DeWit’s Fundamental Concepts and Skills for Nursing, 5th Edition By Patricia A. Williams -Test Bank
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Sample
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Chapter 03: Legal and Ethical Aspects of Nursing
Williams: deWit’s Fundamental Concepts and Skills for Nursing,
5th Edition
MULTIPLE CHOICE
1. A
student nurse who is not yet licensed:
|
a. |
may not perform nursing
actions until he or she has passed the licensing examination. |
|
b. |
is not responsible for his
or her actions as a student under the state licensing law. |
|
c. |
are held to the same
standards as a licensed nurse. |
|
d. |
must apply for a temporary
student nurse permit to practice as a student. |
ANS: C
Student nurses are held to the same standards as a licensed
nurse. This means that although a student nurse may not perform a task
as quickly or as smoothly as the licensed nurse would, the student is expected
to perform it as effectively. In other words, she must achieve the same outcome
without harm to the patient. The student is legally responsible for her own
actions or inaction, and many schools require the student to carry malpractice insurance.
DIF: Cognitive Level:
Knowledge
REF: p.
32
OBJ: Theory #1
TOP: Practice Regulations for the Student Nurse
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
2. During
an employment interview, the interviewer asks the nurse applicant about HIV
status. The nurse applicant can legally respond:
|
a. |
“No,” even though he or she
has a positive HIV test. |
|
b. |
“I don’t know, but I would
be willing to be tested.” |
|
c. |
“I don’t know, and I refuse
to be tested.” |
|
d. |
“You do not have a right to
ask me that question.” |
ANS: D
In employment practice, it is illegal to discriminate against
people with certain diseases or conditions. Asking a question about health
status, especially HIV or AIDS infection, is illegal.
DIF: Cognitive Level:
Application
REF: p.
34
OBJ: Clinical Practice #1
TOP:
Discrimination
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
3. An
example of a violation of criminal law by a nurse is:
|
a. |
taking a controlled
substance from agency supply for personal use. |
|
b. |
accidentally administering
a drug to the wrong patient, who then has a serious reaction. |
|
c. |
advising a patient to sue
the doctor for a supposed mistake the doctor made. |
|
d. |
writing a letter to the
newspaper outlining questionable or unsafe hospital practices. |
ANS: A
Theft of a controlled substance is a federal crime and
consequently a crime against society.
DIF: Cognitive Level:
Application
REF: p.
32
OBJ: Theory #2
TOP: Criminal
Law
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
4. The
LPN (LVN) assigns part of the care for her patients to a nursing assistant. The
LPN is legally required to perform which of the following for the residents
assigned to the assistant?
|
a. |
Toilet the residents every
2 hours and as needed. |
|
b. |
Feed breakfast to one of
the residents who needs assistance. |
|
c. |
Give medications to the
residents at the prescribed times. |
|
d. |
Transport the residents to
the physical therapy department. |
ANS: C
Toileting, feeding, and transporting residents or patients are
tasks that can be legally assigned to a nurse’s aide. Administering medications
is a nursing act that can be performed only by a licensed nurse or by a student
nurse under the supervision of a licensed nurse.
DIF: Cognitive Level:
Application
REF: p.
33
OBJ: Theory #3
TOP: Delegation
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Coordinated
Care
5. If a
nurse is reported to a state board of nursing for repeatedly making medication
errors, it is most likely that:
|
a. |
the nurse will immediately
have his or her license revoked. |
|
b. |
the nurse will have to take
the licensing examination again. |
|
c. |
a course in legal aspects
of nursing care will be required. |
|
d. |
there will be a hearing to
determine whether the charges are true. |
ANS: D
The nurse may have his or her license revoked or be required to
take a refresher course, but this would be based on the evidence presented at a
hearing. The licensing examination is not usually required as a correction of
the situation as described.
DIF: Cognitive Level:
Knowledge
REF: p.
33
OBJ: Theory #3
TOP: Professional
Discipline
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
6. A
nurse co-worker arrives at work 30 minutes late, smelling strongly of alcohol.
The fellow nurses’ legal course of action is to:
|
a. |
have the nurse lie down in
the nurses’ lounge and sleep while others do the work. |
|
b. |
state that, if this happens
again, it will be reported. |
|
c. |
report the condition of the
nurse to the nursing supervisor. |
|
d. |
offer a breath mint and
instruct the nurse co-worker to work. |
ANS: C
Nurses must report the condition. It is a nurse’s legal and
ethical duty to protect patients from impaired or incompetent workers. Allowing
the impaired nurse to sleep enables the impaired nurse to avoid the
consequences of his or her actions and to continue the risky behavior.
Threatening to report “the next time” continues to place patients at risk, as
does masking the signs of impairment with breath mints.
DIF: Cognitive Level:
Application
REF: p.
33
OBJ: Theory #3
TOP: Professional Discipline
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
7. When
a student nurse performs a nursing skill, it is expected that the student:
|
a. |
performs the skill as
quickly as the licensed nurse. |
|
b. |
achieves the same result as
the licensed nurse. |
|
c. |
not be held to the same
standard as the licensed nurse. |
|
d. |
always be directly
supervised by an instructor. |
ANS: B
Students are not expected to perform skills as quickly or as
smoothly as experienced nurses, but students must achieve the same result in a
safe manner.
DIF: Cognitive Level:
Comprehension REF: p.
33
OBJ: Theory #1
TOP: Practice Regulations for the Student
Nurse
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
8. If a
nurse receives unwelcome sexual advances from a nursing supervisor, the first
step the nurse should take is to:
|
a. |
send an anonymous letter to
the nursing administration to alert them to the situation. |
|
b. |
tell the nursing supervisor
that she is uncomfortable with the sexual advances and ask the supervisor to
refrain from this behavior. |
|
c. |
report the nursing
supervisor to the state board for nursing. |
|
d. |
resign and seek employment
in a more comfortable environment. |
ANS: B
The first step in dealing with sexual harassment in the
workplace is to indicate to the person that the actions or conversations are
offensive and ask the person to stop. If the actions continue, then reporting
the occurrence to the supervisor or the offender’s supervisor is indicated.
DIF: Cognitive Level:
Application
REF: p.
34
OBJ: Clinical Practice #1
TOP: Sexual
Harassment
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
9. A
person who has been brought to the emergency room after being struck by a car
insists on leaving, although the doctor has advised him to be hospitalized
overnight. The nurse caring for this patient should:
|
a. |
have him sign a Leave Against
Medical Advice (AMA) form. |
|
b. |
tell him that he cannot
leave until the doctor releases him. |
|
c. |
immediately begin the
process of involuntary committal. |
|
d. |
contact the person’s health
care proxy to assist in the decision-making process. |
ANS: A
A person has the right to refuse medical care, and agencies use
the Leave AMA to document the medical advice given and the patient’s informed
choice to leave against that advice.
DIF: Cognitive Level:
Application
REF: p.
39
OBJ: Clinical Practice #3
TOP: Patient
Rights
KEY: Nursing Process Step: Implementation
MSC: NCLEX: N/A
10. The
information in a patient’s medical record may legally be:
|
a. |
copied by students for use
in school reports or case studies. |
|
b. |
provided to lawyers or
insurers without the patient’s permission. |
|
c. |
shared with other health
care providers at the patient’s request. |
|
d. |
withheld from the patient,
because it is the property of the doctor or agency. |
ANS: C
A release or consent is required to provide information from a
patient’s medical record to anyone not directly caring for that patient. The
patient must provide consent to provide information to insurers, lawyers, or
other health care agencies or providers. The patient has the right to access
the information in his or her medical record (copies), but the agency or doctor
retains ownership of the document.
DIF: Cognitive Level:
Application
REF: p.
