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187 Cards in this Set
- Front
- Back
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Define caring.
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A universal phenomenon influencing the ways in which people think, feel, and behave in relation to one another
Caring is a product of culture, values, experiences, and relationships with others |
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Caring includes: (cultural aspects)
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- knowing a patient's cultural values and beliefs
- knowing a patient's norms for caring practices - knowing a patient's cultural practices regarding end of life care; some cultures it is considered insensitive to tell the patient they are dying - Determining if a member of the patient's family or cultural group is the best resource to use for caring practices such as providing presence or touching - Know the patient's cultural practices regarding removal of life support |
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Who are caregivers?
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people who care for those who cannot care for themselves
A person becomes a caregiver when he or she provides care for children, older adults, or people who have acute or chronic illnesses or disabilities. |
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What is the transcultural perspective of caring?
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Leininger
describes the concept of care as the essence and central, unifying, and dominant domain that distinguishes nursing from other health disciplines caring is an essential human need; caring helps and individual or group improve a human condition; helps to protect, develop, nurture, and sustain people |
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What is transpersonal caring?
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Watson
looks beyond the patients disease and its treatment by conventional means; looks for deeper sources of inner healing to protect, enhance, and preserve a person's dignity, humanity, wholeness, and inner harmony promotes healing and wholeness; rejects the disease orientation to healthcare; places care before cure; emphasizes the nurse-patient relationship also called "transformative model" |
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What is Swanson's Theory of Caring? What are it's five categories?
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composite of three studies in perinatal unit; defines caring as a nurturing way of relating to a valued other, toward whom one feels a personal sense of commitment and responsibility
knowing, being with, doing for, enabling, maintaining belief |
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Swanson's theory of caring: knowing -
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trying to understand how the situation is affecting the other person and their life
striving to understand an even as it has meaning in the life of the other subdimensions: avoiding assumptions, centering on the one cared for, assessing thoroughly, seeking cues, engaging the self or both |
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Swanson's theory of care: being with -
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being there emotionally for the other person
being emotionally present to the other subdimensions: being there, conveying ability, sharing feelings, not burdening |
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Swanson's theory of care: doing for -
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treat that person how they would treat themselves
doing for the other as he or she would do for self if it were at all possible subdimensions: comforting, anticipating, performing skillfully, protecting, preserving dignity |
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Swanson's theory of care: enabling -
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help them to work through the situation; working together with the patient
facilitating the other's passage through life transitions (e.g., birth, death) and unfamiliar events subdimensions: informing/explaining, supporting/allowing, focusing, generating alternatives, validating/giving feedback |
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Swanson's theory of care: maintaining belief -
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always believe that the person will make it through
sustaining faith in the other's capacity to get through an even or transition and face a future with meaning subdimensions: believing in/holding in esteem, maintaining a hope-filled attitude, offering realistic optimism, "going the distance" |
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What is an ethic of care?
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concerned with relationships between people and with a nurse's character and attitude toward others
places the nurse as the patient's advocate, solving ethical dilemmas by attending to relationships and by giving priority to each patient's unique personhood |
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Caring behaviors include:
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providing presence, offering a caring touch, and listening
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Providing presence includes:
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being with
body language listening eye contact tone of voice positive and encouraging attitude |
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What are the common themes in nursing caring theories?
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human interaction or communication
mutuality appreciating the uniqueness of individuals improving the welfare of patients and their families |
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What are the nurse's responsibility in relation to the ethic of care?
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be sensitive to unequal relationships that can lead to patient abuse; be the patient's voice; be attentive to each patient's uniqueness
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What are two elements that facilitate knowing? What are barriers to knowing?
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continuity of care and clinical expertise
organizational structure of the organization and economic constraints |
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Challenges facing nursing in today's health care system:
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torn between caring and multiple tasks to perform and institutional tasks
reliance on technology and cost effectiveness desire to standardize |
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Administering medications safely requires an understanding of...
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the legal aspects of health care
pharmacology pharmacokinetics the life sciences pathophysiology human anatomy mathematics |
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Describe the federal governments role in the regulation of meds.
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regulates the pharmaceutical industry to protect the health of the people by ensuring that meds are safe and effective
Pure Food and Drug Act, FDA, and Med Watch Program |
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Describe the state governments role in the regulation of meds.
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med laws, alcohol, tobacco and substances not regulated by the federal govt
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What is the Nurse Practice Act?
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protects the public from unskilled, undereducated, and unlicensed personnel
medication regs and nursing practice |
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What is a meds chemical name, generic name, and trade name?
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chemical name: exact description of its composition and molecular structure
generic name: the official name listed in publications such as the USP; given by the manufacturer who first develops the drug trade name: name under which a manufacturer markets a med |
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What is a drugs classification?
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it indicates the effect of the med on a body system, the symptoms the medication relieves, or its desired effect
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What is indicated by a meds form? What are forms of meds?
