N4: Exam 3 - Nursing Jurisprudence Questions and Answers Already Passed

Document Content and Description Below

N4: Exam 3 - Nursing Jurisprudence Questions and Answers Already Passed What is nursing jurisprudence? the application of the principles of law as they relate to: -the practice of nursing -obliga ... tions of nurses to their patients -relations of nurses with each other & HCPs What are nursing ethics? moral values, duties, and commitments of nurses in their practice The mission of TBON is to protect and promote welfare of: the people Nursing Jurisprudence Exam Based on NPA and TBON rules and regulations 50 Questions (38Q/75% is passing) Must pass before you can take NCLEX Can take ~10 days after applying to TBON May retest if unsuccessful Who represents their members? Professional organizations Who represents the people of Texas? Texas BON Who cannot lobby legislature? Texas BON Who regulates practice settings to improve work conditions and benefits for nurses? Professional associations TBON services: licensing, enforcement services, audit of CEUs, information services Non-BON services: job referrals, legal referrals, salary questions, co-worker disputes, employment issues TBON Licensing: GN permit lasts for 75 days or until pass/fail of NCLEX TBON Licensing: Notification of license renewal You will receive postcard 60 days prior TBON Licensing: Continuing Education Must complete 20 hrs every 2 years First renewal period is exempt CE hours must be in area of practice Keep records for 4 years in case of audit TBON Licensing: Initial licensure criteria -submit & pass background check -submit application fee -verified completion of nursing program -keep up with financial aid/loan payments -pass NJE -pass NCLEX NCLEX info: # of questions: 75 minimum, 265 maximum test is adaptive to knowledge base. TBON ID regulation You may not call yourself a nurse without a license. Name badge with license level worn at all times. Disclosure of criminal behavior (rule 213.28) You must report any past criminal behavior or pending changes. Minor class C misdemeanors are excluded (ex. parking tickets) Five categories of trust cited by BON: 1. Honesty (ex. accurate/reliable documentation) 2. Accountability (ex. knowing actions/SE of meds) 3. Trustworthiness (ex. following proper procedure with pt valuables) 4. Reliability (ex. keeping up with CEUs) 5. Integrity (ex. accepting accountability of own actions) Good professional character means: -distinguish right from wrong -think and act prudently -keep promises / honor obligations -be accountable -promptly disclose info to enhance pt health/protect from harm -have courage, temperance, liberality, wittiness, modesty, greatness of soul, good temper, gentleness, and be aggreable Professional boundaries You must maintain professional boundaries: -Physical: no inappropriate contact/contact that can be misinterpreted -Sexual: no sexual relations with patients -Emotional: don't let attachment to pts hinder care for others -Financial: don't accept personal gifts/exploit others Standards that apply to RN -make nursing diagnosis -develop care plans -evaluate patient response to care -perform comprehensive assessments -delegate tasks to UAP -practice independently with BON/NPA rules -educate for all patients Standard that apply to LVN -participate in planning care -assist with patient evaluation -perform *focused* assessments -implement certain aspects of care -practice as supervised -reinforce patient teaching Duty to the patient the nurse's obligation to the patient supersedes facility policies. physician orders/facility policy cannot override NPA/BON Be familiar with the Lunsford vs. BON case: https://www.leagle.com/decision/19831039648sw2d39111001 6 step decision making process for nurses: Step 1 Is the activity consistent with NPA/BON rules? No: STOP Yes: Continue 6 step decision making process for nurses: Step 2 Is the activity appropriately authorized? Is there a valid order? Is there a curent policy regarding the procedure? No: STOP Yes: Continue 6 step decision making process for nurses: Step 3 Is it supported by nursing research? Is there a nursing organization statement supporting it? No: STOP Yes: Continue 6 step decision making process for nurses: Step 4 Do you possess the required knowledge and competency to carry out the act? No: STOP Yes: Continue 6 step decision making process for nurses: Step 5 Would a reasonable and prudent nurse perform this activity in this setting? No: STOP Yes: Continue 6 step decision making process for nurses: Step 6 Are you prepared to accept the consequences of your actions? No: STOP Yes: Perform the activity based upon valid order, in accordance with appropriately and established policies & procedures, and as safely as possible. Delegation is: authorizing UAPs to provide nursing services while retaining accountability for how the person performs the task. does not include when UAP is assisting in the presence of an RN. Assignment is: routine care, activities, and procedures that are within the scope of practice of the RN/LVN or part of routine functions of the UAP. Be familiar with the Delegation Resource information: https://www.bon.texas.gov/practice_delegation_resource_packet.asp Five Rights of Delegation 1. Right task 2. Right circumstance 3. Right person 4. Right direction/communication 5. Right supervision/evaluation What can an RN NOT delegate to LVN/UAP? Nursing assessments Plan of Care Professional Judgement/Intervention Initial Teaching Medication Admin (Including IV fluids) in acute care settings Medication admin and IV fluids may be delegated in what setting?? Independent living situations Minor Incident is: Conduct that does not indicate the nurse's continuing to practice professional nursing poses a risk of harm to the client or other person What situations are NOT minor incidents? - An error that contributed to patient death or harm - Criminal conduct - Serious violation of Unprofessional Conduct - Practice-related violation involving chemical impairment Incident-based Nursing Peer Review For any facility with 10+ nurses. Referrals start with an incident. The purpose is fact finding to detemine if an incident has merit. Safe Harbor Allows a nurse to accept an assignment and provide the best care they are capable of without fear of licensure action if there is a practice error. Before refusing an assignment, remember that: THE PATIENT COMES FIRST A nurse may invoke safe harbor if: - you lack the knowledge to render care - the assignment would constitute unprofessional behavior (fraud, theft, etc) Protection for refusal to engage in certain conduct gives the right to: refuse to engage in conduct if it would violate the NPA/BON rules Safe Harbor must be