their plans to cover the unit. The nurse never thanks those who cover for her and often criticizes the work they did in her absence. If another nurse is tardy, she refuses to stay over to cover. Which ethical theories is this nurse violating?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fidelity 2. Autonomy 3. Beneficence 4. Veracity 5. Paternalism Correct Answer: 1,3 Rationale 1: The nurse makes a promise to work when scheduled unless extenuating circumstances are present.

Fidelity is the duty to keep promises.

Rationale 2: Nothing in this scenario indicates the nurse is violating the ethical principle of autonomy.

Rationale 3: Beneficence is the basic obligation to assist others. By refusing to work over to cover for a tardy coworker, even though co-workers often do so for her, this nurse is not working to promote good and is not assuming the obligation to help others.

Rationale 4: Veracity concerns telling the truth. There is nothing in the scenario that indicates the nurse lies about the reasons why she is tardy.

Rationale 5: Paternalism involves completely making the final decisions for others. There is no evidence of paternalism in this scenario.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 3.3 Define and apply to nursing practice the ethical principles of autonomy, beneficence, nonmaleficence, veracity, fidelity, justice, paternalism, and respect for others.

Question 15 Type: MCSA The hospital ethics committee has been asked to consider a controversial issue that has a significant number of persons both for and against it. Which other characteristic would the committee look for when determining if applied ethics should be used as a guide for their work?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. The situation must concern a distinctly moral issue.

2. The situation must involve great expense to the hospital or patient.

3. The situation must involve high risk activities.

4. The situation must occur frequently.

Correct Answer: 1 Rationale 1: To be considered an applied ethical issue, two key characteristics are important. First the issue needs to be controversial with significant numbers of persons both for and against the issue. Second, the issue must concern a distinctly moral issue.

Rationale 2: Expense is not considered in determining if this is an applied ethical issue.

Rationale 3: There is no indication that high risk must be involved in determining whether an issue is an applied ethical issue.

Rationale 4: There is nothing to indicate that a situation must occur frequently in order for it to be considered an applied ethical issue.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 3.4 Discuss the importance and role of hospital ethics committees and ethics grand rounds.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 04 Question 1 Type: MCSA The nurse intends to lobby the state legislature to write a new code of ethics for the nurses in the state. Is this an appropriate idea?

1. No, federal lawmakers have jurisdiction over codes of ethics.

2. No, the code of ethics is the product of hospital associations across the nation.

3. No, professional nursing organizations write the code of ethics for nurses.

4. Yes, the code of ethics is written and published by individual state legislatures.

Correct Answer: 3 Rationale 1: Federal lawmakers do not write codes of ethics for other professional groups such as nurses.

Rationale 2: Hospital organizations do not band together and write nursing codes of ethics.

Rationale 3: Codes of ethics for nursing are written by nursing organizations.

Rationale 4: State legislatures do not write the nursing code of ethics.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4.1 Examine professional codes of ethics.

Question 2 Type: MCMA A nurse manager has started a dialogue regarding the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements among staff nurses. Which staff nurse statements would the manager evaluate as indicating poor understanding of this document?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. “This document describes nursing's own understanding of its commitments to society.”

2. “This document is so out of date, they never revise it.”

3. “At least the ANA understood that professional ethics are different in different regions of the country.”

4. “It is interesting that the ANA first addressed this code over 50 years ago.”

5. “This document has established standards by which we should practice.”

Correct Answer: 2,3 Rationale 1: The ANA's Code of Ethics for Nurses with Interpretive Statements is an expression of nursing's own understanding of its commitments to society.

Rationale 2: The document has been revised, most recently in 2001.

Rationale 3: The statements in the document are inclusive of all nurses and do not change according to region.

Rationale 4: This document was first published in 1950, well over 50 years ago.

Rationale 5: This document gives direction for those entering the nursing profession about their ethical accountability, sets a nursing standard for ethical practice, and informs the consumer about nursing’s ethical standards.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4.1 Examine professional codes of ethics.

Question 3 Type: MCSA The nurse uses the MORAL model for ethical decision making at the bedside. Which option reflects the first step (M) of this model?

1. The nurse investigates the opinions of everyone involved in the issue.

2. The nurse evaluates the situation after an intervention is implemented.

3. The nurse implements an intervention and thinks about its impact.

4. The nurse considers the benefits and risks of possible solutions to the problem.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1 Rationale 1: In the first step of the MORAL model the participants "massage the problem," thinking of it from everyone's point of view.

Rationale 2: Evaluation is the last step, occurring in the "L" stage.

Rationale 3: Implementation occurs in the "A" step.

Rationale 4: Considering benefits and risks occurs in the "O" stage.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.2 Analyze and apply decision-making models in resolving ethical dilemmas, with specific application of the MORAL model.

Question 4 Type: MCSA The hospital administration asks nursing services to assume housekeeping duties from midnight until 6:00 a.m.

Nurses are fearful that this is the first step to shifting complete 24-hour-per-day responsibility for housekeeping duties to nursing services. The nurses believe this would take away from their ability to provide quality nursing care to their patients. This scenario is an example of which ethical concept?

1. The MORAL argument 2. Slippery slope thinking 3. Relevance thinking 4. Reluctance model Correct Answer: 2 Rationale 1: MORAL is an ethical decision-making model.

Rationale 2: Slippery slope thinking or arguments suggest that an action will initiate a chain of events that cumulate in an undesirable event later.

Rationale 3: Relevance thinking is not an ethical concept.

Rationale 4: Reluctance model is not an ethical concept.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4.6 Evaluate slippery slope arguments in the application of ethical decision-making models.

Question 5 Type: MCSA The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments. The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying?

1. Patient advocate model 2. Values-based decision model 3. Rights protection model 4. Jurisprudence model Correct Answer: 3 Rationale 1: The patient advocate model is also known as the respect for persons model and focuses on inherent human dignity and respect. This model is not as specific as the other models.

Rationale 2: In the values-based decision model, the nurse assists the patient by discussing his or her needs and desires and helps the patient make choices that are most consistent with those wishes.

Rationale 3: The rights protection model is also known as the autonomy model, in which nurses assist patients in asserting their autonomy rights. In this situation the nurse is advocating for the patient’s right to direct care and to make care decisions.

Rationale 4: The jurisprudence model is not an advocacy model.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.3 Analyze the role of advocacy from an ethical perspective.

Question 6 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Type: MCMA The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse’s use of the values-based decision model in this situation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “Tell me about what foods are important to your family celebrations.”

2. “Let me help you select your lunch menu as I know you are not familiar with your diet yet.”

3. “You can make the decision of when you want to take your daily oral medication dose.”

4. “I have written down several websites that will provide accurate information about your disease.”

5. “Is there anything you want me to talk to your physician about today?”

Correct Answer: 1,4 Rationale 1: This statement helps the nurse determine the patient’s needs and desires. It will assist the nurse planning education for this patient.

Rationale 2: When the patient is not able to assist in making care decisions the nurse intervenes as an advocate for the patient’s best interests. This is an example of the respect for persons model.

Rationale 3: This statement best reflects the rights protection model or autonomy model.

Rationale 4: The values-based decision model is predicated on the sharing or information and assisting the individual to become empowered to speak on his or her own behalf.

Rationale 5: In the values-based decision model the nurse would educate the patient to speak for himself instead of relying on the nurse.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.3 Analyze the role of advocacy from an ethical perspective.

Question 7 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The nurse believes that a physician's order written at the end of a shift is contrary to the accepted standard of care and could potentially harm the patient. What should the nurse do?

1. Ask the nurse manager what to do.

2. Question the physician regarding the order.

3. Let the next shift make the decision regarding implementation of the order.

4. Complete the order as directed.

Correct Answer: 2 Rationale 1: The nurse should not have to rely on the nurse manager for direction in this situation. The nurse might inform the manager of the situation and the intended action, but would not need to ask for permission or direction.

Rationale 2: Nurses should be aware of hospital policy and procedures, as well as standards of care. If an order appears to violate either of these types of standards or appears dangerous to the patient, the nurse should question the physician about the order.

Rationale 3: Deferring the implementation to the next shift does not protect patient safety.

Rationale 4: Following orders without question is dangerous for the patient and legally dangerous for the nurse.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.3 Analyze the role of advocacy from an ethical perspective.

Question 8 Type: MCSA The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years.

During the review, the nurse begins to cry and tells the manager, "I just can't do this anymore. I can't sleep because I have such bad nightmares about patients. I can't eat and I've already lost 15 pounds." The nurse manager identifies these findings as being possible signs of which problem?

1. Moral distress 2. Too much focus on the patient 3. Developing incompetence Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. Problems at home Correct Answer: 1 Rationale 1: Signs and symptoms of moral distress include powerlessness, guilt, loss of self-worth, self-criticism, low self-esteem, and physiologic responses such as crying, depression, loss of sleep, nightmares, and loss of appetite.

Rationale 2: These statements do not indicate that the nurse has too much focus on patients.

Rationale 3: These comments by the nurse are a call for help and are not indicative developing incompetence.

Rationale 4: There is no evidence that this nurse is experiencing problems at home.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 4.4 Describe moral distress, its effect on nurses in practice settings, and ways of coping with moral distress.

Question 9 Type: MCMA Unrest on the nursing unit has progressed to moral outrage among the nursing staff. Which statements made by the nurse manager to the chief nursing officer indicates an understanding of this issue?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I am concerned that the quality of care we are providing will reduce if this unrest continues.”

2. "We may experience turnover in staff positions if this tension continues."

3. "I think we need to hire some more unlicensed personnel to shift the direct patient care work off the registered nurses."

4. "This will be a good opportunity to get rid of the unit trouble-makers."

5. "I am going to try to divert this energy by asking the nurses to help rewrite the policy and procedures manual."

Correct Answer: 1,2

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Moral outrage may cause the nurses to be unable to effectively care for patients.

Rationale 2: Moral outrage on a nursing unit may increase turnover as nurses resign to rid themselves of stress.

Rationale 3: Most nurses get into the profession because they like to care for patients, so asking nurses to stop caring for patients and start managing more unlicensed personnel will not decrease stress.

Rationale 4: When terminations occur, even justified terminations, it increases unit stress. This is not a time to increase stress.

Rationale 5: Moral energy takes maximum energy, so it is not a good time to ask the nurses to take on new responsibilities.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4.4 Describe moral distress, its effect on nurses in practice settings, and ways of coping with moral distress.

Question 10 Type: MCSA The nurse manager has identified high levels of moral distress on the nursing unit. Which change would be helpful in assisting nurses to cope?

1. Relieving the nurses from service on ethics committees 2. Increasing compensation for overtime hours worked 3. Sending nurses home when they exhibit signs of moral distress 4. Encouraging free discussion of ethical concerns Correct Answer: 4 Rationale 1: Allowing nurses to serve on ethics committees gives the group active participation in the issues.

Rationale 2: While everyone likes to be adequately compensated for work done, simply raising the rate of pay without addressing the causative factors will not have a positive impact on moral distress.

Rationale 3: Sending nurses home may increase their personal stress and will likely increase stress on nurses left to care for more patients to cover.

Rationale 4: Open communications assists nurses in dealing with moral distress.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4.4 Describe moral distress, its effect on nurses in practice settings, and ways of coping with moral distress.

Question 11 Type: MCSA In nursing school, the student learns that the nurse should always consider the possible outcomes of any nursing action taken. What ethical concept does this consideration support?

1. Slippery slope arguments 2. Perception model 3. Autonomy model 4. Therapeutic jurisprudence Correct Answer: 4 Rationale 1: Slippery slope arguments are concerns that one decision may lead to it being taken for granted that other actions are also considered ethical.

Rationale 2: There is not an ethical model titled perception model.

Rationale 3: The autonomy model refers to protecting the patient's rights of self-direction.

Rationale 4: The essence of therapeutic jurisprudence as it applies to nursing is that the nurse should always consider the possible outcomes of any nursing action.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 4.5 Discuss therapeutic jurisprudence and its place in ethical decision making.

Question 12 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nurses are revising the policy and procedure manual for the nursing unit. They work to ensure that the policies address more than one person and more than one set of circumstances. Which aspect of policy does this reflect?

1. Generality 2. Scale 3. Normativity 4. Decision determination Correct Answer: 1 Rationale 1: A policy has generality when it addresses more than one person and more than one set of circumstances.

Rationale 2: A policy has scale in that policies apply at different levels of an organization or society, and policies at one level can supersede policies at lesser levels.

Rationale 3: A policy has normativity when it formalizes judgments about what course of action is better among alternatives and the rules under which those alternatives will be determined.

Rationale 4: Decision determination is not an aspect of policy.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.7 Examine the role of health policy as it relates to resolving ethical dilemmas in nursing practice.

Question 13 Type: MCSA Nurses believe that there is a need to change policy for their clinical unit. What is the first step these nurses should take when considering this need for new policy?

1. Determining how many people are affected by the policy 2. Identifying the problem 3. Looking for ethical arguments regarding the policy 4. Finding out who has authority to change the policy Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 2 Rationale 1: There are steps that are necessary before determining how many people will be affected by the policy.

Rationale 2: Changing and writing policy is a thoughtful and methodical process that should follow a distinct framework. The first step of this framework is identifying the problem.

Rationale 3: Determining the ethical arguments involved in the policy or policy change is important, but this is not the first step.

Rationale 4: It will be very important for these nurses to determine who has the authority to change the policy, but this is not their first step.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.7 Examine the role of health policy as it relates to resolving ethical dilemmas in nursing practice.

Question 14 Type: MCMA In which ways can the nurse best act as a patient advocate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Participate in continuing education offerings pertinent to the current position.

2. Follow all physician orders precisely and completely.

3. Practice with the patient as priority concern.

4. Educate the patient throughout the hospitalization or other nurse–patient contact.

5. Become active in changing outdated policies or procedures.

Correct Answer: 1,3,4,5 Rationale 1: The nurse must remain aware of acceptable standards of care. One method of remaining current is participating in continuing education offerings.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: The nurse must be vigilant in determining if the physician order is appropriate and safe for the patient. If not, the nurse must use independent nursing judgment to decide on action.

Rationale 3: The patient should always be the nurse’s priority concern.

Rationale 4: The nurse should begin education early in the contact with patients and should continue education until discharge.

Rationale 5: The nurse must actively work to change any outdated policy or procedure still being followed by the institution.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 4.3 Analyze the role of advocacy from an ethical perspective.

Question 15 Type: MCMA The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as indicating ability to respond appropriately to the ethical dilemmas?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I think nurses and physicians should discuss care decisions with patients and families.”

2. “I worked an oncology unit for 10 years before we moved here.”

3. “I think that most dilemmas can be solved by taking the option that is most logical.”

4. “At my last job, we were required to take ethics training each year.”

5. “As long as nurses follow orders and policy and procedures ethical dilemmas are unlikely to arise.”

Correct Answer: 1,2,4 Rationale 1: The nurse that perceives she has influence within the health care setting is more likely to be able to respond appropriately to ethical dilemmas.

Rationale 2: A nurse with clinical expertise and competence will be more likely to respond appropriately to ethical dilemmas.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: A nurse that is concerned more about logical actions may not fully understand the ethics involved in a situation. Lack of ethical concern will adversely impact the nurse’s ability to respond appropriately to ethical dilemmas.

Rationale 4: Past experience with ethics education will make the nurse more likely to respond appropriately to ethical dilemmas.

Rationale 5: By making this statement, the nurse is dismissing the importance of monitoring for development of ethical problems. This nurse is not as likely to recognize her role in these issues.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 4.2 Analyze and apply decision-making models in resolving ethical dilemmas, with specific application of the MORAL model.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 05 Question 1 Type: MCSA In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor?

1. The individual's status as a professional 2. The individual's sense of ethical responsibility 3. The individual's sense of societal obligations 4. The individual's understanding of the law Correct Answer: 1 Rationale 1: Individuals of a specific profession have their own unique care standards. These define the minimal requirements of an acceptable level of care that can be expected of a given profession. They are developed to see that no unnecessary harm comes to the patient and to protect and safeguard the public as a whole.

Rationale 2: Too much variation of care practices may exist if standards were only based on an individual provider's sense of ethics.

Rationale 3: Too much variation of care practices may exist if standards were only based on societal obligations.

Rationale 4: Too much variation of care practices may exist if standards were only based on laws.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.1 Define standards of care from a legal and a nursing perspective.

Question 2 Type: MCSA What would the nurse identify as the most basic purpose of standards of care?

1. To protect and safeguard the public as a whole 2. To ensure that all patients receive state-of-the-art care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. To protect health care providers and prevent their giving less than quality care 4. To ensure administrative agencies are protected from frivolous lawsuits Correct Answer: 1 Rationale 1: The standards are meant to protect the public from receiving varying degrees of quality of care.

Rationale 2: State-of-the-art care changes rapidly and cannot be ensured by writing standards of care.

Rationale 3: Standards of care are not primarily written to protect health care providers.

Rationale 4: Frivolous lawsuits are not prevented by writing standards of care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5.1 Define standards of care from a legal and a nursing perspective.

Question 3 Type: MCMA Hospital administration requires that the committee seeking to change nursing policy and procedures review external sources for these standards. Where should the committee look for these standards?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Current nursing literature 2. Individual nurse’s experience and education 3. Federal organizations 4. The hospital’s position job descriptions.

5. State boards of nursing Correct Answer: 1,3,5 Rationale 1: Current nursing literature is a good source of timely information regarding standards of care.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: The individual nurse’s experiences and education is not likely to be sufficient documentation of the existence of a standard of care.

Rationale 3: Federal organizations, particularly those that reimburse for care, frequently set standards of care.

Rationale 4: Job descriptions are more likely to provide internal standards of care.

Rationale 5: State boards of nursing often set standards of care for nurses in their state.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.2 Compare and contrast internal versus external standards of care.

Question 4 Type: MCSA The hospital nursing group has reviewed current nursing and federal literature to establish standards of care for a newly organized patient care unit. The final report generated by this group should assure hospital administration that the standards meet which level of care?

1. Mutually acceptable 2. Worldwide 3. National 4. Locality Correct Answer: 3 Rationale 1: Mutually acceptable is a term to describe these standards.

Rationale 2: Since many external standards are written by state and federal groups they would not necessarily be described as worldwide.

Rationale 3: External standards transcend individual practitioners and single institutions. Since they are set by state and federal organizations, they are relevant to a specific society or country and are considered national standards.

Rationale 4: External standards expand beyond locality care standards.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5.2 Compare and contrast internal versus external standards of care.

Question 5 Type: MCSA Which situation supports the charge of malpractice against a professional nurse?

1. A failure on the part of the nurse to allay a patient's fears about an upcoming procedure 2. A failure on the part of the nurse to ensure that patients only received care for which they could pay 3. A failure on the part of the nurse to establish a therapeutic relationship with the patient 4. A failure on the part of the nurse to exercise reasonable and prudent care in treating a patient Correct Answer: 4 Rationale 1: There is no standard of care that says the nurse should allay all a patient’s fears. This may be impossible.

Rationale 2: Patients receive care regardless of payment.

Rationale 3: Development of a therapeutic relationship makes it easier to meet standards of care. However, it is not impossible to meet these standards without establishing a therapeutic relationship.

Rationale 4: Malpractice is based on the nurse breaching the standard to provide reasonable and prudent care or duty owed to the patient.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.3 Discuss the concept of the reasonably prudent nurse in defining standards of care.

Question 6 Type: MCSA What does the court consider in determining the nurse's legal liability for standards of care?

1. Professional conduct, but not experience or education Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. Professional education, experience, and specific conduct 3. Professional education, but not experience or conduct 4. Professional experience, but not education or conduct Correct Answer: 2 Rationale 1: Professional conduct is not the only consideration.

Rationale 2: Professional education, experience, and specific conduct all could be considered internal standards.

These would be used in determining liability.

Rationale 3: Education is not the only consideration.

Rationale 4: Experience is not the only consideration.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5.3 Discuss the concept of the reasonably prudent nurse in defining standards of care.

Question 7 Type: MCSA What is the single most critical factor in determining whether a particular nurse acted with reasonable care in a given situation?

1. The number of years the nurse has practiced as a professional nurse 2. How the nurse's conduct compares to that of nurses with similar background and experience 3. The experience the nurse has in the particular clinical setting in which the situation occurred 4. The ability of the nurse to perform according to his or her job description Correct Answer: 2 Rationale 1: Amount of experience is not the most important factor.

Rationale 2: While the characteristics of the individual nurse are relevant factors, the nurse's practice will be compared to internal and external standards of care that are practiced by other nurses possessing similar background and experience.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Clinical experience is not the most important factor.

Rationale 4: Ability to meet job description requirements is not the most important factor.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5-5 Describe the importance of standards of care to the individual nurse Question 8 Type: MCSA The state board of nursing has brought action against a nurse's license based upon violation of a regulation. What is true about this scenario?

1. Violation of a rule or regulation is not the same as violation of the state nursing practice act.

2. Rules and regulations are only suggested standards of care and do not have to be followed.

3. Rules and regulations are internal to the state board, not the nurse.

4. These rules and regulations have the force of law.

Correct Answer: 4 Rationale 1: Rules and regulations are promulgated by the state board of nursing. Violation of a rule or regulation is a violation of the state practice act.

Rationale 2: Rules and regulations govern the practice of nursing in the state. These rules and regulations must be followed.

Rationale 3: The nurse should internalize these rules and regulations as part of their individual practice.

Rationale 4: Each state publishes acceptable standards of care as part of the nurse practice act or through the rules and regulations promulgated by the state board of nursing. These rules and regulations have the force of law and must be followed.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 5.5 Describe the importance of standards of care to the individual nurse.

Question 9 Type: MCSA A lawsuit is brought against a nurse in a rural hospital. The nurse replies that the standard of care for rural nurses is different from that for nurses working in large urban facilities. Is this a defensible position?

1. No; rural nurses work in a slower paced environment, so they have more time to provide quality personal care.

2. Yes; the rural nurse does not have access to the same quality of inservice education as the urban nurse.

3. No; nurses in rural settings must meet the same standards as those practicing in large urban areas.

4. Yes; it is well known that rural health care is substandard as compared to urban health care.

Correct Answer: 3 Rationale 1: Rural nurses also work in fast-paced environments.

Rationale 2: There is no evidence that rural nurses do not have access to quality inservice. Nurses, regardless of their practice areas, are responsible for staying current in their practices.

Rationale 3: Nurses are accountable for all standards of care as they pertain to their profession, no matter their practice setting.

Rationale 4: Rural health care is not known to be substandard to urban care.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.4 Differentiate national versus local standards of care.

Question 10 Type: MCSA The nurse holds national certification as a wound care specialist and works in a small, rural hospital. What standard of skill and care applies to this nurse's practice?

1. It should be equal to that of any other wound care specialist in the nation.

2. It should be the same as that of any nurse who provides wound care.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. It should be equal to the practice of a wound care specialist working in the largest facility in the state.

4. It should be the same as that of an average nurse who also holds national wound care certification.

Correct Answer: 4 Rationale 1: This nurse does not have to have skills equal to all other wound care specialists. There may be those that have different or better skills.

Rationale 2: The nurse should have better skills and is held to a higher standard than a nurse who does not hold certification.

Rationale 3: There is no responsibility to be as skilled as a person working in a larger, better equipped hospital.

Rationale 4: A person holding himself or herself out as a specialist should be held to the same standard of skill and care as an average member of that specialty.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 5.4 Differentiate national versus local standards of care.

Question 11 Type: MCMA Which scenarios reflect the "two schools of thought" doctrine?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. An honest error in judgment prevented a nurse from providing quality care.

2. The hospital policy and procedures manual lists both local and national nursing care quality standards.

3. Nurses on one unit vary in their choice of ways to deliver quality care.

4. The nurse manager insists that standards are uniform and all nurses must act in the same manner.

5. The nurse expert witness in a case describes two methods of providing the intervention in question.

Correct Answer: 3,5

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The court evaluates whether the care given meets the prevailing standards, not whether the judgment was correct.

Rationale 2: Two schools of thought doctrine applies to differences in interventions, not in standards.

Rationale 3: Two schools of thought is a doctrine that allows the consideration that an individual can use different approaches when rendering care as long as the standards of care are met.

Rationale 4: Insisting that all nurses provide care in exactly the same manner does not reflect the two schools of thought doctrine.

Rationale 5: There may well be more than one way to provide an intervention and still meet the standard of care.

This is the basis of the two schools of thought doctrine.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.5 Describe the importance of standards of care to the individual nurse.

Question 12 Type: MCSA The hospital policy and procedure manual states that medications should be charted immediately after administration. The nurse routinely charts the medications as they are being prepared for administration. What does this practice reflect?

1. Use of the two schools of thought doctrine 2. Logical and appropriate variation in practice 3. An honest error in judgment 4. A violation of hospital policy and procedure Correct Answer: 4 Rationale 1: The two schools of thought doctrine is used when the court evaluates the standards of care given when the nurse chooses among the alternative modes of treatment. The alternative mode still has to meet standards of care.

Rationale 2: Violating hospital policy and procedure is not logical or appropriate.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The honest error in judgment rule allows the court to evaluate the standards of care given a patient even if there was an honest error in judgment. What the court evaluates is the care given and whether that care met the prevailing standards, not if the judgment was correct.

Rationale 4: This practice is a violation of the policy and procedures of the hospital and therefore is a violation of standard of care.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.5 Describe the importance of standards of care to the individual nurse.

Question 13 Type: MCMA The survivors of a patient who unexpectedly died in a hospital contact an attorney regarding a wrongful death against the hospital and two nurses. Review of the hospital's pertinent policy and procedures found them to be current. Review of the medical record revealed that policy and procedures were followed by the nurses. Based on this information, what is the likely strength of this case?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The survivors have a good case since hospital policy and procedures do not supersede national standards.

2. The survivors have a good case since the death was unexpected.

3. Since the patient is dead and cannot report variation from the standards no case is possible.

4. The case against the nurses is weak since they followed hospital policy and procedures.

5. The case against the hospital is weak since policies and procedures are current.

Correct Answer: 4 Rationale 1: There is no evidence that the hospital’s standards did not meet national standards. The scenario indicates the policies are “current.”

Rationale 2: Unexpected deaths occasionally occur in hospitals through no fault of anyone.

Rationale 3: There is no indication that the patient being dead and unable to report variation from standards will have any impact on the guilt or innocence of the nurses or hospital.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Since the nurses did follow the hospital policies and procedures some other violation would have to be found.

Rationale 5: The hospital is responsible for ensuring that policies and procedures are current. Since this is the case, the case would have to be based on some other occurrence.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 5.5 Describe the importance of standards of care to the individual nurse.

Question 14 Type: MCMA The administration of a health care facility takes the ethical obligation of protecting patients very seriously.

Which actions would help nurses meet standards of care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Create clearly written policy and procedure manuals.

2. Encourage practitioners to find alternate, quicker ways to implement interventions.

3. Refuse to tolerate those who are slow to adapt new standards of care.

4. Emphasize protection of the hospital when developing internal standards and policies.

5. Schedule regular reviews of policy and procedure manuals.

Correct Answer: 1,5 Rationale 1: A good way to ensure that practitioners meet current standards of care is to create policy and procedure manuals that are current and easy to understand.

Rationale 2: Taking quicker routes of implementation often results in deviation from standards of care.

Rationale 3: Intolerance of those who are ignorant of standards or slow to adopt new standards is divisive and is not helpful in encouraging these practitioners.

Rationale 4: The clear and overwhelming focus of all standards should be the patients' safety.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: Regular review of policy and procedure manuals will help ensure that these documents reflect current standards of care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 5.6 Discuss some of the ethical issues that arise concerning standards of care.

Question 15 Type: MCMA Which situation creates an ethical dilemma for the nurse serving as an expert witness in a jury trial?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The documentation in the medical record contradicts itself.

2. There are time lapses in the documentation of the event resulting in the suit.

3. The interventions implemented only minimally met the standards of care.

4. Outcomes for the patient were unexpected and severe.

5. Nurses from more than one department took care of the patient.

Correct Answer: 1,2,3 Rationale 1: Contradictions in the medical record may indicate that the record is not accurate. This creates an ethical dilemma for the expert witness.

Rationale 2: Time lapses in the medical record documentation may indicate that not all of the events that occurred were recorded. This would create an ethical dilemma for the expert witness.

Rationale 3: When the standards of care were met, but were minimal, and could have been more effective, a dilemma exists. Should the nurse report the standards as met or should the nurse explain that additional interventions could have been implemented?

Rationale 4: Just because the outcomes were unexpected does not create an ethical dilemma.

Rationale 5: The department where the nurses generally work should not create an ethical dilemma.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 5.6 Discuss some of the ethical issues that arise concerning standards of care.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 06 Question 1 Type: MCSA A nurse is leaving the parking lot at the hospital and carelessly runs over a patient who was just discharged.

Ironically, the nurse had been assigned to care for that patient that day. If the patient sues this nurse, which statement is true?

1. The nurse cannot be held liable for either malpractice or negligence based upon this set of facts.

2. The nurse can be held liable for both negligence and malpractice.

3. The nurse can be held liable for malpractice but not negligence.

4. The nurse can be held liable for negligence but not malpractice.

Correct Answer: 4 Rationale 1: The nurse may be held liable for this injury depending upon circumstances.

Rationale 2: While the nurse may be held liable for injuries, this liability does not fall under malpractice.

Rationale 3: Malpractice addresses a professional practice standard and professional status of the caregiver.

Rationale 4: The nurse may be considered negligent related to driving performance as driving action resulted in harm to an individual. This has nothing to do with the nurse's nursing practice and the care provided to the patient that day, so malpractice does not apply.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.1 Distinguish negligence from malpractice.

Question 2 Type: MCSA Punitive damages of one million dollars were awarded to the family of a patient who died following a nursing medication error. What is true of these punitive damages?

1. These damages are awarded to set an example to other nurses.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. The jury believes the nurse’s actions were an honest mistake.

3. This jury identified this case as representing simple negligence.

4. The damages are awarded instead of the nurse serving prison time.

Correct Answer: 1 Rationale 1: Punitive damages may be awarded if there is malicious, willful, or wanton misconduct; are usually considerable; and are awarded to deter similar conduct in the future.

Rationale 2: Awarding of punitive damages indicates that the jury absolutely does not think the error was an honest mistake but rather that it was willful in some manner.

Rationale 3: Awarding of punitive damages indicates that the jury absolutely does not think the error was simple negligence but rather that it was willful in some manner.

Rationale 4: Punitive damages do not substitute for prison time.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6.2 List the six elements of malpractice and give examples of each element in professional nursing practice.

Question 3 Type: MCSA A lawsuit has been filed claiming that a nurse’s actions caused the death of a neonate. Why does the attorney for the plaintiff want to prove proximate cause?

1. Proximate cause determines how far the nurse’s liability extends for consequences of the alleged negligent actions.

2. The need for expert witnesses is eliminated because harm can be approximated.

3. A direct line of causation, from incident to injury, is proved.

4. To identify if the harm could have been predicted to result from the action of the defendant Correct Answer: 1 Rationale 1: Proximate cause attempts to determine if the defendant is liable for occurrences that happen after the negligent act took place.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Even if the cause is determined, expert witnesses may be needed to testify on other aspects of the case, such as practice standards.

Rationale 3: The direct line of causation from incident to injury describes the concept of cause-in-fact. Proximate cause can be difficult to prove because there are often intervening variables.

Rationale 4: Foreseeability is the concept that the harm that occurred could have been predicted as a result of the action of the defendant.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6.2 List the six elements of malpractice and give examples of each element in professional nursing practice.

Question 4 Type: MCSA The registered nurse who works in the obstetrics department is walking by the emergency department waiting room when a person cries out, “Help me! My mother is not breathing!” Does this nurse have a duty to assist?

1. Yes, the general duty of care exists to help in times of crisis or imminent harm.

2. No, the nurse is out of the normal working environment and should not interfere.

3. No, the nurse has no more duty to assist in this situation than a lay person.

4. Yes, the nurse has the duty to provide the same standard of care as an emergency department nurse.

Correct Answer: 1 Rationale 1: Even if the nurse is not assigned to a particular patient, a general duty of care arises if the patient presents with an emergency or is in need of instant help. Therefore, this nurse has a duty to assist in this situation.

Rationale 2: The fact that the nurse is out of the normal working environment does not relieve the general duty of care.

Rationale 3: The nurse is an employee of the hospital; therefore, a general duty of care exists.

Rationale 4: This nurse has the duty to provide care at the level of a prudent registered nurse, not as an emergency department nurse.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.2 List the six elements of malpractice and give examples of each element in professional nursing practice.

Question 5 Type: MCSA The court is establishing liability in a case in which several actions caused the plaintiff’s injury. Which test of causation would be most useful in this case?

1. Proximal cause test 2. But-for test 3. Substantial factor test 4. Fact-of-cause Correct Answer: 3 Rationale 1: Proximal cause determines how far the liability extends. Fact-of is not a test of causation.

Rationale 2: The but-for test is used to determine if the act or omission actually caused the injury or harm sustained and is not as related to the percentage of cause.

Rationale 3: Substantial factor is considered the best test to pinpoint liability when several causes occur to bring a given injury. This test asks whether the defendant’s act or omission was a substantial factor in causing the ultimate harm or injury.

Rationale 4: Fact-of-cause is not a test of causation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6.3 Define the three tests currently used by courts in establishing cause-in-fact.

Question 6 Type: MCMA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

A plaintiff’s attorney decides to use the doctrine of res ipsa loquitur in a case against the urologist who perforated a patient’s urethra during a cystoscopy. What must the plaintiff prove?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. This complication does not generally occur unless someone provided negligent care.

2. The locality rule was in effect at the time of the procedure.

3. Several agencies, from the manufacturer to the physician, were involved in the negligence.

4. The plaintiff had no control over the development of the perforation.

5. The event causing the perforation was deliberate.

Correct Answer: 1,4 Rationale 1: In order to prove the doctrine of res ipsa loquitur, the plaintiff must prove that perforation of the urethra does not occur unless someone was providing negligent care.

Rationale 2: The locality rule is not pertinent to the use of res ipsa loquitur. There is no need to prove that the event was deliberate.

Rationale 3: In order for this doctrine to be enacted, the injured party must prove that the accident was caused by an agency or instrumentality within exclusive control of the defendant.

Rationale 4: The instrument that caused the injury must be shown to have been under the management and control of the alleged wrongdoer, not the injured party.

Rationale 5: There is no need to prove that the event was deliberate.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.4 Analyze the doctrine of res ipsa loquitur and give an example of when the doctrine would apply to professional nursing practice.

Question 7 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

A nurse has been named as defendant in a lawsuit claiming patient injury from misuse of equipment. The nurse says, “The small hospital where I work does not provide the same kind of continuing education training on use of equipment as larger, more modern hospitals.” The attorney representing this nurse may choose to use which rule or doctrine?

1. Res ipsa loquitur 2. The locality rule 3. Foreseeability 4. Tortfeasor Correct Answer: 2 Rationale 1: Res ipsa loquitur was developed to prevent patients who have been harmed from being further harmed through their inability to show how the injury occurred. It is not related to continuing education differences between small hospitals and larger hospitals.

Rationale 2: The locality rule attempts to set a standard for the professional similar to that of other professionals practicing in the same geographic area of the country. This rule arose because of wide variations that once existed in patient care, depending on whether the hospital was in an urban or a rural setting. Most states have abolished locality rules.

Rationale 3: Foreseeability is the concept that certain events may reasonably be expected to cause specific outcomes.

Rationale 4: The tortfeasor is the person committing a civil wrong.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 6.5 Compare and contrast the locality rule to a national standard.

Question 8 Type: MCMA The nurse is providing care to a patient whose family has previously brought suit against another hospital and two physicians. How should the nurse provide care to this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Spend as little time as possible interacting with the patient and family so that there will be less chance of saying the wrong thing or performing in an incompetent manner.

2. Provide care in a compassionate, competent manner.

3. Assign the patient to a different nurse each day so that no one nurse has to work under this stress.

4. Keep the patient well informed by explaining all interventions before and during their completion.

5. Review standards of care that pertain to this patient before providing care.

Correct Answer: 2,4,5 Rationale 1: Avoiding the patient does not resolve the issue and may actually increase the patient’s feeling that health care is not reliable.

Rationale 2: Giving the same compassionate, competent care that all patients receive is the best strategy in caring for suit-prone patients.

Rationale 3: Assigning a different nurse each day may give rise to suspicions by the patient and also provides less continuity of care.

Rationale 4: Keeping patients well informed helps to reassure them and make them less fearful.

Rationale 5: The nurse should review any standards of care that apply to this patient or to interventions before providing care. The nurse should ensure that standards of care are met or exceeded.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.6 List ways to avoid or lessen the potential of future malpractice cases.

Question 9 Type: MCMA Which scenarios would the nurse identify as a quasi-intentional tort rather than an intentional tort?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A visitor refuses to leave the patient's room after upsetting the patient and being asked to leave.

2. The physician accuses the nurse of incompetence in front of the patient’s family.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The nurse tells the patient that if he does not starting drinking fluids, an intravenous line will be necessary.

4. The nurse physically restrains a patient so that intravenous access can be obtained.

5. The nursing student takes a cellphone picture of a patient’s leg wound to show her classmates.

Correct Answer: 2,5 Rationale 1: Refusing to leave after being asked is trespass to land, which is an intentional tort.

Rationale 2: Defamatory language about a living person that would adversely affect his or her reputation is defamation. Defamation is a quasi-intentional tort.

Rationale 3: This could be construed as a threat, which would be considered assault. Assault is an intentional tort.

Rationale 4: Physically restraining a patient can be construed as false imprisonment or battery, both of which are intentional torts.

Rationale 5: Using patient’s pictures without consent is invasion of privacy, which is a quasi-intentional tort.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.7 Define and differentiate between intentional and quasi-intentional torts.

Question 10 Type: MCSA Upon entering a patient's room to complete discharge instructions, the nurse discovers the patient in tears. The business office has stated that the patient cannot leave until someone pays a portion of the hospital bill. What should the nurse do?

1. Call social services to request an immediate financial evaluation.

2. Continue preparations for discharge, comforting the patient as much as possible.

3. Stop discharge preparations until the patient is cleared by the billing office.

4. Cancel the discharge plans and notify the physician of the patient’s status.

Correct Answer: 2

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: It is not within the nurse’s scope of practice to request a financial evaluation. This situation could be construed to represent false imprisonment.

Rationale 2: The nurse must continue to practice within the nursing scope of practice. This situation could be construed to represent false imprisonment.

Rationale 3: This scenario could be construed as false imprisonment. The nurse should not stop or slow discharge preparations.

Rationale 4: Cancelling the discharge order is not within the nurse’s scope of practice. This situation could be construed as false imprisonment.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.8 List the more commonly occurring intentional torts in health care settings and give an example of each.

Question 11 Type: MCMA Which action could result in the nurse being charged with conversion of property?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse removes the patient’s shirt and bra during treatment of a fractured ankle.

2. The nurse removes a package of cigarettes from a patient’s robe pocket.

3. The nurse takes the patient’s picture without permission.

4. The nurse searches a patient’s suitcase for evidence of illegal drugs.

5. The nurse places a patient in four-point restraints to place a nasogastric tube.

Correct Answer: 1,2 Rationale 1: Removing the patient’s clothing, especially if done against the patient’s will, could be construed as conversion of property. This is especially the case if there is no apparent reason for the clothing to be removed.

Rationale 2: Conversion of property means that the nurse took something of the patient's without permission.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Taking a patient’s picture without permission is an invasion of the individual’s privacy.

Rationale 4: Searching the patient's suitcase could be considered invasion of privacy, but unless the nurse took something out of the suitcase, it is not conversion of property.

Rationale 5: Restraining the patient may result in a charge of false imprisonment.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.8 List the more commonly occurring intentional torts in health care settings and give an example of each.

Question 12 Type: MCSA An out-of-state caller becomes irate when the nurse cannot provide information over the telephone about a hospitalized friend. The caller says, “If you know what is good for you, you had better tell me.” Has a civil assault occurred?

1. Yes, there is an indication that the caller has the physical strength to do harm.

2. Yes, the threat of harm is assault.

3. No, actual physical contact must be made for it to be assault.

4. No, the caller is out of state and cannot reach the nurse.

Correct Answer: 4 Rationale 1: In this case, the caller is out of state, so it is not reasonable that immediate harmful or offensive contact will occur. While this caller may possess the physical strength to do harm, the caller is too far away to act on the threat immediately.

Rationale 2: Even though this statement may be uncalled for or frightening, it most likely does not meet the definition of assault as the caller is too far away to do immediate physical harm.

Rationale 3: Battery is when actual physical contact or harm occurs.

Rationale 4: Assault is defined as the action or motion that creates a “reasonable apprehension in the other person of immediate harmful or offensive contact to the plaintiff-person.” While this caller may possess the physical strength to do harm, the caller is too far away to act on the threat immediately.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 6.8 List the more commonly occurring intentional torts in health care settings and give an example of each.

Question 13 Type: MCSA Which common practice puts the nurse at liability for invasion of patient privacy?

1. During care the nurse reveals information about the patient to those in the room.

2. The nurse releases information about the patient to nursing students who will be caring for the patient the next day.

3. The nurse conducts a patient care session about a patient whose care is difficult and challenging.

4. Confidential information regarding an admitted patient is released to third-party payers.

Correct Answer: 1 Rationale 1: Giving out information about a patient without permission is an invasion of privacy.

Rationale 2: Providing information to those who will be providing care for the patient is not an invasion of privacy.

Rationale 3: Providing information about a patient to those who will be involved in caring for a patient is not an invasion of privacy.

Rationale 4: Release of information about a patient to a third-party payer is permissible because the patient signs consent for this release on admission.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.9 List the more commonly occurring quasi-intentional torts in health care settings and give an example of each.

Question 14 Type: MCMA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The health care facility has sponsored a continuing education offering on emergency management of pandemic influenza. At lunch, a nurse is overheard saying, “I'm not going to take care of anyone that might have that flu. I have kids to think about.” What is true of this statement?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse has a greater obligation than a lay person to care for the sick or injured in an emergency.

2. This statement reflects defamation and may result in legal action against the nurse.

3. The nurse has the right to refuse to care for anyone that could endanger the nurse.

4. This statement is a breach of the Code of Ethics for Nurses.

5. The nurse has this right as no nurse–patient contract has been established.

Correct Answer: 1,4 Rationale 1: Since nurses have greater ability to provide care, their obligation to provide care is higher than that of lay persons.

Rationale 2: The nurse has not said anything negative about flu victims, so the statement is not an example of defamation.

Rationale 3: Health care professionals have assumed the risk of care for these individuals based on their choice of a profession dedicated to the care of the sick.

Rationale 4: Consistent with the Code of Ethics for Nurses, members of the nursing profession should be available in times of emergency as the profession is a social contract with the public.

Rationale 5: The nurse, by virtue of licensure and employment, is held to a higher standard during emergencies.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6.10 Discuss some of the ethical issues involved in nursing and tort law.

Question 15 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

After 3 years of uneventful employment, the nurse made a medication error that resulted in patient injury. What hospital response to this event is ethical?

1. The hospital was supportive and assistive as the nurse coped with this event.

2. The nurse was dismissed for incompetence.

3. The hospital quality department advised the nurse not to tell the patient about the error.

4. The nurse was reassigned to an area in which there is no direct patient care responsibility.

Correct Answer: 1 Rationale 1: Nurses must be held accountable for errors but should be treated in a professional and assistive manner.

Rationale 2: With this nurse’s employment record, dismissal is not an appropriate or ethical step for the hospital.

Rationale 3: Disclosure of errors is the ethical approach.

Rationale 4: With this nurse’s employment record, transfer to a no-patient-care area is not an appropriate or ethical step for the hospital.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6.10 Discuss some of the ethical issues involved in nursing and tort law.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 07 Question 1 Type: MCSA The nurse has been sued for defamation after charting that the patient is a prostitute. What is the nurse's best defense in this case?

1. Define the contributing factors.

2. Prove that the statement is true.

3. No defense exists for defamation.

4. Provide hearsay evidence.

Correct Answer: 2 Rationale 1: Contributory negligence is a defense used when there is a need to identify fault in the injury.

Rationale 2: Truth is one of the primary defenses for defamation. The nurse must prove that the statement identifying the patient as a prostitute is completely true.

Rationale 3: There are defenses against the charge of defamation.

Rationale 4: Hearsay is not a way of validating truth.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 2 Type: MCSA A patient refused to ambulate postoperatively and subsequently developed bilateral pneumonia, causing his hospital stay to be lengthened. After discharge, the patient filed a lawsuit claiming his primary nurse was negligent in allowing him to develop pneumonia. What is the nurse's best defense in this case?

1. The patient was told that complications could arise when signing the informed consent form.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. The patient should have anticipated a longer hospital stay if complications arose.

3. The patient was aware of the substandard care at the time it occurred.

4. The patient’s conduct contributed to his complications.

Correct Answer: 4 Rationale 1: While the patient assumes risk with informed consent, which could be a potential defense, the patient did not follow advice or instructions.

Rationale 2: The logic that complications will result in longer hospital stays does not help support the nurse’s defense.

Rationale 3: Admitting to the knowledge that care was substandard would hinder the defense, not help it.

Rationale 4: The patient’s own negligence in this case could be argued as a contributory cause. This factor becomes the best defense in this scenario.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 3 Type: MCSA A patient, injured at work, was seen by the factory occupational nurse. The nurse treated the wound and instructed the patient to get a tetanus antitoxin injection at the county health department. The patient failed to follow instructions, developed tetanus, and subsequently filed a suit against the nurse. What is the most likely result of the ensuing trial?

1. The nurse is not liable, because tetanus is a reportable disease and the health department should have insisted the patient take the injection.

2. The nurse is liable, because there was no follow-up to ensure that the patient received the injection.

3. The nurse is liable, because tetanus is easily treatable after diagnosis.

4. The nurse is not liable for damages, because the nurse has a right to expect that instructions will be followed.

Correct Answer: 4 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Unless the disease is one that is a danger to the general public if not treated, the patient can refuse treatment at the health department as well.

Rationale 2: While follow-up is common, the patient still retains the right to follow or not follow instructions.

Rationale 3: Tetanus is not easily treatable, but the ease of treatment is not a factor in this case.

Rationale 4: The court recognizes that the patient’s own negligence could contribute to adverse outcomes, as in this case. The patient has a right to refuse or follow advice or instructions but must bear the results of that decision.

When this occurs, the legal system applies the concept of contributory or comparative negligence.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 4 Type: MCSA When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse’s best defense for applying restraints?

1. Necessity 2. Consent 3. Self-defense 4. Privilege Correct Answer: 3 Rationale 1: Necessity is a defense that allows a nurse to interfere with a patient’s property rights to avoid a threatened injury, which does not apply to this scenario.

Rationale 2: The nurse did not get consent.

Rationale 3: Self-defense and defense of others may be justifiable to protect oneself and others in the area from harm.

Rationale 4: It is not a privilege to act in this manner.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 5 Type: MCSA A patient became confused and used a pocket knife to threaten others. The nurse confiscated the knife. What is the nurse’s best defense for this action?

1. Privilege 2. Self-defense 3. Necessity 4. Consent Correct Answer: 3 Rationale 1: It is not a privilege to act in this manner.

Rationale 2: Self-defense is taking an action to protect oneself, but there is another option that is more specific.

Rationale 3: Necessity is a defense that allows a nurse to interfere with a patient’s property rights to avoid a threatened injury.

Rationale 4: The nurse does not need consent to act in this situation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 6 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do?

1. Chart that the child is a victim of child abuse, so that there is a record of the abuse should such behavior reoccur.

2. Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities.

3. Do nothing, because the nurse cannot prove the child was really abused, and saying anything could open the institution to a possible defamation lawsuit.

4. Downplay the child’s comments, because children often exaggerate.

Correct Answer: 2 Rationale 1: It is not the nurse’s role to diagnose that child abuse exists. Charting this suspicion as fact could put the nurse at legal liability.

Rationale 2: Mandated by law, nurses and other health care professionals must report suspected abuse.

Rationale 3: Doing nothing is a violation of child abuse protection laws.

Rationale 4: The nurse must take all statements seriously regardless of the age of the patient.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 7 Type: MCMA In which scenarios would the nurse assume that apparent consent has been provided?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient follows directions to swallow sips of water as the nurse inserts a nasogastric tube.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. The patient’s family member signed the consent to treat.

3. The patient smiled and held out his arm when the nurse said, “I need to start an intravenous line.”

4. The patient voluntarily signed a consent form for an invasive procedure.

5. An unconscious patient is brought to the hospital following a motor vehicle accident.

Correct Answer: 1,3 Rationale 1: Apparent consent is given by conduct. This patient is following instructions given to help in the placement of the tube, so conduct would indicate consent.

Rationale 2: Depending upon which family member is involved, this situation may be actual consent. For example, a parent signing the consent for a minor child.

Rationale 3: Smiling and holding out the arm is an apparent consent to starting an intravenous line.

Rationale 4: This is an example of actual consent.

Rationale 5: This is a situation of implied consent. The patient is unable to give consent, but would likely give consent if able.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 8 Type: MCSA A lawsuit is being tried in a state that recognizes pure comparative negligence. The attorney for the nurse defendant is attempting to prove the plaintiff has some responsibility for the injury that occurred. If this proof can be established, can the plaintiff recover damages?

1. Only if the plaintiff is over 51% at fault 2. Yes, even if the plaintiff is 99% at fault 3. Only if the plaintiff is less than 50% at fault 4. No; if the plaintiff has any fault, damages cannot be recovered.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 2 Rationale 1: Pure comparative negligence does not set a 51% point of fault as determining recovery.

Rationale 2: Under pure comparative negligence, the plaintiff is allowed to recover the portion of the injury attributable to the defendant’s negligence, even if the plaintiff was 99% at fault.

Rationale 3: In modified comparative negligence, if the plaintiff's negligence is found to exceed that of the defendant, the plaintiff is barred from recovery. In some states, that bar is 50%.

Rationale 4: Under pure comparative negligence, the patient can recover damages if at some amount of fault in the injury.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 9 Type: MCSA The cardiac telemetry unit nurses repeatedly cautioned a patient not to leave the floor because input from telemetry monitors is limited to that area. The patient went to the cafeteria and suffered a fatal dysrhythmia. What is the nurses’ best defense in the negligence lawsuit brought for the patient’s survivors?

1. Assumption of risk 2. Defense of the fact 3. Immunity 4. Exculpatory agreement Correct Answer: 1 Rationale 1: In this case, the nurses warned the patient “repeatedly” of the danger and the patient ignored the warning. Assumption of risk states that plaintiffs (in this case the patient) are partially responsible for consequences if they understood the risks involved when they proceeded with the action.

Rationale 2: Defense of the fact is used when there is no indication that the health care provider’s actions were the cause of the patient’s outcome. In this case, it might be argued that the nurses should have noticed the patient was away from the unit.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Immunity statutes serve to dismiss certain causes of action. An example is the Good Samaritan statute, which does not apply in this situation.

Rationale 4: Exculpatory contracts are signed to limit the amount of recoverable damages and are generally considered invalid.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7.1 Define the term defense and give examples of defenses that may be used against intentional, quasi-intentional, and negligence torts.

Question 10 Type: MCSA The 4-year-old child developed a seizure disorder that may be related to a medication error that occurred 3 years ago. What is true of the statute of limitations in this case?

1. The statute of limitations in this case won’t begin to be calculated until the child reaches the age of 13.

2. There is no statute of limitations on medication errors that occur in children prior to the age of 2.

3. Since the incident occurred over 2 years ago, the statute of limitations has expired.

4. Depending upon the state, the statute of limitations might not begin to be calculated until the child reaches the age of majority.

Correct Answer: 4 Rationale 1: There is no general rule that statutes of limitations do not begin to be calculated until the child reaches age 13.

Rationale 2: There is no ruling that indefinitely extends statute of limitations for children under age 2.

Rationale 3: It is not possible to say that this statement is true as statutes of limitations vary from state to state.

Rationale 4: Statutes of limitations are different for different states and different occurrences. For children, statutes of limitations may not begin to be calculated until the child reaches the age of majority. This rule is changing, but still exists at present.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7.2 Review the concept of statute of limitations, including the importance this statute has in the health care field.

Question 11 Type: MCMA While vacationing in a different state, the nurse encounters an emergency in which a person needs immediate care.

What should the nurse assume about the Good Samaritan law of this state?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A Good Samaritan law exists in the state.

2. The nurse has a legal obligation to provide emergency care.

3. The nurse will be protected by the Good Samaritan law in the state of licensure.

4. The Good Samaritan law in this state may be different than the one in the state of licensure.

5. There is a standard definition of what constitutes an emergency.

Correct Answer: 1,4 Rationale 1: All states have enacted Good Samaritan laws.

Rationale 2: There is no state that requires anyone to provide emergency care. Two states do require individuals to assist others exposed to grave physical harm, but this assistance may entail no more than calling 911.

Rationale 3: The Good Samaritan law that is in effect for this situation is the one in the state where the incident occurred.

Rationale 4: It is very likely that laws in the two states will be different.

Rationale 5: Acts may not define criteria to determine whether an emergency actually exists and what constitutes the scene of an emergency.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 7.3 Examine the Good Samaritan laws and their relevance for health care deliverers.

Question 12 Type: MCMA The nurse is stopped at the scene of a motor vehicle accident with injury. What actions should the nurse take?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Start assessing the injured as is required by all registered nurses.

2. Ask the injured person for permission to help.

3. Move the patient only if it is necessary to prevent further harm.

4. Instruct someone to call for additional aid.

5. Graciously accept any payment the injured patient may offer.

Correct Answer: 2,3,4 Rationale 1: There is no common-law duty to stop and render aid. The nurse should make a quick decision about whether to stay and help.

Rationale 2: It is important to ask for permission to help. The nurse should not force services if they are refused.

Rationale 3: Care should be provided in the exact site where the patient was found, if possible. Moving the patient can result in additional injury, so the patient should not be moved unless absolutely necessary.

Rationale 4: The nurse should stay with the injured persons while someone else summons aid.

Rationale 5: The nurse should not accept any payment or gifts from the patient or their family as this may change care from a Good Samaritan act to fee-for-service which may change liability status.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 7.3 Examine the Good Samaritan laws and their relevance for health care deliverers.

Question 13 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The plaintiff was injured by a defective intravenous catheter. In order to win a product liability case, what must the plaintiff prove first?

1. The intravenous catheter was defective.

2. The intravenous catheter was used incorrectly.

3. The intravenous catheter was sold to him.

4. The hospital purchases the poorly manufactured intravenous catheters.

Correct Answer: 3 Rationale 1: Proving the catheter was defective is not the first step that must be accomplished in a products liability case.

Rationale 2: There is a different first step than proving that the catheter was used incorrectly.

Rationale 3: The first hurdle for the plaintiff in product liability cases is to prove that there has been a sale of a product rather than the mere delivery of a service. Product liability action does not exist if there is no sale of a product.

Rationale 4: There is a different first step in a products liability case.

Global Rationale: Cognitive Level: Applying Client Need: Health Promotion and Maintenance Client Need Sub: Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 7.4 Define and explain product liability and collective and alternative liability defenses.

Question 14 Type: MCMA In which situations would the manufacturer of a drug designated as unavoidably unsafe be held liable for injuries to a patient receiving the drug?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The physician did not educate the patient about the risks of the medication.

2. The physician prescribed the medication after being told that problems with the drug had been corrected.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The nurse was not warned of risks by the pharmacist.

4. The nurse did not educate the patient about the risks of the drug.

5. The information printed in the drug information sheet accompanying the medication was wrong.

Correct Answer: 2,5 Rationale 1: In this case the physician would be at fault for not educating the patient.

Rationale 2: The manufacturer holds the responsibility to warn the health care provider who prescribes the drug about problems that may occur.

Rationale 3: The pharmacist does not hold the responsibility of educating the nurse about risks.

Rationale 4: The manufacturer is not responsible for the nurse’s actions.

Rationale 5: If erroneous information was distributed with the drug, the manufacturer has not met its obligation to provide a warning to the health care provider.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 7.4 Define and explain product liability and collective and alternative liability defenses.

Question 15 Type: MCMA A representative from a drug company tells a group of nurses that one of the company’s products is unavoidably unsafe. How should the nurses interpret this information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The drug has risks that cannot be eliminated.

2. The benefits of using the medication outweigh its risks.

3. The medication has been recalled by the manufacturer.

4. Patients who have been administered this medication are very likely to have severe side effects.

5. There is no safer medication to use an alternative.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1,2,5 Rationale 1: One of the criteria for an “unavoidably unsafe” product is that it has risks that cannot be eliminated.

Rationale 2: One of the criteria for an “unavoidably unsafe” product is that its benefits greatly outweigh its risks.

Rationale 3: There is no indication that this medication has been recalled.

Rationale 4: There is no assurance that patients exposed to this medication will have severe side effects.

