Legal and Ethical Issues in Nursing 6th Edition by Ginny Wacker Guido Test bank

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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 09
Question 1
Type: MCSA
A newly licensed nurse complains to the preceptor about the amount of time spent documenting in the medical record. What is the preceptors best response?
1. The most important reason we document is to help us communicate the patients condition to the rest of the health care team.
2. Since you just took a course in nursing research, you should realize the value of accurate documentation as a source of research data.
3. We have to document so that charges are clear to third-party payers.
4. The medical record protects us if a lawsuit is filed.
Correct Answer: 1
Rationale 1: The primary reason for documentation is to communicate the patients condition to others on the health care team. The preceptor should remind the newly licensed nurse of this fact.
Rationale 2: Information from the medical record can be used for research with the patients permission, but this is not the primary reason it is important.
Rationale 3: It is true that accurate documentation supports third-party reimbursement, but this is not the most important use of this information.
Rationale 4: The medical record may or may not offer information that would protect the nurse in case of a lawsuit. This is not the primary reason for documentation.
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: 9.1 Discuss purposes of the medical record.

Question 2
Type: MCSA
The nurse manager is aware that several patients will be admitted to the unit today. Todays staff includes three registered nurses, two licensed practical nurses, and three unlicensed nursing assistants. Who should the manager expect to assess and document the admitted patients nursing needs?
1. The nursing assistant
2. The admitting physician
3. A registered nurse
4. A licensed practical or vocational nurse
Correct Answer: 3
Rationale 1: The nursing assistant may collect data such as vital signs, but cannot use the data to plan care.
Rationale 2: The physician plans medical care, not nursing care.
Rationale 3: Documentation of admission assessment and nursing needs is the role of the registered nurse.
Rationale 4: The LPN or LVN can collect data, but does not use the data to plan 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: 9.2 Define and describe basic information to be included in the medical record.

Question 3
Type: MCSA
Nursing home policy states that a registered nurse must cosign all charts that licensed practical nurses complete. What is the effect of this policy on the registered nurse?
1. It places the RN in the position of endorsing and authenticating the entries made in the charts cosigned.
2. It gives legal proof that the RN was in the facility.
3. It has no legal effect on the RN.
4. It makes the RN personally liable for any subsequent harm that befalls the patient.
Correct Answer: 1
Rationale 1: Cosigning is a practice that is becoming less frequent. It does place the nurse potentially liable for care, observations, or omissions as charted.
Rationale 2: The RN may have cosigned at a date other than that of the event, so it does not give absolute proof that the RN was in the facility.
Rationale 3: There are legal implications for endorsing or authenticating entries by cosigning.
Rationale 4: The person delivering the care is also liable for any harm that may occur due to malpractice. Liability does not lie exclusively with the person who cosigned.
Global Rationale:

Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Integrated Concepts: Nursing Process: Evaluation
Learning Outcome: 9.3 List and give examples of guidelines for accurate documentation.

