Health Law (Nursing)

A Mexican-American patient puts a picture of the Virgin Mary on the bedside table. Under which section of the assessment should the nurse document this behavior? a. Culture b. Ethnicity c. Verbal communication d. Nonverbal communication

A Cultural heritage is expressed through language, works of art, music, dance, ethnic clothing, customs, traditions, diet, and expressions of spirituality. This patient's prominent placement of the picture is an example of expression of cultural heritage.

While talking with a patient with severe depression, a nurse notices the patient is unable to maintain eye contact. The patient's chin lowers to the chest while the patient looks at the floor. Which aspect of communication has the nurse assessed? a. Nonverbal communication b. A message filter c. A cultural barrier d. Social skills

A Eye contact and body movements are considered nonverbal communication. Insufficient data are available to determine the level of the patient's social skills or whether a cultural barrier exists.

A patient is having difficulty making a decision. The nurse has mixed feelings about whether to provide advice. Which principle usually applies? Giving advice: a. Is rarely helpful. b. Fosters independence. c. Lifts the burden of personal decision making. d. Helps the patient develop feelings of personal adequacy.

A Giving advice fosters dependence on the nurse and interferes with the patient's right to make personal decisions. Giving advice also robs patients of the opportunity to weigh alternatives and to develop problem-solving skills. Furthermore, it contributes to patient feelings of personal inadequacy. It also keeps the nurse in control and feeling powerful.

A hospital is experiencing a drop in patient admissions, resulting in the implementation of a hiring freeze. What is a potential critical consequence of this internal organizational decision? a. A decrease in the availability of future nurses to hire b. A savings of salaries and benefits c. Increased scholarships to nursing students from the local high school d. Increased cross-training of current staff

A In an economic climate where hospitals are not hiring, nursing schools may limit enrollment which will limit the availability of future nurses available to be hired when the current nurses retire or reduce their hours. Salary savings is minimal as the number of patients, staffing, and revenue are closely aligned. Scholarships will decrease as hiring commitments to scholarship holders will no longer be in effect. Cross-training may occur, but it is not a critical consequence of a hiring freeze.

Which technique will best communicate to a patient that the nurse is interested in listening? a. Restate a feeling or thought the patient has expressed. b. Ask a direct question, such as "Did you feel angry?" c. Make a judgment about the patient's problem. d. Say, "I understand what you're saying."

A Restating allows the patient to validate the nurse's understanding of what has been communicated. Restating is an active listening technique. Judgments should be suspended in a nurse-patient relationship. Closed-ended questions such as, "Did you feel angry?" ask for specific information rather than show understanding. When the nurse simply states that he or she understands the patient's words, the patient has no way of measuring the understanding.

A young wife is talking with the nurse about her husband who is returning from the military. The wife confides that her husband is physically okay but is behaving differently. The nurse's best response is which of the following? a. "He is just trying to adjust to civilian life again; he'll be okay." b. "You should observe him closely, because he could attack you." c. "Many times people need care for emotional trauma." d. "Talk with your physician to get medication, and then put it in his food."

ANS: C The nurse is alerting the young wife to the fact that people who have experienced emotional trauma need care too. The nurse does not know how the husband is adjusting so the other options are incorrect.

A nurse manager recognizes that systems theory identifies that there is a social component within an organization that affects the overall functioning of the system. What indicator would demonstrate to the nurse manager that the social needs of an organization are being met? a. Most employees from the organization attend an annual holiday celebration. b. Separate eating areas for each discipline are set up in the cafeteria. c. Nurse managers are planning to move to a centralized area away from the care units. d. The summer softball teams are canceled due to lack of interest.

A Systems theory focuses on the needs and desires of people who work in the organization. Good attendance at a work-sponsored function indicates that staff enjoy interacting and are meeting social and relationship roles. Separating disciplines does not foster a sense of team. Moving administration away from staff limits interaction and informal conversations that build trust. Lack of participation in sponsored events such as a softball team indicates that staff relationships are not stro

Which Nursing diagnosis would be most appropriate for a patient expressing frustration with his inability to function independently following shoulder surgery? a. Powerlessness b. Social isolation c. Anxiety d. Fear

A The Nursing diagnosis of powerlessness denotes a lack of personal control over situations, which is reflected in this patient's verbalized frustration. Social isolation exists if a person desires additional contact with others and is unable to achieve it. The Nursing diagnosis of anxiety is defined as a general uneasiness while fear is a concern related to an identifiable source that is perceived as dangerous. No indications of social isolation, anxiety, or fear are evident in the patient's stated frustration.

When a female Mexican-American patient and a female nurse sit together, the patient often holds the nurse's hand. The patient also links arm and arm with the nurse when they walk. The nurse is uncomfortable with this behavior and thinks the patient is homosexual. Which alternative is a more accurate assessment? a. The patient is accustomed to touch during conversations, as are members of many Hispanic subcultures. b. The patient understands that touch makes the nurse uncomfortable and controls the relationship based on that factor. c. The patient is afraid of being alone. When touching the nurse, the patient is reassured and comforted. d. The nurse is homophobic.

A The most likely answer is that the patient's behavior is culturally influenced. Hispanic women frequently touch women they consider to be their friends. Although the other options are possible, they are less likely.

