Legal Issues
As defined by state nursing licensure acts, registered nurses are responsible for maintaining safe nursing practice. Safe practice for registered nurses employed in telehealth includes:
a.) Overseeing the triage and clinical judgment of LPN's and receptionists
b.) Advising patients and telling them what to do.
c.) Sending patients with chest pain to the walk-in clinic
d.) Ensuring that clinical protocols are comprehensive and updated on an annual basis.
Answer: D.
The registered nurse should be responsible for ensuring that the clinical protocols are updated on annual basis. LPN's and receptionists cannot triage or use clinical judgment. The nurse should not "tell patients what to do" but collaborate with them. The nurse should refer patients with chest pain to the emergency department
During the initial assessment of symptoms, the nurse will “maintain patient safety” by determining:
a.) The least likely outcome of this call.
b.) The patient concerns that can be ignored.
c.) The patient’s telephone number.
d.) The patient’s insurance.
Answer: C.
The nurse should find out the patient's telephone number early in the call in case of an emergency or disconnection. The nurse should not focus on the least likely outcome, what concerns should be ignored or if the patient has insurance.
In evaluating internet information for patient education, the following set of criteria is valuable:
a.) Accuracy, authorship, attribution, current literature, and nursing practice relevance
b.) Literacy level, ease of search, endorsement by specialty organization, and attractive layout
c.) Specifically outcomes oriented, free of abbreviations, and comprehensive
d.) Specific, measurable, attainable and relevance
Answer: A
One of the most important aspects of effective telephone communication is a:
a.) Caring attitude
b.) Telephone mechanics
c.) Audible cues
d.) Cultural environment
Answer: A.
The patient's perception of the nurse's caring attitude often serves to define the potential for a trusting, positive relationship. The nurse must expand development of communication beyond merely skill-based. Adopting certain attitudes that bring a more human quality to each interaction can enhance much of the nurse's "charisma." The nurse's attitude allows the creation of an understanding atmosphere that neither patronizes the patient, nor belittles the problem.
Which of the following qualities has the greatest influence on the caller’s perception of the nurse during telephone communication?
a.) Tone of voice
b.) Volume of voice
c.) Clarity of speech
d.) Nurse’s use of medical terminology
Answer: A.
Tone of voice portrays various shades of meaning. The nurse can sound abrupt, disinterested, or unfriendly. By fluctuating the voice pitch, the nurse may be more successful in engaging the patient. Use of pleasant, natural tone of voice further conveys a sense of friendliness and willingness to help.
The most important reason for using written or computerized decision support tools is to:
a.) Provide standardization, decision support, legal protection and ease of documentation.
b.) Improve efficiencies in handling calls.
c.) Allow non-licensed personnel to be able to give telephone advice.
d.) Meet compliance standards for national review organizations such as national accreditation guidelines.
Answer: A.
Guidelines provide standardization, decision support, legal protection and ease of documentation for nursing telephone assessment and advice by insuring consistency, accuracy, completeness and quality of practice regardless of individual insures background. Guidelines may or may not have cost saving benefits to the organization and may or may not demonstrate compliance to standards. Guidelines do not allow non-licensed personnel to give telephone advice. Only registered nurses should be giving telephone advice.
Mr. Smith calls the nurse complaining of chest pain that radiates down his left arm. He states that the “pain started an hour ago and just won’t go away”. The nurse should next:
a.) Ask several more questions to rule out whether an emergency really exists.
b.) Determine if Mr. Smith is a patient at this clinic.
c.) Instruct Mr. Smith to drive to the E.D. now.
d.) Request the address and telephone number from where Mr. Smith is calling.
Answer: D.
The most critical reasons for requesting the address and telephone number from where the patient is calling is to be able to make contact if the telephone line become disconnected or the caller becomes incapacitated. After this information is obtained, the nurse should continue the assessment to determine the urgency of the situation as well as relationship to the clinic.Patients experiencing chest pain should not drive.
