Management module 3

A nurse on the cardiac catheterization team is required to work an overtime shift each week. Which statement(s) by the nurse best reflects the American Nurses Association (ANA) position on mandatory overtime? Select all that apply.

"I should assess my level of fatigue before working an overtime shift." "I should not be forced to work overtime shifts when I am fatigued." "If my level of fatigue is high, I should not accept an overtime assignment."

A patient in the emergency department waiting area who is impatient to be seen becomes aggressive and threatens the nurse. What is the nurse's best response?

"I understand you are not feeling well. What can I do to make your wait easier?" In this situation, maintain a behavior that helps defuse the anger. Present a calm, caring attitude, and acknowledge the patient's feelings. Do not make threats, give orders, or present with behaviors that may be interpreted as aggressive.

Two nurses are discussing the role of collective bargaining in a future decision about patient care delivery. Which statements indicate the nurse understands collective bargaining? Select all that apply.

"Nurses and managers may experience more conflict than cooperation." "Collective bargaining equalizes power between employee and employer." "We have increased job security when changes are made using collective bargaining." "This process for change may improve our working conditions." Collective bargaining is a formalized decision-making process between employee's and management to negotiate wages and working conditions.

What statement by the nurse is true regarding patient safety and prevention of harm?

"Poorly coordinated care and nosocomial infections are examples of errors." Medical errors may be the result from poorly coordinated care, medication errors, health care-acquired infections, hand-off errors, falls, and diagnostic or surgical errors. Adverse events are errors that cause harm or death. Not all medication errors lead to adverse events. Errors of execution are failures of planned action to be completed as intended. Errors are usually unintentional. According to the Agency for Healthcare Quality and Research (AHRQ, 2017b) as many as 50% of adverse drug events were preventable.

Which statement by the nurse best reflects an understanding of the most current nursing concern for workplace safety identified by the American Nurses Association?

"Stress from overwork and longer shifts is a major safety concern." The greatest concern for nurses in the workplace is stress from being overworked and increasing shift lengths. Policy changes and protective devices have decreased the number of patient assaults on nurses. Devices for assisting with lifting and transferring patients reduced the number of lifting injuries to nurses

A nurse tells a colleague that he gets most of his information on the informal processes of the hospital by watching others. What is this nurse's best response when the colleague asked what he means by informal processes?

"They are ways to get things done faster and easier than the formal processes."

During a mass causality incident involving exposure to radiation, the nurse should assess the victim for GI symptoms such as as nausea, vomiting, loss of appetite, diarrhea, and/or fatigue for approximately how many hours after exposure?

48 During the prodromal phase of acute radiation exposure, presenting signs and symptoms (i.e. anorexia, nausea, vomiting, diarrhea) generally occur during the first 48 hours after exposure.

Which action(s) by the community based nurse are examples of tertiary prevention? Select all that apply.

A cardiac rehabilitation nurse working with a patient who had a heart attack A nurse helping a patient with mobility problems create a safe home environment A mental health nurse counseling a physically abused child in therapy Tertiary Prevention focuses is on improving quality of life and minimizing deterioration. A patient participating in rehabilitation after a stroke is an example of tertiary prevention, cardiac rehabilitation, preventing an injury for a patient who already has mobility problems, and counseling an abused child are also examples of tertiary prevention Glaucoma screening is secondary prevention health maintenance A nurse securing a baby in a car seat when leaving the hospital is primary prevention - health promotion

The code team working on a post nephrectomy patient is most likely utilizing what structured care methodology?

Advanced Cardiac Life Support Algorithm Algorithms are systemic procedures that follow a logical progression based on additional information or patient responses to treatment. Advanced cardiac support algorithms are widely used by code teams in health care facilities.

What situation best describes a culture of safety in health care?

After a medication error, a team works to prevent similar errors in the future Determining why an error was made and how to prevent it in the future promotes a culture of safety. Terminating the nurse and focusing on efficiency does not necessarily promote safety. Reporting safety indicators may be required, but analyzing the information collected and using it to make improvements will better promote safety.

