CPNRE Legal Scope and Accountability 5 — Questions and Answers
Question 1: A practical nurse floats to an unfamiliar unit and is asked to care for patients with conditions outside their usual experience. What is the most appropriate action?
- Accept the assignment and manage independently to avoid inconveniencing staff
- Refuse all patient assignments on the unfamiliar unit
- Accept the assignment but clearly communicate limitations and request appropriate support (Correct answer)
- Contact the regulatory body for direction before accepting any patients
Correct answer: Accept the assignment but clearly communicate limitations and request appropriate support
Nurses must communicate competency limitations honestly; accepting the assignment with disclosed limitations and support allows safe care while meeting staffing needs.
Question 2: Which legal doctrine holds an employer responsible for the negligent acts of an employee committed within the scope of employment?
- Contributory negligence
- Res ipsa loquitur
- Respondeat superior (Correct answer)
- Assumption of risk
Correct answer: Respondeat superior
Respondeat superior ('let the master answer') makes employers vicariously liable for employees' negligent acts performed within the scope of their duties.
Question 3: A practical nurse discovers a medication error made by another nurse on the previous shift. The harmed patient is stable. What documentation is required?
- An incident report only; no chart entry is needed to avoid legal risk
- A chart entry describing the patient's current status and an incident report filed per facility policy (Correct answer)
- Verbal notification to the charge nurse with no written documentation
- A note in the outgoing nurse's personnel file
Correct answer: A chart entry describing the patient's current status and an incident report filed per facility policy
Both a factual, objective chart entry about the patient's condition and an incident report are required to ensure continuity of care and proper quality-improvement processes.
Question 4: A patient's substitute decision-maker (SDM) consents to surgery on behalf of an unconscious patient. Later the patient regains consciousness and refuses the surgery. The practical nurse should:
- Proceed with surgery prep because the SDM already consented
- Recognize that a now-competent patient's refusal supersedes the SDM's prior consent (Correct answer)
- Ask the physician to override the patient's refusal to prevent harm
- Seek a court order before stopping the surgical preparation
Correct answer: Recognize that a now-competent patient's refusal supersedes the SDM's prior consent
A patient who regains decision-making capacity immediately reassumes the right to consent or refuse; the SDM's authority ends when the patient is competent.
Question 5: In which situation would a practical nurse be legally justified in breaching patient confidentiality without consent?
- A family member requests information because they are paying for treatment
- The patient discloses they intend to seriously harm an identifiable person (Correct answer)
- A journalist claims to be writing a story about patient safety issues
- The patient's employer calls asking about the reason for the patient's hospital stay
Correct answer: The patient discloses they intend to seriously harm an identifiable person
The duty to warn applies when there is a serious, credible, and imminent threat of harm to an identifiable third party, justifying disclosure to prevent that harm.
Question 6: A practical nurse fails to apply wrist restraints correctly and the patient sustains a shoulder injury. To succeed in a negligence lawsuit, the patient must prove all of the following EXCEPT:
- The nurse owed the patient a duty of care
- The nurse intended to cause harm (Correct answer)
- The nurse breached the standard of care
- The breach caused the patient's injury
Correct answer: The nurse intended to cause harm
Negligence does not require intent to harm; it requires duty, breach of standard of care, causation, and damages — not intentional wrongdoing.
Question 7: A practical nurse is asked by a supervisor to falsify a patient's chart to conceal a medication error. The nurse should:
- Comply to maintain the employment relationship and avoid conflict
- Alter only the parts of the chart that cannot be independently verified
- Refuse, as falsifying records is a criminal act and a professional misconduct violation (Correct answer)
- Consult a lawyer before deciding whether to comply
Correct answer: Refuse, as falsifying records is a criminal act and a professional misconduct violation
Falsifying medical records constitutes fraud and professional misconduct; a nurse must refuse regardless of who makes the request.
CPNRE Legal Scope and Accountability 5
A practical nurse floats to an unfamiliar unit and is asked to care for patients with conditions outside their usual experience.
What is the most appropriate action?