FNP STUDY Questions

American Nurses Association Code of Ethics

"...developed as a guide for carrying out nursing responsibilities in a manner consistent with quality in nursing care and the ethical obligations of the profession."

Solution focused therapy

"If a miracle were to happen..." This technique is used in what kind of therapy?

Per Applebaum

"The presumption intrinsic to a modern democracy is that the vast majority of persons are capable of making their own decisions." "Hence, only patients with impairment that places them at the very bottom of the performance curve should be considered to be incompetent."

Informed Consent

"Valid informed consent is premised on the disclosure of appropriate information to a competent patient who is permitted to make a voluntary choice."

Social services for what services

$, insurance, place to live, psych,

What are the elements of the concepts "access to care"?

*Client centered model based on the principle that healthcare services should be coordinated and directed by a single provider *Clients connect to services from multiple points of entry *Services can be located in the same facility, or in an integrated network of providers

In terms of treatment, what are the rights of the client?

*Confidentiality *least restrictive treatments *give consents for treatments and withdraw consent at any time

What are the requirements for reporting a conflict of interest?

*Disclose potential COI *Action should be carried out to resolve potential COI's or reduce bias *A COI form indicating any financial or other relationship must be completed prior to any professional presentation

Examples of descriptive statistics

*Mean*: - average of scores *Standard deviation*- indication of the possible deviations of the mean *variance* - how the values are dispersed around the mean the larger the variance, the dispersion of scores

Examples of conflicts of interest

*Relationships with pharmaceutical, medical supplies, or insurance companies *Money, gifts *Referrals *Fee splitting

What are the basics of the client - centered care model (PCC)

*Welcoming environment* *Respect for client's values and expressed needs* (Client preferences, priorities; inform and involve the client/family and decision-making; customize care; promote respectful relationship) *Client empowerment for activation* (Encourage client's role in decision-making and self-management) *Sociocultural competence* (Understand/consider culture; economic/educational status; health literacy level; family patterns by situation; traditions/alternative/folk remedies; communicate at a level the client understands) *Coordination and integration of care* (assess the need for services; teammates care, care management, referrals; advocate; smooth transitions between providers/phases of care) *Comfort and support* (Physical comfort, privacy, emotional supports, involvement of family/friends) *Access and navigation skills* (Minimize waiting times; convenient service hours; promote access; help client attain skills to better navigate the health care system) *Community outreach (Efforts to understand and reach out to the local community)

Describe health policy development

, And plans to achieve specific healthcare goals

Occurrence basis example

- A clinician who has an occurrence basis liability insurance policy in place this year allows the policy to lapse in one year when she is no longer in practice. - Three years from now, a malpractice claim is filed against the NP because of a clinical encounter that occurred while the policy was in place. This claim would fall within the coverage of an occurrence basis policy.

Claims-made policy

- Covers the clinician only if the injury occurs within the policy period, and if the claim is filed during the period the policy is in effect - or when an uninterrupted "tail" insurance policy is in effect.

Utilitarianism

- Defined as allocation of healthcare resources so that the best is done for the greatest number of people. - Rationale-Healthcare is a finite, costly resource that needs to be carefully allocated.

Justice

- Defined as the assertion that all people are to be treated in the same equitable manner regardless of socioeconomic status, ethnicity, sexual orientation, diagnosis or other personal characteristics.

Beneficence

- Defined as the healthcare provider's obligation to help people in need

Occurrence basis

- Policy covers injuries that occur during the period the policy was active, regardless of whether the policy is renewed or continues to be in effect

Additional DEA responsibilities

- Regulates the prescribing and distribution of methadone and buprenorphine - Enforces complaints about manufacturing, abuse, and illegal distribution of controlled substances

nurse practitioner has agreed to participate in the Medicare health insurance program. Medicare paid 80% of the charges billed for a clinic visit. What can be done about the other 20% that is owed?

-Bill or for the remainder -NP is a "participating" provider because he agreed to accept assignments. An assignment is an agreement between Medicare and the NP to accept the Medicare Approved Amount (MAA) as payment in full and not charge Medicare recipients a higher rate. The NP can bill the patient for a percentage of the remaining bill that was not paid by Medicare. The NP may opt out of participating.

Components of Informed Consent • The patient

-Has the capability or capacity to make an informed decision. - Is able to comprehend the information presented. - Can ask questions about the proposed therapeutic procedure, be it a treatment, diagnostic other.

What happens if client refuses to sign consent to release protected health information (PHI) for treatment, payment or other healthcare operations (TPO)?

-Health care provider can deny treatment. -Health plan may condition enrollment on provision of consent.

Medicare • Part A

-Hospital services, some post-hospital, some home health, hospice, others - Religiously associated facilities, such as Christian Science nursing facilities (Religious Nonmedical Health Care Institutions in Medicare terms)

Components of Informed Consent • The healthcare provider

-Must disclose information on the treatment, test, or procedure in question, including the expected benefits and risks, and the likelihood of problems. - In treatment, the benefits and risks are discussed in addition to anticipated outcome without therapy.

When is consent not needed

-The health plan/insurance company that is paying for the medical care. -A third party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor's office hires to assist in payment of their services (e.g., medical billing services). -Health care operations (medical services review, sale of health care plan, audits). -Collection agency for unpaid bills. -Victims of abuse/neglect or domestic violence. -No separate consent is needed to consult with other health care providers.

Patient states I do not want to do chemo and I know I'm going to die! what to ethical principles are considered here

-beneficence and autonomy -Beneficence is the duty to prevent harm implement good -Autonomy The duty to respect the individuals thoughts and actions. -As a nurse practitioner these two are often in conflict with each other. -as we try to do what is right but the patient does not want it

Trust v Mistrust

0-1 year ability to form relationships, hope, trust in others

oral stage

0-18 months sucking, chewing, feeding linked to schizophrenia, substance abuse, paranoia

CIWA

0-8 mild withdrawal 9-15 moderated withdrawal > 15 severe, with possible DT

delirium statistics

0.4% general population 1.1% over 50 years 30% hospitalized over 50 years 60% in elderly clients in nursing homes 25% those with cancer 40% in hospitalized clients with AIDS 80% of those that are terminal

cyclothymic disorder

0.4-1% prevalence 15-50% go on to develop BPAD

FT4

0.8-2.8 increased: graves dz decreased: hypothyroidism

What are the 7 HEDIS measures for behavioral health?

1) antidepressant medication management 2) follow up after hospitalization 3) follow-up for children with ADHD 4) diabetes screening for people with schizophrenia and bipolar disorder 5) cardiovascular monitoring for people with cardiovascular disease and schizophrenia 6) adherence to antipsychotic medications for clients with schizophrenia 7) initiation of engagement in alcohol and other drug treatment

Quantitative hierarchy of research evidence

1) evidence from systematic reviews of descriptive and qualitative studies 2) evidence from a single descriptive or qualitative study 3) Evidence from expert opinion or committee 4) evidence-based guidelines based on systematic review of RCTs 5) evidence from well designed controlled trials without randomization 6) systematic reviews or meta-analysis 7) evidence from at least one well-designed RCT

Qualitative hierarchy of research evidence

1) randomized controlled trials (RCT), meta-analysis, systematic review 2) evidence-based guidelines based on systematic review 3) evidence from RCT without randomization 4) evidence from systemic review of descriptive and qualitative studies 5) evidence from expert opinion or committee reports

statistics on schizophrenia

1-1.5% of US population higher rates in urban born, first born, lower socioeconomic status earlier onset in men versus women the earlier then onset the poorer the prognosis

Autonomy v Shame and doubt

1-3 years self control, self esteem, will power

What 4 elements of negligence must be estalished to prove malpractice?

1. A DUTY to the patient exists 2. There is a BREACH OF DUTY e.g. violation of applicable standard of care 3. PROXIMATE CAUSE i.e. causal relationship between breach in standard of care and patient injury 4. DAMAGES - permanent and substantial damages to patients as a result of breach in standard of care

Professional role responsibilities

1. Confidentiality 2. Informed consent 3. Ethical decision-making (right vs wrong; moral duties, obligations, responsibilities) 4. Mentoring 5. Patient advocacy, including health policy at local, state, national and international levels

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1. DEONTOLOGICAL Theory: an action is judged as good or bad based on the act itself, regardless of consequences 2. TELEOLOGICAL theory: an action is judged as good or bad based on the consequence or outcome 3. VIRTUE ETHICS: actions are chosen based on the moral virtues (e.g. honesty, courage, compassion, wisdom, gratitude, self-respect) or the character of the person maing the decision.

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1. If a patient reveals an intent to harm self or others 2. To attorneys involved in litigation 3. When records are released to insurance companies 4. When answering court orders, subpoenas, or summons 5. When meeting state requirments for mandatory reporting of diseases or conditions 6. Tarasoff principle (1976): duty to warn potential victim of imminent danger of homicidal patients 7. Child abuse or elder abuse

What laws cover patient confidentiality?

1. Medical Record Confidentiality Act of 1996: protected under federal statue through the (pertaining to verbal and written patient information. Requires provider to discuss confidentiality issues with patients, establish consent, and clarify any questions about disclosure of information, and to obtain signed medical authorization and consent form to release medical records and info when requested by the patient or another HCP. 2. HIPPA: guarantees patients 4 fundamental rights: a) to be educated about HIPAA privacy protection, b) to have access to their own medical records, c) to request amendment of their health information to which they object, and d) to require their permission for disclosure of their personal information 3. Health Information Technology for Economic and Clinical Health Act (HITECH) 2009: Promotes electronic health record use (and meaningful incentives) and sharing information to improve individual and population-based outcomes.

What is an ethical dilemma

1. Occurs in a situation which there are two or more justifiable alternatives. 2. Occurs when the choice is made to promote good Harm reduction approach: which option sacrifices the fewest high-priority values?

What is reflective practice?

1. Reflection uses a model or framework to systematical "make sense of experience" (Sherwood & Horton-Deutch) 2. Process to tell a story abut self and others to gain insight into practice 3. Enhances critical thinking to problem-solve and enhance clinical reasoning & decision-making 4. Links theory and practice.

Medicaid: True or false? 1. Medicaid is the largest payor for nursing facility care. 2. Impoverishment is the primary requirement for Medicaid eligibility. 3. A person who is Medicaid eligible in one state might be deemed to be ineligible in another state.

1. True 2. False, One of the requirements 3. True

Magnesium

1.3-2.1 hypomagnesmia causes depression, irritability, confusion, nystagmus, muscle weakness, ataxia hypermagnesmia causes n/v, muscle weakness, respiratory depression

GGT

10-38 known or suspected etoh abusers, as levels will rise with only a slight elevation of alcohol

formal operational

12 and on ability to abstract, logical thinking

Identity v role confusion

12-20 years personal sense of identity

Sodium

135-148 hyponatremia causes lethargy, confusion, headache, seizure, edema, jvd hypernatremia causes pulmonary edema, thirst, fever, tachycardia, restlessness

anal stage

18 - 3 years sphincter control, expulsions, retentions linked to depressive disorders

anxiety statistics

18% of population more common in girls/women (except OCD and social phobia)

male schizophrenia

18-25 more negative symptoms, poor prognosis, less response to medications

health prevention - women

18-39: monthly skin and self exam yearly blood pressure, labs, grin

Tarasoff principle

1976 - duty to warn victims of potential harm from client

MRI

2 dimensional images, can separate white and grey matter expensive, not for every patient structural

TSH

2-10 increased: hypothyroidism along with decreases in T3 & T4; may mimic unipolar depression decreased: hyperthyroidism along with increases in T3 & T4; may mimic BPAD values can increase with lithium

preoperational

2-7 year extensive use of language, symbolism, magical thinking

Intimacy v isolation

20-35 years committed relationships, capacity to love

female schizophrenia

23-35 less premorbid dysfunction more dysphoria more paranoid delusions and hallucinations

statistics of MDD

2:1 women 15% will commit suicide 60% risk of second episode, 70% risk after second, 90% after third

What are the five reportable conditions that a nurse practitioner must report

3 STDs 2 medical Gonorrhea, chylamidia and syphilis, HIV and TB Chylamidia is not reportable in every state

CT scan

3 dimensional view of brian structures inexpensive but not sensitive structural imaging

social anxiety disorder statistics

3-13% prevalence rate

statistics for ADHD

3-5% of US children more common in boys versus girls average age of onset is 3 years old, mean age of diagnosis is 9 60% of patients have symptoms that persist into adulthood - inattention more common

phallic stage

3-6 years exhibitionism, masturbation linked to sexual identity issues

Initiative v guilt

3-6 years self directed behavior, goal formation, sense of purpose

potassium

3.5-5.1 hyperkalemia causes muscle weakness, paralysis, tingling cramping, diarrhea, EKG changes tall, narrow T waves hypokalemia causes impaired renal function, polyuria, cardiac dysrhythmias, respiratory arrest

generativity v self absorption or stagnation

35-65 years ability to give time and talent to others, ability to grow and change

rapid cycling

4 or more mood episodes in 12 months 20% are rapid cyclers 90% of rapid cyclers are women poorer prognosis

ALT

5-35 liver disease, damage

AST

5-40 liver disease, damage

homelessness

50% of homeless people have co-occurring substance use disorder or psychiatric disorder including bipolar, schizophrenia, depression 15-45% of homeless in the US are schizophrenic

dysthymic disorder statistics

6% of people will develop this women are 2-3xs likely than men associated with personality disorders

Industry v inferiority

6-12 years ability to work, sense of competency and achievement

latency stage

6-puberty peer relationships, learning, socialization linked to issues forming relationships

concrete operational

7-12 years reversibility conservation

Calcium

8.8-10.5 hypocalcium causes confusion, hyperreflexia, seizures, prolonged QT, cramping hypercalcium causes fatigue, weakness, shortened QT, heart block

NP reimbursement

85%

integrity v despair

> 65 years fulfillment and comfort with life, willingness to face death, insight

suicide risk factors

>45 if male >55 if female divorced/single/separated white living alone psychiatric d/o physical illness substance abuse previous attempt family hx of suicide recent loss male gender

Claim based policy

A claim is filed in court against an NP in January 2011 for an incident that occurred in January 2009. The NP remains enrolled with the same malpractice insurance company. Therefore, the claim will be covered. But if the NP has changed jobs or is retired (and does not carry tail coverage), the claim will not be covered even if the NP was insured at that time. What is "tail" insurance or "tail coverage"? When an NP with claims-based malpractice insurance retires or changes to a new job, it is advisable to buy "tail" coverage insurance. The tail coverage insurance will cover the NP for malpractice claims that may be filed against him or her in the future.

Early childhood

A client is displaying low self-esteem, poor self-control, self-doubt, and a high level of dependency. These behaviors indicate developmental failure of which stage of development?

The nurse practitioner decides to study a group of patients who are trying to quit smoking. They all will be taking the same type of medication for 42 days to help them stop smoking. The patients have agreed to return to the clinic once weekly for the study's duration. This type of study design is termed: experimental study. cohort study. case control study. controlled trial.

A cohort study describes an observational study that is prospective in nature, such as the case with this group of smokers. Cohort studies usually ask the question, "what will happen?" A case control study looks backward in time (retrospective). Case control studies usually ask the question, "what happened?" A controlled trial is an experimental study, not observational

Primary prevention

A community has an unusually high incidence of depression and drug use among the teenage population. The public health nurse addresses the problem by modifying the environment and strengthening capacities of families to prevent the development of new cases of depression and drug use. This is an example of

Guardian ad litem

A court-appointed guardian who is assigned by a court (and has the legal authority) to act in the best interest of the "ward." The ward is usually a person who is a child, frail, or vulnerable.

HIPAA Consent

A document that a patient signs to confirm that he/she has received a Notice of Privacy Practices statement from the health practitioner's office as required by law - Indicates how the facility uses or shares personal information about patients -Generally provided before any treatment is provided

What is family?

A group of adults and children who are usually related and whose adults participate in carrying out essential functions of providing food, clothing, shelter, safety, and education of the children Family initially teaches the belief patterns, religion, culture, and mores of a society

What is community?

A group of families often sharing the same race, tribe, or culture and who have beliefs or behaviors shared by others

What is competency?

A legal (not medical) concept: a determination (by a court) that a person can make reasonable judgments and decisions regarding treatment and other health concerns. A person is considered competent until a court rles the person to be incompetent, in which case a court-appointed guardian will make health-related decisions for that person.

