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AMBULATORY NURSING
CERTIFICATION REAL EXAM 222
QUESTIONS WITH VERIFIED
SOLUTIONS RATED A+ BRAND
NEW!
"PMCH - CORRECT ANSWER=> Model of primary care that is comprehensive, team-based, coordinated, accessible, and focused on quality and safety. Included physicians nurses, and other interprofessional providers. Focus is on whole-person orientation, goal is delivery of right care at right time in right setting" "ACO - CORRECT ANSWER=> Model of care in which a provider group of primary care physicians, specialists, and hospitals accepts the responsibility for cost and quality of care delivered to a specific population of patients cared for by the group's clinicians" "PACT - CORRECT ANSWER=> Developed by the Veterans Health Administration, and provides patient-driven, proactive, personalized team based care focused on the whole person and life- long wellness and disease prevention" "HIT - CORRECT ANSWER=> Health information technology" "Goals of professional interpersonal alliances with the nurse and the patient - CORRECT ANSWER=> 1. Accurately understand patient and family experience
- Help build understanding of self-management strategies
- Provide emotional and informational support
- Assist with coping and finding meaning
- Help patients and families identify new directions within one's abilities
- Connect patients and families with the health care team
- Empower patients and families through education, skill, and tools for success toward health goals and decisions" "Nursing actions that support boundaries - CORRECT ANSWER=> 1. Be responsible for the care process and recognize when results are outside of the nurse's control
- Focus on what can be changed or influenced
- Be aware of professional limitations and boundaries
- Be aware of reactions and seek help when uncomfortable
- Find a balance between patient care and own self-care" "Trust - CORRECT ANSWER=> A relational process, one that is dynamic and fragile, yet involving the deepest need and vulnerabilities of individuals" "Steps for shared decision making - CORRECT ANSWER=> 1. decision making should be patient- centered
- Outline the pros and cons of treatments and plans; discuss choices, options, and decision- making" "Steps for active listening - CORRECT ANSWER=> 1. listen attentively to understand in an empathetic and collaborative manner
- Pause own reactions to avoid misunderstanding and build upon the therapeutic relationship
- Use interactive dialogue to ponder new viewpoints and facts regarding the topic
- Demonstrate appreciation for one's own unique qualities" "C.A.R.E. - CORRECT ANSWER=> Connect: Be attentive Appreciate: acknowledge the patient's point of view Respond: Identify patient/family needs and expectations Empower: Problem solve and help build confidence toward goals" "Two phases of motivational interviewing - CORRECT ANSWER=> 1. Explore the pt's reluctance to change
- Investigate capacity and commitment to make the change" "Stages of change - CORRECT ANSWER=> Pre-contemplation: no intent to change behavior within the next 6 months Contemplation: State intent to change behavior within the next 6 months Preparation: Take steps toward making change within the next month Action: Has made modifications for less than 6 months
Truth telling" "Fidelity - CORRECT ANSWER=> One of the ethical principles. Faithfulness" "Justice - CORRECT ANSWER=> One of the ethical principle's. The allocation of scarce resources" "Advocate - CORRECT ANSWER=> To intercede on another's behalf. Involves action" "4 Characteristics of a transformational leader - CORRECT ANSWER=> 1. Influences through visioning
- Supports followers in understanding what gives meaning in work
- Creates environment that sustains the organization
- Understands individual differences and supports self-esteem" "12 Responsibilities of a follower - CORRECT ANSWER=> 1. Knowledgeable about the organization
- Engaged in their personal organizational goals
- Accountable for their work
- Actively engaged in work
- Aware of their own sense of meaning in relationship to the organization
- Aligned with organizational values
- Aware of self and organizational values
- Committed to change
- Expect more of themselves as leaders
