Module 11 Flashcards
T/F: Preferred provider organizations (PPOs) are prepaid, group-managed care plans that allow subscribers to receive all medical services through a group of affiliated providers.
FALSE
A program of palliative and supportive care that provides physical, psychological, social, and spiritual care for dying people is known as ______________ service.
hospice
A hospital designated with ___________status has been recognized for quality patient care, nursing excellence, and innovations in professional nursing practice.
magnet
T/F: The United States spends more per person on health care than any other nation in the world
TRUE
The Patient Protection and Affordable Care Act, beginning in 2014, will provide __________ or subsidized coverage to qualifying people with incomes up to 400% of poverty
medicare
A strategy to reduce health care costs is __________, a system that gives providers of care a fixed amount of money per enrollee.
capitation
T/F: Fifty years ago, half of the doctors in the United States practiced primary care, but today fewer than one in three do.
TRUE
T/F: The government estimates that by 2021, 20% of the U.S. gross domestic product will be allocated to health care.
TRUE
Immunizations and health risk screenings are examples of a __________ level of health care
primary
T/F: Managed care systems always allow patients to choose their own health care providers.
FALSE
According to Kübler-Ross, in the _____________ stage of dying, the patient goes through a period of grief before death.
depression
While hospice care focuses on the needs of the dying, ___________ care is appropriate across the spectrum of disease and illness.
palliative
T/F: Perceived loss is felt by the person and can be recognized by others.
FALSE
T/F: The Patient Self-Determination Act of 1990 required all hospitals to conform to a standard, uniform set of advance directives
FALSE
Patient Self-Determination Act of 1990 requires all hospitals to inform patients about advance directives.
During _____________ loss, a person displays loss and grief behaviors for a loss that has yet to take place.
anticipatory
T/F: Terminal weaning is the gradual withdrawal of mechanical ventilation from a patient with a terminal illness or an irreversible condition with a poor prognosis.
TRUE
Death is defined as the irreversible cessation of all functions of circulatory and ______________ functions, or irreversible cessation of all functions of the entire brain, including the brainstem.
respiratory
A ___________ power of attorney appoints an agent whom the person trusts to make decisions in the event of subsequent incapacity
durable
T/F: Active euthanasia is defined as withdrawing medical treatment with the intention of causing the patient’s death.
FALSE
passive euthenasia
T/F: During Engel’s stage of grief known as idealization, there is often an exaggeration of the good qualities that the deceased person possessed
TRUE
A nursing diagnosis related specifically to spirituality would be __________, a subjective state in which a person sees limited or no alternatives or personal choices available and is unable to mobilize energy on one’s behalf.
hopelessness
T/F: Members of the religion Jesus Christ of Latter Day Saints (Mormons) believe in divine healing through the “laying on of hands.”
TRUE
Closely related to spirituality, faith, and religion, ______ is the ingredient in life responsible for a positive outlook even in life’s bleakest moments.
hope
T/F: An emergency department nurse is aware that those who practice the religion of Jehovah’s Witnesses will not accept blood transfusions.
TRUE
T/F: Faith is a confident belief in something for which there is no material evidence or proof
TRUE
The religion known as _____________ teaches that there are “Four Noble Truths” that indicate the range of “suffering,” its “origin,” its “cessation,” and the “way” that leads to its cessation.
Buddhism
T/F: Spirituality is anything that pertains to a person’s relationship with a nonmaterial life force or higher power.
TRUE
The nursing diagnosis of spiritual _________ can be used to describe the impaired ability to experience and integrate meaning and purpose in life through one’s connectedness with such things such as self, others, art, and music.
distress
An atheist is a person who denies the existence of a higher power; an _________ is one who holds that nothing can be known about the existence of a higher power.
agnostic
T/F: Nurses always have the moral right to withdraw from administering care that violates their personal moral code.
TRUE
The client’s spouse says to the nurse, “It’s been really tough this last month caring for my spouse. Even though I have an aide who comes in to help for a couple of hours a week, I’m just spent, physically and emotionally.” A referral for which service would be appropriate?
