Exam 5: Nursing 290

What are standards for patient education?

All state Nurse Practice Acts recognize that patient teaching falls within the scope of nursing practice. The Joint Commission sets standards for patient and family education. Successful accomplishment of standards requires collaboration among health care professionals.

What is the ADA?

Americans with Disabilities Act, protects rights of people with physical or mental disabilities

What is the process of ethical dilemma?

Step 1: Ask if this is an ethical dilemma. Step 2: Gather all relevant information. Step 3: Clarify values (examine and determine her own values and opinions about the issues) Step 4: Verbalize the problem. Step 5: Identify possible courses of action. Step 6: Negotiate the outcome. Step 7: Evaluate the action.

Define teaching

The concept of imparting knowledge through a series of directed activities.

What is the circular transaction communication process?

The model shows the situational contextual inputs, channels of communication, interpersonal contextual concepts, and factors affecting the sender and receiver. Both parties view the perceptions, attitudes, and potential reactions to a sent message. Communication becomes a continuous and interactive activity. Components: -Referent -Sender and receiver -Message -Channels -Feedback -Interpersonal variables -Environment

What is the Uniform Anatomical Gift act?

an individual who is at least 18 years of age has the right to make an organ donation. Donors need to make the gift in writing with their signature. In many states adults sign the back of their driver's license, indicating consent to organ donation

What is psychomotor learning?

learning that involves acquiring skills that require coordination and integration of mental and physical movements IE patient demonstrates how to change a dressing wound

Who is the referent?

motivates one person to communicate with another

Define justice

refers to fairness. The term is most often used in discussions about access to health care resources, including the just distribution of scarce resources

Define responsibility

refers to the willingness to respect one's professional obligation and to follow through. Example is following an agency's policies and procedures. As a nurse you are responsible for your actions and the actions of those to whom delegate tasks.

What is cognitive learning?

the acquisition of mental information, whether by observing events, by watching others, or through language Includes all intellectual behaviors and requires thinking

What is health literacy?

the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions the cognitive and social skills that determine the motivation and ability of individuals to gain access to, understand, and use information in ways that promote and maintain good health. Health literacy includes patients' reading and mathematics skills, comprehension, and decision-making and functioning skills with regard to health care.

What is the sender and receiver?

the sender is the person who encodes and delivers the messages, and the receiver is the person who receives and decodes the message

Define liability

the state of being legally responsible for the harm one causes another person

Whats the difference between EHR and EMR?

An EMR is a narrower view of a patient's medical history (why are they here for this visit), while an EHR is a more comprehensive report of the patient's overall health.

What is motivational interviewing?

a client-centered, directive method for enhancing intrinsic motivation to change by exploring and resolving ambivalence A technique that holds promise for encouraging patients to share their thoughts, beliefs, fears, and concerns with the aim of changing their behavior. The interviewing is delivered in a nonjudgmental, guided communication approach.

Define intrapersonal communication

is a powerful form of communication that you use as a professional nurse. This level of communication is also called self talk. Peoples thoughts and inner communications strongly influence perceptions, feelings, behavior, and self esstem

define electronic communication

is the use of technology to create ongoing relationships with patients and their health care team

Define interpersonal communication

is a one on one interaction between a nurse and another person that often occurs face to face

What is problem oriented medical records?

(POMR) is a system of organizing documentation to place the primary focus on patient's individual problems. Data are organized by problem or diagnosis. Ideally each member of the health care team contributes to a single list of identified patient problems, which coordinates a common plan of care. Includes the: -database (history and physical examination, ongoing assessment) -Problem list -Care plan -Progress notes; progress made toward resolving a patients problem, different forms include SOAP: Subjective, Objective, Assessment, Plan. SOPIE: Subjective, Objective, Assessment, Plan, Intervention, Evaluation. PIE: Problem, Intervention, Evaluation. DAR: Data, Action, Response

What is important about communication in nursing practice?

-A lifelong learning process for nurses -Therapeutic communication promotes personal growth and attainment of patients' health-related goals -Key to nurse-patient relationships -Patient safety requires effective communication -Improves patient outcomes and increases patient satisfaction

How does communication work in teaching?

-Closely parallels the communication process -Depends partly on effective interpersonal communication -The learning objective describes what the learner will be able to accomplish after instruction is given -Effective communication involves feedback

Example of nursing diagnosis based off of patient education

-Deficient knowledge (affective, cognitive, psychomotor) Ineffective health maintenance -Impaired home maintenance -Ineffective family therapeutic regimen management -Ineffective self-health management Noncompliance (with medications)

What is important about documentation in long term health care settings?

-Governmental agencies are instrumental in determining standards and policies for documentation. -Documentation in the long-term care setting supports an interprofessional approach to the assessment and planning process for all patients.

What are standards for documentation

-Know standards of your organization -Documentation needs to conform to standards of the National Committee for Quality Assurance (NCQA) and TJC to maintain institutional accreditation and minimize liability Assessment Nursing process -Medical record components

What is important about documentation in Home Health care setting?

-Medicare has specific guidelines for establishing eligibility for home care. -Medicare guidelines for establishing a patient's home care cost reimbursement serve as the basis for documentation by home care nurses. -Documentation is the quality control and justification for reimbursement from Medicare, Medicaid, or private insurance. -Nurses need to document all their services for payment.

What are the 3 basic learning principles?

-Motivation to learn Addresses the patient's desire or willingness to learn -Ability to learn Depends on physical and cognitive abilities, developmental level, physical wellness, thought processes -Learning environment Allows a person to attend to instruction

What is the acuity rating system?

-Nurses use acuity ratings to determine the hours of care and number of staff required for a given group of patients every shift or every 24 hours. -Based on type and number of nursing interventions required by a patient over a 24-hour period. -The acuity level is a classification used to compare one or more patients to another group of patients.

What are nonverbal forms of communication?

-Personal appearance -Posture and gait -Facial expressions -Eye contact -Gestures -Sounds -Territoriality and personal space -includes the five scenes and everything that does not involve the spoken or written word.

What are the phases of nurse patient relationships?

1. Preinteraction phase: occurs before meeting the patient 2. Orientation phase: when the nurse and the patient meet and get to know each other 3. Working phase: when the nurse and the patient work together to solve problems and accomplish goals 4. Termination phase: occurs at the end of a relationship

What is the role of a nurse in teaching and learning?

-Teach information that patients and families need to make informed decisions regarding their care -Determine what patients need to know -Identify when patients are ready to learn

What are informatics in health care

-The Technology Informatics Guiding Education Reform (TIGER) is focused on better preparing the clinical workforce to use technology and informatics to improve the delivery of patient care -TIGER transformed to Healthcare Information and Management Systems Society (HIMSS) -Competence in informatics is not the same as computer competency. -The use of information and computer technology to support all aspects of nursing practice, including direct delivery of care, administration, education, and research -Nursing informatics is also recognized as a specialty area of nursing practice

What are verbal forms of communication?

-Vocabulary -Denotative and connotative meaning -Pacing (speed) -Intonation -Clarity and brevity (simple and brief) -Timing and relevance - uses spoken or written words. Verbal language is a code that conveys specific meaning through a combination of words.

interpersonal relationships

-becoming sensitive to self and others -promoting and accepting the expression of positive and negative feeling -developing caring relationships -instilling faith and hope -promoting interpersonal teaching and learning -providing s supportive environment -assisting with gratification of human needs -allowing for spiritual expression - A nurses ability to relate to others is important for interpersonal communication. This includes the ability to take initiative in establishing and maintaining communication to be authentic (one's self), and to respond appropriately to other people -Communication includes posture, expressions, gestures, words, attitudes

How do you develop communication skills?

-critical thinking -perseverance and creativity -self confidence -humility -integrity help create a bond with patient and acquire information, promote understanding, assist with planning patient centered care

What makes a good learning environment?

-well lit -good ventilation -appropriate furniture -comfortable temp -quiet -private

When working with an older adult who is hearing-impaired, the use of which techniques would improve communication? Select all that apply. 1. Check for needed adaptive equipment. 2. Exaggerate lip movements to help the patient lip read. 3. Give the patient time to respond to questions. 4. Keep communication short and to the point. 5. Communicate only through written information.

1, 3, 4. Communication techniques such as assessing the need for adaptive equipment, keeping communication short and direct, and giving the patient time to respond, assist the nurse in providing clear effective communication. Patients may have difficulty with rapid or lengthy explanations. Exaggerated lip reading may be difficult or demeaning to individuals with hearing deficits.

