Know your roll
A nurse is asking the manager for help with role segmentation strategies. What suggestion by the manager would be best?
A. Develop an “I’m at home now” routine such as changing clothes immediately.
B. Distract yourself by exercising, reading a book, or doing some other activity.
C. Limit yourself to checking work e-mails only once on each day off.
D. Try to forget about work when you get home and in the house.
ANS: A
Role segmentation means possessing clear boundaries between roles. One method might be to develop a ritual that physically and emotionally signifies to the nurse that he or she is at home and off work, such as changing clothes immediately when home. Distraction might be helpful, but it is only useful when the stress of role integration is apparent. Limiting work-related activities to once on days off only ensures the nurse really never has a true day off. Trying to forget work is a vague suggestion that has no concrete information to help the nurse operationalize that idea.
A nurse wants to change a law that regulates nursing practice. Before proposing this change, the priority action by the nurse should be to:
A. check for national standards regarding the practice under question.
B. determine whether other professional groups would help implement it.
C. find a state senator who will sponsor and support the proposed bill.
D. hire a lobbyist to represent the nurse’s opinion in the legislature.
Answer: A
Larry said " Always start with researching laws or standards then collaborate with nursing organizations"
A nursing manager wants to be involved in activities that would systematically improve quality care. The manager would best accomplish this by:
A. ensuring that temporary agency nurses fill open positions.
B. hiring only baccalaureate-prepared nurses on that unit.
C. preparing cost estimates for a new telemetry system.
D. teaching nurses on the unit to use positive conflict-resolution skills.
Answer: C
Nurse managers are involved in quality improvement activities in two ways: by creating a culture that is supportive of quality improvement and by making business cases for investments in technology and structural changes. By preparing a cost analysis for a new telemetry unit, this nurse manager is participating in systemic quality improvement.
Filling open positions is important to maintain quality in the hospital, but using temporary agency nurses is working from a crisis mode and not working toward long-term quality improvement. Policy groups do recommend a higher proportion of BSN-prepared nurses on staffs. However, this does not guarantee improved quality. Conflict-resolution skills are a great asset, but this does not address quality improvement.
A nurse is complaining about the pharmacy being too slow in delivering medications. The nurse describes an example in which a patient could have been harmed from the delay and is angry because the nurse knows it is critical that certain medications be given on time. This nurse is most likely experiencing:
A. caregiver fatigue.
B. burnout.
C. moral distress.
D. personal fatigue.
Answer: C
Moral distress occurs when a person feels uneasy about a situation in which he or she knows the right course of action but is unable to perform it. This nurse is suffering from moral distress. Caregiver fatigue occurs when the burden of giving care is too great for an individual. It is often used to describe a situation involving a lay person giving care to a significant other. Although this might be the case, it is not the most likely answer. Job burnout occurs when the demands of the job are too great and often leads to nurses leaving the profession or to change jobs. This could be a component of the problem, but it is not the best answer because it is too narrow in focus. Personal fatigue is certainly a barrier to providing excellent patient care, but it does not appear to be involved in this situation.
A bill has passed both Houses. Before it gets sent to the president, it must be:
A. approved by appropriate party chairs.
B. fully financed with appropriations.
C. registered as a pending law to sign.
D. resolved in conference committee.
Answer: D
After both Houses pass their version of a bill, a conference committee works on the bill to resolve any differences between the two versions that passed. After a bill passes in both Houses, it does not go to the party chairs. The party chairs run the political party; the committee chairs set the legislative agenda. Bills may be passed fully, partially, or not funded at all. Bills that have passed do not need to be registered anywhere as pending laws.
The emotional response to an occurrence of role stress is called role:
A. ambiguity.
B. conflict.
C. overload.
D. strain.
Answer: D
Role strain refers to the emotional reactions to a role stress event and occurs when role stress is not resolved. Role ambiguity occurs when the expectations of a role are not clearly defined. Role conflict occurs when a person feels unable to meet the obligations of two or more roles. Role overload is a situation when time or resources are inadequate to meet the obligations of a role.
