Cliffs Test Prep NCLEX-RN - EXAM

SUBJECT AREA REVIEW SUBJECT AREA REVIEW CHAPTERS CHAPTERS Coordinated Care This chapter contains questions and answers from the following topic areas: ■ Advance Directives ■ Advocacy ■ Client Care Assignments ■ Client Rights ■ Collaboration with Multidisciplinary Team ■ Concepts of Management and Supervision ■ Confidentiality ■ Consultation ■ Continuity of Care ■ Delegation ■ Establishing Priorities ■ Ethical Practice ■ Informed Consent ■ Legal Rights Responsibilities ■ Performance Improvement (Quality Assurance) ■ Referral Process ■ Resource Management ■ Staff Education ■ Supervision (2) The purpose of the PSDA is to promote decision making prior to need. The focus of the PSDA is healthcare decision making. A federal standard for advance directives does not exist. Each state has jurisdiction regarding these policies and protocols. The PSDA emphasizes the need for patient education in order to support an individual’s treatment decisions. (3) The document dated 2003 supersedes the previous version and should be used as a basis for care direction. Choice 1 and 2 are incorrect as the 1998 version is now outdated. Choice 4 is incorrect; the nurse could be held negligent for not responding to the 2003 document as directed. 1. TheintentofthePatientSelfDeterminationAct(PSDA)of1990isto: 1. enhance personal control over legal care decisions. 2. encourage medical treatment decision making prior to need. 3. give one federal standard for living wills and durable powers of attorney. 4. emphasize patient education. 2. Theadvanceddirectiveinyourpatient’schartisdatedAugust12,1998.Thepatient’sdaughterproducesaPower of Attorney for Healthcare dated 2003 that contains different care direction(s). As the nurse you are to: 1. follow the 1998 version because it’s part of the legal chart. 2. follow the 1998 version because the physician’s “code” order is based on it. 3. follow the 2003 version, place it in the chart, and communicate the update appropriately. 4. follow neither until clarified by the unit manager. 17 Part I: Subject Area Review Chapters 3. AnadvancedirectiveiswrittenandnotarizedaccordingtolawinthestateofColorado.Thisdocumentislegal and binding: 1. internationally. 2. in the state of Colorado only. 3. in the continental United States. 4. in the county of origination only. (2) Choices 1, 3, and 4 are incorrect; advance directive protocols and documents are defined by each state. (4) Only the person who delegates authority has the legal right to revoke the authority. Choices 1, 2, and 3, therefore, are incorrect. (3) Each healthcare facility is required to have advance directives on file. Choices 1, 2, and 4 are incorrect as advance directives are not considered confidential information. They are to be shared information in order to ensure their direc- tion will be followed. (2) Eighteen years of age is the minimum legal age for establishing advance directives. (1) 2, 3, and 4 are incorrect. An individual can sign his name on a form without higher level comprehension of what he is signing, it’s appropriateness, and so on. Orientation is one aspect of cognitive function that does not support decision making, concrete thinking, and problem solving. An individual may be able to perform basic activities of daily living (ADLs) but still have impaired thought processes, judgment, and decision making, which are also important factors in competency determination. 4. TheauthorityconveyedtoaPowerofAttorneyisrevocableby: 1. a primary care physician. 2. a court proceeding. 3. the family if all members agree. 4. the person who originally delegated the authority following proper documentation procedures. 5. Copiesofadvancecaredirectivesshouldbe: 1. kept in a safe or safe deposit box only. 2. given to the attorney responsible for preparing the documents. 3. provided to each healthcare institution upon entry for services. 4. kept as private and confidential documents. 6. Thelegalageforexpressingone’swishesthroughanadvancedirectiveis: 1. 21 years. 2. 18 years. 3. 65 years. 4. Any age. 7. Apatientis“competent”whenhe/sheis: 1. able to understand risks and benefits of treatment options and manipulate the information rationally. 2. able to sign a consent form. 3. is oriented to person, place, and time. 4. is able to physically take care of him/herself. 18 (3) The document records contact information of the party named. Choice 1, 2, and 4 are incorrect. A person named as a DPOAHC can be anyone of choice. That person does not have to be any personal or professional relation. The DPOAHC does not have to agree with the designee’s decisions but be willing and able to speak for them should decisions regarding care be needed. (1) Choices 2, 3, and 4 are incorrect according to state law definitions. (2) It is NOT a correct assumption that a patient with an AD is a DNR. Choices 1, 3, and 4 are true as written. Coordinated Care 8. Thenightbeforeanelectivesurgery,aclientasksthenursewhyhewasaskedtocompleteanadvancedirective on admission. The nurse’s best response is: 1. “It’s just a formality.” 