Professional Role

Question 1

(1)

The obligation to help the patient—to remove harm, prevent harm, and promote good (“do no harm”). Acting in the patient’s best interest. Compassionate patient care. The core principle in patient advocacy.

Answer 1

Beneficence

Examples:

• Educating patient with a new prescription about how to take the medication
• Encouraging a patient to stop smoking and enroll in smoking cessation program
• Calling the surgeon to get a prescription for stronger pain medications (a narcotic) for a postsurgical patient who complains of severe pain

Question 2

(1)

The obligation to avoid harm. Protecting a patient from harm.

Answer 2

Nonmaleficence

Example: A middle-aged woman with osteoporosis wants to be treated with bisphosphonates. The nurse practitioner (NP) advises that the patient is not a good candidate for these drugs because of her past medical history of gastrointestinal (GI) bleeding and peptic ulcer disease (PUD). The NP decides not to prescribe bisphosphonates.

Question 3

(1)

The obligation to act in a way that is useful to or benefits the majority. The outcome of the action is what matters. It also means to use a resource (e.g., tax money) for the benefit of most. It may resemble justice, but it is not the same concept.

Answer 3

Utilitarianism

Example: The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is for only pregnant women and children, not other adults and elderly men. The reason may be that it would cost society more if women (and their fetuses), infants, and children are harmed by inadequate food intake (e.g., affects the brain growth).

Question 4

(1)

The quality of being fair and acting with a lack of bias. The fair and equitable distribution of societal resources.

Answer 4

Justice

Example: A homeless alcoholic man without health insurance presents to the ED with abdominal pain. The patient is triaged and treated in the same manner as the other patients who have health insurance.

Question 5

(1)

The quality or state of being worthy of ethical and respectful treatment. Respect for human dignity is an important aspect of medical ethics. A person’s religious, personal, and cultural beliefs can influence greatly what a person considers “dignified” treatment.

Answer 5

Dignity

Examples:

• Hospital gowns should be secured correctly so that when patients get up to walk, their backs are not visible.
• Foley catheter urine bags should not be visible to visitors so patients are not embarrassed. NPs should move urine bags to the opposite bed rail so that they are not visible to outsiders.

Question 6

(1)

The obligation to maintain trust in relationships. Dedication and loyalty to one’s patients. Keeping one’s promise.

Answer 6

Fidelity

Example: The relationship between a patient and their healthcare team is important. The primary care NP should try their best to develop a trusting relationship with a patient.

Question 7

(1)

The obligation to protect the patient’s identity, personal information, test results, medical records, conversations, and other health information. This “right” is also protected by the Health Insurance Portability and Accountability Act (HIPAA), which restricts release of patient information. Psychiatric and mental health medical records are protected information and require separate consent.

Answer 7

Confidentiality

Example: The HIPAA Privacy Rule protects most “individually identifiable health information” in any format (oral, paper, electronic). It is known as protected health information (PHI). The PHI includes demographic information (name, address, date of birth, Social Security number) as well as the individual’s past, present, or future physical/mental health and provision of care.

Question 8

(1)

The obligation to ensure that mentally competent adult patients have the right to make their own health decisions and express treatment preferences. If the patient is mentally incapacitated (dementia, coma), the designated surrogate’s choices are respected. See later discussion on advance healthcare directives. A mentally competent patient can decline or refuse treatment even if their adult children disagree.

Answer 8

Autonomy

Example: An alert elderly woman who has breast cancer decides to have a lumpectomy after discussing the treatment options with her oncologist. The woman’s daughter tells the NP that she does not want her mother to have the surgery because she thinks her mother is too old. The NP has a duty to respect the patient’s decision. This case is also a good example of the NP acting as the patient advocate.

Question 9

(1)

Healthcare providers are responsible for their own choices and actions and do not blame others for their mistakes.

Answer 9

Accountability

Example: An NP has an adult male patient with acute bronchitis who complains of acute onset of chest pain. He is diagnosed with pleurisy. The patient goes to the ED and is diagnosed with an acute myocardial infarction (MI). The NP made an error in diagnosis and is held accountable for the decision and actions in a court of law.

Question 10

(1)

Describes situations in which one person interferes with or overrules the autonomy of another. In healthcare, it occurs when a provider or family member makes decisions for an elderly patient because they “believe” that it is in the patient’s best interest. The opinion (or desire) of the patient is minimized or ignored. The patient is “powerless.”

Answer 10

Paternalism

Question 11

(1)

The obligation to present information honestly and truthfully. In order for patients to make an informed and rational decision about their healthcare, pertinent information (including “bad” news) should not be withheld or omitted.

Answer 11

Veracity

Example: The mammogram result of a 64-year-old female patient is highly indicative of breast cancer. The patient’s son does not want his mother to know about the results. The NP has a duty to discuss the mammogram results with the patient and refer her to a breast surgeon.

Question 12

Exam Tip

Become familiar with some of the ethical concepts (e.g., beneficence, veracity, nonmaleficence, justice) and how they are applied (see examples provided in this chapter).

Answer 12

Become familiar with some of the ethical concepts (e.g., beneficence, veracity, nonmaleficence, justice) and how they are applied (see examples provided in this chapter).

Question 13

(1)

“the ethical standard for the profession and provides a guide for nurses to use in ethical analysis and decision-making.”

“is a nonnegotiable standard.”

For example, under Provision 4.4, “Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate selected interventions according to _____ nurse practice acts” (ANA, 2015)

Answer 13

The American Nurse Association ANA Code of Ethics for Nurses

For example, under Provision 4.4, “Nurses may not delegate responsibilities such as assessment and evaluation; they may delegate selected interventions according to state nurse practice acts” (ANA, 2015)

Question 14

(1)

Legal term: A person who acts as an intermediary (or as a liaison) between the patient and an organization (long-term care facilities or nursing homes, hospitals, governmental agencies, courts). Who investigates and mediates the complaint from both sides and attempts to reach a fair conclusion.

Answer 14

Ombudsman

Question 15

(1)

An individual who is assigned by a court (and has the legal authority) to act in the best interest of the ward. The ward is usually a person who is a child or someone who is frail or vulnerable. Adults who are incompetent may be assigned a guardian ad litem by the court.

Answer 15

Guardian Ad Litem

Question 16

(1)

Advance Directive that is a document that contains the patient’s instructions and preferences regarding healthcare if the patient becomes seriously ill or is dying. It contains the patient’s preferences (or not) for aggressive life-support measures. Healthcare providers should ensure that there is a copy of the document in the patient’s chart.

Answer 16

Living Will

Question 17

(1)

Advanced Directive: The patient designates a person (family member or a close friend) who has the legal authority to make future healthcare decisions for the patient in the event that the patient becomes mentally incompetent or incapacitated (e.g., comatose). Also known as a “healthcare proxy,” “durable medical power of attorney,” or “healthcare surrogate.” Power is only for healthcare decisions (not financial assets).

When does this go into effect?

To be legal, must be signed in presence of?

Answer 17

Healthcare Power of Attorney

It goes into effect when the patient’s doctor has determined that they are physically or mentally unable to communicate in a willful manner.

To be legal, it must be signed in the presence of two adult witnesses who must also sign the document (the designated surrogate cannot act as a witness).

Question 18

(1)

Advance Directive: A document whereby the patient designates a person (the “agent”) who has the legal authority to make all decisions for the incapacitated patient. The document should be signed and notarized. Also known as the “durable power of attorney.” This role is broader and encompasses not only healthcare decisions but also other areas of the patient’s life, such as those relating to financial affairs.

Answer 18

Power of Attorney

Question 19

Health Insurance Portability and Accountability Act (HIPAA)

Also known as the “HIPAA _____ Rule” (or Public Law 104–191). The law was passed by the U.S. Congress and enacted in August 1996. The law provides protections for “the u___ and dis_____ of individuals’ health in______”—called “pr_____ health information” by organizations subject to the Privacy Rule, which are called “cov____ entities.”

Answer 19

Also known as the “HIPAA Privacy Rule” (or Public Law 104–191). The law was passed by the U.S. Congress and enacted in August 1996. The law provides protections for “the use and disclosure of individuals’ health information”—called “protected health information” by organizations subject to the Privacy Rule, which are called “covered entities.”

Question 20

(1)

All healthcare providers, health insurance companies, healthcare plans, laboratories, hospitals, skilled nursing facilities (SNFs), and third-party administrators (TPAs) who electronically transmit health information must follow the HIPAA regulations.

Answer 20

Covered Entities

Question 21

(1)

The organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).

Answer 21

Third-Party Administrator (TPA)

Question 22

HIPAA Requirements (Not Inclusive)

Health providers are required to provide each patient with a ____ of their office’s _____ policy (patient to sign the form).

The HIPAA form must be reviewed and signed _____ by the patient.

A mental health provider has the right to _____ patients’ requests to view their psychiatric and mental health records.

When patients request to review their medical records, the health provider has up to ____ days to comply.

Patients are allowed (under HIPAA) to _____ errors in their medical records.

Providers must keep _______ information (name, date of birth, address, Social Security number) and any diagnosis/disease or health concerns private except under certain conditions (see next flashcard)

Answer 22

Health providers are required to provide each patient with a copy of their office’s HIPAA policy (patient to sign the form).

The HIPAA form must be reviewed and signed annually by the patient.

A mental health provider has the right to refuse patients’ requests to view their psychiatric and mental health records.

When patients request to review their medical records, the health provider has up to 30 days to comply.

Patients are allowed (under HIPAA) to correct errors in their medical records.

Providers must keep identifying information (name, date of birth, address, Social Security number) and any diagnosis/disease or health concerns private except under certain conditions (see list that follows)

Question 23

When Patient Consent Is Not Required

To contact the health plan/_______ company that is paying for the medical care

To contact a ______ party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor’s office hires to assist in payment of their services (e.g., medical billing services)

To perform certain healthcare operations (medical services review, sale of healthcare plan, audits)

To contact _______ agency for unpaid bills

To report ______/neglect or domestic ______

To con_____ with other healthcare providers

Answer 23

To contact the health plan/insurance company that is paying for the medical care

To contact a third party or business associate (e.g., accounting, legal, administrative) that the insurance company or doctor’s office hires to assist in payment of their services (e.g., medical billing services)

To perform certain healthcare operations (medical services review, sale of healthcare plan, audits)

To contact collection agency for unpaid bills

To report abuse/neglect or domestic violence

To consult with other healthcare providers

Question 24

HIPAA Case Scenario

1. If a staff member (who is not involved in the patient’s care) calls the attending NP and wants to discuss a patient’s progress, can the NP discuss it with this staff member?
2. How to communicate results of lab tests or procedures?

Answer 24

1. The NP cannot release information to the staff member.
2. The Rule “does not prohibit us from leaving messages for patients on their answering machines,” however, we must “reasonably safeguard” their privacy. It is prudent to avoid leaving messages about lab results, medication names, or types of tests in the patient’s voicemail. Leave the clinic name (exceptions exist), your name, and phone number for the patient to contact you.

Question 25

HIPAA and Patient Care Situations

1. Putting patient charts on door box
2. Having sign-in sheets on front desk
3. Calling a patient in the waiting room to go inside the clinic exam room
4. Leaving messages on voice mail
5. Having a colleague who works in same clinic or hospital call, wanting information about a patient’s progress

Answer 25

1. Putting patient charts on door box
   
   1. Place the chart so that the front of the chart is facing the door (so that patient name is hidden)
   2. Limit access to certain areas; ensure area is supervised.
2. Having sign-in sheets on front desk
   
   1. This is allowed if it does not list patient’s diagnosis.
   2. Attendance list can show names, dates, and time
3. Calling a patient in the waiting room to go inside the clinic exam room
   
   1. Use only first name. If more than one person with same first name, use the first letter of last name.
   2. If you have two patients named Ann (e.g., Ann Lee and Ann Smith), use Ann L. and Ann S.
4. Leaving messages on voice mail
   
   1. When calling, first provide your name and contact information. Be concise. Limit to 60 seconds. Maximum of three calls per week.
   2. Information that can be given may include appointment reminders, notifications about prescriptions, and preoperative and postoperative instructions.
   3. Avoid leaving messages about lab results, diagnosis, or other sensitive information on the patient’s voicemail.
5. Having a colleague who works in same clinic or hospital call, wanting information about a patient’s progress
   
   1. If staff member is not part of the healthcare team, no patient information can be released to that person.
   2. HIPAA also does not allow such a person to access a friend’s or family member’s records without permission.

Question 26

HIPAA and Patient Care Situations

What are special considerations in each of these scenarios?

1. Having a family member call, wanting information about a patient’s progress
2. Having inappropriate access of health information on the computer - ie family member in the hospital?
3. Using personal devices (smartphones, laptops, tablets) at work
4. Discussing a patient’s drugs and other instructions with a health aide who is with the patient
5. Discussing patient’s treatment in front of a patient’s friend who is visiting

Answer 26

1. Having a family member call, wanting information about a patient’s progress
   
   1. Put on hold and tell patient about the call. If patient gives permission, you can speak with the family member.
   2. If patient does not consent, then advise the family member about the patient’s decision. Do not release patient information.
2. Having inappropriate access of health information on the computer
   
   1. Viewing the records of your relatives, friends, or coworkers is an HIPAA violation
   2. Do not allow someone to use your computer password.
3. Using personal devices (smartphones, laptops, tablets) at work
   
   1. Ideally, it is best to avoid using personal devices at work.
   2. Requirements: Secure Wi-Fi with passwords, regular encrypted backups, antivirus software, policies, etc
   3. If you want to use a personal device, discuss it with your manager and/or consult information technology. Best practice is to use the facility’s or clinic’s devices.
4. Discussing a patient’s drugs and other instructions with a health aide who is with the patient
   
   1. Discussing information is allowable.
   2. If patient has the capacity to make healthcare decisions, discussing information is allowable
5. Discussing patient’s treatment in front of a patient’s friend who is visiting
   
   1. Discussing treatment with the patient’s friend is allowable if the patient gives consent or requests that the friend come inside the treatment room
   2. Discussing patient information with others is allowable if patient agrees to it.

Question 27

HIPPA, Psychotherapy, and Mental Health Records

Are psych records treated the same as other medical records?

What should you do with psych records?

A ______ consent form is needed to release psychotherapy records.

Exceptions include? (2)

Answer 27

Psychotherapy records made by a mental health professional are treated differently under HIPAA.

They should be separated from the patient’s other medical records.

A separate consent form is needed to release psychotherapy records.

The exceptions are mandatory reporting of abuse and “duty to warn” when the patient threatens serious and imminent harm to others. “In situations where the patient is given an opportunity and does not object, HIPAA allows the provider to share or discuss the patient’s mental health information with family members or other persons involved in the patient’s care or payment for care” (U.S. Department of Health and Human Services, 2017).

Question 28

HIPAA and Minors

Can parents obtain medical records of minors without the minor’s consent?

