Question 1

The emergency room nurse is often faced with the responsibility of providing care for people who were responsible for motor vehicle accidents. In some cases, the nurse is caring for that person along with victims of the accident. This situation causes the nurse moral distress. How could the nurse best help to alleviate this distress?

A) Refuse to care for these patients in the future.
B) Be frank with the patients about how uncomfortable the nurse is.
C) Remember to respect the person, not the actions of the person.
D) Ask a co-worker to care for the patients.

Accepted Answer

Rationale 1: Refusing to care for these patients is not ethical and does not address the root problem.
Rationale 2: While honesty is a good policy, the nurse should not impose his or her discomfort onto the patient.
Rationale 3: The best option is to remember that all people deserve respect as human beings, even if their actions cannot be respected.
Rationale 4: Diverting the stress onto a co-worker is not handling the situation, only shifting it to someone else.

Question 2

Which option is an example of a and statement regarding violence a nurse should use in the assessment of all patients?&#10;A) &#34;Do you feel safe in your home?&#34;&#10;B) &#34;Most violence involves physical abuse.&#34;&#10;C) &#34;Violence is rare in upper middle class families.&#34;&#10;D) &#34;Don't take your safe home environment for granted.&#34;&#10;

Accepted Answer

Rationale 1: This question is a good way to begin discussion of violence. All patients should be assessed for the presence of domestic violence or abuse.
Rationale 2: The nurse should educate patients that violence includes much more than physical behaviors.
Rationale 3: Violence occurs across all socioeconomic levels.
Rationale 4: The nurse should not assume that a patient's environment is safe.

Question 3

Telenursing presents numerous ethical concerns. What is one way the nurse can help to control for the ethical issues surrounding this technology?&#10;A) Use telenursing to give only general, not specific, advice.&#10;B) Ask specific questions about the patient's presenting situation.&#10;C) Restrict telenursing to patients who have been seen in person within the last two days.&#10;D) Refuse to give advice to patients over the telephone.&#10;

Accepted Answer

Rationale 1: Giving only general advice negates the purposes of telenursing.
Rationale 2: One of the ethical issues that arises in telenursing is that assessment may be more difficult. The nurse can help control for this problem by asking specific questions.
Rationale 3: Restricting advice to patients that have recently been seen negates the purposes of telenursing.
Rationale 4: Refusing to give advice negates the purposes of telenursing.

Question 4

The nurse's neighbor routinely calls and asks for advice regarding health issues. What should the nurse do about these calls?&#10;A) Tell the neighbor that the nurse is not legally able to give health advice outside the work environment.&#10;B) Charge the neighbor a flat fee of $25 for each call.&#10;C) Be certain that any advice given reflects both nursing and community standards.&#10;D) Tell the neighbor that nurses are not educationally prepared to give health advice.&#10;

Accepted Answer

Rationale 1: It is not illegal for the nurse to provide health advice to a neighbor.
Rationale 2: If the nurse charges the neighbor for the advice, there is a different legal standard applied as the advice is no longer voluntary.
Rationale 3: When giving health-related advice, the nurse should be certain the advice meets both community and nursing standards.
Rationale 4: Nurses are educationally prepared to give health advice.

Question 5

A patient presents at a small rural medical clinic after falling from a ladder. The physician suspects that the patient may have intracranial injuries but no diagnostic equipment to determine the severity of injury is available. What is necessary for the physician to legally transfer this unstable patient?

A) Documentation that the receiving hospital has available space
B) Physician certification that the medical benefits of transferring the patient outweigh the risks of transfer
C) Documentation that the transferring hospital is a qualified Medicare provider
D) An agreement with the receiving hospital stating willingness to provide care
E) Confirmation that the incident causing the injuries was accidental

Accepted Answer

Rationale 1: In order for transfer of an unstable patient to meet EMTALA requirements the physician must certify that the receiving hospital has space available for the patient's care.
Rationale 2: Transferring patients is not without risk. The transferring physician must certify that the risks associated with transferring the patient are outweighed by the benefits of transfer.
Rationale 3: There is no requirement to certify that the receiving hospital is a Medicare provider.
Rationale 4: The receiving hospital must be willing to provide care to the patient being transferred.
Rationale 5: There is no need to confirm that an accident caused the injuries.

