Health Policy
A client with metastatic brain cancer is admitted to the oncology floor. What action will the admitting nurse take regarding an advanced directive for this client? Decide on a treatment plan if the client cannot. Inform the client or legal guardian of the right to execute an advance directive. Respect the individuals' moral rights. Advise the client to refuse medical treatment if unable to make health care decisions.
Inform the client or legal guardian of the right to execute an advance directive. All clients have a right to execute an advance directive. The admitting nurse would ensure that the client is aware of that right. The facility's ethics committee can decide on a treatment plan if the client is unable and a health care power of attorney has not been appointed. Facility employees are not required by law to respect an individual's moral rights; however, the health care professional should respect the client's individual rights as part of professional responsibility. While a client may refuse medical treatment via an advanced directive, the nurse would not advise this.
The nurse is preparing to administer a unit of blood to a client. The client says that he is not sure he wants to give consent to receive the blood transfusion because he does not want to get AIDS from the blood. Select the best response from the nurse. "All blood is now tested for the AIDS virus, so there is no risk of getting AIDS from a blood transfusion." "I understand what you are saying, but the doctor ordered the blood, so it is important that you receive it." "All blood is now tested for the AIDS virus, so the risk of getting AIDS from a blood transfusion is extremely low." "Tell me more about your fear of getting AIDS."
"All blood is now tested for the AIDS virus, so the risk of getting AIDS from a blood transfusion is extremely low." Some transfusions of whole blood, plasma, platelets, or blood cells before 1985 resulted in the transmission of HIV. Since 1985, all blood donations in the United States have been screened for HIV, so this is no longer a transmission risk; however, infection can occur from transfused blood that was screened for HIV antibody and found negative because the donor was recently infected and still in the window period.
A nurse is conducting a teaching session with a group of adolescent females at a local women's health clinic. When describing appropriate screening guidelines for cervical cancer, at which age would the nurse would instruct the group to have their first Papanicolau test? 18 21 25 30
21 Although professional medical organizations disagree as to the recommended frequency of screening for cervical cancer, ACOG (2015) recommends that cervical cancer screening should begin at age 21 years (regardless of sexual history) since women younger than age 21 are at very low risk of cancer.
What percentage of adults requiring mental health services get the care they need? 5% 15% 25% 35%
25% Only about 25%, or 1 in 4, of adults requiring mental health services get the care that they need.
For which potential neonatal infection does the nurse anticipate using ophthalmic erythromycin Chlamydia trachomatis Group B streptococcus Human immunodeficiency virus Herpes simplex virus Type 1
Chlamydia trachomatis Ophthalmic erythromycin is routinely provided to the newborn after birth to prevent acquiring a Chlamydia trachomatis or Neisseria gonorrhoeae infection during vaginal birth. IV antibiotics are used to treat a Group B streptococcus infection. Antiviral therapy is given to neonates with herpes simplex and human immunodeficiency virus.
Why are health promotion and illness prevention a key responsibility of nurses Chronic illnesses can cause pain and suffering. Treatment of chronic illnesses is very expensive. Chronic illnesses are the leading health problem in the world. People do not like to be sick and feel bad.
Chronic illnesses are the leading health problem in the world. Because chronic illnesses are the leading health problems in the world, health promotion and illness prevention activities are vital to nursing care. By endorsing health promotion and illness prevention, the nurse can assist the client to achieve optimal health even with a chronic illness. It is true that treating chronic illnesses can be expensive, they do cause pain and suffering, and people do not like to be sick, but these are not the most important reasons for promoting health and preventing illnesses.
Which of the following best reflects the interpretation of the Health Insurance Portability and Accountability Act (HIPAA) and genetic information. Genetic information cannot be used to establish insurance eligibility. Group insurance plans can increase premuiums for clients with a genetic condition. A lifetime cap on benefits cannot be instituted for a specific genetic disorder. Employers are not allowed to use a client's genetic information for hiring decisions.
Genetic information cannot be used to establish insurance eligibility. The Health Insurance Portability and Accountability Act prohibits the use of genetics information to establish insurance eligibility. However, it does not prohibit group plans form increasing premiums, excluding coverage for a specific condition, or imposing a lifetime cap on benefits.
Which are the goals of health care reform? Select all that apply. Make costs for the uninsured manageable Improve access to health care Increase the quality of health care Decrease centralization Improve safety
Make costs for the uninsured manageable Improve access to health care Increase the quality of health care Cost containment, improved access, and increased quality are goals of health care reform. A decrease in centralization is not a goal. Increased centralization is proposed to eliminate wasteful spending on duplicative services. Safety is not a goal of health care reform, it is a goal of Quality and Saftey Education for Nurses.
