RN-BC: Medical-Surgical Certification Review

RN-BC: Medical-Surgical Certification Review Nursing Code of Conduct Correct Answer: • Participating in intra-professional collaboration • Avoiding conflicts of interests • Maintaining respect for human dignity • In ...

RN-BC: Medical-Surgical Certification Review Nursing Code of Conduct Correct Answer: • Participating in intra-professional collaboration • Avoiding conflicts of interests • Maintaining respect for human dignity • Integrating professional values with personal values The Code of Ethics from the American Nurses Association (ANA) states in point 5.3: "Nurses have both personal and professional identities that are neither entirely separate, nor entirely merged, but are integrated. In the process of becoming a professional, the nurse embraces the values of the profession, integrating them with personal values. Duties to self involve an authentic expression of one's own moral point-of-view in practice. Sound ethical decision-making requires the respectful and open exchange of views between and among all individuals with relevant interests." Nursing Ethics Correct Answer: Ethics: moral principles that govern behavior; ideal, standards Principles: • Autonomy: duty to allow patient to make independent decisions • Veracity: duty to tell the truth • Fidelity: duty to keep promises and commitments • Justice: duty to provide equal and fair distribution of resources • Beneficence: duty to promote good and take positive actions • Nonmaleficence: duty to do no harm and avoid negative actions • Confidentiality: duty to keep some information from disclosure without consent • Privacy: duty to protect physical body or information from unauthorized view Ethical Dilemmas Correct Answer: Issues surrounding quality-of-life, end-of life, and DNR orders most often trigger ethical dilemmas, when no clear course of action is apparent. Obtain a referral to ethics committee for disagreements about treatments: • Between family members • Among healthcare providers • Between healthcare providers and the patient or family Advocacy Correct Answer: What it is: action or series of actions that argues for, speaks in favor of, recommends, or supports another person, place, or thing Nursing Advocacy: • Integrates individuality, professionalism, and empowering • Involves a process of analyzing, counseling, responding, and shielding An effective nursing advocate actively participates in supporting patients' wishes and needs through listening, educating, and collaborating. The ANA 2001 Code of Ethics includes: • The nurse's primary commitment is to the patient, whether an individual, family, group, or community. • The nurse promotes, advocates for, and strives to protect the health, safety, and rights of the patient. (ANA, 2001) Kubler-Ross Stages of Grief Correct Answer: Patients, families, and other caregivers can progress through these stages. • Denial: avoiding the inevitable • Anger: expressing emotions previously bottled-up • Bargaining: trying to find a way out • Depression: acknowledging the inevitable • Acceptance: moving forward Leadership Styles Correct Answer: Autocratic: unilateral, dictatorial, works toward single goal; meets resistance from mature, experienced staff Democratic/participative: team approach, staff participation, retains responsibility for outcome Laissez-faire: little control; leaves decision to others; works well with committed, motivated staff who can analyze well Charismatic: trigger emotional response; eloquent communicator and persuader Transformational: connection between leader and follower increases motivation for problem -solving Transactional: compliance via reward/ punishment system Quantum: flexible, non-controlling, analytical, empathetic, visionary team player Situational/Contingency: match style to situation; high-stress situations are best handled by task-oriented leaders; moderate situations are best handled by relationship-oriented leader Shared Governance Correct Answer: What it is: • A model of nursing practice designed to improve work environment, satisfaction, and nurse retention • Champions staff as most important asset of organization • Encourages autonomy, empowerment, involvement, and participation • Teams and groups are designed to be self-led and self-managed Nursing Application: Bedside nurses are given equal footing with managers and leaders in the creation of policies, procedures, and other decision-making processes that directly affect nursing practice within the organization. Adult Learning Correct Answer: The education process should reflect the nursing process (assess, plan, implement, evaluate) • Multiple sensory avenues for learning increases learning and retention. • Doing and saying (teach-back) is more effective than reading and hearing. • Learning needs: patient goals met through instruction • Non-learning needs: patient