Longitudinal Studies

A long-term study follows the same group of subjects (or a subpopulation) over many years to observe and measure the same variables over time. It is an observational study (there is no manipulation or intervention). For example, the Framingham Heart Study has tracked the same research subjects (N = 5,029) from the town of Framingham, MA. The goal is to study the development and identify the factors that are associated with the development of cerebrovascular disease.

Consent Versus Assent

A minor (who is not emancipated) as young as the age of 7 years up to age 17 years can give assent to participate in a research study, but cannot give consent legally. The parent or legal guardian must first consent to the minor's participation in the study. In addition, the researcher needs parental permission to speak with the minor in order to obtain assent (the child signs a separate assent form).

Integrative bargaining

A negotiation technique used for handling conflict, it reaches a solution that enhances both parties and produces high joint benefits

Just Culture

A nurse is concerned about errors and wants to improve quality, reduce errors to promote safety. She knows Human error can cause error and harm by creating an open and fair environment. What concept is she employing?

O'Connor vs. Donaldson

A patient's right to refuse treatment is a legal doctrine that applies to all persons except during emergencies. What 1976 court case originally determined a patient's right to refuse treatment?

Ombudsman

A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care or nursing homes, hospitals, governmental agencies, courts). The ombudsman represents the patient and works in the best interests of the patient.

Power of attorney

A person who is designated by the patient, and who has the legal authority to make decisions for the patient. This role is broader and encompasses not only health care decisions but also other areas of the patient's life, such as financial affairs.

The research design that provides the strongest evidence for concluding causation is:

A randomized clinical trial (RCT) is the epitome of all research designs. Subjects are randomly assigned to treatment groups. This type study provides the best evidence that the results were due to the intervention and not something else. A RCT is an experimental design, not an observational one.

Duty

A relationship exists between patient and provider

Significance level of p value

A significance level of p <.05 means that there is a 5% probability that the data from the study are due to chance.

Define conflict of interest

A situation in which a person's financial, professional, or personal situation may affect the person's judgment in their professional responsibilities for the potential of personal or professional gain or advantage

Circadian rhythm sleep disorder

A sleep disruption due to mismatch between the sleep-wake cycle required by a person's environment and the circadian sleep-wake pattern

Medicare C

A+B = C So if you have A and you qualify for B we can get C Here you can pick in a HMO or PPO from a specific list.

P value

A.k.a. "level of significance" the probability that a particular result occurring by chance the probability of a particular result occurring by chance P= .01 (there is a 1% probability of of obtaining a result by chance)

How does the Americans with Disabilities Act protect employees, and what are the drawbacks?

ADA: employers (with 15 or more employees) are required to make reasonable accommodations for qualified applicants or employees with a disability (including mental illness), and provides protection for qualified individuals in hiring, firing, advancement, job training, compensation, and workplace conditions.

components of functional assessment

ADL - basic self care skills IADLs - complex skills needed for independent functioning such as shopping, cooking, cleaning, driving executive functions - judgment and planning, ability to maintain calendar, manage money

Healthcare Agent (aka Healthcare Proxy)

AKA healthcare proxy, surrogate or attorney-in-fact - A person chosen in advance by an individual to make healthcare decisions in the event that a patient becomes unable to do so

domestic violence abusers

ASPD, narcissistic, borderline with stressors including financial issues, ending of a relationship, unemployment

Anal stage

According to Freud, successful resolution of which psychosexual stage provides the basis for the development of personal autonomy and capacity for self-confidence?

What is critical thinking

Acquisition of knowledge through deliberate inquiry. Making clinical decisions based on EBP (decreases difficulty choosing from conflicting or multiple recommendations when diagnosing/treating) Develops self-awareness through metacognitive process to gain new insights about self & in relation to self and others (OK, I know this is psychobabble - I just need to be able to use their language to pass the exam!!!!)

Right to refuse care

Advised at the time of the mission that they have the right to refuse any kind of care as long as they are competent. Danforth adornment, 1991

Family Systems Theory

All parts of a system are interrelated and dependent on each other. If one part of the system is damaged or dysfunctional, the rest of the system is also affected. Families develop at different rates. If one family member becomes dysfunctional, it will affect the whole family. Another family member may compensate and take over some of the duties or the role of the dysfunctional family member.

"Incident to" Billing: A Medicare Term

Allows 100% reimbursement. -NP must be employed by MD. • Except for select rural exceptions, MD must be present/available in office. -MD initiates treatment. - Services provided by NP are under MD supervision

Growth of nurse practitioners focus with an emphasis on which settings

Ambulatory an outpatient care.

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Amish/Mennonites They do not participate in Medicare or Social Security. The community pays for health care. Traditional roles for women. Prefer large families with several children. Prefer giving birth (using midwives) and dying at home.

What is a health care home?

An approach to primary care that provides coordinated care for individuals with multiple chronic health conditions, including mental health and substance use Offers team-based care Build on community supports

Authenticity

An essential part of building a therapeutic relationship

Suppression

An example of a mature, healthy defense mechanism is

What is informed consent? What are the elements of informed consent?

An explanation of relevant information that enables the patient to make an appropriate and informed decision to accept or reject a proposed treatment. Includes: 1. Nature and purpose of proposed treatment or procedure 2. Risks or discomforts and benefits of treatment 3. Risks and benefits of not undergoing treatment 4. Alternative procedures or treatments 5. Diagnosis and prognosis Provider must document that informed consent has been obtained from patient. PMNP is responsible for ensuring the patient is cognitively capable of giving informed consent.

What is ANOVA?

Analysis of variance: Inferential statistic method that tests differences between 3 groups.

Covered entities

Any health care provider, health insurance company, health care plans, and third-party administrators (TPAs) who "electronically transmit health information" must follow the HIPAA regulations.

Who Needs a Healthcare Proxy?

Anyone age =>18 years, regardless of state of health -Would need to speak for patient in case of general anesthesia, any health problem where patient unable to comprehend situation and voice choice of therapy.

T-test

Assesses whether the means of 2 groups are statistically different from one another

What is the value of providing culturally competent care?

Assumes that if the NP is more sensitive to cultural issues surround the patient's symptoms and treatment, more comprehensive health care can be provided.

What are standards of practice?

Authoritative statements regarding the quality & type of practice that should be provided Provides a way to judge the nature of care provide, the expectations for care, and reflects professional agreement focused on the minimum levels of acceptable performance. Can be used legally to describe the standard of care that must be met by a provider.

What ethical principle Examples: An alert elderly female with periods of forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist. The woman's daughter tells the NP that she does not want her mother to have a mastectomy because she thinks her mother is too old and confused. The NP has the duty to respect the patient's forgetfulness and who has breast cancer decides to have a mastectomy after discussing the treatment options with her oncologist.

Autonomy

alcohol labs

BAL >100 @ exam, >150 without gross evidence, >300 MCV - elevated GGT - elevated AST/ALT - elevated PT - elevated Amylase - elevated WBC - low Na - low K - low hyperlipidemia uric acid - elevated triglycerides - elevated

Define professional civility

Behavior that shows respect for the other person

Superstition Defined

Belief or notion, not based on reason or knowledge, of ominous significance of a particular thing, circumstance, occurrence, proceeding, or the like

Belmont Report

Belmont Report A paper that outlines the important ethical principles that should be followed when doing research involving human subjects. It was issued by a national commission of experts in the United States in 1978.

What ethical principle : Calling the surgeon to get a prescription for stronger pain med

Beneficence

What ethical principle Educating an obese patient on the harmful effects of obesity and recommending weight loss.

Beneficence

What ethical principle Encouraging a patient to stop smoking and enroll in smoking cessation programs.

Beneficence

Medicaid, which reimbursement form differs from state to state

Benefits... The is an AID The benefits are paid after all third-party payments are paid

Antiretroviral therapy

Best treatment for AIDS dementia complex

Tuberoinfundibular dopamine pathway

Blockage of this pathway results in elevated prolactin levels, which can cause symptoms of galactorrhea

Increased BDNF production (Brain-derived neurotropic factor)

Caloric restriction and weight loss are associated with which neuroprotective factor?

Incident-to billing

Can get reimbursed 100% of the physician fee schedule rate. furnished under the physicians direct personal supervision and are furnished by the physician or by an individual who is an employee or independent contractor of the physician. Direct supervision does not require the physician presence in the room, but the end date must be present in the same office suite in the mediately available. The physician must perform the initial service and subsequent services of a frequency which reflect his or her at the participation in the management in the course of the treatment. Never allowed in a hospital setting! so the NP must bill under his or her provider number.

What would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state? Randomized clinical trial Cohort study Case series Case control

Case control case control study would be ideal for discovering the cause of this situation. Case control looks at "what happened"? It would identify those subjects who have leukemia and would identify a control group of adults from the area who did not have leukemia. Both groups would be analyzed for characteristics or risk factors that were present in the "case" group but not the "control" group. This is an observational study.

Types of observational study

Case series Cross sectional Cohort study Observational studies are studies where subjects are observed. No intervention takes place with them.

What would be the study of choice to determine the cause of a cluster of adult leukemia cases found in an isolated area of a rural state?

Case study

Case study

Cause

What is certification?

Certification is a credential that provides title protection, determines scope of practice (who NPs can see and what NPs can treat) for those licensed to practice as a professional in that specialty. Process by which a professional organization or association (ANCC for PMHNPs) certifies that an individual has met certain predetermined standards specified by that profession for specialty practice.

Hypothalamus

Changes in appetite, fatigue, problems with sleep-rest cycle and changes in libido are due to regulation of which neuro anatomical area of the brain?

Hypoglossal

Client is asked to hold out her arms and stick out tongue when assessing for tremors. What crania nerve is being assessed?

Bulimia nervosa

Client with normal weight and is socially extroverted, at times seeks attention is most consistent with which type of eating disorder?

For distinct roles of the nurse practitioner

Clinician, consultant or collaborator, educator and researcher

Social anxiety disorder

Commonly seen in Japan and Korea, the syndrome of "taijin kyofusho" is a form of this disorder

What ethical principle Psychiatric and mental health medical records are protected information and require separate consent.

Confidentiality

What ethical principle This "right" is also protected by the Health Insurance Portability and Accountability Act (HIPAA) (release of patient information for electronic billing purposes).

Confidentiality

Confidentiality

Confidentiality The obligation to protect the patient's identity, personal information, test results, and medical records.

Control group Significance level

Control group: The subjects in an experiment who do not receive treatment. Significance level: Also known as the "α" or a "p-value." It is the probability that the study results are due to chance. The p value is usually set at either p <.05 or p <.0.1

The name given to subjects in a research study who do not have the disease or condition being studied, but who are included in the study for comparison are: studied subjects. controls. case series. cross sectionals.

Controls Studied subjects are those members of a study who have a specific disease or condition of interest or who are receiving a specific treatment. Case series may refer to an observational study where a group of patients with interesting characteristics are studied. Cross sectional is a type of observational study where a particular characteristic is studied at one time rather than over time. Controls are commonly employed in many types of research studies.

When using a patient classification system, the nurse executive should understand that such systems: a. are used to solve unit staffing shortages. b. use nonvariable nursing care hours. c. are designed to eliminate human error d. are periodically reevaluated

Correct Answer: d. are periodically reevaluated The dynamic nature of health care, changing patient characteristics, the introduction of new technology, and so forth, require that nursing departments periodically review the current patient classification process.

The duty to select members of a hospital's medical staff is legally vested in: a. the governing board b. the chief of staff c. the administration d. the executive committee

Correct answer is: A (the governing board) The responsibility for choosing/appointing members of the medical staff of a given institution rests with the governing board (board of directors) of that organization.

The legal boundaries of nursing practice are defined in each state by the: a. American Nurses Association's Code for Nurses b. American Nurses Associations' standards of practice c. state board of registered nurses d. state nurse practice act

Correct answer is: D The practice act establishes the legal boundaries for educational requirements and scope of nursing practice in any given state.

Critical pathways are: a. a patient's expected progress from admission to discharge based upon her or his diagnosis. b. mandated professional care standards. c. the essential feature of the Nursing Minimum Data Set (NMDS). d. prospective structure audits that look at costs as well as quality.

Correct answer is: a. Critical pathways are (or should be) derived from evidence-based studies and suggest the trajectory the patient will follow, in the absence of unanticipated complications, from admission to discharge.

A staff nurse at a unionized agency reports that overtime pay for an after-duty class requiring mandatory attendance was coded as straight pay instead of time and one half as called for in the union contract. Unit managers certify the type and amount of overtime pay. Appropriate action by the nurse exectuive would be to: a. follow up with the nurse's manager to make certain she or he is familiar with the contractual overtime requirements b. accompany the nurse to the payroll office and tell them to make the adjustment c. request that the nurse file a grievance so that payroll adjustment can occur d. turn the matter over to the personnel department for corrective action.

Correct answer is: a. Managers are responsible for knowing the legalities and contract requirements regaridng overtime. By encouraging the manager to become more familiar with the contract, the nurse executive helps the manager fulfill her or his responsibilities and adds to the manager's competency.

The physician-patient relationship may be established by: a. an expressed or implied contract b. a writen contract, witness and notarized c. consultation or abandonment punitive damages

Correct answer is: a. The fact that the patients seeks care, or in the case of an emergency, needs care, can be interpreted as an implied contract.

Costs per unit of service will increase as: a. volume decreases below the break-even point. b. volume increases c. acuity increases d. management turnover occurs.

Correct answer is: a. This model is based on the premise that a certain volume is needed to maintain cost balance. When the volume decreases below the break-even point, costs go up. For example, staffing for a 50-bed unit is calculated for an occupancy rate of 85%, with a break-even point of 80%. Downward adjustments in staff numbers occur only when the occupancy rate dips to 75%. Any occupancy rate between 76% & 79% results in a "loss" based on the cost model.

Healthcare professionals have formed a state coalition to propose legislation to change the state's nursing practice act. Controversies have surfaced regarding entry into nursing practice, the role of the license practical nurse, and the definition of professional nursing. To communicate information about the proposed changes, it would be most effective for the coalition to: a. form a network of all categories of nurses in the state. b. mail minutes from coalition gorup meetings to all constituencies. c. work with groups that have lobbied in the past for changes in the nurse practice act. d. request that coalition members put the proposed changes on the meeting agendas of other groups to which they belong.

Correct answer is: a. This step will reach the widest audience and generate the greatest response. The network concept also allows for connectivity and relatively quick dissemination of information.

When evaluating the nursing service philosophy, the most important thing to ascertain is that the philosophy: a. is congruent wit the mission of the organization b. can be implemented in a cost-effective manner c. flows from organizational goals d. is brief and simply worded.

Correct answer is: a. Congruency among the organization's mission, vision, philosophy, goals, and objectives is essential to the success of the entity.

In assessing the philosophy for nursing services for possible revision, the nurse executive is most heavily influenced by the organization's: a. mission statement b. consumer surveys c. financial resources d. policy statements

Correct answer is: a. mission statement The organization's philosophy must always be consistent with the mission of the enterprise. In this way, there is clarify of intent about what the organization stands for and what it intends to accomplish.

With regard to nonprofit institutions, labor-management relations laws, such as the Federal Labor Relations Act, a. have no bearing on the relationship between labor and management b. apply in the nonprofit sector in the same way they apply in the for-profit sector c. are modified for nonprofits compared with their application in for-profit organizations d. are irrelevant in a unionized organization

Correct answer is: b Labor-management relations laws apply to nonprofit the same as they apply to for-profit organizations.

Under Title VII of the Civil Rights Act, the employer: a. is not responsible for discrimination on the part of individual supervisors b. is responsible for discrimination on the part of individual supervisors c. can terminate a supervisor for practices determined to be discriminatory d. can se the individual supervisor to recover monetary loss suffered because of discrimination settlements against the organization because of a supervisor's behavior.

Correct answer is: b The act stipulates that the employer remains responsible for the acts of its employees.

Nurse executives have a responsibility to know and understand legislation affecting nursing practice in order to: a. prevent administrative personnel malpractice actions b. respond quickly and appropriately to necessary changes in nursing services c. protect the organization from lawsuits d. ensure that procedures in nursing practice are carried out correctly.

Correct answer is: b. As legislation that affects nursing practice becomes law, nurse executives must be cognizant of the changing statutes, their impact, and the modifications that must be made in their organizations in order to comply. Nurse executives become the "translators" of legislative change for staff.

