N138 COMPREHENSIVE EXAM UPDATED QUESTIONS AND
SOLUTIONS RATED A+
✔✔Malpractice lawsuits are part of ______ law. - ✔✔civil
✔✔Legal Risks in Professional Nursing Practice: Determining - ✔✔Was the prevailing
standard of care met?
Nursing standard of care is what a reasonable, prudent nurse, under similar
circumstances, would have done
Standard of care - "do no harm" Nonmaleficence
"Prevailing" is ascertained through expert witness testimony, documents, patient record,
other pertinent evidence (direct testimony of those involved)
- what may be negligent now may not have been negligent back then
✔✔2 Requirements of Malpractice Action - ✔✔1. Nurse (defendant) practices with
specialized knowledge and skills
2. Through this practice of specialized knowledge and skills, the nurse caused patient's
(plaintiff's) injury
✔✔4 Elements of Negligence - Failing to Meet Standard of Care - ✔✔1. *Duty* - the
professional nurse assumed duty of care for the client
2. *Breach* - the professional nurse failed to meet standard of care, and thus, basic
prudent nursing care
3. *Causation* - the failure of professional nurse to meet standard of care was the
proximate case of the injury
4. *Damages* - the injury is proved
All 4 elements must be proved
✔✔"Captain of the Ship" Doctrine - ✔✔Implies that the physician is ultimately in charge
of all patient care and thus should be responsible financially (not the case anymore,
outdated)
✔✔Respondeat Superior Doctrine - ✔✔The employer is responsible for the actions of
the employee
✔✔Delegation and Malpractice - ✔✔Professional nurses may delegate independent
nursing activities (as well as medical functions that have been delegated to them) to
other registered nursing personnel
, State NPAs do NOT give LPN/LVNs the authority to delegate since they are not state
licensed
Professional RNs retain accountability for acts delegated to another person; however, if
the task is delegated to another licensed RN, they may also be legally liable if
something goes wrong
It is the legal responsible of the RN to know the limitations of the UAP; UAP absolutely
cannot assess or interpret info that is the responsibility of the RN's (e.g. vital signs can
be obtained or delegated by UAP, but it is the nurse's responsibility to analyze)
✔✔Five Rights of Delegation - ✔✔From licensed RN to a UAP/another licensed RN:
1) Right task
2) Right circumstance - is it appropriate to delegate this task? think about client acuity
3) Right person
4) Right direction/communication
5) Right supervision/evaluate the performance of the task
✔✔Informed Consent - ✔✔Three major conditions:
1. consent must be given voluntarily
2. consent must be given by an individual with the capacity and competence to
understand (in the case of language barriers, need to ensure they understand what is
happening via professional translator--having family members translate is unacceptable)
3. the patient must be given enough information
✔✔Role of Nurse in Informed Consent - ✔✔1. collaborate with primary provider
2. witness patient's signing
3. nurse is NOT responsible for evaluating the physician
4. nurse is responsible for determining that the elements of valid consent are in place,
providing feedback, and communicating the patient's need and further information to the
primary provider
5. advocate for the patient if you sense they want to change their minds, need more
information, etc. and relay that to the primary care team
✔✔Confidentiality - ✔✔A legal and ethical concern in nursing practice; the protection of
private information gathered about a client during the provision of health care services.
The Code of Ethics for Nurses emphasizes the importance of this, and HIPAA
(federally, legally) enforces protections for clients.
✔✔Exceptions to Obligation of Confidentiality - ✔✔Discussing the care of patients to
others who are directly involved in care
Quality assurance activities
SOLUTIONS RATED A+
✔✔Malpractice lawsuits are part of ______ law. - ✔✔civil
✔✔Legal Risks in Professional Nursing Practice: Determining - ✔✔Was the prevailing
standard of care met?
Nursing standard of care is what a reasonable, prudent nurse, under similar
circumstances, would have done
Standard of care - "do no harm" Nonmaleficence
"Prevailing" is ascertained through expert witness testimony, documents, patient record,
other pertinent evidence (direct testimony of those involved)
- what may be negligent now may not have been negligent back then
✔✔2 Requirements of Malpractice Action - ✔✔1. Nurse (defendant) practices with
specialized knowledge and skills
2. Through this practice of specialized knowledge and skills, the nurse caused patient's
(plaintiff's) injury
✔✔4 Elements of Negligence - Failing to Meet Standard of Care - ✔✔1. *Duty* - the
professional nurse assumed duty of care for the client
2. *Breach* - the professional nurse failed to meet standard of care, and thus, basic
prudent nursing care
3. *Causation* - the failure of professional nurse to meet standard of care was the
proximate case of the injury
4. *Damages* - the injury is proved
All 4 elements must be proved
✔✔"Captain of the Ship" Doctrine - ✔✔Implies that the physician is ultimately in charge
of all patient care and thus should be responsible financially (not the case anymore,
outdated)
✔✔Respondeat Superior Doctrine - ✔✔The employer is responsible for the actions of
the employee
✔✔Delegation and Malpractice - ✔✔Professional nurses may delegate independent
nursing activities (as well as medical functions that have been delegated to them) to
other registered nursing personnel
, State NPAs do NOT give LPN/LVNs the authority to delegate since they are not state
licensed
Professional RNs retain accountability for acts delegated to another person; however, if
the task is delegated to another licensed RN, they may also be legally liable if
something goes wrong
It is the legal responsible of the RN to know the limitations of the UAP; UAP absolutely
cannot assess or interpret info that is the responsibility of the RN's (e.g. vital signs can
be obtained or delegated by UAP, but it is the nurse's responsibility to analyze)
✔✔Five Rights of Delegation - ✔✔From licensed RN to a UAP/another licensed RN:
1) Right task
2) Right circumstance - is it appropriate to delegate this task? think about client acuity
3) Right person
4) Right direction/communication
5) Right supervision/evaluate the performance of the task
✔✔Informed Consent - ✔✔Three major conditions:
1. consent must be given voluntarily
2. consent must be given by an individual with the capacity and competence to
understand (in the case of language barriers, need to ensure they understand what is
happening via professional translator--having family members translate is unacceptable)
3. the patient must be given enough information
✔✔Role of Nurse in Informed Consent - ✔✔1. collaborate with primary provider
2. witness patient's signing
3. nurse is NOT responsible for evaluating the physician
4. nurse is responsible for determining that the elements of valid consent are in place,
providing feedback, and communicating the patient's need and further information to the
primary provider
5. advocate for the patient if you sense they want to change their minds, need more
information, etc. and relay that to the primary care team
✔✔Confidentiality - ✔✔A legal and ethical concern in nursing practice; the protection of
private information gathered about a client during the provision of health care services.
The Code of Ethics for Nurses emphasizes the importance of this, and HIPAA
(federally, legally) enforces protections for clients.
✔✔Exceptions to Obligation of Confidentiality - ✔✔Discussing the care of patients to
others who are directly involved in care
Quality assurance activities
