Nursing Practice EXAM 1

Advanced Directives vs. Informed Consent

*Advance directives:* legal documents that specify what may and may not be done to patients when they are unable to speak for themselves. (ex: living wills) *Informed consent:* protects patients from having procedures or treatments performed without FULL disclosure.

Discuss legal implications: assault, battery, libel, slander, duty, breach of duty, negligence, malpractice, fraud.

*Assault:* Any threat to another person, either to his or her person or property. *Battery:* Actual physical contact with another person without his or her explicit permission. *Libel:* Written defamation of character. *Slander:* Verbal defamation of character. *Duty:* Required actions of licensed or credentialed professionals. *Breach of duty:* Failure to perform acts expected by virtue of licensure or credentialing that another prudent person with the same educational and experiential background would have done under similar circumstances. *Negligence:* Acting or failing to act in accordance with licensure or credentialing requirements. *Malpractice:* Negligence by a licensed professional. *Fraud:* Misrepresentation of person, credentials, or promised outcomes.

Define what the Nursing Process is and explain how and why it is essential to the practice of Nursing.

*Assessment:* Assessment is the first step in the nursing process. In this step, the nurse gathers as much information as possible about the patient and the patient's condition. Nurses need to obtain both objective and subjective data. *Nursing Diagnosis:* Data obtained during assessment from all sources (physical assessment, verbal statements made by the patient, and/or observed behaviors) are then sorted and re-grouped according to priority needs. These priority needs are then specified according to an identifiable classification base developed by NANDA International, Inc. *Patient-Centered Goals:* Once the diagnoses are prioritized, the nurse then needs to establish patient-centered goals. This is the planning stage of the nursing process. Goals should be identified as outcomes that can be objectively measured and should also include a realistic time frame. A measurable goal is one that identifies the criteria that evidences progress. For example: "Patient will take 10−20 steps with the assistance of the physical therapist by the end of the day." *Nursing Interventions:* The next phase of the nursing process is to establish nursing interventions that will facilitate the accomplish-ment of the stated goals. The intervention component of the nursing process is that phase that actually puts into action the plan of care that the nurse has proposed. For example, for "acute pain", the interventions may include "assess for pain by asking the patient to evaluate the intensity level on a scale of 1−10," "administer pain medication as ordered by the physician, and evaluate the effectiveness of the pain medication 30 minutes after administration," "notify physician if pain intensity level does not subside," "provide comfort measures such as making sure that patient is properly po-sitioned in bed and that there is no pressure on the incision site," and "teach patient to maintain positioning in order to prevent pressure to the incision site." Interventions should always include assessment criteria, nursing actions, and patient teaching. *Evaluation:* The next stage of the nursing process is evaluation. This part of the nursing process answers many questions: Were the priority patient needs correctly identified? Were the goals met e.g., did the pain decrease? Did the swelling and redness at the incision site decrease? Did the nutritional intake improve? Did the fear of standing at the bedside decrease? Were the nursing interventions effective? Why or why not? And the most important part of evaluation is reassessing patient status and progress and reestablishing new patient need priorities, more realistic goals, and different or more effective nursing interventions. And then the process starts all over again. Nursing care plans are ongoing reassessments of patients. Nursing care plans should never be static but continuously updated and revised.

Differentiate complementary and alternative health care practices and give 2 examples of each.

*Complementary healing practices:* Use of means other than surgery and pharmaceutical products to promote, restore, and/or maintain human health that is consistent with U.S. health care protocols. Examples include meditation, biofeedback, imagery and therapies (respiratory, occupational, physical, and nutritional). *Alternative healing practices:* Use of healing protocols not yet recognized or officially accepted by the U.S. health care delivery system. Examples are herbs, acupuncture, reflexology, and rituals by curanderas or shamans.

Variables (dependent/independent):

*Dependent variables* are affected or changed by independent variables. *Independent variables* can be manipulated or changed by a researcher, or they may represent conditions that already exist.

Evidence-Based Practice, what is it, what does it mean to be a change agent?

*Evidence-Based Practice:* Professional nursing practice that is based on scientific research. *Change agent:* A professional who is alert to ineffective practices and takes the initiative to implement change how, where, and when it is needed.

Briefly explain the major theme of four major nurse theorists.

*Florence Nightingale - Environmental Theory* A patient's environment along with the presence of a nurse significantly impact a patient's health outcome. She noted that factors such as cleanliness, ventilation, air, light, noise, and variety, all play a role in a patient's recovery. *Martha Rogers - Science of Unitary Human Beings* In this theory, nurses are to look at individuals as a whole, not divided into parts. Human beings are one with the environment, and this environ-ment affects recovery from illness or injury. Life processes include the energy field, openness, pattern, and pan-dimensionality. *Dorothea Orem - Self-care Deficit Nursing Theory* This theory describes nursing as helping the patients to help themselves. This means that the nurse educates and assists the patient to find the resources and abilities to achieve the desired positive outcomes and only intervenes when the patient is wholly or partly dependent because of his or her diagnosis and/or treatment. *Madeleine Leininger - Transcultural Nursing Theory* Maximizing the art of humanistic and cultural sensitivity, that is, being totally aware of and sensitive to patient needs. This theory focuses on the unique characteristics of the individual and not so much on the disease processes and encompasses culture care preservation, culture care accommodation, and culture care repatterning.

Describe the major GOALS of nursing and give at least 2 examples of each.

*Health promotion* is teaching, encouraging, and motivating patients to engage in healthy lifestyle practices. *Health maintenance* is nursing that is focused on minimizing negative potential consequences—that is, preventing complications and/or anticipating adverse effects. *Health restoration*, on the other hand, usually refers to nursing of individuals who have experienced an acute illness or injury that is amenable to medical or surgical treatment interventions; that is these patients will get better with help.

Informatics and Documentation:

*Informatics:* System of communication that uses a full range of media including electronic formats to retrieve, analyze, organize and communicate data. In today's health care delivery, communication and documentation are paramount to positive patient out-comes. The EMR and accurate and efficient informatics have greatly improved health care delivery and serve health care professions well in critical areas ethically and legally. *Documentation:* Documentation is another frequent area of concern for nursing liability. As a time-saving and efficient method of documentation, most hospitals have checklist forms for patient assessment criteria as well as for medication administration and routine procedures such as blood glucose testing and/or vital signs. This is known as "charting by exception," because the nurse is checking off assessment criteria as normal unless otherwise indicated. This is indeed time saving and efficient but should never be used instead of a detailed narrative of any unusual findings or adverse occurrences. One of the best means of minimizing the risk of being sued is timely, accurate and complete documentation. Documentation is evidence of care, evidence of quality of care and evidence that the care was necessary or ordered. Documentation must be legible, timely, accurate and complete.

Compare and contrast Medicare and Medicaid related to eligibility, premiums and coverage.