Which organization website would be most appropriate for a nurse using the Internet to access research results concerning evidence based practice for nursing care of elderly patients?

Agency for Healthcare Research and Quality The Agency for Healthcare Quality and Research is the lead federal agency charged with improving the safety, efficiency, and effectiveness of healthcare for all Americans. Their website includes the National Quality Measures Clearinghouse which is a public resource for evidence-based quality measures and measure sets.

The risk manager is teaching a class about decreasing the risk for infectious disease transmission when caring for a patient who has Vancomycin-resistant Enterococci (VRE). Which statement by the staff nurse indicates a need for further education?

Alcohol hand sanitizer does not prevent the spread of VRE

A Graduate Nurse who just started working in a busy ER recently developed hives, rhinitis, and conjunctivitis. What is the most likely cause of the nurse's symptoms?

An allergic reaction to the latex gloves Reactions to latex range from contact dermatitis, with scaling, drying, cracking and blistering skin, to allergic contact dermatitis in the form of generalized hives. Most serious reactions can progress to generalized urticaria, rhinitis, wheezing, swelling, shortness of breath, and anaphylaxis. Latex allergy should be expected if an employee develops symptoms after latex exposure.

Which patient is most likely to seek health care late in the course of his/her disease and deteriorate more quickly than other patients?

An individual who is homeless The homeless are often underinsured or uninsured who have limited or no access to health care. They seek health care late in the course of a disease and deteriorate more quickly. Their health problems are usually related to their living conditions. Street life is difficult and shelters are frequently overcrowded and unventilated. The homeless have high rates of trauma, upper respiratory infections, poor nutrition, lice, scabies, peripheral vascular disorders, sexually transmitted infections, dental problems, arthritis, hypothermia and heatstroke, skin disorders, and foot problems. Common chronic health problems among the homeless include diabetes, hypertension, heart disease, and alcohol or drug abuse.

In which practice setting would the nurse be most susceptible to hazardous chemical exposure?

An oncology outpatient facility The list of hazardous chemicals in the health care setting includes hazardous drugs such as those used in cancer therapy. Health care workers who prepare and/or administer cancer therapy drugs are at most risk for exposure to hazardous chemicals.

A private, proprietary for profit hospital has a decentralized organizational structure. Which organizational characteristic should a nurse considering employment in this organization expect to find?

Any profits realized by the organization will be distributed to owners and managers Private proprietary for profit hospitals are owned by individuals, partnerships, or corporations and have financial gain as their primary purpose. They distribute profits to the owners and managers. The hospital's decentralized structure is characteristic of an organic organizational structure. Work divided according to departmental lines, patient care services heavily influenced by governmental guidelines, and a number of employees supervised by each manager are all characteristics of a bureaucratic (hierarchical) organization.

A RN identifies safety concerns on an inpatient unit and implements changes to improve patient outcomes. What does this scenario best describe?

Applying quality improvement Quality improvement involves identification of errors and safety hazards, as well as designing and implementing interventions to change processes and improve safety. Utilizing informatics involves using information technology to communicate, manage knowledge, mitigate error, and support decision making. Evidence-based practice involves integrating current best practices, research, and clinical expertise into practice. Patient-centered care means the patient's preferences, values, and thoughts are considered. The patient is educated on care provided and decision making is shared.

A RN on orientation is learning the layout of emergency department patient rooms. What organizational culture level does this best describe?

Artifact level The artifact level of organizational culture includes visible characteristics, such as the layout of patient rooms. The espoused beliefs of organizational culture include written goals and the philosophy of the organization. Underlying assumptions of organizational culture are beliefs and feelings of those in the organization. The organizational culture is a set of shared values, beliefs, and assumptions, and includes the artifact level, espoused beliefs, and underlying assumptions.

What is a priority action for a nurse involved in the decontamination process for victims of a terrorist attack with a chemical weapon?