A mother is talking with the community-based nurse concerning her adult son. The son is mentally challenged and not able to live on his own. The mother is concerned about her son's welfare when she is no longer able to care for him. The best response by the nurse would be which of the following? a. "Let's look into the community resources that are available to assist you." b. "You have raised your son well, and he will be okay on his own." c. "Contact your distant relatives to see if anyone would take your son." d. "There are places for mentally challenged adults; let's place him there."

A The mother, with the assistance of the nurse, can research resources in the community that will service and care for her son when she is no longer able to do so. How the son is raised does not mean that he will be okay on his own. Distant relatives may not want or be able to care for the son, so this may not be a viable option. Placing the son is too general of an option, and he may not do well in this setting.

The community health nurse is assessing a family who has a chronically ill child. The child needs special care, and the nurse has to coordinate the care for the home setting. What behavior will the nurse assess for to know that the family can care for the child? a. The family is willing to learn about the care and share the caregiving needs. b. The mother is going to care for the child and the family herself. c. The older siblings are going to care for the child while the parents are at work. d. An outside agency will be coming to the home three times a week to give care.

A The nurse will look for a family who is willing to provide care plus support each other in this need. Having a situation where just siblings or a mother or an outside agency give care puts an undue burden on the caregiver and brings disharmony to the family.

Strategies to include in a teaching plan for an adult who has repeatedly not followed the written discharge instructions would include a. individualized handout. b. instructional videos. c. Internet resources. d. self-help books.

B An instructional video would provide a visual/auditory approach for discharge instructions. Repeatedly not following written instructions is a clue that the patient may not be able to read or understand the information. While assessing the literacy level of an adult patient can be challenging, the information that they have not been able to follow previous written instructions would suggest that the nurse use an alternate strategy that does not require a high degree of literacy. An individualized handout would be written, very similar to previous instructions, and would not address a concern about literacy. Internet resources generally require an individual to be able to read, and although videos are available through the Internet, this is not the best response. Self-help books would be appropriate for an individual who reads. There is a question about whether this patient is literate, so these would not be the best choice.

In order to effectively communicate via written e-mail with patients from an outpatient facility, a clinic nurse must implement which strategy? a. Look for visual cues. b. Verify shared information. c. Listen for voice inflection. d. Validate nonverbal signs.

B Electronic communication requires verification of information to avoid misinterpretation. Nonverbal signs, visual contact, and voice inflection cannot be evaluated via written e-mail communication.

Which action by a nurse demonstrates an understanding of diversity factors related to proxemics? a. Assigning a male nurse to care for a young female Middle Eastern patient who needs total care b. Standing at least 18" away from English-speaking patients when discussing medical concerns c. Recognizing the need for greater personal space of people born in highly populated areas d. Acknowledging the need of teens for greater physical contact than toddlers during hospitalization

B English-speaking people typically prefer at least 18" of distance between themselves when conversing. It is preferable to assign a same gender nurse to care for a young female Middle Eastern patient who will require personal care. People born in more densely populated areas typically require less personal space rather than more. Children demonstrate a need for greater personal space as they age.

An African-American patient says to a Caucasian nurse, "There's no sense talking. You wouldn't understand because you live in a white world." The nurse's best action would be to: a. explain, "Yes, I do understand. Everyone goes through the same experiences." b. say, "Please give an example of something you think I wouldn't understand." c. reassure the patient that nurses are in contact with people from all cultures. d. change the subject to one that is less emotionally disturbing.

B Having the patient speak in specifics rather than globally helps the nurse understand the patient's perspective. This approach helps the nurse engage the patient.

A patient cries as the nurse explores the patient's relationship with a deceased parent. The patient says, "I shouldn't be crying like this. It happened a long time ago." Which responses by the nurse will facilitate communication? Select all that apply. a. "Why do you think you are so upset?" b. "I can see that you feel sad about this situation." c. "The loss of your parent is very painful for you." d. "Crying is a way of expressing the hurt you're experiencing." e. "Let's talk about something else because this subject is upsetting you.

B, C, D Reflecting ("I can see that you feel sad" or "This is very painful for you") and giving information ("Crying is a way of expressing hurt") are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental, and they are difficult to answer. Changing the subject is a barrier to communication.

Many grandparents today are caring for grandchildren in place of a parent. Identify the reasons why this phenomenon is happening. (Select all that apply.) a. Children prefer living with their grandparents. b. Parents are incarcerated. c. Parents are deceased. d. Grandparents are better caregivers. e. Parents are mentally ill. f. Parents are substance abusers.

B, C, E, F Grandparents are usually caring for children because the parents are deceased, in prison, substance abusers, or mentally ill and cannot care for the children. The fact that children prefer to live with the grandparents or the grandparents may be better caregivers is not a main reason for this phenomenon to happen.

A hospital organization is working to improve a feeling of being valued and respected among all staff members. Which action by administration would reinforce the feeling of being valued? a. Create professional pathways that require advanced education for any advancement of staff. b. Seek staff input when planning a remodeling project of patient rooms. c. Form committees that consist of upper management to plan organizational goals. d. Consistently schedule required staff meetings at the same time each month.

