Test bank for essentials of nursing leadership managementm 3rd edition by kelly

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Test Bank for Essentials of Nursing Leadership Managementm 3rd
Edition by Kelly
Chapter 14: Legal Aspects of Health Care
Sample
MULTIPLE CHOICE

1. Mrs. J’s son has medical power of attorney for her and has arrived at her
bedside to discuss care options with her. Mrs. J has just been dialyzed, has not
received any pain medication, and is rational in her decision making. Mrs. J’s
son decides that she should not receive any more dialysis treatments due to
the acute stage of her illness, the discomfort that she has suffered, and her
inability to care for herself. Mrs. J disagrees. Whose decision should be
followed?
a.

Mrs. J’s son

b.

Mrs. J

c.

Both, and the hospital’s ethics committee should
convene and decide

d.

Neither, this is a legal decision and should be done by
a court of law

ANS: B




Even though Mrs. J has given her son legal power of attorney over her health care
decisions, if she is competent and disagrees with the wishes or decision of her agent
(her son), her decisions are the ones that prevail.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: False Imprisonment

2. Good Samaritan laws were enacted to protect the health care professional
from legal liability. An example of care rendered that does not fall into this
category is:
a.

a doctor who delivers a baby during a football game

b.

a nurse who sets a broken leg while hiking in the
mountains

c.

an EMT who, upon arrival at an accident, intubates an
accident victim who stopped breathing and who was
forcibly thrown from his own vehicle

d.

a nurse who stops to help at the scene of a water
skiing accident

ANS: C
Some of the components of care given under the Good Samaritan laws are: care that
is rendered in an emergency situation (the nurse at the water skiing accident or who
sets the broken leg while hiking) and the health care worker not being paid. The
situation of an EMT that did intubate the patient who was thrown from his vehicle
indicates that the EMT arrived in response to a call, and therefore was working at
the time. If the EMT was just passing by and happened to see the accident and was




not called there to render care or was off-duty at the time, then the care would fall
under the Good Samaritan laws. The doctor who delivers a baby during a football
game also rendered care under the Good Samaritan law.

PTS: 1
Laws

OBJ: Cognitive Level: Understanding

TOP: Good Samaritan

3. Providing CPR and resuscitation to a patient who has an advance directive
puts the caregiver at risk for:
a.

negligence

c.

assault

b.

battery

d.

licensure

ANS: B
Failing to honor a patient’s advance directive (living will, medical power of attorney,
or durable medical power of attorney) puts caregivers at risk for charges of
malpractice via battery. An example of negligence would be not honoring the wishes
of a patient who does not have an advance directive and letting him die. Licensure
could be revoked or suspended due to certain acts (or failure to act), but this is not a
guarantee and is dependent upon the circumstances and outcomes involved.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Following Orders, Including Do Not Attempt Resuscitation (DNAR)

4. Tort law is concerned with:




a.

torts and lies, and always being correct

b.

always being correct and failure to show up for jury
duty

c.

failure to show up for jury duty and touching people
when they don’t want to be touched

d.

touching people when they don’t want to be touched
and always being correct

ANS: C

According to The ’Lectric Law Library’s legal lexicon on the Federal Tort Claims Act
(2011), tort is defined as a negligent or intentional civil wrong that does not arise
from a contract or statute, that injures someone in some way, and for which the
injured party can then sue the wrongdoer for damages. Examples of this include the
failure to show up for jury duty (failure to comply with a public duty) and touching
people when they do not want to be touched (battery, which is a type of tort
charge).

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Tort Law

5. Nurse W is a new graduate who is working on a unit project regarding patient
care and gastrointestinal (GI) treatments. While interviewing Mr. P, who has
been incessantly complaining of his lack of daily bowel movements, complete
with graphic details about the type and consistency, she tells him that if he is
not quiet, she will give him an enema he will never forget. Nurse W’s actions
are an example of:




a.

invasion of privacy

c.

assault

b.

battery

d.

defamation

ANS: C
Threatening to touch (or treat) another person without his consent is a definition of
assault. By threatening Mr. P by giving him “an enema he will never forget” if he is
not quiet, Nurse W has threatened to give him a treatment (the enema) against his
will. Battery is the actual act of giving the enema (treatment), and defamation is the
act of giving intentionally false information, communication, or publication (such as
making a statement that could cause an individual to lose his job).