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its route of administration
forms include solid, liquid, topical, parenteral; forms for instillation into the body cavity |
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What are pharmacokinetics?
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the study of how meds enter the body, reach their site of action, metabolize, and exit the body
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What is absorption? What are factors that effect it?
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the passage of medication molecules into the blood from the site of medication administration
route of admin, ability of the med to dissolve, blood flow to the site of admin, BSA, and lipid solubility of medication |
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ID the factors that affect the rate and extent of med distribution.
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physical and chemical prop of med, physiology of the person, circulation, membrane permeability, and protein binding
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What is biotransformation? Where does it occur?
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most occurs in the liver, although the lungs, kidneys, blood, and intestines also metabolize meds
the metabolism breaking down the med into a less active or inactive form that is easier to excrete occurs under the influence of enzymes that break down and remove biologically active chemicals |
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What is the main organ for excretion? What determines the organ of excretion?
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the kidneys are the main organ but the chemical makeup of a med determines the organ of excretion
the liver, bowel, lungs, and exocrine glands are also means of excretion |
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What are four possible mild allergic rxns?
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urticaria: raise, irregularly shaped skin eruptions with varying sizes and shapes; eruptions have reddened margins and pale centers
rash: small, raised vesicles that are usually reddened; often distributed over entire body pruritus: itching of skin; accompanies most rashes rhinitis: inflammation of mucous membranes lining nose; causes swelling and clear, watery discharge |
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What is a therapeutic effect?
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what we want in a med
expected or predicted physiological response that a med causes |
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What are side effects?
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predictable and often unavoidable secondary effects produced at a usual therapeutic dose
some meds are given for their side effects, ex. Botox |
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What are toxic effects?
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develop after prolonged intake of a med or when a med accumulates in the blood because of impaired metabolism or excretion
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What are adverse effects?
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unintended, undesirable, and often unpredictable severe responses to meds
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What are idiosyncratic reactions?
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unpredictable effects; a patient overreacts or underreacts to a med or has a reaction different from normal
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What is a med allergy?
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the med or chemical acts as an antigen, triggering the release of the antibodies in the body
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What are anaphylactic reactions?
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life threatening; characterized by sudden constriction of bronchiolar muscles, edema of the pharynx and larynx, and severe wheezing and shortness of breath
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What is a medication interaction?
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when one med modifies the action of another
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What is a synergistic effect?
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when two meds combined effect is greater than the effect of the meds when given separately
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What is a meds onset?
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time it takes after a med is administered for it to produce a response
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What is a meds peak?
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time it takes for a med to reach its highest effective concentration
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What is a meds trough?
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minimum blood serum concentration of med reached just before the next scheduled dose
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What is a meds duration?
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time during which the med is present in concentration great enough to produce a response
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What is a meds plateau?
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blood serum concentration of a med reached an maintained after repeated fixed doses
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What is MEC?
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minimum effective concentration
plasma level of med below which the effect of the med does not occur |
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When a med is prescribed what is the goal in regards to med levels?
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to achieve a constant blood level within a safe therapeutic range, which falls between MEC and the toxic concentration
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What is biological half-life?
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time it take for excretion processes to lower the amt of unchanged med by 1/2
the half-life does not change, no matter how much med is given |
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What are time-critical meds?
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meds in which early or delayed admin of maintenance doses (more than 30 minutes before or after the scheduled dose) will most likely cause harm or result in subtherapeutic responses in a patient
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What are non-time-critical meds?
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include meds in which the timing of admin will most likely not affect the desired effects of the med if given 1 to 2 hours before or after its scheduled time
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What is a solution?
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a given mass of solid substance dissolved in a known volume of fluid or a given volume of liquid dissolved in a known volume of another fluid
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What is the prescribers role in med admin?
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the physician, NP, or PA prescribes meds by writing an order on a form in the pts med record, in an order book, on a legal Rx pad
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What is a standing order or routine med order?
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order that is carried out until the prescriber cancels it by another order or a prescribed number of days elapse
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What is a prn order? What needs to be documented with a prn order?
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med that is only to be given when a patient requires it
document the assessment findings that show why the patient needs the med and the time of admin; evaluage the effectiveness of the med and record findings in the appropriate record |
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What are single (one-time) orders?
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given only once at a specified time
common for preoperative meds or meds given before diagnostic exams |
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What is a STAT order?
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signifies that a single dose of a med is to be given immediately and only once
often written for emergencies when a pts condition changes suddenly |
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What are now orders?
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more specific than a one-time order and is used when a patient needs a med quickly but not right away
the nurse has up to 90 minutes to administer the med |
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What is a prescription?
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meds that are to be taken out of the hospital; is more detailed than a regular order
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Medication errors include:
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inaccurate prescribing
administering the wrong med giving the med using the wrong route or time interval administering extra doses failing to admin a med |
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What is med reconciliation?
