Nursing Test 5: Burns, Quality Improvement, Health Policy, Patient-Centered Care
The development of disaster plans should take into consideration that children are more susceptible to the effects of a chemical attack than adults because children: a) have thinner skin than adults. b) have smaller body surface areas than adults. c) have a low risk of developing rapid dehydration. d) breathe at a slower rate than adults.
A - Children are more susceptible to the effects of chemical and biological attacks because they have thinner skin than adults, increasing their risk of absorbing a chemical. They also have a larger, not smaller, body surface area in relation to their weight than do adults, which increases the chance of chemical absorption. Children breathe at a faster, not slower, rate than adults, allowing them to inhale greater amounts of a toxic agent. Additionally, some chemical agents are heavier than air and accumulate close to the ground, which is closer to a child's breathing zone than an adult's. Because they have less fluid reserve than adults, children are at greater risk of developing rapid dehydration from agents that cause vomiting or diarrhea.
A nurse implements a health care facility's disaster plan. Which action should she perform first? a) Identify a command center at which activities are coordinated. b) Provide treatment for incoming clients according to time of admission. c) Turn off all cellular phones and pagers. d) Instruct all essential off-duty personnel to report to the facility within 24 hours.
A - During a disaster, having a command center to provide direction and coordinate activities is crucial. Cellular phones and pagers may be essential communication tools during a disaster. Essential off-duty personnel should respond to a disaster as quickly as possible. Admitted clients should be triaged and treated in accordance with the facility's triage policy.
An airplane crash results in mass casualties. The nurse is directing personnel to tag all victims. Which information should be placed on the tag? Select all that apply. a) Medications and treatments administered. b) Next of kin. c) Identifying information when possible (such as name, age, and address). d) Triage priority. e) Presence of jewelry.
A, C, and D. • Triage priority. • Identifying information when possible (such as name, age, and address). • Medications and treatments administered. Tracking victims of disasters is important for casualty planning and management. All victims should receive a tag, securely attached, that indicates the triage priority, any available identifying information, and what care, if any, has been given along with time and date. Tag information should be recorded in a disaster log and used to track victims and inform families. It is not necessary to document the presence of jewelry or next of kin.
The nurse is a member of a team that is planning a client-centered approach to care of clients with chronic obstructive pulmonary disease (COPD) using the Chronic Care Model (CCM). The team should focus on improving quality of care and delivery in which of the following areas? Select all that apply. a) Emphasis on the acute care setting. b) Clinical information systems. c) Administrative leadership. d) The community. e) Delivery system design.
B, D, and E. • The community. • Clinical information systems. • Delivery system design. Explanation: The process of changing a health care system from an acute care model to a Chronic Care Model (CCM) uses continuous quality improvement (CQI) methods. The goal of the CCM is to improve the health of chronically ill clients. The CCM identifies six basic areas upon which health care organizations need to focus to improve quality of care and delivery: health systems, delivery system design, decision support, clinical information systems, self-management support, and the community. This system requires health care services that are client-centered and coordinated among members of the health care staff and the client and family. CCM does not focus on the administrative leadership or the care in the acute care setting alone.
An emergency department nurse is awaiting the arrival of multiple persons exposed to botulism at the local shopping mall. What should the nurse do? a) Separate those exposed to botulism from those who were not exposed. b) Implement contact precautions with all exposed victims. c) Activate the facility's emergency disaster plan. d) Notify community agencies of the incident.
C - The nurse should activate the facility's emergency disaster plan to ensure availability of sufficient personnel and supplies. The Centers for Disease Control and Prevention and local health departments are the designated agencies responsible for collaboration with hospital agencies regarding community biochemical exposures. The Public Health Agency of Canada and the the Department of Public Safety and Emergency Preparedness are the designated agencies responsible for disaster coordination in Canada and should notify all community agencies of the incident. The nurse must implement standard precautions, not contact precautions, to prevent botulism transmission from one person to another. It is not necessary to quarantine exposed individuals.
There has been an increase in medication errors and errors in ordering laboratory studies in the emergency department. The nurse manager is conducting a staff education session on when to use "read-back" procedures. "Read-back" procedures should be performed in which of the following situations? Select all that apply. a) When the agency uses computerized health care records. b) Whenever a written order or printed critical test result is received. c) When any verbal or phone order is received. d) When the unit secretary takes a phone order. e) When a medication order or critical lab result is received verbally or over the telephone.
C and E. A goal of patient safety is to improve the effectiveness of communication among caregivers. For verbal or telephone orders, or for telephone reporting of critical test results, one must verify the complete order or test result by having the individual receiving the information record "read-back" the complete order or test result. The Unit Secretary is not a licensed health care professional who has a Scope of Practice or the authority to receive orders or results. The type of charting system used by the health care agency is not a factor in using "read back" orders.
Which of the following would be true regarding medication reconciliation? Select all that apply. a) Medications are considered reconciled if a medication order exists that is therapeutically equivalent to the one prior to admission. b) Medication reconciliation is designed to obtain and communicate an accurate list of a client's home medications across the continuum of care. c) Medication reconciliation is an important patient safety goal. d) Only nurses or health care providers can be involved in medication reconciliation. e) A medication is considered to be any medication ordered by a physician.
• Medication reconciliation is an important patient safety goal. • Medication reconciliation is designed to obtain and communicate an accurate list of a client's home medications across the continuum of care. • Medications are considered reconciled if a medication order exists that is therapeutically equivalent to the one prior to admission. Accurately and completely reconciling medications across the continuum of care is an important safety goal. The requirement is that there is a process for comparing the client's current medications with those ordered for the client while under the care of the health care organization. Clients are most at risk during transitions in care (hand-offs) across settings, services, providers, or levels of care. The development, reconciliation, and communication of an accurate medication list throughout the continuum of care are essential in the reduction of transition-related adverse drug events. The client or client's family is an integral component of medication reconciliation, particularly at the point of admission to, and discharge from, a health care facility. Any medications that the client uses, for example, over-the-counter medications, must be included in the reconciliation process.