A nurse has been gathering physical assessment data on a patient and is now listening to the patient's concerns. The nurse sets a goal of care that incorporates the patient's desire to make treatment decisions. This is an example of the nurse engaged in which phase of the nurse-patient relationship? 1. Working phase 2. Preinteraction phase 3. Termination phase 4. Orientation phase

1. The nurse assists the patient in the identification of goals and expression of feelings during the working phase of the helping relationship.

Motivational interviewing (MI) is a technique that applies understanding a patient's values and goals in helping the patient make behavior changes. What are other benefits of using MI techniques? Select all that apply. 1. Gaining an understanding of patient's motivations 2. Focusing on opportunities to avoid poor health choices 3. Recognizing patient's strengths and supporting their efforts 4. Providing assessment data that can be shared with families to promote change 5. Identifying differences in patient's health goals and current behaviors

1, 3, 5. Motivational interviewing is a technique used to promote an understanding of patients' motivation, health goals, and current behaviors in a non-judgmental environment while focusing on the patient's strengths and efforts. The nurse provides a supportive approach to assist the patient in establishing and promoting positive healthcare changes.

Which strategies should a nurse use to facilitate a safe transition of care during a patient's transfer from the hospital to a skilled nursing facility? Select all that apply. 1. Collaboration between staff members from sending and receiving departments 2. Requiring that the patient visit the facility before a transfer is arranged 3. Using a standardized transfer policy and transfer tool 4. Arranging all patient transfers during the same time each day 5. Relying on family members to share information with the new facility

1, 3. Providing a standardized process, policy and tool can assist in a predictable, safe transfer of important patient information between healthcare facilities. Communication and collaboration between the sender and receiver of information enables the staff to validate the information was received and understood. Requiring a patient visit is not always necessary and relying on family member to share information does note release staff from their responsibilities.

A nurse is using AIDET to communicate with patients and families. Match the letters of the acronym to the behavior a nurse will use A. Nurse describes procedures and tests B. Nurse lets the patient know how long the procedure will last C. Nurse recognizes the person with a positive attitude D. Nurse thanks the patient E. Nurse tells the patient " I am an RN and will be taking care of you today" 1. A-____ 2. I-____ 3. D-_____ 4. E-____ 5. T-______

1. C 2. E 3. B 4. A 5. D

A new nurse complains to her preceptor that she has no time for therapeutic communication with her patients. Which of the following is the best strategy to help the nurse find more time for this communication? 1. Include communication while performing tasks such as changing dressings and checking vital signs. 2. Ask the patient if you can talk during the last few minutes of visiting hours. 3. Ask Pastoral care to come back a little later in the day. 4. Remind the nurse to complete all her tasks and then set up remaining time for communication.

1. It is important for the nurse to take the opportunity to provide communication opportunities while providing routine patient care.

What are the 3 professional nursing relationships?

1. Nurse family relationships 2. Nurse health care team relationships 3. Nurse community relationships

Nurses must communicate effectively with the health care team for which of the following reasons? Select all that apply. 1. Improve the nurse's status with the health team members 2. Reduce the risk of errors to the patient 3. Provide optimum level of patient care 4. Improve patient outcomes 5. Prevent issues that need to be reported to outside agencies

2, 3, 4. Effective communication in healthcare has been linked to a decrease in medical errors, and an improvement in quality of care and patient outcomes. The status and of the nurse or reportable issues are not the focus of communication with patients.

The nurse uses silence as a therapeutic communication technique. What is the purpose of the nurse's silence? Select all that apply. 1. Prevent the nurse from saying the wrong thing 2. Prompt the patient to talk when he or she is ready 3. Allow the patient time to think and gain insight 4. Allow time for the patient to drift off to sleep 5. Determine if the patient would prefer to talk with another staff member

2, 3. Silence can provide that patient an opportunity to think and gain insight. Often the patient feels compelled to break the silence and is prompted to talk.

A nurse is talking with a young-adult patient about the purpose of a new medication. The nurse says, "I want to be clear. Can you tell me in your words the purpose of this medicine?" This exchange is an example of which element of the transactional communication process? 1. Message 2. Obtaining feedback 3. Channel 4. Referent

2. In this example, the nurse's question is a way to obtain feedback. Feedback is the message a receiver receives from the sender. It indicates whether the receiver, in this case the patient, understood the meaning of the sender's message

A patient is evaluated in the emergency department after causing an automobile accident while being under the influence of alcohol. While assessing the patient, which statement would be the most therapeutic? 1. "Why did you drive after you had been drinking?" 2. "We have multiple patients to see tonight as a result of this accident." 3. "Tell me what happened before, during, and after the automobile accident tonight." 4. "It will be okay. No one was seriously hurt in the accident."

3. Focusing gives direction which enables the nurse to obtain more clear information without probing. Asking why questions can convey judgment on the part of the nurse. Giving false reassurance is not a therapeutic communication technique.

A patient who is Spanish-speaking does not appear to understand the nurse's information on wound care. Which action should the nurse take? 1. Arrange for a Spanish-speaking social worker to explain the procedure 2. Ask a fellow Spanish-speaking patient to help explain the procedure 3. Use a professional interpreter to provide wound care education in Spanish 4. Ask the patient to write down questions that he or she has for the nurse

3. Professional certified interpreters can assist with simple or complex healthcare communications such as teaching instructions, test results, or education related to surgical consent. Other healthcare workers who are not certified interpreters cannot be relied on to provide clear and effective communication of healthcare information or teaching

A new nurse is experiencing lateral violence at work. Which steps could the nurse take to address this problem? 1. Challenge the nurses in a public forum to embarrass them and change their behavior 2. Talk with the department secretary and ask if this has been a problem for other nurses 3. Talk with the preceptor or manager and ask for assistance in handling this issue 4. Say nothing and hope things get better

3. Talking with a preceptor, manager, or mentor, notifies others of the problem, provides support for the nurse, and helps the nurse learn skills in addressing lateral violence.

A nurse stops to help in an emergency at the scene of an accident. The injured party files a suit, and the nurse's employing institution insurance does not cover the nurse. What would probably cover the nurse in this situation? 1. The nurse's automobile insurance 2. The nurse's homeowner's insurance 3. The Good Samaritan law, which grants immunity from suit if there is no gross negligence 4. The Patient Care Partnership, which may grant immunity from suit if the injured party consents

3. The Good Samaritan law holds the health care provider immune from liability as long as he or she functions within the scope of his or her expertise.

A nursing student is reviewing a process recording with the instructor. The student engaged the patient in a discussion about availability of family members to provide support at home once the patient is discharged. The student reviews with the instructor whether the comments used encouraged openness and allowed the patient to "tell his story." This is an example of which step of the nursing process? 1. Planning 2. Assessment 3. Intervention 4. Evaluation

4. By reviewing a conversation with a patient and determining whether the student encouraged openness and allowed the patient to "tell his story," expressing both thoughts and feelings - involves evaluation

A nurse is assigned to care for a patient for the first time and states, "I don't know a lot about your culture and want to learn how to better meet your health care needs." Which therapeutic communication technique did the nurse use in this situation? 1. Validation 2. Empathy 3. Sarcasm 4. Humility

4. Humility is admitting to limitations in knowledge and skill. This enables the nurse to admit a knowledge deficit, so that guidance is sought from the patient. Humility helps improve the therapeutic relationship, and enables a nurse to provide safe and effective care.

A nurse prepares to contact a patient's physician about a change in the patient's condition. Using SBAR (Situation, Background, Assessment, and Recommendation) communication, which of the following is the correct order? 1."She is a 53-year-old female who was admitted 2 days ago with pneumonia and was started on Levaquin at 5 pm yesterday. She complains of a poor appetite." 2. "The patient reported feeling very nauseated after her dose of Levaquin an hour ago." 3. "Would you like to make a change in antibiotics, or could we give her a nutritional supplement before her medication?" 4. "The patient started complaining of nausea yesterday evening and has vomited several times during the night." a. 1, 3, 4, 2 b. 4, 1, 2, 3 c. 2, 1, 3, 4 d. 4, 2, 1, 3

4S, 1B, 2A, 3R. The nurse describes the patient's complaint of nausea and vomiting to the physician (Situation). Specific patient demographic information and reason for admission with current symptomology is provided (Background). The physician is informed of the patient's complaint of nausea after receiving levaquin (Assessment). Physician is asked if they would like to make a change in the antibiotic or provide a nutritional supplement prior to medication administration (Recommendation).

