Final Exam:

Question 1

Teamwork:

Answer 1

A STRONG Nursing Team works together to achieve the best outcomes for patients

Effective team development requires team building and training, trust, communication, and a workplace that facililtates collaboration

Question 2

Leadership Qualities and skill:

Answer 2

charismatic

dynamic

enthusiastic

poised

confident

self-directed

flexible

knowledgeable

politically aware

Question 3

leadership Skills:

Answer 3

commitment to excellence

problem solving skills

commitment to and passion for ones work

trustworthiness and integrity

respectfulness

accessibility

empathy and caring

responsbility to enhance personal growth of all staff

Question 4

Five Model components of Magnet Status:

Answer 4

transformational leadership

structural empowerment

exemplary professional practice

new knowledge, innovation, and improvements

empirical quality results

Question 5

Conflict Resolution strategies:

Answer 5

avoiding

collaborating

competing

compromising

cooperating/accommodating

smoothing

Question 6

Lewins Theory of change:

Answer 6

Unfreezing: the need for change is recognized

Moving: change is initiated after a careful process of planning

Refreezing: change becomes operational

Question 7

Reasons for resistance to change:

Answer 7

threat to self

lack of understanding

limited tolerance for change

disagreement about the benefits of change

fear of increased responsibility

Question 8

Overcoming resistance to change:

Answer 8

explain proposed change to all affected

list the advantages of the change

relate the change to the person existing beliefs and values

provide opportunites for open communication and feedback

indicate how change will be evaluated

introduce change gradually

provide incentives for commitment to change

Question 9

Achieving self-knowledge:

Answer 9

identify your strengths

evaluate how you accomplish work

clarify your values

determine where you belong and what you can contribute

assume responsibility for relationships

Question 10

developing leadership responsibilities:

Answer 10

Mentorship

Preceptorship

Nursing Organizations

Continuing education

Question 11

Steps for using time effectively:

Answer 11

establish goals and priorities for each day

evaluate goals in terms of your ability to meet needs of patients

establish a time line

evaluate your success or failure in managing time

use these results to direct your day priorities and time line

Question 12

Priorities setting:

Answer 12

determine which patient needs should address first:
High priority: immediate threat to patient survival or safety

Intermediate priority: nonemergent, non-life threatening

Low priority: actual or potential problems may or may not be directly related to patient illness or disease

Question 13

Considerations when delegating Nursing Care:

Answer 13

patient condition

complexity of the activity

potential for harm

degree of problem solving and innovation necessary

level of interaction required with the patient

capabilities of the UAP

avaliability of professional staff to accomplish workload

Question 14

ANA Principles for delegating Care:

Answer 14

the nursing profession determines the scope of nursing practice

the nursing profession defines and supervises UAP involved in providing direct nurse care

the RN is responsible and accountable for nursing practice

the RN supervises any assistant providing direct patient care

the purpose of UAP is to work in supportive role to the RN

Question 15

Factors to consider prior to delegating patient care:

Answer 15

qualifications and capabilites of the UAP

stability of the patient condition

complexity of the activity to be delegated

the potential for harm

the predictability of the outcome

the overall context of other patient needs

Question 16

Time Management:

Answer 16

remain goal oriented

identity priorities

establish personal goals

make to do list

delegate

anticipate

Question 17

Purpose of patient record:

Answer 17

communication

diagnostic and therapeutic orders

care planning

quality process and performance improvement

research; decision analysis

education

credentialing, regulation, legislation

reimburesement

legal and historical documentation

Question 18

characteristics of effective documentation:

Answer 18

Factual:
subjective data: pt yelling “ I want to kill my boyfriend”

Objective data:
Descriptive: what the nurse sees, hears, feels, and smells
do not write pt is agitated, write pt is pacing back and forth in his room yelling loudly

Accurate and concise:
facts only, exact measurement, only approve abbreviations

Complete and accurate:
timely: never pre-chart

Organized: communicate in a logical sequence

consistent with health laws and facility standards

legally prudent

confidential

Question 19

Confidentiality:

Answer 19

all information about patient written on paper, spoken aloud, saved on computer

name, address, phone, fax, social security number

Reason the person is sick

treatment patient receives

information about past health conditions

Question 20

potential breaches in patient confidently:

Answer 20

displaying information on a public screen

sending confidential e-mail messages via public networks

sharing printers among units with differing functions

discard copies of patient information in trash cans

holding confidential information to unauthorized persons

sending confidental messages overheard on pagers

Question 21

documentation tips

Answer 21

be accurate

avoid late entry: always date, time and signature/title

prioritize legibility

black, non-erasable ink

use the right tools

follow policy on abbreviations

document physician consultantion

chart the symptom and the treatment

avoid opinions and hearsay

chart only for yourself

do not leave black spaces, line or boxes on chart

write enough to convince a reader that the patient was adequately cared for

do not use correction fluid, erase, scratch out, or blacken out errors, make line through and sign

Question 22

Common Nursing Documentation Errors:

Answer 22

medication, allergy or pertinent health omission

failing to record nursing action

failing to record that medications have been given

recording on the wrong chart

blank items on a chart

unclear orders, transcribe order improperly

failure to communicate and monitor

failure to record drug reactions or changes in the patient condition

failure to document a discontinued medication

writing illegible

failure to date, time, and sign medical entry

document subjective data

using the wrong abberviations

Question 23

8 behaviors of purposeful rounding:

Answer 23

use opening key words (C-I-CARE) with PRESENCE

accomplish scheduled task

address four Ps

address additional personal needs, questions

conduct enviromental assessment

Ask is there anything else I can do for you? I have time.

Tell the patient when you will be back

document the round

Question 24

Conferring about care:

Answer 24

consultations and referrals

nursing and interdiscipinary team care conferences

nursing care round

purposeful rounding

Question 25

HIPPA:

Answer 25

Health insurance portability and accountability act security and privacy of medical records and protected health information (PHI)

Question 26

Protecting patient Privacy:

Answer 26

tips for safeguarding PHI: Paper: never leave a medical record or other printed or written PHI where other can access it shred any printed or written patient information for reporting or patient care after use properly dispose of document in a confidental waste container Electronic: log off from computer before leaving the workstation make sure computer screens cannot be viewed by the public never share a user ID or password with anyone

Question 27

Social Media Precautions:

Answer 27

know the implications of HIPAA before using social networking sites for school or work related communication many organizations, it will be against the code of conduct when taking pictures in an hospital become familiar with your facility policy regarding the use of social networking do not use or view social networking media in clinical setting do not post information about your facility, clinical sites, clinical experience, patient or other health care staff do not take pictures that show patient or family members

Question 28

Patient Rights

Answer 28

patient have the right to: see and copy their health record update their health record get a list of disclosures request a restriction on certain uses or disclosures choose how to recieve health information

Question 29

Change of Shift/Hand- off reports:

Answer 29

basic identifying information about each patient: name, room number, bed designation, diagnosis, and attending and consulting physicans current appraisal of each patient health status current orders (esp any new changed orders) abnormal occurrences during shift any unfilled orders that need to be continues onto next shift patient/family questions, concern, needs report on transfers/discharge

Question 30

Telephone/Telemedicine Reports:

Answer 30

identify yourself and the patient, state relationship to patient report concisely and accurately the change in the patient condition that is of concern and what has already been done in reponse to this condition report patient vital signs and clinical manifestations have patient record at hand to make knowledgeable responses to any physcian inquiries concisely record time and date of the call, what was communicated and physicians response

Question 31

Formats for Nursing Documentation:

Answer 31

initial nursing assessement care plan; patient care summary critical collaborative pathway progress notes flow sheets and graphic records medication record acuity record discharge and transfer summary long-term care and home health care documentation

Question 32

Method of documentation:

Answer 32

computerized documentation/ electronic health records (EHRs) source- oriented records problem-oriented medical records PIE charting (problem, intervention, evaluation) focus charting charting by exception case management model

Question 33

Duties of RN receiving Telephone Orders (TO)

Answer 33

record the orders in patient medical record read orders back to practitioner to verify accuracy date and note the time orders were issued record telephone records, and full name and title of physician or nurse who issued orders sign the orders with name and title

