ANCC study guide: legal/ethical/policy 100 Questions with Verified Answers
what legal document governs the practice of a NP - CORRECT ANSWER the
... [Show More] state nurse practice act
What are the 4 ethical principles? (and define) - CORRECT ANSWER 1. beneficence (promoting well being for pt. and society)
2. nonmalefecience - "above all, do no harm"
2. autonomy (person acts intentionally after being given informed consent)
4. justice (equitable distribution of social benefits
What is he difference between an ethical dilemma and an ethical conflict? - CORRECT ANSWER ethical dilemma = when asked to choose between two ethically legitimate alternatives (e.g. preserving pt. confidentiality or protecting endangered third parties)
ethical conflict = involves the compromise of an ethical principle (usually bc of self interest like pt-therapist sexual relations)
YES or NO if ethical below:
a. sex with a family member of pt.
b. discussing cases with spouse
c. confidentiality must be maintained after death of pt.
d. Psych provider can make determination of suicide as a result of mental illness for insurance purposes solely from reading the patients records
e. Dating a pt. one year after discharge - CORRECT ANSWER a. NO (especially with child/ad)
b. NO (even saying pt name is breach of confidentiality)
c. YES (only exceptions are legally and protecting others from harm)
d. YES (calles psychological autopsy)
e. NO (1-2 years maybe.. currently "unethical")
f. YES
Describe what an assessment of environmental maintenance is? - CORRECT ANSWER assessing for risk of injury, violence, and possession of weapons
biggest risk factor for a parent abusing a child? - CORRECT ANSWER past abuse of the parent
A group of nursing students at Nurseslabs University is currently learning about family violence. Which of the following is true about the topic mentioned?
a. Family violence affects every socioeconomic level.
b. Family violence is caused by drugs and alcohol abuse.
c. Family violence predominantly occurs in lower socioeconomic levels.
d. Family violence rarely occurs during pregnancy. - CORRECT ANSWER a. Family violence affects every socioeconomic level.
Family violence occurs in all socioeconomic levels, races, religions, and cultural groups. Although violence is associated with substance abuse, it is not the singular cause. The statement that the family violence predominantly occurs in lower socioeconomic levels is false. Abuse often occurs during pregnancy; about 23% of all pregnant women seeking prenatal care are victims of abuse.
What describes reasonable and prudent practice for a NP? - CORRECT ANSWER - professional standards and scope of practice document
What determines what is acceptable education prep for practice? - CORRECT ANSWER professional nursing organizations
What determines the legal boundaries of practice? - CORRECT ANSWER state legislation statutes - specifically the Nurse Practice act. . REMEMBER!! determines LEGAL practice
What grants legal authority for NP practice? - CORRECT ANSWER state legislative statutes (e.g. nurse practice act)
What does the state practice act do? - CORRECT ANSWER - defines the scope of practice of NP
- protects the title of NP
- Has required educational components and certifications
- determines collaborative agreement - what can be prescribe by nurse and physician oversight
- places restrictions on practice
- disciplines
-NPA accompanies the Board of Nursing (created by state legislature) that develops further rules and regulations
What is the umbrella term for the regulations of NPs?
define it - CORRECT ANSWER credentialing - process used to protect the public by ensuring minimal level professional competency
What is credentialing? - CORRECT ANSWER process used to protect the public that determines the minimum level of professional competency - it is the umbrella term for certification and licensure
What is licensure - CORRECT ANSWER process by which an agency of the STATE grants permission to practice in the profession
What is certification? - CORRECT ANSWER It is a NONGOVERNMENTAL body that is voluntary.
