contemporary: chapters 7-12
A patient informs the nurse, "I can't sit in the yard for even 10 minutes without my skin turning red and tender." The nurse would assess for the use of which complementary alternative medicine (CAM)? a. St. John's wort b. Ginkgo biloba c. Feverfew d. Echinacea
A. St. John's wort
While completing a nursing degree in Virginia, a student who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nursing student values: a. cultural competence. b. ethnocentrism. c. prejudice. d. stereotyping.
A. cultural competence.
An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as: a. diagnosis-related groups (DRGs). b. subjective symptom management. c. acuity classification system. d. organized managed care.
A. diagnosis-related groups (DRGs).
A patient with kyphosis is visiting a practitioner of chiropractic medicine for the first time and asks, "How does this therapy work?" The practitioner replies, "I will use my hands along with heat to correct the misalignment of your spine by placing pressure on the nerves that have produced pain. The misalignment of your spine is referred to as: a. subluxation." b. a sprain." c. a fracture." d. epicondylitis.
A. subluxation."
A Mexican-American patient is attacked and beaten. This patient is at risk for "fright disease," which is known as: a. susto b. empacho. c. bilis. d. mal ojo.
A. susto
A patient who is pregnant has used the herb feverfew for a history of migraine headaches. The nurse should provide teaching related to a risk for: a. uterine contractions resulting in possible miscarriage. b. reduced fetal growth. c. insomnia. d. tiredness the following day.
A. uterine contractions resulting in possible miscarriage.
An older adult woman who stops using complementary alternative medicine (CAM) becomes disoriented and is given a diagnosis of dementia. The family is upset with the family physician and the CAM practitioner for not diagnosing the condition earlier. Which CAM may have interfered with early detection of the dementia? a. Large doses of calcium caused cerebral plaques to form, thereby disguising atrophy of the brain. b. Excess doses of folic acid masked a vitamin B12 deficiency that led to dementia. c. Hypnotherapy focused on current pleasant thoughts, eliminating clues to the past. d. The electrical current from magnetic fields interfered with normal brain waves, resulting in confusion and inability to concentrate.
B. Excess doses of folic acid masked a vitamin B12 deficiency that led to dementia.
A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of: a. accountability. b. autonomy. c. nonmaleficence. d. veracity.
B. autonomy.
Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as: a. charity. b. cost shifting. c. price sharing. d. governmental reimbursement.
B. cost shifting.
A nurse is seeking to become culturally competent in regards to obtaining information during health history and when performing physical diagnosis. The nurse is aware that which biologic variation is found in all of the following ethnicities: African Americans, Asians, Hispanics, and American Indians? a. Mongolian spots b. Sickle cell anemia c. Lactose intolerance d. Thalassemia
C. Lactose intolerance
The use of plants in conventional modern medicine is evidenced by the drug atropine, which is derived from which plant? a. Digitalis purpurea b. Cephaelis ipecacuanha c. Rauwolfia serpentina d. Atropa belladonna
D. Atropa belladonna
The physician who insists on providing treatment in spite of the client's wishes because he "knows best" is reflecting: a. autonomy. b. beneficence. c. justice. d. paternalism.
D. paternalism.
Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing: a. hospital admission rates. b. length of hospital stay. c. outpatient services. d. specialty groups.
B. length of hospital stay.
A patient observes the practitioner burning a dried herb on the needle during an acupuncture session and asks about this practice. The practitioner responds, "I am inciting the acupuncture points and this is referred to as: a. doshas." b. moxibustion." c. yoga." d. kapha."
B. moxibustion."
Ethics applied to nursing can best be defined as: a. doing what is best for the client. b. making good decisions about care. c. care based on what should be done in keeping with the values of the client. d. rules for providing competent care that is based on scientific principles.
C. care based on what should be done in keeping with the values of the client.
A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include: a. chronic obstructive pulmonary disease. b. malnutrition. c. cirrhosis of the liver. d. cancer.
D. cancer.
A patient wants to reduce health care costs by being a model for making wise decisions that both promote health and reduce cost. Which statement by the patient would indicate a need for further teaching? a. "I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won't be sick as long." b. "I looked up urinary tract infection prevention on the Internet." c. "I had my weight, body fat, and blood sugar measured at a local health fair." d. "My allergies are really bothering me. I spoke to the pharmacist, who recommended an over-the-counter antihistamine."