Respite care
When conducting an education program for a group preparing for retirement, the nurse would include information about applying for Social Security benefits and Medicare insurance. The nurse would include in the education that Medicare is a federally funded insurance program which bases the fee for payment on what?
Correct response:
A prospective payment plan based on a predetermined fixed cost
Which is the main focus of care for a school nurse?
Community care
Explanation:
A nurse employed as a school nurse is considered to be working in community-based care. School nurses provide many different services, including maintaining immunization records, providing emergency care for physical and mental disorders, administering prescribed medications, conducting routine health screenings (e.g., vision, hearing, scoliosis), and providing health information and education.
The nurse shares with the health care team the need for a client, diagnosed with cancer and receiving chemotherapy, to attend an adult child’s wedding. What discussion does the nurse have with the health care team to advocate for the client attending the wedding?
To affirm that the decision is consistent with client goals
Which is the acute care setting for people who are too ill to care for themselves at home, are severely injured, or require surgery?
Hospitals
Which six trends in health care reflect the Institute of Medicine’s (IOM) focus?
“The system should be safe, effective, efficient, patient centered, timely, and equitable.”
A client is being prepared for discharge from the hospital after an exacerbation of heart failure. The client needs assessment of cardiac status, instruction in medications and diet therapy as well as exercises to increase endurance and stamina. The client also needs assistance with self-care, both in performing it now and learning how to adapt to the limitations to maintain independence. The client also lives alone with an older adult, frail spouse. In addition to the client’s physician, which members of the interdisciplinary team would need to be involved? Select all that apply.
Nurse Physical therapist Occupational therapist Unlicensed assistive personnel Social worker Explanation: Based on the client's condition, the following members would be involved: nurse to assess cardiac status and teach about medications and diet; physical therapist to assist with exercises; occupational therapist to assist with self-care adaptations; unlicensed assistive personnel to assist with self-care now; and social worker to assist with supportive services for the couple since the spouse is elderly and frail.
The nurse is caring for several clients with chronic conditions that need to be evaluated for long-term care. After evaluating each client, the nurse determines which client is most appropriate to receive long-term care?
A client who suffered a stroke who has mobility issues and problems completing activities of daily living (ADLs).
A client is admitted to the facility after fracturing a hip. The client has undergone surgery to repair the fracture and is receiving services to promote healing of the surgical site and regain mobility. Which discussion should the nurse have with a member of the interdisciplinary team member to promote the goal of regaining mobility?
Speak with the physical therapist about exercises to strengthen muscles.
Which statement is true when comparing home care with acute care?
The nurse is the guest in the client’s home.
A nurse has an older adult home care client who lives alone with no family nearby. On a recent visit, the nurse notices that his clothes are very loose, and he has difficulty letting the nurse leave when the visit is ending. After talking with him, the nurse learns that he has not been cooking for himself and he can’t get to the grocery store easily. What service could the nurse suggest as an immediate response until a long-term plan can be formed?
Enroll the client in Meals on Wheels.
The nurse is a member of the multidisciplinary team in a large primary healthcare setting. The nurse understands that which healthcare team member is responsible for a client’s swallow evaluation following a cerebral vascular accident?
Speech pathologist/therapist
Which client would a nurse correctly refer to Medicare services?
A 66-year-old client with diabetes
Explanation:
Medicare is a federal health care plan for individuals over the age of 65. An individual with a disability might be referred to Medicare, but other federal organizations must be involved for this to occur.
A nurse working for a home health agency is scheduled to evaluate a client with worsening heart failure to determine whether the client is a candidate for the new “Hospital at Home” program. Which statement accurately reflects an outcome for this program?
Correct response:
Clients in the “Hospital at Home” program have been found to require shorter lengths of stay than when admitted to the acute care setting.
Explanation:
Clients who receive care in their own homes, surrounded by familiar family and friends, have been found to recover more quickly than those in inpatient acute care settings
The growth in home health care is largely attributed to which factor?
Early discharge of clients from the hospital setting
Nurses in various health care settings provide services to prevent the fragmentation of care that is occurring as a health care trend in today’s society. What role of the nurse is most important in preventing this effect?
