DETAILED QUESTIONS AND ASNWERS
ANCC MEDSURG Exam Review.
Scope of Practice -
\Based on legal allowances in each state, individual state nurse practice acts providing
guidelines for nursing practice
Key elements of the NP role include -
\integration of care across the acute illness continuum with collaboration and
coordination of care; research based clinical practices, clinical leadership, family
assessment, and discharge planning
Standards of Advanced Practice are delineated by... -
\American Nurses Association which measure quality of practice, service, or education
State Practice Acts -
\Authorize Boards of Nursing in each state to establish statutory authority for licensure
of RNs
State Practice Acts - authority includes: -
\use of title, authorization for scope of practice including prescriptive authority, and
disciplinary grounds
States vary in practice requirements, such as -
\certification
Prescriptive authority -
\Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain.. -
\registration numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass... -
\required education, licensure and certification to practice as an NP
Credentials establish... -
\minimal levels of acceptable performance
Credentialing is necessary to: -
\ensure that safe healthcare is provided by qualified individuals; comply with federal and
state laws r/t APN
Credentials also... -
,\acknowledges the scope of practice of NP, mandates accountability, enforces
professional standards for practice
Licensure -
\establishes that a person is qualified to perform in a particular professional role
Licensure is granted as defined by rules and regulations set forth by -
\a governmental regulatory body (ie. state board of nursing)
Certification -
\Person has met certain standards that signify mastery of specialized knowledge
Certification is granted by nongovernmental agencies such as -
\ANCC, AANP
Admitting privileges to hospitals (non physican) were granted -
\1983 by JC
Credentialing and privileging -
\process which an NP is granted permission to practice in an inpt setting
Credentialing with hospital privileges is granted by a -
\Hospital Credentialing Committee
Pt Medical Abandoment -
\When caregiver-pt relationship is terminated w/o making reasonable arrangements w
an appropriate person so that care can be continued
Determination of pt abandonment depends on factors such as: -
\Whether NP accepted pt assignment, whether NP provided reasonable notice before
termination, whether reasonable arrangements could have been made
Following do not constitute pt abandonment -
\NP refuses to accept responsibility for pt assignment when NP has given reasonable
notice to proper authority that NP lacks competence to carry out assignment; NP
refuses assignment of a double shift or addtl hrs beyond posted work schedule when
proper notification has been given..latter phrase can be controversial
Risk Mgmt -
\Systematic effort to reduce risk begins w formal written risk mgmt plan that includes:
organizations goals, delineation of program's scope, components, methods; delegating
responsibility for implementation and enforcement; demonstrating commitment by the
board; confidentiality and immunity from retaliation for those who report sensitive info
Most common method of documentation for risk mgmt -
\incident reports
,Policies regarding incident reports should address: -
\ppl authorized to complete report; ppl responsible for review of a report, immediate
actions needed to minimize the effects of the event; ppl responsible for follow up; plan
for monitoring aftermath; security/storage of completed report
Risk mgmt - Satisfaction surveys -
\Important for identifying problems before they develop into incidents or claims; for pts
and employees
Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and
managing complaints by clearly identifying: -
\ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for
monitoring follow up
Action taking initiatives: -
\Prevention, correction (corrective steps must be monitored and audited),
documentation, education, departmental coordination
Medical Futility -
\Interventions that are unlikely to produce significant benefit for pt - "Does the
intervention have any reasonable prospect of helping this pt?"
Two kind of medical futility: -
\Quantitative futility: likelihood that intervention will benefit pt is extremely poor
Qualitative futility: quality of benefit an intervention will produce is extremely poor
Informed consent - competence (decisional capability) -
\state that pt is able to make personal decisions about their care
competence implies that ability to: -
\understand, reason, differentiate good and bad, and communicate
informed consent -
\pt has received adequate instruction or info regarding aspects of care to make prudent,
personal choice regarding such tx
Informed consent includes: -
\discussing benefits and risk
consent is assumed if... -
\pt's condition is life threatening
Danforth Amendment 1991 -
, \pts are informed at time of admission to federally funded institution (such as hospital,
nursing home, hospice, HMO, etc) that they have the right to refuse care as long as the
pt has decisional capability (competence)
Ethics -
\study of moral conduct and behavior protecting the rights of an individual
1st priority is the -
\most salvagable pts. Most critically injured cared for last.
Key ethical principles are: -
\nonmaleficence, utilitarianism, beneficence, justice, fidelity, veracity, autonomy
Nonmaleficence -
\duty to do no harm
Utilitarianism -
\the right act is the one that produces the greatest good for the greatest number
Beneficence -
\duty to prevent harm and promote good
Justice -
\duty to be fair
Fidelity -
\duty to be faithful
Veracity -
\duty to be truthful (tends to be in conflict with fidelity)
Autonomy -
\duty to respect an individual's thoughts and actions (tend to be in conflict with
beneficence)
Dismissing/discharging a pt or closing practice -
\NP cannot withdraw from caring for a pt without notification
Examples of reasons for discharging a pt from practice: -
\abuse, refusal to pay, persistent non-adherence to care
Steps for discharging a pt from practice: -
\send a certified letter with return receipt (copy for chart), provide general healthcare
coverage for 1st 15-30 days post termination deadline, obtain release of info to provide
copies of all needed records for next care provider
ANCC MEDSURG Exam Review.
