HSC 175 Ch 2

Qualities of effective leaders (select all that apply): 1. Supportive 2. Assertive 3. Calculating 4. Sensitive and objective 5. Responsible 6. Facultative

1, 2, 4, 5, 6 #3 is incorrect

1. Legal retention is when a patient is admitted for ________ hour hold in order to obtain COA for an extended admission 2. When the patient is unable to stand trial due to mental incapacity, admission to a psychiatric facility will occur only until they are deemed ________ to stand trial.

1. 24 hours 2. Fit to stand trial

Informational: List four actions the Nurse should take in regards to caring for a restrained client. • Use the least restrictive restraints, physical or chemical after trying all the other least restrictive alternatives. • Check frequently to make sure restraints do not impair circulation or cause pressure sores or other injuries. • Allow nutrition, hydration, and stimulation in frequent intervals. Q2H • Remove the restraints ASAP. • Document: other interventions before applying restraints, rational for restraints, how long in restraints, time u called the Dr. , Family notified, type of restraints

1. Least restrictive first. 2. Frequently check for circulation/areas which can lead to pressure sores 3. Eat, drink, and engage Q2H 4. Restraints must be removed ASAP 5. Family notification 5. Documentation - if it's not documented you didn't perform all the least restrictive methods and you didn't do ANY of the above.

What things must be present in order for a client to provide valid written consent (select all that apply)? 1. A family member must be present 2. Alert, coherent, and an otherwise competent adult. 3. Parent or legal guardian 4. Emancipated minor 5. 14 YO and older must agree to treatment along with his/her parent or guardian.

2, 3, 4, 5 #1 is incorrect

When a patient is in leather restraints, how often do you assess the patient? 1. 30 mins 2. 2 hours 3. 15 mins 4. 10 mins

3. 15 mins.

A STAT order has been given for Morphine 4mg IV push. Premed vitals reveal BP 96/54, HR 58, RR 10, T 36.1. The RN retakes the vitals and they have not changed. You place a call to the physician who tells you to administer the medication as ordered. What are the next steps of the nursing process? 1. Hold the medication and document your findings and why you held the medication. 2. Administer as ordered because the doctor knows what is best and monitor the patient closely. 3. Inform the MD, that you either don't have enough knowledge and/or experience to carry out the prescription, refuse to carry out the prescription, or arrange to have an RN supervisor or nurse with enough education and experience to carry out the procedure, then document your assessment findings, why you held the medication, what the MD stated, and speak with your charge nurse.

3. Inform the MD, that you either don't have enough knowledge and/or experience to carry out the prescription, refuse to carry out the prescription, or arrange to have an RN supervisor or nurse with enough education and experience to carry out the procedure, then document your assessment findings, why you held the medication, what the MD stated, and speak with your charge nurse. It is appropriate for the you to seek higher up for guidance. This is also the same when the RN is not properly trained to carry out an order. Remember, "Do no harm."

You have placed your patient in soft restraints because he is confused and pulling on his IV, NG-tube, and Foley catheter, (no order written). The physician must assess the patient in ____ _________, and you are required to assess the patient and alternate limb release (and allow for physical needs), every ___ ________. 1. 1 hour, every 15 mins. 2. 30 mins, every 30 mins. 3. 24 hours, every hour. 4. 24 hours, every 2 hours.

4. 24 hours, every 2 hours.

Your patient has been placed in leather restraints for his/her protection and the staff. When is the MD required to assess the patient? 1. 15 mins 2. 30 mins 3. 45 mins 4. 60 mins

4. 60 mins or 1 hour

The RN can delegate the following to the LPN (select all that apply): A. UAP supervision (patient is stable) B. Promethazine (Phenergan) 25mg IV push C. Follow-up patient care D. B12 1gm IM.

A, C, & D. 3 Tasks RN would delegate to an LPN: a. Follow-up b. Med admin: PO, ID, IM, SubQ c. Supervising UAP once patient is stable and predictable.

Which of the following statements is true? A. Ineffective use of time is a learned behavior. B. It takes approximately a week to change your time management behavior. C. If you don't learn effective time management as a child, you will not learn it as an adult. D. If you slip back into old habits in time management, you will not successfully break these habits.

