NURS 104 Exam 2: Legal Foundations, Medical Math, Ethics, Respiratory, Leadership, and Cardiovascular Systems

Vocabulary practice flashcards covering legal foundations of nursing, medical mathematics and medication safety, ethical and bioethical principles, respiratory system terminology, nursing leadership and management models, delegation guidelines, and cardiovascular terminology.

Nurse Practice Act (NPA)

State legislation defining the legal scope, functions, and limitations of professional nursing practice, establishing standards of competent performance and grounds for disciplinary action.

Grounds for Disciplinary Action Under the NPA

The $10$ statutory violations leading to sanctions: practicing without a valid license, failure to use appropriate nursing judgment, felony conviction, falsification of records, failure to complete documentation, incorrect documentation, failure to practice in accordance with nursing standards, inappropriate behavior at work, Medicare fraud, and misappropriation of personal items.

Board of Nursing (BON)

The state regulatory agency empowered to enforce the Nurse Practice Act, establish clinical standards, administer criminal background checks, issue licenses, regulate continuing education, and issue disciplinary sanctions.

Disciplinary Penalties Imposed by the BON

The $4$ administrative consequences levied for violating nursing practice acts:

• Issuing a formal reprimand

• Establishing a period of probation

• Levying fines

• Limiting, suspending, or revoking the nursing license

Legal Standard Mandates

Statutory requirements utilizing absolute, enforceable directives such as 'must, will, shall' that permit no clinical discretion.

Ethical Standard Guidelines

Professional behavioral ideals utilizing permissive terminology such as 'may, should' that reflect societal norms and professional values rather than statutory absolutes.

ANA Code of Ethics

The explicit professional framework establishing implicit standards, values, and rules for professional nurses, emphasizing human dignity, professional boundaries, interprofessional collaboration, and clinical responsibility.

Professional Accountability

The ethical and clinical obligation defined by the ANA Code of Ethics as being answerable to oneself and others for one's own clinical choices, actions, and competence.

Negligence

The failure to act in a reasonable and prudent manner that an ordinary person would exercise in the same or similar circumstances.

Malpractice

A specialized category of professional negligence occurring when a licensed individual possessing specialized education and training fails to act in a reasonable and prudent manner.

Gross Negligence

An extreme, reckless clinical act or omission that demonstrates a conscious, voluntary disregard for patient safety and welfare.

Criminal Negligence

A clinical act of such egregious recklessness that it causes severe patient harm or death, resulting in state criminal prosecution.

Sentinel Event

An unexpected adverse medical occurrence resulting in death, permanent loss of bodily function, coma, paralysis, or severe physical trauma (e.g., wrong-site surgery, inpatient suicide, or fatal fall).

Error Disclosure Protocol

The institutional requirement to promptly disclose unanticipated clinical outcomes to patients and families; evidence confirms that transparent apologies reduce severe legal and professional ramifications.

Personal Liability

The legal doctrine holding individual nurses directly accountable for their own negligent acts, establishing that damages can be levied against personal assets and future earnings.

Legal Duty to Refuse Assignments

The professional mandate holding that nurses are not permitted to render care if competent requisite knowledge is lacking, establishing an affirmative legal duty to refuse specific tasks when floating or cross-training.

Incident Report Charting Protocol

The clinical standard requiring nurses to document objective factual details of an event in the patient's medical record while strictly omitting any mention or reference to the completed incident report itself.

Assault

An intentional tort consisting of words or conduct that creates a reasonable apprehension or immediate fear of unconsented physical touching.

Battery

An intentional tort defined by unauthorized, harmful, or offensive physical contact delivered directly to a person without consent.

Informed Consent Disclosure Requirements

The statutory duty of the operating clinician to disclose $5$ core elements prior to obtaining consent: nature of procedure, expected benefits, potential risks, alternative therapies, and risks of refusal.

Living Will

A legally binding advance directive detailing a competent individual's specific desires regarding life-sustaining and extraordinary medical treatments in situations where recovery is impossible.

Durable Power of Attorney for Healthcare (MPOA)

A legal instrument designating a specific surrogate decision-maker to manage healthcare choices on behalf of an individual who has become decisionally incapacitated.

Do Not Resuscitate (DNR) Order Protocol

A written medical order executed by a physician based on patient directives; nurses hold an absolute legal and ethical duty to follow a lawfully executed DNR.

Leaving Against Medical Advice (AMA) Nursing Protocol

The process followed when a competent patient insists on leaving: promptly notify the provider, articulate hazards (aggravation of condition, disability, death), document thoroughly, and never unlawfully detain the patient.

Metric System (SI)

A standardized decimal measurement system established in $1875$ in France based on powers of $10$, utilized in $98\%$ of clinical calculations.