Coordinator of care
The implementation of diagnosis-related groups (DRGs) by Medicare in 1983 affected hospitals in which way?
Medicare pays only the amount of money preassigned to a treatment for a diagnosis.
The nurse understands that a diagnostic-related group is one of the reimbursement strategies in a prospective payment system. The diagnostic-related group is a part of which health care system?
Medicare
A nurse demonstrates understanding of Healthy People 2030 by supporting which statement?
A client’s health is affected by social, economic, and political factors.
A hospitalized client with advanced metastatic lung cancer states, “I want to go home. I don’t have much time left. I want to be with my family.” Which type of care referral by the nurse is most appropriate?
Hospice
A client diagnosed with a terminal illness is displaying periods of depression and anger alternating with acceptance. The client’s spouse is concerned about the client’s labile mood. When talking with the client’s spouse, which statement made by the nurse best addresses principles of loss and grieving?
“Not everyone experiences grief in the same way and your loved one needs our support.”
The nurse is preparing a presentation on preparing children for death. What information should the nurse include? Select all that apply.
Encourage expression of feelings.
Provide for stability and safety.
Talk openly about death and the feelings associated with it.
A nurse completing admission paperwork asks the client about having an advanced directive. The client states, “I do not know, what is an advanced directive?” What is the nurse’s best response?
“It is a written document that identifies a person’s preferences regarding which medical interventions to use in the event of a terminal condition.”
A client with a terminal illness is overheard by the nurse saying, “If I promise never to smoke another cigarette in my life, please let me recover from this lung cancer.” How will the nurse document this stage of grief according to the Kübler-Ross model?
bargaining
A client is informed about the results of a biopsy, which indicate a malignant tumor that has spread. The client states, “Well once you remove the tumor, I will be just fine.” What stage of the grief process does the nurse identify the client is experiencing?
denial
The wife of a client who has been diagnosed with a terminal illness asks the nurse about the differences between palliative care and hospice care. Which information would the nurse most likely include in the response?
Hospice care is provided for clients who have 6 months or less to live; palliative care is provided at any time during illness.
A client at a health care facility has died after a prolonged illness. A nurse is assigned to perform postmortem care for the client. Which intervention should the nurse perform when providing postmortem care?
Cleanse drainage from the skin.
The nurse provides postmortem care for a client who is not undergoing an autopsy. To achieve the desired outcome of this procedure, which nursing actions should be included? Select all that apply.
Remove any tubes and replace soiled dressings.
Place an identification tag on the client’s ankle.
Provide emotional support to the client’s family.
Ensure the death certificate has been signed.
The psychologist is teaching students about the factors that affect a person’s reaction to grief. Which statements by the students about developmental considerations are accurate? Select all that apply.
“Death of a parent can delay a child’s development.”
“Sense of loss for a child is just as great as it is for an adult.”
A client is being discharged from the hospital with terminal brain cancer and a life expectancy of 1 month. When planning this client’s discharge, it is most important for the nurse to include a referral to which agency?
hospice
A client is dying and the nurse has developed a strong rapport with the client and spouse. The spouse states to the nurse, “I just don’t know how I am going to deal with the process. It makes me nervous to think I can’t deal with it.” What is the priority concern with the spouse of the client?
Anxiety related to unknown reaction to stages of death
A nurse is providing care to a terminally ill client. Which finding would alert the nurse to the fact that the client is dying? Select all that apply
Pale, cool skin Decreased urine output Irregular heart rate Explanation: Signs of dying include extremely pale, cyanotic, jaundiced, mottled or cool skin; irregular heart rate; weak, rapid, irregular pulse; shallow, labored, faster, slower, or irregular respirations; and decreased urine output.
A terminally ill client is being cared for at home and receiving hospice care. The hospice nurse is helping the family cope with the client’s deteriorating condition, educating them on the signs of approaching death. Which sign would the nurse include in this education plan?
difficulty swallowing
The condition of a client with a traumatic brain injury continues to deteriorate despite medical efforts. The decision is made to terminally wean the client from mechanical ventilation. Which statement by the nurse is most significant in educating the family regarding terminal weaning?
“All efforts will be taken to make sure your loved one is comfortable and out of pain.”