If you need authorization to release the minor’s medical record, who must sign for that authorization? Exceptions include what type of minors?

Answer 28

The health records of a minor (by law, an individual younger than 18 years of age) can be released to parents or legal guardians without the minor’s consent.

If authorization is needed to release a minor’s medical record, the parent or legal guardian must sign for it (except for emancipated minors). Emancipated minors can sign their own legal documents.

Question 29

Exam Tips

Become familiar with how HIPAA is applied in real life. Study the HIPAA case scenarios

Is it a HIPAA violation to leave any laboratory results on a patient’s voicemail?

Understand the role of an ombudsman, guardian ad litem, and others who act on behalf of a patient.

(1) the organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).

Answer 29

Become familiar with how HIPAA is applied in real life. Study the HIPAA case scenarios

It is a HIPAA violation to leave any laboratory results on a patient’s voicemail.

Understand the role of an ombudsman, guardian ad litem, and others who act on behalf of a patient.

• Obudsman = liaison/intermediary between patient and organization ie hospital (mediates complaints from both sides)
• Guardian Ad Litem = guardian assigned by court (has legal authority) usually for incompetent adults/children/frail/vulnerable

A TPA (Third Party Administrator) is the organization that does the processing of claims and administrative work for another company (health insurer, health plan, retirement plan).

Question 30

The Affordable Care Act (2010)

This national health insurance legislation, officially known as the Patient ______ and Affordable Care Act (ACA) and unofficially nicknamed Obamacare, was signed by President Obama in March 2010 (and upheld by the U.S. Supreme Court in 2012),

With the goal of expanding health insurance for the millions of Americans who were then ___insured.

It expanded health coverage through various provisions (e.g., allowing adult children younger than age ___to be insured under their parents’ healthcare insurance).

This comprehensive reform of U.S. health insurance law prohibits an insurance company from rejecting people with ___existing health conditions.

There is also a _____ for employers (and individuals) who choose not to participate in the national health plan.

Although increased numbers of Americans gained insurance as a result of the law’s passage, many millions more still ____ coverage.

Answer 30

This national health insurance legislation, officially known as the Patient Protection and Affordable Care Act (ACA) and unofficially nicknamed Obamacare, was signed by President Obama in March 2010 (and upheld by the U.S. Supreme Court in 2012),

With the goal of expanding health insurance for the millions of Americans who were then uninsured.

It expanded health coverage through various provisions (e.g., allowing adult children younger than age 26 to be insured under their parents’ healthcare insurance).

This comprehensive reform of U.S. health insurance law prohibits an insurance company from rejecting people with preexisting health conditions.

There is also a penalty for employers (and individuals) who choose not to participate in the national health plan.

Although increased numbers of Americans gained insurance as a result of the law’s passage, many millions more still lack coverage.

Question 31

(1)

This act provides for the continuation of coverage of preexisting group health insurance (from the employer) for workers and their families who lose their coverage (between jobs, quit job, or are fired) for a fixed period of time.

How long does this coverage last?

Answer 31

“COBRA” Consolidated Omnibus Budget Reconciliation Act of 1985

COBRA coverage is generally offered for 18 months (up to 36 months in some cases)

Question 32

Managed Care

(2)

“managed healthcare plans.”

Answer 32

HMOs health maintenance organizations

PPOs preferred provider organizations

Question 33

Health Maintenance Organizations (HMOs)

Patients are assigned a (1), who is the “gatekeeper.” The patient has a set “_____” per visit, and the participating physician/health provider is paid a ____ fee (per patient) monthly. The physician receives a _____ check from the HMO.

• Specialist/consultant:* The PCP must first ____ the referral. The patient is l_____ to seeing the physicians/specialists who are enrolled in the HMO’s ___work.
• “____-of-network physicians” or ____ referred by the PCP:* The visit may not be covered, or it will be reimbursed at a lower rate.

Answer 33

Patients are assigned a primary care provider (PCP), who is the “gatekeeper.” The patient has a set “copay” per visit, and the participating physician/health provider is paid a set fee (per patient) monthly. The physician receives a monthly check from the HMO.

• Specialist/consultant:* The PCP must first approve the referral. The patient is limited to seeing the physicians/specialists who are enrolled in the HMO’s network.
• “Out-of-network physicians” or not referred by the PCP:* The visit may not be covered, or it will be reimbursed at a lower rate.

Question 34

Preferred Provider Organization

The patient can visit any provider in the network _____ a referral.

____ assigned a PCP (as in HMOs).

The patient can ______ their own PCP.

____ referral is needed to see a specialist who is part of the PPO panel.

PPOs are usually ____ expensive than HMOs.

Answer 34

The patient can visit any provider in the network without a referral.

Not assigned a PCP (as in HMOs).

The patient can choose their own PCP.

No referral is needed to see a specialist who is part of the PPO panel.

PPOs are usually more expensive than HMOs.

Question 35

Medicare and Medicaid

Both Medicare and Medicaid programs are under the aegis of the (1) (CMS). The CMS is one of the agencies under the U.S. (1) (DHHS).

Answer 35

Both Medicare and Medicaid programs are under the aegis of the Centers for Medicare & Medicaid Services (CMS). The CMS is one of the agencies under the U.S. Department of Health and Human Services (DHHS).

Question 36

Medicare Part A (Inpatient Hospitalization)

“Automatic” at age ___ if the person paid the pr_____ (automatically deducted from paycheck by the employer).

If the person never paid the premiums (e.g., full-time housewife), the person is ___eligible for Medicare coverage.

Also covers persons with (1) diseases at any age.

Certain religious groups (e.g., Amish, Mennonites) do ____participate in Medicare.

Answer 36

“Automatic” at age 65 if the person paid the premiums (automatically deducted from paycheck by the employer).

If the person never paid the premiums (e.g., full-time housewife), the person is not eligible for Medicare coverage.

Also covers persons with end-stage renal diseases at any age.

Certain religious groups (e.g., Amish, Mennonites) do not participate in Medicare.

Question 37

• Medicare Part A Covers*
• these “medically necessary” services*

(4)

Medicare Part A will not pay for ____ care ((2) homes).

Answer 37

“medically necessary” services

Inpatient hospitalization (including inpatient psychiatric hospitalization)

Hospice care

Home healthcare

SNF care

Medicare Part A will not pay for custodial care (nursing homes, retirement homes).

Question 38

Medicare Part B (Outpatient Insurance)

Medicare Part B is a ____ program with ____ premiums. One must enroll during the “general ______ period.”

Answer 38

Medicare Part B is a voluntary program with monthly premiums. One must enroll during the “general enrollment period.”

Question 39

• Medicare Part B Covers*
• Will pay for the following “medically necessary” services:*

1. ___patient visits (including walk-in clinics, urgent care clinics, ED visits)
2. L_____ and other types of tests (EKG, x-rays, CT scans)
3. (1)*
4. “______ opinions” with another physician (surgery)
5. Kidney ______ (outpatient), self-dialysis equipment/supplies, organ transplants, and many others
6. _______ service for emergency care or transportation to a hospital or SNF if transport in any other vehicle will endanger patient’s health

Answer 39

1. Outpatient visits (including walk-in clinics, urgent care clinics, ED visits)
2. Laboratory and other types of tests (EKG, x-rays, CT scans)
3. Durable medical equipment*
4. “Second opinions” with another physician (surgery)
5. Kidney dialysis (outpatient), self-dialysis equipment/supplies, organ transplants, and many others
6. Ambulance service for emergency care or transportation to a hospital or SNF if transport in any other vehicle will endanger patient’s health

Question 40

Medicare Part B DOES NOT pay for:

• Most ___glasses and ____ exams (except following cataract surgery that implants an intraocular lens)
• ______ aids
• Most d_____ and d_____ care
• Cosmetic ______ surgery (unless it is medically necessary)
• (1) drugs and most (1) drugs*

Answer 40

• Most eyeglasses and eye exams (except following cataract surgery that implants an intraocular lens)
• Hearing aids
• Most dentures and dental care
• Cosmetic plastic surgery (unless it is medically necessary)
• Over-the-counter drugs and most prescription drugs

Question 41

Medicare Part B does pay for some health prevention services:

• Abdominal aortic ______ screening
• I______ shots once a year and P_____ and P____ 13 (each once in a lifetime)
• Screening m______ (once every 12 months for women age 40+)
• Hepatitis __ vaccine series for individuals at medium or high risk
• Hepatitis ___ screening if high risk
• Screening c_______ or flexible sigmoidoscopy (age 50 years or older) every 10 years if low risk
• Routine P_____ smears (once every 2 years or once every 12 months for women at high risk)
• (1) screening (digital rectal exam [DRE] and prostate specific antigen [PSA] once a year after age 50)

Answer 41

• Abdominal aortic aneurysm screening
• Influenza shots once a year and Pneumovax and Prevnar 13 (each once in a lifetime)
• Screening mammogram (once every 12 months for women age 40+)
• Hepatitis B vaccine series for individuals at medium or high risk
• Hepatitis C screening if high risk
• Screening colonoscopy or flexible sigmoidoscopy (age 50 years or older) every 10 years if low risk
• Routine Pap smears (once every 2 years or once every 12 months for women at high risk)
• Prostate cancer screening (digital rectal exam [DRE] and prostate specific antigen [PSA] once a year after age 50)

Question 42

Medicare Part B does pay for some health prevention services:

• (1) testing allowed once every 24 months if at risk for osteoporosis, taking prednisone, taking bisphosphonate therapy to monitor progress
• H____screening; ______ transmitted disease/infection screenings covered once every 12 months
• Ph_____ exams (once a year)
• ______-cessation counseling and treatment
• A_____misuse screening and counseling
• D_____ screening (twice yearly if at risk)
• C_______ disease screening

Answer 42

• Bone density testing allowed once every 24 months if at risk for osteoporosis, taking prednisone, taking bisphosphonate therapy to monitor progress
• HIV screening; sexually transmitted disease/infection screenings covered once every 12 months
• Physical exams (once a year)
• Smoking-cessation counseling and treatment
• Alcohol misuse screening and counseling
• Diabetes screening (twice yearly if at risk)
• Cardiovascular disease screening

Question 43

Medicare Advantage (Medicare Part C)

Covers (2) and some (1)

Administered by what type of insurance?

Answer 43

Medicare Advantage Plans cover both inpatient care (Part A) and outpatient care (Part B), and some plans cover some prescription drugs.

They are administered by private health insurance companies approved by Medicare.

Question 44

Medicare Part D

=

• Who is eligible for Medicare Part D?
• One type of Part D coverage is called the Medicare _____ (MA) plan.
• All prescription drug plans have a list of ______ drugs (the f______). If a (1) drug is used, it may not be covered, and the patient has to pay for it “____of pocket.”

Answer 44

Medicare prescription drug benefit

• Only individuals who are enrolled (or eligible) for Medicare Part A and/or Part B are eligible.
• One type of Part D coverage is called the Medicare Advantage (MA) plan.
• All prescription drug plans have a list of preferred drugs (the formulary). If a nonformulary drug is used, it may not be covered, and the patient has to pay for it “out of pocket.”

Question 45

Medicaid

Authorized by Title XIX of the (1) Act. A federal and state matching program.

Provides health insurance coverage for (1) individuals and their families who meet the federal _____-level criteria.

Covers children, pregnant women, adults, seniors, and individuals with dis_____ (e.g., blindness).

Pays for (1) and (1).

Currently, Medicaid is the single largest payer for ____ health services in the United States. It covers care offered by _____ use disorder and ______ planning services (including contraception) as well as by maternal and infant health programs.

Answer 45

Authorized by Title XIX of the Social Security Act. A federal and state matching program.

Provides health insurance coverage for low-income individuals and their families who meet the federal poverty-level criteria.

Covers children, pregnant women, adults, seniors, and individuals with disabilities (e.g., blindness).

Pays for healthcare and prescription drugs.

Currently, Medicaid is the single largest payer for mental health services in the United States. It covers care offered by substance use disorder and family planning services (including contraception) as well as by maternal and infant health programs.

Question 46

Children’s Health Insurance Programs

The Children’s Health Insurance Program (CHIP) and the Children’s Health Insurance Program Reauthorization Act of 2009 (CHIPRA) covers who?

Answer 46

Cover uninsured children (infancy to adolescents) and pregnant women.

Question 47

(1)

Usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses, usually chronic, resource-intensive diseases (e.g., asthma [children], chronic obstructive pulmonary disease [COPD], chronic heart failure, diabetes). The process is called (1). Mainly done by (1).

Answer 47

Case Managers

Usually experienced RNs who act as coordinators for the outpatient management of patients with certain diagnoses, usually chronic, resource-intensive diseases (e.g., asthma [children], chronic obstructive pulmonary disease [COPD], chronic heart failure, diabetes). The process is called case management. Case management is mainly done by telephone.

Question 48

Patient-Centered Medical Home

Patient-centered medical home (PCMH) is a healthcare delivery model that is also known as the ____ care medical home. It is another way to deliver _____-centered primary care.

In PCMH, the p____ and f_____ are considered important members of the healthcare team. Most of the patient’s healthcare needs are taken care of in the _____ setting.

Other _____ members may include physicians, advanced practice nurses, physician assistants (PAs), nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.

Answer 48

Patient-centered medical home (PCMH) is a healthcare delivery model that is also known as the primary care medical home. It is another way to deliver patient-centered primary care.

In PCMH, the patient and family are considered important members of the healthcare team. Most of the patient’s healthcare needs are taken care of in the home setting.

Other team members may include physicians, advanced practice nurses, physician assistants (PAs), nurses, pharmacists, nutritionists, social workers, educators, and care coordinators.

Question 49

Patient-Centered Medical Home

Delivery of healthcare is coordinated to ensure smooth ______ between home and the h_____, home health agency, and community services.

The patient and/or family has _____ access to a member of the team by ______, video chat, or email.

Answer 49

Delivery of healthcare is coordinated to ensure smooth transition between home and the hospital, home health agency, and community services.

The patient and/or family has 24-7 access to a member of the team by phone, video chat, or email.

Question 50

(1)

Program that involves monitoring, identifying problems, measuring outcomes, and establishing new parameters for improved performance.

The goal of these programs is to improve the _____ of care, decrease complications, decrease hospitalizations, lower patient m______, decrease s_____ errors, and increase patient s______.

Patient out______ are important indicators of a health system’s quality.

Answer 50

Quality-Improvement Programs

The goal of these programs is to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction.

Patient outcomes are important indicators of a health system’s quality.

Question 51

Risk Management in Healthcare

Risk management is an important aspect of ______-improvement/quality-assurance programs in the healthcare setting.

It is the s______ organizational process used to identify _____ practices to minimize ______ patient outcomes and corporate l______.

For example, high-risk areas that are usually checked by risk managers are medication _____, _____-acquired infections, patient id______ problems, and f_____. Risk management promotes s____ and effective patient care practices.

Answer 51

Risk management is an important aspect of quality-improvement/quality-assurance programs in the healthcare setting.

