Chapter 23: Legal Implications in
Nursing
Practice
Chapter 23: Legal Implications in Nursing Practice
Potter et al.: Fundamentals of Nursing, 9th Edition
MULTIPLE CHOICE
1. A newly hired experienced nurse is preparing to change a
patient’s abdominal dressing and hasn’t done it before at this
hospital. Which action by the nurse is best?
1. Have another nurse do it so the correct method can be viewed.
2. Change the dressing using the method taught in nursing school.
3. Ask the patient how the dressing change has been recently done.
4. Check the policy and procedure manual for the facility’s
method.
ANS: D
The Joint Commission requires accredited hospitals to have written nursing
policies and procedures. These internal standards of care are specific and
need to be accessible on all nursing units. For example, a policy/procedure
outlining the steps to follow when changing a dressing or administering
medication provides specific information about how nurses are to perform.
The nurse being observed may not be doing the procedure according to the
facility’s policy or procedure. The procedure taught in nursing school may not
be consistent with the policy or procedure for this facility. The patient is not
responsible for maintaining the standards of practice. Patient input is
important, but it’s not what directs nursing practice.
DIF:Apply (application)REF:303
OBJ: List sources of standards of care for nurses. TOP: Planning
MSC:Management of Care
2. A new nurse notes that the health care unit keeps a listing of
patient names in a closed book behind the front desk of the nursing
station so patients can be located easily. Which action is most
appropriate for the nurse to take?
1. Talk with the nurse manager about the listing being a violation of the
Health Insurance Portability and Accountability Act (HIPAA).
, 2. Use the book as needed while keeping it away from individuals
not involved in patient care.
3. Move the book to the upper ledge of the nursing station for easier
access.
4. Ask the nurse manager to move the book to a more secluded area.
ANS: B
The book is located where only staff would have access so the nurse can use
the book as needed. The privacy section of the HIPAA provides standards
regarding accountability in the health care setting. These rules include
patient rights to consent to the use and disclosure of their protected health
information, to inspect and copy their medical record, and to amend
mistaken or incomplete information. It is not the responsibility of the new
nurse to move items used by others on the patient unit. The listing is
protected as long as it is used appropriately as needed to provide care. There
is no need to move the book to a more secluded area.
DIF:Apply (application)REF:306
OBJ: Describe the legal obligations and role of the nurse regarding federal
and state laws that affect health care. TOP: Implementation MSC:
Management of Care
3. A 17-year-old patient, dying of heart failure, wants to have
organs removed for transplantation after death. Which action by the
nurse is correct?
1. Instruct the patient to talk with parents about the desire to
donate organs.
2. Notify the health care provider about the patient’s desire to donate
organs.
3. Prepare the organ donation form for the patient to sign while still
oriented.
4. Contact the United Network for Organ Sharing after talking with the
patient.
ANS: A
In this situation, the parents would need to sign the form because the
teenager is under age 18. An individual who is at least 18 may sign the form
allowing organ donation upon death. The nurse cannot allow the patient to
sign the organ donation document because the patient is younger than age
18. The health care provider will be notified about the patient’s wishes after
the parents agree to donate the organs. The United Network for Organ
,Sharing (UNOS) has a contract with the federal government and sets policies
and guidelines for the procurement of organs.
DIF:Apply (application)REF:306
OBJ:Analyze legal aspects of nurse-patient, nurse-health care provider,
nurse-nurse, and nurse- employer relationships.TOP:Implementation
MSC:Management of Care
4. An obstetric nurse comes across an automobile accident. The
driver seems to have a crushed upper airway, and while waiting for
emergency medical services to arrive, the nurse makes a cut in the
trachea and inserts a straw from a purse to provide an airway. The
patient survives and has a permanent problem with vocal cords,
making it difficult to talk. Which statement is true regarding the
nurse’s performance?
1. The nurse acted appropriately and saved the patient’s life.
2. The nurse stayed within the guidelines of the Good Samaritan Law.
3. The nurse took actions beyond those that are standard and
appropriate.
4. The nurse should have just stayed with the patient and waited for help.
ANS: C
An obstetric nurse would not have been trained in performing a
tracheostomy (cut in the trachea), and doing so would be beyond what the
nurse has been trained or educated to do. If you perform a procedure
exceeding your scope of practice and for which you have no training, you are
liable for injury that may result from that act. You should only provide care
that is consistent with your level of expertise. The nurse did not act
appropriately. The nurse is not protected by the Good Samaritan Law
because the nurse acted outside the scope of practice and training. The
nurse should have acted within what was trained and educated to do in this
circumstance, not just stay with the patient.
DIF:Apply (application)REF:307
OBJ: Explain the legal concept of standard of care and informed consent.
TOP:EvaluationMSC:Management of Care
5. A nurse performs cardiopulmonary resuscitation (CPR) on a 92-
year-old with brittle bones and breaks a rib during the procedure,
which then punctures a lung. The patient recovers completely
without any residual problems and sues the nurse for pain and
, suffering and for malpractice. Which key point will the prosecution
attempt to prove against the nurse?
1. The CPR procedure was done incorrectly.
2. The patient would have died if nothing was done.
3. The patient was resuscitated according to the policy.
4. The older patient with brittle bones might sustain fractures when chest
compressions are done.
ANS: A
Certain criteria are necessary to establish nursing malpractice. The
prosecution would try to prove that a breach of duty had occurred (CPR done
incorrectly), which had caused injury. The defense team, not the prosecution,
would explain the correlation between brittle bones and rib fractures during
CPR and that the patient was resuscitated according to policy. In this
situation, although harm was caused, it was not because of failure of the
nurse to perform a duty according to standards, the way other nurses would
have performed in the same situation. The fact that the patient sustained
injury as a result of age and physical status does not mean the nurse
breached any duty to the patient. The nurse would need to make sure the
defense attorney knew that the cardiopulmonary resuscitation (CPR) was
done correctly. Without intervention, the patient most likely would not have
survived.
DIF:Understand (comprehension)REF:304 | 309
OBJ: List the elements needed to establish negligence. TOP: Evaluation
MSC:Management of Care
6. A recent immigrant who does not speak English is alert and
requires hospitalization. What is the initial action that the nurse
must take to enable informed consent to be obtained?
1. Ask a family member to translate what the nurse is saying.
2. Request an official interpreter to explain the terms of consent.
3. Notify the nursing manager that the patient doesn’t speak English.
4. Use hand gestures and medical equipment while explaining in English.
ANS: B
An official interpreter must be present to explain the terms of consent if a
patient speaks only a foreign language. A family member or acquaintance
who speaks a patient’s language should not interpret health information.
Family members can tell those caring for the patient what the patient is
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