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新加坡护士面试培训资料(内部秘籍必看)

www.nursesky.com 更新时间:2012-11-15 9:08:59  点击:
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文章摘要:内部秘籍,参加新加坡公立医院项目的护士必看,另外祝大家都能顺利考试通过。

1. What must the physician order include for the use of restraints?

  The condition present that warrants the use of restraints.
  b) Type of restraint
  c) Time of the order
  d) Date
 e) Physician's signature

2. If a patient is restrained for sudden aggressive behavior, how soon must the patient be assessed face-to-face by the physician and how long is the restraint good for?

If a patient exhibits sudden aggressive behavior and poses an imminent danger to himself or others and restraints are applied, a physician must see and evaluate the need for restraint within ONE hour after the intervention.
Each written order for a physical restraint for aggressive behavior is limited to four (4) hours for adults, two (2) hours for children and adolescents age 9-17 and one (1) hour for children under the age of 9.
When the time span for the original order is close to expiring, a nurse is to telephone the physician, report the results of his/her most recent assessment and request that the original order be renewed for another period of time.....not to exceed the time limits set by the original order. The physician does not have to perform another face-to-face assessment until the 24hr. maximum is reached.

3. Name alternative interventions to restraint application

Sitters
Bed check system
Family staying with patient
Frequent toileting
Ambulation
Leaving lights on

4. Where do you dispense needles and sharps?

In the sharps containers

5. What is your role in managing information? 

Protect Our Hospital Computer System by following proper procedures for protecting records and information from tampering/damage, unauthorized access or use and theft. 
      
Make entries in a patient’s record only if you are authorized to do so.
 Never leave open files on your computer screen or reports from a printer unattended.
 Keep patient information confidential.    
For example:  Get written permission from the patient before you share information with any unauthorized person or agency.  Do not talk about patients in public areas such as the elevator or cafeteria.  Never leave patient files open or unattended where unauthorized people could see them.
Keep documentation up to date and accurate.  All entries should be signed, dated and checked for accuracy. 
Anytime you see how a process can be improved, tell your supervisor!

6. What rights and responsibilities do our patients have? 

(Policy Patient and family Rights & responsibilities .ADT-11)
RIGHTS FOR TREATMENT: 
Patients have the right to be treated without discrimination. They cannot be denied appropriate and necessary services because of their race, religion, national origin, gender or ability to pay. 

Patients also have a right to care that is considerate and respectful of their personal values and beliefs.
Patients have a right to appropriate assessment and management of pain.
Patients have the right to review their medical record.  They also have the right to have their questions about their condition answered.

INFORMED CONSENT:
Patients have the right to know:
Treatment options including alternative options and the option to refuse treatment
Risks, benefits and alternatives of each option including the expected length of recovery
Possible side effects of treatments and medications
Costs including what the patient’s insurance may and may not cover

INVOLVEMENT IN CARE DECISIONS:
Patients have the right to be involved in making decisions which  includes informed consent,  withholding resuscitative services, care at the end of life and other options outlined in various documents known as “advance directives”.
 Patients also have the right to file a complaint and receive help in resolving any conflicts.

CONFIDENTIALITY:
Information about a patient (medical records, test results, etc.) must be kept private.  Anyone not directly involved in the patient’s care, including family members, must have the patient’s permission to get information.

CONFIDENTIALITY:
Staff must not needlessly talk about a patient’s personal or medical details!  Be cautious of where and how you discuss patient information!  Remember you signed a confidentiality statement upon employment that must be taken seriously

PRIVACY:
All care (examinations, tests, etc.) should be given in ways that respect the patient’s dignity.  Some examples of how you do this should include:
Knocking before entering the patient’s room
Keeping curtains drawn during examinations
Discussing sensitive issues in a private area
Asking the patient’s permission to speak about his or her condition in front of visitors and/or family members.

ACCESS TO PROTECTIVE SERVICES:
Know our facility policy ……. addressing issues of suspected abuse and neglect.  All healthcare workers are responsible for notifying our Social Workers ….when suspicion of abuse or neglect exists!
PATIENT RESPONSIBILITIES:
These include giving accurate information, following instructions, asking questions  when something isn’t clear, showing respect and consideration for other patients, hospital staff and visitors, and following hospital rules such as visiting hours and no smoking within the building).