Which federal law prevents insurance companies from enforcing annual or lifetime dollar amounts to be paid for mental health care? Action for Mental Health Mental Health Parity Act Patient Protection and Affordable Care Act National Mental Health Act
Mental Health Parity Act In 1996, Congress passed the Mental Health Parity Act, which eliminated annual and lifetime dollar amounts for mental health care for companies with more than 50 employees. However, substance abuse was not covered by this law, and companies could still limit the number of days in the hospital or the number of clinic visits per year. None of the other options represent a federal law that addresses that issue.
Nurses should screen for hematuria to rule out bladder cancer in which clients at high risk for development of bladder cancer? Select all that apply. People who have a history of smoking People who have a family history of bladder cancer People under 40 years of age People who are exposed to chemicals Males
People who have a history of smoking People who have a family history of bladder cancer People who are exposed to chemicals Males Early screening of hematuria for bladder cancer is needed especially with people who have high-risk factors such as history of cigarette smoking, family history of bladder cancer, exposure to chemicals, male gender, and age greater than 55 years.
A nurse has custody of a client's daily Kardex and care plan so in order to give a change-of-shift report. After reporting to the next shift, what steps should the nurse implement to maintain client confidentiality? Throw the documents in the trash can. Shred the documents or place them in a container to protect confidentiality. Place the documents in the client's chart. Leave the documents at the nurses' station.
Shred the documents or place them in a container to protect confidentiality. Kardexes, care plans, and other client documents contain confidential client information. The nurse should shred them or place them in a special confidential container for proper disposal. Regular garbage isn't secure and isn't an appropriate place to dispose of documents containing a client's name and information. Leaving the documents at the nurses' station may allow others to view them. It isn't necessary to place the nursing Kardex and care plan in the client's chart when the nurse has finished using them
The nurse is caring for a 17-year-old girl in the terminal phase of osteosarcoma. Which action demonstrates integration of the recommendations of the American Academy of Pediatrics (AAP) Committee on Bioethics? Telling the child exactly what to expect of further treatments Encouraging the child to support the wishes of her parents Explaining the prognosis using accepted clinical terminology Allowing the child to listen during discussions of the care plan
Telling the child exactly what to expect of further treatments The committee recommends telling the child exactly what to expect of further treatments and procedures, explaining the prognosis in a developmentally appropriate way to ensure the child's understanding, and endeavoring to gain the child's candid opinion of the proposed care plan. It also recommends that decision making for older children and adolescents should include the assent of the child or adolescent.
Nursing students are reviewing legislation about the use of genetic information. The students demonstrate a need for additional review when they identify which of the following as being prohibited by the Genetic Information Nondiscrimination Act (GINA)? . Use of genetic information to establish insurance eligibility Health insurers from denying coverage to a healthy person at risk for a genetic condition Health insurers from charging higher rates for people at risk for a genetic condition Employers from using genetic information to make a decision about promotions
Use of genetic information to establish insurance eligibility The Health Insurance Portability and Accountability Act (HIPAA) prohibits the use of genetics information to establish insurance eligibility. The GINA prohibits insurers from denying coverage to a healthy person or charging higher insurance rates based on a person's genetic predisposition to a disease. It also prevents employers from using a person's genetic and genomic information to make decisions about hiring, job placement, promotion, or firing.
During the Reformation, which factor influenced the decline of nursing? Advancement of medicine Implementation of technology Establishment of men in nursing Women's subordination to men
Women's subordination to men Women were viewed as subordinate to men and were expected to remain at home caring for children; this decreased the number of qualified women practicing nursing.
In addition to standard precautions, contact precautions should be implemented for measles. impetigo. varicella. tuberculosis.
impetigo. Contact precautions should be instituted for a client with impetigo. Airborne precautions are used for clients with measles, varicella, and tuberculosis.
During the 1800s, Pinel believed that the cure for mental illness was ... arrest and confinement. placement outside of the community. moral treatment. use of chains.
moral treatment. During the 1800s, the cure for mental illness was believed to be moral treatment, defined as kindness, compassion, and a pleasant environment. Philippe Pinel was one of the first physicians who began using moral treatment in France.