Question 34

Verbal Orders:

Answer 34

review orders for accuracy sign orders with name, title, and pager number date and note orders signed

Question 35

Protected Health Information (PHI)

Answer 35

HIPAA has defined 18 identifiers that compose individually identifiable health information: names, including initials street address, city, county, zip code all elements of date telephone number fax number email address social security number medical record number Health plan ID number account numbers certificate/lisense number vehicle identifer and serial number device identifiers/serial number web addresses Internet IP address biometric identifers full face photographic and comparable images any other unique identifying characterisitc or code

Question 36

7 Basic Tenets of bill of rights for RNS registered:

Answer 36

practice in a manner that fulfills obligations to society and to those who receive nursing care practice in environments that allow them to act in accordance with professional standards and legally authorized scope of practice work in environment that supports and facilitates ethical practice, in accordance with the Code of Ethics for Nurse freely and openly advocate for themselves and their patient, without fear of retribution receive fair compensation for their work, consistent with their knowledge, experience, and professional resonsibilites practice in a work environment that is safe for themselves and their patient negotiate the conditions of their emplyment, either as individuals or collectively, in all practice setting

Question 37

Basic Terms in Health Ethics:

Answer 37

Autonomy: commitment to include patient in decisions Beneficence: taking positive actions to help others Nonmaleficence: avoidance of harm or hurt Justice: being fair Fidelity: agreement to keep promises

Question 38

Values:

Answer 38

Value: personal belief about the worth of a given idea, attitude, custom or object that sets standards that influence behavior Value Clarification: ethical dilemmas almost always occur in the presence of conflicting value to resolve ethical dilemmas, one needs to distinguish among value, fact and opinion

Question 39

Professional Value:

Answer 39

Altruism: concern for welfare and well-being of others Autonomy: right to self-determination Human dignity: respect for inherent worth and uniqueness of individuals and populations Integrity: acting according to code of ethics and standard of practice Social Justice: upholding moral, legal, and humanistic rights

Question 40

Processing an ethical dilemma:

Answer 40

Assess the situation (gather data) diagnose (identify) the ethical problem Plan: identify options think ethical problem though make a decision Implement your decision evaluate your decision

Question 41

Institutional Resources:

Answer 41

ethics committee are usually multidiscipinary and serve several purpose; education, policy, recommendation, case review, and consultation, occasionally research any person involved in an ethical dilemma, including nurse, physicians, health care providers, patient, and family member, can request access to an ethic committee

Question 42

Professional and Legal regulation of nursing practice:

Answer 42

nurse practice acts standards credentialing accreditation lisensure certification

Question 42

Ethical Issues:

Answer 42

paternalism deception privacy confidentiality allocation of scarce nursing resources valid consent or refusal conflict concerning new technologies unprofessional, imcompetent, unethical, or illegal physicican practice unprofessional, imcompetent, unethical, or illegal nurse practice short staffing and whistle blowing beginning of life issue end of life issue

Question 43

Reasons for suspending or revoking a license:

Answer 43

drug or alcohol abuse fraud deceptive practice criminal acts previous displinary actions gross or ordinary negligence physical or mental impairment including age

Question 44

Standards of Care:

Answer 44

Internal Standards: Job description education expertise institutional polices and procedures

Question 45

4 Elements of Liability:

Answer 45

duty breach of duty causation damages

Question 46

Nursing Students and Liability:

Answer 46

you are liable if your action cause harm to patients, as is your instructor, hospital, and college/university never perform a task that you dont feel prepared to safely complete you are expected to perform as a professional when rendering care you must separate your student nurse role from your work as certified nursing assistant (CNA)

Question 47

Incident Reports:

Answer 47

complete name of person and name of witness factual account of incident date, time, and place of incident pertinent characteristics of person involved any equipment or resources being used any other important variables documentation by physician of medical exam of person involved

Question 48

Legal Safeguards for nurse:

Answer 48

adequate staffing whistle-blowing professional liability insurance risk management programs just culture incident, variance, or occurance reports; sentinel events and never events patient rights good samaritian law student liability competent practice informed consent/ refusal contracts collective bargaining patient education executing physican orders delegating nursing care documentation appropriate use of social media