goals met through something other than instruction or in combination with instruction Basic Learning Styles: • Visual: reading instructions or watching demonstration • Hearing: listening to instructions while performing • Tactile: hands-on Learning Barriers Correct Answer: Physical Impairments: inadequacies of the five senses; impaired mobility • Cognitive: mental disability or impairment; dyslexia, phobias • Language: aphasic; lack of fluency, reads at less than 8th grade level • Emotional: fear/superstitions, anxiety, depression • Religious/cultural: values differ, beliefs focus on healing from a higher power, dietary restrictions • Financial: patient perception that they are unable financially to follow recommended plan of care Teaching Strategies—Adults Correct Answer: Assess: mental and physical capabilities, perception of the problem, preferred learning style Plan: establish mutual goals with patient that are specific, practical, attainable, relevant, and culturally sensitive Intervene: use multiple methods to enhance learning; ensure methods use vocabulary suited to learner's comprehension - Oral, written, or electronic information via internet - Visual/pictorial information such as DVDs and charts - Demonstration and return demonstration - Peer learning - Group work Evaluate: observe the patient/family implement new skills, request a "teachback" from the patient; assess comments and conversations for misinformation or gaps in learning Maslow's Hierarchy of Needs Correct Answer: Physiological: basic needs such as air, water, food, shelter, and freedom from pain (comfort) Safety: free from harm or threat of harm; stability Love/Belonging: friendship, acceptance, affection; support system Esteem: self-respect, self-confidence, rewarding work/relationships Self-actualization: truth, justice, beauty, personal growth, "born to do" These drives (needs) are met in order from physiological to self-actualization. Illness can change a patient's focus to meeting basic needs as the priority. Nursing Diagnoses, Domains Correct Answer: NANDA-II taxonomy, 13 Domains (47 Classes, 216 Diagnoses) • Activity/Rest • Comfort • Coping/Stress Tolerance • Elimination • Growth/Development • Health Promotion • Life Principles • Nutrition • Perception/Cognition • Role Relationships • Safety/Protection • Self-perception • Sexuality Nursing Diagnoses, Format Correct Answer: Diagnosis: (example) Imbalanced nutrition: Less than body requirements Related to: (example) Insufficient caloric intake Evidenced by: (example) Weight loss Expected Outcomes: (example) The patient will achieve and maintain adequate weight (use NOC terminology) Nursing Interventions (independent/collaborative): Use words such as assess, monitor, teach, assist, provide, and record. For collaborative, use words such as obtain consult and administer medications, tube feedings, etc. (refer to NIC terminology) Evaluation: (example) The patient achieves and maintains optimal weight. Nursing Intervention Classification Correct Answer: What it is: A list of 554 interventions (in 2013 6th ed.) that nurses perform; includes direct, indirect, collaborative, and independent interventions that address both physiologic and psychosocial aspects of patient care. Interventions fall into three categories: illness prevention, illness treatment, and health promotion. Nursing Application: The standardized language of these interventions should be used when creating patient care plans. The interventions are sorted into 7 domains: Physiological: basic, Physiological: complex, Behavioral, Safety, Family, Health System, and Community. Nursing Outcomes Classification Correct Answer: What it is: A system which describes patient outcomes sensitive to nursing intervention; includes 490 outcomes in the 5th edition (2013); a means of standardizing nursing language used in the nursing process, similar to NANDA for diagnoses, and NIC for nursing interventions, NOC language is for outcomes Nursing Application: The use of NOC outcomes provides a standardized, measurable terminology that all health care providers can understand and use. These outcomes are used when formulating care plans, and are individualized to each patient by the addition of "indicators." Each indicator is ranked from 1 (extremely compromised/severe) to 5 (not compromised/ none) based on patient presentation. Problem Prioritization Correct Answer: What it is: A means of focusing nursing interventions on the most important patient problems; usually follows Maslow's Hierarchy and the ABCDE mnemonic. Nursing Application: Once immediate ABC needs are met, the patient and family should participate in formulating the plan of care, including prioritization. What a nurse perceives as a priority may not be a priority in the patient's mind. Assess the patient's thought processes through therapeutic communication, and determine a