- It gives out a credential (giving title protect)
- determines scope
- profesional nursing organization certifies someone to practice as a professional
- The person meet preset standards showing a mastery of a specific body of knowledge (has the skills to function in that field)
EXAMPLE: For psych NP's the ANCC is the ONLY certifying body
What is the manual used to determine Scopes and Standards of Practice for Pscyh NP's - CORRECT ANSWER Psychiatric-Mental Health Nursing: Scopes and Standards of Practice
What federal statute protects the confidentiality (right to assume that information given to the healthcare provider will not be disclosed) ? - CORRECT ANSWER The Medical Record Confidentiality Act of 1995 (pertaining to both verbal and written info)
- also need medical authorization and consent form to release medical records and information when requested by client or another healthcare provider
What 4 rights does HIPPA guarantee - CORRECT ANSWER Health Insurance
Portability and Accountability Act
1. To be educated about HIPPA
2.. To have access to their own medical records
3. TO request amendment of their health information to which they object, and
4. To require permission for disclosure of their personal information
What does the HITECH do? - health information technology for economic and clinical health act do? - CORRECT ANSWER - showed that EMR can improve outcomes (safety, quality, efficiency)
- incentive payments for sharing EMR's
meaningful use incentives
When can confidentiality be broken? - CORRECT ANSWER - harm to self or others (duty to warn from Tarasoff principle)
- giving information to insurance companies
- ansering court orders, subpoenas, summons
- information given to attorneys involved in litigation
- meeting state requirements for mandatory reporting of disease and conditions
- elder or child abuse
what is fidelity - CORRECT ANSWER keeping with promise; being true and loyal
What is the first code of ethics principle in the ANA - CORRECT ANSWER nurse practice with compassion and respect
What is an ethical dilemma - CORRECT ANSWER issue when there are two "right or justifiable choices" one must choose between
Describe
a. teleological theory
b. deontological theory
c. virtue ethics - CORRECT ANSWER a. the ends justify the means. an action is judged good or bad based on the consequences/outcomes
b. the action is not judged by outcomes but by the action itself
c. do things based on moral virtues - compassion, honor, respect, wisdom, honesty, courage or the character of the person making the decision
What does the Americans with Disabilities Act do? - CORRECT ANSWER it requires the business of 15 or more employees must not discriminate based on disability (like depression) against qualified persons in hiring, firing, advancement, job training, compensation, and workplace conditions
- grants employment with equal basis to others without disability
- employers re REQUIRED to make reasonable accommodations (e.g. can have job coach
What is competency - CORRECT ANSWER a LEGAL, not a medical concept
- a determination that a client can make reasonable judgements and decisions regarding treatment and other health concerns
- court rules if a person incompetent
What re the four element son negligence to prove malpractice - CORRECT ANSWER 1. Duty: Np should have given reasonable care for tx
2. Breech of Duty: NP violated standard of care of tx
3. Proximate Cause: Causal relationship between the breach and client's injuries
4. Damages: The client experiences permanent and substantial damages as a result
What is case management
a. define
b. overall goal - CORRECT ANSWER a. a system of controlled OVERSIGHT and authorization of SERVICES and benefits provided to clients consisting of coordinating care, ensuring quality outcomes, monitoring plan of care, and doing advocacy
b. Overall goal is to promote quality, cost effective outcomes
What can be used when a client has severe mental disease and prevent relapse - CORRECT ANSWER durable power of attorney
what percentage of homeless has
a. substance use
b. SCZ - CORRECT ANSWER a. 50%
b. 15-45%
hoe many migrants and farm workers are there? - CORRECT ANSWER 3 million
what is most important when treating those in prisons? - CORRECT ANSWER self-reflection
what does forensics do?
specifically nurses - CORRECT ANSWER apply science to the knowledge of legal issues
- makes relationship for investigation based on crime committed
Which is an accurate statement regarding the formal evaluation of quality of care?
a. Continuous quality improvement (CQI) programs focus on individual incidents.
b. Health care regulatory agencies have not identified an effective means to measure quality.
c. Hospitals do not receive payment for services if quality of care evaluations are not performed.
d. The Joint Commission mandates that hospitals implement CQI programs - CORRECT ANSWER d. The Joint Commission mandates that hospitals implement CQI programs
20. While providing a history, a patient requests that an acute care nurse practitioner disclose the information gathered with no one but the patient's spouse. By respecting this request, the nurse practitioner demonstrates which component of a therapeutic relationship?
a. Autonomy
b. Beneficence
c. Confidentiality
d. Empathy - CORRECT ANSWER c confidentiality
An adult nurse practitioner evaluates a patient who has been a victim of domestic violence. After the office visit, law enforcement authorities contact the nurse practitioner, requesting information regarding any visible injuries observed during the visit. The nurse practitioner's response is to:
a. call the patient to obtain consent.
b. provide the written record, as requested.
c. refer the request to the office manager.
d. require a court order for release. - CORRECT ANSWER b. provide the written record, as requested.