The nurse hears a health care provider say to the charge nurse that a certain nurse cannot care for patients because the nurse is stupid and won't follow orders. The health care provider also writes in the patients medical records that the same nurse, by name, is not to care for any patients because of incompetence. Which torts has the health care provider committed (select all that apply) A. Libel B. Slander C. Assault D. Battery E. Invasion of privacy

A, B. Slander occurred when the health care provider spoke falsely about a nurse, and libel occurred when the health care provider wrote false information in the chart.

A patient has a diagnosis of pneumonia. Which entry should the nurse chart to help with financial reimbursement? A. Used incentive spirometer to encourage coughing and deep breathing. Lung congested upon auscultation in lower lobs bilaterally. Pulse ox 86%. Oxygen per nasal cannula applied at 2 L/min per standing order. B. Cooperative, patient coughed and deep breathed using a pillow as a splint. Stated, 'feel better'. Finally, patient had no complaints C. Breathing without difficulty. Sitting up in bed watching TV. Had a good day. D. Status unchanged. Remains stable with no abnormal finding. Checked every 2 hours

A. Accurately documenting services provided, including the supplies and equipment used in a patient's care, clarifies the type of treatment a patient received.

A nurse is teaching the staff about health care reimbursement. Which information should the nurse include in the teaching session? A. Home health, long term care, and hospital nurses documentation ca affect reimbursement for health care B. A clinical information system must be installed by 2014 to obtain health care reimbursement C. A near miss helps determine reimbursement issues for health care D. HIPAA is the basis for establishing reimbursement for health care

A. Nurses documentation practices in home health, long term care, and hospitals can determine reimbursement for health care.

A nurse is completing an OASIS data set on a patient. The nurse works in which area? A. Home health B. Intensive care unit C. Skilled nursing facility D. Long term care facility

A. Nurses use two different data sets to document the clinical assessments care provided in the home care setting, the Outcome and Assessment Information Set (OASIS) and Omaha system. Intensive care do not do this. Long care facility do SNIFs

A nurse is charting on a patient's record. Which action will the nurse take that is accurate legally? A. Charts legibly B. States the patient is belligerent C. Writes entry for another nurse D. Uses correction fluid to correct error

A. Record all entries legibly. Do not use personal opinions. Enter only objective and factual observations of patients behavior, quote all patient comments.

During a teaching session, the nurse tells a patient with a recent neck injury that damage to the nerves is comparable to a water hose that has been pinched off. During this teaching session, the nurse is using the process of: A. analogy. B. discovery. C. role playing. D. demonstration

A. analogy.

A student nurse employed as a nursing assistant may perform care: A. as learned in school. B. expected of a nurse at that level. C. identified in the hospital's job description. D. requiring technical rather than professional skills.

A. as learned in school.

Information regarding a patient's health status may not be released to non-health care team members because: A. legal and ethical obligations require health care providers to keep information strictly confidential. B. regulations require health care institutions to document evidence of physical and emotional well-being. C. reimbursement issues related to patient care and procedures may be of concern. D. fragmentation of nursing and medical care procedures may be identified.

A. legal and ethical obligations require health care providers to keep information strictly confidential.

What are critical pathways? or CareMap tools

Are interprofessional care plans that identify patient problems, key interventions, and expected outcomes within an established time frame. This document facilitates the integration of care because all health care team members use the same critical pathways for a specific disease or condition. Eliminates nurse notes, flow sheets, and care plans because it is built into the pathway document

intentional tort

Assault: is an intentional threat toward another person that places the person in reasonable fear or harmful, imminent, or unwelcome contact Battery: Is any intentional offensive touching without consent False Imprisonment; unjustified restraint of a person without a legal reason

How do patients use motivation to learn?

Attentional set -The mental state that allows the learner to focus on and comprehend a learning activity. Motivation -Force that acts on or within a person to cause the person to behave in a particular way.

A patient is being discharged home. Which information should the nurse include? A. Activity level B. Community resources C. Standardized care plan D. Signature for verbal order

B. Discharge documentation includes medications, diet, community resources, follow up care, and who to contact in case of an emergency or for questions

A nurse is experiencing an ethical dilemma with a patient. Which information indicates the nurse has a correct understanding of the primary cause of ethical dilemmas? A. Unequal powers B. Presence of conflicting values C. Judgmental perceptions of patients D. Poor communication with the patient

B. Ethical dilemmas almost always occur in the presence of conflicting values. While unequal powers, judgmental perceptions, and poor communication can contribute to the dilemma, these are not causes of a dilemma. Without clarification of values, the nurse may not be able to distinguish fact from opinion or value, and this can lead to judgmental attitudes

A nurse has just admitted a patient with a medical diagnosis of congestive heart failure. When completing the admission paper work, the nurse needs to record: A. an interpretation of patient behavior. B. objective data that are observed. C. lengthy entry using lay terminology. D. abbreviations familiar to the nurse.

B. objective data that are observed.

A hospital is using a computer system that allows all health care providers to use a protocol system to document the care they provide. Which type of system/design will the nurse be using? A. Clinical decision support system B. Nursing process design C. Critical pathway design D. Computerized provider order entry system

C. One design model for Nursing Clinical Information Systems (NCIS) is the protocol or critical pathway design.

A nurse obtained a telephone order from a primary care provider for a patient in pain. Which chart entry should the nurse document? A. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. VO Dr. Day/J. Winds, read back B.12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO J. Winds, RN, read back C. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO Dr. Day/J. Winds, RN, read back D. 12/16/20XX 0915 Morphine, 2 mg, IV every 4 hours for incisional pain. TO J. Winds, Rn.

C. The nurse receiving a TO or VO enters the complete order into the computer using the computerized provider order enter software or writes it out on physician's order sheet for entry in the computer as soon as possible. VO stands for verbal order, not telephone order.

A nurse records that the patient stated his abdominal pain is worse now than last night. This is an example of: A. PIE documentation. B. SOAP documentation. C. narrative charting. D. charting by exception.

C. narrative charting.

Define Casuistry

Case-based reasoning, turns away from conventional principles of ethics as a way to determine best actions and focuses instead on an intimate understanding of particular situations

What is the purpose of medical records?

Communication Legal documentation Reimbursement Education Research Auditing/monitoring

What are the channels?

Communication channels are means of sending and receiving messages through visual, auditory, and tactile senses (spoken words, facial expressions)

Which behaviors indicate that the student nurse has a good understanding of confidentiality and the Health Insurance Portability and Accountability Act (HIPAA)? (Select all that apply.) a. Writes the patient's room number and date of birth on a paper for school b. Prints/copies material from the patient's health record for a graded care plan c. Reviews assigned patient's record and another unassigned patient's record d. Gives a change-of-shift report to the oncoming nurse about the patient e. Reads the progress notes of assigned patient's record f. Discusses patient care with the hospital volunteer

D, E. When you are a student in a clinical setting, confidentiality and compliance with HIPPAA are part of the professional practice. Reading the progress notes of a assigned patients records and giving a change of shift report to the oncoming nurse about the patient are behaviors that follow HIPPAA.

A nurse is preparing to teach a patient with a risk for hypertension how to take blood pressure. Which action by the nurse is the priority? A. Assess laboratory results for high cholesterol and other data B. Identify that teaching is the same as the nursing process C. Perform nursing care therapies to address hypertension D. Focus on a patient's learning needs and objectives

D. The teaching process focuses on the patient's learning needs, motivation, and ability to learn; writing learning objectives and goals is also included

A nurse whats to find a daily weights of a patient. Which form will the nurse use? A. Database B. Progress notes C. Patient care summary D. Graphic record and flow sheet

D. Within the computerized documentation system, flow sheets and graphic records allow you to quickly and easily enter assessment data about a patient, such as vital signs, admissions and or daily weights, and percentage of meal eaten.

A nurse is caring for a patient who states, "I just want to die." For the nurse to comply with this request, the nurse should discuss: A. living wills. B. assisted suicide. C. passive euthanasia. (give drug to family member) D. advance directives.

D. advance directives.

A patient you are assisting has fallen in the shower. You must complete an incident report. The purpose of an incident report is to: A. exchange information among health care members. B. provide information about patients from one unit to another unit. C. ensure proper care for the patient. D. aid in the hospital's quality improvement program.

D. aid in the hospital's quality improvement program.

A patient newly diagnosed with diabetes needs to learn how to use a glucometer. Use of a glucometer constitutes: A. affective learning. B. cognitive learning. C. motivational learning. D. psychomotor learning.

D. psychomotor learning.

You are invited to attend the weekly unit patient care conference. The staff discusses patient care issues. This type of communication is: A. public. B. intrapersonal. C. transpersonal. D. small group.

D. small group

What is the importance of planning during patient education

Determine goals and expected outcomes that guide the choice of teaching strategies and approaches with a patient: -Set priorities. -Select timing to teach. -Organize the teaching materials. -Use teamwork and collaboration

What are guidelines for documentation?

