HESI EAQ: Issues in Nursing
A registered nurse is explaining the term "just culture" to the student nurse. Which explanation provided by the registered nurse is accurate?
1 "It refers to the agreement to keep promises." 2 "It refers to taking positive actions to help others." 3 "It refers to the ability to answer for one's actions." Correct4 "It refers to promoting open discussion whenever error occurs without fear of recrimination." R: The term "just culture" refers to the promotion of open discussion whenever errors occur without fear of recrimination. Fidelity refers to the agreement to keep promises. Beneficence refers to taking positive actions to help others. Accountability refers to the ability to answer for one's actions.
The nurse informatician is designing a protocol in the electronic health record for all clients with indwelling urinary catheters to decrease the risk of urinary tract infections. When developing the protocol, the nurse should follow the steps that are listed in what order?
While designing a protocol, the nurse would first meet with the nursing staff to determine the evidence supporting urinary tract infections in clients with an indwelling urinary catheter. Based on the results, the nurse would select an assessment tool and other data to manage the risk of urinary tract infections. Then the nurse would determine the levels of risk and interview nursing staff to determine the workflow. With this information, the nurse would design the assessment screens, evaluate the results, and determine evidence. The nurse would select the appropriate language to retrieve the data entered the in electronic health record. The nurse would also add a decision support rule to determine the level of risk.
A nurse instructs a client who avoids bathing to take a bath or shower each day as a means of maintaining hygiene and preventing infection. Which of these reactions should the nurse expect if the client is in the action stage? Select all that apply.
1 "I only take a bath once a week, but I don't see any infections on my skin." Correct2 "I try to take a shower every day, but I skip it sometimes because of my tight work schedule." Correct3 "I understand that bathing regularly is a good habit, but my bathroom is very cold in the mornings." 4 "Please tell me how to get into the habit of taking a bath daily so I can keep myself clean and healthy." Correct5 "I want to take a bath regularly, but I don't have time because I need to look after my kids and my parents." R: In the action stage, the client notices that old habits are hindering him or her from engaging in new behaviors. In this scenario, the client says that he or she tries to take a daily shower but skips it sometimes because of a tight work schedule. In the second scenario, the client says that he or she understands the importance of taking baths but the bathroom is very cold. In another scenario, the client says that he or she wants to take baths but has to look after the family and doesn't have time. All these scenarios indicate that the client is in the action stage. Saying that he or she only takes one bath a week but doesn't see any skin infections indicates that the client is in the precontemplation stage. Saying that he or she wants to know how to get into the habit of taking regular baths indicates that the client is in the preparation stage.
A nurse administers medication via the central venous access device (CVAD) and forgets to monitor the client at the required intervals. The client then develops phlebitis. What charges may the nurse face for this action?
1 Battery Correct2 Malpractice 3 False Imprisonment 4 Defamation of Character R: The nurse may face malpractice charges due to the failure to monitor the client in a timely manner after administering medications through a central venous access device (CVAD). Battery is any intentional touching without the client's consent. False Imprisonment is an intentional tort that occurs when a client is placed under restraints without legal documentation. Defamation of character is the publication of false statements that result in damage to a person's reputation.
A nurse is recalling common terms that are used in health ethics. What does beneficence in health ethics refer to?
1 Beneficence refers to the agreement to keep promises. Correct2 Beneficence refers to taking positive actions to help others. 3 Beneficence refers to the ability to answer for one's actions. 4 Beneficence refers to avoiding harming or hurting an individual. R: Beneficence refers to taking positive actions to help others. Fidelity refers to the agreement to keep promises. Accountability refers to the ability to answer for one's actions. NON-maleficence refers to avoiding harming an individual.
The nurse is caring for a client with breast cancer who is receiving chemotherapy. Which action performed by the nurse is in accordance with the rules of the Centers for Medicare & Medicaid Services (CMS)?
1 Checks the prescription before administering medications to the client 2 Refers the client to support systems and provides financial assistance 3 Teaches safety measures to the client in order to prevent the risk of infection Correct4 Enters symptoms and treatment provided to the client in the electronic health record (EHR) R: The Centers for Medicare & Medicaid Services (CMS) specify how health care professionals should use electronic health records (EHRs) to receive Medicare and Medicaid payment incentives. The nurse should enter symptoms, treatments, and outcomes in the EHR because doing so helps to claim insurance. The CMS does not provide guidelines to prevent medication errors. The Joint Commission's National Client Safety Rules provides guidelines to prevent medication errors. Therefore checking the prescription before administering the medication is not in accordance with the rules of CMS. The CMS does not direct the nurse to refer the client to support systems or to provide financial assistance. The hospital's social worker provides information about support systems and financial assistance. The CMS does not provide guidelines to prevent infection in clients. The Centers for Disease Control (CDC) provides guidelines to prevent client infections. Therefore teaching safety measures to the client in order to prevent infection is not in accordance with the CMS.