B Including staff at all levels of an organization in planning and projects demonstrates respect for the intelligence and creativity of the individual. Requiring advanced education for any advancement limits those with barriers to attending additional schooling; advancement should be available in a variety of ways to show the value of the individual. Committees that only consist of upper management cause a feeling of disconnect between staff and administration. Scheduling meetings at the same time does not consider those who work shifts and either have to come in on their day off or must disrupt sleep to attend.

A patient with paranoid schizophrenia tells the nurse, "The CIA is monitoring us through the fluorescent lights in this room. Be careful what you say." Which response by the nurse would be most therapeutic? a. "Let's talk about something other than the CIA." b. "It sounds like you're concerned about your privacy." c. "The CIA is prohibited from operating in health care facilities." d. "You have lost touch with reality, which is a symptom of your illness."

B It is important not to challenge the patient's beliefs, even if they are unrealistic. Challenging undermines the patient's trust in the nurse. The nurse should try to understand the underlying feelings or thoughts the patient's message conveys. The correct response uses the therapeutic technique of reflection. The other comments are nontherapeutic. Asking to talk about something other than the concern at hand is changing the subject. Saying that the CIA is prohibited from operating in health care facilities gives false reassurance. Stating that the patient has lost touch with reality is truthful but uncompassionate.

A nurse is interviewing at an agency owned by a national religious organization that serves homeless and uninsured patients. A large poster display shows a proposed addition that would add 16 beds to the facility that will be funded from profits of the previous 3 years of operation. The nurse recognizes that the agency is most likely what type of agency? a. For-profit b. Not-for-profit c. Publicly-owned d. Investor-owned

B Many religious organizations are privately owned and administer not-for-profit health facilities, where profits are returned into the facility for improvements or equipment. For-profit agencies distribute profits to shareholders. Publicly-owned facilities are government supported and not linked to religious organizations. Investor-owned agencies would be for-profit agencies with profits distributed to investors.

The patient says, "My marriage is just great. My spouse and I usually agree on everything." The nurse observes the patient's foot moving continuously as the patient twirls a shirt button. What conclusion can the nurse draw? The patient's communication is: a. clear. b. mixed. c. precise. d. inadequate.

B Mixed messages involve the transmission of conflicting or incongruent messages by the speaker. The patient's verbal message that all is well in the relationship is modified by the nonverbal behaviors denoting anxiety. Data are not present to support the choice of the verbal message being clear, explicit, or inadequate.

A patient with acute depression states, "God is punishing me for my past sins." What is the nurse's best response? a. "Why do you think that?" b. "You sound very upset about this." c. "You believe God is punishing you for your sins?" d. "If you feel this way, you should talk to a member of your clergy."

B The nurse reflects on the patient's comment, a therapeutic technique to encourage sharing for perceptions and feelings. The incorrect responses reflect probing, closed-ended comments, and giving advice, all of which are nontherapeutic.

During the first interview with a parent whose child died in a car accident, the nurse feels empathic and reaches out to take the patient's hand. Select the correct analysis of the nurse's behavior. a. It shows empathy and compassion. It will encourage the patient to continue to express feelings. b. The gesture is premature. The patient's cultural and individual interpretation of touch is unknown. c. The patient will perceive the gesture as intrusive and overstepping boundaries. d. The action is inappropriate. Patients in a psychiatric setting should not be touched.

B Touch has various cultural and individual interpretations. Nurses should refrain from using touch until an assessment can be made regarding the way in which the patient will perceive touch. The other options present prematurely drawn conclusions.

The relationship between a nurse and patient as it relates to status and power is best described by which term? a. Symmetric b. Complementary c. Incongruent d. Paralinguistic

B When a difference in power exists, as between a student and teacher or between a nurse and patient, the relationship is said to be complementary. Symmetrical relationships exist between individuals of like or equal status. Incongruent and paralinguistic are not terms used to describe relationships.

Documentation in a patient's chart shows, "Throughout a 5-minute interaction, patient fidgeted and tapped left foot, periodically covered face with hands, and looked under chair while stating, 'I enjoy spending time with you.'" Which analysis is most accurate? a. Patient is giving positive feedback about the nurse's communication techniques. b. Nurse is viewing the patient's behavior through a cultural filter. c. Patient's verbal and nonverbal messages are incongruent. d. Patient is demonstrating psychotic behaviors.

C When a verbal message is not reinforced with nonverbal behavior, the message is confusing and incongruent. Some clinicians call it a "mixed message." It is inaccurate to say that the patient is giving positive feedback about the nurse's communication techniques. The concept of a cultural filter is not relevant to the situation; a cultural filter determines what a person will pay attention to and what he or she will ignore. Data are insufficient to draw the conclusion that the patient is demonstrating psychotic behaviors.

A hospital organization is applying for Magnet© status to show excellence in nursing practice. What components would indicate that the hospital is meeting Magnet© principles? (Select all that apply.) a. The education budget for nursing has been cut to provide for new laboratory equipment. b. On average, 40% of new nurses are leaving within 1 year of hire. c. Nurses are active participants on all major hospital committees. d. Quality improvement projects are planned and evaluated by nurses. e. Patient care outcome data are reported in the annual executive board meeting.

C, D To gain Magnet© status, an organization must show that nurses are active participants in the organization administrative structure, fully involved in quality improvement projects, and are recognized as a valuable resource.