It is the systematic organizational process used to identify risky practices to minimize adverse patient outcomes and corporate liability.

For example, high-risk areas that are usually checked by risk managers are medication errors, hospital-acquired infections, patient identification problems, and falls. Risk management promotes safe and effective patient care practices.

Question 52

(1)

A voluntary process through which a nongovernmental association evaluates and certifies that an organization (e.g., hospital, clinic, nursing program) has met the requirements and excels in its class.

Answer 52

Accreditation

For example, the American Nurses Credentialing Center and the National League for Nursing Accrediting Commission are accreditation organizations.

Question 53

(1)

An independent, not-for-profit organization that accredits healthcare organizations (hospitals, nursing homes, home care, laboratories) via inspection and evaluation of their facilities (charged a fee).

Achieving this certification means that a facility has met or surpassed the organization’s strict requirements. The purpose of the accreditation process is to enhance quality of care and patient safety.

Answer 53

The Joint Commission

Question 54

(1)

A patient safety event (not primarily related to the natural course of the patient’s illness or condition) that results in any of the following: death, permanent harm, and/or severe temporary harm with intervention required to sustain life.

When an event like this occurs what is the healthcare organization expected to?

_______ organizations are strongly encouraged but are not required to report SEs to the (1).

Answer 54

Sentinel Event

When an SE occurs, the healthcare organization is expected to conduct a root cause analysis (RCA), make improvements to reduce risk, and monitor effectiveness of the improvements.

Accredited organizations are strongly encouraged but are not required to report SEs to the TJC.

Question 55

Examples of Sentinel Events

S______ that occurs while receiving care in a staffed around-the-clock facility or within 72 hours of discharge

Unanticipated d_____ of an infant or discharge of infant to the _____ family

R____ or ass_____ of a staff member, visitor, or vendor

Invasive procedure on the _____ patient, the wrong procedure is done on a patient, or the procedure is done to the wrong l_____

Unintended retention of a ______ object

F____, flame, or unanticipated smoke or heat during an episode of patient care

Answer 55

• Suicide that occurs while receiving care in a staffed around-the-clock facility or within 72 hours of discharge
• Unanticipated death of an infant or discharge of infant to the wrong family
• Rape or assault of a staff member, visitor, or vendor
• Invasive procedure on the wrong patient, the wrong procedure is done on a patient, or the procedure is done to the wrong limb
• Unintended retention of a foreign object
• Fire, flame, or unanticipated smoke or heat during an episode of patient care

Question 56

(1)

A structured, facilitated team process used in healthcare to identify the contributing factors that result in an error. The TJC has mandated the use of this to analyze (1). The gathered data are analyzed for the root causes (usually a combination of h____, en______, and s_____ factors). The goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one c______ action to reduce or eliminate each root cause. The focus is on the ____ and not on _____ individuals.

Done for what?

Answer 56

Root Cause Analysis

A structured, facilitated team process used in healthcare to identify the contributing factors that result in an error. The TJC has mandated the use of this to analyze SEs. The gathered data are analyzed for the root causes (usually a combination of human, environmental, and system factors). The goal is to identify the system breakdowns that resulted in an inadvertent mistake and to propose at least one corrective action to reduce or eliminate each root cause. The focus is on the system and not on blaming individuals.

Sentinel Events

Question 57

(1)

Refers to analysis and tracking of patient outcomes by using outcome measures such as surveys and questionnaires.

Answer 57

Outcomes Analysis

Question 58

Hospice

The majority of hospice care in the United States takes place in patient’s ____ (59% die in their own homes).

The goal is p_____ care, not curative care.

Ensuring the patient’s _____ of life and c_____ are the ultimate goals of hospice care.

Hospice care is available for both pediatric and adult patients.

An inter_______ team provides hospice care. This team usually consists of the patient’s primary physician, hospice physician, RN, nursing assistants, therapists, social workers/grief counselor, and clergy.

Hospice staff are on call ____ hours a day.

They provide gr____-and-l____ counseling for patients and family members.

Answer 58

The majority of hospice care in the United States takes place in patient’s homes (59% die in their own homes).

The goal is palliative care, not curative care.

Ensuring the patient’s quality of life and comfort are the ultimate goals of hospice care.

Hospice care is available for both pediatric and adult patients.

An interdisciplinary team provides hospice care. This team usually consists of the patient’s primary physician, hospice physician, RN, nursing assistants, therapists, social workers/grief counselor, and clergy.

Hospice staff are on call 24 hours a day.

They provide grief-and-loss counseling for patients and family members.

Question 59

Hospice

Hospice is covered under Medicare Part __, Medi_____, and most health insurance plans.

Are hospice patients allowed to have physical therapy (PT), occupational therapy (OT), and speech therapy?

Answer 59

Hospice is covered under Medicare Part A, Medicaid, and most health insurance plans.

Hospice patients are allowed to have physical therapy (PT), occupational therapy (OT), and speech therapy if prescribed

Question 60

Eligibility Criteria for Hospice

=

Patient is rapidly de_____ or exhibits w_____ symptoms.

Patient needs ______ with two or more activities of (1)

Patient accepts p_______ care, not curative care. If they do not ____ to be in hospice (even if all criteria are met), then patient is not eligible.

Answer 60

Hospice physician and the patient’s physician certify that the patient is terminal and has 6 months (or less) to live. The hospice physician approves of admission.

Patient is rapidly declining or exhibits worsening symptoms.

Patient needs assistance with two or more activities of daily living (ADL).

Patient accepts palliative care, not curative care. If they do not want to be in hospice (even if all criteria are met), then patient is not eligible.

Question 61

Examples of _____ Conditions

• Metastatic cancers (e.g., lung cancer, colon cancer)
• End-stage lung disease (e.g., COPD)
• End-stage heart disease (e.g., congestive heart failure [CHF] class III or IV)
• End-stage liver disease
• HIV/AIDS with comorbidities and refusal/discontinuation of antiretrovirals
• End-stage renal disease with plan to discontinue dialysis
• Amyotrophic lateral sclerosis, Parkinson’s disease, stroke, coma
• End-stage dementia (e.g., Alzheimer’s disease)

Answer 61

Examples of Terminal Conditions

• Metastatic cancers (e.g., lung cancer, colon cancer)
• End-stage lung disease (e.g., COPD)
• End-stage heart disease (e.g., congestive heart failure [CHF] class III or IV)
• End-stage liver disease
• HIV/AIDS with comorbidities and refusal/discontinuation of antiretrovirals
• End-stage renal disease with plan to discontinue dialysis
• Amyotrophic lateral sclerosis, Parkinson’s disease, stroke, coma
• End-stage dementia (e.g., Alzheimer’s disease)

Question 62

(1)

Short-term care for the primary caregiver that is reimbursed by Medicare. This gives the primary caregiver a break, even if it is only a few hours. For example, gives the caregiver a chance to go see a movie and to “relax” and rest.

Answer 62

Respite Care

Question 63

Human Genetic Symbols

The exam may include questions about genetic symbols,

Healthy male =

Disease/affected male =

Healthy female =

Disease/affected female =

Dead person =

Answer 63

Healthy male = empty square

Disease/affected male = filled square

Healthy female = empty circle

Disease/affected female = filled circle

Dead person = diagonal dash across symbol

Question 64

Exam Tips

A patient may meet the criteria for hospice admission, but if the patient refuses hospice care, then the patient is ____ eligible.

If the patient meets the criteria for hospice care, Medicare Part ___ will reimburse hospice.

Medicare Part ___ will pay for an ambulance for emergency care. If transport in any other vehicle will endanger the patient’s health, transport by ambulance is allowed.

Does Medicare Part B reimburse for dentures, eyeglasses, or hearing aids?

(1) is a law that allows a person to continue group health insurance coverage from a job even if they have quit (the individual has to pay the insurance premiums).

Is separate consent required for entities that pay or process the patient’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or third-party contractors hired by the company to pay or to process claims)?

Answer 64

A patient may meet the criteria for hospice admission, but if the patient refuses hospice care, then the patient is not eligible.

If the patient meets the criteria for hospice care, Medicare Part A will reimburse hospice.

Medicare Part B will pay for an ambulance for emergency care. If transport in any other vehicle will endanger the patient’s health, transport by ambulance is allowed.

Medicare Part B does not reimburse for dentures, eyeglasses, or hearing aids.

COBRA is a law that allows a person to continue group health insurance coverage from a job even if they have quit (the individual has to pay the insurance premiums).

No separate consent is required for entities that pay or process the patient’s health bills, such as health insurance companies, HMOs, medical billers, or collection agencies (or third-party contractors hired by the company to pay or to process claims).

Question 65

Exam Tips

The “(1)” is a method of primary healthcare delivery. Healthcare providers and therapists (physical, occupational, speech) deliver care in the patient’s home, with the family. These patients have chronic long-term illness. To communicate, technology is used, such as phone, video chat, or email.

Use common sense in answering questions on quality improvement and risk management. Keep in mind the goals of these processes: to improve the _____of care, decrease com______, decrease hos______, lower patient m______, decrease s_____errors, and increase patient s_______. Look for the answer that fits these goals.

Learn the human genetic symbol for a diseased (or affected) male and female =

Answer 65

The “medical home” is a method of primary healthcare delivery. Healthcare providers and therapists (physical, occupational, speech) deliver care in the patient’s home, with the family. These patients have chronic long-term illness. To communicate, technology is used, such as phone, video chat, or email.

Use common sense in answering questions on quality improvement and risk management. Keep in mind the goals of these processes: to improve the quality of care, decrease complications, decrease hospitalizations, lower patient mortality, decrease system errors, and increase patient satisfaction. Look for the answer that fits these goals.

Learn the human genetic symbol for a diseased (or affected) male and female = filled in square (diseased male), filled in circle (diseased female)

Question 66

The Nurse Practitioner Role

History

Loretta C. F____, PhD, RN, FAAN, and Henry K. S_____, MD, started the first nurse practitioner (NP) program at the University of ______in 19___. Initially, it was a certificate program and later became a m_____ program in the 1970s. The first NPs were p______ NPs who practiced in poor r_____ areas where there were no physicians (because of a severe shortage of primary care physicians).

Answer 66

Loretta C. Ford, PhD, RN, FAAN, and Henry K. Silver, MD, started the first nurse practitioner (NP) program at the University of Colorado in 1965. Initially, it was a certificate program and later became a master’s program in the 1970s. The first NPs were pediatric NPs who practiced in poor rural areas where there were no physicians (because of a severe shortage of primary care physicians).

Question 67

Educational Requirements

An NP must meet the minimal educational requirements that are mandated by the nurse _____ act of the _____ (where they plan to practice).

Answer 67

An NP must meet the minimal educational requirements that are mandated by the nurse practice act of the state (where they plan to practice).

Question 68

State Nurse Practice Act

The nurse practice act is enacted into law by the ____ legislature. Therefore, the NP’s ____ right to practice is derived from the state legislature.

Each state has its own nurse practice act that contains regulations that dictate the ed_____ requirements, responsibilities, and s____ of practice for NPs and other nurses (e.g., RNs, licensed practical nurses, midwives) who practice in the state.

NP practice is ____ regulated by the federal government, the American Medical Association (AMA), or the U.S. Department of Health and Human Services (DHHS).

Answer 68

The nurse practice act is enacted into law by the state legislature. Therefore, the NP’s legal right to practice is derived from the state legislature.

Each state has its own nurse practice act that contains regulations that dictate the educational requirements, responsibilities, and scope of practice for NPs and other nurses (e.g., RNs, licensed practical nurses, midwives) who practice in the state.

NP practice is not regulated by the federal government, the American Medical Association (AMA), or the U.S. Department of Health and Human Services (DHHS).

Question 69

State Board of Nursing

The state board of nursing (SBON) is responsible for enforcing the (1)

The SBON is a formal g_______ agency that has the statutory authority to reg_____ nursing practice.

The SBON has the legal authority to l_____, monitor, and discipline nurses.

The SBON is also authorized to _____ a nurse’s license (after formal hearings).

Answer 69

The state board of nursing (SBON) is responsible for enforcing the state’s nurse practice act.

The SBON is a formal governmental agency that has the statutory authority to regulate nursing practice.

The SBON has the legal authority to license, monitor, and discipline nurses.

The SBON is also authorized to revoke a nurse’s license (after formal hearings).

Question 70

(1)

Professional designations, such as RN, NP, or APRN, are protected by law. It is _____ for any person to use these titles without a valid license. It is under mandate by a state’s nurse practice act. It protects the public from un_____ “nurses.”

Answer 70

Title Protection

Professional designations, such as RN, NP, or APRN, are protected by law. It is illegal for any person to use these titles without a valid license. Title protection is under mandate by a state’s nurse practice act. Title protection protects the public from unlicensed “nurses.”

Question 71

Licensure

=

Obtained through a _____ entity, the (1)

The NP must meet the minimal _____ and _____ requirements in order to become licensed.

Answer 71

The legal requirement to practice as an NP

It is obtained through a governmental entity, the SBON.

The NP must meet the minimal educational and clinical requirements in order to become licensed.

Question 72

• Certification*
• =*

. The majority of states in the United States now ____ board certification (or certification) as a condition to obtain licensure.

Answer 72

A “voluntary” process and is done through a nongovernmental entity such as a professional nursing association or specialty organization.

. The majority of states in the United States now mandate board certification (or certification) as a condition to obtain licensure.

Question 73

Standards of Professional Nursing Practice

Standards are auth______ statements of the _____ that all RNs, regardless of role, population, or specialty, are expected to perform.

According to the (1), these include both the Standards of Practice and the Standards of Professional Per_____

They are developed by professional societies (1) as well as specialty organizations; for example, the(1) publishes Standards of Practice for Nurse Practitioners (AANP, 2019).

Answer 73

Standards are authoritative statements of the duties that all RNs, regardless of role, population, or specialty, are expected to perform.

According to the American Nurses Association (ANA), these include both the Standards of Practice and the Standards of Professional Performance.

They are developed by professional societies (e.g., ANA) as well as specialty organizations; for example, the American Association of Nurse Practitioners (AANP) publishes Standards of Practice for Nurse Practitioners (AANP, 2019).

Question 74

(1)

A written agreement between a physician and NP outlining the NP’s role and responsibility to the clinical practice.

A _____ of the collaborative practice agreement must be kept at the NP’s practice setting and mailed to the S_ _ _.

Most states require an ______ review of the agreement that contains signatures of the individuals involved and dates.

The state practice environment differs for each specific state. Some states allow f____ practice under the exclusive authority of the SBON, some states allow reduced practice, and some have restricted practice.

In these states, the NP must be under the super_____ or delegation of an outside health discipline such as the Board of ______.

Answer 74

Collaborative Practice Agreements

A copy of the collaborative practice agreement must be kept at the NP’s practice setting and mailed to the SBON.

Most states require an annual review of the agreement that contains signatures of the individuals involved and dates.

