legal/ethics of questions N134 – Flashcards
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A nurse is providing care for three patients on a medical unit, two of whom are significantly more acute than the third. The nurse is making a concerted effort to ensure that the less acute patient still receives a reasonable amount of time, attention, and care during the course of the shift. Which of the following is the nurse attempting to enact? a)Fidelity b)Justice c)Nonmaleficence d)Beneficence
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b
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A student nurse contaminates the catheter by inserting it into the vagina on a female patient. The student quickly pulls back and reinserts the foley into the urinary meatus. As a result of the technique used when inserting the catheter, the patient develops an urinary tract infection. As a result of this incident which of the following could legally occur? Question 1 options: The student nurse does not have to worry due to the scope of practice of student nurses. The student nurse could be found negligent. The student nurse had informed consent with the patient to agree to allow the student to insert the catheter. The student nurse would not be considered as part of a law suit due to lack of licensure.
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b Correct. The student nurse breached the duty and the patient was injured as a result of the breach.
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Sources of law that the nurse might consult when investigating the legality of a particular situation might include Question 2 options: Common law Senatorial law Clerical law Misdemeanor
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a Common law is created by judicial decision in court when legal cases are decided.
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A student nurse is caring for a patient with a terminal illness for the first time. The patient's wife and daughter disagree with each other on course of treatment. The patient is not able to make decisions and has not made it know how he would prefer the treatment to be directed. It has been determined that an ethical dillemma is present and all the information relevent to care has been gathered. What would the best next step be in processing this ethical dilemma that the nursing student would desire for resolution? Question 3 options: a.Consider possible courses of action. b.Evaluate the outcome. c.Negotiate the outcome to the ethical dilemma. d.Examine and determine your own values on the issues.
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d correct ethical dilemma Step 1. Is this an ethical dilemma? Step 2. Gather all the information relevant to the case. Step 3. Examine and determine your own values on the issues. Step 4. Articulate the problem. Step 5. Consider possible courses of action. Step 6. Negotiate the outcome. Step 7. Evaluate the outcome. Many examples in text of careful, deliberte step by step decision making.
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An example of the intentional tort, assault, that a nurse could commit would be Question 4 options: Showing the patient restraints that the nurse could apply if consent is not obtained. Intentional touching of the patient without the patient's consent. Speaking defamatory statements about a patient. Written publication of false statements that result in damage to the patient's reputation
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a.Assault is any intentional threat, no actual contact is necessary b.This is battery c.This is slander d.This is libel
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A student nurse tells the patient that he will be back next week for clinical, knowing that he will be advancing to the next level of education and will not see the patient again. This is an example of breaching which health care principle of ethics? Question 5 options: Veracity Autonomy Nonmaleficence Beneficence
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c . correct a. This has to do with truth telling. b.This has to do with self-determination. c. This has to do with avoiding deliberate harm. It may be harmful to a trusting patient when the student does not appear the following week d.This has to do with the promotion of good.
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Nurses are aware that the American Nurses' Association (ANA) Standards of Nursing Practice are: Question 6 options: Legal statutes that guide nursing practice. Progressive actions for a nursing procedure. Requirements for registered nurse licensure. Policy statements defining the obligations of nurses.
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d.The ANA has general resolutions that recommend the responsibilities and obligations of nurses; these standards help determine if a nurse has acted as any prudent, reasonable nurse would given similar education, experiential background, and environment.
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A nurse obtains an informed consent from a patient who is to have an invasive procedure. The nurse's signature on the informed consent form indicates that the: Question 7 options: Surgeon described the procedure and its potential risks. Patient knows and understands expected outcomes. Patient actually signed the consent form. Surgeon is protected from being sue
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c. correct a.The nurse's signature does not document that the physician described the procedure and its risks; the patient's signature documents that the procedure and its risks are understood. b.The nurse's signature does not document that the patient was properly informed about expected outcomes c. The nurse only witnesses the patient's signature and examines the document for the correct date. d.The nurse's signature on an informed consent form does not protect the surgeon from being sued. Reasonably prudent practice protects the surgeon from being sued.
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A nurse says to a patient, "You should get a second opinion because your physician is not the best." The nurse could be sued for: Question 8 options: Libel Assault Slander Negligence
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c Slander is defamation of character by spoken words.
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The nurse observes a multivehicle collision where several people are seriously injured. When a nurse stops at the scene of this accident, the nurse is: Question 9 options: Given legal immunity by the Good Samaritan Law. Held responsible for the care provided at the scene. Meeting the legal trust that accompanies a nursing license. Immune from prosecution because a contract does not exist.
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a.The Good Samaritan Law does not provide legal immunity; the nurse can still be held accountable for gross departure from acceptable standards of practice or willful wrongdoing. b.Nurses are responsible for their own actions, and the care provided must be what any reasonably prudent nurse would do under similar circumstances c.Assistance at the scene of an accident is an ethical, not a legal, duty A contract does not have to exist for a nurse to commit negligence.
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A nurse working on a critical care unit was informed by a patient with multiple sclerosis that she did not wish to be resuscitated in the event of cardiac arrest. The patient is no longer able to express her wishes, and the family has informed the physician that they want the patient to be resuscitated. Aware of the patient's wishes, the nurse is involved in a situation that may experience: a) confidentiality. b) paternalism. c) ethical distress. d) deception.
