Healthcare Economics, Organizations, and Policy Adaptive Quiz

The nurse is entering a patient's data in the electronic health record. What action should the nurse take to minimize ambiguity and confusion? 1 Use consistent, codified terminology. 2 Record the data in the patient's presence. 3 Enter the data in the patient's native language. 4 Upload scanned copies of the patient's records

1 An electronic health record is a patient's official digital health record, and is shared among multiple facilities and agencies. Therefore, the nurse must use consistent, codified terminology to eliminate ambiguity and confusion. Recording the data in the presence of the patient will not help another health care professional understand the data. Health care providers review electronic health record for continuing a patient's treatment; therefore, the nurse should enter patient data by using a clear codified scheme, not in the patient's native language. The nurse should not upload scanned copies of patient records, as others may not understand the nurse's handwriting and may get confused.

How are profits used in a for-profit healthcare organization? 1 Profits are paid out to shareholders. 2 Profits are used to buy new equipment. 3 Profits are used to build additional facilities. 4 Profits are invested in improving healthcare services.

1 Healthcare organizations can be classified as for-profit and not-for-profit, based on how the profits are distributed. In a for-profit organization, the profits are generated for the shareholders. In a not-for-profit organization, the profits are used to buy new equipment, build additional facilities, and improve healthcare services.

A patient whose medical expenses are covered under Medicare is hospitalized. Which component of Medicare can be claimed? 1 Part A 2 Part B 3 Part C 4 Part D

1 Medicare is a federal insurance program and consists of four components: Part A, B, C, and D. Part A covers hospital insurance. Part B covers supplemental medical insurance. Part C is Medicare advantage plans. Part D is outpatient prescription drug coverage.

What was the goal of the Executive Order Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator? 1 To develop a nationwide health information technology system 2 To ensure availability of paper health records for all Americans 3 To provide insurance coverage for all of the citizens of America 4 To promote privacy and confidentiality of patient information

1 President George W Bush enacted the Executive Order Incentives for the Use of Health Information Technology and Establishing the Position of the National Health Information Technology Coordinator in 2004. The objective of this order was to develop a nationwide health information technology system. It also aimed to ensure availability of electronic medical records for all Americans by 2014. The Executive Order did not aim to provide medical insurance to Americans; this was enacted by the Patient Protection and Affordable Care Act. The Health Insurance Portability and Accountability Act was enacted to promote the privacy and confidentiality of patient information.

A patient with diabetes mellitus experiences a sudden fall in blood glucose levels while travelling by air. The patient is not carrying any medications or a copy of a personal medical record. Which type of health information technology would be beneficial for this patient? 1 Personal health record (PHR) 2 Electronic medical record (EMR) 3 Clinical health care informatics 4 Regional health information organization (RHIO)

1 The PHR is an electronic health record which consists of health data and the treatment provided for the patient. The patient can enter the data and maintain these health records. It is easy to carry and helps health care providers provide treatment in emergency conditions. Health care facilities maintain an EMR for each patient. The patient does not have access to these records in the air. Clinical health care informatics seeks to transform patient health by educating and training health care professionals. It does not help to provide emergency treatment to the patient while travelling. RHIO oversees the exchange of patient's information among the patient's health care providers and across geographical areas.

The nurse is interacting with a postpartum patient who has undergone vaginal delivery. The nurse finds that the patient believes that she has received high-quality care in the health care facility according to Meade. Which patient response supports the nurse's conclusion? 1 The patient thanks the nurse for providing extraordinary service. 2 The patient is happy that she had no postpartum complications. 3 The patient thanks the nurse for discharging her within 72 hours after delivery. 4 The patient promises to follow all the suggestions given by the primary health care provider.

1 The meaning for quality differs for individuals based on their perception. According to Meade, when health care professionals provide extraordinary services to patients, they believe that they have received high-quality care. The primary health care providers may consider high quality to be providing cost-effective treatment to the patient without any complications. Usually, postpartum patients would be discharged 2-3 days after delivery if they undergo vaginal delivery without any complications. Therefore, the patient may not be happy with a long hospital stay. If the patient promises to follow all the suggestions given by primary health care provider, then it indicates that the patient would adhere to the treatment regimen. It does not mean that the patient believes that she has received high-quality care in the hospital.

The registered nurse observes a new graduate nurse caring for patients on a geriatric unit and concludes that the new graduate is providing patient-centered care. Which action by the new graduate led to the registered nurse's conclusion? 1 The new graduate maintains eye contact with the patients. 2 The new graduate provides food according to the patients' preferences. 3 The new graduate spends more time with patients who have few visitors. 4 The new graduate avoids holding the patients' hands while interacting with them.

1 The nurse should consider the patient's preferences, needs, and values to provide patient-centered care. Therefore, when the student nurse provides food according to the patient's preference, it indicates that the nurse is providing patient-centered care. The nurse should treat the patient with respect and dignity to provide patient-centered care. The elderly patients may feel disrespected if the nurse maintains eye contact with them. The nurse should spend the same amount of time with all the patients to provide equitable care. If the nurse spends more time with the patients who have few visitors, the nurse has less time to spend and interact with the other patients. To provide therapeutic touch to the patient to reduce anxiety and to comfort the patient, it is appropriate for the nurse to hold the patient's hand during interactions.

