ULM nursing concepts final

What situation demonstrates a nurse engaging in active listening?

Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location.

What is the first step in both the nursing and problem-solving processes?

Gathering relevant information

According to the Quality Chasm report what statement is true?

Health care providers should be proactive rather than reactive to patient needs.

What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals?

Institute of Medicine (IOM)

The Metropolitan Medical Response System (MMRS) is accurately described by which statement?

It consists of responders who have obtained specialized training and equipment to deal with mass casualty events.

A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group?

Legitimate

The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? (Select all that apply.)

a. A patient falls and fractures a hip. b. A patient develops bilateral pressure ulcers on their heels. c. A patient develops a catheter-associated urinary tract infection. e. A patient develops pneumonia related to ventilator use.

A terrorist incident has occurred, resulting in a possible exposure to smallpox. What term would be used to classify this incident?

biologic

A nurse asks, "What is meant by 'internal' customers?" The correct response should identify which person or persons? (Select all that apply.)

c. X-ray technicians d. Clinical pharmacist e. Chief financial officer

An RN with excellent assessment and psychomotor skills would derive power based on which source?

expert

In today's world of fast, effective communication, what is the most commonly used means of societal communication?

Spoken word

A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact which agency for access to the needed medication?

Strategic National Stockpile.

Troops from the United States participating in a peace mission in a foreign country were the victims of suicide bombers and many soldiers were evacuated back home to receive specialized medical care. The nation's medical responses will be augmented by what organization?

The federally coordinated National Disaster Medical System

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy?

"I understand how you could feel angry about the diagnosis."

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy?

"I'll close the door so you can spend time with your dad. I will check back in a few minutes."

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism?

C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process.

What is the difference between a leader and a manager?

A manager focuses on coordinating resources.

Which of the following occurrences would be classified as a sentinel event?

A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of negative communication?

Blocking

Which component of an e-mail shown below would be both effective and concise?

Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess?

Connection

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function?

Controlling

A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management?

Corporate supporter

The Federal Bureau of Investigation (FBI) has determined from a reliable source that a bomb is in the possession of a known terrorist group and the likely target is a government building in the local community. What term is used to identify this situation?

Credible threat

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term?

Deployment chart

Which action represents the key management function of strategic planning?

Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

A state is devastated by a tornado killing many people, destroying communication systems, utility services, homes, and medical facilities. The state requests immediate assistance from the U.S. Congress and from surrounding states. The affected state should first contact what agency?

Emergency Management Assistance Compact (EMAC)

What is the focus of care during the relief response phase of a disaster resulting from a "dirty bomb"?

Treatment for burns and poisoning is provided for victims.

When considering online communication etiquette, which nurse demonstrates a primary rule that should be adhered to by all?

"My friend's wedding was lovely and anyone wanting to see pictures can view them on my website."

During a community health fair, the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, "In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?" How should the DMAT respond to this question?

"The community is essentially the 'first responder' to any disaster."

A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices?

"What exercise practices do you participate in?"

A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit?

Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting what communication technique?

Active listening

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy?

Appeal to emotion

According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement?

Authoritative

The emergency response team responded to a terrorist attack where hundreds of people died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited exposure through the skin. The concentration of Sarin has not been measured. What level is the minimum level of personal protection and safety equipment (PPE) that would be needed?

B

Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term?

Critical pathway

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both situations?

Filtration

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly, I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation?

Generation X

A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement?

Give spur-of-the-moment recognition to an employee who has accomplished a goal.

During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation?

Improper construction that caused the leak and towel placement

The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse's action has what possible outcome?

Increasing the risk for HIPAA violations

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies?

Informatics

A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact/response stage, activities focus on what?

Initiating effective, appropriate response activities

A group of local volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of what organization?

Medical Reserve Corps (MRC)

A group of nurses are presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that supports what?

Medication-related errors place a tremendous financial burden on the U.S. health care system.

Regardless of the term used to describe high-quality health care, what is the primary focus of quality?

Meeting consumer needs and wants

Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated to begin to address victim and provider psychosocial needs?

Metropolitan Medical Response System (MMRS)

A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation?

Pareto chart

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what?

Pareto chart

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style?

Passive-aggressive

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication?

Past experiences

A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation?

Patient- centered care

A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of what communication associated process?

Preconceived idea

A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is referred to by what term?

Red herring

A nurse gives phenytoin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "You've disliked me since I refused to switch my vacation time last month." Which type of logical fallacy has influenced the nurse?

Red herring

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power?

Referent

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. These practices are associated with which stage of Lewin's change process?

Refreeze

A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?

Safety

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term?

Sentinel event

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication?

Tell me what day of the week today is.

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?

The competencies address both individual and system approaches to transform care.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring?

The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not."

Which nurse is demonstrating a common, productive conflict resolution style?

The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?"

A nurse is interested in learning the phases of the disaster continuum and realizes it has many similarities to the nursing process. To better understand the phases of a disaster, which is true when comparing the phases of the disaster continuum to the nursing process?

The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process.

A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that care will be based on what fact regarding these situations?

The same ground rules practiced in other settings and during smaller crises will be applicable.

The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph to present this information?

Time plot

The surgical team arrives in the operating room and one-member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is referred to by what term?

Time-out

The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. What is the primary responsibility of this representative regarding information regarding the event?

To provide understandable and straightforward facts about the event within the facility and possibly to the news media

Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader based on these qualities are practicing which leadership theory?

Trait

A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse?

Transactional

A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader?

Transformational

Nurses caring for the victims of a mass casualty incident based on what principle?

Triaging will give priority for care to those with the greatest chance of survival rather than those most critically ill.

In the preparedness phase for disasters, the community plans for a possible terrorist attack using anthrax as the weapon of destruction. What treatments and/or preparations would be needed?

Vaccines and Level B Personal Protection Equipment (PPE)

Which statement accurately describes communication?

When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that fact about the situation? (Select all that apply.)

a. In the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving. b. Communities should use their own resources first to attempt to stabilize and organize the response.

Registered nurses who are entering the workforce will have expanded leadership responsibilities that include what tasks? (Select all that apply.)

a. Serving on interdisciplinary care teams c. Attending a meeting to plan advanced training for unlicensed assistive personnel d. Evaluating outcomes of care that are reported to a standing committee e. Managing units with higher acuity, shorter length of stay, and more diverse patients and staff

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? (Select all that apply.)

a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

The healthiest form of communication is the ________ style.

assertive

An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation?

autocratic

When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide assistance in what form? (Select all that apply.)

b. Creating teams of health care providers who are experts and have specialized supplies and equipment c. Facilitating patient evacuation from the disaster area to an unaffected area d. Arranging for hospitalization in federal and volunteer nonfederal acute care hospitals

A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. What competency is included? (Select all that apply.)

b. Patient-centered care d. Quality improvement e. Safety

Managers who exhibit an authoritative behavioral style are most likely to use which source of power?

coercive

The emergency preparedness term that is used to describe the process of limiting the emergency within a well-defined area is ___________.

containment

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool?

control chart

The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is referred to by what term?

decontamination

Quality is defined by the ____________.

patient

Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which phase of a disaster continuum?

preparedness

A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are engaged in what process?

root cause analysis

While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

sentinel

The term used during a pandemic disaster that refers to the attempt to contain germs by limiting socialization and personal interactions is ___________.

social distancing

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through implementation of what communication technique?

supportiveness

Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated?

teamwork and collaboration

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred to by what term?

top-down flowchart

To persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change?

unfreeze