2. “This form helps the care team understand your wishes so we won’t be sued.” 3. “It is a legal requirement that all clients entering the hospital have the opportunity to express their wishes through an advance directive.” 4. “Are you worried that you might not live through your surgery?” (3) All patients entering the hospital for any reason are asked to complete advance directives according to JCAHO standards. Choices 1, 2, and 4 are incorrect. Advance directives are more than a formality as they give guidance to treatment based on the individual’s wishes. The guiding ethical principle is patient autonomy, not liability protection for the healthcare providers. Choice 4 is an inappropriate response by the nurse as it reflects that she did not understand or interpret the patient’s original question. 9. AsthenursecaringforMrs.Peet,youdiscoverduringheradmissionassessmentthatshedoesnothaveadvance directives. She asks whether there are any specific rules about naming a Durable Power of Attorney for Healthcare (DPOAHC) or document requirements. You accurately answer: 1. “A person designated DPOAHC must be a family member.” 2. “A DPOAHC must be a lawyer.” 3. “The DPAOHC document must include the name, address, and contact information of the party named.” 4. “The individual named as DPOAHC must agree with the designee’s decisions.” 10. Forindividualswhoarenolongercapableofspeakingforthemselves,theorderofsurrogacyfortheirhealthcare decision making is: 1. guardian, DPOAHC, spouse, adult children of patient, parents of patient, adult brothers and sisters of patient. 2. spouse, DPOAHC, parents of patient, adult children of patient. 3. DPOAHC, spouse, adult children of patient, adult brothers and sisters of the patient. 4. spouse, guardian, adult children of patient, DPOAHC. 11. IntherelationshipbetweenDNRordersandadvancedirectives(AD),allofthefollowingaretrueexcept: 1. an AD may help a physician decide whether a DNR order is the “right” decision for a particular patient. 2. it can be assumed that a patient with an AD is a DNR. 3. an AD is not necessary in order for a physician to write a DNR order (with the exception of New York State). 4. a hospital-based DNR order should not require the patient’s or family’s signature but does require the physician’s signature. 12. Patientself-determinationistheprimaryfocusof: 1. malpractice insurance. 2. nursing’s advocacy for patients. 3. confidentiality. 4. healthcare. 19 Part I: Subject Area Review Chapters (2) Advocacy for patients by nurses is centered around the patient’s right to autonomy and self-determination. Confidentiality involves the maintenance of the privacy of the patient and information regarding them. Malpractice insurance is a type of insurance for professionals. (4) The nurse acts as an advocate for the nursing profession by encouraging appropriate persons to become nurses, by being a positive role model and mentor, and by communicating the needs of nurses to those making the laws in the most professional manner possible. (2) Nurse advocates work with patients to provide information and assistance in decision making. The decisions and care that occur from these decisions are based on the right of the patient to self-determination and the work of the nurse advocate supports this right. (3) Nurse practice acts are based in state law, not federal law, as mandated for the advocacy of nurses; JCAHO, ANA, and institutional review boards all support nurse advocacy. (1) An ombudsman is an individual who works for the government or an institution to investigate consumer complaints. The goal of the ombudsman is fair investigation, reporting, and resolution of the complaint. (4) Any and all of these organizations provide advocacy services to older persons. 20 13. Thenurseactsasanadvocateforthenursingprofessionbyallofthefollowingexcept: 1. encouraging political involvement by nurses with their legislators. 2. acting as a first-aid provider for a children’s athletic team. 3. precepting newly licensed nurses in the work situation. 4. encouraging as many persons to become nurses as possible. 14. Anursingadvocateisonewho: 1. makes decisions for others. 2. encourages people to make decisions for themselves and acts with or on their behalf to support those decisions. 3. manages the care of others. 4. is the legal representative for a person. 15. Allofthefollowingsupportthenurseasapatientadvocateexcept: 1. ANA Code of Ethics for Nurses. 2. institutional review boards for the protection of human subjects engaged in research. 3. federal nurse practice acts. 4. JCAHO. 16. Anombudsmanis: 1. an individual, usually an employee of the government or an institution, who investigates consumer complaints and assists in achieving a fair resolution. 2. a lawyer designated to try a case. 3. an individual hired by a family as their representative. 4. a family member designated to make decisions for an individual. 17. Inadditiontoanursingadvocate,anolderadultmightutilizewhichoftheseadvocacygroups? 