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Assault and Battery

6. Assault differs from battery in that it:
a.

is the act instead of the threat of the act being done
without permission

b.

is the threat instead of the actual act itself being done
without permission

c.

concerns being offensive without permission




d.

concerns the thought without the act or threat

ANS: B
Assault concerns the threat to touch (or treat) another person without his
permission. Battery occurs through the actual act of touching (or treating) another
person without his permission.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Assault and Battery

7. Three types of public laws are:
a.

constitutional, governmental, and criminal

b.

criminal, constitutional, and administrative

c.

criminal, tort, and administrative

d.

administrative, governmental, and civil

ANS: B
Public law defines a citizen’s relationship with the government. Three examples of
these types of laws are: 1) criminal (deals with the actions of individuals that
intentionally do harm to others), 2) constitutional (works from a constitution of




basic laws specifying powers of parts of the government), and
3) administrative (protection of the rights of citizens).

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Sources of Law

8. _____ law is concerned with the protection of the rights of citizens.
a.

Tort

b.

Civil

c.

Administrative

d.

HIPAA (The Health Insurance Portability and
Accountability Act)

ANS: C
Administrative law deals with the protection of the rights of citizens. An example of
this type of law is the Civil Rights Act of 1964, which prohibits forms of
discrimination in the workplace. Civil law deals with how people relate to each
other in everyday matters. It encompasses both tort law and contract law. HIPAA is
a type of federal administrative law and is concerned with the protection of medical
information.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Administrative Law




9. The use of a whiteboard to organize nursing assignments per shift or to give
patients information about their practitioners and/or diagnosis is a violation
of:
a.

civil law

b.

tort law

c.

HIPAA

d.

OSHA (Occupational Safety and Health
Administration)

ANS: C
HIPAA was enacted to safeguard medical information. Some previously accepted
methods for the organization of patient information have now fallen under what is
considered to be HIPAA violations (such as the use of the whiteboard listed above),

as they provide a means for others to access private medical information about
individual patient care. Examples of HIPAA violations include: the use of
whiteboards to organize shift assignments and nursing organizational charts (used
to organize patient treatments, diagnoses, etc.).

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Invasion of Privacy and Confidentiality

10. The Nurse Licensure Compact is:




a.

a plan for all nurses to need only one license with a
large annual fee

b.

a project of the National Council of State Boards of
Nursing

c.

a type of specialized organizational tool used in
licensure and the NCLEX examinations

d.

a spin-off of EEOC legislation

ANS: B
The Nurse Licensure Compact is a project of the National Council of State Boards of
Nursing. It is an agreement among states to allow nurses to be multistate licensed
(without applying for new licenses per state) in those states that have agreed to this
practice (no extra-large fee).

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Multistate Licensure Compact

11. According to contract law, an agreement must contain the following in order
to be considered legal:
a.

an agreement between two people that states what
the first party must do




b.

an agreement between two people in which a fee was

paid up front

c.

a mutual understanding of the obligations that the
contract imposes upon each party

d.

must be a written document

ANS: C
Contract law regulates certain transactions between individuals, legal entities,
and/or businesses. For a contract to be considered legal, it must contain certain
elements such as: 1) a mutual understanding of the terms and obligations that the
contract imposes on each party (not only the first party) to the contract, and 2) an
agreement between two or more legally competent individuals/parties stating what
each must or must not do. It can be either oral or written.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Contract Law

12. There is a going-away party for a nurse you work with who has been
promoted to a managerial position in another facility that is part of the same
health care organization you both currently work under. Photographs have
been taken of nurses around the unit as a way for the nurse to remember
fellow colleagues. If patients are inadvertently photographed and no consent

for this has been obtained, this is an example of:
a.

assault

c.

invasion of privacy




b.

battery

d.

defamation

ANS: C
Consent must always be obtained for any photographs, use of statements made by
patients, or disclosure of confidential information about a patient. To not obtain
consent under these situations is considered to be an invasion of privacy. Assault
deals with the threat to touch another person against his will. Battery is the actual
act of touching or treating another person against his will. Defamation (including
libel and slander) is concerned with intentionally giving false information that may
cause the loss of a person’s reputation.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Invasion of Privacy and Confidentiality

