Chapter 6: Legal Context for Community/Public Health Nursing Practice


Chapter 6: Legal Context for Community/Public Health Nursing Practice
Test Bank


1. In which legislation can most public health documents be found?
a. County or district law
b. Federal acts
c. Local ordinances
d. State statutes
Because states retain powers not delegated to the federal government, states are primarily responsible for health care law. Therefore, most public health legislation is contained in state law.

DIF: Cognitive Level: Knowledge REF: p. 137

2. Which of the following is the name for the rules and regulations written by state boards of nursing?
a. Administrative law
b. Common law
c. Legislative law
d. Tort law
By definition, administrative law comprises the rules and regulations of administrative branches of government.

DIF: Cognitive Level: Knowledge REF: p. 137

3. What are laws passed by a local government unit such as a village, town, or city called?
a. Acts
b. Judicial law
c. Ordinances
d. Statutes
Laws from the legislative branches of the federal and state governments are called statutes. Similar laws from local governments are usually called ordinances. Common law is court-made law or precedent.

DIF: Cognitive Level: Knowledge REF: p. 137

4. Which of the following actions should be taken by a nurse who wants to influence proposed administrative law?
a. Calling, e-mailing, faxing, or writing the leaders of the House of Representatives and Senate concerning what should be included in the administrative law
b. Writing the state legislators to suggest that appropriate legislation be introduced
c. Promising to contribute money to the legislator’s reelection campaign if the administrative law reflects the nurse’s views
d. Providing input, either verbally or in writing, to the involved agency, after notice of proposed rules is published
Administrative law, or the writing of rules and regulations, can be influenced by nurses initiating ideas and commenting on proposed regulations during periods for public review.

DIF: Cognitive Level: Analysis REF: p. 137

5. Which of the following descriptions best reflects the central purpose of laws?
a. Ensuring that the highest priority needs in society are met
b. Ensuring that ethical issues are resolved on the basis of the majority’s agreement about the conclusion represented in the law
c. Helping society maintain employment (e.g., courts, jails and prisons, police officers, attorneys)
d. Maintaining public order and communicating expectations about behavior
e. Ensuring that the desires of the majority in society become the rules
The purpose of laws is to govern society to maintain order and inform citizens and residents of which behaviors are expected and which are not allowed. Although laws typically reflect the will of the majority, laws protect the rights of minority groups as well. Because time and energy are needed for legislation to pass and agencies to implement such legislation, laws may not always be consistent with the current priorities in society.

DIF: Cognitive Level: Comprehension REF: p. 138

6. Who is protected by state laws when an employed nurse provides care to a client?
a. The health care provider and the client
b. The agency or hospital and the client
c. The health care provider and the agency or hospital
d. The client and the general population
Statutes are intended to protect the rights of both the health care provider and the consumer.

DIF: Cognitive Level: Knowledge REF: p. 138

7. A community/public health nurse is providing care to a client who reports that he has received a diagnosis of tuberculosis. The nurse wants to be sure that the legally safe action is chosen when care is provided to this client. With whom should the nurse consult?
a. Agency director
b. State hygienic laboratory personnel
c. Attending physician
d. State’s attorney general
The nurse may ask anyone, but only the attorney general’s written interpretation of the law within that state will protect the nurse if a court case follows.

DIF: Cognitive Level: Application REF: pp. 138-139

8. A nurse’s action resulted in serious harm to a client. Many years later, the client brings a court case against the nurse for damages. What might prevent the case from going to court for a ruling against the nurse?
a. The client agreed to the care at the time.
b. The nurse did not know the chosen action was inappropriate.
c. The nurse thought what was being done was appropriate.
d. The time limit for suing had passed.
Typically, statutes used as the basis for legal action resulting from malpractice or negligence have a limited time frame within which a legal action must be brought. If that time limit has passed, regardless of the nurse’s action, a civil lawsuit cannot go to trial.

DIF: Cognitive Level: Application REF: p. 138

9. A nurse is caring for a client who is ill with a contagious infectious disease that has a high death rate. Which of the following actions should be taken by the nurse?
a. Asking the client to talk to a health care provider about disease progression
b. Reporting the disease if such reporting is required by state law
c. Determining whether the disease is easily transmitted through air or body fluids
d. Encouraging the client to stay at home and not have visitors
A nurse must obey the state law, which is written to protect the community from epidemics of communicable disease. It is important for the client to learn about disease progression; however, the nurse should be able to provide this education. It is important to determine how the disease is spread and, if necessary, encourage the client to avoid contact with others. However, the main concern is the protection of the community by reporting the disease.

