Leadership Week 9

responsibility: creating an environment that minimizes risk for error

joint commisions national patient safety guidelines

A new graduate asks the nurse manager what organization develops the standards of the nursing profession so that the quality of practice can be measured. What is the best response by the manager? a. The American Medical Association (AMA) b. The American Nurses Association (ANA) c. The Joint Commission (JC) d. The Institute of Medicine (IOM)

b. ANA

A nurse manager is implementing the National Patient Safety Goals (NPSG) for the acute care unit. What will the manager have the staff implement to meet these goals? (Select all that apply.) a. Ask the patient about their financial status to determine ability to pay for hospitalization. b. Ensure that urinary catheters are properly secured to promote unobstructed urine drainage. c. When handing off report to other staff, use SBAR format. d. Have patient identify surgical site prior to going to the perioperative suite. e. Check identification bracelet and ask the patient name and date of birth prior to medication administration.

b. c. d. e.

Quality control tools used by the nurse leader include which of the following? a. Outcome audits and structure audits b. Program audits and process audits c. Process audits and structure audits d. Outcome audits and program audits

c. process and structure audits - Process audit allows the nurse manager to assess and measure how nursing care is provided - Structure audit establishes a relationship based on quality care and correct structure. - Both are used by the nurse leader to assess the quality of patient care. - Outcome audits are used to measure goal obtainment

responsibility: report near misses of medical errors

to err is human

TQM (Total Quality Management)

- aka continuous quality improvement (CQI) - individual performing the service is the most informed/empowered to make improvements - focus: problem prevention planning - NOT inspective/reactive

A health care team is implementing the Toyota Production System (TPS) because the facility is having financial difficulty and may have to consider minimizing its workforce. Prior to implementing TPS, what should the team consider? (Select all that apply.) a. The level of staff preparation and involvement that will be required b. How it will change the organization's culture, values, and roles c. How it will allow for problem solving d. The ease with which the transition will take place d. The commitment of time and resources from the facility's leadership

a, b, d Implementing TPS is not easy and usually requires a change in organizational culture, values, and roles since responsibility and accountability for solving problems is decentralized. Eliminating problems at their root is far different from solving an immediate problem at hand. Adopting TPS in an organization requires a substantial commitment of leadership time and resources. It also requires a tremendous amount of staff preparation and involvement.

Total Quality Management (TQM) and Lean say what?

employees impacted by the process changes should suggest improvements (example: nurse leader)

Nurse leaders should understand the criteria or standards that are needed to establish effective quality control process. TRUE FALSE

true

Total quality management is referred to as continuous quality improvement and is used to meet the Healthy People Living 2020 goals. TRUE FALSE

true

A nurse leader is performing a process audit. Which would be a consideration on a process audit? (Select all that apply.) a. Comparing a patient's medication order to the medications the patient has been taking b. Checking the completeness of a patient's medical record c. Ensuring that a patient has access to television in their room d. Assessing the availability of fire extinguishers in patient care areas e. Ensuring that machines are recalibrated according to department policy

a, b, e - measure how nursing care is provided against standard guidelines - Process audits would not include the availability of fire extinguishers in patient care areas nor would they include the patient's access to television because those standards aren't within the nurse's scope of providing high-quality patient care.

The nurse manager of an acute care unit determines the increase in the incidence of medication errors over the last six months and identifies this as a focus area for improvement. What is the next action by the nurse manager? a. Organize a total quality management (TQM) meeting b. Implement action plan c. Assess results d. Identify variations

a. organize a meeting After identifying the focus area for improvement, the nurse manager should organize a TQM meeting with a variety of health care personnel. - Identification of variations, implementation, and assessment of results all are done after the team has met and formulated goals

A chemically impaired nurse has voluntarily entered a state diversion program for treatment. What is the most important function of the diversion program? a. Public safety b. Nurse reentry to practice c. Suspension of impaired nurses d. Treatment for addiction

a. public safety Primary goal of state-run diversion programs: - protect the public through early identification and rehabilitation of impaired nurses. - While suspension may be necessary, it is not always required, particularly if the nurse seeks treatment prior to any overarching patient safety concerns. The program does provide treatment that will hopefully lead to reentry into practice so that the nurse may again provide safe care and not be a threat to public safety.

