Nursing Exam 2|74 Questions with Verified Answers,100% CORRECT, Exams of Nursing

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Nursing Exam 2|74 Questions with Verified Answers Physician (MD) - CORRECT ANSWER -"Doctor" is a US title used for MD, DO, OD, DPM, DDS, DDM, DVM, DC, and any academic doctorate degree -Practice of general or specialty medicine (including surgery) based upon diagnosis and treatment -Pre-requisite 4-year BS degree -Medical College Admission Test (MCAT) -4-years of medical school (abbreviated 6 year combined program available) for a doctorate in medicine (MD) degree -MD = entry-level degree (similar to JD) -Some MDs continue onward for a MS or PhD Post-MD Clinical Training - CORRECT ANSWER Overseen by the Accreditation Council on Graduate Medical Education (ACGME) Clinical training with salary Rotating internship X 1 year Specialty residency X 2-6 years Fellow (optional, additional specialty training X 1-2 years) ***General medical or surgical training may be required prior to specialty training (eg. general surgery prior to cardiac surgery) US Medical Licensing Examination (USMLE) - CORRECT ANSWER 4-step standardized examination process Step 1 exam - medical school Step 2 exam/CK - medical school Step 2 exam/CS - medical school Step 3 - post-MD degree and after completion of at least 12 mos of GME clinical training MD licensure issued by state MD Certification - CORRECT ANSWER Optional board-certification as a physician demonstrates expertise in a medical specialty American Board of Medical Specialties (ABMS) Initial peer evaluation and rigorous oral and/or written testing Ongoing education/assessment to maintain certification Pharmacist - CORRECT ANSWER Consult on need for prescribed medications, dispense/administer medications, and patient/family teaching about medications Approx 60 credits of pre-requisite general ed/science courses...preference for BA or BS+ degree Pharmacy College Admission Test (PCAT) 4-year curriculum leading to the entry level Doctorate of Pharmacy (PharmD) degree since 2005 Standardized NAPLEX exam prior to state licensure Social Worker - CORRECT ANSWER Assist patients experiencing a potential/actual health crisis with emotional or practical support/logistics including community resources Bachelor degree in social work....many hospitals and health care agencies require a Master degree in social work as well (eg medical social worker/MSW) Supervised practice for approx 2+ years Standardized ASWB exam prior to state licensure (LCSW) but states vary in requirements Optional, additional credentialing by the National Association of Social Workers Physical Therapist (PT) - CORRECT ANSWER Assess impairment, limitation, and disabilities...and promote mobility and functional ability threatened by aging, injury, or disease Role of the PT was further defined/valued during the polio epidemic of the 1950s Current entry-level Master (MPT, MSPT) or Doctor of Physical Therapy (DPT) degree Pre-requisite bachelor degree for DPT Combined 6 programs are available (3+3) for DPT Supervised clinical practice Standardized NPTE exam prior to state licensure ABPTS board certification in a specialty area is optional (eg pediatrics, sports, geriatric) Occupational Therapist (OT) - CORRECT ANSWER Similar to PT but promote activities of daily living (ADLs) within the home, work, or recreational setting Supervised clinical practice Supportive services (PT/OT, Respiratory Rx, MSW, case management, dietary...) 1946 Hill-Burton Act - CORRECT ANSWER "Hospital Survey and Construction Act" Post-war development of suburbia and roads/highways created a need for hospitals both within and outside of major cities Provided federal funding to increase the # US hospitals to 4.5/1000 Americans Covered initial construction, expansion and major renovation Major Milestones in Health Care Reimbursement - CORRECT ANSWER Blue Cross/Blue Shield private health insurance to cover both MD and hospital costs Kaiser Permanente Healthcare as the initial health maintenance organization Center for Medicare (elderly)/Medicaid (impoverished/disabled) Services (CMS) DRG Managed Care - CORRECT ANSWER 1983 CMS mandate Past retrospective payment = 100% CMS reimbursement of billed healthcare charges regardless of variance among providers. Provider fees covered both direct and indirect costs of care. New prospective payment = Capitated and standardized CMS reimbursement of billed healthcare charges based upon average care needed per diagnosis Diagnosis-related group (DRG) Reduced hospital admissions, hospital length of stays (LOS), # used hospital beds, and # hospitals Hospital Terms - CORRECT ANSWER Length of stay (LOS) - # days hospitalized Average length of stay (ALOS) - mean length of stay, often adjusted per patient age, diagnosis, and co-morbidities Capacity - # beds which can be made available for nursing care quickly, not always # beds licensed Average daily census (ADC) - # patients that day Occupancy rate - % available beds that are occupied by patients Physicians in the Hospital Setting - CORRECT ANSWER Considered non-employees with admission/prescription/surgical privileges