invoked ___ you engage in the activity. BEFORE Mandatory Overtime: Rule in place to permit nurses to refuse overtime. Defined as requirement to work days/hours in addition to scheduled shifts regardless of length or number of shifts Mandatory overtime is not prohibited when: - there is an ongoing procedure requiring nurse presence - during a distaster - in certain emergenies (aka code blue) Patient abandonment there is no BON rule on when a nurse's duty to the pt begins. good rule of thumb: - if nurse quits (employment issue) - if nurse violates duty to patient (license issue) If you are requested to go to an area you are not familiar with, you as the nurse: - are responsible for safe patient care - may request additional training - may refuse assignment What do you do if you question the safety of an assignment? First: Ask yourself what about the situation makes you uncomfortable. Next: Consider what changes can occur that would make you more comfortable. Then: State your concern, identify your concerns, and give recommendations to modify Listen: to the response. Was your concern understood? If the modification feasible? Disciplinary action can result from: - chemical or alcohol dependency - mental illness - fatigue & sickness What are some red flags that may determine a nurse is not fit to practice? - lack of energy - frequent absences - spike in pt need for pain meds - lateness to work - red eyes - no/unusual documentation - frequently in line to sign out meds Does an actual injury to a patient need to occur to be considered a violation? No! The act itself is a violation. What are examples of unprofessional conduct as a nurse? - drug diversion - unsafe practice - failure to repay student loans - dismissal from peer review assistance program - drug-related actions - criminal conduct Process of an investigation - nurse is notified and invited to respond - investigator gathers and reviews evidence - decision is made - nurse must promptly respond to all requests for info - keep contact info current - do not ignore mail from board Filing a complaint against another nurse: - any violation must be reported - report through chain of command - must be written & signed by person who made the report - include identity of accused - all complaint info is confidential - failure to report is a violation Nurse licensure compact - you must be licensed in home state - can work in an party state with home license - if you move you must update home license within 90 days - must comply with state laws What is one of the primary responsibilities of the Texas Board of Nursing? A.Protecting and advocating for nurses B.Answering employment related questions C.Protecting the interest of the public D.Assisting nurses facing litigation C.Protecting the interest of the public Part of the mission of the BON is to protect nurses against unfair employment practices. A. True B. False B. False The BON can lobby the Texas Legislature to enact laws that help nurses in their profession. A. True B. False B. False Which standard of practice does not apply to all nurses?A.Knowledge of Board rules B.Ability to delegate tasks C.Advocate for patient safety B.Ability to delegate tasks You can rely on your employer to let you know which acts fall within your scope of practice? A. True B. False B. False The Texas Board of Nurse Examiners states specific nursing tasks that may or may not be delegated to a UAP. Which nursing task may be delegated? Select all that apply. A.Writing down a verbal or phone order from the HCP B.Medication administration in an extended care facility C.Evaluation of a client’s mobility status D.Instructing the client and family on proper insulin administration E.Calculating the dose of a simple, routine, oral med B.Medication administration in an extended care facility D.Instructing the client and family on proper insulin administration Which nurse must be reported to the Board of Nursing? A.A nurse who misses a 0900 stool softener and is suspected of chemical abuse B.A nurse who gives 10 mEq potassium chloride when 20 mEq is prescribed C.A nurse who does not notify the HCP of labs that are within defined parameters prior to surgery D.A nurse who does not show up for a shift and fails to notify the hospital A.A nurse who misses a 0900 stool softener and is suspected of chemical abuse A client has pantoprazole sodium (Protonix) 40mg IV Push daily scheduled at 0730. The nurse overlooked the med on the MAR and did not give the med until 1100. According to the Texas BON, the nurse manager should take which action? A.Ask the nurse to complete a medication variance form and track as a minor incident B.Report the nurse to the hospital's Incident Based Nursing Peer Review Committee C.Notify the Texas Board of Nursing and recommend remediation for the nurse D.No action is needed since the medication is ordered daily as long as it is only given once that day A.Ask the nurse to complete a medication variance form and track as a minor incident The nurse who performs which action should be reported to the incident based peer review committee? A.Failure to notify the primary HCP of a serum creatinine level of 0.7 mg/dl B.Administration of Phenobarbital to a client with a Phenobarbital level of 60 mcg/dl C.Timing a trough level to be drawn just prior to the next dose of Vancomycin D.Administration of sodium bicarbonate to a client with an arterial pH of 7.29 B.Administration of Phenobarbital to a client with a Phenobarbital level of 60 mcg/dl A neonatal nurse who has not worked with adults in 10 years has accepted a job at a new facility. The nurse is told when hired that neonatal nurses must float to adult units when the census is down. Which action should the nurse take? A.Have paperwork ready to fill out for Safe Harbor if floating is required B.Ask the Nurse Manager to provide training on the skills necessary to provide safe adult care C.Tell the Nurse Manager this is outside the realm of a neonatal nurse and floating will be refused D.Accept the floating assignment because adult skills were learned in basic nursing education D.Accept the floating assignment because adult skills were learned in basic nursing education Which incident could be considered patient abandonment? A.A med/surg nurse who clocks out after receiving oncoming shift patient report B.A L&D nurse who refuses to care for a patient who plans to abort her pregnancy C.An ICU nurse who, after providing coverage, has left the building in the middle of a shift to smoke D.A home health nurse who refuses to return to a patient's home after learning they have HIV A.A med/surg nurse who clocks out after receiving oncoming shift patient report [Show More]

Last updated: 2 years ago

Preview 1 out of 19 pages