A child admitted to the hospital is in need of a life-saving heart transplant surgery. However, the parents refuse to allow the surgery stating that such surgeries are against their belief system. The nurse in charge of the client recognizes the situation as an ethical dilemma. What first step should the nurse take in order to resolve the dilemma?
1 Evaluate the outcome of the plan of action over time. 2 Verbalize the problem and agree to a statement as a group. 3 Examine his or her own values critically to formulate an opinion about the issue. Correct4 Obtain information from the child, the parents, health care workers, and other sources. R: After determining that an ethical dilemma exists in a situation, the nurse should focus on gathering information from multiple sources. The perspectives obtained from the child, the parents, health care workers, and other sources are helpful because it is essential to incorporate as much knowledge as possible. Evaluating the outcome of the plan of action over time is the last step of resolving an ethical dilemma. After gathering all relevant information regarding the issue and clarifying values, it is essential to verbalize the problem. A group agrees on a simple problem statement in order to hold a discussion on an issue. After gathering relevant information regarding the ethical dilemma, the nurse should examine his or her own values critically in order formulate an opinion regarding the matter.
A registered nurse is educating a nursing student about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Which points mentioned by the nursing student post-teaching are correct? Select all that apply.
1 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores are not affected by nursing environments. Correct2 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure client perceptions of their hospital experience. Correct3 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey is administered to a randomly selected sample of adults who were discharged from a hospital between 48 hours and 6 weeks ago. 4 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) was developed by the National Committee for Quality Assurance (NCQA) as a way for hospitals to collect and report data publicly for comparison purposes. Correct5 Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys have 27 questions that ask clients to rate their communication with nurses and physicians, discuss other details about treatment, and share their willingness to recommend the hospital. R: The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) is a standardized survey developed to measure client perceptions of their hospital experience. The survey is administered to a randomly selected sample of adults who were discharged from a hospital between 48 hours and 6 weeks ago. The survey has 27 questions that ask clients to rate their communication with nurses and physicians, discuss other details about treatment, and share their willingness to recommend the hospital. HCAHPS scores are affected by nursing environments. HCAHPS was developed by the Centers for Medicare and Medicaid Services (CMS) and the Agency for Healthcare Research and Quality to enable hospitals to collect and report data publicly for comparison purposes. The National Committee for Quality Assurance (NCQA) created Healthcare Effectiveness Data and Information Set (HEDIS) to collect various data to measure the quality of care and services provided by different health plans.
A nursing student is giving examples of healthcare settings and services. Which scenario is a perfect example of tertiary care?
1 Preparing a client for an X-ray who has sustained a leg fracture in an accident 2 Teaching community members about the importance of using seat belts in cars Correct3 Caring for a postoperative client in the intensive care unit who is suffering from respiratory distress 4 Advising a client with stage 1 Parkinson's disease to include exercise in his or her daily routine R: Tertiary care consists of intensive care and subacute care. Caring for a postoperative client in an intensive care unit who is suffering from respiratory distress is a perfect example of tertiary care. Preparing a client with a leg fracture for an X-ray is an example of secondary acute care. Teaching community members about the importance of using seat belts in cars is an example of secondary acute care. Advising a client in stage 1 of Parkinson's disease about the importance of exercise in his or her daily routine is an example of primary care.
A nursing student is recalling information about the primary level of prevention. Which statement accurately describes primary prevention?
1 Primary prevention is directed at rehabilitation rather than treatment. Correct2 Primary prevention is applied to clients who are physically and emotionally healthy. 3 Primary prevention includes screening techniques and the treatment of the early stages of a disease. 4 Primary prevention focuses on individuals who are ill and have a possibility for developing complications. R: Primary prevention is true prevention. This prevention is applied to clients who are considered to be physically and emotionally healthy. The tertiary level of prevention is directed at providing rehabilitative care to clients. Secondary prevention includes screening techniques and treatment of early stages of disease. Secondary prevention is focused on individuals who are ill and are at risk for further complications.