A. Ineffective use of time is a learned behavior. Ineffective use of time is a learned behavior, better known as a habit. It takes at least 21 days of consistently repeating a task to break a habit. Habits (learned behavior) can be unlearned. If you slip back, you need to reinstate the plan and start again. REF: p. 14

Developing an action blueprint of time use is an example of which stage of time management? A. Planning B. Evaluation C. Implementation D. Data Collection

A. Planning A plan helps to keep you honest. It reflects the face-to-face classes you must attend and the studying you need to do to reach your long-term goal. It is your blueprint for action. Ref. p. 14

Which of the following reflects left-brain thinking? A. Time management strategies B. Resisting carefully organized tasks C. Devising tools for time management D. Preferring one's own ideas for time management

A. Time management strategies A linear, methodical approach to time management is consistent with left-brain thinking style. Right-brain thinkers resist carefully organized tasks. Right-brain thinkers prefer their own tools for time management. Right-brain thinkers prefer using their own ideas for time management. REF: p. 14

Be true A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

A. Veracity

Info Only: Ethical Decision-Making 1. Ask "Is it ethical?" 2. Gather all the facts that are relevant. 3. Know your own values (feelings and reactions) 5. State the problem clearly (for better conclusion) 6. Consider the possible course of action 7. Negotiate the outcome for all involved Evaluate the outcome

Ask, gather info, know yourself, state it clear, consider what will happen, negotiate the change, then evaluate the outcome of the change.

Your patient 4 hours status-post head injury, slip and fall in the shower. He is confused and a fall risk. You do not have a CNA assigned to your floor. What alternatives should be utilized prior to restraint use, (select all that apply): A. Raising all bed rails B. A Sitter C. Unscheduled Ativan (in the patient's MAR). D. Removing the walker from the patient's reach. E. A family member F. Foley Catheter placement to address their need.

B & E Rationale: Raising all the bed rails, (considered restraining), administering unscheduled Ativan, (patient is already confused), removing the walker from the patient's reach (shouts injury), and placing a Foley Catheter to meet the patient's need to urinate, (this meets the nurse's need). Anything utilized to keep the patient on his bed is considered a restraint.

Unintentional Torts include the following (select all that apply): A. Restraints, solitary room confinement, or forced admission w/o consent, w/o court order. B. Leaving a heating pad on longer than required. C. Writing/saying something that destroys the reputation of a patient which is true (in the hallway). D. Harm to a patient due to lack of skill which causes personal injury.

B and C Def: Unintentional Tort: injury to person causing pain or damage (resulting in money) - 1. Unintentional Harm (negligence due to lack of skill or error). 2. Malpractice - Professional negligence which is reasonable and prudent of Duty, Breach of duty, Injury or damages, Proximate cause.

Fair to all - Equal treatment and care A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

B. Justice

Active Listening Requires that you: A. Listening to what is said to you, while doodling or look out the window, all the while thinking of what to eat for lunch. B. Sense that someone is talking to you, comprehending what they say, and then interpreting it to your own understanding, evaluate what was said, and confirm your understanding.

B. Sensation or sense that someone is talking to you, comprehending what they say, and then interpreting it to your own understanding, evaluate what was said, and confirm your understanding. (Ref. Lecture notes) * Passive: Staring at instructor, doodling, looking out of window, copy everything while thinking of where to eat after class * Active Listening - Always thinking not just listening, asking themselves questions about content, listen and look with 100% attention * Comprehend - Understanding what you read. Assist with critical thinking skills * Efficiency: helps you get things done as quickly as possible * Effectiveness: Setting priorities among the tasks that needs to be done. Start with the most important one (Ref. Shab's notes)

Which of the following statements is true about minitasking? A. Minitasks should be stored in computer files for access. B. The minitask must take no longer than 5 minutes. C. The minitask must take no longer than 10 minutes. D. Minitasks must be pleasant.