Rationale 5: One of the criteria for an “unavoidably unsafe” product is that no safer product exists as an alternative.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 7.4 Define and explain product liability and collective and alternative liability defenses.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 08 Question 1 Type: MCSA The nurse is preparing a patient for a procedure. The patient has signed a consent form but states, “I don’t really know anything about this procedure. I wonder if there is something else I could do instead?” How should the nurse proceed?

1. Continue with the preparation as consent may not be revoked.

2. Try to convince the patient to go through with the procedure.

3. Stop the preparation as the patient can revoke consent at any time.

4. Have the patient document the question in writing since the original consent was written.

Correct Answer: 3 Rationale 1: Since the patient has expressed lack of knowledge about the procedure, the preparation should not be continued.

Rationale 2: The nurse should not attempt to talk the patient into a procedure.

Rationale 3: The patient always retains the right to verbally revoke consent at any time during the course of treatment. The preparation should be stopped and the physician notified.

Rationale 4: Whether the question is verbal or written is not pertinent and does not make this a situation of informed consent.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.1 Define informed consent, comparing and contrasting informed consent with consent.

Question 2 Type: MCSA The patient presents to the emergency department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Oral 2. Implied 3. Partial 4. Expressed Correct Answer: 2 Rationale 1: There is no indication that the patient gave oral consent before collapsing.

Rationale 2: Implied consent is consent that may be inferred by the patient’s conduct or that may be legally presumed in emergency situations. Because this patient presented to the ED, consent is implied.

Rationale 3: “Partial” is not a type of consent.

Rationale 4: Expressed consent is consent given by direct words, written or oral.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.2 Describe means of obtaining informed consent, including expressed, implied, oral, written, complete, and partial.

Question 3 Type: MCMA As a result of shared medical decision making, a patient undergoes a surgical procedure that results in paralysis.

What must the patient prove to bring a successful malpractice suit based on informed consent?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient had no part in the decision to operate.

2. The procedure’s known risk of paralysis was not explained to the patient.

3. Since the decision making was shared, no malpractice suit is possible.

4. It was the procedure that caused the harm.

5. That the amount of damage to the patient cannot be determined.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 2,4 Rationale 1: This patient participated in shared decision making and therefore had a part in the decision to operate. There is no need to prove that this participation did not occur in order for malpractice to be proved.

Rationale 2: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the health care provider breached responsibility to know and disclose risks.

Rationale 3: It is possible for malpractice to have occurred even if the consent to operate was based on shared decision making.

Rationale 4: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the the procedure caused the harm.

Rationale 5: To bring a successful malpractice suit based on informed consent, the plaintiff must prove that plaintiff suffered injury for which damages can be assessed.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.3 Compare and contrast standards of informed consent.

Question 4 Type: MCMA In which instances would the nurse feel comfortable providing care without first obtaining informed consent?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient is deaf.

2. The physician feels the disclosure of information required for informed consent might cause the patient to commit suicide.

3. A visitor suffers a cardiopulmonary arrest in the emergency department waiting room.

4. The patient has signed a waiver at the suggestion of the primary nurse.

5. Informed consent was obtained when the patient had the same procedure last week.

Correct Answer: 2,3,5 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The fact that the patient is deaf does not remove the requirement to obtain consent.

Rationale 2: Therapeutic privilege exists when the health care provider believes the disclosure of information poses immediate and serious harm to the patient.

Rationale 3: Emergency situations, such as a cardiopulmonary arrest, constitute an exception to the need for informed consent.

Rationale 4: The patient must initiate a waiver; it cannot be suggested by staff.

Rationale 5: Prior patient knowledge involves the patient to whom the risks and benefits were fully explained the first time the patient consented to the procedure.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.4 Describe four exceptions to informed consent.

Question 5 Type: MCSA The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, "I'll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot." What action should be taken by the nurse?

1. Remind the patient that the surgery is to remove his lower leg, not just his toe.

2. Check to see if the patient signed consent for the above-the-knee amputation.

3. Continue the transfer, as the patient is not reliable since opioid medications have been administered.

4. Stop the transfer and notify the surgeon of the patient’s comment.

Correct Answer: 4 Rationale 1: This action is based on the assumption that the patient has full understanding of the surgery and that his memory is affected by medication. This may not be the case, so this is not the best option.

Rationale 2: The nurse has assessed that this patient does not understand the planned surgery. The presence of a signed consent does not change that fact.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: It is unknown if the presence of medications has impaired the patient’s judgment. This is not the best option.

Rationale 4: The nurse should advocate for the patient by stopping the transfer and contacting the surgeon. The surgery should not be done until it is certain that the patient is fully informed.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.5 Describe who has responsibility for obtaining informed consent.

Question 6 Type: MCMA The state now mandates a detailed consent for all hospitals receiving state funding. Which information should the committee designing this form include?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Description of risks and alternatives of the proposed procedure, including no treatment 2. Estimated cost of the procedure 3. Date and time the procedure is scheduled 4. Signature of the competent patient or a legal representative 5. Name and full description of the proposed procedure Correct Answer: 1,4,5 Rationale 1: Full informed consent includes a description of the risks associated with the proposed procedure. If alternative procedures exist, they should also be listed. If no treatment is an option, that should also be noted.

Rationale 2: The cost of the procedure is not part of the consent form.

Rationale 3: The date and time of a procedure are often fluid and are not included in the consent form.

Rationale 4: The consent form should include the signature of the patient, if competent. The form should also include space for the signature of a legal representative to be used if the patient is not competent.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: The exact name and a full description of the proposed procedure should be included in the consent form.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 8.6 Describe types of consent forms in use in health care settings.

Question 7 Type: MCMA In which instance would the nurse accept informed consent from a 13-year-old patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. If the child is consenting to treatment for an emergency surgery 2. If the child is consenting to treatment for a venereal disease 3. Under no circumstances can a 13-year-old give valid consent.

4. When the parents are not readily available 5. The patient is seeking treatment for drug dependency.

Correct Answer: 2,5 Rationale 1: A 13-year-old cannot give consent for surgery, even in an emergency. In the case of an emergency, if the parents are not available to give consent, the emergency doctrine applies and surgery would proceed.

Rationale 2: The law recognizes a minor’s right to provide consent in some circumstances, including treatment for venereal diseases.

Rationale 3: In some circumstances minors can give consent for treatment.

Rationale 4: An attempt to reach parents must be made even if they are not readily available.

Rationale 5: Minors can give consent for diagnosis and treatment of drug dependency, drug addiction, or any condition directly related to drug usage.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.7 Analyze whose signature must be obtained to ensure informed consent.

Question 8 Type: MCSA In which case might the nurse expect the state to deny a patient’s right of refusal for medical treatment?

1. The patient has an illness that poses a threat to public health if left untreated.

2. A competent adult refuses a blood transfusion based on religious belief.

3. The patient refuses treatment to slow the advancement of an inoperable brain tumor.

4. The patient’s insurance refuses to pay if treatments are refused.

Correct Answer: 1 Rationale 1: If the patient has an illness that poses a threat to public health, the state may require the patient to submit to treatment.

Rationale 2: In most instances, the competent adult patient has right of refusal for treatment of any illness or condition, including blood transfusion.

Rationale 3: In most instances, the competent adult patient has right of refusal for treatment of any illness or condition. This is true even if the refusal could cost the patient's life.

Rationale 4: Insurance reimbursement is not a factor in whether a patient has the right to refuse treatment.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.8 Describe one’s right to refuse consent for medical care.

Question 9 Type: MCSA A nursing faculty has included a requirement that students participate as medical research subjects as a part of their clinical practice grade. Does this requirement meet the guidelines for research participants’ rights?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Yes, as long as there is no physical risk to the students.

2. Probably, depending upon university regulations on course content.

3. Yes, if the participation is outlined as a course requirement in the syllabus.

4. No, the individual must be given the choice to participate or not.

Correct Answer: 4 Rationale 1: The students’ rights to refuse this assignment are not affected by the risk of physical harm.

Rationale 2: University regulations do not supersede students’ rights.

Rationale 3: The syllabus cannot supersede student rights.

Rationale 4: The rights of a person involved in research include the right to refuse to participate without penalty.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 8.9 Describe the patient’s right to either consent to or deny consent for research.

Question 10 Type: MCMA Which patient behavior would the nurse assess as possible indication that the patient will have health information literacy deficiency?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient asks questions that are not pertinent to the information provided.

2. A patient reports that she took many herbal medications before emigrating from Viet Nam. 3. The patient fiddles with his hearing aid during instruction.

4. The nurse finds the medication information sheets she gave the patient tucked into a novel as a bookmark.

5. The patient’s wife cannot visit in the evenings because of her work schedule.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1,2,3 Rationale 1: Patients who ask questions that do not pertain to the education being provided may not understand the information.

Rationale 2: Persons who learned English as a second language are at high risk for health information illiteracy.

Rationale 3: Inability to hear well, which might be evidenced by “fiddling” with a hearing aid, can seriously affect ability to comprehend health care information.

Rationale 4: The fact that the patient is using the information sheets as a bookmark does not mean they were not read. Ability to read and comprehend a novel would likely indicate ability to understand health information that is presented on an appropriate level.

Rationale 5: The wife’s work schedule would have little to do with the patient’s health literacy.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.10 Discuss the issue of health care literacy as it pertains to informed consent.

Question 11 Type: MCSA The patient who has tested positive for a gene associated with breast cancer is concerned that this finding will affect her ability to get a government job position for which she has applied. How should the nurse respond to this concern?

1. “Surely there would be no way for the personnel department to find out that information.”

2. “There is a federal law that prohibits genetic information from being used in employment decisions.”

3. “Worrying about these concerns is not good for your health.”

4. “It should be a problem only if you intend to use the insurance plan.”

Correct Answer: 2 Rationale 1: This statement does not offer the patient guidance and is not therapeutic. It may increase the patient’s concern as it indicates that the nurse is not certain about the confidentiality of the information.

Rationale 2: The Genetic Information Nondiscrimination Act of 2008 prevents discrimination from health insurers and employers. The Act specifically applies to Congress and federal executive branch agencies.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The nurse should address the patient’s concerns rather than giving health advice.

Rationale 4: This information should not be disclosed or used in an employment decision, whether or not the patient intends to subscribe to the potential employer’s insurance plan.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 8.11 Discuss the various issues that arise with informed consent and genetic testing.

Question 12 Type: MCSA The nurse determines that an adult patient has signed a statutory living will, also known as a natural death act.

What does this mean to the nurse?

1. That the health care providers who abide by the document cannot be charged with criminal negligence associated with the patient’s death.

2. The document is legally binding and all health care providers will abide by its provisions.

3. The directions of the document will be followed, even if the patient makes a verbal request that directly contradicts the provisions of the document.

4. In order to revoke the document, the patient must sign a subsequent living will.

Correct Answer: 1 Rationale 1: Natural death acts are much like the living wills of the 1960s and function as a living will with statutory enforcement. This means that practitioners are protected from potential civil and criminal lawsuits.

Rationale 2: There is no way to determine if all health care providers will abide by the provisions of this document.

Rationale 3: The patient’s expressed wishes always take precedence over the document, and the patient can verbally revoke the living will.

Rationale 4: The patient does not have to sign a subsequent document in order to revoke the living will.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 8.12 Describe advance directives, including living wills, natural death acts, and durable power of attorney for health care and do-not-resuscitate directives.

Question 13 Type: MCSA The nurse has recently moved to a state that has fully enacted a Physician Orders for Life Sustaining Treatment (POLST) program. How will this affect the nurse’s practice?

1. It will have little effect since the program was developed for emergency medical service providers.

2. The program will provide research regarding best practice in end-of-life care for all health care providers, including nurses.

3. The document will provide insight into the patient’s preferences for end-of-life care.

4. The document will provide the name of the person holding the patient’s durable power of attorney.

Correct Answer: 3 Rationale 1: The POLST documents were first developed to provide guidance to emergency medical service providers. However, they are also used to provide direction to nurses and other health care providers.

Rationale 2: POLST documents do not provide best practice information.

Rationale 3: POLST documents outline a person’s preferences for end-of-life care.

Rationale 4: POLST documents do not address the identity of the patient’s decision surrogate.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 8.13 Discuss the purpose of the Physician Order for Life-Sustaining Treatment and its implementation.

Question 14 Type: MCSA Which nurse action is appropriate according to the American Nurses Association’s stance on assisted suicide and active euthanasia?

1. The nurse helps withdraw treatments that are life-saving.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. The nurse tells the patient that suicide is a sin.

3. The nurse goes to the pharmacy and procures medication the patient intends to use to commit suicide.

4. The nurse asks questions about why the patient is considering suicide.

Correct Answer: 4 Rationale 1: Withdrawal of life-saving treatments can be construed as active euthanasia. The ANA opposes nurses’ participation in active euthanasia.

Rationale 2: The nurse should never pass judgment on the patient’s belief system.

Rationale 3: The ANA is opposed to the nurse obtaining lethal doses of medication for the purpose of suicide or euthanasia. The nurse may procure and/or administer medication for pain control.

Rationale 4: The ANA opposes nurses’ participation either in assisted suicide or active euthanasia because they violate the ethical traditions embodied in the Code of Ethics for Nurses. The nurse should decline the patient’s request, but should look beyond the request to what the patient may be saying.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.14 Discuss legal issues surrounding physician-assisted suicide.

Question 15 Type: MCSA A patient who is terminally ill is experiencing extreme pain and suffering. The patient says, “If I were an animal, you would put me out of this misery.” Which intervention would the nurse be ethically correct in providing as a last-resort option for this patient?

1. Tell the patient how much pain medication would be needed to cause death.

2. Administer pain medication with the intention of causing respiratory arrest.

3. Administer sedative medications sufficient to cause unconsciousness.

4. Encourage the patient to stop eating and drinking.

Correct Answer: 3 Rationale 1: According to ANA standards, the nurse should not participate in assisted suicide.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: The nurse should not intentionally give medication to cause arrest. This is active euthanasia, which is not ethical according to the ANA. Rationale 3: Sedation to unconsciousness is a valid alternative at the end-of-life.

Rationale 4: The nurse should not encourage this action, but should not intervene if the patient makes this decision independently.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 8.15 Analyze selected ethical issues surrounding informed consent and patient selfdetermination.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 09 Question 1 Type: MCSA A newly licensed nurse complains to the preceptor about the amount of time spent documenting in the medical record. What is the preceptor’s best response?

1. “The most important reason we document is to help us communicate the patient’s condition to the rest of the health care team.”

2. “Since you just took a course in nursing research, you should realize the value of accurate documentation as a source of research data.”

3. “We have to document so that charges are clear to third-party payers.”

4. “The medical record protects us if a lawsuit is filed.”

Correct Answer: 1 Rationale 1: The primary reason for documentation is to communicate the patient’s condition to others on the health care team. The preceptor should remind the newly licensed nurse of this fact.

Rationale 2: Information from the medical record can be used for research with the patient’s permission, but this is not the primary reason it is important.

Rationale 3: It is true that accurate documentation supports third-party reimbursement, but this is not the most important use of this information.

Rationale 4: The medical record may or may not offer information that would protect the nurse in case of a lawsuit. This is not the primary reason for documentation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.1 Discuss purposes of the medical record.

Question 2 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The nurse manager is aware that several patients will be admitted to the unit today. Today’s staff includes three registered nurses, two licensed practical nurses, and three unlicensed nursing assistants. Who should the manager expect to assess and document the admitted patient’s nursing needs?

1. The nursing assistant 2. The admitting physician 3. A registered nurse 4. A licensed practical or vocational nurse Correct Answer: 3 Rationale 1: The nursing assistant may collect data such as vital signs, but cannot use the data to plan care.

Rationale 2: The physician plans medical care, not nursing care.

Rationale 3: Documentation of admission assessment and nursing needs is the role of the registered nurse.

Rationale 4: The LPN or LVN can collect data, but does not use the data to plan care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9.2 Define and describe basic information to be included in the medical record.

Question 3 Type: MCSA Nursing home policy states that a registered nurse must cosign all charts that licensed practical nurses complete.

What is the effect of this policy on the registered nurse?

1. It places the RN in the position of endorsing and authenticating the entries made in the charts cosigned.

2. It gives legal proof that the RN was in the facility.

3. It has no legal effect on the RN. 4. It makes the RN personally liable for any subsequent harm that befalls the patient.

Correct Answer: 1 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Cosigning is a practice that is becoming less frequent. It does place the nurse potentially liable for care, observations, or omissions as charted.

Rationale 2: The RN may have cosigned at a date other than that of the event, so it does not give absolute proof that the RN was in the facility.

Rationale 3: There are legal implications for endorsing or authenticating entries by cosigning.

Rationale 4: The person delivering the care is also liable for any harm that may occur due to malpractice.

Liability does not lie exclusively with the person who cosigned.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 9.3 List and give examples of guidelines for accurate documentation.

Question 4 Type: MCSA A patient requests that records of her hospitalization for treatment of an infection following an abortion be destroyed as soon as she is discharged. What is the likely outcome of this request?

1. The record will be sealed.

2. The record will be destroyed.

3. The request will be denied.

4. The record will be given to the patient’s attorney.

Correct Answer: 1 Rationale 1: Even though the patient has requested that the record be destroyed, medical records departments are generally unwilling to do so. In most cases, the record will be sealed rather than destroyed.

Rationale 2: Destroying the medical record is a permanent action that is generally done only after a specified amount of time, often several years. It is unlikely that the medical records department will honor this request.

Rationale 3: Simply denying the patient’s request does not fulfill the patient’s need for privacy of information.

Rationale 4: The hospital will not turn the only copy of this record over to the patient’s attorney. If a lawsuit were to be filed, the hospital would have no record of the hospitalization.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 5 Type: MCSA The patient demands to see the actual medical record of a hospitalization that occurred 1 year ago. How should the hospital handle this request?

1. Deny the demand; the patient has no legal right to this record.

2. Have the patient come to the hospital to review the original record.

3. Send the patient a copy of the medical record by registered mail.

4. Do not comply with this demand unless the patient provides a subpoena for the record.

Correct Answer: 2 Rationale 1: The patient does have a legal right to view the record.

Rationale 2: In this case, the hospital should have the patient come to the hospital to review the original record.

The patient should be monitored while reviewing this record.

Rationale 3: Making a copy of the record for the patient does not fulfill the patient’s demand or the patient’s right to see the original.

Rationale 4: Since the patient has a right to see the original record, there is no need for a subpoena.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 6 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Which statement, made by a staff nurse, would the nurse manager evaluate as evidence of good understanding of the importance of the electronic medical record?

1. “Since nurses are the only ones using this system, I won’t have to wait to document anymore.”

2. “I’m glad that it will take less time for us to document.”

3. “I hope we don’t have to keep changing passwords.”

4. “They say that our patient care will improve while we are using this system.”

Correct Answer: 4 Rationale 1: Access to the record is not limited to nursing; all disciplines use the system.

Rationale 2: It does not take less time to document fully using this system.

Rationale 3: Passwords are changed frequently for security purposes.

Rationale 4: Electronic records allow immediate access to patient care information; therefore, patient care is improved.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 7 Type: MCMA The nurse working in a physician’s office recorded assessment data in the wrong patient’s medical record about 1 hour ago. How should the nurse correct this error?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Black out the error with a marker and enter the new information.

2. Indicate the date and time the correction was made.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. Indicate the reason the correction is being made by writing “wrong patient chart” along with the new information.

4. Enclose the corrected information in brackets to set it off from the original post.

5. Either initial or sign the correction.

Correct Answer: 2,3,5 Rationale 1: The information written in error should not be obliterated or blacked out.

Rationale 2: The nurse should indicate the date and the time the correction was made in order to show when the new notation was made.

Rationale 3: There should be some indication of why the correction is being made. “Wrong patient chart” is adequate explanation.

Rationale 4: There is no reason to bracket the new information.

Rationale 5: Depending upon the extent of the correction, the nurse should either initial or sign the corrected area.

It is important to make it very clear who made the new notation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 8 Type: MCMA A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Carefully document the completion of an incident report in the nurse’s notes.

2. Write a recommendation for future prevention of such incidents in the report.

3. Include only the facts and the nurse’s observations in the incident report.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. Assist the nursing supervisor who will write the report.

5. Include documentation in the medical record about the event that mandated completion of an incident report.

Correct Answer: 3,5 Rationale 1: The completion of an incident report should never be referenced or documented in the nurse’s notes, which are a part of the patient record. This report is for institutional use only.

Rationale 2: Recommendations for prevention are not part of the incident report.

Rationale 3: The nurse should include what was actually observed in this report.

Rationale 4: The person discovering or directly involved in the incident must complete the report. This could be any staff member, not just the nursing supervisor.

Rationale 5: The facts of what happened to the patient and the patient’s response must be documented in the medical record.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.5 Describe important aspects of incident reports.

Question 9 Type: MCSA As part of conversion to a new electronic medical record format, a hospital is also instituting charting by exception. The nurse manager would caution staff nurses that charting by exception has which major drawback?

1. It may not provide enough information to support trending of the patient’s condition.

2. It does not allow for use of uniform standards.

3. It is not admissible in court because there is not enough background in the documentation.

4. This method takes much more time than narrative charting.

Correct Answer: 1 Rationale 1: The major problem with charting by exception is that it is often difficult to see the changes or trends that may indicate worsening of the patient’s condition.

Rationale 2: In order for charting by exception to be meaningful, uniform standards must first be established.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Charting by exception is admissible in court.

Rationale 4: Charting by exception was designed to reduce charting time.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.6 Compare and contrast charting by exception to traditional charting.

Question 10 Type: MCSA The parents of a 17-year-old who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider?

1. Refuse the request pursuant to the provision of the common-law duty to disclose.

2. Refuse the request as it is likely to interfere with the treatment plan.

3. Release the information immediately as parents always can receive information on minor children.

4. Release information only if the patient has signed consent to do so.

Correct Answer: 4 Rationale 1: The common-law duty to disclose recognizes the duty to disclose medical information in limited circumstances related to public safety.

Rationale 2: Interference with the treatment plan is not the primary concern.

Rationale 3: It is not true that parents can always receive information on minor children.

Rationale 4: A minor must always sign consent for information about substance abuse to be released, even to a parent.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.7 Define confidentiality and relate that concept to substance abuse conferences, AIDS/HIV conferences, access laws, child/elder abuse conferences, electronic mail, and Internet service.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 11 Type: MCSA The nursing student began a case study paper by writing, “J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital.” What is the significance of this statement?

1. It is incomplete, as the date and time of admission should be included.

2. It is a good description of the patient to begin the paper.

3. It violates Health Insurance Portability and Accountability Act regulations.

4. It is incomplete, as the patient’s physician’s name should be included.

Correct Answer: 3 Rationale 1: Inclusion of additional information such as date and time of admission only makes it easier to identify the patient, which is a HIPAA violation.

Rationale 2: Since information about age, race, and gender is important to the faculty grading the case study, that information should be included.

Rationale 3: The inclusion of the patient's initials, age, race, and place of admittance potentially makes it possible to identify the patient, which violates HIPAA. Rationale 4: The patient’s physician’s name should not be included as it makes it easier for others to identify the patient.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 12 Type: MCMA The nurse discussing the Health Insurance Portability and Accountability Act (HIPAA) says, “I am aware that this act changed the way we handle confidential information.” What other provisions of this act should the nurse consider?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Standard Text: Select all that apply.

1. An anti-fraud and anti-abuse program 2. Establishment of state governments as health care regulators 3. A law preventing portability of health care coverage 4. Tax incentives for preventive care 5. Streamlining of transfer of patient information between insurers and providers Correct Answer: 1,5 Rationale 1: An anti-fraud and anti-abuse program is part of HIPAA. Rationale 2: The act established the federal government as a national health care regulator.

Rationale 3: This act provides for the portability of health care coverage.

Rationale 4: There are no tax incentives for preventive care included in this act.

Rationale 5: HIPAA was designed to help streamline transfer of patient information between insurers and providers. As part of this streamlining effort, changes to confidentiality also occurred.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 13 Type: MCMA The patient brings suit against a health care provider. In which ways would the nurse expect this action will affect the confidentiality of the patient’s medical record?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The confidentiality of the record will remain intact.

2. The patient’s attorney will have access to the information in the record.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The record loses confidentiality and is discoverable by any interested party.

4. The record will be released to the defendant’s attorney.

5. Only the judge will have full access to the medical record.

Correct Answer: 2,4 Rationale 1: As being the primary source to describe the course of the patient’s evaluation, treatment, and change in condition, the medical record is a discoverable record.

Rationale 2: The patient’s attorney must have access to this information in order to pursue the lawsuit.

Rationale 3: Information in the medical record is not discoverable to anyone who is not involved in the suit.

Rationale 4: The defendant’s attorney will have access to the medical record.

Rationale 5: Others other than the judge must have access to the medical record to establish and defend the suit.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 14 Type: MCMA A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Every state requires that all sexual contacts of a person diagnosed with AIDS be contacted and treated.

2. AIDS status must be disclosed to any health care provider who has cared for the patient within the last 18 months and to any future health care provider.

3. In general AIDS status is considered confidential.

4. All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

5. All babies born in the United States are tested for presence of HIV at birth.

Correct Answer: 3,4 Rationale 1: Not all states require or permit this tracking and content.

Rationale 2: There is no regulation mandating disclosure of AIDS status to health care providers.

Rationale 3: In general AIDS status is considered confidential. There are very limited situations in which this status can be disclosed.

Rationale 4: All 50 states require reporting of AIDS cases to the Centers for Disease Control and Prevention or to the state health department for epidemiological purposes.

Rationale 5: There is no universal standard by which all babies are tested for HIV at birth.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.9 Describe reporting and access laws, including the common-law duty to disclose and limitations to disclosure.

Question 15 Type: MCSA A nurse strongly believes that all newborns should be screened for HIV at birth. Which ethical principle would the nurse cite to support this argument?

1. Informed consent 2. Confidentiality 3. Beneficence 4. Autonomy Correct Answer: 3 Rationale 1: Informed consent might be transgressed through mandatory testing.

Rationale 2: Confidentiality might be transgressed by mandatory testing.

Rationale 3: The principle of beneficence (greatest good for greatest number) supports HIV screening of newborns.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Autonomy might be transgressed through mandatory testing.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 9.10 Analyze some of the ethical issues involved in documentation and patient confidentiality.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 10 Question 1 Type: MCSA The nurse recruiter says, “We have a liability insurance policy that covers all nursing employees.” The nurse seeking employment at this facility identifies which policyholder?

1. The party against whom a suit is filed 2. The nursing department employees 3. The hospital 4. The insurance agent who sells the policy Correct Answer: 3 Rationale 1: The party against whom a suit is filed is a defendant (who may or may not hold an insurance policy).

Rationale 2: The nursing department employees are the “insured.”

Rationale 3: The holder of the policy is the person (in this case, the hospital) who purchases the policy.

Rationale 4: The agent is a representative of the insurance company.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.1 List elements common to all professional liability insurance policies.

Question 2 Type: MCMA A nurse has been named in a lawsuit. The nurse’s insurance company has declined to cover any costs until policy exclusions have been verified. What would the nurse expect the company to review?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Length of employment 2. The insured's educational preparation 3. Length of time the nurse has been registered 4. Licensure of the insured 5. Nature of the insured's work Correct Answer: 4,5 Rationale 1: Length of employment does not fall under policy exclusions.

Rationale 2: Educational preparation is verified when the policy is issued and does not pertain to exclusions at this time.

Rationale 3: Length of time the nurse has been registered is not pertinent to exclusions.

Rationale 4: In professional liability policies, exclusions frequently describe circumstances or activities that will prevent coverage of the insured party. Exclusions also include the absence of appropriate licensure or certification.

Therefore, the company would check the insured's licensure.

Rationale 5: In professional liability policies, exclusions frequently describe circumstances or activities that will prevent coverage of the insured party. The insurance company would check the activities that are a part of the insured's work to ensure that they do not fall in the exclusions category.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.1 List elements common to all professional liability insurance policies.

Question 3 Type: MCSA The nurse has been named in a lawsuit claiming a patient was injured due to her negligence. The nurse dropped her personal professional liability insurance several months ago, but believes the policy may have been in effect at the time of the incident. In which part of the policy would the nurse look for information about the coverage period?

1. Deductibles 2. Exclusions Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. Declarations 4. Liabilities Correct Answer: 3 Rationale 1: Deductibles are a separate section of the policy and would not include information about coverage dates.

Rationale 2: Items not covered by the policy are called exclusions. This is not associated with the coverage period.

Rationale 3: Declarations include the "demographics" of the policy: the policyholder's name, address, covered professional occupation, and the covered time period.

Rationale 4: The limits of liability are in a separate section of the policy and do not speak to the coverage period.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.1 List elements common to all professional liability insurance policies.

Question 4 Type: MCSA The nurse understands that the professional liability insurance provided by the hospital where he works is a claims-made policy. Which claim would the nurse expect this policy to cover?

1. A claim that was filed 3 months after the hospital purchased the policy 2. A claim that was filed while the hospital and insurance company were negotiating about the policy 3. A claim filed for an event that occurred during the coverage period that was filed after the hospital changed carriers 4. Any claim filed as long as it was within 30 days of the end of the policy Correct Answer: 1 Rationale 1: Claims-made policies provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period or during an uninterrupted extension of that policy period.

Rationale 2: The policy will not cover claims that were filed prior to the coverage being activated.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The policy will not cover claims made after the end date of the policy, even if the claim was associated with an incident that occurred while the policy was in effect.

Rationale 4: There is no 30 day grace period associated with this type of coverage.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.2 Differentiate types of professional liability insurance policies available commercially to professional nurses.

Question 5 Type: MCSA In which situation is an occurrence-based policy most beneficial to the nurse?

1. A nurse had insurance coverage during 20 years of practice, but is now retired and no longer has an active policy 2. A nurse acquired insurance coverage after a patient unexpectedly died during the nurse’s care.

3. A nurse fears she will be named in a lawsuit even though she was only a witness to an occurrence.

4. A nurse had an untoward evaluation at work and needs coverage in case she is terminated for unsatisfactory performance Correct Answer: 1 Rationale 1: The occurrence-based policy is preferable because lawsuits may not be filed immediately, and the nurse needs coverage for any lawsuits that might arise even after retirement from active practice.

Rationale 2: No policy will cover an incident that has already occurred.

Rationale 3: A policy will not cover an incident that has already occurred even if the person purchasing the policy was just an observer.

Rationale 4: This performance has already occurred, so no policy will provide coverage.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 10.2 Differentiate types of professional liability insurance policies available commercially to professional nurses.

Question 6 Type: MCSA A nurse has decided to obtain individual professional liability insurance. In general, which type of insurance is best for most nurses?

1. Certificate-based 2. Employer-sponsored 3. Occurrence-based 4. Claims-made Correct Answer: 3 Rationale 1: Certificate-based is not a form of insurance.

Rationale 2: Employer-sponsored coverage is the narrowest coverage for individual nurses.

Rationale 3: For most nurses the occurrence-based policy is preferable. This policy continues coverage for claims made for incidents that occurred during the time the policy was in effect, even if the policy has expired.

Rationale 4: Claims-made policies cover only claims made during the life of the policy.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 10.2 Differentiate types of professional liability insurance policies available commercially to professional nurses.

Question 7 Type: MCSA The limits of liability on an insurance policy are $1,000,000 for each claim, $4,000,000 aggregate. A nurse is charged in a serious situation in which five separate lawsuits have been filed. What is the most the insurance company will likely pay in this situation?

1. $4,000,000 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. $200,000 3. $1,000,000 4. $5,000,000 Correct Answer: 3 Rationale 1: $4,000,000 represents the most the insurance company will pay during a given policy period.

Rationale 2: There is no indication that the insurance company will divide the $1,000,000 by 5 when considering how much to pay.

Rationale 3: The limit of liability for each claim is $1,000,000 and that is likely all the insurance company will pay since each of the 5 suits came out of the same situation.

Rationale 4: It is unlikely that the company will pay $1,000,000 for each claim since they all arose from the same incident.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 10.3 Identify issues to be considered when deciding among individual coverage, group coverage, and employer-sponsored coverage.

Question 8 Type: MCSA The nurse believes that her need for individual malpractice insurance is decreased because she practices in a small-town home health agency. What is true about this situation?

1. Residents of small towns are less likely to bring suit than residents of urban areas.

2. Slower paced environments, such as home health care, are less likely to create situations in which the nurse makes an error.

3. Nurses working in home health are covered by mandatory federal malpractice insurance policies.

4. Home health care is an area in which the risk of lawsuit is higher than in many other practice areas.

Correct Answer: 4 Rationale 1: There is no guarantee that a resident of a small town will not be just as suit-prone as a resident in an urban area.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: In home health care, the nurse is making many independent decisions daily and does not have easy access to others for consultation.

Rationale 3: There is not a federal malpractice policy for nurses.

Rationale 4: Home health care joins critical care, emergency departments, operating rooms, and maternal/child care as areas where the risk of lawsuits is higher.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 10.3 Identify issues to be considered when deciding among individual coverage, group coverage, and employer-sponsored coverage.

Question 9 Type: MCSA A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit pay the nurse for those days?

1. In most cases, the hospital is only required to pay the nurse for one-half of time missed.

2. No, since the nurse caused the lawsuit to be filed, the hospital has no responsibility for pay.

3. Yes, the hospital is always responsible for expenses associated with work whether or not the expenses are related to a lawsuit.

4. Not necessarily, it depends upon the hospital's insurance policy and what it covers.

Correct Answer: 4 Rationale 1: There is no standard by which the hospital must pay the nurse for one-half time.

Rationale 2: The fact that the nurse did or did not “cause” the lawsuit to be filed is not pertinent to whether the hospital will pay this nurse.

Rationale 3: The hospital is not necessarily responsible for these expenses.

Rationale 4: Most hospital insurance policies do not have supplementary payments for the nurse-defendant. This means that if the nurse incurs additional expenses in investigating the claim or loses days of work defending the claim, the nurse must cover those expenses out of pocket. However, some policies do have this coverage, so this is the most accurate answer.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.3 Identify issues to be considered when deciding among individual coverage, group coverage, and employer-sponsored coverage.

Question 10 Type: MCSA The hospital-employed nurse volunteered to assist with physical examinations for athletes at the local high school.

How does this situation affect the nurse's hospital malpractice insurance?

1. The nurse is covered by the hospital's malpractice insurance as a community volunteer.

2. The nurse is very likely not covered by any malpractice insurance.

3. The nurse is covered by the school's insurance.

4. The nurse is exempt from liability for any occurrences because of the volunteer status of the work.

Correct Answer: 2 Rationale 1: Many hospital liability insurance policies have limited coverage and cover employees only while they are performing work as hospital employees.

Rationale 2: As a volunteer, the most likely situation is that the nurse is not covered by any insurance, unless a private insurance policy is in effect.

Rationale 3: The school most likely covers only its own employees.

Rationale 4: There is no indication that volunteer work will not result in lawsuit.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 10.3 Identify issues to be considered when deciding among individual coverage, group coverage, and employer-sponsored coverage.

Question 11 Type: MCMA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

As a part of a malpractice case, the hospital has decided to bring an indemnity claim against a nurse. What is the implication to the nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse should obtain a private lawyer.

2. The nurse will have to pay monetary damages to the hospital if the hospital wins the claim.

3. The nurse is required to disclose patient information that the patient believed would be kept confidential between the nurse and the patient.

4. The hospital is released from paying monetary damages to the nurse.

5. The hospital attorney has identified the work practices implicated in the incident causing the lawsuit.

Correct Answer: 1,2 Rationale 1: The filing of an indemnity claim also means the nurse should obtain a private lawyer as the hospital is now suing the nurse.

Rationale 2: Indemnity claims are those brought by the employer for monetary contributions from the nurse whose actions or failure to act caused the original patient injury in a lawsuit.

Rationale 3: Indemnity has nothing to do with confidentiality between nurse and patient.

Rationale 4: Indemnity does not have any bearing on monetary damages owed the nurse.

Rationale 5: Indemnity is not related to work practice identification.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 10.3 Identify issues to be considered when deciding among individual coverage, group coverage, and employer-sponsored coverage.

Question 12 Type: MCMA A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse can be held personally responsible for all damages assessed.

2. The nurse is considered judgment-proof and will not be required to pay damages.

3. The nurse will be nonsuited from the filed lawsuit once this fact is known.

4. The nurse can rely upon the hospital's insurance policy as protection from personal financial liability.

5. The nurse’s best interests may not be protected during the case.

Correct Answer: 1,5 Rationale 1: Despite not having insurance, nurses are liable for their actions and can be held personally liable for damages.

Rationale 2: Nurses are never considered judgment-proof.

Rationale 3: Nurses are not released from a suit because there is no insurance.

Rationale 4: The hospital's insurance policy does not always provide all the financial protection that may be needed.

Rationale 5: In some cases, nurses have not been adequately represented by legal counsel in the lawsuit.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 10.4 Compare and contrast the various arguments that arise when deciding about having individual coverage.

Question 13 Type: MCMA What should the nurse consider about today’s healthcare environment when making a decision about purchasing individual professional liability insurance?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. The frequency with which nurses are named in lawsuits has not changed in the last several decades.

2. Obstetrics is the only specialty in which risk of being sued has increased.

3. Having personal insurance does not increase one’s risk of suit.

4. Monetary awards in cases where nurses have personal insurance are higher.

5. Most lawsuits are filed against nurses who are not specialized in any particular field.

Correct Answer: 3,5 Rationale 1: Due to the expanding role of nursing there is a heightened legal accountability and increased potential for being named in lawsuits.

Rationale 2: Obstetrics, critical care, and emergency nursing are all suit-prone.

Rationale 3: A common misconception is that having personal insurance will increase the nurse’s risk of being sued. This is an incorrect argument.

Rationale 4: This is not a true statement, but is widely believed to be true.

Rationale 5: Current literature indicates the most malpractice cases involve non-specialized RNs. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 10.4 Compare and contrast the various arguments that arise when deciding about having individual coverage.

Question 14 Type: MCSA Which option reflects one of the more convincing arguments for the nurse having individual malpractice insurance?

1. Defending against a lawsuit is costly in today's society.

2. Filing a lawsuit is costly in today's society.

3. Having insurance ensures that the nurse will not be named in lawsuits.

4. Having insurance makes it more costly for the plaintiff to file suit against the nurse.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1 Rationale 1: Defending oneself in a lawsuit is very costly.

Rationale 2: The cost of filing a lawsuit is minimal as compared to defending against a suit.

Rationale 3: Insurance does not provide a guarantee that lawsuits will not be filed.

Rationale 4: The cost of filing a suit is not associated with having insurance.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.4 Compare and contrast the various arguments that arise when deciding about having individual coverage.

Question 15 Type: MCMA Nurses who work on a medical unit do not have personal professional liability coverage. In the event of a lawsuit, which options are true?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. They can be covered under the employer's insurance policy.

2. They may be refused coverage under the employer's insurance policy.

3. They will be covered under the professionals' group policy.

4. They need to contact their own attorneys.

5. They will be covered with their state's Emergency Health Care Providers policy.

Correct Answer: 1,2,4 Rationale 1: There is a chance that the employer's insurance would cover these nurses.

Rationale 2: The employer's insurance may elect not to cover the nurses, depending upon the circumstances of the incident.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Professionals' group policies are more commonly found in private clinics or businesses.

Rationale 4: These nurses should contact personal attorneys.

Rationale 5: There is not an Emergency Health Care Providers insurance policy.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 10.4 Compare and contrast the various arguments that arise when deciding about having individual coverage.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 11 Question 1 Type: MCSA Changes to nursing licensure are being considered. The nurse identifies which source of the state’s power to license nurses?

1. Police power within the state 2. State and federal case laws 3. Constitution of the United States 4. Nurse practice act Correct Answer: 1 Rationale 1: It is the states' police power that enables them to provide a license for nurses.

Rationale 2: State and federal case laws may define actions that the state may take in certain circumstances, but they do not extend to providing licensure for nurses.

Rationale 3: The Constitution is a federal document that does not address licensing power of the states.

Rationale 4: The state practice act defines the scope of practices and the processes for licensure, not the power to issue the license.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.1 Define licensure, including mandatory, permissive, and institutional licensure and the advantages and disadvantages of each.

Question 2 Type: MCSA A medical technician working in a physician’s office routinely refers to herself as a nurse. Which type of licensure protects that title as well as the professional actions associated with nursing?

1. Mandatory Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. Institutional 3. Transitional 4. Permissive Correct Answer: 1 Rationale 1: Mandatory licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. It protects both the title "nurse" and the professional actions associated with the nursing.

Rationale 2: Institutional licensure is the process by which a state government regulates health institutions and is an alternative to individual licensure. It does not protect individual practice or title.

Rationale 3: Transitional is not a term used to describe licensure in this text.

Rationale 4: With permissive licensure, nurses cannot use the title RN unless duly licensed, but can perform many or all of the same actions as long as they do not call themselves RN. So, permissive licensure regulates the use of the title, not the actions.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.1 Define licensure, including mandatory, permissive, and institutional licensure and the advantages and disadvantages of each.

Question 3 Type: MCSA A nurse appointed to the state board of nursing would expect work focused on which basic purpose of that body?

1. Establishing a means of protecting the public at large 2. Ensuring that all schools of nursing seek national accreditation 3. Ensuring that all practicing nurses are competent 4. Restricting nursing practice through regulations Correct Answer: 1 Rationale 1: The main purpose of the state board of nursing is to protect the public.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: The state board of nursing may support this effort, but this is not the basic function of the board.

Rationale 3: Overseeing nurse competence is a way to support the board’s basic purpose.

Rationale 4: The state board may restrict nursing practice in order to support its basic purpose.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11.2 Describe the process for creating state boards of nursing and their authority, including limitations on their authority.

Question 4 Type: MCSA A physician reported a case of possible nursing negligence to the state board of nursing. What action will be taken by the board?

1. The complaint will be screened and an investigation initiated if appropriate.

2. Nothing will be done as only another professional nurse is qualified to report nursing negligence.

3. The nurse or nurses will be placed on probation pending investigation of the complaint.

4. The incident will be recorded as a "first strike" against the nurse or nurses involved.

Correct Answer: 1 Rationale 1: A single complaint triggers action on the part of the board. The complaint is screened and an investigation is initiated, if appropriate.

Rationale 2: Any interested person can file a complaint with the board of nursing.

Rationale 3: There is no way to know if probation is necessary until an investigation is done.

Rationale 4: No action against the nurse is indicated until an investigation is completed.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 11.2 Describe the process for creating state boards of nursing and their authority, including limitations on their authority.

Question 5 Type: MCSA The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor?

1. Report the concerns to the state board of nursing.

2. Terminate the nurse's hospital employment.

3. Transfer the nurse to a non-patient care position.

4. Nothing as the nurse might sue the supervisor.

Correct Answer: 1 Rationale 1: Of the options provided, the one most protective of public safety is to report concerns to the state board of nursing.

Rationale 2: Simply terminating employment does not address the problem at the nurse's level and does not guarantee that the nurse will not have similar issues at the next place of employment.

Rationale 3: Transfer of the nurse to a non-patient care position is only a temporary solution and does not address the safety issues. Nurses can make errors that impact the public, even in non-patient care roles.

Rationale 4: Ignoring the problem for fear of suit will not make the problem go away.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.2 Describe the process for creating state boards of nursing and their authority, including limitations on their authority.

Question 6 Type: MCSA The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. ANA Code of Ethics 2. State Nurse Practice Act 3. Nurse's Bill of Rights 4. Nightingale Pledge Correct Answer: 2 Rationale 1: The ANA Code of Ethics is the document that defines ethical principles for nurses.

Rationale 2: The state nurse practice act is the legal guide to define the scope of practice for nurses.

Rationale 3: The Nurse's Bill of Rights are references to nurses' rights, not specific legal aspects of nursing practice.

Rationale 4: The Nightingale Pledge is the nurses' pledge or commitment to serving their patients derived from the writings of Florence Nightingale.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11.3 Describe the process of how state nursing acts define the professional scope of practice.

Question 7 Type: MCSA A nursing student reports that her grandmother served as a nurse in World War II. At the end of the war, her grandmother was licensed as a nurse, even though she never graduated from nursing school. Which type of exemption from licensure does this reflect?

1. Grandfather clause 2. Reciprocity 3. Endorsement 4. Licensure by waiver Correct Answer: 1

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The grandfather clause is a form of exemption that allows certain persons working within a given profession prior to a given deadline to apply for licensure without meeting all the requirements for that licensure.

It was used to allow World War II nurses with on-the-job training and expertise licensure as a nurse.

Rationale 2: Reciprocity allows a person who has a license in one state to practice in another state if the states have an agreement to do so.

Rationale 3: Endorsement is similar to reciprocity but there is no prior agreement among the states.

Rationale 4: Licensure by waiver is similar to licensure by exam. If the person meets the exam requirements without taking the test, the exam is waived and a license is issued.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11.4 Describe entry into practice in relationship to state nursing practice acts.

Question 8 Type: MCMA In which situations would the state board of nursing have probable grounds for disciplining a nurse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse can no longer lift 30 pounds.

2. The nurse fails to report a co-worker who is working outside his scope of practice.

3. The nurse questioned a direct physician order.

4. The nurse made a false statement on the licensure application.

5. The nurse told a co-worker that she is taking antidepressant medications.

Correct Answer: 2,4 Rationale 1: Inability to lift 30 pounds may change where a nurse can safely work, but is not grounds for action against the license.

Rationale 2: Failure to report another person for fraudulent, incompetent, unprofessional, or unethical conduct is grounds for action against the non-reporter’s license.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Questioning an order is not grounds for action against the nurse unless the questioning is done in an unethical or unprofessional manner.

Rationale 4: Making a false statement on the licensure application is grounds for action against the nurse's license.

Rationale 5: If the nurse is seeking treatment for depression and the depression does not interfere with safe, competent nursing care there is no reason for disciplinary action.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.4 Describe entry into practice in relationship to state nurse practice acts.

Question 9 Type: MCMA A nurse executive has requested that additional budgetary funds be allocated to support staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this executive provide during discussions of this funding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “Research shows no correlation between an increased number of BSN prepared nurses and increased nursing salaries.”

2. “Nurse specialty certification has been shown to lower patient mortality.”

3. “If our nursing staff is educated at a higher level and are certified we will see fewer lawsuits for negligence and malpractice.”

4. Higher failure-to-rescue rates 5. “Education at the BSN level, when coupled with specialty certification, has been shown to reduce adverse patient outcomes.”

Correct Answer: 2,4,5 Rationale 1: Typically nurses do receive salary increases as educational level increases.

Rationale 2: Kendall-Gallagher and colleagues (2011) concluded that hospitals’ nurse specialty certification lowers patient mortality.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: There is no evidence that this is the case.

Rationale 4: Higher rates of nurse specialty certification have been correlated with reduction of failure-to-rescue rates in hospital settings.

Rationale 5: Researchers have noted a reduction of adverse patient outcomes when specialty certification exists along with education at the BSN level.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.5 Analyze the impact of education on nursing practice issues.

Question 10 Type: MCSA The patient tells the nurse that the physician mentioned deep tissue massage as treatment for rheumatoid arthritis.

As a part of the subsequent conversation, the nurse demonstrates techniques and encourages the patient to begin a regimen immediately. What is true regarding this situation?

1. Since back massage is a standard skill taught in nursing school, the nurse has no liability for these actions.

2. The nurse's liability centers on the recommendation to begin a massage regime.

3. Since the physician initiated the discussion, the nurse has no liability.

4. This nurse may be guilty of practicing massage without a license.

Correct Answer: 4 Rationale 1: The nurse is responsible for all nursing actions.

Rationale 2: The recommendation itself would probably not be a liability issue if the nurse was educated to make such a recommendation.

Rationale 3: The nurse is responsible for all nursing actions.

Rationale 4: Deep tissue massage goes beyond the bedtime "backrub" type of massage taught in nursing school and is used for a specific disease therapy, so the nurse may be guilty of practicing massage without a license.

States differ on this licensure.

Global Rationale:

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.6 Describe the legal ramifications of complementary and alternative medicine, including the medical use of cannabis (marijuana).

Question 11 Type: MCMA The home health nurse discovers that a homebound cancer patient is using marijuana to control nausea from chemotherapy. What advice should the nurse give this patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The effect of marijuana on decreasing nausea is fleeting and not worth the health problems caused by using it.

2. Since the patient is homebound, it is likely the use of marijuana will not be discovered by anyone else.

3. Possession of marijuana is illegal under federal law.

4. Some states have current legislative guidelines for legal possession of medical marijuana.

5. As long as it is documented that an illness exists that can be treated with marijuana, no risk of prosecution is present.

Correct Answer: 3,4 Rationale 1: Some patients report that marijuana does decrease nausea from chemotherapy.

Rationale 2: The nurse cannot legally advise the patient that it is permissible to break a law.

Rationale 3: Any possession of marijuana remains illegal under federal law.

Rationale 4: Some states do have such guidelines and if these are in place and followed, it is unlikely that federal charges would be pursued.

Rationale 5: The mere presence of an illness that can be treated with marijuana is not sufficient to avoid prosecution for the patient and those providing the substance.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.6 Describe the legal ramifications of complementary and alternative medicine, including the medical use of cannabis (marijuana).

Question 12 Type: MCSA Which information would the nurse provide as rationale for supporting the nurse licensure and mutual recognition movements?

1. Advancing technologies, especially telehealth and telephone triage makes single state licensure problematic.

2. Some areas have an oversupply of nurses while others are still experiencing a nursing shortage.

3. Multistate licensure will protect the safety of consumers who use call-in phone lines for health advice.

4. The number of practicing nurses holding more than one state license is increasing.

Correct Answer: 1 Rationale 1: Advancing technologies such as telehealth and telephone triage have expanded practice beyond geographic boundaries.

Rationale 2: Multistate licensure is not a logical means of correcting this situation.

Rationale 3: There is no guarantee that changes in licensure will protect these patients.

Rationale 4: While this situation has some relation to mutual recognition and nurse licensure compacts it is not the most important force to consider.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 11.7 Discuss the status and future of nurse licensure compacts.

Question 13 Type: MCMA The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse in a remote state, what is the status of the nurse's license?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Standard Text: Select all that apply.

1. Only the state in which the nurse demonstrated poor practice can act to suspend or revoke the nurse's license.

2. License suspension or revocation can only occur if all three states agree to the action.

3. Only the state in which the nurse holds licensure can act to suspend or revoke that license.

4. The remote state can place the nurse’s license on probation.

5. The remote state can limit or stop the nurse from practicing in that state.

Correct Answer: 3,5 Rationale 1: Action may be taken by the home state and the remote state where poor practice was demonstrated.

Rationale 2: All three states do not have to be in accordance with the action against this nurse’s license.

Rationale 3: Only the state that issued the license can suspend or revoke it.

Rationale 4: Only the home state can act against the license by using probation.

Rationale 5: The remote state would act against the practice privilege by limiting or stopping practice with a cease-and-desist order.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.7 Discuss the status and future of nurse licensure compacts.

Question 14 Type: MCMA The patient decides to discontinue standard medical treatment for diabetes mellitus and to rely on diet and herbal medications for blood sugar control. Which statements, made by the nurse, are appropriate?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “You are an adult and can do anything you want to do.”

2. “We need to talk about how medications work to control diabetes mellitus.”

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. “Tell me more about why you decided to make this change.”

4. “Don't you know that you are gambling with your health?”

5. “I think that would be a mistake.”

Correct Answer: 2,3 Rationale 1: This statement closes the conversation before additional assessment can be completed.

Rationale 2: This statement could be helpful in setting the stage for additional patient education.

Rationale 3: Before the nurse makes any other comments, more assessment must be done. Asking the patient to describe why this decision was made will help gather data for this assessment.

Rationale 4: This statement is not therapeutic and could be evaluated as belittling to the patient.

Rationale 5: The nurse should not offer this opinion, but should seek to continue talking with the patient about this choice.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.8 Analyze some of the ethical issues surrounding licensure, certification, and scope of practice.

Question 15 Type: MCSA The nurse has a strong religious conviction against elective sterilization procedures. When seeking employment, how should the nurse handle this belief?

1. Request placement on a unit where care of these patients is unlikely.

2. Be up front and discuss the issue during the employment interview.

3. Say nothing about this belief as it is personal, private information.

4. Be certain that this information is documented in the employment contract.

Correct Answer: 2 Rationale 1: While many units would be unlikely to receive such patients, it cannot be guaranteed that the nurse would never come into contact with them.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: The best strategy is to be up front about these beliefs and to discuss them at the time of the employment interview.

Rationale 3: While it is true that these are personal beliefs, they may impact the way the nurse is assigned or able to practice in given environments.

Rationale 4: There is no need to document the information in the contract.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 11.8 Analyze some of the ethical issues surrounding licensure, certification, and scope of practice.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 12 Question 1 Type: MCSA A nurse discussing the establishment of today’s advanced nurse practitioner role would discuss which factor as the primary driving force?

1. The physician shortage of the late 1960s 2. The need for providers to work in primary care settings 3. The need for more rural health care by qualified providers 4. The refusal of physicians to see rural patients Correct Answer: 1 Rationale 1: The primary driving factor was a shortage of primary physicians that occurred in the late 1960s and early 1970s.

Rationale 2: The situation driving the development of this role was not limited to primary care settings.

Rationale 3: The situation driving the development of this role was not limited to rural health care.

Rationale 4: There is no indication that physicians were refusing to care for rural patients.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.1 Outline the roles of advanced practice nurses, including nurse anesthetists, nurse midwives, advanced nurse practitioners, clinical nurse specialists, clinical nurse leaders, and doctorate of nursing practice.

Question 2 Type: MCMA A certified registered nurse anesthetist (CRNA) is addressing a group of high school students that have expressed interest in this profession. Which information should the nurse provide?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Standard Text: Select all that apply.

1. The fastest way to gain certification as a CRNA is through a physician’s assistant program.

2. Nurse anesthetists are a newly developing field.

3. Currently, the entry level for this certification is a master’s degree.

4. Nurse anesthetists practice outside the scope of nursing by virtue of a grandfather clause in anesthesia.

5. In the future, nurses wishing to become CRNAs must have a doctoral degree.

Correct Answer: 3,5 Rationale 1: CRNAs are advanced practice nurses, not physician assistants.

Rationale 2: The first “official” nurse anesthetist was administering anesthesia as early as 1877.

Rationale 3: In order to write the certificate examination, applicants must have completed a master’s program.

Rationale 4: Nurse anesthetists practice within the scope of nursing for their specialty.

Rationale 5: Beginning in 2025, a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP) will be required for certification.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.1 Outline the roles of advanced practice nurses, including nurse anesthetists, nurse midwives, advanced nurse practitioners, clinical nurse specialists, clinical nurse leaders, and doctorate of nursing practice.

Question 3 Type: MCMA A student nurse is contemplating seeking independent practice as a certified nurse midwife. If the nurse reaches this goal, which components of practice should the she expect to fulfill?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Physical examinations Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. PAP smears 3. Management of postpartum complications 4. Family planning counseling 5. One-on-one management of high-risk pregnancies Correct Answer: 1,2,4,5 Rationale 1: Physical examinations are a part of the normal prenatal, intrapartum, and gynecological care provided to women and normal newborns. This is part of the midwife role.

Rationale 2: Certified nurse midwives provide normal gynecological services such as preventive health screenings.

Rationale 3: Management of complications is not an independent practice role. The midwife may participate in this care but does not do so independently.

Rationale 4: Certified nurse midwives provide family planning counseling as part of their role.

Rationale 5: Certified nurse midwives offer an alternative childbearing experience to low-risk patients. They do not provide independent care of high-risk pregnancies.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12.1 Outline the roles of advanced practice nurses, including nurse anesthetists, nurse midwives, advanced nurse practitioners, clinical nurse specialists, clinical nurse leaders, and doctorate of nursing practice.

Question 4 Type: MCSA Hospital management has identified quality of care issues that center around coordination of multidisciplinary services. Which classification of advanced practice nurse would be the best choice to help address these issues?

1. Clinical nurse leader 2. Advanced nurse practitioner 3. Nurse with a doctorate of nursing practice 4. Clinical nurse specialist Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1 Rationale 1: The role of clinical nurse leader is envisioned by the AACN to be a person who "designs, implements, and evaluates client care by coordinating, delegating, and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals." The clinical nurse leader should have the skill set to address quality of care issues.

Rationale 2: ANPs are nurses who have specialized in one or more practice specialties. Most provide primary care to low-risk patients and may serve as the primary health care provider.

Rationale 3: DNP programs vary in focus. The nurse holding a DNP may or may not have the leadership skills needed to address this hospital’s quality of care issues.

Rationale 4: Clinical nurse specialists are often practice-focused and may or may not have the skills necessary to address hospital-wide quality of care issues.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12.1 Outline the roles of advanced practice nurses, including nurse anesthetists, nurse midwives, advanced nurse practitioners, clinical nurse specialists, clinical nurse leaders, and doctorate of nursing practice.