*Medicare:* for those over the age of 65 if they have worked in U.S and have contributed to fund and those with end stage renal disease and/or disability - Part A (no premium but requires co-pay) >>> Hospital care - Part B (requires premium + co-pay) >>> Physicians office visits, diagnostic tests - Part C (combination of A, B, D (requires premium + co-pay) ) - Part D (Pharmaceuticals) *Medicaid:* for those considered at or below the poverty level - No premium - Covers: all medical expenses except vision, dental, as well as pharmaceuticals - Pregnant females and children under 5 covered ABOVE poverty level *Medicare Part A* is free to eligible individuals and covers all essential costs for care in a hospital or skilled nursing facility (first 20 days), and for end-of-life hospice care. *Medicare Part B* is available to individuals receiving Part A but requires a monthly premium and a deductible and only covers 80% of expenses. To cover these deductibles and co-pay, many adults on Medicare opt to purchase a supplemental private insurance plan or to enroll in a Medicare Part C Advantage Plan as described below: *Medicare Part C* (often referred to as an Advantage Plan) is essentially a supplement to Parts A, B, and D and provides additional coverage for dental, vision and hearing services. By having everything under one plan, individuals only pay one premium to one collector, and this is perceived to be less complicated and more desirable to many consumers. *Medicare Part D* covers prescription medications but requires a premium and a deductible (some of which may be covered by a private insurance supplemental plan or by Part C) and has some restrictions. Medications on a formulary (pre-established list) are covered at minimal costs, but many medications that are frequently prescribed for chronic conditions that affect older adults are not covered at this reduced rate. *Medicaid* is a national health insurance for the poor (those at or below the established poverty level) but is managed and disbursed at the State level. The eligibility of pregnant females and children under the age of 5 is set above the poverty level to assure that these individuals have maximal opportunities for health care. Medicaid does not require a premium unless recipients choose to add options for vision and dental coverage.

Describe observation, palpation, percussion, auscultation.

*Observation:* Observation is simply noting that which is seen. This might be facial grimacing by the patient, perspiration, awkward positioning or posture, hesitancy in speaking, inability or discomfort (obvious looking away) in maintaining eye contact either with health care providers or with family members, swelling, redness, discoloration, bruising (ecchymosis), eruptions on the skin, shivering, restlessness, listlessness, or asymmetry. Observation also includes awareness of the patient's immediate surroundings. Respirations may be assessed by observation (watching and counting the rise and fall of the chest) *Palpation:* Palpation is feeling or touching. By touching the patient, the nurse can determine arterial pulsations, swelling or enlargement of organs, areas sensitive to pain, and muscle strength. Pulses should be palpated bilaterally, that is, simultaneously on both sides of the body. Heart rate can usually be assessed by palpation (feeling the pulsations with the forefingers at the radial or femoral artery). *Percussion:* Percussion is "thumping," as if striking a drum. This technique is performed by placing the middle finger of one hand over an area and striking that finger with the tip of the middle finger of the other hand. This thumping is usually done to determine if the swelling is related to tissue or fluid. When the thumping results in a dull thud, this usually indicates that the percussion is occurring over solid tissue such as organ or bone. When the thumping results in a tympanny or resonance, this usually indicates the presence of fluid. *Auscultation:* Auscultation is listening, usually with a stethoscope. Nurses are expected to listen to the sounds of the heart, lungs, and abdomen. Through the stethoscope, the nurse can determine the rate, regularity, and strength of the flow of blood through the heart. Heart rate can usually be assessed by palpation (feeling the pulsations with the forefingers at the radial or femoral artery) or auscultation, but blood pressure can only be assessed by auscultation.

Describe why six types of skill are required in the nursing profession.

*Physical Skills:* Nursing can sometimes be very physically demanding. Nurses are often on their feet for long hours. Nurses also need to be somewhat flexible in bending and stooping to accommodate patient interactions. *Cognitive Skills:* To respond appropriately to patient needs, nurses must have extensive knowledge in the fields of anatomy and physiology, microbiology, chemistry, nutrition, pathophysiology, pharmacology, and growth and development; they must also learn to be competent in nursing skills and procedures. *Emotional Intelligence Skills:* Nurses bear witness to and are involved in intensely emotional situations in the workplace and in clin-ical settings, and these situations may evoke feelings of sadness, anger, and frustration. Nurses must be skilled at perceiving the emotions within them and around them, use emotions to facilitate thinking and problem-solving, develop their understanding of emotions, and manage their own and others' emotions. *Technical Skills:* A major expectation in most nursing schools is for students to learn how to per-form certain procedures. These include taking vital signs, starting intravenous therapies, administering medications by various routes, catheterizations, suctioning, tube feedings, wound care, and ambulation techniques. Although most nursing students think this is what nursing is all about, it is really a very small component. *Interpersonal Skills:* Nurses learn that use of self is probably the most effective procedure that can be offered to patients. This is therapeutic, purposeful, respect-ful, clarifying communication. Nurses have a distinct opportunity to in-teract with others, and they have an obligation to positively impact those in their care. In the profession of nursing, it is necessary to maximize the effectiveness of communication in order to accomplish patient-centered outcomes. *Cultural Sensitivity Skills:* Nurses treat individuals of many different races, creeds, ability levels, and personalities. In order to meet the needs of each individual, nurses must be culturally sensitive, that is, respectful at all times to the unique pref-erences of each patient.

Differentiate Primary, Secondary, & Tertiary Care from Primary, Secondary, & Tertiary Prevention.

*Primary care* refers to a first encounter with health care. Primary care would typically be sought in an outpatient physician's office or clinic. This is known as ambulatory care, that is, one can walk in and out to receive care. Primary care is also sought in a workplace clinic (industrial nursing) and in a school's nurse's office. This is considered entry-level care. The patient may be experiencing symptoms of disease or injury, but these are usually not life threatening. Primary care practitioners seek to address the problem before it escalates to a more serious situation. Many people, unfortunately, also use the emergency departments at local hospitals to address non-life-threatening problems as well. This occurrence continues to plague the health care system because this practice detracts from caring for those with true emergencies. Thus, even though this is sometimes an entry-level site, it is not considered primary care. *Secondary* care refers to a higher level of care that is required be-cause the primary care physician cannot successfully treat the problem on an outpatient basis. Secondary health care usually refers to in-house patients with acute (serious) or chronic problems that need medicinal or surgical interventions. This care is ordinarily given in a hospital or similar acute care setting. Very often, these conditions are life threatening or at least critical. When patients with chronic disease experience a re-surfacing of symptoms with intensity, or experience a stage of non-control, they may also require hospitalization. If the situation requires hospitalization, it is considered secondary care. This is also considered life threatening because the condition is out of control. Because of the currently enforced shorter hospital stays, home health services are often now called upon to continue acute care interventions after discharge, and thus home health is also sometimes considered to be a secondary health care venue. Home health is also engaged in tertiary care situations. *Tertiary care* refers to caring for patients with non-acute con-ditions who need assistance in carrying out activities of daily living. One form of tertiary care is delivered in a skilled nursing facility. In these facilities, care related to oxygenation, transfer, feeding, and elimination is provided for individuals who are unable to do this for themselves. For example, individuals recovering from surgery may need additional aid in mobility or function and are often sent to rehabilitation centers until they are sufficiently healed and strength-ened to care for themselves. This is considered tertiary care. Hospice care is also considered tertiary care because patients with terminal illness choose not to receive further aggressive treatment for their disease. This option for palliative care, which keeps the patient comfortable and pain-free, is usually implemented in the patient's home.