Be sure all rescuers are wearing personal protective equipment Evacuation from the area, removal of the victim's clothing, and decontamination as close to the scene as possible before transport is an essential process that limits chemical exposure. In most cases, washing with soap and water is an effective means of decontamination. Rescuers and staff involved in the decontamination process must wear PPE, and contain and dispose of the soap and water runoff from the decontamination process

The nurse who works on the night shift enters the medication room and finds a co-worker with a tourniquet wrapped around the upper arm. The co-worker is about to insert a needle, attached to a syringe containing a clear liquid, into the antecubital area. Which is the most appropriate action by the nurse?

Call the nursing supervisor Nurse practice acts require reporting impaired nurses. The board of nursing has jurisdiction over the practice of nursing and may develop plans for treatment and supervision of the impaired nurse. This incident needs to be reported to the nursing supervisor, who will then report to the board of nursing and other authorities, such as the police, as required. The nurse may call security if a disturbance occurs, but no information in the question supports this need, and so this is not the appropriate action. Locking the coworker in the room is an inappropriate and unsafe action.

Which of the following organizations partners with other agencies in an effort to conduct research and implement prevention strategies to promote safe and healthy work environments?

Centers for Disease Control and Prevention The Centers for Disease Control and Prevention works with other agencies to conduct research, implement prevention strategies, and promote safe and healthy work environments. The Joint Commission's purpose is to provide accreditation through an extensive on-site review of an organization There is not an 'Institute for Medical Reponse' or 'National Council of Nursing'

A new nurse is unsure about how to irrigate a triple-lumen central line. What action should the nurse take first?

Consult the nursing procedure manual

What is the most allergic common reaction to latex?

Contact dermatitis

With the changing population of health care consumers, it has become important for the acute care nurse to collaborate with public health and home health nurses. What nursing function has increased in importance because of these changes?

Discharge planning Discharge planning is an essential component of facilitating the transition of the patient from the acute care setting to the community or home care setting, or for facilitating the transfer of the patient from one health care setting to another health care setting such as a skilled nursing facility. A documented discharge plan is mandatory for patients who receive Medicare or Medicaid health insurance benefits.

What action by the nursing director can best improve patient care outcomes on the nursing unit?

Encouraging nurses to further their education Increasing education of nurses improves patient outcomes. Patient teaching alone may not improve patient care outcomes because other factors can impact its success. Both successes and failures in teaching should be evaluated. The entire team should be involved in decision making.

A new graduate has a minor hearing impediment. When applying for a job, this new graduate should be aware that which area of employment legislation may help protect from discrimination during the interview process?

Equal opportunity laws Equal opportunity laws such as the American with DIsabilities Act protect against discrimination in the workplace

Which statement by the nurse indicates shared governance is a valued part of a health care organization?

I serve on the committee created to redesign our nursing philosophy Health care facilities that value shared governance include staff/employees in decision making processes. The nurse who is serving on the committee created to redesign the nursing philosophy is an example of shared governance. Being paid extra or getting an extra vacation day does not relate to shared governance. The nurse manager submitting a plan to change a wound care policy did not indicate nursing staff were involved in the decision making process

A graduate nurse employed by a large healthcare organization is most likely to assume which role in nursing research?

Identify nursing problems for clinical research

Shift work disorder results in a greater risk for accidents, ulcers, heart disease, and chronic fatigue. What action by the night shift worker can prevent or lessen the risk of shift work disorders?

If driving home during the morning sunlight, wear sunglasses Wear sunglasses if driving home during the bright morning sunlight. Schedule the same shifts rather than rotating between days and nights in order to avoid disturbing the circadian rhythm. Scheduling consistent days off establishes a routine. Schedule a continuous block of sleep time regularly.

What measures are required of healthcare employers to protect staff from workplace injury? Select all that apply.

Immediate treatment if exposed to blood borne pathogens Safety and efficacy evaluation of all sharps Protective equipment including gowns, gloves, and goggles Healthcare worker employers must provide:Free Hepatitis B vaccineProtective equipment that fits correctly (gloves, gowns, goggles, masks)Immediate, confidential medical evaluation, treatment and follow-up if exposedImplementation of universal precautions institution-wideAdequate evaluation of sharps and sharps disposalProper removal of hazards from the workplaceAnnual employee training There is not a requirement for an appointed physician or an experienced preceptor.