Question 5 Type: MCSA A nurse working as a clinical nurse specialist (CNS) in a hospital is aware of a greater risk for being sued for malpractice than that of the staff nurses’ co-workers. What rationale would the CNS give for this difference?

1. “I have greater autonomy in my work.”

2. “Since I make more money, I am a better litigation target.”

3. “I assume greater legal liability because of my specialty credentials.”

4. “The patients I work with are sicker and more likely to develop treatment related complications.”

Correct Answer: 3 Rationale 1: Decreased autonomy does not protect the staff nurses from litigation.

Rationale 2: The fact that this nurse makes more money would not be likely to play into the decision to sue.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Nurses who hold specialty credentials are assumed to be experts in their role. This increases the likelihood of suit if an unexpected outcome occurs.

Rationale 4: The seriousness of the patient’s illness is not a major determining factor in unexpected outcomes.

When a person who is not seriously ill has a poor treatment outcome, litigation is often considered.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.2 Describe some of the legal constraints to advanced professional practice encountered by nurses educationally and clinically competent to perform these roles, including scope of practice issues, reimbursement issues, malpractice issues, standards of care, prescriptive authority, hospital or admitting privileges.

Question 6 Type: MCSA The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges?

1. The state board of medicine 2. The individual hospital 3. The Joint Commission 4. The state board of health Correct Answer: 2 Rationale 1: The state board of medicine may recommend guidelines for credentialing but does not grant privileges to specific hospitals.

Rationale 2: Institutions grant the privileges for individuals to practice in their facility. This privilege granting is governed by the institution based on a set of credentials that are determined by a designated peer group practicing in that institution.

Rationale 3: The Joint Commission specifies that standards for privileging must be present and followed, but this organization does not grant privileges to individual practitioners.

Rationale 4: The state board of health may have guidelines for granting privileges but does not grants privileges to individuals.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12.2 Describe some of the legal constraints to advanced professional practice encountered by nurses educationally and clinically competent to perform these roles, including scope of practice issues, reimbursement issues, malpractice issues, standards of care, prescriptive authority, hospital or admitting privileges.

Question 7 Type: MCSA A nursing student's grandmother relates a time in the 1920s when medications were selected based upon the recommendation of a nurse who lived in the neighborhood. How is this possible?

1. Prescriptive authority was not removed from nurse practice acts until the 1950s.

2. The grandmother must be mistaken because medications have always been selected based upon physician prescription.

3. Prior to 1938, most medications were over-the-counter and nurses were instrumental in their choice.

4. This student's grandmother must have lived on a military base or facility where nurses were granted this privilege.

Correct Answer: 3 Rationale 1: The legislation limiting prescriptive authority to physicians was introduced before 1950.

Rationale 2: At one time, most medications were available over-the-counter and nurses often helped direct patients toward appropriate medications.

Rationale 3: In 1938, the federal government took control of prescriptive authority when it passed the Federal Food, Drug, and Cosmetic Act. Until that time, most medications, except narcotics, were over-the-counter and both nurses and physicians helped direct patients toward appropriate medications.

Rationale 4: There was no need to live on a military base for this to occur.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.2 Describe some of the legal constraints to advanced professional practice encountered by nurses educationally and clinically competent to perform these roles, including scope of practice issues, reimbursement issues, malpractice issues, standards of care, prescriptive authority, hospital or admitting privileges.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 8 Type: MCSA The patient requires a controlled substance for the treatment of pain. What is true of the advanced nurse practitioner's role in independently prescribing this medication?

1. Some states allow advanced nurse practitioners to prescribe controlled substances.

2. There are no states in which any advanced nurse practitioner can prescribe controlled substances.

3. Prescriptive authority allows all advanced practice nurses to prescribe any medication necessary for the treatment of their patients.

4. Prescriptive authority is limited to nurse anesthetists.

Correct Answer: 1 Rationale 1: Laws about prescriptive authority vary from state to state.

Rationale 2: The APN may have prescriptive authority for some controlled substances, depending upon the state of licensure.

Rationale 3: The vast majority of states still require some degree of physician involvement or delegation in the area of prescriptive authority, including direct supervision or use of a formulary.

Rationale 4: Prescriptive authority is not limited to CRNAs. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.2 Describe some of the legal constraints to advanced professional practice encountered by nurses educationally and clinically competent to perform these roles, including scope of practice issues, reimbursement issues, malpractice issues, standards of care, prescriptive authority, hospital or admitting privileges.

Question 9 Type: MCSA The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse's practice?

1. There is no problem as the practice requirements are the same.

2. There would be no problem as the move is to an area that is primarily minority.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. This would be an unwise move for the nurse, as advanced practice is limited to rural areas.

4. There would be no problem if the move is to a medically underserved area.

Correct Answer: 1 Rationale 1: All 50 states recognize the advanced practice nurse role.

Rationale 2: There is no requirement that APNs restrict their practice to minority areas.

Rationale 3: There is no requirement that APNs restrict their practice to rural areas.

Rationale 4: There is no requirement that APNs restrict their practice to medically underserved areas.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12.2 Describe some of the legal constraints to advanced professional practice encountered by nurses educationally and clinically competent to perform these roles, including scope of practice issues, reimbursement issues, malpractice issues, standards of care, prescriptive authority, hospital or admitting privileges.

Question 10 Type: MCMA The advanced nurse practitioner is considering changing malpractice insurance carriers. What should the nurse consider prior to making this change?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The expanding role of the advanced nurse practitioner has increased the number of lawsuits filed.

2. The advanced nurse practitioner should carry medical malpractice, just as the physician does.

3. Advanced nurse practitioners are less likely to be sued than nurses holding a doctorate of nursing practice.

4. The advanced nurse practitioner is more likely to be sued than a physician.

5. The severity of malpractice claims against some ANP roles has increased in the last few years.

Correct Answer: 1,5

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: As the role of the ANP has expanded, so has the frequency with which these nurses are sued.

Rationale 2: Advanced nurse practitioners are nurses and should carry nursing malpractice specific to their role.

Rationale 3: ANPs are not less likely to be sued than nurses holding a DNP. Rationale 4: There is no indication that ANPs are more likely to be sued than physicians.

Rationale 5: APRNs have seen the severity of malpractice claims rise in the past few years.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 11.3 Analyze means to overcome these legal constraints.

Question 11 Type: MCMA The advanced nurse practitioner is routinely addressed as "doctor" by clinic patients. What is the best way for the nurse to handle this mistake?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Only allow this practice if the ANP has an earned doctorate.

2. Accept the mistake with good humor and ignore it.

3. Be certain patients are aware that the nurse is not a physician.

4. Ask the patients to address the ANP by first name.

5. Wear a nametag that clearly lists the nurse’s credentials as an ANP. Correct Answer: 3,5 Rationale 1: While it is true that an ANP with an earned doctorate has the right to be addressed as "doctor," in the clinic situation, this may lead to confusion between the roles, which are sometimes confusing to patients anyway.

Rationale 2: The practice should not be ignored.

Rationale 3: The ANP must be certain that patients understand the role difference between an ANP and physician.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Unless the physician is called by first name, the ANP should be addressed as Miss, Mrs., Ms., or Mr., as the situation dictates.

Rationale 5: Routinely wearing a nametag that clearly presents credentials is one method to identify the nurse’s role.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 12.3 Analyze means to overcome these legal constraints.

Question 12 Type: MCMA A group is working to increase the number of advanced nurse practitioners (ANPs) who have hospital admitting privileges. Which barriers should these nurses address?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. There is no Medicare regulation mandating medical staff membership of APNs. 2. The fees associated with obtaining admitting privileges are prohibitive for ANPs. 3. State laws concerning ANP admitting privileges are confusing and contradictory.

4. Some state laws limit the scope of ANP practice.

5. Some hospitals do not allow non-physicians to admit patients.

Correct Answer: 1,3,4,5 Rationale 1: Medicare regulations may prevent the ANP from conducting patient examinations in the hospital setting because the ANP does not have medical staff membership.

Rationale 2: There is no indication that any fees associated with admission privileges are prohibitive.

Rationale 3: Some state laws allow for ANP admitting privileges, but they also require each admitted patient to have an attending physician. This is confusing and contradictory.

Rationale 4: In some states, the ANP is required to work with a physician, so that practice is not truly autonomous.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: Some hospital bylaws state that non-physicians cannot have admitting privileges.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: Analyze means to overcome these legal constraints Question 13 Type: MCSA The office director of a medical practice has recommended that the advanced practice nurses bill for service under the name of one of the group’s physicians. What is the probable rationale for this suggestion?

1. Patients are more likely to pay physician bills than nurse bills.

2. Typically physicians are reimbursed at a higher rate than ANPs. 3. Having a smaller number of names under which billing is submitted is more efficient.

4. Nurses are not permitted to bill government payers.

Correct Answer: 2 Rationale 1: There is no information to support this statement.

Rationale 2: Using the physician’s reimbursement codes ensures that reimbursement is billed at 100% rather than the 80-85% rate for ANPs. Rationale 3: Efficiency is not the most likely reason for this suggestion.

Rationale 4: Medicare does accept billing from advanced practice nurses.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 12.3 Analyze means to overcome these legal constraints.

Question 14 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Which option reflects a change that may occur in the roles of advanced practice nurses?

1. Movement to decrease the educational requirements for advanced practice nursing to the baccalaureate level 2. Development of a new category to include clinical nurse specialists and advanced nurse practitioners 3. Change of the doctor of nursing practice to eliminate the practice emphasis 4. Elimination of nurse midwifery Correct Answer: 2 Rationale 1: There is no movement to decrease the educational requirements for advanced practice nursing.

Rationale 2: Confusion exists between the roles of the CNS and the ANP. There is movement to create a category of APN that includes both of these roles. There is no movement toward the other options.

Rationale 3: By definition, the doctor of nursing practice is a practice-focused doctoral program.

Rationale 4: There is no movement to eliminate nurse midwifery.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 12.4 Compare and contrast the current status of advanced nursing practice with that role in the future.

Question 15 Type: MCSA The advanced nurse practitioner believes that he should spend as much time with each patient as the patient desires. Does this practice raise ethical challenges?

1. No, patients should expect to wait in any health care provider's office.

2. Yes, this practice reflects poorly on the nurse's physician colleagues.

3. No, this is the way all nursing should be practiced.

4. Yes, if this practice makes other patients wait past their own appointment times.

Correct Answer: 4

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Patients no longer expect to wait in the health care provider’s office.

Rationale 2: The issue has nothing to do with the nurse’s physician colleagues.

Rationale 3: Nurses should provide as much care as necessary, but unlimited amounts of time with patients is not realistic.

Rationale 4: The ethical dilemma arises when taking extra time with one patient requires another patient to wait past his or her appointment time. Is it ethical to let the needs of one patient supersede the needs of another?

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 12.5 Analyze ethical issues that may arise with advanced practice roles.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 13 Question 1 Type: MCSA Which statement indicates that a nurse understands how the doctrine of respondeat superior alters his liability for negligent conduct?

1. “If I can prove that this doctrine applies, all of the liability is shifted to the hospital.”

2. ”Respondeat superior will not alter my liability in any way.”

3. “My liability to the patient is reduced by this doctrine.”

4. “Since the hospital is liable for my actions, I am liable to my employer to provide competent care.”

Correct Answer: 4 Rationale 1: Vicarious liability is not a shift of liability, but an extension of liability allowing justice to be fairly distributed.

Rationale 2: If respondeat superior applies to this case, the nurse’s liability will be altered.

Rationale 3: The nurse is always liable for all actions in the care of the patient.

Rationale 4: The courts have supported the concept that the employer is liable for its employees' actions as an element of the master-servant relationship; therefore, the nurse is liable to the employer. The employer is liable for the conduct and actions of the employee, but the employee is responsible to the employer.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13.1 Describe the doctrines of respondeat superior, borrowed and dual servant doctrines, ostensible authority, corporate negligence, and direct corporate liability.

Question 2 Type: MCSA In an effort to attract clinic physicians, the hospital has agreed to provide a nurse to work in the physician's office.

The nurse will work under the direction and supervision of the physician whose clinic is housed with the hospital building. Which doctrine most closely describes the conditions in which this nurse is working?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Borrowed servant 2. Dual servant 3. Agent of the principal 4. Independent contractor Correct Answer: 1 Rationale 1: Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

Rationale 2: A dual servant is one who can be shown to serve both entities at the same time.

Rationale 3: As an agent of the principal, the person is under the control of only the principal or single employer.

Rationale 4: An independent contractor is one who arranges with another to perform a service for him or her but who is not under the control or right to control of the second person.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.1 Describe the doctrines of respondeat superior, borrowed and dual servant doctrines, ostensible authority, corporate negligence, and direct corporate liability.

Question 3 Type: MCSA The hospital has outsourced housekeeping services to an independent contractor. A patient who was injured in a fall on wet flooring brings suit against the company. Does the hospital also hold liability?

1. Yes, secondary to the doctrine of borrowed servant 2. No, secondary to the doctrine of respondeat superior 3. Maybe, secondary to the doctrine of dual servant 4. Perhaps, secondary to the doctrine of ostensible authority Correct Answer: 4 Rationale 1: Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Respondeat superior is the common law principle of substituted liability based on a master-servant relationship.

Rationale 3: A dual servant is one who can be shown to serve both entities at the same time.

Rationale 4: Ostensible authority is an application of agency law that allows a principal to be liable for acts and omissions by independent contractors working within the principal's place of business or at the direction of the principal, and a third party misinterprets the relationship as employer-employee.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.1 Describe the doctrines of respondeat superior, borrowed and dual servant doctrines, ostensible authority, corporate negligence, and direct corporate liability.

Question 4 Type: MCSA The hospital acts to revoke the clinical privileges of a physician who has repeatedly refused to respond to emergency calls from nursing staff. Under which doctrine is this action advisable?

1. Respondeat superior 2. Corporate liability 3. Borrowed servant 4. Dual servant Correct Answer: 2 Rationale 1: Respondeat superior is the common law principle of substituted liability based on a master-servant relationship.

Rationale 2: Under the doctrine of corporate liability, corporations have a direct duty to the public they serve, ensuring that competent and qualified practitioners deliver quality health care to consumers.

Rationale 3: Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

Rationale 4: A dual servant is one who can be shown to serve both entities at the same time.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.1 Describe the doctrines of respondeat superior, borrowed and dual servant doctrines, ostensible authority, corporate negligence, and direct corporate liability.

Question 5 Type: MCSA The hospital has been sued for the actions of a nurse employee. The hospital proves that the nurse was not providing care within the scope of employment as a nurse. Can the hospital still hold liability in this case?

1. Yes, if the plaintiff can prove the nurse was incompetent and that the hospital was aware of the incompetence.

2. No, the doctrine of ostensible authority relieves the hospital of liability related to a rogue employee.

3. Yes, the hospital is automatically liable for the action of any employee.

4. No, at this point the nurse is considered a "lone ranger" and the hospital is not liable for the nurse's actions.

Correct Answer: 1 Rationale 1: The hospital may be found negligent in hiring and firing if it can be proved that the nurse was incompetent and that the hospital did or should have known it.

Rationale 2: The doctrine of ostensible authority is not pertinent to this case as the nurse was an employee, not an independent contractor.

Rationale 3: The hospital is not automatically liable for all of the actions of its employees.

Rationale 4: If the hospital had no reason to believe that the nurse was incompetent, the nurse could stand to hold 100% of the liability in a case.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13.1 Describe the doctrines of respondeat superior, borrowed and dual servant doctrines, ostensible authority, corporate negligence, and direct corporate liability.

Question 6 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Which legal doctrine cannot apply to a nurse's practice as a private duty nurse?

1. Res ipsa loquitur 2. Negligent cause of action 3. Personal liability 4. Respondeat superior Correct Answer: 4 Rationale 1: Res ipsa loquitur, as presented in a previous chapter, means “the thing speaks for itself.” This doctrine could be applied to a situation involving a private duty nurse.

Rationale 2: Private duty nurses can be charged with negligence.

Rationale 3: Private duty nurses can have personal liability in provision of patient care.

Rationale 4: Private duty nurses are employed by individuals to give care. The doctrine of respondeat superior implies that the employer is responsible for the nurse's actions. It is illogical to view the patient as responsible for his or her nurse's actions as an employee.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.2 Define and discuss the role of the individual contractor in the health care delivery system.

Question 7 Type: MCMA Which nurses would be most likely to be protected under the Age Discrimination Employment Act of 1967 if fired?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A 40-year-old nurse with excellent work history whose replacement is 35 years old 2. A 49-year-old male nurse who held a position in obstetrics Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. A 23-year-old nurse who was told that she was "too young" for the job 4. A 72-year-old nurse who was fired from an OR scheduling position 5. A competent 60-year-old nurse who discovers the nurse hired for his position is 50 years old Correct Answer: 1,5 Rationale 1: In order to file a successful age discrimination lawsuit under the Age Discrimination Employment Act of 1967, the employee must meet four criteria: be 40-70 years old, perform job responsibilities according to the employer's expectations, be discharged, and be replaced by a substantially younger person.

Rationale 2: It would be more likely that this nurse has experienced gender discrimination.

Rationale 3: Since this nurse is 23, the criteria for age discrimination are not met.

Rationale 4: Since this nurse is 72, the criteria for age discrimination are not met.

Rationale 5: This nurse is competent, within the covered ages and was fired. Being replaced by a nurse who is “substantially younger” (in this case 10 years younger) fulfills the criteria for age discrimination.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 13.4 Describe federal and state employment laws that affect the delivery of health care in the United States.

Question 8 Type: MCMA The nurse who was found to be negligent in a lawsuit was just told by her attorney that the hospital will attempt to recover damages from the nurse pursuant to the principle of indemnification. What will the hospital have to prove for this to occur?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The hospital is only liable in the suit because of the employee’s actions.

2. The nurse has been employed at the hospital for less than 6 months.

3. The hospital incurred monetary damages because of the employee’s actions.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. The employee has personal professional liability insurance.

5. The money owed by the hospital is in excess of one million dollars.

Correct Answer: 1,3 Rationale 1: One key to applying the principle of indemnification is that the employer is at fault in a liability suit only because of the employee’s negligence.

Rationale 2: The length of employment is not a factor in this decision.

Rationale 3: One key to applying the principle of indemnification is that the hospital incurred monetary damages because of the employee’s negligence.

Rationale 4: Whether or not the employee has personal professional liability insurance is not a factor in the principle of indemnification.

Rationale 5: The amount of monetary damages owed by the hospital is not a factor in the application of indemnification.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.3 Describe the impact of indemnification from a corporate perspective.

Question 9 Type: MCMA The female nurse works in a nursing home where many of the patients are military service veterans. She discovers that a male nurse with whom she works makes $2.80 per hour more than she makes. In which situations could this be legal under affirmative action?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The male nurse's yearly evaluations are better than the female nurse's.

2. The male nurse is friendlier and gets along better with the male patients.

3. The male nurse is also a veteran.

4. The male nurse is physically stronger than the female nurse.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

5. The male nurse has worked in the facility 3 years more than the female nurse.

Correct Answer: 1,5 Rationale 1: Courts have upheld that unequal pay may be legal if based on merit. In this case, the male nurse has a better track record of yearly evaluations. This is sufficient to justify the difference in pay, unless the female nurse can prove preferential treatment in the evaluation system.

Rationale 2: Friendliness is not a reason to pay one employee more than another.

Rationale 3: Veteran status cannot be used as a reason for pay differences.

Rationale 4: If the female nurse meets the physical requirements of the job, the fact that the male nurse is stronger is not relevant.

Rationale 5: Seniority is a valid reason for pay rate differences.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.4 Describe federal and state employment laws that affect the delivery of health care in the United States.

Question 10 Type: MCSA A nurse was granted 12 weeks' leave under the Family and Medical Leave Act for care of an adult son. At the conclusion of the 12 weeks the nurse does not want to return to work. Under which situation might the leave be extended?

1. If the son is under treatment for substance abuse 2. If the son is still too sick to work 3. If the son is a firefighter, police officer, or other public servant 4. If the son is a member of the National Guard Correct Answer: 4 Rationale 1: Treatment of substance abuse is not a reason for extension of this leave.

Rationale 2: The nurse must be able to return to work at the end of this leave except for a specific reason.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The son’s work as a public servant does not remove the need for the nurse to return to work at the end of this leave.

Rationale 4: In 2008, President George W. Bush signed an amendment to the Family and Medical Leave Act to permit a spouse, son, daughter, parent, or next of kin to take up to 26 work weeks of leave to care for a member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 13.4 Describe selected federal and state employment laws that affect the delivery of health care in the United States.

Question 11 Type: MCMA The nurse cited "intolerable working conditions" as the reason for resignation. In order to claim constructive discharge, what must the nurse prove?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse’s performance evaluation was not as good as other nurses on the unit.

2. The workplace stress had increased since hire.

3. The nurse was tired of waiting for a transfer to the day shift that had been promised for 6 months.

4. The employer deliberately created the work condition to force the nurse to resign.

5. Other nurses working on the unit describe the working conditions as intolerable.

Correct Answer: 4,5 Rationale 1: As long as the performance evaluation is accurate, there is no claim of constructive discharge.

Rationale 2: The workplace stress likely increased for all working on the unit, which will not support a claim of constructive discharge.

Rationale 3: Waiting for a day shift can be irritating but does not support a claim of constructive discharge.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: To claim constructive discharge, the employee must show that the employer deliberately created intolerable working conditions with the intention of forcing the employee to resign.

Rationale 5: Constructive discharge only occurs when a reasonable employee would find the working conditions intolerable. Since others working on the same unit make this assessment, the claim of constructive discharge may be valid.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.4 Describe selected federal and state employment laws that affect the delivery of health care in the United States.

Question 12 Type: MCMA A patient who is well known to be violent arrives by ambulance at the emergency department for care of a laceration. What actions should be taken?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Sedate the patient prior to repairing the laceration.

2. Send the patient to another hospital.

3. Use a buddy system when providing care.

4. Restrain the patient prior to repairing the laceration.

5. Assign the most experienced nurse to work with this patient.

Correct Answer: 3,5 Rationale 1: Sedating the patient may be interpreted as false imprisonment.

Rationale 2: Sending the patient to another hospital may be interpreted as "dumping.”

Rationale 3: Using the buddy system when working with this patient will provide one person to provide care and the other to monitor the patient’s responses.

Rationale 4: Restraining the patient may escalate violent tendencies and can be interpreted as false imprisonment.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: An experienced clinician is likely to be more confident and assured when caring for this patient.

This confidence can be calming and reassuring for the patient.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.4 Describe selected federal and state employment laws that affect the delivery of health care in the United States.

Question 13 Type: MCSA A nurse calls the newspaper and reports that circumstances surrounding several deaths in the local hospital are suspicious and that a cover-up is in action. The subsequent article identifies the nurse by name and the nurse is fired. Is the nurse protected under the whistleblower law?

1. No, the report should have been made in person, not by telephone.

2. Yes, since a death occurred, any action to expose the situation is appropriate.

3. Yes, the nurse's action is one that any reasonable and prudent citizen would take.

4. No, the allegations should have been made to the appropriate authorities.

Correct Answer: 4 Rationale 1: The method of communication is not the most concerning fact of this situation.

Rationale 2: Whistleblower protection is very specific and is not pertinent in this situation.

Rationale 3: The actions taken by this nurse are not protected by whistleblower legislation.

Rationale 4: Whistleblowers are not protected if complaints are made to other than the proper authorities and agencies.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.4 Describe selected federal and state employment laws that affect the delivery of health care in the United States.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 14 Type: MCSA The nurse says, "I don’t want to take care of these patients anymore. I spend my whole day getting patients up to the bathroom or to the bedside chair. My back hurts so badly by the end of my shift.” How should the nurse manager interpret this statement?

1. This nurse is likely burned out and needs a few days off work.

2. The nurse should be transferred to a different unit.

3. Additional assessment of the meaning of this statement is necessary.

4. The nurse should be educated about use of lift equipment.

Correct Answer: 3 Rationale 1: There is not enough information to determine that this nurse is suffering from burn-out.

Rationale 2: Simply transferring the nurse is not a good plan.

Rationale 3: Patients are dependent on nurses for mobility. Unwillingness to provide this basic care may indicate that an ethical challenge exists. The dilemma is the balance between patient mobility and the nurse’s health. The manager should conduct additional assessment of the statement and the situation.

Rationale 4: At this point, the manager does not know if this is the case.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.5 Discuss selected ethical issues that arise in this area of the law.

Question 15 Type: MCSA The nurse and immediate supervisor have a personal conflict. The supervisor warns the nurse that the hospital is an employment-at-will institution. What does that indicate?

1. The nurse must work a given number of hours each week.

2. The nurse can only be dismissed for just cause.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The nurse has the choice of working in any hospital unit.

4. The nurse can be dismissed at any time, without cause.

Correct Answer: 4 Rationale 1: Employment-at-will does not pertain to the number of hours worked each week.

Rationale 2: Employment-at-will does not restrict the hospital to dismissal only for cause.

Rationale 3: Employment-at-will has nothing to do with the choice of where to work within the hospital.

Rationale 4: An ethical issue regarding employment laws is the existence of employment-at-will institutions. This means the employer can dismiss employees for cause or for no cause, including perhaps the aspect that a given supervisor does not like the individual.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 13.5 Discuss some ethical issues that arise in this area of the law.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 14 Question 1 Type: MCSA A nurse manager has been asked to present information about the Americans with Disabilities Act to newly employed nurses. What information about the evolution of this act should be included?

1. This act was written to protect a growing population of older Americans.

2. Increased numbers of children with disabilities resulting from advances in technologies to save premature infants made this legislation essential.

3. People living with HIV/AIDS began to identify loopholes in the existing state and federal non-discrimination laws.

4. There was a big increase in the number of soldiers returning from war with orthopedic injuries.

Correct Answer: 3 Rationale 1: Older Americans were not the focus population necessitating this act.

Rationale 2: While these children will benefit from this legislation, they were not the group necessitating the law.

Rationale 3: The act was necessitated by the discrimination faced by individuals with HIV/AIDS, as those persons identified loopholes not adequately addressed by existing state and federal laws.

Rationale 4: While this is a continuing trend, it was not the impetus for this act.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14.1 Describe the conditions within the United States that caused both the ADA and the Civil Rights Act of 1991 to be written and implemented.

Question 2 Type: MCSA The aim of the Americans with Disabilities Act was to eliminate discrimination against individuals with disabilities. In order to achieve this goal, Congress combines disability with which other legal concept?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Autonomy 2. Right to work 3. Fairness 4. Equality Correct Answer: 4 Rationale 1: Autonomy is not a legal focus of this act.

Rationale 2: Right to work is not assured by this act.

Rationale 3: Fairness is not a major concept in this act.

Rationale 4: The aim was to ensure equality for those with disabilities, without undue hardships being placed on those regulated by the act.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 3 Type: MCMA The nurse manager, making hiring decisions, would consider which applicants as protected from discrimination by the Americans with Disabilities Act and amendments?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A person required to wear a hand brace for 3 weeks 2. A person who takes medication for schizophrenia 3. A person who wears glasses 4. A person who used a wheelchair for 1 year as a child 5. A person who has cancer Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 2,4,5 Rationale 1: Transitory impairments (those with an actual or expected duration of 6 months or less) are not included in this definition.

Rationale 2: Mental impairment is considered a disability. This definition holds despite medication to control the disorder.

Rationale 3: Need to wear ordinary eyeglasses or contact lenses does not meet the definition of a disability.

Rationale 4: A person with history of a disability is covered by this act.

Rationale 5: One of the specific “major life events” covered by the amended act is alteration of normal cell growth.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 4 Type: MCMA A job applicant with a disability has requested that the employer provide a reasonable accommodation. What does this request entail?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Employment opportunities not given to persons without disabilities 2. Workplace modifications to allow the applicant to be a successful employee 3. Selection of this applicant over other qualified applicants 4. Schedule modifications if acceptable to all involved.

5. Workplace modifications that are realistic Correct Answer: 2,4,5

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The employer is not required to provide employment opportunities that would not also be extended to those without disabilities.

Rationale 2: Reasonable accommodation reflects changes that are needed for the worker to be successful. The employer must attempt to make accommodations that are needed and acceptable to all parties involved.

Rationale 3: The employer is not required to hire an applicant with a disability over other qualified applicants.

Rationale 4: Schedule modifications may be considered a reasonable accommodation if the changes are acceptable to both the employee and the employer.

Rationale 5: The requested modifications must be realistic and must not work an undue hardship on the employer.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 5 Type: MCMA Which scenarios meet the Civil Rights Act of 1991 definition of quid pro quo sexual harassment?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A supervisor offers to give a nurse a promotion if she will consent to going to dinner with him.

2. A nurse is fired after breaking off a romantic relationship with the unit nurse manager.

3. The nurse is offended by the jokes told during morning report.

4. The nurse no longer feels comfortable eating lunch in the break room because the other staff members in the room often discuss their sexual encounters.

5. A nurse becomes uncomfortable because one of the unit physicians often hugs or touches her.

Correct Answer: 1,2 Rationale 1: Quid pro quo occurs when submission to or rejection of the sexual conduct by an individual is used as a basis for employment decisions affecting the individual.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Quid pro quo sexual harassment occurs when submission to or rejection of the sexual conduct for an individual is used as a basis for employment decisions affecting the individual.

Rationale 3: This scenario may represent sexual harassment, but does not meet the definition of quid pro quo.

Rationale 4: This situation most closely represents the development of a hostile work environment, but does not represent quid pro quo.

Rationale 5: There is no indication that this physician has any managerial relationship with the nurse or that the physician is involved in hiring or promoting nurses. Therefore, this may be a case of sexual harassment but is not quid pro quo.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 6 Type: MCMA Which employee would likely be unsuccessful in claiming job protection under the Americans with Disabilities act?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A person who has progressive hearing loss 2. A person who has just revealed he is homosexual 3. A person diagnosed with a gender identity disorder 4. A person who is a compulsive gambler 5. A person with a femur fracture who will require a wheelchair for three months.

Correct Answer: 2,3,4 Rationale 1: Progressive hearing loss is a disability as defined by this act.

Rationale 2: The ADA excludes homosexuality from its coverage.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: There are multiple exclusions from the definition of disability under the ADA, including gender identity disorders not resulting from physical impairments.

Rationale 4: Compulsive gambling is not a covered ADA disability.

Rationale 5: This is a transitory condition and is not covered by the ADA. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 7 Type: MCSA Which scenario meets the Civil Rights Act of 1991 definition of hostile environment sexual harassment?

1. A nurse manager suggests that a nurse’s performance evaluation be discussed over dinner and drinks.

2. The nurse continually finds cartoons of a sexual nature posted on the unit bulletin board.

3. The nurse has a continuing argument with a co-worker that makes the workplace uncomfortable.

4. A nurse working on the unit is homosexual.

Correct Answer: 2 Rationale 1: This situation is more likely to represent quid pro quo sexual harassment.

Rationale 2: Submission to sexual innuendos, remarks, and physical acts that alter the conditions of the employee's employment and create an abusive environment is the definition of hostile work environment sexual harassment according to the Civil Rights Act of 1991.

Rationale 3: There is no indication that this argument is of a sexual nature, so sexual harassment is not probable.

Rationale 4: The presence of a homosexual nurse does not constitute hostile work environment sexual harassment.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 8 Type: MCSA A nurse manager is concerned that actions by a female nurse may constitute sexual harassment. What element should the manager consider?

1. The number of male employees working on the unit 2. The females nurse’s age 3. Does the nurse mean to be offensive?

4. Would a reasonable person’s work be affected by this behavior?

Correct Answer: 4 Rationale 1: The existence of sexual harassment is not defined by gender.

Rationale 2: Age is not pertinent in this decision.

Rationale 3: The person does not have to mean to be offensive for actions to constitute sexual harassment.

Rationale 4: If the situation would affect a reasonable person’s work environment, the actions likely represent sexual harassment.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 9 Type: MCSA Which situation would the nurse manager evaluate as sexual favoritism or preferential treatment?

1. The female nurse agrees to meet a male nurse for coffee after work.

2. The promotion the nurse was seeking was given to the supervisor’s girlfriend.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. A nurse reports another nurse who makes a disparaging remark about a lesbian co-worker.

4. Co-workers offer support for a co-worker who decides to divulge his homosexuality to his family.

Correct Answer: 2 Rationale 1: There is no indication that this is anything more than a normal date or encounter.

Rationale 2: An employer may be liable for unlawful sexual discrimination when an employee is denied a job opportunity or benefit due to the preferential treatment of another employee who submits to the employer's sexual advances.

Rationale 3: Making these remarks is unprofessional and unkind but does not represent preferential treatment.

Rationale 4: There is no information in this scenario that supports a claim of preferential treatment.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.2 Describe the various sections of the two acts, necessary definitions, and intended purposes.

Question 10 Type: MCSA A nurse who has an obvious physical disability applies for a staff nurse position. Which question, asked by the nurse recruiter, is legal?

1. "How long have you been disabled?"

2. "Are you able to fulfill the requirements of this job?"

3. "How does your disability affect your life?"

4. "Has your condition stabilized, or do you foresee it getting worse with time?"

Correct Answer: 2 Rationale 1: Questions about the disability are not allowed.

Rationale 2: Applicants may be questioned about their ability to perform essential job functions.

Rationale 3: Questions about the disability are not allowed.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Questions about the disability are not allowed.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 14.3 Describe how the acts affect the health care delivery system in terms of consumers and providers.

Question 11 Type: MCSA The nurse manager requests that a job applicant who has a physical disability receive a medical examination prior to assignment to a work station. Is this examination legal?

1. No, this requirement violates ADA. 2. Only if all other applicants for similar positions are subjected to the same examination 3. Only if the examination takes place before the job offer is extended 4. Only if the applicant agrees to have medical information released to those on the committee screening applicants.

Correct Answer: 2 Rationale 1: This test does not necessarily violate ADA. Rationale 2: This requirement is only legal if all other applicants for similar positions are also required to take the examination.

Rationale 3: The examination must be performed after the offer of a job is extended.

Rationale 4: Only persons with need to know should be told of the results of this test. The final decision to hire probably does not lie with a screening committee, so they would not have a need to know the results of medical exams. Medical exams should not be part of the screening process.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 14.3 Describe how the acts affect the health care delivery system in terms of consumers and providers.

Question 12 Type: MCSA The nurse applies to a faith-based hospital. Another applicant who is of the same faith supported by the hospital is hired instead. Is this seen as discrimination under ADA? 1. No, employers may offer preference to individuals of the same religion.

2. Yes, the hiring decision must be made solely on ability.

3. Only if both nurses have similar experience and skill sets 4. Only if other cases of preference by the facility can be demonstrated Correct Answer: 1 Rationale 1: Employers with religious affiliations may give preference to individuals of the same religious sect.

Rationale 2: Employers with religious affiliations may hire preferentially.

Rationale 3: Experience and skill sets legally may not be the deciding factor in this situation.

Rationale 4: There is no reason to demonstrate a history of preferential hiring.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.3 Describe how the acts affect the health care delivery system in terms of consumers and providers.

Question 13 Type: MCSA Which person best meets the criteria as a "member of a protected class" in a quid pro quo sexual harassment lawsuit?

1. A female nurse as compared to a male staff nurse 2. A male housekeeper as compared to a male laboratory technician Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. A female physician as compared to a male physician 4. A staff nurse as compared to his or her supervisor Correct Answer: 4 Rationale 1: This female nurse does not meet the requirements to be considered in a “protected class.”

Rationale 2: Differences in job description at the same supervisory level do not place one person in a “protected class.”

Rationale 3: Gender is not considered as a component is determining placement in a “protected class.”

Rationale 4: Persons that are members of a protected class are those who are employees in a lower position in the power chain of command.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.3 Describe how the acts affect the health care delivery system in terms of consumers and providers.

Question 14 Type: MCMA An employee has requested special accommodations secondary to a disability. The hospital refuses, citing undue hardship. What must be present for that refusal to be upheld?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The accommodation would be very difficult to implement.

2. The accommodation would require physical changes to the work environment.

3. The accommodation would not be necessary if the employee changed positions.

4. The accommodation has never been made before this case.

5. The requested accommodation will require very expensive equipment and renovation.

Correct Answer: 1,5 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: An accommodation that is extremely difficult to implement may qualify under the undue hardship provision.

Rationale 2: Physical changes to the environment are frequently the accommodation requested and many of these changes are reasonable.

Rationale 3: The employee should not have to change positions if a reasonable accommodation can be made.

Rationale 4: Just because an accommodation has not be made previously does not mean it is not appropriate in this case.

Rationale 5: If the requested accommodation is extremely expensive it is not reasonable.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 14.4 Analyze the ever-expanding number of cases filed under both of these acts.

Question 15 Type: MCSA The nurse who has worked at a hospital for twenty five years suffers a disability secondary to a work-related accident and requests accommodation. The nurse is offered a position for which she is qualified, but in an area which she has no experience. Ethically, does the nurse's new position have to provide the same high salary as the old position?

1. No, the nurse's salary may be cut to the entry-level salary of the new position.

2. Yes, the new position must match or exceed the old position's salary.

3. No, but the nurse's seniority should be considered in salary negotiations.

4. Only if the nurse is equally as "productive" in the new position Correct Answer: 3 Rationale 1: Legally this is correct, but is not the most ethical option.

Rationale 2: Reasonable accommodation does not require this legally. Ethically, it is not appropriate to offer a person with no experience a salary that may be higher than those with whom she works.

Rationale 3: There is no legal mandate to continue the salary, but ethically the nurse’s seniority and loyalty to the hospital should be considered.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Since the nurse has no experience in this position, it is unlikely that she will be “productive” for some time. This is not a good way to establish salary level.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 14.5 Describe selected ethical issues that arise in the context of these two federal laws.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 15 Question 1 Type: MCSA The court found a nurse manager liable for failure to warn. Which option reflects a failure to warn scenario?

1. The nurse manager did not advise a newly hired nurse that continuing education was an annual requirement for promotion.

2. The nurse manager did not notify the physician regarding worsening of a patient's respiratory status.

3. The nurse manager did not tell a potential employer that a former employee was asked to resign for incompetence.

4. The nurse manager did not adequately supervise a newly hired nurse who had not practiced nursing in five years.

Correct Answer: 3 Rationale 1: Failure to warn is not associated with failure to tell new employees about job requirements.

Rationale 2: Failure to warn is not related to patient condition.

Rationale 3: Failure to warn is a newer area of potential liability for nurse managers in which the manager fails to warn a potential employer of staff incompetence or impairment. If the institution has sufficient information and suspicion on which to discharge an employee or force a letter of resignation, then subsequent employers should be aware of those issues.

Rationale 4: Failure to warn is not related to supervision of new nurses.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.1 Analyze the concept of corporate liability, including the nurse manager's role in preventing such liability.

Question 2 Type: MCMA Which strategies should the nurse manager employ when asked to float staff from one area to another?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Consider the patient care delivery systems on each unit.

2. Float staff in alphabetical order of their last name.

3. Float nurses to areas with similar patient care requirements if possible.

4. Cross-train staff to various units.

Correct Answer: 1,3,4 Rationale 1: Significant differences in patient care delivery systems can make competent and efficient care more difficult. The nurse manager should try to match these care delivery systems as much as possible.

Rationale 2: Choosing to float nurses according to their name does not support quality care.

Rationale 3: The more closely the home unit and float unit match in patient care requirements, the more comfortable the floated nurse is likely to be.

Rationale 4: If floating is a common need in a facility, it is best overall to cross-train nurses between units. That will allow for nurses to become accustomed to and comfortable providing care on more than one unit.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.2 Define three separate issues concerning staffing from the aspect of the nurse manager's legal liability.

Question 3 Type: MCSA A group of nurses are concerned about the chronic understaffing and mandatory overtime requirements of their state's hospitals. How could this group best help solve this issue?

1. Advise nurses to go home after their assigned shift instead of working overtime.

2. Talk to state legislatures about establishing staffing ratios.

3. Lobby for legislation supporting safe staffing measures.

4. Develop policies whereby nurse managers are the only ones required to work overtime.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 3 Rationale 1: If the nurses go home and there is not adequate staff to care for patients, the nurses may be guilty of abandonment.

Rationale 2: Staffing ratios are not the answer to mandatory overtime. Mandatory overtime generally occurs when there is not enough staff to provide care. Staffing ratios will not address this problem.

Rationale 3: Due to the most recent movement toward adequate numbers of nurses, many states are now moving toward the concept of safe staffing. State legislation for safe staffing helps to bring the issue to light and to protect patients from the dangers associated with this practice.

Rationale 4: Exclusive use of nurse managers for overtime work is illogical as there are not enough nurse managers to fill the staffing slots.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15.11 Identify some of the ethical concerns in the area of corporate and contract law.

Question 4 Type: MCSA The unit policy is that the nurse with the least seniority is required to float to understaffed units. Is this the best policy?

1. Yes, the most senior people should be required to manage their home unit.

2. No, this policy is against most corporate philosophy.

3. No, generally the most capable and efficient person should be floated.

4. Yes, having choice in these matters is a benefit of longevity in the facility.

Correct Answer: 3 Rationale 1: The nurse manager should be certain that enough experienced nurses are left on the home unit so that quality of care is not threatened. However, always floating the least senior staff is not a fair policy.

Rationale 2: There is no indication that this is against more corporate philosophy and is often the manner in which floating decisions are made.

Rationale 3: It is a better policy to float the best nurse as that nurse is more likely to adapt to the other unit.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Seniority can be awarded in other ways. It is not the best policy to always float the nurse with the least seniority.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15.2 Define three separate issues concerning staffing from the aspect of the nurse manager's legal liability.

Question 5 Type: MCSA The hospital's risk management team has identified a hazard to patient safety through review of incident reports.

What should be the team's next action?

1. Discipline staff who have been involved in previous incidents.

2. Eliminate the hazard before anyone else is harmed.

3. Identify and compensate any patient previously injured.

4. Gather and trend data on the occurrences.

Correct Answer: 2 Rationale 1: Disciplining staff may lead to reluctance to report other incidents.

Rationale 2: The first action is to eliminate the hazard before anyone else is harmed.

Rationale 3: Paying for previous injuries does not help identify or eliminate hazards.

Rationale 4: Information should be gathered and trended, but this is not as important as eliminating the hazard.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.3 Describe the goals of risk management.

Question 6 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The news reports that a nurse "contracted over the telephone" to distribute narcotics. Under contract law is that a correct statement?

1. Yes, the contract agreement can be verbal or written.

2. Only if something of value, like money, is offered as compensation 3. If both parties understand the terms and meaning of the contract 4. No, contracts must fulfill a lawful purpose.

Correct Answer: 4 Rationale 1: The fact that this is a verbal agreement is not significant.

Rationale 2: What is offered in exchange for this murder is not significant to whether this is a contract.

Rationale 3: Understanding of the agreement is not significant to this question.

Rationale 4: Contracts must fulfill a lawful purpose and distributing narcotics is not a lawful purpose. There can be no enforceable contract for illegal acts or fraud.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15.4 Define and describe principles and terms used in contract law.

Question 7 Type: MCSA The nurse takes a position working in a clinic and receives a sign-on bonus. After having worked for one month the nurse charges that she never signed a contract with the clinic and therefore can leave for a different, higherpaying job without returning the bonus. What is true about this situation?

1. Since there was no signed paper, the contract does not exist.

2. Cashing the bonus check indicates acceptance of the contract.

3. The contract was accepted when the nurse showed up for work.

4. Acceptance of the terms of a contract must be in writing.

Correct Answer: 3 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: There is no requirement that a signature is necessary for a contract to exist.

Rationale 2: While cashing the bonus check certainly indicates acceptance, the contract already existed prior to this occurrence.

Rationale 3: Contracts may be accepted by the beginning performance of the offeree (by showing up for work).

Rationale 4: There is no requirement that the contract be in writing.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.5 Describe the four elements of a valid contract.

Question 8 Type: MCSA Which situation reflects consideration in contract law?

1. The nurse agrees to work for specific wages.

2. Assertion that the nurse is legally able to enter into a contract 3. The description of the type of work expected by the facility wishing to employ the nurse 4. The nurse agrees to work at an immunization clinic from October through December.

Correct Answer: 1 Rationale 1: The four elements of contract law include the offer, acceptance, consideration, and consent.

Consideration is the economic base for the contract, in this question the specific wages the nurse agrees to accept.

Rationale 2: Assertion of the legal ability to enter into a contract is not the same as consideration.

Rationale 3: The description of the type of work expected is the offer.

Rationale 4: The length of time the nurse is expected to work is part of the offer.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 15.5 Describe the four elements of a valid contract.

Question 9 Type: MCMA Which situations are exceptions to the statute of frauds principle?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A verbal contract for a teenager to receive $25 to mow a neighbor's lawn 2. An oral agreement to purchase a new car by making payments over the next 48 months.

3. A "handshake" agreement to sell a one-acre parcel of land 4. An agreement that the hospital will continue to provide oncology services if the current oncology specialty group breaks their contract.

5. A verbal agreement for a nurse to work in a physician's office indefinitely Correct Answer: 2,3,4,5 Rationale 1: The statute of frauds is the legal principle that a contract does not need to be written to be enforceable. The statute of frauds is in effect and no exception exists.

Rationale 2: This situation likely is an exception to the statues of frauds for two reasons, the price of the car and the length of payment schedule.

Rationale 3: The statute of frauds is the legal principle that a contract does not need to be written to be enforceable. Exceptions to this statute include agreements involving the sale of land. A legal written contract is necessary for sale of land so this is an exception to the statue of frauds.

Rationale 4: Suretyship is an agreement to pay or perform actions in the event that the principle is unable to meet his or her obligations. Since the hospital is agreeing to provide oncology services even if the current specialty group leaves, a written contract is necessary. This is an exception to the statue of frauds.

Rationale 5: Since this agreement cannot be performed within a 12-month period a written contract is necessary.

This is an exception to the statute of frauds.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 15.6 Define the statute of fraud and its relationship to contract law.

Question 10 Type: MCSA The contract between a nurse and a hospital delineates the nurse's salary, benefits package, and when the job will begin. The contract does not state that the nurse must provide quality care. How would the hospital attorney describe this expectation if the nurse brings suit for wrongful discharge?

1. Expressed terms 2. Implied provisions 3. Silent terms 4. Inherent provisions Correct Answer: 2 Rationale 1: Expressed terms are the specific terms discussed or negotiated (in this case, salary, benefits, and job start date).

Rationale 2: Implied terms are those that each side anticipated were a part of the contract but that were never actually expressed or discussed.

Rationale 3: There was no discussion of silent terms.

Rationale 4: There was no discussion of inherent provisions.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15.7 Define types of contracts and give examples of when each type would be used.

Question 11 Type: MCMA In which situations has legal termination of a contract occurred?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. The nurse contracts with another nurse to work out the contract.

2. The hospital refuses to pay the nurse for shifts worked.

3. The facility does not renew a contract that has ended.

4. The nurse repeatedly violates hospital policy and procedure outlined in the contract.

5. The hospital releases a nurse from the contract so that the family can relocate.

Correct Answer: 3,5 Rationale 1: Contracting with a third party to complete the contract is a violation of the terms of a contract and results in breach of contract.

Rationale 2: Refusal to pay for shifts worked is a violation of the terms of a contract and results in breach of contract.

Rationale 3: Once a contract’s terms have been fulfilled the contract is ended. There is no obligation to renew the contract.

Rationale 4: Failing to meet contract obligations results in a breach of contract which ends the contract.

Rationale 5: In this situation, both parties have agreed to end the contract, so the contract termination is legal.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.8 Identify and analyze three remedies for breach of contract law.

Question 12 Type: MCSA Which person would be the best choice for a mediator in a contract dispute between a nurse and a hospital?

1. A nurse who works on a similar unit in the hospital 2. A consultant from outside the hospital 3. A retired nurse who worked at the hospital five years ago 4. A hospital administrator from an area different from nursing Correct Answer: 2 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: Since this person is a nurse and works in the same hospital, this is not the best choice for a mediator.

Rationale 2: The mediator in a contract dispute should be totally unbiased and from outside the organization. An outside consultant would be the best choice.

Rationale 3: Since this nurse worked in the hospital at one time, this is not the best choice for a mediator.

Rationale 4: Since the administrator works in the hospital, this is not the best choice for a mediator.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 15.9 Describe the purpose of alternative dispute resolutions and give four means by which resolutions may be performed.

Question 13 Type: MCMA A work dispute has gone to arbitration. The nurses involved in the dispute are unhappy with the decision made by the arbitrator. Is the arbitrator’s decision binding?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The decision is binding.

2. Only if the other party also does not agree with the decision 3. Unless both parties agreed in advance that the decision is not binding 4. These decisions are only suggestions meant to guide further discussion.

5. If the dispute involves collective bargaining the decision is binding.

Correct Answer: 3,5 Rationale 1: There is not enough information to say the decision is binding.

Rationale 2: Whether the parties agree or disagree with the arbiter’s decision is not relevant to whether it is binding.

Rationale 3: Arbitration is binding unless both parties have agreed, in advance, that the decision is not binding.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Arbitration decisions are not just suggestions.

Rationale 5: In arbitration used with collective bargaining both parties must realize that the arbitrator’s decision is binding on both sides of the dispute.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15.9 Describe the purpose of alternative dispute resolutions and give four means by which resolutions may be performed.

Question 14 Type: MCMA Changes have been made to the employee handbook. What must occur in order for these changes to constitute a contract?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The handbook must have been distributed to all employees of the facility.

2. The handbook must be written clearly.

3. The employee must attend an inservice session about the new handbook.

4. The employee must continue to work after the manual takes effect.

5. The employee must sign a document indicating the handbook has been received.

Correct Answer: 2,4 Rationale 1: The contract is established by distributing the handbook to the employee. It does not have to be distributed to all employees.

Rationale 2: The handbook must be written in language that clearly sets forth a promise that the employee can construe as an offer.

Rationale 3: While the employees should be made aware of changes, specific inservices are not required.

Rationale 4: The employee must begin to work or continue to work after the handbook has been distributed.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: There is no requirement that the employee sign such a document, however; many facilities track distribution in this manner.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 15.10 Describe how contracts may arise after employment.

Question 15 Type: MCSA Mandatory overtime raises ethical issues about patient and nurse safety. How does voluntary overtime affect these issues?

1. It is also outlawed in states controlling mandatory overtime.

2. Nurses working overtime shifts are given smaller patient loads to protect safety.

3. There is no effect since the nurse has chosen to work overtime.

4. It requires nurse managers to be vigilant concerning safety.

Correct Answer: 4 Rationale 1: Voluntary overtime is not outlawed.

Rationale 2: Nurses working overtime are often given the same patient load they carried throughout their regular shift.

Rationale 3: Overtime of any nature may affect both patient and nurse safety. This is true whether the nurse has volunteered to work overtime or is required to do so.

Rationale 4: The nurse manager must be more vigilant concerning safety issues as issues of fatigue are more likely.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 15.11 Identify some of the ethical concerns in this area of the law.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 16 Question 1 Type: MCSA A nurse returning to practice remarks that delegation is much more regulated and complicated than when she last practiced 20 years ago. What rationale would the nurse manager provide for this change?

1. “The shortage of nurses has been the major reason that there are so many rules to follow when delegating.”

2. “Since nursing is trying to move back to the team approach to care delegation has become more important.”

3. “The introduction of multiple levels of professional staff members increases need for delegation rules and regulations.”

4. “The widespread return to primary nursing makes delegation more risky.”

Correct Answer: 1 Rationale 1: The nursing shortage has led to the need to use other licensed and unlicensed personnel to provide patient care that previously may have been performed only by registered nurses. Because this is occurring more frequently in multiple settings, the need for rules and regulations regarding delegation has arisen.

Rationale 2: There is no indication that nursing is trying to move back to a team approach.

Rationale 3: There has been no introduction of multiple levels of professional staff members.

Rationale 4: Delegation is not a component of primary nursing.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16.1 Differentiate delegation from assignment.

Question 2 Type: MCSA The charge nurse has delegated a task to another staff member. Who assumes accountability for the task?

1. It is held jointly by the charge nurse and the person performing the task.

2. It can be imputed to either the charge nurse or the person performing the task.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The charge nurse retains the accountability.

4. Accountability is transferred to the person performing the task.

Correct Answer: 3 Rationale 1: Accountability is not shared in this situation.

Rationale 2: The accountability is held specifically by one of these two people. It is not an either/or decision.

Rationale 3: While the person performing the task is responsible for his or her own actions, the accountability is always retained by the one who delegates.

Rationale 4: The person performing the task is responsible for his or her own actions but does not assume accountability for the task.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16.1 Differentiate delegation from assignment.

Question 3 Type: MCSA The nurse would correctly state that an assignment had been made in which situation?

1. The nurse says to the charge nurse, "Please watch my patients while I run down and pick up some lunch from the hospital cafeteria."

2. The nurse says to the UAP, "Please take all of the vital signs before you begin to deliver breakfast trays.”

3. The charge nurse divides the patient load into one team for each staff nurse who works the shift.

4. The nurse asks a housekeeper to clean a bed quickly for a new admission.

Correct Answer: 3 Rationale 1: This situation is an example of upward transfer of responsibility and accountability (from staff nurse to charge nurse).

Rationale 2: The person with the accountability for monitoring vital signs and assuring the patients are fed (the nurse) has delegated the tasks to the person responsible for their completion (the UAP). This is delegation.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: Dividing the patient load into a team for each staff nurse is an example of downward (charge nurse to staff nurse) transfer of responsibility and accountability and is assignment. This is frequently referred to as "making assignments."

Rationale 4: The person accountable for assuring that patients have clean beds (the nurse) delegates the task to the person responsible for its completion (the housekeeper). This is delegation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.1 Differentiate delegation from assignment.

Question 4 Type: MCMA The nurse is searching for information about nurses' responsibility and accountability for appropriate delegation of tasks. Where should this nurse look for this information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. State nurse practice acts 2. ANA Code of Ethics for Nurses 3. State medical association bylaws 4. ANA Nursing Scope and Standards of Practice 5. Nursing rules and regulations as promulgated by the state Correct Answer: 1,2,4,5 Rationale 1: Nurse practice acts address delegation.

Rationale 2: The ANA Code of Ethics for Nurses (2001) states that nurses have an obligation to delegate tasks appropriately.

Rationale 3: State medical associated bylaws do not provide direction about delegation in nursing.

Rationale 4: The ANA Nursing: Scope and Standards of Nursing Process has specific mandates regarding delegation practices.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 5: States develop specific rules and regulations in addition to the general statements provided in the nurse practice act.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.1 Differentiate delegation from assignment.

Question 5 Type: MCSA The registered nurse has delegated the task of ambulating a patient to two nursing assistants. The patient appears to ambulate without assistance, but must be ambulated with two assistants due to a history of unexpected fall.

What is the most important aspect of delegating this task?

1. The aides understand the importance of walking with the patient.

2. The patient is comfortable walking with the aides.

3. The aides understand the patient is to be ambulated twice daily.

4. The patient understands the need for assistance.

Correct Answer: 1 Rationale 1: Based on the five rights of delegation, the most important aspect is that the aides are given the correct directions and communications about keeping this patient safe.

Rationale 2: Patient comfort is very important, but is not the most important aspect of this delegation.

Rationale 3: The frequency of ambulation is not the most important part of this delegation.

Rationale 4: Ideally the patient will understand the importance of this instruction, but this concept has nothing to do with delegation to the assistants.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 6 Type: MCSA A newly hired nursing assistant can work only when under direct supervision by a registered nurse. In which way can this assistant provide care?

1. The nursing assistant charts care in the patient's medical record and the nurse reviews that charting on a regular basis.

2. The nursing assistant provides hygienic care according to protocols approved by the nurse.

3. The nurse and the nursing assistant work together to provide care to a team of six patients.

4. The nurse is available on the unit while the nursing assistant provides care.

Correct Answer: 3 Rationale 1: While this is a method of supervision, it is not direct supervision.

Rationale 2: The nurse has provided direction and will likely review the assistant’s work, but is not directly supervising the work.

Rationale 3: Direct supervision is provided when the delegator is actually present, observes, works with, and directs the persons being supervised.

Rationale 4: The nurse is available for supervision and direction but is not providing direct supervision.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Question 7 Type: MCSA In which scenario is the nurse providing indirect supervision of a nursing assistant?

1. The nursing assistant and nurse work on the same team, jointly providing care to inpatients.

2. The nurse is easily contactable by pager but is not present in the care environment.

3. The nurse makes rounds on the patient care units, observing the nursing assistant's work, at least every two hours.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. The nursing assistant receives constant instruction regarding patient care from the nurse.

Correct Answer: 2 Rationale 1: Since the nurse and the assistant are jointly providing care the nurse is providing direct supervision.

Rationale 2: Indirect supervision occurs when the delegator is easily contactable, but does not directly oversee the interventions or activities being performed.