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the comparing of what the patient took in the previous healthcare setting (home or nursing unit) with the pts current med orders
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What is the process for med reconciliation?
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verify, clarify, reconcile, transmit
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What are the six rights of med admin? What is a potential seventh right?
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right med
right pt right time right dose right route right documentation right to refuse |
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What are two critical thinking attitudes essential to safe med admin?
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responsibility and accountability
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Briefly summarize The Patient Care Partnership related to med admin:
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- be informed of the name, purpose, action, and potential side effects
- refuse a med regardless of consequences - HCP assess a meds history, including allergies and use of herbals - advised of the experimental nature of med therapy and given written consent for its use - receive labeled meds safely w/o discomfort in accordance w/ 6 rights - receive appropriate supportive therapy in relation to med therapy - to not receive unnecessary meds - to be informed if meds are a part of a research study |
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What are factors that can influence the patient's compliance with the med regimen?
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health beliefs, person motivations, socioeconomic factors, habits
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ID the components of med orders.
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Pts full name, date & time that the order was written, med name, dose, route of admin, time & frequencies of admin, signature of HCP
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What needs to be included when documenting/recording a med?
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med name, dose, route, time of admin, injection site (if applicable)
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What is polypharmacy? How does it occur?
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happens when a patient take two or more meds to treat the same illness, takes two or more meds from the same chemical class, uses two or more meds with the same or similar actions to treat several disorders simultaneously, or mixes nutritional supplements or herbal products with meds
pt seeks relief from a variety of symptoms, multiple meds may be needed to control disorder |
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What things increase the risks for polypharmacy?
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take OTC meds frequently, lack of knowledge about meds, incorrect beliefs about meds, and visiting several health care providers to treat different illnesses
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What are the ways in which a nurse evaluates a patient's response to meds?
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direct observations of physiological measures (BP or lab values), behavioral responses (agitation), and rating scales (rating on a pain scale)
physiological is the most common |
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What is the easiest most desirable way to admin meds?
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orally
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ID the ways to protect a patient from aspiration during med admin.
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- assess pts ability to swallow and cough, check for gag reflex
- prepare oral meds in the from that is easiest to swallow - allow pt to self-admin meds if possible - if pt has unilateral weakness, place the med in the stronger side of the mouth - admin pills one at a time, ensure that each med is properly swallowed before the next one is introduced - thicken regular liquids or offer fruit nectars if pt cannot tolerate thin liquids - avoid straws - have pt hold and drink from a cup if possible - time meds to coincide with mealtimes or when pt is well rested and awake if possible - admin meds using another route if risk of aspiration is severe |
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ID guidelines to ensure safe admin of transdermal or topical meds.
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- document location
- ask if there is an existing patch - ask about routes when reconciling meds - apply noticeable label to the patch, if needed - document removal |
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What is the most commonly admin form of nasal instillation?
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decongestant spray or drops, used to relieve symptoms of sinus congestion and colds
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Four principles for administering eye instillations:
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- avoid instilling into the cornea
- avoid touching eyelids or other eye structures w/ applicator - used med only for affected eye - never allow a pt to use another pts eye meds |
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What is intraocular admin?
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meds delivered this way resemble a contact lens, place the med into the conjunctival sac where it remains in place for up to 1 week
pts require teaching about monitoring for adverse rxns to the disk as well as how to insert and remove the disk |
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Failure to instill ear drops at room temp causes:
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vertigo, dizziness, and nausea
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What are pressurized metered-dose inhalers?
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use chemical propellant to push med out of the inhaler
require sufficient hand strength for use |
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What are breath-actuated metered dose inhalers?
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release med when a lever is raised and patient inhales; release of med depends on the strength of the pts breath on inspiration and is a good choice for pts who have difficulty using pMDIs
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What are dry powder inhalers (DPIs)?
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create an aerosol when the pt inhales through a reservoir that contains med dose
because the device is activated with the pts breath, there is no need to coordinate puffs with inhalation |
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ID the aseptic technique to use to prevent an infection during an injection:
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- draw med from ampule quickly do not allow it to sit open
- avoid letting needle touch contaminated surface - avoid touching length of plunger or inner barrel - prepare skin with soap and water (if necessary) and use antiseptic swab |
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ID the factors that must be considered when selecting a needle for an injection.
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- pts size and weight
- type of tissue the med is being admin into |
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What are the best sites for SubQ injections?