A RN has joined the practice council at the hospital network. The RN is able to have some say regarding nursing practice in the network and feels as if administration is listening to the RN's recommendations. Which components of empowerment does this scenario best describe?

Impact and decision making Impact occurs when an RN feels he or she can make a difference because others listen to his or her ideas. Decision making is control regarding nursing practice within an organization. Joining a practice council empowers the RN through impact and decision making. Decision making is control regarding nursing practice within an organization, but meaning occurs when an RN cares about his or her work, takes it seriously, and enjoys it. Self-determination occurs when an RN feels free to decide how to do his or her work and autonomy means the RN is able to act on his or her own knowledge and experience. Impact occurs when an RN feels he or she can make a difference because others listen to his or her ideas. However, autonomy means the RN is able to act on his or her own knowledge and experience.

The risk manager is investigating a recent med error involving morphine and meperidine. Which statement best describes the primary purpose of the investigation?

Improve patient safety The primary purpose of risk management is to improve patient safety by investigating the incident and recommending changes so that the incident does not happen again

A new RN asked an experienced RN how he/she always gets a timely response from the laboratory department. What process is the experienced RN most likely to describe to the new RN?

Informal process Informal processes are not written processes and may not even be discussed, but are often much simpler and easier to navigate than the formal processes. Formal processes include written policies and procedures. Authority is a source of power where that power is granted to an individual according to the position the individual holds. Reward is a source of power that is the promise of goods, services, recognition, or resources.

A home care nurse enters the home of a patient and finds that the patient's son is noticeably intoxicated. The son, who is slurring his words, is becoming increasingly agitated. What action by the home care nurse would be most appropriate?

Leave the home and reschedule the visit If a patient or family member is intoxicated, hostile, or obnoxious, the home care nurse should reschedule the visit and leave the home. It would be inappropriate to tell the son to leave or threaten to call the police because the son may become more agitated. Ignoring the son's behavior would be inappropriate because the home care nurse is still in danger.

What is this organizational statement an example of? "The purpose of Memorial Hospital is to provide high quality, cost effective patient care."

Mission An organizational mission statement describes the purpose of the organization and how it serves its customers

What organization should a nurse leader monitor to best learn of new and emerging health hazards?

National Institute of Occupational Safety and Health (NIOSH) Initial warnings of new and emerging health hazards usually come from the NIOSH, CDC, or federal, state, and local agencies, who are charged with monitoring potential threats. The Institute of Medicine primarily researches topics of health concern. The ANA primarily advocates for and shares information regarding workplace safety for nurses. OSHA develops and enforces workplace safety policies.

A RN receives a patient with the diagnosis thrombotic stroke from the emergency department (ED). The pharmacy alerts the RN that a dose of tPA must be administered within the next 15 minutes and sends the medication to the RN. Because tPA is usually administered in the ED before transfer, the RN calls the ED nurse and learns that the ED nurse forgot to document administering the tPA. The RN does not give the tPA from the pharmacy. What does this situation best describe?

Near miss An example of a near miss is catching a medication error before the medication is administered. A medication error would have occurred had the RN given the medication, duplicating the dose. An adverse event occurs when there is injury to the patient. Risk management is a process involving identification, analysis, treatment, and evaluation of both real and potential hazards.

A patient suffered a hemolytic transfusion reaction after being given packed red blood cells with an incompatible blood type. The patient recovered. Which type of safety event does this scenario best describe?

Never event A hemolytic transfusion reaction resulting from being given incompatible blood components is a shocking event that should never occur, regardless of the patient outcome. A serious incident occurs when a patient or employee suffers injury without the threat of death. A hemolytic transfusion reaction after being transfused with incompatible blood is a serious event with threat of death. It should never occur. A hemolytic transfusion reaction is not a minor injury. A sentinel event is an unexpected occurrence that results in death or serious permanent injury. A hemolytic transfusion reaction caused by incompatible blood is a shocking event that should never occur.

