READING GUIDE.pdf exam, Exams of Nursing

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READING GUIDE

1. Nursing definition (ANA) - American Nurses Association: "Nursing is the protection, promotion, and optimization of health and abilities, prevention of illness and injury, alleviation of suffering through diagnosis and treatment of human response, and advocacy in care of individuals, families, communities, and populations" - Focuses on human response to health problems - Includes advocacy as core role 2. Roles of the professional nurse - Caregiver: direct practice patient care - Advocate: protect patient rights and wishes - Educator: teach patients and families - Leader: delegate, manage, coordinate care - Researcher: apply evidence-based 3. Scope of practice - Defines what a nurse can and cannot do legally - Determined by state Nurse Practice Act - Varies by license (RN, LPN, APRN) - RN scope includes assessment, diagnosis, planning, implementation, evaluation 4. Standards of care - Legal guidelines for nursing practice - Established by professional organizations (ANA, specialty groups) - Used in court to determine negligence

12. Historical nursing figures – Virginia Henderson - Developed definition of nursing (1955) - Created 14 basic needs of patient - Known as "First Lady of Nursing" 13. Theory – Definition - Set of concepts and propositions that explain a phenomenon - Guides nursing practice and research - Provides framework for decision making 14. Grand theories - Broad, abstract, comprehensive - Example: Orem's Self-Care Deficit Theory - Example: Roy's Adaptation Model - Not easily tested; guides philosophy 15. Middle-range theories - More specific than grand theories - Testable through research - Example: Pender's Health Promotion Model - Example: Mishel's Uncertainty in Illness Theory 16. Practice-level theories - Narrowest focus, situation-specific - Used for specific patient populations or settings - Example: Theory of Pain Management in Older Adults - Directly applicable to bedside nursing 17. Orem's Self-Care Deficit Theory - Patients need to perform self-care activities - Nursing is needed when patient cannot meet self-care needs - Three systems: wholly compensatory, partly compensatory, supportive- educative 18. Roy's Adaptation Model - Patient adapts to environmental stimuli - Four modes: physiological, self-concept, role function, interdependence - Nursing promotes adaptation

19. Neuman's Systems Model - Patient as a system with lines of defense - Stressors threaten stability - Nursing prevents or reduces reactions to stressors 20. Watson's Theory of Human Caring - Emphasizes caring as central to nursing - Ten carative factors - Transpersonal caring relationship between nurse and patient

Module 2: Healthcare Delivery Systems (Terms 21–40)

21. Levels of healthcare – Primary prevention - Health promotion and disease prevention - Example: immunizations, health education, nutrition counseling - Aimed at healthy individuals - Most cost-effective level 22. Levels of healthcare – Secondary prevention - Early detection and treatment of disease - Example: cancer screening, blood pressure checks, urgent care - Aimed at at-risk or early disease populations - Prevents progression 23. Levels of healthcare – Tertiary prevention - Rehabilitation and preventing complications - Example: physical therapy after stroke, cardiac rehab - Aimed at patients with established disease - Restores function and quality of life 24. Levels of healthcare – Quaternary prevention - Protects patients from unnecessary medical interventions - Avoiding overmedicalization and harm

32. Patient-Centered Medical Home (PCMH) - Primary care model with coordinated, team-based care - Patient has ongoing relationship with primary provider - Emphasizes access, communication, whole-person care 33. Value-Based Purchasing (VBP) - Medicare reimburses based on quality, not quantity - Measures: patient satisfaction, mortality, readmissions, HAI rates - Hospitals earn bonuses or penalties 34. Hospital Readmissions Reduction Program (HRRP) - Medicare penalizes hospitals with excess readmissions within 30 days - Conditions tracked: heart failure, MI, pneumonia, COPD, hip/knee replacement - Incentive to improve discharge planning and follow-up 35. Affordable Care Act (ACA) – Key provisions - Expanded Medicaid eligibility - Health insurance marketplaces with subsidies - No denial for pre-existing conditions - Young adults can stay on parents' plan until age 26 36. Medicare - Federal health insurance for age ≥65, disability, ESRD - Part A: hospital insurance (inpatient, hospice, SNF) - Part B: medical insurance (outpatient, MD visits, DME) - Part D: prescription drug coverage 37. Medicaid - State and federal program for low-income individuals - Eligibility varies by state (expanded under ACA in many states) - Covers children, pregnant women, elderly, disabled - Largest payer for long-term care 38. Private insurance - Employer-sponsored or individual plans - HMO: requires PCP referral, limited network - PPO: more flexibility, higher premiums - High-deductible plans with HSA option