39
OBJ: Theory #5
TOP: Legal Documents
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
11. If a
patient indicates that he is unsure if he needs the surgery he is scheduled for
later that morning, the nurse would best reply:
|
a. |
“Your doctor explained all
of that yesterday when you signed the consent.” |
|
b. |
“Your doctor is in the
operating room; she can’t talk to you now.” |
|
c. |
“You should have the
surgery; your doctor recommended that you have it.” |
|
d. |
“I will call the doctor to
speak with you before you go to the operating room.” |
ANS: D
A consent can be withdrawn at any time before the treatment or
procedure has been started. The primary care provider should be notified by the
supervising nursing staff of the unit.
DIF: Cognitive Level: Application
REF: p.
38
OBJ: Clinical Practice #4
TOP: Informed
Consent
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Physiological Integrity: Basic Care and
Comfort
12. A
16-year-old boy is admitted to the emergency room after fracturing his arm from
falling off his bike while visiting with his stepfather who is not the
custodial parent. The nurse is preparing him to go to the operating room but
must obtain a valid informed consent by:
|
a. |
having the patient sign the
consent for surgery. |
|
b. |
obtaining the signature of
his stepfather for the surgery. |
|
c. |
declaring the patient to be
an emancipated minor. |
|
d. |
obtaining permission of the
custodial parent for the surgery. |
ANS: D
The patient is a minor and cannot legally sign his own consent
unless he is an emancipated minor; the guardian for this patient is the
custodial parent. A step parent is not a legal guardian for a minor unless the
child has been adopted by the step parent. The hospital does not have the
authority to declare the patient an emancipated minor.
DIF: Cognitive Level:
Application
REF: p.
38
OBJ: Clinical Practice #3
TOP:
Consent KEY:
Nursing Process Step: Intervention
MSC: NCLEX: Safe, Effective Care Environment: Coordinated
Care
13. A
patient has advance directives spelled out in a durable power of attorney, with
the appointment of his daughter as his health care agent. The daughter will be
responsible for:
|
a. |
paying all the medical
bills associated with the father’s illness. |
|
b. |
making all informed consent
decisions for her father. |
|
c. |
making all choices about
her father’s health care if the father is unable. |
|
d. |
paying only for those
health care decisions based on the advance directives. |
ANS: C
A health care agent makes decisions for the patient only when a
patient is unable, according to the wishes made known by the patient in advance
directives. A health care agent is not responsible for financial decisions or payments.
DIF: Cognitive Level:
Application
REF: p.
39
OBJ: Clinical Practice #5
TOP: Advance
Directives
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
14. A
patient has signed a do-not-resuscitate (DNR) order. If a nurse performs
cardiopulmonary resuscitation (CPR) when the patient stops breathing and then
successfully revives the patient, the:
|
a. |
nurse could be found guilty
of battery. |
|
b. |
patient would have no
grounds for legal action. |
|
c. |
patient could charge the
nurse with false imprisonment. |
|
d. |
nurse could be found guilty
of assault. |
ANS: A
A nurse who attempts CPR on a patient who had a doctor’s order
for a DNR could be found guilty of battery.
DIF: Cognitive Level: Comprehension
REF: p.
39
OBJ: Clinical Practice #3
TOP:
DNR
KEY: Nursing Process Step:
N/A
MSC: NCLEX: N/A
15. A
patient refuses to take his medications or to eat his breakfast. He is alert,
mentally competent, and fairly comfortable. The nurse should:
|
a. |
give the medications by
injection if the patient will not take them orally. |
|
b. |
respect the patient’s right
to refuse medications or food, because he is competent. |
|
c. |
tell the patient that he
must cooperate with his care. |
|
d. |
contact the doctor to
insert a feeding tube to supply both medicine and food. |
ANS: B
The competent patient has the right to refuse medicine, food,
treatments, and procedures. Giving (or threatening to give) medications by
injection over the patient’s objections is considered battery. Threatening the
patient or overriding the patient’s wishes is a violation of the patient’s bill
of rights and constitutes assault or battery.