A clinic for individuals who are uninsured is run by volunteer doctors and nurses. This clinic is most likely what type of healthcare organization?

Not for profit Since volunteers are not paid employees, the clinic is most likely a not for profit healthcare organization.

A charge nurse who is removing hydroxyzine from the computerized medication dispenser notices hydroxyzine and hydralazine are located in bins next to each other. What is the nurse's best response to this situation?

Notify the pharmacist of the location of the two medications

A nurse who was distracted after giving an IM shot was stuck by the needle. What is the nurse's most important action?

Obtain post-exposure prophylaxis within two hours

A nurse who was distracted after giving an IM shot was stuck by the needle. What is the nurse's most important action?

Obtain post-exposure prophylaxis within two hours The nurse's most important action is to obtain post-exposure prophylaxis within two hours.

Which of the following organizations is primarily responsible for developing and enforcing workplace safety policies?

Occupational Safety and Health Administration (OSHA) OSHA, part of the U.S. Department of Labor, develops and enforces workplace safety policies and health regulations. The NSC holds employers and employees responsible for safety in the workplace. NIOSH, part of the U.S. Department of Health and Human Services, supports research, education, and training to promote workplace safety. One part of the U.S. Department of Health and Human Services is the National Institute of Occupational Safety and Health, which is charged with supporting research, education, and training for workplace safety.

What action by the nurse best exemplifies a characteristic of efficient quality in health care?

Opening only the supplies that are necessary Efficiency in health care includes avoiding waste Avoiding injury to patients because of the care provided to them is the characteristic of safety in quality health care. Equitable care is provided by ensuring all patients receive the same care, regardless of patient characteristics. Reduction of wait times is addressing the characteristic of timeliness in quality health care.

What type of organization employs supervisors whose primary main focus is on planning and providing resources?

Organic Organic organizations shift decision making to the individuals who implement the decisions, rather than the supervisors. This leaves the supervisors free to focus on planning and providing resources. Bureaucracy is one form of traditional organization in which decisions are made in the upper levels of the hierarchy. Traditional networks are focused on the hierarchy of organizational structure. Supportive may describe the environment, but it is not a type of healthcare network

A nurse manager requires staff members to complete a new form recording individual patient care activities performed during their shift. Although staff members agree to complete the form, the nurse manager finds many of the forms blank or incomplete. The staff members are demonstrating what type of resistance to change?

Passive resistance

The community health nurse is preparing to conduct a home visit. When performing the home visit, how should the nurse best implement the principles of infection control?

Perform hand hygiene before and after giving direct patient care Infection control is as important in the home as it is in the hospital, but it can be more challenging in the home and requires creative approaches. As in any situation, it is important to clean one's hands before and after giving direct client care, even in a home that does not have running water. Removing the wound dressings from the home and disinfecting all work areas in the home are not the best implementations of infection control in the home. Used syringes are never disinfected and a sterile field is not always necessary.

The triage nurse on scene after a pipe bomb explodes finds a victim with severe dyspnea in close proximity to the initial blast. The nurse suspects the patient has a pulmonary embolism. What is the nurse's best response?

Place the victim in a prone left lateral position Blast lung, caused by the blast wave passing through air-filled lungs, results in hemorrhage and tearing of the lung, hemothorax, pneumothorax, ventilation-perfusion mismatch, and possible air emboli (PE). Symptoms include dyspnea, hypoxia, tachypnea, and apnea. Treatment is based on respiratory support: non-rebreathing mask or endotracheal intubation and mechanical ventilation; chest tube; and placing the patient in a prone left lateral position for a suspected PE.

A GN is interviewing for a position in a healthcare organization where supervisors serve as a resource for staff. What conclusion can the GN make about the decision making power of this organization?

Power is decentralized throughout groups of autonomous teams The description of organization where the GN is interviewing fits the description of an organic organization. The structure of organic organizations is more dynamic, more flexible, and less centralized than traditional hierarchical organizations. Organic organizations have decentralized decision making and give autonomy to working teams who manage themselves. Supervisors are planners and resource people who are responsible for providing the conditions required for optimal functioning of their teams.