39. Uninsured populations - Approximately 8-10% of US population uninsured (varies by state) - Higher rates among low-income, minority groups - Associated with worse health outcomes and delayed care 40. Social determinants of health (SDOH) - Conditions in environments where people live, learn, work, play - Five domains: economic stability, education, healthcare access, neighborhood, social/community context - Major driver of health outcomes (up to 80% of health)

Module 3: Legal & Ethical Foundations (Terms 41–65)

41. Ethics definition - Study of moral principles and values - Guides right vs wrong conduct - In nursing: patient advocacy, confidentiality, informed consent 42. Morals vs ethics - Morals: personal beliefs about right and wrong (individual) - Ethics: systematic principles of conduct (professional/group) - A nurse can have personal moral beliefs but must follow professional ethics 43. Autonomy (ethical principle) - Patient's right to make own healthcare decisions - Nurse respects choices even when disagreeing - Requires informed consent and decision-making capacity 44. Beneficence (ethical principle) - Acting in patient's best interest - Doing good and preventing harm - Example: advocating for pain relief or timely treatment

52. Informed consent - Patient agrees to treatment after understanding risks, benefits, alternatives - Physician or advanced provider obtains consent - Nurse's role: witness signature, confirm understanding, answer questions 53. Elements of informed consent - Diagnosis and nature of procedure - Risks and benefits - Alternative treatments - Consequences of refusing - Right to withdraw consent at any time 54. When consent is not required - Emergency (immediate threat to life or limb) - Patient lacks decision-making capacity (surrogate decides) - Therapeutic privilege (rare – withholding information if harm outweighs benefit) 55. Decision-making capacity - Ability to understand information, weigh options, communicate choice - Can fluctuate (delirium, intoxication, medication effect) - Different from competency (legal determination by judge) 56. Advance directives - Legal documents stating patient's wishes for end-of-life care - Living will: specific treatments patient wants or doesn't want - Durable power of attorney for healthcare: surrogate decision-maker - Nurses must honor and document 57. DNR / DNI orders - Do Not Resuscitate: no CPR if cardiac or respiratory arrest - Do Not Intubate: no endotracheal intubation - Must be written order by physician; verbal order requires co-signature - Nurse must verify order before honoring 58. Negligence vs malpractice - Negligence: failure to act as reasonable prudent nurse (any error) - Malpractice: professional negligence with four elements - Four elements: duty, breach, causation, damages

59. Intentional torts - Assault: threat of harmful contact - Battery: actual harmful or offensive contact - False imprisonment: unjustified restraint - Defamation: false statement harming reputation 60. Unintentional torts - Negligence (including malpractice) - No intent to harm, but harm occurred - Most common legal claim against nurses 61. Reporting requirements - Mandatory reporting for: child abuse, elder abuse, domestic violence - Certain communicable diseases (TB, STIs, foodborne illness) - Gunshot wounds, stabbings, animal bites - Nurse who fails to report may face legal penalties 62. HIPAA – Privacy Rule - Protects patient health information (PHI) - Only share with those directly involved in care - Patient has right to access and amend records - Violations can result in fines and termination 63. HIPAA – Security Rule - Protects electronic PHI (ePHI) - Requires passwords, encryption, access logs - Never share login credentials - Log off computers when leaving workstation 64. Legal exceptions to confidentiality - Mandatory reporting (abuse, certain diseases) - Court orders or subpoenas - Threat to self or others (Tarasoff duty to warn) - Insurance and billing purposes 65. Impaired nurse - Nurse under influence of drugs/alcohol while practicing - Colleague has ethical duty to report (protect patients) - Most states have diversion programs for treatment instead of discipline

