Intro to nursing final

Question 1

When to notify the Rapid Response team

Answer 1

A rapid response team is a group of health care providers that respond to an emergency within the hospital. Example: They respond when a patient’s vital signs drop, if they have trouble breathing, and if their heart stops. - Code Blue (Dr. Caviner asked this question)

Question 2

Responsibilities of a case manager

Answer 2

An RN case manager coordinates patient care with the goal of focusing attention on the quality, outcomes, and cost of care throughout an episode of illness and helping the patient move through the continuum of care. Pg. 367 CASE MANAGEMENT

Question 3

Priority of the hand off report

Answer 3

Attention to handoff reporting is particularly important because of the high number of handoffs that occur in health care and the severity of errors that can result. Perhaps the most important condition of handoff reporting is that it must be real-time, face-to-face. Give and take between the sender and receiver must occur so that clarification and feedback are possible. Reports should also be given in situations free from interruption. The sender-receiver dichotomy with all the associated communication skills is of primary importance. Essentials include the basic SBAR

Question 4

SBAR

Answer 4

SBAR: Situation, Background, Assessment, and Recommendation.
○ Situation: e.g. symptom/ problem, patient stability/ level of college

○ Background: e.g. history of presentation, date of admission and diagnosis, relevant past medical history

○ Assessment & Action: e.g. What is your diagnosis/ impression of the situation? What have you done so far?

○ Recommendation: e.g. What you want done, treatment/investigations underway that need monitoring, review: by whom, when, and of what, plan depending on results/ clinical course.

Question 5

What is the nurse’s responsibility when a patient leaves Against Medical Advice (AMA)?

Answer 5

AMA page 154
● Nurses responsibility is to act promptly to notify the provider. This precautionary statement is reserved for situations in which the life and limb of the patient are at risk and the appropriate providers are not available to address the direct and indirect consequences with the patient. Nurses should include the fact that leaving early may resolve in aggregate the current condition and complicate future care. Resulting physical or mental impairment or disability. Result in complications leading to death.

Example: An athlete is discouraged that they are needing to stay out of sports for a few months and are needing todo some therapy to regain their strength again and they do not want to so they go on and do not take any time off they would leave on AMA.

Question 6

What is the Patient Self-Determination Act? Why is it important?

Answer 6

PSDA page (page 125-126,228)- Definition :
a. Amendment intended to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care

b. Requires federally funded hospitals to give patients written notice on admission to health care facility of their decision making rights and policies regarding advance health care directives in their state/institution- Example(s) :
a. Patients have right to participate in their own health care decisions
b. Patient can accept/refuse medical treatment
c. Patient can make advance healthcare directives (DNR orders)

Question 7

Give an example of a nurse representing these ethical principles : veracity,

Answer 7

Veracity (page 161,171)-
Definition : An ethical duty to tell the truth- Example : Telling a patient accurate and precise information that is revealed in a respectful manner even if the truth is viewed as distressing.

Question 8

Give an example of a nurse representing these ethical principles : confidentiality

Answer 8

Confidentiality (page 338, 266)
- Definition : the state of keeping or being kept secret/private-
Example(s) :

a. (page 338) keep patient’s medical information ‘confidential’ by only exchanging information between people with the need and right to know and should take place in private areas
b. Security of EHR (page 266) -provider has the responsibility to maintain confidentiality of that information and not reveal the information to others who do not have a legitimate need to know

Question 9

Give an example of a nurse representing these ethical principles : beneficence (Chapter 9)

Answer 9

An ethical principle of compassion and patient advocacy, stating that one should do good and prevent or avoid doing harm-

Example : holding a dying patient’s hand in hospice care

Question 10

Explain what the core professional value of social justice is and give an example (Chapter 9).

Answer 10

Social Justice (page 161, 168)-
Definition (page 161) : the equal and fair distribution of resources, regardless of other factors

Example : Residents in rural area soften don’t have access to medical resources. Advanced practice registered nurses (APRN) who can operate with full autonomy, such as in diagnosing patients and prescribing medications, can increase access opportunities and health outcomes for rural citizens.

Question 11

Define ethnocentrism and give an example.