What is the OSHA requirement for handling of hazardous chemicals?

Provide Material Data Safety Sheets Employers are required to clearly label and provide Material Data Safety Sheets for all hazardous chemicals. Air filtration systems will reduce inside air pollution, but are not an OSHA requirement for handling hazardous chemicals. Minimizing the use of toxic disinfectants will reduce inside air pollution, but is not an OSHA requirement for handling hazardous chemicals. Avoiding the use of mercury whenever possible will reduce inside air pollution, but is not an OSHA requirement for handling hazardous chemicals.

A surgical unit is being moved to a new area in the hospital that has been remodeled and upgraded with all new equipment. Which actions by management will help facilitate change when the new unit opens? Select all that apply.

Provide in-services on the new equipment before the unit opens Hold a staff meeting to explain how and when the move will be made Involve staff members in the selection of work station chairs on the unit

The leadership team at an acute care hospital announces a temporary change in nursing assignments designed to help decrease staffing shortages in the ICUs. Which action by the leadership team will help increase the psychological safety of nursing staff?

Provide opportunities for individuals to ask questions Providing an opportunity for individuals to ask questions and express themselves will increase psychological safety. Providing psychological safety can reduce resistance to change Providing information is a good recommendation and will lower resistance, but does not directly impact psychological safety. Allowing individuals to change when they're ready does not help with current staffing issues

What is the nurse manager's first action when developing a safety program for the nursing unit?

Recognize potential safety hazards First - recognize potential safety hazards. Second - assess the amount of risk involved. Third - calculate the costs of the plan Fourth - Provide necessary safety supplies and equipment

A new graduate is not sure what his job responsibilities are at the organization where he was hired as a staff nurse. This new graduate should take which first action?

Review his position description Nursing position descriptions are written statements that list the duties and responsibilities of the position, qualifications of the position, and the chain-of-command for supervision and guidance in organizational management matters and clinical decisions. It is best for nurses to review their own position description and not rely on another's interpretation.

What action(s) should the nurse take to promote personal safety while making home care visits? Select all that apply

Schedule visits during the daylight hours Make sure the agency knows visit schedule Keep car in good working order with a full tank of gas Preprogram cell phones with emergency numbers Park near the patient's home and lock car doors When visit is in high crime area, do not go alone Home health nurses must pay attention to personal safety making home visits. They often practice in unknown environments that may become dangerous. These at-risk working environments require precautions. Suggested precautions include:

A community health nurse has scheduled a hypertension clinic in a local mall in which shoppers will have the opportunity to have their blood pressure measured. This activity is an example of what type of prevention?

Secondary Secondary Prevention- The focus is on health maintenance and early detection with prompt intervention to prevent or minimize the patient's loss of independence. Examples include health screening such as an annual mammogram, yearly cholesterol levels, and blood pressure screenings.

A nurse is completing the morning assessment on a new patient. As the nurse approaches the IV pole, the nurse's foot gets stuck to the floor and the nurse falls to the ground, injuring his knee. It was discovered that an IV bag containing dextrose had leaked onto the floor and was not properly cleaned up. The nurse suffered a sprain and returned to work 1 week later. What does this situation following does this best describe?

Serious incident A serious incident occurs when a patient or employee suffers injury without the threat of death. A service occurrence is an error that does not result in harm or a significant interruption in clinical services. A minor injury occurs when medical intervention for a patient or employee is needed outside of the admission reason. Minor physical or psychological harm occurred. A sentinel event results in death or serious permanent injury.

There is an increased number of catheter-associated urinary tract infections (CAUTI) on the medical unit. To help decrease CAUTI numbers, the unit is adopting a new policy on indwelling catheter care. Which action by the director will promote change to the new policy?

Share a patient's story of how a catheter-associated urinary tract impacted him personally Sharing a patient story or visual presentation impacts feelings will promote change better than presenting statistics or reports, or discussing hospital costs

What is the priority assessment for a victim who was exposed to sulfur mustard?

