JURISPRUDENCE EXAM 2024-2025. QUESTIONS & CORRECT VERIFIED ANSWERS. GRADED A, Exams of Nursing

Download JURISPRUDENCE EXAM 2024-2025. QUESTIONS & CORRECT VERIFIED ANSWERS. GRADED A and more Exams Nursing in PDF only on Docsity! JURISPRUDENCE EXAM 2024-2025. QUESTIONS & CORRECT VERIFIED ANSWERS. GRADED A ________ ____________ is inherent in the type of care and services that nurses provide. It may relate to the physical activities, such as bathing, that nurses perform for, and with, the client that create closeness. - ANSProfessional intimacy ___________ _____________ means all possible alternative interventions are exhausted before deciding to use a restraint. - ANSLeast restraint ___________ is critical in the nurse-client relationship because the client is in a vulnerable position. - ANSTrust ___________ is the recognition of the inherent dignity, worth and uniqueness of every individual, regardless of socio-economic status, personal attributes and the nature of the health problem - ANSRespect ___________ restraints limit a client's movement. These restraints include a table fixed to a chair or a bed rail that cannot be opened by the client. - ANSPhysical ____________ is the expression of understanding, validating and resonating with the meaning that the health care experience holds for the client. - ANSEmpathy ____________ restraints control a client's mobility. Examples include a secure unit or garden, seclusion or a time-out room. - ANSEnvironmental _____________ can take many forms, including verbal and emotional, physical, neglect, sexual and financial. - ANSAbuse _____________ restraints are any form of psychoactive medication used not to treat illness, but to intentionally inhibit a particular behaviour or movement. - ANSChemical ________________ can be essential in situations in which a language barrier exists between the nurse and the client - ANSInterpreters ________________ involves the monitoring and directing of specific activities of UCPs. It does not include ongoing managerial responsibilities. Often, the person who assigns a task also _______________ the performance of that task. This can be direct or indirect, depending on the circumstances. For direct, the supervisor is physically present during the provision of care. For indirect, the supervisor is not Step 5 Obtain consent from the substitute decision-maker. A _______________ ______________ conducts assessments of capacity on persons who need decisions made on their behalf on a continuing basis. - ANSCAPACITY ASSESSOR NPs, RNs and RPNs are eligible to become capacity assessors. Designation will require the successful completion of a capacity assessor education or training course approved or required by the attorney general. A 35-year-old client is diagnosed with chronic renal failure and has started peritoneal dialysis. Maintaining adequate protein intake is an essential part of the client's ongoing treatment, and animal protein is the recommended source. The client is a Hindu by religion and has been eating eggs, chicken and goat all his life. However, since the commencement of dialysis, he has stopped eating these foods and has become a vegetarian. He tells the health care team that he wants to become a good Hindu so that God will help him with his ordeal. He says that even though many Hindus eat meat, not eating meat is a more devout way of life and one he wishes to follow. - ANSRecognizing that, at times of crisis, clients may revert to more traditional beliefs, the team needs to work with this client to determine the reason for his change in dietary practices. The goal is not to change his beliefs, but to increase the client's choices about how to achieve adequate protein intake. The team could involve a dietitian to teach ways to increase protein intake from vegetarian sources, such as cheese, lentils, nuts, beans and tofu. They also want to help the client explore his perceptions of what caused his illness and the role religion plays in his care. Involving a Hindu priest may be an effective way of addressing spiritual needs, and the priest may, in fact, be able to assist the client in resuming some intake of animal protein, if he chooses to do so. Regardless of approach, the ultimate decisions about diet remain with the client. A client asks a nurse to perform an act that has an unknown risk, what two things should the nurse do? - ANS1. refuse to follow the client's wishes if she/he believes it may cause harm. 2. share her/his reasons for this decision with the client. A client from a First Nations community requests that a sweetgrass ceremony be performed in the hospital as part of the treatment. The ceremony involves chanting and burning some substances, which will result in small amounts of smoke (similar to that of burning an incense stick). The nurse's initial reaction is that something like this has never been done, and that it is against hospital policy. However, she also understands the significance of this ritual for the client. The nurse raises the issue with the unit administration and, with the support of colleagues, explores the potential impact on other clients. The nurse also reviews relevant fire policies and consults with appropriate staff in other departments. It is determined that any risk to other clients can be removed by transferring the client to a private room. This is done, and the ceremony is performed. - ANSThe nurse's commitment to client-centred care prompts her to explore ways of meeting the client's needs within the limits of the hospital setting. Lack of experience and fear are two of the most common barriers to providing culturally sensitive care. Through collaboration with other colleagues, the nurse is able to address the assumption that it cannot be done and to determine ways of meeting client needs without exposing other clients to discomfort or risk. The nurse succeeds in meeting the needs of her client, not only because of her creativity, but because she takes responsibility for influencing policies and procedures in the practice setting. A couple comes to a walk-in clinic with a young child who is crying and tugging at his ears. The couple has recently come to Canada, but understands English well enough that the nurse feels language is not an issue. An assessment reveals that the child has an infection in both ears, and the couple is given a prescription for an antibiotic and Tylenol drops for fever and pain. The situation is fairly routine, and an interpreter is not considered necessary. The parents are informed about the diagnosis and treatment, and they nod in understanding. The next day the couple returns with the child whose condition seems to have worsened. There is now pink discharge from both ears, and the entire family is in distress. An interpreter is called to assist. Through the interpreter, the nurse learns that the parents had the prescription filled promptly, and they understood the child was to be given the medicine every four hours. - ANSThis example illustrates the importance of confirming that accurate communication has been achieved. To reduce the chance of confusion, the nurse could have demonstrated how to measure, and then administer, both medications. Culturally appropriate client education materials would also have been