The state practice environment differs for each specific state. Some states allow full practice under the exclusive authority of the SBON, some states allow reduced practice, and some have restricted practice.

In these states, the NP must be under the supervision or delegation of an outside health discipline such as the Board of Medicine.

Question 75

Agreements With Physicians and Dentists

NPs can sign collaborative practice agreements with (3)

(1) (DCs) and (1) (NDs) are not considered physicians under nurse practice acts.

In most states, physicians are the only practitioners who can legally sign a d_____ certificate.

Answer 75

NPs can sign collaborative practice agreements with physicians (MDs), osteopaths (DOs), and dentists/dental surgeons (DMDs/DDSs).

Chiropractors (DCs) and naturopaths (NDs) are not considered physicians under nurse practice acts.

In most states, physicians are the only practitioners who can legally sign a death certificate.

Question 76

Prescription Privileges

The majority of states require NPs to have a written practice protocol with a (1) in order to prescribe drugs.

The protocol usually contains the ____ of drugs (by name, class, or condition) that an NP is allowed to prescribe.

In the United States, all 50 states grant prescriptive authority to NPs, including the right to prescribe _______ substances (varies by state).

Answer 76

The majority of states require NPs to have a written practice protocol with a supervising physician in order to prescribe drugs.

The protocol usually contains the list of drugs (by name, class, or condition) that an NP is allowed to prescribe.

In the United States, all 50 states grant prescriptive authority to NPs, including the right to prescribe controlled substances (varies by state).

Question 77

Prescription Pads

The NP’s prescription pad should contain the following:

• NP’s name, des_____, and _____ number
• Cl____ name, ad_____ , and phone number; if the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.
• To reduce fraud, it is best if the _____ number is not listed (only for controlled substance prescriptions).

Answer 77

• NP’s name, designation, and license number
• Clinic’s name, address, and phone number; if the practice has several clinics, the other clinics where the NP practices should also be listed on the pad.
• To reduce fraud, it is best if the DEA number is not listed (only for controlled substance prescriptions).

Question 78

Food and Drug Administration–Controlled Substances

T_____-resistant prescription pads are required by Medicare and Medicaid, as well as when prescribing Food and Drug Administration (FDA)–_____ substances.

A controlled substance prescription can be typed, but it must be signed by the prescribing practitioner the ____ it is issued.

Answer 78

Tamper-resistant prescription pads are required by Medicare and Medicaid, as well as when prescribing Food and Drug Administration (FDA)–controlled substances.

A controlled substance prescription can be typed, but it must be signed by the prescribing practitioner the day it is issued.

Question 79

Schedule II Drug Prescriptions

Substances in this schedule have a ____ potential for abuse with severe psychological or physical d________.

These _____ be called in. They must be w_____ on tamper-resistant pads and s_____ by the prescriber (not stamped).

There is some v______ among the different state laws regarding prescriptions of Schedule II drugs.

Examples =

Answer 79

Substances in this schedule have a high potential for abuse with severe psychological or physical dependence.

These cannot be called in. They must be written on tamper-resistant pads and signed by the prescriber (not stamped).

There is some variation among the different state laws regarding prescriptions of Schedule II drugs.

Examples: Codeine, morphine, hydrocodone, oxycodone, opium, fentanyl, methadone, amphetamines.

Question 80

E-Prescribing (Electronic Prescriptions)

=

______ method of prescribing by Medicare and Medicaid

Answer 80

A method of sending prescriptions electronically directly to the pharmacy

Preferred method of prescribing by Medicare and Medicaid

Question 81

The Four Generations of Nurses

(4)

There are now _____ generations that work side by side. The “______ Generation” group has ______. Each generation behaves differently.

Answer 81

“Silent Generation”

Baby Boomers

Generation X (Gen Xers)

Generation Y (millenials)

There are now three generations that work side by side. The “Silent Generation” group has retired. Each generation behaves differently

Question 82

Generation Types

Match each generation to their description

(1) Born from 1946 to 1964. Hard workers. Like to achieve. More susceptible to burnout and stress-related illness.

(1) Born from 1981 to 2000. Multitaskers who seek learning and career development but also value free time to socialize.

(1) Born from 1925 to 1945. Disciplined and loyal. Traditional work ethic. More action oriented. The youngest nurses from this generation are now in their 70s, and most have retired.

(1) Born from 1965 to 1980. Question authority, expect immediate results. They are loyal to peers over the company.

Answer 82

Baby Boomers Born from 1946 to 1964. Hard workers. Like to achieve. More susceptible to burnout and stress-related illness.

Generation Y (Millennials) Born from 1981 to 2000. Multitaskers who seek learning and career development but also value free time to socialize.

“Silent Generation” Born from 1925 to 1945. Disciplined and loyal. Traditional work ethic. More action oriented. The youngest nurses from this generation are now in their 70s, and most have retired.

Generation X (Gen Xers) Born from 1965 to 1980. Question authority, expect immediate results. They are loyal to peers over the company.

Question 83

Nursing Leadership Styles

Sit______ Leadership

Trans_______ Leadership

La___-F____ Leadership

A______ Leadership (Autocratic)

Dem______ Leadership

Ser_____ Leadership

Answer 83

Situational Leadership

Transformational Leadership

Laissez-Faire Leadership

Authoritarian Leadership (Autocratic)

Democratic Leadership

Servant Leadership

Question 84

(1)

Type of Leader that engages in minimal supervision and direction of staff members. Prefers “hands-off” approach. May not like to make decisions. This style of leadership works well if workers are experienced, like autonomy, and are self-directed. New or unexperienced staff may feel anxious with this type of authority because of minimal supervision and feedback.

Answer 84

Laissez-Faire Leadership

Question 85

(1)

Leader may like to have more frequent staff meetings because they value staff members’ input and feedback. Team shares in decision-making process, which may be slow due to desire to include all of staff in process. Leader values relationships and staff opinions.

Answer 85

Democratic Leadership

Question 86

(1)

Leader has the ability to communicate vision to staff members. May have charismatic personality. Good communication skills. Staff members usually have higher job satisfaction with this type of leader.

Answer 86

Transformational Leadership

Question 87

(1)

Leader likes control and structure and prefers to give directions. May have many rules. Makes decisions without (or minimal) staff input. Motivated, independent, and self-directed staff may be unhappy in this type of environment.

Answer 87

Authoritarian Leadership (Autocratic)

Question 88

(1)

Leader is flexible and can adjust their leadership style to fit the changing needs of an organization. Can establish rapport easily and bring out the best in people. The result is that staff members are engaged with the goals of the organization and are more productive. This leadership theory was developed by Ken Blanchard and Paul Hersey.

Answer 88

Situational Leadership

Question 89

(1)

Leader likes to work along with staff on the unit. May assume many roles. Develops relationships with staff members and treats staff as individuals, which results in high job satisfaction for staff. But this type of leader may not like to make decisions that can “anger” staff members.

Answer 89

Servant Leadership

Question 90

Types of Malpractice Insurance

(2)

Answer 90

Claims-Based Policy

Occurrence-Based Policy

Question 91

Claims-Based Policy

This type of malpractice insurance covers claims only if the incident occurred when the NP (1) and only if the NP is still (1) at the time the claim is filed in court.

Answer 91

This type of malpractice insurance covers claims only if the incident occurred when the NP paid the premium and only if the NP is still enrolled with the same insurance company at the time the claim is filed in court.

Question 92

Claims-Based Policy

What if a claim is made in the future when the employee does not have the same insurance company?

What can the employee do to address this issue?

Answer 92

The claim will not be covered (in the future) if they do not have the same insurance company as when the lawsuit was filed. - NEEDS INSURANCE AT TIME OF CLAIM

“Tail Coverage”

Buying “tail coverage” can help address this issue.

Tail coverage insurance will cover the NP for malpractice claims that may be filed against them in the future. When an NP with claims-based malpractice insurance retires or changes jobs, it is advisable to buy tail coverage insurance.

Question 93

Occurrence-Based Policy

How are future claims handled by occurrence-based policy?

Answer 93

This type of malpractice policy is not affected by job changes or retirement. If a claim is filed against the NP in the future, it is covered if they had an occurrence-based policy at the time the incident occurred.

Example: An NP who has been retired for 2 years has a claim filed against her for an incident that occurred while she was employed and insured. Since she carried an occurrence-based policy, the claim will be covered.

Question 94

Malpractice Lawsuits

• (1):* The patient or whoever is acting on behalf of the patient (e.g., the patient’s representative) who files the lawsuit claiming injury and/or damage by another party
• (1):* The party who responds to the lawsuit filed by another party who claims an injury and/or damage (e.g., NP, hospital)

Answer 94

• Plaintiff:* The patient or whoever is acting on behalf of the patient (e.g., the patient’s representative) who files the lawsuit claiming injury and/or damage by another party
• Defendant:* The party who responds to the lawsuit filed by another party who claims an injury and/or damage (e.g., NP, hospital

Question 95

Malpractice Lawsuit: Elements of a Case

The plaintiff must prove that all of the following occurred:

• A d____ is owed (a legal duty exists).
• The duty was br______ (e.g., not following standard of care).
• The breach caused an in_____ (proximate cause).
• D_____ occurred.

Answer 95

• A duty is owed (a legal duty exists).
• The duty was breached (e.g., not following standard of care).
• The breach caused an injury (proximate cause).
• Damage occurred.

Question 96

Phases of a Medical Malpractice Trial

A lawsuit is filed in the app________ court.

The “______” phase (e.g., requesting of medical records, depositions, expert opinions) occurs.

(1) has the “burden of proof.”

Court ______ phase (or settle out of court or arbitration) occurs.

The _______ is given.

Either the case is dis_____, or dam______ are awarded (e.g., physical harm, emotional/mental harm).

Answer 96

A lawsuit is filed in the appropriate court.

The “discovery” phase (e.g., requesting of medical records, depositions, expert opinions) occurs.

Plaintiff has the “burden of proof.”

Court trial phase (or settle out of court or arbitration) occurs.

The judgment is given.

Either the case is dismissed, or damages are awarded (e.g., physical harm, emotional/mental harm).

Question 97

Expert Witnesses

Ideally, the NP who will testify as an expert witness should be someone who practices in the same sp_____ and g______ area as the NP defendant.

For example, an NP who practices in Los Angeles, California, may not be the best choice as an expert witness for an NP who is being sued and who is practicing in Miami, Florida.

Answer 97

Ideally, the NP who will testify as an expert witness should be someone who practices in the same specialty and geographic area as the NP defendant.

For example, an NP who practices in Los Angeles, California, may not be the best choice as an expert witness for an NP who is being sued and who is practicing in Miami, Florida.

Question 98

(1)

The first law allowing NPs to be reimbursed directly by Medicare. Prior to this act, only certified pediatric and family NPs were allowed to be primary providers as long as they practiced in designated “rural” areas.

Answer 98

Budget Reconciliation Act of 1989 (HR 3299)

Question 99

(1)

Together with the Primary Care Health Practitioner Incentive Act, this law broadened Medicare coverage of NP and clinical nurse specialist services.

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required health providers to have a (1) number to bill Medicare and Medicaid.

NPs can be reimbursed directly by Medicare Part __, Medicaid, Tricare, and some health insurance plans.

Medicare will reimburse NPs at -___% of the Medicare Physician Fee Schedule.

Answer 99

Balance Budget Act of 1997

The Health Insurance Portability and Accountability Act (HIPAA) of 1996 required health providers to have a National Provider Identifier (NPI) number to bill Medicare and Medicaid.

NPs can be reimbursed directly by Medicare Part B, Medicaid, Tricare, and some health insurance plans.

Medicare will reimburse NPs at 85% of the Medicare Physician Fee Schedule.

Question 100

National Provider Identifier Number

The NPI is a unique __-digit identification number assigned to healthcare providers (or to any entity that bills Medicare/Medicaid).

It is issued by the National Plan and Provider En______ System (NPPES).

All providers who provide services and bill _______ must have an NPI number. Individual healthcare providers may obtain only one NPI for themselves.

To become a M_____-approved provider, one must first obtain an NPI number online. An individual provider’s NPI identifier lasts for their _____time. The identifier does ____ change regardless of state or group affiliations. Medicare requires the NPI number for financial transactions. Electronic claims submission is required by Medicare and Medicaid. Medicare uses e______ fund transfer (EFT) to reimburse providers.

Answer 100

The NPI is a unique 10-digit identification number assigned to healthcare providers (or to any entity that bills Medicare/Medicaid). It is issued by the National Plan and Provider Enumeration System (NPPES). All providers who provide services and bill Medicare must have an NPI number. Individual healthcare providers may obtain only one NPI for themselves.

To become a Medicare-approved provider, one must first obtain an NPI number online. An individual provider’s NPI identifier lasts for their lifetime. The identifier does not change regardless of state or group affiliations. Medicare requires the NPI number for financial transactions. Electronic claims submission is required by Medicare and Medicaid. Medicare uses electronic fund transfer (EFT) to reimburse providers.

Question 101

“Incident-to” Billing and Medicare

“Incident-to” billing is a way to bill Medicare for ___patient services rendered by a ______ health provider (2) and receive the ___% physician fee.

The location of the services can be at the physician’s office, a separate or satellite office, or an institution or in the patient’s home.

Answer 101

“Incident-to” billing is a way to bill Medicare for outpatient services rendered by a nonphysician health provider (NP, PA) and receive the 100% physician fee.

The location of the services can be at the physician’s office, a separate or satellite office, or an institution or in the patient’s home.

Question 102

“Incident-to” Billing and Medicare

Who must eval the patient for the FIRST visit?

(1) visits by the NP can be billed as “incident to” so long as the (1) are being addressed.

The _______ NPI number is used to bill for the service.

The “incident-to” billing is reimbursed at ___% of the physician rate.

But if the same patient is seen for a ____ problem by the NP (or PA), then the visit is billed under the NP’s or PA’s NPI number (__% of physician fee).

Answer 102

During the first visit, the physician must evaluate the patient (and write a care plan).

Follow-up visits by the NP can be billed as “incident to” so long as the same health problems are being addressed.

The physician’s NPI number is used to bill for the service.

The “incident-to” billing is reimbursed at 100% of the physician rate.

But if the same patient is seen for a new problem by the NP (or PA), then the visit is billed under the NP’s or PA’s NPI number (85% of physician fee).

Question 103

Medical Coding and Billing

Every time an NP bills Medicare, Medicaid, and/or a health insurance plan, they must submit an el_____ claim.

The claim form, or the “_____bill,” must contain both the International Classification of Diseases, 10th edition (1); World Health Organization [WHO], 2016) code(s) or the diagnosis and the Current Procedural Terminology (1) code(s).

If a bill is missing the ICD-10 code or CPT code, the bill will be _____ (not paid) and it has to be resubmitted with the required information.

The services rendered must show medical nec_____ and the app_____ness of diagnostic and/or therapeutic services that were completed.

