NURS 450 EXAM
The nurse cares for a patient who has been diagnosed with reoccurring lung cancer. The oncology unit has a nurse-led support group for improving quality of life for cancer patients. The patient declines participation stating that he is a private person and he is not interested in participating in a group. Which of the following is the best response by the nurse?
"What types of support have you found helpful in dealing with trying situations in the past?"
According to the CDC, healthcare workers account for ________ of non-fatal workplace injuries that require time off work
2/3
Health Disparities
Difference in health outcomes linked to disadvantages in these factors: •Social •Economic •Environmental
Which of the following is a primary goal of quality improvement (QI)?
Improve patient outcomes
The nurse is giving a presentation to coworkers regarding the patient benefits of adopting policies based on EBP. Which of the following benefits of EBP should be included in the presentation? Select all that apply
Improved quality of care Decreased lengths of stay. Improved cost savings. Improved patient outcomes.
Why is baseline data useful in quality improvement (QI) activities?
To compare preintervention to postintervention outcomes
Guidelines
evidence-based information for situation/condition to provide quality care and improve outcomes
Social determinants of health
variables impacting health status which are affected by resource distribution
3 ANA LEADERSHIP COMPETECIES
1. Leading yourself 2. Leading others 3. Leading the organization
You are assisting another nurse in providing complex wound care to an alert and attentive patient. The nurse does not wash her hands between her changes of gloves and is in the middle of giving the wound care. Which of the following would be your most appropriate safety action?
Unobtrusively remind the nurse that her hands need to be washed between glove changes.
Fishbone Analysis
Way to diagram the root cause analysis Use the diagram to help identify solutions and an action plan for change
Informal Leaders
not explicit or official; based on personal power or credibility in the eyes of others
Algorithms
series of progressive treatment based on client response
Sentinel Event
serious, unexpected occurrence involving death or severe physical or psychological harm
Structure Indicators
setting in which care is provided Examples: nursing staff skill mix, nursing hours per patient day, nurse turnover rate
Protocols
standard guidelines for a specific intervention Ex: AHA/ASA stroke protocol
Near Miss
unplanned event that did not result in injury, illness, or damage but had the potential to do so
Transformational Leaders
• Goes beyond transactions to inspire and motivate followers • Empowers and inspires followers to achieve common long-term vision • Appeal to higher values rather than individual self-interests
Which of the following is NOT an appropriate reason to launch a QI project?
A fellow staff nurse's poor performance is negatively affecting patient care
A nurse is asked to serve on the hospital's Quality Improvement Committee. What would the nurse expect to be true?
After identifying a problem area, the committee will research best practices to address the problem
Outcome Indicators
Examples: rates of patient falls, pressure ulcers, catheter associated urinary tract infections (CAUTIs), central line associated bloodstream infections (CLABSIs), ventilator associated pneumonia (VAP)
Who is legally responsible for nursing care provided to patients?
RN assigned to patient
The nurse is using bar-code administration technology to facilitate the administration of medications to her patients. This is an example of how bar-code medication administration technology facilitates which of the following QSEN competencies?
Safety
Management
the process of planning, organizing, directing, and coordinating the work within an organization
Authoritative
• Dictator/paternalistic • High control
Democratic
•Supportive/participatory • Moderate control
Which of the following actions best exemplifies advocacy?
Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
The nurse administers the wrong dose of heparin to a patient. This is classified as which of the following?
Adverse event
NATIONAL DATABASE OF NURSING QUALITY INDICATORS (NDNQI)
Benchmarking report comparing similar organizations and units Evaluates "nursing-sensitive" measures at the unit level --> report card for that unit's quality of nursing care
Culture of Safety
Blame-free environment that encourages employees to report errors and prevent situations that threaten safety
The nurse is providing care for a patient who is taking 400 mg of Naproxen for abdominal pain. Which task can be delegated to the unlicensed nursing personnel?
Collect and send a stool sample to the laboratory for guaiac testing.
Which of the following processes using Deming's Plan-Do-Study-Act (PDSA) method for quality improvement is correct?
Collect baseline data, use small-scale trials for change, collect data and compare against desired outcomes, adjust the plan.
What is a common cause of errors within healthcare settings?
Communication problems between caregivers
A nurse can participate in quality improvement (QI) activities by: SELECT ALL THAT APPLY
Conducting data collection and sharing information with others. Educating staff on how to implement an intervention. Conducting reviews of the literature to identify possible improvement interventions. Assembling a unit team to address a quality problem within their control
The ED nurse reads an article that states that patient morbidity and mortality are increased when patients are given plasma volume expanders in the initial treatment of hypovolemic shock. The nurse is concerned about patient outcomes in the ED as plasma volume expanders are often prescribed. What is the best action by the nurse?
Contact the chief of emergency medicine and nurse manager to request creating an interprofessional team to investigate the clinical problem.
When rounding, the nurse discovers that a patient on isolation has soiled the bed. Upon inquiry, the patient indicated that he did not want to bother the nurse because she was busy. The nurse tells the patient to use the call bell anytime. How can the nurse most effectively communicate that she is available to the patient?