Rationale 3: This nurse is providing direct supervision every two hours. There is no indication of what kind of supervision, if any, is occurring between observations.

Rationale 4: If the nurse is present to provide constant instruction, direct supervision is occurring.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Question 8 Type: MCSA The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient's death. Does the preceptor hold any liability in this case?

1. Yes, but only because the event resulted in patient demise.

2. Yes, the preceptor is responsible for delegating appropriately and supervising completion of tasks.

3. No, since the new nurse has a license, all liability is retained by the new nurse.

4. No, since the new nurse is employed by the medical facility, all liability is corporate.

Correct Answer: 2 Rationale 1: The fact that the event resulted in patient demise is not the deciding factor is whether the preceptor holds liability.

Rationale 2: Since the nurse in this case was newly licensed and the task delegated was complex, the preceptor does share liability. It could be shown that the task was delegated inappropriately and that the preceptor did not supervise the task correctly.

Rationale 3: The person delegating tasks must be certain that the person being delegated to is competent to perform the task.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: Nurses are liable for their actions.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Question 9 Type: MCMA A nurse working in the intensive care unit (ICU) notes that a patient is more confused and agitated than yesterday.

Which nursing actions are evidence of patient advocacy?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse assesses for common causes of confusion and agitation.

2. Tell the family that confusion and agitation frequently occur after ICU admission.

3. The nurse contacts the patient’s primary care provider regarding the confusion.

4. The nurse documents findings and actions in the medical record.

5. Ask for assistance from the nurse manager if necessary.

Correct Answer: 1,3,4,5 Rationale 1: Assessment allows the nurse to make comparisons between current status and previous status. This is the first step of collecting information to advocate for the patient’s care.

Rationale 2: Assuming this patient’s confusion and agitation is related solely to being in the ICU does not exemplify advocacy.

Rationale 3: This nurse had taken action to treat the patient which is an example of patient advocacy.

Rationale 4: Advocacy also includes documenting actions taken and response to actions.

Rationale 5: Assisting other nurses and seeking this assistance as necessary is a means of advocating for quality nursing care.

Global Rationale: Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.5 Analyze the role of advocacy from a legal perspective.

Question 10 Type: MCSA A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient's vital signs?

1. The licensed practical nurse who has worked on this unit for 5 years 2. The registered nurse who has worked on this unit for 8 months 3. The unlicensed assistive personnel (UAP) who was recently transferred to the unit from an acute care environment 4. The nursing assistant who has worked in this unit for 7 years Correct Answer: 2 Rationale 1: The licensed practical nurse is not educationally prepared to assess, diagnose, plan, implement, and evaluate care. This patient requires this level of intervention.

Rationale 2: This patient is receiving potent medication using a rapidly acting route. The actions of this medication are reflected in vital signs. The RN is educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

Rationale 3: The UAP is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

Rationale 4: The nursing assistant is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Question 11 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The unit is extremely busy when the physician orders that a urinary catheter be inserted in a patient. The patient's assigned nurse is new, has seen the procedure done, but has never done it independently. How should the charge nurse handle this situation?

1. The charge nurse should assist the new nurse with the procedure.

2. The charge nurse should ask the new nurse to try the procedure alone.

3. The charge nurse should assign the task to a different nurse.

4. The charge nurse should do the procedure to save time.

Correct Answer: 1 Rationale 1: Two things are taken into account in this situation. The task needs to be done efficiently and safely.

The new nurse needs to have experience in doing this common task. The most logical way to assure both those needs are filled is for the charge nurse to assist the new nurse with the procedure.

Rationale 2: If the charge nurse asks the new nurse to do the procedure alone, the charge nurse may end up having to do it anyway or the patient outcomes might be compromised.

Rationale 3: Assigning the task to a different nurse takes that nurse away from assigned patients and does not fulfill the need to help the new nurse learn the skill.

Rationale 4: If the charge nurse does the insertion, a valuable teaching opportunity for the new nurse has been missed.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16.2 Discuss the concept of supervision in effective delegation.

Question 12 Type: MCMA A nurse has delegated the task of ambulating a patient to two nursing assistants. Despite the patient's appearance, assistance of two people is needed for safe ambulation. The nurse discovers the patient being ambulated by only one aide. What nursing actions are indicated?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. Scold the second aide for not carrying through with the delegated task.

2. Determine why only one person is ambulating the patient.

3. Assume that something important must have taken the second assistant away from this task.

4. Assist the aide in completion of the ambulation.

5. Notify the patient’s physician of the incident.

Correct Answer: 2,4 Rationale 1: Scolding an adult is not likely to be an effective method of discipline.

Rationale 2: Part of an effective discipline plan includes investigating all facts and circumstances leading to the action for which discipline is being considered.

Rationale 3: The nurse should not assume anything about this situation.

Rationale 4: Providing for patient safety is always the priority, so the nurse should assist with completion of the ambulation.

Rationale 5: There is no indication that the patient was harmed in any way during this ambulation. There is no need to notify the physician regarding the incident.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.3 Discuss the role of effective discipline in delegation and supervision.

Question 13 Type: MCMA The nurse has recently assumed the position of chief nurse in a long-term care facility with a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Fire any nurse who does not meet established standards of care.

2. Firmly enforce the standards of care guiding the facility.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. Set variable standards of care depending upon the nurse's previous experience.

4. Establish a discipline system that is progressive.

5. Encourage supervisors to be consistent in applying discipline.

Correct Answer: 2,4,5 Rationale 1: Unless a particular employee is doing something illegal, immoral, or dangerous to patients, it would be better not to fire the employee until the nurse has more information and has set the tone of the care expectations.

Rationale 2: Standards of care should be upheld and communicated to all those providing care.

Rationale 3: Standards of care should be the same for all.

Rationale 4: Progressive discipline is generally the fairest process. It will likely be the most effective in a facility that has not been previously disciplined.

Rationale 5: Consistency is a very important aspect of effective discipline.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 16.3 Discuss the role of effective discipline in delegation and supervision.

Question 14 Type: MCMA The nurse manager walks in on a conversation in the break room concerning the hospital’s plan to employ unlicensed assistant personnel (UAPs) to help relieve a nursing shortage. Which statements would the manager correct?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. “I can’t believe our state board authorized this plan.”

2. “I don’t want to have these UAPs working under my license.”

3. “The hospital will have to assure that the UAPs they hire are competent.”

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. “It will be important that the UAPs hired have adequate orientation to our nursing units.”

5. “It will be even more important that we follow delegation policy and procedure.”

Correct Answer: 1,2 Rationale 1: UAPs are not authorized by the state boards.

Rationale 2: UAPs do not work “under” the nurse’s license.

Rationale 3: The corporation (hospital) is accountable for documenting competencies for all staff members providing direct patient care.

Rationale 4: An institutional mechanism for orientation of UAPs must exist. Nurses may participate in this orientation.

Rationale 5: The nurses working with UAPs and delegating to them will be responsible for appropriate delegation.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16.4 Define and evaluate the role of unlicensed assistive personnel in relationship to professional accountability.

Question 15 Type: MCSA A nurse has the reputation of delegating tasks that are time-consuming or distasteful. What should the nurse manager consider before addressing this situation?

1. Misuse of delegation is an ethical issue.

2. One of the privileges of loyalty to the hospital is being able to delegate distasteful tasks to others.

3. Doing distasteful tasks is part of the learning process for new nurses.

4. The nurse reserves the right to delegate any task he or she wishes.

Correct Answer: 1 Rationale 1: The difference between delegating and “dumping” of distasteful tasks is a primary ethical issue that arises with delegation and supervision.

Rationale 2: Inappropriate delegation is an issue regardless of the nurse’s seniority.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: There is no truth in this statement even though it is often used as an excuse for inappropriate delegation.

Rationale 4: Some tasks, such as care planning, cannot be delegated.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 16.6 Describe some of the ethical issues that arise with delegation, supervision, and patient advocacy.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 17 Question 1 Type: MCSA What is the nurse's legal duty with regard to implementing a physician's order?

1. The nurse should follow the order unless the nurse believes some other course of action would be better.

2. The nurse should follow the order unless the nurse has reason to believe that the patient could come to harm if the order is followed.

3. The nurse should discuss each order with the physician, since physicians are only human.

4. The nurse should follow all orders as written.

Correct Answer: 2 Rationale 1: Prescribing treatment is not within the scope of nursing practice.

Rationale 2: Unless the nurse has a valid reason to question an order, the order should be followed.

Rationale 3: It is not feasible or necessary to discuss each order with the physician.

Rationale 4: The nurse should question unclear or unsafe orders.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.1 Describe the changing health care environment that has created responsibility for staff nurses.

Question 2 Type: MCSA What is the principal reason that a higher standard of care may be required for safeguarding mentally ill persons?

1. Mentally ill persons bring more lawsuits than those with no mental illness.

2. The standards of care for mentally ill patients are higher than those for physically ill patients.

3. Mentally ill persons cannot fully appreciate their exposure to potential harm.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. These patients require more care than do those who are physically ill.

Correct Answer: 3 Rationale 1: These patients are not known to bring more suits than others.

Rationale 2: The standards of care for mentally ill patients are not necessarily higher than those for physically ill patients but are different.

Rationale 3: The mentally ill are considered a vulnerable population due to their behavioral and cognitive impairments. Therefore, their judgments and actions may be altered, and they may not be able to recognize the risks of circumstances regarding their care.

Rationale 4: These patients do not necessarily require more care than those that are physically ill.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 17.2 Describe the unique nature of the care of psychiatric and vulnerable patients.

Question 3 Type: MCMA Hostile or angry patients present unique nursing challenges from a legal perspective. Which basic interventions can a nurse take when caring for a hostile or angry patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Allow the patient to be alone and have long periods of quiet time.

2. Spend additional time with the patient, showing that he or she is important.

3. Ensure that family members are always present to calm the patient.

4. Sedate the patient to diffuse further encounters with the patient.

5. Include the patient in discussions of treatment plans.

Correct Answer: 2 Rationale 1: Isolating the patient with time alone can exacerbate the problem of aggression.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: Spending additional time with the patient and showing that he or she is important provides the opportunity to express concern for the patient's issues and allows the nurse the opportunity to identify strategies for resolution of the patient's problems.

Rationale 3: The nurse cannot divert professional responsibility for patient observation onto the family.

Rationale 4: Sedation of the patient does not solve the problem and may be seen as improper use of chemical restraints.

Rationale 5: The nurse should respect the patient’s autonomy by addressing concerns and ensuring that the patient is educated about their condition and treatment plan.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.2 Describe the unique nature of the care of psychiatric and vulnerable patients.

Question 4 Type: MCMA Which options reflect a general criterion for restraining a patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The patient's inability to care for himself or herself 2. The patient's verbally abusive but nonthreatening behavior toward others 3. The patient's immediate ability to harm self 4. The patient's refusal to take psychotropic medications as prescribed 5. The patient’s threat to harm another patient Correct Answer: 3,5 Rationale 1: Inability to care for oneself is not a criterion for use of restraints.

Rationale 2: As long as the behavior is nonthreatening no criteria for use of restraints exist.

Rationale 3: Immediate ability to harm self is a criterion for use of restraints.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: The patient has a right to refuse medications. This is not a criterion for use of restraints.

Rationale 5: Threat to harm another is a criterion for use of restraints.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 17.3 Differentiate two types of restraints, including the nursing management of the restrained patient.

Question 5 Type: MCSA A confused patient frequently calls out for "help" throughout the shift. When nursing staff respond to the call, the patient is unable to explain what is needed. What action should be taken by the nurse?

1. Continue to respond and attempt to reorient the patient.

2. Restrain the patient in soft wrist restraints.

3. Move the call bell out of the patient's reach.

4. Chemically restrain the patient with a mild sedative.

Correct Answer: 1 Rationale 1: Since there is no indication that this patient is in danger of getting out of bed or otherwise getting injured, the correct answer is to keep attempting reorientation.

Rationale 2: The nurse should try other methods of caring for the patient, prior to using physical restraints.

Rationale 3: Moving the call bell out of the patient's reach is dangerous.

Rationale 4: Restraints should never be used for the convenience of the staff.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.3 Differentiate two types of restraints, including the nursing management of the restrained patient.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 6 Type: MCMA The physician made a calculation error that lead to the patient receiving a serious medication error. This error was overlooked by the pharmacist and the nurse who administered the dose as ordered. The patient questioned the medication saying, “This doesn’t look like I was taking at home,” but took the medication anyway when the nurse said it was a generic form of the drug. Who holds liability in this situation?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The physician 2. The pharmacist 3. The nurse 4. The patient 5. The drug manufacturer Correct Answer: 1,2,3 Rationale 1: The physician holds liability for making the original calculation error.

Rationale 2: The pharmacist holds liability for not catching the calculation error.

Rationale 3: The nurse holds liability for not catching the calculation error even when the patient questioned the medication.

Rationale 4: The patient questioned the drug but was given information that eased the concern. The patient would likely not have any liability in this situation.

Rationale 5: There is not enough information to assign plan to the manufacturer. The manufacturer might be liable if the formulation or packaging of the medication was confusing and made it easy to make a calculation error.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 17.4 Describe the nurse's responsibility in medication errors and six means to avoid such errors.

Question 7 Type: MCMA Which options reflect what the nurse should consider prior to administering medication to a hospitalized patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Correct, common dosage for this patient 2. Action of the medication 3. Cost of the medication 4. Signs of untoward reaction to the medication 5. Whether the patient's insurance covers the medication Correct Answer: 1,2,4 Rationale 1: The nurse should always consider if the dosage ordered is a correct and common dosage for this patient.

Rationale 2: By considering the action of the medication the nurse will know how to assess if the drug is having its intended effect.

Rationale 3: Cost of the medication is not a primary consideration for the nurse working in the hospital.

Rationale 4: The nurse should always consider what untoward reactions to the medication are possible and how to recognize their occurrence, and what to do if the patient does have that reaction.

Rationale 5: The nurse working in a hospital does not have access to information about whether the patient’s insurance covers the cost of medication. This is a better consideration for the physician and pharmacist.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.4 Describe the nurse's responsibility in medication errors and six means to avoid such errors.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 8 Type: MCSA Which option reflects the nurse's duty regarding use of equipment?

1. Nurses are responsible for cleaning and repairing equipment so that it can be used readily.

2. Nurses should modify equipment so that it meets the particular patient's requirements.

3. Nurses have no responsibility for use or maintenance of equipment.

4. The nurse is required to select the proper equipment and to use it correctly.

Correct Answer: 4 Rationale 1: If equipment is not working, the nurse should remove it from use and notify the department that is responsible for repairs.

Rationale 2: The nurse should not modify equipment in any way other than what meets the manufacturer's recommendations.

Rationale 3: The nurse does have responsibility for using equipment safely and for instituting action to repair damaged equipment.

Rationale 4: Nurses are responsible for following the manufacturer's recommendations for the use of equipment selected and for selecting equipment appropriate to the patient's condition.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.5 Analyze the potential liability for nurses when using technological advances and specialized equipment.

Question 9 Type: MCSA The nurse suspects that a patient's death was related to faulty monitoring equipment. What is the nurse's duty to report?

1. The nurse must notify the patient's survivors.

2. The nurse must notify hospital risk management.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The nurse must notify local law enforcement.

4. The nurse must notify the Food and Drug Administration.

Correct Answer: 2 Rationale 1: Notification of survivors is not the responsibility of the nurse.

Rationale 2: If there is a possibility that faulty equipment was involved in a patient incident or death, the nurse should notify risk management and take the equipment out of service if possible.

Rationale 3: Notifying law enforcement is not the responsibility of the nurse.

Rationale 4: The nurse is not responsible for notifying the FDA. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.5 Analyze the potential liability for nurses when using technological advances and specialized equipment.

Question 10 Type: MCSA Which option reflects the nurse's duty to prevent patient falls?

1. The nurse has a duty to assess the patient for risk for falls.

2. The nurse has a duty to provide minimal assistance.

3. The nurse has a duty to provide continual observation of patients.

4. The nurse has a duty to see that siderails on all beds are raised at all times.

Correct Answer: 1 Rationale 1: Identification of patient risk is the primary duty to prevent falls.

Rationale 2: Minimal assistance often provides insufficient care.

Rationale 3: Continual observation is not always feasible.

Rationale 4: Siderails often produce a risk for patient falls, in some instances are regarded as restraints, and are not always recommended.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.6 Compare and contrast the nurse's responsibility for assessing, monitoring, and communicating in clinical settings, including failure to listen to and communicate with patients and communicating with culturally and ethnically diverse individuals.

Question 11 Type: MCMA The nurse has many responsibilities in the care of patients. What are the most important components of this care?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Following physician orders exactly as written.

2. Communicating with others regarding patient care.

3. Adequately and efficiently assessing the patient.

4. Monitoring the patient throughout the care encounter.

5. Selecting correct staff to provide patient care.

Correct Answer: 2,3,4 Rationale 1: Just following orders is not sufficient to provide quality care.

Rationale 2: Communication, both verbally and through written documentation, to patients, physician, other staff members, and members of the interdisciplinary team is an essential component of nursing care.

Rationale 3: Assessment is the first step of the nursing process and becomes the basis for all nursing action.

Inadequate assessment can result in dangerous omissions or mistakes.

Rationale 4: Failure to monitor has been found to be the cause of action for liability in multiple legal cases.

Rationale 5: Correctly selecting staff is important, but is all based on other more important components of care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.6 Compare and contrast the nurse's responsibility for assessing, monitoring, and communicating in clinical settings, including failure to listen to and communicate with patients and communicating with culturally and ethnically diverse individuals.

Question 12 Type: MCSA Which person would be the best choice as an interpreter for a non-English-speaking patient?

1. A hospital-provided interpreter 2. The patient's daughter who is bilingual 3. The patient's neighbor who is bilingual 4. A hospital housekeeper who is bilingual Correct Answer: 1 Rationale 1: The best choice of interpreter is one who is hospital-supplied for that purpose. Many of the common problems associated with using interpreters can be avoided by using a hospital-supplied person.

Rationale 2: The patient may not be comfortable divulging sensitive medical information to the daughter.

Rationale 3: Using a neighbor as an interpreter has confidentiality implications that should be avoided if possible.

Rationale 4: A hospital housekeeper may not be aware of medical terminology.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.6 Compare and contrast the nurse's responsibility for assessing, monitoring, and communicating in clinical settings, including failure to listen to and communicate with patients and communicating with culturally and ethnically diverse individuals.

Question 13 Type: MCSA The physician, in telling the nurse to follow an order, states, "If anything happens, I'll take full responsibility."

What effect would the physician's statement have in a subsequent lawsuit for malpractice?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. It alters the rule of professional accountability, because the physician is also a professional.

2. It alters the rule of personal accountability, because accountability is now substituted to the physician.

3. It does not alter the nurse's personal accountability at all.

4. It provides a valid defense for the nurse in the lawsuit.

Correct Answer: 3 Rationale 1: The physician's statement does not remove the nurse’s accountability.

Rationale 2: The nurse has personal accountability for all actions.

Rationale 3: Despite what the physician may say, this nurse has accountability for any action taken. The responsibility and accountability is not to do anything that would bring harm to the patient.

Rationale 4: The physician’s statement will not absolve the nurse of accountability for actions taken.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 17.7 Discuss selected ethical issues that arise in acute care settings.

Question 14 Type: MCSA The triage nurse in a busy emergency department calls the charge nurse and says, “We have a patient who attempted suicide in the waiting room. I think we should just let him wait awhile so he has time to think about what he has done.” Which response by the charge nurse is indicated?

1. “Is he in any danger of dying right now?”

2. “Please bring him back immediately while I get a treatment room prepared.”

3. “Okay if that is what you think we should do.”

4. “Is anyone with the patient?”

Correct Answer: 2 Rationale 1: The manager has done nothing to address the triage nurse’s attitude or to provide quality care by asking this question.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: This patient should be seen immediately as any attempt to kill one’s self is serious.

Rationale 3: The manager has done nothing to address the triage nurse’s attitude by making this statement.

Rationale 4: Whether or not someone is with the patient is not relevant at this time. The patient needs care.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 17.7 Discuss selected ethical issues that arise in acute care settings.

Question 15 Type: MCSA At 2:00 a.m. the night nurse gives a patient 600 mg of ibuprofen according to the standard dosage she has given other patients. When charting the medication the nurse discovers that this patient’s PRN order for ibuprofen calls for administering 400 mg of the drug. What nursing action is indicated?

1. Just monitor the patient as the dose given is within normal limits.

2. Notify the physician immediately.

3. Report the error and complete an incident report.

4. Chart that 400 mg of ibuprofen was given for pain.

Correct Answer: 3 Rationale 1: The nurse should monitor the patient, but this is not sufficient intervention.

Rationale 2: There is likely no need to notify the physician immediately. The physician should be notified at the next convenient time.

Rationale 3: This is a medication error. The ethical action is to report the error and complete an incident report.

Rationale 4: This is not a truthful statement.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 17.7 Discuss selected ethical issues that arise in acute care settings.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 18 Question 1 Type: MCSA A nurse who has a history of difficulty meeting the professional responsibilities of acute care nursing is considering a move to ambulatory nursing. What should this nurse consider about the professional responsibilities of ambulatory nursing prior to making this decision?

1. Ambulatory nursing is totally different from acute care nursing.

2. The responsibilities are equally as technical and demanding as those of acute care nursing.

3. The duty to communicate is lessened in ambulatory care nursing.

4. Ambulatory nursing is less physically demanding on the nurse.

Correct Answer: 2 Rationale 1: Many aspects of acute care nursing are also important in ambulatory care nursing.

Rationale 2: Neither specialty setting is “easier” or “less demanding” than the other. Ambulatory care nurses use advanced technology to provide care, just as do acute care nurses.

Rationale 3: The nurse working in ambulatory care must be very careful to communicate well because the patient is generally in the environment for a lessor amount of time.

Rationale 4: The physical demands of ambulatory care nursing can be just as stringent as those of acute care nursing. Depending upon practice site, ambulatory care nursing may be very physically demanding.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18.1 Describe the area of ambulatory nursing, including its emergence, the role of risk management, and the focus on patient education in ambulatory nursing.

Question 2 Type: MCMA Which situations reflect legal issues associated with telenursing?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Standards of care in one state's hospitals are different from those in hospitals in another state.

2. A telehealth nurse in one state holds an associate degree while a nurse in a similar position in a neighboring state holds a baccalaureate degree in nursing.

3. The use of telenursing equipment is new in the hospital and requires the presence of a non-medical technician.

4. The nurse using telemedicine is paid by the patient "visit," while the hospital staff nurse is paid by the shift.

5. The nurse who is licensed in one state is caring for a patient who is in a different state.

Correct Answer: 1,3,5 Rationale 1: Differences in practice standards addressing quality, scope of practice, patient safety, and documentation exist between and among states. The telehealth nurse may be providing care for patients in a variety of practice areas encompassing multiple states.

Rationale 2: Educational requirements are addressed by licensure requirements for the professional or by the individual employer placing a nurse in the position to perform telenursing.

Rationale 3: When a non-medical technician is present, issues of confidentiality of medical information arise.

Rationale 4: Salary rates are not a legal issue in this case, but depend upon the nurse's contract with the facility.

Rationale 5: Licensure issues are a major legal hurdle in provision of telehealth nursing. Discussions of multistate licensure have arisen from this situation.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18.2 Discuss the field of telehealth and telenursing, including potential for growth as well as legal issues involved in delivery of health via telehealth.

Question 3 Type: MCSA Which option is an example of a question and statement regarding violence a nurse should use in the assessment of all patients?

1. “Do you feel safe in your home?”

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. “Most violence involves physical abuse.”

3. “Violence is rare in upper middle class families.”

4. “Don’t take your safe home environment for granted.”

Correct Answer: 1 Rationale 1: This question is a good way to begin discussion of violence. All patients should be assessed for the presence of domestic violence or abuse.

Rationale 2: The nurse should educate patients that violence includes much more than physical behaviors.

Rationale 3: Violence occurs across all socioeconomic levels.

Rationale 4: The nurse should not assume that a patient’s environment is safe.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18.3 Analyze the nurse's role in caring for victims of violence.

Question 4 Type: MCSA The nurse is caring for a 45-year-old patient who reveals that recent injuries are a result of domestic violence. The patient begs the nurse not to "tell." What action, taken by the nurse, is correct?

1. Report the revelation to the charge nurse.

2. Tell the patient that the law requires reporting this incident.

3. Promise the patient not to tell anyone.

4. Talk with the patient about the reason for secrecy.

Correct Answer: 4 Rationale 1: The nurse should not reveal the information to anyone until further assessment is done.

Rationale 2: Since this patient is not a child or an elder there is not a duty to report. That duty exists only if the patient is a member of a "vulnerable population."

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The nurse should not promise the patient not to tell as divulging information may at some time be crucial to the patient’s health.

Rationale 4: The nurse should explore the reasons the patient desires to keep the information secret.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18.3 Analyze the nurse's role in caring for victims of violence.

Question 5 Type: MCSA The nurse's neighbor routinely calls and asks for advice regarding health issues. What should the nurse do about these calls?

1. Tell the neighbor that the nurse is not legally able to give health advice outside the work environment.

2. Charge the neighbor a flat fee of $25 for each call.

3. Be certain that any advice given reflects both nursing and community standards.

4. Tell the neighbor that nurses are not educationally prepared to give health advice.

Correct Answer: 3 Rationale 1: It is not illegal for the nurse to provide health advice to a neighbor.

Rationale 2: If the nurse charges the neighbor for the advice, there is a different legal standard applied as the advice is no longer voluntary.

Rationale 3: When giving health-related advice, the nurse should be certain the advice meets both community and nursing standards.

Rationale 4: Nurses are educationally prepared to give health advice.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 18.4 Describe the nurse's legal liabilities when volunteering nursing services, including donating health-related advice to consumers.

Question 6 Type: MCMA The nurse volunteers services at a free medical clinic. What is true of these donated services?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. They fall under the auspices of the state nurse practice act.

2. Since the nurse is serving as a volunteer an exemption from possible lawsuit exists.

3. The nurse should practice as a reasonably prudent nurse when providing these services.

4. The nurse should assure that a system of record keeping is initiated and maintained.

5. The nurse’s actions will be protected by Good Samaritan laws.

Correct Answer: 3,4 Rationale 1: Donated services do not fall within the auspices of the state nurse practice act as most of these acts apply only to compensated services.

Rationale 2: The fact that services are donated does not exempt the nurse from a possible lawsuit.

Rationale 3: The reasonably prudent nurse standard should be upheld even when no compensation is being received.

Rationale 4: The nurse should be certain that written record of each nurse-patient encounter is established and that there is a method of maintaining these records.

Rationale 5: Good Samaritan laws often do not cover these services as they are not provided at the scene of an emergency or at an accident scene.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18.4 Describe the nurse's legal liabilities when volunteering nursing services, including donating health-related advice to consumers.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Question 7 Type: MCMA The nurse is considering taking a job with a health maintenance organization. To be federally qualified as an HMO, the nurse's possible job site must have which of these aspects in place?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A list of health care providers from which patients may choose 2. The capacity to provide care by telehealth 3. An agreed-upon set of basic and supplemental health maintenance and treatment services 4. An organized system of providing health care in a geographic region 5. Persons who voluntarily enroll in the plan for services Correct Answer: 3,4,5 Rationale 1: There is no federal requirement that the organization have a list of health care providers from which to choose.

Rationale 2: There is no federal requirement that the HMO has the capacity to provide care by telehealth.

Rationale 3: In order to be federally qualified, the organization must have an agreed-upon set of basic and supplemental health maintenance and treatment services.

Rationale 4: By definition, an HMO is an organized system of providing health care in a certain geographic area.

This must exist for an HMO to be federally qualified.

Rationale 5: In order to be federally qualified, the organization must have a voluntary enrolled group of persons for care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18.5 Define managed care, including health maintenance organizations, preferred provider organizations, point-of-service plans, and indemnity plans.

Question 8 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Type: MCSA The advanced nurse practitioner is an employee of a health maintenance organization, along with several other ANPs and physicians. All the providers receive a set salary from the organization regardless of how many or few patient contacts are made monthly. Which type of HMO does this describe?

1. Network model 2. Group model 3. Staff model 4. Independent practice association model Correct Answer: 3 Rationale 1: In the network model two or more independent group practices and/or independent practice associations contract to provide services. Enrolled members pay a fixed monthly fee.

Rationale 2: A group model exists when a health plan contracts with a multispecialty group to provide care to plan members. The providers are not employees of the HMO, but are employed by the group practice and are paid a negotiated salary.

Rationale 3: The staff model is a health care model in which providers practice as employees and are usually paid a set salary.

Rationale 4: The independent practice association model occurs when a separate legal entity contracts with an HMO for a negotiated fee. The health care providers continue in their existing individual or group practices, seeing HMO patients as a part of the practice.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 18.6 Describe four types of health maintenance organizations.

Question 9 Type: MCSA State legislatures are gradually changing the care that patients potentially receive from health maintenance organizations (HMOs). What is one means by which this improvement has occurred?

1. States have allowed patients who receive substandard care to successfully bring suit against HMOs. Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

2. States have mandated that all citizens be covered by HMOs if that is the desire of the citizen.

3. States have set the premiums that enrollees pay for HMO coverage.

4. States have mandated how many HMOs will operate within the state.

Correct Answer: 1 Rationale 1: Allowing patients to successfully bring suit against HMOs has made the HMOs accountable for their practices by applying state statutes and laws that would apply to other insurance providers.

Rationale 2: States have not mandated universal coverage by HMOs. Rationale 3: Premiums are set by the HMO and are not under the control of the state.

Rationale 4: Mandating numbers of HMOs operating with the state would not be likely to improve quality of care.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18.8 Discuss the Employment Retirement Income Security Act and its application in managed care settings.

Question 10 Type: MCMA A patient presents at a small rural medical clinic after falling from a ladder. The physician suspects that the patient may have intracranial injuries but no diagnostic equipment to determine the severity of injury is available. What is necessary for the physician to legally transfer this unstable patient?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Documentation that the receiving hospital has available space 2. Physician certification that the medical benefits of transferring the patient outweigh the risks of transfer 3. Documentation that the transferring hospital is a qualified Medicare provider 4. An agreement with the receiving hospital stating willingness to provide care 5. Confirmation that the incident causing the injuries was accidental Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 1,2,4 Rationale 1: In order for transfer of an unstable patient to meet EMTALA requirements the physician must certify that the receiving hospital has space available for the patient’s care.

Rationale 2: Transferring patients is not without risk. The transferring physician must certify that the risks associated with transferring the patient are outweighed by the benefits of transfer.

Rationale 3: There is no requirement to certify that the receiving hospital is a Medicare provider.

Rationale 4: The receiving hospital must be willing to provide care to the patient being transferred.

Rationale 5: There is no need to confirm that an accident caused the injuries.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18.8 Discuss the Emergency Medical Treatment and Labor Act and its application in managed care settings.

Question 11 Type: MCMA The nurse is involved in establishing a patient-centered medical home to care for a growing population of older adults. The nurse would support which components of this plan?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The workflow of the organization is focused on the patient as an informed partner in creating plans for care.

2. An interdisciplinary team of care providers will provide prevention and wellness care for these patients.

3. The medical home will serve as a long term care facility for the patients as they age.

4. The medical home will establish a system of email communication with members for rapid access to providers.

5. The medical home will rely heavily on evidence-based decision making.

Correct Answer: 1,2,4,5

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: The medical home supports patients in learning to manage and organize their own care, and ensures that these patients are fully informed partners in establishing realistic care plans.

Rationale 2: A medical home is accountable for meeting preventions and wellness, both in acute and chronic care.

An interdisciplinary team of care providers provides this comprehensive care.

Rationale 3: A patient-centered medical home is not a long term care facility.

Rationale 4: The medical home model delivers accessible services with electronic or telephone access to a member of the care team on a round-the-clock basis.

Rationale 5: The medical home demonstrates a commitment to quality and quality improvement through the use of evidence-based medicine and clinical decision-support tools.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18.7 Describe the patient-centered medical home model and its role in transforming how primary care is organized and delivered.

Question 12 Type: MCSA The nurse has been involved in work to support antitrust laws in health care. Why are these laws important to health care consumers?

1. They encourage activities to promote health.

2. They promote the use of registered nurses rather than unlicensed assistive personnel.

3. They promote competition and efficiency in health care.

4. They prevent physicians from ordering unnecessary tests.

Correct Answer: 3 Rationale 1: Antitrust laws are not associated with health promotion activities.

Rationale 2: Antitrust laws do not necessarily promote the use of registered nurses.

Rationale 3: Antitrust laws promote competition among health care facilities. This competition helps promote efficiency.

Rationale 4: Antitrust laws do not establish means to monitor testing ordered by physicians.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 18. 10 Define antitrust laws and their importance to registered nurses in all practice settings.

Question 13 Type: MCSA Health plan administrators are designing methods to assure that consumers have appropriate access to emergency services. Which standard should guide the development of these methods?

1. That of a reasonable physician 2. That of a prudent layperson 3. That of an ethical insurance provider 4. That of a prudent and reasonable nurse Correct Answer: 2 Rationale 1: The standard of a reasonable physician would exclude many situations for which people believe they should seek emergency care.

Rationale 2: The standard for access to emergency care should be such that a “prudent layperson” could reasonably expect the absence of medical attention to place the consumer’s health in serious jeopardy.

Rationale 3: An ethical insurance provider’s standard for when a person should have access to emergency care may be influenced by reimbursement issues.

Rationale 4: A prudent and reasonable nurse has a higher understanding of medical emergencies. Because of this advanced knowledge this is not the standard for most people.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 18.11 Enumerate patient rights that arise as part of managed care.

Question 14 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Telenursing presents numerous ethical concerns. What is one way the nurse can help to control for the ethical issues surrounding this technology?

1. Use telenursing to give only general, not specific, advice.

2. Ask specific questions about the patient's presenting situation.

3. Restrict telenursing to patients who have been seen in person within the last two days.

4. Refuse to give advice to patients over the telephone.

Correct Answer: 2 Rationale 1: Giving only general advice negates the purposes of telenursing.

Rationale 2: One of the ethical issues that arises in telenursing is that assessment may be more difficult. The nurse can help control for this problem by asking specific questions.

Rationale 3: Restricting advice to patients that have recently been seen negates the purposes of telenursing.

Rationale 4: Refusing to give advice negates the purposes of telenursing.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18.12 Describe some of the ethical concerns that arise in ambulatory and managed care nursing.

Question 15 Type: MCSA The emergency room nurse is often faced with the responsibility of providing care for people who were responsible for motor vehicle accidents. In some cases, the nurse is caring for that person along with victims of the accident. This situation causes the nurse moral distress. How could the nurse best help to alleviate this distress?

1. Refuse to care for these patients in the future.

2. Be frank with the patients about how uncomfortable the nurse is.

3. Remember to respect the person, not the actions of the person.

4. Ask a co-worker to care for the patients.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Correct Answer: 3 Rationale 1: Refusing to care for these patients is not ethical and does not address the root problem.

Rationale 2: While honesty is a good policy, the nurse should not impose his or her discomfort onto the patient.

Rationale 3: The best option is to remember that all people deserve respect as human beings, even if their actions cannot be respected.

Rationale 4: Diverting the stress onto a co-worker is not handling the situation, only shifting it to someone else.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 18.12 Describe some of the ethical concerns that arise in ambulatory and managed care nursing.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 19 Question 1 Type: MCMA The nurse presenting a community education session about community health would include information about which foundational federal laws?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Social Security Act of 1935 2. 1947 Taft Hartley Amendment 3. Civil Rights Act of 1991 4. Americans with Disabilities Act of 1990 5. Public Health Service Act of 1994 Correct Answer: 1,5 Rationale 1: The Social Security Act of 1935 established the means for states to make provisions for establishing public health services. Community health nurses play a significant role in providing care through the programs established by the public health service.

Rationale 2: The Taft Hartley Amendment is a federal law that monitors the activities and power of labor unions.

It is not associated with the development of community health.

Rationale 3: The Civil Rights Act of 1991 deals with the right of employees in regard to discrimination by employers. It did not help to establish community health.

Rationale 4: The Americans with Disabilities Act of 1990 was passed to provide equality for people with disabilities. It did not help to establish community health.

Rationale 5: The Public Health Service Act of 1994 consolidated all existing public health legislation under one law and became the major piece of health legislation for the country.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19.1 Briefly describe the historical beginnings of public and community health nursing.

Question 2 Type: MCMA Which person would likely be provided for under the Social Security Act of 1935?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A 16-year-old whose father died in a motor vehicle accident 2. A 70-year-old man who is retired from a job he held for 30 years 3. A 45-year-old woman who suffered a myocardial infarction 4. A 34-year-old person who files for unemployment after losing her job 5. A 30-year-old woman who has become blind secondary to diabetic retinopathy Correct Answer: 1,2,4,5 Rationale 1: As a dependent child this person is provided for by the Social Security Act of 1935.

Rationale 2: The Social Security Act of 1935 provided for the federal welfare by establishing a system of federal benefits for the aged population.

Rationale 3: Despite having a cardiovascular history, there is no indication the 45-year-old woman meets the criteria for inclusion.

Rationale 4: State unemployment compensation laws are part of the Social Security Act of 1935.

Rationale 5: Blind persons are provided for by the Social Security Act of 1935.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19.1 Briefly describe the historical beginnings of public and community health nursing.

Question 3 Type: MCSA Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

A school nurse negligently administered an overdose of medication to a student, causing the student to suffer a severe reaction that necessitated hospitalization. Should a lawsuit result from this case, the nurse would be held to what standard?

1. The reasonably prudent advanced nurse practitioner 2. The reasonably prudent general duty hospital nurse 3. The reasonably prudent pediatric nurse 4. The reasonably prudent school nurse Correct Answer: 4 Rationale 1: There is no information to suggest this nurse was an advanced nurse practitioner, so this is not the standard of practice for which the nurse would be held.

Rationale 2: There is no evidence to support whether this nurse has ever practiced in a hospital. In any case, this is not the standard to which a nurse in this setting is held.

Rationale 3: While a school nurse should have the skills and knowledge to care for the pediatric population, this is not the standard to which a school nurse is held.

Rationale 4: Nurses are held to the standard of practice specific to their practice area setting, which in this case is that of a reasonably prudent school nurse.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 4 Type: MCSA What is the most significant professional qualification necessary for a nurse who practices as a school nurse?

1. The nurse's ability to exercise independent judgment in emergency situations 2. The nurse's ability to properly counsel students about medical concerns 3. The nurse's ability to work closely with school officials Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. The nurse's ability to effectively teach students about their health Correct Answer: 1 Rationale 1: School nurses practice with no other care provider present and are often called upon as the first person to respond to provide care in emergency situations. Therefore, they must possess the ability to think independently and use critical thinking and judgment.

Rationale 2: Providing counseling is an important aspect of school nursing, but is not the most important skill this nurse can possess.

Rationale 3: The school nurse must work closely with school officials, but this is not the most critical attribute of this nurse.

Rationale 4: The nurse must be able to teach students about health, but this is not this nurse’s most important skill.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 5 Type: MCSA Which nurse is exposed to the greatest risk of liability for malpractice because of the nature of the employment relationship?

1. The hospital-based staff nurse 2. The home health care nurse 3. The federally employed nurse 4. The occupational health nurse Correct Answer: 4 Rationale 1: Hospital-based staff nurses do not face the same amount of liability as do nurses in this specialty.

Rationale 2: The home health care nurse does not face the same amount of liability as nurses in this specialty.

Rationale 3: Federally employed nurses do not face the same amount of liability as those in this specialty.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: The practice of occupational health nurses is greatly influenced by a variety of federal and state laws, particularly workers' compensation laws, mandatory-reporting laws, and occupational safety and health laws.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19.3 Enumerate the potential legal liability for nurses in these public and community health settings.

Question 6 Type: MCMA In which situations would the home health nurse likely be considered to have abandoned a client?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The nurse and patient decided together that home health care was no longer needed.

2. The home health nurse no longer provides care for the patient when reimbursement amounts change.

3. The nurse stops making home visits without giving the patient notice that this would occur.

4. The nurse fails to assess the patient on a daily basis.

5. The nurse left the patient’s home when a grandchild threatened the nurse.

Correct Answer: 2,3 Rationale 1: The patient-home health nurse relationship may end if the patient no longer needs care and is discharged from the service.

Rationale 2: Change in reimbursement amounts does not constitute legal reason to discontinue services. The nurse may be considered to have abandoned this patient.

Rationale 3: The nurse cannot legally stop seeing the patient without providing notice to the patient that services are being discontinued.

Rationale 4: Not all home health patients require daily nursing services.

Rationale 5: The nurse’s safety should be protected, so this is not abandonment. In order to protect the patient, the nurse should immediately contact the agency and law enforcement.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19.3 Enumerate the potential legal liability for nurses in these public and community health settings.

Question 7 Type: MCSA After analyzing assessment data, the home health care nurse determines that a change is necessary in the medical care of a patient. The nurse makes the change without consulting the physician. Under which circumstance is this a legal action by this nurse?

1. If the nurse is experienced and sure the change will not harm the patient 2. If there is a signed, standing order for the change 3. If the nurse is certain the physician will agree with the change 4. If the patient's family agrees that the action is necessary Correct Answer: 2 Rationale 1: The nurse is licensed to practice nursing which does not include alteration of the medical plan of care with orders.

Rationale 2: Standing orders are legal orders once they are signed by the physician. These orders require astute assessment and analysis by the nurse.

Rationale 3: The nurse’s certainty that the physician will agree with the change will not make this a legal action.

Rationale 4: The family’s approval of the action does not make it legal.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19.3 Enumerate the potential legal liability for nurses in these public and community health settings.

Question 8 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Type: MCSA Nurses in which health care settings are required to comply with the Patient Self-Determination Act of 1991?

1. In home health care settings only if they have a validly executed advanced directive when care is first rendered 2. Solely in formal institutional settings, such as hospitals 3. In all health care settings, including home health care settings, if federal funds are received 4. In all health care settings except home health care settings Correct Answer: 3 Rationale 1: This act requires that the facility inquire about advance directives. It is not limited to patients who have already executed these directives.

Rationale 2: Adherence to this act is not limited to formal institutional settings.

Rationale 3: Any agency that receives federal funds, which includes home health care settings, is to abide by the federal legislation of the Patient Self-Determination Act of 1991.

Rationale 4: Home health setting also has to adhere to this act in certain situations.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 9 Type: MCSA The home health care agency that receives federal funds desires to hire a new home health care aide. This aide will provide direct and hands-on care to patients. Which person would meet federal requirements for that position?

1. A nursing assistant who has on-the-job training at a nursing home 2. A nursing assistant who completed a training and competency evaluation program 3. A nursing assistant who has on-the-job training at a hospital Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. A second-semester student enrolled in a registered nursing program Correct Answer: 2 Rationale 1: On the job training at a nursing home is not sufficient for employment in a home health agency that receives federal funds.

Rationale 2: The Omnibus Budget Reconciliation Act of 1986 sets strict criteria of qualifications for home health care aides who have a predominant role in direct, hands-on contact with patients. Under this provision, the agency may not use any individual who is not a licensed health care professional, unless the individual has successfully completed a training and competency evaluation program that meets minimum federal standards and the individual is actually competent to provide the services assigned.

Rationale 3: On the job training at a hospital is not sufficient training for a nursing assistant who will work in a home health agency receiving federal funds.

Rationale 4: Just because a student has some experience in nursing school does not qualify the student as a nursing assistant in this situation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 10 Type: MCMA The nurse preparing to complete an Outcome and Assessment Information Set (OASIS) would expect to collect which information?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Medication history 2. Insurance information 3. Living arrangements 4. Demographic information Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

5. Financial information Correct Answer: 1,3,4 Rationale 1: Medication history is part of the comprehensive data collected for the OASIS. Rationale 2: Insurance information is not collected as part of OASIS. Rationale 3: Information about the patient’s living arrangements is collected as part of the comprehensive OASIS. Rationale 4: Demographic information is collected as part of the comprehensive OASIS. Rationale 5: Financial information is not assessed by the OASIS. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 11 Type: MCMA A nurse responds to help provide care at the scene of a disaster. Which nursing action will help to reduce the chance of lawsuit?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. Do not perform any actions outside of the scope of nursing care.

2. Take breaks to rest when needed.

3. Keep detailed notes on every action taken.

4. Maintain certifications that will support care provided during emergencies.

5. Be honest about one’s capabilities.

Correct Answer: 2,4,5

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: If the nurse is skilled and qualified to perform functions outside the scope of nursing and if the nurse is directly to do so by an authority it is permissible for the nurse to comply. In this situation an exception to scope of practice exists.

Rationale 2: Resting helps the nurse make valid judgments and helps the nurse think clearly.

Rationale 3: Notes are essential, but should be done as quickly as possible, so detail is likely not possible.

Rationale 4: Certifications such as advanced cardiac life support and pediatric advanced life support will help the nurse be more competent at the time of an emergency.

Rationale 5: The nurse should recognize his or her own strengths and capabilities and should not practice outside those parameters.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19.3 Enumerate the potential legal liability for nurses in these public and community health settings.

Question 12 Type: MCSA The occupational nurse has sponsored and taught first aid classes to workers throughout the factory. If a person, taught by the nurse, makes an error in providing first aid that causes further injury, does the nurse hold any liability?

1. No, the liability is on the person who caused the original accident causing the need for first aid.

2. No, all liability is on the person who made the error.

3. The nurse holds all the liability.

4. The nurse may hold liability depending upon circumstances.

Correct Answer: 4 Rationale 1: The liability is likely not limited to this person.

Rationale 2: The person who made the error is not the only person likely to be found to hold liability.

Rationale 3: The nurse will not hold all the liability in this situation.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 4: If the occupational health nurse has the responsibility to teach first aid or to ensure that needed supplies for first aid intervention are available, the nurse may incur potential liability.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 19.3 Enumerate the potential legal liability for nurses in these public and community health settings.

Question 13 Type: MCSA The school nurse is leaving campus after work when an accident occurs on the playground. The nurse responds and treats the injured students. Which standard of care would most likely determine liability?

1. The reasonably prudent pediatric nurse 2. The reasonably prudent general duty hospital nurse 3. The reasonably prudent school nurse 4. The reasonably prudent nurse in an emergency situation Correct Answer: 4 Rationale 1: The primary focus of these nursing actions is more specifically in the scope of care of a different specialty.

Rationale 2: General duty hospital nurses do not routinely provide emergency care, so this is not the standard used for this situation.

Rationale 3: Since these injuries have occurred outside of school hours, this nurse may be functioning outside the usual scope of employment.

Rationale 4: Because of the emergency nature of this situation the most likely standard would be that of a reasonably prudent nurse in an emergency situation.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 19.2 Describe the various settings in which public and community health nurses are employed, including home health care nurses, parish nurses, school health nurses, occupational health nurses, correctional nurses, and disaster nurses.

Question 14 Type: MCSA The nurse is frustrated by the number of single mothers who receive medical services at no cost. What is the greatest danger of this frustration?

1. The nurse may unintentionally neglect to educate patients on services available.

2. The nurse may be rude to these mothers.

3. This frustration may increase the likelihood that the nurse elects to leave this job position.

4. The frustration may increase the nurse's job stress.

Correct Answer: 1 Rationale 1: This type of frustration may raise ethical issues in allowing this nurse to continue to provide care to this group of patients. While the nurse might be rude, have increased stress, or elect to quit this job, the greatest danger is that the nurse will unintentionally neglect to educate the patients regarding all services that are available.

Rationale 2: Rudeness may occur but this is not the greatest danger for this nurse.

Rationale 3: The nurse may elect to leave this job. If frustration is extreme, leaving the job may be the best choice. This is not the biggest danger.

Rationale 4: Job stress will likely increase, but this is not the greatest danger.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 19.4 Describe ethical issues that are involved in public and community health nursing.

Question 15 Type: MCSA The correctional nurse has drawn blood from an inmate who has experienced gastrointestinal bleeding. While performing the venipuncture, the nurse told the inmate the blood was being drawn for the purposes of evaluating the inmate's hemoglobin and hematocrit. Can the blood also be used to screen the inmate for drug usage?

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. No, the blood can be used only for the determination of medical diagnosis.

2. Yes, the inmate signs away all rights to privacy when incarcerated.

3. Yes, as long as the nurse suspects the inmate of drug use.

4. No, the laboratory will not accept this blood drawn and will insist that the blood be drawn again by a laboratory technician.

Correct Answer: 1 Rationale 1: This blood can only be used to determine medical diagnosis.

Rationale 2: Inmates retain their rights to privacy, so if blood is being drawn for a drug screen the inmate must be informed.

Rationale 3: If the nurse suspects the inmate of drug abuse, an order for additional blood draw and screen is necessary.

Rationale 4: The correctional nurse often draws blood that is sent to the laboratory, so there is no indication that there will be need to redraw blood by the technician.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 19.4 Describe ethical issues that are involved in public and community health nursing.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Guido, Legal and Ethical Issues in Nursing, 6e Chapter 20 Question 1 Type: MCSA A person requires assistance with bathing, feeding, ambulation, and skin care. Which inpatient care setting is most appropriate for this person?

1. An elder day care center 2. A hospice care center 3. A nursing home 4. An assisted living center Correct Answer: 3 Rationale 1: Elder day care centers provide care to adults who are unable to stay home by themselves, but go home in the evening to be cared for in the home, many times by adult children or other relatives.

Rationale 2: Hospice care centers are for persons who are terminally ill. There is no indication that this patient is terminally ill.

Rationale 3: A person who requires assistance with three or more activities of daily living is best served by the nursing home environment.

Rationale 4: Assisted living residents may need assistance with two activities. The patient in this question likely needs more care than is traditionally available in an assisted living center.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20.1 Define the various long-term care settings, including nursing homes, assisted living centers, hospice care centers, and elder day care centers.

Question 2 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

An elderly person, who lives with adult children, requires therapeutic and social services and cannot stay alone in the daytime. The person is alert and oriented, but needs a more structured setting during the day. Which care setting is likely the most appropriate for this person?

1. Adult day social care 2. Assisted living 3. Alzheimer's specific adult day care 4. Adult day health care Correct Answer: 4 Rationale 1: Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person.

Rationale 2: Adult day health care provides more intensive health, therapeutic, and social services. Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person. Alzheimer's day care is specific for those with dementia. Assisted living centers become the resident's home.

Rationale 3: Alzheimer's day care is specific for those with dementia.

Rationale 4: Adult day health care provides more intensive health, therapeutic, and social services.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20.1 Define the various long-term care settings, including nursing homes, assisted living centers, hospice care centers, and elder day care centers.

Question 3 Type: MCSA Nurses providing care in a long term care settings should be very aware of the potential for which patient incident that is one of the primary causes of action in lawsuits against these facilities?

1. Medication errors 2. Abuse of residents 3. Resident falls Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

4. Inadequate resident nutrition Correct Answer: 3 Rationale 1: Medication errors are certainly important and should be avoided. However, a different type of incident is more prevalent in this setting.

Rationale 2: Abuse of residents does occur unfortunately. However, a different type of incident is more common.

Rationale 3: Similar to acute care settings, falls are one of the primary reasons that lawsuits are filed against longterm care facilities. Statistics show an average of 2.6 falls per person per year. In this setting, falls are frequently more preventable than in an acute care facility and thus are less able to be defended.

Rationale 4: Unfortunately cases in which residents do not receive adequate nutrition do occur. They are not as common as another incident.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 20.3 Discuss aspects of providing quality care in long-term care settings, including falls and restraints, skin and wound care, nutrition and hydration, patient safety issues, patient transfer, and duty to assess, monitor, and communicate.

Question 4 Type: MCMA What is true of the use of restraints in long-term care facilities today?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The least restrictive restraint possible should be used.

2. Restraints should be used for all residents at risk for falls.

3. They are expressly forbidden by federal laws.

4. Use of restraints increases the need to monitor the resident.

5. Chemical restraints are preferable to physical restraints.

Correct Answer: 1,4 Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 1: In cases where restraints are indicated, the least restrictive device possible should be used.

Rationale 2: Restraints may not be routinely applied for residents whose individualized assessments do not point to a need for restraints to protect their safety. Risk for falls does not always constitute need for restraints.

Rationale 3: Restraints are not expressly forbidden by any laws.

Rationale 4: If restraints are used the resident must be properly supervised which often increases the frequency at which monitoring should be done.

Rationale 5: Any method to restrict the mobility of the resident is considered a restraint. Physical restraints are not better or worse than chemical restraints.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20.3 Discuss aspects of providing quality care in long-term care settings, including falls and restraints, skin and wound care, nutrition and hydration, patient safety issues, patient transfer, and duty to assess, monitor, and communicate.

Question 5 Type: MCSA A long-term care resident has limited use of the right side of his body, but is coherent at intervals. If this patient develops decubiti, which factor might the facility plead to prevent liability?

1. The resident is unable to obtain proper nutrition because of his refusal to eat.

2. The resident must be confined to bed for prolonged periods of time because of his condition.

3. Nursing notes reveal that the patient is repositioned frequently, but somehow manages to return to the backlying position.

4. Understaffing prevents the nurses from performing necessary passive range of motion exercises to the patient's affected side.

Correct Answer: 3 Rationale 1: Inadequate nutrition is a circumstance that should be addressed to reduce the incident of decubiti.

Not addressing this situation could be considered substandard care.

Rationale 2: Being confined to bed for long periods of time must be addressed to reduce the incident of decubiti.

Alternate forms of movement and exercise should be implemented. Not addressing these could be considered substandard care.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 3: The fact that nurses are turning this patient indicates the staff is attempting to prevent the occurrence of decubiti in this patient and could help in the defense of a lawsuit.

Rationale 4: Understaffing is never a valid reason for a resident not receiving adequate care.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20.3 Discuss aspects of providing quality care in long-term care settings, including falls and restraints, skin and wound care, nutrition and hydration, patient safety issues, patient transfer, and duty to assess, monitor, and communicate.

Question 6 Type: MCSA A frail 90-year-old resident of a long-term care facility refuses to sign an advanced directive and tells the nurse she “wants everything done” to save her life if she should go into cardiopulmonary arrest. What action by the nurse is ethically and legally indicated?

1. Discuss the situation with the resident’s family and plan to follow their wishes.

2. Tell the resident that end of life interventions are generally up to the physician.

3. Tell the resident that everything will be done, but make a do not resuscitation note on the medical record.

4. Support the patient in her wishes but continue education about end-of-life care.

Correct Answer: 4 Rationale 1: The family’s wishes do not supersede the patient’s wishes Rationale 2: The physician’s wishes do not supersede those of the patient.

Rationale 3: It is unethical to tell the patient one thing when intending to do another.

Rationale 4: The nurse should support this resident’s right to self-determination, but should be certain the resident is aware of what her wishes entail.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20.6 Explore the issues of end-of-life care and patient education for this patient population.

Question 7 Type: MCSA The nurse executive wishes to change the culture of the long-term care facility to one in which restraints are seldom used. Which information would the nurse provide when discussing this change with the facility’s ownership?

1. In facilities where restraints are seldom used the rate of falls has decreased.

2. Reducing restraint use increases fall rate and injury rate, but results in better patient satisfaction ratings.

3. Fall rates have increased, but the incidence of long-term injuries has remained unchanged.

4. Chemical restraints can be substituted for most physical restraints.

Correct Answer: 3 Rationale 1: The rate of falls has not decreased in these facilities.

Rationale 2: Fall rates and injury rates have not increased in these facilities.

Rationale 3: Fall rates go up in these facilities, but the rate of long-term injury does not. This supports the concept that allowing the patients more mobility by not using restraints does not result in an increase in long-term injury.

Rationale 4: A restraint is a restraint, whether it is chemical or physical. Substituting chemical restraints for physical restraints is not a valid proposal.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20.3 Discuss aspects of providing quality care in long-term care settings, including falls and restraints, skin and wound care, nutrition and hydration, patient safety issues, patient transfer, and duty to assess, monitor, and communicate.

Question 8 Type: MCSA

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

The nurse manager of a long-term care facility is planning to hire additional nursing staff. What should this manager consider about how the need to assess resident/patient changes and potential problems differ between the long-term care facility and an acute care facility?

1. There is a need for greater assessment skills in acute care because patients are so sick.

2. There is a need for greater assessment skills in long-term care because of the lack of direct physician contact with residents.

3. There is a lesser need for good assessment in long-term care because the residents are generally stable.

4. They are the same.

Correct Answer: 2 Rationale 1: While it is true that acute care patients are sicker, there is also availability of consults both with other nurses and with physicians.

Rationale 2: The long-term care nurse does not have ready consult available and the physician may not have as good a working knowledge of the resident. This difference requires the nurse to have astute assessment, monitoring, and communication skills.

Rationale 3: Long-term care residents often have multiple chronic illnesses complicated with changes associated with aging. This makes good assessment and intervention skills essential.