In order to stimulate the staff nurses's involvement in research within the organization, the nurse executive's best course of action would be to: a. hire a well-qualified researcher to conduct reserach studies. b. provide staff nurses with needed time for research activities. c. create a joint medical/nursing staff research committee d. ensure that research designs are well grounded and scientific.

Correct answer is: b. If research at the staff nurse level is a value of the organization, the organization will find a way to provide the staff with time to engage in research.

The union contract in the facility where you are a manager requires that discipline be progressive in all areas except for substance abuse and theft. When an employee commits a first offense of not coming to work as scheduled and neglecting to notify anyone regarding the absence, you would: a. give the employee a written reprimand b. counsel the employee verbally (verbal warning). c. suspend the employee with pay d. suspend the employee without pay

Correct answer is: b. The first action by the manager in the progressive discipline process is a verbal warning.

Carter, a physicain specializing in internal medicine, treated Jones for a broken arm. Should Jones later bring a suit for malpractice, Carter will be held liable to the standard of care required for: a. his specialty b. the specialty in which he was treating Jones c. a general practitioner d. ordinary medical care

Correct answer is: b. The patient can reasonably expect that his broken bone will be set according to the standards of orthopedic practice. If the internal medicine physician cannot perform to this standard, then she or he should ensure that the care of the patient is transferred to someone who can practice accordingly.

In evaluating the nursing administration's philosophy statement, the nurse executive's most important step would be to: a. assess whether the statement provides for flexibility. b. assess whether there is consistency between the statement and actual practice. c. create a task force of registered nurses to review the statement d. solicit input from peers about the statement's relevance.

Correct answer is: b. The reputation and integrity of the organization is judged by the consistency between its stated philosophy and its actual practices.

When nurse executives examine job classifications as they plan salary adjustments, they must remember that there are equal-pay tests that must be met to justify such determinations. Therefore, they would examine jobs for which of the following? a. Equal danger on the job, equal intelligence for hire, equal responsibility, and indentical working conditions. b. Equal skill, equal effort, equal responsibility, and similar working conditions. c. Equal job requirements, same working conditions, equal job duties, and equal responsibilities. d. Equal effort, equal working conditions, identical job duties, and equal job requirements.

Correct answer is: b. This statement accurately reflects the equal-pay test requirements.

Use of the ______________ is the most fiscally responsible method for determining daily staffing needs. a. maximum patient load b. patient classification system c. midnight census d. total bed capacity

Correct answer is: b. Assuming that the classification system accurately matches resources to patient care needs, the classification system is an effective financial tool.

The nurse executive who is implementing a hospital's cost containment program should realize that the most important step is to: a. develop an inservice curriculum that focuses on cost containment. b. develop methods for determining nursing care costs for each patient category. c. Negotiate redistribution of non-nursing tasks to other departments. d. Ask nurses to become a part of the decision-making process in the areas of patient care, unit management, and hospital governance.

Correct answer is: b. By knowing the specific cost of care of various patient categories, the nurse executive, along with others withint the department, has needed knowledge upon which to base a cost-containment plan.

Despite her family's requests to the contrary, Dr. Huang writes a "Do not resuscitate" order on Mrs. Bosko's chart following a conversation with the patient in which Dr. Huang affirmed the patient's wishes to forgo life-prolonging intervention in the presence of end-stage renal disease. The predominant ethical principle evident in this case is: a. beneficence b. autonomy c. justice d. veracity

Correct answer is: b. autonomy Autonomy holds that the patient's wishes are to be respected even if her wishes are contrary to those of her family/ The covenant is between patient and physician. In this case, the physician honors the patient's decision. The patient's competence to make decisions about the extent of her care is not in question.

The predominant ethical belief underlying the requirements of the Health Insurance Portability and Accountability Act (HIPAA) is that of: a. truth-tellilng (veracity) b. confidentiality c. utility d. autonomy

Correct answer is: b. confidentiality HIPAA promises stringent adherance to the principles of confidentiality and includes stiff penalties in the face of violation of its tenets.

The Americans with Disabilities Act: a. applies exclusively to those with physical disabilities b. applies only to companies with 25 or more employees c. applies to those whose mental or physical impairment limits one or more major life activities d. sets limits on "reasonable accomodation."

Correct answer is: c

A physician who performs a procedure upon a patient without proper consent has committed: a. assault b. invasion of privacy c. battery d. false imprisonment

Correct answer is: c Except in emergency situations, where consent is implied, the prfomrance of a procedure upon a patient without his or her explicit consent, or the explicit consent of his or her agent where indicated, constitutes battery on the part of the practitioner. Battery is defined as "the deliberate touching of another without authorization."

The major anti-discrimination legislation is the: a. HIll-Burton act b. Fair labor standards act c. Civil Rights Act of 1964 d. Hospital survey and constuction act

Correct answer is: c.

Which of the following has the strongest potential for moving the United States toward a national healthcare system? a. Dissatisfaction Americans feel toward healthcare quality. b. The American Medical Association's dissatisfaction with the present system. c. Skyrocketing cost of private insurance premiums d. The rationing of services due to federal healthcare costs.

Correct answer is: c. Continuing increases in cost of care and the inability of individuals or organizations to afford health insurance coverage may eventually result in national health care. However, the "free market" philosophy of the United States remains a powerful deterrent to national/universal health care.

Of the following activities, which would be the most important for the nurse executive to personally carry out? a. Serve on the policy and procedure committee b. Interpret the job description for a newly hired registered nurse c. Facilitate the dissemination of research in nursing and management systems d. Review the orientation schedule for newly graduated registered nurses

Correct answer is: c. Such an activity is within the purview of the executive. By ensuring that systems are in place to disseminate research in both nursing and management, the nurse exectuive helps set expectations for the organization's leadership group.

A labor union is attempting to organize the employees of an institution. It would be considered an unfair labor practice if management: a. removed outside organizers from the institution's premises b. refused to allow employees to attend a meeting held by labor organizers during work hours c. supplied the union with information requested about specific employees of the institutions d. told employees that the nurse executive would rather deal directly with them than with the union when differences arise.

Correct answer is: c. Supplying the union with information about employees is contrary to regulations governing collective bargaining activities.

A physician who promises to use a certain procedure in performing an operation and uses a different procedure instead may be liable for: a. negligence b. invasion of privacy c. breach of contract d. libel

Correct answer is: c. The physician has violated the contract agreed to with the patient, whether or not the alternative procedure is preferable, or more advantageous, to the procedure that the physician contracted to perform.

Presently, your agency has policies and procedures in place that meet state requirements for personnel handling toxic substances. Recently, the federal government adopted a new requirement regarding these substances. It will not be necessary to make changes in nursing service policy and procedure at your agency because the: a. nurses in your agency hae received recent instructions and education in handling these agents. b. environmental control officer in your agency has informed you that it is not necessary. c. state in which your agency is located has another more restrictive policy than the new federal policy. d. board of directors and chief administrative officer of your agency told you to ignore the policy

Correct answer is: c. When the state's policies are more stringent than the federal policies, the state policies predominate. The opposite is also true. More stringent legislation always "trumps" less rigous legislation.

Which of the following use of limited resources would most likely result in increased reiumbursement revenues? Increasing the: a. number of clinical nurse specialists b. educational paid days for licensed staff c. educational programs on documentation d. mix and number of clinical staff

Correct answer is: c. Adequate documentation of patient acuity and complexity may translate to better reiumbursement for the organization. Reimbursement processes such as prospective payment (DRGs) are adjusted for acuity. Coders rely on the accuracy and adequacy of clinicians' documentation to code correctly.

The relationship between the operating room nurses and the surgical nurses at a large hospital has become competitive and uncooperative. The focus of the conflict is patient arrival times at the operating room. The nurse executive appoints a performance improvement team to resolve the conflict. Which of the following statements, if made by a team member, would best indicate that progress has been made toward conflict resolution? a. "I think it's pretty clear that some people are more responsible than others for this problem." b. "I think we should keep exact records of the time factors for 1 month. Then we will know where the disrepancy lies." c. "I hadn't realized how much time is involved in preparing patients for surgery." d. "It's always good to be able to vent your feelings. It helps when you can tell people what you think."

Correct answer is: c. This statement shows an awareness of the importance of data gathering and analysis. This person is beginning to understand the performance improvement process.

All department heads are required to re-justify their fiscal needs annually during the budget cycle. Budget allocations are made accordingly. This is a description of which of the following types of budgeting? a. Incremental budgeting b. Perpetual budgeting c. Zero-based budgeting d. Managed care budgeting.

Correct answer is: c. Zero-based budgeting The zero-based budgeting approach asks managers/department heads to begin each budget year with a clean slate and to justify expenditures accordingly.

Critical pathways outline a patient's expected progress from admission to discharge and are part of: a. functional nursing b. primary care nursing c. case management d. team nursing.

Correct answer is: c. case management. Critical pathways are inherent in the case management approach to care and guide care across the continuum.

The authority to license healthcare practitioners is found in the regulating power of: a. the individual hospital b. the appropriate training program c. the state d. the licensing board

Correct answer is: c. the state The state issues regulations pertaining to licensure of various professions.

In terms of professional ethics, the nurse executive is responsible for ensuring that: a. ethics education programs are provided for the nursing staff on an ongoing basis. b. a nursing ethics committee is convened and meets regularly. c. each nurse is provided with a copy of the Code for Nurses with Interpretive Statements published by the American Nurses Association d. nursing's perspective is represented in the organization's formal mechanisms for addressing ethical dilemmas.

Correct answer is: d The nurse executive ensures that nursing is well-represented within whatever formal framework the organization has in place to deal with ethical issues. Nursing is generally represented on the organization's multidisciplinary ethics committee. Policies and procedures are in place to guide nurses faced with ethical dilemmas in the course of their practice.

The nurse executive at a hospital maintains contracts with affiliated educational institutions whose nursing students want to acquire clinical experience. The nurse executive should ensure that each contract includes a: a. copy of the nursing program curriculum b. provision that all nursing faculty members be licensed. c. provision that each student carry individual malpractice insurance d. provision that the hospital's nursing department retains responsibility for nursing care provided by the students.

Correct answer is: d. Ensuring that the hospital retains responsibility for patient care assures accountability and is consistent with the hospital's regulatory requirements.

The nurse executive attends all high-level meetings. However, he or she seems to have limited access to the organization's true power base and believes there is inequitable distribution of power among executives of the same rank. To change this situation, the nurse executive's most appropriate first step would be to: a. propose a plan for organizational restructuring. b. form a coalition within the organization to extend her or his network of power. c. improve her or his power base by creating a useful level of tension and competition. d. become sensitive to informal lines of communication in order to gain entry into informal power groups.

Correct answer is: d. Greater awareness of the informal structure and the power within it will help the nurse executive strategize in such a way that she or he can improve her or his base of support within the organization.

In attempting to reduce costs, the nurse executive should remember that the largest share of financial resources will be found in: a. short-term capital acquisitions b. operating costs c. supplies and equipment d. personnel costs

Correct answer is: d. personnel costs The largest line item in a healthcare organization's budget is personnel. This is also the most malleable item and lends itself to up and down adjustments in response to or in anticipation of changes in the financial status of an organization.

Descriptive Versus Correlational Studies Descriptive Describes and measures the characteristics of a group or a phenomenon. Data are measurable, numerical, and are evaluated by statistical testing. No correlations are measured between the variables. Also known as surveys. Example: "HIV knowledge of college students."

Correlational Describes and measures relationships between two or more variables (or interrelationships). Data are measurable and are numerical. Data are subjected to statistical testing. Example: "Is there a relationship between HIV knowledge and safe sex behaviors of college students?"

Appreciating the situation (ability to eval the options realistically); understanding; reasoning; and communicating choices

Criteria to factor into the adequacy of informed consent

What is the research utilization process?

Critique research Synthesize the findings Apply the findings Measure outcomes

Radical acceptance and change (acceptance of the current reality of what is and the ability to engage in personal change)

DBT affirms dialectical thinking, which involves examining and discussing opposing ideas to find the truth. The central dialectical pattern emphasized in DBT involves the tension between:

Cognitive and behavioral techniques, mindfulness (meditation), and emotional regulation, SKILLS TRAINING AND EXPOSURE

DBT draws on cognitive theory and behavioral theory along with other theories. Elements of behavioral therapy in DBT include?

Billing by CPT AND ICD-9 codes

DX, therapy, surgery consultation and care plan oversight.

Hospice

Death with survival less than 6 months- No additional tx

Describe the Team Leadership Model

Decision 1: should leader monitor the team or take action? - seek out information to understand the team - analyze information - interpret the information and decide how to act Decision 2: should leader intervene to meet task or relational need? - performance functions - team functions Decision 3: should leader intervene internally or externally? - assess for conflicts between group members (action to maintain group performance) - assess for unclear goals - assess for proper support

What is tertiary prevention?

Decrease the disability & severity of a mental disorder - rehabilitative services - avoidance or postponement of complications (drug treatment programs, case mgmt for physical, housing, or vocational needs, social skills training

What is primary prevention?

Decrease the incidence (new cases) of mental disorders - help people avoid stressor or cope with them more effectively - stress mgmt classes, smoking prevention, drug abuse resistance education

What is secondary prevention?

Decrease the prevalence (number of existing cases) of mental disorders - early case finding - screening - prompt & effective treatment (telephone hotlines, crisis intervention, disaster responses)

Fidelity

Dedication and loyalty to one's patients. Keeping one's promise.

Inductive Versus Deductive Reasoning Inductive reasoning is the process of developing a generalization after studying specific information.

Deductive reasoning is figuring out a problem after evaluating some broad generalization(s).

Isolation

Defense mechanism used by persons with obsessive-compulsive personality disorder

Veracity

Defined as the principle stating that the provider should be honest and give full disclosure to the patient, abstain from misrepresentation or deception, and report known lapses of the standards of care to the proper agencies.

Nonmaleficence

Defined as the requirement that the healthcare provider do no harm, whether with or without intention. If harm is unavoidable, the provider is obligated to minimize harm. Nonmaleficence is usually viewed as the corollary to beneficence.

Scope of practice

Defined by state

Standards of advanced practice

Delineated by the ANA as statements by which to measure the quality of practice, service or education

How can the nurse practitioner show leadership?

Designs, implements, evaluates, and advocates to redesign the healthcare system Translates research into practice

Describe the steps of the research process

Develop a clinical question Systematically search for relevant research evidence Make an evidence-based decision regarding implementation Implement the change Evaluate the change Disseminate results Publish in peer-reviewed journals Publish in professional newsletters

History of the nurse practitioner roll

Developed in the early 1960s as a result of physician shortage in the area of pediatrics. The first NP program was a pediatric NP program at the University of Colorado.

Through which mechanism are health policies developed?

Developed through law and regulations Branches of law: executive (implement law) legislative (formulation) judicial (interpret law)

What with all principle : Hospital gowns should be secured correctly so that when patients get up to walk with their backs not visible

Dignity

Define conflict resolution

Directed by a neutral 3rd party who facilitates a "win - win" solution

state practice act

Distinguishes what a nurse practitioner can do that is different from a registered nurse

Early reporting of potential professional liability clam is advantageous bc...

Documents and witnesses are needed to defend the claim and more likely to be available There is no reporting window with insurance companies

Substantia nigra

Dopamine is produced in what location

Protein bound drugs

Drug binds to protein, only free part of the drug is active. so a drug that is 98% protein bound will have 2% available for distribution in the body those with low protein can experience toxicity

Advanced Directives: What is appropriate for relapse planning: Living will or Durable Power of Attorney for healthcare?

Durable Power of Attorney for Healthcare (healthcare proxy): Designates a specific agent to act on behalf of person should he/she become unable to make healthcare decisions, and covers other aspects e.g. financial decisions during the illness. Use for relapse planning for patient with chronic psych disorders. Living Will: only designates preferences for care if patient becomes incompetent or terminally ill. Varies from state to state whether legally binding.

Advance Directive

Durable statements of intent based upon the patient's written healthcare wishes - A variety of forms - Living Will is one type of advance directive.

Sensorimotor

During this stage (Piaget), the infant develops object permanence

Secondary prevention

Early intervention in abusive situations to minimize their disabling or long-term effects would be considered which type of preventive measure? Example: screening programs can be established for individuals at risk and community services can be provided for continuity of care.