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c
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Using the nursing process to make ethical decisions involves following several steps. Which step is the nurse implementing when he or she reflects on the decision-making process and the role it will play in making future decisions? a) Implementing b) Diagnosing c) Planning d) Evaluating
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d
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In the delivery of care, the nurse acts in accordance with nursing standards and the code of ethics and reports a medication error that she has made. The nurse is most clearly demonstrating which of the following professional values? a) Integrity b) Human dignity c) Social justice d) Altruism
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a
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A client continues to complain of pain despite receiving medication. The family states, ?in our culture it is acceptable to complain out loud.? What would be the best response by the nurse? a) It is not necessary to complain so loud. b) The pain medication should have worked by now. c) Tell me more about your cultural beliefs. d) Describe your home situation to me.
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c
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A 46-year-old patient has been diagnosed with cancer. He has met with the oncologist and is now weighing his options to undergo chemotherapy or radiation as his treatment. This patient is utilizing which ethical principle in making his decision?b a) Justice b) Autonomy c) Confidentiality d) Beneficence
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b
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A nurse is having lunch in the break room and overhears the other nurses talking about a difficult client in an inappropriate way. The nurses attempt to engage them in the conversation. Which of the following responses by the nurse would best represent behavior that supports the value of human dignity in nursing practice? a) Getting up and walking out of the break room because her break is over b)Saying that she believes that this discussion is inappropriate and disrespectful to the client and that she does not want to be a part of it c)Laughing and joining in the conversation even though the nurse really does not believe that the client is as bad as her peers say that he is d)Beginning to tell what the client did to her last week, even though she treats the client with dignity because he cooperates better with his plan of care
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b
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A nurse is aware that the principle of autonomy is being applied in which of the following situations? a) The client has decided to stop chemotherapy treatments. b) A hospice consult is ordered by the nurse. c) An order for an antibiotic is being written in the chart. d) The family is discussing care with the physician.
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a
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A client is brought to the emergency department (ED) by the son who states, "I am unable to care for my mother anymore." The nurses identifies this son's ethical problem as being which of the following? a) Dilemma b) Dissatisfaction c) Uncertainty d) Distress
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c
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Choice Multiple question - Select all answer choices that apply.de A nurse seeks to incorporate the principle of bioethics known as nonmaleficence when caring for patients in a long-term care facility. Which nursing actions best exemplify this principle? a)The nurse arranges for hospice for a patient who is terminally ill. b)The nurse acts fairly when allocating time and resources to patients. c)The nurse provides information to patients to help them make decisions about treatment options. d)The nurse performs regular patient assessments for pressure ulcers. e)The nurse follows "medication rights" when administering medicine to patients. f)The nurse keeps promises to provide diligent care to patients.
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de
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A patient rings the call bell to request pain medication. Upon performing the pain assessment, the nurse informs the patient that she will return with the pain medication. The nurse's promise to return with the pain medication is an example of which principle of bioethics? a) Justice b) Fidelity c) Autonomy d) Nonmaleficence
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b
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Which of the following nursing situations is an example of an ethical dilemma? a) Performing cardiac compressions when a signed Do Not Resuscitate order (DNR) is not available b) Transferring a client to a step-down unit c) Discussing care of a comatose client with the family d) Administering pain medication as ordered
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a
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What are standards for decision making that endure for a significant time in one's life? a) Beliefs b) Values c) Ethics d) Roles
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b
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A nursing student is studying the principle of autonomy. Which of the following examples most accurately depicts this principle? a) Transporting a client to a scheduled physical therapy appointment b) Administering a morning dose of insulin before breakfast c) Changing a dressing on a wound as needed d) Describing surgery to a client before the consent is signed
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d
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Which ethical principle refers to the obligation to do good? a) Beneficence b) Nonmaleficence c) Fidelity d) Veracity
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a
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A nurse arrives on the medical unit wearing large dangling earrings. This is an example of which of the following types of conduct? a) Incompetent b) Unethical c) Illegal d) Unprofessional
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b
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Choice Multiple question - Select all answer choices that apply. The International Council of Nurses (ICN) Code of Ethics for Nurses (2005) has which of the following elements? Select all that apply. a) Family b) Profession c) Co-workers d) Practice e) People
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bcde Nurse and people Nurse and practice Nurse and the profession Nurse and co-workers
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Which nursing actions best describe the use of the professional value of altruism? (,Select all that apply.) a) A nurse becomes a mentor to a student nurse working on her floor. b) A nurse respects the right of a Native American to call in a shaman for a consultation. c) A nurse protects the privacy of a patient with AIDS. d) A nurse demonstrates an understanding of the culture of his or her patient. e) A nurse lobbies for universal access to health care. f) A nurse is accountable for the care provided to a mentally challenged patient.
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abd
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Which of the following statements by the nurse is an example of deception? a) "It is important to get out of bed to prevent pneumonia." b) "I will administer your pain medication as soon as it is due." c) "This injection of Novocain will feel like a little pinch." d) "I am going to teach you how to give yourself insulin."
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c
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The foundation for decisions about resource allocation throughout a society or group is based on the ethical principle of a) Autonomy b) Justice c) Veracity d) Confidentiality
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b
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A client is scheduled to have an elective surgical procedure performed and cannot decide if he wants to do it or not. He asks the nurse to help him make the decision because he does not feel that he knows enough about the procedure. Which of the following is the best way for this nurse to advocate for this client? a) Refer the client to the social worker so that she can call in the people who need to help him make his decision. b) Facilitate the client's decision by allowing him to verbalize his feelings and by providing information to help him assess his options. c) Refuse to help the client and state that he must make the decision on his own. d) Call the surgeon and have him explain the procedure again.