B. The minitask must take no longer than 5 minutes. Minitasks should be written down and carried with the person. The minitask must be simple and take no longer than 5 minutes. The minitask is a sure way to finish unpleasant, difficult, or time-consuming tasks. REF: p. 19

Faithful/Trustworthy A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

C. Fidelity F for faithful and T for trustworthy....If your spouse is Faithful, they are Trustworthy (F ideli T y)

Which of the following is a long-term goal? A. Study for my test tomorrow B. Go on a "date" with my spouse on the weekend C. Graduate from a practical nursing program D. Review my notes from class during break

C. Graduate from a practical nursing program Studying for the test is a short-term goal. Going on a date with your spouse is a short-term goal. Completing a nursing program is a long-term goal. Reviewing your notes from class is a short-term goal. REF: p. 14

Which component of the nursing process incorporates putting a time-management plan into action? A. Data collection B. Planning C. Implementation D. Evaluation

C. Implementation Activation of a plan does not occur during the data collection process. Activation of a plan does not occur during the planning process. Implementation is the component in which a plan becomes action. Activation of a plan does not occur during the evaluation process. REF: p. 18

Which component of the nursing process involves prioritizing? A. Implementation B. Data collection C. Planning D. Evaluation

C. Planning Prioritizing is not the key feature in implementation. Prioritizing is not the key feature in data collection. Planning involves setting priorities for tasks. Prioritizing is not the key feature in evaluation. REF: p. 15

Do Good A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

D. Beneficence

Which of the following is a true statement? A. Time management can help a person work smarter and harder. B. Effectiveness may or may not involve priorities. C. Time management deals solely with efficiency. D. Efficiency helps to get things done as quickly as possible.

D. Efficiency helps to get things done as quickly as possible. Time management can help a person work smarter, not harder. Effectiveness involves setting priorities. Time management does not deal solely with efficiency. Efficiency will help to get things done as quickly as possible. REF: p. 14

Info Only: Restraints Notify the family "Why" Assess skin/circulation If the family wants all 4 bedrails up, document and raise the rails.

Documentation: 1. Physician Order 2. Time family notified 3. Your assessments of skin/circulation 4. Why the restraints were initiated 5. The time and how long restraints were utilized 6. Time the physician was notified. 7. The type of restraint used 8. The family requested bedrail restraint.

What 4 things must be proven in order for the plaintiff to successfully charge a Nurse with malpractice?

Duty • obligation to maintain a nursing standard. Being able to anticipate the foreseeable risk. What a prudent nurse would do. Breach of duty • Failure to maintain nursing standard. A prudent nurse in the same situation would not have acted the same. Injury/damage • Failure to maintain nursing standard cause mental or physical injury or damage to plaintiff. Proximate cause • The breach of duty cause the harm and nurse's action or lack of action causes harm to the plaintiff. Connection between conduct and resulting injury is called "proximate cause" or "remoteness of damage."

Free to choose A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

E. Autonomy

Do no harm A. Veracity B. Justice C. Fidelity D. Beneficence E. Autonomy F. Non-maleficence

F. Non-maleficence

True or False: Court Order Admission is required for involuntary admission within 48 hours of admission.

False Involuntary admission requires Court Order within 24 hours.

True or False: Stealing a patient's medications is a Felony and punishable with jail time of more than 2 years.

False Misdemeanor - stealing a patient's medications and punishable of less than 1 year.

True or False: The nurse is responsible for providing the patient with informed consent.

False The RN is responsible to obtain consent forms, ensure they're completed and place them in the charts prior to a procedure, (and can witness informed consent). It is the physician's responsibility to provide: Type of procedure, where and how it's performed, the risks and benefits, any alternative treatment available, and prognosis.

True or False: If you see two similar answers, it's probably one of those two answers.

False Throw them out and look at the other two answers and remember to throw the odd man out, if it doesn't even apply.

True or False: The RN would delegate the following to the LPN: Initial discharge instructions, Invasive/ sterile procedures, and initial assessment

False Can delegate to LPN: (know 3 for test) 1) ORAL medication administration 2) I & O 3) Reinforce teaching 4) Dressing change 5) ADLs Cannot: 1) Nursing Dx 2) Initial assessment 3) Initial teaching 4) IV meds 5) Discharge planning/teaching 6) Unstable pt assessment 7) Assessment of a pt who just got back to the floor

True or False: Patients have a right to obtain their original medical record for their records.