An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply, after "spending down" to qualify?
a. Medicaid
b. Medicare
c. The American Association of Retired Persons
d.The United States Social Security Administration - CORRECT ANSWER Medicaid
An adult-gerontology acute care nurse practitioner who specializes in cardiology is asked to give a presentation on lipid-lowering drugs. A major drug company that markets a lipid-lowering medication plans to pay the presenter an honorarium, but asks the nurse practitioner to limit his or her remarks to its drug. This situation presents a:
breach of contract.
conflict of interest.
personal choice.
reasonable request. - CORRECT ANSWER conflict of interest
A hospital requires adult-gerontology acute care nurse practitioners to submit credentialing applications for the purpose of:
- authorizing clinical roles and responsibilities.
- delineating therapeutic and diagnostic services.
- monitoring the nurse practitioner's clinical activities.
- verifying education, licensure, and experience. - CORRECT ANSWER - verifying education, licensure, and experience.
What legislation allowed nurse practitioners to be recognized Medicare providers in all geographical areas with their own provider number?
a. The Affordable Care Act
b. The Balanced Budget Act
c. The Civilian Health and Medical Program of the Uniformed Services
d. The Omnibus Budget and Reconciliation Act - CORRECT ANSWER balanced budget act
(bc they were able to reimburse less to NP's and thus save money for the budget of the US)
the adult-gerontology primary care nurse practitioner treats several patients for biological exposure. In the patients' records, the nurse practitioner documents which epidemiological factors for each exposure?
Comorbidities and length of exposure.
Location and event intensity.
Mode of transmission and incubation.
Premorbid conditions and surveillance rates. - CORRECT ANSWER Mode of transmission and incubation.
7. When disseminating research findings in a peer-reviewed journal, the adult-gerontology primary care nurse practitioner:
concludes that the study proves the hypothesis.
excludes the discussion section, because the conclusion contains this information.
recommends incorporating the results directly into clinical practice.
uses the methodology section to support the validity of the study. - CORRECT ANSWER uses the methodology section to support the validity of the study.
A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that the parent relies upon the child to explain everything to him or her. The nurse practitioner:
a. asks the child to provide a copy of the patient's advance directive document.
b. assures the child that the nurse practitioner can disclose requested information.
c. informs the child that he or she must come to the clinic to discuss the parent's case.
d. tells the child that the nurse practitioner can discuss the information only with the patient. - CORRECT ANSWER tells the child that the nurse practitioner can discuss the information only with the patient.
The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to:
evaluate standards, risks, benefits, and outcomes.
identify how to anticipate and resolve similar future situations.
investigate the need for disciplinary action.
obtain agreement of all parties with a chosen solution. - CORRECT ANSWER evaluate standards, risks, benefits, and outcomes.
To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner:
A. charges a fee for patients who arrive late to clinic appointments.
B. disseminates research study results to colleagues.
C. expresses opinions about alternative therapies with patients who consider such treatments.
D. schedules time during clinic hours to meet with pharmaceutical representatives. - CORRECT ANSWER disseminates research study results to colleagues.
are cohort or case studies higher level of evidence? - CORRECT ANSWER cohort
A patient who sustained a myocardial infarction comes to the clinic for a refill of atorvastatin (Lipitor). The family nurse practitioner explains that the medication is prescribed for:
cancer prevention.
primary prevention.
secondary prevention.
tertiary prevention. - CORRECT ANSWER tertiary prevention.
