Nursing Exam 2|74 Questions with Verified Answers
Physician (MD) - CORRECT ANSWER -"Doctor" is a US title used for MD, DO, OD, DPM, DDS, DDM, DVM, DC,
... [Show More] and any academic doctorate degree
-Practice of general or specialty medicine (including surgery) based upon diagnosis and treatment
-Pre-requisite 4-year BS degree
-Medical College Admission Test (MCAT)
-4-years of medical school (abbreviated 6 year combined program available) for a doctorate in medicine (MD) degree
-MD = entry-level degree (similar to JD)
-Some MDs continue onward for a MS or PhD
Post-MD Clinical Training - CORRECT ANSWER Overseen by the Accreditation Council on Graduate Medical Education (ACGME)
Clinical training with salary
Rotating internship X 1 year
Specialty residency X 2-6 years
Fellow (optional, additional specialty training X 1-2 years)
***General medical or surgical training may be required prior to specialty training (eg. general surgery prior to cardiac surgery)
US Medical Licensing Examination (USMLE) - CORRECT ANSWER 4-step standardized examination process
Step 1 exam - medical school
Step 2 exam/CK - medical school
Step 2 exam/CS - medical school
Step 3 - post-MD degree and after completion of at least 12 mos of GME clinical training
MD licensure issued by state
MD Certification - CORRECT ANSWER Optional board-certification as a physician demonstrates expertise in a medical specialty
American Board of Medical Specialties (ABMS)
Initial peer evaluation and rigorous oral and/or written testing
Ongoing education/assessment to maintain certification
Pharmacist - CORRECT ANSWER Consult on need for prescribed medications, dispense/administer medications, and patient/family teaching about medications
Approx 60 credits of pre-requisite general ed/science courses...preference for BA or BS+ degree
Pharmacy College Admission Test (PCAT)
4-year curriculum leading to the entry level Doctorate of Pharmacy (PharmD) degree since 2005
Standardized NAPLEX exam prior to state licensure
Social Worker - CORRECT ANSWER Assist patients experiencing a potential/actual health crisis with emotional or practical support/logistics including community resources
Bachelor degree in social work....many hospitals and health care agencies require a Master degree in social work as well (eg medical social worker/MSW)
Supervised practice for approx 2+ years
Standardized ASWB exam prior to state licensure (LCSW) but states vary in requirements
Optional, additional credentialing by the National Association of Social Workers
Physical Therapist (PT) - CORRECT ANSWER Assess impairment, limitation, and disabilities...and promote mobility and functional ability threatened by aging, injury, or disease
Role of the PT was further defined/valued during the polio epidemic of the 1950s
Current entry-level Master (MPT, MSPT) or Doctor of Physical Therapy (DPT) degree
Pre-requisite bachelor degree for DPT
Combined 6 programs are available (3+3) for DPT
Supervised clinical practice
Standardized NPTE exam prior to state licensure
ABPTS board certification in a specialty area is optional (eg pediatrics, sports, geriatric)
Occupational Therapist (OT) - CORRECT ANSWER Similar to PT but promote activities of daily living (ADLs) within the home, work, or recreational setting
Supervised clinical practice
Approx 2 years of pre-requisite courses
Current entry-level Master's degree (MSOT)...entry level doctorate degree now being proposed for OT but pre-requisite BS will be required
Standardized NBCOT exam prior to state licensure