A physician asks a nurse to witness a consent form the patient has already signed, even though the nurse did not see the patient sign the form. The best action by the nurse is to:
A. ask the patient if the signature on the form is his or hers.
B. refuse because the nurse did not witness the signing.
C. tell the physician the consent cannot be witnessed now.
D. write “consent procedure witnessed” on the consent.
ANS: A
The nurse is witnessing that the signature on the consent form is the patient’s. The nurse can show the document to the patient, verify that the signature is authentic, and then sign as a witness to the signature. The nurse does not have to witness the provider obtaining the signature for informed consent. The consent can be witnessed retroactively because the nurse is only verifying that the signature is the patient’s. This phrase could be included if the nurse had actually witnessed the physician (or other provider) providing the information needed for consent and the patient signing the form. However, in this case, the nurse did not actually witness those actions.
An economist explains that consumerism is not a preferred mechanism for the health care market because of the:
A. ethical viewpoint that equal access to health care is a universal human right.
B. inability of most people to save for or borrow enough money to pay for care.
C. trend for prices of health care goods and services that continue to skyrocket.
D. variability in people’s ability to articulate current and future health care needs.
ANS: D
The inability to predict future health care needs, the difficulties undereducated people have in negotiating the complex health care system, and the information imbalance make it very difficult for people to articulate their needs, and consumerism is based on being able to demand when and how people want health care services delivered. People disagree as to whether or not health care is a universal human right, but consumerism says that people should dictate when and how they want health care services, not whether or not it is a right. It is true that people cannot generally save or borrow enough money to pay for expensive health care, but this is not related to consumerism because of the advent of insurance, which guarantees continuing payment for services. Prices and salaries and wages do continue to rise, but this does not explain why consumerism is not a good model for health care
The nursing faculty member explains that paternalism refers to:
A. the physician must understand new ethical and professional standards.
B. the patient is responsible for obtaining health care knowledge.
C. the government imposed strict regulations on patient consent.
D. the belief that physicians know more about the patient’s needs than the patient does.
Answer: D
Paternalism refers to the presumption that health care providers know more about the patient’s health needs than the patient does.
Bills that include funding requests are known as __________ bills.
A. authorization
B. finalized
C. funded
D. supplemental
Answer: A
Bills that contain requests for funding are known as authorization bills. A finalized bill might be one that has passed both houses and has been resolved in conference committee, but the chapter does not discuss finalized bills. A program or mandate gets its funding via authorization bills. A supplemental bill might be used to provide funding for emergencies that were not anticipated and therefore not funded.
What terms and definitions about role stress does the nurse learn? (Select all that apply.)
A. Role ambiguity: expectations of a role are not clearly defined
B. Role conflict: personal values conflict with job requirements
C. Role discrepancy: conflict between conception and expectation of a role
D. Role extension: expansion of duties associated with a role
E. Role overload: demands of the role are overwhelming and endless
Answer: A, C and D
ANS: A, C, D
Role ambiguity occurs when the expectations of a role are not clearly defined. Role discrepancy is a situation where a person’s conception of a role does not match the reality of that role. Role extension occurs as the duties associated with a specific role expand. Role conflict is the state of stress that occurs when a person struggles to meet the demands of two roles. Role overload is a situation in which the time and resources allotted for a given role are insufficient to meet the role expectations.
Define
Assault
Battery
restraints
false imprisonment
Assault: unwanted physical contact
Battery:refers to the actual act causing the physical harm.
restraints: physical(ties)or chemical(medication)
false imprisonment: holding against will.
A nurse wishes to get a job in a large city with many hospitals from which to choose but is dismayed to learn that the wages for nurses are nearly as low in the city as in the rural area where the nurse lives. The nurse concludes that:
A. city hospitals have agreed on wage levels for nurses.
B. demand for nurses in the city is similar to the rural area.
C. state government has mandated wage scales for nurses.
D. the cost of living in the city is similar to the rural area.
ANS: A
The situation of low wages and a nursing shortage is an economic contradiction. The model of monopsony describes a situation in which a market containing few hospitals will set a nurse’s wage according to the returns that the nurse brings to the organization; hence, in that organization, wages stay low despite a nursing shortage. In markets with more opportunities for nurses, wages are more competitive. In this situation, the nurse concludes that the city hospitals have created an artificial monopsony model by banding together to set wages for nurses contrary to market principles. The relative demand might be the same, but the sheer number of hospitals in a city compared with a rural area would mean that there were more organizations competing for nurses, leading to higher wages.
Although it is possible for a state government to mandate wage scales for nurses, it is not probable. Costs of living in the city and rural area might be comparable, but the larger number of hospitals in the city should equate to higher demand and therefore higher wages for nurses.
