The Safe & Effective Care Environment: The Management of Care Practice Questions

47. The current focus of performance improvement activities is to facilitate and address: A. Sound structures like policies and procedures B. Processes and how they are being done C. Optimal client outcomes D. Optimal staff performance

Correct Response: C The current focus of performance improvement activities is to facilitate and address optimal client outcomes. Throughout the last several decades performance improvement activities have evolved from a focus on structures to a focus on process and now, to a focus on outcomes. Staff performance is not the focus of performance improvement activities but instead the focus of competency assessment and validation.

5. A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving in which capacity and role of the registered nurse? A. Client advocate B. Collaborator C. Politician D. Entrepreneur

Correct Response: A A nurse who organizes and establishes a political action committee (PAC) in their local community to address issues relating to the accessibility and affordability of healthcare resources in the community is serving as the client advocate. As you should know, the definition of "client" includes not only individual clients, and families as a unit, but also populations such as the members of the local community. Although the nurse, as the organizer of this political action committee (PAC), will have to collaborate with members of the community to promote the accessibility and affordability of healthcare resources in the community, this is a secondary role rather than the primary role. Additionally, although the nurse is serving in a political advocacy effort, the nurse is not necessarily a politician and there is no evidence that this nurse is an entrepreneur.

41. Legal prohibitions against sharing passwords are legally based on: A. The Security Rule B. The American Nurses Association's Code of Ethics C. The American Hospital's Patients' Bill of Rights D. The Autonomy Rule

Correct Response: A Prohibitions against sharing passwords are legally based on the Security Rule of HIPAA mandates administrative, physical, and technical safeguards to insure the confidentiality, integrity, and availability of electronic protected health information. This rule relates to electronic information security as well as other forms of information. The American Nurses Association's Code of Ethics and the American Hospital's Patients' Bill of Rights both address client confidentiality and their rights to privacy, however, these statements are not legal, but instead ethical and regulatory statements; and lastly, there is no autonomy law or rule.

14. Which type of legal consent is indirectly given by the client by the very nature of their voluntary acute care hospitalization? A. An opt out consent B. An implicit consent C. An explicit consent D. No consent at all is given

Correct Response: B The type of legal consent that is indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent indirectly given by the client by the very nature of their voluntary acute care hospitalization is an implicit consent. An explicit consent, on the other hand, is the direct and formal consent of the client; and an opt out consent is given when a patient does NOT refuse a treatment; this lack of objections by the patient indicates that the person has consented to the treatment or procedure with an opt out consent.

10. You are providing care to a permanently disabled Iraqi war veteran who is 28 years of age. When he returned home from the war at the age of 24 years of age 2 years ago he was deemed permanently disabled by both the Veterans Administration (VA) and the Social Security Administration. He receives a substantial monthly service connected disability check from the Veterans Administration and he has no spouse or legal dependents. Which type of governmental health insurance is he now entitled to? A. Only the VA health care services because he is not 65 years of age B. Medicare because he has been deemed permanently disabled for 2 years C. Medicaid because he is permanently disabled and not able to work D. Choices B and C

Correct Response: B This client is legally eligible for Medicare because he has been deemed permanently disabled for more than 2 years in addition to the VA health care services. People over the age of 65 and those who are permanently disabled for at least two years, according to the Social Security Administration, are eligible for Medicare. Based on the information in this scenario, the client is not eligible for Medicaid because has a "substantial" VA disability check on a monthly basis and is not indigent and with a low income.

24. The stages of conflict and conflict resolution in the correct sequential order are: A. Conceptualization B. Frustration C. Resolution D. Taking action

Correct Response: B, A, D, C The stages of conflict and conflict resolution in the correct sequential order are frustration, conceptualization, and taking action.

21. Conflicts, according to Lewin, include which types of conflict? Select all that are accurate. A. Conceptualization conflicts B. Avoidance - Avoidance conflicts C. Approach - Approach conflicts D. Resolvable conflicts E. Unresolvable conflicts F. Double Approach - Avoidance conflicts G. Approach-Avoidance conflicts

Correct Response: B, C, F, G According to Lewin, the types of conflict are Avoidance-Avoidance conflicts, Approach- Approach conflicts, Double Approach - Avoidance conflicts and Approach-Avoidance conflicts.

36. What ethical principle below is accurately paired with a way that ethical principle is applied into nursing practice? A. Justice: Equally dividing time and other resources among a group of clients B. Beneficence: Doing no harm during the course of nursing care C. Veracity: Fully answering the client's questions without any withholding of information D. Fidelity: Upholding the American Nurses Association's Code of Ethics

Correct Response: C Fully answering the client's questions without any withholding of information is an example of the application of veracity into nursing practice. Veracity is being completely truthful with patients; nurses must not withhold the whole truth from clients even when it may lead to patient distress. Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients. Beneficence is doing good and the right thing for the patient; it is nonmaleficence that is doing no harm.

