EAQ Quality Improvement

A client with congestive heart failure is receiving intravenous digoxin (Cardoxin) therapy. The registered nurse identifies that which items on the client's care plan are appropriate for a licensed practical nurse (LPN) to perform? Select all that apply. 1. Help the client ambulate when required. 2. Monitor the client's vitals every 30 minutes. 3. Administer adequate oral fluids to the client. 4. Prepare the nursing diagnosis after assessing the client. 5. Administer the digoxin (Cardoxin) if the client has chest pain.

Correct Answer 1. Help the client ambulate when required. 2. Monitor the client's vitals every 30 minutes. 3. Administer adequate oral fluids to the client

The count of hydrocodone is incorrect. After several minutes of searching the medication cart and medication records, no explanation is found. Who should the primary nurse notify about the discrepancy? 1. Nursing unit manager 2. Hospital administrator 3. Quality control manager 4. Healthcare provider prescribing the medication

Correct Answer 1. Nursing unit manager Controlled substance issues for a particular nursing unit are the responsibility of that unit's nurse manager. Responsibility flows directly from the staff of a nursing unit to the nurse manager; the nurse manager reports to a nurse administrator. There is no direct flow of accountability from the primary nurse to the quality control manager. Healthcare providers are responsible for medical management issues, not issues associated with management of a nursing unit.

Which is used for determining the hours of care and staff required for a group of clients? 1. Flow sheets 2. Acuity records 3. Standardized care plans 4. Discharge summary forms

Correct Answer 2. Acuity records An acuity record is used to determine the hours of care and staff required for a given group of clients. A client's acuity level is based on the type and number of nursing interventions. Accurate acuity ratings justify overtime and the number and qualifications of staff needed to safely care for clients. A flow sheet helps to assess data about a client; this data includes vital signs and routine repetitive care. Standardized care plans based on an institution's standards of nursing practice are preprinted and established guidelines used to care for clients who have similar health problems. Discharge documentation includes medications, diet, community resources, follow-up care, and medical contact information in case of an emergency or query.

A home health nurse on a first visit checks the client's vital signs and obtains a blood sample for an international normalized ratio (INR). After these tasks are completed, the client asks the nurse to straighten the blankets on the bed. What is the nurse's most appropriate response? 1. "I would, but my back hurts today." 2. "Okay. It will be my good deed for the day." 3. "Of course. I want to do whatever I can for you." 4. "I would like to, but it is not in my job description."

Correct Answer 3. "Of course. I want to do whatever I can for you." Helping the client to meet physical needs is within the role of the nurse; arranging blankets on the client's bed is an appropriate intervention. The nurse's comfort needs should not take precedence over the client's needs; the nurse should not assume responsibility for the role of care provider if incapable of providing care. This act is not a good deed but fulfills the expected role of the nurse; this response sounds grudgingly compliant. This is within the nurse's job description.

The nurse is preparing to insert an intravenous catheter in a thin, emaciated client who is scheduled to begin intravenous fluid therapy. Which interventions should the nurse follow to provide high-quality care? Select all that apply. 1. Insert an 18 gauge IV catheter 2. Change the intravenous line every 7 days 3. Flush the intravenous line with normal saline 4. Insert the intravenous catheter in the client's femur 5. Stop the insertion procedure when there is a break in technique

Correct Answer 3. Flush the intravenous line with normal saline 5. Stop the insertion procedure when there is a break in technique The nurse should flush the IV line with normal saline to maintain patency. The nurse should stop the insertion procedure when there is a break in technique. This intervention helps prevent catheter-related bloodstream infections and provides high-quality care to the client. An 18-gauge needle is not an appropriate size needle to insert in a thin, emaciated client; it would cause unnecessary trauma and a high risk of phlebitis. The nurse should change the intravenous line every 72 to 96 hours to prevent the risk of infection. The nurse should avoid inserting the catheter in the client's femur because it increases the risk of bloodborne infections.

Which statement defines "information" gathered by the nurse? 1. It is an individual piece of reality. 2. It is a combination of pieces of reality. 3. It is the organization and interpretation of data. 4. It is the identification of relationship of various data.

Correct Answer 3. It is the organization and interpretation of data. Information is defined as the organization and interpretation of data or pieces of reality. Datum is an individual piece of reality. When data are combined and relationships among data are identified, the nurse obtains knowledge.

What is the function of the Professional Standards Review Organizations (PSROs) set up by the federal government? 1. To identify "Never Events" in health care 2. To set national priorities to transform healthcare 3. To review the quality, quantity, and cost of hospital care 4. To eliminate overuse of diagnostic and treatment services

Correct Answer 3. To review the quality, quantity, and cost of hospital care The federal government set up PSROs to review the quality, quantity, and cost of hospital care. The National Quality Forum defined a list of 28 "Never Events" in health care. Death or injury due to medication error is an example of a "Never Event." The National Priorities Partnership is a group of 28 organizations from a variety of health care disciplines that work together to transform health care on a national level. Medicare-qualified hospitals have utilization review committees to review admissions and identify and eliminate overuse of diagnostic and treatment services for clients on Medicare.

A nurse is assigned to change a central line dressing. The agency policy is to clean the site with povidone-iodine and then cleanse with alcohol. The nurse recently attended a conference that presented information that alcohol should precede povidone-iodine in a dressing change. In addition, an article in a nursing journal stated that a new product was a more effective antibacterial than alcohol and povidone-iodine. The nurse has a sample of the new product. How should the nurse proceed? 1. Use the new product sample when changing the dressing. 2. Cleanse the site with alcohol first and then with povidone-iodine. 3. Cleanse the site with the new product first and then follow the agency's protocol. 4. Follow the agency's policy unless it is contradicted by a primary healthcare provider's prescription.

Correct Answer 4. Follow the agency's policy unless it is contradicted by a primary healthcare provider's prescription. Agency policy determines procedures; if the procedure is out of date or problematic, the nurse should contact the primary healthcare provider for a change in the prescription. The nurse cannot use another product without a primary healthcare provider's prescription. The nurse will be risking liability if agency policy is not followed unless the prescription is changed by the primary healthcare provider.

A nurse finds that there is an inaccurate match between clinical cues and the nursing diagnosis. What is the category of the diagnostic error? 1. Labeling 2. Collecting 3. Clustering 4. Interpreting

Correct Answer 4. Interpreting An inaccurate match between clinical cues and the nursing diagnosis is an interpreting error. Interpreting errors include failing to consider conflicting cues, using an insufficient number of cues, and using unreliable or invalid cues errors. A labeling error is a failure to validate data. Collecting errors include inaccurate data, missing data, or disorganization. Errors at the clustering level include an insufficient cluster of cues, premature or early closure, or incorrect clustering.

Why should organizations promote transparency in health care? 1. Transparency helps in creating effective insurance policies. 2. Transparency helps determine whether drugs are being diverted. 3. Transparency facilitates recruitment of competent team members. 4. Transparency allows continuous feedback for improving client outcomes.

Correct Answer 4. Transparency allows continuous feedback for improving client outcomes. Transparency means to be clear and unambiguous in the daily operations of a health care organization. Transparency allows continuous feedback for the consumers, which helps improve the clinical outcomes of the clients. Transparency is not related to the diversion of drugs for non-therapeutic purpose. Transparency may not contribute to better recruitment in the organization. Transparency in a health care organization is unrelated to insurance policies.