Factual Accurate Complete Current Organized

What is the nurse-patient relationship?

Focuses on the Pt, has goals, and is defined by specific boundaries. Takes place in a health care setting. When the Pt is discharged, the relationship ends. In this relationship, you are in a helping role rather than a social role. Caring relationships are the foundation of clinical nursing practice. Therapeutic relationships promote a psychological climate that facilitates positive change and growth.

Feminist Ethics

Focuses on the inequality between people

What is metacommunication?

Is a broad term that refers to all factors influence communication. Awareness of influencing factors helps people better understand what is communicated. Awareness of the tone of verbal responses and the nonverbal behavior results in further exploration of the patient's feeling and concerns

Explain a nurses role in confidentiality

Nurses are legally and ethically obligated to keep all patient information confidential. Nurses are responsible for protecting records from all unauthorized readers. HIPAA requires that disclosure or requests regarding health information be limited to the minimum necessary.

What are Torts?

Nursing practice is also regulated by common law or judicial case law or torts. Torts are civil wrongful acts or omissions made against a person or property. They are classified as intentional, quasi-intentonal, or unintentional

Define Utilitarianism

Proposes that the value of something is determined by its usefulness

What are standardized care plans or clinical care guidelines?

Preprinted, established guidelines used to care for patients who have similar health problems

What is the Good Samaritan Law?

Protects healthcare providers who give aid in an emergency situation while off duty. Provider is not obligated to give care but care that is started cannot be abandoned, care must be within providers scope of practice, and care must not be grossly negligent.

What is the Death with Dignity Act?

Providing end of life care in today's world is challenging for health care professionals because people are living longer.

What is important about evaluation during patient teaching

See through the patient's eyes. -Have the patient's learning needs been met? -Reinforces correct behavior, changing incorrect behavior, helps educator determine adequacy of teaching. Patient outcomes: -Legal responsibility -Documentation Teach back

Assessment during patient teaching

See through the patient's eyes. -Teaching is patient-centered. Assess the patient's learning needs. -Information or skills needed to perform self-care and to understand the implications of a health problem. -Patient experiences that influence the need to learn. -Information that family caregivers need to support patient needs. -Motivation to learn -Ability to learn -Teaching environment -Resources for learning

What is charting by exception?

Shorthand method of documenting findings by only charting abnormal findings, patient meets all normal levels/base unless stated other wise.

define learning

The purposeful acquisition of new knowledge, attitudes, behaviors, and skills through an experience or external stimulus.

How do you use therapeutic communication during implementation?

Therapeutic communication techniques are specific responses that encourage the expression of feelings and ideas and convey acceptance and respect. Active listening means being attentive to what a patient is saying both verbally and nonverbally. Use "SOLER": Sit facing the patient; observe an open posture, lean toward the patient, establish and maintain intermittent eye contact; relax

What are some examples of things that can affect communication skills?

Thinking is influenced by perception -Five senses -Culture -Education Perceptual bias Emotional intelligence (is an assessment and communication technique that allows nurses to better understand emotions of themselves and others)

What is the purpose for patient educations?

To help individuals, families, or communities achieve optimal levels of health Patient education includes: -Maintenance and promotion of health and illness prevention (promoting healthy behavior through education allows patients to assume more responsibility for their own health, greater knowledge results in better health maintenance, childbearing classes) -Restoration of health (injured or ill patients need information and skills to help them regain or maintain their levels of health. Need to identify patients willingness to learn) -Coping with impaired functioning (not all patients fully recover, have to learn to cope with permanent alterations)

What is narrative documentation?

Traditional method uses to record patient assessment and nursing care provided. It is simply the use of a story like format to document information. Tends be time consuming and repetitious. have to sort through and look for data, but can provide better detail of the situation.

What is affective learning?

deals with expression of feelings and development of attitudes, opinions, or values -receiving; learner is passive and needs only to pay attention and receive information -requires active participation through listening and reacting with verbal or non verbal -attaching worth and value to acquired knowledge

What are interpersonal variables?

factors within both the sender and receiver that influence communication. Perception provides a uniquely personal view of reality formed by an individuals culture, expectations, and experiences

What is malpractice insurance?

-A contract between the nurse and the insurance company -Provides a defense when a nurse is in a lawsuit involving negligence or malpractice -Nurses covered by institution's insurance while working

Define code of ethics

-A set of guiding principles that all members of a profession accept -Helps professional groups settle questions about practice or behavior -Includes advocacy, responsibility, accountability, and confidentiality

Risk management and quality assurance

-A system of ensuring appropriate nursing care that attempts to identify potential hazards and eliminate them before harm occurs -Steps involved: Identify possible risks Analyze risks Act to reduce risks Evaluate steps taken

What are values?

-A value is a personal belief about the worth of a given idea, attitude, custom, or object that sets standards that influence behavior. -Nursing is a work of intimacy. Nursing practice requires you to be in contact with patients physically, emotionally, psychologically, and spiritually. -As a nurse you agree to provide care to your patients of beneficence and fidelity shape the practice of health care and distinguish or from other common human relationships such as friendships, marriage, etc. But by its very nature relationship in health care sometimes can occur in the presence of conflicting values.

What is the difference between consent and informed consent?

-Consent form Must be signed for admission to a health care agency, invasive procedures such as intravenous central lines insertion, some treatments programs, and research studies. -Informed consent Agreement to allow care based on full disclosure of risks, benefits, alternatives, and consequences of refusal \The nurse's signature as a witness to the consent means that the patient voluntarily gave consent, the patient's signature is authentic, and the patient appears to be competent to give consent 1. the patient receives an explanation of the procedure or treatments 2. the patient receives the names and qualifications of people performing and assisting in the procedure 3. the patient receives a description of the serious harm, including death, that may occur as a result of the procedure and anticipated pain and/or discomfort 4. the patients receives am explanation of alternative therapies to the proposed procedure/treatment and the risks of doing nothing 5. the patient knows that he/she has the right to refuse the procedure/treatment without discontinuing other supportive care 6. the patient knows the he/she may refuse the procedure/treatment even after the procedure has begun

What is the Patient Protection and Affordable Care Act (PPACA)

-Consumer rights and protections -Affordable health care coverage -Increased access to care -Stronger Medicare to improve care for those most vulnerable in our society -PPACA created a new patient's bill of rights that prohibited patients from being denied health care coverage because of prior existing conditions, limits on the amount of care for those conditions, and/or an accidental mistake in paperwork when a patient got sick. -Intended to reduce overall care costs to the consumer by providing tax credits, increasing insurance company accountability for premiums and rate increases and increasing the number of choices patients have to select an insurer that best meets their needs -Patients also have recommended preventive services such as screenings for cancer, BP, and diabetes without having to pay copays.

What is values clarification?

-Ethical dilemmas almost always occur in the presence of conflicting values. -To resolve ethical dilemmas, one needs to distinguish among values, facts, and opinion. -Clarifying values; your own, your patient's, your co-workers, is an important and effective part of ethical discourse. -In the process of values clarification, you learn to tolerate difference in a way that often becomes the key to the resolution of ethical dilemmas

What are institutional resources?

-Ethics committees are usually multidisciplinary and serve several purposes: education, policy recommendation, and case consultation. -An ethics committee devoted to the teaching and processing of ethical issues and dilemmas is required in hospitals. Their three major functions: providing clinical ethics consultation, developing and/or revising policies pertaining to clinical ethics and hospital policy (advance directives, withholding/withdrawing life-sustaining treatments, informed consent, organ procurement), and facilitating education about topical issues in clinical ethics -Any person involved in an ethical dilemma, including nurses, physicians, health care providers, patients, and family members, can request access to an ethics committee.

What are standards of care in nursing?

-Legal guidelines for defining nursing practice and identifying the minimum acceptable nursing care. Standards reflect the knowledge and skill ordinarily possessed and used by nurses actively practicing in the profession. -These standards outline the scope, function, and role of the nurses in practice. -Best known comes from the American Nurses Association (ANA) -Set by state and federal laws that govern where nurses work -Joint Commission requires policies and procedures (P&Ps).

What are the 3 state statutory issues in nursing practice?

-Licensure -Good Samaritan Laws -Public Health Laws

What is a nursing point of view?

-Nurses generally engage with patients over longer periods of time than other disciplines. -Patients may feel more comfortable revealing information to nurses.