11. You are a registered nurse who is performing the role of a case manager in your hospital. You have been asked to present a class to newly employed nurses about your role, your responsibilities and how they can collaborate with you as the case manager. Which of the following is a primary case management responsibility associated with reimbursement that you should you include in this class? A. The case manager's role in terms of organization wide performance improvement activities B. The case manager's role in terms complete, timely and accurate documentation C. The case manager's role in terms of the clients' being at the appropriate level of care D. The case manager's role in terms of contesting denied reimbursements

Correct Response: C Registered nurse case managers have a primary case management responsibility associated with reimbursement because they are responsible for insuring that the client is being cared for at the appropriate level of care along the continuum of care that is consistent with medical necessity and the client's current needs. A failure to insure the appropriate level of care jeopardizes reimbursement. For example, care in an acute care facility will not be reimbursed when the client's current needs can be met in a subacute or long term care setting. Nurse case managers do not have organization wide performance improvement activities, the supervision of complete, timely and accurate documentation or challenging denied reimbursements in their role. These roles and responsibilities are typically assumed by quality assurance/performance improvement, supervisory staff and medical billers, respectively.

39. Which of the following is most closely aligned with the principles and concepts of informed consent? A. Justice B. Fidelity C. Self determination D. Nonmalficence

Correct Response: C Self-determination is most closely aligned with the principles and concepts of informed consent. Self-determination supports the client's right to choose and reject treatments and procedures after they have been informed and fully knowledgeable about the treatment or procedure. Justice is fairness. Nurses must be fair when they distribute care and resources equitably, which is not always equally among a group of patients; fidelity is the ethical principle that requires nurses to be honest, faithful and true to their professional promises and responsibilities by providing high quality, safe care in a competent manner; and, lastly, nonmaleficence is doing no harm, as stated in the historical Hippocratic Oath.

43. Select the legal term that is accurately paired with its description. A. Assault: Touching a person without their consent B. Battery: Threatening to touch a person without their consent C. Slander: False oral defamatory statements. D. Slander: False written defamatory statements.

Correct Response: C Slander is false oral defamatory statements; and libel is written defamation of character using false statements. Assault, an intentional tort, is threatening to touch a person without their consent; and battery, another intentional tort, is touching a person without their consent.

7. The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on which legal consideration? A. The American Nurses Association's Scopes of Practice B. The American Nurses Association's Standards of Care C. State statutes D. Federal law

Correct Response: C The registered nurse, prior to the delegation of tasks to other members of the nursing care team, evaluates the ability of staff members to perform assigned tasks for the position as based on state statutes that differentiate among the different types of nurses and unlicensed assistive personnel that are legally able to perform different tasks. Although the American Nurses Association's Standards of Care guide nursing practice, these standards are professional rather than legal standards and the American Nurses Association does not have American Nurses Association's Scopes of Practice, only the states' laws or statutes do. Lastly, scopes of practice are within the legal domain of the states and not the federal government.

40. Which of the following is NOT an essential minimal component of the teaching that occurs prior to getting an informed consent? A. The purpose of the proposed treatment or procedure B. The expected outcomes of the proposed treatment or procedure C. Who will perform the treatment or procedure D. When the procedure or treatment will be done

Correct Response: D The minimal essential components of the education that occurs prior to getting an informed consent include the purpose of the proposed treatment or procedure, the expected outcomes of the proposed treatment or procedure, and who will perform the treatment or procedure. It is not necessary to include when the treatment or procedure will be done at this time. Other essential elements include: *The benefits of the proposed treatment or procedure *The possible risks associated with the proposed treatment or procedure *The alternatives to the particular treatment or procedure *The benefits and risks associated with alternatives to the proposed treatment or procedure *The client's right to refuse a proposed treatment or procedure

31. Number the priority of the following conditions using the numbers # 1 through # 6 with # 1 as the greatest priority and # 6 as the least priority. 1. Atrial fibrillation 2. First degree heart block 3. Shortness of breath upon exertion 4. An obstructed airway 5. Fluid needs 6. Respect and esteem by others

Correct Response: Client needs are prioritized in a number of different ways including Maslow's Hierarchy of Human Needs and the ABCs. In terms of priorities from # 1 to # 6 the conditions above are prioritized as follows: An obstructed airway First degree heart block Atrial fibrillation Shortness of breath upon exertion Fluid needs Respect and esteem by others The ABCs identifies the airway, breathing and cardiovascular status of the patient as the highest of all priorities in that sequential order; and Maslow's Hierarchy of Needs identifies the physiological or biological needs, including the ABCs, the safety/psychological/emotional needs, the need for love and belonging, the needs for self-esteem and the esteem by others and the self-actualization needs in that order of priority.

9. Which of the following patient care tasks is coupled with the appropriate member of the nursing care team in terms of their legal scope of practice? A. An unlicensed staff member who has been "certified" by the employing agency to monitor telemetry: Monitoring cardiac telemetry B. An unlicensed assistive staff member like a nursing assistant who has been "certified" by the employing agency to insert a urinary catheter: Inserting a urinary catheter C. A licensed practical nurse: The circulating nurse in the perioperative area D. A licensed practical nurse: The first assistant in the perioperative area

Correct Response: A An unlicensed staff member who has been "certified" by the employing agency to monitor telemetry can monitor cardiac telemetry; they cannot, however, interpret these cardiac rhythms and initiate interventions when interventions are indicated. Only the nurse can perform these roles. Unlicensed assistive staff member like a nursing assistant cannot under any circumstances be certified" by the employing agency to insert a urinary catheter or insert a urinary catheter because this is a sterile procedure and, legally, no sterile procedures can be done by an unlicensed assistive staff member like a nursing assistant. Lastly, the role of the circulating nurse is within the exclusive scope of practice for the registered nurse and the role of the first assistant is assumed only by a registered nurse with the advanced training and education necessary to perform competently in this capacity. Neither of these roles can be delegated to a licensed practical nurse or an unlicensed assistive staff member like a nursing assistant or a surgical technician.