The nurse is trying to help the client cope with the dying process. Which nursing statement is most appropriate?
“It must be very difficult for you.”
A client with end-stage chronic obstructive pulmonary disease (COPD) has reached the end of the 6-month period for hospice services and the family caregiver states, “I don’t know what we will do if they cut off our hospice services.” What is the best response by the hospice nurse?
“I will contact the health care provider to extend services since your family member meets the criteria.”
When reviewing a client’s chart, the nurse notes that the client is in the disorganization stage of grief. Which assessment finding would support this diagnosis?
“I feel like I have absolutely no idea what to do next.”
A home hospice client who has Medicare is experiencing extreme pain at home and is refusing to receive inpatient care due to concerns over the cost of inpatient care. What teaching will the nurse include in the plan of care?
Inpatient pain management for hospice patients is covered by Medicare.
The experience of parting with an object, person, belief, or relationship that one values is defined as:
loss.
The nurse is giving palliative care to a client with a diagnosis of COPD. What is the goal of palliative care?
to improve the client’s and family’s quality of life
The husband of a client who has died cannot express his feelings of loss and at times denies them. His bereavement has extended over a lengthy period. What type of grief is the husband experiencing?
Unresolved grief
The nurse is providing care to a group of terminally ill clients. The client who is most likely experiencing the anger stage of grief is the one who states:
“Why did this have to happen to me?”
Which assessment finding would best support a nursing diagnosis of Dysfunctional Grieving?
A man is unable to return to work after his sister’s death 18 months ago.
Which manifestation of grief by the client who lost his wife 3 years earlier is considered abnormal?
leaving the wife’s room and belongings intact
The children of a male client with late-stage Alzheimer disease have informed the nurse on the unit that their father possesses a living will. The nurse should recognize that this document is most likely to:
specify the treatment measures that the client wants and does not want.
What is Kübler-Ross’s third stage of grief?
bargaining
Explanation:
Her proposed stages of grief are denial, anger, bargaining, depression, and acceptance.
In the Parkes model, a person uses denial as a psychological defense in the stage of:
numbness.
Explanation:
In the numbness stage, which is usually brief, trauma so overwhelms the bereaved survivor that he or she must use denial as a psychological defense.
A nurse is paying particular attention to the spiritual needs of a client today. The nurse identifies that spiritual beliefs can have a positive effect on general health of a client in which ways? Select all that apply.
Diet
Support system
Endurance of extreme stress
Positive emotions
Upon assessment, the client reports not belonging to an organized religion. Which assessment question would the nurse ask to assess the client’s spirituality?
“Tell me about spiritual or religious beliefs that are important to you.”
The family members of a dying client have asked for the hospital chaplain’s help in having a member of the clergy come to the client’s bedside to perform the anointing of the sick. The nurse who is providing care for the client should recognize that the family is likely which religion?
Roman Catholic
The nurse enters a client’s room as the client and family are praying. Which is the most appropriate action of the nurse?
Step outside the door until the prayer is finished.
When asked about his religious preference, the client becomes very upset with the nurse. Which response is appropriate for this situation?
“I can see that this question upsets you. Do you have any questions about this?”
A nursing instructor, after teaching about the importance of spirituality, identifies a need for further teaching when overhearing a student make which of the following statements?
“You can provide quality nursing care to clients even though you ignore the spiritual dimension of health.”
When conducting a spiritual assessment, the nurse must be sensitive to the client’s personal beliefs. Which questions should the nurse ask? Select all that apply.
“Is religion or God significant to you?”
“Do you feel your faith is helpful to you?”
“Is there anyone from your church you would like to talk to?”
The nurse overhears a client, who is scheduled to begin chemotherapy, tell a family member that everything will eventually be okay and the cancer will be in remission. Which question will the nurse ask to begin a conversation about hope with the client?
“What provides you with strength to deal with this health situation?”
While interviewing a client, a nurse is told that the client practices Catholicism. This client is identifying:
his faith.
Allen is an 82-year-old retiree who recently relocated to senior apartments. The apartments are not affiliated with any religious beliefs. Allen was raised in the Roman Catholic church and has attended mass every Sunday since childhood. He has not attended mass for 3 weeks. What best describes Allen’s situation?