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- outer posterior aspect of upper arm
- abdomen - anterior thigh |
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Name the principles to follow when mixing insulins:
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- Pts whose blood glucose levels are well controlled on a mixed-insulin dose need to maintain their individual routine when preparing and administering their insulin
- Do not mix insulin with any other med or diluents unless approved by the prescriber - Never mix Lantus or Levemir with other types of insulin - Inject rapid-acting insulins mixed with NPH insulin within 15 minutes before a meal - Verify insulin doses with another nurse while preparing them if required by agency policy |
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List the ways to minimize the patient's discomfort:
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- use a sharp-beveled needle in the smallest suitable length and gauge
- position the patient as comfortably as possible to reduce muscular tension - select the proper injection site, using anatomical landmarks - apply a vapocoolant spray or topical anesthetic to the injection site before giving the med when possible - divert the pts attention from the injection through conversation using open-ended questioning - insert the needle quickly and smoothly to minimize tissue pulling - hold the syringe steady while the needle remains in tissues - inject the med slowly and steadily |
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What is the max amount of water-soluble med given by the SubQ route?
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0.5 to 1.5 mL
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What is the angle of insertion for an IM injection?
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90 degrees
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What is the max volume of med for an IM injection in adults, older children/older adults/thin adults, and older infants/small children?
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adults: 2 - 5 mL
older children/older adults/thin adults: 2 mL older infants & small children: 1 mL |
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What are the recommended sites for insulin injections?
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upper arm and the anterior and lateral portions of the thigh, buttocks, and abdomen
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What is the Needlestick Safety and Prevention Act?
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mandates the use of special needle safety devices to reduce the frequency of needlestick injuries
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The nurse administers medications via IV by what methods?
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- as mixtures within large volumes of IV fluids
- by injection of a bolus or small volume of medication through an existing IV infusion line or intermittent venous access (heparin or saline lock) - by "piggyback" infusion of a solution containing the prescribed med and a small volume of IV fluid through an existing IV line |
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What are the advantages of IVs?
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- in emergencies when fast-acting meds must be delivered quickly
- establish therapeutic levels - when giving alkaline or irritating meds |
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What are the disadvantages of IV bolus meds?
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- there is not time to correct errors
- may cause irritation to the blood vessel |
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What are the advantages of using volume-controlled infusions?
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- reduces the risks of rapid-dose infusion by IV push
- allows for admin of meds that are stable for a limited time in solution - it allows for control of IV fluid intake |
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What is a piggy-back set?
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a type of volume-controlled infusion set
a small IV bag or bottle connected to a short tubing line that connects to the upper Y-port of a primary infusion line or to an intermittent venous access |
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What is a volume-control administration set?
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type of volume-control admin set
small containers that attach just below the primary infusion bag or bottle; it is attached and filled in a manner similar to that used with a regular IV infusion |
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What is a mini-infusion pump?
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type of volume-controlled set
battery operated and allows meds to be given in very small amounts of fluid (5 to 60 mL) within controlled infusion times using standard syringes |
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What is an intermittent venous access? What are its advantages?
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it is an IV catheter capped off on the end with a small chamber covered by a rubber diaphragm or a specially designed cap
advantages include: cost saving, time saving, increased mobility, increased safety, and increased comfort |
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The study of how drugs enter the body, reach their sites of action, are metabolized, and exit from the body is called:
1. pharmacology 2. Pharmacopoeia 3. Pharmacokinetics 4. Biopharmaceutical |
3 - Pg. 567 Fundamentals
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Which statement correctly characterizes drug absorption?
1. Most drugs must enter the systemic circulation to have a therapeutic effect. 2. Oral meds are absorbed more quickly when administered with meals 3. Mucous membranes are relatively impermeable to chemicals, making absorption slow 4. Drugs administered SubQ are absorbed more quickly than those injected IM. |
1
2 - Pg. 593 3 - Pg. 567 4 - IM absorbed quicker than SubQ |
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The onset of drug action is the time it takes for a drug to:
1. produce a response 2. accelerate the cellular response 3. reach its highest effective concentration 4. produce blood serum concentration and maintenance |
1. Pg. 570 Table 31-4
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Which of the following is not a parenteral route of admin?
1. buccal 2. ID 3. IM 4. SubQ |
1 - Pg. 571
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The nurse is preparing an insulin injection in which both regular and NPH will be mixed. Into which vial should the nurse inject air first?
1. the vial of regular insulin 2. the vial of NPH 3. either vial, as long as modified insulin is drawn up first 4. neither vial; it is not necessary to put air into vials before withdrawing med |
2 - Pg. 604 #8 Box 31-22
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The nurse is having difficulty reading a physician's order for a med. He or she knows that the physician is very busy and does not like to be called. What is the most appropriate next step for the nurse to take?
1. Call the pharmacist to interpret the order 2. Call the physician to have the order clarified 3. Consult the unit manager to help interpret the order 4. Ask the unit secretary to interpret the physician's handwriting |
2
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The patient has an order for 2 Tbsp. of Milk of Magnesia. How much med does the nurse give him or her?
1. 2 mL 2. 5 mL 3. 16 mL 4. 30 mL |
4
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A nurse is administering eardrops to an 8-year-old patient with an ear infection. How does the nurse pull the patient's ear when administering the med?