1. AARP 2. Gray Panthers 3. National Committee to Preserve Social Security and Medicare 4. all of the above Coordinated Care 18. Advocacyisdefinedas: 1. helping another. 2. arguing, supporting, or defending a client’s cause. 3. the principle of doing no harm. 4. a duty to do good. (2) The definition of advocacy is to argue, support, or defend a client’s cause. Providing assistance is helping another; the principle of doing no harm is nonmaleficence; beneficence is the duty to do good. (3) When a patient is not autonomous, the nurse must rely on the principles of doing no harm and doing good, or non- maleficence and beneficence, in order to assist in meeting the healthcare needs of the person to the best of the nurse’s ability. (1) Family members, healthcare professionals, ombudsmen, and persons designated as such, act as advocates for clients and patients. (2) Nursing organizations utilize political action committees within their organizations in order to represent the needs of their membership to legislative and organizational persons. (4) In a healthcare setting, all members of the interdisciplinary team are expected to act as advocates for the patient. 19. Whenpatientscannotmakedecisionsforthemselves,thenurseadvocatereliesontheethicalprinciplesof: 1. justice and beneficence. 2. fidelity and nonmaleficence. 3. beneficence and nonmaleficence. 4. fidelity and justice. 20. Clientadvocatesmightincludeallofthefollowingexcept: 1. creditors. 2. family members. 3. nurses. 4. social workers. 21. Politicalactioncommitteesinnursingorganizationsactasadvocates: 1. for legislators. 2. for members of the nursing organizations. 3. for clients. 4. for collective bargaining or union groups. 22. Inanacutecarehospital,thepatientmightexpectwhichpersonstoactasadvocatesforhim/her? 1. the nurse 2. the social worker 3. the physical therapist 4. all members of the interdisciplinary team caring for the patient 23. Anursecasemanager’sfocusis: 1. nursing care needs only on discharge. 2. the comprehensive care needs of the client for continuity of care. 3. patient education needs upon discharge. 4. financial resources for needed care. 21 Part I: Subject Area Review Chapters (2) By definition, case management is a process of providing for the comprehensive care needs of the client for conti- nuity of care through the healthcare experience. (2) The physician is an integral part of the case management process in terms of assisting with defining the patient’s needs and the time frames for movement through the healthcare system; however, the physician is the expert for med- ical diagnosis and treatment rather than resource utilization. (4) Clinical pathways include maps of care outcomes to be achieved prior to discharge or movement through a health- care system. Insurance review for reimbursement is a function of an outside agency from the healthcare provider related to the amount of expected monetary compensation for services rendered to a patient. (4) The correct team for case management will include those professionals whose expertise is needed to meet the conti- nuity of care needs of the patient. 24. Thephysician’sroleincasemanagementincludesallofthefollowingexcept: 1. participate in interdisciplinary planning for patients. 2. serve as the expert for resource utilization. 3. consult with the case management team in order to facilitate timely orders as needed. 4. contribute to the documentation of the patient’s needs for services. 25. Acasemanagementclinicalpathwayforcongestiveheartfailuremightincludeallofthefollowingexcept: 1. physician follow-up appointments with transportation. 2. patient education regarding medication usage. 3. nutritional consult for diet review and accommodation. 4. insurance review for reimbursement. 26. Casemanagementinvolveswhichdisciplinesforeffectiveplanning? 1. nursing, therapy, social work 2. nursing only 3. nursing, medicine, therapy, social work 4. an interdisciplinary team including medicine and nursing based upon the patient’s individualized needs 27. An80-year-oldclientisbeingdischargedfromthehospitalafteratotalkneereplacement.Heronlysonhas decided to take care of her at his home. During discharge planning, it is most appropriate for the nurse to ask the son: 1. “Are you sure this is the best thing for you to do?” 2. “Will caring for your mother affect your lifestyle?” 3. “Do you own your own car?” 4. “Is your home paid off?” (2) This open-ended question allows the son to express his thoughts and feelings regarding his mother’s needs for care and changes that he may expect while he is providing this care. Information on his personal financial situation (ownership of home or car) or questioning his decision making in taking his mother home does not contribute to the plan of care. 28. Casemanagersworkinwhichofthefollowingsettings? 