NUR 212 EXAM 4 - PRACTICE QUESTIONS, KEY TERMS
A group of nurses is meeting as a part of a research committee and one of the points of discussion is that they have limited time to read the required articles. Which response by the chairman may be most helpful to this group doing a literature review? A. "I would suggest reading the abstract." B. "I would suggest reading the article's conclusion." C. "I would suggest reading the introduction." D. "I would suggest skimming the reading for valid points."
A
A home health nurse who is visiting a client to complete a wound dressing notes that the client has a flat affect and is not as responsive as during previous visits. The nurse calls the client's primary healthcare provider for a psychiatric referral. By recognizing the signs and symptoms of possible depression, the nurse is exhibiting which concept associated with evidence-based practice? A) Clinical decision making B) Advocacy C) Professional behaviors D) Accountability
A
A nurse is a member of a quality-improvement committee seeking to reduce the risk of adverse events in a health care facility. When reviewing recently submitted incident reports, which of the following incidents should the nurse identify as a sentinel event? A) Paralysis of a client's lower extremities occurred following epidural anesthesia B) A client fall during ambulation did not result in client injury C) A client's family member complained that a nurse was culturally insensitive D) Surgery to the wrong site was stopped prior to a procedure
A
A nurse working in a home health agency is asked to participate on a committee that is looking to incorporate evidence-based nursing care. What should be the committee's first step in implementing evidence-based practice (EBP)? A) Compile a list of questions. B) Research evidence-based practices that can be implemented. C) Evaluate the results of different research projects. D) Suggest that individual staff members try new means of delivering care.
A
A nursing student who is providing care for an assigned client knows that the information documented in the client's nursing care plan could potentially be used in research to optimize client care. Which type of research is used to convert research knowledge into healthcare applications for improved outcomes? A) Translational research B) Transformational research C) Quantitative research D) Qualitative research
A
Medical errors account for 250,000 deaths per year. It is estimated that as many as 50% of these errors may be preventable. What steps would you take to avoid a medication error? A) Review the patient's medication administration record during bedside shift report. B) Ask your colleagues to get your medication so that you can give it on time. C) Call the pharmacist. D) Review the medication administration policy.
A
Nurses on the institution's research committee are discussing the difference between background questions and foreground questions within clinical research. Which nurse's statement is accurate? A. "Answers to background questions may be found in drug guides." B. "Foreground questions are knowledge based." C. "Background questions address a range of clinical issues." D. "The answer to a foreground question addresses multiple clinical issues."
A
The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking." Which response should the nurse give? A. Comparison of the performance of an individual or organization to industry standards B. Minimum starting point used for comparisons C. Process to identify vulnerabilities within an organization D. Analysis used to prevent certain events from repeating
A
The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. Which quality improvement method is the team using in seeking to reduce waste? A. Lean Six Sigma B. Quality assurance C. Root cause analysis D. Utilization review
A
The nurse is designing a quantitative research study about the relationship between yoga and wellness. Which research question is the most appropriate for this study? A. What is the relationship between engaging in yoga and the incidence of hypertension? B. How do health beliefs about hypertension influence an individual's choice to practice yoga? C. What is the nature of the relationship between engaging in yoga and experiencing wellness? D. How do individuals who engage in yoga perceive the link between exercise and hypertension?
A
The nurse is developing a research study to explore the emotional experiences of individuals whose children are diagnosed with autism spectrum disorder (ASD). Which statement reflects the nurse's intent to protect the participants' autonomy when describing the research plan to the mentor? A. "I'll take steps to ensure that participants are in no way coerced into taking part in this study." B. "Participants will not be exploited in any way during the course of this study nor at any point afterward." C. "Protection of the participants' anonymity will be guaranteed." D. "The primary purpose of this study is to provide the greatest possible benefit to patients."
A
The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A) To improve client outcomes B) To advance the nurse's career C) To fulfill legal requirements D) To maintain accreditation
A
The nurse is responsible for the implementation of an electronic system of documentation involving the use of tablets by the nursing staff when seeing patients. Which program should the nurse use? A. Quality management plan B. Total quality management C. Plan-Do-Study-Act (PDSA) D. Continuous quality improvement
A
The nurse is teaching a colleague how to utilize the mnemonic PICOT for formulating questions that relate to evidence-based practice (EBP). Which question by the colleague would meet the desired outcome? A. "What would you like to achieve from that specific intervention?" B. "What intervention should be utilized?" C. "How long will we collect data?" D. "What population of patients should we study?"
A
The nurse manager is discussing the process of determining which actions done each day are based on evidence-based practice (EBP). Which action should be encouraged to make that determination? A. Creating a list of actions done daily and evaluating which are best practices B. Asking their team member which actions are based on EBP C. Reviewing their job description D. Reviewing daily reports with other nurses
A
To achieve safe patient care, a culture of safety must exist. What are characteristics of an organization with a culture of safety? A) Transparency, openness, reporting of errors is rewarded, blame-free environment B) Honesty, studying of serious events C) Privacy, reporting of errors appreciated D) Blame-free environment, openness, error reporting is encouraged
A
Which of the following measures would be most directly aimed at upholding the principle of respect for persons? A) A policy requiring that any research involving pediatric subjects undergo an extra level of ethical scrutiny prior to approval B) A policy stating that all data gathered during research must be stripped of information that links it to individual research subjects C) A policy stating that a research project must be immediately suspended should any of the participants experience an unexpected adverse event D) A policy requiring that all participants in a research effort receive financial compensation
A
Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services. C) Quality management is the degree to which health services increase the likelihood of desired health outcomes. D) Quality management provides clients with appropriate service in a technically competent manner.
A
Which statement should the nurse understand as reflecting the aim of affordable care in the United States? A. Reducing the cost of quality health care for individuals, families, employers, and government B. Improving the quality of care by making care more patient centered, reliable, accessible, and safe C. Reducing wait times that may result in harmful delays for those who provide or receive care D. Improving health by addressing behavioral, social, and environmental determinants
A
Which term describes an assessment occurring within a group of individuals with similar positions within a healthcare system? A. Intraprofessional B. Internal audit C. Six Sigma audit D. Interprofessional
A
Which type of agency should the nurse recognize as being responsible for providing health insurance for low-income individuals and families? A. State agency B. Centers for Disease Control and Prevention C. Office of Medicare D. Office of the Surgeon General
A
Which would be considered a main objective of the research related to Healthy People 2020 as it relates to children? A. Providing patient-centered care for special needs B. Waiting until the child is 1 year old to vaccinate C. Using limited vaccinations D. Curing the flu virus
A
You are a new nurse. The hospital where you work is committed to providing safe, high-quality care. Which of the following activities would let you know that your organization is committed to improving patient safety? A) The hospital has a good catch program for staff who recognize errors and near misses. B) The hospital subscribes to TJC safety publications. C) The hospital measures performance every month, monitors quality indicators, and regularly reports on quality. D) All of the above
A
Which of the following would be considered sentinel events? Select all that apply. A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a client while at the facility E) Administration of a compatible blood transfusion
A B C D
A nurse is preparing to conduct a research study and wants to do a literature search for relevant articles. Which of the following sections should the nurse expect to find in each search result? Select all that apply. A) Abstract B) Methods C) Funding D) Results E) References
A B D E
The nurse is working with a client who has agreed to participate in a research study. Which actions would constitute a violation of the client's right to full disclosure? Select all that apply. A) Giving the client false information about his or her participation in the study B) Telling a mutual friend about the client's involvement in the study C) Withholding information about the study from the client D) Providing the client's name as a participant in the study E) Suggesting that participating in the study would greatly benefit the client's financial situation
A C
The nurse working in a community hospital is caring for a client who does not seem to be responding well to the current plan of care that has been implemented by the nursing team. Given this information, which actions by the nurse are appropriate? Select all that apply. A) Accessing research journals for evidence that would support a change in the plan of care B) Proposing a nursing research project to the unit manager C) Networking online with other nurses who are giving similar care D) Asking the doctor for a new nursing approach to care E) Trying a different approach to care even though it breaches hospital policy
A C
A nurse manager is encouraging staff on the unit to go back to school and "become professionals, not just workers" by "increasing" their knowledge through education and networking. Which criteria for nursing to be recognized as a profession is the nurse manager highlighting? Select all that apply. A) Joining professional organizations B) Following a code of ethics C) Having specialized education requirements D) Conducting ongoing research E) Having autonomy
A C E
A pregnant woman presents to the clinic with concerns of natural birth being messy and that she would rather have a cesarean birth. Which response by the nurse is based on a national goal set by Healthy People 2020? A. "A cesarean birth makes pregnancy and delivery very convenient." B. "A cesarean birth is a procedure that poses additional risk to you." C. "You should be screened for preeclampsia prior to making that decision." D. "A cesarean birth is basically risk free at this point in medicine."
B
Structured care methodologies (SCM) are: A) Nursing tools designed to identify best practices and facilitate standards of care B) Used to create a stable set of performance indicators to measure outcomes C) Used to assist employees with wellness and injury prevention D) Helpful when making staffing assignments
B
The HHS is charged with protecting the health of all Americans and providing essential health services. Which of the following HHS quality initiatives is currently under way? A) Post-acute care reform initiative B) National health-care research and quality indicators aimed at helping improve access to care C) NDNQI D) Health IT
B
The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A) Peer review B) Interdisciplinary audit C) Utilization review D) Benchmarking
B
The nurse is teaching the mother of a child with cerebral palsy about the concept of a medical home as a valuable resource. How has Healthy People 2020 supported this resource? A. Mandating that they be nursing led B. Increasing access C. Creating a network of outside resources to work together D. Fostering the care to be parent led
B
The nurse recognized making a medication error and immediately reported it to the unit supervisor. Which response from the supervisor should the nurse expect in an environment that promotes quality? A. "Why are you reporting that to me without completing an incident report?" B. "We have a blame-free environment so you can report errors without fearing punishment." C. "You have reported this to me, so you do not need to file an incident report." D. "You need to report directly to the Chief Nursing Officer."
B
The nurse shares with the research committee that the process they have been researching has been given the yellow light. Which member statement describes a correct understanding of the outcome? A. "We will need to discard that intervention and start over." B. "We need to continue our research." C. "We have a strong support for the intervention." D. "We have found a likely positive outcome."
B
The purpose of QI is to continuously improve the capability of everyone involved to provide safe, high-quality patient care. What is important to know about the QI process? A) It is independent of teamwork. B) It is a data-driven approach to improving process. C) Common safety indicators are not used to evaluate quality of care. D) Opportunities for QI are selected by organization leadership.
B
The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. Based on this data, to which benchmarking issue should the quality assurance officer pay particular attention during the review process? A) Structure B) Process C) Outcome D) Competency
B
When evaluating the quality of care, a health-care organization must consider structures, processes, and outcomes of care delivery. Which of the following is a good example of an organizational process? A) Budgeting adequate money for nursing salaries B) Preparing a patient for discharge C) Monitoring for infections D) Increasing time between clinic visits
B
Which problem-solving tool should the nursing committee use to evaluate any sentinel event? A. Process standards B. Root cause analysis C. Brainstorming D. Risk management
B
Which statement should the nurse understand describes the primary goal when conducting a root cause analysis? A. Mandating solutions to problems B. Preventing problem recurrence C. Gaining group consensus D. Producing ideas by holding a group discussion
B
A nurse is participating in an intradisciplinary assessment as part of a quality improvement process. Which of the following should the nurse anticipate will be included in this assessment? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management
B C E
A nurse manager is participating in a root cause analysis following a sentinel event on the unit. Which of the following statements defines the purpose of a root cause analysis? A) Assists in preparing a legal defense for the event B) Estimates the costs involved in the event C) Investigates deviations from standards of care surrounding the event D) Determines if employees involved in the event should be terminated
C
Studying errors and identifying how they occur helps organizations improve patient safety. Which category of errors is the most useful in identifying and remedying vulnerabilities in an organization? A) Sentinel event B) Adverse event C) Near miss event D) Wrong procedure event
C
The head nurse in a pediatrician's office is interested in incorporating more aspects of evidence-based practice (EBP) into the facility's regular nursing procedures and protocols. Which of the following resources would be most useful in helping the nurse achieve this goal? A) An American Nurses Association (ANA) report about best practices for reducing the incidence of pressure ulcers B) Documentation from the Centers for Disease Control and Prevention regarding recommended vaccinations for individuals who plan to travel abroad C) A report from the National Institutes of Health (NIH) describing a new sickle cell screening protocol D) A journal article discussing the perceived versus actual effectiveness of various approaches to smoking cessation
C
The nurse is a member of the utilization review committee that is composed of members from various disciplines within the hospital. Which patient situation should the nurse understand will be of interest to the utilization review committee? A. Routine maintenance of medical equipment B. Routine use of sterile packs in surgery C. Application of adult diapers on every older adult patient D. Each inpatient provided with an admission kit
C
The nurse is administering medications to a client. Which action is most likely to lead to an adverse event? A) The nurse verifies tube placement prior to administering the medications. B) The nurse checks for known allergies prior to administering the medications. C) The nurse combines medications with the same active ingredient. D) The nurse has a second nurse check the medication order.
C
The nurse is collecting data to determine how much of the unit's nursing practice is evidence based. Which action should the nurse implement as a first step to gather this data? A. Compare the charting between each member of the staff. B. Compose a list of the challenges reported by each nurse. C. Compose a list of actions that each nurse completes daily in the clinical setting. D. Look at each nurse's scope of practice.
C
The nurse is designing a presentation about evidence-based practice (EBP). Which example illustrates evidence derived from research? A. A nurse reads studies about the effects of massage on back pain. B. In certain cultures, male patients accept massage treatment only from male therapists. C. Studies suggest that medical massage effectively reduces lower back pain. D. The patient may refuse to have back surgery.
C
The nursing team is using the Total Quality Management (TQM) approach to improve patient satisfaction on the unit. Which process should the team follow to organize their efforts? A. Continuous Quality Improvement plan B. Define-Measure-Analyze-Improve-Control C. Plan-Do-Study-Act D. Define-Measure-Analyze-Design-Verify
C
Using high-quality monitoring tools, a facility committee identifies that clients who have congestive heart failure have an average length of stay of 5 days instead of the established standard of 3 days. Which step should the nurse implement next in the quality-improvement process? A) Educate staff members on shortening the length of stay for these clients B) Collect data regarding the length of stay for these clients C) Determine which actions can be instituted to address this problem D) Research the accuracy of the standard of care that has been accepted
C
What major nursing concept has the strongest relationship to the identification of areas for quality improvement, such as tracking data on healthcare-associated infections? A) Ethics B) Safety C) Informatics D) Evidence-based practice
C
Which governmental agency should the nurse recognize as being instrumental in developing indicators of high-quality care and measures? A. National Institutes of Health (NIH) B. Centers for Disease Control and Prevention (CDC) C. U.S. Department of Health and Human Services (HHS) D. U.S. Red Cross
C
Which of the following would be considered a foreground question when included in a nursing research project? A) "Who is at greatest risk for the development of gestational diabetes?" B) "What are the side effects of this class of antipsychotic medications?" C) "How does use of behavioral interventions compare to use of pharmacological therapies in treating hypertension?" D) "What organisms most commonly cause bacterial pneumonia?"
C
Which statement regarding standards of care in the hospital setting is inaccurate? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."
C
Which statement should the nurse use to describe the purpose of the root cause analysis? A. Identifying risks causing financial loss B. Providing a report to the leader of the committee C. Identifying the root cause of the problem through problem solving D. Brainstorming preferred outcomes
C
Which type of research investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of clients' perspectives? A) Quantitative research B) Thematic research C) Qualitative research D) Clinical research
C
While in the hospital, a patient fell in the shower, had an allergic reaction to the hospital gown, and spiked a high temperature. Which type of assessment should the nurse understand will be used to collect data about the three complications the patient experienced? A. Blame-free environment B. Root cause analysis C. Risk management D. Utilization review
C
Which statements best describe how a quality improvement process can contain healthcare costs? Select all that apply. A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased readmission rates." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."
C D
A nurse is completing an incident report after administering an incorrect dose of medication to a client, even though the client experienced no ill effects from the error. What is the purpose of completing the incident report? A) Alerting the facility administration of a possible litigation situation B) Tracking employee performance for possible disciplinary action C) Providing a detailed report of the occurrence for the client's family D) Identifying situations that contribute to the occurrence of medication errors
D
A nurse is tracking the outcomes of clients on the unit who have received postoperative pain management. This activity demonstrates which of the following competencies of the Quality and Safety Education for Nurses (QSEN) initiative? A) Safety B) Informatics C) Patient-Centered Care D) Quality Improvement
D
As part of a research project, the nurse is discussing with a group of peers about the coping process a woman goes through following a mastectomy. Which statement demonstrates that one of the nurses understands methodologies used in nursing research? A. "We would set that up as a quantitative study." B. "We should examine pregnant women who are over 30." C. "That would be an example of a hypothesis." D. "We would set that up as a qualitative study."
D
Nursing standards of care and the organization's policies and procedures greatly decrease risk to patient safety. Which of the following steps can a nurse take to further reduce risk? A) Submit event or incident reports for near misses. B) Follow medication administration policies and procedures. C) Always report significant data on care to patients and providers in a timely manner. D) All of the above
D
Prior to conducting research, nurse researchers must have their research protocols approved by which of the following bodies? A) The American Nurses Association B) The U.S. Department of Health and Human Services C) The journal in which the researchers plan to publish their results D) An institutional review board
D
Professional nursing organizations review clinical practice guidelines to ensure that interventions are recommended for safe practice. Which group is an example of an organization that would be responsible for publishing that information? A. The Emergency Nurses Association (ENA, n.d.a) B. The American Nurses Association (ANA) C. Putting Evidence into Practice (PEP) D. The Institute for Emergency Nursing Research (IENR)
D
The hospital management is concerned about feedback regarding long waiting times for treatment in the emergency department and forms a committee to resolve the issue. Which should be the first task by the leader of the committee to solve the problem? A. Ask the director of operations for solutions. B. Collect baseline data to determine if a problem exists. C. Reevaluate emergency room waiting times. D. Form a Continuous Quality Improvement team to define the desired outcome.
D
The manager wants to know how a staff nurse supports the use of evidence-based practice (EBP). Which response best reflects the staff nurse's misperception about a barrier to implementing EBP? A. "I've taken extra patients almost every night this month—I can't handle the thought of adding one more thing to my to-do list." B. "I think what we're doing now works just fine—why fix what isn't broken?" C. "I've been picking up a lot of extra shifts—I'm too busy to take on another work-related responsibility." D. "I'm not certified in research, and I don't have time to take a course right now—EBP is outside my scope of practice."
D
The middle school teacher is researching topics in Healthy People 2020 to incorporate evidence-based resources in the school's health program. Which topic would be the most appropriate for the nurse to research? A. International transmission of disease B. Sickle cell disease C. Breast cancer D. Obesity prevention
D
The nurse describes the three components of evidence-based practice (EBP) that support what they do every day. The first component is the knowledge gained in practice and the second is the research evidence. Which item should the nurse identify as the third component? A. Nursing school training B. Nurses' beliefs of the system C. Ability to act quickly D. Preferences of the patient
D
The nurse is caring for a client who requires extensive wound care. The client has consented to participate in a nursing research study regarding the wound care. Which client statement indicates understanding of the research goal? A) "This research will not influence my care." B) "Nursing care is based solely on research." C) "I will be paid to participate in the research project." D) "I will be helping to validate nursing care."
D
The nurse is caring for a client with a chronic disease process. The client tells the nurse he recently read an article about funding for the National Institute of Nursing Research (NINR). He then asks the nurse why the U.S. Congress would fund such an organization. Which response by the nurse is most appropriate? A) "The government is looking to the NINR for information about promoting health." B) "Funding the NINR is one cause of health cost increases in the country." C) "The government is interested in preventing chronic disease." D) "Nursing research is focused on prevention and health promotion, which will decrease healthcare costs."
D
The nurse is caring for a pregnant patient and is interested in evidence-based practice (EBP) resources for both the mother and the infant after birth. Which source should the nurse consider? A. Journal of the American Psychiatric Nursing Association B. Journal of Nursing Education C. Journal of Gerontologic Nursing D. Healthy People 2020
D
The nurse is developing a clinical question that explores the etiology of adult respiratory distress syndrome (ARDS). Which clinical question is the most appropriate? A. How does ARDS affect arterial blood gas values? B. What are some potential complications of ARDS? C. Which medications lead to best outcomes for patients with ARDS? D. What are the causes of ARDS?
D
The nurse is discussing the research process with colleagues who have an interest in learning more about this process. How should the nurse describe a high-yield source? A. A source that can only be found via the internet B. A source that can document high volumes of data C. A source full of opinion D. A reputable source with valuable data
D
The nurse is part of a Continuous Quality Improvement (CQI) team measuring the number of times a patient's blood pressure is incorrect due to a defect. Which defect should the nurse and team define in such a situation? A. Blood pressure is taken when the patient is seated. B. Blood pressure is taken with the patient's legs uncrossed. C. Blood pressure is taken on the nondominant arm. D. Blood pressure is taken with the wrong size cuff.
D
The nurse is preparing a training program to introduce quality management. Which information should the nurse include? A. Staff satisfaction surveys will be used to track the effectiveness of changes. B. Staff will plan in silos. C. Programs will be staff focused. D. The purpose is to improve the experience of patient care, population, and value.
D
The nurse is providing an in-service on evidence-based practice (EBP). When asked what barriers the nurses experience daily related to EBP, one nurse states that they are so busy and overloaded already. Which resource should the nurse suggest to counteract this barrier? A. "Join a journal club." B. "Learn how to do a critical appraisal of evidence." C. "Revisit your scope of practice." D. "Utilize the internet to access practice guidelines."
D
The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A) Shorter breaks B) Ordering extra supplies C) Replacing licensed with unlicensed personnel D) Decreasing staff when the census is low
D
The nurse manager is explaining evidence-based practice (EBP) and how staff nurses should look at their daily work to ensure they include EBP. Which statement made by the nurse demonstrates understanding? A. "I should research a few internet sites." B. "I should ask my coworker to tell me which are based on EBP." C. "I should review my job description." D. "I should evaluate my daily actions and calculate which are based on EBP."
D
The nurse manager's review revealed that the increased number of nursing hours was associated with reduced patient mortality. Which nursing-sensitive indicator area, as it relates to quantity or quality, should the nurse understand to be reflected by this review? A. Quality of structure related to quality of outcome B. Quantity of structure related to quality of process C. Quality of structure related to quantity of process D. Quantity of structure related to quantity of outcome
D
The nurse working in a blame-free environment provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error, and the nurse files a report about the medication error. Which action by the risk management team should the nurse anticipate? A) Taking disciplinary action B) Reporting to the board of nursing. C) Monitoring all nurses on the unit. D) Suggesting system changes to prevent future errors
D
Which best describes the desired outcome of decreased readmission rates? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care
D
Which federal initiative contains the three broad aims of better care, healthy people/healthy communities, and affordable care? A) National Database of Nursing Quality Indicators B) Patient Safety and Quality: An Evidence-Based Handbook for Nurses C) National Patient Safety Goals D) National Quality Strategy
D
While participating in a continuous quality-improvement program, a nurse is reviewing medical records to determine the time of first postoperative ambulation of clients who had abdominal surgery. In which type of quality audit is the nurse participating? A) Outcome B) Structure C) Strategic Planning D) Process
D
While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. Which sentinel event is this action intended to prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly oversedated D) The removal of the wrong arm
D
Your new organization is committed to quality patient care. Which of these are considered characteristics of quality health care? A) The nurses use evidence-based research to guide care delivery. B) The nurses are respectful and responsive to their clients' individual preferences. C) The nurses perform an independent double check when administering chemotherapy medication. D) All of the above
D
In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes. B) Compare outcomes to benchmarks. C) Identify areas for improvement. D) Analyze current protocols of care and associated outcomes. E) Implement changes to improve outcomes. F) Analyze client outcomes to determine effectiveness of changes.
D B C A E F
Sentinel event
Joint Commission term for an unexpected event with death or serious injury, or the risk of death or serious injury
Utilization review
analysis of the use of resources to identify overuse, underuse, and misuse
Evidence
clinical knowledge, expert opinion, or information resulting from research
Standards
established models of high-quality performance
Background questions
general questions that seek more information about a topic, such as diseases or medications (fill gaps in knowledge)
PICOT
helps to define and formulate a clinical question that will contribute to EBP. (Population, or Problem, Intervention, Comparison, Outcome, Time Frame)
Qualitative research
investigates a question through narrative data that explores the subjective experiences of human beings and can provide nursing with a better understanding of the patient's perspective
Foreground questions
narrower in focus and are about a specific clinical issue. Useful for finding nursing interventions that improve patient outcomes
Root Cause analysis
problem solving to identify the root cause of faults or problems
Risk management
process by which vulnerabilities are identified and changes made to reduce adverse patient outcomes and liability
Institutional Review Boards (IRB's)
review research protocols and ensure that such protocols adhere to ethical standards
Nursing clinical research
seeks answers to questions that will ultimately improve patient care
Evidence-based nursing
seeks, considers, and synthesizes the combination of the best available research evidence, the nurse's own clinical experience, and each patient's cultural values and personal preferences to provide individualized, optimal nursing care appropriate for the patient at the point of care
Informed consent
study volunteers have a legal right to full disclosure of the study's purpose, required procedures, length, expectations, risks, and possible benefits before consenting to participate
Translational research
systematic approach of converting research knowledge into applications of healthcare for improved patient outcomes
Nursing research
use of a systematic and strict scientific process to analyze phenomena of interest to all areas of nursing, including practice, education, and administration
Evidence-based practice (EBP)
used to form a bridge between research (a formal, systematic way of answering a question or approaching a problem), and nursing practice
Quantitative Research
uses precise measurement to collect data and analyze it statistically for a summary and a description of the resulting findings or to test relationships among variables
Total quality management (TQM)—
using data and statistics to improve systems processes
Research participants
volunteers for a specific study project who meet all the inclusion criteria, have been informed of all aspects of the study, and have given informed consent
Quality Improvement
systematic and continuous actions to improve services and health status of targeted patient groups
Peer Review
professional critique of a colleague's work using predetermined standards performance improvement—quality improvement is directly linked to the performance of an individual, team, unit, or organization
Outcomes management
use of patient experiences to guide improvement
Which regulatory body should the nurse identify as defining the nursing scope of practice? A. State board of nursing B. American Medical Association C. The Joint Commission D. National League for Nursing
A
After taking a new medication, a patient developed an allergic reaction and died. Which term should the nurse use to describe this event? A. Medication error B. Sentinel event C. Adverse drug event D. Drug incident
C
Benchmarking
comparing outcomes to outcomes of leaders in high-quality care
Quality assurance
data are collected and analyzed with benchmark standards to determine if standards are being met
Quality management
evaluation of medical and nursing processes as compared to accepted standards to correct problems and prevent errors
Audit
examination of records to verify accuracy and proper use
Retrospective audit
examination of records to verify accuracy and proper use after a patient's discharge
The nurse is discussing the purpose of a just culture. Which information should the nurse include? A. Balancing the blame-free environment with appropriate accountability B. Balancing the blame-free environment with discipline C. Balancing quality with justice D. Balancing discipline with accountability
A
The nurse failed to give a medication to a patient at the right time. Which type of scenario should the nurse understand this demonstrates? A. Breach of care B. Standards of care C. Sentinel event D. Risk management
A
Continuous quality improvement (CQI)
customer-driven process for continuous flow of improvements to provide quality health care that meets or exceeds expectations
Breach of care
same as breach of duty. Nurse deviates from the standard of care
Outcome standards
standards focus on the performance of a process
Indicator
statistic that reflects organizational performance
Plan-Do-Study-Act (PDSA)
steps to create a total quality management project process standards—standards focus on the steps to lead to a particular outcome
Which factor would help target health promotion in a patient through a genomic standpoint? A. Community resources B. Availability of new medications C. Family history D. Common vaccines
C
The Continuous Quality Improvement (CQI) team is reviewing customer satisfaction surveys to pinpoint common themes before giving the data to a task force. On which step in the Define-Measure-Analyze-Improve-Control model of Six Sigma is the group addressing? A. Define B. Assess C. Implement D. Measure
A
Which scenario describes an adverse medication event? A. While waiting for a surgery, a patient stops breathing and resuscitation attempts fail. B. The patient's tongue swells and breathing is difficult after taking a new medication. C. The nurse is late with the patient's medication by 1 hour. D. The nurse gives the patient the wrong medication.
B
Blame-free environment
healthcare providers can report errors or near misses without the fear of punishment
Breach of duty
same as breach of care. Nurse deviates from the standard of care
The nurse midwife is researching best practices for pregnant women as presented in Healthy People 2020. Which national health goal for the care of pregnant women does this report include? A. Decreasing mortality rates among pregnant women B. Reducing the occurrence of cesarean births for women at high risk of complications C. Evaluating the various types of infant formula available D. Documenting the rate of pregnancy-related complications
A
The nurse is defining a "safe" healthcare system. Which criterion must the nurse include? A. Safety meets the Occupational Safety and Health Administration (OSHA) guidelines. B. Patient injuries are avoided from the care that is intended to help them. C. There is less than 2% of patient falls per month. D. There is a gradual decrease of patient-related incidents.
B
The nurse is conducting a class about research methods to colleagues. The nurse asks, "What is the difference between qualitative and quantitative research?" Which participant response is the most appropriate? A. "Qualitative research does not use the scientific method." B. "Quantitative research uses precise measurement to collect data and analyze it statistically." C. "Quantitative research explores individuals' subjective experiences." D. "Qualitative research is used to test relationships between variables."
B
A nurse researcher is preparing to give a presentation about evidence-based practice (EBP) to a group of nursing students. Which of the following statements would be appropriate for the nurse researcher to include in this presentation? A) "EBP focuses solely on research-based evidence, and it assumes that best practices for nursing care exist independent of client preferences." B) "EBP involves integrating research evidence, the nurse's own clinical expertise, and client values and preferences." C) "EBP is sometimes also referred to as translational research." D) "EBP is typically only associated with complex nursing tasks, such as preparing clients for surgery and monitoring for adverse effects." Answer: B
B
The nurse is discussing evidence-based practice (EBP) with a colleague and explains that it is the manager's responsibility to direct them in EBP, but that has not happened. How should the colleague respond? A. "The manager is deficient by not providing this information." B. "The use of EBP is the responsibility of each individual nurse." C. "The healthcare provider is a great resource for that training." D. "EBP is not widespread at their facility, so it is not that important."
B
The nurse is discussing the six aims of improvement in healthcare systems. Which term should be used to describe the goal of avoiding patient injuries from the care that is intended to help them? A. Patient-centered B. Safety C. Equitable D. Efficient
B
The nurse is evaluating the effectiveness of changes made to improve quality of care. Which procedure is the nurse conducting? A. Quality management plan B. Quality assurance C. Total quality management D. Continuous quality improvement
B
The nurse is explaining the meaning of equitable care. Which explanation should the nurse include? A. Avoiding injuries to patients from the care that is intended to help them B. Care that does not vary in quality because of personal characteristics C. Reducing wait times that may result in harmful delays for those who receive and give care D. Care that is respectful of and responsive to individual patient preferences, needs, and values
B
The nurse is preparing a presentation of the major goals of the National Database of Nursing Quality Indicators (NDNQI). Which goal should the nurse include? A. To assist nurses in reducing medication errors B. To use data to help nurses and other leaders to improve the quality of care C. To identify patient safety goals every year D. To determine the root causes of sentinel events
B
The nurse is presenting a proposal to the board of directors regarding the impact of staffing on quality care. Which data point should the nurse include in the presentation? A. Limiting nursing hours helps to control costs. B. Increased nursing hours are shown to decrease patient mortality. C. Nursing skill does not correlate to patient outcomes. D. Readmission rates do not necessarily correlate with increased nursing staff.
B
The research committee is meeting to discuss the next step in their proposed study that was just given the yellow light. In beginning their research, which type of study would elicit the strongest evidence related to the hierarchy of research when considering the gold standard? A. Opinions of reviewers B. Quasi-experimental studies C. Individual studies D. Large, randomized, controlled studies
D
The nurse is reviewing the legalities that surround a research study the patient is considering. Which patient statement demonstrates understanding of the process of informed consent? A. "I will not know the length of the study prior to participating." B. "I have to have permission from the healthcare provider to withdraw from the study." C. "I can withdraw from the study at any time." D. "Once I begin the study, I must complete it."
C
A 72-year-old bedridden patient has extensive contractures of the legs and is a resident of a local nursing home. Which statement by the nurse relates to a national goal for the care of older adults from the Healthy People 2020 report? A. "This patient will be tube fed." B. "This patient is vitamin deficient." C. "This patient may quickly develop pressure ulcers." D. "This patient is at risk for infection."
C
A nurse educator is interacting with a group of nurses who are working toward their graduate degrees. The members of the group are interested in replication studies. Which of the following replication studies would be most appropriate given the changing demographics in the United States? A) A study examining the ability of families to adapt to acute health problems B) A study examining how effective use of supplies affects the cost of care C) A study examining the ability of an aging population to care for itself D) A study examining how new technology affects client care
C
A nursing preceptor is working with a novice nurse on a medical-surgical unit. During client care, the novice nurse shares an evidence-based wound care technique that is being used with much success. Which of the following is being encouraged when the novice nurse shares this information with the preceptor? A) Use of trial and error to gain knowledge B) Use of existing unit modes of care C) Use of new knowledge gained through research D) Use of medical knowledge to perform care
C
A specialty trauma center is adopting the concept of Plan-Do-Study-Act to improve their quality and productivity. Which quality assurance program should the nurse identify that the organization is trying to adopt? A. Continuous Quality Improvement B. Quality management C. Total Quality Management D. Lean Six Sigma
C
Nurses are providing care that does not vary in quality due to personal characteristics such as gender, ethnicity, or geographic location. Which term most accurately describes the type of care the nurses are providing? A. Efficient care B. Patient-centered care C. Equitable care D. Culturally competent care
C
The nurse manager for a medical-surgical nursing unit is talking to a group of nursing students. The nurse manager is explaining the types of nursing research studies that are conducted on the unit. Which statement by the students indicates understanding of the nature of nursing research? A) "Nursing research does not include nursing education or nursing leadership." B) "Nursing research does not include the study of nurses themselves." C) "Nursing research impacts nursing by adding knowledge and changing nursing practice." D) "Nursing research is used to enhance medical treatment."
C
The nurse on the research committee agreed to complete a literature review for evidence as part of the team's study. Which statement by the nurse demonstrates understanding of the first step in this process? A. "I will write a proposal to management." B. "I will write a hypothesis." C. "I will look for scientific elements in this journal article." D. "I will read all articles related to the desired outcome."
C
The nurse preceptor is reviewing with a new nurse how to compare the nursing process to the process of evidence-based practice (EBP). Which statement by the preceptor describes the difference in the processes? A. "The nursing process deals with a specific clinical question, while EBP deals with the patient's holistic needs." B. "The nursing process only focuses on the patient, while EBP focuses just on a process." C. "The nursing process deals with the patient's holistic needs and EBP deals with a clinical question." D. "The nursing process is constantly evolving, while EBP is concrete."
C
The nursing team is using statistics that reflect the organization's performance in a specific area to compare the quality of care within the organization to industry standards. Which activity is the team performing? A. Root cause analysis B. Auditing C. Benchmarking D. Risk management
C
A client in the clinic is being asked to participate in a research study. The client asks why a nursing research study is necessary given that research on this subject has already been published by the American Medical Association (AMA). Which of the following responses should the nurse offer in reply to the client's question? A) "This study is useful because it supports the medical profession." B) "This study is useful because it validates nursing through medical research." C) "This study is useful because it supports products used in nursing care." D) "This study is useful because it validates nursing care, not medical care."
D
Which of the following resources would be of least value to a nurse who hopes to employ evidence-based practice (EBP) in support of the Healthy People 2020 objectives for pregnant women? A) A research study linking regular exercise during pregnancy with a reduced likelihood of cesarean section B) A report from the American Congress of Obstetricians and Gynecologists describing best practices for screening for gestational diabetes C) A document from the National Institutes of Health describing newly identified benefits of receiving vaccines during pregnancy D) A report from the American Cancer Society regarding changes in the recommended schedule for mammograms
D
A nurse is planning a research project comparing the use of fingerstick blood glucose testing with the use of alternative sites for adult male clients. Which elements of the PICOT formulation of the clinical question still need to be defined? Select all that apply. A) People B) Issue C) Comparison D) Outcome E) Time
D E