Primary/Secondary/Tertiary Prevention:

*Primary prevention:* Health promotion and prevention strategies to keep healthy people healthy *Secondary prevention:* Early detection (screening and diagnosing) and treatment for those at risk for developing disease or disability. *Tertiary prevention:* Care focusing on quality life functioning (facilitating what individuals can do despite limitations) and on preventing complications from existing disease or disability

Qualitative vs. Quantitative definitions:

*Quantitative* - Data gathered with testing instruments - Data is represented numerically for statistical analyses - Experimental, quasi-experimental, descriptive, correlational *Qualitative* - Data gathered through observations and interviews - Finding meaning in behavior - Historical, phenomenology, ethnographic, case studies, grounded theory, action research

Reliability vs. Validity:

*Reliability*, related to screening, simply means that the same results would be found if another individual conducted the test using similar instrumentation. Reliability refers to repeatability. *Validity* refers to how accurate the screening test is. The screening should have high sensitivity in detecting those who truly need further evaluation (true positives) as well as high specificity in excluding those who do not have a need for further follow-up (true negatives).

Cultural sensitivity skills and definitions:

*Skills:* - Awareness of uniqueness of self and each individual - Awareness of cultural variations - Avoiding stereotyping especially related to pain *Definitions:* - Ethnocentrism - Stereotyping - Bias - Prejudice - Cultural Blindness - Cultural Imposition

Differentiate Subjective data from Objective data as related to the Assessment component of the nursing process and give one example of each.

*Subjective data* are data obtained directly from the patient by taking a patient history, which consists of asking the patient multiple questions. Some of these questions might include: Where does it hurt? When did it start? What have you done to make it better? Does anything seem to make it worse? Has this ever occurred before? *Objective data* are obtained by six major means: chart (EHR) review, consultation with the physician and other nurses and health care providers, observation, palpation, percussion, and auscultation. These sources are described next.

Nursing Body of Knowledge components:

- Anatomy and Physiology - Pharmacotherapeutics - Science - Nutrition - Growth and Development

Legal and Ethical rights of participants in research:

- Before implementing any type of human research, nurses must be fully cognizant of patient legal and ethical rights - Patients always have the right to be fully informed about what is being done (with the exception of required experimental research randomization) - Patients must have the cognitive ability to fully comprehend what is going to be done and then have the autonomy to choose to participate or not - Participation in research must be voluntary - Patients should never fear that their non-participation might jeopardize the quality of their care - Patients always have the right to be protected from harm; no study should ever increase a health care risk for anyone - Patients always have the right to confidentiality, to have their privacy, identify, and health care information protected from public knowledge

Nursing Diagnosis/parts/NANDA I:

- Data obtained during assessment from all sources (physical assessment, verbal statements made by the patient, and/or observed behaviors) are then sorted and regrouped according to priority needs. - These priority needs are then specified according to an identifiable classification base developed by NANDA International, Inc. (NANDA-I). Before 2002, "NANDA" was an acronym that referred to the North American Nursing Diagnosis Association. - It is now officially known as NANDA-I (Herman et al., 2021). This organization is comprised of nurses from across the globe who are members of NANDA-I and who regularly meet and update the official NANDA-I list of nursing diagnoses. This list is updated periodically to reflect the latest evidence in an effort to promote patient safety through the implementation of evidence-based care. - The mission of this organization is to "facilitate the development, refinement, dissemination and use of standardized nursing diagnostic terminology." (Herdman et al., 2021). The current NANDA-I list contains 267 nursing diagnoses organized into 13 health domains. - Please recall that nurses do not diagnose medical conditions, but nurses do diagnose patient responses to illness and/or diagnosis. The American Nurses Association (ANA) has described nursing as the "diagnosis and treatment of human responses to actual or potential health problems." The key word here is responses. - Each individual responds to a medical diagnosis in his or her own unique way, and this response is a multifaceted combination of physiological, sociological, psychological, economical, cultural, and familial factors. The ANA also states that health problems are either actual or potential. - Though nursing priorities must be focused on the actual problems, nurses should be forever mindful of what may follow, whether it may be a potential physiologic complication or a potential psychosocial crisis. If nurses are supposed to diagnose and treat these various types of responses, then nurses need to be knowledgeable and experienced in all of these areas. - The NANDA-I (2021) list of nursing diagnoses is what you will use when developing nursing care plans for your patients. This list, while not exhaustive, addresses the most common human responses to illness and injury. - This list also includes wellness or health promotion diagnoses. These diagnoses relate to patients improving an aspect of their personal wellness. In addition, the NANDA International list of diagnoses standardizes the vocabulary used to describe these responses so that all nurses are speaking the same language.

Nursing Theorists:

- Florence Nightingale: Environmental Theory-Assessment and alteration of environmental impact on healing: fresh air and cleanliness - Virginia Henderson - Nursing Need Theory - 14 individualistic and holistic human needs - Martha Rogers - the Science of Unitary Human Beings-Dynamism: nursing and health as energy forces undergoing constant change - Callista Roy - Adaptation Model of Nursing - Dorothea Orem - Self-Care Deficit Nursing Theory - Madeleine Leininger - the Transcultural Nursing Theory -Cultural Sensitivity - Jean Watson - Nursing Theory of Caring

Patient Protection and Affordability Act (2010):

- Mandated enrollment: no gaps but fines imposed for refusal (this mandate no longer applicable related to Tax Reform Law 2017) - Eliminating cancellation and caps on lifetime coverage - Disallowing refusal of coverage for those with preexisting conditions - Expanding age coverage for young adults previously dropped from parent policies - Establishing standardized minimum coverage required by all insurance policies - Restricting insurance companies from indiscriminately raising premium rates - Providing for preventive and wellness services - Minimizing fraud in practitioner billing

Elements of research (problem, hypothesis, review of literature, etc.)

- Provide a clear statement of the *research problem* - Define a research question(s) >>> Identify the target population >>> Provide background or rationale for research >>> Identify and describe variables of the study - Generate a *hypothesis* or hypotheses - Provide a clear description of the *purpose of the study* - *Review of literature:* Discuss the existing literature related to the topic - Identify a *conceptual framework* or underlying theory that will guide the study - Describe the selected *research design* - Describe the *methods* to be used >>> Describe the sample of study participants >>> Discuss quantitative or qualitative methods of examining collected data >>> Discuss protection of human subjects >>> Describe the testing instruments >>> Describe how data will be collected - Results and Analysis: >>> Discuss the results (findings) of the analyses performed to examine the data - Discussion: >>> Interpret the findings - Strengths and Limitation: >>> Discuss the strengths and limitations of the study - Recommendations and/or implications for practice: >>> Discuss what the findings contribute to clinical practice Conclusion: >>> Provide a brief summary of the study and significant findings

Characteristics of a profession:

- Unique Body of Knowledge - Autonomy - Service oriented practice - Research (evidence basis of practice) - Organization - Standards of Practice - Code of Ethics

What is Healthy People 2020? Identify the main overall objectives.