1. hospitals and insurance companies 2. nursing homes only 3. community agencies 4. all of the above 22 (4) Case managers work in many different healthcare sites in order to encourage continuity of healthcare and provide services to a diverse group of clients. (2) Community-based case management has the goal of support and empowerment of individuals to reach their optimal level of wellness through the use of community resources. (1) Financial planning for individuals is not a role of a case manager. Case managers function as clinical experts, organizers of care, patient educators, monitors and evaluators of outcomes, and patient advocates. (4) Managed care has decreased the length of stay in hospitals, increased the use of home care services, encouraged technology use, and assisted in focusing healthcare on outcomes management. (2) The correct sequence of the case management process is assessment, planning, implementation, coordination, monitoring, and evaluation of care. (4) Standards of professional care, protocols for healthcare delivery, clinical guidelines and pathways, law, and facility protocols all guide case management processes. Coordinated Care 29. Community-basedcasemanagementhasthegoalof: 1. utilizing only community-based agencies. 2. optimizing health for community-based individuals. 3. only completing discharge plans from the hospital-based case manager. 4. managing illness-related states while excluding health promotion and wellness concerns. 30. Casemanagersfunctionsencompassavarietyofrolesincludingallofthefollowingexcept: 1. financial planner. 2. clinical expert. 3. patient educator. 4. outcomes manager. 31. Theeffectofmanagedcareinhealthcaresystemshasbeento: 1. decrease length of stay in hospitals. 2. support the increased use of new technology. 3. focus care strategies on outcomes of care provision. 4. all of the above. 32. Thesequenceofthecasemanagementprocessusedbynursesis: 1. implementation, coordination, planning, evaluation, assessment, and monitoring. 2. assessment, planning, implementation, coordination, monitoring, and evaluation. 3. assessment, planning, coordination, implementation, monitoring, and evaluation. 4. assessment, planning, evaluation, coordination, monitoring, and implementation. 33. Casemanagementprocessesareguidedby: 1. standards of professional care. 2. protocols of healthcare delivery. 3. guidelines for clinical practice. 4. all of the above. 23 Part I: Subject Area Review Chapters 34. Thepatient’srighttorefusetoparticipateinresearchinvolveswhichofthefollowing? 1. research on a new cancer medication 2. research on a new walker by physical therapy 3. research into the body’s hormonal response to stress 4. all of the above (4) The patient’s right to refuse to participate in research extends to all types of research. (4) Confidentiality is the maintenance of privacy of information, which has not been breached. He is expressing the other rights and might exercise them in choosing to leave the hospital early, by requesting to see the actual costs of his care, and by requesting reasonable responses to his requests. (3) The right to confidentiality of patient information might have been breached when patient care situations are dis- cussed in public areas or without regard to maintaining the information as private and confidential. The other rights listed have not been breached in this instance. (3) The right to refuse treatment is the patient right violated and exists even when the medication is ordered by a physician. 35. Mr.H.isupsetregardingbeinginthehospitalforanotherdaybecausehestatesitcoststoomuch.Therightsthat he may be expressing includes all of the following except: 1. the right to examine and question the bill. 2. the right to reasonable response to requests. 3. the right to refuse treatment. 4. the right to confidentiality. 36. Youandacolleagueareontheelevatorafteryourshift,andyouhearagroupofhealthcaregiversdiscussinga recent patient scenario. Which patient right might be breached? 1. right to refuse treatment 2. right to continuity of care 3. right to confidentiality 4. right to reasonable responses to requests 37. Yourpatientrequiresaninjectiontomaintaintherapeuticlevelsofthemedication.Theclientdoesnotwantthe medication, but you give the medication per physician’s order. You have violated which patient right? 1. Privacy. 2. Consideration and respect. 3. Refusal of treatment. 4. You have violated no patient rights as the medication was ordered by the physician. 38. Thenursenoticesthatafamilyiswaitingatthenursingstationdeskfortheirlovedonetobebroughttotheunit for admission during a change-of-shift report. The nurse: 1. requests that the family wait for their loved one in the patient’s room and waits to resume the report until the family has left the desk area. 2. requests that a nursing assistant bring coffee for the family while they wait at the desk and continues with report. 3. requests that the family have a seat in the station rather than stand while awaiting their loved one. 4. requests that the family wait for their loved one in the emergency room waiting room. (1) In order to protect the privacy of the patients and the confidentiality of the information shared in report, the family should be asked to wait in the patient’s room, and the report should be resumed only after they can no longer hear it.