helpful. A nurse is providing direct care to an elderly woman newly diagnosed with angina. She has been prescribed nitroglycerine to manage her angina attacks. The client reveals to the nurse her firm belief that her illness is caused by the "evil eye," a glance cast upon her by another to cause this condition. She shows the nurse her own remedy, which she claims will lift the curse of the evil eye and cure her. - ANSThe nurse assesses the client's remedy for possible health risks, such as a high sodium content. As well, the nurse negotiates with the client to take the nitroglycerine. In doing so, the nurse will need to be vigilant to potential objections the client may have to taking the medication. The goal is to have a plan of care that includes the remedy for the evil eye, but also includes the appropriate use of the nitroglycerine. The nurse and the client may not fully understand each other's preferences, but are willing to accommodate both interventions. A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 1 The nurse has the knowledge, skill and judgment to _______________ the procedure __________________. - ANSperform competently A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 2 The nurse has the _________________ knowledge, skill and judgment to teach the procedure. - ANSadditional A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 3 The nurse accepts ____________ ________________ for the decision to teach the procedure after considering: ■ the known __________ and _____________ to the client of performing the procedure ■ the ________________ of the outcomes of performing the procedure - ANSsole accountability risks and benefits predictability A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 4 The nurse has _______________ that the UCP has acquired, through teaching and supervision of practice, the knowledge, skill and judgment to perform the procedure. - ANSdetermined A nurse may teach a controlled act procedure to a UCP when the nurse meets all of the following six requirements: Requirement 6 Considering the factors in Requirements 3 and 4, the nurse ________________ the continuing competence of the UCP to perform the procedure or reasonably believes that a mechanism is in place to determine the UCP's continuing competence. - ANSevaluates A nurse who teaches, assigns duties to or supervises UCPs must ensure that the UCP: ◗ ________________ the extent of her or his responsibilities in performing the procedure(s) ◗ knows when and who to ask for _______________, ◗ knows when, how and to whom to ___________ the outcome of the procedure. - ANSunderstands A substitute decision-maker has the right to access the same ___________________ that a capable client would be able to access. - ANSinformation A UCP only has the authority to perform a controlled act through an exception or when an individual who has the authority to order or perform the act ________________ this authority to the UCP. - ANSdelegates A woman arrives at a walk-in clinic with her nine- year-old son. She does not speak English, but the child is available to interpret for his mother. The client is clutching her abdomen and showing what appears to be visible signs of pain. The child says he is very worried about his mother. - ANSWhile it is often convenient to rely on children to interpret for their parents, it is important for the nurse to be sensitive to the needs of the parent and the child. If no other interpreter is readily available, the nurse will have to work with the child to do the initial assessment and determine the severity of the situation. The woman and the son may feel uncomfortable talking about health issues such as vaginal discharge, menstruation and pregnancy, thus compromising the accuracy of the health history. An adult, preferably female, interpreter should be sought with urgency to ensure a thorough and comprehensive history. The nurse also needs to address the child's concerns and fears appropriately, as well as the stress associated with having to interpret for his mother. When using family members as interpreters, the nurse must carefully evaluate each situation on an ongoing basis. A woman, 35, is admitted to the general medical unit. While in the hospital, she expresses concern about her partner's ability to care for her children. She also appears worried about how she will manage at home after she is discharged. The nurse suggests that perhaps a family meeting is necessary and offers to contact her husband. The nurse further suggests that maybe the client's mother, who has called often to inquire about her daughter, should be involved in the meeting. - ANSThe nurse has made an assumption that the client's partner is male and that the relationship with the mother is one that will be supportive to the entire family. For many couples in a homosexual relationship, the issue of family can be sensitive. For some people, "family" is often their chosen family as opposed to kin. By using the word "partner," and asking the client who would be appropriate for a family meeting, the nurse shows openness and a nonjudgmental attitude. According to College of Nurses of Ontario (CNO) standards, nurses are accountable for __________ ______________ whether the intervention or service relates to a treatment (as defined in the HCCA or as required in common law), admission to a facility, or the provision of a personal assistance service. - ANSobtaining consent Admission to a care facility without consent may be authorized if: - ANS1. the person who has been deemed incapable requires immediate admission as a result of a crisis; and 2. it is not reasonably possible to obtain immediate consent or refusal on the incapable person's behalf. Also, nurses are professionally accountable for acting as _____________ ______________ and for helping clients __________________ the information relevant to making decisions to the extent permitted by the client's capacity. - ANSclient advocates understand An examination or diagnostic procedure that is a treatment may be conducted without ____________ if it is reasonably necessary to determine if there is an emergency. - ANSconsent An individual's culture is ________________ by many factors, such as race, gender, religion, ethnicity, socio-economic status, sexual orientation and life experience. The extent to which particular factors influence a person will ______________. - ANSinfluenced vary Because allergy testing and desensitizing injections carry a risk of adverse reactions, nurses must be able to do what? - ANSrecognize side effects, intervene COMPETENCY ASSUMPTIONS Entry-level RPNs are _____________ to practise safely, competently and ethically in situations of health and illness with individuals across the lifespan. - ANSprepared COMPETENCY ASSUMPTIONS Entry-level RPNs are beginning practitioners whose level of autonomy and proficiency will grow through ______________ and ______________ from the interprofessional health care team. - ANScollaboration support COMPETENCY ASSUMPTIONS Entry-level RPNs are committed to engaging in quality assurance practices, including ____________ _____________. - ANSReflective Practice COMPETENCY ASSUMPTIONS Entry-level RPNs enter into practice with competencies that are _______________ across diverse