Professional Aspects Exam Flashcards
In 2016, the Council on Accreditation of Nurse Anesthesia Educational Programs established the Programs’ Transition to the_______
Doctoral Level policy.
In 2016, the Council on Accreditation of Nurse Anesthesia Educational Programs established the Programs’ Transition to the Doctoral Level policy. This policy mandates that all accredited programs offer a doctoral degree for students entering programs as of
January 1 of: 2022
A principle of tort law assigning responsibility to the hospital for damages caused an employee of the hospital is
the doctrine of “Respondeat Superior”
Explain the principle of TORT LAW
One of the principles of tort law was the doctrine of “respondeat superior”: let the master answer. When damage is caused by a servant (employee), the master (employer) should be held responsible for it.
The anesthesia-care provider establishes a duty to the patient when?
the provider-patient relationship is established
As a care-provider, duty is established when
the provider-patient relationship exists
There are certain general duties that all providers have to their patients such as
obtaining informed consent, and discussion of risks and alternatives.
During a study of the effects of low-dose dopamine versus placebo on renal perfusion, data was collected and the χ2 test was used for data analysis. The χ2 test helped to determine:
if the null hypothesis was valid
The χ2 test is appropriate for deciding what?
if proportions of data falling into categories are different at a given level of significance.
What information does X2 tells us?
the decision to reject or accept the null hypothesis can be made.
Under US Law, cases supporting anesthesia as a practice of both medicine and nursing include: (Select 2)
- Chalmers-Francis v. Nelson,
2. Frank v. South
What are regulations? .
Regulations: are specific written policies adopted by an administrative agency
Regulations are also frequently referred to as
“rules.”
State administrative agencies derive their rulemaking authority from what?
from an enabling law.
A z score represents what?
how many standard deviations a given raw score is above or below the mean.
4 Reasons that a null result may be obtained include:
- There really is not the trend or difference that the researcher believes exists.
- The sample of cases and observations included in the analysis is biased.
- There are insufficient cases in the sample to detect the trend.
- The measurements chosen have very high or inherent random variability.
What standard is this: There shall be complete, accurate, and timely documentation of pertinent information on the patient’s medical record.
Standard VI
What standard is this: Obtain informed consent for the planned anesthetic intervention from the patient or legal guardian.
Standard II
What standard is this: Transfer the responsibility for care of the patient to other qualified providers in a manner that assures continuity of care and patient safety.
Standard VII
What standard is this: Formulate a patient-specific plan for anesthesia care
Standard III
Prion diseases are responsible for:
spongiform encephalopathies
Prions are highly resistant to denaturation with chemical agents What is the significance of that?
disinfection and sterilization of reusable medical instruments a unique challenge because effective prion decontamination relies upon protein hydrolysis or destruction of protein tertiary structure
Prions are composed of
misfolded protein without nucleic acid
They are responsible for the transmissible spongiform encephalopathies
Prions
Bovine spongiform encephalopathy aka or “nd
mad cow disease” in cattle a
Like mad cow disease in humans is
Creutzfeldt–Jakob disease (CJD) in humans.
What happens when prions enters the human body?
When a prion enters a healthy organism, it provides a template to guide the misfolding of normal protein into the extremely stable prion form, highly resistant to denaturation by chemical and physical agents.
Mechanisms of maintaining coverage when changing professional liability carriers include the: 2
- use of a retroactive policy date
2. use of tail coverage
There are ways to change professional liability insurance carriers while still
maintaining continuous coverage.
Methods to maintain coverage include the placement of a retroactive start date on the new policy and the acquisition of tail coverage, which provides what?
insurance coverage for events that may have occurred during the time of coverage of the previous policy.
The doctrine known as “Captain of the Ship” holds that:
the surgeon assumes control of the operating room and staff and may be held liable for any negligence occurring in the operating room
The doctrine known as “Captain of the Ship” holds that once the surgeon assumes control of the operating room, the surgeon is responsible for everything, including
negligence, that occurs.
Punitive damages: result from
wanton, reckless or fraudulent negligence
The law allows for 3 different types of damages. What are they?
General Damages
Special Damages
Punitive Damages
The Law allows for how many damages?
3
What are general damages?
those such as pain and suffering that directly result from the injury.