13. The reasonable person standard states that:
a.

it takes a reasonable person to maintain a good
relationship

b.

reasonable people tend to have reasonable children
and make good partners

c.

it is used to demonstrate a breach of duty

d.

it is used by State Boards of Nursing to evaluate the




male-female ratios according to clinical position

ANS: C

The reasonable person standard is used by courts of law when dealing with cases of
potential negligence and malpractice to show what a “reasonable person (nurse)
would do” in a given situation. Reviewing the organization’s policies and
procedures, evidence from the states’ Nurse Practice Act, and the use of expert
witnesses to the standard of nursing practice in that community are all examples of
the reasonable person standard.

PTS: 1
Malpractice

OBJ: Cognitive Level: Understanding

TOP: Negligence and

14. Risk management programs:
a.

help protect hospitals from bioethical problems

b.

have an emphasis upon quality improvement and
protection from financial liability

c.

can be combined with quality management goals;
hence no need for specially trained people

d.

only investigate nurses who do not practice according
to evidence-based practice




ANS: B
Risk management programs in hospitals are set up to investigate and correct system
problems that may contribute to errors in patient care or to employee injury. They
have an emphasis upon quality improvement and the protection of the institution
from financial liability. Ethics departments/programs deal with bioethical problems
and dilemmas. While risk management personnel may reside within a quality
management/improvement department, they are specially trained in risk
prevention and are able to focus on identifying risk behaviors and correcting the
problems.

PTS: 1
Programs

OBJ: Cognitive Level: Understanding

TOP: Risk-Management

15. Nurse C, a nurse with 20 years of OB-GYN experience, was asked to float to
the ER. She refused. Was she correct in this decision and why?
a.

She was correct because if she did this once she may
be expected to float on a regular basis.

b.

She was incorrect because she felt she had enough
seniority to not have to float.

c.

She was incorrect because she just did not want to
float.

d.

She was correct because with her lack of experience in
the ER, she felt she could not safely care for her
patients.




ANS: D
Sometimes, nurses may find themselves in conflict with their health care facility’s
expectations and the standard of care. Being asked to float to another unit,
particularly a specialized one such as the ER, when one has no experience in that
area can put patients at risk and can place their safety in jeopardy. By refusing to
float to this unit, the experienced OB-GYN nurse is advocating for the ER patient’s
rights and safety. When refusing to comply with a request or assignment such as
this, the nurse would be wise to work through the health care facility’s chain of
command and to notify her supervisor of her patient safety concerns. In addition,
nurses should be aware whether the individual contract they signed with the facility

designates criteria for floating to another location or unit.

PTS: 1

OBJ: Cognitive Level: Evaluating

TOP: Other Legal Risks for the Nurse, Doctor, or Hospital

16. Nurses should be sure that their documentation includes a number of key
criteria in order to be thorough and help protect them from liability. Which of
the following is not necessarily correct regarding thorough documentation
practices?
a.

complies with professional practice standards, such as
those provided by the ANA

b.

can use the FATE acronym to ensure good charting
practices

c.

is written evidence of what was done, the patient’s
response, and any revisions made in the patient’s plan
of care

d.

a method of communication among health care
providers responsible for the patient’s care

ANS: B
Documentation serves a number of purposes in health care, but the key reasons why
nurses document are professional responsibility and accountability. Some of the
primary criteria that thorough documentation should contain include: 1) complies
with professional practice standards, such as those provided by the ANA, and with
accreditation criteria, 2) is written evidence of what was done, the patient’s
response, and any revisions made in the patient’s plan of care, 3) a method of
communication among health care providers responsible for the patient’s care, and
4) the FLAT (not FATE) acronym can be used by nurses to help ensure accurate and
thorough documentation.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Documentation

17. Which United States–based entity has the largest electronic health record
system?
a.

U.S. Indian Health Services

b.

U.S. Public Health Service

c.

U.S. Department of Health Services and Resources

d.