1. Attain high-quality longer lives free of preventable disease, disability, injury and premature death. 2. Achieve health equity, eliminate disparities, and improve the health of all groups. 3. Create social and physical environments that promote good health for all. 4. Promote quality of life, healthy development, and healthy behaviors across all life stages.

Describe the 6 major techniques that are used in gathering Objective assessment data.

1. Chart (EHR) review 2. Consultation with the physician and other nurses and health care providers 3. Observation 4. Palpation 5. Percussion 6. Auscultation

What is a DRG? How do DRGs impact health care costs and quality?

A DRG is a Diagnostic Related Group. - Diagnostics, pharmaceuticals, specialists, increase in older adult population - DRGs regulate how much an insurance will pay for hospitalization and medical treatment or surgery as well as how long an individual stays in a hospital to accomplish treatment Hospital stays are now shorter than ever before. This is as result of insurance companies' DRGs. Insurance companies now operate from a perspective that all individuals with similar diagnoses should require and receive standardized packages of care. This system of DRGs regulates not only how much they will pay for hospitalization and medical treatment or surgery, but for specifying the number of days during which an individual should be able to accomplish this, that is, how many days one can stay in a hospital. There is minimal individuation of care under this perspective. Even though exceptions are sometimes granted upon request, this is not encouraged. Physicians and nurses agree that this is a very restrictive and limiting basis for providing quality care. In addition, there is persistent lobbying by physicians and hospitals to increase these specified DRG limits.

Accountability:

Accountability means to be answerable to oneself and others for one's own actions. Being accountable means speaking up and speaking out about issues that really threaten the core ethical values of our profession.

Describe the three major types of nursing interventions and give at least one example of each type.

Assessment criteria Nursing actions Patient teaching

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Compare and contrast nursing independent actions from dependent actions.

Dependent nursing actions include those responsibilities that have been ordered or authorized by the attending physician. These include catheterizations, suctioning, and medication administration protocols. Independent nursing actions are those that the nurse could do and should do without being told or ordered. These include patient monitoring (assessment), securing a safe patient environment (lighting, clear path, ambulation aids, venti-lation, etc.), positioning (proper body alignment, elevation of head or feet), nutritional assistance, comfort measures, therapeutic communication, teaching, and advocacy.

Explain what is meant by the phrase: "If it wasn't documented, it wasn't done," and explain how this impacts on the legal and ethical practice of nursing.

Documentation is the final component of the nursing process. A common phrase taught in most nursing schools is: "If it wasn't documented, it wasn't done." Nurses should always remember that their documentation is a key piece of information that the nurse on the next shift may need to know in order to provide the proper care for the patient. The doctor also needs to know exactly what is happening with the patient. Without documentation, many critical points could be overlooked. Besides, there is the legal aspect. When nurses do not document what they have done, they leave themselves vulnerable to legal action for negligence or failure to perform their duty. Documentation is covered in greater detail in Chapter 5: The Ethical and Legal Basis of Nursing Practice.

What were the Elizabethan Poor Laws? Describe how the carryover of these laws has impacted Health Care delivery in the U.S.

Elizabethan Poor Laws allowed access to health care for the very poor and for those who could not work due to illness or disability. These laws helped the poor with other commodities and opportunities as well. It was assumed that healthy people could sustain themselves, but for those who could not work due to illness or injury, there must be some form of compensation. These laws were not in place in early America, but became necessary as the country grew and the poor and needy emerged. The Elizabethan Poor Laws are the basis for many of our welfare programs in existence today. In addition, the health-related impact of modern day wars cannot go unnoticed. Agent Orange, a toxic bio-chemical used in the Vietnam War, has resulted in life long chronic conditions (such as diabetes and cancer) for many U.S. veterans. And Post-Traumatic Stress Disorder (PTSD) from the effects of war is highly associated with an excessive number of depressive disorders and suicides.

Name 3 notable nurses and describe the contribution that they made to health and health care delivery.

Florence Nightingale, a British nurse, considered the founder of the nursing profession, served during the Crimean War. It was through her efforts that it was recognized that the environment in which health care is delivered is equally as important as wound care and medicine. She recognized that fresh air, clean sheets, and personal attention greatly facilitated healing as well as morale. Through her efforts, mortality was dramatically decreased among the injured soldiers. Clara Barton, also a war nurse (American Civil War), founded the American Red Cross, and Dorothea Dix, known for her advocacy for the mentally ill, was superintendent of the Army Nurse Corps during the Civil War. Meanwhile, Harriet Tubman, also a civil war nurse, became famous for her abolitionist services involving the underground railroad (a lifeline for slaves to escape to freedom). Lillian Wald is best known for her nursing role during the Industrial Revolution. The overwhelming num-ber of people succumbing to disease and death during the Industrial Revolution demanded intervention. Lillian Wald was the first to serve as a public health nurse in the Henry Street Settlement House in New York City. Through her efforts of health promotion and disease prevention, morbidity was greatly decreased.

The Patient Self-Determination Act:

Guarantees that patients have the right to advance directives, to informed consent and to refuse treatment.

Which health practice is most universally identified throughout history as a deterrent to disease? Why is this?

Hand washing is the #1 known deterrent to the spread of disease.

Define homeostasis and describe how it relates to health.

Homeostasis, the process by which living things maintain a physiological balance through consistent internal regulation, such as body temperature, was first described by physiologist Walter Cannon in 1925. The term homeostasis was derived from the Greek words homeo, meaning "similar" and stasis, meaning "standing still". The idea that a living organism self-regulates to maintain equilibrium despite external conditions in order to survive was introduced by French physiologist Claude Bernard in 1878. He called this the "milieu interieur" (Cooper, 2008; Kontopoulou & Marketos, 2002). The Greek pre-Socratic philosopher Empedocles proposed the theory of the four elements. These elements are: air (clean air for healthy respirations), water (healthy water to drink, bathe and cook), fire (healthy body temperature and control of internal inflammation), and earth (consuming healthy products from the soil). He proposed these elements are foundational to all structures of the world. The interaction of the elements fuel life and call for balance. The idea of balance in mind and body has also evolved from Asian cultures. The framework of yin and yang has served as the basis for multiple meditative practices that are now recognized as assets to total health. Yin and yang, in Chinese philosophy, are opposing forces that are actually interrelated and complementary but must be kept in balance. They are dualities, like fire and water, male and female, light and dark, that must co-exist and be kept in balance. Practices such as Taoism, yoga, tai chi, and feng shui are all examples of how these dual forces are sustained in balance.

Identify and describe the five stages of illness behavior as explained by Suchman.

In *stage 1*, an individual experiences symp-toms and labels him or herself as sick related to an awareness of a symptom: fever, rash, cough, sore throat, and so forth. The individual usually seeks validation from someone else about this self-diagnosis and symptom-atology and then, in *stage 2*, assumes a sick role. In this role, the individual may attempt self-treatment by purchasing an over-the-counter remedy, or seek advice from family members or esteemed elders. If this does not help to alleviate the problem, the individual will probably then enter *stage 3*, assuming a dependent role. In this stage, the individual turns over his or her claim to be able to handle the situation to a medical physician for professional diagnosis and treatment. In *stage 4*, the individual follows the treatment protocol recommended by the professional. And in *stage 5*, the individual regains control of his or her health status in experiencing recovery and rehabilitation and then resumes normal everyday activities.