AOTA board certification in a specialty area is optional
Speech Therapist - CORRECT ANSWER Evaluate and treat communication and swallowing disorders
5-year curriculum leading to a Master's degree for entry into practice
Clinical doctorate degree available
Supervised clinical practice
Standardized PRAXIS exam prior to state licensure
Respiratory Therapist (RT) - CORRECT ANSWER Assess and manage airway and respiratory function through the use of oxygen, artificial airways, monitory devices, assistive ventilation devices, and specific medications
Common in the ED, OR/PACU, ICU, medical-surgical unit, and selected clinics (eg asthma)
Increased use in home care settings
Minimal of Associate of Science in Respiratory Care degree from a community college
Standardized NBRC examination prior to initial licensure and Certified Respiratory Therapist (CRT) status
Later certification as a Registered Respiratory Therapist (RRT) after passing additional NRBC-WRE and NBRC-CSE exams
BS and MS degrees available
State variance in terms of licensure titles
Registered Dietician - CORRECT ANSWER Expertise in food and nutrition, especially in the presence of a potential or actual health crisis
BS degree in Nutrition and Dietetics
Supervised clinical practice
Standardized CDR exam prior to state licensure
Graduate degrees available
Return of the Hospital - CORRECT ANSWER Surgery under anesthesia and antisepsis *
Sophisticated diagnostic and treatment services *
Charitable hospitals under a governing board
(eg local businessmen)
University affiliation with new MD training and research opportunities
Increased chance for profit
Outpatient Care - CORRECT ANSWER 24/7 nursing care not necessary
Emergency Department (ED) without admission to the hospital
Urgent care center
Clinic
MD/NP office
In-home care (including hospice)
Inpatient Care - CORRECT ANSWER 24/7 need for nursing care
Acute hospital
Chronic care hospital
Rehabilitation hospital
Skilled nursing inpatient facility (SNIF)
Nursing home
Hospice facility
Hospital - CORRECT ANSWER >6 beds with 24/7 nursing care, kitchen and pharmacy
Provides diagnostic and treatment services
Organized medical staff
Medical records system
Hospital administration guided by a CEO and governing board
Licensed and credentialed
Acute Care Hospital Services - CORRECT ANSWER ED
Operating room (OR)/Post-anesthesia recovery unit (PACU)
Adult and medical-surgical units
Critical care/intensive care units (ICU)
Pediatric/neonatal units
Maternal-child (obstetrical/OB) unit
Psychiatric/mental health unit
Diagnostic services (lab, radiology, endoscopy, nuclear medicine...)
Supportive services (PT/OT, Respiratory Rx, MSW, case management, dietary...)
1946 Hill-Burton Act - CORRECT ANSWER "Hospital Survey and Construction Act"
Post-war development of suburbia and roads/highways created a need for hospitals both within and outside of major cities
Provided federal funding to increase the # US hospitals to 4.5/1000 Americans
Covered initial construction, expansion and major renovation
Major Milestones in Health Care Reimbursement - CORRECT ANSWER Blue Cross/Blue Shield private health insurance to cover both MD and hospital costs
Kaiser Permanente Healthcare as the initial health maintenance organization
Center for Medicare (elderly)/Medicaid (impoverished/disabled) Services (CMS)
DRG Managed Care - CORRECT ANSWER 1983 CMS mandate
Past retrospective payment = 100% CMS reimbursement of billed healthcare charges regardless of variance among providers. Provider fees covered both direct and indirect costs of care.