Nonexperimental has two broad categories what are they

Ex post facto or correlational in the past. examine relationships among variables IE Pulling charts to look at % of.. descriptive=Aims to describe situations, experiences as they exist

Parenting skills classes for pregnant adolescents (information reduces incidence)

Example of a Primary prevention strategy for community behavioral health

Health Belief Model Health Belief Model (HBM) A model that attempts to explain why people engage in health behavior(s). According to the HBM, a person is more likely to engage in healthier behavior if he or she feels threatened by the condition (perceived susceptibility), and believes that he or she can overcome the barriers (perceived barriers), will benefit, and can successfully perform the action (self-efficacy) (Rosenstock, Stretcher, & Becker, 1988)

Example: Who is more likely to perform healthier behavior—a 50-year-old smoker who recently had a myocardial infarction (MI), or 16-year-old girl who is obese? In this case, it is probably the 50-year-old smoker who is more likely to quit smoking due to the seriousness of a MI and his older age, rather than the teenager who has to lose weight.

Collaborative practice

Exist to enhance the quality and care and improve patient outcome

Expiration on HIPAA

Expiration date not required but often added to consent form

List 4 cultural influences as determinants of health

FAMILY ETHNICITY COMMUNITY ENVIRONMENTAL

HIPAA: True or false? • In keeping with HIPAA's requirements: - You cannot announce a patient's name in a waiting room.

False

T/F: Medicaid benefits are paid to the enrollee, then the enrollee is responsible for paying the healthcare bill.

False

An older adult was screened for colorectal cancer and had a positive screen. She went on to have a colonoscopy that was normal. She does not have colorectal cancer. The screen was a: false negative. false positive. true negative. true positive.

False positive

True or false? • The NP certification exam will contain a number of questions about my state's NP practice act

False, National Exam

True or false? • Once I have achieved national certification, I can practice as a nurse practitioner. • The charge of the State Board of Nursing is to ensure public safety

False, True

Medicare Defined

Federally sponsored health insurance for the following: - Age => 65 years - Age <= 65 years with certain disabilities - People of any age with End-Stage Renal Disease (ESRD) (permanent kidney failure requiring dialysis or a kidney transplant)

What ethical principle Example: A woman with terminal breast cancer does not want the NP to reveal her poor prognosis to her mother. The patient explains to the NP that her mother is very anxious and she wants to wait until the next week before she tells her mother news. If the NP keeps the prognosis in confidence from the patient's mother, she is exercising the concept of fidelity.

Fidelity

Attorneys office hires a nurse practitioner to testify in a lawsuit. and they say I want you to defend this nurse practitioner. We know that she follow standard of care and we want you to tell the jury that. BUT Tell the jury that that was the only possible solution. Which two ethical principles

Fidelity and veracity Fidelity-duty to be fateful And Veracity -duty to be truthful

Level III: severe anxiety

Fight-or-flight response, pupils dilated, VS increased, sweating, muscles rigid, perceptual field greatly narrowed, difficulty with problem solving, dissociative symptoms

Medicare: Issues with NP Reimbursement

For NPs to be able to bill: -NP must be qualified and legally authorized in state services rendered. - Bill only for services deemed "medically necessary," ordered by MD/NP, required for symptom management, provided in accordance with accepted healthcare practice

Do not challenge negative views or recollection of events

For a client who has paranoid personality disorder, what are the best treatment strategies

History of NP Role

Ford and SIlver in CO in 1965

Psychodynamic theory

Freud intrapsychic conflict among structures of mind Id (I want), ego (I think, I evaluate), superego (I should or ought) all behavior is purposeful and meaningful

side effects of stimulants

GI upset, cramps, anorexia, weight loss, growth suppression, headaches, dizziness, irritability, rare psychosis

SSRI side effects

GI upset, sexual dysfunction, nervousness, headaches, dry mouth

Longitudinal

GROUP Over time compare variables study that involves taking multiple measures of a group or a population over an extended period of time to find the relationship between the variables

Apolipoprotein E4

Genetic marker that can be tested for using a serum sample to determine if a person is at risk for Alzheimer's disease

List psychological preventative factors

Good self-esteem or self-concept, internal locus of control, healthy ego defenses

Difference in credentialing and privileging

Granted permission to practice in the inpatient setting the hospital has credentialing committee made up of physicianshey Grant you privileges

85th

Greater than what percentile for BMI places a child at increased risk for being overweight?

Utilitarianism

Greatest good for the greatest number. example hey should get the vaccine first.

endocrine theory of depression

HPA dysregulation hypothalamus releases CRH which stimulates pituitary to release ACTH, which stimulates adrenals to release cortisol --> hyperactive in those with depression which will lead to CNS destruction over time

Rounding at hosp and doc see pt behind you

He can bill 100% - not np. So incident-to billing not about hospital.

Health Risk Management

Health Risk Management A systematic organizational process to identify risky practices to minimize adverse patient outcomes and corporate liability. For example, high-risk areas that are usually checked by risk managers are medication errors, hospital-acquired infections, patient identification problems, and falls.

Accountable Care Organization (ACO)

Health care clinics/systems doctors or hospitals that join together are called?

Accountability

Health care providers are responsible for their own choices and actions and do not blame others for their mistakes.

HIPPA

Health providers are required to provide each patient with a copy of their office's HIPAA policy (patient to sign the form). The HIPAA form must be reviewed and signed annually by the patient. Patients have the right to review their medical files. A mental health provider has the right to refuse patients' requests to view their psychiatric and mental health records. When patients request to review their medical records, the health provider has up to 30 days to comply. Patients are allowed (under HIPAA) to correct errors in their medical records. Must keep identifying information (name, DOB, address, Social Security number) and any diagnosis/disease or health concerns private except with allowed exceptions (see list below).

Caring for the Patient Unable to Make an Informed Decision

Healthcare provider can provide the needed information. - If patient unable to interpret this information and treatment continues, legal ramifications could be equal to or exceed that of treating a person who is competent but no informed consent obtained.

To ensure patient autonomy

Healthcare provider must put aside his or her personal or professional opinion of what the patient should do, and provide him or her with unbiased information about the risks and benefits of treatment.

1. male gender 2. alcohol use disorder 3. previous suicide attempt 4. caucasian race 5. history of violent behavior

High-risk characteristics for committing suicide include:

Taking the number of cases with The disease and dividing it by the population during the same period

How do you calculate a prevalence rate?

Human Genetic Symbols

Human Genetic Symbols A new development in the exam is questions about genetic symbols. The symbol for a healthy male is an empty square; for a diseased/affected male, it is a filled square. The symbol for a healthy female is an empty circle; for a diseased/affected female, it is a filled circle. A diagonal dash across a symbol means that the person is dead.

Healthy people 2020

Human health services initiative started with heakthy people 20000 but did not reach goals so lnow the goals 1. Increase the quality of years of healthy life. 1, eliminate health disparities among Americans here

Negative symptoms

Hx of schizophrenia: Limited social interactions, likes to be alone, has never dated or had the desire...symptoms are best explained by?

Schedule 2

II--Legal to prescribe but significant abuse potential - Examples: Morphine, fentanyl, methadone, oxycodone, methylphenidate, anabolic steroids

Schedule 3

III--Includes medications with less abuse potential than the drugs or other substances in schedules I and II - Includes compounds with limited quantities of opioids such as hydrocodone, codeine and others in combination wi

What do you institutional review boards insurer in research?

IRAs ensure: Risks to participants are minimized Participant selection is equitable Adverse events are reported Risks versus benefits are reevaluated Informed consent is obtained Data safety monitoring plans are implemented The rights and welfare of human research dispense are protected

Schedule 4

IV--Includes medications or substances with low potential for abuse relative to the drugs or other substances in schedule III - Commonly prescribed medications to aid in sleep (Ambien, short-acting benzos), relieve anxiety (benzodiazepines), control appetite (phentermine)

Secondary prevention

If a NP screens an 87 year old patient for dementia, what type of prevention is this?

Awareness Skill Knowledge Encounters Desire

If the APN must continually strive to effectively work within the cultural context of a "client" (family, individual or community), then what does the ASKED cultural assessment tool represent?

Competency

Implies the ability to understand, reason, differentiate good and bad and communicate

One Goal of Autonomy: Avoiding Paternalism

In a situation where the healthcare provider believes the patient would benefit from therapy but the informed patient declines intervention, the patient's wishes must be followed.

Does the nurse practitioner have to report domestic violence?

In many states not. So it depends on state's laws. Offer support and call social services.

differentiation

In terms of family concepts, the ability to develop a strong identity and sense of self at the same time maintaining an emotional connectedness with one's family of origin

Cholinesterase inhibitors

In the early stages of Alzheimer disease clients suffer from mild dementia. What is the class of medication considered to be the mainstay treatment?

Scope of HIPAA Privacy Regulations

Includes all medical records and other protected health information maintained by a health care provider or a health plan • Covers information in any format -Paper - Electronic -Oral • Affects use and disclosure of all client health information

QUALITATIVE

Includes case studies, open ended questions, field studies, participant observations. Observation and interviews are used to explore phenomena. Potential problem for researcher bias. Calls in the question generalizability of findings. And produces very rich data through no other means of research. No Lakert scale

Variable And Dependent vs independent variable Variable A characteristic, an object, or an event that is being measured.

Independent Variable The variable that is not affected by the other variables. It is the variable that is manipulated. The result from the manipulation is called the dependent variable. Dependent Variable The variable(s) that is the result of the manipulation of the independent variable.

What is a t-test?

Inferential statistic method to assess if the means of 2 groups are different from each other.

What is Pearson's r correlation?

Inferential statistic method to test the relationship between 2 variables.

What is the function of IRBs?

Institutional Review Boards protect the rights & welfare of HUMAN research subjects including: Minimize risks to participants Equitable participant selection Adverse events are reports & risks/benefits re-evaluated Informed consent obtained & documented Data & safety monitory plans are implements.

What is meant by internal and external validity?

Internal validity describes when the independent variable (treatment) causes a change in the dependent variable (outcome). External validity exists when the sample represents a population and the results can be generalized

Fourteenth amendment

Involuntary hospitalization is subject to this US amendment. It causes restrictions of patient rights. Must be careful to make sure no laws are broken, and any restrictions are performed legally.

Confidence interval

It's about the mean or the range. Has nothing to do with the differences between the variables.

Steps of continuing quality improvement in quality assurance are outlined by

Joint commission

What ethical principle A homeless alcoholic male without health insurance presents to the ED for abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance.

Justice

What ethical principle Low-income individuals do not pay some types of taxes to the government, but they still have equal access to the postal service and other public services that are supported by taxes.

Justice

Theory of cultural care

Leininger regardless of culture, care is the focus of nursing, health can be predicted through cultural care

You have read an article and what would be most significant that you would change the way you practice

Level of significance

What is a p-value

Level of significance - the probability of a particular result occurring by chance alone. p = .01 means 1% probability it was by chance alone.

Rules for Medicare

Like that for credentialing Must hold a state license, And have national certification . Holds master

What is probability?

Likelihood of an event occurring (lies between 0 [impossible] and 1 [certain])

Living will

Living Will A document that contains the patient's instructions and preferences regarding health care if the patient becomes seriously ill or is dying. It contains the patient's preferences (or not) for aggressive life-support measures. Health care providers should have a copy of the document in the patient's chart.

Serotonin

Low levels of what chemical transmission may explain a vulnerability to impulsiveness and potential aggression? This NT creates a calming influence on the brain

List social preventative factors.

Low stress occupation, higher socioeconomic status, higher level of education

Paternalism

Making decisions for a patient (or for others) because you "believe" that it is for their best interest. The opinion (or desires) of the patient is minimized or ignored. The patient is "powerless."

nurse practitioner is volunteering in a homeless clinic to gain clinical experience. Which statement is true about this?

Malpractice insurance is needed in any situation where patients are treated by a nurse practitioner malpractice IBS is needed. Some states have a "good Samaritan" law which protects professional volunteers from being sued. Unless this is specifically provided by state law, a nurse practitioner should have professional liability insurance in the event the NP is sued

Quality assurance, quality improvement and continuous process improvement.

Management process of monitoring, evaluating, continuous review, and improving the quality and providing healthcare. Quality assurance is a process for evaluating the care of patients easing establish standard of care to ensure quality. Continuous process improvementis based on a Japanese industry and the methodology develop by Deming. Deals with structures and processes of care and outcomes.

psychiatric advance directive

Many mental illnesses (bipolar and schizophrenia) have patterns of relapse. In some states, this legal document is for those with a SMI to use to designate a health care agent to make treatment decisions during an illness relapse.

Certification

Mastery level and non govt

P value of less than 0.05

Means that there is a 95% chance that it's NOT due to chance

Median Mode

Median: The numerical value separating the higher half from the lower half. The middle value in a list of numbers. The numbers are sorted from the lowest to the highest value. Mode: The most common value in a list of numbers.

The Medicare program pays for any services that are covered by Medicare before any payments are made by the Medicaid program, since _____ is always the payer of last resort

Medicaid

Medicaid

Medicaid Authorized by Title XIX of the Social Security Act. A federal and state matching program. Provides health insurance coverage for low-income individuals and their families who meet the federal poverty level criteria. Provides health insurance for children, pregnant women, parents, seniors, and individuals with disabilities (i.e., blindness). Pays for health care and prescription drugs.

Medicare and physical

Medicare will not reimburse for a wellness physical. So you have to code differently. IE . Follow up on hypertension, follow up on what breasts... For follow up so not pay for screening or counseling

Disulfiram

Medication that can induce mania

Autonomy

Mentally competent adult patients have the right to make their own health decisions and express treatment preferences. If the patient is mentally incapacitated (dementia, coma), the designated surrogate's choices are respected. A patient can decline or refuse treatment.

Experimental study

Meta analysis A meta-analysis takes published information from other studies and combines the information to arrive at a conclusion. Although a meta-analysis can use observational studies, these should be reported separately.

Emancipated Minor Criteria

Minors Any person who is under 18 years of age. Emancipated Minor Criteria Legal court document declaring that the minor is an "emancipated minor." Active duty in the U.S. military. Legally binding marriage (or divorced from a legally binding marriage).

Median Median: The numerical value separating the higher half from the lower half. The middle value in a list of numbers. The numbers are sorted from the lowest to the highest value.

Mode: The most common value in a list of numbers.

Occupational therapy

More fine motor work like learning how to write. Stack building blocks - recovering from stroke

Memantine (Namenda)

Most likely to be used in treating SEVERE dementia

N n

N: The symbol to indicate the total size of the sample. n: The symbol to indicate the number of subjects in the group.

A nurse practitioner's scope of practice is influenced by a number of factors. Which one does not influence scope of practice? Code of ethics State and federal laws governing practice Court of law CorrectEducational preparation

NOT COURT OF LAW scope of practice for nurse practitioners is established legally, ethically, and by boards of nursing and professional organizations. Scope of practice sets the boundaries and indicates what is permitted legally, etc. Scope of practice is not influenced by court of law. Scope of practice is determined by state statutes, state nursing boards, common practice in a locale, educational preparation, and others. Scope of practice can vary from state to state.

A 45 year-old woman calls up your practice and speaks to the triage nurse, stating, "I am going to sue you all. That NP gave me amoxicillin and now I have a have yeast infection." Does this meet the "damages" standard?

No

List biological preventative factors

No family history of mental illness, healthy nutritional status, good general health

There are mainly Three types of research what are they

Nonexperimental, experimental and qualitative

What ethical principle The NP discusses a new anticancer drug that may be more effective in treating a patient's cancer. The NP discusses the known risk versus the benefits of the new drug. The patient declines the treatment

Nonmaleficence

What ethical principle A new nurse practitioner (NP) is told to suture a laceration on a patient's face. The NP tells the physician that she has not been trained to suture facial area lacerations and therefore is unable to do it.

Nonmaleficence

Nonmaleficence

Nonmaleficence The obligation to avoid harm. Protecting a patient from harm.

Level I: Mild anxiety

Normal level experienced by all, perceptual field broadened, heightened awareness of environment

Adventitious crisis

Not a part of everyday life;involves an event that is unplanned and accidental; includes natural disasters and crimes of violence

What ethical principle The Women, Infants, and Children food (WIC) program

Not only for pregnancy and children. It is not open to adults and elderly males. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (affects the brain growth, etc.).

