ANCC Risk mgt Exam Questions with Verified Answers,100% CORRECT, Exams of Nursing

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ANCC Risk mgt / ethics / research Exam 93 Questions with

Verified Answers

What are some systematic components to reducing risk? What does it begin with? - CORRECT ANSWER Begins with a formal written plan -organizational goals -delineation of program scope, components, methods -delegating responsibility for implementation and enforcement -commitment of the board -guarantees of confidentiality and immunity for those who squeal goals -> scope/methods -> delegation -> board buy in -> protect squealers What is the most common method of documentation of risk mgt? And what should be delineated in it? - CORRECT ANSWER Incident report -who is authorized to write it -who is responsible for review -what do you do once you've had mtg -who is responsible for follow up -plan for monitoring aftermath -security and storage of completed forms Why are satisfaction forms an important part of risk mgt? - CORRECT ANSWER B/C they help to identify a problem before it happens; they should be tracked and analyzed just like incident reports -employee and patient surveys complaints are a key source of potential risk mgt what 3 things should they identify - CORRECT ANSWER they identify: -person notified after recieveing complaint -person responsible for responding -person responsible for follow up monitoring of resolution

What are 5 action taking initiatives - CORRECT ANSWER -Prevention: risk awareness and safety programs -Correction: remediation to mitigate impact and prevent future occurrences (must be monitored and audited) -Documentation: important for legal defense, good records and institituional policies -Education: in-services at orientation and annually -Dept. Coordination: enc. dept and mgrs to work together for common goal of improved safety for pt and staff what is Medical futility - CORRECT ANSWER unlikely to produce any significant benefit What question can you ask yourself to determine medical futility - CORRECT ANSWER "does the intervention have any reasonable prospect of helping this pt?" what are the 2 types of medical futility - CORRECT ANSWER -Quantative: likelihood of intervention will benefit is extremely poor -Qualitative: the quality of benefit an intervention will produce is extremely poor What must a pt possess to sign an informed consent - CORRECT ANSWER Competence (decisional capability) -implies ability to understand, reason, and differentiate b/w good and bad AND bea ble to communicate What does informed consent mean? what must it include? - CORRECT ANSWER the pt has rcvd ADEQUATE instruction or info re. aspects of care to make a PRUDENT, PERSONAL choice re. treatment -discussion of ALL risks/benefits -GENERALLY consent is assumed if the pt/s condition is life-threatening Describe the right to refuse care what ruling says they have this right - CORRECT ANSWER pt must be advised at time of admission to a hospital, nsg home, hospice, HMO that they have this right (DANFORTH AMENDMENT) and that this can include ANY, SOME or ALL of care as long as they have decisional capability

expect 2-3 ethics questions - CORRECT ANSWER Nonmaleficence - CORRECT ANSWER the duty to do no harm utilitarianism - CORRECT ANSWER right to act is the one that produces the greatest good for the greatest number beneficence - CORRECT ANSWER duty to prevent harm and promote good justice - CORRECT ANSWER duty to be fair fidelity - CORRECT ANSWER duty to be faithful veracity - CORRECT ANSWER duty to be truthful autonomy - CORRECT ANSWER duty to respect and individuals thoughts and actions what is often in conflict with veracity? - CORRECT ANSWER fidelity what is often in conflict with beneficence? - CORRECT ANSWER autonomy How to dismiss a pt or close a practice how long should you cover them what do you need to obtain from the pt how long do you keep records - CORRECT ANSWER -MUST have NOTIFICATION -send a certififed letter with return reciept, copy for chart -content in letter should be general not specific -establish there will be SOMEONE ELSE to assume care -provide general coverage within reason , at least 30days -obtain release of info to get records for subsequent provider -keep files for 5 yrs what are 3 examples of reasons to d/c a pt? - CORRECT ANSWER abuse, refusal to pay, pt persistent non-adherence to care