A patient who underwent open heart surgery died 2 days after the surgery due to septicemia. Which tool will the nurse use to determine the cause of the patient's death? 1 Root cause analysis (RCA) 2 Plan-do-study-act (PDSA) 3 Failure mode effective analysis (FMEA) 4 Computerized physician order entry (CPOE)

1 The root cause analysis (RCA) is an error prevention management tool that helps prevent sentinel events. Septicemia usually occurs when health care professionals do not follow hygiene procedures during the surgery. The sentinel events are the medical errors that lead to patient's death. Therefore, the nurse would use RCA to find the cause of the patient's death. Plan-do-study-act (PDSA) is a quality plan. It does not help in detecting an error. Failure mode effective analysis (FMEA) helps identify the cause for near-miss and adverse events. Computerized physician order entry (CPOE) is a health information technology that helps in maintaining the record of medication prescribed for the patient.

A group of nursing students can utilize which websites to find codes for nursing diagnoses, interventions, and outcomes of endocrine diseases as a part of an assignment? Select all that apply. 1. NANDA International 2. Clinical Care Classification 3. International Classification of Nursing Practice 4. Nursing Interventions Classification 5. Nursing Outcomes Classification

1, 2, & 3 The American Nurses Association has recognized a few terminologies that provide codes for nursing diagnoses, interventions, and outcomes for various diseases. NANDA International (www.nanda.org) classifies and provides codes for nursing diagnoses. The Clinical Care Classification (CCC) system (www.sabacare.com) provides codes for nursing diagnoses, interventions, and outcomes. The International Classification of Nursing Practice (ICNP; www.icn.ch/icnp.htm) provides codes for nursing diagnoses, interventions, and outcomes as well. Therefore, the student would refer to these three websites to get the codes for diagnosis. The Nursing Intervention Classification (NIC) system (http://www.nursing.uiowa.edu/cncce/nursing-interventions-classification-overview) provides codes for interventions, and Codes for Nursing Outcomes Classification are available at (http://www.nursing.uiowa.edu/cncce/nursing-outcomes-classification-overview). Therefore, the student would not get codes for nursing diagnoses by using these websites.

A nursing instructor is teaching a group of nursing students about sentinel events. What is appropriate to include in the education? 1 A sentinel event causes moderate harm to the patient. 2 A sentinel event is undesirable and largely avoidable. 3 A sentinel event's impact is mitigated by interventions. 4 A sentinel event is very common in hospital settings.

2 A sentinel event causes severe, undesirable, and avoidable harm or even death to the patient. It causes severe harm to the patient, whereas an adverse event causes moderate to severe harm to the patient. The impact of near-miss events can be mitigated by various interventions. Sentinel events are not common in hospitals; they should be ideally rare.

A nurse's co-worker approaches the nurse to inquire about the test results of a friend that is being cared for by the nurse. How should the nurse respond? 1 Answer the questions softly so other people will not hear. 2 Decline to discuss the friend's medical condition. 3 Give the co-worker the name of the client's health care provider, so the co-worker can contact the provider instead. 4 To provide reassurance, tell the co-worker of the friend's test results that are within normal limits.

2 All client health information in this situation is confidential, regardless of the relationship of the employee to the client. Therefore declining to discuss this information and suggesting visiting the client is the best response. It is especially important that answering any questions regarding the client's status or test results, including names and room number, not be discussed in public places to maintain the client's right to confidentiality. The client's physician should also follow the same procedure regarding discussion of a client.

Which statement best describes the mission of a community hospital? 1 To educate health care professionals 2 To provide general medical and surgical services 3 To provide end-of-life services to patients and families 4 To provide health care services to military members

2 Each health care organization has a unique mission or purpose. The mission of a community hospital is to provide general medical and surgical services to the nearby community. The mission of the health care organization of the US Department of Defense is to provide health care services to military members. The mission of a hospice is to provide end-of-life services to patients and families. The mission of a research and teaching hospital is to educate health care professionals.

A nursing instructor states that hospitals should operate like high-reliability organizations (HROs). What should the nursing student infer from this statement? 1 HROs operate in a conducive environment. 2 HROs have a low incidence of adverse events. 3 HROs allow transparency of information. 4 HROs help create effective organizational policies.

2 High-reliability organizations (HROs) are those that have very few incidences of adverse events. The hospitals should also strive to take measures to reduce potential errors. This low incidence of adverse events is possible despite operating under hazardous conditions. Any organization can be transparent, not specifically HROs. HROs may have effective policies, but do not help other organizations in creating them.

What is the subset of clinical health care informatics? 1 Clinical informatics 2 Nursing informatics (NI) 3 Public health informatics 4 Clinical research informatics

2 NI is the subset of clinical health care informatics. NI is a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. Clinical health care informatics is a subdomain of clinical informatics. Public health informatics is one of the major domains of informatics that uses computer science and technology to improve public health. Clinical research informatics is a subdomain of clinical informatics.