Hypothesis Hypothesis: The proposed explanation for a phenomena

Null hypotheses There is no significant relation between the variables of the study. If the null hypothesis is rejected, it means that the results of the study are not due to chance.

Inferential statistics

Numerical values that enable one to reach conclusions that extend beyond the immediate data alone makes inferences about populations using data drawn from the population. *generated by quantitative research designs*

What are descriptive statistics? Examples?

Numerical values that summarize, organize, and describe observations, such as: Mean Standard deviation Variance

What does the Institute of Medicine say about nurse leadership

Nurses should be leaders and engage with health professional to transform and redesign healthcare

Forensic nursing

Nursing practice when health and legal systems intersect (direct services, consultative services to agencies, expert court testimony). Forensic risk assessment is a psych eval performed in the ED after arrest, before a person is confined to a correctional facility. Goal is to protect the public from persons with known mental disorders having dangerous, violent, and criminal histories.

What type of malpractice An NP who has been retired for 2 years has a claim filed against her for an incident that occurred while she was employed. Since she carried an occurrence-based policy, the claim will be covered.

Occurrence

Define conflict

Occurs when a person believes their needs, interests, or values are incompatible with others

delete

Olfactory Optic Oculomotor Trochlear Trigeminal Abducens Facial Acoustic Glossopharyngeal Vagus Accessory Hypoglossal

Theory of self care

Orem self care - activities that maintain life, health, and well being

Federal Drug Enforcement Agency

Origin of DEA number needed to prescribe controlled substances - Schedule 1-5 substances ranked from higher (Schedule 1) to lower (Schedule 5) abuse potential, with occasional state-level additions such as pseudoephedrine

evidence based practice model

P - patient, population, problem I - intervention C- comparison treatment or placebo O - outcome

Describe the PICO method to develop a clinical question

P = patient, population of patients, problem I = intervention C = comparison (another treatment or therapy, placebo) O = outcome Systematicall search for relevant research evidence. Critique the research evidence Make an evidence-based decision regarding implementation Implement the change Evaluate the change.

The level of significance is what kind of value...

P value < 0.05

What method can be used to develop a clinical question?

PICO P - patient, population, problem I-intervention C- comparison (another treatments, therapy, placebo) O-outcome

Human Becoming theory

Parse individuals choose personal meaning in situations

Medicare A

Part A of Medicare refers to the hospital insurance program. There is no enrollment fee for most patients and they are charged a monthly premium based on the number of eligible quarters they or their spouse contributed. This benefit also covers some skilled nursing facilities.

What ethical principle Example: A 92-year-old male does not want to be on a ventilator if he codes. The son disagrees and quietly tells the NP and physician that he wants this father to be aggressively treated with life support, if it is necessary.

Paternalism

Components of Competency

Patient must have: - Ability to communicate a choice. -Understand the relevant information. - Appreciate the healthcare consequences of the situation. - To reason about treatment choices.

Quality improvement programs

Patient outcomes are important indicators of a health system's quality. The goal of these programs is to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction.

What are the ethics of disclosure by providers?

Patients have a right to know what is happening during the course of their treatment. Providers have an ethical responsibility to disclose medical errors, accidents, injuries, and negative results to patients. As a result of disclosure, a patient may have legal right to compensation for harm suffered due to medical misadventures.

Health promotion theory

Pender explains behaviors that enhances health and prevents disease

Therapeutic Nurse-Client Relationship Theory/Interpersonal Theory

Peplau nursing as interpersonal process in which all interventions occur within the context of nurse-client relationship phases of relationship - orientation, working, termination

Damages

Permanent, substantial damages as a result of malpractice • Monetary payment typically awarded in compensation for these damages related to the malpractice

Confabulation

Persons with early cognitive decline have problems with short-term memory and to cover up the deficits, often make up stories that sound rational. This is an example of

Anterograde

Persons with early dementia symptoms forget recent events but have an intact long-term memory. What type of memory deficiency is associated with early dementia?

Concrete operations

Piaget's cognitive theory consists of 4 stages of cognitive development. The stage at which a person develops the concepts of reversibility and conservation is?

Proximate Cause

Plaintiff establishes relationship between the breach and the injuries

Define the elements of the PDSA cycle

Plan - plan the change Do - carry out the plan Study - examine the results Act - decide what action will improve the process

Impact of Not Complying with HIPAA

Possible litigation • Potential withholding of federal Medicaid and Medicare funds • Penalties - Civil, monetary for violations of each standard

Health Belief Model

Postulates that readiness to act on behalf of a person's own health is predicated on 6 concepts 1. perceived susceptibility to the condition in question 2. perceived seriousness of the condition in question 3. perceived benefits to taking action 4. barriers to taking action 5. cues to action 6. self-efficacy

RX pad

Prescription Pads The NP's prescription pad should contain the following: NP's name, designation, license number. Clinic's name, address, and phone number. If the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.

Is Consent Ever Presumed?

Presumed consent appropriate in limited situations - In emergency, potentially lifethreatening situations when the patient is unconscious or incompetent and no surrogate decision maker is available

Tertiary prevention

Prevent complications and relapse. Educating the family when a client with schizophrenia is being discharged is an example of this type of prevention.

What is the most cost effective form of healthcare?

Primary prevention services, aimed at avoiding health problems, can help with healthcare cost savings and help actualize the principle of utilitarianism.

What are the 4 components of health policy?

Process - formulation, implementation, evaluation Policy reform - changes in programs and practices Policy environments - the arena in which the process takes place Policymakers - key players and stakeholders

Define arbitration

Process in which a 3rd party reviews evidence from all sides and makes a decision to settle the case

What is commitment? What are the basic criteria (4)

Process of involuntarily forcing a person to receive evaluation or treatment. Process differs between states. Basic criteria: 1) Person has a DIAGNOSED psych disorder, 2) is HARMFUL TO SELF OR OTHERS as a consequence of the disorder; 3) is UNAWARE OR UNWILLING to accept the nature and severity of the disorder; 4) TREATMENT is likely to improve functioning.

What is credentialing?

Process used to protect the public by ensuring a minimum level of professional competence

What is the purpose of quality improvement?

Projects that aim to improve systems, decreased cost, and improve productivity Provide standardized method to: identify gaps in practice and systems to evaluate ways to improve structure, function, and resources in care delivery

What is complexity science in reference to healthcare?

Provides a framework to understand, design, and structure change

If in a setting and someone says I'm going to shoot them -- who do you call

Psych- not police or social services

License

Qualified and government

Qualitative Versus Quantitative Studies Quantitative Systematic gathering of data. The study's data are measurable and numerical. Data are evaluated by using statistical methods. Quantitative research is deductive.

Qualitative The researcher uses observation and detailed interviews to gather data. Qualitative research is inductive. Identifies phenomena and concepts. Asks broad questions. The study's data are gathered as "words" and not numerical data.

"problem" is identified (diabetic complications such as peripheral neuropathy, retinopathy, etc.). Then outcome measures are identified (such as an A1c of less than 6.5 %, etc.).

Quality improvement programs Be familiar about what a good outcome is for a disease (for diabetics, a good outcome is A1c less than 6.5%) and what a poor outcome is (A1c greater than 8%).

What are inferential statistics?

Quantitative research uses inferential statistics such as: t-test (assesses in

Experimental Versus Quasiexperimental Studies Experimental Design Considered the "gold standard" in research design. An important criterion is the use of random sampling to recruit research subjects. There is an intervention (or treatment) group and a control group. For example, a simple two-group experimental design will contain a control group and an intervention group that are "matched." Pretest (before intervention) and posttest data are measured. Data are numerical and evaluated using rigorous statistical testing.

Quasiexperimental Design The design is similar to an experimental study except there is no randomization of the research subjects. Instead, recruitment of subjects is by convenience sample.

elderly male with moderately severe dementia presents with his caregiver daughter. His BMI is 18. His clothes have food stains on them and he looks as though he hasn't been bathed in days. How should the nurse practitioner handle this?

REPORT as potential abuse This patient presents as though he is being poorly cared for and mistreated. This occurs in about 3-8% of the adult population in the United States. There is no evidence that the patient has been physically abused, but he obviously suffers from neglect. This is a form of elder abuse just as physical, sexual, psychological, or financial abuse is. Elderly patients with dementia are those who suffer abuse most frequently

PT

ROM - rehab

What two things do you need for an experimental study

Randomization and a control group. if it lacks one or the other or both you can still do the research however is called a quasi-experimental design

research design that provides the strongest evidence for concluding causation is:

Randomized control trial

In a research study, the difference between the smallest and largest observation is the: standard deviation. first degree of freedom. range. absolute value.

Range

Obsessive-compulsive disorder (OCD)

Recurrent, repetitive, and intrusive thoughts are extremely difficult to control. What disorder is this indicative of?

Beneficence

Refers to a mental health nurses' duty to promote the good of others and their patients.

Privilege

Refers to the patient's right to prevent disclosure of information from treatment in judicial hearings.

Describe the importance of reflection

Reflection uses a framework to systematically "make sense of experience" Tell the story about self and others to gain insight into practice Enhances critical thinking to problem solve and enhance clinical reasoning and decision-making Link theory to practice

The certifying body that we take the exam from determines the....

Reliability

Reliability vs validity

Reliability is the results are the same overtime. Validity yes we are saying we are testing what we are supposed to be testing.

With suspected child and / or elder abuse. What does a nurse practitioner do

Report to social services, not the police. Social services will contact the police after investigation.

quasi-experimental

Research involves manipulation of variables BUT lacks a comparison group or randomization

Quasi-experimental

Research takes place when a variable may be manipulated but subjects are not assigned randomly to control and treatment groups. What type of research is this?

What are 2 models for reducing the gap between research findings and application to practice?

Research utilization evidence-based practice

Dignity

Respect for human dignity is an important aspect of medical ethics. A person's religious, personal, and cultural beliefs can influence greatly what a person considers "dignified" treatmaent.

Prospective Versus Retrospective Studies Prospective Studies that are done in the present (to the future) time frame.

Retrospective Studies done on events that have already occurred (e.g., chart reviews, recall of events). Another name for this study design is "Ex post facto."

Norming phase

Roles and norms are established with a move toward consensus and objectives, members reach a common understanding of the true nature of the opportunity to reach the group's goals. What phase is this?

Theory of Adaptation

Roy promotion of adaptive responses is the goal of nursing

Cross sectional study-'

SURVEY Could be descriptive but doesn't have to be You examine the population with a similar attributes that differs in one specific variable. like age, so it is designed to find relationship between variables at a specific point in time

What are the Institute of Medicine's 6 quality aims?

Safety Effective Client-centered Timely Efficient Equitable

0-8:mild 9-15: moderate >15:severe

Score of 17 on CIWA indicates what phase of withdrawal?

Cognitive triad

Seeing oneself as defective or worthless; seeing the world as a demanding and defeating place; and expecting hardship to be ongoing

What are elements of the team leadership model?

Seek out information to understand the team Analyze information Interpret the information in the site how to act Assess conflicts between group members and take action to maintain group performance Assess for unclear goals and proper support

Bandura

Self-efficacy is essential for longevity

What is ethnicity?

Self-identified race, tribe, or nation with which a person or group identifies which greatly influences beliefs and behavior

Raphe nuclei

Serotonin is produced in what location

Sedation and weight gain

Side effects caused by inhibition of serotonin 2C and histamine receptors

Parasomnia

Sleep disorder that includes sleepwalking and nightmares

Medicare Advantage (Part C)

Sometimes called "Part C" or "MA Plans" - Offered by private companies that are approved by Medicare. - Provide PPO or HMO services, provide Part A (Hospital Insurance) and Part B (Medical Insurance) coverage, usually a prescription drug benefit

What do we mean when we say culture bound syndromes?

Specific behaviors relation to a person's culture and not linked to a psychiatric disorder. Examples: - Amok: dissociative episode followed by violent aggression directed at people and objects (males from Malaysia, Laos, Philippines, Papua New Guinea, Polynesia, Puerto Rico) - Koro (SE Asia): fear the penis will recede into body & cause death. - Falling out (southern US, Caribbean): indiv collapses w/o reason - Susto (US, Latin America, S. America): belief the soul will leave the body after a frightening experience - Wind attacks (Cambodian): dizziness, SOB, palpitations, autonomic arousal

What are the 3 variables in the Donabedian model

Structure process outcome

What is the Donabedian Model?

Structure - Process - Outcome May address the 6 dimensions of health care systems: safe, effective, patient-centered, timely, efficient, equitable QI process: PDSA (Plan-Do-Study-Act)

Level II: moderate anxiety

Subjective feeling of tension or worry, narrowed perceptions, VS normal

What is research utilization

Subset of Evidence-based Practice. Process is: 1. critique research, 2. synthesize the findings, 3. apply the findings 4. Measure the outcomes. Hierarchy of evidence effectiveness of interventions (from lowest level [expert opinion] to highest level [systemic review/meta-analysis of all relevant RCTs]) Hierarchy of effectiveness of meaning (lowest level [at least one well-designed RCT] to highest level [systematic reviews of qualitative and descriptive studies])

Interpersonal theory

Sullivan behavior occurs because of interpersonal dynamics; the self system is all components of personality when individuals need for satisfaction and security is interfered with by the self-system, mental illness occurs

Medicare Part B

Supplemental insurance -Outpatient services, home health -NP's can be reimbursed under Part B as long as services are physician-like services, not RN services

What are the American nurses Association position statements on "just culture of safety"

Supports collaboration efforts among state boards of nursing, professional organizations, patient safety centers, and health systems to develop "just culture" initiatives Most people accountable for the behaviors and investigate errors Goal of creating open and fair learning environments to design safe systems and manage choices Mindset that affects work environment to proactively look for system breakdowns and identifies ways to improve systems

may confabulate for memory gaps (Memory in a client with dementia will show progressive deficits. Recent memory loss will be greater than remote).

Symptom that would be more associated with dementia as opposed to pseudo pseudodementia?

Examples of inferential statistics

T - test Analysis of variance (ANOVA) Pearson' s R correlation Probability P value

What does mental health promotion and education include?

Teaching about interventions and ways to cope with specific stressors Validating "normalcy" of feelings, ensuring patients they are not "crazy" Helping patients recognize & identify their feelings or behaviors Helping patients identify resources in the community

Analysis of variance (ANOVA)

Test the differences among 3 or more groups

Pearson's R correlation

Tests the relationship between 2 variables

4%

The 12 month prevalence of separation anxiety in children living in the United States?

1.2%

The 12-month prevalence of OCD in the United States

American Nurses Association (ANA) Code of Ethics for Nurses

The ANA Code of Ethics for Nurses with Interpretive Statements (2001) contains "the goals, values and ethical precepts that direct the profession of nursing." According to the ANA, the Code "is nonnegotiable." Each nurse "has an obligation to uphold and adhere to the code of ethics."

13 to 80 years old

The Beck Depression Inventory II is designed for patients of what age range

Claims-made policy example

The NP had a claims-made liability insurance policy in place in 2 years ago, but allows the primary policy to lapse 1 year ago when no longer in practice. This year, a malpractice claim is filed against the NP based on a clinical encounter in 2 years ago.

What are health effectiveness data information sets (HEDIS)?

The National Committee for Quality Assurance develops HEDIS to measure health outcomes

Competency in decision making

The ability to exercise rights, more in particular the ability to exercise one's right to give or refuse informed consent

Define critical thinking

The acquisition of knowledge with an attitude of deliberate inquiry Making clinical decisions based on evidence-based practice Develop self-awareness to gain new insights about self in relation to others

In planning for managed care, which of the folllowing goals would be most appropriate for the nurse manager? a. Clinical outcomes should occur within a prescribed time frame. b. Case managers should not function as providers of patient care. c. Managed care practice should be unit-based and unit-specific. d. Outcome management should be carried out for each patient.

The correct answer is: a. Evidence-based trajectories with defined outcomes should be used to effectively and efficiently manage the care of most patients to achieve long-term goals.

Strategic planning: a. focuses on the long-range goals for the organization b. requires a broad range of management expertise c. is synonymous with tactical planning d. is generally a middle-management function.

The correct answer is: a. Strategic planning, in contract to tactical planning, is future-directed and concerned primarily with putting in place the resources to achieve long-term goals.

In planning for change, the successful change agent makes a commitment to: a. help followers arrive at total consensus regarding the change. b. encourage subgroup opposition to change so many viewpoints can be heard c. utilize change by drift if resistance to change is too strong d. be available to support those affected by change until refreezing occurs.