34. Which is most closely aligned with ethics? A. Morals B. Laws C. Statutes D. Client rights

Correct Response: A Morals are most closely aligned with ethics. Ethics is a set of beliefs and principles that guide us in terms of the right and wrong thing to do which is the most similar to ethics. Laws and statutes defined what things are legal and what things are illegal. Lastly, client rights can serve as a factor to consider when ethical decisions are made; but they are not most closely aligned with ethics, but only, one consideration of many that can be used in ethical decision making.

38. One of the roles of the registered nurse in terms of informed consent is to: A. Serve as the witness to the client's signature on an informed consent. B. Get and witness the client's signature on an informed consent. C. Get and witness the durable power of attorney for health care decisions' signature on an informed consent. D. None of the above

Correct Response: A One of the roles of the registered nurse in terms of informed consent is to serve as the witness to the client's signature on an informed consent. Other roles and responsibilities of the registered nurse in terms of informed consent include identifying the appropriate person to provide informed consent for client, such as the client, parent or legal guardian, to provide written materials in client's spoken language, when possible, to know and apply the components of informed consent, and to also verify that the client comprehends and consents to care and procedures. The registered nurse does not get the client's or durable power of attorney for health care decisions' signature on an informed consent, this is the role and responsibility of the physician or another licensed independent practitioner.

52. Which statement about referrals is accurate? A. Referrals complement the healthcare teams' abilities to provide optimal care to the client. B. Referrals simply allow the client to be discharged into the community with the additional care they need. C. Nurses facilitate referrals to only the resources within the facility.

Correct Response: A Referrals complement the healthcare teams' abilities to provide optimal care to the client. When clients have assessed needs that cannot be fulfilled and met by the registered nurse in collaboration with other members of the nursing care team, the registered nurse should then seek out resources, as well as utilize and employ different internal or external resources such as a physical therapist, a clergy member or a home health care agency in the community and external to the nurse's healthcare agency.

45. Which statement about Respondeat Superior is accurate? A. Respondeat Superior does not mean that a nurse cannot be held liable. B. Respondeat Superior does not mean that a nurse cannot be held libel. C. Respondeat Superior is an ethical principle. D. Respondeat Superior is a law.

Correct Response: A Respondeat Superior does not mean that a nurse cannot be held liable and not libel which is a written defamation of character using false statements. Liability is legal vulnerability. Respondeat Superior is the legal doctrine or principle and not a law or ethical principle.

13. Which of these case management methods employs the intrinsic use of multidisciplinary plans of care that are based on the client's current condition, and reflect interventions and expected outcomes within a pre-established time line? A. The Case Manager Model B. The ProACT Model C. The Collaborative Practice Model D. The Triad Model of Case Management

Correct Response: A The Case Manager Model and the Collaborative Practice Model of case management are the only models of case management that employ the mandated and intrinsic use of critical pathways which are multidisciplinary plans of care that are based on the client's current condition, and that reflect interventions and expected outcomes within a pre-established time line. The ProACT Model, the Collaborative Practice Model and the Triad Model of Case Management do not necessarily employ critical pathways; these models can use any system of medical records and documentation.

17. Select the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait. A. The physical therapist B. The occupational therapist C. The podiatrist D. The nurse practitioner

Correct Response: A The member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient's functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient's ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Podiatrists care for disorders and diseases of the foot; and nurse practitioners, depending on their area of specialty, may also collaborate with nurses when a client is affected with a disorder in terms of gait, strength, mobility, balance, coordination, and joint range of motion, however the member of the multidisciplinary team that you would most likely collaborate with when the client is at risk for falls due to an impaired gait is a physical therapist.

49. The primary purpose of root cause analysis is to: A. Discover a process flaw B. Determine who erred C. Discover environmental hazards D. Determine basic client needs

Correct Response: A The primary purpose of root cause analysis is to discover process flaws. Root cause analysis and a blame free environment are essential to a successful performance improvement activity, therefore, root cause analysis does not aim to determine who erred and made a mistake. Root cause analysis explores and digs down to the roots of the problem, its root causes and the things, not people, which are the real reasons why medical errors and mistakes are made. It is nursing assessment that determines the basic client needs and environmental surveillance that discovers environmental safety hazards, and not root cause analysis.

33. Which of these skills is most closely related to successfully meeting the established priority needs of a group of clients? A. Time management skills B. Communication skills C. Collaboration skills D. Supervision skills

Correct Response: A Time management skills are most closely related to successfully meeting the established priority needs of a group of clients. In addition to prioritizing and reprioritizing, the nurse should also have a plan of action to effectively manage their time; they should avoid unnecessary interruptions, time wasters and helping others when this helping others could potentially jeopardize their own priorities of care. Although good communication skills, collaboration skills and supervision are necessary for the delivery of nursing care, it is time management skills that are most closely related to successfully meeting the established priority needs of a group of clients.

1. You are caring for a client at the end of life. The client tells you that they are grateful for having considered and decided upon some end of life decisions and the appointments of those who they wish to make decisions for them when they are no longer able to do so. During this discussion with the client and the client's wife, the client states that "my wife and I are legally married so I am so glad that she can automatically make all healthcare decisions on my behalf without a legal durable power of attorney when I am no longer able to do so myself" and the wife responds to this statement with, "that is not completely true. I can only make decisions for you and on your behalf when these decisions are not already documented on your advance directive." How should you, as the nurse, respond to and address this conversation between the husband and wife and the end of life? A. You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. B. You should be aware of the fact that the wife of the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. C. You should be aware of the fact that the client has a knowledge deficit relating to advance directives and durable powers of attorney for healthcare decisions and plan an educational activity to meet this learning need. D. You should reinforce the wife's belief that legally married spouses automatically serve for the other spouse's durable power of attorney for health care decisions and that others than the spouse cannot be legally appointed while people are married.