A. "I will ask for the brand name drug Tylenol rather than acetaminophen since it works better and I won't be sick as long."
A patient states, "My cancer is in remission finally after all that chemotherapy, my friend used the same chemotherapy and wasn't so lucky. I want to continue participating in spiritual care and 'mind games' to keep my memory intact. I am also enrolled in Tai chi, but I just can't stop thinking about my sick lung." This patient adheres to which principle underlying alternative healing? a. A negative alteration in the body produces a parallel effect on the mind and spirit. b. The body can heal itself with the help of complementary alternative therapies. c. Approaches to therapy are individualized. d. There is a focus on the total lifestyle.
A. A negative alteration in the body produces a parallel effect on the mind and spirit.
The massage therapist uses kinesthesia, or thinking about how movement is expressed, to correct habits that cause poor posture and limited movement. This type of massage is called: a. Alexander technique. b. Feldenkrais method. c. healing touch. d. Reiki.
A. Alexander technique.
During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power. c. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure.
A. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway.
A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act
A. Emergency Medical Treatment and Active Labor Law
A nurse is admitting a Mexican-American child, and the mother comments that the child was exposed to mal ojo. The nurse should expect to find which symptom associated with this exposure? a. Fever b. Nervous tension c. Bruising d. Somnolence
A. Fever
A patient is eligible to change health care providers and insurance and asks, "I am interested in health promotion activities; I walk, swim, and eat healthy. Which health insurance plan would support these activities rather than just pay for services when I am sick"? Which, if any, health insurance plan would best meet the needs of this patient? a. Health Maintenance Organization (HMO) b. Fee for Service c. Preferred Provider Organization (PPO) d. None, because health insurance plans currently cover only disease management, not preventive care.
A. Health Maintenance Organization (HMO)
A pregnant woman reports back pain and wants to try a complementary alternative medicine (CAM) therapy. The nurse knows that which CAM would be contraindicated? a. Magnet therapy b. Aromatherapy c. Imagery d. Therapeutic touch
A. Magnet therapy
A young adult on a limited income who is having back pain states, "I want to see a chiropractor, but I don't have any money. However, I do have health insurance." The most appropriate response that the nurse can provide is: a. "Most insurance companies will pay for chiropractic treatment." b. "Because chiropractors are not licensed in any state, all services must be paid for by the patient." c. "Chiropractic medicine is a new CAM therapy that has not yet been recognized by insurance companies." d. "Chiropractic medicine is more than 100 years old, but because it is preventive in nature, it is not covered by most insurance."
A. Most insurance companies will pay for chiropractic treatment."
The nurse is preparing a plan of care for an African-American patient who has had a change of bowel habits from being constipated and having only two firm stools weekly to having three or more loose stools daily. Which comment is related to cultural variation for health information? a. The individual states, "I will need to discuss health care options with my grandmother." b. The eldest male member of the family will make all health care decisions. c. The patient has high respect for the nurse and nods approvingly, although she has no intention of complying with instructions or plan of care. d. The individual speaks very quietly and gently reaches to hold the nurse's hand for support.
A. The individual states, "I will need to discuss health care options with my grandmother."
The nurse who admits making a medication error and immediately files an incident report is demonstrating: a. accountability. b. individuality. c. an injustice. d. values clarification.
A. accountability.
A nurse is assigned to a unit where 95% of all patients required total care. Most days the assistive personnel are able to complete their assignments and provide high-quality care. A patient returning from a procedure was somehow "skipped" when daily baths were performed and requests that her care now be provided. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating: a. altruism. b. veracity. c. autonomy. d. whistle blowing.
A. altruism.
The nurse caring for a patient who practices Ayurveda would assess for: a. an increased stool osmolality gap resulting from dehydration. b. petechiae resulting from fine-needle punctures. c. use of over-the-counter remedies intended for intended symptom. d. magnets strategically placed on affected joints.
A. an increased stool osmolality gap resulting from dehydration.
When assessing an ethical issue, the nurse must first: a. ask, "What is the issue?" b. identify all possible alternatives. c. select the best option from a list of alternatives. d. justify the choice of action or inaction.
A. ask, "What is the issue?"
A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying the principles of: a. beneficence. b. human dignity. c. justice. d. human rights.
