Ethical/Legal/assessment tools

Question 1

Nonmaleficence

Answer 1

The duty to do no harm

Question 2

Utilitarianism

Answer 2

The right act is the one that produces the greatest good for the greatest number.

Question 3

Beneficence

Answer 3

The duty to prevent harm and promote good.
Performing a deed that benefits someone.

Question 4

Justice

Answer 4

The duty to be fair

Question 5

Fidelity

Answer 5

The duty to be faithful

Question 6

Veracity

Answer 6

The duty to be truthful

Question 7

Autonomy

Answer 7

The duty to respect an individuals thoughts and actions.

Question 8

Sentinel events

Answer 8

Unexpected occurrences involving death or serious physical or psychological injury, or the risk therof.
Serious injury specifically includes death, permanent harm, or severe temporary harm among others.
The phrase “or the risk thereof” includes any process variation for which a recurrence would carry a significant chang of serious adverse outcome.
The term “sentinel event” and “medical error” are not synonymous. Not all sentinel events occur because of an error and not all errors result in sentinel events.
In response to a sentinel event, clinicians and insitutions are expected to conduct a root cause analysis.

Question 9

Root cause analysis

Answer 9

A tool for identifying prevention strategies to ensure safety.
A process that is part of the effort to build a culture of safety and move beyond the culture of blame.

Question 10

Malpractice

Answer 10

Failure of a professional to render services with the degree of care, diligence and precaution that another member of the same profession under similar circumstances would render to prevent injury to someone else.
Violation of standard of care by a licensed medical professional.
-Professional misconduct
-Unreasonable lack of skill
-Illegal/immoral conduct
-Other allegations resulting in harm to a pt.

Question 11

Negligence

Answer 11

Failure of an individual to do what a reasonable person would do, resulting in injury to the patient.
Most people do not know they are negelecting to do something.

Question 12

Defamation

Answer 12

A communication that causes someone to suffer a damaged reputation:
-Libel- Defaming, distrubuted written material
-Slander- Spoken defamation.

Question 13

Battery

Answer 13

An illegal, willful, angry, violent, or negligent striking of a person, his clothes or anything with which he is in contact.
One can commit battery on an unconsicous person, but not assault.

Question 14

Assault

Answer 14

An intentional act by one person that creates an apprehension in another of an imminent harmful or offensive contact.
Putting someone in fear.
An assault is carried out by a threat of bodily harm coupled with an apparent present ability to cause the harm.

Question 15

Sensitivity

Answer 15

True positives +
The degree to which those who have a disease screen or test positive.

Question 16

Specificity

Answer 16

True negatives -
The degree to which those who do not have a disease screen or test negative.

Question 17

Health literacy

Answer 17

The degree to which patients have the capacity to obtain, process, and understand basic health care info and services necessary to make appropriate health care decisions.

Average american reads at 8th grade level. Medical/health info should be written at no higher of a 6th-8th grade level.

Question 18

CAGE-AID

Answer 18

A useful assessment tool used to for drug and alcohol use. 5 questions.
A yes to two or more questions warrants more questions.
C: Have you ever fel the need to cut down on your drinking?
A: Have people annoyed you by criticizing your drinking?
G: Have you ever felt guilty about your drinking?
E: Have you ever had an eye opener? (drink first thing in the morning to steady your nerves or get rid of a hangover)

Question 19

Wong-Baker FACES pain rating scale

Answer 19

Self assessment tool. Useful for language barrier.
Patient rates pain by choosing among six faces, ranigng in expression from smiling to crying.
0: No hurt
2: Hurt a little bit
4: Hurts little more
6: Hurts even more
8: Hurts a whole lot
10: Hurts worst

Question 20

Critical care pain observation tool (CPOT)

Answer 20

Tool designed to be used in the critical care unit to assess pain.
Assesses 4 behavioral categories:
1.) Facial expression
-0-relaxed
-1-tense
-2-grimacing
2.) Body movement
-0-None
-1-Protection
-2-Restless
3.) Muscle tension
-0-Relaxed
-1-Tense
-2-Rigid
4.) Compliance wit hthe ventilator (intubated pts)
-0-Tolerating
-1-Coughing
-2-Fighting
OR vocalization (extubated pts)
-0-Normal
-1-Moaning
-2-Crying out loud