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b
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A nurse is acting inappropriately and has an odor of alcohol. This behavior breaches which of the following? a) Fidelity b) Beneficence c) Autonomy d) Ethical conduct
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d
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the nurse is managing the care for a post operative client. How does the nurse demonstrate advocacy? a) Changing the channel on the television while providing care b) Turning and positioning the client every four hours c) Limiting visitors due to client complaining of pain d) Administering pain medication when the pain level reaches 9/10
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c
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An elderly client falls out of bed after a nurse inadvertently left the side rails down. The nurse feels guilty and is upset about the incident. This is an example of which of the following types of ethical situations? a) Distress b) Moralizing c) Accountability d) Dilemma
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A
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A home care nurse visits a patient who is confined to bed and is cared for by her daughter. The daughter is known to suffer from chemical dependence. The home is cluttered and unclean. During the assessment the nurse notes that the patient is wet with urine and has dried feces on her buttocks, and demonstrates signs of dehydration. After caring for the patient, the nurse contacts the physician and reports the incident to Adult Protective Services. This is an example of which ethical framework? a) Beneficence b) Nonmaleficence c) Justice d) Fidelity
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b
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Nurses uphold human dignity when providing care. Examples of this behavior would include what? Select all that apply. a) Providing culturally competent care b) Protecting the privacy of the client c) Promoting universal health care d) Demonstrating accountability e) Maintaining confidentiality
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abc
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A nurse may experience ethical distress in which of the following client situations? a) Administering pain medication as ordered b) Turning and positioning a client every hour c) Continuing IV fluids for a client who wants to die d) Ambulating a client who is postoperative from a hip replacement
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c
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What would be an example of the nurse practicing fidelity? The nurse: a) Stays with the patient during his or her death as promised b) Provides continuity of care c) Withholds information as requested d) Regulates visitors
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a
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Which of the following words is best described by the following: the protection and support of another's rights? a) Advocacy b) Ethics c) Autonomy d) Paternalism
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a
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A nurse educator understands that his teaching was effective regarding the Code of Ethics for Nurses when students state which of the following? a) "The code provides nurses with specific action guides for practice." b) "The code is an expression of nursing?s own understanding of its commitment to society." c) "The code critiques existing patterns of oppression and domination in society." d) "The code enables nurses to provide good care to clients."
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b
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A nurse is providing care for a client with cancer. The client's wife indicates that she does not want her husband to be told he is terminal. This is a breach of which of the following ethical principles? a) Nonmaleficence b) Fidelity c) Beneficence d) Autonomy
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b
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An emergency department nurse and healthcare team, caring for a 2-year-old, semiconscious child with numerous fractures and evidence of cigarette burns, suspect child abuse. The nurse reports the family to the child abuse hotline. The nurse is following which ethical principle? a) Justice b) Fidelity c) Nonmaleficence d) Beneficence
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c
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Choice Multiple question - Select all answer choices that apply. Which of the following actions by the nurse demonstrates the principle of fidelity? Select all that apply. a) Taking scheduled breaks on time b) Calling in sick due to lack of sleep c) Taking an extra client assignment due to high acuity d) Working an extra shift due to inadequate staffing e) Refusing to cross a picket line during a strike
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ce?
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Choice Multiple question - Select all answer choices that apply. The nurse educator provides an educational session to the nursing staff on protection of a client's privacy. Which circumstances, identified by the staff, would indicate to the educator that the teaching was effective? Select all that apply. a) The nurse removed the client from the emergency department waiting room into a private area to collect assessment data. b) The nurse questioned the client about her social life even though it did not affect care planning. c) Because the facility is a teaching facility, the nurse allowed the nursing student to take the client?s picture for his care plan. d) With the client?s permission, the nurse explained the client?s diagnosis to the client?s spouse. e) During a bed bath, the nurse exposed the client?s upper torso while washing the client?s face.
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ad
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Choice Multiple question - Select all answer choices that apply. Legal safeguards are in place in the nursing practice to protect the nurse from exposure to legal risks as well as protect the patient from harm. What are examples of legal safeguards for the nurse? (Select all that apply.)a,d,e a)The nurse obtains informed consent from a patient to perform a procedure. bThe physician is responsible for administration of a wrongly prescribed medication. c)The nurse executes physician orders without questioning them. The nurse educates the patient about the Patient Bill of Rights. e) The nurse documents all patient care in a timely manner. f) The nurse claims management is responsible for inadequate staffing leading to negligence.
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a,d,e
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A client newly diagnosed with congestive heart failure has a prescription for digoxin (Lanoxin). The nurse counts the heart rate before administration of the medication and obtains a heart rate of 51 beats per minute. Which action by the nurse demonstrates adherence to the standards of nursing care? a) Nurse withheld the medication, retook the heart rate, and gave it at a later time b) Nurse administered the medication and reassessed the client in 30 minutes c) Nurse administered the medication after reviewing the client?s serum potassium level d) Nurse withheld the medication and notified the health care practitioner
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d
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Choice Multiple question - Select all answer choices that apply. A,d Which of the following is an area of potential liability for the nurse? Select all that apply. a)The nurse documents that the client's blood pressure has increased from 118/72 to 188/98 and decides to re-take the blood pressure in an hour. b)The nurse administers the client's preoperative medication after the informed consent is signed. c)The nurse notifies the physician of the client's adverse reaction to a medication. d)The nurse fails to document refusal by the client to ambulate following surgery. e)The nurse documents that the client accurately prepared the correct amount of insulin after instruction was given.