Differentiate an HMO from a PPO system in terms of how services are provided and how the health care providers are paid.

In an *HMO* system, primary care physicians receive a pre-set amount of money for each patient enrolled. The emphasis on this type of coverage is to keep patients healthy because if the patient becomes ill, there are no further reimbursable funds available. The primary care physicians are the gatekeepers of patient referrals and diagnostic tests, that is, all health-related services are coordinated through the primary care physician. Unfortunately, there are very few HMO systems today. In a *PPO* system, insured individuals may access any physician on the preferred list. This includes primary care physicians as well as specialists. The physicians on this preferred list have agreed to accept reimbursement for services based on pre-established fees for designated services (DRGs) as set by the insurance company. Most insurance systems today are PPOs.

Explain the difference between correlation and cause-and-effect as related to research.

In correlation studies, the relationship between the numerical values assigned to two variables can be compared to see if they both increase or decrease in the same direction. A positive correlation occurs when the value of one variable tends to increase as the value of the other variable increases, or when there is a decrease as the other value of another variable decreases (moving in the same direction). A negative correlation occurs when the value of one variable increases as the other decreases, also known as an inverse correlation (mov-ing in opposite directions). For example, a positive correlation would be demonstrated if student test scores increased with every numerical unit of increase in student motivation scores. A negative correlation would be observed if student test scores increased with every numerical unit of decrease in the number of hours spent studying.

What are the three essential components of informed consent?

Informed consent requires complete information, full comprehension, and voluntary approval.

Describe how Maslow's Hierarchy of Needs relates to the prioritization of nursing diagnoses.

Maslow's hierarchy of needs is also used to determine priority diagnoses for patients. In accordance with Maslow's hierarchy of needs, the physiological needs of airway, breathing and circulation should always be the first priorities. The nurse should also recognize that nutrition, hydration, and elimination are essential components of existence, and anything that interferes with these processes should be given preference. When these life-sustaining needs are being met, then the nurse focuses on the patient needs of safety and security. This may include assuring that the patient is mobile enough or cognitive enough to stand, walk, and/or use the bathroom without assistance. The nurse should also be alert to safety concerns related to obstacles in the patient's path; accessibility to mobility assistive devices such as canes, walkers, wheel chairs, and so forth; whether or not bed rails are restrictive or assistive; and whether electrical equipment is plugged in and functional. In addition, the nurse should recognize that patients feel much more secure when the telephone, TV remote, call bell, and water are within comfortable reach.

Describe what is meant by the Nursing Profession having 'autonomy' and give an example of how this is demonstrated.

Nurses have set their own standards of care and practice, but this does not mean that the nursing profession acts independently of other professions; it just means that we all have our own unique, defined roles.

Describe what is meant by respecting a patient's autonomy. Give an example.

Nurses must also respect the patient's autonomy (freedom to choose or not to choose) in making health care decisions. This is often difficult for nurses who know from previous experience that there will most likely be some ill effects as a result of poor choices. good example of patient autonomy is when nurses must obtain a signed informed consent form from patients. This is a permission by the patient to have a procedure done, such as surgery. After a physician explains a procedure, a patient must sign a consent if they agree to having the procedure.

Differentiate beneficence from maleficence.

Nurses must always act with beneficence—that is, they must always act in a way that benefits the patient. Nurses are required to make critical clinical decisions that are evidence-based to promote positive patient outcomes and that carry minimal risk to those in their care. Maleficence: the act of committing harm or evil. Non-maleficence: Avoiding doing harm to others. *Advocate:* An individual who conscientiously addresses issues that are of concern for other persons or principles of action. The nurse, as *advocate*, has an obligation to speak up for the patient, but may find that the end result sometimes backfires to the point that there is rejection and isolation by co-workers, or a recommendation is made for the nurse to seek employment elsewhere. This may cause some legitimate concern for the nurse. *Fidelity:* Staying true to one's commitment. This is where the nurse must also practice fidelity by continuing a caring response no matter what the circumstances are. Fidelity is loyalty to one's duty; it is accountability. *Justice:* Nurses must also practice justice in treating all patients fairly, that is, with the same amount of care and expertise. This does not necessarily mean that nurses don't have to make priority choices in tending to those with the most imminent needs. It just means that there should not be bias or prejudicial treatment for patients under a nurse's care. For example, there is a natural tendency to want to help someone who is pleasant and non-complaining, but it is difficult sometimes to offer that same type of assistance to someone who is constantly complaining. It is interesting to note that nurses who make routine hourly rounds to check in on their patients receive less complaints and less demands from their patients. *Autonomy:* Nurses must also respect the patient's autonomy (freedom to choose or not to choose) in making health care decisions. This is often difficult for nurses who know from previous experience that there will most likely be some ill effects as a result of poor choices. good example of patient autonomy is when nurses must obtain a signed informed consent form from patients. This is a permission by the patient to have a procedure done, such as surgery. After a physician explains a procedure, a patient must sign a consent if they agree to having the procedure.

Discuss the nurse scope of practice.

Nurses must always carry out their duties within their scope of practice. This means that the nurse delivers care that they have been deemed competent to perform and are permitted to undertake according to the terms of their nursing licensure. Competence refers to the nurse's ability to acquire relevant knowledge, develop psychomotor skills, and apply this knowledge and these skills appropriately in a given context.

Describe what is meant by cultural sensitivity. How is this best accomplished in a nurse patient relationship?

Nurses treat individuals of many different races, creeds, ability levels, and personalities. In order to meet the needs of each individual, nurses must be culturally sensitive, that is, respectful at all times to the unique preferences of each patient. It is extremely helpful if the nurse is multilingual and can speak and understand the language of all patients, but that is usually not possible, nor is it always necessary. What is necessary is to make every effort to learn what is important to the patient and strive to meet that need.

Explain what it means that goals should be measurable.

Once the diagnoses are prioritized, the nurse then needs to establish patient-centered goals. This is the planning stage of the nursing process. Goals should be identified as outcomes that can be objectively measured and should also include a realistic time frame. A measurable goal is one that identi-fies the criteria that evidences progress. For example: "Patient will take 10−20 steps with the assistance of the physical therapist by the end of the day." This is very specific and can very objectively be evaluated as the patient either did meet this goal or not. This goal being partially met would be described as "took 5 steps within the room with the assistance of the physical therapist." An incorrectly stated patient goal, such as "Patient will increase ambulation," is not measurable and therefore is too vague to evaluate. The plan of care should also include "patient-centered" goals, that is, goals considered to be a priority to the patient. The goals that are established by nurses for patient outcomes may or may not always be compatible with what the patient is feeling or wanting. For this reason, nursing care plans should address goals that are established with the patient in addition to establishing goals for the patient whenever possible. Maintaining patient autonomy is essential to achieving positive outcomes.