Separation from spiritual ties
When preparing for a spiritual counselor to visit a hospitalized client, the nurse should:
take measures to ensure privacy during the counselor’s visit.
While interviewing a hospitalized client, he states, “The holy days of Ramadan are coming soon. I am not to have any food or drink from sunrise to sunset during this time.” Further assessment reveals that the client’s request is associated with which religion?
Islam
The nurse receives a “do not resuscitate” (DNR) order for a dying client. What should the nurse do next?
Assess the client’s spiritual needs
A nurse overhears a client telling a family member that a belief in God is the only thing helping in the fight against a terminal illness. What is this client demonstrating?
faith
An older adult client is spiritual and has a deep faith. The client asks the nurse to say a prayer for the client. The nurse, who is not very comfortable praying out loud, wants to honor the client’s request. What would be the best action by the nurse?
Correct response:
Read a printed interfaith prayer to the client.
Explanation:
A nurse unaccustomed to praying aloud or in public may find it helpful to have a printed interfaith prayer readily available. Interfaith prayers are designed for use regardless of the client’s faith.
A college foreign exchange student is living with a family in England and is confused about the daily Catholic prayers and rituals of the family. The student longs for the comfort of her fundamentalist Protestant practices and reports to the campus nurse for direction. The nurse recognizes the student is experiencing which type of spiritual distress?
Spiritual alienation
Explanation:
Spiritual alienation occurs when an individual is separated from one’s faith community.
A nurse provides care on the palliative unit of a hospital. Which intervention will support a client who has expressed strong spiritual beliefs?
Carefully assessing verbal and nonverbal cues of spiritual needs by the client
The nursing instructor has been discussing spirituality with a group of nursing students. Which statement by a student would indicate a need for further education?
“Spiritual beliefs and practices do not give strength when a person is in crisis.”
A nurse interviews a client and finds that, because of religious beliefs, the client’s view on health care does not involve blood transfusions. How can the nurse best handle this client situation?
Record this information in the client’s chart.
The parents of three children ages 4, 7, and 11 years are interested in fostering spiritual development in their children. The nurse informs the parents that the development of a child’s spirituality is best accomplished by:
educating through parental behaviors.
The son of a dying female client is surprised at his mother’s adamant request to meet with the hospital chaplain and has taken the nurse aside and said, “I don’t think that’s what she really wants. She’s never been a religious person in the least.” What is the nurse’s best action in this situation?
Contact the chaplain to arrange a visit with the client.
Which client statement most clearly suggests the potential of a nursing diagnosis of Spiritual Anxiety?
“Now that I’m nearing the end, I’m worried that God won’t think I lived a good enough life.”
Explanation:
Worry about one’s spiritual condition is indicative of the nursing diagnosis of Spiritual Anxiety. Unfamiliarity with the religious character of a care setting suggests Spiritual Alienation, while questions of suffering often indicate Spiritual Pain or Spiritual Despair. Regrets over previous religious or spiritual apathy may suggest a nursing diagnosis of Spiritual Guilt.
______ are ethics that encompass all those perspectives that seek to understand human nature and behavior, the domain of social science, and the natural world.
bioethics
_____ are standards of character and behavior related to what is right and wrong in a clinical setting.
Clinical ethics
______ a subset of bioethics; formal study of ethical issues that arise in the practice of nursing and of the analysis used by nurses to make ethical judgments
nursing ethics
The ______ approach to ethics offers specific action guides such as autonomy, beneficence, nonmaleficence, and justice.
principles-based
The _______ approach to ethics prioritizes the nurse–patient relationship and directs nurses to respond to the vulnerabilities of patients as well as cultivate virtues such as kindness, attentiveness, empathy, compassion, and reliability.
care-based
______ is a situation that arises when attempted adherence to basic ethical principles results in two conflicting courses of action.