upon approval of professional credentials Contracted by the hospital to provide 24/7 specialty services (ED, anesthesia, radiology, hospitalist in a non-teaching hospital) Considered employees of the hospital (Chief Medical Officer, Kaiser Permanente) Types of Hospitals - CORRECT ANSWER Community Tertiary/referral Public General v. specialty Tax exempt/not for profit Proprietary/for profit Teaching University hospital system Trauma Center Community Hospital - CORRECT ANSWER Small and located in local communities (both inner city and suburbia) Provide average-level care to the stable patient with average co-morbidities Full service except for psychiatric-mental health (PMH), OB > pediatric care, and low-level ICU care Rarely university-affiliated unless in the inner city No GME interns and residents Example = Inova Fair Oaks Hospital Tertiary/Referral Hospital - CORRECT ANSWER Larger than community hospital May be located in city or region Provide high-level care to the unstable patient with complicated diagnosis and co- morbidities Full-service if general hospital, including high-level OB and pediatric unit High level and multiple ICUs University affiliated with GME program May include trauma, organ transplant, and oncology Example = Inova Fairfax Hospital, Washington Hospital Center Public Hospital - CORRECT ANSWER Publically-funded (city, county, state or federal government) Often located in inner city and care for impoverished, aged, and chronically-ill local residents Often associated with a busy ED Not necessarily 100% available to all (Department of Defense, Veteran's Administration, Native American Indian) May be specialized (mentally-ill, TB) Public Hospital Examples - CORRECT ANSWER Open - the former DC General Hospital (Wash DC), Boston City Hospital (Boston), Cook County General Hospital (Chicago) Limited - Walter Reed National Military Medial Center at Bethesda, National VA Medical Center, NIH Clinical Care Center General v. Specialty Hospital - CORRECT ANSWER General hospital - full service (including OB and pediatrics) Inova Fairfax Hospital, Inova Alexandria Hospital Specialty - Care is limited but intense within a specific specialty (oncology, orthopedics, pediatrics, psychiatric-mental health....) National Children's Medical Center, Dominion Hospital, Shriner's Hospital for Children (burns, orthopedics, Sloan-Kettering Oncology Center, National Rehabilitation Hospital) Not-For Profit/Tax Exempt Hospitals - CORRECT ANSWER Still make a profit but 100% turned back into the hospital instead of pay out to investors Provide essential healthcare to the community Budget is funded by paid patient fees, philanthropic donations/endowments, and investments Now run more like a business than a charity Still compete with "for-profit" hospitals Examples of Tax Exempt Hospitals - CORRECT ANSWER General - Most hospitals in this region, any Inova Hospital Religious - Holy Cross Hospital, Providence Hospital, New England Deaconess Hospital (Boston), St Elizabeth's Hospital (Boston), Beth Israel Hospital (Boston), Washington Adventist Hospital Philanthropic - St Jude's Hospital for Children, Shriner's Hospitals for Children (burns, orthopedics) For-Profit/Proprietary Hospitals - CORRECT ANSWER Originally small and owned by MDs for supplemental income Now run as a corporation, often as a regional or national health system A portion of profits is paid out to investors Medicare - CORRECT ANSWER Primarily for the elderly > 65 yo Part A (automatic) - hospital and post-discharge SNIF, hospice, or home care on a temporary basis Part B (optional) - MD, outpatient services, home care, home equipment, some preventive care Part C (optional) - HMO and PPO Part D (optional) - Pharmacy plan Medicaid - CORRECT ANSWER Matched state and federal CMS funding Administered by each state Provides funding of health care to the proven impoverished within certain eligibility groups (eg disabled) Healthcare Reimbursement in 1970s - CORRECT ANSWER Concerns about increasing costs of Medicare-funded health care Diagnosis-Related Group (DRG) process implemented by CMS to standardize hospitalization costs DRG process later adopted by private insurers DRG process was problematic as not initially reflective of acuity and co- morbidities DRG Consequences - CORRECT ANSWER What happened to the large number of massive hospitals built in the 1950-1960s? Could family handle the "earlier" discharge of the patient without supportive community resources? RN/MD utilization review process - CORRECT ANSWER Shorter hospital length of stay Development of non-hospital options for Dx testing and Rx procedures Ambulatory procedures (eg cardiac cath, infusion Rx, endo/colonoscopy) Same day admit for OR Skilled nursing inpatient facility (SNIF) Increased complexity of home care services Social Security Disability Insurance (SSDI) - CORRECT ANSWER Provides monthly payments to the disabled Must meet strict Social Security criteria of a "disabling medical condition" Disability prevents return to recent job or adjustment to a new job Disability expected to last > 1 year or result in death Must have prior work experience which paid 40+ credits into Social Security (20 credits within the 10 years prior to the disability) At retirement age, SSDI converts to Social Security benefits at same rate Healthcare Reimbursement 1980-90s - CORRECT ANSWER Integrated health care networks for contractual comprehensive care Health maintenance organization (HMO) Preferred MD/DDS provider organization (PPO) For-profit hospital systems with their own HMO/PPO Co-payments v. no-cost to user if stay within network for all aspects of care unless outside referral is authorized Network now controls the reimbursement process Prospective Capitation Payments - CORRECT ANSWER Providers are paid a contractual monthly flat fee per patient regardless of provider utilization If "provider cost" exceeds reimbursement, provider absorbs the cost. If "provider cost" is less than reimbursement, provider absorbs the profit Goal = keep the patient healthy and reduce utilization of services! Kaiser Permanente - CORRECT ANSWER 1930s - Dr Sidney Garfield and his 12-bed hospital provided care to laborers building the LA Aqueduct (and later the Grand Coulee Dam) at a pre-paid daily rate of $0.05 per person WW2 - Kaiser Industries shipyards in San Francisco contracted with Dr Garfield to care for 30K shipyard workers on a pre-paid basis 1945 - Kaiser Permanente Health Care Plan open to the public (primarily union workers) Current and Future State - CORRECT ANSWER Most health care occurs within the last 6-12 months of life Aging US population with high % of 1+ chronic illness and a growing % of underinsured or uninsured Must reduce costs while increasing the quality of patient outcomes Future reimbursement will be correlated to +/- patient outcomes Obama Health Care Reform - CORRECT ANSWER Now provides coverage for pre- existing conditions "Right thing to do" but will further increase health care costs Strategies for Limited Reimbursement - CORRECT ANSWER Preventive education and care Effective disease screening for early detection "Gatekeeper" primary care MD controls specialist referrals Use of non-MD providers (eg APNs and PAs) Standardize care using pathways and protocols RN/MD peer review Morals - CORRECT ANSWER What you personally believe to be right versus wrong "Personal compass" May change if personal beliefs change Ethics - CORRECT ANSWER Rules for conduct within a particular group or culture "Society's compass" May lead to professional/legal guidelines (eg ANA Code of Ethics for Nurses) Ethical Principles - CORRECT ANSWER Beneficence - Do good Example = Use all hospital resources to reduce suffering, restore health, and/or improve patient quality of life Dilemma = Use all hospital resources even if patient is uninsured??? Ethical Principles pt 2 - CORRECT ANSWER Non-maleficence = Do no harm Actual/potential treatment benefit must > risk Example = Withdrawal or cessation of treatment that is no longer effective or could result in increased risk to patient Dilemma = What if patient's family insist on continuation of treatments regardless??? Ethical Principles pt 3 - CORRECT ANSWER Justice - Must be fair/equitable Example = Hospital resources must be available equally to all patients based upon clinical need regardless of gender, age, race/culture, faith, politics etc Dilemma = What about VIP care to hospitalized celebrities??? "Moral courage in healthcare helps to address the ethical issue and take action when doing the right thing is not easy" Hospital Ethics Committee - CORRECT ANSWER Especially within referral/tertiary hospitals with high patient acuity Interdisciplinary team (eg. MD, RN, MSW, chaplain, lawyer, hospital administration, community representative, ethicist...) Develop guidelines and standards to aid ethical decision-making in clinical situations Can assess and guide ethical decision-making in a particular patient scenario Legal Issues in Healthcare - CORRECT ANSWER Patient abuse and neglect Clinical errors of judgment Breach of professional standards of practice: what would the average RN/MD do? Breach of patient confidentiality Lack of informed consent prior to invasive/risky diagnostic testing and treatments Informed Consent - CORRECT ANSWER Written at common reading level Translated if needed into native language Presented and fully explained by provider doing the procedure (including risk v. benefit) All patient/family questions are answered to satisfaction Signed by mentally competent patient or legal guardian/medical power of attorney Witnessed signature Included in medical record AD versus MPOA - CORRECT ANSWER Advance directive (AD) to document the patient's wishes for care if no longer able to speak for self Medical power of attorney (MPOA) to speak/sign on behalf of the patient if above, using the advance directive as a guide for decision making whenever possible HIPAA - CORRECT ANSWER 1996 Health Insurance Portability and Accountability Act (federal law) Includes the Privacy Rule for protected health information (PHI) of a patient PHI is to be shared only on a "need to know" basis Form signed upon hospital admission or MD office visit Costly fines for HIPAA violations Healthcare Reimbursement 1945-1970 - CORRECT ANSWER