What are special damages are those
actual damages that are a consequence of the injury, such as medical or funeral expenses.
Punitive damages are intended to punish the care-provider for
negligence that was reckless, wanton, fraudulent or willfu
Punitive damages are intended to punish the care-provider for
negligence that was reckless, wanton, fraudulent or willful
After abdominal surgery, the patient arrived to the PACU with a stridor, which was found to be the result of laryngeal edema with vocal cord laceration, secondary to difficulty with intubation. Damages may be awarded to this patient due to:
res ipsa loquitor “ The thing speaks for itself”
Re
Res ipsa loquitor means
“the thing speaks for itself”.
What does RES IPSA LOQUITOR states?
This holds that under certain circumstances the mere fact that the damage occurred (e.g. a corneal abrasion) is sufficient proof of negligence without requiring the plaintiff to have to prove a specific act of negligence.
Interpretations of the law by the attorney general are:
not binding on the courts. However, they are important because they tell how the executive branch will act.
Research studies focused on the changes noted in a sample over the course of time are known as:
longitudinal studies
Longitudinal studies deal with changes in a study group over the course of time.
prospective (A.K.A. cohort) studies
retrospective (A.K.A. case-control) studies.
Cross-sectional studies deal with a
phenomenon at a particular point in time.
The null hypothesis asserts that: there is
no difference between groups or relationship between variables
The null hypothesis claims that any
differences in the data are due to chance, or that any difference among groups is due to random effects.
Within the AANA bylaws, there are provisions allowing for the establishment of 3 separate and autonomous councils including the: (Select 3)
The councils do not report to the association president or executive director, with the exception of evaluation oversight.
- The National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA)
- Council on Accreditation of Educational Programs in Nurse Anesthesia
- Council for Public Interest in Anesthesia
Within the AANA bylaws, there are provisions allowing for the establishment of 3 separate and autonomous councils including the: (Select 3)
- The National Board on Certification and Recertification of Nurse Anesthetists (NBCRNA)
- Council on Accreditation of Educational Programs in Nurse Anesthesia
- Council for Public Interest in Anesthesia
These 3 autonomous councils are solely responsible for their
own internal affairs, including the election of officers and the direction of financial activities.
According to Standard V of the Scope and Standards for Nurse Anesthesia Practice: (Select 2)
- continuous end-tidal carbon dioxide monitoring is required on all patients during controlled or assisted ventilation
- continuous electrocardiography and monitoring of heart sounds are required on all patients
Standard V concerns the
monitoring of the patient’s physiologic condition as appropriate for the type of anesthesia and patient needs.
State all the provision of standard V:
- Monitor ventilation continuously with auscultation, chest excursion and ETCO2 during controlled or assisted ventilation. Use spirometry and ventilatory pressure monitors as indicated.
- Monitor oxygenation continuously with clinical observation and pulse oximetry.
- Monitor cardiovascular status continuously via electrocardiogram and heart sounds. Record blood pressure and heart rate at least every five minutes.
- Monitor body temperature continuously on all pediatric patients receiving general anesthesia and when indicated on other patients.
- Monitor neuromuscular function and status when neuromuscular blocking agents are administered
- Monitor and assess patient positioning.
An administrative agency, such as the Food and Drug Administration: combines what
combines all of elements of the three branches of government
An administrative agency is part of the
Regulations issued must be consistent with enabling acts and other legislation..
executive branch.
Administrative agency such as the FDA, As an entity, it combines all 3 branches of the government,
has a legislative function, an executive function as well as a judicial function in that the agency can conduct hearing s on charges and determines guilt or innocence.
The limits of your professional liability coverage are $1,000,000/$3,000,000, this means that: (Select 2)
- $1,000,000 of coverage is available for any one event in a policy year
- $3,000,000 of coverage is available for the sum of events in a policy year
Limits of professional liability coverage have two components. The limits are indicated with a
slash mark between two numbers
Damages based on the value of the injury caused are called
compensatory damages
Damages based on the value of the injury caused, even if it is difficult to value, are called compensatory damages. If the wrongdoing has been intentional or gives a sense of outrage
courts may aware punitive or exemplary damages.
An important aspect of punitive damages is the
lack of insurance coverage.
