Texas Nursing Practice Act and Board of Nursing Rules and Regulations, Exams of Nursing

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Nursing Jurisprudence Exam Questions with Complete Rationales Jurisprudence - Correct Answer: the science or philosophy of law Sources of Law - Correct Answer: -Constitutional Law: Federal, State -Statutory Law: Federal, State -Common Law -Administrative Law Criminal Law - Correct Answer: Federal or state government attempting to deprive an individual of life or liberty for something the law considers an offence against society in general Civil Law - Correct Answer: Seeks to resolve disputes between private parties, which often result in payment of money Different Burden of Proof - Correct Answer: Beyond a reasonable doubt; preponderance of the evidence Types of Torts - Correct Answer: -Negligence -Intentional: Assault Battery False Imprisonment -Quasi-Intentional: Defamation, Liable, Slander Malpractice - Correct Answer: Negligence committed by a person in his or her professional capacity is malpractice. Also known as professional negligence. Medical and nursing malpractice occur when a doctor or nurse fails to do that which a reasonable, prudent doctor or nurse would do under the same or similar circumstances, or does that which a reasonable or prudent doctor or nurse would not do under the same or similar circumstances. Elements of a Nursing Malpractice Lawsuit - Correct Answer: Duty - the existence of a duty, owed by the nurse to a patient, to conform to a recognized standard of care Breach - a failure to conform to the required standard of care Harm - an actual injury Cause - there must be proof that the injury was caused by the nurse's act or omission Intentional Tort: Assault - Correct Answer: Example of this tort: A nurse threatens to place an NG tube in a client who is refusing to eat Intentionally placing another in apprehension or fear that they will suffer harmful or offensive contact. Intentional Tort: Battery - Correct Answer: Intentional contact that is harmful or offensive, or creating the apprehension that such contact is imminent. -false imprisonment accompanied by forceful restraint or threat of restraint is BATTERY. IE: Restraining a person to give an injection against their consent or order Intentional Tort: False Imprisonment - Correct Answer: "unjustifiable detention of a person without legal warrant to confine the person" (client has the right to leave AMA) -false imprisonment accompanied by forceful restraint or threat of restraint is BATTERY. Quasi-Intentional Tort: Defamation - Correct Answer: A communication that tends to hold the plaintiff up to hatred, contempt or ridicule, or to cause him to be shunned or avoided. Tarnishing the reputation of someone. Quasi-Intentional Tort: Defamation Types - Correct Answer: Types: Libel - printed or broadcast Slander - spoken Nurse Practice Act (NPA) - Correct Answer: defines the scope and limitations of professional nursing practice; vary from state to state. Clearly Legible Insignia - Correct Answer: When interacting with the public in a nursing role, RNs and LVNs must wear an insignia identifying them as RNs or LVNs [NPA § 301.351] APRNs practicing in an advance practice role must identify themselves with their APRN title BON Rule 217.10(b) requires the nurse's first or last name and licensure level Although the board does not require the inclusion of any other designations, with the exception of the specific authorization of advanced practice nurses, the insignia may not contain information other than: - Correct Answer: (A) the registered nurse or licensed vocational nurse designation; (B) the nurse's name, certifications, academic degrees, or practice position; (C) the name of the employing facility or agency, or other employer; or (D) a picture of the nurse. No More Paper Licenses - Correct Answer: The BON discontinued issuing wallet-sized paper licenses for nurses renewing their licenses beginning September 1, 2008Paper license certificates are issued for: Graduate nurses who pass the NCLEX® exam and obtain their initial license in Texas;Nurses who hold licenses in other states and are obtaining a Texas license for the first time; andNurses who receive full licensure as APRNs Licensure Verification - Correct Answer: Employers may verify the licensure status of all nurses seeking employment online or by phone. Renewal of Licensure - Correct Answer: 60 days prior to license expiration, the BON will mail a postcard reminder to renew online. This is one of the reasons it is important to keep your contact information up to date! Continuing Competency (TAC Chapter 216) - Correct Answer: Purpose: to ensure nurses stay abreast of current industry practices, enhance their professional competence, learn about new technology and treatment regimens, and update their clinical skills. [TAC § 216.2] All nurses are required to demonstrate continuing competency for renewal of licensure. Methods: Complete 20 hours of continuing education, or Attain, maintain, or renew an approved national nursing certification in the area of practice Nursing Jurisprudence & Ethics - 2 hours [Rule 216.3 (g)] Older Adult or Geriatric Care - 2 hours [Rule 216.3 (h)] Nurse Licensure Compact (NLC) - Correct Answer: endorsed by the National Council of State Boards of Nursing (NCSBN) as a framework for regulating the interstate practice of nursing for RNs and LPNs/VNs; under this concept, nurses holding a valid license in one state could practice (both physically in person and electronically by using the telephone or telemedicine connectivity to assess and provide care) in other states, according to the rules and regulations of the states The Nurse Licensure Compact (NLC) allows RNs and LVNs to have one multistate license, with the ability to practice in both their home state and other NLC states.The APRN Compact allows an advanced practice registered nurse to hold one multistate license with a privilege to practice in other compact states.Agreement among states to mutually recognize each others' licenses Texas among first to adopt Premise: current licensure requirements essentially the same from state to state Does not interfere with each state defining scope of practice Only defines requirements to hold license Nurse Licensure Compact - Definitions - Correct Answer: Party states - states who have adopted the compact Home state license - where you permanently reside Remote state - where you practice using multistate privilege (must be a party state) Nurse Licensure Compact - Requirements - Correct Answer: Maintain home state license Adhere to state practice laws of state in which patient is located at the time care is provided Use multistate privilege only in party states Hold home state license in only one party state at a time. Practice in a Non-Party State - Correct Answer: To practice in a state that is not part of the Compact, the nurse must obtain license from the non-party state May concurrently hold a home state license and a license to practice in a non-party state If you live in a non-party state, you must obtain a non-resident Texas license in order to practice in Texas Ethical Conduct - Correct Answer: Year after year, Nursing is recognized as one of the most trusted professions.It is important to maintain that trust, so we can practice efficiently....what is good and bad and with moral duty and obligation... Good Professional Character - Correct Answer: Integrated pattern of personal, academic and occupational behaviors which, in the judgment of the Board, indicates that an individual is able to consistently conform his or her conduct to the requirements of the Nursing Practice Act, the Board's rules and regulations, and generally accepted standards of nursing practice including, but not limited to, behaviors indicating honesty, accountability, trustworthiness, reliability, and integrity [TAC § 213.27(a)]. Factors Indicating Good Professional Character - Correct Answer: Distinguish right from wrong; Think and act rationally; Keep promises and honor obligations; Accountable for own behavior; Able to practice nursing in an autonomous role with patients/clients, their families, significant others, and members of the public who are or who may become physically, emotionally, or financially vulnerable; Recognize and honor the interpersonal boundaries appropriate to any therapeutic relationship or health care setting; and Promptly and fully self-disclose facts, circumstances, events, errors, and omissions when such disclosure could enhance the health status of patients/clients or the public or could protect patients/clients or the public from unnecessary risk of harm [ Rule 213.27(b)(2)(A-G)]. Any conviction for a felony or for a misdemeanor involving moral turpitude or order of probation with or without an adjudication of guilt for an offense that would be a felony or misdemeanor involving moral turpitude if guilt were adjudicated [Rule 213.27 (b)(3)]. Any revocation, suspension, or denial of, or any other adverse action relating to, the person's license or privilege to practice nursing in another jurisdiction [Rule 213.27 (b)(4)]. Criminal Behavior Disclosure - Correct Answer: Requirement for criminal history for applicants for a license [NPA § 301.2511]. Requirement for criminal history for renewal of license [NPA § 301.3011]. Perform comprehensive assessment Evaluate patient response to nursing care Vocational Nursing - Correct Answer: Practice in Planning of Nursing Care Assisting in evaluating patient response to nursing care Perform focused assessment LVN Supervision - Correct Answer: The practice of vocational nursing must be performed under the supervision of a registered nurse, physician, physician assistant, podiatrist, or dentist. Duty of a Nurse in any Practice Setting - Correct Answer: Establishes, through the NPA and Board Rules, that a nurse has a responsibility and duty to a client/patient to provide and coordinate the delivery of safe, effective nursing care. This duty supersedes any facility policy or physician order. Duty to the patient Lunsford v. Board of Nurse Examiners, 648 S.W. 2d 391 (Tex. App.