New prospective payment = Capitated and standardized CMS reimbursement of billed healthcare charges based upon average care needed per diagnosis
Diagnosis-related group (DRG)
Reduced hospital admissions, hospital length of stays (LOS), # used hospital beds, and # hospitals
Hospital Terms - CORRECT ANSWER Length of stay (LOS) - # days hospitalized
Average length of stay (ALOS) - mean length of stay, often adjusted per patient age, diagnosis, and co-morbidities
Capacity - # beds which can be made available for nursing care quickly, not always # beds licensed
Average daily census (ADC) - # patients that day
Occupancy rate - % available beds that are occupied by patients
Physicians in the Hospital Setting - CORRECT ANSWER Considered non-employees with admission/prescription/surgical privileges upon approval of professional credentials
Contracted by the hospital to provide 24/7 specialty services (ED, anesthesia, radiology, hospitalist in a non-teaching hospital)
Considered employees of the hospital (Chief Medical Officer, Kaiser Permanente)
Types of Hospitals - CORRECT ANSWER Community
Tertiary/referral
Public
General v. specialty
Tax exempt/not for profit
Proprietary/for profit
Teaching
University hospital system
Trauma Center
Community Hospital - CORRECT ANSWER Small and located in local communities (both inner city and suburbia)
Provide average-level care to the stable patient with average co-morbidities
Full service except for psychiatric-mental health (PMH), OB > pediatric care, and low-level ICU care
Rarely university-affiliated unless in the inner city
No GME interns and residents
Example = Inova Fair Oaks Hospital
Tertiary/Referral Hospital - CORRECT ANSWER Larger than community hospital
May be located in city or region
Provide high-level care to the unstable patient with complicated diagnosis and co-morbidities
Full-service if general hospital, including high-level OB and pediatric unit
High level and multiple ICUs
University affiliated with GME program
May include trauma, organ transplant, and oncology
Example = Inova Fairfax Hospital, Washington Hospital Center
Public Hospital - CORRECT ANSWER Publically-funded (city, county, state or federal government)
Often located in inner city and care for impoverished, aged, and chronically-ill local residents
Often associated with a busy ED
Not necessarily 100% available to all (Department of Defense, Veteran's Administration, Native American Indian)
May be specialized (mentally-ill, TB)
Public Hospital Examples - CORRECT ANSWER Open - the former DC General Hospital (Wash DC), Boston City Hospital (Boston), Cook County General Hospital (Chicago)
Limited - Walter Reed National Military Medial Center at Bethesda, National VA Medical Center, NIH Clinical Care Center
General v. Specialty Hospital - CORRECT ANSWER General hospital - full service (including OB and pediatrics)
Inova Fairfax Hospital, Inova Alexandria Hospital
Specialty - Care is limited but intense within a specific specialty (oncology, orthopedics, pediatrics, psychiatric-mental health....)
National Children's Medical Center, Dominion Hospital, Shriner's Hospital for Children (burns, orthopedics, Sloan-Kettering Oncology Center, National Rehabilitation Hospital)
Not-For Profit/Tax Exempt Hospitals - CORRECT ANSWER Still make a profit but 100% turned back into the hospital instead of pay out to investors
Provide essential healthcare to the community
Budget is funded by paid patient fees, philanthropic donations/endowments, and investments
Now run more like a business than a charity
Still compete with "for-profit" hospitals
Examples of Tax Exempt Hospitals - CORRECT ANSWER General - Most hospitals in this region, any Inova Hospital
Religious - Holy Cross Hospital, Providence Hospital, New England Deaconess Hospital (Boston), St Elizabeth's Hospital (Boston), Beth Israel Hospital (Boston), Washington Adventist Hospital
Philanthropic - St Jude's Hospital for Children, Shriner's Hospitals for Children (burns, orthopedics)
For-Profit/Proprietary Hospitals - CORRECT ANSWER Originally small and owned by MDs for supplemental income
Now run as a corporation, often as a regional or national health system
A portion of profits is paid out to investors
Examples: Any Kaiser or Tenet hospital, Doctors' Hospital Modesto (CA), Reston Hospital (HCA), Northern Virginia Medical Center (Sentara), Prince William Hospital (Novant), Georgetown U Hospital (Medstar) and Washington Hospital Center (Medstar)
Teaching Hospital - CORRECT ANSWER "University-affiliated"
Sponsors 1+ GME programs (medical, surgical) for clinical training of new MDs
Large, tertiary hospital with high level care
General or specialty hospital
Promotes clinical research
Examples = Inova Fairfax Hospital, Washington Hospital Center
Academic Medical Center - CORRECT ANSWER University Hospital System (UHS)
Sponsors numerous general (medical, surgical) and specialty (surgical specialty, pediatrics, OB...) GME programs for new MDs
UHS new RN residency program
Large, tertiary, general hospital with the highest level of care
Oncology, trauma (Level I or II), and organ transplantation
Actively sponsors clinical research
Nearby Academic Medical Centers - CORRECT ANSWER Georgetown U Hospital
George Washington U Hospital
U Maryland Medical Center
Johns Hopkins U Medical Center
VA Commonwealth U Medical Center
U Virginia Medical Center
Trauma Center - CORRECT ANSWER Ranked Level l (highest) to Level III (lowest) by the American College of surgeons
Provide 24/7 emergency care
1941 - 1st trauma center in Birmingham, England
1960 Shock Trauma Center (Baltimore) and 1966 Cook County Hospital (Chicago)
Level 1 Trauma Center - CORRECT ANSWER 24/7 care
Trauma surgeon, CNS, anesthesiologist, and specialty surgeons (neurosurgery, orthopedic surgery, plastic/burns surgery)
Access to evacuation helicopter, fixed wing aircraft as well as ambulance
Burn unit?