practice settings. - ANStransferable COMPETENCY ASSUMPTIONS Entry-level RPNs have a _______________ ___________ in nursing, health and social sciences, ethics, leadership and research. - ANSknowledge base COMPETENCY ASSUMPTIONS Entry-level RPNs possess the ________________ required to demonstrate the wide range of competencies in this document. - ANSknowledge COMPETENCY ASSUMPTIONS Entry-level RPNs use ____________ _______________ skills to support clinical decision-making and reflect upon practice experiences. - ANScritical thinking COMPETENCY ASSUMPTIONS Entry-level RPNs' practice decisions are _________-___________ and must take into account the environment, the client's circumstances and whether the client's needs can be met by the entry-level RPN. - ANSclient-specific Conflict between a nurse and a client can escalate if a client has: - ANSa) a history of aggressive or violent behaviour, or is acting aggressively or violently (for example, using profane language or assuming an intimidating physical stance); b) a medical or psychiatric condition that causes impaired judgment or an altered cognitive status; c) an active drug or alcohol dependency or addiction; d) difficulty communicating (for example, has aphasia or a language barrier exists); and/or e) ineffective coping skills or an inadequate support network. Conflict between a nurse and a client can escalate if a client is: - ANSa) intoxicated or withdrawing from a substance- induced state; b) being constrained (for example, not being permitted to smoke) or restrained (for example, with a physical or chemical restraint); c) fatigued or overstimulated; and/or d) tense, anxious, worried, confused, disoriented or afraid. Conflict between a nurse and a client can escalate if a nurse: - ANSa) judges, labels or misunderstands a client; b) uses a threatening tone of voice or body language (for example, speaks loudly or stands too close); c) has expectations based on incorrect perceptions of cultural or other differences; DEFINITION A client-specific order can be an order for a procedure, treatment, drug or intervention for an individual client - ANSDIRECT CLIENT ORDER DEFINITION A clinical practice guideline, decision guide, algorithm or standardized interview tool. - ANSPROTOCOL DEFINITION a prescription for a procedure, treatment, drug or intervention - ANSORDER DEFINITION a process that destroys or kills some, but not all, disease-producing micro- organisms on an object or surface. - ANSDISINFECTION DEFINITION A process that ensures that a second practitioner conducts a verification, either in the presence or absence of the first practitioner. - ANSIndependent double-check. DEFINITION A relationship that is professional and ensures the client's needs are first and foremost. The relationship is based on trust, respect and intimacy and requires the appropriate use of the power inherent in the health care provider's role. The professional relationship between RPNs and their clients is based on a recognition that clients (or their alternative decision-makers) are in the best position to make decisions about their lives when they are active and informed participants in the decision-making process. - ANSTHERAPEUTIC RELATIONSHIP DEFINITION a substance that destroys or stops the growth of micro-organisms on living tissue (for example, skin). - ANSANTISEPTIC DEFINITION a waterless antiseptic designed for application to the hands to reduce the number of viable micro-organisms. In Canada, such preparations usually contain 70 percent ethyl alcohol. - ANSALCOHOL-BASED HAND RINSE DEFINITION Actively supporting a right and good cause; supporting others for speaking for themselves or speaking on behalf of those who cannot speak for themselves. - ANSADVOCATE DEFINITION Activities that are considered potentially harmful if performed by unqualified people. - ANSCONTROLLED ACTS DEFINITION Administrating one's own medication. - ANSSELF-ADMINISTRATION DEFINITION All people sharing a common health issue, problem or characteristic. These people may or may not come together as a group. - ANSPOPULATIONS DEFINITION an agent that destroys micro-organisms, especially pathogenic organisms. A product with the suffix "-cide" indicates that it is an agent that destroys the micro-organism identified by the prefix (for example, virucide, fungicide, bactericide). - ANSGERMICIDE DEFINITION any preventable event that may cause or lead to inappropriate medication use or client harm while the medication is in the control of the health care professional, client or consumer. - ANSMEDICATION ERROR DEFINITION Any sudden unexpected event that has an emotional impact that can overwhelm the usually effective coping skills of an individual or a group - ANSCRITICAL INCIDENT DEFINITION At every stage of life, health is determined by complex interactions among social and economic factors, the physical environment and individual behaviour. They do not exist in isolation from each other. These determinants, in combination, influence health status. - ANSDETERMINANTS OF HEALTH DEFINITION Care that aims to relieve client suffering and improve the quality of living and dying. It strives to help clients and families address physical, psychological, social, spiritual and practical issues, and their associated expectations, needs, hopes and fears. - ANSPALLIATIVE CARE DEFINITION defining lines that separate the therapeutic behaviour of an RPN from any behaviour that, well-intentioned or not, could reduce the benefit of nursing care to clients, families or communities. - ANSBOUNDARY DEFINITION Descriptions of the expected performance behaviour that reflects the professional attributes required in a given nursing role, situation or practice setting. - ANSCOMPETENCY STATEMENTS DEFINITION Dosages, frequencies or routes that are prescribed in ranges (for example, Gravol 50-100 mg for nausea). - ANSRANGE DOSES Most medications are not prescribed in range doses; however, range doses are used in situations in which the need for the amount of a drug varies from day to day or within the same day. Range doses give nurses the flexibility to administer the dose that best suits the assessment of the client. DEFINITION Drugs that bear a heightened risk of causing significant client harm when they are used in error. - ANSHIGH ALERT MEDICATIONS DEFINITION Expectations that contribute to public protection that inform nurses of their accountabilities and the public of what to expect of nurses. These apply to all nurses regardless of their role, job description or area of practice. - ANSNURSING STANDARDS DEFINITION formal process that transfers the authority to perform a controlled act - ANSDELEGATION DEFINITION giving the wrong medication - ANSERROR OF COMMISSION DEFINITION if the person is experiencing severe suffering or is at risk of sustaining serious bodily harm if the treatment is not administered promptly. - ANSEMERGENCY DEFINITION In this approach, a client is viewed as a whole person. - ANSCLIENT-CENTRED CARE Medications that are prescribed and administered as needed. - ANSPRN MEDICATION DEFINITION microscopic organisms such as bacteria, virus or fungus, commonly known as germs, that can cause an infection in humans. - ANSMICRO-ORGANISM DEFINITION not administering an ordered