Professional Nursing Final Exam Questions With Correct Answers

WEEK 1 What are the characteristics of a profession? - Answer • Education takes place in a college or university. • Education is prolonged • Work involves mental creativity • Decision making is based largely on evidence-based practice. • Values, beliefs and ethics are an integral part of preparation. • Commitment and personal identification are strong. • Workers are autonomous. • People are unlikely to change professions. • Commitment transcends material reward. • Accountability rests with individual. How are professions different than occupations? The following are characteristics of an occupation that may be directly compared to the previous list. - Answer • Training is usually on the job. • Length of training varies. • Work is largely manual. • Decision making is largely guided by experience or trial by error. • Values, belief and ethics are not prominent. • Commitment and personal identification vary. • Workers are supervised. • People often change jobs. • Material reward is main motivation. • Accountability rests primarily with employer. What is nursing's social contract? - Answer Social contracts are the mechanisms by which society legitimizes professions and grants them authority and autonomy to carry out their functions. The nursing profession is urrently renegotiating its contract with society in a manner which clearly reflects a change from physician dominance, and emphasis on 'illness care' to increased independent and autonomous functioning within a newly developing framework of nursing science which emphasizes 'health care'. - Nurses relationship with society and nurse's obligation to those who receive professional nursing care. What is the role of the American Nurses Association in advancing the profession's objectives? - Answer ANA is the official voice of nursing and therefore is the primary advocate for nursing interests in general. ANA encourages and supports high standards of practice. What are the main recommendations of the IOM Report on the Future of Nursing in terms of the educational composition of the nurse workforce? - Answer Remove scope of practice barriers - Advanced practice registered nurses should be able to practice to the full extent of their education and training. - Answer Expand opportunities for nurses to lead and diffuse collaborative improvement efforts - Expand opportunities for nurses to lead and manage collaborative efforts with physicians and other members of the health care team to conduct research and to redesign and improve practice environments and health systems. - Answer Implement nurse residency programs - Completion of a transition-to-practice program (nurse residency) after completion of a prelicensure or advanced practice degree program or when they are transitioning into new clinical practice areas. - Answer Increase proportion of nurses with BSN from 50% to 80% by 2020 - Increase the diversity of students to create a workforce prepared to meet the demands of diverse populations across the lifespan. - Answer Double number of nurses with doctorate by 2020 - This will add to the cadre of nurse faculty and researchers, with attention to increasing diversity. - Answer Ensure that nurses engage in lifelong learning - Ensure that nurses and nursing students and faculty continue their education and engage in lifelong learning to gain the competencies needed to provide care for diverse populations across the lifespan. - Answer Prepare and enable nurses to lead change to advance health - Prepare the nursing workforce to assume leadership positions across all levels. - Answer Build an infrastructure for the collection and analysis of inter-professional health care workforce data - Effort to improve research and the collection and analysis of data on health care workforce requirements. WEEK 2 What are the differences between for-profit, not-for-profit and government ownership of hospitals and other delivery organizations? - Answer Not-for-profit agency is one that uses profits to pay personnel, improve services, advertise services, provide educational programs, or otherwise contribute to the mission of the agency. For-profit agencies distribute profits earned to partners or shareholders. Voluntary (private) agency gets its support generally through private donations. Non-governmental organization (NGO) is an association of citizens that operates independently of the government with the goal to deliver resources or serve a social or political purpose (example: MSF). Governmental (public) agencies contribute to the health and well-being of US citizens. Primarily supported by taxes, administered by elected or appointed officials, and tailored to the needs of the public. What is the role of safety net hospitals in the United States? - Answer A safety net hospital or health system provides a significant level of care to low- income, uninsured, and vulnerable populations. Safety net hospitals are not necessarily distinguished from other providers by ownership - some are publicly owned and operated by local or state governments and some are non-profit. Rather, they are distinguished by their commitment to provide access to care for people with limited or no access to health care due to their financial circumstances, insurance status, or health condition. What are the differences in the complexity of care among primary, secondary, tertiary and sub-acute services? What types of services would you expect to encounter at each of these levels of care? - Answer • Primary care is rendered at the point at which a patient first enters the health care system. Primary heath care provides: Entry into the system, emergency care, health maintenance, ,management of long-term and chronic conditions, treatment of temporary health problems that do not require hospitalization. - Answer • Secondary care involves the prevention of complications from disease. Allows patients to keep out of the hospital while managing their disease. (home health agencies, surgical centers, ambulatory care agencies). - Answer • Tertiary care is provided to acutely ill patients, to those requiring long-term care, to those needing rehabilitation services, and to terminally ill patients. Usually involves many health care professionals working as a team to provide care. (trauma centers, burn centers, skilled nursing long term care). - Answer • Subacute care (emerged in 1990s) is impatient care that lies between hospital care and long-term care. Provides lower cost care to acutely ill patients until stabilized. Creates a seamless transition through health care system. How is healthcare financed (paid for) in the United States? - Answer • Private Insurance - Premiums are paid to allow for health care benefits. • Medicare - Nationwide federal health insurance program available to people over the age of 65, regardless of income. • Medicaid - Jointly federal-state funded programs for low-income, elderly, blind and disabled individuals. • Personal Payment - Out-of-Pocket Payment - "Straight up Benjamins, Yo." What are the key provisions of the Affordable Care Act of 2010? - Answer • Providing insurance options, covering preventive services, and lowering cost. • Coverage available to children up to age 26. • Yearly wellness visit and many free preventive services for some seniors with Medicare. • Insurers must justify any premium increase of 10% or more before the rate takes effect. • Putting information for consumers online. • Prohibiting Denying Coverage of Children Based on Pre-Existing Conditions. • Prohibiting Insurance Companies from Rescinding Coverage ( companies cannot use application errors to deny coverage). • Eliminating Lifetime Limits on Insurance Coverage. • Provides consumers a way to appeal Insurance Company Decisions. • Establishing Consumer Assistance Programs in the States. • Providing Small Business Health Insurance Tax Credits. • Cracking Down on Health Care Fraud. • Holding Insurance Companies Accountable for Unreasonable Rate Hikes. • Increasing Payments for Rural Health Care Providers. • Strengthening Community Health Centers. What is the role of states/state governors in implementing the Affordable Care Act of 2010? - Answer The governors need to decide whether or not expand the Medicaid program in their state. States that are expanding Medicaid will have larger gains in insurance coverage than those states that do not and will see very large reductions in the number of uninsured. Those states that have not expanded Medicaid will see less impact on the uninsured. These states have more uninsured to begin with, thus current disparities in coverage will increase, at least in the early years. What is the role of the Joint Commission in the healthcare sector? - Answer One of the two accrediting not-for-profit agencies approved by the CMS. JC serves as the nation's predominant stand-setting and accrediting body on health care. The goal of accreditation is to improve patient outcomes. What is the difference between fee-for-service and managed care payment? - Answer • Under the fee-for-service method, doctors and hospitals got paid for each service they performed. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary. patients did not always benefit because their insurance companies would often only pay a percentage of the fees being charged. • Managed care organizations supervise the financing of medical care delivered to members. They all are concerned with cost-effectiveness, or saving money. They make the primary care physician the core of health care delivery. Types of plans: HMOs, PPOs, POS. What are the major recommendations of the IOM report on disparities in care in the US? - Answer • Base decisions about resource allocation (e.g., which patients should receive particular treatments for specific health conditions) on published clinical guidelines; • Take steps to improve access to care—including the provision of interpretation and translation services, where community need exists; • To the extent possible, equalize access to the