• Only valid when studies are sufficiently similar 71. Randomized controlled trial (RCT)
• Gold standard for interventional studies
• Participants randomly assigned to treatment or control group
• Reduces bias
• Expensive and not always feasible 72. Qualitative research
• Explores experiences, meanings, perceptions
• Methods: interviews, focus groups, observation
• Answers "why" or "how" questions
• Does not test hypotheses 73. Quantitative research
• Measures variables numerically
• Uses statistical analysis
• Answers "how many" or "does X cause Y"
• Includes RCTs, cohort studies, surveys 74. PICOT question format
• P: Patient/population
• I: Intervention
• C: Comparison (optional)
• O: Outcome
• T: Time (optional)
• Example: "In adults with hypertension (P), does daily home BP monitoring (I) compared to clinic monitoring only (C) improve BP control (O) over 6 months (T)?" 75. Steps of EBP process
• 0: Cultivate a spirit of inquiry
• 1: Ask a clinical question (PICOT)
• 2: Search for best evidence
• 3: Critically appraise evidence
• 4: Integrate evidence with clinical expertise and patient preferences
• 5: Evaluate outcomes
• 6: Disseminate findings 76. Database searching

• CINAHL: nursing and allied health literature
• PubMed/MEDLINE: biomedical literature
• Cochrane Library: systematic reviews
• PsycINFO: psychology and mental health 77. Boolean operators
• AND: narrows search (hypertension AND exercise)
• OR: broadens search (hypertension OR high blood pressure)
• NOT: excludes terms (hypertension NOT pregnancy) 78. Critical appraisal
• Evaluating quality and relevance of research
• Questions: Is it valid? Is it important? Does it apply to my patient?
• Use appraisal tools (CASP, JBI, GRADE) 79. Research ethics – IRB
• Institutional Review Board approves all human subjects research
• Protects patient rights, safety, and welfare
• Ensures informed consent and risk/benefit analysis 80. Informed consent in research
• Patient must understand purpose, procedures, risks, benefits, alternatives
• Voluntary participation, right to withdraw anytime
• No coercion or undue influence 81. Vulnerable populations in research
• Children, pregnant women, prisoners, cognitively impaired
• Have additional protections in research
• Requires surrogate consent for those unable to consent 82. Quality Improvement (QI) vs Research
• QI: improves local practice, not generalizable, does not require IRB
• Research: generates new knowledge, generalizable, requires IRB
• QI example: reducing falls on one unit
• Research example: testing a new fall prevention device across hospitals 83. PDSA cycle (QI)
• Plan: identify change, set goals
• Do: implement change on small scale

89. Acute illness - Sudden onset, short duration - Usually self-limiting or treatable - Example: pneumonia, appendicitis, influenza - Patient often returns to baseline 90. Chronic illness - Lasts ≥3 months, often lifetime - Requires ongoing management - Example: diabetes, heart failure, COPD - Patient may not return to baseline; focuses on function 91. Health promotion definition - Activities that enhance well-being and prevent disease - Not disease-specific; focuses on overall health - Example: exercise, healthy diet, stress reduction 92. Health protection definition - Behaviors with specific intent to prevent disease - Example: vaccinations, cancer screening, wearing helmet - More focused than health promotion 93. Health maintenance definition - Activities that preserve current state of health - Example: routine dental cleaning, medication adherence - Prevents decline or complications 94. Primary prevention - Prevents disease before it occurs - Example: immunizations, health education, handwashing - Target: healthy individuals 95. Secondary prevention - Early detection and prompt treatment - Example: mammogram, BP screening, colonoscopy - Target: at-risk or early disease 96. Tertiary prevention