- Respectful of the leader
- Understanding of policies and bureaucracy
- Ready and willing to express their opinion" "Trait Theory of Leadership - CORRECT ANSWER=> The traits of the person make the leader. The situation may determine the leader" "Behavior or Style Theory of Leadership - CORRECT ANSWER=> The leader's behavioral style is one of the following Autocratic Democratic Laissez-faire"
"Situational/Contingency Theory of Leadership - CORRECT ANSWER=> Leadership is contingent on the situation needed and the leader uses the style appropriate to the situation, relationships, amount of trust, clarity of vision, and amount of power shared or provided to the follower" "Interactional Theory of Leadership - CORRECT ANSWER=> Leadership is supported and changed by the relationship with the follower" "Traits of a leader with emotional intelligence - CORRECT ANSWER=> Self-awareness The ability to manage emotions Self-motivation to delay gratifications and strive for innate goals Empathy Social development" "5 Stages of Project Management - CORRECT ANSWER=> 1. Definition
- Initiation
- Planning
- Executing
- Closing" "Steps to benchmarking - CORRECT ANSWER=> 1. Identifying the area of improvement and goals for outcomes
- Review established standards of practice to identify questions for benchmarking
- Identify data and information about the current process/practice
- Seek similar internal or external organizations to determine process or outcomes
- Keep questions brief
- Set future outcome processes and outcome targets to measure against
- Share results and comparison measurements
- Implement process improvement actions to change outcomes
- Measure and continue to change processes to support positive outcomes in comparison to the benchmarked level" "Conditions of a healthy work environment - CORRECT ANSWER=> 1. Communication
- Employee engagement
- Relationship building
- Mutual respect 5 Recognize those who are moving toward growth and nurtures professionalism"
"Indirect costs - CORRECT ANSWER=> Costs within a service unit that are not incurred for direct patient care" "Relevant range - CORRECT ANSWER=> Normal range for an expected activity for a cost center" "Fixed costs - CORRECT ANSWER=> Costs that are fixed in the context of a relevant range; cost does not change with a change in volumes" "Variable costs - CORRECT ANSWER=> Costs that vary with changes in volumes of service units" "Mixed costs - CORRECT ANSWER=> Costs that include both fixed or variable costs" "Statutes or codes - CORRECT ANSWER=> Federal laws that are usually passed by congress and signed by the president, then complied into the United States Code" "State Laws - CORRECT ANSWER=> Usually passed by state legislatures and signed by governors or enacted by a popular vote through referenda or voter initiatives and complied into various state codes. Obviously they differ from state to state" "Regulations - CORRECT ANSWER=> Rules promoted by federal agencies (like DHHS) and state agencies, that are supplemented by formal and informal agency guidance" "Judicial and administrative agency action - CORRECT ANSWER=> Court decisions and court orders issued as a result of criminal enforcement or civil litigation. Administrative agency decisions and orders issued in connection with disputes among private parties or arising from agency enforcement of regulations" "Contracts - CORRECT ANSWER=> Legal agreements among two or more parties that may be enforced by courts or through private arbitration proceedings" "Criminal law - CORRECT ANSWER=> Defined by statute, supplemented by regulations, and interpreted by judges. Violation may be punished by fines and/or imprisonment, depending on the severity of the offense" "Examples of criminal law - CORRECT ANSWER=> 1. Practice of nursing without a license
- Illegal prescription or use of controlled substances; drug diversion
- Fraud
- Assisted suicide
- failure to report child or elder abuse or neglect" "Civil law - CORRECT ANSWER=> Defined by statute, regulation, and common law; interpreted by administrative agencies and judges. Violations can be punished by fines, civil penalties, damages, or other sanctions, including suspension or revocation of licensure" "Examples of conduct that may be the subject of civil disputes - CORRECT ANSWER=> 1. malpractice/professional negligence or misconduct