Health Insurance Portability and Accountability Act (HIPAA)

-Provides right to patients and protects employees. It protects individual employees from losing their health insurance when changing jobs by providing portability. It allows individual employees to change jobs without losing coverage as a result of preexisting coverage exclusion as long as they have had 12 months of continuous group health insurance coverage. -In the privacy section of the HIPPA there are standards regarding accountability in the health care setting. These rules create patient right to consent to the use and disclosure of their protected health information, to inspect and copy one's medical record, and to amend mistaken or incomplete information. It limits who is able to access a patient's record.

What are the 3 sources of law?

-Statutory law (Nurse Practice Act: defines the scope of nursing practice) •Criminal law (felonies or misdemeanors) •Civil law -Regulatory law (administrative law) Reflects decisions made by administrative bodies such as State Boards of Nursing when rules and regulations are passed. -Common law (judicial decisions) Results from judicial decisions made by court when individual legal cases are decided.

What is role of nursing student in clinicians?

-You are liable if your actions cause harm to patients, as is your instructor, hospital, and college/university. -You are expected to perform as a professional when rendering care. -You must separate your student nurse role from your work as a certified nursing assistant (CNA).

What is Autopsy?

-an examination of body after death -sudden death or occurring within 48 hours of admission to determine cause of death - learn more about disease and collecting statistics

Which of the following statements indicate that the new nursing graduate understands ways to remain involved professionally? Select all that apply. 1. "I am thinking about joining the health committee at my church." 2. "I need to read newspapers, watch news broadcasts, and search the Internet for information related to health." 3. "I will join nursing committees at the hospital after I have completed orientation and better understand the issues affecting nursing." 4. "Nurses do not have very much voice in legislation in Washington, DC, because of the nursing shortage." 5. "I will go back to school as soon as I finish orientation."

1, 2, 3. Nurses need to be actively involved in their community and be aware of current issues in health care. Staying abreast of current news and public opinion through the media is essential. Nurses need to join nursing committees to be involved in decision making. Nurses have a powerful voice in the legislature.

Which of the following properly applies an ethical principle to justify access to health care? Select all that apply. 1. Access to health care reflects the commitment of society to principles of beneficence and justice. 2. If low income compromises access to care, respect for autonomy is compromised. 3. Access to health care is a privilege in the United States, not a right. 4. Poor access to affordable health care causes harm that is ethically troubling because nonmaleficence is a basic principle of health care ethics. 5. Providers are exempt from fidelity to people with drug addiction because addiction reflects a lack of personal accountability. 6. If a new drug is discovered that cures a disease but at great cost per patient, the principle of justice suggests that the drug should be made available to those who can afford it.

1, 2, 4. Justice is the ethical principle that justifies the agreement to ensure access to care for all, but it does not necessarily clarify how to resolve issues of limited resources, like money or organs available for transplant. Privilege is not an ethical principle. Nonmaleficense means "first do no harm". A lack of care because of poor access causes harm (no preventative services, no early detection, no risk reduction) and is therefore ethically troubling. The principal of fidelity implies that we agree to ensure access to care even for people whose beliefs and behaviors may differ from our own, including drug addicts.

Which of the following actions, if performed by a registered nurse, would result in both criminal and administrative law sanctions against the nurse? Select all that apply. 1. Taking or selling controlled substances 2. Refusing to provide health care information to a patient's child 3. Reporting suspected abuse and neglect of children 4. Applying physical restraints without a written physician's order 5. Completing an occurrence report on the unit

1, 4. The inappropriate use of controlled substances is prohibited by every Nurse Practice Act. A physical restraint can be applied only on the written order of a health care provider based on the Joint Commission and Medicare guidelines.

A patient has a fractured femur that is placed in skeletal traction with a fresh plaster cast applied. The patient experiences decreased sensation and a cold feeling in the toes of the affected leg. The nurse observes that the patient's toes have become pale and cold but forgets to document this because one of the nurse's other patients experienced cardiac arrest at the same time. Two days later the patient in skeletal traction has an elevated temperature, and he is prepared for surgery to amputate the leg below the knee. Which of the following statements regarding a breach of duty apply to this situation? Select all that apply. 1. Failure to document a change in assessment data 2. Failure to provide discharge instructions 3. Failure to follow the six rights of medication administration 4. Failure to use proper medical equipment ordered for patient monitoring 5. Failure to notify a health care provider about a change in the patient's condition

1, 5. The failure to document a change in assessment data and the failure to notify a health care provider about a change in patient status reflect a breach of duty to the patient.

The ethics of care suggests that ethical dilemmas can best be solved by attention to relationships. How does this differ from other ethical practices? Select all that apply. 1. Ethics of care pays attention to the environment in which caring occurs. 2. Ethics of care pays attention to the stories of the people involved in the ethical issue. 3. Ethics of care is used only in nursing practice. 4. Ethics of care focuses only on the code of ethics for nurses 5. Ethics of care focuses only on understanding relationships.

1,2,5

Resolution of an ethical dilemma involves discussion with the patient, the patient's family, and participants from all health care disciplines. Which of the following best describes the role of the nurse in the resolution of ethical dilemmas? 1. To articulate the nurse's unique point of view, including knowledge based on clinical and psychosocial observations. 2. To study the literature on current research about the possible clinical interventions available for the patient in question. 3. To hold a point of view but realize that respect for the authority of administrators and physicians takes precedence over personal opinion. 4. To allow the patient and the physician to resolve the dilemma on the basis of ethical principles without regard to personally held values or opinions.

1. A nurse's point of view is essential to full discussion of ethical issues because of the nature of the relationship that nurses develop with patients and the intensity and intimacy of contact with the patient and family.

A nurse is teaching a patient about hypertension. In which order from first to last will the nurse implement the steps of the teaching process? 1. Set mutual goals for knowledge about hypertension 2. Teach what the patient wants to know about hypertension 3. Assess what the patient already knows about hypertension 4. Evaluate the outcomes of patient education for hypertension

3,1,2,4

When designing a plan for pain management for a postoperative patient, the nurse assesses that the patient's priority is to be as free of pain as possible. The nurse and patient work together to identify a plan to manage the pain. The nurse continually reviews the plan with the patient to ensure that the patient's priority is met. Which principle is used to encourage the nurse to monitor the patient's response to the pain? 1. Fidelity 2. Beneficence 3. Nonmaleficence 4. Respect for autonomy

1. Fidelity means keeping promises. Keeping the promise in this case includes not just tending to the clinical need, but evaluating the effectiveness of the interventions.

You are floated to work on a nursing unit where you are given an assignment that is beyond your capability. Which is the best nursing action to take first? 1. Call the nursing supervisor to discuss the situation 2. Discuss the problem with a colleague 3. Leave the nursing unit and go home 4. Say nothing and begin your work

1.Alerting the nursing supervisor as a representative of the hospital administration is the first step in providing notice that a problem may exist related to insufficient staffing. This notice serves to share the burden of knowledge of the staffing inequity issues that may create an unsafe patient situation for the hospital and nursing staff.

Match the examples with the professional nursing code of ethics: 1. You see an open medical record on the computer and close it so no one else can read the record without proper access. 2. You administer a once-a-day cardiac medication at the wrong time, but nobody sees it. However, you contact the primary care provider and your head nurse and follow agency procedure. 3. A patient at the end of life wants to go home to die, but the family wants every care possible. The nurse contacts the primary care provider about the patient's request. 4. You tell your patient that you will return in 30 minutes to give him his next pain medication. A. Advocacy B. Confidentiality C.Responsibility D. Accountability

1d,2c,3a,4d

It can be difficult to agree on a common definition of the word quality when it comes to quality of life. Why? Select all that apply. 1. Average income varies in different regions of the country. 2. Community values influence definitions of quality, and they are subject to change over time. 3. Individual experiences influence perceptions of quality in different ways, making consensus difficult. 4. The value of elements such as cognitive skills, ability to perform meaningful work, and relationship to family is difficult to quantify using objective measures. 5. Statistical analysis is difficult to apply when the outcome cannot be quantified. 6. Whether or not a person has a job is an objective measure, but it does not play a role in understanding quality of life.

2, 3, 4, 5. A person's average income and whether the person is employed are incorrect answers because income level is not necessarily a determining factor in measuring quality of life, but the ability to do meaningful work usually does influence the definition.

A nurse is caring for a patient who recently had coronary bypass surgery and now is on the postoperative unit. Which are legal sources of standards of care that the nurse uses to deliver safe health care? Select all that apply. 1. Information provided by the head nurse 2. Policies and procedures of the employing hospital 3. State Nurse Practice Act 4. Regulations identified in The Joint Commission manual 5. The American Nurses Association standards of nursing practice

2,3,4,5. All of these sources govern the legal standards of care and are individualized by State and agency. Policies and procedures of employing agencies and standards set by statutes, accrediting agencies, and professional organizations describe the minimum requirements for safe care.