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a,d
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During the admission assessment of a 40-year-old female patient with a suspected mandibular fracture, the patient discloses to the nurse that her injury came as a result of her husband hitting her. Which of the following actions should the nurse prioritize when responding to this disclosure? a) Performing an assessment to confirm the patient's statement b) Reporting the abuse to the appropriate authorities c) Informing the patient of her right to keep this information private d) Ensuring the patient's statement is confirmed by another nurse
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Reporting the abuse to the appropriate authorities Correct Explanation: Nurses have a legal and ethical obligation to report cases of abuse. It would be inappropriate and likely unethical to require a third party witness to the statement or to withhold action pending assessment results. The nurse's obligation to report abuse legally supersedes the patient's right to privacy
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A nurse who obtains a license to practice nursing by misrepresenting him or herself is guilty of what tort? a) Assault b) Libel c) Slander d) Fraud
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Fraud Correct Explanation: Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property. The example in the question is an example of fraud. Assault is a threat or an attempt to make bodily contact with another person without that person's consent. Slander is one form of defamation of character. Defamation of character is an intentional tort in which one party makes derogatory remarks about another that diminish the other party's reputation. Slander is spoken defamation of character; libel is written defamation.
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Choice Multiple question - Select all answer choices that apply. Which of the following is an area of potential liability for the nurse? Select all that apply. a) The nurse fails to document refusal by the client to ambulate following surgery. b) The nurse documents that the client accurately prepared the correct amount of insulin after instruction was given. c) The nurse notifies the physician of the client's adverse reaction to a medication. d) The nurse administers the client's preoperative medication after the informed consent is signed. e) The nurse documents that the client's blood pressure has increased from 118/72 to 188/98 and decides to re-take the blood pressure in an hour.
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• The nurse documents that the client's blood pressure has increased from 118/72 to 188/98 and decides to re-take the blood pressure in an hour. • The nurse fails to document refusal by the client to ambulate following surgery. Correct Explanation: Areas of potential liability would include failure to document refusal by the client to participate in the treatment regimen, such as ambulation after surgery, and failure to assess the client in a timely manner. Waiting an hour to reassess a significant elevation in blood pressure does not meet the standard of care. Reporting a client's adverse reaction to a medication, administering preoperative medication after the informed consent is signed, and documenting the client's response to teaching are nursing behaviors that meet the standard of care. (less)
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Choice Multiple question - Select all answer choices that apply. A nursing student administers an overdose of a narcotic to a client and the client arrests. When discussing the incident with nursing faculty, which statements, if made by the student, indicate the need for further teaching? a) ?I cannot be held liable because this is only my second time at this facility.? b) ?I realize that I am held to the same standards as a registered nurse.? c) ?I should have informed you that I felt unprepared for my assignment.? d) ?I have also put the nursing faculty at risk with my action.? e) ?I am glad I am a student because nursing faculty will be blamed, not me.?
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• ?I am glad I am a student because nursing faculty will be blamed, not me.? • ?I cannot be held liable because this is only my second time at this facility.? Correct Explanation: A nursing student is responsible and held liable for his or her own actions. The student is responsible for being familiar with the facility?s policies and procedures. The student is held to the same standards as a registered nurse, and puts the clinical faculty at risk and should inform faculty when unprepared for an assignment.
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Nurse Practice Acts are examples of which type of laws? a) Statutory laws b) Administrative law c) Constitutional laws d) Common law
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Statutory laws Correct Explanation: Nurse Practice Acts are statutory laws. Statutory laws must be in keeping with both the federal constitution and the state constitution.
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A client admitted with Hodgkin disease has a handwritten prescription for vinblastine 3.7 mg intravenously (IV) weekly. The nurse interprets the prescription as vincristine 3.7 mg and administers the wrong medication. The client becomes neurovascularly compromised and has a fatal reaction to the medication. The client's family begins a litigious suit against the facility and the nurse's license is suspended by the board of nursing. In preparation for the lawsuit, the nurse meets with the nurse attorney to review the events. Which appropriate statement, if given by the nurse, indicates he has an understanding of the lawsuit? a) ?I had a duty and it was my responsibility to get clarification before administering the medication, which I did not.? b) ?I had a duty and it was my responsibility to double check the medication, which I did, yet this still happened.? c) ?I could not read the health care provider?s handwriting, so I am not at fault.? d) "I checked the medication before giving it and literature states it is for Hodgkin disease.?
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?I had a duty and it was my responsibility to get clarification before administering the medication, which I did not.? Correct Explanation: The nurse has a legal obligation to carry out health care provider?s prescriptions unless the order is ambiguous (the nurse could not read provider?s handwriting), contraindicated (vincristine dosage was too high), and contraindicated (wrong medication). The nurse had a duty and needed to get clarification, which he did not. The nurse is liable because there was a duty, which was breached, causation (wrong medication), and harm (client?s death). Checking the medication is the correct thing to do, but the priority was assuring the medication was the correct one as prescribed.
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The nurse educator is presenting a lecture on the Occupational Safety and Health Act. Which situations, if identified by the nursing staff, would indicate to the educator that the staff understands which actions about the Occupational Safety and Health Act? a) Protects nurses who are recovering from drug or alcohol addiction or have communicable diseases b) Requires nurses to report abuse of infants, children, and adults of all ages c) Helps reduce workforce injuries and illness in the workplace d) Acts as an information clearing house for nurses who engage in unprofessional conduct
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Helps reduce workforce injuries and illness in the workplace Correct Explanation: The Occupational Safety and Health Act helps to reduce injuries and illness in the workplace. The National Practitioner Data Bank is a clearinghouse for health care practitioners who engage in unprofessional conduct and restrict them from moving from state to state. Nurses are obligated to report abuse because of the nurse-patient relationship; it is not a requirement of the Occupational Safety and Health Act. The American with Disabilities Act protects people with communicable diseases and those recovering from drug or alcohol addiction
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Choice Multiple question - Select all answer choices that apply. The nurse educator is presenting an in-service on nursing and malpractice. Which statements, made by the nursing staff, would indicate to the educator that further teaching is required? Select all that apply. a) ?If I make a mistake, I will not tell anyone? b) ?The nursing plan of care must be accurate and be followed. It is part of the client?s permanent record.? c) ?I am accountable for any task that I delegate.? d) ?When I document, I make sure it is factual, accurate, complete, and timely.? e) ?I will have the supervisor fill out the incident report when I make an error.?
