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The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse:
- A. is showing empathy and as long as she lets the patient know the money is not from her, she is not violating any social media guidelines.
- B. is at risk for HIPAA violations.
- C. has properly followed policy and protected the patient by not using her name.
- D. is demonstrating the logical fallacy of slippery slope.
Correct Answer: B
Rationale: The correct answer is B because the nurse is at risk for HIPAA violations by sharing patient information on social media. The Health Insurance Portability and Accountability Act (HIPAA) protects patients' privacy and prohibits healthcare providers from disclosing their health information without consent. In this scenario, the nurse shared specific details about the patient's health condition, visit to the ED, and financial situation, which could easily identify the patient. This violates the patient's right to privacy and confidentiality. Choices A, C, and D are incorrect because the focus should be on the HIPAA violation rather than empathy, policy following, or logical fallacies. The nurse should have found alternative ways to help the patient without compromising their privacy.
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A new graduate secures the first interview and wants to work where cultural diversity is appreciated. The applicant feels that accepting this interview was the right choice when the recruiter states, "We do not discriminate based on sex, race, or age and practice inclusiveness of diversity." Which question would reflect this statement?
- A. "Nurses must work a master schedule where one month is Monday through Friday and the next month is the weekend shift. What is your religious belief about working on Sunday?"
- B. "We offer many benefits for employees such as educational benefits and health insurance."
- C. "Our mission is to provide patient-centered care that reflects the belief of the patient and family with an aim to win them over to Western medicine and less superstition, don't you agree?"
- D. "Do you have any issues with working with patients who are from a disadvantaged background because we have many people who refuse to work then want free care?"
Correct Answer: B
Rationale: The correct answer is B because it focuses on the benefits offered to employees, which aligns with the recruiter's statement about inclusiveness and non-discrimination. Asking about educational benefits and health insurance shows that the organization values its employees' well-being and development regardless of their background.
Choice A is incorrect because it is discriminatory to ask about religious beliefs related to work schedules. Choice C is incorrect because it promotes a biased perspective on patient care and cultural beliefs. Choice D is incorrect as it implies a negative stereotype about patients from disadvantaged backgrounds, which goes against the principles of inclusivity and non-discrimination stated by the recruiter.
A client is admitted with chest pain. A series of diagnostic tests are ordered, and the client undergoes coronary artery bypass grafting. The cost of care for this client is increased because of a four-pack-per-day smoking history that resulted in extension of the client's intensive care unit (ICU) stay by 3 days because of respiratory problems. The case manager realizes that under the terms of the diagnosis-related group (DRG) payment system for this diagnosis:
- A. the cost of caring for this client was $5000 greater than the DRG reimbursement fee, and the hospital will be allowed to collect the additional fees from the insurance company.
- B. although the cost of care for this client was greater than the DRG reimbursement amount, the hospital will be reimbursed only at the set fee.
- C. the client will be sued to pay back the insurance company for the extra fees incurred because smoking is a modifiable health risk for heart disease.
- D. the physician who admitted the client will receive a reduced payment to cover the loss incurred by the hospital.
Correct Answer: B
Rationale: The correct answer is B. The DRG payment system is a fixed reimbursement amount for a specific diagnosis or procedure. In this case, the cost of care exceeded the DRG reimbursement amount due to the extended ICU stay caused by the client's smoking history. The hospital will only be reimbursed at the set fee specified by the DRG, regardless of the actual cost incurred.
Choice A is incorrect because the hospital cannot collect additional fees from the insurance company beyond the DRG reimbursement amount. Choice C is incorrect as the client is not typically held responsible for the additional costs incurred. Choice D is incorrect because physician payment is not directly impacted by the hospital's financial losses. The DRG system focuses on fixed reimbursements based on diagnoses, not individual physician payments.
A nurse entering the job market wants to be certain that the first position is rewarding and allows for growth as a registered nurse. According to the Hallmarks of the Professional Nursing Environment, the nurse should ask:
- A. about the philosophy related to clinical care to determine the role of RNs in deciding outcomes related quality outcomes.
- B. if professional development opportunities are supported through paid leave and tuition reimbursement.
- C. how compensation packages compare to others in the same area and nationally.
- D. what the projected need for RNs is in the next 5 years and current turnover rate.
Correct Answer: B
Rationale: The correct answer is B because professional development opportunities supported through paid leave and tuition reimbursement are crucial for a nurse's growth. This allows for continuous learning, skill enhancement, and career advancement. It indicates that the organization values its nurses and invests in their development. The other choices, A, C, and D, while important in their own right, do not directly address the nurse's growth and professional development. Choice A focuses on the philosophy of care, not personal growth. Choice C is mainly about compensation, not professional development. Choice D pertains to workforce planning, not individual career advancement.
During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy?
- A. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway.
- B. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power.
- C. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call.
- D. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure.
Correct Answer: A
Rationale: The correct answer is A because denying the older person with Alzheimer's disease the right to ambulate violates their autonomy by restricting their freedom to make choices about their own body and movement. Autonomy is the ethical principle that respects an individual's right to make decisions about their own health and well-being. In this situation, the person should have the autonomy to decide whether or not they want to ambulate, even if they have advanced Alzheimer's disease.
Choice B is incorrect because the mentally competent adult has the right to refuse medical treatment based on their beliefs, which is an expression of autonomy.
Choice C is incorrect because the mentally competent visitor has the right to refuse examination, which is also an expression of autonomy.
Choice D is incorrect because the mentally competent adult has the right to refuse a local anesthetic, which is also an expression of autonomy.
The role of the Clinical Nurse Leader (CNL) would include:
- A. diagnosing a patient with pneumonia and prescribing antibiotics.
- B. teaching members of a faith community how to avoid skin cancer and referring those with suspicious lesions.
- C. participating in the team who is investigating possible abuse of elderly persons by members of a gang known to sell illegal drugs.
- D. coordinating care of a patient admitted 4 days ago with stage IV heart failure and chronic bronchitis by revising care plan to include ambulation 50 feet with assistance.
Correct Answer: D
Rationale: The correct answer is D because the role of a Clinical Nurse Leader (CNL) involves coordinating and managing the care of patients. In this scenario, the CNL is revising the care plan for a patient with complex health issues, such as heart failure and chronic bronchitis, by incorporating specific interventions like ambulation with assistance. This aligns with the core responsibilities of a CNL, which include care coordination, implementation of evidence-based practice, and leadership in interdisciplinary teams.
Choice A is incorrect because nurses, including CNLs, do not have the authority to diagnose and prescribe medications, as this falls under the scope of practice of a physician or advanced practice nurse.
Choice B is incorrect because while health education and referral are important aspects of nursing practice, they are more aligned with the role of a community health nurse rather than a CNL.
Choice C is incorrect because investigating abuse and criminal activities is beyond the scope of a CNL's role, as their focus is primarily on