medication - ANSERROR OF OMISSION DEFINITION physical, chemical or environmental measures used to control the physical or behavioural activity of a person or a portion of his/her body. - ANSRESTRAINT DEFINITION Practice that is based on successful strategies that improve client outcomes and are derived from a combination of various sources of evidence, including client perspective, research, national guidelines, policies, consensus statements, expert opinion and quality improvement data. - ANSEVIDENCE-INFORMED PRACTICE DEFINITION Reasoning in which one analyzes the use of language, formulates problems, clarifies and explains assumptions, weighs evidences, evaluate conclusions, discriminates between pros and cons, and seeks to justify those facts and values that result in credible beliefs and actions. - ANSCRITICAL THINKING DEFINITION Referring to the extension of communication over a distance, this term covers all forms of distance and/or conversion of the original communications, including radio, telegraphy, television, telephony, data communication and computer networking - ANSTELECOMMUNICATION DEFINITION relationship involves planned and structured psychological, psychosocial and/or interpersonal interventions aimed at influencing a behaviour, mood and/or the emotional reactions to different stimuli - ANSPSYCHOTHERAPEUTIC RELATIONSHIP DEFINITION specialized clothing or equipment (for example, gloves, masks, protective eyewear, gowns) worn by an employee for protection against an infectious hazard. - ANSPERSONAL PROTECTIVE EQUIPMENT DEFINITION The ability of a nurse to integrate the professional attributes required to perform in a given role, situation or practice setting. Professional attributes include, but are not limited to, knowledge, skill, judgment, values and beliefs. - ANSCOMPETENCE DEFINITION the act of determining or allocating responsibility for particular aspects of care to another individual. This includes procedures that may or may not be a controlled act. Ideally, a range of care needs, rather than specific procedures. - ANSASSIGNING DEFINITION the conversion of data into a form called cipher text that cannot be easily understood by unauthorized people. - ANSENCRYPTION DEFINITION The delivery, management and coordination of care and services provided via telecommunication technology - ANSTELEPRACTICE DEFINITION The formal process that transfers authority to perform a controlled act. - ANSDELEGATE DEFINITION They include a wide range of treatment modalities, such as herbal therapies and manual healing, such as reflexology and acupuncture. The therapies are not discipline-specific, and the knowledge required to provide them is not specific to nursing. - ANSCOMPLEMENTARY THERAPIES DEFINITION thin sheets of tissue that line various openings of the body, such as the mouth, nose, eyes and genitals. - ANSMUCUS MEMBRANES DEFINITION To work together with one or more members of the health care team who each make a unique contribution to achieving a common goal. Each individual contributes from within the limits of her or his scope of practice. - ANSCOLLABORATE DEFINITION Undesirable physical reactions to health products, including drugs, medical devices and natural health products. - ANSADVERSE REACTION DEFINITION viruses found in blood which produce infection, such as hepatitis B virus (HBV), hepatitis C virus (HCV) or human immunodeficiency virus (HIV). - ANSBLOOD- BORNE PATHOGENS DEFINITION What a capable person expresses about treatment, admission to a care facility or a personal assistance service. - ANSWISHES DEFINITION when, in the opinion of the health care team, the client is irreversibly and irreparably terminally ill; that is, there is no available treatment to restore health or the client refuses the treatment that is available. - ANSEXPECTED DEATH DEFINITION A board established by and accountable to the government. Its members are appointed by the government. The Board considers applications for review of findings of incapacity, applications relating to the appointment of a representative, and applications for direction regarding the best interests and wishes of an incapable person. - ANSConsent and Capacity Board (CCB) DEFINITION A legal document in which a capable person gives someone else the authority to make decisions about his/her personal care in the event that he/she becomes incapable. The document could also contain specific instructions about particular treatment decisions. - ANSPower of attorney for personal care DEFINITION A person identified by the HCCA who may make a treatment decision for someone who is incapable of making his/her own decision. Usually a spouse, partner or relative. - ANSSUBSTITUTE DECISION-MAKER DEFINITION A plan that is developed by one or more health care practitioners, dealing with one or more of the health problems that a person has and is likely to have. It provides for the administration of various treatments or courses of treatment. It may include the withholding or withdrawal of treatment in light of the person's health condition. - ANSPLAN OF TREATMENT DEFINITION A series or sequence of similar treatments administered to a person over a period of time for a particular health problem. - ANSCOURSE OF TREATMENT DEFINITION Explain to the interpreter the importance of ______________ everything that the client and the health care provider say, without omissions, summary or judgments. - ANSrepeating Factors that influence a person's ________________ include age; general physical, mental and emotional health; the amount and duration of exposure to the agent; and the immune status and inherent susceptibility of the individual. - ANSsusceptibility Hierarchy of substitute decision-makers - ANS1. Guardian of the person — appointed by the court. 2. Someone who has been named as an attorney for personal care. 3. Someone appointed as a representative by the CCB. 4. Spouse, partner or relative in the following order: a. spouse or partner, b. child if 16 or older; custodial parent (who can be younger than 16 years old if the decision is being made for the substitute's child); or Children's Aid Society; c. parent who has only a right of access; d. brother or sister; e. other relative. 