A nurse is involved in an international committee to address global health problems. What suggestion is most appropriate for the nurse to make to best meet the challenge associated with a potential emerging influenza pandemic? 1 Stockpile antibiotics. 2 Establish a global surveillance plan. 3 Limit vaccination programs to school-age children. 4 Initiate vaccination programs during the months of August and September.

2 Surveillance and containment are the first lines of defense against outbreaks of infectious disease . While it is important to have adequate supplies of antibiotics to treat illness, antibiotics do not prevent illness; vaccines should be administered to protect vulnerable populations. Vaccines should be used to protect all vulnerable populations such as older adults, immunocompromised individuals, those with chronic medical conditions, those caring for individuals at high risk, and health care providers, not just children; some influenza vaccines are not administered to children younger than 5 years of age. Most vaccination programs inoculate clients during the months of October and November in preparation for the influenza season, which is generally from November through March.

A nurse administrator needs to assess the quality of health care delivered in the hospital. What is the most important prerequisite for measuring health care quality? 1 To prepare nurse performance evaluation forms 2 To collect all the medical records of the hospital 3 To review all the incident reports documented 4 To implement the root cause analysis tool

2 The most important prerequisite for assessing the quality of health care delivery system is to collect the medical records of the patients admitted and discharged from the hospital. The process of care provided to the patients and the outcomes of care are the most important determiners of health care quality. The nurse performance evaluation forms should be prepared to assess the clinical skills and knowledge of the nurses working in the health care system. The incident reports document the adverse events that have occurred in a hospital due to medical errors. These alone do not predict the health care quality provided in a health care system. The root cause analysis tool only helps find the cause of sentinel events that have occurred in the hospital.

Which terminology system should the nurse use to enter nursing diagnoses, interventions, and outcomes in electronic health records? 1 Omaha system 2 Perioperative Nursing Data Set (PNDS) 3 Nursing Interventions Classification (NIC) 4 North American Nursing Diagnosis Association (NANDA) International

2 The nurse should use clear a coding scheme while recording data in electronic health records, as it helps to prevent confusion and ambiguity. The PNDS provides codes for nursing diagnoses, interventions, and outcomes of treatment. The Omaha system provides codes for problem classification, intervention, and a problem rating scale for outcomes. NIC provides codes only for interventions. NANDA International provides codes only for nursing diagnoses.

The nurse reviews various standardized terminology before entering patient data in the electronic medical record. What is the purpose of this review? 1 To store patient information properly in order to apply for Medicaid incentives 2 To ensure that patient information is meaningful to other health care professionals 3 To allow the nurse to retrieve the information the next time it is needed 4 To ensure that patients can understand information within the electronic health record

2 The use of standardized terminology is important for communicating care delivered to the patient and exchanging health information with the health care team. Therefore, the nurse should use standardized terminology to make the patient's information meaningful to other health care professionals. In order to store the patient information, the nurse must know how to use the software involved in the electronic medical record. Use of standardized terminology does not help in retrieving patient information from the hospital database. Standardized terminology helps in proper exchange of health care information among the health professionals. Standardized terminology is not well understood by the patient.

A health care worker is collecting data on the quality of health care provided in a health care center. The health care worker finds that too many nurses are attending to a single patient. What does the health care worker conclude from this? 1 The nursing team is not providing safe care. 2 The nursing team is not providing efficient care. 3 The nursing team is not providing effective care. 4 The nursing team is not providing patient-centered care

2 Too many nurses attending to a single patient indicates that the work that can be performed by a few nurses is being performed by many nurses. This indicates that the nursing team lacks efficiency. The inability of the nursing team to avoid injuries in the patient indicates that the nursing team is unable to perform safe care. The inability to address the problems of the vulnerable groups indicates that the nursing team is unable to provide effective care. The inability to address all the problems of the patient while providing care indicates that the nursing team is unable to provide patient-centered care.

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

2 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 patients. 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.

Which organization assists in establishing policies related to Medicare and Medicaid payment for meaningful use of EHRs? 1 National Institute of Health (NIH) 2 American Medical Informatics Association (AMIA) 3 Center for Medicare and Medicaid Services (CMS) 4 Health Information Management Systems Society (HIMSS)

3 CMS rules specify how health care facilities and providers make meaningful use of the EHRs and technologies in order to receive payment from Medicare and Medicaid. The National Institutes of Health uses translational bioinformatics for medical research. The American Medical Informatics Association and the Health Informatics Management Systems Society have been involved in identifying nursing informatics competencies.

The nurse is providing care in a multi-specialty hospital. Which nursing action is indicative of a failure to provide equitable care to patients? 1 The nurse treats all males and female patients alike. 2 The nurse maintains direct eye contact while talking to patients. 3 The nurse provides preferential treatment to patients from low economic status. 4 The nurse asks a female nurse to attend to the patient according to the patient's wishes.

3 Equitable care refers to providing care without any bias in terms of religion, ethnicity, or socioeconomic status. The nurse believes in providing treatment first to people from low socioeconomic background. This indicates that the nurse is biased toward poor people and has failed to provide equitable health care. Treating both males and females alike indicate that the nurse is providing equitable care. Maintaining firm eye contact indicates that the nurse is exhibiting therapeutic communication with all patients. The nurse asks another female nurse to attend to the patient according to the patient's wishes. This indicates that the nurse respects the patient's decision and tries to implement it.