- violation of legal or ethical standards, protecting patient rights (HIPPA may be enforced criminally depending on the circumstances)
- Improper claims or reimbursement
- Breach of contract" "Standard of care - CORRECT ANSWER=> A standard by which nurses are judged in license board hearings and medical negligence lawsuits a) defined as usual and customary professional standard practice in the community b) Describes the qualities and coditions that should occur in a praticular clinical setting, that a reasonable, average, and prudent practitioner would fllow c) Derived from statutes, case law, licensing board regulations, consensus of professionals, and ethic codes d) Determine scope of practice" "Anything a nurse does that is not within the RN scope of practice needs to be supported by one of the following: - CORRECT ANSWER=> 1. An order from a clinician authorized to order treatment and therapies
- A document in which a physician, advanced practice nurse, or PA delegates to the RN the authority to perform a medical act, usually within specified circumstances
- A protocol developed within the organization or adopted from an outside organization and approved by the clinic manager" "Eight Principles of Delegation - CORRECT ANSWER=> 1. The RN takes responsibility and accountability for the provision of nursing practice
- The RN directs care and determines appropriate utilization of any assistance needed in providing direct pt care
- The RN may delegate parts of the care, but does not delegate the nursing process itself. The nursing process of assessment, planning, intervention, and nursing judgment cannot be delegated
"Damages - CORRECT ANSWER=> Did the patient suffer injury, illness, or financial loss as a result of the RN's actions?" "Abandonment - CORRECT ANSWER=> Occurs when the professional relationship between a health care provider and the patient is terminated abruptly and without the pt's consent" "Policies and procedures - CORRECT ANSWER=> Formal written statements under which an organization manages its activities" "Informed consent - CORRECT ANSWER=> A communication process in which the physician provides the patient with information about all possible treatment or decision options, allowing time for questions and understanding so the patient is able to select the option that best fits his/her goals, values, and preferences" "Information required for informed consent - CORRECT ANSWER=> 1. nature of the treatment
- benefits or the anticipated outcome
- Possible risks involved, and the probability of each risk
- Alternatives to treatment
- Consequences associated with declining treatment
- Opportunity to raise questions and be provided with understandable answers
- Opportunity to make a voluntary decision that is free of undue influence" "NMDS - CORRECT ANSWER=> Nursing minimum data set - 16 specific terms of information across three broad categories, relative to the majority of nursing practice across health care settings and patient populations" "Patient demographic elements - CORRECT ANSWER=> Part of the NMDS. Includes: a) Date of birth b) sex c) Personal identification d) Race and ethnicity e) Residence including living arrangements" "Facility or service elements - CORRECT ANSWER=> Part of the NMDS. Includes: a) Individual facility or service agency number b) Unique health record number c) Unique number of priciple registered nurse provider (most often the log-in or sign on identification)
d) Admission or encounter date e) Discharge or termination date f) Disposition of patient g) Expected Payer" "Nursing elements - CORRECT ANSWER=> Part of the NMDS. Includes: a) Nursing diagnosis b) Nursing intervention c) Nursing outcome d) Intensity of nursing care" "UACDS - CORRECT ANSWER=> Uniform Ambulatory Care Data Set. A set of data based on an individual patient encounter." "UACDS elements - CORRECT ANSWER=> a) provider identification b) Place of encounter c) Reason for encounter d) Diagnostic services e) Problem, diagnosis, or assessment f) Therapeutic services g) Preventive services h) Disposition" "Purpose of standardized language - CORRECT ANSWER=> 1. Exchange information
- Share information (?)