Identify at least three other laws in the U.S. that protect an individual's health and health information.

Patients are also protected by the Health Insurance Portability and Accountability Act (HIPAA). Initially this law was enacted to protect individuals who were transferring insurance from one company to another. This act protected them from being denied insurance with a new employer if they acquired a disease or condition during the initial employment. This Act also protected the patient from having conditions or diagnoses disclosed to anyone not needing to know. This act now is more commonly associated with safeguarding patient health information confidentiality. Under this law, it is illegal and unethical to discuss a patient's diagnosis or status with anyone who does not have a right or need to know. This relates to documents as well as discussions.

Explain why it is important for patients to have a primary care physician even if they are seeing multiple specialist physicians.

Primary care practitioners seek to address the problem before it escalates to a more serious situation. Many people, unfortunately, also use the emergency departments at local hospitals to address non-life-threatening problems as well. This occurrence continues to plague the health care system because this practice detracts from caring for those with true emergencies. Thus, even though this is sometimes an entry-level site, it is not considered primary care. Primary care can help reduce the need for secondary or tertiary care.

Briefly describe the major components required of a profession and describe how Nursing, as a profession, meets these criteria.

Professions must first and foremost have a unique body of knowledge that is the basis for practice. Nursing encompasses the sciences of biology and chemistry, the humanities of psychology and sociology, and a specialized set of skills. Professions must also have autonomy. This means that the members have an internal authority to establish their own standards of practice and standards of care. Nurses have set their own standards of care and practice, but this does not mean that the nursing profession acts independently of other professions; it just means that we all have our own unique, defined roles. Professions must also involve a service-oriented practice. This means that the knowledge is not just theorized, it is implemented to serve others, that is, to help humankind. Nursing knowledge would not benefit the patient until/unless put into practice. Professions must also be actively engaged in research to better define the theory of nursing practice and to better offer evidence of effective nursing practice. Although nurses with PhDs generate research, all nurses are responsible for being able to understand, critique, and utilize findings in clinical practice. Professions must have a code of ethics. As explained earlier, professional nurses are held to a standard of care that mandates quality care for the betterment of patients. Anything less would make nursing non-ethical. Professions must also have an organization in which members can voice concerns and vote on practices and policies. It is through organizations that members can promote causes for concern to the public. In nursing, the professional organization is the American Nurses Association (ANA).

Explain the difference between basic and applied quantitative research.

Research can be characterized based on its purpose or the extent of the usefulness of its findings. Basic research is theoretical whereas applied research is intended to directly influence and/or improve professional practice. Basic research involves acquiring new knowledge for the sake of learning more about a topic. An example of this would be researchers learning how brain cells function. Applied research is concerned with solving problems and testing theories that guide clinical practice. An example of this would be researchers exploring whether applying one type of wound dressing to a stage IV pressure ulcer promotes healing faster than another type of wound dressing. It is applied research that nurses in the clinical setting will be using routinely.

Compare and contrast Smith's Model of Health with Travis' Model of Health.

Smith (1983) describes health perspectives from four vantage points: *Clinical model:* clients present with no apparent illness and/or disease (no signs and symptoms). *Role performance model:* clients may have signs and symptoms or even disease, but can perform all roles considered essential in life. *Adaptive model:* clients are able to accept and/or adapt to changes necessary to deal with health issues. *Eudamonistic model:* clients present an exuberant sense of well-being. Travis (2004) describes health as a forward-moving continuum toward high-level wellness, or being on a two-way path: one moving toward wellness and the other toward disability and death. In the latter model, the absence of signs and symptoms of disease is the dividing line between illness and wellness. According to Travis, individuals in the treatment model put their energies into eliminating signs and symptoms, so they do not become ill or have a disability and eventually suffer premature death. On the other hand, those who adhere to the wellness model value their good health, increase their awareness through education, continue to sustain health, and eventually achieve a high level of wellness. In this model, individuals heading in the direction of premature death will experience illness and disability along the way, while those in good health and with increased awareness and education will aspire for high-level wellness. The arrow going completely across this continuum depicts that we are all capable of high-level well-ness because signs and symptoms of illness and disability can be overcome to achieve this level of wellness.

Differentiate and give an example of each of the following: utilitarian, deontological and principle based ethics.

Some individuals believe that something is either right or wrong based on the usefulness or purpose or outcome that ensues. Recent rulings by the Supreme Court are examples of utilitarian ethics. *Utilitarianism* poses that the most ethical choices are the ones that will result in the greatest good for the greatest number. Granting individuals the right to receive subsidies and tax breaks for Obama Care insurance was for the purpose of keeping more individuals insured. Similarly, the ruling for the right for same-sex marriage serves to value the ability of individuals who are part of the LGBTQ+ community to have the rights of inheritance, power of attorney, joint credit cards and banking accounts, and for health related information disclosures historically afforded to heterosexual couples. In both situations, there was a use for making these rulings. A negative example of this might be a young child wanting to please his or her mother who picks and presents to her a neighbor's prize rose. In this situation, even though the intentions were good, it would be considered wrong based on utilitarian principles because a prize rose was destroyed. Others believe that there is an inherent god-like (or devil-like) quality in all human action—that is, it either is or isn't right or wrong based on the act itself. This is referred to as deontological ethics. *Deontology* calls for people to follow the rules regardless of any consequences of doing so. A classic example of deontological ethics would be the ten commandments which dictate that persons should not lie, steal or kill and should respect the integrity and possessions of others. Those who adhere to deontological ethics would be against war, euthanasia, abortion, and the death penalty under any circumstance. Nursing involves more *principle-based ethics*, ethics based on certain principles valued by the majority of people. These are the same self-evident truths that our country was founded upon. Some of these basic principles include autonomy, confidentiality and privacy, self-respect, honesty, fairness, and self-preservation.

Differentiate the educational preparation requirements for nurses at the ADN and BSN levels.

Students who attend nursing classes in a 2-year college (usually a community college) will earn an As-sociate Degree in Nursing (ADN). Students in ADN programs master the same skills as required of those in a Bachelor of Science in Nursing (BSN) program, but without taking extended courses in the sciences and the humanities as well as extended nursing courses. It is these extended courses that offer BSN nurses a broader perspective of patient care, and these are the courses that must be completed to earn the BSN degree. Specifically, a BSN curriculum offers the added dimensions of leadership, research, and community health. These courses, in turn, give nurses the opportunity to advance their education even further.

Explain what a Nurse Practice Act is. Explain why it is so important to nurses and why it is so important to health care consumers.

The Board of Nursing (BON) for each of the United States issues a Nurse Practice Act that defines these standards and practice guidelines. This assures the public (patients and their families and the general public) that those who are licensed as nurses are practicing at a level of guaranteed safety to "do no harm."

In the U.S., which Department oversees the health of the nation? And which other Departments/Agencies are accountable to them?

The Department of Health and Human Services (DHHS) oversees all health-related concerns of the general public. The other departments and agencies accountable to them are: - Centers for Disease Control (CDC) - Housing and Urban Development (HUD) - Occupational Safety and Health Administration (OSHA) - Environmental Protection Agency (EPA) - Food and Drug Administration (FDA) - U.S. Department of Agriculture (USDA)

Explain how the Nursing Profession is both an art and a science.

