Chapter 15 Kozier And Erbs Fundamentals of Nursing 10th Edition by Berman Snyder

Chapter 15 Kozier And Erbs Fundamentals of Nursing 10th Edition by Berman Snyder

Complete Chapter Questions With Answers

Sample Questions Are Posted Below

Question 1

Type: MCSA

A client who is being transferred to a rehabilitation center asks the nurse if he can take his chart with him, as it’s his record. How should the nurse respond to this client’s request?

1. “You’ll have to ask your doctor for permission to do that.”
2. “Actually, the original record is the property of the hospital, but you are welcome to copies of your records.”
3. “We’ll make sure that all of your records are sent ahead to the rehab hospital, so you don’t really have to worry about those details.”
4. “There’s a new law that protects your records, so you’re not going to be able to have access to them.”

Correct Answer: 2

Rationale 1: The doctor’s permission is not a requirement for the release of a client’s medical record.

Rationale 2: Although the client’s record is protected legally as private, access to the record is restricted to health professionals involved in the client’s care. The institution or agency is the rightful owner of the client’s record, but the client has the right to access all information contained within his own record and to have a copy of the original record. The hospital has the right to charge a fee for the copying costs. The Health Insurance Portability and Accountability Act (HIPAA) is a law enacted to protect health information and maintain confidentiality of client records.

Rationale 3: The client does have a legal right concerning his medical record, so this option doesn’t adequately address the question.

Rationale 4: This option is not correct; the client does have a legal right to access his medical records.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: IV. C. 3. Protect confidentiality of protected health information in electronic health records

AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients’ right to privacy

NLN Competencies: Context and Environment; Ethical Comportment; Act in accordance with legal and regulatory requirements, including HIPAA, for faculty, students, patients, and families

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. List the measures used to maintain confidentiality and security of computerized client records.

MNL Learning Outcome: 1.1.2. Examine the impact the legal aspects of nursing have on practice.

Page Number: 221

Question 2

Type: MCSA

After classroom discussion regarding confidentiality policies and laws protecting client records, a student asks why it’s permissible for them to review and have access to client records in the clinical area. How should the nursing instructor respond?

1. “Confidentiality and privacy laws don’t apply to students.”
2. “Most students review so many records and charts that they could not possibly remember details from any one of them.”
3. “Records are used in educational settings and for learning purposes, but the student is bound to hold all information in strict confidence.”
4. “As long as the clinical instructor is in the area, accessing client records is part of the education process.”

Correct Answer: 3

Rationale 1: This option is not correct; the laws do apply to students.

Rationale 2: Although this may or may not be a true statement, it is not an appropriate response to the student’s question.

Rationale 3: For purposes of education and research, most agencies allow students and graduate health professionals access to client records. The student or graduate is bound by a strict ethical code and legal responsibility to hold all information in confidence. It is the responsibility of the student or health professional to protect the client’s privacy by not using a name or any statements in the notations that would identify the client.

Rationale 4: Although this is true, the nursing instructor should not imply that the laws of confidentiality don’t apply to students.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: IV. C. 3. Protect confidentiality of protected health information in electronic health records

AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients’ right to privacy

NLN Competencies: Context and Environment; Ethical Comportment; Act in accordance with legal and regulatory requirements, including HIPAA, for faculty, students, patients, and families

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. List the measures used to maintain confidentiality and security of computerized client records.

MNL Learning Outcome: 1.1.2. Examine the impact the legal aspects of nursing have on practice.

Page Number: 222

Question 3

Type: MCSA

The nurse works at an organization that is installing a new computerized record system. What should the nurse learn that has been implemented to help ensure the security of client records?

1. A firewall to protect the server from unauthorized access
2. One unit password to protect the unit’s information
3. Expectation to log off a terminal after using it
4. Expectation to turn the monitor away from view when unattended
5. Requirement to shred all computer-generated worksheets

Correct Answer: 1, 3, 5

Rationale 1: The Security Rule of HIPAA became mandatory in 2005 and governs the security of electronic protected health information. Guidelines for confidentiality and security of computerized records include the installation of a firewall to protect from unauthorized access.

Rationale 2: Guidelines for confidentiality and security of computerized records include assignment of a personal password to enter and log off computer files. The password should not be shared with anyone, including other team members.

Rationale 3: The Security Rule of HIPAA became mandatory in 2005 and governs the security of electronic protected health information. The nurse should learn to never leaving a monitor unattended after logging on.

Rationale 4: The Security Rule of HIPAA became mandatory in 2005 and governs the security of electronic protected health information. Turning the monitor away from view is not a sufficient safeguard.

Rationale 5: The Security Rule of HIPAA became mandatory in 2005 and governs the security of electronic protected health information. Guidelines for confidentiality and security of computerized records include shredding all confidential information.

Global Rationale:

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Management of Care

QSEN Competencies: IV. C. 3. Protect confidentiality of protected health information in electronic health records

AACN Essentials Competencies: IV. 8. Uphold ethical standards related to data security, regulatory requirements, confidentiality and clients’ right to privacy

NLN Competencies: Context and Environment; Ethical Comportment; Act in accordance with legal and regulatory requirements, including HIPAA, for faculty, students, patients, and families

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 1. List the measures used to maintain confidentiality and security of computerized client records.

MNL Learning Outcome: 1.1.2. Examine the impact the legal aspects of nursing have on practice.

Page Number: 222