Answer 11

Believing that one’s own ethnic group, culture, or nation is best.
○ Example: The nurse should engage in a cultural self assessment to identify individual culturally based attitudes about clients who are from a different culture.

Question 12

What can be delegated to RN?

Answer 12

Determining patient needs and when to delegate, Being available to Delegatee Assessment and follow-up evaluation, Any intervention or corrective actions that may be required to ensure safe and effective care.

Question 13

What can be delegated to an LPN?

Answer 13

Can push IV medications that are not critical medications, such as cardiac medications, or high risk medications, Making observations, Administer antibiotics after the first dose has been administered by an RN, administering oral medications, start a peripheral IV, give injections, Obtain blood glucose, Insert a Foley catheter, ambulate a patient, complete a dressing change for wound care, and change peripheral IV tubing and site care (responsibility of LPN and UAPs from module 3 on blackboard)

Question 14

What can be delegated to a UAP?

Answer 14

Care for basic needs, 
bathe patients, ambulate a patient that is not high risk, collect stool samples, take routine vital signs on stable patients, turn and reposition patients, empty Foley catheter bags and colostomy bags, and feed patients who are not at risk for delegation. They cannot perform invasive procedures or assess patients for the nurses.(responsibility of LPN and UAPs from module 3 on blackboard)

Question 15

What is the karnofsky prognostication scale used for?

Answer 15

This scale is used for prognostication. Scores are an indication about disease progression to death. The Karnofsky scale is appropriate for a patient with a cancer diagnosis. Ch.12, Table 12.4. pg. # 221

Question 16

The nurse’s responsibility when helping with Advanced Directives

Answer 16

Nurses may be asked questions about living wills and durable power of attorney for health care by patients and their families. An important aspect of speaking to the patient about these issues is to provide the written materials about advanced directives.
Keyterm: Written or verbal instructions created by the patient that describe specific wishes about medical care in the event he or she becomes incapacitated or incompetent.
Examples: living wills and durable powers of attorney.Ch.8 pg.# 151 & 152

Question 17

Give an example of patient-centered care at the end of life.

Answer 17

Palliative care- care that seeks to improve the quality of life of patients who are facing serious illness.

Hospice Care- This is not only a type of care but also a philosophy of care that focuses on comfort for the patient and family at the end of life. Exp. 32 year old divorced female who has been undergoing aggressive cancer chemotherapy for 4year. Her physician has just informed her that her disease continues to spread in spite of these therapies. He tells her she has two primary options: phase 1 clinical trail and hospice care. She longs to see her young children settled in with her parents before she dies, but she suffers with constant pain and intermittent nausea, and gravitates between anxiety and deep periods ofdepression, which she hides best so she can form her family. She struggles between the two options of care, but doesn’t know what questions to ask related to treatment. How does she tell her children? How does she prepare her parents for the role of parenting their grandchildren? How does she prepare herself for what lies ahead? She feels the depression enveloping her age

Question 18

What are the standards of practice for palliative care?

Answer 18

8 practice domains for palliative care to follow
Domain 1: Structure and Process of Care.
This domain describes the use of the inter-professional team to work together assessing and planning care with patients and families.
Domain 2: Physical Aspects of Care.
This domain emphasizes the use of validated tools for assessment and the treatment of physical symptoms. Domain 3: Psychological and Psychiatric Aspects of Care. The domain stresses the need to address assessment and treatment of psychiatric concerns and diagnoses. Included also in this domain are the requirements of a bereavement program.
Domain 4: Social Aspects of Care. This domain’s focus emphasizes engaging patients and families in the patient’s care and taking advantage of their strengths. The team and social worker begins this process.
Domain 5: Spiritual, Religious, and Existential Aspects of Care. This domain focuses on involving the chaplain the pan of care throughout the disease trajectory. Spiritual and religious practices and encouragement as a means to obtain comfort.
Domain 6: Cultural Aspects of Care.
This domain focuses on the inclusion of cultural aspects when providing care and holds that the inter-professional team should be culturally competent.
Domain 7: Care of the Patient at the End of Life. This domain emphasizes communication and physical signs and symptoms of the dying process.
Again the patient/families/inter-professionals team should be involved with scrupulous assessment and management of pain and other symptoms. Ongoing education for families about the dying process is of utmost importance.
Domain 8: Ethical and Legal Aspects for Care. This domain addresses advance care planning and ethical/legal aspects. Advance care planning is seen as something that is ongoing and may change throughout the disease course. This domain reaffirms that ethical issues are common and must be addressed. The identification of complex legal and regulatory issues of palliative care is also addressed.