The most commonly considered evidence of whether an appropriate standard of care was upheld comes from:
expert witnesses
Generally, depositions: are done where?
conducted outside the courthouse by agreement of the parties.
The witness swears to
tell the truth and a certified court reporter takes down every word spoken during the deposition.
What is The doctrine of “Sovereign Immunity” ?
protects the government from being sued without its consent
The doctrine of “sovereign immunity” protects the government from being sued without its consent. The federal government permits lawsuits to be brought against it under most circumstances, but these suits must be
brought in federal courts.
The most restrictive type of state-granted credential is:
licensure
Persons who do not possess the requisite license may neither
use the title of the profession nor practice the profession as it is defined.
Normal distribution is ____Curve
Bell-shaped
As a result of the negative skew, most data points are
high and spread out toward the lower end of the distribution.
What is the Rosenthal effect?
At times, the expectations of the researchers in a study influence the outcome.
According to Standard II of the Scope and Standards for Nurse Anesthesia Practice:
documentation of informed consent for the anesthetic should be acquired and/or documented in the medical record by the CRNA.
The CRNA shall obtain or verify that an informed consent has been obtained by a qualified provider. standard ____
II
Discuss anesthetic options and risks with the patient and/or legal guardian in a language the patient and/or legal guardian can understand–> Standard
II
Document in the patient’s medical record that the informed consent was obtained –> Standard
II
Determination of the facts of the case as well as the applicable law is the responsibility of the:
trial court
Courts are either
Courts are either trial courts or appellate courts.
Trial courts are where
cases are brought and facts presented.
What are appellate courts?
Decisions of the trial courts can be appealed to the appellate courts.
Specificity refers to: the
proportion of patients who do not have abnormal pseudocholinesterase out of all of the negative tests
Specificity refers to the proportion of individuals who test as
negative who really do not have the disease, out of all of the negative test results.
Sensitivity refers to the proportion of people who test as
positive who really have the disease, out of all of the positives.
A perfectly accurate test has a specificity of ____ and a sensitivity of _____
1.0; 1.0
The doctrine of res ipsa loquitur depends on which 3 things?
- The injury must occur under circumstances such that it would not have happened if someone had not been negligent
- the injury must be caused by something within the exclusive control of the defendant
- the injury must not have been due to any voluntary action or contribution on the part of the plaintiff
The standard of care for administering anesthesia:
is the same for both physician and nurse anesthetists
The standard of care for administering anesthesia is the same for both physician and nurse anesthetists and either may be used as
expert witnesses.
As a defendant, means of testifying regarding involvement with a patient include: THREE
information that is remembered
information from the patient care record
information from habitual conduct
The two basic forms of civil litigation are:
- Contract disputes
2. Torts
In some states, the requirement exists that CRNAs be
supervised” by a licensed physician.
In some states, the requirement exists that CRNAs beThese physicians: need only possess a
current state license
No state, however, specifically requires in either its nurse practice act or board of nursing regulations that the supervising physician
be an anesthesiologist.
Patients indicate their degree of pain using the scale shown below. This is an example of:
an ordinal scale
Measurements with ordinal scales are ordered in the sense that
higher numbers represent higher values.
Ordinal data are usually presented by
counting the number of cases or each ordered rank making up the scale.
In a study of minimum alveolar concentrations (MACs) of desflurane in pediatric patients less than 2-years of age, the relevant variable was expressed as a percentage over or under 6.0%. This is an example of what kind of scale?
a ratio scale
The distinguishing feature of a ratio scale is that
zero is not an arbitrary number.
Ratio scales produce quantitative measurement and are regarded as the
“highest” scale of measurement.
Ratio scales produce what kinds of measurements
Quantitative.
A study of the effect of a 500 mL bolus of normal saline prior to the induction of general anesthesia is being undertaken to assess the effect on the incidence of hypotension. An initial sample size of 20 test subjects is completed. An increase in sample size will result in:
a decrease in sampling error
Relationship between sample size and sampling error
The greater the sample size, the smaller the probability of sampling error.
In fact, the sampling error is
inversely proportional to the square root of the sample size.
The standard of care in the specialty of anesthesia:
is nationwide and does not vary from state to state
In specialty areas such as anesthesia, there is a nationwide standard of care that does not
t vary from community to community.