Scored from 0, 1, or 2
Total score range 0-8

Question 21

Confusion Assessment Method for the ICU (CAM-ICU)

Answer 21

Tool designed to be used in the critical care unit to assess for delirium including altered mental status and disorganized thinking.
Four features:
1.) Acute onset of mental status changes or fluctuating course.
2.) Inattention
3.) Disorganized thinking
4.) ALtered level of consiousness

Should be conduected every day/shift with ICU pts

Question 22

Glascow coma scale (GCS)

Answer 22

Eye response:
4- Opens eyes spontaneously
3- Opens eyes to speech
2- Opens eyes to pain
1- No response
Verbal
5- Oriented x4
4- Confused
3- Innapropriate words
2- Innapropriate sounds
1- No response
Motor
6- Obeys commands
5- Loacalized
4- Withdraws
3- Decorticate posturing (flexion)
2- Decerebrate postering (extension)
1- No response

Question 23

Mini mental status exam (MMSE) (ORArL 2, 3, RWD)

Answer 23

Screening tool for cognitive impairment with older, community dwelling, hospitalized and institutionalized adults.
ORArL 2, 3, RWD:
O- Orientation to time AND place
R- Recognition (repeat three objects such as orage, dog, pencil)
A- Attention (serial 7s counting backward from 100)
r- recall (ask to recall three objects 5 minutes later)
L- Language
2- Identify names of 2 objects (clock and chair)
3- Follow a 3 step command (take this paper in your right hand, fold it in half and place it on the floor)
R- Reading (read this statement to yourself, do exactly what it says but do not say it aloud “close your eyes”)
W- Writing (write a sentence)
D- Drawing (copy a design)

Max score of 30
24-30= no cognitive impairement
18-23=mild impairment
0-17= severe impairment

Question 24

Clock drawing exam

Answer 24

Used to assess cognitive impairement
The pt is asked to draw numbers in the circle to make a circle look like the face of a clock and then draw the hands of the clock to read “10 after 11”
The clock is scored 1-6 with a score less than 3 representing cognitive deficit.
The number 12 must appear on top (3 points), there must be 12 numbers present (1 point), there must be two distinguishable hands (1 point), and the time must be identified correctly (1 point) for full credit.

Question 25

Index of Independence in Activities of Daily Living (Katz index of ADLs)

Answer 25

The most appropriate instrument to assess functional status as a measurement of the clients ability to perform ADLs independently.
Can be used to assess the progression of an illness, need for care, and effectiveness of treatment rehabilitation.
Assesses six self care functions: Bathing, dressing, toileting, transferring, continence and feeding.
6= high independence
4= moderately independent
0-2=low, patient very dependent.
1 point for each activity they can do independently.

Question 26

Get up and go test

Answer 26

Short test to measure a patients risk of falling.
Patient is asked to rise from the chair, stand still momentarily, walk a short distance, turn around, walk back to the chair, turn around, and then sit down in the chair.
Rated 1-5, with a score >3 indicated a risk of falling
1=normal
2=very slightly abnormal
3=mildly abnormal
4=moderately abnormal
5=severely abnormal

Question 27

Pain Assessment in Advanced Dementia Scale

Answer 27

Tool to measure pain in older adults with dementia.
Five behaviors are observed: Breathing, negative vocalization, facial expression, body language, and consolability.
Each behavior is scored 0-2, with 0 indicating no pain.
1-3= mild pain
4-6= moderate pain
7-10=severe pain

Breathing:
-0-Normal
-1- Occasional labored breathing. Short period of hyperventilation.
-2- Noisy labored breathing. Long period of hyperventilation. Cheyne-Stokes respirations.

Negative vocalization:
-0- None
-1- Occasional moan or groan. Low- level speech with a negative or disapproving quality.
-2- Repeated troubled calling out. Loud moaning or groaning. Crying.