Question 6

The nurse is involved in establishing a patient-centered medical home to care for a growing population of older adults. The nurse would support which components of this plan?&#10;A) The workflow of the organization is focused on the patient as an informed partner in creating plans for care.&#10;B) An interdisciplinary team of care providers will provide prevention and wellness care for these patients.&#10;C) The medical home will serve as a long term care facility for the patients as they age.&#10;D) The medical home will establish a system of email communication with members for rapid access to providers.&#10;E) The medical home will rely heavily on evidence-based decision making.&#10;

Accepted Answer

Rationale 1: The medical home supports patients in learning to manage and organize their own care, and ensures that these patients are fully informed partners in establishing realistic care plans.
Rationale 2: A medical home is accountable for meeting preventions and wellness, both in acute and chronic care. An interdisciplinary team of care providers provides this comprehensive care.
Rationale 3: A patient-centered medical home is not a long term care facility.
Rationale 4: The medical home model delivers accessible services with electronic or telephone access to a member of the care team on a round-the-clock basis.
Rationale 5: The medical home demonstrates a commitment to quality and quality improvement through the use of evidence-based medicine and clinical decision-support tools.

Question 7

Health plan administrators are designing methods to assure that consumers have appropriate access to emergency services. Which standard should guide the development of these methods?&#10;A) That of a reasonable physician&#10;B) That of a prudent layperson&#10;C) That of an ethical insurance provider&#10;D) That of a prudent and reasonable nurse&#10;

Accepted Answer

Rationale 1: The standard of a reasonable physician would exclude many situations for which people believe they should seek emergency care.
Rationale 2: The standard for access to emergency care should be such that a "prudent layperson" could reasonably expect the absence of medical attention to place the consumer's health in serious jeopardy.
Rationale 3: An ethical insurance provider's standard for when a person should have access to emergency care may be influenced by reimbursement issues.
Rationale 4: A prudent and reasonable nurse has a higher understanding of medical emergencies. Because of this advanced knowledge this is not the standard for most people.

Question 8

A nurse who has a history of difficulty meeting the professional responsibilities of acute care nursing is considering a move to ambulatory nursing. What should this nurse consider about the professional responsibilities of ambulatory nursing prior to making this decision?

A) Ambulatory nursing is totally different from acute care nursing.
B) The responsibilities are equally as technical and demanding as those of acute care nursing.
C) The duty to communicate is lessened in ambulatory care nursing.
D) Ambulatory nursing is less physically demanding on the nurse.

Accepted Answer

Rationale 1: Many aspects of acute care nursing are also important in ambulatory care nursing.
Rationale 2: Neither specialty setting is "easier" or "less demanding" than the other. Ambulatory care nurses use advanced technology to provide care, just as do acute care nurses.
Rationale 3: The nurse working in ambulatory care must be very careful to communicate well because the patient is generally in the environment for a lessor amount of time.
Rationale 4: The physical demands of ambulatory care nursing can be just as stringent as those of acute care nursing. Depending upon practice site, ambulatory care nursing may be very physically demanding.

Question 9

The nurse is caring for a 45-year-old patient who reveals that recent injuries are a result of domestic violence. The patient begs the nurse not to &#34;tell.&#34; What action, taken by the nurse, is correct?&#10;A) Report the revelation to the charge nurse.&#10;B) Tell the patient that the law requires reporting this incident.&#10;C) Promise the patient not to tell anyone.&#10;D) Talk with the patient about the reason for secrecy.&#10;

Accepted Answer

Rationale 1: The nurse should not reveal the information to anyone until further assessment is done.
Rationale 2: Since this patient is not a child or an elder there is not a duty to report. That duty exists only if the patient is a member of a "vulnerable population."
Rationale 3: The nurse should not promise the patient not to tell as divulging information may at some time be crucial to the patient's health.
Rationale 4: The nurse should explore the reasons the patient desires to keep the information secret.