Scope of Practice -
\Based on legal allowances in each state, individual state nurse practice acts providing
guidelines for nursing practice
Key elements of the NP role include -
\integration of care across the acute illness continuum with collaboration and
coordination of care; research based clinical practices, clinical leadership, family
assessment, and discharge planning
Standards of Advanced Practice are delineated by... -
\American Nurses Association which measure quality of practice, service, or education
State Practice Acts -
\Authorize Boards of Nursing in each state to establish statutory authority for licensure
of RNs
State Practice Acts - authority includes: -
\use of title, authorization for scope of practice including prescriptive authority, and
disciplinary grounds
States vary in practice requirements, such as -
\certification
Prescriptive authority -
\Ability and extent of NPs ability to prescribe meds
DEA has ruled that nurses in advanced practice may obtain.. -
\registration numbers, state practice acts dictate level of prescriptive authority allowed
Credentials encompass... -
\required education, licensure and certification to practice as an NP
Credentials establish... -
\minimal levels of acceptable performance
Credentialing is necessary to: -
\ensure that safe healthcare is provided by qualified individuals; comply with federal and
state laws r/t APN
Credentials also... -
,\acknowledges the scope of practice of NP, mandates accountability, enforces
professional standards for practice
Licensure -
\establishes that a person is qualified to perform in a particular professional role
Licensure is granted as defined by rules and regulations set forth by -
\a governmental regulatory body (ie. state board of nursing)
Certification -
\Person has met certain standards that signify mastery of specialized knowledge
Certification is granted by nongovernmental agencies such as -
\ANCC, AANP
Admitting privileges to hospitals (non physican) were granted -
\1983 by JC
Credentialing and privileging -
\process which an NP is granted permission to practice in an inpt setting
Credentialing with hospital privileges is granted by a -
\Hospital Credentialing Committee
Pt Medical Abandoment -
\When caregiver-pt relationship is terminated w/o making reasonable arrangements w
an appropriate person so that care can be continued
Determination of pt abandonment depends on factors such as: -
\Whether NP accepted pt assignment, whether NP provided reasonable notice before
termination, whether reasonable arrangements could have been made
Following do not constitute pt abandonment -
\NP refuses to accept responsibility for pt assignment when NP has given reasonable
notice to proper authority that NP lacks competence to carry out assignment; NP
refuses assignment of a double shift or addtl hrs beyond posted work schedule when
proper notification has been given..latter phrase can be controversial
Risk Mgmt -
\Systematic effort to reduce risk begins w formal written risk mgmt plan that includes:
organizations goals, delineation of program's scope, components, methods; delegating
responsibility for implementation and enforcement; demonstrating commitment by the
board; confidentiality and immunity from retaliation for those who report sensitive info
Most common method of documentation for risk mgmt -
\incident reports
,Policies regarding incident reports should address: -
\ppl authorized to complete report; ppl responsible for review of a report, immediate
actions needed to minimize the effects of the event; ppl responsible for follow up; plan
for monitoring aftermath; security/storage of completed report
Risk mgmt - Satisfaction surveys -
\Important for identifying problems before they develop into incidents or claims; for pts
and employees
Risk mgmt - Complaints: Risk mgmt plan should delineate tracking, analyzing, and
managing complaints by clearly identifying: -
\ppl notified after receiving complaint; ppl responsible for responding; ppl responsible for
monitoring follow up
Action taking initiatives: -
\Prevention, correction (corrective steps must be monitored and audited),
documentation, education, departmental coordination
Medical Futility -
\Interventions that are unlikely to produce significant benefit for pt - "Does the
intervention have any reasonable prospect of helping this pt?"
Two kind of medical futility: -
\Quantitative futility: likelihood that intervention will benefit pt is extremely poor
Qualitative futility: quality of benefit an intervention will produce is extremely poor
Informed consent - competence (decisional capability) -
\state that pt is able to make personal decisions about their care
competence implies that ability to: -
\understand, reason, differentiate good and bad, and communicate
informed consent -
\pt has received adequate instruction or info regarding aspects of care to make prudent,
personal choice regarding such tx
Informed consent includes: -
\discussing benefits and risk
consent is assumed if... -
\pt's condition is life threatening
Danforth Amendment 1991 -
, \pts are informed at time of admission to federally funded institution (such as hospital,
nursing home, hospice, HMO, etc) that they have the right to refuse care as long as the
pt has decisional capability (competence)
Ethics -
\study of moral conduct and behavior protecting the rights of an individual
1st priority is the -
\most salvagable pts. Most critically injured cared for last.
Key ethical principles are: -
\nonmaleficence, utilitarianism, beneficence, justice, fidelity, veracity, autonomy
Nonmaleficence -
\duty to do no harm
Utilitarianism -
\the right act is the one that produces the greatest good for the greatest number
Beneficence -
\duty to prevent harm and promote good
Justice -
\duty to be fair
Fidelity -
\duty to be faithful
Veracity -
\duty to be truthful (tends to be in conflict with fidelity)
Autonomy -
\duty to respect an individual's thoughts and actions (tend to be in conflict with
beneficence)
Dismissing/discharging a pt or closing practice -
\NP cannot withdraw from caring for a pt without notification
Examples of reasons for discharging a pt from practice: -
\abuse, refusal to pay, persistent non-adherence to care
Steps for discharging a pt from practice: -
\send a certified letter with return receipt (copy for chart), provide general healthcare
coverage for 1st 15-30 days post termination deadline, obtain release of info to provide
copies of all needed records for next care provider