DIF: Cognitive Level: Application
REF: p.
40
OBJ: Clinical Practice #3
TOP: Patient’s
Rights
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
16. A
nurse remarks to several people that “Dr. X must be getting senile because she
makes so many mistakes.” If that remark results in some of Dr. X’s patients
changing to another doctor, Dr. X would have grounds to sue the nurse for:
|
a. |
slander. |
|
b. |
libel. |
|
c. |
invasion of privacy. |
|
d. |
negligence. |
ANS: A
A person who makes untrue, malicious, or harmful remarks that
damage a person’s reputation and cause injury (loss of business) is guilty of
defamation and slander. Libel is defamation that is written.
DIF: Cognitive Level:
Application
REF: p.
40
OBJ: Clinical Practice #5
TOP:
Defamation/Slander
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
17. A
licensed nurse is liable for charges of malpractice when she:
|
a. |
does not show up for work
and fails to call to notify the agency. |
|
b. |
clocks in for another nurse
to prevent that nurse from having pay docked. |
|
c. |
falsifies data, causing the
patient to suffer problems resulting in death. |
|
d. |
assists in performing CPR
that is unsuccessful, and the patient dies. |
ANS: C
Malpractice is professional negligence or, in this case, doing
(falsifying) something the reasonable and prudent nurse would not do. It is the
proximate cause of the patient injury. This is a case of causation.
DIF: Cognitive Level:
Application
REF: p. 40|Box 3-6
OBJ: Theory #5
TOP: Negligence and
Malpractice
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
18. A
postoperative patient in the intensive care unit (ICU) is so confused and
agitated that staff have not been able to safely care for him. He has pulled
out his central line once, and he slides to the bottom of the bed, where he
attempts to climb out, pulling and disrupting the various tubes and monitors.
The nurse’s best course of action is to:
|
a. |
place him in a protective
vest device. |
|
b. |
use a sheet to tie him in a
chair at the nurses’ station. |
|
c. |
request that the doctor
write an order for a protective device and/or medication. |
|
d. |
call a family member to
stay with the patient. |
ANS: C
A protective device may not be used (except in an emergency)
without a doctor’s order, and it is used only when other less restrictive means
do not provide safety for the patient.
DIF: Cognitive Level:
Application
REF: p. 41
OBJ: Clinical Practice #3
TOP: False
Imprisonment
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and
Infection Control
19. An
elderly, slightly confused patient sustains an injury from a heating pad that
was wrongly applied by the nurse. The nurse should:
|
a. |
pretend to be unaware of
the injury to the patient. |
|
b. |
report the incident to the
risk management team via an incident report. |
|
c. |
document in the patient’s
medical record that an incident report was filled out. |
|
d. |
not document anything about
the injury in the patient’s medical record. |
ANS: B
When an incident occurs that has potential for a future lawsuit,
the risk management team should be aware of it as soon as possible. An incident
report should be filled out, and the patient medical record should be
documented to describe the injury. No mention of the incident report is usually
made in the patient medical record. Honesty and a forthright explanation to the
patient reduce the risk of lawsuits.
DIF: Cognitive Level:
Application
REF: p.
43
OBJ: Theory #5
TOP: Incident
Reports
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
20. Nursing
liability insurance is a policy purchased and put into effect by the nurse for
the purpose of:
|
a. |
providing protection
against being sued. |
|
b. |
reducing the chance of
litigation. |
|
c. |
paying attorney fees and
any award won by the plaintiff. |
|
d. |
providing the hospital with
added protection. |
ANS: C
Nursing liability insurance pays attorney fees and any award won
by the plaintiff.
DIF: Cognitive Level:
Comprehension REF: p.