Facial expression:
-0- Smiling or inexpressive
-1- Sad. Frightened. Frown.
-2- Facial grimacing.

Body language:
-0- Relaxed
-1- Tense. Distressed pacing. Fidgeting.
-2- Rigid. Fists clenched. Knees pulled up. Pulling or pushing away. Striking out.

Consolability
-0- No need to console
-1- Distracted or reassured by voice or touch.
-2- Unable to console, distract or reassure.

Question 28

Complementary and alternative medicine (CAM)

Answer 28

A term that refers to treatments that are used along with, or in place of, conventional medicine.
Focus is on the whole person. Includes physicaly, emoional, mental and spiritual health.
Examples: Natural products such as herbs, vitamins, probiotics.
Mind and body practices such as yoga, chiroproactor, mediation, massage, acupuncture, tai chi, music, etc.

Question 29

Integrative medicine

Answer 29

Bringing conventional and complementary approaches together in a coordinated way such as incorporating mindfullness meditation with pain management programs for chronic pain.

Question 30

Benchmarking

Answer 30

Comparison and measurement of a healthcare organizations services against other national healthcare organizations.
Helps leaders understand how their organization compares with similar organizations.
Allows for sharing of best practices and evidence based practice clinical research outcomes.
**Four core prinicples: MIIC
1.) Maintaining quality
2.) Improving customer satisfaction
3.) Improving patient safety
4.) Continuous improvement

Question 31

Establishing Rapport and Professional Therapeutic Relationships

Answer 31

5 approaches:
1.) Non-judgemental approach
2.) Mutual trust
3.) Professional boundaries
4.) Confidentiality
5.) Cultural competency
-Respect (whether you agree or diagree with culture)
-Spiritual needs (being culturally sensitive to religion/spiritual needs)

All of these play a role in establishing rapport with pt and having a professional therapeutic relationship.

Question 32

Therapeutic Communication

Answer 32

The long answer is often no the correct one.
Open ended questions
Listen more than talk
“Tell me…”
Never “Why?”
Focus on feeling: “How do you feel?”
-Mad, sad, glad, afraid, ashamed
Do not mince words, no euphemisms, less is more.

Question 33

FIFE model

Answer 33

Patient centered interview approach that assesses the patients illness experience/understanding
Feelings: related to the illness, especially fears
Ideas: and explanations of the cause of a symptom or illness
Functioning: The illness’ impact on everyday life
Expectations: of the doctor and illness

Question 34

HIPAA title 1

Answer 34

Protects health insurance coverage for workers and their families when they change or lose their job (COBRA;Comprehensive Omnibus Reconcilitation Act)

Question 35

HIPAA title 2

Answer 35

Has to do with protecting privacy.
Known as the Administrative Simplification (AS) provision. Requires the establishment of national standards for electronic health care transactions and national identifiers for providers, health insurance plans, and employers.

Question 36

Invasion of privacy

Answer 36

Damaging ones reputation as a result of info being shared without the pts permission.
*The charge cannot be made if the info can be shown to have been accurate, given in good faith, and the reciever had a valid reason for obtaining the info (a consulting provider has the right to know specific pt info).

Question 37

Healthy people 2030 goals

Answer 37

Increase the quality of years of healthy life.
Eliminate health disparities among americans.
Individuals, communities, and organizations are responsible for determining how to meet the goals of healthy people 2030.
Evaluated at the local level.

Question 38

Reportable events

Answer 38

1.) Criminal acts and injury from a dangerous weapon (Police)
2. Diseases, 4 are STDs: (GCS)
-Gonorrhea
-Chlamydia
-Syphilis
-HIV
-TB
-Covid-19
3.) Animal bites (animal control)
4.) Suspected or actual child or elder abuse (police vs social services).

Question 39

Palliative care

Answer 39

Multidisciplinary approach intended to improve quality of life of patients and their families facing a life threatening illness, through the prevention and relief of suffering.
Palliative care can begin at diagnosis and at the same time as treatment.
Hopice begins after treatment is stopped and when it is determined that the patient will not survive an illness.