A nurse is teaching a community health class about the risk factors for cancer. Which factor has the least influence in predisposing an individual to cancer of the larynx? 1 Air pollution 2 Heavy alcohol ingestion 3 Inadequate dental hygiene 4 Chronic respiratory infection

3 Inadequate dental hygiene may predispose a person to oral infections but is involved only remotely in laryngeal neoplasms because of the anatomic relationship of the oral cavity and the larynx. Irritation by air pollutants may initiate tissue changes that can lead to malignancy. Alcohol is an irritant that may initiate tissue changes that result in a malignant neoplasm. Tissue alterations caused by repeated microbiologic stress may result in a malignant neoplasm.

What is the advantage for the nurse practitioner working in a Federally Qualified Health Clinic (FQHC)? 1 The nurse practitioner is able to formulate health policies. 2 The nurse practitioner has better access to higher education. 3 The nurse practitioner is able to receive a higher rate of reimbursement. 4 The nurse practitioner is able to provide care to underserved populations.

3 Nurse-managed centers can be reviewed and designated with Federally Qualified Health Clinic (FQHC) status. A nurse practitioner working for a FQHC is eligible to receive a higher rate of reimbursement. Health policies are created via a public decision-making process; FQHC status is unrelated to this process. Likewise, access to higher education is unrelated to working in a FQHC. Nurse-managed centers provide care to underserved people irrespective of FQHC status.

What is an example of private indemnity health insurance? 1 Medicare 2 Medicaid 3 Blue Cross Blue Shield Association 4 State Children's Health Insurance Program

3 Private indemnity health insurance is purchased as a group policy by an employer for its employees or by an individual themselves. The Blue Cross Blue Shield Association is an example of private indemnity health insurance provider. Medicare is a federally funded program. Medicaid and State Children's Health Insurance Program are state programs.

How does the International Classification of Nursing Practice (ICNP) help nurses deliver effective care to patients? 1 It gives information about medications and their side effects. 2 It provides information about various cultural practices and beliefs. 3 It provides vocabulary to include nursing data in computerized information systems. 4 It helps the nurse to conduct biosurveillance and gives information on various diseases.

3 The American Nurses Association recognizes the International Classification of Nursing Practice (ICNP) as standardized terminology for nursing. It provides vocabulary to include nursing data in computerized information systems, such as the electronic health record. ICNP is not a drug guide, so it does not provide information about medications and their side effects. ICNP does not give information on cultural practices and beliefs. Unlike public health informatics, ICNP does not help to develop new tools and methodologies for conducting biosurveillance.

The nurse working in a cardiac center is preparing to enter patient data using health information technology. The nurse needs to refer to this data during subsequent follow-up visits. Which type of record should the nurse use to enter the patient's data? 1 Personal health record (PHR) 2 Electronic health record (EHR) 3 Electronic medical record (EMR) 4 Regional Health Information Organization health record (RHIO)

3 The EMR is a patient's health record within a health care provider's facility. These records are not intended to be shared between multiple facilities and agencies. The PHR is self-recorded and maintained by the patient. An EHR is an individual's official, digital health record; it is shared among multiple facilities and agencies. RHIO health records are patient records that can be exchanged among providers and across geographic areas.

During an initial survey in a health care facility, members of The Joint Commission (TJC) find that the facility does not follow regulations for seclusion set by TJC. What will be the possible consequence of this negligence by the health care facility? 1 The organization has to pay a large-dollar-amount to TJC. 2 The organization cannot provide treatment to psychiatric patients. 3 The organization will receive a condition-level deficiency certificate. 4 The organization will not receive funding from Medicaid and Medicare.

3 The Joint Commission (TJC) sets high quality standards for providing quality care to patients. It evaluates the performance of the health care organizations based on these standards. If an organization fails to meet these standards, the TJC gives a condition-level deficiency certificate to the organization. The organization need not pay a penalty and stop treating psychiatric patients after the initial survey. TJC would give time to the members of health care organization to improve the quality of care and to follow the regulations. If the organization fails to clear a condition-level deficiency after the second survey, then the organization may not receive funding from Medicaid and Medicare.

A geriatric patient with hypertension and diabetes mellitus is taking propranolol (Inderal) and insulin (Humulin N) therapy. Which interventions by health care professionals help prevent patient medication errors according to the Leapfrog Group? 1 Scheduling regular follow-up visits 2 Prescribing low dosage of medication 3 Using computer physician order entry 4 Closely monitoring the patient for 24 hours

3 The Leapfrog Group suggests using computer physician order entry (CPOE) to prevent medication errors. CPOE provides immediate information to the primary health care providers and nurses about the medications prescribed to the patients and helps prevent drug interactions and adverse effects. Scheduling regular follow-up visits helps prevent the side effects of the medication, but not medical errors. The Leapfrog Group does not suggest the dosage guidelines for geriatrics. Therefore, the Leapfrog Group does not prescribe low dosage of medication. Closely monitoring the patient for just 24 hours will not help prevent medication errors, drug interactions, and other adverse effects.