Ensure that all the patient's needs have been met before leaving the patient's room, avoid appearing rushed, and let the patient know when the nurse will return.
A non-English-speaking patient arrives in the ED and is noted to be crying quietly. Which of the following is the most important for the nurse to consider in initially providing care for this patient?
Expressions and interpretations of caring may be perceived differently across cultures.
Driving Forces
Factors that facilitate change Examples: rewards, elimination of a problem, improved outcomes
Restraining Forces
Factors that impede change Examples: timing, lack of power, inadequate knowledge
Which of the following is NOT expected to be found in a high reliability organization (HRO)?
Financial performance is negatively impacted
Chain of Command
Hierarchy of authority within an organization Should be used for flow of communication and delegation
Joint Commission
Identify setting-specific safety goals
A group of emergency room (ER) nurses are asked to develop an action plan to improve the time before patients who present with chest pain receive an ECG. Which of the following would NOT be helpful when working on a quality improvement (QI) effort like this?
Identify whose fault it is that results are not very good.
The nurse is concerned about his patient's lab values and medication regimen. The nurse uses the electronic health record to obtain information about medication doses, lab results, and notes that the patient's lab results are within normal limits. This use of the electronic health record is an example of using which QSEN competency?
Informatics
EVIDENCE-BASED PRACTICE (EBP)
Integrates best research evidence with clinical expertise and the patient's unique values and circumstances to make decisions about the care of individual patients
A group of nurses on a medical-surgical unit noted their readmission rates were higher than other units. With further investigation, the nurses identify that patients were readmitted to the hospital based on a lack of understanding of discharge instructions. As a team, they decide to look at how they could assess every patient's health literacy level (understanding of health information) because health literacy was identified as a contributing factor to increased readmissions. The team identifies three tools commonly found in the literature. They decide on one tool that is appropriate for their medical-surgical population of patients. To implement the tool, they teach the staff how to use it, document the patient's literacy level score in the electronic medical record (EMR), and brief the rest of the patient's care team on use of that health literacy information during interactions with the patient. Readmissions are reduced from 15% to 8% at the end of a 4-month trial period. Is this considered research, quality improvement, or evidence-based practice?
It is quality improvement since the nurses used data and identified an intervention to improve their readmission outcome.
Too narrow a functional orientation
Lacks depth to manage outside one's current function
Leadership plays an important role in creating a high reliability organization (HRO). Which of the following statements demonstrates the best understanding of the role of leadership in an HRO?
Leaders are accountable for the provision of effective and efficient care while protecting the safety of patients, employees, and visitors.
A patient falls and experiences a severe injury. In a culture of safety, what consequences might the assigned nurse, who never had a patient experience an injury before, reasonably anticipate?
Meeting with the risk manager
The nurse is gathering the best available evidence on interventions to reduce hospital-acquired pressure ulcers. Which of the following would be considered the highest level of evidence?
Meta-analysis systematic review
Swiss Cheese Model
Most accidents result from multiple, smaller errors in environments with serious underlying system flaws
What is the most important reason that excellent communication skills are essential for nurses?
Most nursing activities occur in relationships.
The registered nurse delegated to the unlicensed assistive personnel (UAP) to ambulate a patient to the bathroom. The UAP is having difficulties completing this delegated task. What is the proper action the UAP must take?
Notify the licensed nurse of the UAP's difficulties with completing this task.
Which of the following methods are helpful for assessing the culture of an high-reliability organization (HRO)? SELECT ALL THAT APPLY
Observe the behaviors of employees when they think no one is watching to determine if they are adhering to the policies and expectations of the organization. Review safety event reports, including near miss, precursor, and serious safety events. Use a standard tool to assess the patient safety of the organization.
The nurse is involved in a task force to design patient care plans using evidence. Which of the following statements is true regarding evidence-based practice (EBP)?
Patient values are a key component of EBP.
The nurse is caring for a newly admitted patient. She introduces herself using her first and last name and asks the patient what his values, needs, and preferences are for this hospital stay. The nurse is practicing which of the QSEN competencies?
Patient-centered care (PCC)
The nurse is participating in a team meeting with her patient, the dietician, physician, and social worker. The nurse recalls that the patient had expressed that spirituality was important to her. A pastoral care representative is not present in the meeting. The nurse notices this and contacts pastoral care to be included in the meeting. This inclusion is an example of using which QSEN competency?
Patient-centered care (PCC)
Root Cause Analysis (RCA)
Process used to understand the cause of an error Retrospective review of incident to identify sequence of events to identify the root causes that led to the error
The nurse wants to use a patient-centered approach to perform patient care. Which of the following best describes the nurse's approach?
Providing care through the eyes of the patient
Which of the following is the best motivator for improving patient safety and quality of care?
Public reporting of performance
The nurse notices that there was an earlier medication error that resulted in an adverse patient outcome. She asks for assistance from her manager in analyzing the error. This is an example of using which QSEN competency?