A. beneficence.
A client who is reading a newspaper asks, "This article about health care states that many providers of health care lack effectiveness. What is the difference between effectiveness and efficiency?" The nurse explains that: a. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome. b. effective refers to competence in clinical practice and efficiency describes quick completion of the task. c. efficiency means wasting and meeting a minimum standard and effectiveness refers to taking all the time needed to exceed expectations. d. efficiency refers to speed and effectiveness refers to the usefulness of the implementation.
A. effective means performing the correct test or intervention whereas efficiency refers to the wise use of supplies and resources for the desired outcome.
A patient informs the nurse, "I burn a lavender-scented candle for an hour before bedtime to help me relax and sleep." The nurse realizes this patient is using: a. the mind-body intervention of aromatherapy. b. an energy technique known as qi gong. c. the manipulative method using the Alexander technique. d. conventional medicine, also called allopathic.
A. he mind-body intervention of aromatherapy.
A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his/her own values as they relate to this issue. The nurse must: a. know his/her own values and how these values relate to beliefs and the philosophy of nursing. b. rid the impurities in his/her value system. c. ignore his/her own values. d. realize that values do not change and that they cannot be influenced by others.
A. know his/her own values and how these values relate to beliefs and the philosophy of nursing.
A nurse caring for a Hispanic child admitted with diarrhea notices the child is wearing red yarn around the wrist. The nurse compliments the child's "jewelry," knowing it is believed to prevent: a. mal ojo. b. susto. c. bilis. d. empacho.
A. mal ojo.
Certain groups of individuals are opposed to the Patient Protection and Affordable Care Act (PPACA) based on religious beliefs that prohibit circumcision and blood transfusions. These individuals believe the PPACA is unconstitutional because it: a. mandates that all U.S. and legal residents must secure health insurance. b. replaces current Medicare and Medicaid plans. c. requires all citizens to participate in offered preventive services. d. prohibits use of health practices outside of Western medicine.
A. mandates that all U.S. and legal residents must secure health insurance.
When planning health care, the nurse should be mindful that members of the Asian culture tend to: a. miss appointments because they are present oriented and time is viewed as flexible. b. look to their ancestors for guidance. c. plan ahead and be future oriented. d. arrive early because they have no concept of time.
A. miss appointments because they are present oriented and time is viewed as flexible.
A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with: a. negligence. b. assault. c. defamation of character. d. tort.
A. negligence.
A nurse is charged with battery after helping an invalid patient back to bed and not calling for help due to a reduced staffing level. The patient sustained excessive bruising, sore joints, and extended stay. In this case, the: a. patient is the plaintiff. b. nurse can be charged with forcefully restraining the patient without orders. c. nurse is accountable due to the decreased level of staffing. d. charge of invasion of privacy may be withheld.
A. patient is the plaintiff.
A nurse is newly employed by a state-owned hospital that provides health care insurance requiring a deductible paid by the employee with the majority of the premium cost covered by the employer. The insurance provided to the nurse is: a. private health insurance. b. a federal insurances program known as PPACA. c. state-subsidized Medicaid insurance. d. single-payer system coverage.AA
A. private health insurance.
A nurse practices a relaxing massage technique to stimulate and apply pressure to the feet or hands, increasing blood supply circulation to various parts of the body and relieving pain. The massage technique used by the practitioner is referred to as: a. reflexology. b. Feldenkrais method. c. Reiki. d. Rolfing.
A. reflexology.
When differentiating between slander and libel, the nurse knows that libel: a. results from defamation caused by subjective comments written in the nurse's notes. b. results from negative subjective comments made to those who are not providing care. c. occurs when the nurse verbally describes to the oncoming nurse assigned to the client objective data that place the client in a negative light. d. consists of repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket.
A. results from defamation caused by subjective comments written in the nurse's notes.
A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under: a. the Health Insurance Portability and Accountability Act. b. the ANA Scope and Practice Act. c. affirmative duty failing to question order. d. personal liability with floating and cross-training.
A. the Health Insurance Portability and Accountability Act.
A nurse working in a privately owned hospital is charged A nurse working in a privately owned hospital is charged with a negligent act after failing to check laboratory reports prior to giving a dose of digoxin (Lanoxin) resulting in the patient's condition becoming critical due to decreased cardiac output and falling leading to a broken hip and concussion. A nurse is brought in who testifies that a professional with the knowledge and skill of an RN should understand that, before administering this drug, potassium level and pulse level is always checked to prevent such an occurrence. The nurse's testimony as to what constitutes reasonable care is based on: a. the legal definition of standard of care. b. the legal definition of the informed consent process. c. the doctrine of res ipsa loquitur. d. governmental immunity.