Rationale 4: The need for assessment, monitoring, and communicating about long-term care facility residents is somewhat different than that for acute care patients.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20.3 Discuss aspects of providing quality care in long-term care settings, including falls and restraints, skin and wound care, nutrition and hydration, patient safety issues, patient transfer, and duty to assess, monitor, and communicate.

Question 9 Type: MCMA Which options reflect a scenario that violates the Nursing Home Reform Act of 1987?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

1. If a resident attempts to get out of bed, a soft vest restraint is applied.

2. The nursing staff routinely leave doors open when getting residents up to bedside commodes.

3. The patient is not consulted prior to a change in medical treatment.

4. The nursing assistant is overheard telling a resident, "If you don't eat, I won't take you down to play dominoes this afternoon."

5. The resident falls during a physical therapy session, despite being attended by two staff members.

Correct Answer: 1,2,3,4 Rationale 1: This action violates the resident’s right to freedom from restraint.

Rationale 2: This action violates the resident’s right to privacy.

Rationale 3: This action violates the resident’s right to self-determination.

Rationale 4: This action violates the resident’s right to participate in resident and family groups and is a threatening statement.

Rationale 5: A patient fall, when adequately attended, may occur without being due to abuse, mistreatment, or neglect.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20.2 Describe the Nursing Home Reform Act of 1987 and its significance to residents of nursing homes.

Question 10 Type: MCMA Which actions could meet the definition of a quasi-intentional tort in a long-term care facility?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A resident wanders away from the facility and is found 2 miles away.

2. The resident is restrained to a chair in the day room to prevent wandering.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. The local newspaper publishes pictures of residents enjoying a holiday presentation by children.

4. The nursing assistant slaps a resident's hand when the resident pinches another resident.

5. The nursing home provides a list of names and clothing sizes to a local group who wishes to purchase birthday gifts for residents.

Correct Answer: 3,5 Rationale 1: This action would more likely result in litigation for negligence.

Rationale 2: Restraint would more likely result in the intentional tort of false imprisonment.

Rationale 3: Quasi-intentional torts include invasion of privacy as in the publishing of a resident’s picture (even in a group) without permission from the resident.

Rationale 4: Slapping a resident’s hand would more likely result in litigation for the intentional tort of battery.

Rationale 5: This is an example of the quasi-intentional tort of invasion of privacy.

Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 20.4 Discuss the nurse's potential liability issues for intentional and quasi-intentional torts in long-term care nursing.

Question 11 Type: MCMA The long-term care facility is considering the involuntary discharge of a resident. What should the facility provide the resident prior to making this decision?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. A referral to a different long-term care facility 2. Return of the last month's fees 3. Access to a psychiatric evaluation 4. Social work counseling if requested Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

5. Written notice Correct Answer: 4,5 Rationale 1: The facility does not have to refer the resident to a different facility.

Rationale 2: There is no requirement for return of the last month’s fees.

Rationale 3: There is no requirement that the facility provide access to a psychiatric evaluation.

Rationale 4: The resident has a right to social work counseling.

Rationale 5: To discharge a resident involuntarily, written notice must be given to the resident, a responsible party, a state agency, or an ombudsman.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20.5 Describe the purpose and potential liability involved in involuntary discharge.

Question 12 Type: MCMA In which scenarios could the elderly wife of a homebound patient likely be guilty of elder abuse?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

Standard Text: Select all that apply.

1. The wife restrains the patient in bed while she goes to the grocery store.

2. The wife only bathes the patient three times a week.

3. The wife tries to “stretch” the patient’s medications by giving one half doses twice a week.

4. The wife reports being afraid to intervene when the home health nursing assistant strikes the patient for soiling the bed.

5. The wife cries while telling the nurse that her husband often “yells and screams” when he doesn’t feel well.

Correct Answer: 1,3,4 Rationale 1: The wife may feel she is protecting the patient by this action, but it is actually abuse.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Rationale 2: In many cases this is an adequate bathing schedule. There is no evidence abuse is occurring.

Rationale 3: If the wife is not aware that this is an unwise practice this is unintentional abuse.

Rationale 4: Striking a person or allowing a person to be struck is battery. It is apparent that the wife knows this is abuse, but is fearful.

Rationale 5: In this case the wife may be the victim of abuse, not the abuser.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20.7 Discuss the concept and extent of elder abuse in the United States.

Question 13 Type: MCSA Which option reflects financial exploitation?

1. The caregiver allows the patient to pay for incidentals necessary for care.

2. The caregiver encourages the elder person who wishes to continue to work in the family business.

3. The caregiver takes the patient's Social Security check to the bank for deposit.

4. The caregiver has the patient sign power of attorney papers by saying they are required by the government.

Correct Answer: 4 Rationale 1: This is an appropriate action by the care provider.

Rationale 2: It is not financial exploitation to support the older adult’s wish to continue to be productive.

Rationale 3: There is no indication that the caregiver is not depositing these funds into the older adult’s account.

This is not exploitation.

Rationale 4: Fraudulently obtaining power of attorney is financial exploitation.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

Learning Outcome: 20.7 Discuss the concept and extent of elder abuse in the United States.

Question 14 Type: MCSA A nurse suspects that an elderly person has been physically abused. According to research, which person would be the most likely abuser?

1. The person's paid caregiver 2. Someone previously unknown to the person 3. The individual's adult child 4. The person's neighbor Correct Answer: 3 Rationale 1: While paid caregivers can be abusers, they are not the most likely to abuse.

Rationale 2: Typically the abuser is someone well known to the abused elder.

Rationale 3: Studies have shown that the profile of the person most likely to be abused is an elderly woman and the abuser is frequently an adult child.

Rationale 4: Neighbors could become abusers, but this is not the most likely scenario.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 20.7 Discuss the concept and extent of elder abuse in the United States.

Question 15 Type: MCSA A nursing assistant suspects that another staff member is abusing residents in a nursing home. Is there a duty for this nursing assistant to report this suspicion?

1. Yes, but not until the nursing assistant has proof of the abuse.

2. Yes, older patients are members of a vulnerable population and there is a duty for anyone to report suspected abuse.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

3. Only if another nursing assistant has the same suspicions and is also willing to report the suspicion of abuse 4. No, since the nursing assistant does not have a state license, there is not a duty to report.

Correct Answer: 2 Rationale 1: Proof of abuse is not necessary.

Rationale 2: Older patients are members of a vulnerable population and there is a duty for anyone who suspects abuse to report it.

Rationale 3: A single person can and has a duty to report suspected abuse.

Rationale 4: All persons, regardless of licensure, have a duty to report suspected elder abuse.

Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 20.8 Describe ethical issues that can arise in long-term care settings.

Guido, Legal and Ethical Issues in Nursing, 6e, Test Bank .

\\ MC C \ A nurse would like to advocate for a modification of the state’s nursing practice act and believes the best strategy is to contact the persons with authority to write and change this statutory law.

Whom should the nurse contact? \ State board of nursing \ State governor \ State legislature \ State nursing association \ \ State boards of nursing are involved in the implementation and enforcement of the nurse practice act but not charged with writing the law.

Governors may appoint members of those on the state board of nursing, but are not involved in writing nursing practice acts.

State legislative bodies create and pass the individual nursing practice acts (statutory laws) and create state boards of nursing or state boards of nurse examiners (state administrative agencies) to implement and enforce those acts.

State nursing associations may promote or seek to change nurse practice acts, but they cannot do so independently. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A

\ A patient brought suit against a hospital for injuries sustained in a fall. The case went to trial and the jury found for the hospital. Can the patient take this same suit and evidence to another trial court in hopes of a different decision? \ No, because of the doctrine of res judicata \ Yes, stare decisis allows retrial \ Yes, because of the doctrine of precedent \ No, this is a landmark decision \ \ Res judicata means “a thing or matter settled by judgment” and applies when a legal dispute has been decided by a competent court of jurisdiction. This doctrine prevents the same parties in the original lawsuit from retrying the same issues involved in the first lawsuit.

Stare decisis means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system.

The doctrine of precedent means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system. Landmark decisions signify that precedent is changed by the current court decision.

Landmark decisions signify that precedent is changed by the current court decision. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The circumstances of a lawsuit cause it to be under the jurisdiction of more than one court. In this case, the nurse expects that which court will have the greatest personal jurisdiction?

\ Federal Supreme Court \ Federal district court \ State supreme court \ State trial court \ \ The federal Supreme Court is the highest court in the country and its decisions will affect all citizens. It passes across all state and federal district boundaries, thus having the highest impact on people.

Federal district courts are the first of the three levels of federal courts. They are not the courts with widest jurisdiction.

The state supreme court is the final authority for state issues, unless a federal issue or constitutional right is involved.

A state trial court is often the first court to hear legal disputes. It does not hold the widest jurisdiction. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ Several state nursing associations are working together in an attempt to change a constitutional law. These associations should ask for which action on this law? \ Repeal \ Expansion

\ Amendment \ Redefinition \ \ Statutory laws can be repealed, but constitutional laws cannot.

Statutory laws and administrative bodies can be expanded, but constitutional laws cannot.

Constitutional law is a system of fundamental laws or principles for the governance of a nation, society, corporation, or other aggregate of individuals. It is the highest form of statutory law and is changed only by amendment.

Administrative bodies may be redefined, but constitutional laws cannot. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ An emergency department patient was injured while attacking his neighbor with a knife. After treatment the patient was arrested and charged with battery and assault. Which classification or type of law would determine the case against this defendant? \ Criminal law \ Civil law \ Private law \ Constitutional law \ \

Criminal law is appropriate in this case because the act against the neighbor was of a nature that was offensive and harmful.

Civil law is concerned with the rights and privileges of a citizen.

Private law is synonymous with civil and common law and is not the law of most importance in this case.

Constitutional law is a system of fundamental laws and principles for the governance of a nation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A person who was injured in a motor vehicle accident sued the driver to recover hospital costs.

Which type of law would be enforced in this situation? \ Tort law \ Public law \ Constitutional law \ Procedural law \ \ Tort law is the only option that has a process for allowing the determination of damages and compensation for damages in this case scenario. Tort laws govern wrongful acts that are harmful to an individual.

Public law is the branch of law concerned with the state in its political capacity. There is no information in this scenario to indicate that a criminal offense occurred.

Constitutional law is a system of fundamental laws or principles for the governance of a nation, society, corporation, or other aggregate of individuals. The purpose of a constitution is to

establish the basis of a governing system.

Procedural law concerns the process and rights of the individual charged with violating substantive law, and does not apply to this situation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ An emergency department nurse has agreed to testify as an expert witness in a lawsuit involving a child. The opposing attorney questions the nurse's qualifications as a pediatric nurse. Which type of law does this scenario reflect? \ Due process of law \ Private law \ Substantive law \ Procedural law \ \ Due process of law applies only to state actions and not to actions of private citizens.

Private law is synonymous with civil or common law.

Substantive law concerns the specific wrong, harm, or duty that caused the lawsuit or an action to be brought against an individual.

Procedural law concerns the processes and rights of the individual charged with violating substantive law, and includes questions of admissibility of evidence and qualifications of expert witnesses. \

0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ A nurse is scheduled to appear before the state board of nursing in regard to action against the nurse's license. Which occurrences would violate due process of law?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The time of the hearing was changed without adequate notice to the nurse. \ The nurse was told the meeting was in regard to a complaint about the agency where the nurse was employed. \ Other nurses involved in the situation leading to the action were not similarly summoned before the board. \ The nurse was suspended by her private employer pending outcome of this action. \ A snow storm forced postponement of the board meeting until next month. \ • The nurse must be given adequate notice of changes in the hearing schedule or due process of law is violated.

• The nurse must be given proper information about the purpose of the meeting or due process of law is violated.

• Each nurse’s participation in this situation is individual. Other nurses may not have committed actionable offenses. If their actions were equally as actionable, this would violate the equal protection of the law concept, not due process of law.

• Due process of law applies only to state actions, not to that of private citizens.

• As long as the nurse has adequate notice of this postponement, due process of law is not

violated. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A county-supported hospital elects to limit surgical procedures for morbid obesity to male patients. Female patients receive pharmacologic therapy, counseling, and instruction for diet and exercise, but are excluded from operative procedures. Under which legal concept is this illegal? \ Res judicata \ Due process of law \ Stare decisis \ Equal protection under the law \ \ Res judicata means “a thing or matter settled by judgment” and prevents the same parties in the original lawsuit from retrying the same issues involved in the first lawsuit.

Due process of law ensures that fair procedures are followed in enforcing rules.

The doctrine of precedent, or stare decisis, means to “let the decision stand” and is applied by courts of law in cases with similar fact patterns that have been previously decided by the court system.

Equal protection under the law holds that all similarly situated persons will be affected similarly. \ 0 0

0 0

0000000000 0000000000 0 \\ MC A \ In which case would the judge serve both as a fact-finder and determiner of questions of law? \ Trial by jury is waived by both sides. \ The jury asks the judge to address both types of questions. \ The case is so complex that the jury is unable to decide the question. \ The attorneys for the plaintiff agree to such a condition. \ \ Only in the case where there is no jury does the judge address and answer both questions of law and fact.

The jury is seated to determine questions of fact and cannot ask the judge to assume that responsibility.

Determining questions of fact is the responsibility of the jury.

The attorneys for the plaintiff cannot make this determination. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ During a jury trial, the presence of a nurse–patient relationship is questioned. What kind of question is this and who would determine it? \ Fact to be determined by the judge \ Law to be determined by the jury \ Law to be determined by the judge \ Fact to be determined by the jury \ \ Judges determine law.

The jury determines fact.

The presence of a nurse–patient relationship is determined by the evidence and therefore is a fact and not a law.

The nurse–patient relationship constitutes a determination as to whether a relationship existed.

This is determined by the evidence and therefore is a fact. Facts are determined by the jury. \ 0 0 0 0

0000000000 0000000000 0 \\ MC

A+B+E \ A patient says, “I was told my back pain is the result care I received when I was in the hospital a year ago. How long do I have to file a lawsuit?” Which statements made by the nurse are appropriate?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “A general rule is 2 years from the time you knew what caused your injury.” \ “State laws differ on the statute of limitation for personal injury.” \ “It is too late if you knew you had back pain right after the fall.” \ “You should move to Washington because their statute of limitation is longer.” \ “In some cases it depends if the injury was due to trauma or disease.” \ • The “discovery rule” is a general guideline stating that patients have 2 years from the time that they knew or should have known of the injury to file a personal injury lawsuit. This is a fact that the nurse would be justified in providing to a patient.

• State laws differ widely on statutes of limitations. This is a fact that the nurse would be justified in providing to a patient.

• The nurse is not prepared to determine if it is “too late” to file this suit and should not make this statement.

• The statute of limitation of the state in which the injury occurred would apply.

• Some courts have distinguished between traumatic injury cases and diseases cases. This is a fact and the nurse would be justified in providing this information to the patient. \ 0 0 0 0

0000000000 0000000000 0

\\ MC D+E \ An employee asks for time off to be a juror in a case before the state appellate court. The unit is very busy and this employee’s absence would affect patient care. How should the nurse manager respond to this request?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Give the employee the time off because jury service is required upon subpoena. \ Refuse the request and refer the employee to the personnel department for review of the employee manual. \ Insist that the employee contact the county clerk to request release from jury duty. \ Ask the employee more questions about the request. \ Tell the employee that service as a juror for this case is not required. \ • The nurse manager should not give this employee time off.

• There is no need for this employee to review the employee manual.

• This employee does not need to contact the county clerk.

• The nurse manager should ask questions to gain additional information before responding further to this request.

• State appellate courts have no jurors. \ 0 0 0 0

0000000000 0000000000 0 \\

MC A+D+E \ A nurse has been called to testify in a case that will be tried in family court. The nurse anticipates that the case will involve one of which situations?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Adoption \ Estate division \ Child abuse \ Divorce \ Child custody \ • Adoptions are under the jurisdiction of family court.

• Wills and estates are under the jurisdiction of probate courts.

• Criminal matters are under the jurisdiction of criminal courts.

• Divorces are under the jurisdiction of family court.

• Child custody is under the jurisdiction of family court. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+C \

A nurse reads that a case involving the care provided in a hospital will be reviewed by the United States Supreme Court. The nurse suspects that which situations could have occurred?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The case involves a constitutional issue. \ Two lower federal courts have reached different conclusions in the case. \ The hospital involved is a military hospital. \ The care in question included the suspicion of premeditated homicide. \ The patient involved in the case was an undocumented alien. \ • The U.S. Supreme Court reviews cases in which constitutional issues have been decided.

• The U.S. Supreme Court reviews cases in which two or more lower courts have reached different conclusions.

• Typically the care in a civilian hospital would be under the jurisdiction of state courts.

Cases involving military, veterans’, or other federally funded health centers are frequently settled in federal courts. This may result in Supreme Court review.

• The question of premeditated homicide would not change the jurisdiction to the federal system.

• The citizenship status of the patient involved in the case would not determine if the case was under federal jurisdiction. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B+C+E \ A lawsuit has been filed against the hospital for terminating an employee for excessive tardiness and absenteeism. The defendant’s attorney has contacted nurses who worked with this employee to testify in the case. Which statements would best support the defendant’s case?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “I didn’t work the same shift.” \ “The employee called in sick on several consecutive Fridays.” \ “She often asked me to cover for her while she took her kids to school.” \ “She was never late or absent during the 6 months I worked with her.” \ “Her absences affected the work flow on our unit.” \ • This statement is rather neutral, gives little information about the case, and would not support either side.

• This case exemplifies a pattern of absenteeism that supports the hospital’s case (the defendant) against the employee.

• The defendant in this case is the hospital. This statement indicates that there may be a pattern of tardiness.

• This statement supports the case of the employee who filed the suit who is the plaintiff in this action.

• This statement supports the defendant hospital’s allegation of excessive absenteeism. \ 0 0 0 0

0000000000 0000000000

0 \\ MC A+B+D \ A nurse is served with a summons alerting him that he has been named in a malpractice lawsuit.

What information can the nurse learn from this summons?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Names of any other defendants in the case \ Name of the plaintiff in the case \ Expected length of the trial \ Date to appear before the court \ Breaches in standards of care, injuries, or damages alleged by the defendant \ • The summons will list other defendants named in the complaint.

• The person bringing the suit, or the plaintiff, will be named in the complaint summons.

• A complaint summons is notification that the lawsuit exists and demands that the defendants appear before the court. The length of time of the trial is not indicated on this summons.

• A date to appear, which may change as proceedings progress, is listed on the original complaint summons.

• Allegations are made by the plaintiff in the case. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ In which case might a default judgment be entered? \ The defendant did not respond to the complaint and would otherwise have been shown to have liability. \ The defendant did not respond to the complaint. \ The plaintiff did not respond to the complaint. \ The plaintiff did not respond to the complaint and would otherwise have been shown to have liability. \ \ If the defendant does not respond, liability is assumed and does not have to be shown or proven.

Default judgments are entered when a defendant does not respond to the complaint by the plaintiff.

The plaintiff has initiated the complaint, so a response is not necessary.

The plaintiff is the person bringing the complaint, so a judgment is not entered against the plaintiff in a case. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The attorney for a nurse named in a malpractice case recommends that the case go to a prelitigation panel. What rationale would the attorney offer the nurse for this recommendation?

\ These panels ensure that there is a controversy or fact question for the court. \ Using such a panel negates the need for a full jury trial. \ Such panels shorten the time between filing and conclusion of the lawsuit. \ Questioning of witnesses is not conducted under oath and is more informal. \ \ The sole purpose of a prelitigation panel is to determine facts and whether there is indeed an actual controversy.

Jury trials often proceed after a panel review and are not negated.

In states that use this type of panel, lawsuits are often extended by 6 to 12 months.

While it is an informal process, this informality is not the primary reason for using prelitigation panels. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nurse named in a malpractice case may wish to avoid the expense of a trail by going to arbitration. What is another rationale for using this process? \ There is no need to have attorney representation. \ Arbitration is not binding, so if the parties do not like the outcome, nothing is lost. \ Witnesses do not testify under oath and are easier to obtain. \

There is no formal record made of the arbitration process. \ \ Both sides have legal counsel during arbitration.

The decision of the arbitrator is binding.

Arbitration is a formal process where sworn testimony is heard.

Arbitration is an alternative dispute resolution method. No formal record is made of the arbitration process. This allows the proceedings to be confidential. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ Depositions will be taken of witnesses in a wrongful termination suit filed against the hospital by a former employee. Which information should the attorneys provide to the witnesses that will be deposed?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The testimony provided is sworn testimony. \ Witnesses being deposed will be questioned by their attorney. \ Once the testimony is recorded no changes can be made to the record. \ The witness may refer to notes during the disposition. \ The deposition will be taken in a courtroom with a judge in attendance. \

• The deposing witness is under oath during the entire deposition. Once the deposition is reviewed and signed by the witness it becomes sworn testimony.

• The attorney for the deposing party does not take an active part in the deposition.

Questions will be asked by the opposing attorney.

• The witness will be allowed to review and make minor changes such as for typographical errors. No substantive changes to the record can be made.

• The witness may bring medical records, notes, and literature sources to the deposition, and may refer to them as needed during the deposition.

• Depositions are often taken in an attorney’s office. A judge is not present. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A nurse has agreed to participate in a videotaped deposition in a malpractice case. What does this indicate? \ The nurse is testifying as an expert witness. \ The nurse's testimony can be presented in court, even though the nurse is unavailable for the trial date. \ The nurse is afraid testimony will adversely affect employment opportunities. \ The plaintiff's attorney believes the nurse is a liability for personal trial appearance, but will be credible on tape. \ \ There is no indication that this nurse is testifying as an expert witness.

Taped depositions are frequently reserved for witnesses who will not be present for the actual

trial.

The video will be played as a part of the trial procedures, so there would be no difference in its effect on employment opportunities.

There is no indication that this nurse will be a liability for personal trial appearance. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which person would best qualify as an expert in a nursing malpractice case filed because of failure of a postanesthesia care unit nurse to recognize the early signs and symptoms of respiratory arrest? \ The director of clinical pharmacy who holds a doctoral degree in clinical pharmacology \ A staff nurse who works on the general medical unit and has recently earned a BS in nursing. \ The director of nursing at the hospital who holds an MSN in nursing administration \ A critical care nurse who holds a BS in nursing and certification from the American Association of Critical Care Nurses (AACN) \ \ Simply holding an advanced degree does not indicate expert knowledge in postanesthesia care.

The staff nurse does not have experiential knowledge of postanesthesia unit care.

Simply holding an advanced degree and being in a leadership roll does not indicate expert knowledge in postanesthesia care.

The expert witness is an individual who is highly specialized in the field relevant to the case. In this scenario, recognizing respiratory arrest signs and symptoms are patient care aspects that should be well known to the critical care nurse. Therefore, this individual would be best able to

discuss the patient care standards of practice. The individual's education and certification in a specialty add further evidence of expert skills and knowledge. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Which statement best describes the rule regarding expert testimony in nursing malpractice cases? \ Expert testimony is always required in nursing malpractice suits, and the injured party cannot win his or her case without expert testimony being presented. \ Whether expert testimony is needed is decided on a case-by-case basis after analyzing the facts of the case. \ Expert testimony should be presented whenever there is reason to suspect that the jury will decide in favor of the injured party if expert testimony is not presented. \ The jury is permitted to decide, based on all the evidence submitted, whether expert testimony is needed. \ \ The likelihood of one side of a case winning or losing should not be the determining factor in whether to present expert testimony.

Expert testimony is used to help the jury make conclusions that may involve facts or scientific information that is more than common knowledge. Use of expert testimony is considered on a case-by-case basis.

The likelihood of one side of a case winning or losing should not be the determining factor in whether to present expert testimony.

The decision to use expert testimony is not made by the jury but by the legal representation of

both parties in the case. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ A nurse has been called as a lay witness in a malpractice lawsuit. What information should be provided to the nurse regarding this testimony?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Lay witnesses testify to what others have said about the incident under question. \ The testimony should include opinion on the appropriateness of care provided. \ These witnesses tell only what has transpired from their perspective. \ Lay witnesses may answer hypothetical questions for the jury. \ The lay witness must have a direct connection to the case. \ • Witnesses must tell only what they saw or know, not what was told to them by others.

• Lay witnesses can testify only to the facts and may not draw conclusions or form opinions.

• Testimony is a presentation of factual information that an individual can relay relevant to his or her own perspective.

• Lay witnesses can testify only to the facts and may not draw conclusions. Therefore, they cannot answer hypothetical questions.

• Nurses may be called to serve as a lay witness to describe for the jury what, when and

how a particular event occurred. The nurse must have a direct connection to the case in order to provide this information. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse is involved as an expert witness in a civil court case where life support was withdrawn and the patient expired. Which level of evidence is expected for this case? \ Voir dire evidence \ Preponderance of evidence \ Evidence beyond a reasonable doubt \ Clear and convincing evidence \ \ Voir dire refers to jury selection, not levels of evidence.

Preponderance of evidence is based on the probable truth or accuracy of the evidence presented, the evidence remains subjective, and the judge or jury must be persuaded that the facts are more probable one way than another way.

Evidence beyond a reasonable doubt is the highest level of evidence and is generally the standard required in criminal cases.

For most courts, clear and convincing evidence is the highest level of proof that can be applied in a civil case and is generally the standard of proof seen in a withdrawal of life-sustaining measures cases. \

0 0 0 0

0000000000 0000000000 0 \\ MC D \ Criminal charges have been brought against a nurse who made a medication error that resulted in a child's death. Which level of evidence is expected in this case? \ Preponderance of evidence \ Clear and convincing evidence \ Discovery evidence \ Evidence beyond a reasonable doubt \ \ Preponderance of evidence is based on the probable truth or accuracy of the evidence presented, the evidence remains subjective, and the judge or jury must be persuaded that the facts are more probable one way than another way.

For most courts, clear and convincing evidence is the highest level of proof that can be applied in a civil case.

Discovery is not a level of evidence.

Evidence beyond a reasonable doubt is the highest level of evidence and is generally the standard required in criminal cases. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A nurse has been called to testify in a malpractice lawsuit. Which information should the attorney provide about the process of cross-examination? \ Cross-examination allows the nurse to ask questions of the opposing counsel. \ During this process opposing counsel will try to refute the nurse’s testimony. \ Cross-examination is a process to ensure that both attorneys question all witnesses. \ This process allows opposing counsel to explain the meaning of the nurse’s testimony. \ \ Attorneys do the questioning in a trial, not the parties to the lawsuit.

Cross-examination of a witness is a specific strategy by the opposing attorney to discredit or negate the witness's testimony.

While both attorneys have the option to question all witnesses, they are not required to do so.

Attorneys do not explain testimony, but rather ask questions to support their client’s case. \ 0 0 0 0

0000000000

0000000000 0 \\ MC B+D \ A patient has filed a lawsuit alleging that negligence by a nurse resulted in permanent injury to his legs. At trial what is this person’s burden of proof?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ That the nurse intended to injure the patient \ That the alleged incident actually occurred \ That the nurse being charged was improperly trained and supervised \ That the incident caused the plaintiff’s injury \ That the plaintiff recognized the injury within days of discharge \ • The patient does not have to prove that the nurse intentionally meant to injure the patient.

• The plaintiff must prove that the incident being discussed actually did occur.

• While training and supervision may be part of the information brought to trial it is not part of the required burden of proof.

• The plaintiff must prove that his injury was caused by the incident he claims occurred.

The statute of limitations is not a matter of days. This is not part of the plaintiff’s burden of proof. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ A nurse has agreed to serve as an expert witness in a jury trial. What is this nurse’s major ethical concern? \ Ability to stay objective and unbiased in the work \ Fulfilling the obligation to "fill in the blanks" in the medical record \ To explain that unexpected outcomes sometimes occur in health care \ To make a logical and fair decision at trial \ \ The expert witness has task of being objective and unbiased and conveying these qualities to the judge and jury.

The expert witness must guard against "filling in the blanks" of the medical record with information that is not present.

While unexpected outcomes do occur in health care, it is not the expert witness's role to explain that at trial.

The judge or jury makes the decision at trial. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B+D \ Which statements would the nurse evaluate as correctly identifying difference between ethics and law?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Ethics applies to conduct and actions, and the law applies to motive and attitude. \ Ethics focuses on the individual whereas law focuses on society as a whole. \ Ethics are externally determined. \ Law relies heavily on judicial enforcement. \ Ethics can change situationally, but laws are static and unchangeable. \ • Both ethics and the law apply to conduct, actions, and motive. Attitude is more associated with ethics.

• Ethics, like values, is individualistic and is subject to philosophical, moral, and individual interpretations. The law focuses on rules and regulations that guide society in a formal and binding manner.

• Ethics describes conduct or principles that are internalized.

• The legal system, including the judicial branch, is founded on rules and regulations that guide society in a formal and binding manner.

• Ethical values are subject to philosophical, moral, and individual interpretations and may change as the person grows and develops. Laws are more formal, but can also be changed. \ 0 0 0 0

0000000000 0000000000

0 \\ MC C \ The nurse bases individual nursing practice upon commitment to quality patient care and understanding of the nursing role. Under which broad classification of ethical theory does this fall? \ Applied theories \ Utilitarian theories \ Deontological theories \ Teleological theories \ \ Applied ethics analyzes specific, controversial moral issues and is not a broad category of ethics that serves as a basis for daily decisions.

Utilitarian theory states that what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people. Following utilitarian principles will not always support providing excellent nursing care to an individual.

Deontological theories derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed. The nurse makes a commitment to excellence of patient care.

Teleological theories derive norms or rules for conduct from the consequences of actions.

Teleological principles do not support excellence in individual care. \ 0 0 0 0

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MC A \ The hospital ethics committee has decided to move to the relational ethics framework for decision making. What change should the committee members expect from this framework shift? \ Decisions made will be more practical and action oriented. \ The number of options for discussion will be reduced. \ Use of other ethical theories and guidelines will be eliminated. \ The impact of the environment on the decision will be reduced. \ \ Relational ethics moves decisions into the context of the environment in which these decisions are made, creating more "practical action-oriented" ethics.

Relational ethics is not meant to reduce the amount of options discussed.

Relational ethics is not meant to eliminate other ethical theories and guidelines.

Relational ethics moves decision making into the context of the environment in which the decisions are made.. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse advises a patient to have surgery because, “The doctor knows what is best for you."

The nurse is most likely following which ethical principle? \ Respect for others

\ Paternalism \ Justice \ Fidelity \ \ Respect for others acknowledges the right of individuals to make decisions and to live or die based on those decisions.

Paternalism is allowing someone else to make a decision for another and allows no collaboration in the decision-making process. In this scenario the nurse is encouraging the patient to let someone else (the physician) make treatment decisions.

Justice states that people should be treated fairly and equally. Nothing in this scenario demonstrates use of justice.

Fidelity is keeping one's promises or commitments. Nothing in this scenario demonstrates fidelity. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A group of nurses wishes to improve the ethics of the care their group provides. What is the first step this group should take to reach their goal? \ Request that all dilemmas be presented to the Hospital Ethics Committee for resolution. \ Explore their individual values and beliefs. \ Seek others' input rather than relying on their own ethical determinations.

\ Explore the values and beliefs of the physicians with whom they work. \ \ While the opinion of others and seeking support by hospital ethics committees to aid in the resolution of ethical dilemma can be helpful, it is not the first logical step in these nurses’ work.

Understanding one’s ethics and values is the first step in understanding the ethics and values of others and in assuring the delivery of appropriate and ethical nursing care.

A relying primarily on the ethical determinations of others is not a means to promote the ethics for a group of health care providers.

At some point the nurses will need to consider the ethics and values of those with whom they work. This is not the first logical step in the process being undertaken. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ Prior to surgery, the nurse checks to ensure that the patient has signed an informed consent form.

Which ethical principle is the nurse supporting? \ Beneficence \ Veracity \ Autonomy \ Fidelity \ \ Beneficence states that the actions one takes should promote good.

Veracity concerns truth telling.

Autonomy is the right to choose what will happen to one's own person. Being informed about the benefits and risks of surgery through informed consent is a direct reflection of the principle of autonomy.

Fidelity is keeping one's promises or commitments. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse tells a patient that an immunization "will not hurt at all" when the nurse is aware that the injection will be painful. Which ethical principle has the nurse most clearly violated? \ Veracity \ Beneficence \ Justice \ Autonomy \ \ Veracity concerns truth telling. This nurse knowingly was not truthful with this patient, thereby violating the ethical principle of veracity.

Beneficence states that the actions one takes should promote good.

Justice states that people should be treated fairly and equally.

Autonomy addresses personal freedom and self-determination. \ 0

0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse makes practice decisions based upon each patient's unique characteristics, the relationship between the patient and the nurse, and the most humanistic course of action in the particular case circumstance. Which branch of ethics does this reflect? \ Virtual ethics \ Duty ethics \ Utilitarian ethics \ Situational ethics \ \ Virtual ethics emphasizes development of good character and habitually performing in this quality character mode.

Duty ethics derive norms and rules from the duties human beings owe one another by virtue of commitments that are made and roles that are assumed.

Utilitarian ethics declares that what makes an action right or wrong is its utility, with useful actions bringing about the greatest good for the greatest number of people.

Situational ethics takes into account the unique characteristics of each individual, the caring relationship between the person and the caregiver, and the most humanistic course of action given the circumstances. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+C+D \ A patient is prescribed medication for the treatment of cancer. The nurse is concerned that administering this medication may have a harmful effect on the patient. Which conditions would help the nurse decide that it is ethical to administer the medication through the application of the concept of double effect?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The medication has been proven effective in the treatment of cancer. \ The nurse is administering the medication to achieve treatment of the cancer. \ The harmful effect must not occur in order for the medication to be successful in treating the cancer. \ The benefits of using this medication are more likely to occur than are the undesired actions of the medication. \ The patient must agree to accept the possibility of undesired effects of the medication. \ • One of the conditions that must be present for the concept of double effect to be used is that the action itself must be “good” or at least morally indifferent.

• One of the conditions that must be present for the concept of double effect to be used is that the nurse must intend only the good effect of the action.

• In order for the concept of double effect to be useful the undesired effect must not be the means of attaining the good effect.

• A proportional or favorable balance between the desirable and the undesirable effects of the action must exist for the concept of double effect to be pertinent.

• While teaching about undesired effects is part of patient education and the patient retains the right to refuse the medication this is not a part of the concept of double effect. \

0 0 0 0

0000000000 0000000000 0 \\ MC B \ An ethical dilemma has arisen in regard to a patient who has been declared incompetent and who left no advance directive. Which model is likely to be of best use to the ethics committee reviewing the case? \ Autonomy \ Patient justice \ Patient benefit \ Social justice \ \ The autonomy model facilitates decision making for the competent patient.

Patient justice is not a model used by ethics committees.

The patient benefit model uses substituted judgment and facilitates decision making for the incompetent patient.

The social justice model considers broad social issues and is accountable to the institution. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The hospital is forming an ethics committee. Which concept should be central to that committee's function? \ Most of the committee's work should involve short-term ethical issues. \ The overriding concern of the committee should be protection of the hospital. \ Members should be limited to medical staff. \ The committee should act to provide guidelines for potential problems. \ \ Ethical dilemmas can be both short-term and long-term. There is no restriction on ethics committees to focus primarily on short-term issues.

Protection of the hospital should not be the ethics committee’s primary concern. This committee is concerned about the provision of ethical care to the patient.

Ethics committees should be broad based, including members from a variety of professions and services.

Ethics committees can (1) provide structure and guidelines for potential problems, (2) serve as an open forum for discussion, and (3) function as a true patient advocate by placing the patient at the core of the committee discussions. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ The hospital has a well-designed, fully functioning ethics committee. What ethical debate topics, concerning the entire social network rather than an individual patient, might now be addressed by this committee?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Do-not-resuscitate orders \ Autonomy \ Duplication of services \ Informed consent \ Effects of managed care on patient well-being \ • A do-not-resuscitate order is an issue focused on an individual patient or health care organization.

• Autonomy is a broad-based ethical theory that the committee would use to guide decision making. It is not a specific topic of discussion.

• Duplication of services is a topic that concerns the entire social network of provision of health care and is a much broader topic than the typical individual concerns addressed by maturing committees.

• Informed consent is an ethical concern directed at the individual health care organization and is not a broad based issue that affects larger populations.

• The impact of managed care on patient well-being is the kind of broad-based, societal issue that can be addressed by a well-developed mature ethics committee. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+E \ Which nursing actions would exemplify cardinal virtues as seen by Plato and other virtue ethicists?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse has developed the reputation of making wise decisions. \ The nurse advocated for the patient’s right to autonomy against a physician who is paternalistic. \ When asked to work overtime shifts, the nurse always complies. \ The nurse always puts the good of the unit before personal well-being. \ The nurse treats all people working on the unit fairly and equally. \ • Wisdom in a cardinal virtue as described by Plato and other virtue ethicists.

• This action took courage on the part of the nurse which is one of the cardinal virtues as described by Plato and other virtue ethicists.

• This is an example of fortitude, but is not always wise, so a cardinal virtue is not demonstrated.

• This is an example of generosity, but is not always wise nor does it evidence self-respect.

This is not an example of a cardinal virtue.

• This is an example of justice which is a cardinal virtue as described by Plato and other virtue ethicists. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C \ A nurse is frequently tardy to work causing other nurses to have to change their plans to cover the unit. The nurse never thanks those who cover for her and often criticizes the work they did in her absence. If another nurse is tardy, she refuses to stay over to cover. Which ethical theories is this nurse violating?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Fidelity \ Autonomy \ Beneficence \ Veracity \ Paternalism \ • The nurse makes a promise to work when scheduled unless extenuating circumstances are present. Fidelity is the duty to keep promises.

• Nothing in this scenario indicates the nurse is violating the ethical principle of autonomy.

• Beneficence is the basic obligation to assist others. By refusing to work over to cover for a tardy co-worker, even though co-workers often do so for her, this nurse is not working to promote good and is not assuming the obligation to help others.

• Veracity concerns telling the truth. There is nothing in the scenario that indicates the nurse lies about the reasons why she is tardy.

• Paternalism involves completely making the final decisions for others. There is no evidence of paternalism in this scenario. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The hospital ethics committee has been asked to consider a controversial issue that has a significant number of persons both for and against it. Which other characteristic would the committee look for when determining if applied ethics should be used as a guide for their work? \ The situation must concern a distinctly moral issue. \ The situation must involve great expense to the hospital or patient. \ The situation must involve high risk activities. \ The situation must occur frequently. \ \ To be considered an applied ethical issue, two key characteristics are important. First the issue needs to be controversial with significant numbers of persons both for and against the issue.

Second, the issue must concern a distinctly moral issue.

Expense is not considered in determining if this is an applied ethical issue.

There is no indication that high risk must be involved in determining whether an issue is an applied ethical issue.

There is nothing to indicate that a situation must occur frequently in order for it to be considered an applied ethical issue. \ 0 0 0 0

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\\ MC C \ The nurse intends to lobby the state legislature to write a new code of ethics for the nurses in the state. Is this an appropriate idea? \ No, federal lawmakers have jurisdiction over codes of ethics. \ No, the code of ethics is the product of hospital associations across the nation. \ No, professional nursing organizations write the code of ethics for nurses. \ Yes, the code of ethics is written and published by individual state legislatures. \ \ Federal lawmakers do not write codes of ethics for other professional groups such as nurses.

Hospital organizations do not band together and write nursing codes of ethics.

Codes of ethics for nursing are written by nursing organizations.

State legislatures do not write the nursing code of ethics. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C \ A nurse manager has started a dialogue regarding the American Nurses Association (ANA) Code of Ethics for Nurses with Interpretive Statements among staff nurses. Which staff nurse statements would the manager evaluate as indicating poor understanding of this document?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “This document describes nursing's own understanding of its commitments to society.” \ “This document is so out of date, they never revise it.” \ “At least the ANA understood that professional ethics are different in different regions of the country.” \ “It is interesting that the ANA first addressed this code over 50 years ago.” \ “This document has established standards by which we should practice.” \ • The ANA's Code of Ethics for Nurses with Interpretive Statements is an expression of nursing's own understanding of its commitments to society.

• The document has been revised, most recently in 2001.

• The statements in the document are inclusive of all nurses and do not change according to region.

• This document was first published in 1950, well over 50 years ago.

• This document gives direction for those entering the nursing profession about their ethical accountability, sets a nursing standard for ethical practice, and informs the consumer about nursing’s ethical standards. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse uses the MORAL model for ethical decision making at the bedside. Which option reflects the first step (M) of this model? \

The nurse investigates the opinions of everyone involved in the issue. \ The nurse evaluates the situation after an intervention is implemented. \ The nurse implements an intervention and thinks about its impact. \ The nurse considers the benefits and risks of possible solutions to the problem. \ \ In the first step of the MORAL model the participants "massage the problem," thinking of it from everyone's point of view.

Evaluation is the last step, occurring in the "L" stage.

Implementation occurs in the "A" step.

Considering benefits and risks occurs in the "O" stage. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The hospital administration asks nursing services to assume housekeeping duties from midnight until 6:00 a.m. Nurses are fearful that this is the first step to shifting complete 24-hour-per-day responsibility for housekeeping duties to nursing services. The nurses believe this would take away from their ability to provide quality nursing care to their patients. This scenario is an example of which ethical concept? \ The MORAL argument \ Slippery slope thinking \ Relevance thinking

\ Reluctance model \ \ MORAL is an ethical decision-making model.

Slippery slope thinking or arguments suggest that an action will initiate a chain of events that cumulate in an undesirable event later.

Relevance thinking is not an ethical concept.

Reluctance model is not an ethical concept. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The patient who has been diagnosed with metastatic cancer declines chemotherapy treatments.

The nurse assists this patient in explaining this position to other health care providers. What advocacy model is this nurse exemplifying? \ Patient advocate model \ Values-based decision model \ Rights protection model \ Jurisprudence model \ \ The patient advocate model is also known as the respect for persons model and focuses on inherent human dignity and respect. This model is not as specific as the other models.

In the values-based decision model, the nurse assists the patient by discussing his or her needs

and desires and helps the patient make choices that are most consistent with those wishes.

The rights protection model is also known as the autonomy model, in which nurses assist patients in asserting their autonomy rights. In this situation the nurse is advocating for the patient’s right to direct care and to make care decisions.

The jurisprudence model is not an advocacy model. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ The nurse is providing care for a patient who was just diagnosed with diabetes mellitus. Which statements reflect this nurse’s use of the values-based decision model in this situation?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “Tell me about what foods are important to your family celebrations.” \ “Let me help you select your lunch menu as I know you are not familiar with your diet yet.” \ “You can make the decision of when you want to take your daily oral medication dose.” \ “I have written down several websites that will provide accurate information about your disease.” \ “Is there anything you want me to talk to your physician about today?” \ • This statement helps the nurse determine the patient’s needs and desires. It will assist the nurse planning education for this patient.

• When the patient is not able to assist in making care decisions the nurse intervenes as an

advocate for the patient’s best interests. This is an example of the respect for persons model.

• This statement best reflects the rights protection model or autonomy model.

• The values-based decision model is predicated on the sharing or information and assisting the individual to become empowered to speak on his or her own behalf.

• In the values-based decision model the nurse would educate the patient to speak for himself instead of relying on the nurse. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse believes that a physician's order written at the end of a shift is contrary to the accepted standard of care and could potentially harm the patient. What should the nurse do? \ Ask the nurse manager what to do. \ Question the physician regarding the order. \ Let the next shift make the decision regarding implementation of the order. \ Complete the order as directed. \ \ The nurse should not have to rely on the nurse manager for direction in this situation. The nurse might inform the manager of the situation and the intended action, but would not need to ask for permission or direction.

Nurses should be aware of hospital policy and procedures, as well as standards of care. If an order appears to violate either of these types of standards or appears dangerous to the patient, the nurse should question the physician about the order.

Deferring the implementation to the next shift does not protect patient safety.

Following orders without question is dangerous for the patient and legally dangerous for the nurse. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse manager is conducting a performance review with a nurse who has worked on the unit for 10 years. During the review, the nurse begins to cry and tells the manager, "I just can't do this anymore. I can't sleep because I have such bad nightmares about patients. I can't eat and I've already lost 15 pounds." The nurse manager identifies these findings as being possible signs of which problem? \ Moral distress \ Too much focus on the patient \ Developing incompetence \ Problems at home \ \ Signs and symptoms of moral distress include powerlessness, guilt, loss of self-worth, selfcriticism, low self-esteem, and physiologic responses such as crying, depression, loss of sleep, nightmares, and loss of appetite.

These statements do not indicate that the nurse has too much focus on patients.

These comments by the nurse are a call for help and are not indicative developing incompetence.

There is no evidence that this nurse is experiencing problems at home. \

0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ Unrest on the nursing unit has progressed to moral outrage among the nursing staff. Which statements made by the nurse manager to the chief nursing officer indicates an understanding of this issue?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “I am concerned that the quality of care we are providing will reduce if this unrest continues.” \ "We may experience turnover in staff positions if this tension continues." \ "I think we need to hire some more unlicensed personnel to shift the direct patient care work off the registered nurses." \ "This will be a good opportunity to get rid of the unit trouble-makers." \ "I am going to try to divert this energy by asking the nurses to help rewrite the policy and procedures manual." \ • Moral outrage may cause the nurses to be unable to effectively care for patients.

• Moral outrage on a nursing unit may increase turnover as nurses resign to rid themselves of stress.

• Most nurses get into the profession because they like to care for patients, so asking nurses to stop caring for patients and start managing more unlicensed personnel will not decrease stress.

• When terminations occur, even justified terminations, it increases unit stress. This is not a time to increase stress.

• Moral energy takes maximum energy, so it is not a good time to ask the nurses to take on

new responsibilities. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse manager has identified high levels of moral distress on the nursing unit. Which change would be helpful in assisting nurses to cope? \ Relieving the nurses from service on ethics committees \ Increasing compensation for overtime hours worked \ Sending nurses home when they exhibit signs of moral distress \ Encouraging free discussion of ethical concerns \ \ Allowing nurses to serve on ethics committees gives the group active participation in the issues.

While everyone likes to be adequately compensated for work done, simply raising the rate of pay without addressing the causative factors will not have a positive impact on moral distress.

Sending nurses home may increase their personal stress and will likely increase stress on nurses left to care for more patients to cover.

Open communications assists nurses in dealing with moral distress. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ In nursing school, the student learns that the nurse should always consider the possible outcomes of any nursing action taken. What ethical concept does this consideration support? \ Slippery slope arguments \ Perception model \ Autonomy model \ Therapeutic jurisprudence \ \ Slippery slope arguments are concerns that one decision may lead to it being taken for granted that other actions are also considered ethical.

There is not an ethical model titled perception model.

The autonomy model refers to protecting the patient's rights of self-direction.

The essence of therapeutic jurisprudence as it applies to nursing is that the nurse should always consider the possible outcomes of any nursing action. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Nurses are revising the policy and procedure manual for the nursing unit. They work to ensure that the policies address more than one person and more than one set of circumstances. Which aspect of policy does this reflect? \ Generality \ Scale \ Normativity \ Decision determination \ \ A policy has generality when it addresses more than one person and more than one set of circumstances.

A policy has scale in that policies apply at different levels of an organization or society, and policies at one level can supersede policies at lesser levels.

A policy has normativity when it formalizes judgments about what course of action is better among alternatives and the rules under which those alternatives will be determined.

Decision determination is not an aspect of policy. \ 0 0 0 0

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MC B \ Nurses believe that there is a need to change policy for their clinical unit. What is the first step these nurses should take when considering this need for new policy? \ Determining how many people are affected by the policy \ Identifying the problem \ Looking for ethical arguments regarding the policy \ Finding out who has authority to change the policy \ \ There are steps that are necessary before determining how many people will be affected by the policy.

Changing and writing policy is a thoughtful and methodical process that should follow a distinct framework. The first step of this framework is identifying the problem.

Determining the ethical arguments involved in the policy or policy change is important, but this is not the first step.

It will be very important for these nurses to determine who has the authority to change the policy, but this is not their first step. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C+D+E \ In which ways can the nurse best act as a patient advocate?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Participate in continuing education offerings pertinent to the current position. \ Follow all physician orders precisely and completely. \ Practice with the patient as priority concern. \ Educate the patient throughout the hospitalization or other nurse–patient contact \ Become active in changing outdated policies or procedures. \ • The nurse must remain aware of acceptable standards of care. One method of remaining current is participating in continuing education offerings.

• The nurse must be vigilant in determining if the physician order is appropriate and safe for the patient. If not, the nurse must use independent nursing judgment to decide on action.

• The patient should always be the nurse’s priority concern.

• The nurse should begin education early in the contact with patients and should continue education until discharge.

• The nurse must actively work to change any outdated policy or procedure still being followed by the institution. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D \ The nurse manager of an oncology unit is interviewing nurses for a position. Which statements, made by nurse applicants, would the manager evaluate as indicating ability to respond appropriately to the ethical dilemmas?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “I think nurses and physicians should discuss care decisions with patients and families.” \ “I worked an oncology unit for 10 years before we moved here.” \ “I think that most dilemmas can be solved by taking the option that is most logical.” \ “At my last job, we were required to take ethics training each year.” \ “As long as nurses follow orders and policy and procedures ethical dilemmas are unlikely to arise.” \ • The nurse that perceives she has influence within the health care setting is more likely to be able to respond appropriately to ethical dilemmas.

• A nurse with clinical expertise and competence will be more likely to respond appropriately to ethical dilemmas.

• A nurse that is concerned more about logical actions may not fully understand the ethics involved in a situation. Lack of ethical concern will adversely impact the nurse’s ability to respond appropriately to ethical dilemmas.

• Past experience with ethics education will make the nurse more likely to respond appropriately to ethical dilemmas.

• By making this statement, the nurse is dismissing the importance of monitoring for development of ethical problems. This nurse is not as likely to recognize her role in these issues. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor? \ The individual's status as a professional \ The individual's sense of ethical responsibility \ The individual's sense of societal obligations \ The individual's understanding of the law \ \ Individuals of a specific profession have their own unique care standards. These define the minimal requirements of an acceptable level of care that can be expected of a given profession.

They are developed to see that no unnecessary harm comes to the patient and to protect and safeguard the public as a whole.

Too much variation of care practices may exist if standards were only based on an individual provider's sense of ethics.

Too much variation of care practices may exist if standards were only based on societal obligations.

Too much variation of care practices may exist if standards were only based on laws. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \

What would the nurse identify as the most basic purpose of standards of care? \ To protect and safeguard the public as a whole \ To ensure that all patients receive state-of-the-art care \ To protect health care providers and prevent their giving less than quality care \ To ensure administrative agencies are protected from frivolous lawsuits \ \ The standards are meant to protect the public from receiving varying degrees of quality of care.

State-of-the-art care changes rapidly and cannot be ensured by writing standards of care.

Standards of care are not primarily written to protect health care providers.

Frivolous lawsuits are not prevented by writing standards of care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C+E \ Hospital administration requires that the committee seeking to change nursing policy and procedures review external sources for these standards. Where should the committee look for these standards?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Current nursing literature \ Individual nurse’s experience and education

\ Federal organizations \ The hospital’s position job descriptions. \ State boards of nursing \ • Current nursing literature is a good source of timely information regarding standards of care.

• The individual nurse’s experiences and education is not likely to be sufficient documentation of the existence of a standard of care.

• Federal organizations, particularly those that reimburse for care, frequently set standards of care.

• Job descriptions are more likely to provide internal standards of care.

• State boards of nursing often set standards of care for nurses in their state. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The hospital nursing group has reviewed current nursing and federal literature to establish standards of care for a newly organized patient care unit. The final report generated by this group should assure hospital administration that the standards meet which level of care? \ Mutually acceptable \ Worldwide \ National \

Locality \ \ Mutually acceptable is a term to describe these standards.

Since many external standards are written by state and federal groups they would not necessarily be described as worldwide.

External standards transcend individual practitioners and single institutions. Since they are set by state and federal organizations, they are relevant to a specific society or country and are considered national standards.

External standards expand beyond locality care standards. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which situation supports the charge of malpractice against a professional nurse? \ A failure on the part of the nurse to allay a patient's fears about an upcoming procedure \ A failure on the part of the nurse to ensure that patients only received care for which they could pay \ A failure on the part of the nurse to establish a therapeutic relationship with the patient \ A failure on the part of the nurse to exercise reasonable and prudent care in treating a patient \ \ There is no standard of care that says the nurse should allay all a patient’s fears. This may be impossible.

Patients receive care regardless of payment.

Development of a therapeutic relationship makes it easier to meet standards of care. However, it is not impossible to meet these standards without establishing a therapeutic relationship.

Malpractice is based on the nurse breaching the standard to provide reasonable and prudent care or duty owed to the patient. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ What does the court consider in determining the nurse's legal liability for standards of care? \ Professional conduct, but not experience or education \ Professional education, experience, and specific conduct \ Professional education, but not experience or conduct \ Professional experience, but not education or conduct \ \ Professional conduct is not the only consideration.

Professional education, experience, and specific conduct all could be considered internal standards. These would be used in determining liability.

Education is not the only consideration.

Experience is not the only consideration. \ 0 0 0

0

0000000000 0000000000 0 \\ MC B \ What is the single most critical factor in determining whether a particular nurse acted with reasonable care in a given situation? \ The number of years the nurse has practiced as a professional nurse \ How the nurse's conduct compares to that of nurses with similar background and experience \ The experience the nurse has in the particular clinical setting in which the situation occurred \ The ability of the nurse to perform according to his or her job description \ \ Amount of experience is not the most important factor.

While the characteristics of the individual nurse are relevant factors, the nurse's practice will be compared to internal and external standards of care that are practiced by other nurses possessing similar background and experience.

Clinical experience is not the most important factor.

Ability to meet job description requirements is not the most important factor. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The state board of nursing has brought action against a nurse's license based upon violation of a regulation. What is true about this scenario? \ Violation of a rule or regulation is not the same as violation of the state nursing practice act. \ Rules and regulations are only suggested standards of care and do not have to be followed. \ Rules and regulations are internal to the state board, not the nurse. \ These rules and regulations have the force of law. \ \ Rules and regulations are promulgated by the state board of nursing. Violation of a rule or regulation is a violation of the state practice act.

Rules and regulations govern the practice of nursing in the state. These rules and regulations must be followed.

The nurse should internalize these rules and regulations as part of their individual practice.

Each state publishes acceptable standards of care as part of the nurse practice act or through the rules and regulations promulgated by the state board of nursing. These rules and regulations have the force of law and must be followed. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ A lawsuit is brought against a nurse in a rural hospital. The nurse replies that the standard of care for rural nurses is different from that for nurses working in large urban facilities. Is this a defensible position? \ No; rural nurses work in a slower paced environment, so they have more time to provide quality personal care. \ Yes; the rural nurse does not have access to the same quality of inservice education as the urban nurse. \ No; nurses in rural settings must meet the same standards as those practicing in large urban areas. \ Yes; it is well known that rural health care is substandard as compared to urban health care. \ \ Rural nurses also work in fast-paced environments.

There is no evidence that rural nurses do not have access to quality inservice. Nurses, regardless of their practice areas, are responsible for staying current in their practices.

Nurses are accountable for all standards of care as they pertain to their profession, no matter their practice setting.

Rural health care is not known to be substandard to urban care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D

\ The nurse holds national certification as a wound care specialist and works in a small, rural hospital. What standard of skill and care applies to this nurse's practice? \ It should be equal to that of any other wound care specialist in the nation. \ It should be the same as that of any nurse who provides wound care. \ It should be equal to the practice of a wound care specialist working in the largest facility in the state. \ It should be the same as that of an average nurse who also holds national wound care certification. \ \ This nurse does not have to have skills equal to all other wound care specialists. There may be those that have different or better skills.

The nurse should have better skills and is held to a higher standard than a nurse who does not hold certification.

There is no responsibility to be as skilled as a person working in a larger, better equipped hospital.

A person holding himself or herself out as a specialist should be held to the same standard of skill and care as an average member of that specialty. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ Which scenarios reflect the "two schools of thought" doctrine?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ An honest error in judgment prevented a nurse from providing quality care. \ The hospital policy and procedures manual lists both local and national nursing care quality standards. \ Nurses on one unit vary in their choice of ways to deliver quality care. \ The nurse manager insists that standards are uniform and all nurses must act in the same manner. \ The nurse expert witness in a case describes two methods of providing the intervention in question. \ • The court evaluates whether the care given meets the prevailing standards, not whether the judgment was correct.

• Two schools of thought doctrine applies to differences in interventions, not in standards.

• Two schools of thought is a doctrine that allows the consideration that an individual can use different approaches when rendering care as long as the standards of care are met.

• Insisting that all nurses provide care in exactly the same manner does not reflect the two schools of thought doctrine.