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• ?If I make a mistake, I will not tell anyone? • ?I will have the supervisor fill out the incident report when I make an error.? Correct Explanation: Errors and mistakes should be reported and incident reports filled out. The incident report should be filled out by the person responsible for the error. Documentation should be accurate, factual, complete, and timely. Nurses are accountable for any designated task. The nursing plan is part of the client?s permanent record.
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A client is received in a postoperative nursing unit after undergoing abdominal surgery. During this time, the nurse failed to recognize the significance of abdominal swelling, which significantly increased during the next 6 hours. Later, the client had to undergo emergency surgery. The lack of action on the nurse's part is liable for action. Which of the following legal terms describes the case? a) Misdemeanor b) Felony c) Tort d) Fraud
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Tort Correct Explanation: A tort is a litigation in which one person asserts that a physical, emotional, or financial injury was a consequence of another person's actions or failure to act. The lack of action on the nurse's part truly indicates unintentional tort. A misdemeanor or felony would be an offense under criminal law, and neither is applicable in this case. Fraud is willful and purposeful misrepresentation that could cause, or has caused, loss or harm to a person or property.
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A nurse, while off-duty, tells the physiotherapist that a client who was admitted to the nursing unit contracted AIDS due to exposure to sex workers at the age of 18. The client discovers that the nurse has revealed the information to the physiotherapist. With what legal action could the nurse be charged? a) Negligence b) Malpractice c) Slander d) Libel
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Slander Correct Explanation: The nurse can be charged with slander, which is a verbal attack on a person's character. Libel pertains to damaging written statements read by others. Both libel and slander are considered defamation of character - an intentional tort in which one party makes derogatory remarks about another that diminish the other party?s reputation. Negligence and malpractice pertain to actions which are committed or omitted, thereby causing physical harm to a client.
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A student nurse is assisting an elderly patient to ambulate following hip replacement surgery, and the patient falls and reinjures the hip. Who is potentially responsible for the injury to this patient? a) The student nurse b) The nurse instructor c) The hospital d) All of the above
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All of the above Correct Explanation: As a student nurse, you are responsible for your own acts, including any negligence that may result in patient injury. A hospital may also be held liable for the negligence of a student nurse enrolled in a hospital-controlled program because the student is considered an employee of the hospital. The status of students enrolled in college and university programs is less clear, as is the liability of the educational institution in which they are enrolled and the health care agency offering a site for clinical practice. Nursing instructors may share responsibility for damages in the event of patient injury if an assignment called for clinical skills beyond a student's competency or the instructor failed to provide reasonable and prudent clinical supervision.
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A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an examination. She informs the physician and the nursing supervisor about this incident and also completes an incident report. Which of the following actions by the nurse indicates correct knowledge of handling an incident report? a) Documents a complete description of the happenings in the client's records b) Makes a copy of the incident report and places it in the client's records c) Mentions in the client's report that an incident report was completed d) Makes a copy of the incident report to give to the physician
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Documents a complete description of the happenings in the client's records Explanation: An incident report is a written account of an unusual, potentially injurious event involving a client, employee, or visitor. It is kept separate from the medical record. The incident report is a legal document and making a copy of it is not advisable. It should not be placed in the client's records; however, the nurse can mention the incident in the client's records without mentioning the incident report.
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An HIV-positive client discovers that his name is published in a research report on HIV care prepared by his nurse. He is hurt and files a lawsuit against her. Which of the following offenses has the nurse committed? a) Unintentional tort b) Invasion of privacy c) Defamation of client d) Negligence of duty
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Invasion of privacy Correct Explanation: The nurse has committed the tort of invasion of privacy. Personal names and identities are concealed or obliterated in case studies or research work. Invasion of privacy is a type of intentional tort. Defamation is an act in which untrue information harms a person's reputation, and is therefore not applicable here. Negligence is the harm that results because a person did not act reasonably.
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A client informs the nurse that he is leaving the healthcare facility because he is not satisfied with the treatment. The nurse knows that the client's treatment is incomplete and further testing and evaluations are scheduled. Which action by the nurse would be most appropriate to prevent false imprisonment? a) Tell the client that he will not be able to get access again b) Restrain the client to prevent him from going c) Ask the client to sign a release without medical approval d) Call the physician to speed up the discharge process
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Ask the client to sign a release without medical approval Correct Explanation: If a client wants to leave the healthcare facility, the nurse should ask him to sign a release stating that he or she left without medical approval. The nurse cannot restrain the client because it amounts to false imprisonment. Calling the physician is not an appropriate measure. Telling the client that he may not be able to access the healthcare facility again is an inappropriate response because healthcare is a right and the client can access it whenever necessary.