same health care products and services, to avoid fragmentation of health plans; • Insure that physician financial incentives do not disproportionately burden or restrict minority patients' access to care; • Support the use of community health workers and multidisciplinary treatment and preventive care teams; • Collect and monitor data on patients' access and utilization of health care services by race, ethnicity, and primary language. What are the major roles of the different professional groups on an interdisciplinary care team? - Answer • Physicians - Responsible for medical diagnosis and interventions designated to restore patient health (4 years of education with 3-4 year residency). • Physician Assistant - Perform many functions of the physician under direct supervision of the physician ( 2-3 years of education). • Unlicensed Assistive Personnel - Work under nurse supervision to assist with basic patient care (on-the-job training). • Licensed Practical Nurse - Provide basic bedside care under direction of physicians and RNs (1 year of education, state licensure). - Answer • Dietitians - Understand how what one consumes, whether oral or intravenous, can affect a patient's recovery and promote and maintain health (bachelor's or higher). • Pharmacists - Prepare and dispense medications, instruct patients and other health workers about medications, monitor the use of controlled substances such as narcotics, and work to reduce medication errors (6 years of education, state board licensure). • Technologists - Personnel who assist in the diagnosis of patient problems ( 1-4 years of education, state licensure). - Answer • Respiratory Therapist - Operate equipment such as ventilators, oxygen therapy devices, and intermittent positive-pressure breathing machines. (2-4 years of education, state licensure). • Social Worker - Trained to assist patients and their families as they face the impact of illness and injury (bachelor's or higher). • Therapist - Help patients with special challenges (physical, occupational) (Master's degree). • Administrative Support Personnel - Clerical jobs such as admitting patients, answering phones, directing visitors, scheduling patient tests, filing insurance claims, filing forms, paying bills, facilitating payroll, and other support functions. What structural and social factors account for disparities in access to and quality of healthcare in the United States? - Answer • Cause of disparities may be due to: Race, ethnicity, gender, age, income, education, disability, sexual orientation, and place of residence. • Provider bias had been mentioned as a contributing factor to health care disparities. What are the major barriers to inter-professional team work in healthcare organizations? - Answer Organizational Barriers: • Lack of knowledge and appreciation of the roles of other health professionals. • The need to make compelling arguments for team building to senior decision-makers • Financial and regulatory constraints • Legal issues of scope of practice and liability • Reimbursement structures for different professions, including which services receive reimbursement • Hierarchical administrative and educational structures that discourage inter-professional collaboration. - Answer Barriers at Team Level: • Lack of a clearly stated, shared, and measurable purpose. • Lack of training in inter-professional collaboration. • Role and leadership ambiguity. • Team too large or too small. • Team not composed of appropriate professionals. • Lack of appropriate mechanism for timely exchange of information. - Answer • Need for orientation for new members. • Lack of framework for problem discovery and resolution. • Difference in levels of authority, power, expertise, income. • Difficulty in engaging the community. • Traditions/professional cultures, particularly medicine's history of hierarchy. • Lack of commitment of team members. • Different goals of individual team members. • Apathy of team members. • Inadequate decision making. • Conflict regarding individual relationships to the patient/client. WEEK 4: Pathways to Professionalism - Answer Historical perspective on nursing in the U.S. Education and entry to practice Nurses' roles and responsibilities Professional image and identity What are the tenants of professional nursing practice as defined by the ANA? - Answer Tenants of Nursing Practice (ANA) 1.Nursing practice is individualized 2.Nurses coordinate care by establishing relationships 3.Caring is central to the practice of registered nurses 4.Registered nurses use the nursing process to plan and provide individualized care to their healthcare consumer 5.A strong link exists between the professional work environment and the RNs ability to provide quality care 2. What are the different educational programs to prepare nurses for entry into professional practice? - Answer Education and Entry to Practice: Diploma -hospital based schools of nursing. Early teaching by physicians. On the job training Associates Degree -Community college