False: The healthcare provider/institution is the custodian of the health record. The patient has the right know how to access the record and they must authorize release of records. The patient can authorize release of specific information or all of the record in it's entirety.

In test taking, one should always prioritize patient needs by utilizing ____________ _____________ of needs; ( and ABC's of the nursing process)

Maslow's Hierarchy

LEFT brain thinkers • Process in sequence • Trained musicians • Verbal/fluent side • Robot - like speech • Understand positive emotions • Puzzelled over missing parts (cut your hair.... Who are you?!) • Breakdown of info to bits and pieces so it can be understood • Learn in formal setting • Analytical, rational, objective Ref. Shab

RIGHT brain thinkers • Process spatially • Music students • Add tone and inflection to our voice • High level math • Chess players, problem solvers • Recognize negative emotions faster • Recognize faces in crowd even if you shave your hair! • Gives a total picture of our learning • informal, visual, auditory learners • imaginative, intuitive, impulsive

What are the rights of all hospitalized patients? (List 4 required for test)

Right to: • Wearing own clothes and have some small cash • Individual storage • Having daily visitors • Phone access - be able to have private conversation • Send and receive mail ( unopened) • Refuse treatments, lobotomy, shock...

True or False: A civil law is defined by money paid as a result injury or actions.

True

True or False: Administering a lethal dose of medication is felony and punishable with jail time of more than 1 year.

True

True or False: Assault is when a patient refuses to take a medication and tell the patient, "You will take this medication or else."

True Assault is a threat without touch Battery is touching the pt and doing something to them that they don't want done. Example: putting a BP cuff on pt when he says NO. Resuscitation of a DNR patient (ref. Shab)

True or False: Assault is when a patient refuses to take a medication and you threaten them to take it or else.

True Assault is a verbal threat. Battery is causing physical harm (touch) Assault and Battery is threatening "or else" and then crushed in applesauce and feeding it to the patient.

True or False: Criminal Law: Crimes committed against country, state, or local government.

True Broken legal statues that are set at large, (public, state, country). Example: Not reporting child abuse; Assaulting a patient when no harm to self is evident. Committing a state or government crime even in the workplace. • Stealing narcotics • Not reporting child abuse • HIPPA violation • Not performing an act when legal obligation exists (ref. Shab)

True or False: A physician can obtain Court Order Admission, (COA), when the patient states anything which indicates that the patient is a harm to themselves or the public in general.

True COA must be obtained within 24 hours of admission.

True or False: If you know the answer do not use test taking strategies.

True If you know the answer, you know which answer is correct. Find the correct answer and don't evaluate which answers are essentially the same or which one is the odd man out.

True or False: The skills of a nurse leader are: 1. Good communication skills 2. Good organization skills 3. Delegate appropriately 4. Good supervision skills 5. Utilize critical thinking skills 6. Team building (promote)

True ● Communicate with clear goals, expectations, provide info, verbal and non-verbal cues. ● Organize by utilizing human, material, and financial resources to promote goals. ● Delegate by transferring responsibility and authority of delegated task to another person, but retain responsibility (accountability) for the task. ● Supervise while providing guidance, direction, with evaluation of care and perform follow up ● Critically think, utilizing knowledge, collaboration, management, and reasoning ● Team building by fostering a positive team environment with motivation and coaching, and handle change and conflict

Information only - HIPPA Health Insurance Portability and Accountability Act of 1996 Who are accountable: Anyone who submits electronically and the employees of those institutions Violators: Can be assessed fines, jail time, loss of license.

Violation Examples: 1. Accessing a chart that is not your patient. 2. Disclosure of information to an unauthorized institution or individual. 3. If electronically disclosed to the wrong individual or institution without the disclosure statement included.

When is it appropriate to use restraints?

When all other methods have been exhausted It appropriate to restrain a patient when: • In an emergency • For limited time • For the patient's safety or the safety of others

Will the court consider the policy and procedures of the facility in making determination for responsibility of injury?

Yes. Courts typically view these policies and if the laws are not reasonable, the institution is held liable.