National Council Licensure Examination for Registered Nurses (NCLEX-RN) Safe and Effective Care Environment: Management of Care Flashcards

24 sample cards from the Safe and Effective Care Environment: Management of Care deck

Sampled from the end of the deck, so these are different cards from the ones shown on the syllabus page.

1. Differentiate assault from battery in nursing practice.

   Assault is threatening or creating fear of harmful/unwanted contact; battery is the actual unconsented physical contact (e.g., treating without consent).

2. What is the difference between false imprisonment and lawful restraint use?

   False imprisonment is unlawfully confining/restraining a client without consent or order; lawful restraint requires a provider order, documented need, exhausted alternatives, and proper monitoring.

3. What are the three required elements of valid informed consent?

   The client must receive adequate information (disclosure), have capacity/competence to decide, and give consent voluntarily without coercion.

4. Whose legal responsibility is it to obtain informed consent, and what is the nurse's role?

   The provider performing the procedure must obtain consent; the nurse witnesses the signature and verifies the consent is voluntary and the client understands.

5. Define client advocacy in nursing.

   Acting to protect and promote the client's rights, interests, and wishes — speaking and intervening on the client's behalf.

6. What characterizes a therapeutic nurse-client relationship versus a social relationship?

   A therapeutic relationship is goal-directed, client-centered, professional, and bounded; a social relationship is mutual, reciprocal, and meets both parties' needs.

7. What are the phases of the therapeutic nurse-client relationship (Peplau)?

   Orientation (pre-interaction), working, and termination phases.

8. What is a Nurse Practice Act?

   A state law that defines the scope of nursing practice, licensure requirements, and standards; enforced by the state board of nursing.

9. Which body grants and regulates a nurse's license to practice?

   The State Board of Nursing in the state where the nurse practices.

10. What is the Nurse Licensure Compact (NLC)?

    An agreement allowing a nurse to hold one multistate license and practice in other compact member states without obtaining additional licenses.

11. What U.S. federal law primarily protects the privacy and security of clients' protected health information (PHI)?

    HIPAA — the Health Insurance Portability and Accountability Act.

12. Define confidentiality in the context of client information.

    The duty to protect a client's private health information from unauthorized access or disclosure, sharing only with those involved in care or as legally permitted.

13. What is the 'minimum necessary' standard under HIPAA?

    Access, use, and disclose only the minimum amount of PHI necessary to accomplish the intended purpose.

14. Name two situations where breaching confidentiality is legally mandated.

    Reporting communicable/reportable diseases and suspected abuse (child/elder), plus duty to warn when a client threatens harm to an identifiable person.

15. What is the legal and clinical standard for documentation: what should the nurse do about care that was not charted?

    'Not documented, not done' — if care is not recorded it is legally presumed not performed; document accurately, completely, and timely.

16. What is the correct method to fix a documentation error in a paper chart?

    Draw a single line through the error, write 'error' with your initials and date, and enter the correct information — never erase, white out, or obliterate.

17. Define nursing informatics.

    The specialty integrating nursing science with information and computer science to manage and communicate data, information, and knowledge in nursing practice.

18. What is the difference between an EHR and an EMR?

    An EMR is a digital chart within one organization; an EHR is a comprehensive record designed to be shared across multiple organizations and providers.

19. Define quality improvement (QI) in healthcare.

    A continuous, systematic process of analyzing performance and implementing changes to improve client outcomes and care delivery.

20. What are the four steps of the PDSA quality-improvement cycle?

    Plan, Do, Study, Act.

21. What is the difference between a sentinel event and a near miss?

    A sentinel event is an unexpected occurrence causing death or serious physical/psychological harm; a near miss is an error that was caught before reaching the client (no harm).

22. What is a root cause analysis (RCA), and when is it used?

    A retrospective, structured process to identify the underlying system causes of an adverse/sentinel event in order to prevent recurrence; focuses on systems, not individual blame.

23. Define case management.

    A collaborative process of assessing, planning, coordinating, and evaluating services to meet a client's health needs across the continuum, promoting quality and cost-effective outcomes.

24. What is utilization review (UR) in healthcare?

    The evaluation of the necessity, appropriateness, and efficiency of healthcare services, settings, and length of stay against established criteria to control costs and ensure appropriate resource use.

What this deck covers

Safe and Effective Care Environment: Management of Care flashcards FAQ