--Austin, 1983) The court in affirming the disciplinary action of the Board, held that a nurse has a duty to the patient which cannot be superseded by hospital policy or physician's order. This landmark case involved a gentleman who arrived to a rural hospital via private vehicle. The gentleman was experiencing severe chest pain, nausea, and sweating—all hallmark symptoms of myocardial infarction (heart attack). Nurse Lunsford was summoned to the ER waiting room by this gentleman's friend. Upon seeing the acute distress the man was experiencing and hearing his symptoms, she instructed his friend to drive the man to the nearest facility equipped to handle heart attack victims. This facility was 24 miles away. The man succumbed to the heart attack 5 miles away from the small hospital. When the Board sought to sanction the nurse's license, the nurse maintained that the ER physician (who never saw the man) told her the man needed to be transported to the larger facility. The facility policy was also to transfer patients experiencing heart attacks (via ambulance) to the larger facility that was equipped to provide the broad range of therapies that might be needed. The court sided with the BON and agreed that the nurse had the knowledge, skills and abilities to recognize the life-threatening nature of the man's symptoms. Because of this knowledge, the court maintained that it was the nurse's duty to act in the best interest of the client by assessing the man, taking measures to stabilize him and t Graduate Nurse - Correct Answer: Supervision for a period of six months, or lesser time, if agreed upon by the newly licensed nurse and the supervising nurse Competence to perform independently should be mutually determined by the new graduate and the supervising nurse and demonstrated and supported by documentation Nurses transitioning back to practice or to new primary practice area - Correct Answer: Should not act as charge nurse for at least six months, unless a lesser time period is agreed upon by the nurse and his/her supervisor, based on the competency of the nurse Six Step Decision Making Model - Correct Answer: Tool developed by the BON to assist nurses in making good professional judgments about the nursing tasks or procedures they choose to undertake. Goal is making sure that he/she only accepts those assignments for which the nurse has the education, training, and skill competency 1. Is the activity consistent with the Nursing Practice Act (NPA), Board Rules, and Board Position Statements and or/Guideline? Yes: continue. No: stop. 2. Is the activity appropriately authorized by valid order/protocol and in accordance with established policies and behaviors? Yes: continue. No: stop. 3. Is the act supported by either research reported in nursing and health-related literature or in scope of practice statements by national nursing organizations? Yes: continue. No: stop. 4. Do you possess the required knowledge and have you demonstrated the competency required to carry out this activity safely? "" 5. Would a reasonable and prudent nurse perform this activity in this setting? 6. Are you prepared to assume accountability for the provision of safe care and the outcome of the care rendered? Yes: Perform the activity. No: stop. Delegation - Correct Answer: Authorizing an unlicensed person to provide nursing services while retaining accountability for how the unlicensed person performs the task. It does not include situations in which an unlicensed person is directly assisting a RN by carrying out nursing tasks in the presence of a RN [Rule 224.4 (3)]. RNs may delegate: LVNs may supervise The RN is responsible for the evaluation of the delegated task to ensure it was completed and completed correctly [Rule 224.3].According to the BON website, many find delegation to be a perplexing concept with multiple nuances. The BON created the Delegation Resource Packet to afford RNs clearer direction for delegation in a variety of settings thereby improving the delegation process Criteria for Delegation - Correct Answer: RNs may delegate LVNs may supervise The RN is responsible for the evaluation of the delegated task to ensure it was completed and completed correctly [Rule 224.3]. Nursing Tasks Prohibited from Delegation - Correct Answer: Formulation of the nursing care plan and evaluation of the client's response to the care rendered. Specific tasks involved in the implementation of the care plan which require professional nursing judgment or intervention. The responsibility and accountability for client health teaching and health counseling which promotes client education and involves the client's significant others in accomplishing health goals. Administration of medications, including intravenous fluids, except by medication aides as permitted under §224.9 of this title (relating to The Medication Aide Permit Holder). Mandatory Reporting Requirement - Correct Answer: A nurse shall report to the board if the nurse has reasonable cause to suspect that: Minimum Due Process Rights Include - Correct Answer: Notice must be provided in writing in person or by certified mail Notice must Include a description of the event(s) to be evaluated in sufficient detail to inform the nurse of