The Nursing Profession is an Art: performing actions with a characteristic style that is unique to the nursing profession. It is the special manner in which care is delivered—a unique, organized, sensitive, knowledgeable response to patient needs. The Nursing Profession is a Science: making decisions based on evidence from the biological, psychological, and chemical sciences and from practice expertise. The nursing process is the scientific method of logical reasoning and is grounded in the sciences of biology, chemistry, anatomy and physiology, microbiology, and pharmacology.

What were the goals of the Social Security Act of 1935?

The Social Security Act of 1935 is a federal intervention law that provided financial, nutritional, and health care relief for persons seriously impacted by World War I, the stock market crash of 1929, and multiple natural disasters. The intent of this law was to provide economic relief to those who had been devastated by these events, and to promote the general welfare by means of establishing a system of Federal old-age pension benefit and benefits for the unemployed. Directives to States to make adequate provisions for older persons, blind persons, dependent and disabled children, and disabled adults, comprised much of this law. Provisions were also included to support maternal and child health, and public health (Social Security Administration, n.d.).

Identify and briefly describe the four major competency areas of Standards of Practice as specified by Boards of Nursing.

The competencies address nursing under four major role performance areas: *1. Member of the Profession* Member of the Profession competencies address the level of commitment required of nurses for self-assessment, life-long learning, and the improvement of the discipline of nursing within state and national regulations and ethical standards. As Members of the Profession, nurses are held to a high standard of professional ethics, a standard that bespeaks the trustworthiness of quality care and honesty. *2. Provider of Patient-Centered Care* Most of the competencies under Provider of Patient-Centered Care relate to the nursing process. The nursing process is nothing more than using a scientific method of inquiry in patient care. It is composed of five major parts: assessment, diagnosis, planning, intervention, and evaluation. The nursing process is a strategy usually made into a nursing care plan and is discussed in greater detail in the next chapter. *3. Patient Safety Advocate* As Patient Safety Advocates, nurses know that the most important ethical and legal concern related to patient care is safety. Safety issues related to medication administration, environmental hazards, and the activities of daily living (eating, toileting, dressing/bathing, and ambulation) should be foremost in all patient care. Furthermore, nurses are required to act within their scope of practice, that is, within the bounds of the level of their education and the amount of experience that they have. This will be discussed further in the chapter on legal and ethical issues. *4. Member of the Health Care Team* The Member of the Health Care Team competencies address the need for nurses to collaborate with physicians, nurses, and staff to coordinate with other interdisciplinary health care providers and to facilitate care for patients and their families. Under "Member of the Health Care Team," the BON competencies address the role of the nurse in collaborating with other health care delivery professionals. This requires organizational, leadership, and management skills to collaborate, negotiate, and delegate appropriately.

Explain why secondary care is the most costly health service provided.

The costs associated with health care are astronomical. The greatest costs are associated with secondary and tertiary locales, that is, in hospital and skilled nursing facilities, whereas the least costs are incurred in primary care locales, that is, physician offices or clinics. The costs for the needed expertise and the extent of equipment and diagnostic tests and monitors make today's hospitalization costs at an all-time high. Skilled nursing facilities and rehabilitation centers are less costly than hospitals but are still unbelievably expensive. Home health is less costly than hospitalization and/or rehabilitation centers, so there is an obvious need to engage these services as soon as the patient is stable enough to be discharged to home. The least cost is associated with primary care locales and with primary prevention strategies. Obviously, it is less expensive to prevent disease than to treat it! Unfortunately, the secondary and tertiary settings are used most frequently. This means that the general population is still in a reactive mode of seeking health care. If and when health care is more universally perceived by consumers as a personal responsibility that requires preventive, healthy lifestyle choices, health care costs may be reduced. In the interim, these costs will most likely continue to spiral to unbelievable highs.

Explain why communication is essential to providing quality nursing care. Describe with whom the nurse needs to communicate and when.

The nurse is legally and ethically responsible for communicating with the doctor and the other nurses on the unit. In most acute care settings, there is a smooth transition between shifts when a change of staff takes over the care of patients. There is a session in which the outgoing nurses report to the incoming nurses about what has transpired during their watch. This communication is a prime opportunity for nurses to share nursing process concerns and to make sure that there is no break in the continuity of quality care for the patients on the unit. The nurse is also responsible for maintaining this same type of ongoing communication with the nurses on duty as well as with all of the other health care providers. This assures that there is coordination of care and that the best interests of the patient are being addressed. This might be with physicians, respiratory therapists, physical therapists, occupational therapists, wound care specialists, nutritionists, and so forth.

Identify two major scientific discoveries that have had a major impact on health and health care delivery.

The scientific influences on health practices have been significant. Louis Pasteur's (1861) germ theory opened up a whole new world of possibilities. Pasteurization, especially of dairy products, is such a common practice today that most of us do not stop to think and value the difference this has made in our lives. Joseph Lister's (1865) introduction of antisepsis and sterilization similarly had a tremendous impact on reducing deaths related to surgical procedures. Anton van Leuwenhoek's (1674) discovery of the use of the microscope to identify microbes gave us the first insight into differentiating causes of disease. This discovery also opened up the entire world of pharmacotherapeutics to create medicinal remedies to counter disease and antimicrobials to counter bacterial infections. Alexander Fleming's (1928) discovery of penicillin greatly affected the treatment and control of infection. With second-and third-generation penicillin and other antimicrobial products, and the addition of sulfonamides and chemotherapeutic agents, the major problem is currently the emergence of antibiotic-resistant bacteria. Because antibiotics have been overused or prescribed when not really needed, bacteria have undergone mutations that repel the effects of many antibiotics. Some of the more common resistant microbes are methicillin-resistant staphylococcus aureus (MRSA) and vancomycin-resistant enterococcus (VRE). Van Leuwenhoek (1674) - use of microscope Jenner (1796) - Vaccines (smallpox) Pasteur (1861) - Germ theory Lister (1865) - Antisepsis Fleming (1928) - Penicillin Salk (1955) - Polio Vaccine

What is the Whistleblower Law?

The whistleblower law protects the nurse from retaliation when substandard practices are exposed. This law, under most Nurse Practice Acts, allows the nurse to call into question the actions of others that potentially put patients at risk. The whistleblower law protects nurses from being fired or blocked from employment just because they exposed the unsafe practice, but as indicated, may not necessarily sustain a comfortable work environment. Nonetheless, nurses are actually required to report these unsafe practices by virtue of being an advocate for the patient. Failing to report unsafe practice could be perceived as negligence, thereby putting the "safe" nurse at risk for liability.

Differentiate a medical diagnosis from a nursing diagnosis.

These questions help the nurse to validate the patient's physiologic status, lifestyle habits, mental status, and ability to comprehend. These questions also help the nurse to understand the priority concerns of the patient. Patients are admitted to hospitals with a medical diagnosis. Though this may facilitate the nurse in zero-ing in on priority healing issues, the nurse needs to recognize that nursing is a response to the patient, not to the disease or diagnosis. This means that the nurse must factor in the psychosocial components of the patient's illness as well as the anatomical or physiological problem.