• There may well be more than one way to provide an intervention and still meet the standard of care. This is the basis of the two schools of thought doctrine. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \

The hospital policy and procedure manual states that medications should be charted immediately after administration. The nurse routinely charts the medications as they are being prepared for administration. What does this practice reflect? \ Use of the two schools of thought doctrine \ Logical and appropriate variation in practice \ An honest error in judgment \ A violation of hospital policy and procedure \ \ The two schools of thought doctrine is used when the court evaluates the standards of care given when the nurse chooses among the alternative modes of treatment. The alternative mode still has to meet standards of care.

Violating hospital policy and procedure is not logical or appropriate.

The honest error in judgment rule allows the court to evaluate the standards of care given a patient even if there was an honest error in judgment. What the court evaluates is the care given and whether that care met the prevailing standards, not if the judgment was correct.

This practice is a violation of the policy and procedures of the hospital and therefore is a violation of standard of care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The survivors of a patient who unexpectedly died in a hospital contact an attorney regarding a wrongful death against the hospital and two nurses. Review of the hospital's pertinent policy and procedures found them to be current. Review of the medical record revealed that policy and

procedures were followed by the nurses. Based on this information, what is the likely strength of this case? \ The survivors have a good case since hospital policy and procedures do not supersede national standards. \ The survivors have a good case since the death was unexpected. \ Since the patient is dead and cannot report variation from the standards no case is possible. \ The case against the nurses is weak since they followed hospital policy and procedures. \ The case against the hospital is weak since policies and procedures are current. \ There is no evidence that the hospital’s standards did not meet national standards. The scenario indicates the policies are “current.”

Unexpected deaths occasionally occur in hospitals through no fault of anyone.

There is no indication that the patient being dead and unable to report variation from standards will have any impact on the guilt or innocence of the nurses or hospital.

Since the nurses did follow the hospital policies and procedures some other violation would have to be found.

The hospital is responsible for ensuring that policies and procedures are current. Since this is the case, the case would have to be based on some other occurrence. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ The administration of a health care facility takes the ethical obligation of protecting patients very seriously. Which actions would help nurses meet standards of care?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Create clearly written policy and procedure manuals. \ Encourage practitioners to find alternate, quicker ways to implement interventions. \ Refuse to tolerate those who are slow to adapt new standards of care. \ Emphasize protection of the hospital when developing internal standards and policies. \ Schedule regular reviews of policy and procedure manuals. \ • A good way to ensure that practitioners meet current standards of care is to create policy and procedure manuals that are current and easy to understand.

• Taking quicker routes of implementation often results in deviation from standards of care.

• Intolerance of those who are ignorant of standards or slow to adopt new standards is divisive and is not helpful in encouraging these practitioners.

• The clear and overwhelming focus of all standards should be the patients' safety.

• Regular review of policy and procedure manuals will help ensure that these documents reflect current standards of care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+C \ Which situation creates an ethical dilemma for the nurse serving as an expert witness in a jury trial?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The documentation in the medical record contradicts itself. \ There are time lapses in the documentation of the event resulting in the suit. \ The interventions implemented only minimally met the standards of care. \ Outcomes for the patient were unexpected and severe. \ Nurses from more than one department took care of the patient. \ • Contradictions in the medical record may indicate that the record is not accurate. This creates an ethical dilemma for the expert witness.

• Time lapses in the medical record documentation may indicate that not all of the events that occurred were recorded. This would create an ethical dilemma for the expert witness.

• When the standards of care were met, but were minimal, and could have been more effective, a dilemma exists. Should the nurse report the standards as met or should the nurse explain that additional interventions could have been implemented?

• Just because the outcomes were unexpected does not create an ethical dilemma.

• The department where the nurses generally work should not create an ethical dilemma. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ A nurse is leaving the parking lot at the hospital and carelessly runs over a patient who was just discharged. Ironically, the nurse had been assigned to care for that patient that day. If the patient sues this nurse, which statement is true? \ The nurse cannot be held liable for either malpractice or negligence based upon this set of facts. \ The nurse can be held liable for both negligence and malpractice. \ The nurse can be held liable for malpractice but not negligence. \ The nurse can be held liable for negligence but not malpractice. \ \ The nurse may be held liable for this injury depending upon circumstances.

While the nurse may be held liable for injuries, this liability does not fall under malpractice.

Malpractice addresses a professional practice standard and professional status of the caregiver.

The nurse may be considered negligent related to driving performance as driving action resulted in harm to an individual. This has nothing to do with the nurse's nursing practice and the care provided to the patient that day, so malpractice does not apply. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Punitive damages of one million dollars were awarded to the family of a patient who died following a nursing medication error. What is true of these punitive damages?

\ These damages are awarded to set an example to other nurses. \ The jury believes the nurse’s actions were an honest mistake. \ This jury identified this case as representing simple negligence. \ The damages are awarded instead of the nurse serving prison time. \ \ Punitive damages may be awarded if there is malicious, willful, or wanton misconduct; are usually considerable; and are awarded to deter similar conduct in the future.

Awarding of punitive damages indicates that the jury absolutely does not think the error was an honest mistake but rather that it was willful in some manner.

Awarding of punitive damages indicates that the jury absolutely does not think the error was simple negligence but rather that it was willful in some manner.

Punitive damages do not substitute for prison time. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A lawsuit has been filed claiming that a nurse’s actions caused the death of a neonate. Why does the attorney for the plaintiff want to prove proximate cause? \ Proximate cause determines how far the nurse’s liability extends for consequences of the alleged negligent actions. \ The need for expert witnesses is eliminated because harm can be approximated. \

A direct line of causation, from incident to injury, is proved. \ To identify if the harm could have been predicted to result from the action of the defendant \ \ Proximate cause attempts to determine if the defendant is liable for occurrences that happen after the negligent act took place.

Even if the cause is determined, expert witnesses may be needed to testify on other aspects of the case, such as practice standards.

The direct line of causation from incident to injury describes the concept of cause-in-fact.

Proximate cause can be difficult to prove because there are often intervening variables.

Foreseeability is the concept that the harm that occurred could have been predicted as a result of the action of the defendant. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The registered nurse who works in the obstetrics department is walking by the emergency department waiting room when a person cries out, “Help me! My mother is not breathing!” Does this nurse have a duty to assist? \ Yes, the general duty of care exists to help in times of crisis or imminent harm. \ No, the nurse is out of the normal working environment and should not interfere. \ No, the nurse has no more duty to assist in this situation than a lay person. \ Yes, the nurse has the duty to provide the same standard of care as an emergency department nurse.

\ \ Even if the nurse is not assigned to a particular patient, a general duty of care arises if the patient presents with an emergency or is in need of instant help. Therefore, this nurse has a duty to assist in this situation.

The fact that the nurse is out of the normal working environment does not relieve the general duty of care.

The nurse is an employee of the hospital; therefore, a general duty of care exists.

This nurse has the duty to provide care at the level of a prudent registered nurse, not as an emergency department nurse. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The court is establishing liability in a case in which several actions caused the plaintiff’s injury.

Which test of causation would be most useful in this case? \ Proximal cause test \ But-for test \ Substantial factor test \ Fact-of-cause \ \ Proximal cause determines how far the liability extends. Fact-of is not a test of causation.

The but-for test is used to determine if the act or omission actually caused the injury or harm sustained and is not as related to the percentage of cause.

Substantial factor is considered the best test to pinpoint liability when several causes occur to bring a given injury. This test asks whether the defendant’s act or omission was a substantial factor in causing the ultimate harm or injury.

Fact-of-cause is not a test of causation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ A plaintiff’s attorney decides to use the doctrine of res ipsa loquitur in a case against the urologist who perforated a patient’s urethra during a cystoscopy. What must the plaintiff prove?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ This complication does not generally occur unless someone provided negligent care. \ The locality rule was in effect at the time of the procedure. \ Several agencies, from the manufacturer to the physician, were involved in the negligence. \ The plaintiff had no control over the development of the perforation. \ The event causing the perforation was deliberate. \ • In order to prove the doctrine of res ipsa loquitur, the plaintiff must prove that perforation of the urethra does not occur unless someone was providing negligent care.

• The locality rule is not pertinent to the use of res ipsa loquitur. There is no need to prove that the event was deliberate.

• In order for this doctrine to be enacted, the injured party must prove that the accident was

caused by an agency or instrumentality within exclusive control of the defendant.

• The instrument that caused the injury must be shown to have been under the management and control of the alleged wrongdoer, not the injured party.

• There is no need to prove that the event was deliberate. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A nurse has been named as defendant in a lawsuit claiming patient injury from misuse of equipment. The nurse says, “The small hospital where I work does not provide the same kind of continuing education training on use of equipment as larger, more modern hospitals.” The attorney representing this nurse may choose to use which rule or doctrine? \ Res ipsa loquitur \ The locality rule \ Foreseeability \ Tortfeasor \ \ Res ipsa loquitur was developed to prevent patients who have been harmed from being further harmed through their inability to show how the injury occurred. It is not related to continuing education differences between small hospitals and larger hospitals.

The locality rule attempts to set a standard for the professional similar to that of other professionals practicing in the same geographic area of the country. This rule arose because of wide variations that once existed in patient care, depending on whether the hospital was in an urban or a rural setting. Most states have abolished locality rules.

Foreseeability is the concept that certain events may reasonably be expected to cause specific outcomes.

The tortfeasor is the person committing a civil wrong. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ The nurse is providing care to a patient whose family has previously brought suit against another hospital and two physicians. How should the nurse provide care to this patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Spend as little time as possible interacting with the patient and family so that there will be less chance of saying the wrong thing or performing in an incompetent manner. \ Provide care in a compassionate, competent manner. \ Assign the patient to a different nurse each day so that no one nurse has to work under this stress. \ Keep the patient well informed by explaining all interventions before and during their completion. \ Review standards of care that pertain to this patient before providing care. \ • Avoiding the patient does not resolve the issue and may actually increase the patient’s feeling that health care is not reliable.

• Giving the same compassionate, competent care that all patients receive is the best strategy in caring for suit-prone patients.

• Assigning a different nurse each day may give rise to suspicions by the patient and also provides less continuity of care.

• Keeping patients well informed helps to reassure them and make them less fearful.

• The nurse should review any standards of care that apply to this patient or to interventions before providing care. The nurse should ensure that standards of care are met or exceeded. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+E \ Which scenarios would the nurse identify as a quasi-intentional tort rather than an intentional tort?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A visitor refuses to leave the patient's room after upsetting the patient and being asked to leave. \ The physician accuses the nurse of incompetence in front of the patient’s family. \ The nurse tells the patient that if he does not starting drinking fluids, an intravenous line will be necessary. \ The nurse physically restrains a patient so that intravenous access can be obtained. \ The nursing student takes a cellphone picture of a patient’s leg wound to show her classmates. \ • Refusing to leave after being asked is trespass to land, which is an intentional tort.

• Defamatory language about a living person that would adversely affect his or her

reputation is defamation. Defamation is a quasi-intentional tort.

• This could be construed as a threat, which would be considered assault. Assault is an intentional tort.

• Physically restraining a patient can be construed as false imprisonment or battery, both of which are intentional torts.

• Using patient’s pictures without consent is invasion of privacy, which is a quasiintentional tort. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Upon entering a patient's room to complete discharge instructions, the nurse discovers the patient in tears. The business office has stated that the patient cannot leave until someone pays a portion of the hospital bill. What should the nurse do? \ Call social services to request an immediate financial evaluation. \ Continue preparations for discharge, comforting the patient as much as possible. \ Stop discharge preparations until the patient is cleared by the billing office. \ Cancel the discharge plans and notify the physician of the patient’s status. \ \ It is not within the nurse’s scope of practice to request a financial evaluation. This situation could be construed to represent false imprisonment.

The nurse must continue to practice within the nursing scope of practice. This situation could be construed to represent false imprisonment.

This scenario could be construed as false imprisonment. The nurse should not stop or slow

discharge preparations.

Cancelling the discharge order is not within the nurse’s scope of practice. This situation could be construed as false imprisonment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ Which action could result in the nurse being charged with conversion of property?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse removes the patient’s shirt and bra during treatment of a fractured ankle. \ The nurse removes a package of cigarettes from a patient’s robe pocket. \ The nurse takes the patient’s picture without permission. \ The nurse searches a patient’s suitcase for evidence of illegal drugs. \ The nurse places a patient in four-point restraints to place a nasogastric tube. \ • Removing the patient’s clothing, especially if done against the patient’s will, could be construed as conversion of property. This is especially the case if there is no apparent reason for the clothing to be removed.

• Conversion of property means that the nurse took something of the patient's without permission.

• Taking a patient’s picture without permission is an invasion of the individual’s privacy.

• Searching the patient's suitcase could be considered invasion of privacy, but unless the

nurse took something out of the suitcase, it is not conversion of property.

• Restraining the patient may result in a charge of false imprisonment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ An out-of-state caller becomes irate when the nurse cannot provide information over the telephone about a hospitalized friend. The caller says, “If you know what is good for you, you had better tell me.” Has a civil assault occurred? \ Yes, there is an indication that the caller has the physical strength to do harm. \ Yes, the threat of harm is assault. \ No, actual physical contact must be made for it to be assault. \ No, the caller is out of state and cannot reach the nurse. \ \ In this case, the caller is out of state, so it is not reasonable that immediate harmful or offensive contact will occur. While this caller may possess the physical strength to do harm, the caller is too far away to act on the threat immediately.

Even though this statement may be uncalled for or frightening, it most likely does not meet the definition of assault as the caller is too far away to do immediate physical harm.

Battery is when actual physical contact or harm occurs.

Assault is defined as the action or motion that creates a “reasonable apprehension in the other person of immediate harmful or offensive contact to the plaintiff-person.” While this caller may possess the physical strength to do harm, the caller is too far away to act on the threat immediately.

\ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Which common practice puts the nurse at liability for invasion of patient privacy? \ During care the nurse reveals information about the patient to those in the room. \ The nurse releases information about the patient to nursing students who will be caring for the patient the next day. \ The nurse conducts a patient care session about a patient whose care is difficult and challenging. \ Confidential information regarding an admitted patient is released to third-party payers. \ \ Giving out information about a patient without permission is an invasion of privacy.

Providing information to those who will be providing care for the patient is not an invasion of privacy.

Providing information about a patient to those who will be involved in caring for a patient is not an invasion of privacy.

Release of information about a patient to a third-party payer is permissible because the patient signs consent for this release on admission. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ The health care facility has sponsored a continuing education offering on emergency management of pandemic influenza. At lunch, a nurse is overheard saying, “I'm not going to take care of anyone that might have that flu. I have kids to think about.” What is true of this statement?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse has a greater obligation than a lay person to care for the sick or injured in an emergency. \ This statement reflects defamation and may result in legal action against the nurse. \ The nurse has the right to refuse to care for anyone that could endanger the nurse. \ This statement is a breach of the Code of Ethics for Nurses. \ The nurse has this right as no nurse–patient contract has been established. \ • Since nurses have greater ability to provide care, their obligation to provide care is higher than that of lay persons.

• The nurse has not said anything negative about flu victims, so the statement is not an example of defamation.

• Health care professionals have assumed the risk of care for these individuals based on their choice of a profession dedicated to the care of the sick.

• Consistent with the Code of Ethics for Nurses, members of the nursing profession should be available in times of emergency as the profession is a social contract with the public.

• The nurse, by virtue of licensure and employment, is held to a higher standard during emergencies. \

0 0 0 0

0000000000 0000000000 0 \\ MC A \ After 3 years of uneventful employment, the nurse made a medication error that resulted in patient injury. What hospital response to this event is ethical? \ The hospital was supportive and assistive as the nurse coped with this event. \ The nurse was dismissed for incompetence. \ The hospital quality department advised the nurse not to tell the patient about the error. \ The nurse was reassigned to an area in which there is no direct patient care responsibility. \ \ Nurses must be held accountable for errors but should be treated in a professional and assistive manner.

With this nurse’s employment record, dismissal is not an appropriate or ethical step for the hospital.

Disclosure of errors is the ethical approach.

With this nurse’s employment record, transfer to a no-patient-care area is not an appropriate or ethical step for the hospital. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ The nurse has been sued for defamation after charting that the patient is a prostitute. What is the nurse's best defense in this case? \ Define the contributing factors. \ Prove that the statement is true. \ No defense exists for defamation. \ Provide hearsay evidence. \ \ Contributory negligence is a defense used when there is a need to identify fault in the injury.

Truth is one of the primary defenses for defamation. The nurse must prove that the statement identifying the patient as a prostitute is completely true.

There are defenses against the charge of defamation.

Hearsay is not a way of validating truth. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A patient refused to ambulate postoperatively and subsequently developed bilateral pneumonia, causing his hospital stay to be lengthened. After discharge, the patient filed a lawsuit claiming his primary nurse was negligent in allowing him to develop pneumonia. What is the nurse's best defense in this case?

\ The patient was told that complications could arise when signing the informed consent form. \ The patient should have anticipated a longer hospital stay if complications arose. \ The patient was aware of the substandard care at the time it occurred. \ The patient’s conduct contributed to his complications. \ \ While the patient assumes risk with informed consent, which could be a potential defense, the patient did not follow advice or instructions.

The logic that complications will result in longer hospital stays does not help support the nurse’s defense.

Admitting to the knowledge that care was substandard would hinder the defense, not help it.

The patient’s own negligence in this case could be argued as a contributory cause. This factor becomes the best defense in this scenario. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A patient, injured at work, was seen by the factory occupational nurse. The nurse treated the wound and instructed the patient to get a tetanus antitoxin injection at the county health department. The patient failed to follow instructions, developed tetanus, and subsequently filed a suit against the nurse. What is the most likely result of the ensuing trial? \ The nurse is not liable, because tetanus is a reportable disease and the health department should have insisted the patient take the injection. \

The nurse is liable, because there was no follow-up to ensure that the patient received the injection. \ The nurse is liable, because tetanus is easily treatable after diagnosis. \ The nurse is not liable for damages, because the nurse has a right to expect that instructions will be followed. \ \ Unless the disease is one that is a danger to the general public if not treated, the patient can refuse treatment at the health department as well.

While follow-up is common, the patient still retains the right to follow or not follow instructions.

Tetanus is not easily treatable, but the ease of treatment is not a factor in this case.

The court recognizes that the patient’s own negligence could contribute to adverse outcomes, as in this case. The patient has a right to refuse or follow advice or instructions but must bear the results of that decision. When this occurs, the legal system applies the concept of contributory or comparative negligence. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ When a patient became confused and dangerous to himself and others in the setting, restraints were applied, and the patient was confined to bed. What is the nurse’s best defense for applying restraints? \ Necessity \ Consent \

Self-defense \ Privilege \ \ Necessity is a defense that allows a nurse to interfere with a patient’s property rights to avoid a threatened injury, which does not apply to this scenario.

The nurse did not get consent.

Self-defense and defense of others may be justifiable to protect oneself and others in the area from harm.

It is not a privilege to act in this manner. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A patient became confused and used a pocket knife to threaten others. The nurse confiscated the knife. What is the nurse’s best defense for this action? \ Privilege \ Self-defense \ Necessity \ Consent \ \ It is not a privilege to act in this manner.

Self-defense is taking an action to protect oneself, but there is another option that is more

specific.

Necessity is a defense that allows a nurse to interfere with a patient’s property rights to avoid a threatened injury.

The nurse does not need consent to act in this situation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ In caring for a 6-year-old who entered the emergency center for treatment of a broken arm, the nurse noted that the child had multiple bruises on his trunk and legs. When questioned, the child said his father hit him and broke his arm so that the child would remember to be good. What should the nurse do? \ Chart that the child is a victim of child abuse, so that there is a record of the abuse should such behavior reoccur. \ Report the incident immediately to the nursing supervisor or physician so that the incident will be reported to the proper authorities. \ Do nothing, because the nurse cannot prove the child was really abused, and saying anything could open the institution to a possible defamation lawsuit. \ Downplay the child’s comments, because children often exaggerate. \ \ It is not the nurse’s role to diagnose that child abuse exists. Charting this suspicion as fact could put the nurse at legal liability.

Mandated by law, nurses and other health care professionals must report suspected abuse.

Doing nothing is a violation of child abuse protection laws.

The nurse must take all statements seriously regardless of the age of the patient. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C \ In which scenarios would the nurse assume that apparent consent has been provided?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The patient follows directions to swallow sips of water as the nurse inserts a nasogastric tube. \ The patient’s family member signed the consent to treat. \ The patient smiled and held out his arm when the nurse said, “I need to start an intravenous line.” \ The patient voluntarily signed a consent form for an invasive procedure. \ An unconscious patient is brought to the hospital following a motor vehicle accident. \ • Apparent consent is given by conduct. This patient is following instructions given to help in the placement of the tube, so conduct would indicate consent.

• Depending upon which family member is involved, this situation may be actual consent.

For example, a parent signing the consent for a minor child.

• Smiling and holding out the arm is an apparent consent to starting an intravenous line.

• This is an example of actual consent.

• This is a situation of implied consent. The patient is unable to give consent, but would likely give consent if able. \

0 0 0 0

0000000000 0000000000 0 \\ MC B \ A lawsuit is being tried in a state that recognizes pure comparative negligence. The attorney for the nurse defendant is attempting to prove the plaintiff has some responsibility for the injury that occurred. If this proof can be established, can the plaintiff recover damages? \ Only if the plaintiff is over 51% at fault \ Yes, even if the plaintiff is 99% at fault \ Only if the plaintiff is less than 50% at fault \ No; if the plaintiff has any fault, damages cannot be recovered. \ \ Pure comparative negligence does not set a 51% point of fault as determining recovery.

Under pure comparative negligence, the plaintiff is allowed to recover the portion of the injury attributable to the defendant’s negligence, even if the plaintiff was 99% at fault.

In modified comparative negligence, if the plaintiff's negligence is found to exceed that of the defendant, the plaintiff is barred from recovery. In some states, that bar is 50%.

Under pure comparative negligence, the patient can recover damages if at some amount of fault in the injury. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The cardiac telemetry unit nurses repeatedly cautioned a patient not to leave the floor because input from telemetry monitors is limited to that area. The patient went to the cafeteria and suffered a fatal dysrhythmia. What is the nurses’ best defense in the negligence lawsuit brought for the patient’s survivors? \ Assumption of risk \ Defense of the fact \ Immunity \ Exculpatory agreement \ \ In this case, the nurses warned the patient “repeatedly” of the danger and the patient ignored the warning. Assumption of risk states that plaintiffs (in this case the patient) are partially responsible for consequences if they understood the risks involved when they proceeded with the action.

Defense of the fact is used when there is no indication that the health care provider’s actions were the cause of the patient’s outcome. In this case, it might be argued that the nurses should have noticed the patient was away from the unit.

Immunity statutes serve to dismiss certain causes of action. An example is the Good Samaritan statute, which does not apply in this situation.

Exculpatory contracts are signed to limit the amount of recoverable damages and are generally considered invalid. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The 4-year-old child developed a seizure disorder that may be related to a medication error that occurred 3 years ago. What is true of the statute of limitations in this case? \ The statute of limitations in this case won’t begin to be calculated until the child reaches the age of 13. \ There is no statute of limitations on medication errors that occur in children prior to the age of 2. \ Since the incident occurred over 2 years ago, the statute of limitations has expired. \ Depending upon the state, the statute of limitations might not begin to be calculated until the child reaches the age of majority. \ \ There is no general rule that statutes of limitations do not begin to be calculated until the child reaches age 13.

There is no ruling that indefinitely extends statute of limitations for children under age 2.

It is not possible to say that this statement is true as statutes of limitations vary from state to state.

Statutes of limitations are different for different states and different occurrences. For children, statutes of limitations may not begin to be calculated until the child reaches the age of majority.

This rule is changing, but still exists at present. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ While vacationing in a different state, the nurse encounters an emergency in which a person needs immediate care. What should the nurse assume about the Good Samaritan law of this state?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A Good Samaritan law exists in the state. \ The nurse has a legal obligation to provide emergency care. \ The nurse will be protected by the Good Samaritan law in the state of licensure. \ The Good Samaritan law in this state may be different than the one in the state of licensure. \ There is a standard definition of what constitutes an emergency. \ • All states have enacted Good Samaritan laws.

• There is no state that requires anyone to provide emergency care. Two states do require individuals to assist others exposed to grave physical harm, but this assistance may entail no more than calling 911.

• The Good Samaritan law that is in effect for this situation is the one in the state where the incident occurred.

• It is very likely that laws in the two states will be different.

• Acts may not define criteria to determine whether an emergency actually exists and what constitutes the scene of an emergency. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C+D \ The nurse is stopped at the scene of a motor vehicle accident with injury. What actions should the nurse take?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Start assessing the injured as is required by all registered nurses. \ Ask the injured person for permission to help. \ Move the patient only if it is necessary to prevent further harm. \ Instruct someone to call for additional aid. \ Graciously accept any payment the injured patient may offer. \ • There is no common-law duty to stop and render aid. The nurse should make a quick decision about whether to stay and help.

• It is important to ask for permission to help. The nurse should not force services if they are refused.

• Care should be provided in the exact site where the patient was found, if possible.

Moving the patient can result in additional injury, so the patient should not be moved unless absolutely necessary.

• The nurse should stay with the injured persons while someone else summons aid.

• The nurse should not accept any payment or gifts from the patient or their family as this may change care from a Good Samaritan act to fee-for-service which may change liability status. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The plaintiff was injured by a defective intravenous catheter. In order to win a product liability case, what must the plaintiff prove first? \ The intravenous catheter was defective. \ The intravenous catheter was used incorrectly. \ The intravenous catheter was sold to him. \ The hospital purchases the poorly manufactured intravenous catheters. \ \ Proving the catheter was defective is not the first step that must be accomplished in a products liability case.

There is a different first step than proving that the catheter was used incorrectly.

The first hurdle for the plaintiff in product liability cases is to prove that there has been a sale of a product rather than the mere delivery of a service. Product liability action does not exist if there is no sale of a product.

There is a different first step in a products liability case. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+E \ In which situations would the manufacturer of a drug designated as unavoidably unsafe be held liable for injuries to a patient receiving the drug?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The physician did not educate the patient about the risks of the medication. \ The physician prescribed the medication after being told that problems with the drug had been corrected. \ The nurse was not warned of risks by the pharmacist. \ The nurse did not educate the patient about the risks of the drug. \ The information printed in the drug information sheet accompanying the medication was wrong. \ • In this case the physician would be at fault for not educating the patient.

• The manufacturer holds the responsibility to warn the health care provider who prescribes the drug about problems that may occur.

• The pharmacist does not hold the responsibility of educating the nurse about risks.

• The manufacturer is not responsible for the nurse’s actions.

• If erroneous information was distributed with the drug, the manufacturer has not met its obligation to provide a warning to the health care provider. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+E \ A representative from a drug company tells a group of nurses that one of the company’s products is unavoidably unsafe. How should the nurses interpret this information?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The drug has risks that cannot be eliminated. \ The benefits of using the medication outweigh its risks. \ The medication has been recalled by the manufacturer. \ Patients who have been administered this medication are very likely to have severe side effects. \ There is no safer medication to use an alternative. \ • One of the criteria for an “unavoidably unsafe” product is that it has risks that cannot be eliminated.

• One of the criteria for an “unavoidably unsafe” product is that its benefits greatly outweigh its risks.

• There is no indication that this medication has been recalled.

• There is no assurance that patients exposed to this medication will have severe side effects.

• One of the criteria for an “unavoidably unsafe” product is that no safer product exists as an alternative. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ The nurse is preparing a patient for a procedure. The patient has signed a consent form but states, “I don’t really know anything about this procedure. I wonder if there is something else I could do instead?” How should the nurse proceed? \ Continue with the preparation as consent may not be revoked. \ Try to convince the patient to go through with the procedure. \ Stop the preparation as the patient can revoke consent at any time. \ Have the patient document the question in writing since the original consent was written. \ \ Since the patient has expressed lack of knowledge about the procedure, the preparation should not be continued.

The nurse should not attempt to talk the patient into a procedure.

The patient always retains the right to verbally revoke consent at any time during the course of treatment. The preparation should be stopped and the physician notified.

Whether the question is verbal or written is not pertinent and does not make this a situation of informed consent. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \

The patient presents to the emergency department with chest pain and collapses in the reception area before registering. Physicians and nurses rush to assist the patient. What type of consent protects these health care providers? \ Oral \ Implied \ Partial \ Expressed \ \ There is no indication that the patient gave oral consent before collapsing.

Implied consent is consent that may be inferred by the patient’s conduct or that may be legally presumed in emergency situations. Because this patient presented to the ED, consent is implied.

“Partial” is not a type of consent.

Expressed consent is consent given by direct words, written or oral. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D \ As a result of shared medical decision making, a patient undergoes a surgical procedure that results in paralysis. What must the patient prove to bring a successful malpractice suit based on informed consent?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \

The patient had no part in the decision to operate. \ The procedure's known risk of paralysis was not explained to the patient. \ Since the decision making was shared, no malpractice suit is possible. \ It was the procedure that caused the harm. \ That the amount of damage to the patient cannot be determined. \ • This patient participated in shared decision making and therefore had a part in the decision to operate. There is no need to prove that this participation did not occur in order for malpractice to be proved.

• To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the health care provider breached responsibility to know and disclose risks.

• It is possible for malpractice to have occurred even if the consent to operate was based on shared decision making.

• To bring a successful malpractice suit based on informed consent, the plaintiff must prove that the the procedure caused the harm.

• To bring a successful malpractice suit based on informed consent, the plaintiff must prove that plaintiff suffered injury for which damages can be assessed. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C+E \ In which instances would the nurse feel comfortable providing care without first obtaining informed consent?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The patient is deaf. \ The physician feels the disclosure of information required for informed consent might cause the patient to commit suicide. \ A visitor suffers a cardiopulmonary arrest in the emergency department waiting room. \ The patient has signed a waiver at the suggestion of the primary nurse. \ Informed consent was obtained when the patient had the same procedure last week. \ • The fact that the patient is deaf does not remove the requirement to obtain consent.

• Therapeutic privilege exists when the health care provider believes the disclosure of information poses immediate and serious harm to the patient.

• Emergency situations, such as a cardiopulmonary arrest, constitute an exception to the need for informed consent.

• The patient must initiate a waiver; it cannot be suggested by staff.

• Prior patient knowledge involves the patient to whom the risks and benefits were fully explained the first time the patient consented to the procedure. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The patient scheduled for an above-the-knee amputation for a gangrenous toe received preoperative medication 20 minutes ago. When the transfer team arrives to take the patient to the operating suite, the nurse overhears the patient say, "I'll be so glad to get rid of my sore toe. I was afraid they would have to take my whole foot." What action should be taken by the nurse?

\ Remind the patient that the surgery is to remove his lower leg, not just his toe. \ Check to see if the patient signed consent for the above-the-knee amputation. \ Continue the transfer, as the patient is not reliable since opioid medications have been administered. \ Stop the transfer and notify the surgeon of the patient’s comment. \ \ This action is based on the assumption that the patient has full understanding of the surgery and that his memory is affected by medication. This may not be the case, so this is not the best option.

The nurse has assessed that this patient does not understand the planned surgery. The presence of a signed consent does not change that fact.

It is unknown if the presence of medications has impaired the patient’s judgment. This is not the best option.

The nurse should advocate for the patient by stopping the transfer and contacting the surgeon.

The surgery should not be done until it is certain that the patient is fully informed. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D+E \ The state now mandates a detailed consent for all hospitals receiving state funding. Which information should the committee designing this form include?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

\ Description of risks and alternatives of the proposed procedure, including no treatment \ Estimated cost of the procedure \ Date and time the procedure is scheduled \ Signature of the competent patient or a legal representative \ Name and full description of the proposed procedure \ • Full informed consent includes a description of the risks associated with the proposed procedure. If alternative procedures exist, they should also be listed. If no treatment is an option, that should also be noted.

• The cost of the procedure is not part of the consent form.

• The date and time of a procedure are often fluid and are not included in the consent form.

• The consent form should include the signature of the patient, if competent. The form should also include space for the signature of a legal representative to be used if the patient is not competent.

• The exact name and a full description of the proposed procedure should be included in the consent form. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+E \ In which instance would the nurse accept informed consent from a 13-year-old patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

\ If the child is consenting to treatment for an emergency surgery \ If the child is consenting to treatment for a venereal disease \ Under no circumstances can a 13-year-old give valid consent. \ When the parents are not readily available \ The patient is seeking treatment for drug dependency. \ • A 13-year-old cannot give consent for surgery, even in an emergency. In the case of an emergency, if the parents are not available to give consent, the emergency doctrine applies and surgery would proceed.

• The law recognizes a minor’s right to provide consent in some circumstances, including treatment for venereal diseases.

• In some circumstances minors can give consent for treatment.

• An attempt to reach parents must be made even if they are not readily available.

• Minors can give consent for diagnosis and treatment of drug dependency, drug addiction, or any condition directly related to drug usage. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ In which case might the nurse expect the state to deny a patient’s right of refusal for medical treatment? \ The patient has an illness that poses a threat to public health if left untreated. \

A competent adult refuses a blood transfusion based on religious belief. \ The patient refuses treatment to slow the advancement of an inoperable brain tumor. \ The patient's insurance refuses to pay if treatments are refused. \ \ If the patient has an illness that poses a threat to public health, the state may require the patient to submit to treatment.

In most instances, the competent adult patient has right of refusal for treatment of any illness or condition, including blood transfusion.

In most instances, the competent adult patient has right of refusal for treatment of any illness or condition. This is true even if the refusal could cost the patient's life.

Insurance reimbursement is not a factor in whether a patient has the right to refuse treatment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nursing faculty has included a requirement that students participate as medical research subjects as a part of their clinical practice grade. Does this requirement meet the guidelines for research participants’ rights? \ Yes, as long as there is no physical risk to the students. \ Probably, depending upon university regulations on course content. \ Yes, if the participation is outlined as a course requirement in the syllabus. \ No, the individual must be given the choice to participate or not.

\ \ The students’ rights to refuse this assignment are not affected by the risk of physical harm.

University regulations do not supersede students’ rights.

The syllabus cannot supersede student rights.

The rights of a person involved in research include the right to refuse to participate without penalty. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+C \ Which patient behavior would the nurse assess as possible indication that the patient will have health information literacy deficiency?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The patient asks questions that are not pertinent to the information provided. \ A patient reports that she took many herbal medications before emigrating from Viet Nam. \ The patient fiddles with his hearing aid during instruction. \ The nurse finds the medication information sheets she gave the patient tucked into a novel as a bookmark. \ The patient's wife cannot visit in the evenings because of her work schedule. \ • Patients who ask questions that do not pertain to the education being provided may not

understand the information.

• Persons who learned English as a second language are at high risk for health information illiteracy.

• Inability to hear well, which might be evidenced by “fiddling” with a hearing aid, can seriously affect ability to comprehend health care information.

• The fact that the patient is using the information sheets as a bookmark does not mean they were not read. Ability to read and comprehend a novel would likely indicate ability to understand health information that is presented on an appropriate level.

• The wife’s work schedule would have little to do with the patient’s health literacy. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The patient who has tested positive for a gene associated with breast cancer is concerned that this finding will affect her ability to get a government job position for which she has applied. How should the nurse respond to this concern? \ “Surely there would be no way for the personnel department to find out that information.” \ “There is a federal law that prohibits genetic information from being used in employment decisions.” \ “Worrying about these concerns is not good for your health.” \ “It should be a problem only if you intend to use the insurance plan.” \ \ This statement does not offer the patient guidance and is not therapeutic. It may increase the patient’s concern as it indicates that the nurse is not certain about the confidentiality of the

information.

The Genetic Information Nondiscrimination Act of 2008 prevents discrimination from health insurers and employers. The Act specifically applies to Congress and federal executive branch agencies.

The nurse should address the patient’s concerns rather than giving health advice.

This information should not be disclosed or used in an employment decision, whether or not the patient intends to subscribe to the potential employer’s insurance plan. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse determines that an adult patient has signed a statutory living will, also known as a natural death act. What does this mean to the nurse? \ That the health care providers who abide by the document cannot be charged with criminal negligence associated with the patient’s death. \ The document is legally binding and all health care providers will abide by its provisions. \ The directions of the document will be followed, even if the patient makes a verbal request that directly contradicts the provisions of the document. \ In order to revoke the document, the patient must sign a subsequent living will. \ \ Natural death acts are much like the living wills of the 1960s and function as a living will with statutory enforcement. This means that practitioners are protected from potential civil and criminal lawsuits.

There is no way to determine if all health care providers will abide by the provisions of this

document.

The patient’s expressed wishes always take precedence over the document, and the patient can verbally revoke the living will.

The patient does not have to sign a subsequent document in order to revoke the living will. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse has recently moved to a state that has fully enacted a Physician Orders for Life Sustaining Treatment (POLST) program. How will this affect the nurse’s practice? \ It will have little effect since the program was developed for emergency medical service providers. \ The program will provide research regarding best practice in end-of-life care for all health care providers, including nurses. \ The document will provide insight into the patient’s preferences for end-of-life care. \ The document will provide the name of the person holding the patient’s durable power of attorney. \ \ The POLST documents were first developed to provide guidance to emergency medical service providers. However, they are also used to provide direction to nurses and other health care providers.

POLST documents do not provide best practice information.

POLST documents outline a person’s preferences for end-of-life care.

POLST documents do not address the identity of the patient’s decision surrogate.

\ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which nurse action is appropriate according to the American Nurses Association’s stance on assisted suicide and active euthanasia? \ The nurse helps withdraw treatments that are life-saving. \ The nurse tells the patient that suicide is a sin. \ The nurse goes to the pharmacy and procures medication the patient intends to use to commit suicide. \ The nurse asks questions about why the patient is considering suicide. \ \ Withdrawal of life-saving treatments can be construed as active euthanasia. The ANA opposes nurses’ participation in active euthanasia.

The nurse should never pass judgment on the patient’s belief system.

The ANA is opposed to the nurse obtaining lethal doses of medication for the purpose of suicide or euthanasia. The nurse may procure and/or administer medication for pain control.

The ANA opposes nurses’ participation either in assisted suicide or active euthanasia because they violate the ethical traditions embodied in the Code of Ethics for Nurses. The nurse should decline the patient’s request, but should look beyond the request to what the patient may be saying. \ 0

0 0 0

0000000000 0000000000 0 \\ MC C \ A patient who is terminally ill is experiencing extreme pain and suffering. The patient says, “If I were an animal, you would put me out of this misery.” Which intervention would the nurse be ethically correct in providing as a last-resort option for this patient? \ Tell the patient how much pain medication would be needed to cause death. \ Administer pain medication with the intention of causing respiratory arrest. \ Administer sedative medications sufficient to cause unconsciousness. \ Encourage the patient to stop eating and drinking. \ \ According to ANA standards, the nurse should not participate in assisted suicide.

The nurse should not intentionally give medication to cause arrest. This is active euthanasia, which is not ethical according to the ANA. Sedation to unconsciousness is a valid alternative at the end-of-life.

The nurse should not encourage this action, but should not intervene if the patient makes this decision independently. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ A newly licensed nurse complains to the preceptor about the amount of time spent documenting in the medical record. What is the preceptor’s best response? \ “The most important reason we document is to help us communicate the patient’s condition to the rest of the health care team.” \ “Since you just took a course in nursing research, you should realize the value of accurate documentation as a source of research data.” \ “We have to document so that charges are clear to third-party payers.” \ “The medical record protects us if a lawsuit is filed.” \ \ The primary reason for documentation is to communicate the patient’s condition to others on the health care team. The preceptor should remind the newly licensed nurse of this fact.

Information from the medical record can be used for research with the patient’s permission, but this is not the primary reason it is important.

It is true that accurate documentation supports third-party reimbursement, but this is not the most important use of this information.

The medical record may or may not offer information that would protect the nurse in case of a lawsuit. This is not the primary reason for documentation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C

\ The nurse manager is aware that several patients will be admitted to the unit today. Today’s staff includes three registered nurses, two licensed practical nurses, and three unlicensed nursing assistants. Who should the manager expect to assess and document the admitted patient’s nursing needs? \ The nursing assistant \ The admitting physician \ A registered nurse \ A licensed practical or vocational nurse \ \ The nursing assistant may collect data such as vital signs, but cannot use the data to plan care.

The physician plans medical care, not nursing care.

Documentation of admission assessment and nursing needs is the role of the registered nurse.

The LPN or LVN can collect data, but does not use the data to plan care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Nursing home policy states that a registered nurse must cosign all charts that licensed practical nurses complete. What is the effect of this policy on the registered nurse? \ It places the RN in the position of endorsing and authenticating the entries made in the charts cosigned. \

It gives legal proof that the RN was in the facility. \ It has no legal effect on the RN. \ It makes the RN personally liable for any subsequent harm that befalls the patient. \ \ Cosigning is a practice that is becoming less frequent. It does place the nurse potentially liable for care, observations, or omissions as charted.

The RN may have cosigned at a date other than that of the event, so it does not give absolute proof that the RN was in the facility.

There are legal implications for endorsing or authenticating entries by cosigning.

The person delivering the care is also liable for any harm that may occur due to malpractice.

Liability does not lie exclusively with the person who cosigned. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A patient requests that records of her hospitalization for treatment of an infection following an abortion be destroyed as soon as she is discharged. What is the likely outcome of this request? \ The record will be sealed. \ The record will be destroyed. \ The request will be denied. \ The record will be given to the patient’s attorney. \

\ Even though the patient has requested that the record be destroyed, medical records departments are generally unwilling to do so. In most cases, the record will be sealed rather than destroyed.

Destroying the medical record is a permanent action that is generally done only after a specified amount of time, often several years. It is unlikely that the medical records department will honor this request.

Simply denying the patient’s request does not fulfill the patient’s need for privacy of information.

The hospital will not turn the only copy of this record over to the patient’s attorney. If a lawsuit were to be filed, the hospital would have no record of the hospitalization. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The patient demands to see the actual medical record of a hospitalization that occurred 1 year ago. How should the hospital handle this request? \ Deny the demand; the patient has no legal right to this record. \ Have the patient come to the hospital to review the original record. \ Send the patient a copy of the medical record by registered mail. \ Do not comply with this demand unless the patient provides a subpoena for the record. \ \ The patient does have a legal right to view the record.

In this case, the hospital should have the patient come to the hospital to review the original record. The patient should be monitored while reviewing this record.

Making a copy of the record for the patient does not fulfill the patient’s demand or the patient’s right to see the original.

Since the patient has a right to see the original record, there is no need for a subpoena. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which statement, made by a staff nurse, would the nurse manager evaluate as evidence of good understanding of the importance of the electronic medical record? \ “Since nurses are the only ones using this system, I won’t have to wait to document anymore.” \ “I’m glad that it will take less time for us to document.” \ “I hope we don’t have to keep changing passwords.” \ “They say that our patient care will improve while we are using this system.” \ \ Access to the record is not limited to nursing; all disciplines use the system.

It does not take less time to document fully using this system.

Passwords are changed frequently for security purposes.

Electronic records allow immediate access to patient care information; therefore, patient care is improved. \ 0 0 0

0

0000000000 0000000000 0 \\ MC B+C+E \ The nurse working in a physician’s office recorded assessment data in the wrong patient’s medical record about 1 hour ago. How should the nurse correct this error?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Black out the error with a marker and enter the new information. \ Indicate the date and time the correction was made. \ Indicate the reason the correction is being made by writing “wrong patient chart” along with the new information. \ Enclose the corrected information in brackets to set it off from the original post. \ Either initial or sign the correction. \ • The information written in error should not be obliterated or blacked out.

• The nurse should indicate the date and the time the correction was made in order to show when the new notation was made.

• There should be some indication of why the correction is being made. “Wrong patient chart” is adequate explanation.

• There is no reason to bracket the new information.

• Depending upon the extent of the correction, the nurse should either initial or sign the corrected area. It is important to make it very clear who made the new notation. \ 0 0 0

0

0000000000 0000000000 0 \\ MC C+E \ A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Carefully document the completion of an incident report in the nurse’s notes. \ Write a recommendation for future prevention of such incidents in the report. \ Include only the facts and the nurse’s observations in the incident report. \ Assist the nursing supervisor who will write the report. \ Include documentation in the medical record about the event that mandated completion of an incident report. \ • The completion of an incident report should never be referenced or documented in the nurse’s notes, which are a part of the patient record. This report is for institutional use only.

• Recommendations for prevention are not part of the incident report.

• The nurse should include what was actually observed in this report.

• The person discovering or directly involved in the incident must complete the report. This could be any staff member, not just the nursing supervisor.

• The facts of what happened to the patient and the patient’s response must be documented in the medical record. \ 0 0 0

0

0000000000 0000000000 0 \\ MC A \ As part of conversion to a new electronic medical record format, a hospital is also instituting charting by exception. The nurse manager would caution staff nurses that charting by exception has which major drawback? \ It may not provide enough information to support trending of the patient’s condition. \ It does not allow for use of uniform standards. \ It is not admissible in court because there is not enough background in the documentation. \ This method takes much more time than narrative charting. \ \ The major problem with charting by exception is that it is often difficult to see the changes or trends that may indicate worsening of the patient’s condition.

In order for charting by exception to be meaningful, uniform standards must first be established.

Charting by exception is admissible in court.

Charting by exception was designed to reduce charting time. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The parents of a 17-year-old who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider? \ Refuse the request pursuant to the provision of the common-law duty to disclose. \ Refuse the request as it is likely to interfere with the treatment plan. \ Release the information immediately as parents always can receive information on minor children. \ Release information only if the patient has signed consent to do so. \ \ The common-law duty to disclose recognizes the duty to disclose medical information in limited circumstances related to public safety.

Interference with the treatment plan is not the primary concern.

It is not true that parents can always receive information on minor children.

A minor must always sign consent for information about substance abuse to be released, even to a parent. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ The nursing student began a case study paper by writing, “J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital.” What is the significance of this statement? \ It is incomplete, as the date and time of admission should be included. \ It is a good description of the patient to begin the paper. \ It violates Health Insurance Portability and Accountability Act regulations. \ It is incomplete, as the patient’s physician’s name should be included. \ \ Inclusion of additional information such as date and time of admission only makes it easier to identify the patient, which is a HIPAA violation.

Since information about age, race, and gender is important to the faculty grading the case study, that information should be included.

The inclusion of the patient's initials, age, race, and place of admittance potentially makes it possible to identify the patient, which violates HIPAA. The patient’s physician’s name should not be included as it makes it easier for others to identify the patient. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \

The nurse discussing the Health Insurance Portability and Accountability Act (HIPAA) says, “I am aware that this act changed the way we handle confidential information.” What other provisions of this act should the nurse consider?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ An anti-fraud and anti-abuse program \ Establishment of state governments as health care regulators \ A law preventing portability of health care coverage \ Tax incentives for preventive care \ Streamlining of transfer of patient information between insurers and providers \ • An anti-fraud and anti-abuse program is part of HIPAA. • The act established the federal government as a national health care regulator.

• This act provides for the portability of health care coverage.

• There are no tax incentives for preventive care included in this act.

• HIPAA was designed to help streamline transfer of patient information between insurers and providers. As part of this streamlining effort, changes to confidentiality also occurred. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D \ The patient brings suit against a health care provider. In which ways would the nurse expect this action will affect the confidentiality of the patient’s medical record?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The confidentiality of the record will remain intact. \ The patient’s attorney will have access to the information in the record. \ The record loses confidentiality and is discoverable by any interested party. \ The record will be released to the defendant’s attorney. \ Only the judge will have full access to the medical record. \ • As being the primary source to describe the course of the patient’s evaluation, treatment, and change in condition, the medical record is a discoverable record.

• The patient’s attorney must have access to this information in order to pursue the lawsuit.

• Information in the medical record is not discoverable to anyone who is not involved in the suit.

• The defendant’s attorney will have access to the medical record.

• Others other than the judge must have access to the medical record to establish and defend the suit. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+D \ A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Every state requires that all sexual contacts of a person diagnosed with AIDS be contacted and treated. \ AIDS status must be disclosed to any health care provider who has cared for the patient within the last 18 months and to any future health care provider. \ In general AIDS status is considered confidential. \ All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department. \ All babies born in the United States are tested for presence of HIV at birth. \ • Not all states require or permit this tracking and content.

• There is no regulation mandating disclosure of AIDS status to health care providers.

• In general AIDS status is considered confidential. There are very limited situations in which this status can be disclosed.

• All 50 states require reporting of AIDS cases to the Centers for Disease Control and Prevention or to the state health department for epidemiological purposes.

• There is no universal standard by which all babies are tested for HIV at birth. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A nurse strongly believes that all newborns should be screened for HIV at birth. Which ethical principle would the nurse cite to support this argument?

\ Informed consent \ Confidentiality \ Beneficence \ Autonomy \ \ Informed consent might be transgressed through mandatory testing.

Confidentiality might be transgressed by mandatory testing.

The principle of beneficence (greatest good for greatest number) supports HIV screening of newborns.

Autonomy might be transgressed through mandatory testing. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ The nurse recruiter says, “We have a liability insurance policy that covers all nursing employees.” The nurse seeking employment at this facility identifies which policyholder? \ The party against whom a suit is filed \ The nursing department employees \ The hospital \ The insurance agent who sells the policy \ \ The party against whom a suit is filed is a defendant (who may or may not hold an insurance policy).

The nursing department employees are the “insured.”

The holder of the policy is the person (in this case, the hospital) who purchases the policy.

The agent is a representative of the insurance company. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D+E \ A nurse has been named in a lawsuit. The nurse’s insurance company has declined to cover any costs until policy exclusions have been verified. What would the nurse expect the company to review?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Length of employment \ The insured's educational preparation \ Length of time the nurse has been registered \ Licensure of the insured \ Nature of the insured's work \ • Length of employment does not fall under policy exclusions.

• Educational preparation is verified when the policy is issued and does not pertain to exclusions at this time.

• Length of time the nurse has been registered is not pertinent to exclusions.

• In professional liability policies, exclusions frequently describe circumstances or activities that will prevent coverage of the insured party. Exclusions also include the absence of appropriate licensure or certification. Therefore, the company would check the insured's licensure.

• In professional liability policies, exclusions frequently describe circumstances or activities that will prevent coverage of the insured party. The insurance company would check the activities that are a part of the insured's work to ensure that they do not fall in the exclusions category. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \

The nurse has been named in a lawsuit claiming a patient was injured due to her negligence. The nurse dropped her personal professional liability insurance several months ago, but believes the policy may have been in effect at the time of the incident. In which part of the policy would the nurse look for information about the coverage period? \ Deductibles \ Exclusions \ Declarations \ Liabilities \ \ Deductibles are a separate section of the policy and would not include information about coverage dates.

Items not covered by the policy are called exclusions. This is not associated with the coverage period.

Declarations include the "demographics" of the policy: the policyholder's name, address, covered professional occupation, and the covered time period.

The limits of liability are in a separate section of the policy and do not speak to the coverage period. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse understands that the professional liability insurance provided by the hospital where he works is a claims-made policy. Which claim would the nurse expect this policy to cover? \

A claim that was filed 3 months after the hospital purchased the policy \ A claim that was filed while the hospital and insurance company were negotiating about the policy \ A claim filed for an event that occurred during the coverage period that was filed after the hospital changed carriers \ Any claim filed as long as it was within 30 days of the end of the policy \ \ Claims-made policies provide coverage only if the claim for an injury that has occurred is filed with the courts and is reported to the insurance company during the active policy period or during an uninterrupted extension of that policy period.

The policy will not cover claims that were filed prior to the coverage being activated.

The policy will not cover claims made after the end date of the policy, even if the claim was associated with an incident that occurred while the policy was in effect.

There is no 30 day grace period associated with this type of coverage. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ In which situation is an occurrence-based policy most beneficial to the nurse? \ A nurse had insurance coverage during 20 years of practice, but is now retired and no longer has an active policy \ A nurse acquired insurance coverage after a patient unexpectedly died during the nurse’s care. \

A nurse fears she will be named in a lawsuit even though she was only a witness to an occurrence. \ A nurse had an untoward evaluation at work and needs coverage in case she is terminated for unsatisfactory performance \ \ The occurrence-based policy is preferable because lawsuits may not be filed immediately, and the nurse needs coverage for any lawsuits that might arise even after retirement from active practice.

No policy will cover an incident that has already occurred.

A policy will not cover an incident that has already occurred even if the person purchasing the policy was just an observer.

This performance has already occurred, so no policy will provide coverage. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A nurse has decided to obtain individual professional liability insurance. In general, which type of insurance is best for most nurses? \ Certificate-based \ Employer-sponsored \ Occurrence-based \ Claims-made \

\ Certificate-based is not a form of insurance.

Employer-sponsored coverage is the narrowest coverage for individual nurses.

For most nurses the occurrence-based policy is preferable. This policy continues coverage for claims made for incidents that occurred during the time the policy was in effect, even if the policy has expired.

Claims-made policies cover only claims made during the life of the policy. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The limits of liability on an insurance policy are $1,000,000 for each claim, $4,000,000 aggregate. A nurse is charged in a serious situation in which five separate lawsuits have been filed. What is the most the insurance company will likely pay in this situation? \ $4,000,000 \ $200,000 \ $1,000,000 \ $5,000,000 \ \ $4,000,000 represents the most the insurance company will pay during a given policy period.

There is no indication that the insurance company will divide the $1,000,000 by 5 when considering how much to pay.

The limit of liability for each claim is $1,000,000 and that is likely all the insurance company will pay since each of the 5 suits came out of the same situation.

It is unlikely that the company will pay $1,000,000 for each claim since they all arose from the same incident. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse believes that her need for individual malpractice insurance is decreased because she practices in a small-town home health agency. What is true about this situation? \ Residents of small towns are less likely to bring suit than residents of urban areas. \ Slower paced environments, such as home health care, are less likely to create situations in which the nurse makes an error. \ Nurses working in home health are covered by mandatory federal malpractice insurance policies. \ Home health care is an area in which the risk of lawsuit is higher than in many other practice areas. \ \ There is no guarantee that a resident of a small town will not be just as suit-prone as a resident in an urban area.

In home health care, the nurse is making many independent decisions daily and does not have easy access to others for consultation.

There is not a federal malpractice policy for nurses.

Home health care joins critical care, emergency departments, operating rooms, and maternal/child care as areas where the risk of lawsuits is higher. \

0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nurse has missed 10 days of work while involved as a defendant in a malpractice lawsuit. Must the hospital where this nurse is employed and that was also named in the suit pay the nurse for those days? \ In most cases, the hospital is only required to pay the nurse for one-half of time missed. \ No, since the nurse caused the lawsuit to be filed, the hospital has no responsibility for pay. \ Yes, the hospital is always responsible for expenses associated with work whether or not the expenses are related to a lawsuit. \ Not necessarily, it depends upon the hospital's insurance policy and what it covers. \ \ There is no standard by which the hospital must pay the nurse for one-half time.

The fact that the nurse did or did not “cause” the lawsuit to be filed is not pertinent to whether the hospital will pay this nurse.

The hospital is not necessarily responsible for these expenses.

Most hospital insurance policies do not have supplementary payments for the nurse-defendant.

This means that if the nurse incurs additional expenses in investigating the claim or loses days of work defending the claim, the nurse must cover those expenses out of pocket. However, some policies do have this coverage, so this is the most accurate answer. \ 0 0 0

0

0000000000 0000000000 0 \\ MC B \ The hospital-employed nurse volunteered to assist with physical examinations for athletes at the local high school. How does this situation affect the nurse's hospital malpractice insurance? \ The nurse is covered by the hospital's malpractice insurance as a community volunteer. \ The nurse is very likely not covered by any malpractice insurance. \ The nurse is covered by the school's insurance. \ The nurse is exempt from liability for any occurrences because of the volunteer status of the work. \ \ Many hospital liability insurance policies have limited coverage and cover employees only while they are performing work as hospital employees.

As a volunteer, the most likely situation is that the nurse is not covered by any insurance, unless a private insurance policy is in effect.

The school most likely covers only its own employees.

There is no indication that volunteer work will not result in lawsuit. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ As a part of a malpractice case, the hospital has decided to bring an indemnity claim against a nurse. What is the implication to the nurse?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse should obtain a private lawyer. \ The nurse will have to pay monetary damages to the hospital if the hospital wins the claim. \ The nurse is required to disclose patient information that the patient believed would be kept confidential between the nurse and the patient. \ The hospital is released from paying monetary damages to the nurse. \ The hospital attorney has identified the work practices implicated in the incident causing the lawsuit. \ • The filing of an indemnity claim also means the nurse should obtain a private lawyer as the hospital is now suing the nurse.

• Indemnity claims are those brought by the employer for monetary contributions from the nurse whose actions or failure to act caused the original patient injury in a lawsuit.

• Indemnity has nothing to do with confidentiality between nurse and patient.

• Indemnity does not have any bearing on monetary damages owed the nurse.