A nurse notes that an advance directive is on a patient's medical record. Which statement represents the best description of an advance directive guideline that the nurse will follow? 1. A living will allows an appointed person to make health care decisions when the patient is in an incapacitated state. 2. A living will is invoked only when the patient has a terminal condition or is in a persistent vegetative state. 3. The patient cannot make changes in the advance directive once admitted to the hospital. 4. A durable power of attorney for health care is invoked only when the patient has a terminal condition or is in a persistent vegetative state.

2. A living will does not assign another individual to make decisions for the patient. A durable power of attorney for health care is active when the patient is incapacitated or cognitively impaired. A cognitively intact patient may change an advance directive at any time.

A child's immunization may cause discomfort during administration, but the benefits of protection from disease, both for the individual and society, outweigh the temporary discomforts. Which principle is involved in this situation? 1. Fidelity 2. Beneficence 3. Nonmaleficence 4. Respect for autonomy

2. Beneficence means "doing well" by taking positive actions. It implies that the best interest of the patient (and society) outweighs self-interest.

The application of utilitarianism does not always resolve an ethical dilemma. Which of the following statements best explains why? 1. Utilitarianism refers to usefulness and therefore eliminates the need to talk about spiritual values. 2. In a diverse community it can be difficult to find agreement on a definition of usefulness, the focus of utilitarianism. 3. Even when agreement about a definition of usefulness exists in a community, laws prohibit an application of utilitarianism. 4. Difficult ethical decisions cannot be resolved by talking about the usefulness of a procedure.

2. In our increasingly diverse communities, ideas of usefulness have become equally diverse.

A nurse is planning care for a patient going to surgery. Who is responsible for informing the patient about the surgery along with possible risks, complications, and benefits? 1. Family member 2. Surgeon 3. Nurse 4. Nurse manager

2. The person performing the procedure is responsible for informing the patient about the procedure and its risks, benefits, and possible complications.

A nurse is sued for negligence due to failure to monitor a patient appropriately after a procedure. Which of the following statements are correct about this lawsuit? Select all that apply. 1. The nurse does not need any representation. 2. The patient must prove injury, damage, or loss occurred. 3. The person filing the lawsuit has to show a compensable damage, such as lost wages, occurred. 4. The patient must prove that a breach in the prevailing standard of care caused an injury. 5. The burden of proof is always the responsibility of the nurse.

3, 4. The patient as plaintiff must prove that the defendant nurse had a duty, breached the duty, and because of this breach caused the patient injury or damage.

In most ethical dilemmas in health care, the solution to the dilemma requires negotiation among members of the health care team. Why is the nurse's point of view valuable? 1. Nurses understand the principle of autonomy to guide respect for a patient's self-worth. 2. Nurses have a scope of practice that encourages their presence during ethical discussions. 3. Nurses develop a relationship with the patient that is unique among all professional health care providers. 4. The nurse's code of ethics recommends that a nurse be present at any ethical discussion about patient care.

3. A fundamental goal of this chapter is to promote and nurture the value of the nursing voice in ethical discourse.

The ANA code of nursing ethics articulates that the nurse "promotes, advocates for, and strives to protect the health, safety, and rights of the patient." This includes the protection of patient privacy. On the basis of this principle, if you participate in a public online social network such as Facebook, could you post images of a patient's x-ray film if you obscured or deleted all patient identifiers? 1. Yes, because patient privacy would not be violated since patient identifiers were removed 2. Yes, because respect for autonomy implies that you have the autonomy to decide what constitutes privacy 3. No, because, even though patient identifiers are removed, someone could identify the patient on the basis of other comments that you make online about his or her condition and your place of work 4. No, because the principle of justice requires you to allocate resources fairly

3. Comments, photos, etc. on social media are widely distributed and become a risk for violation of privacy. People often inadvertently give "clues" or hints to the identity of a person plus people accessing your site could know your actual assignment or put "two and two" together.

A home health nurse notices significant bruising on a 2-year-old patient's head, arms, abdomen, and legs. The patient's mother describes the patient's frequent falls. What is the best nursing action for the home health nurse to take? 1. Document her findings and treat the patient 2. Instruct the mother on safe handling of a 2-year-old child 3. Contact a child abuse hotline 4. Discuss this story with a colleague

3. Nurses are mandated reporters of suspected child abuse. These assessment findings possibly indicate child abuse.

The nurse received a hand-off report at the change of shift in the conference room from the night shift nurse. The nursing student assigned to the nurse asks to review the medical records of the patients assigned to them. The nurse begins assessing the assigned patients and lists the nursing care information for each patient on each individual patient's message board in the patient rooms. The nurse also lists the patients' medical diagnoses on the message board. Later in the day the nurse discusses the plan of care for a patient who is dying with the patient's family. Which of these actions describes a violation of the Health Insurance Portability and Accountability Act (HIPAA)? 1. Discussing patient conditions in the nursing report room at the change of shift 2. Allowing nursing students to review patient charts before caring for patients to whom they are assigned 3. Posting medical information about the patient on a message board in the patient's room 4. Releasing patient information regarding terminal illness to family when the patient has given permission for information to be shared

3. Posting the medical condition of a patient on a message board in the patient's room is not necessary for the patient's treatment. Doing so can result in this information being accessed by persons who are not involved in the patient's treatment.

A nurse notes that the health care unit keeps a listing of the patient names at the front desk in easy view for health care providers to more efficiently locate the patient. The nurse talks with the nurse manager because this action is a violation of which act? 1. Patient Protection and Affordable Care Act (PPACA) 2. Patient Self-Determination Act (PSDA) 3. Health Insurance Portability and Accountability Act (HIPAA) 4. Emergency Medical Treatment and Active Labor Act

3. The Privacy Rule of HIPAA requires that patient information be protected from unnecessary publication.

The patient for whom you are caring needs a liver transplant to survive. This patient has been out of work for several months and doesn't have health insurance or enough cash. Even though several ethical principles are at work in this case, what are the principles from highest to lowest priority? 1. Accountability: You as the nurse are accountable for the wellbeing of this patient. 2. Respect for autonomy: This patient's autonomy will be violated if he does not receive the liver transplant. 3. Ethics of care: The caring thing that a nurse could provide this patient is resources for a liver transplant. 4. Justice: The greatest question in this situation is how to determine the just distribution of resources. A. 4, 1, 3, 2 B. 2, 4, 3, 1 C. 4, 2, 3, 1 D. 4, 3, 2, 1

4, 2, 3, 1. Understanding the concept of Justice helps to enrich the conversation about how to act, and lifts the conversation above and beyond the circumstances of the patient. If justice is compromised, then respect for autonomy will be hard to maintain. The nurse will be able to care for the patient, but her commitment to care does not, unfortunately, give her the power to resolve the difficult issue of limited resources. Other concepts are valid but not as relevant to the case.

A woman has severe life-threatening injuries and is hemorrhaging following a car accident. The health care provider ordered 2 units of packed red blood cells to treat the woman's anemia. The woman's husband refuses to allow the nurse to give his wife the blood for religious reasons. What is the nurse's responsibility? 1. Obtain a court order to give the blood 2. Coerce the husband into giving the blood 3. Call security and have the husband removed from the hospital 4. More information is needed about the wife's preference and if the husband has her medical power of attorney

4. Adult patients such as those with specific religious objection are able to refuse treatment for personal religious reasons but there needs to be clear directions on who can make the decision.

A patient is admitted to a medical unit. The patient is fearful of hospitals. The nurse carefully assesses the patient to determine the exact fears and then establishes interventions designed to reduce these fears. In this setting how is the nurse practicing patient advocacy? 1. Seeking out the nursing supervisor to talk with the patient 2. Documenting patient fears in the medical record in a timely manner 3. Working to change the hospital environment 4. Assessing the patient's point of view and preparing to articulate it

4. All answers are correct behaviors, but assessing the patient's point of view and preparing to articulate it best reflects the concept of advocacy because it is standing up for the patient and having his/her views/wishes heard.

You are the night shift nurse caring for a newly admitted patient who appears to be confused. The family asks to see the patient's medical record. What is the priority nursing action? 1. Give the family the record 2. Discuss the issues that concern the family with them 3. Call the nursing supervisor 4. Determine from the medical record if the family has been granted permission by the patient to access his or her medical information

4. Family members do not have the right to private personal health information without the consent of the patient. Confidentiality protects private patient information once it has been disclosed in health care settings.