DIF: Cognitive Level: Analysis REF: p. 139

10. Under which of the following conditions can a nurse knowingly share confidential information about a particular client with anyone not involved in the client’s care?
a. If a client states lack of concern about publicly sharing information with anyone
b. If the client has an extremely contagious disease, in which case the nurse may tell those possibly exposed
c. If the local public health department decides to encourage the general population to take protective measures
d. If the family requests that others are informed so they may be supportive of the client
State legislatures also enact statutes under health codes that describe laws for reporting communicable diseases. An individual’s right to privacy may conflict with the public health duty to protect the general public. States have a duty to warn unless expressly forbidden by a statute.

DIF: Cognitive Level: Comprehension REF: pp. 138-139

11. In which of the following situations would immunity be granted to a health care provider who reports suspected abuse of a client to a legal authority?
a. The provider believes abuse is occurring and reports it in good faith.
b. The provider can prove the abuse.
c. The provider has at least one other witness to the abuse.
d. The provider has good evidence of abuse.
The nurse is immune from suit if suspected abuse is reported in good faith. It is not the nurse’s responsibility to prove the abuse.

DIF: Cognitive Level: Application REF: pp. 138-139

12. Why is it especially important for the community/public health nurse who provides direct care to clients to know federal legislation?
a. The nurse will be able to inform clients of existing federal programs for which the client may be eligible.
b. The nurse will be aware of new resources and opportunities for clients.
c. The nurse will be able to uphold the current administrative rules and regulations.
d. The nurse will be able to protect himself or herself from “nuisance” suits by knowing all the legal safeguards.
Nurses must have adequate knowledge of federal programs in order to refer clients to programs for which they may qualify. In this case, clients eligible for Medicaid or for services for children with special heath care needs are also eligible for the Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) program.

DIF: Cognitive Level: Comprehension REF: p. 139

13. Which of the following events best describes how judicial law is typically created?
a. Suggestions from agency personnel
b. Case precedents or similar previous court decisions
c. Extensive public debate and a legislative vote
d. Decisions made by judges
Judicial law is based on common usage, custom, and previous court rulings called case precedents.

DIF: Cognitive Level: Comprehension REF: p. 139

14. A community/public health nurse was assigned to care for a home care client whose condition was constantly worsening. Because of overwhelming work issues, the community/public health nurse asked a licensed practical nurse (LPN) to care for the client for one day. When the LPN made an error that harmed the client, the client sued both the LPN and the community/public health nurse. Which of the following is the most likely outcome for this lawsuit?
a. As the supervisor responsible for delegating the care, the nurse is also responsible.
b. The nurse cannot be sued for an error made by someone else.
c. The nurse cannot be sued because the statute of limitations has been met.
d. Under respondeat superior, the nurse is responsible for everything any staff member does at any time.
Because the community/public health nurse delegated care to an LPN for a seriously ill client whose condition was worsening, the community/public health nurse was responsible for the inappropriate delegation and therefore liable to suit for not using professional nursing judgment. As a supervisor, a nurse must not delegate tasks to workers that are beyond the scope of their knowledge base or the legal scope of their practice. If such workers harm a client while providing care, the community/public health nurse’s professional judgment when delegating such tasks will be assessed to determine whether it was reasonable. Respondeat superior occurs when nurses delegate tasks to other workers that are beyond the scope of their knowledge base, and it does not mean that the nurse is responsible for all of the other workers’ actions.

DIF: Cognitive Level: Analysis REF: p. 140

15. A client was extremely upset about her prognosis. The nurse looked the client directly in the eye while holding her hand and reassured her by saying, “You’re going to be alright. You can get through this.” The client’s husband was also present when the nurse reassured his wife. When the wife died, the husband sued the nurse for breach of contract. On what basis can the husband win his case?
a. The nurse should have avoided reassurance, because the client took the reassurance as a promise of the outcome.
b. The nurse should have given better care to help ensure that the wife survived her treatment.
c. The nurse should have read the wife’s medical record to determine her prognosis before reassuring her.
d. The nurse should have reassured the wife only when they were alone, without the husband knowing what was said.
Reassurances may be interpreted by clients as binding promises of outcomes, so it is best to avoid promises and reassurances.