An underline confrontational interviewing style increases a patient's resistance to change because it negatively impacts their:
a.) Social environment
b.) Self-efficacy
c.) Expertise of their health issue
d.) Ability to follow a treatment plan
Answer: B
Communication is defined as the “process of exchanging messages or information”. This exchange may be impacted by internal and external influences. During a typical nurse/patient telephone encounter all of the following are examples of internal and external influences except:
a.) Nurse’s horoscope
b.) Environment
c.) Legal issues
d.) Bias
Answer: A.
Bias, socioeconomic factors, environment, diversity, legal issues, and patient confidentiality may distort the exchange of information. These factors can influence the ability of the nurse and the patient to exchange information in an effective, productive manner.
One of the benefits for developing and refining communications skills is:
a.) A decrease in the number of unscheduled office visits.
b.) A decrease in call volume.
c.) Improved patient compliance with care recommendation(s).
d.) An increase in reimbursement for appropriate services.
Answer: C.
Maximizing communication will benefit in improved patient compliance. Excellent communication may or may not influence call volume, unscheduled visits or reimbursement, as these are more likely influenced by the effective and appropriate use of guidelines rather than communication skills.
The most important reason(s) to document every patient related call is/are:
a.) To demonstrate standards of care and the nursing process.
b.) To identify quality issues.
c.) To verify that the call meets JCAHO accreditation standards.
d.) To validate how busy the practice is.
Answer: A.
All of the above are good reasons to document the call. However, the most important reason as discussed in Basics of Documentation is to demonstrate standards of care and the nursing process. All of the other answers are secondary reasons.
Which of the following statements best qualifies and quantifies a patient’s symptoms?
a.) Frequent diarrhea past two days.
b.) Many loose stools with abdominal pain today.
c.) Vomiting off and on with diarrhea x 4.
d.) Diarrhea x 3 since yesterday with slight nausea.
Answer: D.
Documentation of symptoms must include as much fact as possible. Answers A, B and C are vague, and are missing terms that give the quality or the quantity of the symptoms.
Which of the following would be the priority in an educational plan for a woman newly diagnosed with Type 2 DM?
a.) Weigh herself daily and report variations in weight (4+ pounds) in a week
b.) How to self-monitor glucose and use data to address diet, exercise, and medication
c.) How to recognize acute complications of hyper/hypoglycemia and when to seek medical advice
d.) Poorly controlled DM may cause complications like cardiovascular disease, loss of vision, neuropathy, kidney damage
Answer : C.
New diagnosis so want to handle acute complications.
The effectiveness of telehealth nursing may be measured by customer satisfaction scores. Which of the following is most important in measuring customer satisfaction:
a.) The customer’s average wait time for their calls to be answered.
b.) The customer’s expectation and perception of their experience.
c.) The customer’s impression of the physical facility and state of the art technology.
d.) The price a customer is willing to pay for the service.
Answer: B.
An organization can be customer focused, have excellent technology, etc. However, it is the customer's expectation and perception of the experience with the staff that is most important in measuring the effectiveness of service.
A telephone nurse needs to place the patient on hold to look up the requested information. Before placing the patient on hold, the nurse should:
a.) Tell the patient she will be placed on hold and then do so.
b.) Check with the patient every three minutes.
c.) Suggest a web site that the patient might review while waiting.
d.) Obtain demographics including the telephone number from the patient.
Answer: D.
Before the caller is placed on hold for any reason, the nurse needs to have complete demographic information, especially the telephone number the caller is calling from in case there is an interruption in service or unintentional disconnect. The nurse should ask for the caller’s permission before placing them on hold (not “tell the patient”), and the caller should not be left on hold longer than 60 seconds. Suggestion for viewing a web site has no bearing on the situation.
Working with patients over the telephone involves different responsibilities compared to providing direct face-to-face patient care. The registered nurse may perform all of the following except:
a.) Call 911 for a patient who is refusing emergency care.
b.) Carry out standing orders such as phoning in lab orders.
c.) Advise a patient that his described diarrhea symptoms are probably due to a viral infection.
d.) Contact the local child abuse/neglect service about a child after a call.
Answer: C.
According to state nurse practice acts, the registered nurse cannot medically diagnose conditions. However, the nurse may carry out standing orders and call for emergency care. According to federal law, all healthcare workers are mandated reporters for child abuse and information needs to be reported to authorities.