A nurse is caring for a client with a genetic disorder. The client tells the nurse, "I'm scared I'm going to lose my insurance if they find out I have this disease." What is the nurse's best response? "The Patient Self-Determination Act prohibits employers to find out about employee genetic diseases." "HIPAA prohibits insurance group plans from increasing health premiums." "HIPAA prohibits the use of genetic information for insurance eligibility." "The Patient Self-Determination Act prohibits the use of genetic information for insurance eligibility."
"HIPAA prohibits the use of genetic information for insurance eligibility." HIPAA prohibits the use of genetic information for insurance eligibility. HIPAA does not prohibit insurance group plans from increasing health premiums. The Patient Self-Determination Act ensures the client has the right to self-determination and knowledge regarding advance directives.
A client diagnosed with influenza is admitted to the hospital. Which transmission-based precautions should the nurse initiate? Droplet Airborne Contact Neutropenic
Droplet Influenza is transmitted via droplets; therefore, the nurse should initiate droplet precautions. Tuberculosis and varicella would qualify for airborne precautions. Contact precautions are used for organisms that are transmitted by skin-to-skin contact. Neutropenic (or reverse) precautions are used for immunosuppressed clients.
Which is also known as a proxy directive? Medical directive Living will Durable power of attorney for health care Treatment directive
Durable power of attorney for health care A durable power of attorney for health care is also known as a health care power of attorney or a proxy directive. The other options are incorrect.
A nurse is developing a community education program for a local women's club on the topic of managed care in mental health. Which would the nurse include as the main focus? Cost savings Consistent third-party reimbursement Improved access to less costly services Individualized care for additional inpatient stays
Improved access to less costly services Managed care aims to increase access to care and provide the most appropriate level of services in the least restrictive environment. Efforts focus on providing more outpatient and alternative treatment programs and avoiding costly inpatient hospitalizations. When properly conducted and administered, managed care allows clients better access to quality services while using health care dollars wisely.
Which cost-cutting meaure in health care is most likely to facilitate improved client outcomes? A prospective payment system, such as diagnosis-related groups (DRGs) Comparative effectiveness analysis Improving transitions across settings Increased emphasis on capitation and managed care
Improving transitions across settings Improving transitions across settings is most likely to improve client outcomes because it involves better client hand-offs during changes from one level of care to another. DRGs help reduce costs but do not directly improve patient outcomes. Comparative effectiveness analysis encourages the provider to carefully select technologies with cost in mind. Capitation and managed care may actually decrease positive client outcomes if there is too much emphasis on cost cutting.
A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when the client says "If I appoint a healthcare power of attorney, that person can override my wishes even if I'm still competent." "The advance directive allows me to state my healthcare wishes while I'm still able to do so." "The living will allows me to identify a person who can make healthcare decisions for me if I become too ill to make them myself." "I understand that in some states (provinces) a living will and healthcare power of attorney are the same."
"The advance directive allows me to state my healthcare wishes while I'm still able to do so." The advance directive is a document that allows the client to give directions about future medical care or to designate another person to make medical decisions if and when the client loses decision-making capacity. The healthcare power of attorney is a legal document that enables the client to designate another person to act on the client's behalf if the client becomes disabled or incapacitated. The living will is a witnessed document indicating the client's desire to be allowed to die a natural death, rather than be kept alive by heroic life-sustaining measures. The living will applies to decisions that will be made after a terminally ill client is incompetent and has no reasonable possibility of recovery. The living will and health care power of attorney aren't the same.
The nurse is caring for a 20-month-old girl with equivocal bacterial otitis media, a severe earache, and a temperature of 39°C (102.2°F). Which intervention would the nurse expect to implement? Administering antibiotics as soon as they're available Obtaining a culture of fluid from the middle ear Determining if the girl's balance is shaky when walking Administering antivirals to ensure broad coverage of all organisms
Administering antibiotics as soon as they're available Because of the severity of the symptoms, the child will be treated with antibiotics immediately. This decision is based on the clinical practice guideline developed by the American Academy of Pediatrics and American Academy of Family Physicians. This clinical practice guideline helps to eliminate the need for obtaining middle ear fluid for culture. It is unreasonable to obtain a culture of middle ear fluid with every episode of acute otitis media to determine the specific cause. A 20-month-old's gait would most likely appear as swaying from side to side while moving forward. It is not until the toddler is around 3 years of age that he or she demonstrates walking in a heel-to-toe fashion with a steady gait. Antiviral medications would be used if the diagnosis of a viral cause was confirmed and the child was older than the age of 2 years.