What does a nurse understand about the secondary level of prevention?
1 Secondary prevention is aimed at helping clients achieve the highest function possible. 2 Secondary prevention is focused on minimizing effects of long-term disease or disability. Correct3 Secondary prevention is focused on individuals who are in the early stage of their illnesses. 4 Secondary prevention is aimed at attaining health promotion through wellness development activities. R: The secondary level of prevention is focused on individuals who are experiencing health problems or illnesses. Tertiary prevention is aimed at helping clients achieve the highest level of function possible. The tertiary level of prevention is focused on minimizing the effects of a long-term disease or disability. The primary level of prevention is aimed at attaining health promotion through wellness development activities.
The nurse administrator is assessing the quality of health care provided by the nursing team in a health care center using the Donabedian model of care quality. What components should the nurse assess while evaluating the "process" of the health care delivery system? Select all that apply.
1 Whether the nurses renew their licenses regularly Correct2 Whether the nurses work in coordination with each other Correct3 Whether the nurses are providing adequate client education 4 Whether the facilities are adequate to fulfill the client's health care needs 5 Whether the clients are satisfied with the care provided by the nurses R: The "process" of health care system according to the Donabedian model of health care quality includes the services offered by the health care system. It also includes the interpersonal relationships between the health care professionals and the adequacy of client education. Therefore while assessing the process of the health care team, the nurse administrator should find out whether the nurses are working in coordination with one another. The administrator should also ensure that the nurses are able to impart adequate health information to the clients. The nurse should assess the licenses of the nurses while assessing the structure of the health care system. The administrator should assess the adequacy of the health care facilities while assessing the structure of the health care system. Client satisfaction is assessed while assessing the outcomes of the health care system.
What are the characteristics of equitable care? Select all that apply
Correct1 It strives to serve underserved people. Correct2 It does not vary in quality among groups. 3 It promotes delivery of care in a timely manner. 4 It is responsive to individual client preferences. Correct5 It is delivered in a system that allows for exemptions. R: Equitable care is an important ingredient of high-quality health care. It does not vary in quality because of gender, ethnicity, geographic location, or socioeconomic status. Equitable care strives to serve the underserved who have limited access to healthcare. Equitable care is possible only in systems that allow for exemptions based on the requirements of the group. Care provided on time is an attribute of timely, high-quality care. Client-centered care promotes responsiveness to individual client preferences.
A nurse instructs a client who leads a sedentary lifestyle to take up regular physical activity. What are the client's responses in the order reflecting the stages of health behavior change?
Correct1."I'm fit and completely healthy, and I have no time for physical activity." Correct2."I know that exercise is good for my health, but so far my lifestyle hasn't caused me any problems." Correct3."I don't even know how to begin exercising. Could you refer me to a personal trainer?" Correct4."I go to the gym every day, but I feel like giving up." Correct5."I need help fitting my exercise routine into my daily schedule." R: Health behavior change begins with the precontemplation stage, in which the client does not intend to bring about a change in health behavior during the next 6 months. The client is likely to become defensive and reject the instructions. The next stage is contemplation. At this stage, the client considers bringing about a change in health behavior in the next 6 months. He or she accepts the information but is ambivalent about it. The client in this situation understands that exercise is good for one's health but is not yet ready to begin. The third stage is the preparation stage, in which the client takes the initial step towards health behavior change. In this situation, the client seeks the help of the nurse in finding a trainer. The fourth stage of health behavior change is action. At this stage, the client is engaged in activities to change health behavior but may find that old habits act as barriers to new actions. In this situation, the client feels like reverting to the old lifestyle. The last stage of health behavior change is the maintenance stage, in which the client feels the need to integrate changes into his or her lifestyle. In this situation, the client wishes to fit his or her exercise regimen into the daily schedule.
The waiting area of a health care facility displays a pink triangle. What does this signify?
The waiting area of a health care facility displays a pink triangle. What does this signify? 1 The waiting area is for females. 2 The waiting area is for pediatric clients. 3 The health care facility welcomes transwomen. Correct4 The health care facility welcomes lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ) clients. R: A waiting room in a health care facility marked with a pink triangle indicates that the health care facility is in a safe place for LGBTQ clients, and they can expect respectful and knowledgeable quality care. Other symbols might be used to represent areas that are meant for female and pediatric clients. There are no widely used symbols to designate transwomen-specific health care facilities.