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A client with end-stage renal disease decides against further treatment and requests a ?Do Not Resuscitate? (DNR) order. The DNR status is part of the change-of-shift report. The client stops breathing and a nurse begins cardiopulmonary resuscitation. The family is upset and makes a complaint to the charge nurse. When discussing the nurse's action, the charge nurse appropriately identifies which wrongdoing the nurse has violated? a) Assault b) Fraud c) Defamation d) Battery
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Battery Correct Explanation: The nurse has committed battery by performing CPR against the client?s wishes. Assault occurs when a person threatens to touch a client without consent. Fraud is a willful and purposeful misrepresentation, whereas defamation occurs when a derogatory remark is made about another person.
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Choice Multiple question - Select all answer choices that apply. Nurses practice within the legal and mandatory standards of the nursing profession. What are examples of voluntary standards in nursing? (Select all that apply.) a) Rules and regulations of nursing b) American Nurses Association Standards of Practice c) State nurse practice acts d) Professional standards for certification of individual nurses in general practice e) Process of certification
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• American Nurses Association Standards of Practice • Professional standards for certification of individual nurses in general practice • Process of certification Explanation: Voluntary standards in nursing would include the American Nurses Association (ANA) Standards of Practice, the process of certification, and professional standards for certification of individual nurses in general practice. State nurse practice acts is not an example of voluntary standards in nursing. Rules and regulations of nursing are not examples of voluntary standards in nursing.
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The nurse is participating in a discussion about controlled substances. Which statement, made by the nurse, indicates the nurse is aware of laws governing the distribution of controlled substances? a) ?An impaired nurse is promptly punished by being terminated and having his or her license ? b) ?The nurse is only at risk if she diverts medication from the client; using personal drugs decrease your risk.? c) ?Nurses are responsible for adhering to specific documentation about controlled substances.? d) "When a nurse abuses controlled substances in the workplace and gets help, she will not be charged with a criminal act."
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?Nurses are responsible for adhering to specific documentation about controlled substances.? Explanation: Nurses have specific responsibilities regarding controlled substances, including specific documentation. Violation of controlled substances at the workplace is serious and is considered a criminal act. Substance abuse is treatable and the objective is to detect and treat the problem early. It does not matter where the nurse obtains the drugs; she is still liable for her actions
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Which of the following situations is an example of battery that the nurse may experience while performing her nursing duties at the health care facility? a) Telling the client that he cannot leave the hospital b) Performing a surgical procedure without getting consent c) Taking the client's photographs without consent d) Witnessing a procedure done on client without his consent
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Performing a surgical procedure without getting consent Correct Explanation: Performing a surgical procedure without the client's consent is an example of battery. To protect health care workers from being charged with battery, adult clients are asked to sign a general permission for care and treatment during admission and additional written consent forms for tests, procedures, or surgery. Telling the client not to leave the hospital is a false imprisonment. Taking the client's photographs without his permission and witnessing a procedure done on him without consent is violation of the client's privacy.
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A post-anesthesia nurse is reporting about the patient to the intensive care unit nurse in the elevator. There are staff members and visitors in the elevator. The nurse is a) Breaching the patient's confidentiality b) Implementing therapeutic communication c) Maintaining the continuity of care d) Interacting to maintain coordination of care
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Breaching the patient's confidentiality Correct Explanation: The principle of confidentiality requires that information about a patient be kept private. Discussing patients outside the clinical setting, telling friends or family about patients, or even discussing patients in the elevator with other workers violates patient confidentiality and must be avoided.
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A nurse is named as a defendant in a malpractice lawsuit. Which action would be recommended for this nurse? a) Be prepared to tell your side to the press, if necessary. b) Do not volunteer any information on the witness stan c) If a mistake was made on a chart, change it to read appropriately. d) Discuss the case with the plaintiff to ensure understanding of each other's positions.
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Do not volunteer any information on the witness stan Correct Explanation: The nurse on the witness stand should be polite, but not volunteer any information. The nurse should only answer the questions asked. The other examples are not examples of what a nurse should do in a malpractice lawsuit
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A physician is called to see a client with angina. During the visit the physician advises the nurse to decrease the atenolol to 12.5 mg. However, since the physician is late for another visit, she requests that the nurse write down the order for her. What should be the appropriate nursing action in this situation? a) The nurse should inform the client of the change in medication. b) The nurse should write the order and implement it. c) The nurse should ask the physician to come back and write the order. d) The nurse should remind the physician later to write the work order.
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The nurse should ask the physician to come back and write the order. Correct Explanation: The nurse should ask the physician to come back later and write down the order. However, nurses are discouraged from following any verbal orders, except in emergency. The nurse should never write an order on a physician's behalf because this is a wrong practice. The client should be informed about the change of medications, but this is not an appropriate action. The nurse should not leave the work for a later time, because the nurse may forget it.
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Which of the following is an example of certification? a) An education program that meets standards of the National League for Nursing. b) A graduate of a nursing education program who passes NCLEX-RN. c) A hospital that meets the standards of the Joint Commission. d) A nurse who demonstrates advanced expertise in a content area of nursing through special testing.
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A nurse who demonstrates advanced expertise in a content area of nursing through special testing. Correct Explanation: Certification is a voluntary process whereby a person who has met criteria established by a nongovernmental association is granted special recognition in a specified practice area. Licensure is granted by the state to a graduate of a nursing education program who passes NCLEX-RN. Accreditation is a voluntary process by which a nursing education program is recognized as having met certain standards by the National League for Nursing Accrediting Commission and/or the American Association of Colleges of Nursing. The Joint Commission can also accredit healthcare agencies.