History of NP - when was role first developed, and what led to the development? In what area? - CORRECT ANSWER 1960's as a result of physician shortage, pediatrics what 3 problems led to the beginning of acnp's - CORRECT ANSWER result of managed care, hospital restructuring, and decreases in medical residency programs where was first NP program, by whom and where - CORRECT ANSWER Peds NP in 1964, by Dr. Loretta Ford and Dr Henry Silver at U of Colorado Health sciences center Initial NP programs focused in what speciaties - CORRECT ANSWER ambulatory and outpt How did primary care NP programs come about - CORRECT ANSWER as the result of federal funding for preventative and primary are NP education What are the 4 distinct roles of NP - CORRECT ANSWER clinician, consultant/collaborator, educator, researcher know about EBP and research methods - CORRECT ANSWER What are major steps in research process and where does acnp participate - CORRECT ANSWER -formulate problem -literature review -formulate hypothesis -select design -ID population to study -specify methods to collect data -design study -conduct the study -analyze data -interpret results -communicate findings nonnexperimental research - CORRECT ANSWER -involves 2 broad categories:

DESCRIPTIVE

-aims to describe situations, experiences, pheomena as they EXIST EX-POST FACTO (aka CORRELATIONAL)

• examines relationships b/w variables in the PAST ex. sepsis rates over last 6 months in OR could ID a certain MD with higher rates despite same OR's and same staff Others (not always nonexperimental): -CROSS SECTIONAL - looks at pops. with A similar attribute but differ in some other way in a specific time (ex. asthmatics of various ages)(ex. SURVEY where pt documents severity of asthma at a particular time) -COHORT - study a group and an outcome (ex. how many ppl pass boards first time, alumni surveys)(compares an outcome "lung CA" within ***groups of ppl who are alike in MANY ways ***but differ by a characteristic e.g. female nurses who smoke compared with those who do not smoke) -LONGITUDINAL - taking MULTIPLE MEASURES of a group or pop. over a long period of time to find relationships b/w variables. (1 or 5 or 10 yr follow ups) (Framingham study over multiple generations) what is design of research study? what is methodology? what is approach? - CORRECT ANSWER these questions are all asking the same thing 3 broad headings of types of research - CORRECT ANSWER experimental, nonexperimental, qualitative Experimental study what happens if no randomization or control -in the above instance what is manipulated in the study - CORRECT ANSWER must have RANDOMIZATION and CONTROL -can be done without them but will be quasi -RCT: control is what's alike or different -quasi - manipulates variables without randomization or controls Qualitative research

5 examples - CORRECT ANSWER -case studies, ethnography, field studies, observation, open-ended questions -phenomena is explored via detailed descriptions or observed behavior -ex. whats it liek to be a 49 yr old dying of lung ca what are 2 cons to qualitative research - CORRECT ANSWER bias (requires you to interpret what they are saying) are the findings generalizable (small pt population) what are pros to qualitative research - CORRECT ANSWER produces very rich data through no other means of research What is a confidence interval? compare small and large. - CORRECT ANSWER a range with limit with specified probability of including the parameter being estimated -small means VERY PRECISE -large means less precise which of these is most important for you to focus on changing your practice after reading a publication: a)level of signaifcance b)confidence interval c) p value - CORRECT ANSWER both a and c interpret this CI: 2.8 -3.2 - CORRECT ANSWER terminally ill bone ca patients in the final stage of illness have between 2.8 and 3.2 episodes of nausea every 24 hours What is standard deviation what percent fall within one SD what percent fall within 2 SD - CORRECT ANSWER the avg amt of deviation from mean

• bell curve -means that 68% or 2/3 of the population fall within one SD of the mean -95% of sample falls within two SD of mean

Level of significance **** - CORRECT ANSWER If there is a P value in the article it's significant. If there's no numerical P value in the article it means it was not significant. -this means the results are statistically significant -probability of false rejection of null hypothesis in a statistical tese -p<0.5 is significant difference b/w experiment and control What is perfect correlation - CORRECT ANSWER a measure of interdependence of 2 random variables that range in value from -1 to +

• -1 means perfect negative correlation (as one goes up the other goes down)
• +1 means perfect positive correlation (both go together in same directions)
• 0 means absence of correlation does not indicate causation because of confounding variables what is a t-test - CORRECT ANSWER statistical test to eval difference in means between groups what is reliability - CORRECT ANSWER consistency of measurement -degree to which a test measures the same way OVER TIME with same subjects -reflects estimated repeatability
• tells you where a person is doing well (ex. looking at test questions on ACNP exam, 66% miss questions about HIPPA but 84% get right a clinical question) what are 3 ways to establish reliability of a test - CORRECT ANSWER -test/retest: the more CONSERVATIVE method a person should get the same score on exam 1 and 2. ***INVOLVES 2 ADMINISTRATIONs OF THE TEST -Internal consistency: done by grouping questions in a questionairre that measure the same concept ex. one could write 2 sets of 3 questions that measure the same concept (knowledge of lipid panels) and then after responses run a correlation b/w these 2 groups to see if test is reliably measuring ) ***INVOLVES ONLY 1 ADMINISTRATION of the test