DIF: Cognitive Level: Analysis REF: p. 144

16. A newly employed nurse had read the nurse practice act very carefully. After the first orientation day, the nurse read the agency procedure book from cover to cover and discovered that some policies seemed to be contradictory to the state law. Which of the following actions should the nurse take?
a. Ask another nurse working at the agency what to do.
b. Ask the physician what should be done when there are discrepancies.
c. Follow agency policy and procedures that are in place.
d. Report the discrepancies to the agency and volunteer to help revise the policy.
The nurse must uphold the state law regardless of agency policy. A state law overrides any agency policy or procedure. It would be helpful to the agency if the nurse volunteers to help revise the inappropriate policy so the policies are in conformance.

DIF: Cognitive Level: Application REF: p. 145

17. What is the main difference between civil cases and criminal cases?
a. Civil cases involve society as a whole, whereas criminal cases are more limited.
b. Criminal cases are prosecuted by the government, while civil cases involve private persons or businesses.
c. Only in civil cases does the guilty party go to jail; in criminal cases, financial penalties are imposed.
d. The penalties are more severe for civil than for criminal violations because more people are affected.
In civil cases, one person sues another for damages, such as making good a financial loss. Criminal code protects the public; hence, cases against the persons who broke the law are brought by society. Criminal cases typically have more severe penalties, including not only financial penalties but also imprisonment.

DIF: Cognitive Level: Comprehension REF: p. 145

18. In which of the following statements are legal terms common to civil cases used correctly?
a. “The attorney sued for damages from the plaintiff.”
b. “The defendant sued the plaintiff for damages.”
c. “The plaintiff sued the defendant for damages.”
d. “The plaintiff sued the defendant so that he would be incarcerated.”
The person bringing legal action for breach of civil law is the plaintiff, and the person charged is the defendant. The court’s ruling may include monetary payment commonly known as damages.

DIF: Cognitive Level: Comprehension REF: p. 145

19. If a case of failure to act as a reasonably prudent professional is brought to court, what would this failure be called?
a. Vicarious liability
b. Civil disobedience
c. Criminal action
d. Negligence under tort law
By definition, tort law is the branch of civil law under which professional negligence falls. In vicarious liability, the nurse delegates tasks to other workers that are beyond the scope of their knowledge base. Civil disobedience is the refusal to obey certain laws of a government. Criminal action is the reckless endangerment of other people.

DIF: Cognitive Level: Knowledge REF: p. 146

20. A nurse is the subject of a lawsuit and attempts to demonstrate that her behavior was appropriate. To demonstrate this most effectively, the nurse should do which of the following?
a. Call an expert witness to testify that the behavior was prudent and reasonable for a nurse in such a situation.
b. Hire an attorney who will argue that the physician was responsible for the nurse’s behavior.
c. Describe how the textbooks used while the nurse was enrolled in nursing education endorsed the action that the nurse performed.
d. Explain that the client asked the nurse to engage in that behavior, and the client has the authority to decide on personal care.
The nurse must behave as a reasonable and prudent nurse would. That the nurse did so requires that standards were met. These standards are found in case precedents, testimony of expert practitioners, and the written standards of the American Nurses Association (ANA).

DIF: Cognitive Level: Analysis REF: p. 146

21. Because the client was not incorporating the behavior changes the nurse suggested, the nurse decided to no longer visit the client’s home to give care. Which of the following events would allow the client to successfully sue the nurse?
a. The nurse did not tell the client that no further visits would be made and did not suggest other options for care.
b. The nurse supervisor agreed that the suggested changes for the client’s care were unreasonable.
c. The jury believed that the client was always right, regardless of the improperness of the client’s behavior.
d. The physician sided with the client against the nurse and stated that the nursing plan of care was unreasonable.
The nurse was guilty of abandonment because the nurse did not give the client reasonable notice or refer the client to any other source of care.

DIF: Cognitive Level: Application REF: p. 146

22. The nurse described the risks and benefits of immunization to an infant’s mother and told her what immunization would be administered. The mother held the infant’s leg as the nurse administered the injection. The next day the mother called the clinic supervisor and stated she was going to sue because the infant’s leg was red, swollen, and clearly painful. Which of the following actions should the nurse take?
a. Explain that the symptoms, if given some time, will eventually resolve on their own.
b. Emphasize that this type of a reaction is rare and unpredictable.
c. Remind the mother that they had discussed immunizations and that she had held the infant’s leg during the injection, and therefore informed consent had been given.
d. Stress that the infant has more immunity against the disease because of the immunization.
The mother had clearly given informed consent as is implied with holding the baby for the procedure to be done. The symptoms are not atypical for an immunization, and no permanent harm was apparently done.

