A nurse fails to raise the side rails on a confused patient's bed, and the patient subsequently falls and fractures a hip.
Which two elements of malpractice are demonstrated in this case?

Choice A rationale

Measuring intake and output is a basic data collection task that does not require nursing judgment or clinical analysis. Under the principles of delegation, a UAP can perform this task for stable patients. The RN remains responsible for analyzing the numerical data to evaluate the effectiveness of rehydration therapy. Dehydration involves fluid volume deficit where normal urine output is typically 30 mL to 60 mL per hour.

Choice B rationale

Assisting with ambulation is a standard task for UAPs and LPNs when the patient is clinically stable. Postoperative knee replacement patients require movement to prevent venous thromboembolism. If the patient is early in their recovery or unstable, the RN must perform the initial assessment. However, routine assistance with walking is appropriate for delegation as it focuses on physical support rather than complex clinical assessment of the surgical site.

Choice C rationale

Reinforcing teaching is a specific competency within the LPN scope of practice. While the RN must perform the initial education and assessment of the patient's learning needs regarding heart failure and sodium restrictions, the LPN can remind the patient of these instructions. This reinforcement helps solidify the patient's understanding of dietary triggers for fluid retention and exacerbation of heart failure symptoms, supporting the overall plan of care.

Choice D rationale

Monitoring a stable patient is within the scope of both LPNs and UAPs, depending on the specific observation required. For a patient with a history of seizures who is currently stable after a procedure, the LPN can monitor for signs of seizure activity or changes in consciousness. The RN must still perform the primary neurological assessments, but the delegation of routine observation ensures patient safety while the RN manages more complex tasks.

Choice E rationale

Administering oral medications to stable patients is a core function of the LPN. The LPN is trained to verify the five rights of medication administration and monitor for basic side effects. In a postoperative context, once the patient is stable and cleared for oral intake, the LPN can safely provide scheduled medications. The RN retains the responsibility for managing intravenous medications, blood products, and any complex titration required by the patient.

Choice F rationale

Changing a central venous catheter dressing is a sterile, complex procedure that is generally reserved for the RN in many facility policies due to the high risk of central line associated bloodstream infections. This task involves assessing the insertion site for signs of infection and maintaining strict aseptic technique. Because of the potential for significant complications and the need for advanced clinical judgment, it is not typically delegated to UAPs or LPNs.

Choice A rationale

Duty represents the established legal obligation of the nurse to provide a standard of care to the patient. Breach of duty occurs when that specific standard is not met, such as failing to implement safety measures like side rails. While these two elements are certainly present in the scenario, they do not encompass the actual physical injury or the direct link to the fall that the question specifically highlights.

Choice B rationale

Causation and damages are clearly demonstrated because the nurse's failure to raise the rails led directly to the fall, which is the proximate cause. The fractured hip represents the damages, or the actual physical harm suffered by the patient. In malpractice litigation, proving that the breach specifically resulted in a quantifiable injury is essential for a successful claim, making these two elements the most prominently featured.

Choice C rationale

Breach of duty is present because the nurse failed to act as a reasonably prudent professional would by neglecting bed safety. However, autonomy refers to the patient's right to self-determination and making their own healthcare decisions. Autonomy is not a primary element of a malpractice claim and is not directly demonstrated by the nurse's failure to prevent a fall through the use of mechanical bedside safety rails.

Choice D rationale

Negligence is a general umbrella term for failing to provide proper care, which is the basis of malpractice. Fidelity involves the ethical principle of faithfulness and keeping promises to patients. While the nurse arguably failed in their professional commitment, fidelity is an ethical concept rather than one of the four specific legal elements required to prove professional malpractice in a court of law for a physical injury.