Question 40

Appropriate level physical exam documentation to determine levels of EM (Evaluation and Management) services.

Answer 40

Problem focused: A limited exam of the affected body area or organ system.
Expanded problem focused: A limited exam of the affected body area or organ system and any other symptomatic or related body areas or organ systems.
Detailed exam: An extended exam of the affected body areas or organ systems and any other symptomatic or related body areas or organ systems.
Comprehensive exam: A general multisystem exam, or complete exam of a single organ system and other symptomatic or related body areas or organ systems.

Question 41

Types of medicare (A, B, C, D)

Answer 41

Medicare A: The one everyone gets after age 65. Covers inpatient hospitalization, SNF, home health and/or hospice associated with the inpatient event.
Medicare B: Covers physician services, outpatient hospital services, lab and diagnostic procedures, medical equipment and home health services. This is where NPs are covered/paid.
-Supplemental medical insurance requiring recipients to pay a premium.
-NPs and clinical nurse specialists recieve 85% of physician reimbursement for services provided in collaboration with a physician.
-Medicare pays 80% of the patients bill for physician services and the patient pays 20%.
Medicare C: Able to pick provider.
-A+B=C
-Pts entitled to medicare part A and entrolled in part B are eligible to recieve all of their health services through one of the provider organizations under part C.
Medicare D: Limited percription drug coverage.
-Requires a monthly premium and copay on each prescription.

Question 42

Incident to billing

Answer 42

Services billed under the physicians provider number to get the full physician fee (100%) back to the practice.
The physician must perform the initial service and subsequent services of a frequency which reflect his or her active participation in the management of the course of treatment.
Physician must be present and available in the office suite when service is provided.
Incident to billing is not allowed in the hospital setting, an NP must bill under his/her provider number. Only pertinent in the office setting.

Question 43

Medicaid

Answer 43

For poor people.
Federally supported, state administered program for low-income families and individuals.
-Benefits vary from state to state (no other form of reimbursement does this)
-Medicaid payments are made after other insurance or third party payments have been made.

Question 44

Quality improvement (QI)/Quality assurance (QA)/COntinuous process improvement (CPI)

Answer 44

A management process of monitoring, evaluating, continuous review, and improving the quailty in providing health care.
Quality assurance: a process for evaluating the care of pts using established standards of care to ensure quality.
Componenets include monitoring of care quality, care appropriateness, effectiveness of care, cost of care, self regulation and peer review to ensure compliance to care standards.
Monitoring of outcomes is a very important goal in QA/QAI

Question 45

Quality and safety education for nurses (QSEN) initiative

Answer 45

An initiative aimed at providing future nurses with the knowledge, skills, and attitude necessary to ensure continuous improvement in quality and safety of their respective healthcare system.

QSEN identifies, funds, and promotes education across 6 key competencies: (PETQI)
-Patient centered care
-EBP
-Teamwork and collaboration
-Safety
-QI
-Informatics

Question 46

Root cause analysis

Answer 46

A tool for identifying prevention straegies to ensure safety.
It’s a process that is part of the effort to build a cultre of safety and move beyond the culture of blame.

Question 47

Credentials

Answer 47

Encompass required eduction, licensure, and certification to practice as a NP.
Establishes minimal levels of acceptable performance.
Credentialing is necessary to:
-Ensure that safe health care is provided by qualified individuals
-Comply with federal and state laws relating to advanced practice nursing.

Acknowledges the scope of practice of an NP
Mandates accountability
Enforces professional standards for practice.

Question 48

Licensure

Answer 48

Establishes that a person is qualified to perform in a particular professional role.
Licensure is granted as defined by rules and regulations set forth by a governmental regulatory body.

Question 49

Certification

Answer 49

Establishes that a person has met certain standards in a particular profession which signify mastery of specialized knowledge and skills.
Certification is granted by nongovernmental agencies.

