Ch 1 Med-Surg EAQs
What level of evidence is a narrative literature review considered?
A narrative literature review is representative of level V evidence. Levels I and III require stronger evidence. Level VI evidence is weaker than that found in a narrative literature review.
Who are the members of a rapid response team (RRT)? Select all that apply.
A rapid response team (RRT) saves lives and decreases the risk of harm by providing care to patients before a respiratory or cardiac arrest occurs. A respiratory therapist gives chest physiotherapy in case of respiratory arrest and is part of an RRT. An ICU nurse is trained at handling critically ill patients and is part of an RRT. The nursing supervisor is not a part of an RRT. The critical care physician (or Intensivist) specializes in critical care and is part of the RRT. An occupational therapist works closely with the patient when he or she is receiving rehabilitation services. An occupational therapist is not included on an RRT. p8
Which conditions are among the most common risk factors for acid-base imbalance that indicate the nurse should closely monitor the patient's arterial blood pH? Select all that apply.
Any individual is at risk for an acid-base imbalance, but it occurs most commonly as a complication of many acute and chronic health problems. The most common risk factors include diarrhea; poisoning, such as excessive salicylate ingestion; chronic kidney disease; other medical conditions such as chronic obstructive pulmonary disease (COPD) and uncontrolled diabetes mellitus (especially type 1); excessive emesis or intravenous (IV) infusions; and fluid and electrolyte imbalances. Cirrhosis and constipation are not among the most common risk factors. p14
After surgery, a patient states, "I'm capable of taking care of myself at home. I don't need a nurse for my care." The nurse comes to the home anyway. Which ethical principle has the nurse violated?
Autonomy, also known as self-determination or self-management, is the ethical principle that requires the nurse to respect the patient's decisions regarding his or her own care. Fidelity refers to keeping the promises made to a patient to follow through with care. Veracity is being truthful with patients. Beneficence is the promotion of positive actions to help others. p9
What process is also referred to as the evidence-based practice improvement (EBPI) process?
Continuous quality improvement (CQI) is also sometimes called the evidence-based practice improvement (EBPI) process. Evidence testing process and quality recognition process are not other names for EBPI. The Plan-Do-Study-Act model is one of several quality improvement models. p7
Aside from evidence, which factors are considered in evidence-based practice? Select all that apply.
Evidence-based practice takes into consideration, the patient's values, current practices, the patient's preferences, and the practitioner's clinical expertise. Cost of treatment is not directly considered in evidence-based practice. p6
Which health care organizations are obligated to follow the evidence-based interprofessional Core Measures? Select all that apply.
Health care organizations that receive Medicare and/or Medicaid funding are obligated to follow the evidence-based interprofessional Core Measures. Organizations that have surgical centers, offer long-term care, or have nursing research departments are only obligated to follow the Core Measures if they receive Medicare and/or Medicaid funding. p7
What is a way that nurses can respect the diverse needs of patients?
Integrative care in which complementary medicine is incorporated is one of the ways nurses can respect the diverse needs of patients. Standardizing patient care, explaining physicians' decisions, and performing safety checks address aspects of patient care other than diversity. P3
Which method was implemented based on evidence that it decreases medication discrepancies that can cause negative patient outcomes?
Medication reconciliation is an evaluative process that addresses duplications, omissions, and interactions. This process has been demonstrated to decrease medication discrepancies that can cause negative patient outcomes. Medication recall, screening, and discharge are not methods of decreasing medication discrepancies. p3
The nurse instructor is teaching nursing students about the knowledge, skills, and attitudes (KSAs) needed to develop core competencies based on the Institute of Medicine (IOM) and Quality and Safety Education for Nurses (QSEN) initiative. What KSAs are needed to develop the Quality Improvement competency? Select all that apply.
Participating in root cause analyses of issues and implementing activities to improve care processes are KSAs needed to develop the QSEN Quality Improvement core competence. To meet the Quality Improvement competency, nurses are expected to "use data to monitor the outcomes of care processes and use improvement methods to design and test changes to continuously improve the quality and safety of health care systems." Patient education and empowerment is a KSA needed for Patient-Centered Care competency and preparing an interdisciplinary plan of care is needed for Teamwork and Collaboration competence. Using tools to reduce reliance on memory is a Safety core competence.
Which systems have been shown to improve safety through technology? Select all that apply.
RFID, or radiofrequency identification, and BCMA, or barcode medication administration, are examples of systems that have been shown to improve safety through technology. PDSO is the acronym for the Plan-Do-Study-Act quality improvement model. SBAR is a process of communication that does not necessarily involve technology. DMAIC is the acronym for a quality improvement process.
What competency did the QSEN Institute add to the Institute of Medicine's (IOM) competencies?
Several years after the IOM established five core competencies for health care professionals, the QSEN Institute added safety as a sixth competency. Informatics, patient-centered care, and evidence-based practice were existing IOM competencies.
One of the most successful initiatives of the Institute for Healthcare Improvement (IHI) was the creation of the Rapid Response Team (RRT). Which statement about the RRT is correct?
The RRT is also called the medical emergency team (MET), as they respond to medical emergencies. The RRT provides care to patients before a cardiac arrest. Membership of the RRT may vary among different facilities. The team responds to emergency calls not only from nurses, but also from the patient's family. p8
What is indicated by a hospital receiving the American Nurses Credentialing Center's (ANCC) Magnet Recognition?
The ANCC's Magnet Recognition requires nurses to demonstrate how best current evidence guides their practice. This recognition is not related to nurses having advanced degrees, patient satisfaction, or the existence of a nursing research department in the hospital. p7
Which are Institute of Medicine (IOM) competencies for health care professionals? Select all that apply.
The IOM identified five core competencies in the 2003 report Health Professions Education: A Bridge to Quality. These competencies include using informatics in patient care, implementing evidence-based practice, and collaborating with the interdisciplinary health care team. Professionalism is not one of the competencies, and patient-centered care is individualized rather than generalized consistently among patients. p2
Which of the following statements is accurate regarding RN delegation of nursing tasks?
The RN can delegate turning and positioning tasks to the LVN. The nurse can delegate certain nursing tasks, such as turning and positioning, assisting with a urinal, changing of bed linen, etc., to UAP such as patient care technicians (PCT) or patient care assistants (PCA). The nurse can also delegate a nursing task such as the measuring of vital signs to another RN or an LPN.
The Quality and Safety Education for Nurses (QSEN) initiative team has created specific knowledge, skills, and attitudes (KSAs) needed to develop each core competency. What do the KSAs for Informatics competence emphasize? Select all that apply.
The emphases of the KSAs for Informatics include documentation, electronic data access, and data utilization. Informatics involves using information and technology to communicate, manage knowledge, mitigate error, and support decision-making. Communication is part of the KSAs emphasized in the Teamwork and Collaboration competency. Participation in root cause analysis is a part of the KSAs emphasized for the Quality Improvement competency. Using checklists is included in the KSAs emphasized for the Safety competency. p7-8
A nurse is implementing the FOCUS-PDCA model for quality improvement. Which step will be conducted first?
The first step in the FOCUS-PDCA model is to find a process to improve, so the nurse will first identify which process needs improvement. Planning improvements, clarifying how the process is currently conducted, and organizing a team are later steps in the model. p7
I-SBAR-R is a modification of the SBAR method of communication. What additional step has been included in the I-SBAR-R method compared to the SBAR method?
The last "R" in the modified I-SBAR-R method of communication refers to the response of the receiver based on the information provided. The "I" at the beginning reminds the individual to identify him or herself and does not refer to Investigation. Background and Assessment are steps already introduced in the earlier SBAR method of communication.
Who are members of the Medical Emergency Team (MET)? Select all that apply.
The membership of the MET or the Rapid Response Team (RRT) varies among facilities, but may include an intensivist, medical resident, and RT. The intensivist is a physician who specializes in critical care. The RT cares for patients who have trouble breathing. A medical resident is a person with a medical degree who practices in a healthcare facility. The PCT is unlicensed assistive personnel (UAP) who may sometimes be delegated nursing tasks by the RN. The LPN provides basic medical care and may work under the supervision of an RN. The PCT and LPN are not members of the MET. P8
Nurses have six core competencies based on the Quality and Safety Education for Nurses (QSEN) initiative. What specific knowledge, skill, and attitude (KSA) does the nurse need to develop for the Quality Improvement competency?
The nurse accesses and evaluates data to monitor the effectiveness of the health care provided as part of the QSEN competency for Quality Improvement. The nurse respects the patient's preferences for active engagement in care processes as part of the Patient-Centered Care competency. Following the documentation and reporting protocols established for the health care agency is a communication skill developed for the Teamwork and Collaboration competency. The use of checklists to reduce reliance on memory when administering medications to the patient is part of the Safety competency. pp.7
A hospital conducts a study on how a new method of guided meditation affects pain scores in comparison with the use of pain-relieving medication. What level of evidence does this represent?
This study is an example of level II evidence because it is a single experimental study. Levels III, IV, and V include weaker evidence. p6