the incident, circumstances and conduct (error or omission) The nurse must have the opportunity to: (i) submit a written statement regarding the event under review; (ii) call witnesses, question witnesses, and be present when testimony or evidence is being presented Employer Disciplinary Action - Correct Answer: Employment and licensure issues are separate. An employer may take disciplinary action before review by the peer review committee is conducted, as peer review cannot determine issues related to employment. The role of incident-based peer review is to determine if licensure violations have occurred and, if so, if the violations require reporting to the board. Activation of Safe Harbor Peer Review - Correct Answer: Notify the supervisor making the assignment in writing that the nurse is invoking Safe Harbor. This must be done prior to engaging in the conduct or assignment for which safe harbor is requested. The "Comprehensive Request for Safe Harbor Nursing Peer Review" must be completed by the end of the work period and before leaving the practice setting. Please DO NOT mail or fax your request for Safe Harbor Nursing Peer Review to the Board of Nursing. The BON cannot conduct Peer Review - this must be done through the facility or agency where the assignment was made to you. Protections for the Nurse - Correct Answer: A nurse who in good faith requests Safe Harbor peer review: 1. may not be disciplined or discriminated against for making the request; 2. may engage in the requested conduct pending the peer review; and 3. may not be disciplined by the board for engaging in that conduct while the peer review is pending. Withdrawal of Request for Safe Harbor - Correct Answer: The nurse's request for Safe Harbor Peer Review does not become invalid and the nurse does not have to withdraw his/her request for Safe Harbor just because a supervisor is able to respond with adequate staff, equipment, or whatever else was at issue with the original requested assignment. It is the nurse's choice whether or not he/she wishes to still have a nursing peer review of the situation. Safe Harbor - Correct Answer: Idea is that patients are better off with the nurse than without the nurse in the vast majority of cases.a nurse may engage in an assignment or requested conduct unless the requested assignment or conduct is one that: - constitutes a criminal act -constitutes unprofessional conduct, or -the nurse lacks the basic knowledge, skills, and abilities necessary to deliver nursing care that is safe and that meets the minimum standards of care to such an extent that accepting the assignment would expose one or more patients to an unjustifiable risk of harm Unprofessional Conduct - Correct Answer: The unprofessional conduct rules are intended to protect clients and the public from incompetent, unethical, or illegal conduct of licensees. The purpose of these rules is to identify unprofessional or dishonorable behaviors of a nurse which the board believes are likely to deceive, defraud, or injure clients or the public. Actual injury to a client need not be established. BON & Complaints - Correct Answer: More than 16,000 complaints per year are typically received by the BON. Not all complaints result in an investigation or disciplinary action by the Board. In all cases, the identity of the complainant is kept confidential. The nurse is notified of the investigation and invited to respond. The investigator gathers and reviews evidence, and then reviews the nurse's response. Then, a decision is made by the Board. Responsibilities During Investigation - Correct Answer: Respond promptly to all requests for information by the investigator assigned to your case. Ask your investigator questions so you are certain you understand what is happening Keep the investigator informed about how, when, and where you can be reached, and supply a phone number Respond promptly to the notice letter informing you of the allegations against you The response should be concise, clearly written, and should address the facts as you know them Disciplinary Action by the BON - Correct Answer: Denial of an individual's application for a license, license renewal, or temporary permit; A written warning; A public reprimand; Restriction or limitation of the person's license (e.g., limiting one or more specified nursing activities); Suspension of the license; Revocation of the license; Assessment of a fine; Submit to care, counseling or treatment designated by the Board; Participate in a program of education or counseling, including remedial education; Practice for a specified period of time under the direction of an RN or VN designated by the Board; Perform public service the Board considers appropriate; Abstain from the consumption of alcohol or the use of drugs and submit to random periodic drug screens; Accept a voluntary surrender of a license; Impose conditions for reinstatement of a license if the license has been revoked, suspended, or voluntarily surrendered; Place a probationary status on a license; Order a licensee to pay a refund to a consumer; Issue an emergency "cease and desist" order; and