Answer 103

Every time an NP bills Medicare, Medicaid, and/or a health insurance plan, they must submit an electronic claim.

The claim form, or the “superbill,” must contain both the International Classification of Diseases, 10th edition (ICD-10**); World Health Organization [WHO], 2016) code(s) or the diagnosis and the Current Procedural Terminology (CPT**) code(s).

If a bill is missing the ICD-10 code or CPT code, the bill will be rejected (not paid) and it has to be resubmitted with the required information.

The services rendered must show medical necessity and the appropriateness of diagnostic and/or therapeutic services that were completed.

Question 104

What Is the ICD-10 Code?

Answer 104

The ICD-10 code is used to indicate the patient’s diagnosis as determined by the International Classification of Diseases, 10th edition (WHO, 2016). Each disease is assigned a specific ICD-10 code.

Question 105

What Is an ICD-10 “Z-Code” (Z00–Z99)?

Answer 105

ICD-10 uses Z-codes to indicate the reason for each patient encounter. If a procedure is performed, a corresponding CPT code must accompany each Z-code (e.g., to justify the procedure, vaccinations, screening, counseling, others).

Question 106

What Is the CPT?

Answer 106

The CPT is a five-digit code or alphanumeric code (letter with the digits) that is used to identify medical procedures (suturing, incision and drainage [I&D]) and other medical services. It is owned and maintained by the AMA.

Question 107

What Are E&M Codes?

Evaluation and Management Service (E&M) codes are used to bill for patient visits and are part of the ____.

If a bill is missing an E&M code, the healthcare provider will not be reimbursed for the time they spent with the patient.

E&M codes are based on the h____, ex_____, and medical decision-making (_______) that take place.

The provider must document that these three components have been met (or exceeded). The com____ and t____ spent with the patient are assigned codes by the CPT system.

Answer 107

Evaluation and Management Service (E&M) codes are used to bill for patient visits and are part of the CPT.

If a bill is missing an E&M code, the healthcare provider will not be reimbursed for the time they spent with the patient.

E&M codes are based on the history, examination, and medical decision-making (complexity) that take place.

The provider must document that these three components have been met (or exceeded). The complexity and time spent with the patient are assigned codes by the CPT system.

Question 108

(1)

Broad term that encompasses a range of services and technologies designed to extend access, capacity, and delivery of healthcare, as well as improve patient care and outcomes. Services include live videoconferencing (e.g., consultation between patient and provider), patient monitoring (e.g., devices that remotely collect and send patient data to providers or testing facilities), and mobile health (e.g., patient health portals or personal health apps).

Answer 108

Telehealth

Question 109

(1)

A subset of telehealth, refers to remote clinical services provided via secure audio and video connection. Telemedicine is commonly used for management of chronic conditions, medication management, follow-up visits, and specialist consultation.

Answer 109

Telemedicine

Question 110

(1)

This act was signed into law in 2009 as an incentive for healthcare providers to adopt the use of electronic health records (EHRs) and supporting technology.

The act included incentives for early adoption of those technologies until 2015. After 2015, it began to issue financial _______ (e.g., reductions of Medicare and Medicaid reimbursement) for providers and entities who had not adopted EHR technologies. In addition, it strengthened enforcement of H_____ security and privacy laws and penalties for breaches.

Answer 110

(HITECH Act) Health Information Technology for Economic and Clinical Health Act

The act included incentives for early adoption of those technologies until 2015. After 2015, it began to issue financial penalties (e.g., reductions of Medicare and Medicaid reimbursement) for providers and entities who had not adopted EHR technologies. In addition, it strengthened enforcement of HIPAA security and privacy laws and penalties for breaches.

Question 111

Exam Tips

NPs receive their “right to practice” from the ______ legislature.

Identify a ______-focused visit (see example in “What Are E&M Service Codes?”).

There are various types of nursing leadership.

Claims-based malpractice insurance will cover claims only if?

Occurrence-type malpractice insurance will cover a lawsuit in the future even if?

Answer 111

NPs receive their “right to practice” from the state legislature.

Identify a problem-focused visit (see example in “What Are E&M Service Codes?”) = just needs chief complaint and HPI, does not need ROS, past, family, or social history

There are various types of nursing leadership.

Claims-based malpractice insurance will cover claims only if the NP is still enrolled with the same insurance company at the time the claim is filed in court.

Occurrence-type malpractice insurance will cover a lawsuit in the future even if the NP no longer carries the policy, as long as the NP had an active policy during the alleged incident.

Question 112

Exam Tips

The NPI contains __ numbers/digits.

The (1) is used for diagnosis codes. The (1) is used to bill for outpatient office procedures and services. ____ the ICD-10 and CPT codes are required for each ___.

“Incident-to” billing is used for Medicare patients and refers to billing of a ______-up visit performed by a (1) provider billed under the ______ NPI number (the nonphysician provider is paid ___% vs. the rate of an NP or PA, who receives only 85%).

Answer 112

The NPI contains 10 numbers/digits.

The ICD-10 is used for diagnosis codes. The CPT code is used to bill for outpatient office procedures and services. Both the ICD-10 and CPT codes are required for each bill.

“Incident-to” billing is used for Medicare patients and refers to billing of a follow-up visit performed by a nonphysician provider billed under the physician’s NPI number (the nonphysician provider is paid 100% vs. the rate of an NP or PA, who receives only 85%).

Question 113

Culture and Nursing

Culturally competent care improves patient sat______ and patient s_____(e.g., by reducing medication-related errors).

To provide culturally competent care, the APRN must develop knowledge, skills, and p_____ attitudes about div_____ cultures and work individually and within the healthcare system to promote care that is respectful of all cultures.

If a cultural practice has an adverse effect on a patient’s health, then the nurse practitioner (NP) needs to explain to the patient in a sen______ manner the reason for not following the practice.

Answer 113

Culturally competent care improves patient satisfaction and patient safety (e.g., by reducing medication-related errors).

To provide culturally competent care, the APRN must develop knowledge, skills, and positive attitudes about diverse cultures and work individually and within the healthcare system to promote care that is respectful of all cultures.

If a cultural practice has an adverse effect on a patient’s health, then the nurse practitioner (NP) needs to explain to the patient in a sensitive manner the reason for not following the practice.

Example: A female patient tells the NP that her shaman (curandero, in Spanish) “told me not to take my medicine but to drink herbal tea instead” or “told me not to drink water for 2 days.” The NP respectfully explains to the patient why the practice is harmful to her health.

Question 114

Leininger’s Theory of Cultural Care Diversity and Universality

Madeleine Leininger is recognized as the founder of transcultural nursing and credited with the construct of “culturally con_____ care.”

This theory defines _____ as “the specific pattern of behavior that distinguishes any society from others and gives meaning to human expressions of care” (Leininger, 2014).

Leininger’s ______ Model is likely the most frequently used to frame culturally competent nursing care and research. The Sunrise Model recognizes that care is influenced by many cultural features (e.g., technology, religiosity or spirituality, kinship and social structures, cultural values and beliefs and practices, legal and political systems, economics, and education), all of which shape one’s worldview.

Answer 114

Madeleine Leininger is recognized as the founder of transcultural nursing and credited with the construct of “culturally congruent care.”

This theory defines culture as “the specific pattern of behavior that distinguishes any society from others and gives meaning to human expressions of care” (Leininger, 2014).

Leininger’s Sunrise Model is likely the most frequently used to frame culturally competent nursing care and research. The Sunrise Model recognizes that care is influenced by many cultural features (e.g., technology, religiosity or spirituality, kinship and social structures, cultural values and beliefs and practices, legal and political systems, economics, and education), all of which shape one’s worldview.

Question 115

Cultural and Spiritual _______

This is defined as “being knowledgeable about one’s own thoughts, feelings, and sensations, as well as the ability to reflect on how these can affect one’s interactions with other”

Answer 115

Cultural and Spiritual Awareness

This is defined as “being knowledgeable about one’s own thoughts, feelings, and sensations, as well as the ability to reflect on how these can affect one’s interactions with other”

Question 116

African Americans

African Americans often use r______ coping—typically Christian (e.g., prayer, gospel music, Bible reading, engagement with faith community).

Christian (1) are held in high esteem.

Church cong_______ and religion may be important sources of emotional and tangible s______.

Some patients may feel that their illness is caused by ____ of faith or by s____.

Many families have a (1) gender head of household (matriarchal).

Answer 116

African Americans often use religious coping—typically Christian (e.g., prayer, gospel music, Bible reading, engagement with faith community).

Christian pastors and preachers are held in high esteem.

Church congregations and religion may be important sources of emotional and tangible support.

Some patients may feel that their illness is caused by lack of faith or by sin.

Many families have a female head of household (matriarchal).

Question 117

Latinos/Hispanics

Latino families have a strong _______archal element, and the (1) gender parent is an important source of strength and solace in times of illness.

People from various Latino cultures may consult folk healers.

• (1) cultural illness (susto means “fr____”).
• (1) the “evil eye,” is a folk illness (usually of a baby/child).
  
  • It is caused by an adult who _____ with envy at the child. (This is similar to the belief in an “evil eye” among some Muslim and Mediterranean cultures.)
  • The hex can be broken if the person staring at the child _____ the child.
  • Another way to break the hex is to pass an ____ over the child (with prayers) and then place the egg under the bed overnight.

In general, Hispanic families enjoy public aff_____. Extended family are treated like emm______ family. _____generational households are common.

Answer 117

Latino families have a strong matriarchal element, and the (1) gender parent is an important source of strength and solace in times of illness.

People from various Latino cultures may consult folk healers.

• Susto cultural illness (susto means “fright”).
• Mal de ojo the “evil eye,” is a folk illness (usually of a baby/child).
  
  • It is caused by an adult who stare with envy at the child. (This is similar to the belief in an “evil eye” among some Muslim and Mediterranean cultures.)
  • The hex can be broken if the person staring at the child touch the child.
  • Another way to break the hex is to pass an egg over the child (with prayers) and then place the egg under the bed overnight.

In general, Hispanic families enjoy public affection. Extended family are treated like immediate family. Multigenerational households are common.

Question 118

American Indians

There are 574 federally recognized Indian Nations (also known as tr_____, villages, bands, pueblos, rancherias, or communities) and Alaskan Native tribes in the United States.

These many and varied groups have differing cultural practices and beliefs, but most traditionally view illness as “______” by the spirits for wrongful actions.

Healing is done by sh_____ using prayers, dance, fasting, smudging, and sometimes ingesting hallucinogenic plants (peyote).

Smudging =

Some groups use medicine p_____, tied to the patient by a st____, to help cure the illness.

Answer 118

There are 574 federally recognized Indian Nations (also known as tribes, villages, bands, pueblos, rancherias, or communities) and Alaskan Native tribes in the United States.

These many and varied groups have differing cultural practices and beliefs, but most traditionally view illness as “punishment” by the spirits for wrongful actions.

Healing is done by shamans using prayers, dance, fasting, smudging, and sometimes ingesting hallucinogenic plants (peyote).

Smudging is the ritualistic burning of an herb (with prayer) to help cleanse a person or place.

Some groups use medicine pouches, tied to the patient by a string, to help cure the illness.

Question 119

Notes on American Indian and Alaskan Natives

American Indian and Alaska Native people have ____ health status when compared with other Americans. Their life expectancy is ____ years less than the U.S. all-races population (Indian Health Service, 2019).

American Indian and Alaska Native people die at _____ rates than other Americans from chronic liver disease/cirrhosis, diabetes, accidents, assault/homicide, self-harm/suicide, and chronic lower respiratory disease. About 16% of persons (all ages) are considered in fair or poor health. The leading cause of death is _____ disease (Centers for Disease Control and Prevention, 2017). Among men and women aged 18 years or older, about 20% are sm_____.

Answer 119

American Indian and Alaska Native people have lower health status when compared with other Americans. Their life expectancy is 5.5 years less than the U.S. all-races population (Indian Health Service, 2019).

American Indian and Alaska Native people die at higher rates than other Americans from chronic liver disease/cirrhosis, diabetes, accidents, assault/homicide, self-harm/suicide, and chronic lower respiratory disease. About 16% of persons (all ages) are considered in fair or poor health. The leading cause of death is heart disease (Centers for Disease Control and Prevention, 2017). Among men and women aged 18 years or older, about 20% are smokers.

Question 120

Notes on American Indian and Alaskan Natives

American Indian women have the highest rates of r____ and assault in the United States. They are 2.5 times more likely to experience sexual assault and rape compared with other ethnic groups in the United States (Gilpin, 2016).

The (1), a federal agency, is charged with delivery of healthcare to this population.

Answer 120

American Indian women have the highest rates of rape and assault in the United States. They are 2.5 times more likely to experience sexual assault and rape compared with other ethnic groups in the United States (Gilpin, 2016).

The Indian Health Service, a federal agency, is charged with delivery of healthcare to this population.

Question 121

Asians

East Asians (Chinese, Vietnamese, Cambodian, Korean, Japanese) highly value c_____ education and have ____regard (respect) for doctors. Listening q_____ without questioning is considered a sign of respect. Some think that asking questions (or disagreeing) with the treatment plan shows lack of respect.

Kinship ties are very important. Several gen_____ may live in the same household. E_____ are held in high esteem, and their opinion is highly respected. Some Asian cultures have a form of “anc____ veneration” practices. In China, the ____ child is expected to take care of parents when they age

Answer 121

East Asians (Chinese, Vietnamese, Cambodian, Korean, Japanese) highly value college education and have high regard (respect) for doctors. Listening quietly without questioning is considered a sign of respect. Some think that asking questions (or disagreeing) with the treatment plan shows lack of respect.

Kinship ties are very important. Several generations may live in the same household. Elderly are held in high esteem, and their opinion is highly respected. Some Asian cultures have a form of “ancestor veneration” practices. In China, the male child is expected to take care of parents when they age

Question 122

Vietnamese

• May ____ taking prescription medicine when symptoms resolve or may think that only ___ visit is needed to “cure” an illness
• Often save large quantities of left____ prescription drugs
• May fear blood tests and surgery because of a belief that blood ____ worsens illness
• May believe that ______ medicine will put the body ___ of balance

Answer 122

• May stop taking prescription medicine when symptoms resolve or may think that only one visit is needed to “cure” an illness
• Often save large quantities of leftover prescription drugs
• May fear blood tests and surgery because of a belief that blood loss worsens illness
• May believe that Western medicine will put the body out of balance

Question 123

Buddhists

• Majority come from Asia (e.g., Cambodia, Thailand, Bhutan, Japan, Laos, Vietnam, Taiwan, Tibet)
• Main deity is Buddha; they believe that physical suffering is an inev_____ part of life and believe in ____ (“good deeds” create happiness, and “bad deeds” create pain in the future) and the cycle of rebirth (re______); some dying Buddhists may experience anxiety about being reborn into a lower form or less desirable life
• May be (1) dietary lifestyle
• May practice regular medit_____; Buddhists value clarity of m____ and may refuse narcotics or medications that alter con____ness

Answer 123

• Majority come from Asia (e.g., Cambodia, Thailand, Bhutan, Japan, Laos, Vietnam, Taiwan, Tibet)
• Main deity is Buddha; they believe that physical suffering is an inevitable part of life and believe in karma (“good deeds” create happiness, and “bad deeds” create pain in the future) and the cycle of rebirth (reincarnation); some dying Buddhists may experience anxiety about being reborn into a lower form or less desirable life
• May be vegetarian
• May practice regular meditation; Buddhists value clarity of mind and may refuse narcotics or medications that alter consciousness

Question 124

Traditional Chinese Medicine

• Practitioners believe life energy (ch__ or q__) imbalance or blockage is the cause of disease.
• Y___ is the female, and y____ is the male.
• Believe ac_____ and cu_____ correct energy imbalance.
• ______ will create large round reddened marks or bruises on back (after 24 hours). C_______ is when a coin is rubbed vigorously on skin to create welts. Both of these practices may produce lesions that may be misinterpreted as signs of abuse. The NP should question how a child received such lesions before reporting the lesions as abuse.