7. How do you ensure the patient’s right to confidentiality?

Do not share computer password.
Do not discuss patients in open areas (i.e., elevators, cafeteria, and hallways).
Use caution when giving information over the phone.
Share patient information only with appropriate staff.
Tear up papers that contain patient information and place in recycling bins to be confidentially shredded.
Do not use patient’s name when voice paging.
Employees, volunteers, students and affiliated care givers sign an agreement of confidentiality at time of employment.
Only authorized individuals are permitted to access records (Paper or via computer)
Job descriptions/evaluations address confidentiality.
Boards or sign-in sheets with patient’s address or diagnosis should never be visible to the public.
Also, reclose doors/curtains to maintain as much privacy as possible with the patient. 
We provide pen/paper to our patients if they seem embarrassed or uncomfortable to talk. We move to a more private area when possible.  We assure patient gowns fit properly.  We close bathroom doors when occupied, etc.

8. What is your role in obtaining informed consent?  (Consent policy, PFR-01)

The staff’s role is to verify with the patient (by the patient’s signature on the consent form) that the patient has all the information needed regarding the risks, benefits, and alternatives of the procedure to make an informed choice. 
Risks, benefits, and alternatives of the procedure MUST BE ADDRESSED BY THE PATIENT’S PHYSICIAN.
If the patient has questions, the nursing staff may choose to delay the consent process until the physician has satisfactorily answered all the patients’ questions and then proceed with the consent process.

9.  Who can look in a medical record?

Health care professionals with a need to know and who are involved in the patient’s care.

10. What single action is recognized by the CDC (centers for Disease Control and Prevention) as the most effective means of preventing the spread of infection within a facility

HANDWASHING!!!!!

11. What does the term “Standard Precautions” mean?

[YOUR HOSPITAL] has adopted the 1996 CDC Isolation Precautions.  Under these guidelines, standard precautions are used.  Standard precautions mean that blood, non-intact skin, and all body fluids with the exception of sweat are treated as potentially infectious, so we must use personal protective equipment to protect ourselves from being exposed to these body fluids.

12. What would you do for an occupational exposure to blood borne pathogens (needle stick, splash or spray to eyes, non-intact skin)?

Go through the needle stick protocol.  Report exposure to your supervisor, then contact the Employee Health Clinic), the Infection Control Coordinator or the House Supervisor to complete an exposure packet which is available from any of the above individuals.  The details of the exposure will be reviewed with you and the risk of transmission of a blood borne pathogen will be determined.  At this point you will be instructed further regarding any action needed.  Employee clinic, the responsible nurse will follow up with you regarding the results of testing.

13. What isolation system do we use at [YOUR HOSPITAL] and what do the signs mean?

[YOUR HOSPITAL] uses the CDC Isolation Precautions which mandate standard precautions are to be used at all times with all patients.  In addition to Standard Precautions there are three categories of transmission based precautions:

Three categories:
 Airborne - for TB, chickenpox or other airborne disease.
  Droplet - for meningitis, pertussis, influenza or certain other diseases. 
Contact -used for patients with VRE, MRSA or other drug resistant organisms.
 
Signs instruct visitors and other persons to report to the nursing station for information regarding precautions to be taken before entering the patient’s room.
Standard precautions are always used in addition to transmission based precautions.

14. What is personal protective equipment?  Name an example and when you should use it.

Personal protective equipment protects us from contact with blood or body fluids.  Gloves, masks, goggles or face shields and gowns are personal protective equipment

15. Who monitors refrigerator temperatures in our facility and what action should be taken to correct an out of range reading?

In the main facility temperatures are checked daily and logged by our Security personnel.  Any variance is reported to Plant Operations.  Nursing staff a sign to monitor the floors refrigerator temperature 

16. What immunizations are available to our employees?

All of our employees are offered the Hepatitis B vaccine. All employees are offered the flu vaccine yearly.

17. What precautions are taken for patients with known or suspected TB?

The patient is placed in a private room with negative air pressure, outside ventilation and an isolation sign is placed on the door. 
An employee who has been fit tested for an approved mask is assigned to care for the patient.  Patients should not leave the room unless required for testing or treatment and then they must wear a mask the entire time they are out of the room.  Only employees fit tested with an approved mask may enter the room.

18. Do you recap needles?

Generally needles are never recapped, but if there should be a situation where recapping is necessary then you must use a one handed scoop method or a mechanical device designed for needle recapping.

19. How do you dispose of sharps?

Needle/sharps boxes are where all contaminated sharp items are disposed of.

20. What is conscious sedation?

A drug-induced depression of consciousness during which patients respond purposefully  to verbal commands, either alone or accompanied by light tactile stimulation.  No interventions are required to maintain a patient airway, and spontaneous ventilation is   adequate.  Cardiovascular function is usually maintained.

21. What is the difference between “conscious sedation” and other types of sedation?   

Minimal sedation is defined as a drug-induced state during which patients respond   normally to verbal commands.  Although cognitive function and coordination may be impaired, ventilatory and cardiovascular functions are unaffected.(such as medication given for pain or pre-operative medication).
    