A patient is in pain and requests pain medication. The nurse sees that it is too early to administer the medication. Practicing under the principle of veracity, the nurse should:
A. bring the medication a little bit early to give the patient pain relief.
B. call the physician and request an extra dose of the pain medication.
C. sit with the patient and offer nonpharmacological pain interventions.
D. tell the patient when to expect the medication and bring it on time.
Answer: D
Keeping one’s word by returning when the patient expects upholds the principle of veracity, which involves telling the truth and not deceiving others. Giving the pain medication a little early would not be upholding the principle of veracity, which involves telling the truth and not deceiving others. Calling the physician and requesting an extra dose of the pain medication might be a good intervention, but this is not related to veracity, which involves telling the truth and not deceiving others. Nonpharmacological interventions might help reduce the patient’s pain, but this is not related to veracity, which involves telling the truth and not deceiving others.
Reconciliation bill:
Pork barrel deal:
Consolidation budget:
Appropriation bill – approve funding for running the federal environment each fiscal year.
Reconciliation bill – Congressional Budget Office review and calculation of the actual cost of federal government and considers how a particular appropriation fits into the proposed budget.
Pork barrel deal – concession to appease disagreements that cause delays in mandated federal approval in congress.
Consolidation budget: is a combination of appropriation bills by the end of the congressional sessions in April.
A student of nursing history understands Nightingale’s use of the term “art” when describing nursing as having what context?
A. Care activities that were driven by experience and intuition
B. Little scientific knowledge on which to base most nursing actions
C. Nursing roles that were fluid and defined by context and environment
D. Patient preferences dictating nursing actions when providing care
ANS: C
Nightingale viewed nursing as an art and, as such, the various roles in nursing as multilayered and fluid defined by the context and demands of the environment in which that nurse works. Although care activities were often driven by experience (“tried and true”) and there was little scientific knowledge on which to base nursing actions, these are not the main reason for the use of the term “art.” Patient preference has just begun to be incorporated into evidence-based practice.
A nurse administered the wrong dose of insulin to an assigned patient after bypassing the facility policy to have insulin doses double checked. The patient’s blood glucose level remained within normal limits afterward, and the physician was notified per protocol. The patient and family were extremely upset and demanded to be moved to another floor. Later, the patient filed a malpractice suit against the hospital. The nurse lawyer reviewing the case would conclude that:
A. malpractice occurred because the patient had emotional distress.
B. malpractice occurred because the nurse didn’t follow the policy.
C. no malpractice occurred because most nurses don’t verify insulin.
D. no malpractice occurred because there were no actual damages.
ANS: D
The four elements of malpractice are duty, breach of duty, causation, and damages. Because this patient did not have damages, as evidenced by normal blood glucose levels afterward, a case of malpractice would likely not prevail. The four elements of malpractice are duty, breach of duty, causation, and damages. Emotional distress might be a type of nonpecuniary damage, but the patient would have to prove the nurse caused it. However, because there were no physical damages, it would be difficult to win a case based solely on emotional distress. The four elements of malpractice are duty, breach of duty, causation, and damages. The nurse clearly breached the duty by not following policy to double-check insulin. However, the patient did not suffer any damages, so a malpractice claim would likely not prevail. The four elements of malpractice are duty, breach of duty, causation, and damages. Even if it is common practice to sidestep policy, the nurse still has the duty to follow it. However, the patient had no damages, so a case of malpractice would likely not prevail.
MULTIPLE ANSWERS. Select all that apply. Market failure is the inability of patients and health care providers to strike a balance in the supply and demand for health care. What are the supply-side drivers that contribute to market failure?
A. Cost of hospital care
B. Access to health care C. Medication costs D. Government mandates E. Third-party insurance
Answers: A, B and C
Supply-side drivers to market failure include cost of hospital care and HCP services + access to health care – prohibitive costs of tests and medications + medical outcomes
Demand-side drivers to market failure include third-party insurance mechanisms.
A patient asks, “I have family members who had breast cancer, would it be helpful for me to have if I have genetic markers?” The nurse realizes that the patient may most likely be asking for which genetic test?
A. Research testing B. Predictive testing C. Diagnostic testing
D. Carrier testing
Answer: B
Predictive testing – refers to testing for certain conditions that the patient may be at higher risk when compared to the general population. This patient has relatives who had breast cancer.
Carrier testing – having a copy of a mutation or polymorphism that can cause a disease.
Diagnostic testing – helps with treatment decisions
Research testing – learning more about the genes and general knowledge of genetics.
