CliffsTestPrep NCLEX RN eBook
SUBJECT AREA REVIEW
PART I Coordinated Care
This chapter contains questions and answers from the following topic areas:
■ Advance Directives
■ Client Care Assignments
■ Client Rights
■ Collaboration with Multidisciplinary Team
■ Concepts of Management and Supervision
■ Continuity of Care
■ Establishing Priorities
■ Ethical Practice
■ Informed Consent
■ Legal Rights Responsibilities
■ Performance Improvement (Quality Assurance)
■ Referral Process
■ Resource Management
■ Staff Education
1. The intent of the Patient Self Determination Act (PSDA) of 1990 is to:
1. enhance personal control over legal care decisions.
2. encourage medical treatment decision making prior to need.
3. give one federal standard for living wills and durable powers of attorney.
4. emphasize patient education.
(2) The purpose of the PSDA is to promote decision making prior to need. The focus of the PSDA is healthcare decision making. A federal standard for advance directives does not exist. Each state has jurisdiction regarding these policies and protocols. The PSDA emphasizes the need for patient education in order to support an individual’s treatment decisions.
2. The advanced directive in your patient’s chart is dated August 12, 1998. The patient’s daughter produces a Power of Attorney for Healthcare dated 2003 that contains different care direction(s). As the nurse you are to:
1. follow the 1998 version because it’s part of the legal chart.
2. follow the 1998 version because the physician’s “code” order is based on it.
3. follow the 2003 version, place it in the chart, and communicate the update appropriately.
4. follow neither until clarified by the unit manager.
(3) The document dated 2003 supersedes the previous version and should be used as a basis for care direction. Choice 1 and 2 are incorrect as the 1998 version is now outdated. Choice 4 is incorrect; the nurse could be held negligent for not responding to the 2003 document as directed.
Part I: Subject Area Review Chapters
3. An advance directive is written and notarized according to law in the state of Colorado. This document is legal and binding:
2. in the state of Colorado only.
3. in the continental United States.
4. in the county of origination only.
(2) Choices 1, 3, and 4 are incorrect; advance directive protocols and documents are defined by each state.
4. The authority conveyed to a Power of Attorney is revocable by:
1. a primary care physician.
2. a court proceeding.
3. the family if all members agree.
4. the person who originally delegated the authority following proper documentation procedures.
(4) Only the person who delegates authority has the legal right to revoke the authority. Choices 1, 2, and 3, therefore, are incorrect.
5. Copies of advance care directives should be:
1. kept in a safe or safe deposit box only.
2. given to the attorney responsible for preparing the documents.
3. provided to each healthcare institution upon entry for services.
4. kept as private and confidential documents.
(3) Each healthcare facility is required to have advance directives on file. Choices 1, 2, and 4 are incorrect as advance
directives are not considered confidential information. They are to be shared information in order to ensure their direction will be followed.
6. The legal age for expressing one’s wishes through an advance directive is:
1. 21 years.
2. 18 years.
3. 65 years.
4. Any age.
(2) Eighteen years of age is the minimum legal age for establishing advance directives.
7. A patient is “competent” when he/she is:
1. able to understand risks and benefits of treatment options and manipulate the information rationally.
2. able to sign a consent form.
3. is oriented to person, place, and time.
4. is able to physically take care of him/herself.
(1) 2, 3, and 4 are incorrect. An individual can sign his name on a form without higher level comprehension of what he is signing, it’s appropriateness, and so on. Orientation is one aspect of cognitive function that does not support decision making, concrete thinking, and problem solving. An individual may be able to perform basic activities of daily living (ADLs) but still have impaired thought processes, judgment, and decision making, which are also important factors in competency determination.
8. The night before an elective surgery, a client asks the nurse why he was asked to complete an advance directive on admission. The nurse’s best response is:
1. “It’s just a formality.”
2. “This form helps the care team understand your wishes so we won’t be sued.”
3. “It is a legal requirement that all clients entering the hospital have the opportunity to express their wishes
through an advance directive.”
4. “Are you worried that you might not live through your surgery?”
(3) All patients entering the hospital for any reason are asked to complete advance directives according to JCAHO
standards. Choices 1, 2, and 4 are incorrect. Advance directives are more than a formality as they give guidance to
treatment based on the individual’s wishes. The guiding ethical principle is patient autonomy, not liability protection for the healthcare providers. Choice 4 is an inappropriate response by the nurse as it reflects that she did not understand or interpret the patient’s original question.
9. As the nurse caring for Mrs. Peet, you discover during her admission assessment that she does not have advance directives. She asks whether there are any specific rules about naming a Durable Power of Attorney for Healthcare (DPOAHC) or document requirements. You accurately answer:
1. “A person designated DPOAHC must be a family member.”
2. “A DPOAHC must be a lawyer.”
3. “The DPAOHC document must include the name, address, and contact information of the party named.”
4. “The individual named as DPOAHC must agree with the designee’s decisions.”
(3) The document records contact information of the party named. Choice 1, 2, and 4 are incorrect. A person named as a DPOAHC can be anyone of choice. That person does not have to be any personal or professional relation. The DPOAHC does not have to agree with the designee’s decisions but be willing and able to speak for them should decisions regarding care be needed.
10. For individuals who are no longer capable of speaking for themselves, the order of surrogacy for their healthcare decision making is:
1. guardian, DPOAHC, spouse, adult children of patient, parents of patient, adult brothers and sisters of patient.
2. spouse, DPOAHC, parents of patient, adult children of patient.
3. DPOAHC, spouse, adult children of patient, adult brothers and sisters of the patient.
4. spouse, guardian, adult children of patient, DPOAHC.
