CH 19 professional issues part A

Question 1

Nurse Practice Act

Answer 1

rules in each state for nurses
-qualifcations for licensure
-nursing titles (NP) that are allowed to be used
-scope of practice (vary state to state! if practice state A and have full practice authority don’t need doc collab. if move to state B, can u practice like state A? need to check state B practice act to know what to do in that state

Question 2

If i have full practice authority (don’t need doc collab) & I move to state B, can u practice like state A?

Answer 2

need to check state B practice act to know what to do in that state

have 54 different practice acts to fully autonomous to highly restrictive

Question 3

process of credentialing

Answer 3

-confirms HCP meets regulations in the state where practice is located
-investigates NP’s background is well investigated
-provides practice authority in given healthcare setting
-enables insurance reimbursements
-defines clinical, hospital privileges

Question 4

NP credentialing process

Answer 4

education
certification
licensure
criminal backvround check (CORI, SORI)
work hx, employment background
natioanl practitioner data bank (malpractice or other actions against NP)
status of clinical or hospital privileges a/s with former employment

Question 5

DEA number

Answer 5

needed to prescribe controlled substances
schedule 1-5 substances ranked

Question 6

DEA number

Answer 6

needed to prescribe controlled substances
schedule 1-5 substances ranked

Question 7

schedule 1 controlled substances

Answer 7

ILLEGAL
no one has this license
herone, MDMA, PCP

Question 8

schedule 2 controlled substances

Answer 8

legal to prescribe BUT significant abuse potential
morphine, fentanyl, methadone, oxycodone, methylpenidate, anabolic steroids

Question 9

schedule 3 controlled substances

Answer 9

less abuse potential
teststerone, butalbital (Fioricet) etc

Question 10

schedule 4 controlled substances

Answer 10

low abuse potential
common sleeping aids (zolpidem (Ambien), short acting benzos, phentermine

Question 11

schedule 5controlled substances

Answer 11

low abuse relative to schedule 4
few meds like antidiarrheals diphenoxylate/atropine (Lomotil)

Question 12

beneficence

Answer 12

PCP obligation to help people in need

Question 13

nonmaleficence

Answer 13

do no harm with or w/o intention
if harm is unavoidable, must minimize harm

Question 14

autonomy

Answer 14

right of competent person to choose a personal plan of life, action by exercising rights of self determination, independence and freedom
-put my opinions away and provide unbiased info risks and benefits of tx
-i respect pt’s well informed decision

Question 15

goals of autonomy

Answer 15

-avoid paternalism such as forcing my choice to the pt when given 2 options

Question 16

autonomy is not an absolute right because

Answer 16

if it interferes with the rights and wellbeing of others
ie: someone has TB in the hospital and refuses to get tx for it. they can be sued and forced to get tx bc they can expose the nurse

Question 17

if impaired cognitive impaired person, decision making can be deferred to

Answer 17

health care proxy
need sig impairment

Question 18

competency

Answer 18

ability to exercise rights to give or refuse informed consent

Question 19

justice

Answer 19

Question 20

utilitarianism

Answer 20

utility = working well for the most good

Question 21

Answer 21

-ie: vaccines to avoid illness

Question 22

veracity

Answer 22

HONEST!

Question 23

Answer 23

B! fair and unbiased manner

Question 24

Answer 24

denying antibiotics!!!!!

if give antib, and gets complication like c diff and adverse effects and didn’t need it, can get sued

Question 25

Answer 25

A. beneficence = helping ppl in need

Question 26

Answer 26

veracity - to tell the truth

Question 27

Answer 27

autonomy

Question 28

informed consent pt side

Answer 28

disclosing info to competent pt who can voluntary choice
-DISCUSS DIRECTLY TO THE PT WHAT HAPPENS IF NO TX HAPPENS

Question 29

informed consent PCP side

Answer 29

Question 30

is consent ever presumed?

Answer 30

Question 31

components of competency

Answer 31

Question 32

Answer 32

i provide info and make sure pt understands or they can sue

Question 33

who can declare if someone is competent or not?

Answer 33

only court can but if family, HC proxy agree pt cannot make informed decision

Question 34

Answer 34

NO

Question 35

pt needs dialysis but reports wrong date, time, president.

Answer 35

she demonstrates competency and wishes should be followed. and said ‘i guess ill die’ she understands its a machine and is old.