DIF: Cognitive Level: Analysis REF: p. 147

23. An 84-year-old woman with diabetes had leg ulcers that necessitated long-term treatment because of her condition. One day, the client was angry because the nurse was late for their scheduled appointment and refused to let the nurse enter the house. Which of the following would be the best action for the nurse to take?
a. Accept that the client has the right to deny consent but try to visit later when she may not be quite so upset.
b. Call a legal consult because the client has obviously lost the ability to make rational decisions.
c. Demand the client sign an “against medical advice” slip or else change the dressings, using coercion as necessary.
d. Walk away, document the client’s refusal, and accept the client’s decision.
Giving treatment without consent would be assault and battery. The client has the right to deny consent for treatment at any time, but because this issue may be situational, the nurse needs to try again to confirm permanent refusal or to renegotiate a treatment plan.

DIF: Cognitive Level: Analysis REF: p. 148

24. The nurse left a client a telephone answering machine message with his laboratory results so that he could listen at his convenience. Upon hearing that this happened, which of the following would be the most likely action taken by the nurse’s supervisor?
a. Explaining to the nurse that it is the client’s responsibility to get in touch with the clinic office
b. Applauding the nurse’s actions for showing good use of technology
c. Asking other nurses to follow this example as it made very efficient use of agency time
d. Instructing the nurse to leave a name and phone number for the client to return the call
Because of confidentiality concerns, no information should be left on an answering machine except the caller’s name and telephone number.

DIF: Cognitive Level: Analysis REF: p. 148

25. After a nurse talked to the physician over the phone, a medication was ordered over the phone, and the nurse gave the young boy his first dose. The boy almost immediately showed serious signs of allergy, and the nurse immediately administered adrenaline per standing orders of the agency. The nurse breathed a sigh of relief that the boy was okay until the boy’s mother exclaimed, “We are definitely suing you.” Which of the following would be the most likely reason that the mother would win such a suit?
a. The nurse did not correctly apply the rights of medication administration.
b. The nurse caused significant emotional distress to the boy and mother.
c. The nurse is the one who administered the drug to the boy that caused the reaction.
d. The nurse has no evidence that the physician ordered the offending drug.
Verbal orders can be a source of risk to the community/public health nurse. The dangers of miscommunication are greatly heightened when communication is verbal. If the mother wins the suit, it may be because the nurse cannot prove what the physician said with just a verbal order. The nurse will have difficulty demonstrating that the doctor’s verbal order was followed accurately.

DIF: Cognitive Level: Analysis REF: p. 149

26. A 17-year-old mother signed her name on the consent form for her child to have an influenza immunization. The nurse asked the mother if she also wanted a flu immunization. If the mother said, “Yes,” can the nurse give her the injection?
a. No, unless the 17-year-old had her parents’ consent
b. Yes, if the mother signs her own consent form
c. Yes; it is important that both mother and child be protected
d. It would depend on the laws in that state regarding emancipated minors
It would depend on state law. Some states recognize teenagers living apart from their parents with their own children as independent, but some states do not. Without such legal protection, the young woman would need a parent’s consent to obtain the immunization.

DIF: Cognitive Level: Application REF: p. 149

27. The new nurse was proceeding through orientation and following the assigned mentor throughout the day when an elderly man was admitted to the home care agency for posthospitalization care. The mentor stressed the importance of asking whether the client had a durable power of attorney. Why would the mentor want this question answered?
a. Agencies are required by law to ask whether such a document exists.
b. The elderly client may not be capable of making his own decisions much longer.
c. If the client becomes confused, the nurse will know which family member to ask for a decision about his care.
d. The information will tell the nurse whether resuscitation should be performed.
The Client Self-Determination Act of 1992 requires that facilities that receive federal funding (including hospitals, nursing homes, home health agencies, hospices, and prepaid health care organizations) inquire whether clients being admitted to their services have executed a living will or special directive.

DIF: Cognitive Level: Application REF: p. 149

28. Which of the following is the best definition for “standard of care”?
a. What a reasonably prudent nurse would do in the same situation
b. What is currently being advocated in nursing textbooks
c. What has been outlined in the policies and procedures of the agency
d. What the customary traditional practices in the community are
Although all of the possible responses may be used in debating what to do in a particular situation, the standard of care is care that a reasonably prudent nurse would provide in similar circumstances.