A. the legal definition of standard of care.
A patient is upset because her health insurance plan refused to pay for a mammogram and services by a women's health specialist because the primary care physician did not order the referral or the mammogram. Which type of insurance plan adheres to this type of payment system? a. Fee for Service b. Health Maintenance Organization (HMO) c. Preferred Provider Organization (PPO) d. Point of Service (POS)
B. Health Maintenance Organization (HMO)
Which statement is true regarding health care for minorities? a. Federal legislation that provides free health insurance for minorities has resulted in fewer minorities than members of the general population who lack health insurance. b. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care. c. Because many Mexican Americans are highly skilled workers with comparable wages, they have the lowest uninsured rate. d. Asians, because of their quiet demeanor and unwillingness to challenge the health care system, have the highest rate of uninsured people.
B. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care.
A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement?a. Health maintenance organization b. Preferred provider organization c. Fee-for-service arrangement d. Philanthropic agency
B. Preferred provider organization
In which case does the nurse act as "whistle blower"? a. One staff member on the unit covers for another nurse, who leaves the premises to purchase illegal substances and signals her friend when she must return. b. The nurse reports that another nurse is taking medications out of stock medicine for her/himself. c. A nurse informs respiratory therapy that a patient is now due a treatment. d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure all care was rendered properly.
B. The nurse reports that another nurse is taking medications out of stock medicine for her/himself.
An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's hand moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology
B. Veracity
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis: a. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company. b. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee. c. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease. d. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
B. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far reaching ethical considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their civil rights under the Rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act (PPACA) could affect their practice in situations that may conflict with their own belief system. Today's practicing nurse must: a. remember it is one's professional duty to render patient-centered care—even when it is in direct conflict with the nurse's own beliefs—or be held liable for withholding treatment. b. consider whether the right to act according to one's inner beliefs will continue to be permissible when federal health insurance becomes fully enacted. c. discuss with the patient and family different options in hopes they will accept the nurse's health care beliefs. d. suggest to the hospital administration that they not accept federal funding to prevent controversial health practices.
B. consider whether the right to act according to one's inner beliefs will continue to be permissible when federal health insurance becomes fully enacted.
A nurse is preparing discharge teaching for an Asian-American woman with a fractured hip. The nurse reviews the client's diet history while hospitalized and is concerned that the patient refused milk and yogurt, placing her at risk for osteoporosis. What cultural variation is the nurse overlooking? Asian Americans: a. have denser bones that other ethnic groups. b. consume diets rich in pork bone and shells, reducing the risk of osteoporosis. c. would participate in the practice of burning to compensate for this injury. d. would consult a curandero for dietary consultation.
B. consume diets rich in pork bone and shells, reducing the risk of osteoporosis.
A priority action for the nurse who works with culturally diverse clients is completion of a: a. sign language course. b. cultural self-assessment. c. cultural client assessment. d. continuing education course on how to speak Spanish.
B. cultural self-assessment.
A cultural phenomenon that is based on biologic variation would include: a. belief that exposure of a pregnant woman to an eclipse can result in cleft lip. b. denser bones in African Americans result in less morbidity associated with osteoporosis. c. the grandmother who determines that her grandchild has scoliosis and should seek treatment, then informs the parents of her decision. d. a family that participates in feasts prepared to celebrate and make decisions.
B. denser bones in African Americans result in less morbidity associated with osteoporosis.
Three illegal immigrants with no health insurance or money sustained life-threatening injuries during an automobile accident. Two of these individuals had head trauma and lacerated internal organs. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The third individual received only minor injuries, which were treated in the emergency department. The care of the two critical clients was based on the ethical principle of: a. utilitarianism. b. deontology. c. autonomy. d. veracity.
B. deontology.
When the client is unable to make medical decisions for himself or herself, authorization that allows another person to make these decisions is called: a. living will. b. durable power of attorney. c. informed consent. d. immunity.
B. durable power of attorney.
A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, "These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do." The nurse is exhibiting: a. stereotyping. b. ethnocentrism. c. cultural accommodation. d. empathy.
B. ethnocentrism.
During an admission history and physical, a female patient states, "I use 5000 mg/day of calcium to prevent osteoporosis and to maintain health." The nurse should assess for: a. excessive bleeding. b. kidney stones. c. lower blood sugar. d. jaundice.