1. outward 2. back 3. upward and back 4. upward and outward |
4
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A patient is to receive cephalexin (Keflex) 500 mg PO. The pharmacy has sent 250-mg tablets. How many tablets does the nurse administer?
1. 1/2 tablet 2. 1 tablet 3. 1 1/2 tablet 4. 2 tablets |
4
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A nurse is administering meds to a 4-year-old patient. After he or she explains which meds are being given, the mother states,"I don't remember my child having that med before." What is the nurse's next action?
1. give the med 2. ID the pt using two patient identifiers 3. WIthhold the med and verify the med orders 4. Provide med education to the mother to help her better understand her child's med |
3
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A patient is transitioning from the hospital to the home environment. A home care referral is obtained. What is a priority in relation to safe med admin for the discharge nurse?
1. set up the follow-up appts with the physician for the pt 2. ensure that someone will provide housekeeping for the patient at home 3. ensure that the home care agency is aware of meds and health teaching methods 4. make sure that the pts family knows how to safely bathe him or her and provide mouth care |
3
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A nursing student takes a patient's antibiotic to his room. The pt asks the nursing student what it is and why he should take it. Which information does the nursing student include when replying to the patient?
1. only the pts physician can give this information 2. the student provides the name of the med and a description of its desired effect 3. information about meds is confidential and cannot be shared 4. he has to speak with his assigned nurse about this |
2
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The nurse is administering a sustained-release capsule to a new pt. The pt insists that he cannot swallow pills. What is the nurse's next best course of action?
1. ask the prescriber to change the order 2. crush the pill with a mortar and pestle 3. hide the capsule in a piece of solid food 4. open the capsule and sprinkle it over pudding |
1
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The nurse takes a med to a patient, and the pt tells him or her to take it away because she is not going to take it. What is the nurse's next action?
1. ask the patient's reason for refusal 2. explain that she must take the med 3. take the med away and chart the pts refusal 4. tell the pt that her physician knows what is best for her |
1
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The nurse receives an order to start giving a loop diuretic to a pt to help lower his or her BP. The nurse determines the appropriate route for administering the diuretic according to:
1. hospital policy 2. the prescriber's orders 3. the type of med ordered 4. the pts size and muscle mass |
2
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A patient is receiving an IV push med. If the drug infiltrates into the outer tissues, the nurse:
1. Continue to let the IV run 2. applies a warm compress to the infiltrated site 3. stops the administration of the med and follows agency policy 4. should not worry about this because vesicant filtration is not a problem |
3
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If a patient who is receiving IV fluids develops tenderness, warmth, erythema, and pain at the site, the nurse suspects:
1. sepsis 2. phlebitis 3. infiltration 4. fluid overload |
2
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After seeing a patient, the physician gives a nursing student a verbal order for a new med. The nursing student first needs to:
1. follow ISMP guidelines for safe medication abbreviations 2. explain to the physician that the order needs to be given to a RN 3. Write down the order on the patient's order sheet and read it back to the physician 4. Ensure that the six rights of med admin are followed when giving the med |
2
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A nurse accidentally gives a patient a med at the wrong time. The nurse's first priority is to:
1. complete an occurrence report 2. notify the health care provider 3. inform the charge nurse of the error 4. assess the patient for adverse effects |
4
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A patient is taking albuterol through a pressurized metered-dose inhaler (pMDI) that contains a total of 200 puffs. The patient takes 2 puffs every 4 hours. How many days with the pMDI last?
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16 days
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A client tells the nurse, "This pill is a different color than the one that I usually take at home." Which is the best response by the nurse?
1. go ahead and take your medicine 2. I will recheck your medication order 3. maybe the doctor ordered a different med 4. I'll leave the pill here while I check with the doctor |
2
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If the following medications are listed on a client's medication admin record, which one should the nurse questions?
1. Lasix 40 mg, po, STAT 2. Ampicillin 500 mg, q 6 hr, IVPB 3. Humulin L (Lente) insulin 36 u, sc, q am, ac 4. Codeine q 4-6 hr, po, prn for pain |
4 - dosage is missing
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The primary care provider prescribed 5 mL of a med to be given deep IM for a 40-year old female who is 5'7" tall and weights 135 lbs. Which of the following is the most appropriate method of admin?
1. A tuberculin syringe, #25-#27 gauge, 1/4- to 5/8-inch needle 2. Two 3-mL syringes, #20-#23 gauge, 1 1/2-inch needle 3. Two 2-mL syringes, #25 gauge, 5/8-inch needle 4. Two 2-mL syringe, #20-#23 gauge, 1-inch needle |
2
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The nurse is to administer 0.75 mL of meds SubQ in the upper arm to a 50-year-old 300 lb. client. The nurse can grasp approximately 2 in of the client's tissue at the upper arm. Which of the following is the most appropriate for the nurse to use?