course of action "with" the patient (not "for" or "to"). Collaboration with the primary practitioners and therapists will further support autonomy while promoting excellent patient care (as defined by the patient). Collaboration Correct Answer: What it is: A dynamic process that produces a synthesis of perspectives and shared responsibilities to address a problem set that cannot be handled by a single individual Nursing Application: The team approach is essential to patient care. Collaboration among patients, families, practitioners, nurses, therapists, technicians, and others leverages group thought and resources to manage complex patient care through all levels of health. Successful collaborators understand their own biases, know how to manage diversity, can resolve conflicts constructively, have interpersonal skills, understand values of other team members, and are able to maintain focus on meeting the patient's needs instead of exercising power plays to their own advantage. Core Measures Correct Answer: Standards of care that improve patient care and outcomes • Data is submitted to CMS (Medicaid/ Medicare) and TJC • Includes reports on diseases/conditions seen, hospital-acquired conditions, Emergency Department (ED) care, and the Surgical Care Improvement Project (SCIP) Diseases: • Acute MI • Heart failure (HF) • Pneumonia (PN) • Venous thromboembolism (VTE) • Stroke (STK) • Children's Asthma Care (CAC) Core Measures: Reportable HospitalAcquired Conditions Correct Answer: Foreign object retained after surgery • Air embolism • Blood incompatibility • Stage 3 and 4 pressure ulcers • Falls and other traumas • CAUTIs (urinary catheter infections) • Vascular catheter-associated infections • Manifestations of poor glycemic control • Surgical site infections (CABG, ortho, bariatrics) • DVT and PE after ortho procedures Core Measures: Prevention Correct Answer: Core Measures also address prevention. Sets of data collected are listed. • Immunization (IMM): pneumococcal immunization rates for overall, age 65+, and high-risk groups ages 5-65; influenza immunization rates • Tobacco Cessation (TOB): screening, treatment provided or offered, treatment, treatment provided or offered at discharge, treatment at discharge, and assessing status after discharge • Substance Abuse (SUB): alcohol screening, alcohol brief intervention provided or offered, alcohol brief intervention, alcohol and other drug use disorder treatment provided or offered at discharge, alcohol and other drug use disorder treatment at discharge, assessing status after discharge Health History Components Correct Answer: Biographical info (demographics): patient registration form, psychosocial data • Chief complaint (CC): reason for visit; patient's exact words; include how long complaint has been going on (i.e., "belly's been hurting for two days") • Health History (HPI, Hx): more details about chief complaint; progression of symptoms; include onset, duration • Past Medical Hx: childhood to adult, meds, foods, habits (ETOH), herbal remedies, sexual hx • Family Hx: notable medical conditions of parents, siblings, and grandparents • Review of Systems: head to toe, identify health concerns that may not have already been discussed, any problems with ADLs HPI Details Correct Answer: Under HPI (history of present illness), include the following: Onset—"when" Duration—"how long" Location—"where" Quality—"what type" Quantity—"how many/much" Precipitating Factors—"what makes it worse" Alleviating Factors—"what makes it better" Can also use PQRST: Provocative/palliative, Quality/quantity, Region/radiation, Severity/pain, Timing Allergies/Sensitivities Correct Answer: Remember, any substance has the potential to cause a reaction. Ask about: • Foods: eggs (vaccinations), shellfish (iodine), peanuts, lactose intolerance, meat (vaccinations and insulin) • Medications: especially the ones used to TREAT allergic reactions (antihistamines, H2 blockers, steroids, etc.) • Herbs and supplements: any reactions to OTC formulas • Environmental: cleaning chemicals, soaps or detergents, pollen, perfumes, bees • Family Hx: any medication or food allergies in immediate family; helps identify potential risks if the patient has yet to be exposed to certain medications in his lifetime • Anything else that 1) causes a rash or itching, or 2) causes difficulty breathing Medication Allergies Correct Answer: Penicillins: MAY tolerate 2nd/3rd generation cephalosporins, use with caution; also use aminoglycosides, quinolones, macrolides, and tetracyclines • Cephalosporins: Avoid any of the "Cef-" or "-ceph-" meds (ceftriaxone, cefixime) • Sulfa: avoid any of the "sulfa-", "zulf-" meds, combination ABx (Septra, Bactrim), dapsone, and suspect other sulfonamides such as glyburide, glimepiride, celecoxib, sumatriptan, furosemide, and HCTZ; HIV patients may have increased sensitivity to sulfa meds