B. kidney stones.
A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows very little about the health beliefs of this ethnic group. To research this group, she can use an Internet search engine and enter the term "Russian cultures" or "Russian health beliefs." To obtain more generalized information, she could also search under: a. federally recognized minorities. b. marginalized populations. c. Asian/Pacific Islander cultures. d. Latino cultures.
B. marginalized populations.
Which statement regarding informed consent is correct? Informed consent: a. is mandated by federal but not state law. b. must reveal expected benefits. c. requires concealing any known risks. d. allows the RN to communicate information needed so that informed consent can be provided.
B. must reveal expected benefits.
A nurse is preparing to teach a class related to risk factors for cancer to a diverse ethnic group attending a health fair. The nurse should be aware: a. that Hispanic women overestimate the prevalence of cancer and strictly following breast self-exam guidelines. b. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with African American. c. that American-Indian women have a higher rate of ovarian cancer than the general population. d. that cancer as well as heart disease and stroke are lower in ethnic groups.
B. of the importance of risk factors such as smoking and alcohol consumption that increase esophageal cancer when speaking with African American.
Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client was able to return to work in 6 weeks and had no permanent damages. This monetary compensation is termed: a. res ipsa loquitur. b. punitive damages. c. vicarious liability. d. immunity.
B. punitive damages.
A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a _____ payment system. a. prospective b. retrospective c. diagnosis-related group d. capitated
B. retrospective
A person who is recovering from a stroke is becoming more forgetful and is unable to recall people's names. A friend suggests the use of a natural ingredient, ginkgo biloba. The nurse is concerned about the most serious risk associated with this herb, which is: a. thromboembolism due to increased clotting. b. seizures due to interaction with anticonvulsants. c. hypertension due to sodium retention. d. photosensitivity due to increased melanin production.
B. seizures due to interaction with anticonvulsants.
An Asian teenager is admitted with an eating disorder which she contributes to by not meeting the academic expectations of her parents. The nurse is overheard saying, "That isn't the reason; all Asians are really smart." This nurse is demonstrating: a. cultural humility. b. stereotyping. c. cultural assimilation. d. acculturation.
B. stereotyping.
A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption." However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves the ethical principle of: a. deontology. b. veracity. c. autonomy. d. beneficence.
B. veracity.
A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client's IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas
C. Beneficence
A nurse is very interested in learning more about health A nurse is very interested in learning more about health care economics and how she can use that knowledge to become a better patient advocate. She comments, "Nurses should not only deliver care one day at a time in one facility but should coordinate patient care as they move from acute care to rehabilitation to home care." This nurse would be a candidate for which nursing role? a. Disease management program (DMP) for chronic illnesses b. A hospital-based utilization management nurse who reviews medical records to determine the most appropriate DRG for patients c. Case management d. Reviewer for Managed Care Organization
C. Case management
A nursing student planning to apply for licensure knows that being charged with which offense would result in a minor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered
C. Failing to report elder abuse
In the triad of health care, which would be considered the third-party payer? a. Client b. Health care provider c. Insurance company d. Government agency that sets reimbursement rules for services
C. Insurance company
An elderly person, age 80, is finding it difficult to live alone and the family is considering long-term care. The elderly person is reasonably healthy, with only normal aging declines, and maintains a healthy appetite. All medications are administered orally and require only minimal assistance. She is financially secure with an income based on retirement from both the military and factory from her deceased husband and herself. The family contacts long-term care and is told that, based on this patient's information: a. Medicare will cover the cost of stay since skilled services are required. b. Medicaid is only for families with dependent children. c. Medicare will pay for home health services should these additional services meet the needs of the individual. d. Medicare will pay regardless of household income or financial status for nursing home care.
C. Medicare will pay for home health services should these additional services meet the needs of the individual.
All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. This act is known as the: a. Emergency Treatment and Active Labor Law. b. Americans With Disabilities Act. c. Patient Self-Determination Act. d. doctrine of res ipsa loquitur.