In relationship to a nurse's ability to communicate, effectiveness in which type of communication most demonstrates professional competence? a. Public b. Small group c. Interpersonal d. Intrapersonal

C A majority of nursing practice involves interpersonal communication with patients and other health care team members; therefore, excellent interpersonal skills are the most reflective of professional competence. A nurse's effectiveness in public speaking, small group leadership, and use of intrapersonal communication is less indicative of professional expertise.

Physical assessment of a patient requires the nurse to function most often in which area of a patient's space? a. Personal b. Social c. Intimate d. Public

C A majority of physical assessment functions such as monitoring blood pressure, assessing bowel sounds, and checking pedal pulses require touching the patient. Intimate space is considered to be a distance of 0 to 1.5 feet. Personal space according to the theory of proxemics is 1.5 to 4 feet. Social space is 4 to 12 feet and public space is considered to be more than 12 feet.

Barriers to patient education the nurse considers in implementing a teaching plan include a. family resources. b. high school education. c. hunger and pain. d. need perceived by patient.

C A patient who is hungry or in pain has limited ability to concentrate or learn. Family resources would be considered in developing a plan of care and could be an asset or a barrier to patient education. The patient's educational level would be considered in planning teaching strategies but would not be a barrier to education. A need perceived by a patient would provide motivation for learning and would not be a barrier

The most appropriate resources to include when planning to provide patient education related to a goal in the psychomotor domain would be a. diagnosis-related support groups. b. Internet resources. c. manikin practice sessions. d. self-directed learning modules.

C A teaching goal in the psychomotor domain should be matched with teaching strategies in the psychomotor domain, such as demonstration, practice sessions with a manikin, and return demonstrations. Diagnosis-related support groups would be most effective with goals in the affective domain. Internet resources would be most effective for goals in the cognitive domain. Self-directed learning modules would be most effective for goals in the cognitive domain.

Which action by the nurse best demonstrates patient advocacy? a. Asking a hospitalized patient's name preference prior to care b. Fostering autonomy and independent decision making c. Arranging transportation home for a patient who is unable to drive d. Sharing evidence-based practice data with other health care professionals

C Advocacy requires a nurse to be assertive and "go the extra mile" in providing for a patient's needs. Calling a patient by a preferred name and fostering autonomy demonstrate respect. Sharing evidence-based practice data with other professionals is collaboration.

A patient discloses several concerns and associated feelings. If the nurse wants to seek clarification, which comment would be appropriate? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that...?" d. "Tell me everything from the beginning."

C Asking, "Am I correct in understanding that...?" permits clarification to ensure that both the nurse and patient share mutual understanding of the communication. Asking about common elements encourages comparison rather than clarification. The remaining responses are implied questions that suggest the nurse was not listening.

A patient tells the nurse, "I don't think I'll ever get out of here." Select the nurse's most therapeutic response. a. "Don't talk that way. Of course you will leave here!" b. "Keep up the good work and you certainly will." c. "You don't think you're making progress?" d. "Everyone feels that way sometimes."

C By asking if the patient does not believe that progress has been made, the nurse is reflecting by putting into words what the patient is hinting. By making communication more explicit, issues are easier to identify and resolve. The remaining options are nontherapeutic techniques. Telling the patient not to "talk that way" is disapproving. Saying that everyone feels that way at times minimizes feelings. Telling the patient that good work will always result in success is falsely reassuring.

The annual report for a hospital shows that external environment factors are affecting the amount of new staff hired. What is a likely factor contributing to this outcome? a. The recent implementation of becoming a not-for-profit institution b. The implementation of a hospital electronic medical record system c. A national recession that has been occurring for 3 years d. The closure of a hospital-based school of nursing due to lack of funding

C External environmental factors that affect organizations are conditions or events that occur outside the control of the agency, such as new health laws, governmental regulations, or economic trends. Internal environmental factors occur within the organizational structure and include such factors as technology issues, changes in personnel roles, or the implementation of new policies.

Which action by a patient indicates participation in the working phase of an effective nurse-patient helping relationship? a. Sharing of pertinent demographic data b. Exchanging of personal e-mail addresses c. Reflecting on the emotional aspects of illness d. Transitioning care to another health care provider

C Personal reflection is a component of the working phase of the nurse-patient helping relationship. Sharing of demographic data takes place during the orientation phase. Exchanging of personal e-mail addresses is a violation of professional role boundaries and should not take place in a nurse-patient helping relationship. Transferring responsibility for care is done during the termination phase.

Which statement by the nurse best promotes reflection on a patient's statement? a. "I don't quite follow what you are asking." b. "Tell me when you started having pain." c. "You seem excited to be going home." d. "Your vital signs are excellent today."

C Reflection focuses on feelings or emotions identified by the patient (either verbally or nonverbally) and is encouraged by stating, "You seem excited to be going home." Seeking clarification is exhibited in the statement, "I don't quite follow what you are asking." "Tell me when you started having pain" is a component of assessment. Informing a patient of his/her vital signs is a form of giving information.

Which principle should guide the nurse in determining the extent of silence to use during patient interview sessions? a. Nurses are responsible for breaking silences. b. Patients withdraw if silences are prolonged. c. Silence provides meaningful moments for reflection. d. Silence helps patients know that what they have said is understood.