(1) Choices 2, 3, and 4 are incorrect according to state law definitions.
11. In the relationship between DNR orders and advance directives (AD), all of the following are true except:
1. an AD may help a physician decide whether a DNR order is the “right” decision for a particular patient.
2. it can be assumed that a patient with an AD is a DNR.
3. an AD is not necessary in order for a physician to write a DNR order (with the exception of New York State).
4. a hospital-based DNR order should not require the patient’s or family’s signature but does require the
(2) It is NOT a correct assumption that a patient with an AD is a DNR. Choices 1, 3, and 4 are true as written.
12. Patient self-determination is the primary focus of:
1. malpractice insurance.
2. nursing’s advocacy for patients.
(2) Advocacy for patients by nurses is centered around the patient’s right to autonomy and self-determination.
Confidentiality involves the maintenance of the privacy of the patient and information regarding them. Malpractice
insurance is a type of insurance for professionals.
13. The nurse acts as an advocate for the nursing profession by all of the following except:
1. encouraging political involvement by nurses with their legislators.
2. acting as a first-aid provider for a children’s athletic team.
3. precepting newly licensed nurses in the work situation.
4. encouraging as many persons to become nurses as possible.
(4) The nurse acts as an advocate for the nursing profession by encouraging appropriate persons to become nurses,
by being a positive role model and mentor, and by communicating the needs of nurses to those making the laws in the most professional manner possible.
14. A nursing advocate is one who:
1. makes decisions for others.
2. encourages people to make decisions for themselves and acts with or on their behalf to support those
3. manages the care of others.
4. is the legal representative for a person.
(2) Nurse advocates work with patients to provide information and assistance in decision making. The decisions and
care that occur from these decisions are based on the right of the patient to self-determination and the work of the nurse advocate supports this right.
15. All of the following support the nurse as a patient advocate except:
1. ANA Code of Ethics for Nurses.
2. institutional review boards for the protection of human subjects engaged in research.
3. federal nurse practice acts.
(3) Nurse practice acts are based in state law, not federal law, as mandated for the advocacy of nurses; JCAHO, ANA, and institutional review boards all support nurse advocacy.
16. An ombudsman is:
1. an individual, usually an employee of the government or an institution, who investigates consumer
complaints and assists in achieving a fair resolution.
2. a lawyer designated to try a case.
3. an individual hired by a family as their representative.
4. a family member designated to make decisions for an individual.
(1) An ombudsman is an individual who works for the government or an institution to investigate consumer complaints.
The goal of the ombudsman is fair investigation, reporting, and resolution of the complaint.
17. In addition to a nursing advocate, an older adult might utilize which of these advocacy groups?
2. Gray Panthers
3. National Committee to Preserve Social Security and Medicare
4. all of the above
(4) Any and all of these organizations provide advocacy services to older persons.
Part I: Subject Area Review Chapters
18. Advocacy is defined as:
1. helping another.
2. arguing, supporting, or defending a client’s cause.
3. the principle of doing no harm.
4. a duty to do good.
(2) The definition of advocacy is to argue, support, or defend a client’s cause. Providing assistance is helping another; the principle of doing no harm is nonmal eficence; beneficence is the duty to do good.
19. When patients cannot make decisions for themselves, the nurse advocate relies on the ethical principles of:
1. justice and beneficence.
2. fidelity and nonmaleficence.
3. beneficence and nonmaleficence.
4. fidelity and justice.
(3) When a patient is not autonomous, the nurse must rely on the principles of doing no harm and doing good, or nonmaleficence and beneficence, in order to assist in meeting the healthcare needs of the person to the best of the nurse’s
20. Client advocates might include all of the following except:
2. family members.
4. social workers.
(1) Family members, healthcare professionals, ombudsmen, and persons designated as such, act as advocates for
clients and patients.
21. Political action committees in nursing organizations act as advocates:
1. for legislators.
2. for members of the nursing organizations.
3. for clients.
4. for collective bargaining or union groups.
(2) Nursing organizations utilize political action committees within their organizations in order to represent the needs of their membership to legislative and organizational persons.
22. In an acute care hospital, the patient might expect which persons to act as advocates for him/her?
1. the nurse
2. the social worker
3. the physical therapist
4. all members of the interdisciplinary team caring for the patient
(4) In a healthcare setting, all members of the interdisciplinary team are expected to act as advocates for the patient.
23. A nurse case manager’s focus is:
1. nursing care needs only on discharge.
2. the comprehensive care needs of the client for continuity of care.
3. patient education needs upon discharge.
4. financial resources for needed care.
(2) By definition, case management is a process of providing for the comprehensive care needs of the client for continuity of care through the healthcare experience.
24. The physician’s role in case management includes all of the following except:
1. participate in interdisciplinary planning for patients.
2. serve as the expert for resource utilization.
3. consult with the case management team in order to facilitate timely orders as needed.
4. contribute to the documentation of the patient’s needs for services.
(2) The physician is an integral part of the case management process in terms of assisting with defining the patient’s
needs and the time frames for movement through the healthcare system; however, the physician is the expert for medical diagnosis and treatment rather than resource utilization.
25. A case management clinical pathway for congestive heart failure might include all of the following except:
1. physician follow-up appointments with transportation.
2. patient education regarding medication usage.
3. nutritional consult for diet review and accommodation.
4. insurance review for reimbursement.
(4) Clinical pathways include maps of care outcomes to be achieved prior to discharge or movement through a healthcare system. Insurance review for reimbursement is a function of an outside agency from the healthcare provider related to the amount of expected monetary compensation for services rendered to a patient.
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