Question 36

advanced directives

Answer 36

durable statements of intent based on pts wishes
-living will is 1 type

Question 37

5 wishes document

Answer 37

a willl that meets requiremnts of AD
-WHO makes decisions when unable
-how pt wants ppl to tx person and what they want love ones to know

Question 38

healthcare proxy/agent

Answer 38

healthcare surrogate or attorney
-18 years and older
-speaks FOR pt if anesthesia or unable to voice
-usu spouses is “de facto” proxy if none other

Question 39

Answer 39

Question 40

daughter of 88 man calls about me. shes asking about his meds.. do u tell her?

Answer 40

assume compentency unless mentioned otherwise!

tell her no she can only speak to pt

Question 41

culture

Answer 41

Question 42

culture sensitivity

Answer 42

Question 43

culture knowledge

Answer 43

Question 44

culture competence

Answer 44

Question 45

if mentions a “Croation” or ethnicity, just cross it out and answer the q with any culture competence answer

Answer 45

ask the pt’s father if he has any q’s with son’s are

Question 46

Answer 46

common in asian cultures
head nodding means he understands

• only go to his son ONLY if he’s not competent and thats his proxy

Question 47

Question 48

Mal de Ojo

Answer 48

Evil eye
folk belief in hex (mediter, latino,muslin, etc)
- stronger or powerful person (adult) gazes at a weaker person
-gaze can be inadvertent ( no ill intent) or intentional

Question 49

the malignant gazer could be

Answer 49

jelaously coveting the baby (curse)
amulet protects

Question 50

the gazer could be admiring a lovely baby

Answer 50

ask permission to look at the baby
then offer congrats and god bless baby and her, in most cultures removes hex on the baby. the mom counteract and say it’s not that beautiful

Question 51

illnesses as a result of evil eye

Answer 51

usu in younger kids
- headache
fever
diarrhea
distuebed sleep
incr fussiness

Question 52

protection from evil eye

Answer 52

diffs culture to culture

Question 53

tx for evil eye

Answer 53

tradtional healer
-support with healthcare
-using raw egg to rub child

Question 54

Answer 54

say you are concerned he will get sick if ppl look at him?
-pose as question to info gathering bc ppl LOOK at him. directing back to ask for more info

Question 55

malpractice

Answer 55

failure of PCP to exercise care as reasonable prudent PCP under the same or similar circumstances
what would your peers do under same situation?

Question 56

compontents of malpractice

Answer 56

duty: relationship b/t me and pt
breach of duty: I violate standards when rendering care

Question 57

if i refill a rx for a neighbor she is now my pt T/F

Answer 57

true

Question 58

proximate cause

Answer 58

plaintiff establishes a relationship b/t breach and the injuries

Question 59

Answer 59

make sure to educate about medication and side effects
explain WHY ur going on this antibiotic and likely will recover in a few days. the neg are diarrhea, candida, vaginitis. i can give u a cream u can buy OTC to help so they are WELL INFORMED. most women don’t need to but just be aware

Question 60

2 types of liability insurance policies

Answer 60

1. occurance basis
2. claims made

Question 61

occurance basis policy

Answer 61

i get sued 3 years from now but my policy was in place during that time

Question 62

claims made policy

Answer 62

I have this in place 2 yrs ago but stopped practice 1 yr ago. this year, someone sue me based on an encounter 2 years ago. I’m covered for this claim since it carries a “tail” policy

Question 63

Answer 63

A

Question 64

Medicare

Answer 64

fed sponsored insurance for:
-65 and older
-under 65 with disabilities
-End stage renal dz (dialysis or transplant)

Question 65

medicare part A

Answer 65

Question 66

medicare part B

Answer 66

NP skill level, not RN lvl to be reimbursed

Question 67

medicare Advantage (Part C)

Answer 67

Question 68

medicare part D

Answer 68

Question 69

“incident to” is a billing MEDICARE term that allows

Answer 69

100% reimbursement at MD rate

Question 70

“incident to” rules

Answer 70

if we are more independent/np only practice, we get reimbursed 85% but if we practice with a MD, we get 100%
-we get paid more when practicing independently

Question 71

medicaid

Answer 71

-low income

Question 72

medicaird requirements

Answer 72

-US national, citizen, permanent resident
-low or v low income
-blind, dissabled, elder, pregnant, children with disability or resp of kids if under 19 yrs old

Question 73

Answer 73

true for all.

Question 74

Answer 74

true

false

Question 75

HIPPA purpose

Answer 75

Question 76

who is a covered entity?

Answer 76

HC providers who electronically transmit health info in connection with a standard transaction