1. A tuberculin syringe, #25-#27 gauge, 1/4 to 5/8 inch needle 2. Two 3 mL syringes, #20-#23 gauge, 1 1/2 inch needle 3. 2 mL syringe, #25 gauge, 5/8 inch needle 4. 2 mL syringe, #20-#23 gauge, 1 inch needle |
3
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5. 1
6. 4 7. 1 |
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8. 2
9. 0.375 mL 10. 3, 4, 1, 5, 2, 6, 7, 8 |
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Which of the following is an example of the principle of patient-centered care focused on continuity and transition?
1. the nurse asks the patient who in the family should have access to patient information 2. the nurse is teaching the patient how to change the wound dressing at home 3. the nurse responds promptly to the patient's request for pain medication 4. the nurse schedules the patient's diagnostic scan following the physical therapy session |
2
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Which activity performed by the nurse is related to maintaining competency in nursing practice?
1. asking another nurse about how to change the settings on the med pump 2. regularly attending unit staff meetings 3. participating as a member of the professional nursing council 4. attending a review course in preparation for the certification examination |
4
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The patient tells the nurse that she is enrolled in a preferred provider organization (PPO) but does not understand what this is. What is the nurse's best explanation of a PPO?
1. This health plan is for people who cannot afford their own health insurance 2. This health plan is operated by the government to provide health care to older adults 3. This health plan provides you with a preferred list of physicians, hospitals, and providers from which you can choose 4. This is a fee-for-service plan in which you can choose any physician or hospital |
3
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Which of the following is an example of the nurse participating in primary care activities?
1. Providing prenatal teaching on nutrition to a pregnant woman during the first trimester 2. working with patients in a cardiac rehab program 3. assessing a patient at an emergent care facility 4. providing home wound care to a patient |
1
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Nurses on a nursing unit are discussing the processes that led up to a near-miss error on the clinical unit. They are outlining strategies that will prevent this in the future. This is an example of nurses working on what issue in the health care system?
1. patient safety 2. evidence-based practice 3. patient satisfaction 4. maintenance of competency |
1
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Which of the following statements is true regarding Magnet status recognition for a hospital?
1. nursing is run by a Magnet manager who makes decisions for the nursing units 2. nurses in Magnet hospitals make all of the decisions on the clinical units 3. Magnet is a term that is used to describe hospital that are able to hire the nurses they need 4. Magnet is a special designation for hospitals that achieve excellence in nursing practice |
4
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Which statement made by the nurse is an example of applying the principle of patient-centered care while focusing on alleviation of a patient's fear and anxiety?
1. lets talk about the concerns that you have about going home 2. I'll get the med prescriptions for you before discharge 3. I'll be back in 30 minutes to help you get cleaned up 4. I'll make a referral to the home health nurse for you |
1
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Which of the following is/are characteristics of managed care systems? (select all that apply)
1. provider receives a predetermined payment for each patient in the program 2. Payment is based on a set fee for each service provided 3. System includes a voluntary prescription drug program for an additional cost 4. system tries to reduce costs while keeping patients healthy 5. focus of care is on prevention and early intervention |
1, 4, 5
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Which of the following nursing activities is found in a tertiary health care environment?
1. administering influenza immunizations at the senior independent living facility 2. providing well-baby care in the clinic run by the local community health department 3. admitting a patient following open heart surgery to the cardiovascular intensive care unit 4. working the triage desk in the emergency department |
3
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Which of the following activities performed by the nurse is/are focused on the patient-centered care principle of physical comfort? (select all that apply)
1. asking the patient what a tolerable level of pain is form him or her following surgery 2. providing a back rub at bedtime 3. offering the patient a warm washcloth for his or her hands before eating 4. teaching the patient about the new antihypertensive medication ordered 5. scheduling the patient's follow-up appointments on discharge 6. changing the bed linens for a patient who is experiencing diaphoresis |
1, 2, 3, 6
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The nursing staff is developing a quality program for the floor. Which of the following are nursing-sensitive indicators from the National Database of Nursing Quality Indicators that the nurses can use to measure patient safety and quality for the unit? (select all that apply)
1. number of medication errors committed by registered nurses 2. turnover rate of nurses on the unit 3. incidence of patient falls 4. number of certified RNs 5. number of emergency department admissions per year |
2, 3, 4
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The nurse is providing restorative care to a patient following an extended hospitalization for an acute illness. Which of the following is an appropriate goal for restorative care?
1. patient will be able to walk 200 feet without shortness of breath 2. wound will heal without signs of infection 3. patient will express concerns related to return to home 4. patient will identify strategies to improve sleep habits |
1
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A nursing is presenting information to a management class of nursing students on the topic of groups of inpatient hospital services that have a fixed reimbursement amount, with adjustments made on the basis of case severity and regional costs. The nurse is presenting information to the class on which topic?