Question 19

Give examples of what the Quality Management nurse would do

Answer 19

Quality management nurse:·
assess the compliance of the agency or institution with established standards and explore variations of these established standards.·

ensures that the outcomes in client care services are consistent with established standards.·

Chart reviews and ongoing interactions with the staff of the agency are integral components of the quality management position. P. 452

Question 20

Pareto chart

Answer 20

picking key things to focus on(looks like bar graph)

○ Work on bars form high-> low

Question 21

Time plot/control chart

Answer 21

measure data over time to find “trends”

Control chart just has a more specific goal of what it looking at

Question 22

Flow chart

Answer 22

mapping out what happens, NOT what was intended

○ Top-down chart: list main/substeps of a process

○ Deployment chart: steps of a process with headings and who will do it

Question 23

Cause-and-effect chart

Answer 23

○ A list of potential causes arranged by categories to show their potential effect on a problem.

○ Help determine potential sources of problems

Question 24

Clinical Algorithm chart

Answer 24

Represent more of a decision that a practitioner might take during a particular episode or need

Question 25

What are some general delegation rules?

Answer 25

Key Term: Transferring to a competent staff member the authority and responsibility to perform a selected task that the staff member would not normally be allowed to perform; the RN retains accountability for the delegated task.

The right task: ensure that the delegated tasks conform to the established guidelines. The right circumstances: delegate tasks that do not require independent nursing judgment.

The right person: delegate to someone who is qualified and competent.

The right direction and communication: give clear explanation about the task and expected outcomes, and indicate when the delegatee should report back to the RN.

The right supervision and evaluation: invite feedback to assess how the process is working and how to improve the process. Also evaluate the patient’s outcomes and results of the tasks.

Question 26

What should the nurse consider when responsible for staffing?

Answer 26

Staffing - ensuring that an adequate number and mix of health care team members are available to provide safe, quality patient care.

Answer: Primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity);

contextual clues; such as the architecture and geography of the environment and the available technology;

level of preparation and and experience of the staff members providing the care; and the quality of the nurses’ work life

Question 27

What should the nurse do if the patient speaks another language?

Answer 27

Key Term: Cultural Sensitivity- Experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another.

Answer: An interpreter needs to be consulted if the nurse does not speak the same language as the patient

Question 28

What CAM therapies are considered low-risk therapies?

Answer 28

Healing philosophies, practices, and products that are outside of what Western society considers mainstream medicine and are not typically taught in the educational programs of physicians, nurses, and other health professionals.

Answer: Massage, Relaxation, Prayer, and physical touch

Question 29

Describe the Law of Cure

Answer 29

This is the principle used to evaluate the effectiveness of a remedy. If the treatment is successful, symptoms should travel from vital to less vital organs of the body, move from within the body outward, and disappear in reverse order of appearance. If symptoms do not follow this sequence, a new or additional treatment is used.

Question 30

Describe homeopathic medicine

Answer 30

n homeopathic medicine, a worsening of symptoms after a remedy is given is considered a positive sign that healing is taking place.

Question 31

Give an example of cultural competence.

Answer 31

Health professionals, educators, and healthcare systems must all respond to the consequences of increasing cultural diversity for the future well-being of all populations. The worldwide shortage of nurses and the global immigration of both nurses and populations have heightened the need to educate nurses to deliver culturally competent care for increasingly diverse populations regardless of geographic location.

Be sensitive to and show respect for the differences in beliefs and values of others.

Question 32

Cultural humility

Answer 32

Incorporates a lifelong commitment to self-evaluation and self-critique, to redressing the power imbalances in the patient-clinician dynamic, and to developing mutually beneficial and advocacy relationships with communities on behalf of individuals and defined populations.

Question 33

Cultural sensitivity

Answer 33

Experienced when neutral language, both verbal and nonverbal, is used in a way that reflects sensitivity and appreciation for the diversity of another

Question 34

What is the purpose of the Affordable Care Act?