• Cronbachs Alpha: computes correlation values among questions of tests. CLOSER TO 1 is better optimal is >. Liability - CORRECT ANSWER legal obligation we have for actions that FAIL to meet STANDARDs of CARE --> ACTUAL of POTENTIAL pt harm How is it determined that negligence has occurred? - CORRECT ANSWER Standards of Care Negligence - CORRECT ANSWER neglecting to do what a reasonable person would do leading to harm Malpractice what wrongdoing is included in this umbrella term - CORRECT ANSWER BROADER UMBRELLA term. Covers: -professional misconduct -unreasonable lack of skill -illegal or immoral conduct (ex. giving a n'bor opiate scripts to sell on black market) -practicing medicine without a license -practicing outside your scope of practice -allegations resulting in pt harm Assault - CORRECT ANSWER INTENTIONAL THREAT which creates fear of imminent harm -ex. holding fist up like you're gonna hit someone Battery - CORRECT ANSWER actually hurting someone -hitting them or their clothes ***An unconscious person - can you commit assault or battery upon an unconscious person - CORRECT ANSWER Battery NOT assault (they would have to be awake to feel threatened) Defamation ant the 2 types - CORRECT ANSWER Communication --> damaged reputation

-libel: written -slander: spoken Is an NP liable if a pt is discharged while in danger of hurting himself or others? - CORRECT ANSWER Yes Restraints documentation requirements - CORRECT ANSWER the exact reason Can an NP be liable if bedside nurse doesn't document properly on restraints? - CORRECT ANSWER yes

• we are supposed to be ensuring that the nurse documents checks and such What is the NP liable for in regards to restraints? - CORRECT ANSWER -excessive use of restraints -exact reason is not charted -safety checks are not charted What are good samaritan statutes? - CORRECT ANSWER protects hc providers from law suits if they aid at the scene of an accident and render reasonable, emergency care, within their scope of practice What are the 12 standards of practice for Culturally and Linguistically appropriate services? - CORRECT ANSWER Aim is to: contribute to elimination to racial and ethnic health disparities and to improve the health of everybody -social justice -critical reflection -EBP and research -Language assistance services at no cost to pt -verbal and written notices must be provided to them in their preferred language that they have the right to recieve language assistance -friends and family should not be used to provide interpretation services unless requested by pt The adult-gerontology primary care nurse practitioner evaluates an 80-year-old patient with cognitive deficits, who is unaccompanied by the adult child who typically is present. The patient has urinary symptoms, for which the nurse practitioner considers ordering sulfamethoxazole-trimethoprim (Bactrim). The

patient's previous medical record is unavailable. Before prescribing the medication, the nurse practitioner: contacts the patient's adult child. queries the other staff members. relies on the patient's self-report. waits until the patient's chart is available. - CORRECT ANSWER waits till chart available To improve the quality of clinical practice, the adult-gerontology primary care nurse practitioner: charges a fee for patients who arrive late to clinic appointments. disseminates research study results to colleagues. expresses opinions about alternative therapies with patients who consider such treatments. schedules time during clinic hours to meet with pharmaceutical representatives. - CORRECT ANSWER disseminates research The adult-gerontology primary care nurse practitioner is appointed to a hospital's multidisciplinary medical ethics review committee. The nurse practitioner's role is to: evaluate standards, risks, benefits, and outcomes. identify how to anticipate and resolve similar future situations. investigate the need for disciplinary action. obtain agreement of all parties with a chosen solution. - CORRECT ANSWER evaluate standards... A patient's adult child telephones the adult-gerontology primary care nurse practitioner to inquire about the patient's illness. The patient's child reports that