C Silence can be helpful to both participants by giving each an opportunity to contemplate what has transpired, weigh alternatives, and formulate ideas. A nurse breaking silences is not a principle related to silences. Saying that patients withdraw during long silences or that silence helps patients know that they are understood are both inaccurate statements. Feedback helps patients know they have been understood.

A quality improvement committee is reviewing discharge surveys. Results show that patients and their families have difficulty finding departments and areas of the hospital. What action by the committee would best address this concern for the organization? a. Continue to review future surveys to monitor the situation. b. Give additional training to the receptionists and switchboard personnel to give better directions. c. Form a multidisciplinary committee to identify options to help travel through the hospital. d. Send a work order to the maintenance department requesting that brighter lights be installed.

C Successful organizations respect the input of all disciplines when searching for solutions for problems. Continuing to gather data delays solving a problem. There is no indication that verbal directions will solve the problem; additional measures may be required. Merely providing additional light may not solve the problem—multi-language signs or even remodeling may be identified by the committee as being needed.

The nurse is counseling a woman who is caring for her 83-year-old father. The father has had mental changes and is becoming more confused. The father lives with the daughter in her home. The nurse knows the daughter understands the father's care needs when she states which of the following? a. "Dad will only need my help for a short time, and then he will get better." b. "I can leave dad alone during the day; I'll just deadbolt the door." c. "I can send dad to the adult daycare; that way I can work and care for him at night." d. "Dad misses mom since she passed; he will be okay in a few weeks."

C The father will be cared for at the adult daycare, and it is a nice alternative for the daughter. She will be able to work and know that her father is safe during the day. The daughter thinking the father will be okay in a few days is not realistic, nor can she deadbolt the door and lock him in the house.

4. A nurse interacts with a newly hospitalized patient. Select the nurse's comment that applies the communication technique of "offering self." a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "I hope you will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me."

D "Offering self" is a technique that should be used in the orientation phase of the nurse-patient relationship. Sitting with the patient, an example of "offering self," helps build trust and conveys that the nurse cares about the patient. Two incorrect responses are ineffective and nontherapeutic. The other incorrect response is therapeutic but an example of "offering hope."

A nurse is reported for taking prescribed patient medications for their personal use. Who has direct authority over deciding if the nurse may keep their professional license to continue practicing as a nurse? a. The hospital where the nurse is currently employed b. The American Nurses Association c. The National League for Nursing d. The State Board of Nursing who issued the license

D Decisions related to practice are the responsibility of the licensing body, or State Board of Nursing, who is charged with protecting the public. The hospital does not determine who is eligible for a professional license. The National League for Nursing is active in nursing education standards. The American Nurses Association helps develop standards of care and is politically active, but it does not enforce standards for individuals.

When a patient with stool incontinence and significant body odor is admitted to the floor from the Emergency Department, what is the most appropriate first response of the nurse? a. Treat the incontinence episode in a matter-of-fact manner. b. Notify the ED personnel that transporting a patient in this condition is inexcusable. c. Explain how daily hygiene is important while assessing the patient. d. Assist the patient in getting cleaned up without expressing frustration.

D Focusing on the needs of the patient is the nurse's first priority. When a patient is ill and newly admitted to a nursing floor, it is most important to assist the patient with care needs and address procedural issues at a later time. Being matter-of-fact does not go far enough; the nurse needs to convey acceptance of the patient. At a later time, it may or may not be appropriate to use the proper channels of communication within the hospital to discuss issues concerning the condition of patients admitted to nursing floors. A discussion of daily hygiene is unnecessary and might be offensive.

When describing patient education approaches, the nurse educator would explain that informal teaching is an approach that a. addresses group needs. b. follows formalized plans. c. has standardized content. d. often occurs one-to-one.

D Informal teaching is individualized one-on-one teaching which represents the majority of patient education done by nurses that occurs when an intervention is explained or a question is answered. Group needs are often the focus of formal patient education courses or classes. Informal teaching does not necessarily follow a specific formalized plan. It may be planned with specific content, but it is individualized responses to patient needs. Formal teaching involves the use of a curriculum/course plan with standardized content.

A Puerto Rican-American patient uses dramatic body language when describing emotional discomfort. Which analysis most likely explains the patient's behavior? The patient: a. Has a histrionic personality disorder. b. Believes dramatic body language is sexually appealing. c. Wishes to impress staff with the degree of emotional pain. d. Belongs to a culture in which dramatic body language is the norm.

D Members of Hispanic-American subcultures tend to use high affect and dramatic body language as they communicate. The other options are more remote possibilities.

Many middle-aged adults are called the "sandwich" generation because they are caring for their children and their aging parents. The aging parents need care due to a. mental clarity. b. immobility. c. blindness. d. multiple chronic illnesses.

D Multiple chronic illnesses come with the aging process. Middle-aged adults are becoming the caregivers for the generation before them and the one after them. Mental clarity is a positive aspect of aging and does not need care. Immobility and blindness do not always mean that the person needs direct care.

The nurse educator would identify a need for further teaching when the student lists the types of learning as a. affective. b. cognitive. c. psychomotor. d. self-directed.

D Self-directed is one approach to learning but is not considered a type or domain of learning. Self-directed would be a cognitive way of learning. Affective (feelings/attitude), cognitive (knowledge), and psychomotor (skills/performance) are the main domains of learning.