The rate of seroconversion in healthcare workers sustaining a percutaneous exposure to HIV-infected blood is estimated to be:
0.3%
The rate of seroconversion in HCWs after a mucous membrane exposure is
0.09%.
To be successful in a negligence suit, the patient-plaintiff must prove: what 4 things (DBCD)
Duty
Breach of duty
Causation
Damages
The Closed Claims Project found that, excluding dental damage, the two leading injuries resulting in a claim of negligence were: those 2 things
Death (24%) and nerve injury (22%) were reported by the Closed Claims Project as the
death, nerve injury
The Closed Claims Project found that, excluding dental damage, the two leading injuries resulting in a claim of negligence were: those 2 things
death, nerve injury
two leading causes of negligence claims, excluding dental damage.
Death, nerve injury
Closed claims projects nerve injury percentage
22%
In general, the types of policies written by professional liability insurance companies include: (Select 2)
Occurrence
Claims-made
In general, the types of policies written by professional liability insurance companies include occurrence policy and claims-made policy: What is an occurrence policy?
An occurrence policy covers the insured for all acts occurring within the policy period, regardless of when the lawsuit is filed.
In general, the types of policies written by professional liability insurance companies include occurence policy and claims-made policy: What is claims-made policy?
Under a claims-made policy, the insured must have coverage at the time of the incident and continuously through the the date the claim is made or the lawsuit is filed.
Failure to follow a standard of care set forth in a statute is known as:
negligence per se. This is helpful to the plaintiff since expert testimony as to the standard of care is not required..
Does not constitute negligence per se
Violation of an institutional policy
According to OSHA regulations, employers of healthcare workers must: have 4 things
- offer appropriate personal protective equipment in various sizes
- offer the HBV vaccine at no charge to personnel
- Offer an annual educational program informing employees of their risk for blood-borne infection and available resources
- offer a mechanism for postexposure treatment and follow-up
In statistical terms, proportions are_____
statistics:
In statistical terms, proportions are statistics: which are
calculated by putting the frequency of one category over that of the total sample number
Ratios express
The relative frequency of one set of frequencies in relation to another;
Proportions are calculated by putting the
frequency of one category over that of the total in the sample or population.
In a study by Katz (2001), the most stressful aspect of anesthesia practice was identified as:
demands associated with night call
In a study by Katz (2001), the most stressful aspect of anesthesia practice was identified as:
demands associated with night call
The most frequently cited impetus toward retirement.
Demands associated with night call
During a research study, improvement of the test subjects’ performances as a result of being observed is known as the:
Hawthorne effect
Placebo effect is an example of the
Hawthorne effect.
Statistical tests are chosen on what basis?
on the basis of the type of scales that are being analyzed.
Tests that are suitable for the analysis of ordinal or nominal data are termed:
non-parametric tests
Non-parametric statistical tests are best suited for the analysis of
ordinal or nominal data.
Non-parametric statistical tests are best suited for the analysis of
ordinal or nominal data.
Fluoroscopic equipment is commonly used in the operative suite. Radiation exposure to the CRNA and OR personnel: Should not exceed what?
The U.S. Regulatory Commission has established an occupational exposure limit of 5,000 mrem/year. Radiation exposure results in stochastic biologic effects that are cumulative and permanent.
should not exceed of 5,000 mrem/year, becomes minimal at a distance greater than 36 inches from the source,
Fluoroscopic equipment is commonly used in the operative suite. Radiation exposure to the CRNA and OR personnel: Should not exceed what?
should not exceed of 5,000 mrem/year, becomes minimal at a distance greater than 36 inches from the source,
Radiation exposure to the CRNA and OR personnel is
is inversely proportional to the square of the distance from the source
Unfortunately, the lead apron and thyroid collarr leave many exposed vulnerable sites such as the
long bones, cranium and skin.
2 Leads use to shield
Lead apron and thyroid collar
Radiation exposure results in
stochastic biologic effects that are cumulative and permanent.
The Likert scale is commonly used in
surveys and questionnaires.