Base Metric Clinical Units

The three standard SI foundational measures used in healthcare: meter ($\text{m}$) for length, liter ($\text{L}$) for volume, and gram ($\text{g}$) for weight.

Clinical Metric Prefixes

Prefixes altering base units by factors of $1000$:

• kilo- ($\times 1000$)

• milli- ($\div 1000$)

• micro- ($\div 1{,}000{,}000$)

• centi- ($\div 100$)

Leading Zero Rule

The notation convention requiring a zero prior to a decimal point when not preceded by a whole number (e.g., $0.5\,\text{mL}$ rather than $.5\,\text{mL}$) to prevent ten-fold medication errors.

Trailing Zero Rule

The clinical safety convention prohibiting unnecessary zeros following a decimal point (e.g., $1\,\text{mL}$ instead of $1.0\,\text{mL}$) to prevent lethal overdose misinterpretations.

Decimal Direction Rule for Metric Conversions

To convert to a smalleR unit, move the decimal $3$ places to the Right ($\text{smalleR} = \text{Right}$; multiply by $1000$). To convert to a Larger unit, move the decimal $3$ places to the Left ($\text{Larger} = \text{Left}$; divide by $1000$).

International Units Notation Rule

The standard mandating that 'units' always be written out completely in lowercase, never abbreviated as 'U' or 'u', with commas placed only when reaching five or more digits (e.g., $45{,}000\,\text{units}$).

Joint Commission 'Do Not Use' List: Units

The standard prohibiting abbreviations 'U' and 'u' because they are easily mistaken for $0$, $4$, or 'cc', requiring clinicians to write out 'units'.

Percentage Solution Calculation Formula

Determining solute mass by converting the percentage to a decimal (dividing by $100$) and multiplying by the total volume: $\text{Grams of Drug} = \text{Volume of Solution (mL)} \times \text{Concentration (decimal)}$

Milliequivalent (mEq)

A unit of measure indicating the number of grams of an active solute present in $1\,\text{mL}$ of solution, commonly applied to electrolytes such as potassium chloride ($\text{KCl}$).

Ratio Strengths in Pharmacology

The notation representing parts of drug per parts of solution (e.g., $1 : 1000$); solutions with less solvent per part of solute are more concentrated (e.g., $1 : 10$ is stronger than $1 : 100$).

Accurate Liquid Medication Measurement Protocol

Clinical technique requiring pouring solutions on a flat, steady surface, lining up the specific calibration markings, and viewing the meniscus at eye level.

Pre-Calculator Division Steps

The three steps to perform before calculator computation:

1. Eliminate decimal points by shifting them equally in numerator and denominator

2. Reduce fractions via common denominators

3. Reduce numbers ending in zeros by crossing out matched pairs

Basic Formula Method for Oral and Parenteral Doses

The clinical dosage calculation equation: $\frac{\text{D}}{\text{H}} \times \text{Q}$ Where $\text{D}$ = Desired dose, $\text{H}$ = Have on hand, and $\text{Q}$ = Quantity (vehicle).

Medication Administration Record (MAR / eMAR)

The official legal record documenting all pharmacological therapies a patient has historically received as well as scheduled future doses.

Six Rights of Medication Administration

The core nursing safety protocol verifying: Right Drug, Right Dose, Right Route, Right Time, Right Patient, and Right Recording (Documentation).

Three Label Checks of Medication Administration

The verification procedure requiring comparison of the medication order to the drug label at $3$ distinct milestones:

1. When pulling/retrieving the medication from dispensing storage

2. When preparing/opening the drug package

3. At the bedside immediately before administering to the patient

Acceptable Patient Identifiers

The dual-verification standard requiring the nurse to ask the patient to state their full name and check their hospital identification band, strictly prohibiting room or bed numbers.

Right Reason and Right Response

Complementary medication administration rights verifying the clinical rationale for why a specific drug is indicated for the patient's condition, followed by systematically evaluating its clinical effectiveness.

Four Human Factors Inducing Medication Errors

The primary operational stressors causing drug administration errors: fatigue, distraction, stress, and complacency.

Sequence of Action Following a Medication Error

The mandatory prioritized steps:

1. Immediately perform a physical assessment of the patient

2. Notify the healthcare provider

3. Identify the cause of the error

4. Complete an institutional incident report

5. Implement corrective policy updates

Bioethics

The branch of ethics dedicated to addressing moral dilemmas introduced by advancements in healthcare technology, organ transplantation, genomics, life-support prolongation, and clinical research.

Values Clarification

The continuous cognitive process by which individuals examine their personal beliefs, value system, and moral priorities to understand how they influence behavior and clinical choices.