The correct answer is: d Unless there is support until the desired change has replaced the status quo, the likelihood of "backsliding" is high. The successful change agent recognizes the need to help her or his clients remain with the process until the desired change has replaced the prior way of doing things.

How should the HCP interpret the direction of the healthcare proxy?

The direction of the appointed healthcare proxy should be followed as you would follow the direction of the patient. As a result, the proxy must be... • Well-versed on the patient's wishes, and the wishes should be clearly documented. • Capable of carrying out these wishes even in the face of opposition from other loved ones or personal feelings about the situation.

Veracity

The duty to present information honestly and truthfully.

CBT

The focus of this therapy is to link thoughts to behavior and emotions

Determining Competency

The goal of competency determination - Striking balance between respecting the autonomy of patients who are capable of making informed decisions and protecting those with cognitive impairment.

Define internal validity

The independent variable (the treatment) caused a change in the dependent variable (the outcome) internal validity is only relevant in studies that try to establish a causal relationship

Internal validity

The independent variable (the treatment) causes a change in the dependent variable (the outcome)

Define evidence-based practice How does it shape practice?

The integration of: best research evidence with clinical expertise client values and needs The NP needs to know the effectiveness of evidence-based interventions and selected intervention to meet the client need

Justice

The lack of bias. The right to fair and equitable treatment. The fair and equitable distribution of societal resources.

Accountability Act (HIPAA) * Also known as the "HIPAA Privacy Rule"

The law was passed by the U.S. Congress and enacted in August, 1996. The law provides protections for: "the use and disclosure of individuals' health information"—called "protected health information" by organizations subject to the Privacy Rule—called "covered entities."

Definition of culture

The learned beliefs and behaviors or the socially inherited characteristics that are common among all members of a group e.g. racial, social, ethnic, or religious

Beneficence

The obligation to help the patient. Remove harm, prevent harm, promote good. ("do no harm"). Acting in the patient's best interest. Compassionate patient care.

Capitation

The organization is paid a fixed, negotiated rate per member (life-covered) per month. The organization receives payment whether or not the member uses the services of the organization in a given time period.

Utilitarianism

The outcome of the action is what matters with utilitarianism. It also means to use a resource for the benefit of most (e.g., tax money). It may resemble justice, but it is not the same concept (see below).

Durable power of attorney

The patient designates a person (family member or a close friend) who has the legal authority to make future health care decisions for the patient in the event that the patient becomes mentally incompetent or incapacitated (i.e., comatose).

Installation

The patient installs and strengthens the positive thought that he/she has declared as a replacement of the original negative thought. What phase of EMDR is this?

Densensitization

The patient visualizes the trauma, verbalizes negative or maladaptive beliefs, and remains attentive to physical sensations. Blocks out negative thoughts. What phase of EMDR is this?

What is confidentiality?

The patient's right to assume that information given to the healthcare provider will not be disclosed.

What is environment?

The physical and psychological factors that make up the general circumstances of a person's life. Includes: social contracts housing surroundings climate, altitude, temperature air pollution water fluoridation, water contamination crime poverty transportation

Steady state

The point at which the amount of drug eliminated between doses is approx equal to the dose administered. Drugs are usually administered once every half-life to achieve a steady state. It takes approx 5 half-lives to achieve a steady state and 5 half-lives to completely eliminate a drug

Glutamate

The primary excitatory neurotransmitter is

Tarasoff v Regents of the University of California

The principle which holds that a mental health therapist is responsible for being pro-active in preventing harm by a particular patient was established by? Includes the duty to warn

Define research utilization

The process of synthesizing, disseminating, and using research generated knowledge to make a change in practices *A subset of the broader evidence-based practice*

Mental Health America

The public health organization that supports advocacy

Be able to cite case management

The purpose is to mobilize monitor and control resources that a patient uses during a course of an illness while balancing quality and cost.

Define the role and actions of the NP

The purpose of the ANAs Psychiatric Mental Health Nursing Scope and Standards of Practice is to

Define external validity

The sample is representative of the population and the results can be generalized the extent to which the results of a study can be generalized to other situations and to other people.

Pharmacokinetics

The study of what the body does to drugs

Connective leadership

The type of leadership that draws on the leader's ability to bring others together as a means of effecting change. Leaders in this category realize the whole is greater than the sum of its parts and results are achieved through collaboration, cooperation, and collegiality

What must investigators before they can execute their research?

They must take and pass a test on protection of human participants

Chronobiological theory

This biological theory of the etiology of depression states that the desynchronization of the circadian rhythms produces a symptom constellation collectively called MDD?

Sublimation

This defense mechanism is considered healthy; a person can express aggression through pleasurable games, sports and hobbies

nurse practitioner examined a patient who had been bitten by her husband during an assault. There were numerous bite marks and lacerations on the patient's forearms. The nurse practitioner sutured the lacerations, though this was contraindicated because of the highly infectious nature of human bites. The patient suffered no ill effects after suturing. How can this be described? .

This is negligence. This is not malpractice. This is negligence. Negligence occurs when one fails to exercise the care that a reasonable person would exercise. Injury does not have to occur for negligence to occur. Human bites, known to be dirty bites with high probability of infection should not be sutured. Malpractice is usually described as having multiple elements that all must be satisfied for malpractice to occur. There must be a duty, a breach of the duty, and a subsequent injury due to the breach. Comparison of performance is based on the standard of care delivered by nurse practitioners.

Prodromal phase

This phase of schizophrenia begins with a change from premorbid functioning and extends until the onset of frank psychotic symptoms.

Motivational interviewing

This principle is to support self-efficacy, give the client the belief that he can make a change and there is no "right way" to change

Moral behavior

This term describes the respect for freedom, justice, honesty, confidentiality and autonomy for other people

Aggression-turned-inward theory

This theory assumes that early psychological developmental issues lay the foundation for depressive responses later in life. Losses experienced by a child can be real or imagined and may be R/T maternal death, illness or emotional lack of availability

Bowen family therapy

This therapy focuses on family of origin issues and increasing self-differentiation

passive-aggressive behavior

This type of behavior is characterized by covert obstructionism along with procrastination, stubbornness, and inefficiency. It has psychological origins in contradictory and inconsistent training methods.

Vicarious liability

This type of liability holds certain parties may not be negligent themselves, but their negligence is assumed because of association with the negligent individual

Occurrence

This type of malpractice policy is not affected by job changes or retirement. When a claim is filed against the NP in the future, it is covered if he or she had an occurrence-based policy at the time the incident occurred.

Antipsychotics

This type of medication is contraindicated in persons with dementia or Parkinson's disease

Existential/Gestalt model

This type of therapy facilitates people's self-actualization processes by helping them become more aware of their full potential, their alternatives or choices and their feelings and emotions; primary goal is to help them take responsibility for their emotions and behaviors through the process of support and feedback

Objectives of HIPAA Privacy Regulations

To ensure - Each covered health care component protects the health information it maintains - A client's health information is not used inappropriately - The minimum amount of information is used or disclosed whenever possible. - Clients have more control over when and how their personal health information is used

7 years of age

Tourette's disorder is characterized by multiple motor tics and at least one vocal tic that are not caused by a substance or medical condition. The average age of onset is:

What is culturally competent care?

Treating patients from diverse cultures as unique individuals, noting a potential relationship between the patients' cultural experiences and their symptoms in presentation and perceptions

T/F: Contraception, STI, Drug abuse can be treated without parental consent

True

Tuskegee Syphilis Experiment

Tuskegee Syphilis Experiment An infamous study of 600 African American sharecroppers (1932 to 1972) from Alabama. The men were all tested for syphilis infection and those with positive results were never informed or treated. Due to this study, laws were passed that protect human subjects' rights and mandate informed consent

Informed consent

Two things, must be competent and patient is aware of all benefits and risk. iE death even if taking off toenail So he has to know that he could die from surgery

Mental illness prevention

Type of advocacy being employed if a NP is working to strengthen families and the community of those suffering with a mental illness

Existential therapy (Viktor Frankl)

Type of therapy in which reflection on life and self-confrontation are encouraged. Emphasizes an individual's accepting freedom and making responsible choices. Goals: to live authentically and to focus on the present and on personal responsibility

Schedule III

Under which classification would appetite suppressants and testosterone fall?

Strategic family therapy

Using a paradoxical directive is part of which therapy?

The expert panel he put your test together test is the....

Validity

RX authority

Varies from state to state

What ethical principle Example: An elderly woman is recently diagnosed with advanced pancreatic cancer. The patient thinks that she has a very good chance of being cured. The oncologist explains to the patient her poor prognosis. The oncologist is being truthful and honest to the patient about her prognosis.

Veracity

Define mediation

Voluntary and confidential s in which a third-party facilitates discussion to reach an agreement

Vulnerable population and consent...

Vulnerable Populations Almost all types of biomedical and behavioral research in the United States require informed consent. Groups considered "vulnerable populations" have additional paperwork and consent requirements. The following groups have special protections and have additional informed consent requirements: Infants and children under the age of 18 years. Pregnant women. Prisoners. Persons at risk for suicide. Persons with impaired decision capacity (e.g., mental retardation, Down's syndrome, etc.).

Caring Theory

Watson caring is essential component of nursing

TCAs Potentially fatal due to cardiac side effects combined with hypokalemia commonly experienced in bulimia

What class of antidepressants would NOT be sued to manage bulimia?

5HT2a receptor antagonist properties

What differentiates atypical antipsychotics from first-generation or typical antipsychotic medications?

Recognize and change automatic thoughts

What is the best rationale for using cognitive behavioral therapy?

Adjustment disorder

What is the most common diagnosis given in a hospital psychiatric setting?

frontal lobe

What lobe of the brain controls thought processes, planning, formulating or selecting goals, and insight.

Calcium

What will impair the absorption of tetracycline?

Standards in Informed Consent

What would a typical healthcare provider say about this intervention? -HCP must be as well informed as of the typical provider about possible risks and benefits of the intervention

Experimental research

When the experimenter uses random sampling, manipulates the independent variable, and uses control and experimental groups.

External validity

When the research sample is representative of the population and the results can be generalized

Decreased protein binding

When treating older adults you should keep in mind they are more sensitive to issues of drug toxicity because

Psychic determinism principle

Which Freudian based psychodynamic principle assumes that all behavior and actions are purposeful?

OCD

Which anxiety disorder is equally prevalent in men and women?

Increases social skills, is cost-effective, and enables participants to acquire the curative factors

Why is group therapy beneficial?

Say. Nurse visit - can we bill

Yes we can bill for procedure- is shot administration. EKG

An APN prescribes clarithromycin for the treatment of a sinusitis in a woman taking simvastatin. While on the antibiotic, the patient develops rhabdomyolysis. Can you see a correlation between the above events?

Yes, clarithromycin CYP3A4 Inhbitor and Simvastatin is a 3A4 substrate, clarithromycin inhibited the metabolism of simvastatin

contraindicated due to increase rates of confusion and memory problems

You are treating a client with a hx of traumatic brain injury. What is the rationale to taper off of climaxes am?

Absolute neutrophil count of less than 1,000/uL

You are treating a client with schizophrenia who takes clozapine. What lab values will indicate the need to discontinue treatment?

intentional tort

a conscious decision to commit or omit an act and to either intend the result or to possess reasonable knowledge of the foreseeable consequences.

plan-do-study-act (PDSA)

a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a product or process

What are institutional review boards (IRB's)

a type of committee used in research ithat has been formally designated to: * approve, monitor, modify, or disapprove research involving humans*

performance deficit

ability to perform a functional skill, but lacks the motivation to do so - as seen in depression

NMS

abnormal labs - increased CPK, WBC, LFT first symptoms - altered, hyperthermic, hyper-reflexia autonomic instability including hypotension, extreme muscular rigidity, tacky, diaphoretic, coma treat with tantrum or parlodel

akinesia

absence of movement

deontological theory

action is judged based on the act itself

teleological theory

action is judged based on the consequences

virtue ethics

actions are chosen based on moral virtues of the person

OCD

age of onset earlier in men genetic loading linked to tourettes obsessions more common in adults - dying compulsions r/t washing and cleaning

licensure

agency of state grants permission to individuals accountable for the practice of a profession

categories of behavior for conduct

aggression towards people and animals destruction of properly deceitfulness or theft serious violation of rules lacks remorse

secondary prevention

aimed at decreasing prevalence ex. telephone hotlines, crisis intervention, disaster response

tertiary prevention

aimed at decreasing the disability and severity of mental disorder ex. day programs, housing, social skills training

basal ganglia

aka corpus striatum feedback system to modulate and stabilize somatic motor activity movements learning actions EPS track involuntary movements contains caudate and putamen

pick's disease

aka frontotemporal dementia neuronal loss, gliosis, pick's bodies personality and behavioral changes early cognitive changes later Kluver-Bucy syndrome - hypersexuality, hyperorality, placidity

etiology of sexual abuse

alcohol is involved in 34% of all forcible rapes 1 in 4 rapes are reported incestuous behavior is more frequently reported in families of low socioeconomic status

Clubhouse model

allows persons with SMI to run their own businesses, such as a housekeeping service. This teaches all members to perform a job in order to run the business.

histrionic

always wants to be the center of attention sexualized or seductive uses physical appearance to draw attention to oneself speech excessively impressionistic and lacking in detail suggestible, easily influenced considers relationships more intimate than they are

eating disorders

anorexia, bulimia, binge eating biological factors include decreased hypothalamic norepinepherine activation, dysfunction of lateral hypothalamus and decreased serotonin

TCAs side effects

anticholingeric - dry mouth, blurred vision, constipation, memory problems antiadrengeric - orthostatic hypotension antihistaminergic - sedation and wgt gain ekg changes, cardiac dysrhythmias known to induce hypomania

anxiety in children

anxiety is manifested in worry over competence in school, sports, etc common worry over punctuality or natural catastrophes accompanied by overly conforming behavior, perfectionist, excessive seeking of approval, need for reassurance

recessive conditions

appear only in one generation when they possess two copies of recessive gene, one from each of the unaffected parents, i.e. cystic fibrosis

emotional cutoffs

attempting to break contact with family of origin

undoing

attempting to make up for or undo an unacceptable behavior

intellectualization

attempts to master current stressor or conflict by expansion of knowledge

serotonin syndrome

autonomic instability, restlessness, agitation, myoclonus, hyperreflexive, hyperthermic, diaphoresis, altered, tremor, chills, diarrhea, cramps, ataxia, headache, insomnia

Denial

avoidance of unpleasant realities but ignoring them

Self efficacy/social learning theory

bandura behavior is the result of cognitive and environmental factors learn by observing others self-efficacy is the perception of one's ability to perform a certain task at a certain level

acetylcholine

basal nucleus of mynert decrease leads to alzheimers, impaired memory

cognitive therapy

beck goal is to change client's negative beliefs and cognitive distortions

cognitive theory of depression

beck theory assumes that individuals with a tendency to be depressed think about the world differently than non-depressed persons and that these individuals are more negative and believe that bad things will happen to them due to their own personal shortcomings. tend to have low self esteem and pessimistic perceptions, seem hopeless

health belief model

becker healthy people do not always take advantage of screenings due to perception of susceptibility, benefits of tx, barriers to change etc

Cerebral cortex

behavior that makes us human - speech, cognition, judgment, perception, and motor function

psychodynamic theory of addiction

behaviors of abuse are seated in oral stage fixation

fidelity

being true and loyal

medications that induce depression

beta blockers, steroids, interferon, accutane, retrovirals, neoplastic, benzodiazepines, progesterone

Sensorimotor

birth - 2 years object permanence - objects have existence regardless of child's involvement

family systems therapy

bowen - believes that an individual's problematic behavior may serve a function or purpose for the family or be a symptom of dysfunctional patterns focus is on chronic anxiety within families treatment is to increase family member's awareness of their function within the family and to increase self-differentiation

Lewy body disease

caused by lewy inclusion bodies in the cortex presents with hallucinations, parkinsonian features, and EPSs reacts adversely to antipsychotics

trans-theorectical model of change

change occurs in stages: precontemplation, contemplation, preparation, action, maintenance

Sleep terror disorder

characterized by recurrent episodes of abrupt awakening from sleep without dream recall.

biological theory of depression

clear genetic predisposition - having a depressed parent is the single strongest predictor of depression children are 3xs more likely, 40% chance of having MDD episode before age 18 the earlier the onset the more severe and chance for genetic load

suppression

conscious analog of repression

avoidant

consider cultural factors, even in genders avoidance of activities involving significant interpersonal contact fear of criticism, disapproval or rejection unwillingness unless certain they are liked restraint in relationships view self as socially inept, inferior

mood stabilizers

considered first line - always first line for rapid cycling

Cross sectional

correlational study that evaluates for interrelationships between two or more groups.