Level I Trauma Center continued - CORRECT ANSWER Trauma research, outreach prevention programs, and education (including GME residency)
Advanced Trauma Life Support (ATLS) and Trauma Nurse Core Curriculum (TNCC) certification of providers
RNS certified in emergency nursing (CEN)
Examples = Inova Fairfax Hospital, Washington Hospital Center, UVA Medical Center
2009 Annual US Health Care Costs - CORRECT ANSWER $2.2 trillion for the nation (16.2% GDP)
Average of $7026 per American
75% of above funded by federal government (CMS)
2014 US Healthcare Costs - CORRECT ANSWER Dan Munro, in FORBES - Pharma and Healthcare on 2/2/2014
$3.83 trillion = Estimated healthcare costs for 2014
$4.01 trillion = Estimated healthcare costs to increase in 2015
Blue Cross Blue Shield Insurance - CORRECT ANSWER 1929 - Private health care insurance prototype developed at Baylor U in Dallas, Texas for teachers
1930s - Blue Cross insurance (hospital coverage)
1947 - Blue Shield insurance (MD coverage)
1982 - Combined Blue Cross Blue Shield Association
Healthcare Reimbursement 1945-1970 - CORRECT ANSWER Limited # private insurance companies (mainly Blue Cross Blue Shield)
MDs and hospitals controlled the reimbursement process (what was billed was paid on a "fee for service" basis)
Pre-authorization not required prior to care
Many large hospitals with high census, long LOS, and generous reimbursements
Center for Medicare/Medicaid Services - CORRECT ANSWER Federal CMS agency established in 1965 by President Johnson (first proposed by President Truman)
Provides funding of health care for elderly > 65 yo, impoverished, and disabled
Parts A, B, C and D
Medicare - CORRECT ANSWER Primarily for the elderly > 65 yo
Part A (automatic) - hospital and post-discharge SNIF, hospice, or home care on a temporary basis
Part B (optional) - MD, outpatient services, home care, home equipment, some preventive care
Part C (optional) - HMO and PPO
Part D (optional) - Pharmacy plan
Medicaid - CORRECT ANSWER Matched state and federal CMS funding
Administered by each state
Provides funding of health care to the proven impoverished within certain eligibility groups (eg disabled)
Healthcare Reimbursement in 1970s - CORRECT ANSWER Concerns about increasing costs of Medicare-funded health care
Diagnosis-Related Group (DRG) process implemented by CMS to standardize hospitalization costs
DRG process later adopted by private insurers
DRG process was problematic as not initially reflective of acuity and co-morbidities
DRG Consequences - CORRECT ANSWER What happened to the large number of massive hospitals built in the 1950-1960s?
Could family handle the "earlier" discharge of the patient without supportive community resources?