Define confidentiality

A right to privacy concerning health information

What is a Licensure?

A state board of nursing or nursing commission licenses all RN's in the state in which they practice. The requirements for licensure vary among states. All states use the National Council Licensure Examination (NCLEX) for RNs and licensed practical nurse examinations. Licensure permits people to offer special skills to the public, and it also provides legal guidelines for protection of the public.

A nurse performs cardiopulmonary resuscitation (CPR) on a 92 year old with brittle bones and breaks a rib during the procedure, which then punctures a lung. The patient recovers completely without any residual problems and sues the nurse for pain and suffering and for malpractice. Which key point will the prosecution attempt to prove against the nurse? A. The CPR procedure was done incorrectly B. The patient would have died if nothing was done C. The patient was resuscitated according to policy D. The older patient with brittle bones might sustain fractures when chest compression are done

A. Certain criteria are necessary to establish nursing malpractice. The prosecution would try to prove that a breach of duty had occurred (CPR done incorrectly), which had caused injury. The defense team, not the prosecution, would explain the correlation between brittle bones and rib fractures during CPR and that the patient was resuscitated according to policy

A 17 year old patients, dying of heart failure, wants to have organs removed for transplantation after death. Which action by the nurse is correct? A. Instruct the patient to talk with parents about the desire to donate organs B. Notify the health care provider about the patient's desire to donate organs C. Prepare the organ donation form for the patient to sign while still oriented D. Contact the United Network for Organ Sharing after talking with the patient

A. In this situation, the parents would need to sign the form because the teenager is under age 18.

Four patients in labor all requests epidural analgesia to manage their pain at the same time. Which ethical principle is most compromised when only one nurse anesthetist is on call? A. Justice B. Fidelity C. Beneficene D. Nonmaleficence

A. Justice refers to fairness and is used frequently in discussion regarding access to health care resources. Here the just distribution of resources, in this case pain management, cannot be justly apportioned. Nonmaleficence refers to avoidance of harm; beneficence refers to taking positive actions to help others. Fidelity refers to the agreement to keep promises. Each of these principles partially expressed in the question; however, justice is most comprised because not all laboring patients have equal access to pain management owing to lack of personal resources.

A nurse is preparing to teach a kinesthetic learner about exercise. Which technique will the nurse use? 1. Let the patient touch and use exercise equipment B. Provide the patient with pictures of the exercise equipment C. Let the patient listen to a video about the exercise equipment D. Provide the patient with a case study about the exercise equipment

A. Kinesthetic learners process knowledge by moving and participating in hands-on activities.

While preparing a teaching plan, the nurse describes what the learner will be able to accomplish after the teaching session about healthy eating. Which action is the nurse completing? A. Developing learning objectives B. Providing positive reinforcement C. Presenting facts and knowledge D. Implementing interpersonal communication

A. Learning objectives describe what the learner will exhibit as a result of a successful instruction. Positive reinforcement follows feedback and reinforces good behavior and promotes continued compliance. Interpersonal communication is necessary for the teaching/learning process, but describing what the learner will be able to do after successful instruction constitutes learning objectives. Facts and knowledge will be presented in the teaching session

A home health nurse notices that a patient's preschool children are often playing on the sidewalk and in the street unsupervised and repeatedly takes them back to the home and talks with the patient, but the situation continues. Which immediate action by the nurse is mandated by law? A. Contact the appropriate community child protection facility B. Tell the parents that the authorities will be contracted shortly C. Take pictures of the children to support the overt child abuse D. Discuss with both parents about the safety needs of their children

A. The nurse has a duty to report the situation to protect the children. Any health care professional who does not report suspected child abuse or neglect may be liable for civil or criminal legal action

A nurse is charting on a patient's record. Which action will the nurse take that is accurate legally? A. Determining the degree to which standards of care are met by reviewing patients' health records B. Realizing that care not documented in patients' health records still qualifies as care provided C. Basing reimbursement upon the diagnosis related groups documented in patients' records D. Comparing data in patients' record to determine whether a new treatment had better outcomes than the standard treatment

A. the auditing and monitoring of patients' health records involves nurses periodically auditing records to determine the degree to which standards of care are met and identifying areas needing improvement and staff development

What abandonment and assignment issues?

Abandonment of a patient occurs when a nurse refuses to provide care for a patient after having established a patient-nurse relationship. 1. The nurse lacks the knowledge or skill to provide competent care 2. Care exceeding the nurse practice act is expected 3. health of the nurse or her unborn child is directly threatened by the type of assignment 4. orientation to the unit has not been completed and safety is at risk 5. the nurse clearly states and documents a conscientious objection on the basis of moral, ethical, or religious grounds 6. Nurse's clinical judgment is impaired as a results of fatigue, resulting in a safety risks for the patient -Can include short staffing, floating, health care provides' orders

What are public health laws?

Nurses, especially those employed in community health settings; need to understand public health laws. State legislatures enact statutes under health codes, which describe the requirements for reporting communicable diseases, school immunizations, and other conditions intended to promote health and reduce health risks in communities.

Ethical dilemmas often arise over a conflict of opinion. Reliance on a predictable series of steps can help people in conflict find common ground. All of the following actions can help resolve conflict. What is the best order of these actions in order to promote the resolution of an ethical dilemma? 1. List the actions that could be taken to resolve the dilemma. 2. Agree on a statement of the problem or dilemma that you are trying to resolve. 3. Agree on a plan to evaluate the action over time. 4. Gather all relevant information regarding the clinical, social, and spiritual aspects of the dilemma. 5. Take time to clarify values and distinguish between facts and opinions—your own and those of others involved. 6. Negotiate a plan. A. 4, 5, 2, 6, 1, 3 B. 4, 5, 2, 1, 6, 3 C. 5, 4, 2, 1, 3, 6 D. 4, 5, 1, 2, 3, 6

B. 4, 5, 2, 1, 6, 3. This is the correct order to determine the dilemma and influencing factors. This process provides opportunities for the nurse and healthcare team to reflect on personal values and then identify the exact nature of the ethical problem, design a plan, and evaluate the success of the plan.

A nursing student has been written up several times for being late with providing patient care and for omitting aspects of patient care and not knowing basic procedures that were taught in the skills course one term earlier. The nursing student says 'I don't understand what the big deal is. As my instructor, you are there to protect me and make sure I don't make mistakes.' What is the best response from the nursing instructor? A. "You are practicing under the license of the hospital's insurance" B. "You are expected to perform at the level of a professional nurse" C. "You are expected to perform at the level of a prudent nursing student" D. "You are practicing under the licence of the nurse assigned to the patient"

B. Although nursing students are not employees of the health care facility where they are having their clinical experience, they are expected to perform as professional nurses would in providing safe patient care

Which type of nurses make the best communicators with patients? A. those who learn effective psychomotor skills B. Those who develop critical thinking skills C. Those who like different kinds of people D. Those who maintain perceptual biases

B. Nurses who develop critical thinking skills make the best communicators, because it is important to apply critical thinking standards to ensure sound effective communication

The nurse questions a health care provider's decision to not tell the patient about a cancer diagnosis. Which ethical principle is the nurse trying to uphold for the patient? A. Conseqentialism B. Autonomy C. Fidelity D. Justice

B. The nurse is upholding autonomy. Autonomy refers to the freedom to make decisions free of external control. Respect for patient autonomy refers to the commitment to include patients in decisions about all aspects of care. Consequentialism is focused on the outcome and is a philosophical approach. Justice refers to fairness and is most often used in discussions about access to health care resources. Fidelity refers to the agreement to keep promises

During a severe respiratory epidemic, the local health care organizations decide to give health care providers priority access to ventilators over other members of the community who also need that resource. Which philosophy would give the strongest support for this decision? A. Deontology B. Utilitarianism C. Ethics of care D. Feminist ethics

B. Utilitarianism focuses on the greatest good for the most people; the organizations decide to ensure that as many health care workers as possible will survive to care for other members of the community. Deontology defines actions as right or wrong based on their 'right-making characteristics' such as fidelity to promises, truthfulness, and justice. Feminist ethics looks to the nature of relationships to guide participants in making difficult decisions, especially relationships in which power is unequal or in which point of view has become ignored or invisible. The ethics of care and feminist ethics are closely are closely related, but ethics of care emphasizes the role of feelings.

If a nurse decides to withhold a medication because it might further lower the patient's blood pressure, the nurse will be practicing the principle of: A. responsibility. B. accountability. C. competency. D. moral behavior.

B. accountability.

You are about to administer an oral medication and you question the dosage. You should: A. administer the medication. B. notify the physician. C. withhold the medication. D. document that the dosage appears incorrect.