Answer 124

• Practitioners believe life energy (chi or qi) imbalance or blockage is the cause of disease.
• Yin is the female, and yang is the male.
• Believe acupuncture and cupping correct energy imbalance.
• Cupping will create large round reddened marks or bruises on back (after 24 hours). Coining is when a coin is rubbed vigorously on skin to create welts. Both of these practices may produce lesions that may be misinterpreted as signs of abuse. The NP should question how a child received such lesions before reporting the lesions as abuse.

Question 125

Sikhs

Baptized Sikhs (Khalsa) and some others will obey a code of conduct that stipulates one wears five symbols of Sikh identity: ____ hair, a sw____, sh____, hair c____, and iron wrist r____.

These symbols should not be re_____ unless negotiated with the patient.

Sikhs will not consume m___, al____, or stimulants.

Adult male Sikhs may wear a large _____-like head covering (usually white color).

Most come from southern or Southeast Asia, India, Canada, United Kingdom, and the United States.

Answer 125

Baptized Sikhs (Khalsa) and some others will obey a code of conduct that stipulates one wears five symbols of Sikh identity: uncut hair, a sword, shorts, hair comb, and iron wrist ring.

These symbols should not be removed unless negotiated with the patient.

Sikhs will not consume meat, alcohol, or stimulants.

Adult male Sikhs may wear a large turban-like head covering (usually white color).

Most come from southern or Southeast Asia, India, Canada, United Kingdom, and the United States.

Question 126

Hindus

A central belief of Hinduism is the doctrine of K____, the law of cause and effect, which can affect decision-making regarding healthcare. All illness may be seen as the result of karma.

Hinduism encourages the ______ of pain and suffering as part of the consequences of karma. Hindu patients may not be ____coming about pain and may prefer to accept it as a means of progressing sp_____.

Hindus believe that all illnesses have a b_____, ps_____, and sp_____ element. Treatments that do not address all three causes may not be considered effective by a Hindu patient.

Many Hindus attach a st_____ to mental illness and cognitive dysfunction. Hindus believe that the time of death is determined by one’s destiny and ____ death and illness as part of life.

Answer 126

A central belief of Hinduism is the doctrine of karma, the law of cause and effect, which can affect decision-making regarding healthcare. All illness may be seen as the result of karma.

Hinduism encourages the acceptance of pain and suffering as part of the consequences of karma. Hindu patients may not be forthcoming about pain and may prefer to accept it as a means of progressing spiritually.

Hindus believe that all illnesses have a biological, psychological, and spiritual element. Treatments that do not address all three causes may not be considered effective by a Hindu patient.

Many Hindus attach a stigma to mental illness and cognitive dysfunction. Hindus believe that the time of death is determined by one’s destiny and accept death and illness as part of life.

Question 127

Hindus

Most Hindus do not eat b____ or p____, and many follow a ______ diet.

F______ is an integral part of Hinduism and is seen as a means of purifying the body and the soul.

May wear a tal_____ that should not be cut or removed.

Countries with highest percentage of Hindus are N____, I___, and Maur____.

Answer 127

Most Hindus do not eat beef or pork, and many follow a vegetarian diet.

Fasting is an integral part of Hinduism and is seen as a means of purifying the body and the soul.

May wear a talisman that should not be cut or removed.

Countries with highest percentage of Hindus are Nepal, India, and Mauritius.

Question 128

Muslims

In traditional Muslim families, Sh____ law (Islamic law) is followed.

M_____ is paramount; garments of adolescent females and women should cover arms, legs, and head. A h____ is a head scarf (hides hair, ears, neck), and the bur___ or ab____ is the full veil/robe that covers the body.

The ____ hand is reserved for bodily functions (considered unclean). Shake the patient’s hand by using your right hand.

Clinicians of ____ gender preferred. Some male patients may be uncomfortable receiving healthcare from a female health provider. An unmarried woman needs her father’s permission to see a clinician, and a married woman needs her husband’s permission.

In addition, women are not allowed to be ____ or to visit with men who are not family members. If a woman is seen by a male health provider, her husband or another male family member must be present in the room.

The female patient may refuse to un____ (examine with the gown on).

Answer 128

In traditional Muslim families, Sharia law (Islamic law) is followed.

Modesty is paramount; garments of adolescent females and women should cover arms, legs, and head. A hijab is a head scarf (hides hair, ears, neck), and the burqa or abaya is the full veil/robe that covers the body.

The left hand is reserved for bodily functions (considered unclean). Shake the patient’s hand by using your right hand.

Clinicians of same gender preferred. Some male patients may be uncomfortable receiving healthcare from a female health provider. An unmarried woman needs her father’s permission to see a clinician, and a married woman needs her husband’s permission.

In addition, women are not allowed to be alone or to visit with men who are not family members. If a woman is seen by a male health provider, her husband or another male family member must be present in the room.

The female patient may refuse to undress (examine with the gown on).

Question 129

Muslims

The (1) (Koran) forbids drinking _____, eating ____, or eating meat not slaughtered in the “____” manner.

The holy month of (1) is observed by 30 days of fasting.

• It is forbidden to eat or drink fluids/water during the ___time, but one can eat or drink from sun___ to before sun____.
• If possible, schedule oral medications after sun___.
• Those who are s____ may be exempted (pr_____ women, physically or mentally ill people).
• Children are not expected to fast until p_____.

Answer 129

The Qur’an (Koran) forbids drinking alcohol, eating pork, or eating meat not slaughtered in the “halal” manner.

The holy month of Ramadan is observed by 30 days of fasting.

• It is forbidden to eat or drink fluids/water during the daytime, but one can eat or drink from sunset to before sunrise.
• If possible, schedule oral medications after sunset.
• Those who are sick may be exempted (pregnant women, physically or mentally ill people).
• Children are not expected to fast until puberty.

Question 130

Jews

Orthodox Jews, such as Hasidic Jews, prefer clinicians of the ____gender. Male Hasidic Jews may refuse to shake a female clinician’s hand.

Female Hasidic Jews wear a ___ to cover their hair.

Sh______ (Sabbath) is observed from sundown _____ to sundown ______ as a holy day that forbids any form of work.

• Some believe that el______ is a form of work and may stop using light switches or any electronic equipment during Shabbat (may have to turn on the light switch for the patient).
• Some observant Jews do not dr____ or use cell ______ or other personal electronics at this time.
• If possible, avoid accessing unnecessary health services on the Sabbath and avoid scheduling follow-up visits or tests on the Sabbath.

Answer 130

Orthodox Jews, such as Hasidic Jews, prefer clinicians of the same gender. Male Hasidic Jews may refuse to shake a female clinician’s hand.

Female Hasidic Jews wear a wig to cover their hair.

Shabbat (Sabbath) is observed from sundown Friday to sundown Saturday as a holy day that forbids any form of work.

• Some believe that electricity is a form of work and may stop using light switches or any electronic equipment during Shabbat (may have to turn on the light switch for the patient).
• Some observant Jews do not drive or use cell phones or other personal electronics at this time.
• If possible, avoid accessing unnecessary health services on the Sabbath and avoid scheduling follow-up visits or tests on the Sabbath.

Question 131

Jews

Jews may keep k_____ dietary laws (kashruth; e.g., not m_____ meat and dairy products within specified time frame, eating only meaty foods certified as kosher).

Families may have _____ separate kitchens at home: kosher and nonkosher.

Each kitchen has its own utensils, pots, and plates (not allowed to m___ because the kosher items will become cont_____).

Answer 131

Jews may keep kosher dietary laws (kashruth; e.g., not mixing meat and dairy products within specified time frame, eating only meaty foods certified as kosher).

Families may have two separate kitchens at home: kosher and nonkosher.

Each kitchen has its own utensils, pots, and plates (not allowed to mix because the kosher items will become contaminated).

Question 132

Jehovah’s Witnesses

Jehovah’s Witnesses refuse to donate or accept? What will they accept?

If a blood transfusion is needed to save the life of a child, can the parents refuse? but might need a?

What do believers believe about civil holidays, birthdays, Christmas, Easter, and others?

Healthcare providers should encourage believers to carry an (1) or medical release form that states their convictions; such a card is available from the church. In urban locations, a hospital l______ from the church may be available to support believers with decision-making.

Answer 132

Jehovah’s Witnesses refuse to donate blood, store blood, or accept own blood (autologous transfusion) but accept nonblood plasma expanders and blood components without red blood cells (RBCs; albumin, cryoprecipitate, clotting factors, immunoglobulins).

If a blood transfusion is needed to save the life of a child, parents may refuse (may require a court order).

Believers do not celebrate civil holidays, birthdays, Christmas, Easter, and others.

Healthcare providers should encourage believers to carry an advance directive or medical release form that states their convictions; such a card is available from the church. In urban locations, a hospital liaison from the church may be available to support believers with decision-making.

Question 133

Seventh-Day Adventists

Dietary Lifestyle? Avoidance of?

Adventists believe the human body is a?

They observe ______ (sundown Friday to sundown Saturday) as a holy day for rest from work/school and spiritual nurturing. If possible, avoid accessing unnecessary health services on the Sabbath.

Answer 133

Believers are often vegetarian and abstain from tobacco, alcohol, and caffeinated beverages.

Adventists believe the human body is a temple of God that deserves care (healthy lifestyle).

They observe Sabbath (sundown Friday to sundown Saturday) as a holy day for rest from work/school and spiritual nurturing. If possible, avoid accessing unnecessary health services on the Sabbath.

Question 134

Amish/Mennonites (Old Order)

Believers do not participate in Medi____ or S_____ Security or go to w____.

The individual’s comm_____ pays for healthcare (__ health insurance).

Use of f____ practitioners and folk/alternative medicine is common.

If surgery or an expensive test is needed, permission from _____ elders is required.

Believers may speak G_____ dialect.

They avoid modern t______, such as telephones and electricity, and use horses and buggies for transportation.

L____ families, tr______ roles for women, and agr______ work are characteristic.

Amish prefer giving birth (using mid_____) and dying at home.

These closed communities have higher rates of some g_____ diseases such as maple syrup urine disease, Crigler–Najjar syndrome, a type of dwarfism (Ellis–van Creed syndrome), and cystic fibrosis, as well as certain metabolic disorders.

Answer 134

Believers do not participate in Medicare or Social Security or go to war.

The individual’s community pays for healthcare (no health insurance).

Use of folk practitioners and folk/alternative medicine is common.

If surgery or an expensive test is needed, permission from church elders is required.

Believers may speak German dialect.

They avoid modern technology, such as telephones and electricity, and use horses and buggies for transportation.

Large families, traditional roles for women, and agricultural work are characteristic.

Amish prefer giving birth (using midwives) and dying at home.

These closed communities have higher rates of some genetic diseases such as maple syrup urine disease, Crigler–Najjar syndrome, a type of dwarfism (Ellis–van Creed syndrome), and cystic fibrosis, as well as certain metabolic disorders.

Question 135

Church of Latter-Day Saints (Mormons)

Mormon churches provide a strong _____ support net____ for the ill.

The local ward bishop, elders, missionaries, home or visiting teachers, and/or lay people provide spiritual and temporal support.

Patients may wear “_____ garments” under hospital gown or clothing as a symbol of covenant they made in the temple. Treat such undergarments with respect.

Answer 135

Mormon churches provide a strong social support network for the ill.

The local ward bishop, elders, missionaries, home or visiting teachers, and/or lay people provide spiritual and temporal support.

Patients may wear “temple garments” under hospital gown or clothing as a symbol of covenant they made in the temple. Treat such undergarments with respect.

Question 136

Lesbian, Gay, Bisexual, Transgender

Avoid assumptions regarding sexual or_____ or gender id______.

Facilitate disclosure while remaining respectful of an individual’s “coming ___” process.

Recognize and support the patient’s family of choice and use gender-n_____ language on forms and during history taking (e.g., “Have you had sex with a male, female, both, or neither?”).

Respectfully ask how the patient wants to be addressed and what pro_____ to use (e.g., he vs. she).

Many LGBT people have been ____treated by the medical community and are rel_____ to obtain healthcare unless absolutely necessary.

Organizations like the ____ Institute in Miami maintain lists of culturally competent LGBT healthcare providers (https://yesinstitute.org).

The National L_____+ Health ______ Center, a program of the Fenway Institute, provides educational programs, resources, and consultation to healthcare organizations with the goal of optimizing quality, cost-effective healthcare for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minority people

Answer 136

Avoid assumptions regarding sexual orientation or gender identity.

Facilitate disclosure while remaining respectful of an individual’s “coming out” process.

Recognize and support the patient’s family of choice and use gender-neutral language on forms and during history taking (e.g., “Have you had sex with a male, female, both, or neither?”).

Respectfully ask how the patient wants to be addressed and what pronouns to use (e.g., he vs. she).

Many LGBT people have been mistreated by the medical community and are reluctant to obtain healthcare unless absolutely necessary.

Organizations like the Yes Institute in Miami maintain lists of culturally competent LGBT healthcare providers (https://yesinstitute.org).

The National LGBTQIA+ Health Education Center, a program of the Fenway Institute, provides educational programs, resources, and consultation to healthcare organizations with the goal of optimizing quality, cost-effective healthcare for lesbian, gay, bisexual, transgender, queer, intersex, asexual, and all sexual and gender minority people

Question 137

Military Veterans

(2) Conditions are prevalent among U.S. veterans.

Military personnel are accustomed to self-protect when exposed to certain s_____ or experiences (e.g., hide under bed when helicopter is overhead).

They are socialized to be st_____ about pain or suffering and nonquestioning of auth_____ figures.

It is important to include the patient’s ____ in their care, as they are aware of the military culture.

Answer 137

PTSD, TBI are prevalent among U.S. veterans.

Military personnel are accustomed to self-protect when exposed to certain sounds or experiences (e.g., hide under bed when helicopter is overhead).

