Legal And Ethical Issues in Nursing 6th Edition by Ginny Wacker Guido – Test Bank

 

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Guido, Legal and Ethical Issues in Nursing, 6e
Chapter 05

Question 1

Type: MCSA

In given situations, the nature and degree of reasonable care expected of people providing care may differ depending upon which factor?

1. The individual’s status as a professional
2. The individual’s sense of ethical responsibility
3. The individual’s sense of societal obligations
4. The individual’s understanding of the law

Correct Answer: 1

Rationale 1: Individuals of a specific profession have their own unique care standards. These define the minimal requirements of an acceptable level of care that can be expected of a given profession. They are developed to see that no unnecessary harm comes to the patient and to protect and safeguard the public as a whole.

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

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

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

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.1 Define standards of care from a legal and a nursing perspective.

 

Question 2

Type: MCSA

What would the nurse identify as the most basic purpose of standards of care?

1. To protect and safeguard the public as a whole
2. To ensure that all patients receive state-of-the-art care
3. To protect health care providers and prevent their giving less than quality care
4. To ensure administrative agencies are protected from frivolous lawsuits

Correct Answer: 1

Rationale 1: The standards are meant to protect the public from receiving varying degrees of quality of care.

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

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

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

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.1 Define standards of care from a legal and a nursing perspective.

 

Question 3

Type: MCMA

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

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

Standard Text: Select all that apply.

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

Correct Answer: 1,3,5

Rationale 1: Current nursing literature is a good source of timely information regarding standards of care.

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

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

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

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

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.2 Compare and contrast internal versus external standards of care.

 

Question 4

Type: MCSA

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

1. Mutually acceptable
2. Worldwide
3. National
4. Locality

Correct Answer: 3

Rationale 1: Mutually acceptable is a term to describe these standards.

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

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

Rationale 4: External standards expand beyond locality care standards.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5.2 Compare and contrast internal versus external standards of care.

 

Question 5

Type: MCSA

Which situation supports the charge of malpractice against a professional nurse?

1. A failure on the part of the nurse to allay a patient’s fears about an upcoming procedure
2. A failure on the part of the nurse to ensure that patients only received care for which they could pay
3. A failure on the part of the nurse to establish a therapeutic relationship with the patient
4. A failure on the part of the nurse to exercise reasonable and prudent care in treating a patient

Correct Answer: 4

Rationale 1: There is no standard of care that says the nurse should allay all a patient’s fears. This may be impossible.

Rationale 2: Patients receive care regardless of payment.

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.3 Discuss the concept of the reasonably prudent nurse in defining standards of care.

 

Question 6

Type: MCSA

What does the court consider in determining the nurse’s legal liability for standards of care?

1. Professional conduct, but not experience or education
2. Professional education, experience, and specific conduct
3. Professional education, but not experience or conduct
4. Professional experience, but not education or conduct

Correct Answer: 2

Rationale 1: Professional conduct is not the only consideration.

Rationale 2: Professional education, experience, and specific conduct all could be considered internal standards. These would be used in determining liability.

Rationale 3: Education is not the only consideration.

Rationale 4: Experience is not the only consideration.

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.3 Discuss the concept of the reasonably prudent nurse in defining standards of care.

 

Question 7

Type: MCSA

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

1. The number of years the nurse has practiced as a professional nurse
2. How the nurse’s conduct compares to that of nurses with similar background and experience
3. The experience the nurse has in the particular clinical setting in which the situation occurred
4. The ability of the nurse to perform according to his or her job description

Correct Answer: 2

Rationale 1: Amount of experience is not the most important factor.

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

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

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

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5-5 Describe the importance of standards of care to the individual nurse

 

Question 8

Type: MCSA

The state board of nursing has brought action against a nurse’s license based upon violation of a regulation. What is true about this scenario?

1. Violation of a rule or regulation is not the same as violation of the state nursing practice act.
2. Rules and regulations are only suggested standards of care and do not have to be followed.
3. Rules and regulations are internal to the state board, not the nurse.
4. These rules and regulations have the force of law.