43
OBJ: Theory #5
TOP: Nursing Ethics
KEY:
Nursing Process Step: N/A
MSC: NCLEX: N/A
21. Ethics
and law are different from each other in that ethics:
|
a. |
bear a penalty if violated. |
|
b. |
are voluntary. |
|
c. |
rarely change. |
|
d. |
can always direct all
decisions. |
ANS: B
Ethics are voluntary and are based on values. Ethics may change
as parameters of health care change. There is no penalty for violation.
DIF: Cognitive Level:
Analysis
REF: p.
43
OBJ: Theory #6
TOP: Nursing
Ethics
KEY:
Nursing Process Step: N/A
MSC: NCLEX: N/A
22. To
best protect himself or herself from being sued, the nurse should:
|
a. |
continue to do procedures
as taught in school. |
|
b. |
purchase malpractice
insurance. |
|
c. |
maintain competency. |
|
d. |
use evidence-based
practice. |
ANS: C
Keeping up with continuing education, maintaining competency,
and seeking to improve one’s own practice by self-evaluation will best protect
the nurse.
DIF: Cognitive Level:
Comprehension REF: p. 42|Box 3-7
OBJ: Theory #5
TOP: Avoiding
Lawsuits
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
23. The
Health Insurance Portability and Accountability Act’s (HIPAA) main focus is in
keeping:
|
a. |
patients safe from harm. |
|
b. |
patient information in a
secure office area. |
|
c. |
medications in a locked
area. |
|
d. |
hospital infections under
control. |
ANS: B
HIPAA regulates the way patient information is conveyed and
stored.
DIF: Cognitive Level:
Comprehension REF: p. 37|Box 3-4
OBJ: Clinical Practice
#1
TOP: HIPAA
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
24. Which
of the following could place the nurse in a serious legal situation?
|
a. |
A nurse posts a poem about
the qualities of a compassionate nurse on his or her social media page. |
|
b. |
A nurse’s mother shares a
“selfie” of her daughter (a nurse) and a celebrity patient she is caring for
on her social media page. |
|
c. |
A nurse posts a request for
prayer for strength after a difficult day at work. |
|
d. |
A nurse posts a video of
fellow nurse’s lip syncing and dancing to a popular song, “We are Strong.” |
ANS: B
Legal and Ethical Considerations
Social Media and HIPAA
Health care agencies and institutions have had to become more
diligent in protecting personal health information (PHI) as a result. It is
imperative that no PHI be disseminated, either intentionally or unintentionally,
over social media. Posting of pictures, discussions (even those that do not use
patient or hospital names), and images of x-rays all violate HIPAA and place
the nurse in a serious legal situation. It is generally best to separate one’s
personal and professional life when dealing with social media. The National
Council of State Boards of Nursing (2011) provides guidelines and suggestions
for nurses in dealing with social media and nursing practice.
DIF: Cognitive Level:
Analysis
REF: p.
37
OBJ: Clinical Practice #6
TOP: Social Media and
HIPAA
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
25. When
a patient asks a nurse to witness the signing of a will, the nurse should refer
the request to the:
|
a. |
nurse supervisor. |
|
b. |
hospital legal department. |
|
c. |
notary public for the
hospital. |
|
d. |
nurse’s attorney. |
ANS: C
Although witnessing a legal document for a patient is not
illegal, most agencies have a policy regarding the proper course of action by
referring the patient to the notary public.
DIF: Cognitive Level:
Application
REF: p.
39
OBJ: Theory #1
TOP: Witnessing Wills and Other Legal Documents
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Safe, Effective Care Environment: Safety and
Infection Control
26. Criteria
that justify becoming an emancipated minor and able to sign a medical consent
include all of the following except:
|
a. |
independence established
through a court order. |
|
b. |
service in the armed
forces. |
|
c. |
a 14-year-old whose parents
are dead. |
|
d. |
a 17-year-old pregnant
female. |
ANS: C
Criteria are that the minor be independent by court order, be a
member of the military, be pregnant, or be married.