They are socialized to be stoic about pain or suffering and nonquestioning of authority figures.

It is important to include the patient’s family in their care, as they are aware of the military culture.

Question 138

(1)

“degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions”

Answer 138

Health Literacy

It affects the person’s ability to learn about how to access healthcare, complete forms, respond to questions, implement recommended treatments, and so forth. It depends on communication and language, existing knowledge about health, culture, and numerical ability and skills, as well as the demands of the situation and system within which the individual presents.

Question 139

Language Barriers

Even one mis__________ or misspoken word can affect a patient’s decision-making or implementation of a treatment.

Strategies for communication between patients and healthcare providers who speak different languages include (1) (virtual, telephonic, or in-person interpreters) and handheld documents at point of service that present clinicians with patient information.

Who should not be used as interpreters? (2)

Answer 139

Even one misunderstood or misspoken word can affect a patient’s decision-making or implementation of a treatment.

Strategies for communication between patients and healthcare providers who speak different languages include language access services (virtual, telephonic, or in-person interpreters) and handheld documents at point of service that present clinicians with patient information.

Untrained staff and family members should not be used for interpretative services.

Question 140

Individualistic and Collectivistic Societies

Cultures are often categorized as ______istic or _____istic.

_______ societies value the individual above the family, organization, or group.

In contrast, ______ societies consider the rights, needs, and wishes of the family or group over those of individuals.

Answer 140

Cultures are often categorized as individualistic or collectivistic.

Individualist societies value the individual above the family, organization, or group.

In contrast, collectivist societies consider the rights, needs, and wishes of the family or group over those of individuals.

Question 141

Differing Interpretations of Illness

Medical anthropologist and psychiatrist Arthur Kleinman proposed that the culture-infused “illness narrative” is essential for any healing clinician to understand. In other words, things associated with the disease, not the disease itself, are important. Kleinman offered these questions for assessment:

• What do you think has c_____ your illness? (Etiology)
• Why do you think it st____ when it did? (Onset of symptoms)
• What do you think your illness does to you? How does it w____? (Pathophysiology)
• How ______ is your illness? Will it last a short or long time? (Course of illness)
• What kind of tr_____ do you think you need? What results do you hope for? (Treatment)
• What are the biggest pr_____ your illness has caused you?
• What do you f____ most about your illness?

Non_______ and other problems are usually explained by a dis______ between the patient and professional’s int______ of the illness. When the explanatory models for the illness do not align, the clinician must seek to understand and negotiate them as a “therapeutic ___” with the patient.

Answer 141

• What do you think has caused your illness? (Etiology)
• Why do you think it started when it did? (Onset of symptoms)
• What do you think your illness does to you? How does it work? (Pathophysiology)
• How severe is your illness? Will it last a short or long time? (Course of illness)
• What kind of treatment do you think you need? What results do you hope for? (Treatment)
• What are the biggest problems your illness has caused you?
• What do you fear most about your illness?

Noncompliance and other problems are usually explained by a discrepancy between the patient’s and professional’s interpretation of the illness. When the explanatory models for the illness do not align, the clinician must seek to understand and negotiate them as a “therapeutic ally” with the patient.

Question 142

Exam Tips

Muslim women who refuse to wear a gown can be examined how?

(1) do not accept blood transfusions (including autologous), but some may accept blood components without _____ (e.g., cryoprecipitate, immunoglobins).

Prolonged direct eye contact with males or strangers is considered rude by some cultures (e.g., A____, female M_____).

(1) is a Muslim holiday that lasts for 30 days. Both fluids and food are forbidden from (1) to (1).

Orthodox Jewish patients may refuse to touch anything powered by ______ (e.g., light switch, call light, electronic pumps, cell phones) from sunset ____ to sunset ______ (Sabbath). Do not schedule visits during the Sabbath. If you call during this time, observant patients will not answer the phone.

Answer 142

Muslim women who refuse to wear a gown can be examined through their clothing (modified or partial physical exam).

Jehovah’s Witnesses do not accept blood transfusions (including autologous), but some may accept blood components without RBCs (e.g., cryoprecipitate, immunoglobins).

Prolonged direct eye contact with males or strangers is considered rude by some cultures (e.g., Asians, female Muslim).

Ramadan is a Muslim holiday that lasts for 30 days. Both fluids and food are forbidden from sunrise to sunset.

Orthodox Jewish patients may refuse to touch anything powered by electricity (e.g., light switch, call light, electronic pumps, cell phones) from sunset Friday to sunset Saturday (Sabbath). Do not schedule visits during the Sabbath. If you call during this time, observant patients will not answer the phone.

Question 143

Clinical Pearls

Each person interprets and implements their cultural and religious beliefs and practices uniquely; therefore, the clinician should make no ass_______ and assess as needed. In other words, talk to the patient and act______ listen and verify what is being said.

R______ practices often influence behavior around birthing, marriage, child rearing, illness, death, burial, and mourning. Patient beliefs and practices should be honored, provided they do not cause harm.

Answer 143

Each person interprets and implements their cultural and religious beliefs and practices uniquely; therefore, the clinician should make no assumptions and assess as needed. In other words, talk to the patient and actively listen and verify what is being said.

Religious practices often influence behavior around birthing, marriage, child rearing, illness, death, burial, and mourning. Patient beliefs and practices should be honored, provided they do not cause harm.

Question 144

Sources of Data

(1) = research from which the data originated
(1) = sources created where the original data are interpreted or analyzed by another person (not the original researcher)

Which is preferred?

Answer 144

Primary Sources = research from which the data originated

Secondary Sources = sources created where the original data (primary data) are interpreted or analyzed by another person (not the original researcher) “second hand accounts”

Primary Sources Preferred

Question 145

Ethical Issues in Nursing Research

(1)

A body that works to ensure the rights, safety, and welfare of human research subjects who are participating in research studies in their institution, hospital, or clinic. According to U.S. Food and Drug Administration (FDA) guidelines, these bodies have the authority to approve or reject research proposals that are submitted to their institution or hospital. If a member has a conflict of interest, “they must absent themselves from deliberation and abstain from voting”

Answer 145

Institutional Review Boards (IRB)

Question 146

Committee Members

The members of the IRB committee are usually affiliated or non-affiliated with the institution?

What types of individuals are preferred?

Answer 146

The members of the IRB committee are formally designated to review and monitor research that involves human subjects at their institution. The IRB members are individuals who are affiliated with the institution. Therefore physicians, clinicians, or retail pharmacists who are not affiliated with the institution are generally not included in an IRB committee (unless they are hired as consultants).

In addition, experienced staff members, not recent graduates, are preferred. The size of the IRB and the number of members depend on the type of institution.

Question 147

Vulnerable Populations

Almost all types of biomedical and behavioral research in the United States require informed consent. “Vulnerable populations” require special protections and consent requirements.

• (1) younger than ___ years of age
• _______ women, f______
• Pr______
• Ref______, ethnic m_______
• Persons with mental or physical ________, visual or hearing impairment
• Persons who are ec______ disadvantaged

Answer 147

• Infants and children younger than 18 years of age
• Pregnant women, fetuses
• Prisoners
• Refugees, ethnic minorities
• Persons with mental or physical disabilities, visual or hearing impairment
• Persons who are economically disadvantaged

Question 148

(1)

A report that outlines the important ethical principles that should be followed when performing research that involves human subjects.

Issued by the National Commission for the Protection of Human Subjects of Biomedical and Behavioral Research (1979).

Answer 148

Belmont Report

Question 149

(1)

Infamous study of 600 African American sharecroppers (1932–1972) in Alabama. The men were all tested for syphilis infection, and those who had positive results were never informed or treated. Because of this study, laws were passed that protect human subjects’ rights and mandate informed consent.

Answer 149

Tuskegee Syphilis Experiment

Question 150

Informed Consent of Human Subjects

Research subjects must be informed that they have the right to _____ from the research study at any time without adverse consequences or penalty. There are additional requirements for minors and vulnerable subjects.

• Describe the st_____. Inform the subject of what they are expected to do (e.g., questionnaires, labs).
• Describe the r_____ or the discomforts of participating in the study in the present and the future (if applicable).
• Describe the b_____ of participating in the study in the present and the future (if applicable).
• Discuss the al______ to the study. Allow enough time for the subject to ask questions.
• Discuss whether there is any com______ or reward for participation.
• Discuss how conf_______ and data will be secured to protect the subject’s identity.
• Give the number and/or e_____ address of the con_____ for the study so that the subject can contact that person if they have any concerns or problems with the study.

Answer 150

Research subjects must be informed that they have the right to withdraw from the research study at any time without adverse consequences or penalty. There are additional requirements for minors and vulnerable subjects.

• Describe the study. Inform the subject of what they are expected to do (e.g., questionnaires, labs).
• Describe the risk or the discomforts of participating in the study in the present and the future (if applicable).
• Describe the benefits of participating in the study in the present and the future (if applicable).
• Discuss the alternatives to the study. Allow enough time for the subject to ask questions.
• Discuss whether there is any compensation or reward for participation.
• Discuss how confidentiality and data will be secured to protect the subject’s identity.
• Give the number and/or email address of the contact for the study so that the subject can contact that person if they have any concerns or problems with the study.

Question 151

Minors

=
Emancipated Minor Criteria

• (1) declaring that the minor is an “emancipated minor”
• Active (1)
• Legally binding (1)

Answer 151

<18 yo

Emancipated Minor Criteria

• Legal court document declaring that the minor is an “emancipated minor”
• Active duty in the U.S. military
• Legally binding marriage (or divorced from a legally binding marriage)

Question 152

Consent Versus Assent

What is difference?

(1) may be given only by individuals who are aged 18 years or older.

A minor (who is not emancipated) as young as the age of 7 years up to age 17 years can give (1) to participate in a research study but cannot give consent legally. The child should be assured that they can withdraw from the study after discussing it with their parents.

The ______ must first consent to the minor’s participation in the study. In addition, the researcher needs parental permission to speak with the minor in order to obtain (1) (the child signs a separate _____ form).

Answer 152

Consent may only be given by individuals who have reached the legal age of consent (in the U.S. this is typically 18 years old). Assent is the agreement of someone not able to give legal consent to participate in the activity (the expression of approval)

Consent may be given only by individuals who are aged 18 years or older.

A minor (who is not emancipated) as young as the age of 7 years up to age 17 years can give assent to participate in a research study but cannot give consent legally. The child should be assured that they can withdraw from the study after discussing it with their parents.

The parent or legal guardian must first consent to the minor’s participation in the study. In addition, the researcher needs parental permission to speak with the minor in order to obtain assent (the child signs a separate assent form).

Question 153

Statistical Significance

(1): Also known as the “significance level” or “__-value.” It is usually set as either por p

• A significance level of p < 0.05 means that there is a __% probability that a study’s results are due to ______
• A significance level of p < 0.01 means that there is a __% probability that a study’s results are due to _____. Therefore a α of p < 0.01 is “_____” than an α of p < 0.05

Significance level: Also known as the “α” or a “p-value.” The p-value is usually set at either pp

Answer 153

α: Also known as the “significance level” or “p-value.” It is usually set as either p< 0.05 or p < 0.01

• A significance level of p < 0.05 means that there is a 5% probability that a study’s results are due to chance
• A significance level of p < 0.01 means that there is a 1% probability that a study’s results are due to chance. Therefore a α of p < 0.01 is “better” than an α of p < 0.05

Significance level: Also known as the “α” or a “p-value.” The p-value is usually set at either p<0.05 or p<0.01

Question 154

Research Terms

• (1) group:* Subjects in an experiment who do not receive treatment.
• (1)*: This letter indicates the total size of the sample.
• (1)*: This letter indicates the number of subjects in the group.

Answer 154

• Control group**:* Subjects in an experiment who do not receive treatment.
• N*: This letter indicates the total size of the sample.
• n*: This letter indicates the number of subjects in the group.

Question 155

(1)

Any attribute or characteristic that varies and is measurable.

• (1):* Variable that is being manipulated and is used to influence the dependent variable. In experimental studies, the researcher has control over the independent variable.
• (1):* This is the result of the manipulation of the independent variable.
• Example:* Manipulation by researcher (_____ variable) allows a response to manipulation that can be observed and measured (_____ variable).

Answer 155

Variables

• Independent variable:* Variable that is being manipulated and is used to influence the dependent variable. In experimental studies, the researcher has control over the independent variable.
• Dependent variable**:* This is the result of the manipulation of the independent variable.
• Example:* Manipulation by researcher (independent variable) allows a response to manipulation that can be observed and measured (dependent variable).

Question 156

(1)

An idea (or supposition) that can be tested and refuted. When conducting research, an examiner tests a this or several and can either accept or refute it.

Answer 156

Hypothesis

Question 157

Null hypothesis (H₀):

=

Therefore, if you prove your hypothesis (ie p<0.01), what are you doing to the null hypothesis?

Answer 157

This is the opposite of the hypothesis being studied.

REJECT THE NULL: If the research data meets the set p-value (p < .01), the results are considered significant (not due to random chance), and the null hypothesis can be rejected.

Example: If the hypothesis is “corn plants grow faster when exposed to sunlight,” the null hypotheses is “corn plants will not grow faster when exposed to sunlight.” If the research data meets the set p-value (p < .01), the results are considered significant (not due to random chance), and the null hypothesis can be rejected. If the null hypothesis cannot be rejected, it means that there is no relationship between the variables, and the results are due to chance.

Question 158

• Normal Curve*
• =*

Answer 158

bell-shaped curve

Question 159

• Measures of Distribution*
  (1) : Also known as the average. Calculated by adding all of the scores together and dividing it by the total number.
• Example: 5, 5, 5, 10, 10 (35 ÷ 5 = 7, average is “7”)
  (1) : The number that is in the middle when values are arranged from lowest to highest (chronological order)
• Example: 1, 3, 4, 5, 7, 10, 14 (median value is “5”)
  (1) : The most common value or frequently occurring value in a set of scores
• Example: 3, 5, 7, 7, 7, 8, 9, 10, 10 (mode is “7”)
  (1) : The difference between the largest and smallest values in a distribution
• Example: 2, 3, 5, 7, 10, 15 (15 − 2 = 13, range is “13”)

Answer 159

Mean: Also known as the average. Calculated by adding all of the scores together and dividing it by the total number.

• Example: 5, 5, 5, 10, 10 (35 ÷ 5 = 7, average is “7”)

Median: The number that is in the middle when values are arranged from lowest to highest (chronological order)

• Example: 1, 3, 4, 5, 7, 10, 14 (median value is “5”)

Mode: The most common value or frequently occurring value in a set of scores

• Example: 3, 5, 7, 7, 7, 8, 9, 10, 10 (mode is “7”)

Range: The difference between the largest and smallest values in a distribution

• Example: 2, 3, 5, 7, 10, 15 (15 − 2 = 13, range is “13”)

Question 160

(1)

Studies done in the present (to the future). Longitudinal studies are a type of this study. Data are obtained in the present and then periodically measured in the future.