RN/MD utilization review process - CORRECT ANSWER Shorter hospital length of stay
Development of non-hospital options for Dx testing and Rx procedures
Ambulatory procedures (eg cardiac cath, infusion Rx, endo/colonoscopy)
Same day admit for OR
Skilled nursing inpatient facility (SNIF)
Increased complexity of home care services
Social Security Disability Insurance (SSDI) - CORRECT ANSWER Provides monthly payments to the disabled
Must meet strict Social Security criteria of a "disabling medical condition"
Disability prevents return to recent job or adjustment to a new job
Disability expected to last > 1 year or result in death
Must have prior work experience which paid 40+ credits into Social Security (20 credits within the 10 years prior to the disability)
At retirement age, SSDI converts to Social Security benefits at same rate
Healthcare Reimbursement 1980-90s - CORRECT ANSWER Integrated health care networks for contractual comprehensive care
Health maintenance organization (HMO)
Preferred MD/DDS provider organization (PPO)
For-profit hospital systems with their own HMO/PPO
Co-payments v. no-cost to user if stay within network for all aspects of care unless outside referral is authorized
Network now controls the reimbursement process
Prospective Capitation Payments - CORRECT ANSWER Providers are paid a contractual monthly flat fee per patient regardless of provider utilization
If "provider cost" exceeds reimbursement, provider absorbs the cost. If "provider cost" is less than reimbursement, provider absorbs the profit
Goal = keep the patient healthy and reduce utilization of services!
Kaiser Permanente - CORRECT ANSWER 1930s - Dr Sidney Garfield and his 12-bed hospital provided care to laborers building the LA Aqueduct (and later the Grand Coulee Dam) at a pre-paid daily rate of $0.05 per person
WW2 - Kaiser Industries shipyards in San Francisco contracted with Dr Garfield to care for 30K shipyard workers on a pre-paid basis
1945 - Kaiser Permanente Health Care Plan open to the public (primarily union workers)
Current and Future State - CORRECT ANSWER Most health care occurs within the last 6-12 months of life
Aging US population with high % of 1+ chronic illness and a growing % of underinsured or uninsured
Must reduce costs while increasing the quality of patient outcomes
Future reimbursement will be correlated to +/- patient outcomes
Obama Health Care Reform - CORRECT ANSWER Now provides coverage for pre-existing conditions
"Right thing to do" but will further increase health care costs
Strategies for Limited Reimbursement - CORRECT ANSWER Preventive education and care
Effective disease screening for early detection
"Gatekeeper" primary care MD controls specialist referrals
Use of non-MD providers (eg APNs and PAs)
Standardize care using pathways and protocols
RN/MD peer review
Morals - CORRECT ANSWER What you personally believe to be right versus wrong
"Personal compass"
May change if personal beliefs change
Ethics - CORRECT ANSWER Rules for conduct within a particular group or culture
"Society's compass"
May lead to professional/legal guidelines
(eg ANA Code of Ethics for Nurses)
Ethical Principles - CORRECT ANSWER Beneficence - Do good
Example = Use all hospital resources to reduce suffering, restore health, and/or improve patient quality of life
Dilemma = Use all hospital resources even if patient is uninsured???
Ethical Principles pt 2 - CORRECT ANSWER Non-maleficence = Do no harm
Actual/potential treatment benefit must > risk
Example = Withdrawal or cessation of treatment that is no longer effective or could result in increased risk to patient
Dilemma = What if patient's family insist on continuation of treatments regardless???
Ethical Principles pt 3 - CORRECT ANSWER Justice - Must be fair/equitable
Example = Hospital resources must be available equally to all patients based upon clinical need regardless of gender, age, race/culture, faith, politics etc
Dilemma = What about VIP care to hospitalized celebrities???
Ethical Dilemma - CORRECT ANSWER An ethical dilemma is a complex situation that involves an emotional conflict between >1 moral imperatives in which to obey one would result in transgressing another
Healthcare example = Administration of narcotic analgesia for pain to a dying patient with irregular, labored breathing
Dilemma = Narcotic drug can cause respiratory depression
Recipe for an Ethical Dilemmas in Healthcare - CORRECT ANSWER Advanced and costly diagnostic testing/treatment
Rapid decision-making needed
Dynamic, complex, and acute patient care scenario
Stressed, anxious, and exhausted family members with conflicting priorities
Multi-disciplinary healthcare team with conflicting priorities
Budgetary constraints and limited reimbursement
Ethical guidelines that lag behind scientific advances
Examples of Ethical Dilemmas in Healthcare - CORRECT ANSWER Cancer diagnosis/treatment during pregnancy
Targeted pregnancy to produce a sibling bone marrow donor
Resuscitation at birth of the anticipated neonate with life-threatening congenital defects
Liver transplantation in the presence of
Hepatitis B or ETOH abuse
Withdrawal of life support (mechanical ventilation, tube feedings) in vegetative state
Suicide of the terminally ill
Which Is The Most Important Question? - CORRECT ANSWER What is in the best interest of the patient?