Question 4
Type: MCSA
A patient requests that records of her hospitalization for treatment of an infection following an abortion be destroyed as soon as she is discharged. What is the likely outcome of this request?
1. The record will be sealed.
2. The record will be destroyed.
3. The request will be denied.
4. The record will be given to the patients attorney.
Correct Answer: 1
Rationale 1: Even though the patient has requested that the record be destroyed, medical records departments are generally unwilling to do so. In most cases, the record will be sealed rather than destroyed.
Rationale 2: Destroying the medical record is a permanent action that is generally done only after a specified amount of time, often several years. It is unlikely that the medical records department will honor this request.
Rationale 3: Simply denying the patients request does not fulfill the patients need for privacy of information.
Rationale 4: The hospital will not turn the only copy of this record over to the patients attorney. If a lawsuit were to be filed, the hospital would have no record of the hospitalization.
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: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 5
Type: MCSA
The patient demands to see the actual medical record of a hospitalization that occurred 1 year ago. How should the hospital handle this request?
1. Deny the demand; the patient has no legal right to this record.
2. Have the patient come to the hospital to review the original record.
3. Send the patient a copy of the medical record by registered mail.
4. Do not comply with this demand unless the patient provides a subpoena for the record.
Correct Answer: 2
Rationale 1: The patient does have a legal right to view the record.
Rationale 2: In this case, the hospital should have the patient come to the hospital to review the original record. The patient should be monitored while reviewing this record.
Rationale 3: Making a copy of the record for the patient does not fulfill the patients demand or the patients right to see the original.
Rationale 4: Since the patient has a right to see the original record, there is no need for a subpoena.
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: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 6
Type: MCSA
Which statement, made by a staff nurse, would the nurse manager evaluate as evidence of good understanding of the importance of the electronic medical record?
1. Since nurses are the only ones using this system, I wont have to wait to document anymore.
2. Im glad that it will take less time for us to document.
3. I hope we dont have to keep changing passwords.
4. They say that our patient care will improve while we are using this system.
Correct Answer: 4
Rationale 1: Access to the record is not limited to nursing; all disciplines use the system.
Rationale 2: It does not take less time to document fully using this system.
Rationale 3: Passwords are changed frequently for security purposes.
Rationale 4: Electronic records allow immediate access to patient care information; therefore, patient care is improved.
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: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 7
Type: MCMA
The nurse working in a physicians office recorded assessment data in the wrong patients medical record about 1 hour ago. How should the nurse correct this error?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Black out the error with a marker and enter the new information.
2. Indicate the date and time the correction was made.
3. Indicate the reason the correction is being made by writing wrong patient chart along with the new information.
4. Enclose the corrected information in brackets to set it off from the original post.
5. Either initial or sign the correction.
Correct Answer: 2,3,5
Rationale 1: The information written in error should not be obliterated or blacked out.
Rationale 2: The nurse should indicate the date and the time the correction was made in order to show when the new notation was made.
Rationale 3: There should be some indication of why the correction is being made. Wrong patient chart is adequate explanation.
Rationale 4: There is no reason to bracket the new information.
Rationale 5: Depending upon the extent of the correction, the nurse should either initial or sign the corrected area. It is important to make it very clear who made the new notation.
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: 9.4 Analyze the concepts of alteration of records, retention of records, ownership of the medical record, access to medical records, and computerized charting.

Question 8
Type: MCMA
A patient incident occurred on the nursing unit. What should the nurse caring for the patient do in regard to the incident report?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Carefully document the completion of an incident report in the nurses notes.
2. Write a recommendation for future prevention of such incidents in the report.
3. Include only the facts and the nurses observations in the incident report.
4. Assist the nursing supervisor who will write the report.
5. Include documentation in the medical record about the event that mandated completion of an incident report.
Correct Answer: 3,5
Rationale 1: The completion of an incident report should never be referenced or documented in the nurses notes, which are a part of the patient record. This report is for institutional use only.
Rationale 2: Recommendations for prevention are not part of the incident report.
Rationale 3: The nurse should include what was actually observed in this report.
Rationale 4: The person discovering or directly involved in the incident must complete the report. This could be any staff member, not just the nursing supervisor.
Rationale 5: The facts of what happened to the patient and the patients response must be documented in the medical record.
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: 9.5 Describe important aspects of incident reports.

Question 9
Type: MCSA
As part of conversion to a new electronic medical record format, a hospital is also instituting charting by exception. The nurse manager would caution staff nurses that charting by exception has which major drawback?
1. It may not provide enough information to support trending of the patients condition.
2. It does not allow for use of uniform standards.
3. It is not admissible in court because there is not enough background in the documentation.
4. This method takes much more time than narrative charting.
Correct Answer: 1
Rationale 1: The major problem with charting by exception is that it is often difficult to see the changes or trends that may indicate worsening of the patients condition.
Rationale 2: In order for charting by exception to be meaningful, uniform standards must first be established.
Rationale 3: Charting by exception is admissible in court.
Rationale 4: Charting by exception was designed to reduce charting time.
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: 9.6 Compare and contrast charting by exception to traditional charting.

Question 10
Type: MCSA
The parents of a 17-year-old who is receiving state-funded substance abuse treatment have asked the provider for information about their child. What is the correct action by the health care provider?
1. Refuse the request pursuant to the provision of the common-law duty to disclose.
2. Refuse the request as it is likely to interfere with the treatment plan.
3. Release the information immediately as parents always can receive information on minor children.
4. Release information only if the patient has signed consent to do so.
Correct Answer: 4
Rationale 1: The common-law duty to disclose recognizes the duty to disclose medical information in limited circumstances related to public safety.
Rationale 2: Interference with the treatment plan is not the primary concern.
Rationale 3: It is not true that parents can always receive information on minor children.
Rationale 4: A minor must always sign consent for information about substance abuse to be released, even to a parent.
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: 9.7 Define confidentiality and relate that concept to substance abuse conferences, AIDS/HIV conferences, access laws, child/elder abuse conferences, electronic mail, and Internet service.