- Communicate across disciplines and settings
- Integrate disparate data systems
- Compare information at regional, national, and international levels
- Link data in a secure environment" "Functions of nursing process appropach - CORRECT ANSWER=> a) Nursing admission assessment b) Discharge instructions using menu lists c) specific data documentation d) Standardized care plans that can be individualized for patients e) Documentation of nursing care in a progress note format f) Documentation of medication administration via MAR"
"National Patient Safety Foundation - CORRECT ANSWER=> NPSF" "Eight recommendations for total systems approach to culture of safety - CORRECT ANSWER=> 1. Ensure leaders establish and sustain a safety culture
- Create centralized and coordinated oversight of patient safety
- Create a common set of safety metrics that reflect meaningful outcomes
- Increase funding for research in patient safety and implementation science
- Address safety across the entire care continuum
- Support the health care workforce
- Partner with patients and families for the safest care
- Ensure technology is safe and optimized to improve patient safety" "Clinical reasoning - CORRECT ANSWER=> The use of data to come to a rational conclusion. It is used at the point of care and results in clinical judgement" "Steps of the nursing process - CORRECT ANSWER=> 1. Assessment
- Diagnosis
- Identification of goals/expected outcomes
- Planning
- Implementation
- Evaluation" "Assessment - CORRECT ANSWER=> Systematic collection of focused data relating to health needs and concerns of a patient, group, or population" "Nursing diagnosis - CORRECT ANSWER=> Clinical judgement based on nursing assessment about individual, family, or community responses to actual or potential health problems/life developments stated in standardized terminology" "Nursing-sensitive outcome - CORRECT ANSWER=> An indiviual, family, or community state, behavior, or perception that is measured along a continuum in response to nursing interventions" "SMART - CORRECT ANSWER=> Specific Measurable Attainable Realistic/relevant Timely"
"Planning - CORRECT ANSWER=> Prioritize nursing diagnoses and set timeframes. Obtain additional resources for implementation" "Implementation - CORRECT ANSWER=> The action component of the nursing process. May involve delegation and care coordination. ALWAYS requires documentation" "Evaluation - CORRECT ANSWER=> Systematic, ongoing, and criteria-based activity that includes ongoing assessment" "Family process - CORRECT ANSWER=> The ongoing interaction between family members through which they accomplish their instrumental and expressive tasks" "Patient Self-Determination Act - CORRECT ANSWER=> Federal law that defines informed consent" "Education process - CORRECT ANSWER=> A systematic and consistent cycle centered on a participatory, shared approach to leaching and learning to achieve mutual, desired outcomes" "Engagement in health - CORRECT ANSWER=> Steps the patient takes to engage in their won health to manage their disease or illness and to acieve better outcomes" "Health literacy - CORRECT ANSWER=> The capacity to obtain, process, and understand basic information and services needed to make appropriate decisions regarding health" "Health belief model - CORRECT ANSWER=> An individual will take a health-related action if they percieve susceptibility to ilness and severity of illness can be avoided or reduced by a personal ability to successfully take a recommended action" "Motivational interviewing - CORRECT ANSWER=> Intended to guide and individuals exploration of their ambivalence about changing behavior" "Social cognitive theory - CORRECT ANSWER=> Critical factors include and individuals ability to demonstrate certain behaviors, anticipate outcomes, learn by observing others, perform behaviors with confidence, self-regulate behavior, and reflect on the change experience"
"Tertiary prevention - CORRECT ANSWER=> occurs when a long-term disease or disability is already diagnosed. Aims to achieve the highest level of function, minimize complications, and reduce disability" "Anticipatory guidance - CORRECT ANSWER=> Counseling, therapeutic or educational services provided to a patient before they undergo an anticipated development or situational crisis" "CCTM - CORRECT ANSWER=> Care coordination and transition management" "Chronic Care Model - CORRECT ANSWER=> Can be applied to a variety of health states in multiple care settings. Includes a) Community b) Health system c) Self-management support d) Delivery system design e) Decision support f) Clinical information systems" "Logic Model - CORRECT ANSWER=> Evidence-based process used to guide the organization of CCTM dimensions within a framework to define competencies, activities, and outcomes" "Nine dimensions of care coordination and transition management - CORRECT ANSWER=> 1. Support for self-management
- Advocacy
- Education and engagement of patients and families
- Cross setting communication and care transitions
- Coaching and counseling of patients and families
- Nursing process
- Population health management
- Teamwork and collaboration
- Patient-centered care planning" "Care coordination - CORRECT ANSWER=> The deliberate organization of patient care activities between two or more participants (including the patient) Involved in a patient's care to facilitate the appropriate delivery of health care services."
"Transitional care - CORRECT ANSWER=> A broad range of time-limited services to ensure health care continuity, avoid preventable poor outcomes, and promote the safe and timely transfer of patients from one level of care to another or from one type of setting to another" "Trasition management - CORRECT ANSWER=> Ongoing support of patients and their families over time as they navigate care and relationships among more than one provider and/or more than one setting and /or more than one service. Not determined by age, time, place, or healthcare condition" "Care management - CORRECT ANSWER=> A process designed to assist patients and their support systems in managing their medical/social/mental health conditions more efficiently and effectively" "Case management - CORRECT ANSWER=> A collaborative process of assessment, planning, facilitation, and advocacy for patients and services to meet an individuals health needs through communication and available resources to promote quality cost-effective outcomes" "Disease management - CORRECT ANSWER=> A system of coordinated health care interventions and communication for populations and conditions in which patient self-care efforts are significant" "Social determinants of health - CORRECT ANSWER=> The conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life" "Evidence-based practice - CORRECT ANSWER=> The conscientious integration of best research evidence with clinical experience and the patient values and needs in the delivery of quality, cost-effective healthcare" "Five pillars of excellence - CORRECT ANSWER=> 1. Service
- People
- Quality
- Growth
- Finance" "Wellness - CORRECT ANSWER=> The actives pursuit of good health" "Normal BP measurement - CORRECT ANSWER=> <120/80"
- diet
- hormones 7/ immunosuppression
- infections agents
- obesity
- radiation
- sunlight
- tobacco" "Presbyopia - CORRECT ANSWER=> Difficulty with near vision that is a natural occurrence with aging, and typically occurs starting around age 40" "Risky or hazardous drinking for men - CORRECT ANSWER=> More than 15 drinks per week, more than 5 drinks per occasion" "Risky or hazardous drinking for women - CORRECT ANSWER=> More than 8 drinks per week or more than 5 drinks per occasion" "Leading cause of childhood death - CORRECT ANSWER=> Unintentional injury" "Advanced cardiac life support - CORRECT ANSWER=> Protocols and algorithms created through the AHA to provide guidelines for medical management of cardiac arrest and or arrhythmia, respiratory support, and stroke" "Automated external defibrillator - CORRECT ANSWER=> Device delivering electrical joules in response to shockable cardiac arrhythmias utilizing ACLS protocols" "BLS - CORRECT ANSWER=> Process of providing circulation and respiration through artificial means in an organized, scientifically proven way in an effort to sustain life until advanced care can be provided" "PALS - CORRECT ANSWER=> Pediatric advanced life support, protocols and algorithms created through the AHA to provide guidelines for medical management of potentially fatal health conditions in the pediatric populations, as well as to provide guidelines for medical management of cardiac arrest and/or arrhythmia and respiratory support" "Perfusion - CORRECT ANSWER=> Tissues in the body exchanging metabolic waste and receiving oxygen through arterial venous circulation"
"Respiratory arrest - CORRECT ANSWER=> Lung tissue is not able to receive carbon dioxide or give oxygen to circulating blood" "Ventilation - CORRECT ANSWER=> Mechanism by which the blood gives off carbon dioxide and takes on oxygen in the lungs." "Ventricular tachycardia - CORRECT ANSWER=> Fatal hear arrhythmia with the wide QRS complexes; Does not result in pulselessness initially. The rapid rate of ventricular contraction inhibits adequate blood filling and decreased cardiac output" "Ventricular fibrillation - CORRECT ANSWER=> Fatal heart arrhythmia that presents with pulselessness. The ventricles contract in an unorganized manner resembling a quiver and produce no cardiac output" "How soon should AED be available - CORRECT ANSWER=> Within 3-5 minutes of collapse" "Steps for anaphylaxis management - CORRECT ANSWER=> 1. access anaphylaxis kit
- place pt in Trendelenburg
- administer epinephrine into large muscle for faster absorption
- Administer oxygen, establish IV access, document vital signs" "Risk factors for stroke - CORRECT ANSWER=> 1. hypertension
- hypercholesterolemia
- dietary factors
- physical inactivity
- diabetes
- family history
- heart disease
- atrial fibrillation
- transient ischemic attach
- excessive alcohol consumption
- tobacco use" "FAST - CORRECT ANSWER=> Face drooping Arm weakness Speech difficulty Time to call 911"