Answer 34

Also known as the Patient Protection Act. This health care reform was designed to expand health insurance coverage to uninsured Americans while controlling costs and improving the quality of health care. This is a plan for a comprehensive national health insurance program to provide funding for U.S citizens and legal residents to secure health insurance beyond current programs such as Medicare

Question 35

Computerized Adaptive Testing/Quizzing

Answer 35

Computer Adaptive Testing- a testtaken on a computer that uses computer technology and measurement theory.
ANSWER: CAT (computer adaptive testing) adapts to the level of the candidate’s knowledge, skills and ability. After a candidate answers a question at a particular level of difficulty, the computer selects the next item that the candidate should have a 50% chance of answering correctly. The GOAL of CAT is to determine competency based on the difficulty of questions answered correctly rather than on the number of questions answered correctly.

Example: NCLEX exam is computerized adaptive testing

Question 36

What does “mandatory licensure” mean?

Answer 36

Once each state had established permissive licensure, the next movement was towards a requirement that all nurses must be licensed

Question 37

The NCLEX-RN length, and how the exam works when it cuts off at a certain number?

Answer 37

6 hour long exam, There is a minimum of 75 questions and a maximum of 265 questions.

Run out of time rule: The candidate runs out of time and the 95% confidence interval has not been determined. If the candidate has not answered the minimum number of questions, then her or she fails. If the candidate has answered the minimum number of questions, the computer analyzes the last 60 questions to determine whether these questions were above or below the passing standard.

Question 38

Why are nurses attracted to hospitals that have magnet status?

Answer 38

Research has consistently shown that Magnet hospital nurses have higher levels of autonomy, more control over the practice setting, and better relationships with physicians. Key Terms: Autonomy- Professional freedom and the right of competent people to make choices.

Question 39

What to say to the “What are your weaknesses?”

question in an interview.

Answer 39

Honesty is always best. It is not advisable to avoid the issue of weaknesses. Everyone has them. It is better to admit them, but to present them in a positive way. In addition it may be helpful to tell the interviewer what is being done to correct weakness.
For example, “Sometimes I tend to see the big picture and have to remind myself to pay more attention to the details. I’ve started keeping lists, and they seem helpful.”
Another suggestion might be, “I have limited bedside nursing experience, but I am excited about building on the clinicals skills I have learned in school.

Question 40

Interviews can include exams for the nurse interviewing. What subject will likely be on the exams?

Answer 40

• Parts of screening for safety might include paper-and-pencil testing, such as skills test, pharmacology test, and, in some cases, personality testing and psychological testing for specialty areas.
• Example: Examples might be starting cardiopulmonary resuscitation on a simulated patient, demonstrating the proper procedure for starting an intravenous like, and talking through the assessment of a patient.

Question 41

What should be included in a cover letter?

Answer 41

Chance for an applicant to sell himself or herself and make the recruiter look forward to meeting an attractive candidate.
● A cover letter should reflect the nurse’s own style of writing, should never appear to have been copied from a book, and should be tailored to the particular job. Should be clean, direct, and letter perfect. It should be attractive and effortless. There must be no typing errors and no grammar or spelling mistakes.

Everything should fit on a page of 8.5 by 11 in white heavyweight bond paper with ample margins on the top, bottom, and sides. Should be addressed to a specific person.

Paragraph 1 - a statement of purpose that tells the recruiter what kind of position is being sought, the writer’s expected date of graduation. State licensing status, and the date the writer will be ready to begin work .Paragraph 2 - emphasize the writer’s suitability. The implied message should be “I’m the person for the job” without going into all the details that will be included in the resume. A sentence should describe past work or educational experience that relate to the agency’s particular needs and philosophy.

Question 42

What are some ways to make sure the potential employer is right for you. Ch. 27
( Pg476 - 478) (The applicant’s tasks)

Answer 42

• Assessing the work climate, ask for a tour, follow-up (thank you letter, avoid impulse decisions, weighing options, does the position match the nurse’s qualification, what are the actual responsibilities of the job, does this position lead the nurse in the direction of projected career goals, how will the work be compensated.)