the parent relies upon the child to explain everything to him or her. The nurse practitioner: asks the child to provide a copy of the patient's advance directive document. assures the child that the nurse practitioner can disclose requested information. informs the child that he or she must come to the clinic to discuss the parent's case. tells the child that the nurse practitioner can discuss the information only with the patient. - CORRECT ANSWER tells the child that the nurse practitioner can discuss the info with only the pt When disseminating research findings in a peer-reviewed journal, the adult- gerontology primary care nurse practitioner: concludes that the study proves the hypothesis. excludes the discussion section, because the conclusion contains this information. recommends incorporating the results directly into clinical practice. uses the methodology section to support the validity of the study. - CORRECT ANSWER use method section Preparing to implement an incontinence reduction program at a nursing home, the adult-gerontology primary care nurse practitioner reviews several studies. Place the studies in sequential order of the strength of evidence for this population from strongest to weakest. (Fill in your answer by providing a numerical value to each letter with no spaces eg. A1B2C3) A: a case report of an experimental incontinence reduction program in older adults B: A concensus statement from the urologic association regarding the use of scheduled toileting

C: a systematic review of nonrandomiized trails concerning the use of vaginal estrogen - CORRECT ANSWER c b a A patient has fully recovered from septic shock due to bacteremia. The patient has been accepted to a long-term acute care facility for continuation of antibiotic therapy. The infectious disease physician has not seen the patient in two days. The adult-gerontology acute care nurse practitioner: contacts the physician to determine the appropriate duration of antibiotic therapy. notifies medical staff services that the physician has not seen the patient. waits for the physician to come see the patient. writes transfer orders for the patient. - CORRECT ANSWER conyacts An 80-year-old patient has macular degeneration and is seen on the surgical unit for postoperative care after repair of a hip fracture. To prepare the patient for discharge, the adult-gerontology acute care nurse practitioner: gives illustrative pictures that instruct the patient on body alignment during activity. has the patient watch a video about surgeries and pre-operative care for hip fractures. provides the patient with an audio tape for care of hip fractures and range-of- motion activities. provides verbal reinforcement to the patient on how to keep proper body alignment following hip surgery. - CORRECT ANSWER provides verbal reinforcement

When serving as a nurse researcher, the adult-gerontology acute care nurse practitioner is guided by which ethical principle to ensure that research participants are protected from harm or exploitation? Confidentiality. Justice. Nonmaleficence. Right to self-determination. - CORRECT ANSWER nonmaleficence The adult-gerontology acute care nurse practitioner is asked to provide evidence to the hospital administration about the safety of nurse practitioners placing central lines. Which resource provides the strongest level of evidence? A nurse practitioner's journal editorial. A randomized control trial. A systematic review. The American Association of Colleges of Nursing's Nurse Practitioner Competencies. - CORRECT ANSWER An 80-year-old male patient with dementia requires long-term care placement. To which funding agency does the patient apply after "spending down" to qualify? American Association of Retired Persons. Medicaid. Medicare. United States Social Security Administration. - CORRECT ANSWER aid Which clinical scenario does the adult-gerontology acute care nurse practitioner evaluate for a quality improvement process change? A new case of necrotizing fasciitis in an immunocompromised patient. A projected increase in the number of influenza cases requiring hospitalization. An expected rate of ventilator-associated pneumonia in pulmonary disease patients. An increased incidence of postoperative sternal wound infections. - CORRECT ANSWER sternal wound infections

A root cause analysis of a crisis situation in the intensive care unit identified a lack of clinician-family communication as the basis for the resulting adverse outcome. As part of the performance improvement plan, the adult-gerontology acute care nurse practitioner is asked to develop evidence-based polices to establish clinician-family communication standards in the unit. These policies should include: an evaluation tool to assess the health care surrogate's decision-making ability and anxiety level. guidelines for having discussions with family members that are geared toward establishing treatment goals. limits on the number of consulting services utilized to prevent sending mixed messages. requirements for a formal family conference within 12 hours of a patient's admission to the intensive care unit. - CORRECT ANSWER guidelines A patient is brought to the emergency department after being found unresponsive in a car. The patient's spouse arrives at the hospital to find the patient comatose, on mechanical ventilation, and brain death has been established. The spouse informs the staff that the patient has an advance directive and did not want to be kept alive, artificially. The spouse struggles with the decision to remove the patient from life support. The adult-gerontology acute care nurse practitioner: consults the ethics committee to help with the decision-making process. discusses with the spouse that removing the patient is the right thing to do. encourages the spouse to have a family meeting to make the decision as a group. r eviews the patients advance directive with the spouse. - CORRECT ANSWER reviews