ethical dilemma
_____ is the protection and support of another’s rights
advocacy
How to prevent Malpractice from happening:
Main thing is to prevent from occurring maintain excellent standard of care self awareness adapting proposed assignments following protocols- change based on evidence based practice effective documentation
_______ occurs when a patient believes he or she has been injured because of the negligence of a nurse or other health care professional and pursues legal action
Malpractice
_______ self-determination; being independent and self-governing
autonomy:
_______principle of doing good
beneficence:
__________ type of ethical approach that aims to critique existing patterns of oppression and domination in society, especially as these affect women and the poor
feminist ethics:
_______ keeping promises and commitments made to others
fidelity:
_________ process that distributes benefits, risks, and costs fairly
justice:
_______ principle of avoiding evil
nonmaleficence:
_______ action-guiding theory of ethics that states that the rightness or wrongness of an action depends on the consequences of the action
utilitarian:
_________ is unknowingly doing harm
unintentional tort
A wrong committed against a person or that person’s property may be categorized as a _____ or _____
crime or a tort.
A ______ is a violation punishable by the state
crime
A _____ is subject to action in a civil court, with damages usually being settled with money.
tort
_______ include assault and battery, defamation, invasion of privacy, false imprisonment, and fraud.
Intentional torts
Negligence and malpractice are ______ torts.
unintentional
Liability involves four elements that must be established to prove that malpractice or negligence has occurred:
duty, breach of duty, causation, and damages
_______ term generally used to refer to employees who report their employers’ violation of the law to appropriate law enforcement agencies outside the employers’ facilities
whistle-blowing:
_______ are designed to protect health care providers when they give aid to people in emergency situations.
Good Samaritan laws
________ an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof
sentinel event:
_________performing an act that a reasonably prudent person under similar circumstances would not do, or failing to perform an act that a reasonably prudent person under similar circumstances would do
negligence:
_______a report of any event that is not consistent with the routine operation of the health care facility that results in or has the potential to result in harm to a patient, employee, or visitor
incident report:
______ state of optimal functioning or well-being
(It is a state of complete physical, mental, and social well-being, not merely the absence of disease or infirmity)
health:
_______is a medical term, referring to pathologic changes in the structure or function of the body or mind.
Disease
An ______ is the response of the person to a disease; it is a process in which the person’s level of functioning is changed when compared with a previous level.
illness
_____ rapidly occurring illness that runs its course, allowing a person to return to one’s previous level of functioning
acute illness: Asthma attacks. Broken bones. Pneumonia. Croup. Bronchitis. Typhoid. Strep throat. Respiratory tract infection.
_________irreversible illness that causes permanent physical impairment and requires long-term health care.
chronic illness: Alzheimer disease and dementia. Arthritis. Asthma. Cancer. COPD. Crohn disease. Cystic fibrosis. Diabetes.
_______something that increases a person’s chance for illness or injury.
risk factor:
How can a nurse meet a patient’s physical safety and security needs?
Using proper hand hygiene and sterile techniques to prevent infection
Using electrical equipment properly
Administering medications knowledgeably
Skillfully moving and ambulating patients
Teaching parents about household chemicals that are dangerous to children
How can a nurse meet a patient’s self esteem needs?
Nurses can help meet patients’ self-esteem needs by respecting their values and beliefs, encouraging patients to set attainable goals, and facilitating support from family orsignificant others.
How can a nurse meet a patient’s self actualization needs?
To help meet patients’ self-actualization needs, the nurse focuses on the person’s strengths and possibilities rather than on problems.
_____ isassigning characteristics to a group of people without considering specific individuality
stereotyping:
_____ is the tendency of some to impose their beliefs, practices, and values on another culture because they believe that their ideas are superior to those of another person or group
cultural imposition:
_____ is the process of ignoring differences in people and proceeding as though the differences do not exist
cultural blindness:
_______ is a situation that occurs when people become aware of cultural differences, feel threatened, and respond by ridiculing the beliefs and traditions of others to make themselves feel more secure about their own values
culture conflict:
______ iscare delivered with an awareness of the aspects of the patient’s culture
cultural competence:
_______ enables nurses to deliver services that are respectful of and responsive to the health beliefs, practices, and cultural and linguistic needs of diverse patients; critical to reducing health disparities and improving access to high-quality health care
cultural respect:
