270 PrepUs - Week 11

Stop the transfusion, infuse normal saline solution, and call the physician. (When a transfusion reaction occurs, the transfusion should be immediately stopped, normal saline solution should be infused to maintain venous access, and the physician and blood bank should be notified immediately. Other nursing actions include saving the blood bag and tubing, rechecking the blood type and identification numbers on the blood tags, monitoring vital signs, obtaining necessary laboratory blood and urine samples, providing proper documentation, and monitoring and treating for shock.)

A client receiving a blood transfusion experiences an acute hemolytic reaction. Which nursing intervention is the most important?

moxifloxacin 400 mg daily (Among the Joint Commission's list of "do not use" abbreviations are Q.D., qd, and OD when denoting a once-per-day drug administration. Because of the potential for misinterpretation and consequent drug errors, the Joint Commission recommends writing "daily" in the order.)

A client's diagnosis of pneumonia requires treatment with antibiotics. The corresponding order in the client's chart should be written as

Unauthorized entry

A day-shift nurse gives a client an injection of pain medication. The nurse forgets to document the injection on the medication administration record (MAR). The day-shift nurse tells the evening-shift nurse that she gave the client 4 mg of morphine at 2 p.m. for postoperative pain but didn't document the injection. The evening-shift nurse puts the day-shift nurse's initials and the date and time the dose was administered in the appropriate area of the MAR. The evening-shift nurse's action is considered to be which type of documentation error?

The client has had a sudden change in status needing immediate attention. (Computerized charting, which means documenting client information electronically, is most useful for nurses when a terminal is available at the point of care or bedside. These point-of-care (POC) systems allow for timely documentation that can be shared with multiple people and can reduce errors.)

A health care provider suggests that the nurse use the computer terminal that is available at the point of care or at the client's bedside. In what scenario is this most important?

Completes a full incident report

A nurse enters a client's room and finds that the client is lying on the floor. The nurse makes the client comfortable on the bed and completes an assessment. The nurse then informs the health care provider and the nursing supervisor about this incident and also completes an incident report. Which actions by the nurse indicates correct knowledge of handling an incident report?

Assess the client and notify the client's physician. (This is a medication error. The priority is to assess the client and then call the physician to advise them of the error and seek further direction.)

A nurse gives a client 0.25 mg of digoxin instead of the prescribed dose of 0.125 mg. What should the nurse do next?

The incident report will provide a basis for promoting quality care and risk management.

A nurse gives a client the wrong medication. After assessing the client, the nurse completes an incident report. Which statement describes what will happen next?

The nurse details the client's response and the examination and treatment of the client after the incident. (An unintentional injury or incident that compromises safety in a health care agency requires the completion of a safety event report (incident report). )

A nurse is filing a safety event report for an older adult client who tripped and fell when getting out of bed. Which action exemplifies an accurate step of this process?

-Improvement in health care quality -Greater client engagement -Reduction in privacy breaches of client information

A nurse is reading a journal article about health information technology and the need for this technology to demonstrate meaningful use. Which information would the nurse anticipate reading about as reflective of meaningful use?

Investigate the circumstances that contributed to client falls. (The most effective method to address the increased frequency of client falls (and to promote a positive working environment) would be to determine the circumstances that contributed to the clients' falls.)

A nurse manager notes an increase in the frequency of client falls during the last month. To promote a positive working environment, how would the nurse manager most effectively deal with this problem?

"We can discipline the ED staff for not getting the clients to the ICU fast enough."

A nurse on a neurologic unit is working on performance improvement with a stroke-management team. The nurse identifies a gap between the time a client enters the emergency department (ED) and the time that client is admitted to the intensive care unit (ICU) for aggressive treatment. The nurse meets with the team to develop a change strategy based on indicators. Which statement by a team member shows a need for further teaching regarding performance management?

Meet with the new nurse and the primary nurse and help set up an additional week of orientation. (The nurse-manager is responsible for adequate orientation of new staff. A need for additional orientation does not mean that a nurse is not competent or that there are deficits in performance. Although a 6-week orientation may be standard, orientation periods should be individualized to meet the needs of the staff as well as provide the best client outcomes.)

A primary unit nurse tells the nurse-manager that a registered nurse hired 6 weeks ago needs an additional week of orientation to function effectively on the staff. Which action is most appropriate for the nurse-manager to take?

Optimization (commonly includes strategies to improve processes, maximize effective use, reduce errors, and eliminate workflow inefficiencies. Updating and streamlining reflect such strategies.)

An informatics nurse specialist is involved with implementing strategies to improve the performance of the clinical information system being used. As part of this process, the nurse specialist is working on updating the plans of care in the system to reflect changes to a procedure based on new evidence. The nurse is also working to streamline the display screens to reduce the need to document the same information in three different areas. The nurse specialist is addressing which aspect of the system?

"Incorporating evidenced-based practice into our care routines links our interventions to valued outcomes, thereby increasing quality care. When we provide quality care, we can decrease cost."

At the last hospital unit meeting, the policy for the insertion of Foley catheters was revised based on current evidence. The new nurse on the unit just learned "the old way" and is frustrated to now have to learn a new methodology. Several other nurses comment that the change is "all about money." The charge nurse must educate the staff about the importance of this new policy. What explanation by the charge nurse is most appropriate?

Step-by-step decision-making tree for dressing selection (Algorithms are step-by-step methods for solving problems)

Facility policies on wound dressing selection refer the nurse to a dressing algorithm. The nurse anticipates that the algorithm will include:

A-positive blood to an A-negative client.

In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving

Healthy People 2030 (provides an overall action plan to improve the health and quality of life of people living in the United States)

The National Center for Health Statistics uses data from healthcare agencies to issue quarterly and annual reports on performance related to goals for improving the health of the U.S. population. Which initiative is targeted with improving the health of all Americans?

Planning (Establishing the outcomes and actions will help the client achieve the overall goals of care.)

The RN develops an outcome standard of "client will ambulate with an assistive device 60 feet with assistance twice a day" for a client who had a hip replacement. What part of the nursing process is involved with this outcome statement?

Listen to the new nurse's suggestion and evaluate its usefulness. (It is appropriate for health care professionals to be constantly evaluating whether the client's needs are being met in the best way.)

The RN is orienting a new nurse who suggests a different way to perform a procedure. What is the RN's most appropriate reaction?

-The development of evidence-based practice guidelines require a research review from different studies to develop the most accurate diagnostic method to implement. -When developing a CVA set of step-by-step directions, the nursing unit should ask for assistance from experts in the neuroscience field. The potential users of the guidelines should pilot test it for further feedback. -A meta-analysis could be utilized to combine evidence from different studies to produce a more accurate diagnostic method.

The neuroscience nursing unit has developed a set of step-by-step directions of what should occur if a nursing assessment reveals the client may be exhibiting clinical manifestations of a cerebrovascular accident (CVA).

Suggest to the nurse manager that an in-service on abbreviation use would be helpful. (Many abbreviations and symbols are not permitted for use in health care records. The nurse should never alter documentation, nor is it appropriate to ask another nurse or the IT department to do so. The nurse should talk to the nurse manager about an in-service on appropriate abbreviation use.)

The nurse is reading another nurse's notes that were recorded in the electronic health record (EHR) during the previous shift. What is the appropriate nursing action when numerous unapproved abbreviations are noticed in the previous nurse's notes?

Better patient outcomes (Magnet® hospitals have better patient outcomes than facilities without the recognition.)

The nurse is working at a facility that is applying for Magnet® Recognition. The nurse knows that compared with other hospitals, Magnet® hospitals have which direct effect on client care?

Enlist volunteers to help develop a community outreach project that will educate teenagers on methods to prevent pregnancy.

The nurse manager is concerned about the large number of teenage mothers being seen in the obstetrics clinic. How can the nurse manager use the transformational leadership style to address the concern?

Quality by inspection (an approach to quality assurance in which nurses watch for deficient workers and remove them in an effort to prevent harm to clients.)

The nurse manager observes one of the unit nurses failing to wash hands on entering a client room. Hospital protocol is to wash hands before and after entering a client room. This scenario is an example of which approach to quality assurance?

SBAR (The nurse should use SBAR to communicate verbally to the physician. Situation, Background, Assessment, and Recommendation (SBAR) is the communication tool to provide critical client information to the physician.)

The nurse notes that a client's blood glucose level is increased. The nurse plans to inform the physician by phone. Which technique should the nurse use to communicate verbally to the physician?

Formally report the findings related to the ulcers to the nurse manager. (When a quality of care issue is identified, it should be reported through the chain of command. Informing the nurse manager of the finding is the first action to take. The nurse manager would initiate an investigation, including a review of medical records, to determine the potential cause for the pressure injuries.)

The nurse notes that several assigned clients are developing signs of pressure injuries. Which action should the nurse take first?

Discovering a problem (Detecting that there are several readmissions with heart failure is the first step in the process of performance improvement. The next step would be to plan a strategy using indicators, which includes calling an interdisciplinary meeting.)

The nurse on a busy acute care floor identifies that several clients with heart failure are being readmitted within 2 weeks of discharge. Which step in performance improvement is the nurse demonstrating?