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The nursing student is taking an examination on Nursing Ethics and Law. Which choice selected by the student would indicate to the nursing faculty that the student has a good understanding of negligence? a) The nurse assesses distal pulses on a client three hours after a femoral arteriography. b) The nurses assesses for collateral circulation (Allen?s test) before preforming an arterial blood gas (ABG). c) The nurse auscultates breath sounds every 8 hours on a client receiving enteral feedings. d) The nurse advises a visitor to avoid bringing fresh fruit to a client with neutropenia.
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The nurse assesses distal pulses on a client three hours after a femoral arteriography. Correct Explanation: Distal pulses should be checked immediately after a femoral arteriography; therefore, the nurse is negligent for checking three hours after the procedure. Fresh fruit may contain bacteria and further compromise a client with neutropenia. The Allen?s test confirms that there is proper circulation to the hand before drawing an ABG. The nurse checks breath sounds at least every 8 hours for adventitious sounds that may indicate aspiration.
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Which of the following nursing students would most likely be held liable for negligence? a) The nursing student who reports that insulin was not administered to the client by the nurse on the previous shift. b) A nursing student who completes an incident report after administering a medication to a client who experiences an adverse reaction to the medication. c) A nursing student administers medication to a resident, while working as a nursing assistant at a local nursing home. d) A nursing student who performs a dressing change using sterile technique and documents the presence of necrotic tissue in the wound.
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A nursing student administers medication to a resident, while working as a nursing assistant at a local nursing home. Correct Explanation: The nursing student who administers medication to a resident, while working as a nursing assistant at a local nursing home is performing a task outside the scope of the job responsibilities of a nursing assistant. The other options demonstrate legally defensible actions by the nursing student.
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Choice Multiple question - Select all answer choices that apply. A lawyer is describing the litigation process to a nurse named in a malpractice lawsuit. Which statements by the lawyer accurately describe this process? (Select all that apply.) a) "The process of bringing and trying this lawsuit is called litigation." b) "As the defendant, you will be presumed guilty until proven innocent." c) "Common law is based on the principle of stare decisis." d) "The opinions of appellate judges are published and become common law." e) "The defendant is the person who is initiating the lawsuit." f) "We will start litigation in the first-level court known as the appellate court."
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• "Common law is based on the principle of stare decisis." • "The opinions of appellate judges are published and become common law." • "The process of bringing and trying this lawsuit is called litigation." Correct Explanation: The process of bringing and trying a lawsuit is called litigation. The opinions of appellate judges are published and become common law. Common law is based on the principle of stare decisis, or "let the decision stand." After a decision has been made in a court of law, the principle in that decision becomes the rule to follow in other similar cases. The other options listed are not true about the litigation process.
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Choice Multiple question - Select all answer choices that apply. The nurse recognizes liability requires specific elements that must be established to prove that malpractice or negligence has occurred. Identify the specific elements. Select all that apply. a) Duty b) Misrepresentation c) Damages d) Breach of duty e) Breach of confidentiality f) Causation
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• Breach of duty • Damages • Causation • Duty Correct Explanation: Elements of liability are duty, breach of duty, causation, and damages. Misrepresentation occurs in fraud. Breach of confidentiality is a violation of HIPAA.
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Choice Multiple question - Select all answer choices that apply. The nurse attorney provides an educational session to the nursing staff on acts of negligence. Which responses by the staff would indicate to the attorney that the staff can accurately identify acts of negligence? Select all that apply. a) ?I can be charged with negligence if I notify the heath care practitioner about a change in a client?s status, but am unable to reach him and do not follow up or document.? b) ?When I am using a new piece of equipment for the first time, I must make sure I know how to properly operate it.? c) ?I can be charged with negligence if I am following the standards of care for my specialty, which is ambulatory nursing.? d) ?I can be charged with negligence if I apply a heating pad to the client?s skin and the client suffers a first-degree burn.? e) ?I can be charged with negligence if I follow the policy for administering insulin and the client has a reaction to it.?
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• ?I can be charged with negligence if I notify the heath care practitioner about a change in a client?s status, but am unable to reach him and do not follow up or document.? • ?I can be charged with negligence if I apply a heating pad to the client?s skin and the client suffers a first-degree burn.? Correct Explanation: Negligence occurs when a nurse fails to provide care that another nurse with the same educational background would perform. Applying heat and burning the client?s skin is not an act another prudent nurse would do. The nurse must act as the client?s advocate by following up and documenting when a health care provider does not respond to a change in the client?s condition. When a nurse follows correct policies for administering medications, following the standards of care and using equipment in the correct manner eliminates the risk of practicing in a negligent manner.
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Two nurses meet at their home, where one of the nurses discusses a client who had been physically abused. The next day, the client is shifted to another nursing unit after a surgical procedure and comes the care of the second nurse who had been a part of the discussion. The nurse asks the client about the physical abuse. The client discovers that his nurse revealed the information and is hurt. What would be the charges if the client files a suit? a) The nurses could be charged for libel b) The nurses could be charged for slander c) No charges because the second nurse is also involved in client care d) No charges because the revelation took place in off-duty hours
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The nurses could be charged for slander Correct Explanation: Slander is the character attack uttered orally in the presence of others. The injury is considered to occur because the derogatory remarks attack a person's character and good name. In this case, the nurse can be charged with slander. If the defamation had been written, it would be libel. Even if the discussion took place at home and the second nurse was involved in the care, the revelation was without the client's consent. Even if the nurse is in off-duty hours or may not be directly involved in the client's care, the nurse can still be charged with slander.