5. PGT is the substitute decision-maker of last resort in the absence of any more highly ranked substitute, or in the event two more equally ranked substitutes cannot agree. HOW MANY CONTROLLED ACTS ARE SPECIFIED BY THE Regulated Health Professions Act, 1991? - ANS13 HOW MANY CONTROLLED ACTS CAN A NURSE PERFORM? - ANS3 How many requirements must be met before a nurse can accept delegation? - ANS7 How many requirements must be met before a nurse can delegate to an UCP. - ANS10 How the infectious agent is transmitted from the reservoir to the susceptible host is called the ___________ of ___________________ - ANSmode of transmission If a health practitioner or evaluator finds that a person is incapable of making a decision about a treatment or admission to a care facility, consent must be obtained from a _________________________ - ANSsubstitute decision-maker If a person is incapable, and there is no other substitute decision- maker, who is the substitute decision-maker of last resort. - ANSthe PGT If a person is incapable, the consent (or refusal to give consent) is to be obtained from who? - ANShighest- ranked available substitute decision-maker from the HCCA hierarchy who is willing to make the decision. If consent to admission to a care facility is required by law, then consent is needed in all cases except in a _____________ _____________. - ANScrisis situation If the nurse proposing a treatment or evaluating capacity to make an admission or personal assistance service decision determines the client is __________________ of making the decision, then the nurse _______________ the client that a substitute decision-maker will be asked to make the final decision. This is __________________ in a way that takes into account the particular circumstances of the client's condition and the nurse-client relationship. - ANSincapable informs Informed consent does not always need to be ______________, but can be oral or implied. - ANSwritten Jody, a three-year-old, is intubated post-operatively on a ventilator following brain surgery. To prevent her from pulling out the endotracheal tube, her hands are restrained with mittens. Prior to the surgery, the need to use the mittens was explained to her parents and consent was obtained. - ANSThis is an appropriate use of restraints that will be discontinued as soon as possible. To avoid frightening the child, the nurse arranged for the family to reassure Jody during the post- operative period. As well, using language Jody could understand, the nurse explained to her why she had to wear mittens. There are circumstances in which a nurse may need to restrain clients when they are not capable of understanding the necessity for the intervention. The nurse needs to consider these situations carefully and use the least restraint possible. Many facilities in Ontario use a __________ ____________ philosophy that the quality of life for each client, with the preservation of dignity, is the value guiding the practice of health care practitioners, including nurses. CNO supports this in all settings where nurses practise. - ANSleast restraint MEDICATION TERMS a prick/puncture procedure to determine allergies, if any. - ANSALLERGY TESTING MEDICATION TERMS A vaccine. - ANSIMMUNIZING AGENT MEDICATION TERMS an intracutaneous injection to desensitize to an allergen - ANSDESENSITIZING INJECTION MEDICATION TERMS Any type of drug that the federal government has categorized as having a higher- than-average potential for abuse or addiction. Such drugs are divided into categories based on their potential for abuse or addiction. - ANSCONTROLLED SUBSTANCE MEDICATION TERMS Medications and preparations that do not require a prescription; for example, herbal therapies and acetaminophen. - ANSOVER THE COUNTER (OTC) MEDICATION TERMS The administration of an allergen by oral, inhaled or other route in which a positive test is a significant allergic response (for example, anaphylactic shock). - ANSAllergy challenge testing Nurses ______________ the client from harm by ensuring that abuse is prevented, or stopped and reported. - ANSprotect Nurses are responsible for effectively establishing and maintaining the limits or ______________ in the therapeutic nurse-client relationship. - ANSboundaries Nurses can employ client-centred care strategies to _______________ behaviours that contribute to the escalation of conflict. - ANSprevent Nurses can prevent the escalation of conflict by: _____________ and address the client's wishes, concerns, values, priorities and point of view; - ANSrespect Nurses can prevent the escalation of conflict by: __________________ the feelings behind the client's behaviour; - ANSacknowledge resuscitation Nurses communicate the goals of care and treatment by: _________________ with other health care team members as required, to identify and resolve treatment and/or end-of-life care _________________. (For example, a nurse could present a client situation during a team meeting or rounds or include an ethicist on the care team, if it is appropriate); - ANSconsulting issues Nurses communicate the goals of care and treatment by: contributing to ongoing communication about end-of-life care wishes and implementing the client's wishes by: - ANS■ reviewing the client's plan of treatment including resuscitation wishes as needed or when required by organizational policy. (For example, in long- term care settings, the review could be part of the regular client health review); ■ documenting the relevant information; and ■ communicating any changes in client's wishes to the interprofessional team and ensuring the wishes are included in the plan of treatment; Nurses communicate the goals of care and treatment by: helping and being involved in client and family _________________ about treatment and/or end-of- life care; - ANSdiscussions Nurses communicate the goals of care and treatment by: identifying and using appropriate _______________ ______________ when discussing treatment and end-of-life issues with the client; - ANScommunication techniques Nurses communicate the goals of care and treatment by: identifying the client's wishes about preferred treatment and/or end-of-life care as ___________ as ________________, while considering the client's condition and the degree to which the therapeutic nurse-client relationship has been established; - ANSearly as possible Nurses communicate the goals of care and treatment by: knowing the end-of-life care wishes of the client or obtaining that knowledge from: - ANS■ the client's direct instructions (which include non-verbal means); ■ the client's advance directive (such as a living will or power of attorney for personal care); ■ the substitute decision-maker's instructions, if the client is incapable; or ■ documented instructions from another member of the health care team; Nurses communicate the goals of care and treatment by: maintaining ______________ of client and interprofessional team communications about treatment and end-of-life care decisions according to organizational policies and procedures as well as the College's Documentation practice document; - ANSrecords Nurses communicate the goals of care and treatment by: providing an opportunity to discuss, identify and review the client's end-of-life care ________________; - ANSwishes Nurses communicate the goals of care and treatment by: using professional ________________ to determine how the interprofessional team needs to be involved in discussions about the client's end-of-life care wishes; - ANSjudgment Nurses implement a client's treatment and end-of- life care wishes by: __________________ in a written plan of treatment all information that is relevant to the implementation of the client's wishes for treatment at end of life; - ANSdocumenting Nurses implement a client's treatment and end-of- life care wishes by: __________________ the client's wish for no resuscitation even in the absence of a physician's written do-not-resuscitate (DNR) order; - ANSfollowing ■ it is an emergency situation, there is no information about the client's wish, and a substitute decision-maker is not immediately available; Nurses implement a client's treatment and end-of- life care wishes by: not initiating treatment that is not in the plan of treatment, except in emergency situations, when: - ANS■ the client