The percentage of clients on the unit diagnosed with an acute MI who were taught about resuming sexual activity (The unit council needs to assess the number of clients diagnosed with an acute MI on the telemetry unit who were actually taught about resuming sexual activity.)

The nurse's unit council in the telemetry unit is responsible for performance improvement studies. What information should they gather to study whether client education about resuming sexual activity after an acute myocardial infarction (MI) is being taught?

"You can make extra money with overtime pay with end-of-shift charting."

The nursing student is discussing the benefits of electronic charting with a precepting nurse who is frustrated with computerized documentation. Which statement by the student requires intervention from the nursing instructor?

Summarize findings from multiple studies that are related to a particular nursing practice. (A systematic review suggests that the nurse has reviewed multiple studies regarding a particular nursing practice question or topic. Asking the question about a clinical practice would come in the first step.)

The second step in implementation of evidence-based practice includes systematic review. To complete a systematic review of the literature, what must the nurse do?

Incident reports document

These types of reports document unusual occurrences and deviations from care. Facilities use the internal documents to evaluate care, determine potential risks, or discover system problems that might have contributed to the error. This type of error won't result in a report to the state board of nursing or in the nurse's suspension. Some facilities do track the number of errors a nurse or a particular unit makes; the purpose of tracking errors is to provide appropriate education and to improve the nursing process.

Variance report or occurrence report

This (aka incidence report) is a tool used by health care agencies to document the occurrence of anything out of the ordinary that results in (or has the potential to result in) harm to a client, employee, or visitor. These reports are used for quality improvement and not for disciplinary action. They are a means of identifying risks and high-risk patterns as well as initiating in-service programs to prevent future problems.

The Joint Commission (TJC) -Organization

This organization, audits client records regularly under specific guidelines that are announced annually and shared with each institution. This organization also encourages institutions to set up ongoing quality assurance programs.

Quality as opportunity

This type of quality, focuses on finding opportunities for improvement and fosters an environment that thrives on teamwork, with people sharing the skills and lessons they have learned.

The ANA defines Nursing informatics (NI)

This, is defined as "the specialty that integrates nursing science with multiple information management and analytical sciences to identify, define, manage, and communicate data, information, knowledge, and wisdom in nursing practice." It is more than just working with computers or the electronic health record (although this is the core of informatics practice).

Standards

This, is defined as the "levels of performance accepted by and expected of nursing staff or other health team members."

An acute hemolytic reaction

This, occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause this. Likewise, giving Rh-positive blood to an Rh-negative client would cause this. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O-negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility.

Maintenance (A person is in the maintenance stage of the Transtheoretical Model of Change when there is work to prevent relapse and to sustain the gains made from the actions taken.)

When a person works to prevent relapse and to sustain the gains made from actions taken, he or she is in which stage of the Transtheoretical Model of Change?

Hold the medication and report the information to the physician to ensure client safety.

When checking a client's medication profile, a nurse notes that the client is receiving a drug contraindicated for clients with glaucoma. The nurse knows that this client, who has a history of glaucoma, has been taking the medication for the past 3 days. What should the nurse do first?

Nurse practice act (Each state legislature has enacted a nurse practice act. These statutes outline the legal scope of nursing practice within a particular state. State boards of nursing oversee the statutory law.)

Which guidelines define and regulate what the nurse may and may not do as a professional?

"We will be having a team conference to discuss concerns that clients' relatives have raised." (Team conferences are effective communication strategies to discuss the relatives' concerns because this usually involves the multidisciplinary team and the relatives could be involved.)

Which statement by the nurse is the best example of an internal communication strategy the nurse should use to discuss the use of new equipment, client care problems, and change in policies?

"The quality assurance programs focus on processes used to provide care and improving those processes." (n the 1980s, hospitals and other health care agencies implemented ongoing quality assurance programs that provided the foundation for the establishment of continuous quality improvement (CQI) programs in the 1990s.)

Which statement by the nurse shows an understanding of the focus of the quality assurance programs developed in the 1980s?

It cannot be mixed with any other type of insulin.

Which statement is correct regarding glargine insulin?

Making a copy of the incident report for the client (A nurse shouldn't copy an incident report for anyone. An incident report is a confidential and privileged document available to agency personnel for risk-management activities. After completing the report, the nurse should submit it according to facility policy.)

While ambulating, a client who had an open cholecystectomy complains of feeling dizzy and then falls to the floor. After attending to the client, a nurse completes an incident report. Which action by the nurse should the charge nurse correct?

Withdraw the needle, apply a new needle to syringe, and administer the injection in an alternate site.

While injecting a needle into a client for an intramuscular injection, the nurse hits the client's bone. What would be the appropriate initial response of the nurse to this situation?