The nurse has been asked to participate in a community health teaching session. Which interventions would the nurse include to help achieve the 2020 National Health Goals to reduce the incidence of anemias? Select all that apply. Explain the importance of healthy eating for adolescent participants. Instruct pregnant women to take iron supplementation as prescribed. Emphasize ways to reduce unintentional injuries at home, work, and play. Review foods that are rich in iron that should be a part of school-age children's diets. Examine strategies for elderly community members to improve the quality of life.
Explain the importance of healthy eating for adolescent participants. Instruct pregnant women to take iron supplementation as prescribed. Review foods that are rich in iron that should be a part of school-age children's diets. Nurses can help the nation achieve the 2020 National Health Goals to improve children's health and reduce hospitalization from anemia by educating parents about the importance of women taking an iron supplement during pregnancy, encouraging iron-rich food sources for young children, and educating adolescents about healthy diets. Prevention of unintentional injuries and improving the quality of life for the elderly are not interventions to achieve this National Health Goal.
Fat is a necessary part of the diet. The Health and Medicine Division's Food and Nutrition Board has set what adult Acceptable Macronutrient Distribution Ranges (AMDR) for fats? 0% - 12% 5% - 20% 25% - 35% 37% - 48%
25% - 35% The Food and Nutrition Board has set an adult acceptable macronutrient distribution range for fat of 25% - 35%, with a minimum of 20% to prevent the fall of HDL cholesterol with very-low-fat diets.
A nurse is caring for a morbidly obese client who has undergone surgery for weight loss. The client reports pain 8/10 despite morphine sulfate 1 mg/hour continuous infusion being administered via a patient-controlled analgesia (PCA) pump. Which action will best protect the nurse from issues of liability? Contact the health care provider with a request for a change in PCA Provide the client with nonpharmacologic means of pain control Add morphine sulfate 1 mg/8 min IV as a client-administered dose to the continuous infusion Explain to the client that pain is expected with weight loss surgery
Contact the health care provider with a request for a change in PCA State Boards of Nursing and the provincial or territorial nursing regulatory bodies set acceptable standards for nursing for a particular state or Canadian province or territory. Practicing within those guidelines will protect the nurse from liability. A nurse has a legal responsibility to address and manage a client's pain. The nurse would recognize that morphine 1 mg/hour continuous intravenous infusion may not provide adequate pain control in a morbidly obese client. The best option to avoid liability issues regarding pain control would be to contact the health care provider to request a change in analgesia for this client. Offering nonpharmacologic means of pain control is appropriate, but fails to address the need for a change in PCA. Adding a self-administered dose of morphine sulfate via PCA without a health care provider prescription would be outside the scope of practice for a registered nurse. Explaining to the client that pain is to be expected does nothing to meet the legal responsibility the nurse has to manage a client's pain and increases a nurse's risk of liability.
The nurse is putting together information for a nutritional class for nullipara women. Which information would be most important for the nurse to include? Select all that apply. Increase consumption of fruits, vegetables, and whole grains. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol. Consume at least one quart of water daily. Increase caloric intake.
Increase consumption of fruits, vegetables, and whole grains. Avoid the intake of alcohol. Decrease intake of saturated fats, trans fats, and cholesterol New guidelines have been issued to help a pregnant woman meet recommended DRIs. Some of these guidelines include eating a variety of food from all food groups, using portion control; increase intake of vitamins, minerals, and dietary fiber; lower intake of saturated fats, trans fats, and cholesterol; increase intake of fruits, vegetables, and whole grains; and balance calorie intake with exercise to maintain ideal healthy weight.
The nurse is assessing a family parented by a 60-year-old grandmother and three school-age grandchildren. The nurse is aware that which problem may occur in a single-parent family at a greater level than in other types of families? Lack of knowledge about child safety Increased financial concerns Child abuse and neglect Conflict between family members
Increased financial concerns Many single-parent families are headed by women. Single parents often have special problems and needs, including financial concerns and role shifts (i.e., having the roles of both parents). Single-parent families are not less knowledgeable about child safety than other family types, nor is there a higher incidence of child abuse, neglect, or conflict among family members.
The Healthy People 2020 initiative targets the improvement of health for all. In addition to eliminating health disparities, what are the broad goals of this plan? Increasing technological innovations Preventing treatable problems Applying a systematic approach to health improvement Increasing the quality and length of a healthy life
Increasing the quality and length of a healthy life Two broad goals of the Healthy People 2020 initiative are to increase quality and years of healthy life and eliminate health disparities. Healthy People 2020 initiatives will help with treatable problems but will not prevent problems. The initiative does not apply a systematic approach to health improvement or increase technological innovations.