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The nurse attempts to notify a health care provider about a client's elevated temperature, but does not get a response. Which statement, if documented by the nurse, would indicate that the nurse is following proper protocol for nursing documentation? a) 1300: Client temperature elevated. Telephoned health care provider's service several times with no response. Will notify nursing supervisor during rounds. b) 1300: Client temperature elevated. Health care provider paged, but did not respond. Administered Tylenol without an order because I knew this health care provider does not return calls. c) 1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified. d) 1300: Client temperature elevated. Telephoned health care provider 3 times. As usual, health care provider did not respond.
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1300: Client temperature elevated. Telephoned health care provider's service 3 times without a response. Tepid sponge bath given and nursing supervisor notified. Correct Explanation: Documentation must have the correct, factual, and timely information. The nurse must document when the health provider was called and response or lack of response; what nursing action was done, if any, and notification of appropriate personnel. The nurse cannot administer medication without an order. The nurse should be careful and not make incriminating statements, such as, ?as usual health care provider did not respond.? The nurse should not wait until rounds are made to inform the supervisor.
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The health care facility is involved in litigation by four clients. When reviewing the cases, which legal case would the nurse attorney identify to best describe malpractice? a) The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. b) The nurse administered the wrong medication to the client, who had one episode of vomiting 5 minutes after consuming the medication with no further adverse reactions. c) The nurse using proper mechanics assists a client to a locked bed. He slips and breaks his left femur. d) The nurse applies an ice pack to a client?s lower back without an order and he feels better.
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The nurse administers amoxicillin (Amicar) to a client with known allergies to penicillin. The client has a seizure with resulting respiratory arrest. Correct Explanation: All elements of liability are in place for administering amoxicillin to a client with documented allergies to penicillin: the nurse had a duty, but breached it when giving the medication. There also was causation (amoxicillin) and harm (seizures and respiratory arrest). The nurse is negligent when applying an ice pack without an order. The nurse used proper mechanics, so the client fall is an accident even though harm occurred. Giving the wrong medication could be cause for malpractice, but there was no harm.
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A nurse exits the room of a confused patient without raising the side rails on the bed. The failure to raise the side rails would be which of the following elements of liability related to malpractice? a) Duty b) Causation c) Damages d) Breach of duty
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Breach of duty Correct Explanation: Breach of duty is failing to meet the standard of care, and in this case, it was the failure to execute and document the use of appropriate safety measures. Causation is the failure to use appropriate safety measures that results in injury to the patient. Duty refers to an obligation to use due care and is defined by the standard of care appropriate for the nursepatient relationship. Damages are the actual harm or injury resulting to the patient.
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A client is brought to the Emergency Department in an unconscious state with a head injury. The client requires surgery to remove a blood clot. What would be the appropriate nursing intervention in keeping with the policy of informed consent prior to a surgical procedure? a) The nurse informs the family about advance directives. b) The nurse informs the family about the living will. c) The nurse ensures that the client signs the consent form. d) The nurse ensures that the client's family signs the consent form.
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The nurse ensures that the client's family signs the consent form. Correct Explanation: The nurse should ensure that the client's family signs the consent form. However, in some states and heath care facilities, it is the physician who ensures that the client's family signs the consent form. The client cannot sign the consent if he is not in an alert state or is unable to communicate. If the client is not in a condition to the sign the consent, a family member can sign the consent on his behalf. Advance directives are written statements identifying a competent person's wishes concerning terminal care and are not applicable here. A living will is an instructive form of advance directive; that is, it is a written document that identifies a person's preferences regarding medical interventions to use in a terminal condition, irreversible coma, or persistent vegetative state with no hope of recovery. (less)
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The health care provider prescribes cold therapy every 4 hours for a client after foot surgery. The nurse places the ice pack directly on the client's skin and returns 60 minutes later. After removal of the ice pack, the skin is pale and cold to the touch. The client develops frostbite and begins a lawsuit for malpractice. When reviewing the case, the nurse attorney recognizes which most important statement about the malpractice suit? a) The nurse did have a duty, so the nurse is liable for the damage. b) All elements are in place to hold the nurse liable. c) The client will have difficulty finding causation. d) The standard of care was established, so the nurse will not be held liable.
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All elements are in place to hold the nurse liable. Explanation: All four elements are met: The nurse had a duty. The duty was breached. It is easy to find causation: an ice pack directly on skin for 60 minutes, and harm (development of frostbite) was done
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A nurse hired to work in an ambulatory setting attends new employee orientation. The nurse never worked in ambulatory before and is concerned about the Scope and Standards of Practice for Professional Ambulatory Care Nursing. Which response, given by the nurse educator, would further explain the Scope and Standards of Practice for Professional Care Nursing to the new nurse? a) ?The Scope and Standards of Practice for Professional Ambulatory Care Nursing determines if a nurse is minimally competent to receive a license to practice as a nurse.? b) ?The Scope and Standards of Practice for Professional Ambulatory Care Nursing deal with the professional obligations of a nurse working in the ambulatory setting.? c) ?The Scope and Standards of Practice for Professional Ambulatory Care Nursing sets the standards for the nursing supervisor to assess a nurse.? d) ?The Scope and Standards of Practice for Professional Ambulatory Care Nursing takes precedent over the facility?s policies and procedures.?
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?The Scope and Standards of Practice for Professional Ambulatory Care Nursing deal with the professional obligations of a nurse working in the ambulatory setting.? Correct Explanation: The Scope and Standards of Practice for Professional Ambulatory Care Nursing are the standards of care for nurses working in the ambulatory arena. It does not take precedent over the facility?s policies and procedures, but must be worked in conjunction with the policies and procedures. It is not used for assessing nurses. NCLEX determines if a nurse is minimally competent to practice as a nurse.