A nursing manager is concerned about staffing levels and their impact on patient safety. What action by the nurse would have the best chance of influencing this issue?
A. Call senators from the state, explaining the need for staffing laws.
B. Donate money to the American Nurses Association for lobbying.
C. Organize a petition drive calling for a city ordinance on staffing.
D. Work with the state nurses association on related state legislation.
Answer: D
The nurse should work with the state nurses association in that state because state legislatures typically are the level of government to regulate nursing working environments, including staffing levels. Mandatory staffing issues are typically taken up at the state level. The American Nurses Association is a strong force to join, but staffing levels are typically mandated at the state level. A city ordinance would not be an effective way to ensure safe staffing levels.
Define or summarize nursing theory below
1. Kristen Swanson theory of caring
2.Leininger's theory
3. Nightingales theory
4. Cornelia M. Ruland and Shirley M. Moore. Peaceful End-of-Life Theory
1. Caring is a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.•Nursing – informed caring for the well-being of others.•WHO and WHAT influenced her: women who experienced miscarriage, caregivers of infants in NICU, and interview of socially at-risk mothers.
2.Leininger's theory is to provide care measures that are in harmony with an individual or group's cultural beliefs, practices, and values. In the 1960's she coined the term culturally congruent care, which is the primary goal of transcul- tural nursing practice.
3. Nightingale’s Environmental Theory: The environment is critical to health. The nurse must provide a clean, quiet, peaceful environment to facility and encourage healing.
4.Cornelia M. Ruland and Shirley M. Moore. Peaceful End-of-Life Theory.•Focus: Provide a peaceful and meaningful living in the time that remains for patients and their significant others.•Purpose: Reflect the complexity involved in caring for terminally-ill patients.
A faculty member explains to students that laws regulating state nursing licensure incorporate which actions? (Select all that apply.)
A. Disciplining licensees
B. Entry into the profession
C. Establishing curricula
D. Handling nurse imposters
E. Safeguarding nurses’ rights
ANS: A, B, D
Disciplining nurses who fail to meet minimum standards is done through state licensure statutes. Entry into the profession is regulated through state licensure statutes. Responding to “nurse imposters” does fall under state licensure statutes. Establishing curricula for nursing schools does not fall under state licensure statutes. Safeguarding nurses’ rights does not fall under state licensure statutes.
Define the following:
Complements
Substitutes
Monopsony
Supply
Demand
Moral hazard
Marginal utility
Market failure
Risk pooling
Compliments: addition to. "An increase in the use of healthcare provider causes a increase use in nursing services"
Substitutes: in replace of. "The privison of similar services. ex: the use of registered nurses and licensed vocational nurses"
Monopsony:A Dominant employer controls the demand for nurses. All persons who do the same work get the same wage.
Supply:depends on a nurse being licensed and contributing to the workforce.
Demand: The patients ability/willingness to pay for services
Moral Hazard: Changes in behavior based on insurance coverage. (pg123)
Marginal utility:extra satisfaction, welfare or well-being gained from consuming one more unit of goods and services. (example: buying insurance to cover in case)(pg123)
Market failure:characerized by the inability of buyers and sellers to strike a balance in the supply and demand of goods and services and ultimately fail to provide a socially desirable level of output. (pg124)
Risk pooling:insurance spreads risk across a group of people and involves a series of trades between people. (pg123)
MULTIPLE ANSWERS. Select all that apply. Early palliative interventions:
A. Promote nutrition and hydration
B. Increase care discussions
C. Lower depression
D.Improve quality of life
E.Treat underlying disease
Answer: B, C and D
The other options are not necessarily associated or linked with palliative care. They may be patient and family preferred care options.
A student nurse understands that state nurse practice acts delineate: (Select all that apply.)
A. eligibility for licensure.
B. national accreditation standards.
C. required educational preparation.
D. rules for members of compacts.
E. scope of practice for nurses.
Answer: A, C and E
Eligibility for licensure is explained in the individual state nurse practice acts. The required educational preparation nurses must obtain is included in state nurse practice acts. The scope of practice for nurses is outlined within each state’s nurse practice act. Nursing students have to graduate from a program approved by the state board of nursing, but this program does not have to have national accreditation. State compacts allow nurses who have licenses in one member state to practice nursing in the other member states without having to get another license. Rules for these compacts are not included in the state nurse practice acts. These compacts were developed by the National Council of State Boards of Nursing.