The Likert scale employs a:
5-point scale, for example: Strongly Agree Agree Undecided Disagree Strongly Disagree
NIOSH has determined that the maximum level for safe noise exposure should not exceed:
90 dB for 8 hours
NIOSH has determined that the maximum level for safe noise exposure should not exceed:
90 dB for 8 hours
It is estimated, from the Harvard Medical Practice Study, that the incidence of a patient injury becoming a malpractice suit is approximately:
4%
Relatively few adverse outcomes end up in a malpractice suit. It has been estimated that
less than 1 of 25 patient injuries result in malpractice litigation.
According to the Joint Commission, sentinel events: ALWAYS
always should undergo a root cause analysis
According to the Joint Commission, sentinel events: ALWAYS
always should undergo a root cause analysis
Sentinel event: The incident
may or may not have resulted in patient injury.
What agency requires all sentinel events to undergo root cause analysis?
The Joint Commission
Failure to obtain informed consent could expose the CRNA to possible prosecution for:
Battery
A researcher is investigating the effectiveness of a nuperidine, an investigational opiate, on post-operative pain. A random sample of 100 patients, having unilateral total knee replacements, was selected. Patients were randomly selected to receive nuperidine PCA (Group A) or morphine PCA (Group B). The level of pain was assessed using a standardized pain scale questionnaire. The independent variable in this study is:
the type of treatment used
In an experiment, an independent variable is the
variable or condition manipulated by the researcher.
The dependent variable is the
observed result of the independent variable being manipulated.
NIOSH has determined that at any point in time, the maximum allowable noise exposure in an industrial setting should not exceed
115 dB
The noise level in many operating rooms is surprisingly high and can easily exceed
75 - 90 dB.
Characteristics of the correlation coefficient include: (Select 2).
it is calculated from pairs of measurements on variables for the same group
its values range from +1 to -1
The Correlation Coefficient is a statistic which expresses
numerically the magnitude and direction of the association between two variables
Correlation coefficients are calculated from
pairs of measurements for the same group of individuals.
Characteristics of the correlation coefficient include:
A positive correlation is denoted by + and a negative correlation by -.
where +1 is a perfect positive correlation, 0 is no correlation and -1 is a perfect negative correlation.
Characteristics of the correlation coefficient include:
A positive correlation is denoted by + and a negative correlation by -.
The values of the correlation coefficient range from
+1 to -1;
The values of the correlation coefficient range from
+1 to -1; where +1 is a perfect positive correlation, 0 is no correlation and -1 is a perfect negative correlation.
In a normal distribution curve, what is the relationship of mean, median and mode?.
mean = median = mode.
In curves with a negative skew, what is the relationship of mean, median and mode?
mode > median > mean
In curves with a positive skew, what is the relationship of mean, median and mode?
mean > median > mode.
While making rounds on patients receiving patient-controlled analgesia (PCA), the following pain-scores are obtained: 4, 5, 3, 7, 9, 2, 4, 5, 3, 4, 5 The median value of this data set is: (Enter numerical answer in box below. Click ‘Next’ when completed.)
4
The median is the score that
divides the distribution into half; half of the scores fall under the median and half above the median.
It is important to remember to put the
data in order when calculating the median.
Examples of discontinuous data include variables such as:
Continuous data does not contain discrete categories. For example, measurements of temperature or body mass.
male and female sexes
Discontinuous data, sometimes called,
discrete data
Discontinuous data, sometimes called discrete data, includes variables that have discrete categories, for example
male versus female.
Continuous data does not
contain discrete categories.
Continous date For example, measurements of
Temperature or body mass.
Studies and reports using meta-analysis: do what?
pp. 201-202
combine the results of several studies that address a set of related research hypotheses. Data are obtained from controlled trials already in the medical literature.
A meta-analysis combines the results of
several studies that address a set of related research hypotheses.
Most meta-analyses compare
two interventions.
The component responsible for most of the generalized allergic reactions to latex-containing surgical gloves is the:
protein content
The protein content is responsible for most of the generalized allergic reactions to latex-containing surgical gloves. These reactions are exacerbated by the presence
of powder that enhances the potential of latex particles to aerosolize and spread to the respiratory system and to environmental surfaces.
Exposure to methyl methacrylate has been associated with
eye irritation, skin irritation, burns, allergic reactions, as well as lung, liver and kidney damage.