A Filipino-American patient had this nursing diagnosis: Situational low self-esteem, related to poor social skills as evidenced by lack of eye contact. Interventions were used to raise the patient's self-esteem; however, after 3 weeks, the patient's eye contact did not improve. What is the most accurate analysis of this scenario? a. The patient's eye contact should have been directly addressed by role-playing to increase comfort with eye contact. b. The nurse should not have independently embarked on assessment, diagnosis, and planning for this patient. c. The patient's poor eye contact is indicative of anger and hostility that remain unaddressed. d. The nurse should have assessed the patient's culture before making this diagnosis and plan.

D The amount of eye contact in which a person engages is often culturally determined. In some cultures, eye contact is considered insolent, whereas in other cultures, eye contact is expected. Asian Americans, including persons from the Philippines, often prefer not to engage in direct eye contact.

Interrelated concepts to the professional nursing role a nurse manager would consider when addressing concerns about the quality of patient education include a. adherence. b. developmental level. c. motivation. d. technology.

D The interrelated concepts to the professional role of a nurse include health promotion, leadership, technology/informatics, quality, collaboration, and communication. Adherence, culture, developmental level, family dynamics, and motivation are considered interrelated concepts to patient attributes and preference.

A patient says to the nurse, "I dreamed I was stoned. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which comment would be appropriate if the nurse seeks clarification? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So, all in all, you feel as though you had a rather poor night's sleep?" d. "Can you give me an example of what you mean by 'stoned'?"

D The technique of clarification is therapeutic and helps the nurse examine the meaning of the patient's statement. Asking for a definition of "stoned" directly asks for clarification. Restating that the patient is uncomfortable with the dream's content is parroting, a nontherapeutic technique. The other responses fail to clarify the meaning of the patient's comment.

A nurse manager finds an unsigned note reporting that patient care standards are not consistently being followed. Within the organizational structure, what is the best action for the manager? a. Schedule a staff meeting to ask staff who left the note. b. Send an email reminder that all staff need to review the policy and procedure book. c. Wait for a staff member to come forward who is willing to be identified. d. Form a small group to explore why staff are not comfortable reporting errors.

D There are significant problems in an organization where staff are not willing to openly discuss problems, especially problems that affect patient care. A focus group can help identify what is preventing a sense of comfort to reveal problems. Scheduling a meeting is unlikely to have the person admit to complaining about care provided by coworkers in front of coworkers. A request to review policies and procedures is so broad the staff will not be able to identify a specific problem that needs to be corrected. Unless organizational changes are made, it is unlikely that staff will decide to come forward when they would not do so in the first place.

During an interview, a patient attempts to shift the focus from self to the nurse by asking personal questions. The nurse should respond by saying: a. "You've turned the tables on me." b. "Nurses direct the interviews with patients." c. "Do not ask questions about my personal life." d. "The time we spend together is to discuss your concerns."

D When a patient tries to focus on the nurse, the nurse should refocus the discussion back onto the patient. Telling the patient that interview time should be used to discuss patient concerns refocuses discussion in a neutral way. Telling patients not to ask about the nurse's personal life shows indignation. Saying that nurses prefer to direct the interview reflects superiority. Saying "You've turned the tables on me" states the fact but does not refocus the interview.

1.A new nurse needs further teaching when stating a valid consent involves which action? It must be presented to the patient by a nurse. The consent includes information about the risks and benefits of the procedure. The patient must have the capacity to give consent. The patient must voluntarily give consent.

It must be presented to the patient by a nurse. The person presenting the informed consent document must be the provider performing the procedure. To be valid, information for consent must be given by the provider who will be performing the procedure and includes information about the risks and benefits of the procedure. The patient must voluntarily give consent.

6. Which of the following is an example of a nurse violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996? a. The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital. b. A group of fellow employees are discussing a patient's clinical status in a public place. The nurse manager requests that they step into private room to complete the discussion. c. After entering the progress notes on a patient's electronic medical record, the nurse logs off the computer to allow her coworker to use the terminal. d. As a family approaches the nursing desk, the nurse removes the patient census sheet from view on the counter.

a. The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital. When the nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital, the nurse is accessing protected health information not required for the nurse to perform his or her job. This is a violation of privacy even if it is a relative. The other choices are all actions that are consistent with protecting a patient's privacy right as defined by HIPAA.

4. One of the major attributes of health care law is a. it defines the expected behavior of persons in the business of health care. b. the law or rule is easy to interpret and comply with. c. it is established by any health care authority. d. the creator must be an expert in health care.

a. it defines the expected behavior of persons in the business of health care. A health care law or rule defines expected behavior of persons in the business of health care or in health care relationships. Health care law is not easy to interpret or comply with and can only be established by organizations with legal authority for law making. Creators of health care law are often not experts in health care.

8. Which of the following is false regarding state licensure laws? a. These laws establish the requirements for licensure to practice. b. Licensure is not necessary if the individual has completed training. c. The state regulatory agencies such as the state board of nursing are responsible for creating and enforcing these rules. d. The scope of practice defines what the professional can and cannot do within the scope of their licensure.

b. Licensure is not necessary if the individual has completed training. Licensure is required to practice after the completion of all required training for the profession. The state laws establish the requirements to practice and the state regulatory agencies are responsible for creating and enforcing the rules. The scope of practice defines what activities the professional is legally authorized to perform.

1. A law is defined as a a.fundamental concept for health care professionals. b. rule developed by the employee's organization. c. rule enacted by a government agency that defines what must be done in a given circumstance. d. mandate from the Joint Commission or other accrediting agency.

c. rule enacted by a government agency that defines what must be done in a given circumstance. This is the correct definition of a law.

6.The nurse is working with a student nurse who is not yet licensed. Which of the following is true? The student nurse may perform nursing actions until he or she has passed the licensing examination. The student nurse is not responsible for his or her actions as a student under the state licensing law. The student nurse may perform nursing actions only under the supervision of a licensed nurse. The student nurse must apply for a temporary student nurse permit to practice as a student.

The student nurse may perform nursing actions only under the supervision of a licensed nurse. By most state laws, nursing students may perform nursing actions before they are licensed but only under the supervision of a licensed nurse. The student is responsible for his or her own actions; however, the supervising nurse may also be responsible, depending on the situation. No special permit is required to practice as a student in an approved school of nursing.

3.A nurse protecting a patient's right to consent to a procedure is represented in which of the following answers? Finding that the informed consent document is not with the chart, the nurse gives the patient another consent document to sign before the procedure. When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. The nurse finds that the consent form is unsigned in the chart and waits until after the procedure to get the document signed. Knowing the patient is not competent to sign a consent form, the nurse asks the friend who came with the patient to sign it.

When the nurse finds that the informed consent document is not yet complete, she holds the patient's pre-procedure narcotics until the physician can obtain patient consent. To be valid, information for consent must be given prior to the procedure by the provider who will be performing the procedure and the information given must include a description of the procedure, a description of the risks and benefits of the procedure, and a discussion of any alternatives to the proposed procedure. Consent by the patient must be voluntarily given, and the person who consents must have the capacity to consent. Capacity can be determined by the health care provider and may be affected by drugs or the current or underlying medical condition. If the patient is unable to give consent directly, he or she may designate a person who can give consent on his or her behalf. If such a person is not designated by the patient, most states provide a statutory solution or a law that lists "statutory surrogates."

7.The nurse is interviewing for a position in the hospital. During the interview, the interviewer asks the nurse when she plans to start a family. The nurse applicant can legally respond: No, not until I get married. I plan to start a family when I get benefits. I don't know and will let you know when I do. You do not have a right to ask me that question.

You do not have a right to ask me that question. In employment practice, it is illegal to ask about family planning. The nurse is not obligated to disclose family planning.

5. The admission personnel working to comply with the Patient Self Determination Act of 1991 would do which of the following? a. Request identification from the patient to complete the registration process. b. Ask the patient if they would like a private or semi-private room. c. Inquire about the patient's reason for their visit. d. Ask the patient or representative if the patient has an advanced directive and advise them of their right to participate in their medical decisions.

d. Ask the patient or representative if the patient has an advanced directive and advise them of their right to participate in their medical decisions. Inquiring about a patient's advanced directive is a requirement of the Patient Self Determination Act of 1991. Inquiring about identification, type of room requested, and reason for visit are not addressed by the Patient Self Determination Act.

3. An example of the regulatory power to make law is the a. Joint Commission establishing a medication reconciliation standard. b. Centers for Disease Control and Prevention (CDC) developing recommendations for childhood immunizations. c. Institute of Medicine (IOM) defining the approximate number of medication errors that result in significant patient harm or death. d. Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals.

d. Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals. The Centers for Medicare and Medicaid Services (CMS) enacting rules for restraint and seclusion for participating hospitals refers to the enactment of law, while the other answers discuss the development of standards and recommendations that do not have the authority of law. There are some health care rules that may define expected behavior, but if these rules were not created by a government entity with legal authority, then they are not health care laws.

When planning to evaluate a patient's satisfaction with a teaching activity, the most appropriate strategy would be to a. include a survey instrument. b. observe for level of skill mastery. c. present information more than one time. d. provide for a return demonstration.

A A survey or questionnaires can be used to measure affective behavior change as well as patient satisfaction with the teaching experience. Observing for level of skill mastery would evaluate achievement of a psychomotor goal rather than satisfaction with the experience. Repeating information more than one time or in more than one way may be appropriate strategies to include in the teaching plan but would provide no evaluation data. Providing for a return demonstration would help in evaluating achievement of a psychomotor goal, not satisfaction with the activity.

2.Which of the following is an example of a medical malpractice tort liability? A patient is informed of all known side effects of a medication and voluntarily takes the medication. The patient experiences an adverse effect from a medication prescribed by a physician. A nurse follows the standard of care for initiating an intravenous line, but the patient's vein bursts, causing a hematoma and the need for minor surgery to evacuate the fluid. A surgeon does not complete the postprocedure count process, and a sponge is retained in the patient's abdominal cavity. The Department of Justice fines an organization for releasing protected health information to a pharmaceutical company without individual patient consent

A surgeon does not complete the postprocedure count process, and a sponge is retained in the patient's abdominal cavity. For tort liability to attach, four elements must be satisfied: duty, breach, causation, and harm. An adverse effect experienced by a patient who was informed of all known side effects of a medication, is prescribed the medication, and voluntarily takes the medication is an adverse event, not a tort liability. When a nurse follows the standard of care for initiating an intravenous line, but the patient's vein bursts, this is an adverse event and not a tort liability. Releasing protected health information to a pharmaceutical company without individual patient consent is regulated by federal law enforcement; it is considered employer liability and may be considered to be criminal if proven to be purposeful and egregious.

Which benefits are most associated with the use of telehealth? Select all that apply. a. Cost savings for patients b. Maximization of care management c. Access to services for patients in rural areas d. Prompt reimbursement by third-party payers e. Rapid development of trusting relationships with patients

A, B, C Use of telehealth technologies has shown that it can maximize health and improve disease management skills and confidence with the disease process. Many rural patients have felt disconnected from services; telehealth technologies can solve these problems. Although telehealth's improved health outcomes regularly show cost savings for payers, one significant barrier is the current lack of reimbursement for remote patient monitoring by third-party payers. Telehealth is not associated with rapid development of trusting relationships.

Caregivers are often categorized by their relationship to the person being cared for. Which of the following are the roles? (Select all that apply.) a. Grandparent b. Spouse c. Parent d. Adult children e. Neighbor/friend f. Young children

A, B, C, D, E All of these options can provide care whether it is on a temporary or permanent basis. Young children do not provide care.

What strategies would promote effective communication with a patient who is blind or deaf? (Select all that apply.) a. Provide adequate lighting when conversing with deaf patients. b. Stay within 3 to 6 feet while speaking to a visually impaired patient. c. Stay within 3 to 6 feet while speaking to a hearing-impaired patient. d. Utilize an interpreter to explain medical procedures to a deaf patient. e. Use light touch to arouse blind patients sleeping in a noisy environment.

A, C, D, E Providing adequate lighting assists people with hearing impairment to lip read. Staying within 3 to 6 feet of patients while talking is important when interacting with hearing-impaired patients, not visually impaired patients. Sign language interpreters are the best people to communicate detailed procedural information with deaf patients. Light touch will alert blind individuals who are sleeping that someone is present with them. This is especially true in a noisy environment when the person's approach cannot be heard.

4.Which of the following statements is true regarding The Joint Commission's authority relating to healthcare organizations? The Joint Commission standards have the same effect as law, and organizations can be fined by The Joint Commission for noncompliance. The Joint Commission regulations have no effect on the legal process in health care. The Joint Commission serves as an advisor to the federal government in establishing fines related to noncompliance. The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases.

The Joint Commission regulations may be seen as having the effect of law because they accredit organizations to bill Medicare and the standards are frequently used in malpractice cases. The Joint Commission standards do not have the same effect as law; however, they are often utilized as best practice standards in a malpractice case against which negligence is measured. The Joint Commission does not establish fines for noncompliance.

5.Which of the following would be a violation of the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986? The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. After providing a medical screening examination, the patient's attending physician determines that transfer for a psychiatric service is necessary and not provided by the hospital. The attending seeks consent from the competent surrogate decision maker for the patient prior to transfer. The patient's attending physician determines the patient to be in stable condition after completing the medical screening examination and stabilizing the patient. The patient's condition would deteriorate without a life-saving procedure not available at the hospital. The physician explains the risks of staying at the hospital and the risks of the transfer to the patient's power of attorney. Informed consent is received from the patient's power of attorney for the transfer. The hospital does not contract with the patient's insurance company. The emergency room physician completes a medical screening examination and stabilizes the patient for discharge. The patient financial services department informs the patient of insurance status after discharge and arranges for payment options.

The hospital emergency room physician suspects that a patient is not competent in making decisions for his post-care treatment. The physician does not complete a competency evaluation prior to transfer for a non-emergent treatment and allows the patient with suspected incompetence to sign the consent for transfer. The physician who allows the patient with suspected incompetence to sign the consent for transfer did not complete the medical screening examination. EMTALA required that any hospital that operated an emergency department and received Medicare funds provide an appropriate screening examination to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility.

2. Which of the following is true about health care legislation? a. The US Constitution addresses health care law specifically to give the federal government the ability to license professionals and institutions. b. The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states. c. State laws are considered the highest source of health care law and trump the federal laws. d. The federal government asserts its power over health care legislation through the US Constitution.

b. The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states. The power of the US Constitution does not have a direct relationship to health care and reserves most of the power to the states. The other statements are false. The US Constitution does not address health care specifically. Either state or federal laws can be considered the highest source of law depending on which law has the stricter regulation or rule.

7. In which of the following answers is the hospital in compliance with the Consolidated Omnibus Budget Reconciliation Act and Emergency Medical Treatment and Active Labor Act of 1986 (EMTALA)? a. The emergency department staff asks a patient to stay in the waiting room until the patients with insurance are treated. b. The emergency registration personnel explain to a patient that they must have proper identification to receive treatment. c. A patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized. d. The emergency department physician discharges and instructs a patient who is actively suicidal to go the neighbor facility that has psychiatric services.

c. A patient with chest pain is triaged directly to a room for evaluation and registration information is obtained after the patient is stabilized. EMTALA requires that any hospital that operates an emergency department and receives Medicare funds provide an appropriate screening exam to anyone who presented and stabilize any emergency medical condition prior to transfer to another facility. The other choices are in conflict with EMTALA because a medical screening exam must be provided without consideration of the patient's insurance, whether the patient has identification, or the facility's services.