B. notify the physician.

A smiling patient angrily states, "I will not cough and deep breathe." How will the nurse interpret this finding? A. The patient denotative meaning is wrong B. The patient personal space was violated C. The patient's affects is inappropriate D. The patient's vocabulary is poor

C. An inappropriate affects is a facial expression that does not match the content of a verbal message (smiling when describing a sad situation) The patient is smiling but is angry, which indicates an inappropriate.

A nurse is preparing to teach a patient about smoking cessation. Which factors should the nurse assess to determine a patient's ability to learn? A. Sociocultural background and motivation B. Stage of grieving and overall physical health C. Developmental capabilities and physical capabilities D. Psychosocial adaptation to illness and active participation

C. Developmental and physical capabilities reflect one's ability to learn. Sociocultural background and motivation are factors determining readiness to learn. Psychosocial adaptation to illness and active participation are factors in readiness to learn.

A nurse is using therapeutic communication with a patient. Which technique will the nurse use to ensure effective communication? A. Interpersonal communication to change negative self talk to positive self talk B. Small group communication to present information to an audience C. Electronic communication to assess a patient in another city D. Intrapersonal communication to build strong teams

C. Electronic communication is the use of technology to create ongoing relationships with patients and their health care team. Intrapersonal communication is self talk. Interpersonal communication is one on one interaction between a nurse and another person that often occurs face to face.

When making rounds, the nurse finds a patient who is not able to sleep because of surgery in the morning. Which therapeutic response is most appropriate? a. "It will be okay. Your surgeon will talk to you in the morning." b. "Why can't you sleep? You have the best surgeon in the hospital." c. "Don't worry. The surgeon ordered a sleeping pill to help you sleep." d. "It must be difficult not to know what the surgeon will find. What can I do to help?"

D. "It must be difficult not to know what the surgeon will find. What can I do to help?" is using therapeutic communication techniques of empathy and asking relevant questions. False reassurances (You will be okay and Don't worry) tend to block communication. Patients frequently interpret 'why' questions as accusations or think the nurse knows the reason ans is simply testing them.

What are the correct steps to resolve an ethical dilemma on a clinical unit? Place the steps in correct order. 1. Clarify values. 2. Ask the question, Is this an ethical dilemma? 3. Verbalize the problem. 4. Gather information. 5. Identify course of action. 6. Evaluate the plan. 7. Negotiate a plan. A. 2, 4, 1, 5, 3, 7. 6 B. 2, 4, 3, 1, 5, 6, 7 C. 4, 1, 2, 3, 5, 7, 6 D. 2, 4, 1, 3, 5, 7, 6

D. 2,4,1,3,5,7,6

A nurse's goal is to provide teaching for restoration of health. Which situation indicates the nurse is meeting this goal? A. Teaching a family member to provide passive range of motion for a stroke patient B. Teaching a woman who recently had a hysterectomy about possible adoption C. Teaching expectant parents about changes in childbearing women D. Teaching a teenager with a broken leg how to use crutches

D. Injured or ill patients need information and skills to help them regain or maintain their levels of health. An example includes teaching a teenager with a broken leg how to use crutches. Not all patients fully recover from illness or injury. Many have to learn to cope with permanent health alterations. For a women with a hysterectomy, teaching about adoption is not restoration of health; restoration of health in this situation would involve activity restrictions and incision care if needed.

Which learning objective/outcome has the highest priority for a patient with life-threatening, severe food allergies that require an EpiPen (epinephrine)? a.The patient will identify the main ingredients in several foods. b. The patient will list the side effects of epinephrine. c. The patient will learn about food labels. d. The patient will administer epinephrine.

D. Once you assist in meeting patient needs related to basic survival (how to give epinephrine), you can discuss other topics, such as nutritional needs and side effects of medication.

Your patient is about to undergo a controversial orthopedic procedure. The procedure may cause periods of pain. Although nurses agree to do no harm, this procedure may be the patient's only treatment choice. This example describes the ethical principle of: A. autonomy. B. fidelity. C. justice. D. nonmaleficence

D. nonmaleficence

Define Deontology

Defines action as right or wrong

Ethics of Care

Emphasizes the importance of understanding relationships, especially as they are revealed in personal narratives

What is a quasi-intentional tort?

INTENT IS LACKING but volitional action and direct causation occur such as invasion of privacy or defamation of character (slander, Libel). HIPAA and HITECH Act protect privacy standards.

Define nonmaleficence

Maleficence refers to harm or hurt. Refers to the avoidance of harm or hurt. In health care ethical practice involves not only the will to do good but the equal commitment to do no harm. A health care professional tries to balance the risks and benefits of care while striving at the same time to do the least harm possible.

What is the uniform determination of death act?

Many legal issues surround the event of death, including a basic definition of the actual point at which a person is legally dead. There are two standards for the determination of death. The cardiopulmonary standards requires irreversible cessation of circulatory and respiratory functions. The whole brain standard requires irreversible cessation of all functions of the entire brain, including the brain stem. Nurses have a specific legal obligation to treat and deceased person's remains with dignity. Wrongful handling of a deceased person's remains causes emotional harm to the surviving family

The point of the ethical practice is an agreement to reassure the public that in all ways the health care team not only works to heal patients but agrees to do this in the least painful and harmful way possible. This principle is commonly called the principle of _____________

Nonmaleficence

What are some issues in health care ethics?

Quality of life: Central to discussions about end-of-life care, cancer therapy, physician-assisted suicide, and DNR Disabilities: Anti-discrimination laws enhance the economic security of people with physical, mental, or emotional challenges Care at the end of life: Interventions unlikely to produce benefit for the patient Health care reform: facilitated access to care for millions of uninsured Americans

Define beneficence

Refers to taking positive actions to help others. The principle of beneficence is fundamental to the practice of nursing and medicine.

Define accountability

Refers to the ability to answer for one's actions. You ensure that your professional actions are explainable to your patients and your employer.

Define fidelity

Refers to the agreement to keep promises. As a nurse you keep promises by following through on your actions and interventions

Define Advocacy

Refers to the support of a particular cause. As a nurse you advocate for the health, safety, and rights of patients, including their right to privacy and their right to refuse treatment.

Explain the Mental Health Parity Act as Enacted Under PPACA

Required insurance companies to offer the same level of coverage for mental health care that they provide for medical and surgical care. PPACA extended this to include mental health, behavioral health, substance use services. Insurers may not discriminate or deny coverage to patient with mental illness because of preexisting conditions; and patients may remain on their parents health insurance until 26

A homeless man enters the emergency department seeking health care. The health care provider indicates that the patient needs to be transferred to the City Hospital for care. This action is most likely a violation of which of the following laws? 1. Health Insurance Portability and Accountability Act (HIPAA) 2. Americans with Disabilities Act (ADA) 3. Patient Self-Determination Act (PSDA) 4. Emergency Medical Treatment and Active Labor Act (EMTALA) without triage completed

The EMTALA requires that an emergency situation needs to be established and that the patient needs to be stabilized before a transfer is appropriate

What are advanced directives?

They are based on values of informed consent, patient autonomy over end-of-life decisions, truth telling, and control over the dying process. Health care providers are required by to provide patients with written information about their rights under state law to make decisions, including the right to refuse treatment and formulate advanced directives -A patient must be declared legally incompetent or lack of capacity to make decisions regarding their own health care treatment for durable powers of attorneys to step in. Examples: -living wills; represent written documents that direct treatment in accordance with a patient 's wishes in the event of a terminal illness of condition. With this document a patient is able to declare which medical procedures they want or does not want often difficult to interpret and not clinically specific in unforeseen circumstances (within the hospital we can help patient change things) -durable power of attorney; Is a legal document that designates a person or people of one's choosing to make health care decisions when a patient is no longer able to make health care decisions when a patient is no longer able to make decisions on his or her own behalf. This agent makes health care treatment decisions on the basis of the patient's wishes

What is the Emergency Medical Treatment and Active Labor Act?

This act provides that , when a patient comes to the emergency department or hospital, an appropriate medical screening occurs within the capacity of the hospital. If an emergency condition exists, staff must evaluate the patient and may not discharge or transfer them until the patient's condition stabilizes.

What is unintentional tort?

negligence; is conduct that falls below the generally accepted standards of care of a reasonably prudent person. Standard of care to protect others against an unreasonably great risk of harm malpractice; is one type of negligence and often referred to as professional negligence. When nursing care falls below a sary to establish nursing malpractice; the nurse did not carry out/breached duty to care for the patient and the patient was injured due to it, even though she did not mean to harm them, its malpractice