Question 10

The advanced nurse practitioner is an employee of a health maintenance organization, along with several other ANPs and physicians. All the providers receive a set salary from the organization regardless of how many or few patient contacts are made monthly. Which type of HMO does this describe?

A) Network model
B) Group model
C) Staff model
D) Independent practice association model

Accepted Answer

Rationale 1: In the network model two or more independent group practices and/or independent practice associations contract to provide services. Enrolled members pay a fixed monthly fee.
Rationale 2: A group model exists when a health plan contracts with a multispecialty group to provide care to plan members. The providers are not employees of the HMO, but are employed by the group practice and are paid a negotiated salary.
Rationale 3: The staff model is a health care model in which providers practice as employees and are usually paid a set salary.
Rationale 4: The independent practice association model occurs when a separate legal entity contracts with an HMO for a negotiated fee. The health care providers continue in their existing individual or group practices, seeing HMO patients as a part of the practice.

Question 11

The nurse has been involved in work to support antitrust laws in health care. Why are these laws important to health care consumers?&#10;A) They encourage activities to promote health.&#10;B) They promote the use of registered nurses rather than unlicensed assistive personnel.&#10;C) They promote competition and efficiency in health care.&#10;D) They prevent physicians from ordering unnecessary tests.&#10;

Accepted Answer

The answer of The nurse has been involved in work...

Question 12

The nurse volunteers services at a free medical clinic. What is true of these donated services?&#10;A) They fall under the auspices of the state nurse practice act.&#10;B) Since the nurse is serving as a volunteer an exemption from possible lawsuit exists.&#10;C) The nurse should practice as a reasonably prudent nurse when providing these services.&#10;D) The nurse should assure that a system of record keeping is initiated and maintained.&#10;E) The nurse's actions will be protected by Good Samaritan laws.&#10;

Accepted Answer

The answer of The nurse volunteers services at a free...

Question 13

The nurse is considering taking a job with a health maintenance organization. To be federally qualified as an HMO, the nurse's possible job site must have which of these aspects in place?&#10;A) A list of health care providers from which patients may choose&#10;B) The capacity to provide care by telehealth&#10;C) An agreed-upon set of basic and supplemental health maintenance and treatment services&#10;D) An organized system of providing health care in a geographic region&#10;E) Persons who voluntarily enroll in the plan for services&#10;

Accepted Answer

The answer of The nurse is considering taking a job...

Question 14

Which situations reflect legal issues associated with telenursing?&#10;A) Standards of care in one state's hospitals are different from those in hospitals in another state.&#10;B) A telehealth nurse in one state holds an associate degree while a nurse in a similar position in a neighboring state holds a baccalaureate degree in nursing.&#10;C) The use of telenursing equipment is new in the hospital and requires the presence of a non-medical technician.&#10;D) The nurse using telemedicine is paid by the patient &#34;visit,&#34; while the hospital staff nurse is paid by the shift.&#10;E) The nurse who is licensed in one state is caring for a patient who is in a different state.&#10;

Accepted Answer

The answer of Which situations reflect legal issues associated with...

Question 15

State legislatures are gradually changing the care that patients potentially receive from health maintenance organizations (HMOs). What is one means by which this improvement has occurred?&#10;A) States have allowed patients who receive substandard care to successfully bring suit against HMOs.&#10;B) States have mandated that all citizens be covered by HMOs if that is the desire of the citizen.&#10;C) States have set the premiums that enrollees pay for HMO coverage.&#10;D) States have mandated how many HMOs will operate within the state.&#10;

Accepted Answer

The answer of State legislatures are gradually changing the care...

Deck 18: Nursing in Ambulatory and Managed Care Settings