Skin lesions Sulfur mustard is a vesicant (blistering) agent.Its initial presentation is superficial to partial-thickness burns in warm moist areas of body. Stinging and erythema occur the first 24 hours followed by pruritus, painful burning, and small vesicle formation 2-18 hours after exposure. Vesicles can coalesce into large fluid filled bullae.

A new nurse asked the charge why upper management has all of the power. What statements by the charge nurse best describe power in a bureaucratic healthcare organization?

Sources of power exist at all levels of the hierarchy Power is not only related to authority, it is also related to the available sources of power. Sources of power exist at all levels of the hierarchy and all stakeholders have sources of power, no matter where they fall in the hierarchy. Power is the ability to influence others despite resistance. This does not necessarily increase with hierarchy.

Nurses face threats to safety in their daily work experiences. According to an American Nurses Association (ANA) study in 2011, which of the following is currently the greatest threat to safety of nurses in the workplace?

Stress Stress from being overworked and increased shift lengths is a major safety concern. Sharps injuries have declined because of the use of protective devices. Policy changes and protective devices have decreased the number of patient assaults on nurses. Devices for assisting with lifting and transferring patients reduced the number of ergonomic injuries to nurses.

Your role as a member of a continuous quality improvement (CQI) interdisciplinary team is collecting data on the availability of supplies on the nursing unit. Your team is evaluating which of the three aspects of care?

Structure

What action best demonstrates a nurse's contribution towards achieving an organization's goal to decrease hospital readmission rates?

Teaching a post stroke patient to perform self-care A patient who can take care of himself/herself at home more likely to follow treatment recommendations and less likely to suffer complications. This will decrease the potential for patient readmission, which will help decrease the hospital's readmission rates.

Which action by the nurse demonstrates primary prevention in the community health setting?

Teaching college students about the importance of regular exercise Primary prevention—preventive measures that prevent the onset of illness/injury before disease process begins. Secondary prevention—preventive measures that lead to early diagnosis and prompt treatment of a disease, illness or injury Tertiary prevention—preventive measures aimed at rehabilitation following significant illness. retrain, re-educate, or rehabilitate individuals who already have an impairment/disability. Teaching college students about the importance of regular exercise - primary prevention Screening people at the mall for high blood pressure - secondary prevention Working to rehab an elderly patient who suffered a stroke - tertiary prevention Checking patients at the free health clinic for elevated cholesterol - secondary prevention

The community health nurse is working with disaster relief personnel after a hurricane that ruined many homes in the local community. The nurse is working to find housing for the survivors and is organizing counseling services. Which prevention level do the nurse's actions represent?

Tertiary Tertiary prevention involves reduction of the amount and degree of disability, injury, or damage after a crisis. Primary prevention means keeping the crisis from occurring, and secondary prevention focuses on reducing the intensity and duration of the crisis during the crisis itself. There is no known quaternary care prevention level.

A patient will need to walk with a two wheeled walker for six weeks after having a total knee replacement. What is most important for the home care nurse to asses during the initial home visit?

The characteristics of the home environment Besides caring for the patient during the home visit, the nurse should also assess the patient's home environment and complete a home safety assessment.The patient's safety at home is a priority.

What is the primary reason for the recent growth in home health nursing care?

The discharge of patients who are more critically ill

What statement is true regarding an incident report?

The incident report is kept with internal hospital correspondence In the event a paper incident report is completed, a single copy should be kept with hospital correspondence. The incident report does not become a part of the patient's medical record. The incident report may be subpoenaed by the plaintiff's attorney. The incident report should not contain subjective information, such as the nurse's impressions. The incident report should be objective, complete, and accurate.

A home care nurse is planning to visit a new diabetic patient of Japanese heritage. Upon arriving at the home, the nurse notes that there are shoes on a mat next to the door. Which action by the nurse demonstrates cultural competence during the home visit?

The nurse removes her shoes, places them on the mat, and completes the home health visit The nurse demonstrates cultural competence by removing her shoes before entering the home to complete the home health visit.

What action by a nurse best indicates the nurse's workplace values a culture of safety?