what is tertiary prevention - CORRECT ANSWER Tertiary prevention generally consists of the prevention of disease progression and attendant suffering after it is clinically obvious and a diagnosis established. This activity also includes the rehabilitation of disabling conditions. Examples include eliminating offending allergens from asthmatic patients; routine screening for and management of early renal, eye, and foot problems among diabetics; and preventing reoccurrence of heart attack with anticlotting medications and physical modalities to regain function among stroke patients
A 42-year-old patient with epistaxis, dilated pupils, tachycardia, and mild euphoria shows symptoms associated with the use of:
benzodiazepine (Alprazolam).
cocaine.
morphine (MS Contin).
oxycodone (OxyContin). - CORRECT ANSWER coaine
Which symptom requires immediate medical attention for a 16-year-old female patient who recently started using oral contraceptives?
Increasing breast tenderness.
Increasing emotional lability.
Spotting between periods.
Worsening headaches. - CORRECT ANSWER Worsening headaches.
The pediatric primary care nurse practitioner obtains a sexual history from a 15-year-old female patient. The patient reports that her boyfriend has recently been pressuring her to agree to engage in sexual intercourse. The nurse practitioner:
explains the risks of having unprotected sexual intercourse.
explores the patient's feelings about consenting to sexual intercourse.
offers the patient oral or transdermal birth control medications.
performs a gynecologic examination to obtain a baseline Pap test. - CORRECT ANSWER explores the patient's feelings about consenting to sexual intercourse.
. In reacting to parental divorce, a child between the ages of 9 and 12 differs from a younger child in his or her:
a. acceptance of the family's dissolution.
b. experience of grief and intense anger.
c. positive reaction to the departure of a parent.
d. tendency toward emotional decompensation. - CORRECT ANSWER b. experience of grief and intense anger.
Evidence-based practice in clinical management is grounded in:
clinical practice guidelines.
cohort studies.
expert opinions.
systematic reviews. - CORRECT ANSWER systematic reviews.
Statements that define the core knowledge of a pediatric primary care nurse practitioner's care are contained within the professional:
accreditation standards.
certification requirements.
licensure application.
scope of practice. - CORRECT ANSWER scope of practice.
When does the pediatric primary care nurse practitioner administer the first hepatitis B immunization to an infant born to a mother with an unknown hepatitis B status?
Within 12 hours of birth.
At two weeks of age.
At one month of age.
At two months of age. - CORRECT ANSWER Within 12 hours of birth.
Which behavior reflects existentially oriented therapy?
Attempting to understand a patient's subjective world
Challenging a patient's irrational beliefs
Developing specific plans for change
Establishing general group goals - CORRECT ANSWER Attempting to understand a patient's subjective world
Which statement by a male patient who has posttraumatic stress disorder (PTSD) and chronic persistent suicidal ideation indicates a need for hospital assessment?
"I feel so bad all the time. I wish I were dead."
"My wife is so scared that she has taken all my guns out of the house."
"My wife just left with the children. I have no one left and no future."
"Those medications you gave me make me feel worse. I stopped taking them." - CORRECT ANSWER "My wife is so scared that she has taken all my guns out of the house."
According to current clinical guidelines for treating a patient with bipolar I disorder mania with psychotic features, an adult psychiatric and mental health nurse practitioner prescribes:
alprazolam (Xanax).
citalopram (Celexa).
lamotrigine (Lamictal).
quetiapine (Seroquel). - CORRECT ANSWER quetiapine (Seroquel).
Which nonpharmacologic treatment modality is recommended for depression?
Biofeedback
Dialectical behavioral therapy
Eye movement desensitization and reprocessing therapy
Supportive group therapy - CORRECT ANSWER Supportive group therapy
The psychiatric-mental health nurse practitioner is responsible for initiating quality improvement at a community mental health clinic. The effective strategy for evaluating the clinic's services is to:
- analyze the data from epidemiological studies.
- conduct a root cause analysis.
- interview patient families.
- use a survey to elicit patient satisfaction responses. - CORRECT ANSWER - use a survey to elicit patient satisfaction responses.