C. Patient Self-Determination Act.
A patient is placed on reserpine (Serpalan) to decrease mild anxiety and treat hypertension. The patient researches the medication on the Internet and finds that this medication comes from which plant?a. Atropa belladonna b. Digitalis purpurea c. Rauwolfia serpentina d. Cephaelis ipecacuanha
C. Rauwolfia serpentina
Despite the presence of safety aids such as handrails in the bathrooms at an assisted living facility, the number of fractures due to unsteady ambulation upon arising from the bed and when attempting to perform activities of daily living has increased. Which complementary alternative medicine (CAM) would be an effective intervention for this population? a. Yoga b. Acupuncture c. Tai chi d. Magnet therapy
C. Tai chi
A patient has fallen at home and complains that joints are very painful when trying to climb stairs. The patient desires to use an alternative complementary medicine rather than pain medication. The practitioner begins treatment with touch consisting of rocking, rhythmical motions to loosen tense, sore muscles and joints. The patient is receiving which type of treatment? a. Swedish massage b. Rolfing c. Trager approach d. Reflexology
C. Trager approach
A Southeast Asian woman brings her baby into the clinic because the baby is lethargic. The nurse determines that the baby has had diarrhea and vomiting for several days, resulting in dehydration. Physical examination reveals small, round burns on the abdomen. These burns probably are the result of cigarettes or burning cotton used to: a. try to quiet the child and is considered child abuse. b. bring out toxic wind from the body. c. balance heat loss from the body. d. brush the body with ruda to allow spirits to return.
C. balance heat loss from the body.
A physician shares with the patient's family that, while a central line was being inserted, the patient's lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician's role in this instance is based on the legal principle of: a. comparative negligence. b. gross negligence. c. disclosure. d. the Emergency Medical Treatment and Active Labor Act (EMTALA).
C. disclosure.
A client states, "I am leaving. No one here knows what they are doing." The nurse completing the Against Medical Advice form must: a. defer notifying the provider until the client has had ample time to leave. b. state in medical terms the risks of leaving. c. inform the client that leaving could result in complications and impairment. d. detain the person with the use of soft restraints until security arrives.
C. inform the client that leaving could result in complications and impairment.
When reviewing the literature on the effects of Medicaid on health care for the poor, the nurse researcher found that the poor: a. have less access than even the uninsured. b. receive many unnecessary treatments. c. lack consistent providers. d. abuse preventive services.
C. lack consistent providers.
A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating the ethical principle of: a. veracity. b. beneficence. c. nonmaleficence. d. autonomy.
C. nonmaleficence.
A nurse performing a history and physical on a newly admitted Hispanic patient learns the patient has just used the services of a savador to: a. determine which herbs would best reduce hot flashes in a menopausal woman. b. communicate with a family member who recently died. c. receive treatments to reduce lower back pain. d. receive acupuncture to stop smoking.
C. receive treatments to reduce lower back pain.
A physician orders a drug for a patient with a known allergy resulting in anaphylactic shock. The nurse: a. realizes that disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. should disclose the occurrence before speaking with the physician who ordered the drug or with hospital management. c. recognizes disclosure as an essential component of the national patient safety movement. d. should report the occurrence to the patient's insurance company to decrease patient costs.
C. recognizes disclosure as an essential component of the national patient safety movement.
In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on the principle of: a. veracity. b. values. c. utilitarianism. d. autonomy.
C. utilitarianism.
The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, known as a _____ nurse. a. case management b. quality assurance c. utilization review d. cost-control
C. utilization review
A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual: a. is more likely to participate in mammography screening than are individuals covered by private insurance. b. has designated primary care and a specialist as sources of care. c. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier. d. has decreased access to health care when compared with the uninsured.
C. will more likely wait to seek care and will require hospitalization for a mastectomy, which could have been avoided if care had been sought earlier.
On a nursing unit all assigned breaks including lunch/dinner breaks are assigned at the beginning of the shift. A nurse caring for a patient with anemia and heart failure prepares to hang a unit of packed red blood cells and realizes her break is in 5 minutes. She decides it is not necessary to have another nurse check the blood against the patient's information since the patient's blood type is O+ which she incorrectly remembered to be the universal donor. She hangs the blood, noting the patient is "reading and vital signs normal." She leaves the floor for her break and does not report leaving or ask anyone to perform required vital signs. Upon returning she meets a family friend who is visiting and time "just flies." She returns to the patient's room after admitting a new patient. The patient is hypotensive and color is cyanotic and anxious. She reports the findings to the charge nurse, who then contacts the physician. A blood reaction occurrence is noted. The nurse providing care is charged: a. with comparative negligence. b. with a preventable adverse event. c. with criminal negligence. d. under the doctrine of res ipsa loquitur.