• Indemnity is not related to work practice identification. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ A nurse is named in a lawsuit and has no professional malpractice insurance coverage. What is true of this situation?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse can be held personally responsible for all damages assessed. \ The nurse is considered judgment-proof and will not be required to pay damages. \ The nurse will be nonsuited from the filed lawsuit once this fact is known. \ The nurse can rely upon the hospital's insurance policy as protection from personal financial liability. \ The nurse’s best interests may not be protected during the case. \ • Despite not having insurance, nurses are liable for their actions and can be held personally liable for damages.

• Nurses are never considered judgment-proof.

• Nurses are not released from a suit because there is no insurance.

• The hospital's insurance policy does not always provide all the financial protection that may be needed.

• In some cases, nurses have not been adequately represented by legal counsel in the lawsuit. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ What should the nurse consider about today’s healthcare environment when making a decision about purchasing individual professional liability insurance?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The frequency with which nurses are named in lawsuits has not changed in the last several decades. \ Obstetrics is the only specialty in which risk of being sued has increased. \ Having personal insurance does not increase one’s risk of suit. \ Monetary awards in cases where nurses have personal insurance are higher. \ Most lawsuits are filed against nurses who are not specialized in any particular field. \ • Due to the expanding role of nursing there is a heightened legal accountability and increased potential for being named in lawsuits.

• Obstetrics, critical care, and emergency nursing are all suit-prone.

• A common misconception is that having personal insurance will increase the nurse’s risk of being sued. This is an incorrect argument.

• This is not a true statement, but is widely believed to be true.

• Current literature indicates the most malpractice cases involve non-specialized RNs. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Which option reflects one of the more convincing arguments for the nurse having individual malpractice insurance? \ Defending against a lawsuit is costly in today's society. \ Filing a lawsuit is costly in today's society. \ Having insurance ensures that the nurse will not be named in lawsuits. \ Having insurance makes it more costly for the plaintiff to file suit against the nurse. \ \ Defending oneself in a lawsuit is very costly.

The cost of filing a lawsuit is minimal as compared to defending against a suit.

Insurance does not provide a guarantee that lawsuits will not be filed.

The cost of filing a suit is not associated with having insurance. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D \

Nurses who work on a medical unit do not have personal professional liability coverage. In the event of a lawsuit, which options are true?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ They can be covered under the employer's insurance policy. \ They may be refused coverage under the employer's insurance policy. \ They will be covered under the professionals' group policy. \ They need to contact their own attorneys. \ They will be covered with their state's Emergency Health Care Providers policy. \ • There is a chance that the employer's insurance would cover these nurses.

• The employer's insurance may elect not to cover the nurses, depending upon the circumstances of the incident.

• Professionals' group policies are more commonly found in private clinics or businesses.

• These nurses should contact personal attorneys.

• There is not an Emergency Health Care Providers insurance policy. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ Changes to nursing licensure are being considered. The nurse identifies which source of the state’s power to license nurses? \ Police power within the state \ State and federal case laws \ Constitution of the United States \ Nurse practice act \ \ It is the states' police power that enables them to provide a license for nurses.

State and federal case laws may define actions that the state may take in certain circumstances, but they do not extend to providing licensure for nurses.

The Constitution is a federal document that does not address licensing power of the states.

The state practice act defines the scope of practices and the processes for licensure, not the power to issue the license. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A medical technician working in a physician’s office routinely refers to herself as a nurse. Which type of licensure protects that title as well as the professional actions associated with nursing? \

Mandatory \ Institutional \ Transitional \ Permissive \ \ Mandatory licensure requires that all persons who are compensated as a member of a licensed profession obtain licensure prior to practicing actions of the profession. It protects both the title "nurse" and the professional actions associated with the nursing.

Institutional licensure is the process by which a state government regulates health institutions and is an alternative to individual licensure. It does not protect individual practice or title.

Transitional is not a term used to describe licensure in this text.

With permissive licensure, nurses cannot use the title RN unless duly licensed, but can perform many or all of the same actions as long as they do not call themselves RN. So, permissive licensure regulates the use of the title, not the actions. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A nurse appointed to the state board of nursing would expect work focused on which basic purpose of that body? \ Establishing a means of protecting the public at large \ Ensuring that all schools of nursing seek national accreditation \

Ensuring that all practicing nurses are competent \ Restricting nursing practice through regulations \ \ The main purpose of the state board of nursing is to protect the public.

The state board of nursing may support this effort, but this is not the basic function of the board.

Overseeing nurse competence is a way to support the board’s basic purpose.

The state board may restrict nursing practice in order to support its basic purpose. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A physician reported a case of possible nursing negligence to the state board of nursing. What action will be taken by the board? \ The complaint will be screened and an investigation initiated if appropriate. \ Nothing will be done as only another professional nurse is qualified to report nursing negligence. \ The nurse or nurses will be placed on probation pending investigation of the complaint. \ The incident will be recorded as a "first strike" against the nurse or nurses involved. \ \ A single complaint triggers action on the part of the board. The complaint is screened and an investigation is initiated, if appropriate.

Any interested person can file a complaint with the board of nursing.

There is no way to know if probation is necessary until an investigation is done.

No action against the nurse is indicated until an investigation is completed. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The hospital nurse supervisor has concerns that a staff nurse is no longer capable of competent patient care because of alcohol use. Repeated counseling sessions with the nurse have not changed the behaviors that are of concern. What action should be taken by the supervisor? \ Report the concerns to the state board of nursing. \ Terminate the nurse's hospital employment. \ Transfer the nurse to a non-patient care position. \ Nothing as the nurse might sue the supervisor. \ \ Of the options provided, the one most protective of public safety is to report concerns to the state board of nursing.

Simply terminating employment does not address the problem at the nurse's level and does not guarantee that the nurse will not have similar issues at the next place of employment.

Transfer of the nurse to a non-patient care position is only a temporary solution and does not address the safety issues. Nurses can make errors that impact the public, even in non-patient care roles.

Ignoring the problem for fear of suit will not make the problem go away. \ 0

0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse is searching for the legal guide to the practice of registered nurse. Which document should the nurse review? \ ANA Code of Ethics \ State Nurse Practice Act \ Nurse's Bill of Rights \ Nightingale Pledge \ \ The ANA Code of Ethics is the document that defines ethical principles for nurses.

The state nurse practice act is the legal guide to define the scope of practice for nurses.

The Nurse's Bill of Rights are references to nurses' rights, not specific legal aspects of nursing practice.

The Nightingale Pledge is the nurses' pledge or commitment to serving their patients derived from the writings of Florence Nightingale. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A nursing student reports that her grandmother served as a nurse in World War II. At the end of the war, her grandmother was licensed as a nurse, even though she never graduated from nursing school. Which type of exemption from licensure does this reflect? \ Grandfather clause \ Reciprocity \ Endorsement \ Licensure by waiver \ \ The grandfather clause is a form of exemption that allows certain persons working within a given profession prior to a given deadline to apply for licensure without meeting all the requirements for that licensure. It was used to allow World War II nurses with on-the-job training and expertise licensure as a nurse.

Reciprocity allows a person who has a license in one state to practice in another state if the states have an agreement to do so.

Endorsement is similar to reciprocity but there is no prior agreement among the states.

Licensure by waiver is similar to licensure by exam. If the person meets the exam requirements without taking the test, the exam is waived and a license is issued. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D \ In which situations would the state board of nursing have probable grounds for disciplining a nurse?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse can no longer lift 30 pounds. \ The nurse fails to report a co-worker who is working outside his scope of practice. \ The nurse questioned a direct physician order. \ The nurse made a false statement on the licensure application. \ The nurse told a co-worker that she is taking antidepressant medications. \ • Inability to lift 30 pounds may change where a nurse can safely work, but is not grounds for action against the license.

• Failure to report another person for fraudulent, incompetent, unprofessional, or unethical conduct is grounds for action against the non-reporter’s license.

• Questioning an order is not grounds for action against the nurse unless the questioning is done in an unethical or unprofessional manner.

• Making a false statement on the licensure application is grounds for action against the nurse's license.

• If the nurse is seeking treatment for depression and the depression does not interfere with safe, competent nursing care there is no reason for disciplinary action. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ A nurse executive has requested that additional budgetary funds be allocated to support staff seeking a baccalaureate degree in nursing or specialty certification. Which information should this executive provide during discussions of this funding?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “Research shows no correlation between an increased number of BSN prepared nurses and increased nursing salaries.” \ “Nurse specialty certification has been shown to lower patient mortality.” \ “If our nursing staff is educated at a higher level and are certified we will see fewer lawsuits for negligence and malpractice.” \ Higher failure-to-rescue rates \ “Education at the BSN level, when coupled with specialty certification, has been shown to reduce adverse patient outcomes.” \ • Typically nurses do receive salary increases as educational level increases.

• Kendall-Gallagher and colleagues (2011) concluded that hospitals’ nurse specialty certification lowers patient mortality.

• There is no evidence that this is the case.

• Higher rates of nurse specialty certification have been correlated with reduction of failure-to-rescue rates in hospital settings.

• Researchers have noted a reduction of adverse patient outcomes when specialty certification exists along with education at the BSN level. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The patient tells the nurse that the physician mentioned deep tissue massage as treatment for rheumatoid arthritis. As a part of the subsequent conversation, the nurse demonstrates techniques and encourages the patient to begin a regimen immediately. What is true regarding this situation? \ Since back massage is a standard skill taught in nursing school, the nurse has no liability for these actions. \ The nurse's liability centers on the recommendation to begin a massage regime. \ Since the physician initiated the discussion, the nurse has no liability. \ This nurse may be guilty of practicing massage without a license. \ \ The nurse is responsible for all nursing actions.

The recommendation itself would probably not be a liability issue if the nurse was educated to make such a recommendation.

The nurse is responsible for all nursing actions.

Deep tissue massage goes beyond the bedtime "backrub" type of massage taught in nursing school and is used for a specific disease therapy, so the nurse may be guilty of practicing massage without a license. States differ on this licensure. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+D \ The home health nurse discovers that a homebound cancer patient is using marijuana to control nausea from chemotherapy. What advice should the nurse give this patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The effect of marijuana on decreasing nausea is fleeting and not worth the health problems caused by using it. \ Since the patient is homebound, it is likely the use of marijuana will not be discovered by anyone else. \ Possession of marijuana is illegal under federal law. \ Some states have current legislative guidelines for legal possession of medical marijuana. \ As long as it is documented that an illness exists that can be treated with marijuana, no risk of prosecution is present. \ • Some patients report that marijuana does decrease nausea from chemotherapy.

• The nurse cannot legally advise the patient that it is permissible to break a law.

• Any possession of marijuana remains illegal under federal law.

• Some states do have such guidelines and if these are in place and followed, it is unlikely that federal charges would be pursued.

• The mere presence of an illness that can be treated with marijuana is not sufficient to avoid prosecution for the patient and those providing the substance. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Which information would the nurse provide as rationale for supporting the nurse licensure and mutual recognition movements? \ Advancing technologies, especially telehealth and telephone triage makes single state licensure problematic. \ Some areas have an oversupply of nurses while others are still experiencing a nursing shortage. \ Multistate licensure will protect the safety of consumers who use call-in phone lines for health advice. \ The number of practicing nurses holding more than one state license is increasing. \ \ Advancing technologies such as telehealth and telephone triage have expanded practice beyond geographic boundaries.

Multistate licensure is not a logical means of correcting this situation.

There is no guarantee that changes in licensure will protect these patients.

While this situation has some relation to mutual recognition and nurse licensure compacts it is not the most important force to consider. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C+E \ The nurse holds original licensure in a compact state and has practice privileges in two remote states. Should practice concerns arise with this nurse in a remote state, what is the status of the nurse's license?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Only the state in which the nurse demonstrated poor practice can act to suspend or revoke the nurse's license. \ License suspension or revocation can only occur if all three states agree to the action. \ Only the state in which the nurse holds licensure can act to suspend or revoke that license. \ The remote state can place the nurse’s license on probation. \ The remote state can limit or stop the nurse from practicing in that state. \ • Action may be taken by the home state and the remote state where poor practice was demonstrated.

• All three states do not have to be in accordance with the action against this nurse’s license.

• Only the state that issued the license can suspend or revoke it.

• Only the home state can act against the license by using probation.

• The remote state would act against the practice privilege by limiting or stopping practice with a cease-and-desist order. \ 0 0 0 0

0000000000 0000000000

0 \\ MC B+C \ The patient decides to discontinue standard medical treatment for diabetes mellitus and to rely on diet and herbal medications for blood sugar control. Which statements, made by the nurse, are appropriate?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “You are an adult and can do anything you want to do.” \ “We need to talk about how medications work to control diabetes mellitus.” \ “Tell me more about why you decided to make this change.” \ “Don't you know that you are gambling with your health?” \ “I think that would be a mistake.” \ • This statement closes the conversation before additional assessment can be completed.

• This statement could be helpful in setting the stage for additional patient education.

• Before the nurse makes any other comments, more assessment must be done. Asking the patient to describe why this decision was made will help gather data for this assessment.

• This statement is not therapeutic and could be evaluated as belittling to the patient.

• The nurse should not offer this opinion, but should seek to continue talking with the patient about this choice. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ The nurse has a strong religious conviction against elective sterilization procedures. When seeking employment, how should the nurse handle this belief? \ Request placement on a unit where care of these patients is unlikely. \ Be up front and discuss the issue during the employment interview. \ Say nothing about this belief as it is personal, private information. \ Be certain that this information is documented in the employment contract. \ \ While many units would be unlikely to receive such patients, it cannot be guaranteed that the nurse would never come into contact with them.

The best strategy is to be up front about these beliefs and to discuss them at the time of the employment interview.

While it is true that these are personal beliefs, they may impact the way the nurse is assigned or able to practice in given environments.

There is no need to document the information in the contract. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ A nurse discussing the establishment of today’s advanced nurse practitioner role would discuss which factor as the primary driving force? \ The physician shortage of the late 1960s \ The need for providers to work in primary care settings \ The need for more rural health care by qualified providers \ The refusal of physicians to see rural patients \ \ The primary driving factor was a shortage of primary physicians that occurred in the late 1960s and early 1970s.

The situation driving the development of this role was not limited to primary care settings.

The situation driving the development of this role was not limited to rural health care.

There is no indication that physicians were refusing to care for rural patients. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ A certified registered nurse anesthetist (CRNA) is addressing a group of high school students that have expressed interest in this profession. Which information should the nurse provide?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The fastest way to gain certification as a CRNA is through a physician’s assistant program. \ Nurse anesthetists are a newly developing field. \ Currently, the entry level for this certification is a master’s degree. \ Nurse anesthetists practice outside the scope of nursing by virtue of a grandfather clause in anesthesia. \ In the future, nurses wishing to become CRNAs must have a doctoral degree. \ • CRNAs are advanced practice nurses, not physician assistants.

• The first “official” nurse anesthetist was administering anesthesia as early as 1877.

• In order to write the certificate examination, applicants must have completed a master’s program.

• Nurse anesthetists practice within the scope of nursing for their specialty.

• Beginning in 2025, a Doctor of Nursing Practice (DNP) or a Doctor of Nurse Anesthesia Practice (DNAP) will be required for certification. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D+E \ A student nurse is contemplating seeking independent practice as a certified nurse midwife. If the nurse reaches this goal, which components of practice should the she expect to fulfill?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

\ Physical examinations \ PAP smears \ Management of postpartum complications \ Family planning counseling \ One-on-one management of high-risk pregnancies \ • Physical examinations are a part of the normal prenatal, intrapartum, and gynecological care provided to women and normal newborns. This is part of the midwife role.

• Certified nurse midwives provide normal gynecological services such as preventive health screenings.

• Management of complications is not an independent practice role. The midwife may participate in this care but does not do so independently.

• Certified nurse midwives provide family planning counseling as part of their role.

• Certified nurse midwives offer an alternative childbearing experience to low-risk patients. They do not provide independent care of high-risk pregnancies. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Hospital management has identified quality of care issues that center around coordination of multidisciplinary services. Which classification of advanced practice nurse would be the best choice to help address these issues? \ Clinical nurse leader

\ Advanced nurse practitioner \ Nurse with a doctorate of nursing practice \ Clinical nurse specialist \ \ The role of clinical nurse leader is envisioned by the AACN to be a person who "designs, implements, and evaluates client care by coordinating, delegating, and supervising the care provided by the health care team, including licensed nurses, technicians, and other health professionals." The clinical nurse leader should have the skill set to address quality of care issues.

ANPs are nurses who have specialized in one or more practice specialties. Most provide primary care to low-risk patients and may serve as the primary health care provider.

DNP programs vary in focus. The nurse holding a DNP may or may not have the leadership skills needed to address this hospital’s quality of care issues.

Clinical nurse specialists are often practice-focused and may or may not have the skills necessary to address hospital-wide quality of care issues. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A nurse working as a clinical nurse specialist (CNS) in a hospital is aware of a greater risk for being sued for malpractice than that of the staff nurses’ co-workers. What rationale would the CNS give for this difference? \ “I have greater autonomy in my work.” \

“Since I make more money, I am a better litigation target.” \ “I assume greater legal liability because of my specialty credentials.” \ “The patients I work with are sicker and more likely to develop treatment related complications.” \ \ Decreased autonomy does not protect the staff nurses from litigation.

The fact that this nurse makes more money would not be likely to play into the decision to sue.

Nurses who hold specialty credentials are assumed to be experts in their role. This increases the likelihood of suit if an unexpected outcome occurs.

The seriousness of the patient’s illness is not a major determining factor in unexpected outcomes.

When a person who is not seriously ill has a poor treatment outcome, litigation is often considered. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The advanced nurse practitioner wishes to obtain admitting privileges at an area hospital. To whom should this nurse apply for these privileges? \ The state board of medicine \ The individual hospital \ The Joint Commission \ The state board of health \

\ The state board of medicine may recommend guidelines for credentialing but does not grant privileges to specific hospitals.

Institutions grant the privileges for individuals to practice in their facility. This privilege granting is governed by the institution based on a set of credentials that are determined by a designated peer group practicing in that institution.

The Joint Commission specifies that standards for privileging must be present and followed, but this organization does not grant privileges to individual practitioners.

The state board of health may have guidelines for granting privileges but does not grants privileges to individuals. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A nursing student's grandmother relates a time in the 1920s when medications were selected based upon the recommendation of a nurse who lived in the neighborhood. How is this possible? \ Prescriptive authority was not removed from nurse practice acts until the 1950s. \ The grandmother must be mistaken because medications have always been selected based upon physician prescription. \ Prior to 1938, most medications were over-the-counter and nurses were instrumental in their choice. \ This student's grandmother must have lived on a military base or facility where nurses were granted this privilege. \ \

The legislation limiting prescriptive authority to physicians was introduced before 1950.

At one time, most medications were available over-the-counter and nurses often helped direct patients toward appropriate medications.

In 1938, the federal government took control of prescriptive authority when it passed the Federal Food, Drug, and Cosmetic Act. Until that time, most medications, except narcotics, were overthe-counter and both nurses and physicians helped direct patients toward appropriate medications.

There was no need to live on a military base for this to occur. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The patient requires a controlled substance for the treatment of pain. What is true of the advanced nurse practitioner's role in independently prescribing this medication? \ Some states allow advanced nurse practitioners to prescribe controlled substances. \ There are no states in which any advanced nurse practitioner can prescribe controlled substances. \ Prescriptive authority allows all advanced practice nurses to prescribe any medication necessary for the treatment of their patients. \ Prescriptive authority is limited to nurse anesthetists. \ \ Laws about prescriptive authority vary from state to state.

The APN may have prescriptive authority for some controlled substances, depending upon the state of licensure.

The vast majority of states still require some degree of physician involvement or delegation in

the area of prescriptive authority, including direct supervision or use of a formulary.

Prescriptive authority is not limited to CRNAs. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The advanced practice nurse would like to move to a large metropolitan area. How will this move impact the advanced practice nurse's practice? \ There is no problem as the practice requirements are the same. \ There would be no problem as the move is to an area that is primarily minority. \ This would be an unwise move for the nurse, as advanced practice is limited to rural areas. \ There would be no problem if the move is to a medically underserved area. \ \ All 50 states recognize the advanced practice nurse role.

There is no requirement that APNs restrict their practice to minority areas.

There is no requirement that APNs restrict their practice to rural areas.

There is no requirement that APNs restrict their practice to medically underserved areas. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ The advanced nurse practitioner is considering changing malpractice insurance carriers. What should the nurse consider prior to making this change?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The expanding role of the advanced nurse practitioner has increased the number of lawsuits filed. \ The advanced nurse practitioner should carry medical malpractice, just as the physician does. \ Advanced nurse practitioners are less likely to be sued than nurses holding a doctorate of nursing practice. \ The advanced nurse practitioner is more likely to be sued than a physician. \ The severity of malpractice claims against some ANP roles has increased in the last few years. \ • As the role of the ANP has expanded, so has the frequency with which these nurses are sued.

• Advanced nurse practitioners are nurses and should carry nursing malpractice specific to their role.

• ANPs are not less likely to be sued than nurses holding a DNP. • There is no indication that ANPs are more likely to be sued than physicians.

• APRNs have seen the severity of malpractice claims rise in the past few years. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ The advanced nurse practitioner is routinely addressed as "doctor" by clinic patients. What is the best way for the nurse to handle this mistake?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Only allow this practice if the ANP has an earned doctorate. \ Accept the mistake with good humor and ignore it. \ Be certain patients are aware that the nurse is not a physician. \ Ask the patients to address the ANP by first name. \ Wear a nametag that clearly lists the nurse’s credentials as an ANP. \ • While it is true that an ANP with an earned doctorate has the right to be addressed as "doctor," in the clinic situation, this may lead to confusion between the roles, which are sometimes confusing to patients anyway.

• The practice should not be ignored.

• The ANP must be certain that patients understand the role difference between an ANP and physician.

• Unless the physician is called by first name, the ANP should be addressed as Miss, Mrs., Ms., or Mr., as the situation dictates.

• Routinely wearing a nametag that clearly presents credentials is one method to identify the nurse’s role. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C+D+E \ A group is working to increase the number of advanced nurse practitioners (ANPs) who have hospital admitting privileges. Which barriers should these nurses address?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ There is no Medicare regulation mandating medical staff membership of APNs. \ The fees associated with obtaining admitting privileges are prohibitive for ANPs. \ State laws concerning ANP admitting privileges are confusing and contradictory. \ Some state laws limit the scope of ANP practice. \ Some hospitals do not allow non-physicians to admit patients. \ • Medicare regulations may prevent the ANP from conducting patient examinations in the hospital setting because the ANP does not have medical staff membership.

• There is no indication that any fees associated with admission privileges are prohibitive.

• Some state laws allow for ANP admitting privileges, but they also require each admitted patient to have an attending physician. This is confusing and contradictory.

• In some states, the ANP is required to work with a physician, so that practice is not truly autonomous.

• Some hospital bylaws state that non-physicians cannot have admitting privileges. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The office director of a medical practice has recommended that the advanced practice nurses bill for service under the name of one of the group’s physicians. What is the probable rationale for this suggestion? \ Patients are more likely to pay physician bills than nurse bills. \ Typically physicians are reimbursed at a higher rate than ANPs. \ Having a smaller number of names under which billing is submitted is more efficient. \ Nurses are not permitted to bill government payers. \ \ There is no information to support this statement.

Using the physician’s reimbursement codes ensures that reimbursement is billed at 100% rather than the 80-85% rate for ANPs. Efficiency is not the most likely reason for this suggestion.

Medicare does accept billing from advanced practice nurses. \ 0 0 0 0

0000000000

0000000000 0 \\ MC B \ Which option reflects a change that may occur in the roles of advanced practice nurses? \ Movement to decrease the educational requirements for advanced practice nursing to the baccalaureate level \ Development of a new category to include clinical nurse specialists and advanced nurse practitioners \ Change of the doctor of nursing practice to eliminate the practice emphasis \ Elimination of nurse midwifery \ \ There is no movement to decrease the educational requirements for advanced practice nursing.

Confusion exists between the roles of the CNS and the ANP. There is movement to create a category of APN that includes both of these roles. There is no movement toward the other options.

By definition, the doctor of nursing practice is a practice-focused doctoral program.

There is no movement to eliminate nurse midwifery. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \

The advanced nurse practitioner believes that he should spend as much time with each patient as the patient desires. Does this practice raise ethical challenges? \ No, patients should expect to wait in any health care provider's office. \ Yes, this practice reflects poorly on the nurse's physician colleagues. \ No, this is the way all nursing should be practiced. \ Yes, if this practice makes other patients wait past their own appointment times. \ \ Patients no longer expect to wait in the health care provider’s office.

The issue has nothing to do with the nurse’s physician colleagues.

Nurses should provide as much care as necessary, but unlimited amounts of time with patients is not realistic.

The ethical dilemma arises when taking extra time with one patient requires another patient to wait past his or her appointment time. Is it ethical to let the needs of one patient supersede the needs of another? \ 0 0 0 0

0000000000 0000000000 0

\\ MC D \ Which statement indicates that a nurse understands how the doctrine of respondeat superior alters his liability for negligent conduct? \ “If I can prove that this doctrine applies, all of the liability is shifted to the hospital.” \ ”Respondeat superior will not alter my liability in any way.” \ “My liability to the patient is reduced by this doctrine.” \ “Since the hospital is liable for my actions, I am liable to my employer to provide competent care.” \ \ Vicarious liability is not a shift of liability, but an extension of liability allowing justice to be fairly distributed.

If respondeat superior applies to this case, the nurse’s liability will be altered.

The nurse is always liable for all actions in the care of the patient.

The courts have supported the concept that the employer is liable for its employees' actions as an element of the master-servant relationship; therefore, the nurse is liable to the employer. The employer is liable for the conduct and actions of the employee, but the employee is responsible to the employer. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \

In an effort to attract clinic physicians, the hospital has agreed to provide a nurse to work in the physician's office. The nurse will work under the direction and supervision of the physician whose clinic is housed with the hospital building. Which doctrine most closely describes the conditions in which this nurse is working? \ Borrowed servant \ Dual servant \ Agent of the principal \ Independent contractor \ \ Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

A dual servant is one who can be shown to serve both entities at the same time.

As an agent of the principal, the person is under the control of only the principal or single employer.

An independent contractor is one who arranges with another to perform a service for him or her but who is not under the control or right to control of the second person. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The hospital has outsourced housekeeping services to an independent contractor. A patient who was injured in a fall on wet flooring brings suit against the company. Does the hospital also hold liability? \

Yes, secondary to the doctrine of borrowed servant \ No, secondary to the doctrine of respondeat superior \ Maybe, secondary to the doctrine of dual servant \ Perhaps, secondary to the doctrine of ostensible authority \ \ Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

Respondeat superior is the common law principle of substituted liability based on a masterservant relationship.

A dual servant is one who can be shown to serve both entities at the same time.

Ostensible authority is an application of agency law that allows a principal to be liable for acts and omissions by independent contractors working within the principal's place of business or at the direction of the principal, and a third party misinterprets the relationship as employeremployee. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The hospital acts to revoke the clinical privileges of a physician who has repeatedly refused to respond to emergency calls from nursing staff. Under which doctrine is this action advisable? \ Respondeat superior \ Corporate liability \

Borrowed servant \ Dual servant \ \ Respondeat superior is the common law principle of substituted liability based on a masterservant relationship.

Under the doctrine of corporate liability, corporations have a direct duty to the public they serve, ensuring that competent and qualified practitioners deliver quality health care to consumers.

Borrowed servant occurs when a person, while under contract to one entity, is "loaned" to another entity that will direct and supervise the details of the person's work.

A dual servant is one who can be shown to serve both entities at the same time. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The hospital has been sued for the actions of a nurse employee. The hospital proves that the nurse was not providing care within the scope of employment as a nurse. Can the hospital still hold liability in this case? \ Yes, if the plaintiff can prove the nurse was incompetent and that the hospital was aware of the incompetence. \ No, the doctrine of ostensible authority relieves the hospital of liability related to a rogue employee. \ Yes, the hospital is automatically liable for the action of any employee. \

No, at this point the nurse is considered a "lone ranger" and the hospital is not liable for the nurse's actions. \ \ The hospital may be found negligent in hiring and firing if it can be proved that the nurse was incompetent and that the hospital did or should have known it.

The doctrine of ostensible authority is not pertinent to this case as the nurse was an employee, not an independent contractor.

The hospital is not automatically liable for all of the actions of its employees.

If the hospital had no reason to believe that the nurse was incompetent, the nurse could stand to hold 100% of the liability in a case. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which legal doctrine cannot apply to a nurse's practice as a private duty nurse? \ Res ipsa loquitur \ Negligent cause of action \ Personal liability \ Respondeat superior \ \ Res ipsa loquitur, as presented in a previous chapter, means “the thing speaks for itself.” This doctrine could be applied to a situation involving a private duty nurse.

Private duty nurses can be charged with negligence.

Private duty nurses can have personal liability in provision of patient care.

Private duty nurses are employed by individuals to give care. The doctrine of respondeat superior implies that the employer is responsible for the nurse's actions. It is illogical to view the patient as responsible for his or her nurse's actions as an employee. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ Which nurses would be most likely to be protected under the Age Discrimination Employment Act of 1967 if fired?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A 40-year-old nurse with excellent work history whose replacement is 35 years old \ A 49-year-old male nurse who held a position in obstetrics \ A 23-year-old nurse who was told that she was "too young" for the job \ A 72-year-old nurse who was fired from an OR scheduling position \ A competent 60-year-old nurse who discovers the nurse hired for his position is 50 years old \ • In order to file a successful age discrimination lawsuit under the Age Discrimination Employment Act of 1967, the employee must meet four criteria: be 40-70 years old, perform job responsibilities according to the employer's expectations, be discharged, and be replaced by a substantially younger person.

• It would be more likely that this nurse has experienced gender discrimination.

• Since this nurse is 23, the criteria for age discrimination are not met.

• Since this nurse is 72, the criteria for age discrimination are not met.

• This nurse is competent, within the covered ages and was fired. Being replaced by a nurse who is “substantially younger” (in this case 10 years younger) fulfills the criteria for age discrimination. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C \ The nurse who was found to be negligent in a lawsuit was just told by her attorney that the hospital will attempt to recover damages from the nurse pursuant to the principle of indemnification. What will the hospital have to prove for this to occur?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The hospital is only liable in the suit because of the employee’s actions. \ The nurse has been employed at the hospital for less than 6 months. \ The hospital incurred monetary damages because of the employee’s actions. \ The employee has personal professional liability insurance. \ The money owed by the hospital is in excess of one million dollars. \ • One key to applying the principle of indemnification is that the employer is at fault in a liability suit only because of the employee’s negligence.

• The length of employment is not a factor in this decision.

• One key to applying the principle of indemnification is that the hospital incurred monetary damages because of the employee’s negligence.

• Whether or not the employee has personal professional liability insurance is not a factor in the principle of indemnification.

• The amount of monetary damages owed by the hospital is not a factor in the application of indemnification. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ The female nurse works in a nursing home where many of the patients are military service veterans. She discovers that a male nurse with whom she works makes $2.80 per hour more than she makes. In which situations could this be legal under affirmative action?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The male nurse's yearly evaluations are better than the female nurse's. \ The male nurse is friendlier and gets along better with the male patients. \ The male nurse is also a veteran. \ The male nurse is physically stronger than the female nurse. \ The male nurse has worked in the facility 3 years more than the female nurse. \ • Courts have upheld that unequal pay may be legal if based on merit. In this case, the male nurse has a better track record of yearly evaluations. This is sufficient to justify the difference in

pay, unless the female nurse can prove preferential treatment in the evaluation system.

• Friendliness is not a reason to pay one employee more than another.

• Veteran status cannot be used as a reason for pay differences.

• If the female nurse meets the physical requirements of the job, the fact that the male nurse is stronger is not relevant.

• Seniority is a valid reason for pay rate differences. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nurse was granted 12 weeks' leave under the Family and Medical Leave Act for care of an adult son. At the conclusion of the 12 weeks the nurse does not want to return to work. Under which situation might the leave be extended? \ If the son is under treatment for substance abuse \ If the son is still too sick to work \ If the son is a firefighter, police officer, or other public servant \ If the son is a member of the National Guard \ \ Treatment of substance abuse is not a reason for extension of this leave.

The nurse must be able to return to work at the end of this leave except for a specific reason.

The son’s work as a public servant does not remove the need for the nurse to return to work at the end of this leave.

In 2008, President George W. Bush signed an amendment to the Family and Medical Leave Act to permit a spouse, son, daughter, parent, or next of kin to take up to 26 work weeks of leave to

care for a member of the Armed Forces, including a member of the National Guard or Reserves, who is undergoing medical treatment, recuperation, or therapy, is otherwise in outpatient status, or is otherwise on the temporary disability retired list for a serious injury or illness. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D+E \ The nurse cited "intolerable working conditions" as the reason for resignation. In order to claim constructive discharge, what must the nurse prove?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse’s performance evaluation was not as good as other nurses on the unit. \ The workplace stress had increased since hire. \ The nurse was tired of waiting for a transfer to the day shift that had been promised for 6 months. \ The employer deliberately created the work condition to force the nurse to resign. \ Other nurses working on the unit describe the working conditions as intolerable. \ • As long as the performance evaluation is accurate, there is no claim of constructive discharge.

• The workplace stress likely increased for all working on the unit, which will not support a claim of constructive discharge.

• Waiting for a day shift can be irritating but does not support a claim of constructive discharge.

• To claim constructive discharge, the employee must show that the employer deliberately created intolerable working conditions with the intention of forcing the employee to resign.

• Constructive discharge only occurs when a reasonable employee would find the working conditions intolerable. Since others working on the same unit make this assessment, the claim of constructive discharge may be valid. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ A patient who is well known to be violent arrives by ambulance at the emergency department for care of a laceration. What actions should be taken?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Sedate the patient prior to repairing the laceration. \ Send the patient to another hospital. \ Use a buddy system when providing care. \ Restrain the patient prior to repairing the laceration. \ Assign the most experienced nurse to work with this patient. \ • Sedating the patient may be interpreted as false imprisonment.

• Sending the patient to another hospital may be interpreted as "dumping.”

• Using the buddy system when working with this patient will provide one person to provide care and the other to monitor the patient’s responses.

• Restraining the patient may escalate violent tendencies and can be interpreted as false imprisonment.

• An experienced clinician is likely to be more confident and assured when caring for this patient. This confidence can be calming and reassuring for the patient. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nurse calls the newspaper and reports that circumstances surrounding several deaths in the local hospital are suspicious and that a cover-up is in action. The subsequent article identifies the nurse by name and the nurse is fired. Is the nurse protected under the whistleblower law? \ No, the report should have been made in person, not by telephone. \ Yes, since a death occurred, any action to expose the situation is appropriate. \ Yes, the nurse's action is one that any reasonable and prudent citizen would take. \ No, the allegations should have been made to the appropriate authorities. \ \ The method of communication is not the most concerning fact of this situation.

Whistleblower protection is very specific and is not pertinent in this situation.

The actions taken by this nurse are not protected by whistleblower legislation.

Whistleblowers are not protected if complaints are made to other than the proper authorities and agencies. \ 0

0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse says, "I don’t want to take care of these patients anymore. I spend my whole day getting patients up to the bathroom or to the bedside chair. My back hurts so badly by the end of my shift.” How should the nurse manager interpret this statement? \ This nurse is likely burned out and needs a few days off work. \ The nurse should be transferred to a different unit. \ Additional assessment of the meaning of this statement is necessary. \ The nurse should be educated about use of lift equipment. \ \ There is not enough information to determine that this nurse is suffering from burn-out.

Simply transferring the nurse is not a good plan.

Patients are dependent on nurses for mobility. Unwillingness to provide this basic care may indicate that an ethical challenge exists. The dilemma is the balance between patient mobility and the nurse’s health. The manager should conduct additional assessment of the statement and the situation.

At this point, the manager does not know if this is the case. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse and immediate supervisor have a personal conflict. The supervisor warns the nurse that the hospital is an employment-at-will institution. What does that indicate? \ The nurse must work a given number of hours each week. \ The nurse can only be dismissed for just cause. \ The nurse has the choice of working in any hospital unit. \ The nurse can be dismissed at any time, without cause. \ \ Employment-at-will does not pertain to the number of hours worked each week.

Employment-at-will does not restrict the hospital to dismissal only for cause.

Employment-at-will has nothing to do with the choice of where to work within the hospital.

An ethical issue regarding employment laws is the existence of employment-at-will institutions.

This means the employer can dismiss employees for cause or for no cause, including perhaps the aspect that a given supervisor does not like the individual. \ 0 0 0 0

0000000000

0000000000 0

\\ MC C \ A nurse manager has been asked to present information about the Americans with Disabilities Act to newly employed nurses. What information about the evolution of this act should be included? \ This act was written to protect a growing population of older Americans. \ Increased numbers of children with disabilities resulting from advances in technologies to save premature infants made this legislation essential. \ People living with HIV/AIDS began to identify loopholes in the existing state and federal nondiscrimination laws. \ There was a big increase in the number of soldiers returning from war with orthopedic injuries. \ \ Older Americans were not the focus population necessitating this act.

While these children will benefit from this legislation, they were not the group necessitating the law.

The act was necessitated by the discrimination faced by individuals with HIV/AIDS, as those persons identified loopholes not adequately addressed by existing state and federal laws.

While this is a continuing trend, it was not the impetus for this act. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \

The aim of the Americans with Disabilities Act was to eliminate discrimination against individuals with disabilities. In order to achieve this goal, Congress combines disability with which other legal concept? \ Autonomy \ Right to work \ Fairness \ Equality \ \ Autonomy is not a legal focus of this act.

Right to work is not assured by this act.

Fairness is not a major concept in this act.

The aim was to ensure equality for those with disabilities, without undue hardships being placed on those regulated by the act. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ The nurse manager, making hiring decisions, would consider which applicants as protected from discrimination by the Americans with Disabilities Act and amendments?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A person required to wear a hand brace for 3 weeks

\ A person who takes medication for schizophrenia \ A person who wears glasses \ A person who used a wheelchair for 1 year as a child \ A person who has cancer \ • Transitory impairments (those with an actual or expected duration of 6 months or less) are not included in this definition.

• Mental impairment is considered a disability. This definition holds despite medication to control the disorder.

• Need to wear ordinary eyeglasses or contact lenses does not meet the definition of a disability.

• A person with history of a disability is covered by this act.

• One of the specific “major life events” covered by the amended act is alteration of normal cell growth. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ A job applicant with a disability has requested that the employer provide a reasonable accommodation. What does this request entail?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Employment opportunities not given to persons without disabilities

\ Workplace modifications to allow the applicant to be a successful employee \ Selection of this applicant over other qualified applicants \ Schedule modifications if acceptable to all involved. \ Workplace modifications that are realistic \ • The employer is not required to provide employment opportunities that would not also be extended to those without disabilities.

• Reasonable accommodation reflects changes that are needed for the worker to be successful. The employer must attempt to make accommodations that are needed and acceptable to all parties involved.

• The employer is not required to hire an applicant with a disability over other qualified applicants.

• Schedule modifications may be considered a reasonable accommodation if the changes are acceptable to both the employee and the employer.

• The requested modifications must be realistic and must not work an undue hardship on the employer. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ Which scenarios meet the Civil Rights Act of 1991 definition of quid pro quo sexual harassment?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected.

\ A supervisor offers to give a nurse a promotion if she will consent to going to dinner with him. \ A nurse is fired after breaking off a romantic relationship with the unit nurse manager. \ The nurse is offended by the jokes told during morning report. \ The nurse no longer feels comfortable eating lunch in the break room because the other staff members in the room often discuss their sexual encounters. \ A nurse becomes uncomfortable because one of theoften hugs or touches her. unit physicians \ • Quid pro quo occurs when submission to or rejection of the sexual conduct by an individual is used as a basis for employment decisions affecting the individual.

• Quid pro quo sexual harassment occurs when submission to or rejection of the sexual conduct for an individual is used as a basis for employment decisions affecting the individual.

• This scenario may represent sexual harassment, but does not meet the definition of quid pro quo.

• This situation most closely represents the development of a hostile work environment, but does not represent quid pro quo.

• There is no indication that this physician has any managerial relationship with the nurse or that the physician is involved in hiring or promoting nurses. Therefore, this may be a case of sexual harassment but is not quid pro quo. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C+D \ Which employee would likely be unsuccessful in claiming job protection under the Americans with Disabilities act?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A person who has progressive hearing loss \ A person who has just revealed he is homosexual \ A person diagnosed with a gender identity disorder \ A person who is a compulsive gambler \ A person with a femur fracture who will require a wheelchair for three months. \ • Progressive hearing loss is a disability as defined by this act.

• The ADA excludes homosexuality from its coverage.

• There are multiple exclusions from the definition of disability under the ADA, including gender identity disorders not resulting from physical impairments.

• Compulsive gambling is not a covered ADA disability.

• This is a transitory condition and is not covered by the ADA. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Which scenario meets the Civil Rights Act of 1991 definition of hostile environment sexual harassment? \ A nurse manager suggests that a nurse’s performance evaluation be discussed over dinner and drinks.

\ The nurse continually finds cartoons of a sexual nature posted on the unit bulletin board. \ The nurse has a continuing argument with a co-worker that makes the workplace uncomfortable. \ A nurse working on the unit is homosexual. \ \ This situation is more likely to represent quid pro quo sexual harassment.

Submission to sexual innuendos, remarks, and physical acts that alter the conditions of the employee's employment and create an abusive environment is the definition of hostile work environment sexual harassment according to the Civil Rights Act of 1991.

There is no indication that this argument is of a sexual nature, so sexual harassment is not probable.

The presence of a homosexual nurse does not constitute hostile work environment sexual harassment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A nurse manager is concerned that actions by a female nurse may constitute sexual harassment.

What element should the manager consider? \ The number of male employees working on the unit \ The females nurse’s age \ Does the nurse mean to be offensive? \

Would a reasonable person’s work be affected by this behavior? \ \ The existence of sexual harassment is not defined by gender.

Age is not pertinent in this decision.

The person does not have to mean to be offensive for actions to constitute sexual harassment.

If the situation would affect a reasonable person’s work environment, the actions likely represent sexual harassment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Which situation would the nurse manager evaluate as sexual favoritism or preferential treatment? \ The female nurse agrees to meet a male nurse for coffee after work. \ The promotion the nurse was seeking was given to the supervisor’s girlfriend. \ A nurse reports another nurse who makes a disparaging remark about a lesbian co-worker. \ Co-workers offer support for a co-worker who decides to divulge his homosexuality to his family. \ \ There is no indication that this is anything more than a normal date or encounter.

An employer may be liable for unlawful sexual discrimination when an employee is denied a job opportunity or benefit due to the preferential treatment of another employee who submits to the employer's sexual advances.

Making these remarks is unprofessional and unkind but does not represent preferential treatment.

There is no information in this scenario that supports a claim of preferential treatment. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A nurse who has an obvious physical disability applies for a staff nurse position. Which question, asked by the nurse recruiter, is legal? \ "How long have you been disabled?" \ "Are you able to fulfill the requirements of this job?" \ "How does your disability affect your life?" \ "Has your condition stabilized, or do you foresee it getting worse with time?" \ \ Questions about the disability are not allowed.

Applicants may be questioned about their ability to perform essential job functions.

Questions about the disability are not allowed.

Questions about the disability are not allowed. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse manager requests that a job applicant who has a physical disability receive a medical examination prior to assignment to a work station. Is this examination legal? \ No, this requirement violates ADA. \ Only if all other applicants for similar positions are subjected to the same examination \ Only if the examination takes place before the job offer is extended \ Only if the applicant agrees to have medical information released to those on the committee screening applicants. \ \ This test does not necessarily violate ADA. This requirement is only legal if all other applicants for similar positions are also required to take the examination.

The examination must be performed after the offer of a job is extended.

Only persons with need to know should be told of the results of this test. The final decision to hire probably does not lie with a screening committee, so they would not have a need to know the results of medical exams. Medical exams should not be part of the screening process. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse applies to a faith-based hospital. Another applicant who is of the same faith supported by the hospital is hired instead. Is this seen as discrimination under ADA? \ No, employers may offer preference to individuals of the same religion. \ Yes, the hiring decision must be made solely on ability. \ Only if both nurses have similar experience and skill sets \ Only if other cases of preference by the facility can be demonstrated \ \ Employers with religious affiliations may give preference to individuals of the same religious sect.

Employers with religious affiliations may hire preferentially.

Experience and skill sets legally may not be the deciding factor in this situation.

There is no reason to demonstrate a history of preferential hiring. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \

Which person best meets the criteria as a "member of a protected class" in a quid pro quo sexual harassment lawsuit? \ A female nurse as compared to a male staff nurse \ A male housekeeper as compared to a male laboratory technician \ A female physician as compared to a male physician \ A staff nurse as compared to his or her supervisor \ \ This female nurse does not meet the requirements to be considered in a “protected class.”

Differences in job description at the same supervisory level do not place one person in a “protected class.”

Gender is not considered as a component is determining placement in a “protected class.”

Persons that are members of a protected class are those who are employees in a lower position in the power chain of command. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+E \ An employee has requested special accommodations secondary to a disability. The hospital refuses, citing undue hardship. What must be present for that refusal to be upheld?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The accommodation would be very difficult to implement.

\ The accommodation would require physical changes to the work environment. \ The accommodation would not be necessary if the employee changed positions. \ The accommodation has never been made before this case. \ The requested accommodation will require very expensive equipment and renovation. \ • An accommodation that is extremely difficult to implement may qualify under the undue hardship provision.

• Physical changes to the environment are frequently the accommodation requested and many of these changes are reasonable.

• The employee should not have to change positions if a reasonable accommodation can be made.

• Just because an accommodation has not be made previously does not mean it is not appropriate in this case.

• If the requested accommodation is extremely expensive it is not reasonable. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse who has worked at a hospital for twenty five years suffers a disability secondary to a work-related accident and requests accommodation. The nurse is offered a position for which she is qualified, but in an area which she has no experience. Ethically, does the nurse's new position have to provide the same high salary as the old position? \ No, the nurse's salary may be cut to the entry-level salary of the new position. \

Yes, the new position must match or exceed the old position's salary. \ No, but the nurse's seniority should be considered in salary negotiations. \ Only if the nurse is equally as "productive" in the new position \ \ Legally this is correct, but is not the most ethical option.

Reasonable accommodation does not require this legally. Ethically, it is not appropriate to offer a person with no experience a salary that may be higher than those with whom she works.

There is no legal mandate to continue the salary, but ethically the nurse’s seniority and loyalty to the hospital should be considered.

Since the nurse has no experience in this position, it is unlikely that she will be “productive” for some time. This is not a good way to establish salary level. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ The court found a nurse manager liable for failure to warn. Which option reflects a failure to warn scenario? \ The nurse manager did not advise a newly hired nurse that continuing education was an annual requirement for promotion. \ The nurse manager did not notify the physician regarding worsening of a patient's respiratory status. \ The nurse manager did not tell a potential employer that a former employee was asked to resign for incompetence. \ The nurse manager did not adequately supervise a newly hired nurse who had not practiced nursing in five years. \ \ Failure to warn is not associated with failure to tell new employees about job requirements.

Failure to warn is not related to patient condition.

Failure to warn is a newer area of potential liability for nurse managers in which the manager fails to warn a potential employer of staff incompetence or impairment. If the institution has sufficient information and suspicion on which to discharge an employee or force a letter of resignation, then subsequent employers should be aware of those issues.

Failure to warn is not related to supervision of new nurses. \ 0 0 0 0

0000000000 0000000000 0 \\ MC

A+C+D \ Which strategies should the nurse manager employ when asked to float staff from one area to another?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Consider the patient care delivery systems on each unit. \ Float staff in alphabetical order of their last name. \ Float nurses to areas with similar patient care requirements if possible. \ Cross-train staff to various units. \ \ • Significant differences in patient care delivery systems can make competent and efficient care more difficult. The nurse manager should try to match these care delivery systems as much as possible.

• Choosing to float nurses according to their name does not support quality care.

• The more closely the home unit and float unit match in patient care requirements, the more comfortable the floated nurse is likely to be.

• If floating is a common need in a facility, it is best overall to cross-train nurses between units. That will allow for nurses to become accustomed to and comfortable providing care on more than one unit. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C

\ A group of nurses are concerned about the chronic understaffing and mandatory overtime requirements of their state's hospitals. How could this group best help solve this issue? \ Advise nurses to go home after their assigned shift instead of working overtime. \ Talk to state legislatures about establishing staffing ratios. \ Lobby for legislation supporting safe staffing measures. \ Develop policies whereby nurse managers are the only ones required to work overtime. \ \ If the nurses go home and there is not adequate staff to care for patients, the nurses may be guilty of abandonment.

Staffing ratios are not the answer to mandatory overtime. Mandatory overtime generally occurs when there is not enough staff to provide care. Staffing ratios will not address this problem.

Due to the most recent movement toward adequate numbers of nurses, many states are now moving toward the concept of safe staffing. State legislation for safe staffing helps to bring the issue to light and to protect patients from the dangers associated with this practice.

Exclusive use of nurse managers for overtime work is illogical as there are not enough nurse managers to fill the staffing slots. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The unit policy is that the nurse with the least seniority is required to float to understaffed units.

Is this the best policy? \

Yes, the most senior people should be required to manage their home unit. \ No, this policy is against most corporate philosophy. \ No, generally the most capable and efficient person should be floated. \ Yes, having choice in these matters is a benefit of longevity in the facility. \ \ The nurse manager should be certain that enough experienced nurses are left on the home unit so that quality of care is not threatened. However, always floating the least senior staff is not a fair policy.

There is no indication that this is against more corporate philosophy and is often the manner in which floating decisions are made.

It is a better policy to float the best nurse as that nurse is more likely to adapt to the other unit.

Seniority can be awarded in other ways. It is not the best policy to always float the nurse with the least seniority. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The hospital's risk management team has identified a hazard to patient safety through review of incident reports. What should be the team's next action? \ Discipline staff who have been involved in previous incidents. \ Eliminate the hazard before anyone else is harmed. \ Identify and compensate any patient previously injured.

\ Gather and trend data on the occurrences. \ \ Disciplining staff may lead to reluctance to report other incidents.

The first action is to eliminate the hazard before anyone else is harmed.

Paying for previous injuries does not help identify or eliminate hazards.

Information should be gathered and trended, but this is not as important as eliminating the hazard. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The news reports that a nurse "contracted over the telephone" to distribute narcotics. Under contract law is that a correct statement? \ Yes, the contract agreement can be verbal or written. \ Only if something of value, like money, is offered as compensation \ If both parties understand the terms and meaning of the contract \ No, contracts must fulfill a lawful purpose. \ \ The fact that this is a verbal agreement is not significant.

What is offered in exchange for this murder is not significant to whether this is a contract.

Understanding of the agreement is not significant to this question.

Contracts must fulfill a lawful purpose and distributing narcotics is not a lawful purpose. There

can be no enforceable contract for illegal acts or fraud. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse takes a position working in a clinic and receives a sign-on bonus. After having worked for one month the nurse charges that she never signed a contract with the clinic and therefore can leave for a different, higher-paying job without returning the bonus. What is true about this situation? \ Since there was no signed paper, the contract does not exist. \ Cashing the bonus check indicates acceptance of the contract. \ The contract was accepted when the nurse showed up for work. \ Acceptance of the terms of a contract must be in writing. \ \ There is no requirement that a signature is necessary for a contract to exist.

While cashing the bonus check certainly indicates acceptance, the contract already existed prior to this occurrence.

Contracts may be accepted by the beginning performance of the offeree (by showing up for work).

There is no requirement that the contract be in writing. \ 0 0

0 0

0000000000 0000000000 0 \\ MC A \ Which situation reflects consideration in contract law? \ The nurse agrees to work for specific wages. \ Assertion that the nurse is legally able to enter into a contract \ The description of the type of work expected by the facility wishing to employ the nurse \ The nurse agrees to work at an immunization clinic from October through December. \ \ The four elements of contract law include the offer, acceptance, consideration, and consent.

Consideration is the economic base for the contract, in this question the specific wages the nurse agrees to accept.

Assertion of the legal ability to enter into a contract is not the same as consideration.

The description of the type of work expected is the offer.

The length of time the nurse is expected to work is part of the offer. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C+D+E \ Which situations are exceptions to the statute of frauds principle?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A verbal contract for a teenager to receive $25 to mow a neighbor's lawn \ An oral agreement to purchase a new car by making payments over the next 48 months. \ A "handshake" agreement to sell a one-acre parcel of land \ An agreement that the hospital will continue to provide oncology services if the current oncology specialty group breaks their contract. \ A verbal agreement for a nurse to work in a physician's office indefinitely \ • The statute of frauds is the legal principle that a contract does not need to be written to be enforceable. The statute of frauds is in effect and no exception exists.

• This situation likely is an exception to the statues of frauds for two reasons, the price of the car and the length of payment schedule.

• The statute of frauds is the legal principle that a contract does not need to be written to be enforceable. Exceptions to this statute include agreements involving the sale of land. A legal written contract is necessary for sale of land so this is an exception to the statue of frauds.

• Suretyship is an agreement to pay or perform actions in the event that the principle is unable to meet his or her obligations. Since the hospital is agreeing to provide oncology services even if the current specialty group leaves, a written contract is necessary. This is an exception to the statue of frauds.

• Since this agreement cannot be performed within a 12-month period a written contract is necessary. This is an exception to the statute of frauds. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The contract between a nurse and a hospital delineates the nurse's salary, benefits package, and when the job will begin. The contract does not state that the nurse must provide quality care.

How would the hospital attorney describe this expectation if the nurse brings suit for wrongful discharge? \ Expressed terms \ Implied provisions \ Silent terms \ Inherent provisions \ \ Expressed terms are the specific terms discussed or negotiated (in this case, salary, benefits, and job start date).

Implied terms are those that each side anticipated were a part of the contract but that were never actually expressed or discussed.

There was no discussion of silent terms.

There was no discussion of inherent provisions. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ In which situations has legal termination of a contract occurred?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse contracts with another nurse to work out the contract. \ The hospital refuses to pay the nurse for shifts worked. \ The facility does not renew a contract that has ended. \ The nurse repeatedly violates hospital policy and procedure outlined in the contract. \ The hospital releases a nurse from the contract so that the family can relocate. \ • Contracting with a third party to complete the contract is a violation of the terms of a contract and results in breach of contract.

• Refusal to pay for shifts worked is a violation of the terms of a contract and results in breach of contract.

• Once a contract’s terms have been fulfilled the contract is ended. There is no obligation to renew the contract.

• Failing to meet contract obligations results in a breach of contract which ends the contract.

• In this situation, both parties have agreed to end the contract, so the contract termination is legal. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Which person would be the best choice for a mediator in a contract dispute between a nurse and a hospital? \ A nurse who works on a similar unit in the hospital \ A consultant from outside the hospital \ A retired nurse who worked at the hospital five years ago \ A hospital administrator from an area different from nursing \ \ Since this person is a nurse and works in the same hospital, this is not the best choice for a mediator.

The mediator in a contract dispute should be totally unbiased and from outside the organization.

An outside consultant would be the best choice.

Since this nurse worked in the hospital at one time, this is not the best choice for a mediator.

Since the administrator works in the hospital, this is not the best choice for a mediator. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E

\ A work dispute has gone to arbitration. The nurses involved in the dispute are unhappy with the decision made by the arbitrator. Is the arbitrator’s decision binding?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The decision is binding. \ Only if the other party also does not agree with the decision \ Unless both parties agreed in advance that the decision is not binding \ These decisions are only suggestions meant to guide further discussion. \ If the dispute involves collective bargaining the decision is binding. \ • There is not enough information to say the decision is binding.

• Whether the parties agree or disagree with the arbiter’s decision is not relevant to whether it is binding.

• Arbitration is binding unless both parties have agreed, in advance, that the decision is not binding.

• Arbitration decisions are not just suggestions.

• In arbitration used with collective bargaining both parties must realize that the arbitrator’s decision is binding on both sides of the dispute. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D \

Changes have been made to the employee handbook. What must occur in order for these changes to constitute a contract?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The handbook must have been distributed to all employees of the facility. \ The handbook must be written clearly. \ The employee must attend an inservice session about the new handbook. \ The employee must continue to work after the manual takes effect. \ The employee must sign a document indicating the handbook has been received. \ • The contract is established by distributing the handbook to the employee. It does not have to be distributed to all employees.

• The handbook must be written in language that clearly sets forth a promise that the employee can construe as an offer.

• While the employees should be made aware of changes, specific inservices are not required.

• The employee must begin to work or continue to work after the handbook has been distributed.

• There is no requirement that the employee sign such a document, however; many facilities track distribution in this manner. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D

\ Mandatory overtime raises ethical issues about patient and nurse safety. How does voluntary overtime affect these issues? \ It is also outlawed in states controlling mandatory overtime. \ Nurses working overtime shifts are given smaller patient loads to protect safety. \ There is no effect since the nurse has chosen to work overtime. \ It requires nurse managers to be vigilant concerning safety. \ \ Voluntary overtime is not outlawed.