U.S. Department of Veterans Affairs




ANS: D
The largest electronic health record (EHR) system in the United States is located at
the U.S. Department of Veterans Affairs. It is called the Veterans Health Information
Systems and Technology Architecture (VistA). The U.S. Indian Health Service has a
similar type of EHR system, but it is not as large.

PTS: 1

OBJ: Cognitive Level: Remembering

TOP: Documentation

18. Which of the following is not one of the reasons that the implementation of
the electronic medical record has been slow in the United States?
a.

stark antidefamation
law

c.

HIPAA

b.

federal antikickback
statute

d.

antitrust laws

ANS: A
Shay (2005) noted a number of reasons why the implementation of the electronic
medical record has been slow in the United States. Some of these factors include: the
federal antiKickback statute, HIPAA, antitrust laws, stark antireferral (not
antidefamation) rules, and concerns about malpractice exposure.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Documentation

19. A state board of nursing that develops rules specifying the duties of
registered nurses is displaying a type of law under which specific branch of
the government at the state level?
a.

tort

c.

administrative

b.

legislative

d.

judicial

ANS: C
When a state board of nursing develops rules that specify the duties of registered
nurses in that state, that board is demonstrating administrative branch law at the
state level. An example at the state level of legislative branch law would be the
Nurse Practice Act. An example of judicial branch law at the state level would be
courts and juries deciding whether a nurse’s actions and behaviors comply with the
law governing the practice of nurses in the state.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Sources of Law

20. A patient is requesting a priest to come and visit. Which type of law is the
nurse following when the nurse calls for a clergy to visit the patient?
a.

administrative

c.

federal

b.

constitutional

d.

state




ANS: B
Several categories of public law affect the practice of nursing. The nurse
accommodates patients’ constitutional right to practice their religion every time the
nurse calls a patient’s clergy as requested, follows a specific religious custom for the
preparation of meals, or prepares a deceased person’s remains for burial.

PTS: 1

OBJ: Cognitive Level: Applying

TOP: Constitutional Law

21. A health care organization can do two things to comply with criminal law to
protect the public. These are:
a.

background checks and drug screens

b.

drug screens and vaccination requirements

c.

vaccination and OSHA requirements

d.

background checks and vaccination requirements

ANS: A
One aspect of criminal law affecting nursing practice is the state and federal
requirement that criminal background checks be performed. This is an attempt to
protect the most vulnerable citizens. Another area of criminal law which affects
nursing practice is the prohibition against substance abuse. Both federal and state

laws require health care organizations to keep a strict accounting of the use and
distribution of regulated drugs. Health care facilities can perform random drug
screens on nurses and all employees as well as drug screens for a condition of
employment.




PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Criminal Law

22. Other than having a legal record of patient care, documentation is important
as:
a.

evidence of physician orders

b.

evidence of professional standard compliance

c.

evidence of staffing patterns

d.

evidence of consent for treatment

ANS: B
Professional responsibility and accountability are two primary reasons why nurses
document. Thorough documentation provides a method of communication among
health care team members, written evidence of what was done for the patient and
evidence of compliance with professional practice standards. Evidence of physician
orders is not seen in documentation nor is the evidence of staffing patterns or
consent for treatments.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Documentation

23. One way to avoid or decrease professional liability is to:




a.

have every employee take a flu shot

b.

have a risk management department

c.

avoid taking telephone or verbal orders

d.

deliver care in teams

ANS: C
There are many ways nurses can use to decrease the risk for liability. One way to do
this is to avoid taking verbal or telephone orders from a health care practitioner. If it
is necessary for the nurse to take a verbal or telephone order, always repeat the
order back to the provider and document on the physician’s order sheet that the
order was “read back” and “verified.”