Question 50

Medical futility
-Quantitative futility
-Qualitative futility

Answer 50

Refers to intervention that are unlikely to produce any significant benefit for the patient: “Does the intervention have any reasonable prospect of helping this patient?”

Quantitative futility: Where the likelihood that an intervention will benefit the pt is extremely poor. The # question.
Qualitative futility: Where the quality of benefit an intervention will produce is extremely poor. The quality question.

Question 51

Liability

Answer 51

The legal responsibility a NP has for actions that fail to meet the standard of care, resulting in actual or potential harm to a pt.
Standards of care are used as criteria to measure whether megligence has occurred.

Question 52

Indicence vs prevelance

Answer 52

Incidence: The frequency with which a disease or disorder appears in a particular population or area at a given time.
The rate in which new cases occur during a specific time period.

Prevelance: The proportion of a population that is affected by a disease or disorder at a particular time.

Question 53

Levels of prevention

Answer 53

• Primordial prevention: Begins in childhood and focuses on lifestyle choises to prevent the development of risk factors. Such as a healthy diet, exercise, avoiding tobacco.
• Primary prevention: Involves modifying existing risk factors to prevent the development of disease. Prior to disease development. Such as lifestyle and behavioral changes, wearing seat belts, immunizations, safety intitiatives.
• Secondary prevention: Focuses on screening, early identification and treatment of existing problems. Screening. Such as pap smears, prostate cancer screenings, cholesterol screenings.
• Tertiary prevention: Includes rehabilitation and resoration of health. Such as cardiac rehab after MI, physical therapy after MVC, aspirin after MI.

Question 54

Culturally and linguistically appropriate services (CLAS)

Answer 54

The aim of the standards is to contribute to the elimination of racial and etnic health disparities and to improve the health of all americans.
* Standard 5: Must offer and provide language assistance services, bilingual staff and interpreter services at not cost to the pt in a timely manner.

• Standard 6: Must provide pts in their preffered language (both verbal and written) notices informing them of their rights to recieve language assistance services.
• Standard 7: Must assure the competence of language assistance provided to limited english proficient pts by interpreters and bilingual staff. Friends and family should NOT be used to provide interpretation services (Except by request by pts).

Question 55

Stages of change model

Answer 55

1.) precontimplation
2.) contemplation
3.) Preparation
4.) Action
5.) Maintenance
6.) Sometimes relapse

Question 56

Papsmear screening, when? who?

Answer 56

Starting at age 21 and every 3 years.
Discontinue at 65 with 2 consecutive normal cytology tests and no abnormal tests in the past 10 years.

Question 57

HIV screening, when? who?

Answer 57

Age 13-64, also depends on level of sexual activity or IV drug use.
Screen atleast once, assess knowledge of prevention, contraception, protective barriers.

Question 58

Hep B and C

Answer 58

Hep B: all three serologies starting at age 18, atleast once in a lifetime.

Hep C: Screen at least once starting at age 18 except where high prevelence.

Question 59

Lipid panel screening, when? who?

Answer 59

Starting at age 20 and every 5 years unless cholesterol >200

Question 60

Tetanus vaccine, when? how often?

Answer 60

As early as age 7, every 10 years.

Question 61

Pneumococcal vaccine, when? who?

Answer 61

The retirement age vaccine.
For those 65 or greater.
Also for those age 19-64 with certain underlying health conditions (asthma, current smoking, heart/kidney/liver/lung disease, immunocompromised, or living in nursing home).

Question 62

Mammogram, when? who?

Answer 62

Annually for age 45-54, then every 2 years after age 55.

Question 63

Prostate exam, when? who?

Answer 63

Digital exam beginning at age 40 and PSA at age 40 for men with a family history of prostate cancer or if african american.

Question 64

Colorectal screen, who? when?

Answer 64

Age 45-75
Stool based every 3 years
Colonoscopy every 10 years

Question 65

Shingles vaccine, when? who?

Answer 65

Age 50 years and older who are immunocompetent
2 dose series, 2-6 months apart.

Question 66

AAA screening with US

Answer 66

Age 65-75 years who have ever smokes, selectively screen if never smoke.
Once