Exposure to methyl methacrylate OSHA has established an ___-hour time-weighted average allowable exposure of:
8; 100 ppm
Concentrations of methyl methacrylate as high as ____ ppm have been measured when it is prepared for use in the operating room.
280
Concentrations of methyl methacrylate as high as 280 ppm have been measured when it is prepared for use in the operating room. However, peak environmental concentrations can be decreased by
75% when scavenging devices are properly used.
In statistical analysis, a Type I error involves: Type I errors involve mistakenly rejecting the null hypothesis, while T
mistaken rejection of the null hypothesis
Two types of elementary decision errors are identified in statistics as
Type I and Type II errors.
Type II errors involve mistakenly
retaining the null hypothesis (rejecting the alternative hypothesis).
A researcher is investigating the effectiveness of a new laryngoscopy blade for intubation. Anesthesia providers are asked to evaluate intubating conditions using the new blade on a 1 to 5 scale, with one being excellent intubating conditions and 5 being unacceptable intubating conditions. The following data was obtained:
1, 1, 1, 1, 2, 2, 2, 2, 2, 3, 3, 3, 4, 4, 4, 5
The mean score from this data set is:
2.5
The mean is defined as the
sum of all of the scores divided by the number of scores
Umbrella coverage is activated when:
the need to pay a claim exceeds the limits of coverage on the standard malpractice liability policy
Another component to the liability insurance situation is consideration of the advisability of purchasing yet another type of insurance called
umbrella coverage
Within the Americans with Disabilities Act, chemical dependency:
is considered a disability as long as the individual is in active recovery
Within the ADA, chemical dependency is classified as a disability as long as the individual is in active recovery. This does not mean that an employer
has an obligation to hire the recovering individual, but given equal qualifications, the addiction history should not be a restriction to employment.
While assessing the rate of post-operative nausea at an ambulatory surgery center, the researcher selects the 10th name form a list of patients treated at the center in the past year for surveying. This type of sampling is know as:
systematic sampling
Systematic sampling involves
working through a list and choosing cases for inclusion in the study at fixed intervals.
Systematic sampling is not It is not
a truly random technique, but will usually give a representative sample.
The enactment of the Omnibus Reconciliation Act of 1987: requires the
federal Medicare program to implement a separate payment for services provided by CRNAs
This requires the federal Medicare program to implement a separate payment for services provided by CRNAs
Omnibus Reconciliation Act of 1987
Omnibus reconcilliation act was done in
1987
Prior to January 1989, reimbursement for the professional services of anesthesia administration was primarily limited to.
the anesthesia services provided by a physician
The enactment of the Omnibus Reconciliation Act of 1987 required the federal Medicare program to implement a separate payment within the professional services sector for the services provided by
CRNAs.
This sector of the Medicare program, would be responsible for the reimbursement of nearly all CRNA services throughout the Medicare system.
titled Medicare Part B
During a study of changes in patient core temperatures during laparoscopic cholecystectomy, the following temperatures were recorded: 36.2, 35.8, 36.4, 36.5, 35.8, 34.9, 36.2, 35.8.. The mode of this data set is:
35.8
The mode is the
most frequently occurring score in a distribution.
The best statistical analysis for handling comparisons of means between the several measurements obtained within the same study group is called the:
analysis of a variance (ANOVA)
The most versatile approach for handling comparisons of means between more than two groups or between several measurements in the same group is called
analysis of variance and is frequently cited by the acronym ANOVA.
Analysis of variance consists of rules for
creating test statistics on means when there are more than two groups. These test statistics are called F ratios.
Continuing quality improvement (CQI) programs: try to
An important premise is that poor results may be the result of either random or systematic error. Syste
identify systematic problems and opportunities for improvement
CQI programs take a systems approach to identifying and improving
quality of care.
System errors should be
controllable and strategies to minimize them should be within reach.
If a hospital hires a CRNA and approves clinical privileges, those involved in the hiring and approval decisions may be held liable in the courts for the CRNA’s actions in light of the legal doctrine known as:
vicarious liability
If an individual, group or institution hires a CRNA or even simply approves clinical privileges, those involved in the decision may later be held liable in the courts for the individual’s actions. This is known as
vicarious liability.