has not given informed consent, and/or the plan of treatment does not address receiving the treatment; ■ the incapable client's wish is not known, and the substitute decision-maker has indicated that he or she does not want the client to receive the treatment; ■ the attending physician has informed the client that the treatment will be of no benefit and is not part of the plan of treatment that the client has agreed to. In this situation, the nurse is not expected to perform life-sustaining treatment (for example, resuscitation), even if the client or substitute decision-maker requests it; or ■ the client exhibits obvious signs of death, such as the absence of vital signs plus rigor mortis and tissue decay; Nurses implement a client's treatment and end-of- life care wishes by: recognizing that all nurses have the _________________ to pronounce death when clients are _______________ to die and their plan of treatment does not include resuscitation. - ANSauthority expected Nurses implement a client's treatment and end-of- life care wishes by: the knowledge, skill and judgment to determine that ___________ has occurred; - ANSdeath Nurses may administer the flu vaccine to their colleagues if the employer approves this practice and provides the necessary supports to meet the standards of practice. What should they remember when doing so? - ANSIt is important to recognize that by administering the vaccine, the nurse is establishing a nurse- client relationship with the colleague and must keep any information obtained in the course of providing the treatment confidential. Nurses need to __________________ for clients' access to information about care and treatment if it is not ___________________ from other care providers. - ANSadvocate forthcoming Nurses should not provide a treatment if there is any ______________ about whether the client understands and is capable of consenting. This applies whether or not there is an _____________, or even if the client has already consented. It does not ________________ if a substitute decision-maker has consented. - ANSdoubt order apply Nurses use a wide range of effective _____________ _____________ and _____________ __________ to appropriately establish, maintain, re-establish and terminate the nurse-client relationship. - ANScommunication strategies interpersonal skills Nurses who obtain consent have a professional ___________________ to be satisfied that the client is capable of giving consent - ANSaccountability Nurses work with the client to ensure that all professional behaviours and actions meet the _______________ needs of the client. - ANStherapeutic One of Joanne's clients in the psychiatric unit, John, confides to her that he is fascinated by young children, boys and girls. He tells Joanne he is afraid that he will hurt a child some day. Joanne brings that information to the team. A short time later, John is discharged. Some weeks following his discharge, Joanne notices that John is the ice-cream vendor in her neighbourhood. She is - coping mechanisms and supports unknown, not functioning or not in place - requires close, frequent monitoring and reassessment - ANSRN RN OR RPN? - predictable changes in health condition - predictable outcomes - ANSRPN/RN RN OR RPN? - unpredictable, systemic or wide- ranging responses - signs and symptoms subtle and difficult to detect - ANSRN RN OR RPN? high risk of negative outcomes - ANSRN RN OR RPN? recognizes changes, probes further and manages or consults appropriately with other health care team member - ANSRPN STANDARD STATEMENTS Nurses ensure that they are ________________ in both the cognitive and technical aspects of a procedure prior to performing it. - ANScompetent STANDARD STATEMENTS Nurses ensure that they have the appropriate _______________ before performing procedures. - ANSauthority STANDARD STATEMENTS Nurses must consider each situation to determine if the performance of the procedure promotes safe client care, and if it is ______________ for a nurse to perform the procedure. - ANSappropriate STANDARD STATEMENTS Prior to performing procedures, nurses ensure that they are able to identify the potential outcomes of procedures, have the authority and competence to ____________ the ________________ , or have the resources available to manage those outcomes. - ANSmanage the outcomes Steps a nurse should take if they are concerned with the plan of care. - ANS■ assess the situation, consult with the client (as appropriate), nursing colleagues and other experts (for example, other health care professionals) and refer to relevant reference material; ■ inform the responsible health care provider of the concern and support the concern; ■ discuss the concern with the immediate manager (if the concern remains unresolved); ■ contact the responsible health care provider for further discussion (if the immediate nursing manager shares the concern); ■ refer to agency policy to identify how to bring the concern to the attention of a higher medical or other authority in the facility (if the health care provider doesn't consider alternatives to the original treatment plan); ■ decide whether to report the concern to a higher management authority (if the immediate manager does not share the concern and cannot provide information that will eliminate the concern); ■ continue to report to higher authorities in the facility until convinced of the appropriateness of the treatment or until the treatment is changed; ■ inform the health care provider of the decision and the action taken to date (if the decision is to refuse to implement the treatment plan); and ■ document in the client's record the concern and the steps taken that directly relate to client care. If necessary, refer to agency policy for the appropriate format to document information not directly related to client care. The four major elements to preventive practice are: - ANS1. HANDWASHING 2. PROTECTIVE BARRIERS 3. CARE OF EQUIPMENT 4. HEALTH PRACTICES OF THE NURSE The goal of end-of-life care is to _______________ the quality of living and dying, and ________________ unnecessary suffering. - ANSimprove minimize The HCCA does not specify that consent to a personal assistance service is ________________. - ANSrequired The Health Care Consent Act (HCCA) ______________ adjustments to a treatment plan for an incapable client can be made without having to seek repeated consent from a substitute decision- maker. - ANSMinor The Health Care Consent Act (HCCA) _________________ the client's capacity to make a treatment decision is the responsibility of the health care practitioner proposing the treatment. - ANSAssessing The Health Care Consent Act (HCCA) A _______________ ________________ acting as a substitute decision- maker is not required to make a formal statement verifying his/her status. The legislation does contain a __________________ of substitute decision-makers. - ANSfamily member hierarchy The Health Care Consent Act (HCCA) A person's ________________ about treatment, admissions or personal assistance services may be expressed _____________, in ______________, in any other form, or they may be _______________. - ANSwishes orally writing implied The Health Care Consent Act (HCCA) An ___________________ determines client capacity to