Beneficence

The fundamental ethical obligation compelling healthcare providers to do good, promote kindness and charity, and act in the client's best interest at all times.

Nonmaleficence

The core bioethical duty obligating practitioners to do no harm, prevent injury, and actively eliminate harmful elements from care delivery.

Veracity

The ethical principle of truth-telling requiring healthcare providers to communicate accurately, transparently, and respectfully with patients.

Paternalism

The ethical violation occurring when a clinician deliberately withholds diagnoses, alternatives, or prognoses under the assumption that they know what is best for the patient, undermining self-determination.

Autonomy

The bioethical doctrine acknowledging an individual's personal sovereignty, moral self-determination, and legal right to make informed choices to accept or decline medical interventions.

Fidelity

The ethical principle grounded in the virtue of caring that binds clinicians to honor therapeutic commitments, maintain trustworthiness, and keep promises.

Ethical Integration of Artificial Intelligence (AI)

The standards governing AI use in nursing: maintain accountability without delegating clinical judgment, verify veracity against verified references, and protect confidentiality by never entering protected health information.

Primary Function of the Respiratory System

The continuous delivery of oxygen ($O_2$) into circulating pulmonary capillary blood and the simultaneous extraction and elimination of carbon dioxide ($CO_2$).

Anatomical Pathway of Airflow

The sequential $7$-step route of inhaled air:

1. Nose / mouth

2. Pharynx

3. Larynx

4. Trachea

5. Bronchi

6. Bronchioles

7. Alveoli (site of alveolar-capillary gas exchange)

Respiratory Combining Forms: Lungs and Air

Medical roots indicating either the lung tissue or presence of air:

• pneum/o, pneumat/o, pneumon/o (lungs or air)

• pulmon/o (lungs exclusively)

Upper Respiratory Word Roots

Combining forms designating upper airway structures:

• nas/o, rhin/o (nose)

• sept/o (nasal septum)

• sin/o, sinus/o (sinus)

• tonsill/o (tonsils)

• adenoid/o (adenoids)

Conducting Airway Word Roots: Throat to Windpipe

Combining forms designating middle airway tracts:

• pharyng/o (pharynx / throat)

• laryng/o (larynx / voice box)

• trache/o (trachea / windpipe)

Lower Respiratory Word Roots: Bronchi to Pleura

Combining forms designating distal respiratory structures:

• bronch/o, bronchi/o (bronchus)

• bronchiol/o (bronchiole)

• alveol/o (alveolus)

• pleur/o (pleura / lung lining)

Chest and Diaphragm Word Roots

Combining forms for surrounding structures:

• lob/o (lobe of lung)

• thorac/o, pector/o, steth/o (chest)

• phren/o (diaphragm)

Respiration and Blood Gas Combining Forms

Word parts reflecting ventilation and gas transport:

• spir/o, -pnea (breathing)

• ox/o (oxygen)

• capn/o, carb/o (carbon dioxide)

Hemoptysis

The expectoration or coughing up of blood or blood-stained secretions originating from the respiratory tract.

Atelectasis

The partial or complete collapse of pulmonary alveoli leading to decreased lung expansion and impaired gas exchange.

Orthopnea

Shortness of breath occurring when lying flat (supine), requiring an upright or elevated sitting position to breathe comfortably.

Tachypnea

An abnormally rapid respiratory rate exceeding $20\,\text{breaths/min}$ in an adult.

Bradypnea

An abnormally slow breathing pattern falling below $12\,\text{breaths/min}$ in an adult.

Apnea vs. Eupnea

Apnea denotes the complete cessation or absence of spontaneous respirations, whereas eupnea signifies normal, unlabored breathing within standard physiological limits.

Hyperpnea

An abnormal pattern of hyperventilation characterized by deep respirations that blow off carbon dioxide, resulting in hypocapnia.

Hypopnea

An abnormal pattern of hypoventilation characterized by shallow respirations that retain carbon dioxide, leading to hypercapnia.

Epistaxis

The clinical term designating a hemorrhage from the nose (nosebleed).

Physical Assessment Techniques of the Thorax

The three classical clinical diagnostic methods:

• Auscultation: listening to breath sounds via stethoscope

• Palpation: feeling for tenderness, masses, or subcutaneous crepitus

• Percussion: tapping thoracic surfaces to evaluate resonance, density, fluid, or air

Pleural Effusion

The abnormal accumulation of fluid within the pleural cavity between the parietal and visceral pleural membranes.

Pneumothorax

The pathological entry of free air into the pleural space, collapsing lung tissue through positive atmospheric pressure.

Empyema (Pyothorax)

The collection of purulent material (pus) inside the pleural cavity, secondary to severe infection.