The research nurse is conducting genomic analyses of patients with acquired immune deficiency syndrome (AIDS) to identify new biomarkers for AIDS. Which computational method would the nurse use for these analyses? 1 Nursing informatics 2 Public health informatics 3 Translational bioinformatics 4 Consumer health informatics

3 Translational bioinformatics optimizes the biomedical data and genomic data into predictive health. Therefore, the nurse would use translational bioinformatics for a genomic analysis and to identify new biomarkers for AIDS. Nursing informatics helps to use computer and information science to manage patient data. It does not help analyze and use genomic data for developing new drugs and screening methods. Public health informatics helps to develop tools for conducting biosurveillance. Consumer health informatics analyzes consumer needs and helps the health care provider to provide effective care according to the patient's perspective.

According to Avedis Donabedian, which is the most important validator of quality and effectiveness of health care in a hospital? 1 The number of patients admitted in a hospital 2 The values and goals presented by the hospital 3 The number of health care workers in the hospital 4 The patient outcomes achieved by the care provided

4 Avedis Donabedian was a physician and founder of the Donabedian model of care. According to him, the patient outcomes obtained by health care delivery determines the quality and effectiveness of the health care. The number of patients admitted to a hospital does not indicate the quality of the health care delivered in the hospital. The values and goals presented by the hospital define the quality of the medical system. Similarly, the number of health care workers in the hospital does not determine the quality or effectiveness of the health care system.

The nurse is caring for a patient diagnosed with a rare genetic disorder. Which domain of informatics would the nurse use to gather information about this condition to provide good quality patient care? 1 Public health informatics 2 Clinical research informatics 3 Translational bioinformatics 4 Clinical health care informatics

4 Optimal health care can be delivered only if the clinician has in-depth knowledge of the patient's condition. The nurse uses clinical health care informatics for gathering information about the patient's condition. Clinical research informatics uses computer and information science to discover new knowledge relating to health and disease. Public health informatics uses information technology for improving the health of populations. Translational bioinformatics refers to the development of storage, analytic, and interpretive methods to assess the proactive, predictive, preventive, and participatory health of a population.

The student nurse is reviewing the electronic health record for patients in a health care facility. Which action by the student nurse may inhibit patients from disclosing personal information? 1 Use of patients' data for nursing research 2 Use of patient data for Medicaid payment 3 Discussing a patient's illness with the patient 4 Sharing patients' data with family members

4 Patients may not want their health information shared with others, and may want to maintain their privacy. If the nurse retrieves patient data from the electronic health record and shares it with family members, it may lead to patients not sharing information. The nurse can use patient data for research without mentioning a patient's personal details. The nurse can use patient data for filing insurance to receive Medicaid payments. The nurse can discuss the patient's illness with the patient; doing so helps to understand the patient's perspective and to provide effective care.

The nurse is caring for a patient with breast cancer who is receiving chemotherapy. Which action performed by the nurse is in accordance with the rules of the Centers for Medicare & Medicaid Services (CMS)? 1 Checks the prescription before administering medications to the patient 2 Refers the patient to support systems and provides financial assistance 3 Teaches safety measures to the patient in order to prevent the risk of infection 4 Enters symptoms and treatment provided to the patient in the electronic health record (EHR)

4 The Centers for Medicare & Medicaid Services (CMS) specify how health care professionals should use electronic health records (EHRs) to receive Medicare and Medicaid payment incentives. The nurse should enter symptoms, treatments, and outcomes in the EHR, as doing so helps to claim insurance. The CMS does not provide guidelines to prevent medication errors. The Joint Commission's National Client Safety Rules provides guidelines to prevent medication errors. Therefore, checking the prescription before administering the medication is not in accordance with the rules of CMS. The CMS does not direct the nurse to refer the patient to support systems or to provide financial assistance. The hospital's social worker provides information about support systems and financial assistance. The CMS does not provide guidelines to prevent infection in patients. The Centers for Disease Control (CDC) provides guidelines to prevent patient infections. Therefore, teaching safety measures to the patient in order to prevent infection is not in accordance with the CMS.

A child with hip dysplasia has undergone a closed reduction surgery. The nurse assesses the child 2 days after the surgery and feels that the treatment and care provided for the child were not effective. The nurse made this conclusion based on what findings? 1 The child has a staggering gait. 2 The child is unable to walk independently. 3 The child has impaired muscle tone and flexibility. 4 The child's femoral head did not return to the hip socket.

4 The nurse and health care professionals set realistic outcomes and evaluate them regularly to determine the quality and effectiveness of the treatment. During closed reduction surgery, the surgeon fits the femoral head into the hip socket. If the laboratory reports indicate that the femoral head did not return to the hip socket, it implies that the surgery was ineffective and useless. The child may have a staggering gait for a few weeks after the surgery; this does not indicate that the surgery was ineffective. The child may experience pain after the surgery and may require support to walk. The child will be in a spica cast for 6 months after the surgery and because of this, the child may temporarily lose muscle tone and flexibility. Therefore, these outcomes do not indicate that the treatment was ineffective or useless.