make a decision about admission to a care facility or a personal assistance service. Registered Nurses (RNs), Registered Practical Nurses (RPNs) and Nurse Practitioners (NPs) may be _________________. - ANSevaluator evaluators The Health Care Consent Act (HCCA) Consent to treatment involves an ongoing process that can ________________ at any time. - ANSchange The Health Care Consent Act (HCCA) Consent to treatment, and assessing the capacity to consent to treatment, must relate to a specific treatment or plan of treatment. A person could be _____________ of giving consent to one treatment, but ________________ with respect to another. - ANScapable incapable The Health Care Consent Act (HCCA) Health care practitioners have no ___________________ to make treatment decisions on behalf of clients, except in an ________________ when no authorized person is available to make the decisions. Similarly, they have no The health care practitioner who proposes the treatment is responsible for taking ______________ __________ to ensure that treatment is not administered without ______________. - ANSreasonable steps consent The infectious agent needs a ______________ where it can live, grow and reproduce - ANSreservoir The more complex the care requirements, the greater the need for consultation and/or the need for an _______ to provide the full spectrum of care. - ANSRN The more complex the client situation and the more dynamic the environment, the greater the need for the ___________ to provide the full range of care, assess changes, reestablish priorities and determine the need for additional resources. - ANSRN The nurse is responsible for ________________ and _______________ appropriately to the client's cultural expectations and needs. - ANSassessing responding The nurse uses _______________ ______________ and _______________ __________ to determine whether the client is able to ________________ the information. For example, a young child or a client suffering advanced dementia is not likely to understand the information. It would not be reasonable in these circumstances for the nurse to inform the client that a substitute decision-maker will be asked to make a decision on his/her behalf. - ANSprofessional judgment common sense understand The nurse uses professional judgment to determine the scope of ______________ ______________ to assist the client in exercising his/her options. The nurse documents her/his actions according to CNO's Documentation, Revised 2008 practice standard and agency policy. - ANSadvocacy services The nurse-client relationship is one of unequal ___________. Although the nurse may not immediately perceive it, the nurse has more _____________ than the client. - ANSpower power The Outreach Program provides ways for nurses to engage in _____________ ___________ by offering consultation and resources to help members practise according to the practice standards. - ANSnursing regulation The Regulated Health Professions Act, 1991 identifies a number of exceptions that allow individuals who are not members of a regulated health profession to perform some controlled act procedures. These exceptions include: - ANS1. treating a member of her/his household, and the procedure falls within the second or third controlled acts authorized to nursing, 2. assisting a person with routine activities of living, and the procedure falls within the second or third controlled acts authorized to nursing (see the table below). The spread of infection requires an _____________ ____________ - ANSinfectious agent The Substitute Decisions Act (SDA) A ____________ _____ _______________ for personal care comes into _______________ when the person who granted it becomes mentally incapable, unless it states otherwise. - ANSpower of attorney effect The Substitute Decisions Act (SDA) To manage conflict, a nurse can: __________ arguing, criticizing, defending or judging; - ANSavoid To manage conflict, a nurse can: ____________ the client, the client's family and the health care team members in assisting with the behaviour and developing ______________ to prevent or manage it; - ANSinvolve solutions To manage conflict, a nurse can: focus on the client's _________________ rather than the client personally; - ANSbehaviour To manage conflict, a nurse can: implement a ____________ ______________ management plan; - ANScritical incident To manage conflict, a nurse can: leave the situation to develop a ________ ___ ________ with the assistance of a colleague if the client intends to harm the nurse - ANSplan of care To manage conflict, a nurse can: protect themselves and other clients in abusive situations by ______________ services, if necessary - ANSwithdrawing To manage conflict, a nurse can: remain calm and ______________ the client to express his/her concerns; - ANSencourage To manage conflict, a nurse can: state that abusive language and behaviours are ______________, if the nurse believes this will not ______________ the client's behaviour; - ANSunacceptable escalate Transfer requires a route for the infectious agent to exit the _____________ (a portal of exit), a mode of travel to the ________________ _______ (a mode of transmission) and a ___________ to enter the susceptible host (a portal of entry) - ANSreservoir susceptible host route Treatment in an emergency can be provided immediately if communication can't take place because of a ____________ ____________ or _____________, and reasonable efforts to overcome these have been made, but a ___________ will prolong the suffering the person is apparently experiencing or will put the person at risk of sustaining serious bodily harm, and there is no reason to believe the person does _______ ___________ the treatment. - ANSlanguage barrier or disability delay not want Treatment in an emergency can be provided immediately if incapable with respect to a treatment, a substitute decision-maker is not readily ___________, it is not ___________ ____________ to obtain a consent or refusal from the substitute, and a __________ will put the person at risk of sustaining serious bodily harm. - ANSavailable reasonably possible It is important to maintain eye contact with the interpreter at all times so that valuable information is not missed. - ANSFALSE. Talk to the client, not to the interpreter. Maintain eye contact as appropriate. Looking at the client directly reinforces that the communication is between the provider and the client, assisted by the interpreter. This also allows the provider to assess the non-verbal reactions and responses. TRUE OR FALSE? When a nurse learns information that, if not revealed, could result in harm to the client or others, she/he must keep this information confidential within the therapeutic relationship. - ANSFALSE. He/she must consult with the health care team and, if appropriate, report the information to the person or group affected. TRUE OR FALSE? A nurse cannot teach a PSW how to administer medication. - ANSFALSE Nurses may teach UCPs medication administration, including the process of administration and documentation, as required. TRUE OR FALSE? Ethical disagreements between nurses are acceptable. - ANSTRUE. There is room for disagreement among nurses on how they weigh the different ethical values. But above