Question 49

Elements of Informed consent:

Answer 49

disclosure comprehension competence voluntariness

Question 50

Safeguards to competent Practice:

Answer 50

developing interpersonal communication skill respecting legal boundaries of practice following institutional procedures and policy owning personal strengths and weakness evaluating proposed assignment keeping current in nursing knowledge and skills respecting patient rights and developing rapport with patient keeping careful documentation working within agency for management policy

Question 51

Categories of Negligence that result in malpractice:

Answer 51

failure to follow standards of care failure to use equipment in a responsible manner failure to communicate failure to document failure to assess and monitor failure to act as a client advocate

Question 52

Aims of teaching and counseling:

Answer 52

maintaining and promoting health preventing illness restoring health facilitating coping

Question 53

Teaching Outcome:

Answer 53

high level wellness and related self care practice disease prevention or early detection quick recovery from trauma or illness with minimal or no complication enhanced ability to adjust to developmental life changes and acute, chronic, and terminal illness patient and family acceptance of lifestyle necessitated by illness or disability

Question 54

Basic Learning Principles:

Answer 54

Motivation to learn: addresses the patient desire or willingness to learn Ability to learn: depends on physical and cognitive abilities, developmental level, physical wellness, thought processes Learning Environment: allows a person to attend to instruction

Question 55

Factors affecting Patient learning:

Answer 55

age and developmental level family support networks financial resources cultural influences language deficits health literacy level

Question 56

Critical development areas:

Answer 56

physical maturation and abilities psychosocial development cognitive capacity emotional maturity moral and spiritual development

Question 57

Four assumptions about adult learners:

Answer 57

as a person matures, one self- concept is likely to move from dependence to independence the previous experience of the adult is a rich resource for learning an adult readiness to learn if often related to a developmental task or social role most adult orientation to learning is that material should be useful immediately, rather than at some time in the future

Question 58

COPE MODEL

Answer 58

C: creativity O: optimism P:planning E: expert information

Question 59

Providing culturally competent patient education:

Answer 59

develop an understanding of the patient culture work with multicultural team be aware of personal assumptions, biases, and prejudices understand the core cultural value of the patient or group develop written material in patient preferred language

Question 60

Teaching plan for older adults:

Answer 60

identify learning barrier allow extra time plan short teaching sessions accommodate for sensory deficits reduce environmental distractions relate new information to familiar activities or information

Question 61

Health literacy: ask me 3 questions

Answer 61

what is my main problem what do i need to do? why is it important for me to do this?

Question 62

Three learning domains:

Answer 62

cognitive: storing and recalling of new knowledge in brain psychomotor: learning a physical skill affective: changing attitude, value, feeling

Question 63

Assessment Parameters:

Answer 63

knowledge, attitude, and skills needed to be independent readiness to learn ability to learn learning strengths

Question 64

Consideration for successful patient teaching:

Answer 64

forming contractual agreement considering time constraints scheduling group vs. individual teaching formal vs informal teaching manipulating the physical enviroment

Question 65

Key points to effective communication:

Answer 65

be sincere and honest avoid to much detail and stick to basics ask for questions be a cheerleader for the patient use simple vocab vary tone of voice keep content clear and concise listen and do not interupt ensure that the environment is conducive to learning and free of interuptions be sensitive to the timing of teaching sessions

Question 66

Documentation of the teaching- learning process:

Answer 66

Learner: patient, family, caregiver How: verbal, demonstration, written, video, TV translator, group, class Barrier to learning: communication difficulties, physical impairment, cognitive impairment, sensory impairment, cultural barriers, denies/resists, emotional barrier, religious barrier, language, readiness/motivation, no barrier Evaluation: verbalized understanding, demonstrates ability, needs reinforcement, not able (explain)

Question 67

Teach Back:s

Answer 67

start with most important message focus on 2-4 key points use plain language no medical jargon

Question 68

Nurse Coaching Process

Answer 68

establishing relationship and identifying readiness for change identifying opportunities, issue, and concern establishing patient- centered goals creating structure of the coaching interaction empowering and motiviating patient to reach goal assisting the patient to determine progress toward goal