The psychiatric-mental health nurse practitioner is employed in a newly created attending role on a psychiatric inpatient unit. To promote an interprofessional environment, the nurse practitioner:
- discusses the resistance directly with the physicians.
- assigns a role for all staff members in improving patient outcomes.
- educates staff members on the role of a psychiatric-mental health nurse practitioner.
- works with the nurse manager to organize all levels of nursing staff. - CORRECT ANSWER - assigns a role for all staff members in improving patient outcomes.
What are the components of negligence that proves malpractice? - CORRECT ANSWER 1. Duty
2. Breech of Duty - deviates from standard of practice
3. Direct/Proximate Cause - deviation directly caused outcome
4. Damages
What are the 5 elements of informed consent - CORRECT ANSWER 1. Informing of diagnosis
2. Explaining risks/beenfits of treatment
3. Explaining risks and benefits of NOT having treatment
4. Alternate treatments
5. Prognosis/consequences
What is managed care - CORRECT ANSWER a system is which the insurer is not only the payer but also the provider of health care (insurers monitor costs and will only pay for certain things) - incentivizes everyone to provide quality in care
what two components are a part of the advanced directive and define - CORRECT ANSWER living will (designates preferences for care if patient becomes incompetent or terminally ill; specific instructions)
durable power of attorney (healthcare proxy that selects and= agent to act of behalf of person should he or she become unable to make their own healthcare decisions. it also covers finances)
What is health production function - CORRECT ANSWER a mathematical expression that shows the relationship between a persons health and a number of other factors including the amount of health care consumed
define health care system - CORRECT ANSWER organizational and institutional structures through which an economy makes choices regarding production, consumption, and distribution of medical services
define health alliance - CORRECT ANSWER public agency that uses its bargaining power to negotiate competitive prices for health insurance from the private insurance market
whats the difference between grassroots lobbying and special interest group - CORRECT ANSWER special interest group is a collection of individuals who coordinate lobbying efforts around a common interest and seek to influence policy makers
grassroots lobbying occurs when non paid individuals contact their legislatures to influence policy
what is a caucas - CORRECT ANSWER congress members or political party that comes together to support a defined political ideology
outcomes management uses variance data to change a system of health care practice. All of the following are sources of variance except:
a. patient survey
b. practitioner competency
c. severity of patient illness
d. practice patterns of care delivery - CORRECT ANSWER a. patient survey
outcomes management is the use of variance data to change system of health care practice. VARIANCE IS ANY EVENT THAT ALTERS PATIENT PROGRESS TOWARD THEIR EXPECTED OUTCOMES. Sources of variance include practitioner behavior (competency), severity of illness (with high risk), and practice patterns that inhibit or expedite care
What are some of the roles of the FDA? - CORRECT ANSWER regulates the intro of new drugs tot he US, protects consumers from the risks associated with drug purchases, approve new drugs before they can be sole, determine which drugs can be OTC or prescription status
they DO NOT accept or deny new drug patents
what is an insurance "benefit" vs a claim vs pre approval vs denying - CORRECT ANSWER benefit = the amount the insurance pays when the insured suffers a loss
claim = request o insurance company to pay benefits for a loss
pre-approval = insurance will approve certain claim before it is provided
denying a claim = insurance company does not pay a bill bc certain required conditions were not met
what is nursing informatics - CORRECT ANSWER integration of nursing knowledge with info processing and communication technology to support health
crossing the quality chasm
a. who wrote it
b what issues contribute to bad quality care
c. main point
d. six goals of quality care - CORRECT ANSWER a. institute of medicine
b. - complexity of knowledge, skills, interventions
- increase in chronic conditions
- insufficient and disorganized healthcare system
- challenge to implement info technology
c healthcare professional need to COLLABORATE
d. safe, effective, efficient, patient-centered, timely, equitable
What is it called when medicare enrollees can purchase private insurance to cover additional medical expenses not covered by medicare? - CORRECT ANSWER medicare + choice