C. with criminal negligence.
Health care is one of the major stories in newspaper and television and a group of nurses are interested in how the economy impacts their nursing practice. The group critiques the relationship between contemporary economic trends and professional nursing practice and finds: a. the implementation of the DRG system led to the nursing shortage since cost of nursing care is not billed. b. nursing care is focused on technologically advanced acute care rather than preventive, patient-centered care. c. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices. d. economic issues have little or no impact on nursing practice.
C. with pay for performance, nurses have a significant effect on the quality of patient outcomes by reducing errors and providing care based on best practices.
The nurse who presents a class on different methods of complementary alternative medicine (CAM) differentiates between imagery and hypnosis in which of the following ways? a. Imagery involves the dependent mental construction of a picture, whereas hypnosis requires the patient to recall and verbally describe difficult times in his or her life. b. Hypnosis requires a trained psychologist, but imagery can be performed by any health care practitioner. c. Imagery produces a temporary sense of well-being compared with hypnosis, which evokes a permanent positive effect. d. Although both therapies focus on specific problems and guide the patient into relaxation, imagery requires the patient to formulate the impression, whereas the hypnotist constructs the image for the patient.
D. Although both therapies focus on specific problems and guide the patient into relaxation, imagery requires the patient to formulate the impression, whereas the hypnotist constructs the image for the patient.
An older adult has atrial fibrillation, which causes the heart to have an irregular rhythm. The client uses imagery to alter the dysrhythmia. The client is using which type of complementary alternative medicine (CAM)? a. Ayurveda b. Dosha c. Homeopathy d. Biofeedback
D. Biofeedback
A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services? a. Prospective payment system b. Retrospective payment system c. Single-payer system d. Capitation
D. Capitation
When can a nurse detain a client by using restraints? a. Staffing resources are insufficient to monitor a patient with hemiplegia. b. The client is confused. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current physician orders following a medical evaluation.
D. There are current physician orders following a medical evaluation.
A client and her husband used in vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. The nurse realizes that: a. the client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. a logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. the client has not been able to navigate the complicated issues inherent in this situation. d. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.
D. a rational decision was reached that was based on reflection and on the value systems of the wife and the husband.
A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others' cultural beliefs. The nurse's first step to ensure cultural competence and sensitivity is to: a. enroll in a nursing theories course to increase knowledge about transcultural practices. b. become immersed in nursing literature about culturally diverse clients. c. participate in continuing education that focuses on health assessment variations among cultural groups. d. conduct a cultural self-assessment.
D. conduct a cultural self-assessment.
A nurse who functions in the role of team leader can be held negligent for matters involving: a. inadequate training. b. lack of development of proper policies and procedures. c. failure to discipline unsafe workers. d. delegation of client care tasks.
D. delegation of client care tasks.
A Hispanic patient is visited by several family members and the nurse witnessed one visitor who pinches a piece of skin at the waist. The nurse asks the purpose and learns the "provider" is listening for a snap from the abdominal region, which is then repeated several times. The patient most likely suffers from: a. mal ojo. b. susto. c. bilis. d. empacho.
D. empacho.
A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client's physician. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse's actions reflect: a. invasion of privacy. b. libel. c. slander. d. negligence.
D. negligence.
A patient who is just beginning to use homeopathy to treat depression is concerned because symptoms are actually becoming worse with increasing sadness, anxiety, and fatigue. The practitioner of homeopathy bases teaching on the Law of Cure and instructs the patient to: a. discontinue the therapy and seek another alternative therapy. b. concentrate the preparation to increase its potency in hopes to improve depressive symptoms. c. increase the dosage of the substance to increase its effectiveness. d. remain on the current regimen since worsening is a positive sign that healing is occurring.
D. remain on the current regimen since worsening is a positive sign that healing is occurring.
in February 2010, Congress passed legislation to support universal health care for all Americans. At a local health fair, an individual asks about the difference between universal health care and a single payer system. The nurse explains the difference is that: a. with universal health, one universal payer, usually the government, pays all expenses for health care. b. single-payer systems offer health care only to eligible persons based on income. c. single-payer systems rely on insurance companies to pay predetermined fees for services. d. with universal health, one payer is responsible for all health care costs, providing health care to all citizens.
D. with universal health, one payer is responsible for all health care costs, providing health care to all citizens.