DIF: Cognitive Level: Application
REF: p.
38
OBJ: Clinical Practice #3
TOP: Emancipated
Minor
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
27. A
written statement expressing the wishes of a patient regarding future consent
for or refusal of treatment in case the patient is incapable of participating
in decision making is an example of:
|
a. |
a privileged relationship. |
|
b. |
a health care agent. |
|
c. |
an advance directive. |
|
d. |
witnessed will. |
ANS: C
An advance directive makes the patient’s wishes known regarding
medical decisions and consent in the event that he or she is unable to
participate in decision making.
DIF: Cognitive Level:
Knowledge
REF: p.
39
OBJ: Clinical Practice #5
TOP: Legal Terms KEY: Nursing
Process Step:
N/A
MSC: NCLEX: N/A
28. A
nurse is caring for an unmarried 16-year-old patient who has just given birth
to a baby boy. The nurse will get the consent to perform a circumcision on the
patient’s son from the:
|
a. |
patient’s father. |
|
b. |
patient’s primary care
provider. |
|
c. |
patient’s mother. |
|
d. |
16-year-old patient. |
ANS: D
Pregnancy qualifies as the basis for the 16-year-old to be
treated as an emancipated minor.
DIF: Cognitive Level: Application
REF: p.
38
OBJ: Clinical Practice #3
TOP: Patient
Rights
KEY: Nursing Process Step: Implementation
MSC: NCLEX: N/A
29. A
48-year-old man refuses to take a medication ordered for the control of his
blood pressure. The nurse’s most effective response would be:
|
a. |
“Your doctor expects you to
be compliant.” |
|
b. |
“You have the right to
refuse. This medication keeps your blood pressure under control.” |
|
c. |
“Fine. I will document that
you are refusing this drug.” |
|
d. |
“Are you aware that you
could have a stroke?” |
ANS: B
Patients have the right to refuse medication, but it is the
nurse’s responsibility to explain the reason for the particular drug.
DIF: Cognitive Level: Application
REF: p.
38
OBJ: Theory #1
TOP: Legal
Standards
KEY: Nursing Process Step: Implementation
MSC: NCLEX: Health Promotion and Maintenance: Prevention
and Early Detection of Disease
30. The Occupational
Safety and Health Act includes all of the following, except:
|
a. |
regulations for handling
infectious materials. |
|
b. |
radiation and electrical
equipment safeguards. |
|
c. |
staffing ratios and
delegation criteria. |
|
d. |
regulations for handling toxic
materials. |
ANS: C
The Occupational Safety and Health Act was passed in 1970 to
improve the work environment in areas that affect workers’ health or safety. It
includes regulations for handling infectious or toxic materials, radiation safeguards,
and the use of electrical equipment.
DIF: Cognitive Level:
Comprehension REF: p.
34
OBJ: N/A
TOP:
OSHA
KEY: Nursing Process Step:
N/A
MSC: NCLEX: N/A
31. The
most frequently cited cause of a sentinel event by the Joint Commission is a
problem in:
|
a. |
applying physical
restraints. |
|
b. |
methods of patient
transportation. |
|
c. |
medication errors. |
|
d. |
inadequate communication. |
ANS: D
The most frequently cited cause of a sentinel event by the Joint
Commission is communication. During “handoff” communication, there is a risk
that critical patient care information might be lost due to lack of
communication.
DIF: Cognitive Level:
Knowledge
REF: p.
35
OBJ: Clinical Practice #2
TOP:
Communication
KEY: Nursing Process Step: N/A
MSC: NCLEX: N/A
32. The
acronym SBAR is a method to communicate with a primary care provider that
clarifies a situation that may result in litigation. The acronym stands for:
|
a. |
situation, background,
alterations, results. |
|
b. |
subjective, believable,
actual, recommendation. |
|
c. |
situation, background,
assessment, recommendation. |
|
d. |
situation, basis,
assessment, recommendation. |
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