What is in the best interest of the patient's family?
What is in the best interest of the RN/MD?
What is in the best interest of the hospital?
What is in the best interest of the community?
J Larson, AMN Healthcare News (6 March 2013) - CORRECT ANSWER Healthcare quality v. efficiency
Adequate/equitable access to healthcare
Building/sustaining healthcare workforce
End of life issues
Allocating limited # healthcare resources
Quality v. Efficiency? - CORRECT ANSWER ED discharge of the un/underinsured patient
Same-day discharge of a surgical patient
Staffing strategies based upon clinical acuity of the patient exclusive of patient/family emotional or teaching needs
Timely discharge of the elderly back to "questionable" independent living
Discharge of the homeless back to the streets
"Burnout" and Attrition - CORRECT ANSWER Healthcare providers can get physically/emotionally exhausted ("burnout") from morally/ethically challenging patient care scenarios
Perceive that they lack the clarity/power to resolve a patient care dilemma
May lead to attrition from specific job v. temporary or permanent attrition from the profession at large
End Of Life Ethical Issues - CORRECT ANSWER Medical advances which increase lifespan into the 70-90s have resulted in ethical dilemmas
What can we do?
What should we do?
What can we afford to do?
Alternate Standard of Care - CORRECT ANSWER Refers to allocation of limited healthcare resources when demand > supply
Especially in a disaster or shortage situation
Example 1 = decreased medication production due to minimal profit (generic drugs)
Example 2 = decreased availability of donor organs (especially pediatric)
Example 3 = limited ICU beds/ventilators in a disaster or pandemic
Moral Courage - CORRECT ANSWER J Murray in "Moral courage in healthcare: acting ethically even in the presence of risk", The Online Journal of Issues in Nursing (30 Sept 2010)
"Moral courage in healthcare helps to address the ethical issue and take action when doing the right thing is not easy"
Hospital Ethics Committee - CORRECT ANSWER Especially within referral/tertiary hospitals with high patient acuity
Interdisciplinary team (eg. MD, RN, MSW, chaplain, lawyer, hospital administration, community representative, ethicist...)
Develop guidelines and standards to aid ethical decision-making in clinical situations
Can assess and guide ethical decision-making in a particular patient scenario
Legal Issues in Healthcare - CORRECT ANSWER Patient abuse and neglect
Clinical errors of judgment
Breach of professional standards of practice: what would the average RN/MD do?
Breach of patient confidentiality
Lack of informed consent prior to invasive/risky diagnostic testing and treatments
Informed Consent - CORRECT ANSWER Written at common reading level
Translated if needed into native language
Presented and fully explained by provider doing the procedure (including risk v. benefit)
All patient/family questions are answered to satisfaction
Signed by mentally competent patient or legal guardian/medical power of attorney
Witnessed signature
Included in medical record
AD versus MPOA - CORRECT ANSWER Advance directive (AD) to document the patient's wishes for care if no longer able to speak for self
Medical power of attorney (MPOA) to speak/sign on behalf of the patient if above, using the advance directive as a guide for decision making whenever possible
HIPAA - CORRECT ANSWER 1996 Health Insurance Portability and Accountability Act (federal law)
Includes the Privacy Rule for protected health information (PHI) of a patient
PHI is to be shared only on a "need to know" basis
Form signed upon hospital admission or MD office visit
Costly fines for HIPAA violations
Healthcare Reimbursement 1945-1970 - CORRECT ANSWER [Show Less]