education. Developed during WWII. Technically focused training Bachelor's Degree -University based education. Preferred entry to practice degree; Theory, research and evidence base, emphasizes leadership and holistic approach. - Answer NURSES WITH THESE THREE EDUCATIONAL BACKGROUNDS ALL SIT FOR THE SAME NCLEX EXAM TO BE LISCENSED AS AN RN RNs MOSTLY HAVE THE SAME JOB FUNCTIONS IN PRACTICE REGARDLESS OF THEIR EDUCATIONAL PREPARATION MASTER'S DEGREES: - Answer - developed in the 1960s and 1970s. Focus on specialization;. -Research foundation and practice development. Advanced Clinical Nursing Roles -Multiple tracks in graduate education in nursing -Nurse Practitioner, Anesthesia, Midwifery, Education, Administration, Clinical Nurse Specialist, Informatics (c. 1990s), Clinical Nurse Leader (c. 2004) What is the difference between a PhD and a DNP degree? - Answer .Doctoral Education in Nursing: PhD in Nursing: -Research focused degree; first doctoral programs in NURSING developed in the late 1950s. NYU created the first PhD program in nursing in the US. -Theory development—to explain 'how' things work; Researchers advance the body of knowledge for the discipline. - Answer Doctor of Nursing Practice: -Clinically-focused practice degree (widely implemented in the 2000s). -Focus on clinical expertise and health systems leadership skills (leadership, policy, economics, evidence-based practice, quality improvement) -States determine which nursing roles can attain the DNP degree ( for example, in NY only NPs are eligible for the DNP degree) . What is the difference between certification and licensure in nursing? - Answer LISENCE VS. CERTIFICATION: LICENCE: -Mandated by the state -Legal credential needed to practice nursing -Sets a minimum standard of knowledge and competence for practitioners CERTIFICATION: -Is voluntary -Verifies that you possess a higher level of knowledge or proficiency in a particular -practice area -Has professional status NOT legal status -Certification is not standardized in Nursing What strategies can nurses use to improve their credibility in the clinical setting? - Answer -Use SBAR communication model; prepare what you're going to say before talking -Focus on the facts and the key clinical data -Develop personal rapport with physician colleagues -Educate your physician colleagues on your education and experience and the nursing role -Work to align the medical goals with the nursing goals when communicating with residents -Present yourself in a competent manner (Don't say "I don't know" at the end of a statement or "I feel" to start off a request). What are the major components of the nursing profession's identity? - Answer Nurses' Professional Identity: -Set of beliefs, attitudes and understanding about one's roles, within the context of work, is generally refer to as 'professional identity' (Adams et al., 2006; Lingard et al., 2002). -The values and roles form a common view of "What we stand for". -The professional identity of nursing has changed over time in response to social factors. - Identity has an internal (how you see yourself) and external component (how others see you). In what ways is the popular image of nursing at odds with the profession's image? - Answer Professional Image and discrepancies: -How nurses are portrayed in the media -The status they are afforded to comment or share their expertise -Primary values "What do nurses stand for?" -Competence vs. sexual objects -Primary or trivial role in healthcare delivery -Dress, demeanor, comportment (look, act, behave) Describe the social and historical factors that shaped professional nursing practice in each era of the 20th century (eg: 1900s; WWI; WWII; 1980s; 2000s). - Answer 1900s Financing Mechanism: Private payment for physician, hospital, and nursing services. Philanthropic sponsored hospitals Industry Structure: Specialty hospitals for specific disease. Proliferation of general hospitals; 1 bed per 304 people Medical Terminology: Germ theory, aseptic techniques, and anesthesia developed Blood transfusions, Stethoscopes, thermometers, microscopes Leading Causes of Mortality: Influenza, pneumonia, TB, gastritis, heart disease, stroke, personal injury, chronic nephritis, cancer, diseases of early infancy, diptheria Nursing Profession: Nurse's training schools established, ANA founded First nurse registration laws Organization of Nursing Services: Functional nursing in hospitals by student nurses. Private duty, public health visiting nurse careers for graduates. - Answer Financing Mechanism: Blue cross/Blue shield formed, Social Security Act, Hill-Burton and Lantham Acts, National Mental Health Act Industry Structure: AMA-created hospital ownership designations, Joint Commision established Medical Terminology: Sulfa drugs, penicillin, vaccines, EKGs and EEGs, ICU's established, University hospital system established Leading Causes of Mortality: Heart disease, stroke, cancer, personal injury, respiratory disease, diabetes, suicide, chronic liver disease, homicide Nursing Profession: Federal legislation to fund nursing education, State boards of nursing license exams, University-based nursing education advocated, Practical and associates depree programs established, NLN and ANF founded. Organization of Nursing Services: Team nursing, Professional nursing (graduates move to hospitals) - Answer Financing Mechanism: Medicare legislation, Tax Equity and Financial Responsibility Act. Industry Structure: rise of For-Profit hospitals and multihospital chains Medical Terminology: Cardiac care units, chemotherapy, electronic monitoring, renal dialysis, open heart surgery, organ thansplants, computerized scanners Leading Causes of Mortality: Heart disease, cancer, stroke, personal injury, pneumonia, liver disease, diabetes, suicide, homicide Nursing Profession: ANA position paper on nursing education, commonwealth fund and nurses training act for advanced nursing education. First doctorate in nursing science program, prescriptive authority for NP's in some states, National center for Nursing research at NIH. Organization of Nursing Services: Primary nursing, shared governance practice models. - Answer Financing Mechanism: Manage care financing/health reform, Balanced Budget Amendment, Medicare/Medicaid funding Industry Structure: Mergers, alliances, partnerships, growth of for-profit and managed care delivery organizations Medical Terminology: Second-generation scanners, telemedicine and information systems, clinical guidelines, service technologies, AIDS therapies Leading Causes of Mortality: Heart disease, cancer, stroke, personal injury, COPD, pneumonia, flu, diabetes, suicide, liver disease, cirrhosis, HIV/AIDS Nursing Profession: Pew report on the Health Professions, National Institute for Nursing Research, J&J Campaign for Nurses' future Organization of Nursing Services: Introduction of unlicensed assistive personnel, trend towards multidisciplinary teams - Answer Financing Mechanism: Managed care and fee for service; Children's Health Act- insurance for low income children; HIPPA—Privacy protections; Affordable Care Act Industry Structure: Mergers, trend towards ambulatory care, chronic disease management programs, patient-centered medical homes and accountable care organizations Medical Terminology: IT and tele-health. Consumer-focused care, Cancer treatments, minimally invasive surgeried, biotechnology/genetics/personalized medicine Leading Causes of Mortality: Heart disease, cancer, chronic respiratory disease, stroke, accidents, Alzheimers, flu, pneumonia, nephritis, suicide Nursing Profession: IOM reports on quality and future of nursing, Carnegie report on educating nurses; CNL and DNP graduate programs established; funding for nursing education; NP regulations loosened in some states. Organization of Nursing Services: Increased focus on care coordination quality improvement, patient-centered and multidisciplinary team approaches WEEK 5 What is Martha Rogers's relationship to NYU? - Answer -Developed the first PhD program in Nursing which was founded at NYU Describe the nursing theories advanced by Nightingale, Henderson, Roy, Benner, Leininger, Peplau, Orem, and King. - Answer Florence Nightingale (nursing theory): •A social innovator and the founder of modern nursing •Wrote Notes on Nursing, What it is and What it is Not and Notes on Hospitals •Believed that healing occurs within the environment and nurses have a role in creating an environment to promote healing. •Collected data and used statistics to document the effectiveness of the careful maintence of the environment on health outcomes during the Crimean War. Nightingale's 8 aspects of Professional Nursing - Answer 1. Ventilation and Warming 2. Health of the Home 3. Noise 4. Variety 5. Bed and Bedding 6. Light 7. Cleanliness of rooms and walls 8. Observation of the sick Virginia Henderson (Nursing theory) - Answer Developed the classic definition of nursing in 1960s " The unique function of the nurse is to assist the individual, sick or well, on performance of these activities contributing to health or its recovery (or peaceful death) that he would perform unaided if he had the necessary strength or knowledge." •Viewed patients as individuals who required help towards achieving independence and wholeness of mind and body •Developed 14 basic needs of the patient that nurses use to define their role, assist the patient/client over time •The 14 needs include physical, psychological, emotional, social, spiritual, and developmental needs. •In addition to her theory, Henderson created the first catalogue of nursing literature published between Dorothea Orem (Nursing theory) - Answer Self-Care Deficit Theory Developed 3 interrelated theories -Theory of Self-Care -Theory of Self-Care deficits -Theory of Nursing Systems -Focuses on designing nursing actions so that people can meet their care needs -The nurse prescribes and regulates the system based on the patient's self-care deficit -Uses a process of assessment, relationship building, education and intervention to support self-care