1. utilization review committee 2. resource utilization group 3. capitation payment system 4. diagnosis-related groups |
4
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When a nurse uses information and technology to communicate, locate and use knowledge, reduce and eliminate errors, and help make decisions, the nurse is working in which area?
1. integrated delivery system 2. health care patient system 3. nursing informatics 4. computerized nursing network |
3
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Which of the following are examples of the principle of patient-centered care that is focused on respect, values, preferences, and expressed needs? (select all that apply)
1. administer antihypertensive medications to patient daily 2. pulling the curtain around the patient bed before changing the wound dressing on the patient's leg 3. allowing the patient to ask questions and express his or her concern about surgery 4. explaining a colonoscopy procedure to the patient 5. working with the family to bring in ethnic foods that the patient prefers |
2, 3, 5
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What is primary healthcare?
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focuses on improved health outcomes for an entire population
ex. prenatal and well-baby care, nutrition counseling, family planning, exercise classes |
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What is preventive care?
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disease oriented and focused on reducing and controlling risk factors for disease through activities such as immunization and occupational health programs
ex. BP and cancer screening, immunizations, mental heath counseling and crisis prevention, community legislation (e.g. seat belts, air bags, bike helmets) |
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What are examples of secondary acute care?
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emergency care, acute med-surg care, radiological procedures for acute problems (e.g. x-rays, CT scans)
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What are examples of tertiary care?
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intensive care and subacute care
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What is restorative care?
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help individuals regain maximal functional status and enhance quality of life through promotion of independence and self-care
ex. cardiovascular and pulmonary rehab, sports medicine, spinal cord injury programs, home care |
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What is continuing care?
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describes a variety of health, personal, and social services provided over a prolonged period; these services are for people who are disabled, who were never functionally independent, or who suffer a terminal disease
is available within institutional settings, communities, or the home ex. assisted living, psychiatric and older adult day care |
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What is a prospective payment system (PPS)?
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one of the most significant factors that influenced payment for healthcare
eliminated cost-based reimbursement - hospitals serving patients who received Medicare benefits were no longer able to charge whatever a patient's care cost |
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What are diagnosis-related groups (DRGs)?
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hospitals receive a set dollar amount based on an assigned group
each group has a fixed reimbursement amount with adjustments based on case severity, rural/urban/regional costs, and teaching costs |
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What is capitation?
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the providers receive a fixed amount per patient or enrollee of a health care plan; aims to built a payment plan for select diagnoses or surgical procedures that consists of the best standards of care at the lowest cost
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What are resources utilization groups (RUGs)?
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are used in long-term care; method of classification for health care reimbursement for long-term facilities
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What is managed care?
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describes health care systems in which the provider or health care system receives a predetermined capitated payment for each patient enrolled in the program
administrative control over primary health care services for a defined patient population |
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What are integrated delivery networks (IDNs)?
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include a set of providers and services organized to deliver a continuum of care to a population of patients at a capitated cost in a particular setting
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What is work redesign?
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it is a formal process used to analyze the work of a certain work group and change the actual structure of the jobs performed
many hospitals have redesigned nursing units to contain costs; because of work redesign, more services are available on nursing units, thus minimizing the need to transfer and transport patients across multiple diagnostic and treatment areas |
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What is discharge planning?
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a centralized, coordinated, multidisciplinary process that ensures that the patient has a plan for continuing care after leaving the health care agency
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What is the goal of restorative care?
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to help individuals regain maximal function status and enhance quality of life through promotion of independence and self care
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It allows patients to retain more independence by living at home
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adult day care center
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focus of care is palliative, not curative, treatment
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hospice
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provides short-term relief to the family members who care for the patient
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respite care
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long-term care setting with greater resident autonomy
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assisted living
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What is the philosophy of care of a nursing center?
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to provide a planned, systematic and interdisciplinary approach to nursing care to help residents reach and maintain their highest level of function
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What is rehabilitation?
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restores a person to the fullest physical, mental, social, vocational, and economic potential possible
rehab services include physical, occupational, and speech therapy and social services occurs in many health care setting, including special rehab agencies, outpatient settings, and the home |
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What is evidence-based practice?
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use of current best evidence along with clinical expertise, patient preferences, and values in making decisions about patient care
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What is the Resident Assessment Instrument (RAI) and Minimum Data Set (MDS)?
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the RAI consists of the MDS
RAI provides a national database for nursing facilities so policy makers will better understand the health care needs of the long-term care population the MDS is a rich resource for nurses in determining the best interventions to support the health care needs of this growing population |
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What is the goal of pay for performance programs?
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promote quality, effective, and safe patient care by physicians and healthcare organizations
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What are nurse sensitive outcomes?