Quality improvement (QI)
The nurse realizes that her patient's pain management is not effective. She has noticed this with other patients in the past and decides to analyze the unit-based pain control chart posted in the break room. She decides to explore additional pain management options for patients whose pain is not controlled with the usual pain management. Which QSEN competency best describes her approach?
Quality improvement (QI)
Nurse-sensitive quality indicators are data collected to determine the:
Quality of nursing care provided at an institution
The patient assigned to a new graduate nurse has an order to have a nasogastric tube inserted. The nurse has never completed this procedure. How should the new graduate nurse proceed?
Request assistance from an experienced nurse.
QUALITY & SAFETY EDUCATION FOR NURSES (QSEN)
Resources for learning the knowledge, skills, and attitudes needed to be safe practitioners
Which patient is demonstrating high health literacy? The patient who:
Reviews information on the pros and cons for two types of treatment before deciding which one is best for them
A medical resident walks into a patient's room to complete a physical assessment. The nurse notices that the resident did not wash her hands before entering the room. The nurse gently reminds the resident to use the hand sanitizer before touching the patient. This reminder is an example of using which of the following QSEN competencies?
Safety
In administering medication to her patient, the nurse saw that the medication administration record indicated the dose amount to be .5 mg. She immediately double checked the order and confirmed that the dose was supposed to be 0.5 mg. The nurse remembered to always use a zero before a decimal when the dose is less than a whole unit and she updated the medication administration record accordingly. Which QSEN competency applies?
Safety
4 PARTS OF EMOTIONAL INTELLIGENCE FRAMEWORK
Self-Awareness Self-Regulation Social Awareness Social Skills
The nurse is transferring a patient from the ICU to the step-down patient-care unit. When the ICU nurse calls report to the receiving unit, what is the best way for the nurse to provide the handoff information?
Situation, background, assessment, recommendations
Which one of the following is an example of a Never Event?
Stage IV hospital-acquired pressure ulcer
The nurse is transferring their patient from the Post Anesthesia Care Unit (PACU) to the surgical unit. They are calling the receiving nurse with a patient handoff report. Ensuring patient safety by using the handoff report, they are careful to describe the situation, background, assessment, and recommendation for the patient's continued care. Giving an accurate handoff report is an example of assuring patient safety by using which QSEN competency?
Teamwork and collaboration
The nurse is preparing to review discharge instructions with a patient. The nurse instructs the patient regarding her medications and wound care for her foot. What indicates to the nurse the level of understanding the patient has regarding discharge instructions?
The nurse observes the patient changing the dressing on her foot wound.
Following
active, creative role to support, influence, and complement leader
Standards of care
baseline of quality care a client should receive
Chaos Theory
change is not orderly (and often disruptive)
32% of nursing malpractice cases involve 1 or more ________________
communication errors
Cultural competency
emphasizes knowledge of other populations (expertise)
Never Events
errors in medical care that are clearly identifiable, preventable, and serious in their consequences for patients
Process Indicators
how care is provided Example: pain cycle completion (assess, intervene, reassess)
Purpose of Risk Management
identify, analyze, and evaluate risks develop plan to reduce frequency and severity of accidents and injuries
2015 OSHA memo
inpatient healthcare settings consistently have exposure to safety and health hazards
A fishbone diagram:
is a quality improvement tool to identify relationships among possible factors. OR is commonly used to determine definitive cause and effect relationships.
What is the 3rd leading cause of death in the US?
medical errors
Systems Theory
most errors reflect predictable human failings in poorly designed systems
System Theory
organizations evolve in positive ways
The nurse-sensitive indicator result "unit fall rate of 0.0 for the last 3 months" is assessing which of the following:
outcome
Failure to Rescue
patient develops a complication that leads to death with health care personnel missing the indicators that the complication was occurring
The nurse-sensitive indicator result "monthly pain reassessment within 30 minutes post-IV narcotics was at 44%" is assessing which of the following:
process
Agency for Healthcare Research and Quality (AHRQ) Mission
produce evidence to make health care safer, higher quality, more accessible, equitable, and affordable
Critical/clinical pathway
projected path of treatment based on a set time frame for clients with the same diagnosis
Incident report
record of unexpected or unusual incident that affected a patient, employee, volunteer, or visitor in a health care facility
Greater efficiency & proactive planning decreases what?
resource constraints
Cultural humility
see the person as the expert on their culture
Formal Leaders
specific role responsibility related to the position one holds
The nurse-sensitive indicator result "unit vacancy is at 5% for the last month" is assessing which of the following:
structure
Leadership
the ability to inspire others to achieve a desired outcome
Laissez-faire
• Permissive/passive • Low control
Transactional Leaders
•Focus on immediate problems •Maintain the status quo by performing work according to policy and procedures •Rely on formal authority to reward or punish --> motivation for followers
Most common healthcare sentinel events
•Wrong patient, wrong site, wrong procedure •Unintended retention of foreign body •Delay in treatment •Suicide •Operative/postoperative complications •Fall •Medication error