Explain how the Patient Protection and Affordable Care Act (2010) addresses cost, access and quality of health care.

Though controversial from the outset, President Barack Obama signed the Patient Protection and Affordable Care Act (Obama Care) into law on March 23, 2010. This law was intended to improve the quality of health care by providing preventive services at little or no cost, lifting any pre-existing condition restrictions from coverage, expanding age coverage for young adults, and providing consumer protection from health care delivery restrictions (cancellation, lifetime limitations and out of pocket cost caps) and fraud. The law also promised improved access to health care and lower health care costs including financial assistance to consumers through reduced premiums and/or tax credits. Key to the success of the law, as originally enacted, were three major shifts: 1. Employers were expected to offer health care insurance to their employees. 2. There was to be an increased participation in the State CHIP (Child Health Insurance Program) Program offered primarily through State schools. 3. States were expected to expand Medicaid coverage. Since health insurance coverage for employees would have been a substantial burden for small business owners, the ACA (2010) provided for a tax credit to these smaller companies and non-profit organizations that provided a credit worth up to 25%-35% of the employer's contribution to the employees' health insurance.

Describe what is meant by veracity and explain how this relates to nursing scope of practice.

Veracity does not mean that the nurse is obliged to tell the patient everything that he or she knows, but only that the responses must be truthful and accurate. Nurses must also be aware of their scope of practice, which concerns divulging certain information about the patient's condition. This is the doctor's role. Veracity also requires the nurse to honestly report errors in a timely manner. It is never easy for most of us to admit that we have made a mistake, but in the situation of patient care, this is an obligation.

Which of the following traits are essential to a profession? Choose all that apply. a. Autonomy and orientation to service b. Unique body of formalized education and on-going research c. Organizational policies and standards d. High salaries

a. Autonomy and orientation to service b. Unique body of formalized education and on-going research c. Organizational policies and standards

Which of the following health care practices are considered complementary to Western medical practices in the United States today? Choose all that apply. a. Biofeedback b. Acupressure c. Guided imagery d. Acupuncture

a. Biofeedback c. Guided imagery

Insurance companies would best be described as a system of a. Managed care. b. Care management. c. Primary prevention. d. Primary care.

a. Managed care.

In an applied quantitative study, if there is an increase or improvement in the desired outcome related to one variable, this correlation would be considered: a. Positive b. Negative c. Cause-and-effect d. Non-existent

a. Positive

Which of the following are considered outcome competencies of Standards of Practice under most Nurse Practice Acts? Select ALL that apply. a. Provider of Patient-Centered Care b. Member of the Profession c. Member of the Health Care Team d. Patient Safety Advocate

a. Provider of Patient-Centered Care b. Member of the Profession c. Member of the Health Care Team d. Patient Safety Advocate

Which of the following is false regarding research involving human subjects? a. Subjects must be informed of which option they are receiving (treatment or placebo). b. Subject must voluntarily agree to participate. c. Subjects may freely quit the study if they so desire. d. Harm to subjects must be minimized.

a. Subjects must be informed of which option they are receiving (treatment or placebo).

Which of the following best describes the type of quantitative research conducted to directly influence or improve clinical practice? a. Basic b. Applied c. Experimental d. Descriptive

b. Applied

Which of the following best describes the 'goals' of nursing? a. Hospitals, Rehabilitation Centers, Public Health Clinics b. Health promotion, Health restoration, Health maintenance c. Education, Research, Practice d. Patient autonomy, Patient privacy, Patient rights

b. Health promotion, Health restoration, Health maintenance

Which type of assessment data is obtained when taking vital signs? a. Subjective b. Objective c. Chart review d. Observation

b. Objective

Which of the following health-related policies provides patients with the right to have a power of attorney? a. American with Disabilities Act b. Patient Self-Determination Act c. Health Insurance Portability and Accountability Act d. Equal Opportunity Act

b. Patient Self-Determination Act

Most theories relating to nursing practice address four major components. These include: a. Health, sickness, injury, and wellness. b. Person, health, philosophy of health/nursing, and purpose. c. Standards of practice, standards of care, standards of the profession, and standards of health. d. Health promotion, disease prevention, health maintenance, and health restoration.

b. Person, health, philosophy of health/nursing, and purpose.

Which of the following health care delivery settings is the most costly? a. Primary care b. Secondary care c. Tertiary care d. Hospice care

b. Secondary care

Which of the following prevention modes is targeted to those at risk for disease or injury? a. Primary prevention b. Secondary prevention c. Tertiary prevention d. Palliative prevention

b. Secondary prevention

Which of the following has been a health care practice since very early in history? a. Use of masks and gowns b. Sterilization c. Burial of the dead d. Vaccination

c. Burial of the dead

A researcher is studying the effects of exercise and sleep on blood pressure. What type of variable is the blood pressure in this study? a. Exploratory b. Correlational c. Dependent d. Independent

c. Dependent

Which of the following was enacted to counter the thinking that being poor and/or unable to work was a personal moral failing? a. Shattuck Report b. Sheppard Towner Act c. Elizabethan Poor Laws d. Social Security Act

c. Elizabethan Poor Laws

Which of the following health-related practices has been consistently present throughout history? a. Waste disposal b. Pasteurization c. Hand washing d. Prenatal care

c. Hand washing

A new arena of nursing practice in which nurses retrieve, analyze, organize and communicate data related to patient care in an electronic format is known as... a. Research b. Consultation c. Informatics d. Advocacy

c. Informatics

Which of the following should be given priority when establishing a nursing care plan? a. Patient's main complaint b. Doctor's diagnosis c. Physiologic needs d. Personal/social concerns

c. Physiologic needs

Which of the following best describes palpation? a. Listening b. Thumping c. Touching d. Observing

c. Touching

What information is mandated by HIPAA to be given to patients on admission to a health care facility? a. The type of insurance that is required in order to receive care b. Who will be providing the different types of care c. The different levels of care that are provided d. How health care information will be used

d. How health care information will be used

NANDA International diagnoses identifying actual problems are composed of three parts. These are: a. Medical diagnosis, nursing diagnosis, and treatment plan. b. Assessment, planning, and interventions. c. Health promotion, disease prevention, and health restoration. d. Patient response to condition, diagnosis/prognosis, and symptomatology.

d. Patient response to condition, diagnosis/prognosis, and symptomatology.

What is the Safe Harbor Law?

he safe harbor law, also prevalent in most Nurse Practice Acts, is a protective process for nurses when they are asked to perform tasks or take on assignments that might violate their duty to patients, the NPA, or Board Rules. After invoking safe harbor in good faith, a nurse cannot be suspended, terminated, disciplined or retaliated or discriminated against, reported to the Board of Nursing, or disciplined by the Board for engaging in this conduct, or for refusing to engage in this conduct, while a safe harbor nursing peer review is pending. An example of this might be when there are insufficient personnel to care for an excessive number of patients. Nurses may continue to do what they can in this situation but should file for safe harbor protection, knowing that this is a very dangerous and precarious circumstance.