The nurse informatician is designing a protocol in the electronic health record for all patients with indwelling urinary catheters to decrease the risk of urinary tract infections. When developing the protocol, the nurse should follow the steps that are listed in what order? 1. Selects an assessment tool 2. Selects a standardized language 3. Designs the assessment screens 4. Meets with the nursing staff 5. Interviews the nursing staff 6. Adds a decision support rule 7. Evaluates and determines data

4, 1, 5, 3, 7, 2, 6 While designing a protocol, the nurse would first meet with the nursing staff to determine the evidence supporting urinary tract infections in patients with an indwelling urinary catheter. Based on the results, the nurse would select an assessment tool and other data to manage the risk of urinary tract infections. Then the nurse would determine the levels of risk and interview nursing staff to determine the workflow. With this information, the nurse would design the assessment screens, evaluate the results, and determine evidence. The nurse would select the appropriate language to retrieve the data entered the in electronic health record. The nurse would also add a decision support rule to determine the level of risk.

Which are examples of high-reliability organizations? Select all that apply. A Aviation B Air traffic control C Nuclear power plants D Cancer hospitals E State transport agencies

A, B, & C Aviation, air traffic control, and nuclear power plants are examples of high-reliability organizations as they have to operate in hazardous conditions, yet have very few adverse events. Cancer hospitals and state transport agencies are not high-reliability organizations because they do not operate under hazardous conditions.

Which statements best describe a health policy? Select all that apply. A It involves goal-directed decision-making. B It involves governments or other authorized entities. C It involves decision-making on current political issues. D It includes actions, nonactions, decisions, and guidance. E It results from an authorized personal decision-making process

A, B, & D A health policy is a goal-directed decision-making process about health care-related issues. The decision is taken by the government or other authorized entities. It includes actions, nonactions, decisions, and guidance that are related to health care and its delivery. It does not involve decision-making on political issues; rather, it focuses on health care-related issues. A health policy is a result of authorized public decision-making process, rather than decisions made on a personal level.

What are the minor attributes that affect the quality of care provided for the patient by the nurse? Select all that apply. A Equitable care B Timely care C Cost-effective care D Patient-centered care E Sound decision making

A, B, & D Being equitable, being timely, and patient-centered care are the minor attributes that affect the quality of care. Equitability helps the nurse provide similar quality of care to all the patients irrespective of their gender, ethnicity, geographic location, or socioeconomic status. Being timely reduces the wait times and harmful delays in treatment. Patient-centered care helps nurses treat patients with respect and dignity and to make the patient feel comfortable. Cost-effective care and sound decision making are the major attributes that affect the quality of care.

Which patients would be eligible for Medicare coverage? Select all that apply. A A 67-year-old man with pneumonia B A 40-year-old physically handicapped man C A 50-year-old sales executive with a leg fracture D A 75-year-old woman with end-stage renal failure E A 30-year-old irregularly employed woman with appendicitis

A, B, & D Medicare is a federal health insurance program that provides health care coverage for all people ages 65 and older, people who are permanently disabled, and individuals with end-stage renal disease. Therefore, the 67-year-old man with pneumonia, the 40-year-old physically handicapped man, and the 75-year-old woman with end-stage renal failure would be eligible for Medicare coverage. The 29-year-old sales executive with a leg fracture and the 30-year-old irregularly employed woman with appendicitis do not fall into the Medicare category due to their ages and the nature of their conditions.

A group of nurses is preparing strategies to improve the quality of health care provided by the nursing team in the hospital. Which points should the nurse consider while preparing the strategies? Select all that apply. A The nurses should be prepared to deal with events that may cause harm to a patient. B The nurses should determine the root causes of the adverse events. C The nurses should focus chiefly on the process of the care delivery system. D The nurses should ensure that all adverse events are well documented. E The nurses should use failure mode effective analysis to assess the root cause of a sentinel event.

A, B, & D To improve the quality of care delivery, the nurses should be proactive and prepared to deal with any event before it occurs and harms the patient. For improving quality, the nurses should first find out the root cause of the adverse events to prevent them from recurring. Preventing the adverse events would only be possible if these events occurring in the hospital are identified. For this, it is very important that the adverse events are documented properly. To improve health care quality, the nurses should focus on both the process and outcome of the health care delivery system. The root cause analysis tool is used to assess the cause of sentinel events.

The nurse is caring for a patient with diabetes mellitus who is on insulin therapy. After the patient experiences a cardiac arrest, the patient is transferred to the intensive care unit (ICU). Which nursing interventions are the major attributes that affect the quality of care provided to the patient? Select all that apply. A Coordinate with the members of the ICU while transferring the patient B Provide cardiopulmonary resuscitation before transferring the patient C Develop a diet plan according to the patient's food preference D Encourage the patient's family members to visit the patient frequently E Administer digoxin (Cardoxin) to the patient according to the prescription

A, B, & E The major attributes that affect the quality of care are coordinating with the members of different departments during transitions, providing most important services, and acting within the scope of practice. Therefore, coordinating with the members of the ICU while transferring the patient, providing cardiopulmonary resuscitation, and administering digoxin (Cardoxin) are the major attributes. Considering the patient's preference is a minor attribute that affects the quality of care and helps provide patient-centered care. Thus, developing a diet plan according to the patient's food preference is a minor attribute. The nurse should take measures to prevent the risk of infection. Therefore, the nurse should not ask the family members to visit the patient frequently because it increases the risk of infection.