The nurse reports he/she made a medication error A culture of safety is a blame free environment in which the reporting of errors is promoted. When a culture of safety exists, individuals do not fear reprisal and are not blamed for identifying or reporting errors. Reported errors provide data and information necessary to understand how and why the error occurred. This information is used to improve care and prevent harm.

An acute care hospital loses its Joint Commission (JC) accreditation. What consequence will pose the greatest threat to the organization's survival?

The organization may not receive Medicare reimbursement money Joint Commission accreditation is based on standards for quality of care. Reimbursement program eligibility may be tied to JC accreditation. This means that without accreditation, a health care organization may not receive reimbursement for patient services from Medicare/Medicaid.

Which statement by the nurse reflects the appropriate care of a victim who has inhaled anthrax?

The victim should receive antibiotics as soon as possible after exposure Treat with antibiotics should begin as soon as possible after exposure. Inhalation, cutaneous and gastrointestinal anthrax are not transmitted directly from human-to-human. All staff should observe Standard Precautions when caring for patients with suspected or confirmed anthrax. The bacteria's presence and victims's diagnosis is confirmed with blood cultures. Anthrax is a categroy A agent and has a high mortality rate.

The nurse completes an incident report for which primary purpose?

To promote a culture of safety in the organization.

What statement is true regarding ergonomic injuries?

Unexpected patient movements during transfers can cause back injuries to nurses. Unexpected movements or resistance from patients during transfers can throw a nurse off balance and result in a back injury. When equipment is not easily accessible, too heavy or clumsy, or staff is not properly trained, it may not be used. Health-care facilities are required to keep workplaces free from ergonomic hazards, rather than simply trying not to do so. Nurses may be at risk for repetitive stress injuries.

What action by the nurse best exemplifies a characteristic of effective quality improvement in health care?

Using current evidence to improve practice Utilizing evidence-based practice fits with the characteristic of effectiveness in providing quality health care. Frequent assessments of patients with soft wrist restraints best describes safety as a characteristic of quality in health care. Including the patient in care planning best describes patient-focused as a characteristic of quality in health care. Timely response to patient needs describes the characteristic of timeliness in quality health care.

The nurse is teaching a group of volunteers about the mode of transmission for different bioterrorism agents. Which statement by a volunteer indicates a need for additional teaching?

We need to place patients who have botulism in standard and contact precautions Smallpox - standard, contact, and airborne precautions Anthrax - standard precautions (if no draining wounds) Botulism - only standard precautions Individuals who are decontaminating individuals with anthrax powder on them include should wear a respirator (N95 mask or Powered Air Purifying Respirators), and protectaive clothing.

The pneumonia rates for patients receiving ventilator therapy at Hospital X are above the usual thresholds during the most recent month. Which question would be most important for the CQI team investigating the increase in pneumonia rates to ask first to gain a better understanding of the problem?

Were any of these patients admitted with pneumonia?

Triage these mass casualty incident victims using the START triage method 1.Broken wrist, walking around scene 2.Unresponsive, grey matter showing 3.Responsive, pale, moist skin, respirations 32/minute. 4.Deformed tibia and fibula. Oriented, respirations 20, pulse about 100 5.Unresponsive, slow, snoring respirations. Breathing improves when airway opened

1. GREEN 2. BLACK 3. RED 4. YELLOW 5.RED Red - Immediate: Injuries life threatening, but survivable with minimal intervention. Individuals can progress rapidly to Expectant if treatment is delayed. Yellow - Delayed: Injuries significant, require medical care but can wait hours without threat to life/limb. Individuals receive treatment after Immediate casualties Green - Minimal: injuries minor, treatment can be delayed hours/days. Individuals should be moved away from the main triage area. "walking wounded" Black - Expectant: injuries extensive, chances of survival minimal. Individuals should be moved away from other casualties. Provide comfort measures

A nurse manager is developing a safety program for the unit. Place the steps of safety plan development in the correct order.

1. Recognize potential safety hazards 2. Assess the amount of risk involved 3. Calculate the costs of the plan 4. Provide the necessary safety supplies and equipment