PTS: 1

OBJ: Cognitive Level: Applying

TOP: Nursing Actions to Decrease Liability

24. The respondent superior law states:
a.

nurses may be sued individually

b.

employers must cover liability insurance for the nurse

c.

nurses must carry liability insurance

d.

the hospital is responsible for nurses damage

ANS: D
It is a well-established law throughout the United States that a “master is subject to
liability for the torts of the servants committed while acting in the scope of
employment.” The law is called the respondent superior. In other words, a hospital,
nursing home, clinic, and so on are legally responsible for the damages caused by
the negligence of their nurses.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Nurses Involved in Litigation

25. State laws are interpreted as administrative rules when they:
a.

specify licensing requirements

b.

specify payment for federal funds

c.

protect employees from violence

d.

mandate the requirements for nursing education




ANS: A
Both the federal government and state government have administrative laws that
affect nursing. The Code of Federal Regulations has rules that health care
organizations must adhere to if they are to qualify for federal funding. Likewise,
state laws are interpreted in administrative rules that specify licensing
requirements for health care providers in the state. Protecting employees from
violence is covered under federal law and mandating requirements for nursing
education is covered under state law.

PTS: 1

OBJ: Cognitive Level: Analyzing

TOP: Administrative Law

MULTIPLE RESPONSE

1. Identify the reasons nurses may need to carry their own malpractice
insurance. Select all that apply.
a.

their institution’s insurance may not cover them if
they fail to comply with its policies and procedures.

b.

nurses are being named individually in lawsuits.

c.

their institution may fail to cover them if they acted
outside the scope of their employment.

d.

nurses are being considered easy targets for lawsuits.




ANS: A, B, C
Some reasons why nurses may consider carrying their own malpractice insurance
pertain to an employer’s liability coverage that might not protect them if it is found
that they acted outside their scope of employment (e.g., NAP who started an IV) or
failed to comply with facility policies and procedures. In addition, nurses are being
named individually as defendants more frequently, and it would be advantageous
for a nurse to be assured of a sound defense independent of the nurse’s employer.

PTS: 1

OBJ: Cognitive Level: Applying

TOP: Professional Liability Insurance

2. Following are suggestions for consulting and collaborating with attorneys.
Which are not correct? Select all that apply.
a.

Look them straight in the eye and try not to worry
about costs.

b.

Be attentive and don’t set your own course.

c.

Retain a specialist and do not notify your carrier of a
possible liability until you are sure.

d.

Weed through the writing and set your own course.

ANS: A, B, C
In the event that you as a nurse are named as a defendant in a malpractice case, it is
important to understand some criteria and guidelines when working with attorneys.

LaDuke (2002) noted a number of helpful suggestions: 1) keep costs
sensible (expenses should be explained up front and sometimes a retaining fee is
paid), 2) be attentive (read the documents your attorney provides), 3) set your own
course (insist on a collaborative relationship with your attorney for the duration of
your case), 4) retain a specialist (professional malpractice, professional disciplinary
proceedings, and employment disputes require the expertise of a specialist in those
areas), 5) DO notify your insurance carrier as soon as you are aware of a real or
potential liability issue, and 6) weed through the writing (your attorney needs to
explain all facts and opinions).

PTS: 1

OBJ: Cognitive Level: Applying

TOP: Nurse | Attorney Relationship

3. A number of issues that impact nursing practice are covered by criminal law.
Which of the following are some of these issues? Select all that apply.
a.

criminal
background checks

c.

Medicare

requirements

b.

prohibition against
substance abuse

d.

reportability of
physical abuse

ANS: A, B, D
Criminal law concentrates on the actions of individuals that intentionally do harm to
others. Some areas of criminal law that affect nurses and nursing practice include:
1) criminal background checks, 2) prohibition against substance abuse, and 3)
reportability of physical abuse. Medicare requirements and eligibility fall under the
administrative law category.




PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Criminal Law

4. Which are terms that relate to the tort law on intentionally false
communication or publication? Select all that apply.

a.

libel

c.

defamation

b.

slander

d.

DNAR

ANS: A, B, C
Defamation is an intentionally false communication or publication (Black’s Law
Dictionary, 2005). Other terms that relate to defamation are: slander (verbal
communication) and libel (written communication). DNAR refers to a do not
attempt resuscitation order on a patient, but is not a term specific to defamation.

PTS: 1

OBJ: Cognitive Level: Understanding

TOP: Defamation

5. A nursing checklist of actions to decrease liability notes a number of different
ways to help prevent liability. Which of the following are suggestions from

this list? Select all that apply.
a.

communicate with your patients and keep them
informed

b.

maintain ongoing monitoring of the process and
outcome of patient care through incident reports,