Correct Response: A You should respond to the couple by stating that only unanticipated treatments and procedures that are not included in the advance directive can be made by the legally appointed durable power of attorney for healthcare decisions. Both the client and the client's spouse have knowledge deficits relating to advance directives. Legally married spouses do not automatically serve for the other spouse's durable power of attorney for health care decisions; others than the spouse can be legally appointed while people are married.

23. You are the chair person for the healthcare facility's newly formed multidisciplinary Safety Committee. During the Forming stage of this group's development major conflicts have arisen. Which technique of conflict resolution should you use to resolve these conflicts? A. Passivity B. Compromise C. Competition D. Accommodating Others

Correct Response: B Conflicts can be effectively resolved using a number of different strategies and techniques such as compromise, negotiation, and mediation. Avoidance of the conflict, withdrawing in addition to other passivity, competition, and accommodating others are not effective and healthy conflict resolution techniques.

50. Which question is asked more than any other root cause analysis activity? A. What? B. Why? C. Who? D. When?

Correct Response: B Root cause analysis activities ask "Why", rather than "Who", which would place blame on a person or group of people: and What? and When? Questions are rarely asked.

6. Which of the following are the five Rights of Supervision? A. The right task, the right circumstances, the right person, the right competency, and the right supervision or feedback B. The right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback C. The right competency, the right education and training, the right scope of practice, the right environment and the right client condition D. The right competency, the right person, the right scope of practice, the right environment and the right client condition

Correct Response: B The Five Rights of Delegation include the right task, the right circumstances, the right person, the right direction or communication, and the right supervision or feedback. The right competency is not one of these basic Five Rights, but instead, competency is considered and validated as part of the combination of matching the right task and the right person; the right education and training are functions of the right task and the right person who is able to competently perform the task; the right scope of practice, the right environment and the right client condition are functions of the legal match of the person and the task; and the setting of care which is not a Right of Delegation and the matching of the right person, task and circumstances.

28. Which of the following terms is used to describe the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another? A. Case management B. Continuity of care C. Medical necessity D. Critical pathway

Correct Response: B The continuity of care is defined as the sound, timely, smooth, unfragmented and seamless transition of a client from one area within the same healthcare facility, from one level of care to a higher and more intense level of care or to a less intense level of care based on the client's status and level of acuity, from one healthcare facility to another healthcare facility and also any discharges to the home in the client's community. Case management and critical pathways may be used to facilitate the continuity of care, but they are not the sound, timely, smooth, unfragmented and seamless transition of the client from one level of acuity to another. Lastly, medical necessity is necessary for reimbursement and it is one of the considerations for moving the client from one level of acuity to another but medical necessity is not the continuity of care.

18. Select the member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for cutting food? A. The physical therapist B. The occupational therapist C. The dietician D. The podiatrist

Correct Response: B The member of the multidisciplinary team that you would most likely collaborate with when the client can benefit from the use of adaptive devices for eating is the occupational therapist. Occupational therapists assess, plan, implement and evaluate interventions including those that facilitate the patient's ability to achieve their highest possible level of independence in terms of their activities of daily living such as bathing, grooming, eating and dressing. Many of these interventions include adaptive devices such as special eating utensils and grooming aids. Physical therapists are licensed healthcare professionals who assess, plan, implement and evaluate interventions including those related to the patient's functional abilities in terms of their gait, strength, mobility, balance, coordination, and joint range of motion. They also provide patients with assistive aids like walkers and canes and exercise regimens. Dieticians assess, plan, implement and evaluate interventions including those relating to dietary needs of those patients who need regular or therapeutic diets. They also provide dietary education and work with other members of the healthcare need when a client has dietary needs secondary to physical disorders such as dysphagia; and podiatrists care for disorders and diseases of the foot.

42. Which of these statements related to information technology is accurate? A. Social networks and cell phone cameras pose low risk in terms of information technology security and confidentiality. B. The security of technological data and information in healthcare environments is most often violated by those who work there. C. The security of technological data and information in healthcare environments is most often violated by computer hackers. D. Computer data deletion destroys all evidence of the data.

Correct Response: B The security of technological data and information in healthcare environments is most often violated by those who work there. The vast majority of these violations occur as the result of inadvertent breaches with carelessness and the lack of thought on the part of employees. Technology is a double edged sword. Technological advances such as cell phone cameras, social networks like Facebook, telephone answering machines and fax machines pose great risk in terms of the confidentiality and the security of medical information. Computer data deletion does not always destroy all evidence of the data; data remains.

46. Which of these choices contains the six elements necessary for malpractice? A. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct rather than indirect harm to the client. B. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. C. Causation, correlation, damages to the patient, a duty that was owed to the client and this duty was breached, and direct and/or indirect harm to the client. D. Causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and a medical license.

Correct Response: B The six essential components of malpractice include causation, foreseeability, damages to the patient, a duty that was owed to the client and this duty was breached, and, lastly, this breach of duty led to direct and/or indirect harm to the client. A medical license is not necessary; nurses and other healthcare professionals can be found guilty of malpractice. Lastly, correlation is the relationship of simultaneously changing variables. For example, a ppositive correlation exists when the two variables both increase or decrease; and a negative occurs when one variable increases and the other decreases.