Part C
2010 future of nursing:leading change, advancing health
a. writer
b. what it said - CORRECT ANSWER a. IOM
b. nurses should practice to full extent of knowledge, seek higher levels of education, full/equal partners to docs,improved information infrastructure needed
what have managed care organizations done to reduce costs - CORRECT ANSWER - enroll employees by offering premiums LESS than traditional insurers
- decrease ER visits
- decrease # hospital stays
- decrease LOS at hospitals
- bargain with medical practices for reduced rates on visits
of organizations iddim't adopt meaningful use by 2015 what penalty was faced? - CORRECT ANSWER reduced medicare reimbursement rates
What are some of the system organization of healtcare - CORRECT ANSWER microsystem = direct pt. care (
macrosystem = hospital, skilled nursing facility
megasystem = american healthcare system
metasystem = something at societal level of economy, political, social (e.g. global economy)
who is eligible for medicaid? - CORRECT ANSWER low income children, low income pregnant women, elderly and disabled that qualify for supplemental security income program
who is eligible for medicare? - CORRECT ANSWER elderly over the age of 65 who have worked 40 quarters and paid medicare taxes
certain you're ppl with disabilities
ppl with end stage renal disease
ppl who need a kidney transplant
individuals receiving social security disability who have amyotrophic later sclerosis
Explain the different parts of Medicare - CORRECT ANSWER Part A = hospitalizations (up to 90 days), skilled nursing facility (up to 100 days), hospice (up to 6 months), some home healthcare
Part B = Ambulatory practitioner service, physical, occupational, speech therapy, medical equipment, diagnostic tests, preventative care
Part C = OPTIONAL coverage for beneficiaries who can choose to receive all of their health care services through one of the provider organizations covered under the medicare advantage plan
Part D = OPTIONAL coverage for outpatient pharmaceuticals
to establish a living will one must: - CORRECT ANSWER comprehend the act of wrong and signing the will
know the potential heirs
understand the extent of ones assets
han no undue influence
absence of delusions compromising rational thought
what are the covered tests within medicare part b - CORRECT ANSWER pap smears, mamagromas, screening for colorectal cancer, prostate cancer, screening for CV dz, screening for diabetes, glaucoma screening, influenza vaccines, PNA vaccines
LIVER AND SKIN CANCER NOT COVERED
when can you have romantic relationship with client? - CORRECT ANSWER NEVER!!
minimum level of professional competence is called - CORRECT ANSWER credentialing
what is translational research? - CORRECT ANSWER hows studies can best be translated into practice
what act incentivizes physicians to find drugs for rare diseases? - CORRECT ANSWER orphan drug act
what rule prohibits NPs from discussing alternative treatments not covered by the managed care organization? - CORRECT ANSWER gag rule
what law says that patients can refuse treatment but a guardian may authorize treatment? - CORRECT ANSWER Roger vs Oken
for an act to be consider criminal it has to have actus reus and mens rea - CORRECT ANSWER actus = voluntary conduct
mens= evil intent
describe the differences of:
a. conflict resolution
b. negotiation
c. mediation
d. professional civility - CORRECT ANSWER a. 2 or more parties come together to find a peaceful solution to a disagreement (negotiation or mediation is a way of getting conflict resolution done)
b. searching for an agreement that satisfies both parties
c. uses a trained, impartial third party to help reach consensus on substantive issues at disagreement (usually employed later on than negotiation..) - helps people to see each others perspective
d. treating others with respect and dignity
what is transformational leadership? - CORRECT ANSWER leader and follower find purpose and meaning because of the growth of their relationship
Foundation of leadership - CORRECT ANSWER trust
describe kurt lewis's theory of change - CORRECT ANSWER unfreezing = challenging the status quo to make sure ppl are ready for change
change
freezing = solidifying the change
what is complexity science? - CORRECT ANSWER things are interconnected not linearly but holistically - focuses on the connections that can make the changes
what are some the steps for change? - CORRECT ANSWER Unfreezing - need widespread discussion
serve on inter professional team
team has vision and identifies forces
implements change
evaluates outcomes
Freezing
do you want people on an interporfessional team to have distinct roles or similar roles? - CORRECT ANSWER DISTINCT [Show Less]