The nurse accurately and concisely documents all telephone nursing encounters. Which of the following is most true regarding this documentation?
a.) The effective application of documentation principles and standards increases the nurse’s legal protection.
b.) Concise documentation minimizes the nurse’s liability.
c.) Administrative policies decrease the nurse’s liability.
d.) Lengthy documentation increases the nurse’s legal protection.
Answer: A
By applying principles and standards on what to document and basic guidelines on how to effectively document, the nurse increase the chance of defending professional judgment and actions in a court of law. Neat and concise documentation will not limit liability if it is not comprehensive and does not follow principles or standards. Administrative policies and documentation standards will only decrease a nurse's liability if applied correctly. Lengthy documentation will not help protect the nurse is it is not accurate and does not follow documentation principles and standards.
The provider is making rounds and mentions he will order placement of an NG tube on Ms Lewis . Because this is your first time inserting an NG tube you go to your VDT and log into ..... to view the steps beforehand
Answer: Lippincott Procedures
As a representative for the organization, the telehealth nurse has multiple opportunities to practice customer service skills and influence the caller’s perspective of the organization. Which of the following actions by the nurse is most likely to result in an unfavorable customer service experience?
a.) Lack of follow through on a commitment made to the caller.
b.) Calling the patient within one hour of the initial phone call.
c.) Connecting the caller to another department that might better meet their needs.
d.) Asking permission and then placing the caller on hold for a brief period of time.
Answer: A.
Customers expect high quality service and attention to detail. This includes following through with promises made to the customer/caller.
Promoting advocacy and positive patient relations includes:
a.) Analyzing and integrating data from multiple sources
b.) Adapting and responding rapidly to change in healthcare environment
c.) Providing service recovery processes that resolve patient/family complaints
d.) Articulating the institutions mission/values/goals
Answer: C
A community based call center receives a call from a male complaining of a “nose bleed" for the past 30 minutes. The patient refuses to provide the nurse with his medical history including current medications. Because the nurse does not know this patient’s medical history or status of current medications, the best action for the nurse is to:
a.) Assume the patient does not have a pertinent medical history.
b.) Instruct the patient to see the provider if symptoms continue over the next few hours.
c.) Refuse to provide any information.
d.) Provide the patient with only general first aid measures because of not knowing the medical history.
Answer: D.
When a patient does not provide their medical history to the nurse, the nurse is unable to assess and triage them appropriately. The nurse would not know if the patient has chronic medical problems or medications that could influence the triage decision. The most appropriate response from the nurse is to offer general first aid measures only.
Which of the following scenarios potentially violates the confidentiality of the patient’s protected health information?
a.) Using patient information to measure the percentage of pediatric immunizations up-to-date at 2 years of age
b.) Talking to an elderly patient’s daughter about the need to bring the patient back for another appointment because of abnormal test results
c.) Reporting domestic abuse to the local public health authorities
d.)Reviewing the record of an outpatient procedure by the billing department to obtain reimbursement from the patient’s insurance company
Answer B
Don’t tell anything about the mother being compromised mentally. Does not state permission was given
Engage/Focus/Evoke/Plan represent what critical communication model and teaching?
a.) Expert Assumption Intervention
b.) Behavioral Change Model
c.) Motivation Interview (MI)
d.) Telehealth Nursing Model
Answer: C
Taking call after call, day after day, a nurse may be prone to developing various manifestations of stress. To minimize stress the nurse should:
a.) Develop personal strategies to maintain a positive mental outlook.
b.) Frequently review the shift events, focusing on all the things the nurse could have changed.
c.) Avoid or delay meals and fluid intake when work demands make it difficult to take a break.
d.) Understand that the employer is responsible for personal work issues.
Answer: A.
There are constructive ways to cope when the nurse is in a mentally stressful situation. Developing a positive mental attitude and approaching a situation in small increments will help minimize psychological stress.
When faced with an angry caller, what acronym best reflects how a RN is to handle the challenging situation?
a.) S.C.H.O.L.A.R.
b.) P.D.S.A.
c.) H.E.A.T.
d.) P.C.W.A.S.
Answer: C: HEAT
Hear them out
Empathize
Apologize (if appropriate)
Take actions