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patient outcomes and select nursing workforce characteristics that are directly related to nursing care such as changes in patients' symptom experiences, functional status, safety, psychological distress, RN job satisfaction, total nursing hours per patient per day, and costs
ex. falls, turn overs, and medications |
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Health promotion programs are designed to help patients:
1. reduce the incidence of disease 2. maintain maximal function 3. reduce the need to use more expensive health care services 4. all of the above |
4
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Rehabilitation services begin:
1. when the patient enters the health care system 2. after the patient's physical condition stabilizes 3. after the patient requests rehabilitation services 4. when the patient is discharged from the hospital |
1
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An example of an extended care facility is a:
1. home care agency 2. skilled nursing facility 3. suicide prevention center 4. state-owned psychiatric hospital |
2
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A patient and his or her family facing the end stages of a terminal illness might best be served by a:
1. hospice 2. rehabilitation center 3. extended care facility 4. crisis intervention center |
1
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What is quality health care?
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the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge
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What are pay for performance programs?
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quality improvement strategies that reward excellence through financial incentives to motivate change to achieve measurable improvements
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What is Magnet status?
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established by the American Nurses Credentialing Center (ANCC), meant to recognize health care organizations that achieve excellence in nursing practice
HCO that apply for Magnet status must demonstrate quality patient care, nursing excellence, and innovations in professional practice the professional work environment must allow nurses to practice with a sense of empowerment and autonomy to deliver quality nursing care |
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What is the nurse's responsibility in regards to Magnet status?
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Magnet status requires nurses to collect data on specific nursing-sensitive quality indicators or outcomes and compare their outcomes against a national, state, or regional database to demonstrate quality of care
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What is nursing informatics?
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uses information and technology to communicate, manage knowledge, mitigate error, and support decision-making
nurses need to use technology and informatics to improve the effectiveness of nursing care, enhance safety, and improve patient outcomes |
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What is an organization?
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a group of people who come together for a purpose or as a collection of people brought together for a predetermined purpose in a defined environment
having a socially determined structure provided by formal properties such as rules, policies, and procedures, and by informal properties such as customs, norms, and values |
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What is an HCO? How can they be broadly classified?
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a purposefully designed, structured social system developed for the delivery of health care services by specialized workforces to defined communities, populations, or markets; notable for the highly specialized workforce needed to deliver healthcare services
their mission, financial classificiation, and ownership |
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How are HCOs distinguished from other types of organizations?
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their unique purpose, by their specialized workforce, and by a level of public trust that these institutions are primarily designed to help others achieve and maintain optimal health and/or well-being
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What is health care economics?
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a behavioral science that addresses how to allocate limited resources among unlimited demands and how to pay for these resources
beings with two propositions about human behavior --- 1) human behavior is purposeful or goal directed, implying that persons act to promote their own interests 2) human desires and demands are unlimited, especially for something like health care; however, resources are limited and cannot meet unlimited demands |
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What is the basic problem addressed by health care economics?
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how to allocate limited resources among unlimited demands and how to pay for these resources
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What are three main attributes associated with health care economics?
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cost-effectiveness, efficiency, and value
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What is the overall aim of economic evaluation?
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to aid decision makers to make efficient and equitable decisions about the allocation of resources by comparing the cost-effectiveness and benefits of health care interventions
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What is an Accountable Care Organization (ACO)?
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an organization of health care providers that agrees to be accountable for the quality, cost, and overall care of Medicare patients, for whom they provide the bulk of primary care services
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What is pay for performance designed to do?
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enhance the communication and coordination of care between patients, providers, and clinicians (including nurses) by offering additional reimbursement to clinicians and hospitals for the provision of health care services considered appropriate and of high quality
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What is the definition of health policy?
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goal-directed decision making about health that is the result of an authorized, public decision-making process
those actions, non actions, directions, and/or guidance related to health that are decided by governments or other authorized entities |
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Why are regulatory agencies established?
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to implement and enforce laws through a rule-making process; the rules developed by these agencies are made through public administrative processes and have the force of law
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Which of the following is an example of a primary prevention activity?
1. antibiotic treatment of a suspected UTI 2. occupational therapy to assist a client in adapting his or her home environment following a stroke 3. nutrition counseling for young adults with a strong family history of high cholesterol 4. removal of tonsils for a client with recurrent tonsillitis |
3
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Which of the following statements is true regarding types of health care agencies?
1. hospitals provide only acute, inpatient services 2. public health agencies are funded by governments to investigate and provide health programs 3. surgery can only be performed inside a hospital setting 4. skilled nursing, extended care, and long-term care facilites provide care for the elderly whose insurance no longer covers stays |
2
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A client is seeking to control health care costs for both preventive and illness care. Although no system guarantees exact out-of-pocket expenditures, the most prepaid and predictable client contribution would be seen with:
1. medicare 2. an individual fee-for-service insurances 3. a preferred provider organization 4. a health maintenance organization |
4
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