Respiratory Endoscopic Procedures

Diagnostic visualizations of respiratory anatomy:

• Bronchoscopy: internal examination of bronchial airways

• Thoracoscopy: visual examination of the outside of the lung and pleural cavity

Respiratory Medications: Bronchodilators vs. Antitussives

Bronchodilators open constricted bronchial airways to alleviate bronchospasms, whereas antitussives act to suppress cough reflexes.

Respiratory Surgical Interventions

Operative procedures on the airway:

• Lobectomy: surgical excision of a single lobe of the lung

• Pneumonectomy: surgical removal of an entire lung

• Tracheostomy: creation of an artificial, patent opening into the trachea

Normal Adult Baseline Vital Signs

Standard clinical baseline values for resting adults:

• Temperature: $97.8\text{--}99.1^\circ\text{F}$

• Heart Rate: $60\text{--}100/\text{min}$

• Respiratory Rate: $12\text{--}20/\text{min}$

• Blood Pressure: $< 120/80\,\text{mmHg}$

• Pulse Oximetry ($\text{SpO}_2$): $95\text{--}100\%$

Leadership

The ability to inspire, motivate, and direct individuals toward achieving a common vision by shaping their beliefs, attitudes, and behaviors.

Management

The structured organizational coordination of institutional resources (people, time, supplies, and budgets) to maintain day-to-day operations and achieve set goals.

Authority

The official, legitimate institutional power to issue directives to subordinates, granted by an organization through an executive title or designated managerial role.

Power

The capacity to influence and motivate colleagues toward common objectives, effective with or without formal institutional authority.

Formal Leadership

The positional influence derived from an appointed managerial role or recognized title within an organizational hierarchy.

Informal Leadership

The lateral influence exercised by clinical peers who shape unit attitudes and behaviors through competence and personal respect rather than an official title.

Transactional Leadership

A task-focused, reactive management framework that controls daily operations through direct commands and reward-and-punishment incentives.

Transformational Leadership

A forward-thinking, proactive approach where leaders motivate and empower colleagues to surpass expectations through vision, mentorship, and collaboration.

Core Nursing Leadership Skill Categories

The three competencies of effective leaders:

• Technical Skills: clinical expertise and specialized knowledge

• Human Skills: maintaining trust, role-modeling excellence, and fostering a teaching culture

• Conceptual Skills: understanding organizational dynamics and aligning with mission goals

Autocratic / Authoritative Management

A directive leadership style characterized by top-down decision-making and strict control with negligible group input, effective during acute emergencies.

Laissez-Faire Management

A passive, hands-off leadership philosophy where the manager relinquishes control and transfers decision-making autonomy to the team.

Democratic / Participative Management

A collaborative leadership model that invites employee input and shared decision-making, increasing staff buy-in despite requiring more time.

Five Functions of a Manager

The administrative operational steps comprising:

• Planning: establishing goals and action steps

• Organizing: arranging resources, tasks, and structures

• Staffing: recruiting, training, and scheduling

• Directing: supervising and guiding execution

• Controlling: evaluating quality, safety, and performance standards

Assignment

The distribution of comprehensive patient care across a scheduled work period according to staff licensure and unit scope.

Delegation

The transfer of responsibility and authority to execute a selected nursing task to a competent worker while the delegating RN retains ultimate accountability.

Non-Delegable Nursing Activities

Core professional nursing functions that must never be delegated: initial comprehensive physical assessments, formulating nursing diagnoses, care plan development, evaluating clinical outcomes, and initial patient teaching.

Scope of Practice: Unlicensed Assistive Personnel (UAP)

Core supportive tasks: assisting with activities of daily living (ADLs), measuring intake and output (I&O), assisting with ambulation, and collecting routine vital signs on stable patients.

Scope of Practice: Licensed Practical Nurse (LPN)

Technical supportive care: administering routine oral medications, performing non-complex sterile wound dressings, inserting urinary catheters, and reinforcing existing education for stable clients under RN supervision.

Three Primary Circulations of the Cardiovascular System

The vascular circuits:

• Pulmonary circulation: heart to lungs and back for gas exchange

• Systemic circulation: heart to peripheral tissues and back

• Coronary circulation: heart chambers into coronary arteries supplying the myocardium

Heart Chambers and Blood Flow Pathways

The internal four-chambered cardiac layout:

• Right atrium and right ventricle receive deoxygenated blood from the body and pump it to the lungs

• Left atrium and left ventricle receive oxygenated pulmonary blood and pump it systemically into the aorta

Four Unidirectional Heart Valves

The internal fibrous structures preventing backflow:

• Right atrioventricular (tricuspid) valve

• Left atrioventricular (mitral/bicuspid) valve

• Pulmonary semilunar valve

• Aortic semilunar valve