CAGE

cut down annoyed by criticism guilty about drinking eyeopener 0-2 mild to moderate 3-4 high risk

neurotransmitter theory of depression

decreased serotonin, norepinephrine, or dopamine

primary prevention

decreasing the incidence of mental disorders ex. stress management classes, smoking prevention, DARE

scope of practice

defines NP roles and action, varies from state to state

cognitive disorders

delirium dementia

solution focused therapy

deshazer, o'hanlon, berg focus is to rework solutions that have previously worked goal is effective resolution of problems through cognitive problem solving and use of personal resources and strengths

certification

determines scope of practice, certifies that an individual has met certain standards

functional assessment of elderly

determines the degree to which the individual's abilities and performance match the demands of his or her life helps distinguish dementia from depression

Rett's Disorder

development of specific deficits following a period of normal functioning after birth progressive, deteriorating couse after initial normal period, compatible with probable metabolic disorder, suspected genetic mutation occurs primarily in girls, associated with profound MR

rigid boundaries

distant relationships and disengagement

hiearchies

distribution of power

autonomy

doing for self

nonmalfeasance

doing no harm

Justice

doing what is fair, fairness in care

Four elements of malpractice

duty, breach of duty, proximate cause, damages

triangles

dyads that form triads to decrease stress; the lower the level of family adaptation the more likely a triangle will form

multi-transmission process

dysfunction present over many generations

EEG

electrical function of CNS, least expensive functional

Oppositional defiant disorder

enduring pattern of negativistic, defiant, disobedient, hostile, and defiant behaviors, usually directed at authority figures

neurodevelopment theory of schizophrenia

enlarged ventricles smaller frontal and temporal lobes cortical atrophy decreased cerebral blood flow hippocampal reduction

abnormalities in schizophrenic brain structure

enlargement of lateral ventricles widened cortical sulci diffuse decreases in volume of white and gray matter decreased volume of frontal lobe hypovolume in hippocampus, amygdala, and thalamus

diffuse boundaries

enmeshment

neurotransmitter theory of schizophrenia

excessive D2 in mesolimbic decreased D2 in mesocortical excess glutamate decreased GABA decreased serotonin

Narcolepsy

excessive daytime sleepiness and abnormal manifestations of REM sleep

glutamate

excitatory significant in bipolar and seizure d/o increase leads to psychosis and bpad

risk factors for abusers

exposure to violence at an early age, low self-esteem, social isolation, lack of support, cognitive impairment, physical and financial dependency

object loss theory

fairbairn, winnicott, guntrip early psychological development issues lay the foundation for depressive responses in later life; the child is able to form relationships but then experiences a loss, usually maternal. dept of loss then produces responses including separation anxiety, grief, mourning, despair - predisposes child to react in similar ways to future losses

family homeostasis

families resist change to maintain homeostasis

morphogenesis

family's tendency to adapt to change when changes are necessary

morphostasis

family's tendency to remain stable in the midst of change

Creutzfeld-Jacob Disease

fatal and rapidly progressive disorder occurs in adults middle age or older initially manifests with fatigue, flu-like symptoms, cognitive impairment later with aphasia, apraxia, emotional lability, depression, mania, psychosis, personality changes and dementia

MSE findings of physical abuse

fearful, evasive, guarded, depressed, passive, dependent

anticipatory guidance

framework for implementation of prevention strategies; based on the premise that information can be provided to people that helps them cope more effectively with events that occur along the lifespan

existential therapy

frankl reflection on life and self-confrontation are encouraged; focuses on individuals accepting freedom and making responsible choices; focus on the present and personal responsibility

psychoanalytic therapy

freud change through the development of insight and awareness of maladaptive defenses attends to past development that now shapes present issues

psychodynamic theory of anxiety

freud conflict between id, ego, superego which is unconscious but anxiety is consciously felt conflict entails fear of punishment

aggression turned inward theory

freudearly psychological development issues lay the foundation for depressive responses in later life ; the child is able to form relationships but then experiences a loss, real or imagined but unexpected, usually maternal. this loss can be death, illness, or lack of emotional availability, birth of sibling. the child feels angry but is afraid to express this anger, and may fear future loss if he/she does express anger, leading to the child to believe that anger is unacceptable. the child turns the anger inward and rationalizes that he or she was the cause of the abandonment, then develops guilt over the lost love. a similar reaction occurs as an adult in response to loss

The Medicaid funded health program is: funded with premiums from participants. unlimited on the number of adult visits. funded by both state and federal governments. Correctbasically the same from state to state.

funded by both state and federal governments. Medicaid is state run and specific to each state. The state programs are funded by a combination of state and federal funds. Most states have limits on the number of adult visits. Some states have no limits on visits for children. Participants generally do not pay premiums like Medicare recipients pay

risk factors for substance abuse

genetic loading association with peer structure with heavy substance abuse co-occurring psychiatric disorder age and gender chronic pain untreated pathologic anxiety

risk factors for conduct disorder

genetic loading dysfunctional family patterns substance abuse

risk factors for BPAD

genetic loading family history of BPAD or MDD 24% increase if relative has type I 5% increase if relative has type II 25% increase in relative has MDD

risk factors for cyclothymic

genetic loading family hx BP disorder type I substance abuse

risk factors for dysthymia

genetic loading first degree relative with MDD first degree relative with dysthymia female

risk factors for anxiety

genetic loading limited coping skills

risk factors for ADHD

genetic loading - ADHD, mood disorders, anxiety disorders pregnancy and perinatal complications family conflict

biological theory

genetic loading - defects in reward center of the brain

risk factors for schizophrenia

genetic loading - first degree relative prenatal exposure to flu or virus prenatal malnutrition obstetrical complications CNS infection in childhood

risk factors for PTSD

genetic loading - tend to run in families experienced or witnessed trauma hx of MDD in relatives

risk factors for depression

genetic loading, female, prior episode of MDD, postpartum, medical comorbidity, single marital status, significant environmental stressors such as loss

risk factors and incidence for aspergers

genetic loading- more present in families with the disorders or ASDs

genetic theory of schizophrenia

genetics - 1% general population increases to 50% monozygotic twins, 15% in dizygotic twins, 40% if both parents have the dz SNP defect is believed to exist

structural mapping

genogram mapping relationships using symbols to represent

lithium

good standard for treating mania shows some effectiveness for depression 0.5-1.2 rapid cycling seldom respond to lithium

narcissistic

grandiose sense of self-importance preoccupation with fantasies of power, success, brilliance, beauty belief of self-importance excessive admiration required entitlement empathy lacking envy of other others and belief that other envy them arrogant

state legislative statutes

grant legal authority, the nurse practice act, may require collaborative agreement

dementia

group of disorders characterized by development of multiple cognitive deficits: impaired executive functioning impaired global intellect with preservation of LOC impaired problem solving impaired organizational skills altered memory

strategic therapy

haley symptoms are viewed as metaphors and reflect problems in the hierarchal structure treatment goal is to help family members behave in ways that will not perpetuate the problem behavior interventions are problem focused; more symptom focuses than structural therapy

HIPAA

health care privacy act: educated about HIPAA, have access to medical records, request amendments, require their permission for disclosure

In a situation where the patient is cognitively impaired-Decision-making often deferred to a

healthcare proxy.

etiology of MR

heredity accounts for 5% - tay-sachs, tuberous sclerosis, trisomy 21, fragile X early alteration in embryonic development for 30% - prenatal exposure medical conditions for 5% - infections, brain trauma pregnancy and perinatal problems for 10% - fetal malnutrition, premature birth, fetal hypoxia, birth trauma no clear etiology for 30-50% most preventable cause is fetal alcohol syndrome

biological risk factors

hx of mental illness, poor nutrition, poor health

physical abnormalities in ADHD

hypertelorism - increased distance btw eyes highly arched palate low-set ears higher than average accidental injury rate

MAOIs side effects

hypertensive crisis when taken with tyramine caution when taking with SSRIs, meperidine, decongestants, TCAs, antipsychotics, st johns wort, tryptophan, ritalin, asthma meds other side effects include insomnia, wgt gain, anticholinergic effects, lightheadedness or dizziness, sexual dysfunction

abnormalities in schizophrenia brain function

hypofrontality decreased cerebral blood flow and metabolism diffuse hypometabolic action in cortical-subcortical circuitry

structural changes of MDD

hypovolemic hippocampus hypovolemic pre-frontal cortex

schizotypal personality disorder

ideas of reference odd beliefs, magical thinking unusual perceptual experiences paranoid ideation inappropriate or constricted affect behavior overtly odd, eccentric or peculiar few or no friends excessive social anxiety

PET

images of brain with radiographic dye is inserted; very expensive and rare functional

Etiology of autism

imbalances of glutamate, serotonin, and GABA are thought to be implicated brain imaging studies show micro and macroscopic abnormalities of the amygdala, hippocampus, and cerebellum decreased number of purkinje cells in the cerebellum

dysarthria

impaired ability to articulate words

Insomnia

inability to get the amount of sleep needed to function efficiently during the day

dysnomia

inability to name objects

skill deficit

inability to perform a functional skill despite the physical ability - as seen in dementia

dysgraphia

inability to write

group therapy

increases self-insight, increases social skills, is cost effective, develops sense of community uses yalom's factors including ope, universality, altruism, increased social skills, imitative behaviors, interpersonal learning, group cohesiveness, catharsis, existential factors, corrective refocusing

sibling position

influences interactions and personality characteristics

confidentiality

information is not disclosed, protected by Medical Record Confidentiality Act of 1996

SPECT

information on cerebral blood flow, expensive functional

GABA

inhibitory decrease leads to anxiety

evidence based practice

integration of best research evidence with clinical expertise and patient values and needs

Autism Spectrum Disorders

involves marked impairment of social and cognitive abilities

rationalization

justification of illogical ideas, feelings or actions by developing an acceptable explanation

schizoid personality disorder

lacks close friends or social supports is indifferent to opinion of others appears cold and detached exhibits affective flattening

behavioral therapy

lazarus changing maladaptive behaviors by participating in active techniques such as exposure, relaxation, problem solving, and role playing

statistics for domestic violence

leading cause of injury to women 15-44 1 in 4 pregnant women are abused 63% of men incarcerated btw ages of 11 and 20 have murdered their mother's abuser 33% of male abusers are well educated and include men in professional jobs

competency

legal, not medical concept - determination that client can make reasonable judgments and decisions regarding treatment and health concerns

nuclear family emotional system

level of differentiation of the parents usually equal to the level of differentiation of the entire family

The difference between licensure and certification

licensure establishes a person is qualified to do a role and granted by governmental regulations. certification implies mastery learning and comes from a non-governmental agency

DBT

linehan used in BPD patients goals are to decrease suicidal behavior, decrease therapy interfering behavior, decrease emotional reactivity, decrease self invalidation, decrease crisis generating behavior, decrease active passivity, increase realistic decision making, increase active communication

norepinepherine

locus ceruleus decrease leads to depression

categories of behavior for ODD

loses temper, argues with adults, refuses to comply with adult's rules, deliberately annoys people, blames other for their mistakes, touchy or easily annoyed, angry and resentful, spiteful or vindictive

clearly defined boundaries

maintain individual separateness and belongingness

risk factors for ASD

male MR genetic loading

hierarchy of needs

maslow health model certain needs are more important than others self actualization is highest

autosomal dominant

may be present in more than one generation and up to 50% of offspring when one parent is affected, i.e. mar fan syndrome

altruism

meeting the needs of others in order to discharge drives

Pharmacology for ADHD

methylphenidate - ritalin, metadate, concerta, methylin amphetamine - dexadrine, adderall, focalin, vyvanse atomoxetine - strattera

levels of MR

mild - IQ is 50-55 - 70 moderate - IQ is 35-40 - 50-55 severe - 20-25 - 35-40 profound - below 20-25

structural family therapy

minuchin - placed emphasis on how, when, and to whom family members relate to in order to understand and change family structure individual symptoms are rooted in the family; the symptom is a function of the health of the whole family and is maintained by structural problems

pediatric OCD

more common in boys than girls washing, checking, ordering most common linked to learning disorders, disruptive behaviors, tourettes PANDAS - group A strep

statistics of conduct disorder

more common in children of parents with ASPD, alcohol dependence, mood disorders, or schizophrenia 1-10% of US population with 6-16% of boys and 2-9% of girls onset is earlier for boys, 10-12, than for girls, 16

statistics of ODD

more common in children of parents with hx of ODD, conduct disorder, ADHD, ASPD, mood disorders, or substance abuse affects 2-16% of US population boys with disorder are more prevalent than girls before puberty, but then the ratio is equal

demographics of autism

more common in families with history of PDD concordant rate for identical twins is 60% incidence is 2-5 cases per 10,000 in US male to female ration is 4:1 75% of children with ASD have MR onset of symptoms is before 3 years

adolescent mania

more psychotic, associated with antisocial behavior, substance abuse, school issues

pedophilia

most common paraphilia (sexual impulse disorder)

Dementia of the alzheimer's type

most common type gradual onset and progressive decline without focal neurological deficits hallmark amyloid deposits and neurofibrillary tangles

dependent

most frequently diagnosed personality disorder higher in women than men co-morbid with those with chronic physical abuse difficulty making decisions without advice needing others to assume responsibility goes to excessive lengths to obtain nurturing and support urgent seeking of a relationship if a close relationship ends preoccupation with being left alone

OCD personality do

mostly men, similar by less severe than OCD preoccupation with detail, rules, order perfectionism that interferes with task completion excessive devotion to work and productivity inflexible on issues of morality inability to discard worn out or worthless objects miserly spending rigid and stubborn

akathisia

motor restlessness

dystonia

muscle spasm, mostly back or neck

paranoid personality disorder

neither desires nor enjoys close relationships chooses solitary activities shows little to no interest in sexual activity derives no pleasure in social activities

biological theory of BPAD

neurotransmitter deregulation GABA deregulation increased noradregergic activity voltage-gate ion channel abnormalities kindling - process of neuronal membrane threshold sensitivity dysfunction neuronal misfiring

Accredidation

nongovernmental association evaluates and certifies that an organization (e.g., hospital, clinic, nursing program) has met the requirements and excels in its class. For example, the American Nurses Credentialing Center and the National League for Nursing Accrediting Commission, Inc., are accreditation organizations.

prevalence rate

number of existing cases of a disorder at a specific time

incidence rate

number of new cases occurring over specific time

type II panic attack

occurs immediately and invariably on exposure to or in anticipation of a situational cue or trigger

family systems theory

one can not understand any family member without understanding how all family members operate together

circular causality

ongoing feedback loop in which actions and reactions maintain a problem

risk factor for delirium

over 50 years male multisystem medical issues substance abuse past episode of delirium

reaction formation

overcompensation; opposite feeling is acted on

family projection process

parents transmitting their own level of differentiation onto the most susceptible child

access to care model

patient centered care model based on the principle that health care services should be coordinated and directed by a single physician or other provider

conduct disorder

persistent pattern of behavior in which the rights of others or societal norms or rules are violated

cognitive theory

piaget human development evolves through cognition, learning, and comprehending stages of development

Theories of ADHD

polygenic neurobiological deficits are associated abnormalities of front-subcortical pathways: frontal cortex and basal ganglia abnormalities of reticular activating system structural abnormalities producing neurotransmitter deficits in dopamine and norepinepherine dysfunction

psychological risk factors

poor self concept, external locus of control, poor ego defenses

BPD

predominantly in women often with positive hx of significant childhood abuse, neglect or loss frantic efforts to avoid real or imagined abandonment unable, intense relationships identity disturbance impulsive with self-damaging behavior recurrent suicidal behavior feelings of emptiness inappropriate anger or affective response transient psychosis

Reticulation formation system

primitive brain involuntary movement, reflex, muscle tone, vital sign control, BP, RR

neurobiological theory of anxiety

problems with HPA axis problems with amygdala not being able to shut off low GABA

Reminiscence therapy

progressive return of memories of past experiences used with the elderly enables participants to search for meaning in life, strive for resolution of conflicts