35. Select the ethical term that is accurately paired with it brief description. A. Deontology: The school of ethical of thought that requires that only the means to the goal must be ethical. B. Utilitarianism: The school of ethical of thought that requires that only the end goal must be ethical. C. Deontology: The school of ethical of thought that requires that only the end goal must be ethical. D. Utilitarianism: The school of ethical of thought that requires that only the means to the goal must be ethical.

Correct Response: B The two major classifications of ethical principles and ethical thought are utilitarianism and deontology. Deontology is the ethical school of thought that requires that both the means and the end goal must be moral and ethical; and the utilitarian school of ethical thought states that the end goal justifies the means even when the means are not moral.

3. Your client is in the special care area of your hospital with multiple trauma and severe bodily burns. This 45 year old male client has an advance directive that states that the client wants all life saving measures including cardiopulmonary resuscitation and advance cardiac life support, including mechanical ventilation. As you are caring for the client, the client has a complete cardiac and respiratory arrest. This client has little of no chance for survival and they are facing imminent death according to your professional judgement, knowledge of pathophysiology and your critical thinking. You believe that all life saving measures for this client would be futile. What is the first thing that you, as the nurse, should do? A. Call the doctor and advise them that the client's physical status has significantly changed and that they have just had a cardiopulmonary arrest. B. Begin cardiopulmonary resuscitation other emergency life saving measures. C. Notify the family of the client's condition and ask them what they should be done for the client. D. Insure that the client is without any distressing signs and symptoms at the end of life.

Correct Response: B You must immediately begin cardiopulmonary resuscitation and all life saving measures as requested.by the client in their advance directive despite the nurse's own beliefs and professional opinions. Nurses must uphold the client's right to accept, choose and reject any and all of treatments, as stated in the client's advance directive. You would not call the doctor first; your priority is the sustaining of the client's life; you would also not immediately notify the family for the same reason and, when you do communicate with the family at a later time, you would not ask them what should or should not be done for the client when they wishes are already contained in the client's advance directive. Finally, you would also insure that the client is without pain and all other distressing signs and symptoms at the end of life, but the priority and the first thing that you would do is immediately begin cardiopulmonary resuscitation and all life saving measures as requested by the client in their advance directive, according to the ABCs and Maslow's Hierarchy of Needs.

2. The Patient Self Determination Act of the United States protects clients in terms of their rights to what? Select all that apply. A. Privacy and to have their medical information confidential unless the client formally approves the sharing of this information with others such as family members. B. Make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. C. Be fully informed about all treatments in term of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it D. Make decisions about who their health care provider is without any coercion or undue influence of others including healthcare providers.

Correct Response: B, D The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers. The Health Insurance Portability and Accountability Act (HIPAA) supports and upholds the clients' rights to confidentially and the privacy of their medical related information regardless of its form. It covers hard copy and electronic medical records unless the client has formally approved the sharing of this information with others such as family members. The elements of informed consent which includes information about possible treatments and procedures in terms of their benefits, risks and alternatives to them so the client can make a knowledgeable and informed decision about whether or not to agree to having it may be part of these advanced directives, but the law that protects these advance directives is the Patient Self Determination Act.

27. You are the Nurse Manager for the trauma unit. Which of these staff comments or statements indicate the need for you to provide an educational activity relating to confidentiality and information security? A. "A computer in the hallway was left unattended and a client's medical record was visible to me." B. "I just saw a nursing student looking at the medical record for a client that they are NOT caring for during this clinical experience." C. "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes." D. "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit."

Correct Response: C A staff members comment, "As I was walking past the nursing station, I saw a dietician reading the progress notes written by members of the laboratory department in addition to other dieticians' progress notes" "indicates the need for the Nurse Manager to provide an educational activity relating to confidentiality and information security because dieticians often have the "need to know" about laboratory data so that they can, for example, assess the client's nutritional status in terms of their creatinine levels. The report that the nursing student was "looking at the medical record for a client that they are NOT caring for during this clinical experience" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; the report that a "computer in the hallway was left unattended and a client's medical record was visible to me" indicates that the reporting staff member is correctly applying the principles for maintaining confidentiality and privacy of information; and lastly, "I refused the nursing supervisor's request to share my electronic password for the new nurse on the unit" also indicates that the staff member is knowledgeable about privacy and confidentiality.

30. Select the standardized "hand off" change of shift reporting system that is accurately paired with its elements. A. SBAR: Symptoms, background, assessment and recommendations B. ISBAR: Interventions, symptoms, background, assessment and recommendations C. The Five Ps: The patient, plan, purpose, problems and precautions D. BATON: Background, assessment, timing, ownership and next plans

Correct Response: C The Five Ps are the patient, plan, purpose, problems and precautions. The elements of the other standardized reporting systems are listed below: SBAR stands for: S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs B: Background: The patient's code or DNR status, vital Signs, medications and lab results A: Assessment: The current assessment of the situation and the patient's status and R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours ISBAR stands for: I: Introduction: The introduction of the nurse, the nurse's role in care and the area or department that you are from S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs B: Background: The patient's code or DNR status, vital Signs, medications and lab results A: Assessment: The current assessment of the situation and the patient's status and R: Recommendations: All unresolved issues including things like pending diagnostic testing results and what has to be done over the next few hours BATON stands for: B: Background: Past and current medical history, including medications A: Actions: What actions were taken and/or those actions that are currently required T: Timing: Priorities and level of urgency O: Ownership: Who is responsible for what? and N: Next: The future plan of care IPASS stands for: Introduction: The introduction of the nurse, the nurse's role in care and the area or department that you are from P: Patient: The patient's name, age, gender, location and other demographic data A: Assessment: The current assessment of the situation and the patient's status S: Situation: The patient's diagnosis, complaint, plan of care and the patient's prioritized needs and S: Safety concerns: Physical, mental and social risks and concerns

25. Which federal law is most closely associated with the highly restrictive "need to know"? A. The Patient Self Determination Act B. The Mental Health Parity Act C. The Health Insurance Portability and Accountability Act D. The Americans with Disabilities Act of 1990

Correct Response: C The federal law is most closely associated with the highly restrictive "need to know" is the Health Insurance Portability and Accountability Act. This law restricts access to medical information to only those persons who have the need to know this information in order to provide direct and/or indirect care to the client. The Patient Self Determination Act, which was passed by the US Congress in 1990, gives Americans the right to make healthcare decisions and to have these decisions protected and communicated to others when they are no longer competent to do so. These decisions can also include rejections for future care and treatment and these decisions are reflect in advance directives. This Act also supports the rights of the client to be free of any coercion or any undue influence of others including healthcare providers. The Mental Health Parity Act passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage. And, lastly the Americans with Disabilities Act of 1990 and the Rehabilitation Act of 1973 forbid and prohibit any discrimination against people with disabilities.

51. The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on: A. Historical data and performance improvement activities focus on current data. B. Current data and performance improvement activities focus on historical data. C. Decreasing financial liability and performance improvement activities focus on process improvements. D. Decreasing falls and performance improvement activities focus on process improvements.

Correct Response: C The primary distinguishing characteristic of risk management when compared and contrasted to performance improvement is that risk management activities focus on decreasing financial liability and performance improvement activities focus on process improvements. Risk management focuses on decreasing and eliminating things that are risky and place the healthcare organization in a position of legal liability. Some examples of risk management activities include preventing hazards and adverse events such as patient falls and infant abduction and the legal liabilities associated with these events.

19. What is the primary goal of multidisciplinary case conferences? A. To fulfill the nurse's role in terms of collaboration B. To plan and provide for optimal client outcomes C. To solve complex multidisciplinary patient care problems D. To provide educational experiences for experienced nurses

Correct Response: C The primary goal of multidisciplinary case conferences is to plan care that facilitates optimal client outcomes. Other benefits of multidisciplinary case conferences include the fulfillment of the nurse's role in terms of collaboration and collegiality, to solve complex multidisciplinary patient care problems so that optimal client outcomes can be achieved and also to provide educational experiences for nurses; these things are secondary rather than primary goals.

29. The Joint Commission on the Accreditation of Healthcare Organizations mandates standardized "hand of" change of shift reporting. Which of the following is a standardized "hand off" change of shift reporting system that you may want to consider for implementation on your nursing care unit? A. The Four P's B. UBAR C. ISBAR D. MAUMAR

Correct Response: C The standardized "hand off" change of shift reporting system that you may want to consider for implementation on your nursing care unit is ISBAR. Other standardized change of shift "hand off" reports, as recommended by the Joint Commission on the Accreditation of Healthcare Organization, include: SBAR, not IBAR BATON The Five Ps not the Four Ps and IPASS Lastly, MAUUAR is a method of priority setting and not a standardized "hand off" change of shift reporting system.

15. You are asked by your supervisor to take photographs of the residents and their family members who are attending a holiday dinner and celebration at your long term care facility. What should you do? A. Take the photographs because these photographs are part of the holiday tradition at this facility B. Take the photographs because all of the residents are properly attired and in a dignified condition C. Refuse to take the photographs unless you have the consent of all to do so D. Refuse to take the photographs because this is not part of the nurse's role

Correct Response: C You should refuse to take the photographs unless you have the consent of all to do so because to do otherwise is a violation of the residents' rights to privacy and confidentiality as provided in the Health Insurance Portability and Accountability Act (HIPAA). This, rather than the false belief that this is not part of the nurse's role, is the reason that you would not automatically take these photographs. Regardless of whether or not these photographs are part of the holiday tradition at this facility and whether or not the residents are properly attired and in a dignified condition, no photographs can be legally taken without the residents' permission and consent.

22. Select the types and stages of conflict that are accurately paired with their description. Select all that apply. A. Frustration: The phase of conflict that is characterized with personal agendas and obstruction B. Conceptualization: The phase of conflict that occurs when contending parties have developed a clear and objective understanding of the nature of the conflict and factors that have led to it C. Taking action: The phase of conflict that is characterized with individual responses to and feelings about the conflict D. Resolution: The type of conflict that can be resolved E. Avoidance-Avoidance: A stage of conflict that occurs when there are NO alternatives that are acceptable to the contending parties F. Approach- Approach Conflicts: The type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict. G. Approach-Avoidance Conflicts: The type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory nor completely dissatisfactory.

Correct Response: C, F, G Taking action is the phase of conflict that is characterized with individual responses to and feelings about the conflict; Approach- Approach conflicts are a type of conflict that occurs when the people involved in the conflict want more than one alternatives or actions that could resolve the conflict; and Approach-Avoidance conflicts are a type of conflict that occurs when the people involved in the conflict believe that all of the alternatives are NEITHER completely satisfactory or completely dissatisfactory. Frustration is the phase of conflict that occurs when those involved in the conflict believe that their goals and needs are being blocked and not met, and not necessarily characterized with personal agendas and obstruction; conceptualization is the phase of conflict that occurs when those involved in the conflict begin to understand what the conflict is all about and why it has occurred. This understanding often varies from person to person and this personal understanding may or may not be accurate, clear or objective, and not a clear and objective understanding of the nature of the conflict and factors that have led to it; resolution is a phase of conflict resolution, not a type of conflict, that is characterized when the contending parties are able to come to some agreement using mediation, negotiation or another method; an Avoidance-Avoidance conflict is a type of conflict and not a phase of conflict, that occurs when there are NO alternatives that are acceptable to any the contending parties; Approach- Approach conflicts occur when the people involved in the conflict want more than one alternative or action that could resolve the conflict; and lastly, Double Approach - Avoidance is a type of conflict and not a stage of conflict that occurs when the people involved in the conflict are forced to choose among alternatives and actions, all of which have BOTH positive and negative aspects to them.

26. Which of the following personnel do not have the "right to know" medical information? A. The facility's Performance Improvement Director who is not a healthcare person and who has no direct contact with clients B. A nursing student who is caring for a client under the supervision of the nursing instructor C. The facility's Safety Officer who is not a healthcare person and who has no direct contact with clients D. A department supervisor with no direct or indirect care duties

Correct Response: D A department supervisor with no direct or indirect care duties does not have the "right to know" medical information; all of the others have the "right to know" medical information because they provide direct or indirect care to clients. For example, both the facility's Performance Improvement Director who is not a healthcare person and who has no direct contact with clients and the facility's Safety Officer who is not a healthcare person and who has no direct contact with clients provide indirect care to clients. For example, they collect and analyze client data in order to fulfill their role and responsibilities in terms of process improvements and the prevention of incidents and accidents, respectively. Nursing and other healthcare students also have the "need to know" medical information so that they can provide direct client care to their assigned client(s).

48. What is the term that is used to describe a healthcare related incident or accident that may have possibly led to client harm? A. An adverse event B. A root cause C. A healthcare acquired event D. A sentinel event

Correct Response: D A sentinel event is an event or occurrence, incident or accident that has led to or may have possibly led to client harm. Even near misses, that have the potential for harm, are considered sentinel events because they have the potential to cause harm in the future. An adverse event, like an adverse effect of a medication, has actually led to an adverse response; it is not a near miss. A root cause is a factor that has led to a sentinel event; and there is no such thing as a healthcare acquired event.

32. The 2nd priority needs according to the MAAUAR method of priority setting include which of the following? A. Assessment B. Movement C. Understanding level D. Risks

Correct Response: D One of the 2nd priority needs according to the MAAUAR method of priority setting is risks. The ABCs / MAAUAR method of priority setting places the ABCs, again, as the highest and greatest priorities which are then followed with the 2nd and 3rd priority level needs of the MAAUAR method of priority setting. The 2nd priority needs according to the MAAUAR method of priority setting after the ABCs include M-A-A-U-A-R which stands for: Mental status changes and alterations Acute pain Acute urinary elimination concerns Unaddressed and untreated problems that require immediate priority attention Abnormal laboratory and other diagnostic data that are outside of normal limits and Risks including those relating to a healthcare problem like safety, skin breakdown, infection and other medical conditions The 3rd level priorities include all concerns and problems that are NOT covered under the 2nd level priority needs and the ABCs. For example, increased levels of self care abilities and skills and enhanced knowledge of a medical condition are considered 2nd level priority needs.

16. Select the law that is accurately paired with its description in terms of client rights. A. The Patient Self Determination Act: The client's right to choose the level of care B. The Patient Self Determination Act: The clients' right to healthcare insurance coverage for mental health disorders C. The Mental Health Parity Act: The privacy and security of technological psychiatric information D. The Health Insurance Portability and Accountability Act (HIPAA): The privacy and security of technological medical information

Correct Response: D The Health Insurance Portability and Accountability Act (HIPAA) protects the client's legal rights to the privacy, security and confidentiality of all medical information including data and information that is technologically stored and secured. The Patient Self Determination Act uphold the client's right to choose and reject care and not the level of care that is driven and decided upon as based on medical necessity and health insurance reimbursement; this Act also does not give client's the right to any health insurance including healthcare insurance coverage for mental health disorders. Lastly, the Mental Health Parity and Addiction Equality Act, passed in 2008, mandates insurance coverage for mental health and psychiatric health services in a manner similar to medical and surgical insurance coverage; it does not protect the privacy and security of technological psychiatric information, HIPAA does.

12. Select the nurse case management model used for patient care delivery that is accurately paired with one of its descriptors: A. The ProACT Model: Registered nurses perform the role of the primary nurse in addition to the related coding and billing functions B. The Collaborative Practice Model: The registered nurse performs the role of the primary nurse in addition to the role of the clinical case manager with administrative, supervisory and fiscal responsibilities C. The Case Manager Model: The management and coordination of care for clients throughout a facility who share the same DRG or medical diagnosis D. The Triad Model of Case Management: The joint collaboration of the social worker, the nursing case manager, and the utilization review team

Correct Response: D The Triad Model of case management entails the joint collaboration of the social worker, the nursing case manager, and the utilization review team. The Professionally Advanced Care Team, referred to as the ProACT Model, which was developed at the Robert Wood Johnson University Hospital, entails registered nurses serving in the role of both the primary nurse the clinical case manager with no billing and coding responsibilities; these highly specialized and technical billing and coding responsibilities are done by the business office, medical billers and medical coders. The Case Manager Model entails the registered nurses' role in terms of case management for a particular nursing care unit for a group of clients with the same medical diagnosis or DRG. In contrast to this Case Manager Model of Beth Israel Hospital, the Collaborative Practice Model of case management entails the role of some registered nurses in a particular healthcare facility to manage, coordinate, guide and direct the complex care of a population of clients throughout the entire healthcare facility who share a particular diagnosis or Diagnostic Related Group.

8. The best way to objectively evaluate the effectiveness of an individual staff member's time management skills in a longitudinal manner is to: A. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities. B. Observe the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks. C. Ask the staff member how they feel like they have been able to employ their time management skills for the last six months. D. Collect outcome data over time and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty.

Correct Response: D The best way to objectively evaluate the effectiveness of an individual staff member's time management skills in a longitudinal manner is to collect outcome data over time, and then aggregate and analyze this data to determine whether or not the staff member has completed reasonable assignments in the allotted time before the end of their shift of duty. Another way to perform this longitudinal evaluation is to look at the staff member's use of over time, like the last six months, when the unit was adequately staffed. Observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately established priorities is a way to evaluate the short term abilities for establishing priorities and not assignment completion and observing the staff member during an entire shift of duty to determine whether or not the nurse has accurately and appropriately completed priority tasks is a way to evaluate the short term abilities for completing established priorities and not a complete assignment which also includes tasks that are not of the highest priority. Lastly, asking the staff member how they feel like they have been able to employ their time management skills for the last six months is the use of subjective rather than objective evaluation.

20. Which member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation one or more months ago? A. A Pedorthist B. A pediatric nurse practitioner C. A trauma certified clinical nurse specialist D. A prosthetist

Correct Response: D The member of the multidisciplinary team would you most likely collaborate with when your pediatric client has had a traumatic amputation secondary to a terrorism blast explosion a month ago or more ago is a prosthetist. Prosthetists, in collaboration with other members of the healthcare team, assess patients and then design, fit and supply the patient with an artificial body part such as a leg or arm prosthesis. They also follow-up with patients who have gotten a prosthesis to check and adjust it in terms of proper fit, patient comfort and functioning. Pedorthists modify and provide corrective footwear and employ supportive devices to address conditions which affect the feet and lower limbs. Lastly, you may collaborate with a trauma certified clinical nurse specialist and a pediatric nurse practitioner but this consultation and collaboration should begin immediately upon arrival to the emergency department, and not a month after the injury.

4. You are caring for a high risk pregnant client who is in a life threatening situation. The fetus is also at high risk for death. Clinical decisions are being made that concern you because some of these treatments and life saving measures promote the pregnant woman's life at the same time that they significantly jeopardize the fetus' life and viability and other decisions can preserve the fetus's life at the expense of the pregnant woman's life. Which role of the nurse is the priority at this time? A. Case manager B. Collaborator C. Coordinator of care D. Advocacy

Correct Response: D The priority role of the nurse is advocacy. The nurse must serve as the advocate for both the fetus and the mother at risk as the result of this ethical dilemma where neither option is desirable. As an advocate, the nurse would seek out resources and people, such as the facility's ethicist or the ethics committee, to resolve this ethical dilemma.

44. You have loosely applied a bed sheet around your client's waist to prevent a fall from the chair. What have you done? A. Ensured the client's safety which is a high patient care priority B. Violated Respondeat Superior C. Violated the client's right to dignity D. Committed a crime

Correct Response: D When you loosely apply a bed sheet around your client's waist to prevent a fall from the chair, you have falsely imprisoned the client with this make shift restraint. False imprisonment is restraining, detaining and/or restricting a person's freedom of movement. Using a restraint without an order is considered false imprisonment even when it is done to protect the client's safety. Respondeat Superior is the legal doctrine or principle that states that employers are legally responsible for the acts and behaviors of its employees. Respondeat Superior does not, however, relieve the nurse of legal responsibility and accountability for their actions. They remain liable. There is no evidence in this question that you have violated the client's right to dignity.

37. You have been asked to teach an inservice class for nurses in your facility about ethics. Which of the following should you consider during the planning of this educational activity? A. Planning a way to evaluate the effectiveness of the class by seeing a decrease in the amount of referrals to the facility's Ethics Committee B. Establishing educational objectives for the class that reflect the methods and methodology that you will use to present the class content C. The need to exclude case studies from the class because this would violate client privacy and confidentiality D. Some of the most commonly occurring bioethical concerns including genetic engineering into the course content

Correct Response: D You would consider including some of the most commonly occurring bioethical concerns including genetic engineering into the course content. You would also plan how you could evaluate the effectiveness of the class by seeing an increase, not a decrease in the amount of referrals to the facility's Ethics Committee, because one of the elements of this class should address ethical dilemmas and the role of the Ethics Committee in terms of resolving these. You would additionally establish educational objectives for the class that reflect specific, measurable learner outcomes and not the methods and methodology that you will use to present the class content; and lastly, there is no need to exclude case studies from the class because "sanitized" medical records can, and should be, used to avoid any violations of client privacy and confidentiality.