An adult-gerontology acute care nurse practitioner needs to communicate the findings of HIV to a patient. The nurse practitioner enters the patient's room and the spouse is at the bedside. To discuss the diagnosis, the nurse practitioner: asks the nurse to step into the room. asks the spouse to step out of the room. speaks with the patient and spouse together. speaks with the spouse privately. - CORRECT ANSWER speak with spouse privately When reading a systematic review, an adult-gerontology acute care nurse practitioner ensures that the review: describes the intended audience. describes the study inclusion criteria. is published in a peer-reviewed journal. is written by experts in the field. - CORRECT ANSWER describes inclusion criteria An exception to the practice of maintaining patient confidentiality is when: a family member of the patient gives consent. a family member of the patient is paying for the treatment. the patient is unresponsive. the patient plans to hurt someone. - CORRECT ANSWER plans to hurt someone A 65-year-old female patient has a confirmed diagnosis of terminal liver disease. The patient's advance directive designates comfort measures, only. An adult- gerontology acute care nurse practitioner's action is to: discuss the patient's decision with the patient's family members. persuade the patient to participate in a hepatitis clinical trial. reconfirm the patient's end-of-life decision. refer the patient for a psychological evaluation. - CORRECT ANSWER reconfirm Which research design has the greatest strength in determining if an intervention is effective? Case control Clinical trial Cohort Cross-sectional - CORRECT ANSWER trial

describe levels of evidence - CORRECT ANSWER 1) Systematic Reviews | 2)Clinical trials | 3)Observational studies -cohort -cross sectional -case control | 4)Case reports, case series | 5)anecdotal, opinions describe prevention as a part of action taking initiatives in risk mgt - CORRECT ANSWER proactive risk awareness and safety programs in place describe correction as a part of action taking initiatives in risk mgt what 2 factors must be included in this - CORRECT ANSWER post incident remediation to minimize impact and prevent future occurrences these steps must be monitored and audited describe documentation as a part of action taking initiatives in risk mgt - CORRECT ANSWER essential for legal defense thorough medical records and institutional policies describe education as a part of action taking initiatives in risk mgt - CORRECT ANSWER in services of all staff at orientation and annually (minimally) describe departmental coordination as a part of action taking initiatives in risk mgt - CORRECT ANSWER encouraging departments and managers to work together for the common goal of improved pt and staff safety describe correlational research - CORRECT ANSWER examines relationships among variables types: natural observation survey research

archival research correlational research can be used as the first step before an experiment begins. It can also be used if experiments cannot be conducted. It determines if a relationship exists between two or more variables, and if so, to what degree the relationship occurs. describe ex post facto research - CORRECT ANSWER x post facto experiment begins with groups that are already different in some respect and searches in retrospect for factors that brought about those differences describe cross sectional research - CORRECT ANSWER usually non experimental -examines a pop with a similar attribute (asthma) but different in one particualar way (age) purpose: to find relationships between variables at a specific time ex. surveys mostly used to determine PREVALANCE by public health departments pro: short, cheap con: can't make causal relationships and thus often form a foundation for a hypothesis describe a cohort study - CORRECT ANSWER compares a particular outcome (lung cancer) in groups that are alike mostly but differ by a particular characterestic (female nurse who smoke compared with those who do not smoke) follow a group of people who do not have the disease for a period of time and see who develops the disease (new INCIDENCE). Can't have already developed the disease (as opposed to a cross sectional) cons: attrition, takes a long time describe a longitudinal study - CORRECT ANSWER Framingham is the famous one

how does a longitudinal study vary from a cohort - CORRECT ANSWER In Cohort studies, subjects are asembled on the basis of some common experience (such as attendinding medical school) and are then monitored for a specified amount of time at regular intervals (e.g., taking Step 1, 2, and 3) until they develop the outcome of interest (they become practicing physicians) or the follow up time ends. The cohort stydy minimizes many of the biases evident in case-control designs and is the definitive observational clinical study. Cohort allows researchers to compute a relative risk. Longitudinal Studies identify individual subjects and follow them over a given period of time. For example, the study of cholesterol-lowering drugs on cardiovascular events requires that the same subject is observed over a significant period of time. what are 5 examples of qualitative studies - CORRECT ANSWER case studies open ended questions field studies paricipant observation ethnographic studies