Correct Answer: 4

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

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

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

 

Question 9

Type: MCSA

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

1. No; rural nurses work in a slower paced environment, so they have more time to provide quality personal care.
2. Yes; the rural nurse does not have access to the same quality of inservice education as the urban nurse.
3. No; nurses in rural settings must meet the same standards as those practicing in large urban areas.
4. Yes; it is well known that rural health care is substandard as compared to urban health care.

Correct Answer: 3

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

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.4 Differentiate national versus local standards of care.

 

Question 10

Type: MCSA

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

1. It should be equal to that of any other wound care specialist in the nation.
2. It should be the same as that of any nurse who provides wound care.
3. It should be equal to the practice of a wound care specialist working in the largest facility in the state.
4. It should be the same as that of an average nurse who also holds national wound care certification.

Correct Answer: 4

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

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Assessment

Learning Outcome: 5.4 Differentiate national versus local standards of care.

 

Question 11

Type: MCMA

Which scenarios reflect the “two schools of thought” doctrine?

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

Standard Text: Select all that apply.

1. An honest error in judgment prevented a nurse from providing quality care.
2. The hospital policy and procedures manual lists both local and national nursing care quality standards.
3. Nurses on one unit vary in their choice of ways to deliver quality care.
4. The nurse manager insists that standards are uniform and all nurses must act in the same manner.
5. The nurse expert witness in a case describes two methods of providing the intervention in question.

Correct Answer: 3,5

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

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

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

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

Rationale 5: There may well be more than one way to provide an intervention and still meet the standard of care. This is the basis of the two schools of thought doctrine.

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

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

 

Question 12

Type: MCSA

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

1. Use of the two schools of thought doctrine
2. Logical and appropriate variation in practice
3. An honest error in judgment
4. A violation of hospital policy and procedure

Correct Answer: 4

Rationale 1: The two schools of thought doctrine is used when the court evaluates the standards of care given when the nurse chooses among the alternative modes of treatment. The alternative mode still has to meet standards of care.

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

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

 

Question 13

Type: MCMA

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

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

Standard Text: Select all that apply.

1. The survivors have a good case since hospital policy and procedures do not supersede national standards.
2. The survivors have a good case since the death was unexpected.
3. Since the patient is dead and cannot report variation from the standards no case is possible.
4. The case against the nurses is weak since they followed hospital policy and procedures.
5. The case against the hospital is weak since policies and procedures are current.

Correct Answer: 4

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

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

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Evaluation

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

 

Question 14

Type: MCMA

The administration of a health care facility takes the ethical obligation of protecting patients very seriously. Which actions would help nurses meet standards of care?

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

Standard Text: Select all that apply.

1. Create clearly written policy and procedure manuals.
2. Encourage practitioners to find alternate, quicker ways to implement interventions.
3. Refuse to tolerate those who are slow to adapt new standards of care.
4. Emphasize protection of the hospital when developing internal standards and policies.
5. Schedule regular reviews of policy and procedure manuals.

Correct Answer: 1,5

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

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

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

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

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

Global Rationale:

 

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Planning

Learning Outcome: 5.6 Discuss some of the ethical issues that arise concerning standards of care.

 

Question 15

Type: MCMA

Which situation creates an ethical dilemma for the nurse serving as an expert witness in a jury trial?

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

Standard Text: Select all that apply.

1. The documentation in the medical record contradicts itself.
2. There are time lapses in the documentation of the event resulting in the suit.
3. The interventions implemented only minimally met the standards of care.
4. Outcomes for the patient were unexpected and severe.
5. Nurses from more than one department took care of the patient.

Correct Answer: 1,2,3

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

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

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

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

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

Global Rationale:

 

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Integrated Concepts: Nursing Process: Implementation

Learning Outcome: 5.6 Discuss some of the ethical issues that arise concerning standards of care.