RPN Legal Practice and Scope 3 — Questions and Answers
Question 1: A patient discloses during an assessment that they plan to seriously harm a specific person. Under the duty-to-warn principle, the RPN must:
- Notify the potential victim and appropriate authorities after informing the healthcare team (Correct answer)
- Maintain confidentiality because patient disclosure is protected
- Document the statement and do nothing further until the physician reviews it
- Discharge the patient immediately to remove the threat
Correct answer: Notify the potential victim and appropriate authorities after informing the healthcare team
The duty to warn (Tarasoff principle) requires healthcare providers to take steps to protect identifiable third parties from credible threats of serious harm.
Question 2: Which of the following BEST describes the RPN's responsibility when a physician's order appears potentially harmful to a patient?
- Clarify the order with the physician and document the concern before proceeding (Correct answer)
- Implement the order because the physician is legally responsible
- Refuse the order without communicating with the physician
- Ask a coworker to administer the medication instead
Correct answer: Clarify the order with the physician and document the concern before proceeding
RPNs have a professional and legal duty to question orders that appear unsafe and must clarify before implementation.
Question 3: What legal document allows a designated individual to make healthcare decisions for an incapacitated patient?
- Durable power of attorney for healthcare (healthcare proxy) (Correct answer)
- Living will
- Do-not-resuscitate order
- Advance beneficiary notice
Correct answer: Durable power of attorney for healthcare (healthcare proxy)
A durable power of attorney for healthcare (or healthcare proxy) designates a surrogate decision-maker for an incapacitated patient.
Question 4: An RPN administers the correct medication but uses the wrong route. This is an example of:
- A medication error that must be reported (Correct answer)
- Acceptable practice if the outcome is the same
- A deviation permitted under RPN scope
- An incident that only requires verbal notification to the charge nurse
Correct answer: A medication error that must be reported
Administering medication via the wrong route is a medication error regardless of intent, requiring documentation and incident reporting.
Question 5: Under the Health Insurance Portability and Accountability Act (HIPAA), an RPN may share a patient's protected health information (PHI) without authorization for which purpose?
- Treatment, payment, and healthcare operations (Correct answer)
- Marketing materials for the hospital
- Research without an IRB waiver
- Informing the patient's employer of their diagnosis
Correct answer: Treatment, payment, and healthcare operations
HIPAA permits disclosure of PHI without patient authorization for treatment, payment, and healthcare operations (TPO).
Question 6: A nurse is found to have practiced while impaired by alcohol. This situation is primarily governed by:
- The state nursing practice act and regulatory college standards (Correct answer)
- Criminal law only
- Hospital human resources policy exclusively
- Federal HIPAA regulations
Correct answer: The state nursing practice act and regulatory college standards
Practicing while impaired is a professional conduct issue governed by the state nursing practice act and regulatory body standards.
Question 7: A patient asks the RPN to witness their signature on a last will and testament. The RPN should:
- Decline and explain that this falls outside nursing scope and could create a conflict of interest (Correct answer)
- Witness the document as a service to the patient
- Witness only if another staff member also signs
- Ask the charge nurse to witness instead, as a more senior nurse is appropriate
Correct answer: Decline and explain that this falls outside nursing scope and could create a conflict of interest
Witnessing legal documents like wills is outside the RPN's professional role and creates a potential conflict of interest.
RPN Legal Practice and Scope 3
A patient discloses during an assessment that they plan to seriously harm a specific person.
Under the duty-to-warn principle, the RPN must: