Professional Nursing Test Questions – Flashcards
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Why is nursing a regulated practice?
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Regulation: an issue/rule ordered by executive authority or regulatory agent of a government and having the force of law Nursing is a regulated practice because it ensures that practitioners are competent to protect the public's safety
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Role of National Counsel of State Boards of Nursing
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Not-for profit organization where the state boards of nursing in 50 states to meet to provide public health, safety, and welfare. 24 associated members. Provide education, services, and research through collaborative leadership to promote evidence based research for patient safety and public protection. Outlines the standard for safe nursing care
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NCSBN Values
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Collaborative Excellence Innovation Integrity Transparency
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Collaborative
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Forge solutions through respect, dignity, and strength from all stakeholders
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Excellence
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To strive and be the best
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Innovation
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To embrace change as an opportunity to get new ideas into action
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Integrity
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Doing the right thing by through honest, informed, open, and ethical dialogue
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Transparency
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Demonstrating openness, clear communication, and accountability of process and outcomes
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Nurse Practice Acts (6)
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Vary among state but all include: 1. Authority, power, and composition of boards of nursing 2. Standards and scope of nursing practice. 3. Education program standards 4. Types of licenses and titles 5. Requirement for licensure 6. Ground rules for disciplinary and violations and remedies
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What are the characteristics of a strong model/nursing practice act?
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Quality, safety, and evidence 1. Self determination 2. Nursing Professional Scope of Practice, Standards of Practice, Code of Ethics, and Specialty Certification 3. Institutional Policies and Procedures 4. Nurse Practice Act and Rules and Regulations
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How is Administrative Roles and Regulations similar to nursing practice acts and what do they address?
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Bounces off the nursing practice acts and are interrelated
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1. Administrative Roles and Regulations
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Clarifies the provisions of the Nursing Practice Act
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2. Administrative Roles and Regulations
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The Rules cannot set requirements that are more severe than the Act
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3. Administrative Roles and Regulations
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The Rules have force and effect by law
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4. Administrative Roles and Regulations
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Confirms what the practicing RN is accountable for
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5. Administrative Roles and Regulations
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Meaning of unprofessional misconduct
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6. Administrative Roles and Regulations
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Expectations and limitation of delegation to others
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7. Administrative Roles and Regulations
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Read your state's Nursing Practice Act
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What are the ANA standards of professional practice?
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Nurses must be competent in critical thinking by using the nursing process - Assessment, Diagnosis, Outcome Identification, Planning, Implementation, Evaluation Used be all nurses with all their patients
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Assessment
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Comprehensive data about the patient
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Diagnosis
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Making up problems and issues based on the patient's data
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Outcomes
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To come up with goals based on patient's data and situation at the time
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Planning
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To come up with strategies/interventions to reach the patient's goals
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Implementation
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Plans go into action - Coordinate care - Health promotion and teaching - Consultation by a graduate-level nurse - Prescription and treatment by APRN
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Evaluation
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To see if the person has reached their goal
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Malpractice - Negligence
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1. Failure to follow the standards of care 2. Failure to use equipment in a responsible manner 3. Failure to communicate 4. Failure to document 5. Failure to assess and monitor 6. Failure to act as a patient advocate
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Two Requirements of Malpractice
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1. Nurse (defendant) practiced with specialized knowledge and skills 2 Through this practice, nurse caused patient's (plaintiff) injury
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Elements for Cause of Action of Negligence
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1. Nurse assumed duty of care 2. Nurse failed to meet standards of care 3. Not meeting standards of care resulted in patient's injury 4. Patient's injury can be proven
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Nurse Licensure Compact (NLC)
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Taking the licensure exam in one state and being able to be an RN in another state in the U.S. Does not require an application Present in 24 states with 6 pending states
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Informed Consent
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Patient or patient's guardian must sign informed consent for all treatments, except for when it's an emergency.
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What does the informed consent include?
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Reason for treatment and its benefits, side effects, cost, and other alternatives (patient has the right to refuse)
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Informed Consent - Patient Requirements
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1. Patient must be willing to voluntarily sign it 2. Must be given to the patient who is competent enough to understand it 3. Patient must be provided enough information to make a decision
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Informed Consent - Nurse's Role
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To maintain patient confidentiality in all clinical, work, and off duty settings
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Professional Liability Insurance (Errors & Omissions Insurance)
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Protects your business, including all your income and assets, if you are sued for negligence and helps you protect your license
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How do State Boards of Nursing address the practice of nurses with substance use disorder?
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Before, nurses would get fired if substance abuse is apparent. Now, nurses with substance abuse are recognized as treated illnesses. They are placed in rehab or treatment programs and are refrained from practicing until treatment is complete.
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What work environments put the nurse at risk of a substance use disorder?
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1. Nurses have increased access to narcotics. 2. Lack of institutional control when storing and distributing narcotics. 3. Stress from the workplace due to increased demands, staff shortages, working long hours, and bullying.
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Non-Profit Hospitals
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Have designated taxes so they are exempt from paying certain taxes and make their own money to pay their employees and services of the hospital. Most hospitals are organized like this and are regulated at state level
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Profit Agencies
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Several investors own stocks of the company and trades are made in the stock exchange. Health care agencies, hospital settings, rehab centers, and outpatient care
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Government Agencies
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Public agencies that provide care for ALL their patients - Promote and conduct research on illness - Fund training of healthcare members and healthcare programs - Involved in community healthcare needs
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State Agencies
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Public agencies that provide care for people in their own state Does not provide direct patient care
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Local Angencies
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Public agencies that provide care for people in their county or a few counties - Immunizations - Prenatal care - Infectious diseases clinics - Other specialty clinics
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Voluntary Agencies
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Private agencies that work and promote healthcare programs through government grants and donations - American Red Cross - American Cancer Society - ALS Foundation
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Non-Government Organizes
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Association of citizens, independent from government, that deliver resources
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Primary Care
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Entrance into the healthcare system and health maintenance Least costly Ex. Clinics, home doctors, outpatient care, ER, community health centers
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Secondary Care
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- Preventing complications of present disease - Temporary dysfunction where medical intervention is not found in clinics - shorter length of stay Ex. Hospitals, home health, surgical centers, ambulatory care, skilled nursing
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Tertiary Care
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- Patients who are acutely ill and need long-term treatment, rehab, and/or palliative care - Most expensive care Ex.rehabs, trauma centers, burn centers, peds hospital, hospice
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Subacute Care
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- Inpatient care for patients in between the hospital and long-term care facility - Does not require diagnostic procedures - Cheaper cost than care at tertiary level - Ex. Long-term facilities for acute illness, injury and exacerbation of disease places
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At what level of care is the most expensive?
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Tertiary care
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At what level of care is the least expensive?
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Primary care
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CCRN
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Certification for care of adult, pediatric, and neonate critical care nurses
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Where do nurses work?
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- Hospital based - peds, psych, medsurg, operative, perioperative - Community Based - LTC, school, urgent care, ambulatory, outpatient care - Alternatives - insurance, business owner, informatics, quality improvement (Joint Commission), consultant, pharmaceutical company, journalist
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What are the roles and titles nurses have?
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- Chief nursing officer - APRN - Nurse managers - RN in staff roles - Licensed Practical Nurse/Licensed Vocational Nurse - Unlicensed Assistive Personnel/Certified Nursing Assistants (CNA)
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NP - Nurse Practitioner
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- Dx, tx, prescribe meds, and write referrals - Requires Masters, DNP - Licensed by the state
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CNS - Clinical Nurse Specialist
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- Specializes in a specific field of nursing to improve patient care - Researches, educators, clinicians - Requires Masters, RN-BC, certification
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CRNA - Certified Registered Nurse Anesthetics
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- Provides surgical anesthesia in the form of sedation, nerve blockers, and numbing agents - Requires Masters, RN-BC, certification
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CNM - Clinical Nurse Midwives
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- RNs that specialize in nurse midwifery - Can perform gynecological services - pap smears, vaginal infections, family planning, pregnancy, L&D, care for newborns - Certification from American College of Nurse Midwifes
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CNL - Clinical Nurse Leader (Advanced Generalist)
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- Goal: to return clinical experts at the bedside for advanced care planning, outcomes management for populations, and quality improvement - Masters, certified by Commission for Nurse Certification (AACN - American Associate for Critical Care Nurse)
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Role of The Joint Commission
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- Non-profit organization that is the nation's standard setting and accrediting body in health care - Evaluates hospitals and improves in patient safety - Comes up with evidence-based solutions for safety problems in the hospital
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What structural and social factors contribute for disparities and access to and quality of healthcare in the U.S.?
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Race, gender, age, disability, sexual orientation, education level, income, place of residence, provider bias
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What are the common sources of inequality in health?
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1. Disease (cancer, DM, HIV/AIDS, HBV, HAV, mental illness) 2. Populations (age, race, SES, sexual orientation) 3. Geography (urban vs. rural, developing countries vs. advanced countries) 4. Risk factors (access to care, insurance, obesity, family hx, environmental factors, sexual behaviors, substance abuse)
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What interventions can help reduce health disparities?
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- Promote equity of evidence-based guidelines - Payment systems to help with pay of services and limit provider incentives - Interpretators needed
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What is the best way to assess patient's level of literacy?
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Ask the patient - "How confident are you filling out the forms by yourself?"
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What are other ways to assess patient's level of literacy?
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- Print Literacy: comprehension of written work - Numeracy: ability to quantify data - Oral Literacy: ability to speak and listen effectively
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How can nurses improvement the effectiveness of patient education for clients with low literacy rates?
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- Use patient's name to develop a connection - Introduce topic and use short stories - State 3-5 reinforcing points at a time (need to know information) - Use active voice and conversation style - Use layman terms - Be specific and include information about their lives
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2. What is the role of states/state governors in implementing the Affordable Care Act of 2010?
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This care act requires all U.S. citizens and legal residents to qualify for health care coverage or pay a tax penalty. Without this mandate, people will only get insurance when they are ill, resulting in high premiums that are unaffordable. This will bring down the average health care coverage and provide many Americans with health care coverage by expanding private and public insurance
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What is the individual mandate?
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All citizens and qualified non-citizens must be under health care coverage. If not, they will be required to pay a tax penalty. This will decrease the average cost of healthcare costs due to the fact that people try to get healthcare coverage when they are already sick, resulting a high premium that is unaffordable.
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What are the key provisions for the Affordable Care Act (2010)?
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New adult medicated program for individuals who meet the following requirements: - 19-64 yo - Does not qualify for any other existing Medicaid program - Income <133% of the Federal Poverty Line - Citizen or qualified non-citizen - No asset/resource test
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Other key provisions for the Affordable Care Act
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- Tax credits to small businesses to offer care - Children with pre-existing conditions will no longer be denied coverage - Allowed to stay under parents' coverage until 26 yo - Temporary risk pool for those who are uninsurable - Eliminates co-pay for preventive care
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What are the major types of insurance programs in the U.S.?
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- Social Insurance Programs: Medicare - Means-tested Programs: Medicaid - Private Health Insurance
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Medicare
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- Social insurance program - 1966 by President Lyndon Johnson - Largest health insurance program - Covers 65 years and older, ESRD, disabled individuals - Distributed by Centers for Medicare & Medicaid Services, SS Administration, and Railroad Retirement Board
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Medicare Part A
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- Hospital Insurance - Ex. hospital inpatient care, skilled nursing facility, home health care, hospice care
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Medicare Part B
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- Medical insurance for outpatient services - Ex. doctor visits, diagnostic tests, preventic care, therapy programs, durable medical equipment
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Medicare Part D
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- Prescription drug coverage
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Medicaid
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- Means-tested program - For individuals or family with low income compared to the FPLs based on family size - Paid by the state and federal government - Must be a U.S. citizen or qualified non-citizen - Pays for most medical care - Covers acute and LTC
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Private Health Insurance
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- Customer may have to pay a copayment when receiving care (ex. inpatient care, doctor visits, prescription drugs) - There may be a deductible - Different companies have different benefits
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Deductible
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Using your own money to pay for healthcare services before your health insurance starts paying for them High premiums have low deductibles
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Premium
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Amount paid monthly, quarterly, or taken out from your paycheck to buy insurance coverage
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Risk Pool
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Protection of insurance companies against catastrophic events (flood, earthquakes)
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Co-payment
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Using your own money to pay for a portion of the medical service and the rest is covered by your health insurance Ex. Paying $20 each time at a doctor visit
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Risk Aversion
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The degree to which a certain income is preferred to a risky alternative with the same, expected income
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Stakeholders
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People who have been affected by the decisions and want to influence politicians or those who have control of policy decisions - Management - payers - Union officials: employers - Employees who want a safe work environment (providers) - Patients
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How is healthcare financed in the U.S.?
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- System based on the free-market; little transparency for consumers to know the costs or quality of healthcare - Buyers (those in need of services) and Sellers (those who provide services and goods) - Competition: sellers can provide healthcare services at different prices and quality - Fee for service model: physicians are reimbursed for each individual service, promoting quantity over quality
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How much money does the U.S. spend on healthcare each year?
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$1.3 trillion in 2000
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What percent of the gross domestic product does healthcare consume and what does this imply?
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Healthcare services has increased to a 4% to 17% consumption. The Great Recession (2009) and economic shifts will not support this and threaten the survival of providers and their business partners.
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Fee-for-Service
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- Offers providers compensation for providing services to each individual - Most dominant payment model in the U.S. - Inherently inflationary
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Managed Care Payment
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- Reduces the cost of health benefits and improves quality of care - HMO + PPO
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Health Maintenance Organization (HMO)
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Obtaining healthcare services from an HMO network, including: - Choosing a PCP that treats and writes referrals to other specialists within the network - Lab work - Medical facilities - Limits where medical care is obtained
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Preferred Provider Organization (PPO)
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- A list is given with preferred providers that patients can seek medical services from - Services are cheaper when choosing a provider on the list - More appropriate for people who want more freedom when choosing who they get their healthcare services from - Can check the site of the healthcare insurance to see if provider is listed there - Higher cost if provider is not on list
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What are the characteristics of value-based approaches of healthcare financing?
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- Focus on maximizing value (lower cost and higher quality) of healthcare delivered by aligning incentives and managing risk - Care coordination driven by standardized protocols and use of technology to share information - Investment of clinical integration, population health, and other cost reduction enhancement opportunities
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How can nurses contribute to reducing the costs of health care and generating value for patients and society?
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There has been an increased in NPs due to more people having access to healthcare services through insurance - Case management - Care coordination and planning - Patient teaching and health coaching - Chronic disease management/chronic care specialist
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What is Martha Roger's relationship to NYU?
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She developed the first PhD program in nursing founded at NYU. She is also the Dean of the NYU School of Nursing.
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Nursing Theories of Nightingale
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- Founder of moderate nursing - Wrote "Notes on Nursing, What it is and What it is Not" and "Notes on Hospitals" - Believed the healing occurs w/in the environment and nurses can create that environment - Used data and statistics to see how effective maintenance of the environment was during the Crimeon war
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Nightingale's 8 Aspects of Professional Nursing
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1. Ventilation and warmth 2. Health of home 3. Light 4. Cleanliness of room and walls 5. Variety 6. Bed and bedding 7. Noise 8. Observation of the sick
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Henderson's Definition of Nursing
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Unique function of nurse is to assist the individual, sick or well, on performing activities that contribute to health or its recovery (or peaceful death) that the person would usually perform on his/her own
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Henderson Nursing Theories
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- Viewed patients as individuals who need help achieving independence and wholeness of mind and body - Developed 14 basic needs that define their role and assist patients over a period of time - Published the first catalogue of nursing literature between 1900-1954
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Henderson's 14 Needs
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1. Physical 2. Psychological 3. Emotional 4. Spiritual 5. Social 6. Developmental needs
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Rogers Unitary Human Beings Model
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- Developed a systems theory from her work in physics - Viewed humans as dynamic energy fields that interact with environment - Continuum of care is better than episodes of care
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Peplau Interpersonal Relationships Model
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- Defines the relationship between the nurse and the patient - Understanding the patient promotes healthy behavior, patient's survival, and patient's understanding of behaviors to maintain health - Mother of psychiatric nursing
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Orem: Self-Care Deficit Theory
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- Theory of Self-Care: uses assessment, education, relationship building, and intervention - Theory of Self-Care Deficit: to detect the patient's care needs that can be achieved through nursing actions - Theory of Nursing Systems
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What are the levels of theory commonly used in nursing research and practice?
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To make clinical judgments based on evidence by: - ADPIE
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What are core concepts that are the focus of nursing science?
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- Person: unique and adaptable; motivated by needs and to seek balance; influenced by genetics and environment - Health: affected by health beliefs and behavior; exists on a continuum, dynamic, and holistic - Environment: affects well-being; physical (Water, food, air) and nonphysical (family, culture, social life)
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What are the characteristics of nursing science?
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- Study of problems experienced by humans along the health-illness continuum - Goal of nursing research is to improve patient care so they can reach their goals - Nursing is built from the basic and social sciences so we can understand patient care and healthcare system problems - Changes over time
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According to the ANA, what is the role of professional nurse in research?
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ANA Code of Ethics Provision 8