all, nurses need to choose ethical interventions that meet the needs of clients. TRUE OR FALSE? If a nurse delegates medication administration to a PSW, they assume all the responsibilities related to med admin. - ANSFALSE The nurse remains responsible for the: - ongoing assessment of the client's needs; - plan of care in conjunction with the health care team; - evaluation of the client's health status; and - effectiveness of the medication(s). TRUE OR FALSE? It is always possible to find a conflict resolution that meets everyone's satisfaction. - ANSFALSE. It is not always possible to find a resolution to a conflict that satisfies everyone. At these times, the best possible outcome is identified in consultation with the client, and the health care team works to achieve that outcome. Nurses may still not be individually satisfied with the resolution; in this case, they need to examine why they're unsatisfied, and consider the possibility of taking follow-up action. TRUE OR FALSE? Nurses must explain to clients that information will be shared with the health care team and identify the general composition of the health care team. - ANSTRUE. TRUE OR FALSE? PHIPA permits the sharing of personal health information among health care team members to facilitate efficient and effective care. - ANSTRUE TRUE OR FALSE. A nurse must obtain consent before using an interpreter in the presence of a language barrier between he/she and the client. - ANSTRUE When using interpreters to communicate with clients, nurses need to obtain client consent, be sensitive to the issues surrounding interpretation and ascertain that the interpreter is appropriate for the particular client situation. TRUE OR FALSE. An RPN hired to be a PSW is only accountable for working within the PSW scope of practice. - ANSFALSE. An RPN working in a UCP role is still accountable as an RPN TRUE OR FALSE. TRUE OR FALSE. In regards to ethical concerns, sometimes the best possible outcome may be the one that is least bad. - ANSTRUE. Sometimes a completely good outcome is impossible TRUE OR FALSE. It is acceptable to spend time outside of work hours with a client. - ANSFALSE TRUE OR FALSE. Omissions are as untruthful as false information. - ANSTRUE. TRUE OR FALSE. Reactions to cultural differences require a lot of thought and reflection. - ANSThey are automatic, and often subconscious and influence the dynamics of the nurse- client relationship. TRUE OR FALSE. The most recent wishes a client expresses while he or she is capable prevail over any earlier wishes the client may have given. - ANSTRUE. TRUE OR FALSE. A nurse's age, gender, past experiences, strengths and weaknesses have no impact client interactions. - ANSFALSE. All the attributes of the nurse, including age, gender, past experiences, strengths and weaknesses, have an impact on the interaction with the client. Through reflection, learning and support, nurses will be better able to strengthen the quality of care they provide to the diverse communities they serve. TRUE OR FALSE. All nurses do not have the authority to certify death in any situation. - ANSFALSE. While RNs and RPNs do not have the authority to certify death in any situation, Nurse Practitioners do have the authority to certify an expected death, except in specific circumstances; TRUE OR FALSE. Disclosing personal information to a specific client is a good way of getting a patient to open up to you. - ANSFALSE. TRUE OR FALSE. Feeling other members of the team do not understand a specific client as well as you do is a warning sign that a nurse should be mindful of - ANSTRUE TRUE OR FALSE. Finding yourself frequently thinking about a client when away from work is a sign of being overly attached to a client. - ANSTRUE TRUE OR FALSE. If a nurse does not have time to complete an act ordered to her, it is acceptable for her to delegate it to a PSW. - ANSFALSE. They cannot delegate an act that has been delegated to them - sub-delegation TRUE OR FALSE. It is acceptable for a nurse to delegate a patient's standard dose insulin injection to a family member. - ANSTRUE The RHPA includes an exception allowing UCPs to perform some controlled acts as long as they are considered to be routine activities of living. Procedures are considered to be routine activities of living when the need for, response to, and outcome of the procedure have been established over time and are predictable. For instance, administering the same dosage of insulin to a person with well- controlled diabetes over an extended period of time is a routine activity of living. It is not a routine activity if the dosage or type of insulin requires frequent adjustment. TRUE OR FALSE. It is acceptable for a nurse to spend extra time with one client beyond his/ her therapeutic needs. - ANSFALSE. TRUE OR FALSE. Keeping secrets with the client and apart from the health care team (for example, not documenting relevant discussions with the client in the health record) is an example of crossing an ethical boundary. - ANSTRUE WHAT IS "The practice of nursing is the promotion of health and the assessment of, the provision of, care for, and the treatment of, health conditions by supportive, preventive, therapeutic, palliative and rehabilitative means in order to attain or maintain optimal function." - ANSSCOPE OF PRACTICE STATEMENT WHAT IS AN INTERPRETER'S ROLE? - ANSThe interpreter's role is to be the voice of the client. What is personal health information? - ANSPersonal health information is any identifying information about clients that is in verbal, written or electronic form. What is the purpose of the Quality of Care Information Protection Act (QOCIPA)? - ANSTo promote open discussion of adverse events, peer review activities and quality of care information, while protecting this information from being used in litigation or accessed by clients. What is the simplest and most important practice a nurse can do to reduce contamination and spread of infection? - ANSProper hand hygiene is the single most- important infection prevention and control practice. WHAT KIND OF ABUSIVE BEHAVIOUR? ■ borrowing money or property from a client; ■ soliciting gifts from a client; ■ withholding finances through trickery or theft; ■ using influence, pressure or coercion to obtain the client's money or property; ■ having financial trusteeship, power of attorney or guardianship; ■ abusing a client's bank accounts and credit cards; and ■ assisting with the financial affairs of a client without the health care team's knowledge. - ANSFINANCIAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ hitting; ■ pushing; ■ slapping; ■ shaking; ■ using force; and ■ handling a client in a rough manner. - ANSPHYSICAL WHAT KIND OF ABUSIVE BEHAVIOUR? ■ non-therapeutic confining or isolation; ■ denying care; ■ non-therapeutic denying of privileges; ■ ignoring; ■ withholding clothing, food, fluid, needed aids or equipment, medication, and/or communication. - ANSNEGLECT WHAT KIND OF ABUSIVE BEHAVIOUR? ■ sarcasm; ■ retaliation or revenge; ■ intimidation, including threatening gestures/ actions; ■ teasing or taunting; ■ insensitivity to the client's preferences; ■ swearing; ■ cultural/racial slurs; and ■ an inappropriate tone of voice, such as one expressing impatience. - ANSVERBAL AND EMOTIONAL