Answer 160

Prospective Study

Question 161

(1)

Studies done on events that have already occurred (e.g., chart reviews, recall of events). Another name for this study design is ex post facto.

Answer 161

Retrospective Study

Question 162

(1)

Long-term studies that follow the same group of subjects (or cohort) over many years to observe, measure, and compare the same variables over time. These are observational studies (there is no manipulation or intervention). For example, the Framingham Heart Study has tracked the same research subjects (N = 5,029) from the town of Framingham, Massachusetts. The goal is to study the development and identify the risk factors that are associated with the development of cerebrovascular disease.

Answer 162

Longitudinal Study

Question 163

(1)

Simply groups of individuals that share some common characteristic (e.g., gender, age, job, ethnicity).

These studies are useful for studying the causative factors or risk factors of a disease(s). For example, the Nurses’ Health Study is a longitudinal cohort study that examined the effects of oral contraceptive use in nurses over the long term. It has been expanded to study the effect of lifestyle choices on health.

Answer 163

Cohort

Question 164

(1)

A study that compares differences and similarities between two or more groups of people or phenomena and collects data at one point in time.

Answer 164

Cross-Sectional Study

Question 165

(1)

An in-depth investigation of a single person, group, or phenomenon.

Answer 165

Case Study

Question 166

(1)

In these studies researchers observe and collect pertinent information but do not manipulate or change the environment. Also known as observational studies.

Answer 166

Descriptive

Question 167

(1)

A type of observational study in which the relationship (interrelationships) between at least two variables is evaluated. There are three types of correlations:

1. _______ correlation: Two variables change together in the same direction. For example, when variable A increases, then variable B also increases.
2. _______ correlation: An increase in one variable results in a decrease in the other. For example, when variable A increases, this causes variable B to decrease.
3. ___ correlation: The variables are not related. For example, a change in variable A does not affect variable B

Answer 167

Correlational

1. Positive correlation: Two variables change together in the same direction. For example, when variable A increases, then variable B also increases.
2. Negative correlation: An increase in one variable results in a decrease in the other. For example, when variable A increases, this causes variable B to decrease.
3. No correlation: The variables are not related. For example, a change in variable A does not affect variable B

Question 168

(1)

An important criterion in this type study is the use of random sampling and random assignment of research subjects. There is at least one control group and one (or more) intervention or treatment group (manipulation). Causality can be determined (If A + B occur, this will cause C).

Answer 168

Experimental Study

Question 169

(1)

The design is similar to an experimental study, except there is no randomization of the research subjects. Instead, recruitment of subjects is by convenience sample.

Answer 169

Quasi-Experimental

Question 170

(1)

Type of reasoning that involves going from more general to more specific findings. Also known as “top-down” logic. In research, this means starting with a theory (generalization) and then narrowing it down by formulating specific hypotheses (deduction). Quantitative studies use this type of reasoning.

Answer 170

Deductive Reasoning

Question 171

(1)

The opposite of deductive reasoning. Also known as “bottom-up” logic. Involves going from specific findings to generalizations. One starts with specific observations, and from these, one may detect a pattern that helps to formulate tentative hypotheses, which may help to generate new theory. Qualitative studies use this reasoning.

Answer 171

Inductive Reasoning

Question 172

Qualitative vs. Quantitative Studies

Answer 172

Question 173

Research Process

• Phase I—(1):* Formulate research problem or question; review literature; develop hypothesis(es)
• Phase II—(1) and (1):* Select research design; identify population/sample; determine protocols, methods, resources required, and ethical considerations; prepare proposal; submit to IRB for approval
• Phase III—(1)**:* Recruit participants (obtain consent); implement research design; collect data
• Phase IV—(1)**:* Organize, analyze, and interpret data
• Phase V—(1):* Prepare final report; publish and disseminate findings (e.g., journal articles, poster presentations, lectures)

Answer 173

• Phase I—Conception:* Formulate research problem or question; review literature; develop hypothesis(es)
• Phase II—Design and Planning:* Select research design; identify population/sample; determine protocols, methods, resources required, and ethical considerations; prepare proposal; submit to IRB for approval
• Phase III—Implementation**:* Recruit participants (obtain consent); implement research design; collect data
• Phase IV—Analysis**:* Organize, analyze, and interpret data
• Phase V—Dissemination:* Prepare final report; publish and disseminate findings (e.g., journal articles, poster presentations, lectures)

Question 174

Exam Tips

(1) data are the preferred source in research (original study that produced the data).

(1) studies use randomization with subject selection.

(1) studies search for relationships between a minimum of two variables.

Deductive logic is used with (1) studies, and inductive logic is used in (1) studies.

Understand the difference between a dependent and an independent variable.

Answer 174

Primary data are the preferred source in research (original study that produced the data).

Experimental studies use randomization with subject selection.

Correlational studies search for relationships between a minimum of two variables.

Deductive logic is used with quantitative studies, and inductive logic is used in qualitative studies.

Understand the difference between a dependent and an independent variable.

Question 175

(1)

Type of medicine that uses “the conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients”

Answer 175

Evidence-Based Medicine

t is also known as evidence-based practice. There will be several questions on the American Nurses Credentialing Center (ANCC) exam that will test your ability to sort and rate articles by the level of evidence.

Question 176

Hierarchy of Research Evidence

Answer 176

Question 177

(1)

This is a statistical method that combines data from multiple studies (systematic review), resulting in higher statistical power and a single conclusion. This method is considered the gold standard for evaluating research evidence for EBM.

Answer 177

Meta-Analysis

Question 178

(1)

In a nutshell, involves random subject selection, one placebo or control group, and one or more intervention group(s). An RCT is a type of this study.

Answer 178

Experimental Study

Question 179

(1)

Can be biased and may not be based on solid evidence. They are the weakest form of evidence.

Answer 179

Opinions and Editorials

Question 180

(1)

Cohort studies are a type of research that is used to investigate risk factors for diseases, risk factors for death, and other conditions. The research subjects are observed for a long period. There is no intervention done (not an experiment). The goal is to identify risk factors and associations (not causation) of a disease(s). For example, the Nurses’ Health Study is a large cohort study of female RNs age 30 to 63 years who reside in the state of Massachusetts. Can be a type of prospective study (present to future).

Answer 180

Cohort Study

Question 181

(1)

A type of literature review that identifies, selects, and analyzes multiple research articles concerning a health condition, disease, or other health-related practice. Follows specific methodology to identify all the relevant studies on a specific topic. Studies to be included must meet explicit criteria. Studies are ranked from grade A (best evidence) to grade D (poor evidence). After it is done, the acceptable studies are pooled together, and statistical testing of the data (meta-analysis) is performed.

Answer 181

Systematic Review

Question 182

(1)

A detailed report of one patient with a disease or an unusual condition that includes demographics, signs and symptoms, diagnosis, response to treatment, and so forth.

(1)

A series of case reports that involves a series of individuals who are given similar treatment.

Answer 182

Case Report

Case Series

Question 183

(1)

Subjects are randomly assigned to either the control group or the treatment group(s). The intervention may be a drug, procedure, or device. Some use a double-blind design (the intervention is hidden from the patient, clinician, and/or researchers). Are experimental studies.

Answer 183

Randomized Controlled Trial

Question 184

Research Databases

(1)

The gold standard database and resource for EBM. These are systematic reviews (Database of Systematic Reviews). The organization does not accept commercial or conflicted funding. Also known as the Cochrane Collaboration

(1)

The U.S. National Library of Medicine (NLM) premier bibliographic database contains more than 26 million journal articles in the life sciences with a concentration in biomedicine. These articles are from 5,200 current biomedical journals published around the world.

(1)

This component of MEDLINE contains over 30 million citations of biomedical, medical, and other life science literature and abstracts.

(1)

The world’s largest source of full-text nursing and allied health journals (>1,300 journals). Complete provides indexing of more than 4,000 journals.

Answer 184

Cochrane Reviews

The gold standard database and resource for EBM. These are systematic reviews (Cochrane Database of Systematic Reviews). The organization does not accept commercial or conflicted funding. Also known as the Cochrane Collaboration (www.cochrane.org).

MEDLINE

The U.S. National Library of Medicine (NLM) premier bibliographic database contains more than 26 million journal articles in the life sciences with a concentration in biomedicine. These articles are from 5,200 current biomedical journals published around the world.

PUBMED

This component of MEDLINE contains over 30 million citations of biomedical, medical, and other life science literature and abstracts.

CINAHL: Cumulative Index to Nursing and Allied Health Literature

The world’s largest source of full-text nursing and allied health journals (>1,300 journals). Cumulative Index to Nursing and Allied Health Literature (CINAHL) Complete provides indexing of more than 4,000 journals.

Question 185

Grades of Research Evidence

Research evidence receives a letter grade:

(4)

Well-designed controlled experimental trials (double-blind RCTs) are considered to be what grade?

Answer 185

A (best evidence), B, C, and D (poor evidence)

Well-designed controlled experimental trials (double-blind RCTs) are considered to be grade A (or level 1) evidence.

Question 186

Practice Drag and Drop EBP Questions

1 =

2 =

3 =

Answer 186

1 = A

2 = C

3 = B

Question 187

Practice Drag and Drop EBP Questions

1 =

2 =

3 =

Answer 187

1 = B

2 = A

3 = C

Question 188

Statistical Terms

(1)

A measure of the degree of certainty in a sampling method. For example, a 95% CI is a range of values that you can be 95% certain contains the true mean of the population.

(1)

A measure of the difference between two different treatments in terms of their ability to reduce a particular outcome (e.g., myocardial infarction [MI], stroke).

(1)

A measure of how much risk is reduced in the experimental group compared with the control group.

Answer 188

Confidence Interval

Confidence interval (CI) is a measure of the degree of certainty in a sampling method. For example, a 95% CI is a range of values that you can be 95% certain contains the true mean of the population.

Absolute Risk Reduction

Absolute risk reduction (ARR) is a measure of the difference between two different treatments in terms of their ability to reduce a particular outcome (e.g., myocardial infarction [MI], stroke).

Relative Risk Reduction

Relative risk reduction (RRR) is a measure of how much risk is reduced in the experimental group compared with the control group.

Question 189

Statistical Terms

(1)

Number of patients you have to treat to avoid one bad outcome (e.g., MI, stroke). For example, an NNT of seven means that it is necessary to treat seven patients to avoid one bad outcome.

(1)

The Probability that a person with a positive screening test result has the disease.

(1)

The probability that a person with a negative test result does not have the disease.

Answer 189

Number Needed to Treat

Number of patients you have to treat to avoid one bad outcome (e.g., MI, stroke). For example, an NNT of seven means that it is necessary to treat seven patients to avoid one bad outcome.

Positive Predictive Value

The probability that a person with a positive screening test result has the disease.

Negative Predictive Value

The probability that a person with a negative test result does not have the disease.

Question 190

Epidemiology Terms

(1)

Refers to immunity to a disease developed either through vaccination or by infection.

(1)

Refers to immunity to a disease after receiving antibodies (immunoglobins) from another host. For example, colostrum from breastfeeding gives the neonate antibodies from the mother.

(1)

Refers to resistance to a disease in a large number of people in the population, which is usually due to immunization programs.

(1)

This refers to a state of complete physical, mental, and social well-being.

Answer 190

Active Immunity

Refers to immunity to a disease developed either through vaccination or by infection.

Passive Immunity

Refers to immunity to a disease after receiving antibodies (immunoglobins) from another host. For example, colostrum from breastfeeding gives the neonate antibodies from the mother.

Herd Immunity

Refers to resistance to a disease in a large number of people in the population, which is usually due to immunization programs.

Health

This refers to a state of complete physical, mental, and social well-being.

Question 191

Epidemiology Terms

(1)

Transmission of an infecting agent from one individual to another. For example, horizontal transmission of HIV and other STDs or infections occurs through sexual intercourse.

(1)

Transmission of an infecting agent from mother to infant. Congenital infections from mother to infant can be passed through vertical transmission. Also, an HIV-positive mother who breastfeeds her infant can infect her infant with HIV through vertical transmission.

(1)

This refers to a baseline level of a particular disease in a population.

(1)

Refers to the rapid increase of a disease in a population that involves a large number of people.

(1)

This is an epidemic that occurs over a very large area (several countries or continents). It involves a large proportion of the global population.

Answer 191

Horizontal Transmission

Transmission of an infecting agent from one individual to another. For example, horizontal transmission of HIV and other STDs or infections occurs through sexual intercourse.

Vertical Transmission

Transmission of an infecting agent from mother to infant. Congenital infections from mother to infant can be passed through vertical transmission. Also, an HIV-positive mother who breastfeeds her infant can infect her infant with HIV through vertical transmission.

Endemic

This refers to a baseline level of a particular disease in a population.

Epidemic

Refers to the rapid increase of a disease in a population that involves a large number of people.

Pandemic

This is an epidemic that occurs over a very large area (several countries or continents). It involves a large proportion of the global population.

Question 192

Epidemiology Terms

(1)

This refers to an illness or any departure from physical and/or mental health.

(1)

Death.

(1)

Refers to infant deaths per 100,000 live births. The leading cause of death in an infant’s first year of life is congenital malformations (including chromosomal abnormalities).

(1)

Refers to the ability of a screening test to correctly identify a person with the disease.

(1)

Refers to the ability of a screening test to correctly identify a person without the disease.

Answer 192

Morbidity

This refers to an illness or any departure from physical and/or mental health.

Mortality

Death.

Infant Mortality

Refers to infant deaths per 100,000 live births. The leading cause of death in an infant’s first year of life is congenital malformations (including chromosomal abnormalities).

Sensitivity

Refers to the ability of a screening test to correctly identify a person with the disease.

Specificity

Refers to the ability of a screening test to correctly identify a person without the disease.

Question 193

Exam Tips

Memorize the definitions of sensitivity and specificity.

Learn how to solve EBM “drag-and-drop” format questions (three or four questions). At the time of writing, only the ANCC exam has this format, although it is possible that the American Academy of Nurse Practitioners Certification Board (AANPCB) may use the question format in future exams.

Learn the difference between endemic, epidemic, and pandemic.

Answer 193

Memorize the definitions of sensitivity and specificity.

• Sensitivity: Refers to the ability of a screening test to correctly identify a person with the disease.
• Specificity: Refers to the ability of a screening test to correctly identify a person without the disease.

Learn how to solve EBM “drag-and-drop” format questions (three or four questions). At the time of writing, only the ANCC exam has this format, although it is possible that the American Academy of Nurse Practitioners Certification Board (AANPCB) may use the question format in future exams.

Learn the difference between endemic, epidemic, and pandemic.

• Endemic: This refers to a baseline level of a particular disease in a population.
• Epidemic: Refers to the rapid increase of a disease in a population that involves a large number of people.
• Pandemic: This is an epidemic that occurs over a very large area (several countries or continents). It involves a large proportion of the global population.