DIF: Cognitive Level: Knowledge REF: pp. 151-152

29. What is the primary purpose of incident reports?
a. Documenting that a particular nurse should not be retained
b. Documenting the breach in a standard of care
c. Punishing the employee at fault
d. Recognizing patterns of possible problems
Incident reports are used for risk management and to help agencies see the situations in which problems are occurring so that procedures and policies can be revised to prevent further recurrences and possible harm to clients.

DIF: Cognitive Level: Comprehension REF: p. 152

30. What should incident reports always include?
a. The person who was responsible for the occurrence of the incident
b. The nurse’s objective observation of the incident
c. The nurse’s perspective as to what probably happened
d. The nurse’s speculation on how such incidents could be avoided in the future
Incident reports should not be alluded to in the client’s record, should not include the nurse’s opinion as to what happened, and should not attempt to place blame; they should contain merely the nurse’s objective observation of the facts.

DIF: Cognitive Level: Knowledge REF: p. 154

31. During orientation at a public health agency, the supervisor informed the nurse that all nurses were legally covered because the agency had its own malpractice/negligence insurance. Which of the following actions should the nurse take?
a. Ask to see a copy of the policy and make sure it totals at least $1 million per occurrence.
b. Continue to carry personal liability insurance for self-protection.
c. Express gratitude because of the high cost of carrying personal liability insurance.
d. Concentrate on providing the best care possible to avoid lawsuits.
Because the agency’s policy is primarily to protect the agency, the nurse must carry a personal liability policy to ensure that an attorney is focused on protecting the nurse.

DIF: Cognitive Level: Analysis REF: p. 155

32. A community/public health nurse offered to take a client to and from the pharmacy in the nurse’s car as the client had no other means of getting her prescription medications. Which of the following statements would most likely be made by the nurse’s supervisor?
a. “Please don’t do that; other clients will start expecting the same service.”
b. “That was very kind and considerate of you to spend your gas and time driving the client.”
c. “You shouldn’t start a habit like that; the client may expect transportation for other errands now.”
d. “Your insurance as an employee may not cover doing personal errands for clients, so avoid taking clients in your personal car.”
If an accident occurs and the client is injured, the fact that the nurse, as an agency professional, is driving a client may cause legal disputes between the various insurance companies, and the nurse may have less legal protection.

DIF: Cognitive Level: Application REF: p. 155

33. What is the relationship between legal obligations and ethical obligations?
a. Legal concerns are always in the news, whereas ethical concerns are not.
b. Legal issues are typically observed before ethical issues are noticed.
c. The nurse must fulfill legal obligations but not necessarily ethical ones.
d. When ethical issues become a social concern, laws are passed to provide guidance.
Ethical issues typically are noticed and in the news before society has an opportunity to achieve consensus. Legislation reflects society’s values.

DIF: Cognitive Level: Comprehension REF: p. 155


1. A nurse has relocated to a different state and is reading the nurse practice act of this state. Why must the nurse become familiar with the information in this document? (Select all that apply.)
a. Because the nurse is required to follow such laws when providing nursing care
b. Because the nurse may be sued at any time for any reason
c. Because the nurse may be terminated by the agency if the law is not upheld
d. Because the nurse may have to quote the law to clients to explain nursing procedures
e. Because this law will protect the agency from lawsuits brought by unhappy clients
f. Because this law will protect the rights of both the nurses giving care and their clients
The nurse must know the law because the nurse is legally required to uphold it, even when functioning in relative autonomy in situations in which neither the agency nor the clients may know the law or whether the nurse’s actions are consistent with it. Laws are written to protect the rights of nurses and their clients. If nurses work within the guidelines of the law, safe care will be provided, benefiting both the client and the nurse. Clients can bring lawsuits with or without justification.

DIF: Cognitive Level: Application REF: pp. 155-156

2. In what way did the 1996 Health Insurance Portability and Accountability Act (HIPAA) affect nursing practice? (Select all that apply.)
a. It established a procedure for the client to choose with whom he or she wants information shared.
b. It assisted health care providers in helping clients submit claims for insurance reimbursement.
c. It required all health agencies to tell clients exactly with whom their personal information will be shared.
d. It allowed health agencies to help clients establish insurance eligibility.
e. It required all health agencies to ensure that only persons immediately involved in the client’s care have access to the client’s health records.
f. It required all health care providers to protect client confidentiality by not writing any personal information in their medical record.
ANS: A, C, E
HIPAA protects confidentiality by defining privacy rights of clients and establishing rules and procedures under which clients choose with whom health information may be shared. HIPAA also defines client privacy rights, who should have access to client information, and what constitutes inappropriate access to health records.

DIF: Cognitive Level: Comprehension REF: p. 156