What are the major attributes of quality health care? Select all that apply. A Safe B Timely C Effective D Efficient E Equitable

A, C, & D The attributes of health care can be major and minor. The major attributes are indispensable to maintain the quality of health care and include safe, effective, and efficient care. Health care is said to be of high quality if the care is safe and does not harm the patient. Health care is effective in reaching its patient goals. Health care should be efficient in terms of time, energy, and resources engaged in providing the care. The minor attributes of quality care include timely and equitable care. Timely care helps in preventing errors and avoiding complications. High-quality care is provided to all people who deserve it, irrespective of any discriminating factor.

Which statements are appropriate for a nursing instructor to include when teaching a group of students about high-quality health care? Select all that apply. A High-quality health care is competent. B High-quality health care is expensive. C High-quality health care meets the patient's needs. D High-quality health care involves the minimal use of hospital resources. E High-quality health care meets an established care standard

A, C, & E High-quality health care has different perspective for different people on the health care team. High-quality health care is competent enough to reach the desired patient goals. The objective of high-quality health care is to meet the patient's goals and, in meeting them, to maintain an established standard of care. High-quality health care is not expensive; it is cost-effective and involves the optimal use of hospital resources.

A nurse is teaching about near-miss events to a group of nursing students. What is appropriate for the nurse to include in the education? Select all that apply. Correct A They do not cause actual harm to the patient. B They may cause moderate harm to the patient. C They are caused by impaired immune functioning. Correct D They are caused by a variation in standard care. Correct E Their cause can be analyzed by failure mode effective analysis

A, D, & E The medical errors that cause no harm to the patient are described as near-miss events. These events do not reach the patient and do not cause severe complications because the interventions to avoid them or correct the damage are instituted. They are caused by a variation in standard care. The nurse can analyze the cause of these events by the failure mode effective analysis (FMEA) system while reporting them. Adverse events cause moderate harm to the patient. Such events are caused by the fault of the system or health care professionals. Near miss events are not caused by impaired functioning of the immune system.

The nurse administrator is assessing the quality of health care provided by the nursing team in a health care center using the Donabedian model of care quality. What components should the nurse assess while evaluating the "process" of the health care delivery system? Select all that apply. A Whether the nurses renew their licenses regularly B Whether the nurses work in coordination with each other C Whether the nurses are providing adequate patient education D Whether the facilities are adequate to fulfill the patient's health care needs E Whether the patients are satisfied with the care provided by the nurses

B & C The "process" of health care system according to the Donabedian model of health care quality includes the services offered by the health care system. It also includes the interpersonal relationships between the health care professionals and the adequacy of patient education. Therefore, while assessing the process of the health care team, the nurse administrator should find out whether the nurses are working in coordination with one another. The administrator should also ensure that the nurses are able to impart adequate health information to the patients. The nurse should assess the licenses of the nurses while assessing the structure of the health care system. The administrator should assess the adequacy of the health care facilities while assessing the structure of the health care system. Patient satisfaction is assessed while assessing the outcomes of the health care system.

What are the major attributes of a healthcare organization? Select all that apply. A Structure B Public trust C Unique purpose D Specialized workforce E Organizational environment

B, C, & D There are major and minor attributes of any health care organization. The major attributes include the public's trust, the organization's unique purpose, and the specialized workforce. Every health care organization has a unique purpose based on its mission. Every health care organization enjoys a level of public trust in serving the community. An organization may also have a specialized health care workforce to carry out its services. Minor attributes include structure and organizational environment. The structure refers to a collective form of rules and policies for effective operation of the organization. The organizational environment consists of the internal and external environments.

Which agencies have the power to implement Medicare and Medicaid reimbursement? Select all that apply. A Institute of Medicine (IOM) B The Joint Commission (TJC) C National Committee for Quality Assurance (NCQA) D Community Health Accreditation Program (CHAP) E Accreditation Commission for Health Care (ACHC) F The National Database for Nursing Quality (NDNQI)

B, C, D, & E The Joint Commission (TJC), National Committee for Quality Assurance (NCQA), Community Health Accreditation Program (CHAP), and Accreditation Commission for Health Care (ACHC) are the agencies that have the power to implement Medicare and Medicaid reimbursement. These agencies provide regulatory oversight and provide accreditation of health care organizations. The Institute of Medicine is an advisory body. It conducts studies and provides unbiased and authoritative advice to provide high-quality care and improve the nation's health. The National Database for Nursing Quality (NDNQI) provides research-based comparative data and helps the registered nurses in providing high-quality care to the patients. These two agencies are not the regulatory bodies and do not have the power to implement Medicare and Medicaid reimbursement.