Question 11
Type: MCSA
The nursing student began a case study paper by writing, J.P., a 65-year-old Asian male, was admitted to the intensive care unit at Southwest Hospital. What is the significance of this statement?
1. It is incomplete, as the date and time of admission should be included.
2. It is a good description of the patient to begin the paper.
3. It violates Health Insurance Portability and Accountability Act regulations.
4. It is incomplete, as the patients physicians name should be included.
Correct Answer: 3
Rationale 1: Inclusion of additional information such as date and time of admission only makes it easier to identify the patient, which is a HIPAA violation.
Rationale 2: Since information about age, race, and gender is important to the faculty grading the case study, that information should be included.
Rationale 3: The inclusion of the patients initials, age, race, and place of admittance potentially makes it possible to identify the patient, which violates HIPAA.
Rationale 4: The patients physicians name should not be included as it makes it easier for others to identify the patient.
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: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 12
Type: MCMA
The nurse discussing the Health Insurance Portability and Accountability Act (HIPAA) says, I am aware that this act changed the way we handle confidential information. What other provisions of this act should the nurse consider?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. An anti-fraud and anti-abuse program
2. Establishment of state governments as health care regulators
3. A law preventing portability of health care coverage
4. Tax incentives for preventive care
5. Streamlining of transfer of patient information between insurers and providers
Correct Answer: 1,5
Rationale 1: An anti-fraud and anti-abuse program is part of HIPAA.
Rationale 2: The act established the federal government as a national health care regulator.
Rationale 3: This act provides for the portability of health care coverage.
Rationale 4: There are no tax incentives for preventive care included in this act.
Rationale 5: HIPAA was designed to help streamline transfer of patient information between insurers and providers. As part of this streamlining effort, changes to confidentiality also occurred.
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: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 13
Type: MCMA
The patient brings suit against a health care provider. In which ways would the nurse expect this action will affect the confidentiality of the patients medical record?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. The confidentiality of the record will remain intact.
2. The patients attorney will have access to the information in the record.
3. The record loses confidentiality and is discoverable by any interested party.
4. The record will be released to the defendants attorney.
5. Only the judge will have full access to the medical record.
Correct Answer: 2,4
Rationale 1: As being the primary source to describe the course of the patients evaluation, treatment, and change in condition, the medical record is a discoverable record.
Rationale 2: The patients attorney must have access to this information in order to pursue the lawsuit.
Rationale 3: Information in the medical record is not discoverable to anyone who is not involved in the suit.
Rationale 4: The defendants attorney will have access to the medical record.
Rationale 5: Others other than the judge must have access to the medical record to establish and defend the suit.
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: 9.8 Define and analyze applications of the Health Insurance Portability and Accountability Act of 1996 (HIPAA).

Question 14
Type: MCMA
A nurse is preparing information to be distributed at a national conference on AIDS. What should be included regarding mandatory disclosure of AIDS status?
Note: Credit will be given only if all correct choices and no incorrect choices are selected.
Standard Text: Select all that apply.
1. Every state requires that all sexual contacts of a person diagnosed with AIDS be contacted and treated.
2. AIDS status must be disclosed to any health care provider who has cared for the patient within the last 18 months and to any future health care provider.
3. In general AIDS status is considered confidential.
4. All AIDS cases must be reported to the Centers for Disease Control and Prevention or to the state health department.
5. All babies born in the United States are tested for presence of HIV at birth.
Correct Answer: 3,4
Rationale 1: Not all states require or permit this tracking and content.
Rationale 2: There is no regulation mandating disclosure of AIDS status to health care providers.
Rationale 3: In general AIDS status is considered confidential. There are very limited situations in which this status can be disclosed.
Rationale 4: All 50 states require reporting of AIDS cases to the Centers for Disease Control and Prevention or to the state health department for epidemiological purposes.
Rationale 5: There is no universal standard by which all babies are tested for HIV at birth.
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: 9.9 Describe reporting and access laws, including the common-law duty to disclose and limitations to disclosure.

Question 15
Type: MCSA
A nurse strongly believes that all newborns should be screened for HIV at birth. Which ethical principle would the nurse cite to support this argument?
1. Informed consent
2. Confidentiality
3. Beneficence
4. Autonomy
Correct Answer: 3
Rationale 1: Informed consent might be transgressed through mandatory testing.
Rationale 2: Confidentiality might be transgressed by mandatory testing.
Rationale 3: The principle of beneficence (greatest good for greatest number) supports HIV screening of newborns.
Rationale 4: Autonomy might be transgressed through mandatory testing.
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: 9.10 Analyze some of the ethical issues involved in documentation and patient confidentiality.

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