• Rehabilitation and preventing complications
• Example: cardiac rehab, physical therapy, diabetes education
• Target: established disease 97. Pender's Health Promotion Model
• Explains factors influencing health-promoting behaviors
• Components: individual characteristics, behavior-specific cognitions, behavioral outcome
• Focuses on self-efficacy and perceived benefits/barriers 98. Health Belief Model
• Predicts health behavior based on perceived threat and benefits
• Components: perceived susceptibility, severity, benefits, barriers, cues to action, self-efficacy
• Example: patient gets mammogram if they believe breast cancer is serious, they are at risk, and benefits outweigh barriers 99. Transtheoretical Model (Stages of Change)
• Precontemplation: not thinking about change
• Contemplation: thinking about change within 6 months
• Preparation: planning to change soon
• Action: actively making changes (<6 months)
• Maintenance: sustaining change (>6 months)
• Relapse: returning to old behavior 100. Motivational interviewing
• Patient-centered counseling to resolve ambivalence
• Principles: express empathy, develop discrepancy, roll with resistance, support self-efficacy
• Use open-ended questions, affirm, reflect, summarize (OARS) 101. Self-efficacy
• Belief in one's ability to succeed
• Strong predictor of health behavior change
• Enhanced by: mastery experiences, vicarious experiences, verbal persuasion, physiologic state 102. Health literacy
• Ability to obtain, process, understand basic health information

• Universally applicable (all settings) 108. Assessment – Data collection
• First step of nursing process
• Gather subjective and objective data
• Primary source: patient
• Secondary sources: family, records, team members 109. Subjective data
• What patient says about themselves
• Cannot be observed or measured by others
• Includes: feelings, perceptions, symptoms, history
• Example: "I feel nauseous" "I have a headache" 110. Objective data
• Observable and measurable by nurse
• Obtained through physical exam, labs, vitals
• Example: BP 140/90, temp 101.2°F, wound drainage 111. Validating data
• Confirming subjective data with objective findings
• Checking inconsistencies or missing information
• Example: patient says no pain but grimaces and guards 112. Clustering data
• Grouping related pieces of information
• Identifies patterns and potential problems
• Example: fever + cough + crackles = possible respiratory infection 113. Diagnosis – Nursing diagnosis
• Clinical judgment about patient's response to health problems
• NANDA-I standardized labels
• Different from medical diagnosis
• Example: Acute Pain, Impaired Gas Exchange, Anxiety 114. Components of nursing diagnosis
• Problem (diagnostic label): name of diagnosis
• Related factors (etiology): cause or contributing factor
• Defining characteristics: signs and symptoms (for actual diagnoses)

115. PES format - P = Problem - E = Etiology (related to) - S = Signs/symptoms (as evidenced by) - Example: Acute Pain (P) related to surgical incision (E) as evidenced by patient report of 8/10 pain and grimacing (S) 116. Types of nursing diagnoses - Actual: patient currently has signs/symptoms - Risk: patient vulnerable to developing problem (no signs/symptoms yet) - Health promotion: patient desires higher wellness - Syndrome: cluster of diagnoses occurring together 117. Medical diagnosis vs nursing diagnosis - Medical: identifies disease (e.g., pneumonia) - Nursing: identifies patient's response (e.g., Impaired Gas Exchange) - Both are needed for comprehensive care 118. Outcome identification - Third step of nursing process - Develop expected outcomes (goals) - Patient-centered, measurable, time-limited - Guides evaluation 119. SMART outcomes - Specific: clearly defined - Measurable: quantifiable - Attainable: achievable by patient - Realistic: within patient's ability - Time-bound: specific deadline 120. NOC (Nursing Outcomes Classification) - Standardized tool for writing outcomes - Provides rating scales (1–5) - Links to NANDA diagnoses 121. Planning – Definition - Fourth step of nursing process - Develop strategies to achieve outcomes