Beneficence

promoting well being and doing good

credentialing

protect the pubic by ensuring minimum level of competence

IRB

protects rights of participants in studies - the belmont report

genital stage

puberty and on integration and synthesis of behaviors from early stages, genital based sexuality linked to sexual perversion disorders

serotonin

raphe nuclei decrease leads to depression, ocd, schizophrenia

alcohol statistics

rates highest in males, african americans, hispanics, native americans - lowest in asian americans 15% general population

temporal lobe

receptive speech/comprehension (wernicke), auditory area, memory, emotion, vision sensory integration problems lead to visual or auditory hallucinations, aphasia, and amnesia

standards of practice

regarding the quality and type of practice, a way to judge the nature of care given

limbic system

regulation and modulation of emotions and memory; contains hypothalamus, thalamus, hippocampus (memory), amygdala (mood, fear emotions, and aggressions)

regression

return to more comfortable thoughts, behaviors, or feelings in earlier stages of development

humanistic therapy

rogers aka person centered therapy concepts include self-directed growth and self actualization; people are born with the capacity to direct themselves toward actualization

statutory law

rules differ for each state, further define scope of practice

experiential therapy

satir behavior is determined by personal experience and not by external reality focus is on being authentic, freedom of choice, human validation, and experiencing the moment goal is to increase self worth of each family member - goal is growth rather than reduction of symptoms

AIMS

scale 0-4 for the following: gait, profile, sitting, arms in front touching thumbs, opening bout, flexing armts

substance abuse statistics

schizophrenic are 4x more likely bipolar 5x more likely

vascular dementia

second most common type aka multi-infarct dementia primarily caused by cardiovascular disease and characterized by step-type declines most common in men with high BP and cardiovascular risk factors hallmarks are bruits, fundoscopic abnormalities, and enlarged cardiac chambers

physical findings with Rett's Disorder

seizures, irregular respirations, scoliosis, loss of purposeful hand skills, stereotypical hand movements

learned helplessness-hopelessness theory

seligman modified cognitive theory individual becomes depressed related to perceptions of a lack of control over life events and experiences these perceptions are learned over time, and this lack of control leads to poor coping and adapting the individual becomes passive and non reaction because of self-perceptions of personal characteristics of helpless, hopeless, powerless

parietal lobe

sensory area, taste, reading and writing problems lead to sensory perceptual disturbances and agnosia

family structure

set of functional demands that organize the way members interact with each other; made up of subsets including martial, paternal, sibling, coalitions in which two members join forces against a third, and boundaries

Asperger's disorder

severe, sustained impairment in social interaction and restricted repetitive patterns of behavior, interests and activities

EMDR

shapiro form of behavioral therapy integrating the use of rapid eye movements to treat traumatic stress and memories, used in ptsd

nurse practitioner is working in a minor care area of an emergency department. An illegal immigrant has a puncture wound caused by an unknown sharp object in a trash container. A dirty needle is suspected. The nurse practitioner

should prescribe appropriate medications for HIV exposure even though the nurse practitioner knows the patient can't afford them The nurse practitioner should prescribe the medications as for anyone with possible HIV exposure and refer to social services or a community referral agency that can help this patient acquire the appropriate medications.

MEG

similar to EEG, more useful in psych disorders functional

type III panic attack

similar to cued but is not immediate and not invariably tied to trigger

subtypes of phobia

situational - bridges, flying; most common adult natural/environmental - storms, water, heights; 2nd most common adult Blood-injection-injury - familial, strong vasovagal component animal - rats, snakes, spiders other - choking, vomit, illness, noise; children usually costumes or noises

medications that induce mania

steroids, antidepressants in those with bipolar, iNH, antabuse

social risk factors

stressful occupation, low socioeconomic status, poor level of social integration

Mental Retardation

subaverage general intellectual functioning based on a standardized intelligence test onset must occur before age 18 IQ below 70 concurrent impairment exists in adaptive functioning in at least two areas: communications, self care, home living, social skills

Huntington's Disease

subcortical dementia characterized by motor abnormalities psychomotor slowing, difficulty with complex tasks memory, language, and insight usually intact until later high incidence of depression and psychosis

dementia due to HIV disease

subcortical dementia progressive cognitive decline, motor abnormalities, and behavioral abnormalities co-occurs with OCD, PTSD, and GAD, depression, and mania development in dementia in client with HIV is an indicator of poor prognosis - death usually within 6 months clinical signs include: global impairment mutism seizures hallucinations delusions apathy mania

risk factors for sexual abusers

substance abuse, psychiatric disorders, divorce, pregnancy, family hx of abuse, long term exposure to violence, social isolation, environmental stressors

Dopamine

substantia nigra and VTA mesolimbic, mesocortical, nigrostriatal, tuberoinfndibular increase leads to schizophrenia, decrease to parkinson's, substance abuse

interpersonal theory of anxiety

sullivan when satisfaction and security goals are unmet conflict occurs because individual feels that their needs won't be met because of rejection, feelings of inferiority

MDD in children

symptoms are the same, however these are more pronounced: irritability, somatic complaints, social withdrawal. these are less common before puberty: psychosis, motor retardation, hypersomnia, increased appetite

delirium

syndrome, not a disease hallmark is a disturbance of consciousness accompanies by changes in cognition

research utilization

synthesizing, disseminating, and using research generated knowledge to make a change in practice

Common inhibitors

tagamet, erythromycin, biaxin, fluoroquinolones, prozac, paxil

Common induces

tegretol, antifungals, rimfampin, dilantin, tripletal or topamax

veracity

telling the truth

HLA-B1502 allele

testing for this gene is required by the FDA in people of asian descent before being prescribed tegretol due to risk of steven johnsons syndrome and toxic epidermal necrolysis

Chronobiology

the field of science that studies the rhythms of life. It explores the many bodily changes governed by hours and the seasons.

external validity

the outcome is generalizable to the population

Autonomy

the right of self-determination, independence, and freedom.

internal validity

the treatment caused a change in the outcome

x-linked disorders

these are caused by a faulty gene on an X chromosome, i.e. color blindness

protease inhibitors

these can increase levels of wellbutrin, benzodiazepines, and SSRIs they may induce depakote and ativan

TPA

third-party administrator is the organization that does the processing of claims and administrative work for another company (health insurer, health plans, retirement plans).

risk factors for simple phobia

traumatic past exposure observation of another's trauma excessive informational transmission - parental warns of danger genetic loading - blood/injection type is most common

respect

treating everyone with equal respect

repression

unconscious exclusion of unwanted emotions or thoughts

sublimination

unconscious process of substitution of socially acceptable constructive activity for strong unacceptable impulse

projection

unconscious rejection of unacceptable personal beliefs or feelings by attributing them to others

type I panic attack

uncued, no association or trigger out of the blue attack over time may become cued

Licensure

used to establish a designated level of professional competence. and establish minimal level of professional competence. Licensure and competence are two distinct recognitions

Best interest standard

used to make decisions regarding a patient's care when the patient is unable to speak for themselves and the patient's values, ideals, attitudes or philosophy are not known

What are descriptive statistics?

used to summarize and describe data Used to describe the basic features of the data Numerical values that summarize organize describe observations Descriptive statistics are just descriptive. They do not involve generalizing beyond the data show or summarize data in a meaningful way such that patterns might emerge from the data. Descriptive statistics do not, however, allow us to make conclusions beyond the data Can be generated by either quantitative or qualitative studies

ASPD

usually diagnosed by age 18, more common in men, high substance abuse, highly impulsive, often diagnosed with conduct d/o failure to conform to social norms repeated acts that are grounds for arrest deceitful, lying impulsive, reckless disregard lack of remorse

reward center

ventral tagmental area and nucleus accumbens DA is released and then enhanced by the release of morphine like neuropeptides with repeated use, the DA system becomes sensitized leaded to increased use

Occipital lobe

visual association is a function of this lobe of the brain

Occipital lobe

visual cortex problems lead to blindness, visual hallucinations

Frontal Lobe

voluntary motor movement, coordinates movement of multiple muscles, sensory input to trigger memory and decision making, working memory, reasoning, planning, insight, judgment, impulse control, intelligence, abstraction, expressive speech (broca), personality problems lead to personality, emotional, and intellectual change

Pharmacokinetics

what the body does to the drug - absorption, distribution, metabolism, and excretion

pharmacodynamics

what the drug does to the body, target sites for action, receptors, etc.

collaborative agreement

what types of drugs may be prescribed and of some oversight board

MSE findings of sexual abuse

withdrawn, frightened to touch, anxious, scattered appearance, hyper reactive to touch

Living Will: The Five Wishes Document

• Five Wishes document - A type of living will that meets the requirements of an advanced directive in 42 states, useful in all 50 states • Delineates the following: -Who patient want to make healthcare decisions when unable to do so. - The kind of healthcare treatment patient does and does not want. -How comfortable patient wants to be. -How patient wants people to treat the person. -What patient wants loved ones to know.

HIPAA Consent for Use and Disclosure of PHI: When is it not required?

• Healthcare providers must document...(cont.) -When required by law to treat and unable to obtain consent (for example, involuntary commitment)

Damage vs Negligence

• Must prove that actual physical or emotional harm (injury) occurred - For instance, there are cases where the NP is negligent but no damage or harm occurred as a result. • If the malpractice case is successful, damages will typically be paid.

HIPAA: A Few Additional Points

• Once provided, the patient can revoke consent. -Must be in writing • If consent is revoked, will not prevent billing for the service • Revocation cannot be backdated - Covered healthcare component does not have to retrieve PHI used or disclosed prior to revocation • Client may request restrictions on uses or disclosures of health information for TPO - Covered health care component does not have to agree to the requested restriction(s)

Competency vs Incompetency

• Only a court can declare a person incompetent and appoint a guardian to make decisions for them. - Impaired judgment alone does not make a patient incompetent. - This is seldom needed, especially if family, healthcare proxy agree patient cannot make an informed decision.

Medicare Part D

• Prescription drug coverage -Must have part A and B in order to qualify for part D - A premium is charged.

Competency

• Respect for autonomy leads to determination of competency. • The law presumes that all adults are competent, until demonstrated otherwise, to make decisions regarding their healthcare.

Failure to Comply with HIPAA Regulations

• The Office of Civil Rights of the Department of Health and Human Services enforces civil violations. - Civil penalties are usually monetary fines. HIPAA allows fines of up to $100 for each violation of the law, to a limit of $25,000 per year for violations of the same requirement

Malpractice Defined

• The failure of a healthcare professional to exercise such care as would a reasonably prudent healthcare professional under the same or similar circumstances.

Autonomy is not an absolute right

- Limitations are placed when person's autonomy could interfere with the rights, health or well-being of another. - Common example - Mycobacterium tuberculosis (or for other contagious condition) therapy can be provided under court order to a competent person

Spouse as Healthcare Proxy

Usually considered de-facto proxy if no other has been appointed - Still advisable that legally married couples appoint a proxy. - Common law, same sex unions are often not recognized.

What Do The HIPAA Privacy Regulations Cover?

Establishes client right to: - Access his/her health information and limits situations wherein access can be denied - Amendment to his health information • Establishes - Requirement for de-identification of health information that can be disclosed with or without consent - Authorization a protocol for using protected health information for marketing and fundraising • Provides special protections for psychotherapy notes • Specifies who may consent or authorize disclosure of information on behalf of the client • Requires -Designation of a privacy officer and a contact person for complaints - Identification of members of the workforce who need access to PHI and categories of information to which access is needed - Training of all staff members

Providing Consent when Unable: Advance Directives

Methods of decision making for patients who cannot communicate wishes - Appointed person makes decisions based upon the patient's past wishes and values

Medicaid:

Provides medical benefits to low income people who have no medical insurance or have inadequate medical insurance. • The federal government establishes general guidelines for the administration of Medicaid benefits. Specific eligibility requirements to receive Medicaid benefits, as well as the type and scope of services provided, are determined by each individual state.

Failure to Comply with HIPAA Regulations

The Department of Justice enforces criminal violations of the HIPAA Standards. - Criminal sanctions for knowing misuse or disclosures of PHI carry fines of up to $50,000 to $250,000 and one to ten years imprisonment.

Schedule 5

V--Includes medication or substances with low potential for abuse relative to the drugs or other substances in schedule IV - Primarily used for anti-tussive (low dose codeine or other opioid containing cough medications), anti-diarrheals (Lomotil)

Purpose of HIPAA

To establish national standards for electronic healthcare transactions and national identifiers for providers, health plans, and employers -Not simply an issue of maintaining privacy The Administrative Simplification Compliance Act (ASCA) amended HIPAA and requires that, since 2003, all claims submitted to Medicare electronically except for certain circumstances.

HIPAA: True or false? In keeping with HIPAA's requirements: - A healthcare provider can leave a patient a message on his or her answering machine but the amount of information disclosed should be limited.

True

HIPAA: True or false? In keeping with HIPAA's requirements: - If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should take the paper healthcare record with him/her, in order to minimize the risk of unauthorized access to information.

True

HIPAA: True or false?- If interrupted during a patient visit, prior to leaving the exam room, the healthcare provider should lock or otherwise disable the electronic health record (EHR) to minimize the risk of unauthorized access to information

True

HIPAA: True or false?In keeping with HIPAA's requirements: (cont.) -Unless asked not to do so by the patient, a healthcare provider is allowed to leave a message with a family member or other person who answers the phone when the patient is not home.

True

T/F: - An employee of a healthcare facility is only able to access patient records for legitimate, job-related purposes.

True

T/F: - If a patient requests a paper copy of his/ her record, the healthcare facility can charge a reasonable fee for this service.

True

T/F: Dental care for Medicaid enrollees under the age of 21 years is a basic requirement of the plan.

True

T/F: In keeping with HIPAA's requirements: (cont.) -Unless under the control of the healthcare provider or staff, paper records should be kept a secure location, such as a locked desk, locked filing cabinet or office with appropriate staff.

True

T/F: The patient must be competent to participate in informed consent

True

True or false? • State level authorization dictates the ability of the NP to obtain a Federal DEA number.

True

True or false? • The services rendered under Medicaid that is provided by one state may differ considerably in amount, duration, or scope from services provided in a similar or neighboring states.

True

True or false? The majority of NPs are eligible to obtain a Federal DEA number.

True

Transactional analysis

When a person is traumatized the thoughts and feelings get tied together and the process of therapy is to unlock the two

Hope

Which curative factor is instilled in AA and NA group members?

Healthcare Proxy Resources

• AARP - http://www.aarp.org/relationships/car egiving/info-09- 2010/legal_documents_women_long_ term_care.html

Medicaid: General Program Requirements

• Enrollee must be: -US national, citizen or permanent resident in need of health care/insurance assistance - Financial situation characterized as low income or very low income • Poverty alone is not a qualifier. • Enrollee characteristics: - Blind - Disabled - Elder in need of nursing home care -Pregnant woman -Have child(ren) with a disability, or be responsible for children under 19 years of age.

Purpose of HIPAA Privacy Regulations

• Gives clients more control over their health information. • Sets boundaries on the use and disclosure of health records. • Establishes appropriate safeguards health care providers and others must achieve to protect privacy of client information. • Holds healthcare providers accountable with civil and criminal penalties if they violate clients' privacy rights

HIPAA: Who is a Covered Entity?

• Health care providers who electronically transmit health information in connection with a standard transaction -Healthcare providers, hospitals, labs, health departments • Health plans (provides or pays the cost of medical care) -Medicaid, Medicare, Blue Cross, others • Healthcare clearinghouses - Any entity used to process or aid in the processing of information

HIPAA Consent for Use and Disclosure of PHI: When is it not required?

• Healthcare providers must document attempt to obtain consent and reason why not obtained, but treatment can be provided. - Emergency treatment situation -Unable to obtain consent due to substantial communication barriers and consent to receive treatment is inferred by client

Schedule of Controlled Substances 1

• I--Illegal for prescription - Examples: Heroin, MDMA, PCP - Select researchers can register to receive small amounts under specific conditions.

The APN writes a prescription for cefpodoxime for a patient who has an acute otitis media and known beta-lactam allergy. The patient takes two doses of the medication, has no reaction, then realizes this might be one of the problematic antibiotics He notifies the practice and the APN changes the medication. He makes a full recovery. • Is there negligence? • Is there damage?

• Is there negligence? Yes • Is there damage? No