The nurse recognizes that which advisory bodies aim to improve the quality, safety, efficiency, and effectiveness of health care? Select all that apply. A The Joint Commission (TJC) B Institute of Medicine (IOM) C National Quality Forum (NQF) D National Center for Nursing Quality (NCNQ) E Centers for Medicare & Medicaid Services (CMS) F Association for Healthcare Research and Quality (AHRQ)

B, C, D, & F Institute of Medicine (IOM), National Quality Forum (NQF), National Center for Nursing Quality (NCNQ), and Association for Healthcare Research and Quality (AHRQ) are the advisory bodies. They aim to improve the quality, safety, efficiency, and effectiveness of health care. The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) are the regulatory bodies that aim to improve the quality of care.

The nurse is teaching the benefits of electronic health records (EHRs) to patients in a community health care center. What would be appropriate for the nurse to include in the education? Select all that apply. A The EHR helps to order medications online at a reduced price. B The EHR helps obtain Medicare and Medicaid payments. C The EHR helps to teach about food interactions with various medications. D The EHR helps to share personal health information with selected family members. E The EHR helps provide more accurate diagnoses and treatment in emergency conditions.

B, D, & E An EHR is a computer-based client medical record. It contains the complete health information of a patient and helps with processing insurance claims for payment. The EHR can be secured with a password, so it helps to maintain privacy. Therefore, the patient can share their health information with selected family members. The data can be shared across different health care settings. Therefore, it helps health care providers make an accurate diagnosis and provide immediate treatment to the patient in cases of emergency. The EHR is not an online medical store, so it does not help the patient to order medications. The EHR is not a library of medicines, so it will not provide information on food-drug interactions.

A patient with a right-sided brain tumor had a surgery performed on the left side of the brain. The patient is presently in a coma. Which actions should the hospital take according to the Leapfrog Group's policy? Select all that apply. A Refer the patient to another hospital. B Report the event to The Joint Commission. C Perform a failure mode effective analysis (FMEA). D Apologize to the family and caregivers of the patient. E Agree to pay all costs related to the condition of the patient.

B, D, & E The patient had undergone a surgery at the wrong site. This falls under the "never events" category. According to the Leapfrog Group's never event policy, the health care organization should report the event to The Joint Commission, state-reporting program for medical errors, or a patient safety organization. The organization should apologize for its mistake to the caregiver of the family and waive the entire amount required for the compensation of this never event. The hospital does not need to refer the patient to another hospital for the treatment. The facility should perform a root cause analysis for analyzing the cause of this never event.

Which professional organizations work towards identifying nursing informatics competencies? Select all that apply. A American Nurses Credentialing Center (ANCC) B Centers for Medicare & Medicaid Services (CMS) C American Medical Informatics Association (AMIA) D Health Information Management Systems Society (HIMSS) E Technology and Informatics Guiding Education Reform (TIGER) Initiative

C, D, & E Certain professional organizations aim to bring technological changes and a proliferation of information and knowledge as well as informatics competencies to all nurses. Such organizations include the American Medical Informatics Association (AMIA), Health Information Management Systems Society (HIMSS), and Technology and Informatics Guiding Education Reform (TIGER) Initiative. The American Nurse Credentialing Center (ANCC) provides certification for informatics nurses. The Centers for Medicare & Medicaid Services (CMS) provide reimbursement for medical facilities to people.

The nursing student has enrolled in a Public Health Informatics (PHI) fellowship program. What does the student expect to learn in this program? Select all that apply. A Developing insurance policies B Providing culturally competent care C Designing new tools for biosurveillance D Developing online analytical processing tools E Methodologies for determining outbreak response

C, D, & E PHI is the systematic application of information and computer science and technology to public health practice. This program helps to develop new tools for conducting biosurveillance. It also helps to develop online analytical processing tools for electronic laboratory reporting and methods for determining outbreak response. PHI does not help to develop insurance policies. It does not help to provide culturally competent care, as it does not consider cultural practices.

What are examples of public or population health informatics? Select all that apply. A Dental informatics B Medical informatics C Consumer informatics D Global health informatics E Community health informatics

D & E Global health informatics and community health informatics are examples of public health informatics that help in biosurveillance and determining outbreak response of a disease. Dental informatics, medical informatics, and consumer informatics are examples of clinical informatics.

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

D & E 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 patient. An 18-gauge needle is not an appropriate size needle to insert in a thin, emaciated patient; it would cause unnecessary trauma and a high risk of phlebitis. The nurse should change the intravenous line every 72-96 hours to prevent the risk of infection. The nurse should avoid inserting the catheter in the patient's femur as it increases the risk of bloodborne infections.

What are the stages of the policy process in correct order? This is the correct order 1. Agenda setting 2. Policy formulation 3. Policy adoption 4. Policy implementation 5. Policy evaluation

Health policies are created through a series of sequential steps. The first stage is agenda setting, during which a health-related issue or a problem is identified. This stage involves debating the issue at hand and mobilizing support. The next step is formulating the policy, which involves the creation and consideration of propositions to address the issue. In the policy adoption stage a suitable proposition is selected. The next stage is policy implementation, which involves carrying out the interventions proposed in the policy. The final stage is policy evaluation, and involves determining if the policy was able to achieve the desired goals.