Deep sedation/analgesia is defined as a drug-induced depression of consciousness during which patients cannot be easily aroused, but respond purposefully following repeated or painful stimulation.  The ability to independently maintain ventilatory function  may be impaired.  Patients may require assistance in maintaining a patent airway and spontaneous ventilation may be inadequate.  Cardiovascular function is usually maintained.(these patients will have an anesthetist in attendance)

22. What equipment is to be readily available in monitoring the patient for conscious sedation?

The following equipment and supplies must be available for the administration of intravenous conscious sedation:
Continuous monitoring non-invasive blood pressure and  pulse oximetry; and cardiac     monitoring (only if known cardiac patient) during and immediately following in the recovery period of the procedure. In case cardiac monitoring is not available, at least pulse oximetry should be available
Continuous intravenous infusion of an appropriate solution functional suction apparatus with appropriate suction catheters.Telephone or some other system so as to be able to activate the emergency medical   system if required  Duct number 8060
Conscious Sedation
An emergency crash cart which includes respiratory emergency equipment.
Reversal agents/medications.
Sedation and analgesia medications as ordered by M.D.

23. Describe how the medication orders are  processed for your hospital.

Practitioners write orders in patient chart.  Nurse verifies order and order is copied onto med administration record (medix). Copy or order goes to pharmacy via dumbwaiter.  Pharmacy sends up enough doses until time of cart exchange, when a new 24hr supply is delivered.  Pharmacy and nursing reconcile drugs being delivered at cart exchange against nursing medix.Use chart to clarify discrepancies.

24. How do you monitor the effects of medications on patients?

Depends on the drug.  If analgesic, go back and ask patient to rate their pain, using pain scale.  If anti-hypertensive, take blood pressure.  If antibiotic, check WBC, temp, confirm C&S for bug and drug.  Etc.  Overall there is a Multidisciplinary approach

Multidisciplinary
Pharmacy screens for drug-drug interactions, drug-food interactions.
Lab reports sub therapeutic or toxic levels/labs.
 Everyone evaluates patient for suspected adverse reactions.
Nursing documents SE, effects. 
Physician, monitor outcomes.

25. Describe how you are addressing the patient’s right to pain management.

First of all, the patient is informed of the right to pain management in the admission brochure.  Upon admission, the nursing assessment is used to assess pain. A standard pain scale (0 pain free-10 worst ever pain) is used to document the pain.. 
Medications are ordered by the physician and administered  according to the instructions.  Appropriate selection and dose of drugs are monitored by pharmacists.  When doses are administered, the nurse re-checks the patient and documents pain after the analgesic dose (or non-pharmacologic)  intervention
Care plans include the pain scale. The physician is informed if the pain regimen prescribed is not effective at managing the patients pain.  In addition, PCA pumps are now available at PCA.  This allows the patient to assist in their pain management.  Patients are educated about their pain meds by the nurse  when given the med and before being discharged home on a pain med.
 
26.How long is a multiple dose drug good for? 

Multiple dose vial for injection 30 days from date opened, as long as not visibly contaminated.  Staff is to write date and initials on vial when opened. 
Bulk or multi use container liquid, etc       
Up to manufacturer’s expiration date as long as no visible signs of contamination and proper dispensing/administration techniques are used 


27. What should you do if you see smoke coming from a patient room, a fire in a  
    waste basket or any other signs of a fire?

Follow the R-A-C-E protocol:
R = Rescue all persons from the immediate area of the fire.
A = Activate the alarm and dial 44 (emergency activation Number)to report the fire.
C = Contain the smoke or fire by closing all doors.
E = Extinguish/Evacuate by using the proper fire extinguisher.


28. How do you use a fire extinguisher?

P-A-S-S:
P = Pull the pin located between the two handles.
A = Aim the base of the fire.
S = Squeeze the handles together.
S = Sweep from side to side at the base of the fire.  Watch for re-flash and use extinguisher again if needed.

29. What by colures do you have for medical waste and for what types?

Yellow bags : Infectious waste
Red bags:       All the human body parts
Green Bags : Contaminated  linen
Orange Bag : Cytotoxic waste
Black bags:    Normal waste
30. What are the 10 golden rules in drug administration:
  1.) administer the right drugs
  2.) administer the right drug to the right patient
  3.) administer the right dose
  4.) administer the right drug by the right route
  5.) administer the right drug at the right time
  6.) document each drug you administer
  7.) teach your patient about the drugs he is receiving
  8.) take a complete drug history (there is a risk of adverse drug reactions when a number of drugs are taken or when patient is taking alcohol drinks)
  9.) Find out if the patient had any allergies.
  10.) Be aware of potential drug-drug or drug-food interaction.

 

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