Nurses working overtime are often given the same patient load they carried throughout their regular shift.

Overtime of any nature may affect both patient and nurse safety. This is true whether the nurse has volunteered to work overtime or is required to do so.

The nurse manager must be more vigilant concerning safety issues as issues of fatigue are more likely. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ A nurse returning to practice remarks that delegation is much more regulated and complicated than when she last practiced 20 years ago. What rationale would the nurse manager provide for this change? \ “The shortage of nurses has been the major reason that there are so many rules to follow when delegating.” \ “Since nursing is trying to move back to the team approach to care delegation has become more important.” \ “The introduction of multiple levels of professional staff members increases need for delegation rules and regulations.” \ “The widespread return to primary nursing makes delegation more risky.” \ \ The nursing shortage has led to the need to use other licensed and unlicensed personnel to provide patient care that previously may have been performed only by registered nurses. Because this is occurring more frequently in multiple settings, the need for rules and regulations regarding delegation has arisen.

There is no indication that nursing is trying to move back to a team approach.

There has been no introduction of multiple levels of professional staff members.

Delegation is not a component of primary nursing. \ 0 0 0 0

0000000000 0000000000 0 \\ MC

C \ The charge nurse has delegated a task to another staff member. Who assumes accountability for the task? \ It is held jointly by the charge nurse and the person performing the task. \ It can be imputed to either the charge nurse or the person performing the task. \ The charge nurse retains the accountability. \ Accountability is transferred to the person performing the task. \ \ Accountability is not shared in this situation.

The accountability is held specifically by one of these two people. It is not an either/or decision.

While the person performing the task is responsible for his or her own actions, the accountability is always retained by the one who delegates.

The person performing the task is responsible for his or her own actions but does not assume accountability for the task. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse would correctly state that an assignment had been made in which situation? \ The nurse says to the charge nurse, "Please watch my patients while I run down and pick up some lunch from the hospital cafeteria." \

The nurse says to the UAP, "Please take all of the vital signs before you begin to deliver breakfast trays.” \ The charge nurse divides the patient load into one team for each staff nurse who works the shift. \ The nurse asks a housekeeper to clean a bed quickly for a new admission. \ \ This situation is an example of upward transfer of responsibility and accountability (from staff nurse to charge nurse).

The person with the accountability for monitoring vital signs and assuring the patients are fed (the nurse) has delegated the tasks to the person responsible for their completion (the UAP). This is delegation.

Dividing the patient load into a team for each staff nurse is an example of downward (charge nurse to staff nurse) transfer of responsibility and accountability and is assignment. This is frequently referred to as "making assignments."

The person accountable for assuring that patients have clean beds (the nurse) delegates the task to the person responsible for its completion (the housekeeper). This is delegation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D+E \ The nurse is searching for information about nurses' responsibility and accountability for appropriate delegation of tasks. Where should this nurse look for this information?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ State nurse practice acts

\ ANA Code of Ethics for Nurses \ State medical association bylaws \ ANA Nursing Scope and Standards of Practice \ Nursing rules and regulations as promulgated by the state \ • Nurse practice acts address delegation.

• The ANA Code of Ethics for Nurses (2001) states that nurses have an obligation to delegate tasks appropriately.

• State medical associated bylaws do not provide direction about delegation in nursing.

• The ANA Nursing: Scope and Standards of Nursing Process has specific mandates regarding delegation practices.

• States develop specific rules and regulations in addition to the general statements provided in the nurse practice act. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The registered nurse has delegated the task of ambulating a patient to two nursing assistants. The patient appears to ambulate without assistance, but must be ambulated with two assistants due to a history of unexpected fall. What is the most important aspect of delegating this task? \ The aides understand the importance of walking with the patient. \ The patient is comfortable walking with the aides. \

The aides understand the patient is to be ambulated twice daily. \ The patient understands the need for assistance. \ \ Based on the five rights of delegation, the most important aspect is that the aides are given the correct directions and communications about keeping this patient safe.

Patient comfort is very important, but is not the most important aspect of this delegation.

The frequency of ambulation is not the most important part of this delegation.

Ideally the patient will understand the importance of this instruction, but this concept has nothing to do with delegation to the assistants. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A newly hired nursing assistant can work only when under direct supervision by a registered nurse. In which way can this assistant provide care? \ The nursing assistant charts care in the patient's medical record and the nurse reviews that charting on a regular basis. \ The nursing assistant provides hygienic care according to protocols approved by the nurse. \ The nurse and the nursing assistant work together to provide care to a team of six patients. \ The nurse is available on the unit while the nursing assistant provides care. \ \ While this is a method of supervision, it is not direct supervision.

The nurse has provided direction and will likely review the assistant’s work, but is not directly supervising the work.

Direct supervision is provided when the delegator is actually present, observes, works with, and directs the persons being supervised.

The nurse is available for supervision and direction but is not providing direct supervision. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ In which scenario is the nurse providing indirect supervision of a nursing assistant? \ The nursing assistant and nurse work on the same team, jointly providing care to inpatients. \ The nurse is easily contactable by pager but is not present in the care environment. \ The nurse makes rounds on the patient care units, observing the nursing assistant's work, at least every two hours. \ The nursing assistant receives constant instruction regarding patient care from the nurse. \ \ Since the nurse and the assistant are jointly providing care the nurse is providing direct supervision.

Indirect supervision occurs when the delegator is easily contactable, but does not directly oversee the interventions or activities being performed.

This nurse is providing direct supervision every two hours. There is no indication of what kind of supervision, if any, is occurring between observations.

If the nurse is present to provide constant instruction, direct supervision is occurring. \

0 0 0 0

0000000000 0000000000 0 \\ MC B \ The preceptor nurse delegates a complex nursing procedure to a newly licensed nurse. The new nurse makes an error, which results in the patient's death. Does the preceptor hold any liability in this case? \ Yes, but only because the event resulted in patient demise. \ Yes, the preceptor is responsible for delegating appropriately and supervising completion of tasks. \ No, since the new nurse has a license, all liability is retained by the new nurse. \ No, since the new nurse is employed by the medical facility, all liability is corporate. \ \ The fact that the event resulted in patient demise is not the deciding factor is whether the preceptor holds liability.

Since the nurse in this case was newly licensed and the task delegated was complex, the preceptor does share liability. It could be shown that the task was delegated inappropriately and that the preceptor did not supervise the task correctly.

The person delegating tasks must be certain that the person being delegated to is competent to perform the task.

Nurses are liable for their actions. \ 0 0

0 0

0000000000 0000000000 0 \\ MC A+C+D+E \ A nurse working in the intensive care unit (ICU) notes that a patient is more confused and agitated than yesterday. Which nursing actions are evidence of patient advocacy?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse assesses for common causes of confusion and agitation. \ Tell the family that confusion and agitation frequently occur after ICU admission. \ The nurse contacts the patient’s primary care provider regarding the confusion. \ The nurse documents findings and actions in the medical record. \ Ask for assistance from the nurse manager if necessary. \ • Assessment allows the nurse to make comparisons between current status and previous status. This is the first step of collecting information to advocate for the patient’s care.

• Assuming this patient’s confusion and agitation is related solely to being in the ICU does not exemplify advocacy.

• This nurse had taken action to treat the patient which is an example of patient advocacy.

• Advocacy also includes documenting actions taken and response to actions.

• Assisting other nurses and seeking this assistance as necessary is a means of advocating for quality nursing care. \ 0 0 0

0

0000000000 0000000000 0 \\ MC B \ A patient who requires vasoactive intravenous medications was just admitted. Which person should the charge nurse ask to measure this patient's vital signs? \ The licensed practical nurse who has worked on this unit for 5 years \ The registered nurse who has worked on this unit for 8 months \ The unlicensed assistive personnel (UAP) who was recently transferred to the unit from an acute care environment \ The nursing assistant who has worked in this unit for 7 years \ \ The licensed practical nurse is not educationally prepared to assess, diagnose, plan, implement, and evaluate care. This patient requires this level of intervention.

This patient is receiving potent medication using a rapidly acting route. The actions of this medication are reflected in vital signs. The RN is educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

The UAP is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care.

The nursing assistant is not educationally prepared to assess, diagnose, plan, implement, and evaluate patient care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The unit is extremely busy when the physician orders that a urinary catheter be inserted in a patient. The patient's assigned nurse is new, has seen the procedure done, but has never done it independently. How should the charge nurse handle this situation? \ The charge nurse should assist the new nurse with the procedure. \ The charge nurse should ask the new nurse to try the procedure alone. \ The charge nurse should assign the task to a different nurse. \ The charge nurse should do the procedure to save time. \ \ Two things are taken into account in this situation. The task needs to be done efficiently and safely. The new nurse needs to have experience in doing this common task. The most logical way to assure both those needs are filled is for the charge nurse to assist the new nurse with the procedure.

If the charge nurse asks the new nurse to do the procedure alone, the charge nurse may end up having to do it anyway or the patient outcomes might be compromised.

Assigning the task to a different nurse takes that nurse away from assigned patients and does not fulfill the need to help the new nurse learn the skill.

If the charge nurse does the insertion, a valuable teaching opportunity for the new nurse has been missed. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D \ A nurse has delegated the task of ambulating a patient to two nursing assistants. Despite the patient's appearance, assistance of two people is needed for safe ambulation. The nurse discovers the patient being ambulated by only one aide. What nursing actions are indicated?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Scold the second aide for not carrying through with the delegated task. \ Determine why only one person is ambulating the patient. \ Assume that something important must have taken the second assistant away from this task. \ Assist the aide in completion of the ambulation. \ Notify the patient’s physician of the incident. \ • Scolding an adult is not likely to be an effective method of discipline.

• Part of an effective discipline plan includes investigating all facts and circumstances leading to the action for which discipline is being considered.

• The nurse should not assume anything about this situation.

• Providing for patient safety is always the priority, so the nurse should assist with completion of the ambulation.

• There is no indication that the patient was harmed in any way during this ambulation.

There is no need to notify the physician regarding the incident. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ The nurse has recently assumed the position of chief nurse in a long-term care facility with a record of poor patient care. How should this nurse approach the issue of effective discipline regarding patient care activities?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Fire any nurse who does not meet established standards of care. \ Firmly enforce the standards of care guiding the facility. \ Set variable standards of care depending upon the nurse's previous experience. \ Establish a discipline system that is progressive. \ Encourage supervisors to be consistent in applying discipline. \ • Unless a particular employee is doing something illegal, immoral, or dangerous to patients, it would be better not to fire the employee until the nurse has more information and has set the tone of the care expectations.

• Standards of care should be upheld and communicated to all those providing care.

• Standards of care should be the same for all.

• Progressive discipline is generally the fairest process. It will likely be the most effective in a facility that has not been previously disciplined.

• Consistency is a very important aspect of effective discipline. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B \ The nurse manager walks in on a conversation in the break room concerning the hospital’s plan to employ unlicensed assistant personnel (UAPs) to help relieve a nursing shortage. Which statements would the manager correct?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ “I can’t believe our state board authorized this plan.” \ “I don’t want to have these UAPs working under my license.” \ “The hospital will have to assure that the UAPs they hire are competent.” \ “It will be important that the UAPs hired have adequate orientation to our nursing units.” \ “It will be even more important that we follow delegation policy and procedure.” \ • UAPs are not authorized by the state boards.

• UAPs do not work “under” the nurse’s license.

• The corporation (hospital) is accountable for documenting competencies for all staff members providing direct patient care.

• An institutional mechanism for orientation of UAPs must exist. Nurses may participate in this orientation.

• The nurses working with UAPs and delegating to them will be responsible for appropriate delegation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ A nurse has the reputation of delegating tasks that are time-consuming or distasteful. What should the nurse manager consider before addressing this situation? \ Misuse of delegation is an ethical issue. \ One of the privileges of loyalty to the hospital is being able to delegate distasteful tasks to others. \ Doing distasteful tasks is part of the learning process for new nurses. \ The nurse reserves the right to delegate any task he or she wishes. \ \ The difference between delegating and “dumping” of distasteful tasks is a primary ethical issue that arises with delegation and supervision.

Inappropriate delegation is an issue regardless of the nurse’s seniority.

There is no truth in this statement even though it is often used as an excuse for inappropriate delegation.

Some tasks, such as care planning, cannot be delegated. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ What is the nurse's legal duty with regard to implementing a physician's order? \ The nurse should follow the order unless the nurse believes some other course of action would be better. \ The nurse should follow the order unless the nurse has reason to believe that the patient could come to harm if the order is followed. \ The nurse should discuss each order with the physician, since physicians are only human. \ The nurse should follow all orders as written. \ \ Prescribing treatment is not within the scope of nursing practice.

Unless the nurse has a valid reason to question an order, the order should be followed.

It is not feasible or necessary to discuss each order with the physician.

The nurse should question unclear or unsafe orders. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ What is the principal reason that a higher standard of care may be required for safeguarding mentally ill persons? \ Mentally ill persons bring more lawsuits than those with no mental illness.

\ The standards of care for mentally ill patients are higher than those for physically ill patients. \ Mentally ill persons cannot fully appreciate their exposure to potential harm. \ These patients require more care than do those who are physically ill. \ \ These patients are not known to bring more suits than others.

The standards of care for mentally ill patients are not necessarily higher than those for physically ill patients but are different.

The mentally ill are considered a vulnerable population due to their behavioral and cognitive impairments. Therefore, their judgments and actions may be altered, and they may not be able to recognize the risks of circumstances regarding their care.

These patients do not necessarily require more care than those that are physically ill. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Hostile or angry patients present unique nursing challenges from a legal perspective. Which basic interventions can a nurse take when caring for a hostile or angry patient? \ Spend additional time with the patient, showing that he or she is important. \ Ensure that family members are always present to calm the patient. \ Sedate the patient to diffuse further encounters with the patient. \ Include the patient in discussions of treatment plans.

\ \ Isolating the patient with time alone can exacerbate the problem of aggression.

Spending additional time with the patient and showing that he or she is important provides the opportunity to express concern for the patient's issues and allows the nurse the opportunity to identify strategies for resolution of the patient's problems.

The nurse cannot divert professional responsibility for patient observation onto the family.

Sedation of the patient does not solve the problem and may be seen as improper use of chemical restraints.

The nurse should respect the patient’s autonomy by addressing concerns and ensuring that the patient is educated about their condition and treatment plan. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+E \ Which options reflect a general criterion for restraining a patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The patient's inability to care for himself or herself \ The patient's verbally abusive but nonthreatening behavior toward others \ The patient's immediate ability to harm self \ The patient's refusal to take psychotropic medications as prescribed \ The patient’s threat to harm another patient

\ • • • • • \

Inability to care for oneself is not a criterion for use of restraints.

As long as the behavior is nonthreatening no criteria for use of restraints exist.

Immediate ability to harm self is a criterion for use of restraints.

The patient has a right to refuse medications. This is not a criterion for use of restraints.

Threat to harm another is a criterion for use of restraints.

0 0 0 0

0000000000 0000000000 0 \\ MC A \ A confused patient frequently calls out for "help" throughout the shift. When nursing staff respond to the call, the patient is unable to explain what is needed. What action should be taken by the nurse? \ Continue to respond and attempt to reorient the patient. \ Restrain the patient in soft wrist restraints. \ Move the call bell out of the patient's reach. \ Chemically restrain the patient with a mild sedative. \ \ Since there is no indication that this patient is in danger of getting out of bed or otherwise getting injured, the correct answer is to keep attempting reorientation.

The nurse should try other methods of caring for the patient, prior to using physical restraints.

Moving the call bell out of the patient's reach is dangerous.

Restraints should never be used for the convenience of the staff. \

0 0 0 0

0000000000 0000000000 0 \\ MC A+B+C \ The physician made a calculation error that lead to the patient receiving a serious medication error. This error was overlooked by the pharmacist and the nurse who administered the dose as ordered. The patient questioned the medication saying, “This doesn’t look like I was taking at home,” but took the medication anyway when the nurse said it was a generic form of the drug.

Who holds liability in this situation?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The physician \ The pharmacist \ The nurse \ The patient \ The drug manufacturer \ • The physician holds liability for making the original calculation error.

• The pharmacist holds liability for not catching the calculation error.

• The nurse holds liability for not catching the calculation error even when the patient questioned the medication.

• The patient questioned the drug but was given information that eased the concern. The patient would likely not have any liability in this situation.

• There is not enough information to assign plan to the manufacturer. The manufacturer

might be liable if the formulation or packaging of the medication was confusing and made it easy to make a calculation error. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D \ Which options reflect what the nurse should consider prior to administering medication to a hospitalized patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Correct, common dosage for this patient \ Action of the medication \ Cost of the medication \ Signs of untoward reaction to the medication \ Whether the patient's insurance covers the medication \ • The nurse should always consider if the dosage ordered is a correct and common dosage for this patient.

• By considering the action of the medication the nurse will know how to assess if the drug is having its intended effect.

• Cost of the medication is not a primary consideration for the nurse working in the hospital.

• The nurse should always consider what untoward reactions to the medication are possible

and how to recognize their occurrence, and what to do if the patient does have that reaction.

• The nurse working in a hospital does not have access to information about whether the patient’s insurance covers the cost of medication. This is a better consideration for the physician and pharmacist. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which option reflects the nurse's duty regarding use of equipment? \ Nurses are responsible for cleaning and repairing equipment so that it can be used readily. \ Nurses should modify equipment so that it meets the particular patient's requirements. \ Nurses have no responsibility for use or maintenance of equipment. \ The nurse is required to select the proper equipment and to use it correctly. \ \ If equipment is not working, the nurse should remove it from use and notify the department that is responsible for repairs.

The nurse should not modify equipment in any way other than what meets the manufacturer's recommendations.

The nurse does have responsibility for using equipment safely and for instituting action to repair damaged equipment.

Nurses are responsible for following the manufacturer's recommendations for the use of equipment selected and for selecting equipment appropriate to the patient's condition. \

0 0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse suspects that a patient's death was related to faulty monitoring equipment. What is the nurse's duty to report? \ The nurse must notify the patient's survivors. \ The nurse must notify hospital risk management. \ The nurse must notify local law enforcement. \ The nurse must notify the Food and Drug Administration. \ \ Notification of survivors is not the responsibility of the nurse.

If there is a possibility that faulty equipment was involved in a patient incident or death, the nurse should notify risk management and take the equipment out of service if possible.

Notifying law enforcement is not the responsibility of the nurse.

The nurse is not responsible for notifying the FDA. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ Which option reflects the nurse's duty to prevent patient falls? \ The nurse has a duty to assess the patient for risk for falls. \ The nurse has a duty to provide minimal assistance. \ The nurse has a duty to provide continual observation of patients. \ The nurse has a duty to see that siderails on all beds are raised at all times. \ \ Identification of patient risk is the primary duty to prevent falls.

Minimal assistance often provides insufficient care.

Continual observation is not always feasible.

Siderails often produce a risk for patient falls, in some instances are regarded as restraints, and are not always recommended. \ 0 0 0 0

0000000000 0000000000 0 \\ MC

B+C+D \ The nurse has many responsibilities in the care of patients. What are the most important components of this care?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Following physician orders exactly as written. \ Communicating with others regarding patient care. \ Adequately and efficiently assessing the patient. \ Monitoring the patient throughout the care encounter. \ Selecting correct staff to provide patient care. \ • Just following orders is not sufficient to provide quality care.

• Communication, both verbally and through written documentation, to patients, physician, other staff members, and members of the interdisciplinary team is an essential component of nursing care.

• Assessment is the first step of the nursing process and becomes the basis for all nursing action. Inadequate assessment can result in dangerous omissions or mistakes.

• Failure to monitor has been found to be the cause of action for liability in multiple legal cases.

Correctly selecting staff is important, but is all based on other more important components of care. \ 0 0 0 0

0000000000 0000000000 0 \\

MC A \ Which person would be the best choice as an interpreter for a non-English-speaking patient? \ A hospital-provided interpreter \ The patient's daughter who is bilingual \ The patient's neighbor who is bilingual \ A hospital housekeeper who is bilingual \ \ The best choice of interpreter is one who is hospital-supplied for that purpose. Many of the common problems associated with using interpreters can be avoided by using a hospital-supplied person.

The patient may not be comfortable divulging sensitive medical information to the daughter.

Using a neighbor as an interpreter has confidentiality implications that should be avoided if possible.

A hospital housekeeper may not be aware of medical terminology. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The physician, in telling the nurse to follow an order, states, "If anything happens, I'll take full responsibility." What effect would the physician's statement have in a subsequent lawsuit for malpractice? \

It alters the rule of professional accountability, because the physician is also a professional. \ It alters the rule of personal accountability, because accountability is now substituted to the physician. \ It does not alter the nurse's personal accountability at all. \ It provides a valid defense for the nurse in the lawsuit. \ \ The physician's statement does not remove the nurse’s accountability.

The nurse has personal accountability for all actions.

Despite what the physician may say, this nurse has accountability for any action taken. The responsibility and accountability is not to do anything that would bring harm to the patient.

The physician’s statement will not absolve the nurse of accountability for actions taken. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The triage nurse in a busy emergency department calls the charge nurse and says, “We have a patient who attempted suicide in the waiting room. I think we should just let him wait awhile so he has time to think about what he has done.” Which response by the charge nurse is indicated? \ “Is he in any danger of dying right now?” \ “Please bring him back immediately while I get a treatment room prepared.” \ “Okay if that is what you think we should do.” \

“Is anyone with the patient?” \ \ The manager has done nothing to address the triage nurse’s attitude or to provide quality care by asking this question.

This patient should be seen immediately as any attempt to kill one’s self is serious.

The manager has done nothing to address the triage nurse’s attitude by making this statement.

Whether or not someone is with the patient is not relevant at this time. The patient needs care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ At 2:00 a.m. the night nurse gives a patient 600 mg of ibuprofen according to the standard dosage she has given other patients. When charting the medication the nurse discovers that this patient’s PRN order for ibuprofen calls for administering 400 mg of the drug. What nursing action is indicated? \ Just monitor the patient as the dose given is within normal limits. \ Notify the physician immediately. \ Report the error and complete an incident report. \ Chart that 400 mg of ibuprofen was given for pain. \ \ The nurse should monitor the patient, but this is not sufficient intervention.

There is likely no need to notify the physician immediately. The physician should be notified at the next convenient time.

This is a medication error. The ethical action is to report the error and complete an incident report.

This is not a truthful statement. \ 0 0 0 0

0000000000 0000000000 0

\\ MC B \ A nurse who has a history of difficulty meeting the professional responsibilities of acute care nursing is considering a move to ambulatory nursing. What should this nurse consider about the professional responsibilities of ambulatory nursing prior to making this decision? \ Ambulatory nursing is totally different from acute care nursing. \ The responsibilities are equally as technical and demanding as those of acute care nursing. \ The duty to communicate is lessened in ambulatory care nursing. \ Ambulatory nursing is less physically demanding on the nurse. \ \ Many aspects of acute care nursing are also important in ambulatory care nursing.

Neither specialty setting is “easier” or “less demanding” than the other. Ambulatory care nurses use advanced technology to provide care, just as do acute care nurses.

The nurse working in ambulatory care must be very careful to communicate well because the patient is generally in the environment for a lessor amount of time.

The physical demands of ambulatory care nursing can be just as stringent as those of acute care nursing. Depending upon practice site, ambulatory care nursing may be very physically demanding. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C+E \

Which situations reflect legal issues associated with telenursing?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Standards of care in one state's hospitals are different from those in hospitals in another state. \ A telehealth nurse in one state holds an associate degree while a nurse in a similar position in a neighboring state holds a baccalaureate degree in nursing. \ The use of telenursing equipment is new in the hospital and requires the presence of a nonmedical technician. \ The nurse using telemedicine is paid by the patient "visit," while the hospital staff nurse is paid by the shift. \ The nurse who is licensed in one state is caring for a patient who is in a different state. \ • Differences in practice standards addressing quality, scope of practice, patient safety, and documentation exist between and among states. The telehealth nurse may be providing care for patients in a variety of practice areas encompassing multiple states.

• Educational requirements are addressed by licensure requirements for the professional or by the individual employer placing a nurse in the position to perform telenursing.

• When a non-medical technician is present, issues of confidentiality of medical information arise.

• Salary rates are not a legal issue in this case, but depend upon the nurse's contract with the facility.

• Licensure issues are a major legal hurdle in provision of telehealth nursing. Discussions of multistate licensure have arisen from this situation. \ 0 0 0 0

0000000000 0000000000 0

\\ MC A \ Which option is an example of a question and statement regarding violence a nurse should use in the assessment of all patients? \ “Do you feel safe in your home?” \ “Most violence involves physical abuse.” \ “Violence is rare in upper middle class families.” \ “Don’t take your safe home environment for granted.” \ \ This question is a good way to begin discussion of violence. All patients should be assessed for the presence of domestic violence or abuse.

The nurse should educate patients that violence includes much more than physical behaviors.

Violence occurs across all socioeconomic levels.

The nurse should not assume that a patient’s environment is safe. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The nurse is caring for a 45-year-old patient who reveals that recent injuries are a result of domestic violence. The patient begs the nurse not to "tell." What action, taken by the nurse, is correct? \

Report the revelation to the charge nurse. \ Tell the patient that the law requires reporting this incident. \ Promise the patient not to tell anyone. \ Talk with the patient about the reason for secrecy. \ \ The nurse should not reveal the information to anyone until further assessment is done.

Since this patient is not a child or an elder there is not a duty to report. That duty exists only if the patient is a member of a "vulnerable population."

The nurse should not promise the patient not to tell as divulging information may at some time be crucial to the patient’s health.

The nurse should explore the reasons the patient desires to keep the information secret. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse's neighbor routinely calls and asks for advice regarding health issues. What should the nurse do about these calls? \ Tell the neighbor that the nurse is not legally able to give health advice outside the work environment. \ Charge the neighbor a flat fee of $25 for each call. \ Be certain that any advice given reflects both nursing and community standards. \

Tell the neighbor that nurses are not educationally prepared to give health advice. \ \ It is not illegal for the nurse to provide health advice to a neighbor.

If the nurse charges the neighbor for the advice, there is a different legal standard applied as the advice is no longer voluntary.

When giving health-related advice, the nurse should be certain the advice meets both community and nursing standards.

Nurses are educationally prepared to give health advice. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+D \ The nurse volunteers services at a free medical clinic. What is true of these donated services?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ They fall under the auspices of the state nurse practice act. \ Since the nurse is serving as a volunteer an exemption from possible lawsuit exists. \ The nurse should practice as a reasonably prudent nurse when providing these services. \ The nurse should assure that a system of record keeping is initiated and maintained. \ The nurse’s actions will be protected by Good Samaritan laws. \ \

• Donated services do not fall within the auspices of the state nurse practice act as most of these acts apply only to compensated services.

• The fact that services are donated does not exempt the nurse from a possible lawsuit.

• The reasonably prudent nurse standard should be upheld even when no compensation is being received.

• The nurse should be certain that written record of each nurse-patient encounter is established and that there is a method of maintaining these records.

• Good Samaritan laws often do not cover these services as they are not provided at the scene of an emergency or at an accident scene. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C+D+E \ The nurse is considering taking a job with a health maintenance organization. To be federally qualified as an HMO, the nurse's possible job site must have which of these aspects in place?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A list of health care providers from which patients may choose \ The capacity to provide care by telehealth \ An agreed-upon set of basic and supplemental health maintenance and treatment services \ An organized system of providing health care in a geographic region \ Persons who voluntarily enroll in the plan for services \

• There is no federal requirement that the organization have a list of health care providers from which to choose.

• There is no federal requirement that the HMO has the capacity to provide care by telehealth.

• In order to be federally qualified, the organization must have an agreed-upon set of basic and supplemental health maintenance and treatment services.

• By definition, an HMO is an organized system of providing health care in a certain geographic area. This must exist for an HMO to be federally qualified.

• In order to be federally qualified, the organization must have a voluntary enrolled group of persons for care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The advanced nurse practitioner is an employee of a health maintenance organization, along with several other ANPs and physicians. All the providers receive a set salary from the organization regardless of how many or few patient contacts are made monthly. Which type of HMO does this describe? \ Network model \ Group model \ Staff model \ Independent practice association model \ \ In the network model two or more independent group practices and/or independent practice

associations contract to provide services. Enrolled members pay a fixed monthly fee.

A group model exists when a health plan contracts with a multispecialty group to provide care to plan members. The providers are not employees of the HMO, but are employed by the group practice and are paid a negotiated salary.

The staff model is a health care model in which providers practice as employees and are usually paid a set salary.

The independent practice association model occurs when a separate legal entity contracts with an HMO for a negotiated fee. The health care providers continue in their existing individual or group practices, seeing HMO patients as a part of the practice. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ State legislatures are gradually changing the care that patients potentially receive from health maintenance organizations (HMOs). What is one means by which this improvement has occurred? \ States have allowed patients who receive substandard care to successfully bring suit against HMOs. \ States have mandated that all citizens be covered by HMOs if that is the desire of the citizen. \ States have set the premiums that enrollees pay for HMO coverage. \ States have mandated how many HMOs will operate within the state. \ \ Allowing patients to successfully bring suit against HMOs has made the HMOs accountable for their practices by applying state statutes and laws that would apply to other insurance providers.

States have not mandated universal coverage by HMOs. Premiums are set by the HMO and are not under the control of the state.

Mandating numbers of HMOs operating with the state would not be likely to improve quality of care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D \ A patient presents at a small rural medical clinic after falling from a ladder. The physician suspects that the patient may have intracranial injuries but no diagnostic equipment to determine the severity of injury is available. What is necessary for the physician to legally transfer this unstable patient?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Documentation that the receiving hospital has available space \ Physician certification that the medical benefits of transferring the patient outweigh the risks of transfer \ Documentation that the transferring hospital is a qualified Medicare provider \ An agreement with the receiving hospital stating willingness to provide care \ Confirmation that the incident causing the injuries was accidental \ • In order for transfer of an unstable patient to meet EMTALA requirements the physician must certify that the receiving hospital has space available for the patient’s care.

• Transferring patients is not without risk. The transferring physician must certify that the risks associated with transferring the patient are outweighed by the benefits of transfer.

• There is no requirement to certify that the receiving hospital is a Medicare provider.

• The receiving hospital must be willing to provide care to the patient being transferred.

• There is no need to confirm that an accident caused the injuries. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+B+D+E \ The nurse is involved in establishing a patient-centered medical home to care for a growing population of older adults. The nurse would support which components of this plan?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The workflow of the organization is focused on the patient as an informed partner in creating plans for care. \ An interdisciplinary team of care providers will provide prevention and wellness care for these patients. \ The medical home will serve as a long term care facility for the patients as they age. \ The medical home will establish a system of email communication with members for rapid access to providers. \ The medical home will rely heavily on evidence-based decision making. \ • The medical home supports patients in learning to manage and organize their own care,

and ensures that these patients are fully informed partners in establishing realistic care plans.

• A medical home is accountable for meeting preventions and wellness, both in acute and chronic care. An interdisciplinary team of care providers provides this comprehensive care.

• A patient-centered medical home is not a long term care facility.

• The medical home model delivers accessible services with electronic or telephone access to a member of the care team on a round-the-clock basis.

• he medical home demonstrates a commitment to quality and quality improvement through the use of evidence-based medicine and clinical decision-support tools. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse has been involved in work to support antitrust laws in health care. Why are these laws important to health care consumers? \ They encourage activities to promote health. \ They promote the use of registered nurses rather than unlicensed assistive personnel. \ They promote competition and efficiency in health care. \ They prevent physicians from ordering unnecessary tests. \ \ Antitrust laws are not associated with health promotion activities.

Antitrust laws do not necessarily promote the use of registered nurses.

Antitrust laws promote competition among health care facilities. This competition helps promote efficiency.

Antitrust laws do not establish means to monitor testing ordered by physicians.

\ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ Health plan administrators are designing methods to assure that consumers have appropriate access to emergency services. Which standard should guide the development of these methods? \ That of a reasonable physician \ That of a prudent layperson \ That of an ethical insurance provider \ That of a prudent and reasonable nurse \ \ The standard of a reasonable physician would exclude many situations for which people believe they should seek emergency care.

The standard for access to emergency care should be such that a “prudent layperson” could reasonably expect the absence of medical attention to place the consumer’s health in serious jeopardy.

An ethical insurance provider’s standard for when a person should have access to emergency care may be influenced by reimbursement issues.

A prudent and reasonable nurse has a higher understanding of medical emergencies. Because of this advanced knowledge this is not the standard for most people. \ 0 0

0 0

0000000000 0000000000 0 \\ MC B \ Telenursing presents numerous ethical concerns. What is one way the nurse can help to control for the ethical issues surrounding this technology? \ Use telenursing to give only general, not specific, advice. \ Ask specific questions about the patient's presenting situation. \ Restrict telenursing to patients who have been seen in person within the last two days. \ Refuse to give advice to patients over the telephone. \ \ Giving only general advice negates the purposes of telenursing.

One of the ethical issues that arises in telenursing is that assessment may be more difficult. The nurse can help control for this problem by asking specific questions.

Restricting advice to patients that have recently been seen negates the purposes of telenursing.

Refusing to give advice negates the purposes of telenursing. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The emergency room nurse is often faced with the responsibility of providing care for people who were responsible for motor vehicle accidents. In some cases, the nurse is caring for that person along with victims of the accident. This situation causes the nurse moral distress. How could the nurse best help to alleviate this distress? \ Refuse to care for these patients in the future. \ Be frank with the patients about how uncomfortable the nurse is. \ Remember to respect the person, not the actions of the person. \ Ask a co-worker to care for the patients. \ \ Refusing to care for these patients is not ethical and does not address the root problem.

While honesty is a good policy, the nurse should not impose his or her discomfort onto the patient.

The best option is to remember that all people deserve respect as human beings, even if their actions cannot be respected.

Diverting the stress onto a co-worker is not handling the situation, only shifting it to someone else. \ 0 0 0 0

0000000000 0000000000

0

\\ MC A+E \ The nurse presenting a community education session about community health would include information about which foundational federal laws?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Social Security Act of 1935 \ 1947 Taft Hartley Amendment \ Civil Rights Act of 1991 \ Americans with Disabilities Act of 1990 \ Public Health Service Act of 1994 \ • The Social Security Act of 1935 established the means for states to make provisions for establishing public health services. Community health nurses play a significant role in providing care through the programs established by the public health service.

• The Taft Hartley Amendment is a federal law that monitors the activities and power of labor unions. It is not associated with the development of community health.

• The Civil Rights Act of 1991 deals with the right of employees in regard to discrimination by employers. It did not help to establish community health.

• The Americans with Disabilities Act of 1990 was passed to provide equality for people with disabilities. It did not help to establish community health.

• The Public Health Service Act of 1994 consolidated all existing public health legislation under one law and became the major piece of health legislation for the country. \ 0 0 0 0

0000000000

0000000000 0 \\ MC A+B+D+E \ Which person would likely be provided for under the Social Security Act of 1935?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A 16-year-old whose father died in a motor vehicle accident \ A 70-year-old man who is retired from a job he held for 30 years \ A 45-year-old woman who suffered a myocardial infarction \ A 34-year-old person who files for unemployment after losing her job \ A 30-year-old woman who has become blind secondary to diabetic retinopathy \ • As a dependent child this person is provided for by the Social Security Act of 1935.

• The Social Security Act of 1935 provided for the federal welfare by establishing a system of federal benefits for the aged population.

• Despite having a cardiovascular history, there is no indication the 45-year-old woman meets the criteria for inclusion.

• State unemployment compensation laws are part of the Social Security Act of 1935.

• Blind persons are provided for by the Social Security Act of 1935. \ 0 0 0 0

0000000000 0000000000 0 \\

MC C \ A school nurse negligently administered an overdose of medication to a student, causing the student to suffer a severe reaction that necessitated hospitalization. Should a lawsuit result from this case, the nurse would be held to what standard? \ The reasonably prudent advanced nurse practitioner \ The reasonably prudent general duty hospital nurse \ The reasonably prudent pediatric nurse \ The reasonably prudent school nurse \ \ There is no information to suggest this nurse was an advanced nurse practitioner, so this is not the standard of practice for which the nurse would be held.

There is no evidence to support whether this nurse has ever practiced in a hospital. In any case, this is not the standard to which a nurse in this setting is held.

While a school nurse should have the skills and knowledge to care for the pediatric population, this is not the standard to which a school nurse is held.

Nurses are held to the standard of practice specific to their practice area setting, which in this case is that of a reasonably prudent school nurse. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \

What is the most significant professional qualification necessary for a nurse who practices as a school nurse? \ The nurse's ability to exercise independent judgment in emergency situations \ The nurse's ability to properly counsel students about medical concerns \ The nurse's ability to work closely with school officials \ The nurse's ability to effectively teach students about their health \ \ School nurses practice with no other care provider present and are often called upon as the first person to respond to provide care in emergency situations. Therefore, they must possess the ability to think independently and use critical thinking and judgment.

Providing counseling is an important aspect of school nursing, but is not the most important skill this nurse can possess.

The school nurse must work closely with school officials, but this is not the most critical attribute of this nurse.

The nurse must be able to teach students about health, but this is not this nurse’s most important skill. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ Which nurse is exposed to the greatest risk of liability for malpractice because of the nature of the employment relationship? \ The hospital-based staff nurse

\ The home health care nurse \ The federally employed nurse \ The occupational health nurse \ \ Hospital-based staff nurses do not face the same amount of liability as do nurses in this specialty.

The home health care nurse does not face the same amount of liability as nurses in this specialty.

Federally employed nurses do not face the same amount of liability as those in this specialty.

The practice of occupational health nurses is greatly influenced by a variety of federal and state laws, particularly workers' compensation laws, mandatory-reporting laws, and occupational safety and health laws. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B+C \ In which situations would the home health nurse likely be considered to have abandoned a client?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The nurse and patient decided together that home health care was no longer needed. \ The home health nurse no longer provides care for the patient when reimbursement amounts change. \

The nurse stops making home visits without giving the patient notice that this would occur. \ The nurse fails to assess the patient on a daily basis. \ The nurse left the patient’s home when a grandchild threatened the nurse. \ • The patient-home health nurse relationship may end if the patient no longer needs care and is discharged from the service.

• Change in reimbursement amounts does not constitute legal reason to discontinue services. The nurse may be considered to have abandoned this patient.

• The nurse cannot legally stop seeing the patient without providing notice to the patient that services are being discontinued.

• Not all home health patients require daily nursing services.

• The nurse’s safety should be protected, so this is not abandonment. In order to protect the patient, the nurse should immediately contact the agency and law enforcement. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ After analyzing assessment data, the home health care nurse determines that a change is necessary in the medical care of a patient. The nurse makes the change without consulting the physician. Under which circumstance is this a legal action by this nurse? \ If the nurse is experienced and sure the change will not harm the patient \ If there is a signed, standing order for the change \ If the nurse is certain the physician will agree with the change \

If the patient's family agrees that the action is necessary \ \ The nurse is licensed to practice nursing which does not include alteration of the medical plan of care with orders.

Standing orders are legal orders once they are signed by the physician. These orders require astute assessment and analysis by the nurse.

The nurse’s certainty that the physician will agree with the change will not make this a legal action.

The family’s approval of the action does not make it legal. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ Nurses in which health care settings are required to comply with the Patient Self-Determination Act of 1991? \ In home health care settings only if they have a validly executed advanced directive when care is first rendered \ Solely in formal institutional settings, such as hospitals \ In all health care settings, including home health care settings, if federal funds are received \ In all health care settings except home health care settings \ \ This act requires that the facility inquire about advance directives. It is not limited to patients who have already executed these directives.

Adherence to this act is not limited to formal institutional settings.

Any agency that receives federal funds, which includes home health care settings, is to abide by the federal legislation of the Patient Self-Determination Act of 1991.

Home health setting also has to adhere to this act in certain situations.. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ The home health care agency that receives federal funds desires to hire a new home health care aide. This aide will provide direct and hands-on care to patients. Which person would meet federal requirements for that position? \ A nursing assistant who has on-the-job training at a nursing home \ A nursing assistant who completed a training and competency evaluation program \ A nursing assistant who has on-the-job training at a hospital \ A second-semester student enrolled in a registered nursing program \ \ On the job training at a nursing home is not sufficient for employment in a home health agency that receives federal funds.

The Omnibus Budget Reconciliation Act of 1986 sets strict criteria of qualifications for home health care aides who have a predominant role in direct, hands-on contact with patients. Under this provision, the agency may not use any individual who is not a licensed health care professional, unless the individual has successfully completed a training and competency evaluation program that meets minimum federal standards and the individual is actually competent to provide the services assigned.

On the job training at a hospital is not sufficient training for a nursing assistant who will work in a home health agency receiving federal funds.

Just because a student has some experience in nursing school does not qualify the student as a nursing assistant in this situation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+C+D \ The nurse preparing to complete an Outcome and Assessment Information Set (OASIS) would expect to collect which information?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Medication history \ Insurance information \ Living arrangements \ Demographic information \ Financial information \ • Medication history is part of the comprehensive data collected for the OASIS. • Insurance information is not collected as part of OASIS. • Information about the patient’s living arrangements is collected as part of the comprehensive OASIS. • Demographic information is collected as part of the comprehensive OASIS.

• \

Financial information is not assessed by the OASIS.

0 0 0 0

0000000000 0000000000 0 \\ MC B+D+E \ A nurse responds to help provide care at the scene of a disaster. Which nursing action will help to reduce the chance of lawsuit?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ Do not perform any actions outside of the scope of nursing care. \ Take breaks to rest when needed. \ Keep detailed notes on every action taken. \ Maintain certifications that will support care provided during emergencies. \ Be honest about one’s capabilities. \ • If the nurse is skilled and qualified to perform functions outside the scope of nursing and if the nurse is directly to do so by an authority it is permissible for the nurse to comply. In this situation an exception to scope of practice exists.

• Resting helps the nurse make valid judgments and helps the nurse think clearly.

• Notes are essential, but should be done as quickly as possible, so detail is likely not possible.

• Certifications such as advanced cardiac life support and pediatric advanced life support will help the nurse be more competent at the time of an emergency.

• The nurse should recognize his or her own strengths and capabilities and should not practice outside those parameters. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ The occupational nurse has sponsored and taught first aid classes to workers throughout the factory. If a person, taught by the nurse, makes an error in providing first aid that causes further injury, does the nurse hold any liability? \ No, the liability is on the person who caused the original accident causing the need for first aid. \ No, all liability is on the person who made the error. \ The nurse holds all the liability. \ The nurse may hold liability depending upon circumstances. \ \ The liability is likely not limited to this person.

The person who made the error is not the only person likely to be found to hold liability.

The nurse will not hold all the liability in this situation.

If the occupational health nurse has the responsibility to teach first aid or to ensure that needed supplies for first aid intervention are available, the nurse may incur potential liability. \ 0 0 0

0

0000000000 0000000000 0 \\ MC D \ The school nurse is leaving campus after work when an accident occurs on the playground. The nurse responds and treats the injured students. Which standard of care would most likely determine liability? \ The reasonably prudent pediatric nurse \ The reasonably prudent general duty hospital nurse \ The reasonably prudent school nurse \ The reasonably prudent nurse in an emergency situation \ \ The primary focus of these nursing actions is more specifically in the scope of care of a different specialty.

General duty hospital nurses do not routinely provide emergency care, so this is not the standard used for this situation.

Since these injuries have occurred outside of school hours, this nurse may be functioning outside the usual scope of employment.

Because of the emergency nature of this situation the most likely standard would be that of a reasonably prudent nurse in an emergency situation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The nurse is frustrated by the number of single mothers who receive medical services at no cost.

What is the greatest danger of this frustration? \ The nurse may unintentionally neglect to educate patients on services available. \ The nurse may be rude to these mothers. \ This frustration may increase the likelihood that the nurse elects to leave this job position. \ The frustration may increase the nurse's job stress. \ \ This type of frustration may raise ethical issues in allowing this nurse to continue to provide care to this group of patients. While the nurse might be rude, have increased stress, or elect to quit this job, the greatest danger is that the nurse will unintentionally neglect to educate the patients regarding all services that are available.

Rudeness may occur but this is not the greatest danger for this nurse.

The nurse may elect to leave this job. If frustration is extreme, leaving the job may be the best choice. This is not the biggest danger.

Job stress will likely increase, but this is not the greatest danger. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \ The correctional nurse has drawn blood from an inmate who has experienced gastrointestinal bleeding. While performing the venipuncture, the nurse told the inmate the blood was being drawn for the purposes of evaluating the inmate's hemoglobin and hematocrit. Can the blood also be used to screen the inmate for drug usage? \ No, the blood can be used only for the determination of medical diagnosis. \ Yes, the inmate signs away all rights to privacy when incarcerated. \ Yes, as long as the nurse suspects the inmate of drug use. \ No, the laboratory will not accept this blood drawn and will insist that the blood be drawn again by a laboratory technician. \ \ This blood can only be used to determine medical diagnosis.

Inmates retain their rights to privacy, so if blood is being drawn for a drug screen the inmate must be informed.

If the nurse suspects the inmate of drug abuse, an order for additional blood draw and screen is necessary.

The correctional nurse often draws blood that is sent to the laboratory, so there is no indication that there will be need to redraw blood by the technician. \ 0 0 0 0

0000000000 0000000000 0

\\ MC C \ A person requires assistance with bathing, feeding, ambulation, and skin care. Which inpatient care setting is most appropriate for this person? \ An elder day care center \ A hospice care center \ A nursing home \ An assisted living center \ \ Elder day care centers provide care to adults who are unable to stay home by themselves, but go home in the evening to be cared for in the home, many times by adult children or other relatives.

Hospice care centers are for persons who are terminally ill. There is no indication that this patient is terminally ill.

A person who requires assistance with three or more activities of daily living is best served by the nursing home environment.

Assisted living residents may need assistance with two activities. The patient in this question likely needs more care than is traditionally available in an assisted living center. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A \

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An elderly person, who lives with adult children, requires therapeutic and social services and cannot stay alone in the daytime. The person is alert and oriented, but needs a more structured setting during the day. Which care setting is likely the most appropriate for this person? \ Adult day social care \ Assisted living \ Alzheimer's specific adult day care \ Adult day health care \ \ Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person.

Adult day health care provides more intensive health, therapeutic, and social services. Adult social care provides social activities, meals, recreation, and some limited health-related services, but not to the extent needed by this person. Alzheimer's day care is specific for those with dementia. Assisted living centers become the resident's home.

Alzheimer's day care is specific for those with dementia.

Adult day health care provides more intensive health, therapeutic, and social services. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ Nurses providing care in a long term care settings should be very aware of the potential for which patient incident that is one of the primary causes of action in lawsuits against these facilities? \ Medication errors

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\ Abuse of residents \ Resident falls \ Inadequate resident nutrition \ \ Medication errors are certainly important and should be avoided. However, a different type of incident is more prevalent in this setting.

Abuse of residents does occur unfortunately. However, a different type of incident is more common.

Similar to acute care settings, falls are one of the primary reasons that lawsuits are filed against long-term care facilities. Statistics show an average of 2.6 falls per person per year. In this setting, falls are frequently more preventable than in an acute care facility and thus are less able to be defended.

Unfortunately cases in which residents do not receive adequate nutrition do occur. They are not as common as another incident. \ 0 0 0 0

0000000000 0000000000 0 \\ MC A+D \ What is true of the use of restraints in long-term care facilities today?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The least restrictive restraint possible should be used. \ Restraints should be used for all residents at risk for falls. \

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They are expressly forbidden by federal laws. \ Use of restraints increases the need to monitor the resident. \ Chemical restraints are preferable to physical restraints. \ • In cases where restraints are indicated, the least restrictive device possible should be used.

• Restraints may not be routinely applied for residents whose individualized assessments do not point to a need for restraints to protect their safety. Risk for falls does not always constitute need for restraints.

• Restraints are not expressly forbidden by any laws.

• If restraints are used the resident must be properly supervised which often increases the frequency at which monitoring should be done.

• Any method to restrict the mobility of the resident is considered a restraint. Physical restraints are not better or worse than chemical restraints. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A long-term care resident has limited use of the right side of his body, but is coherent at intervals. If this patient develops decubiti, which factor might the facility plead to prevent liability? \ The resident is unable to obtain proper nutrition because of his refusal to eat. \ The resident must be confined to bed for prolonged periods of time because of his condition. \ Nursing notes reveal that the patient is repositioned frequently, but somehow manages to return to the backlying position. \

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Understaffing prevents the nurses from performing necessary passive range of motion exercises to the patient's affected side. \ \ Inadequate nutrition is a circumstance that should be addressed to reduce the incident of decubiti. Not addressing this situation could be considered substandard care.

Being confined to bed for long periods of time must be addressed to reduce the incident of decubiti. Alternate forms of movement and exercise should be implemented. Not addressing these could be considered substandard care.

The fact that nurses are turning this patient indicates the staff is attempting to prevent the occurrence of decubiti in this patient and could help in the defense of a lawsuit.

Understaffing is never a valid reason for a resident not receiving adequate care. \ 0 0 0 0

0000000000 0000000000 0 \\ MC D \ A frail 90-year-old resident of a long-term care facility refuses to sign an advanced directive and tells the nurse she “wants everything done” to save her life if she should go into cardiopulmonary arrest. What action by the nurse is ethically and legally indicated? \ Discuss the situation with the resident’s family and plan to follow their wishes. \ Tell the resident that end of life interventions are generally up to the physician. \ Tell the resident that everything will be done, but make a do not resuscitation note on the medical record. \ Support the patient in her wishes but continue education about end-of-life care. \ \

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The family’s wishes do not supersede the patient’s wishes The physician’s wishes do not supersede those of the patient.

It is unethical to tell the patient one thing when intending to do another.

The nurse should support this resident’s right to self-determination, but should be certain the resident is aware of what her wishes entail. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ The nurse executive wishes to change the culture of the long-term care facility to one in which restraints are seldom used. Which information would the nurse provide when discussing this change with the facility’s ownership? \ In facilities where restraints are seldom used the rate of falls has decreased. \ Reducing restraint use increases fall rate and injury rate, but results in better patient satisfaction ratings. \ Fall rates have increased, but the incidence of long-term injuries has remained unchanged. \ Chemical restraints can be substituted for most physical restraints. \ \ The rate of falls has not decreased in these facilities.

Fall rates and injury rates have not increased in these facilities.

Fall rates go up in these facilities, but the rate of long-term injury does not. This supports the concept that allowing the patients more mobility by not using restraints does not result in an increase in long-term injury.

A restraint is a restraint, whether it is chemical or physical. Substituting chemical restraints for physical restraints is not a valid proposal. \

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0 0 0 0

0000000000 0000000000 0 \\ MC B \ The nurse manager of a long-term care facility is planning to hire additional nursing staff. What should this manager consider about how the need to assess resident/patient changes and potential problems differ between the long-term care facility and an acute care facility? \ There is a need for greater assessment skills in acute care because patients are so sick. \ There is a need for greater assessment skills in long-term care because of the lack of direct physician contact with residents. \ There is a lesser need for good assessment in long-term care because the residents are generally stable. \ They are the same. \ \ While it is true that acute care patients are sicker, there is also availability of consults both with other nurses and with physicians.

The long-term care nurse does not have ready consult available and the physician may not have as good a working knowledge of the resident. This difference requires the nurse to have astute assessment, monitoring, and communication skills.

Long-term care residents often have multiple chronic illnesses complicated with changes associated with aging.

This makes good assessment and intervention skills essential.

The need for assessment, monitoring, and communicating about long-term care facility residents is somewhat different than that for acute care patients. \ 0

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0 0 0

0000000000 0000000000 0 \\ MC A+B+C+D \ Which options reflect a scenario that violates the Nursing Home Reform Act of 1987?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ If a resident attempts to get out of bed, a soft vest restraint is applied. \ The nursing staff routinely leave doors open when getting residents up to bedside commodes. \ The patient is not consulted prior to a change in medical treatment. \ The nursing assistant is overheard telling a resident, "If you don't eat, I won't take you down to play dominoes this afternoon." \ The resident falls during a physical therapy session, despite being attended by two staff members. \ • This action violates the resident’s right to freedom from restraint.

• This action violates the resident’s right to privacy.

• This action violates the resident’s right to self-determination.

• This action violates the resident’s right to participate in resident and family groups and is a threatening statement.

• A patient fall, when adequately attended, may occur without being due to abuse, mistreatment, or neglect. \ 0 0 0

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0000000000 0000000000 0 \\ MC C+E \ Which actions could meet the definition of a quasi-intentional tort in a long-term care facility?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A resident wanders away from the facility and is found 2 miles away. \ The resident is restrained to a chair in the day room to prevent wandering. \ The local newspaper publishes pictures of residents enjoying a holiday presentation by children. \ The nursing assistant slaps a resident's hand when the resident pinches another resident. \ The nursing home provides a list of names and clothing sizes to a local group who wishes to purchase birthday gifts for residents. \ • This action would more likely result in litigation for negligence.

• Restraint would more likely result in the intentional tort of false imprisonment.

• Quasi-intentional torts include invasion of privacy as in the publishing of a resident’s picture (even in a group) without permission from the resident.

• Slapping a resident’s hand would more likely result in litigation for the intentional tort of battery.

• This is an example of the quasi-intentional tort of invasion of privacy. \ 0 0 0 0

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0000000000 0000000000 0 \\ MC D+E \ The long-term care facility is considering the involuntary discharge of a resident. What should the facility provide the resident prior to making this decision?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ A referral to a different long-term care facility \ Return of the last month's fees \ Access to a psychiatric evaluation \ Social work counseling if requested \ Written notice \ • The facility does not have to refer the resident to a different facility.

• There is no requirement for return of the last month’s fees.

• There is no requirement that the facility provide access to a psychiatric evaluation.

• The resident has a right to social work counseling.

• To discharge a resident involuntarily, written notice must be given to the resident, a responsible party, a state agency, or an ombudsman. \ 0 0 0 0

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0000000000 0000000000 0 \\ MC A+C+D \ In which scenarios could the elderly wife of a homebound patient likely be guilty of elder abuse?

(Select all that apply.)

Note: Credit will be given only if all correct choices and no incorrect choices are selected. \ The wife restrains the patient in bed while she goes to the grocery store. \ The wife only bathes the patient three times a week. \ The wife tries to “stretch” the patient’s medications by giving one half doses twice a week. \ The wife reports being afraid to intervene when the home health nursing assistant strikes the patient for soiling the bed. \ The wife cries while telling the nurse that her husband often “yells and screams” when he doesn’t feel well. \ • The wife may feel she is protecting the patient by this action, but it is actually abuse.

• In many cases this is an adequate bathing schedule. There is no evidence abuse is occurring.

• If the wife is not aware that this is an unwise practice this is unintentional abuse.

• Striking a person or allowing a person to be struck is battery. It is apparent that the wife knows this is abuse, but is fearful.

• In this case the wife may be the victim of abuse, not the abuser. \ 0 0 0 0

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0000000000 0000000000 0 \\ MC D \ Which option reflects financial exploitation? \ The caregiver allows the patient to pay for incidentals necessary for care. \ The caregiver encourages the elder person who wishes to continue to work in the family business. \ The caregiver takes the patient's Social Security check to the bank for deposit. \ The caregiver has the patient sign power of attorney papers by saying they are required by the government. \ \ This is an appropriate action by the care provider.

It is not financial exploitation to support the older adult’s wish to continue to be productive.

There is no indication that the caregiver is not depositing these funds into the older adult’s account. This is not exploitation.

Fraudulently obtaining power of attorney is financial exploitation. \ 0 0 0 0

0000000000 0000000000 0 \\ MC C \ A nurse suspects that an elderly person has been physically abused. According to research, which person would be the most likely abuser?

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\ The person's paid caregiver \ Someone previously unknown to the person \ The individual's adult child \ The person's neighbor \ \ While paid caregivers can be abusers, they are not the most likely to abuse.

Typically the abuser is someone well known to the abused elder.

Studies have shown that the profile of the person most likely to be abused is an elderly woman and the abuser is frequently an adult child.

Neighbors could become abusers, but this is not the most likely scenario. \ 0 0 0 0

0000000000 0000000000 0 \\ MC B \ A nursing assistant suspects that another staff member is abusing residents in a nursing home. Is there a duty for this nursing assistant to report this suspicion? \ Yes, but not until the nursing assistant has proof of the abuse. \ Yes, older patients are members of a vulnerable population and there is a duty for anyone to report suspected abuse. \ Only if another nursing assistant has the same suspicions and is also willing to report the suspicion of abuse \

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No, since the nursing assistant does not have a state license, there is not a duty to report. \ \ Proof of abuse is not necessary.

Older patients are members of a vulnerable population and there is a duty for anyone who suspects abuse to report it.

A single person can and has a duty to report suspected abuse.

All persons, regardless of licensure, have a duty to report suspected elder abuse. \ 0 0 0 0

0000000000 0000000000 0

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