A nurse leader wants to ensure that the team is always practicing proper hygiene after caring for a patient. A complaint was filed against a nurse for not washing the hands before examining a wound on a child's knee. What is the nurse leader's control criteria? a. Whether the team is practicing proper hygiene b. Why the team is not practicing proper hygiene c. Who on the team is not practicing proper hygiene d. If there are enough hygiene reminders in each patient's room

a. whether the team is practicing proper hygiene she wants to know if they are or are not

The nurse working on a medical-surgical nursing floor should plan to assess which client first? a. A patient with a chest tube treating a spontaneous pneumothorax with continuous bubbling in the suction control chamber. b. A patient who is three days' postoperative for a below-knee amputation (BKA) who is tearful and refusing to get out of bed. c. A patient admitted with renal failure with a previous day's urinary output of 900 cc. d. A patient with diabetes and a MRSA-infected leg wound who is requesting to leave the hospital against medical advice.

c. patient with renal failure with urinary output of 900 cc patient with renal failure has an actual, current problem whose symptom of decreased urine output may suggest worsening renal failure. The patient with MRSA is not a threat to others should they leave the hospital against medical advice. It is normal and expected for a patient with a BKA to experience the various stages of grief (denial, anger, bargaining, depression and acceptance) when dealing with the loss of past body image. Continuous bubbling in the suction control chamber of a chest tube is normal.

An older adult patient fell out of bed 2 days after a hip replacement and had to return to surgery. What process should be done in order to prevent future negative outcomes such as this? a. An audit b. Benchmarking c. Patient outcome evaluations d. Critical event analysis

d. critical event analysis Root cause analysis or critical event analysis helps to identify the process of error and to make sure that it does not reoccur. Benchmarking is the process of measuring products, practices, and services against best performing organizations as a tool for identifying desired standards of organizational performance. An audit would not be appropriate for this grave error since it will only collect the data and not ensure future negative outcomes. Patient outcome evaluations isolate the outcomes that are related to something the nurse does.

Which of the following is considered a nursing leadership role with regard to quality control? a. Establishes measurable patient outcomes b. Selects and uses quality control tools c. Uses findings to determine educational staff needs d. Embraces, supports, and champions the quality improvement process

d. embrace, supports, champions

Several of a nurse's patients over the last few weeks have stated they are not getting any pain medication. However, the nurse has charted medication administration for these patients. What is the nurse manager's best initial action to address the situation? a. Confront the nurse the next time the nurse gets pain medications. b. Call security and have them escort the nurse to the emergency department. c. Stop the nurse in the hallway and ask why these patients are saying they did not get pain medication. d. Gather data on the nurse's behavior, medication delivery, and charting inconsistencies.

d. get your proof!! Step 1: collect as much data as possible prior to confronting the nurse (personal behaviors, time and attendance, checking out of medications and charting inconsistencies, and patient and other nurse reports) AND recording the findings objectively and in writing. Step 2: confront the nurse about the concern of possible narcotic diversion and impairment. (This should be done in a private setting)

After receiving report, which client should the nurse see first? a. A patient who is to receive one unit of packed RBCs today and needs an IV restarted. b. A patient who is scheduled for surgery this afternoon and is requesting a shower. c. A patient admitted with chest pain who has been pain-free since admission and is now requesting breakfast. d. A patient who was admitted with kidney stones and is crying with back pain.

d. pain from kidney stones

The nurse manager may use which quality assurance or performance improvement technique to identify underlying process flaws in the reporting of suspected child or elder abuse? a. Cause and effect b. Root cause analysis c. Small group process d. People at fault process

b. root cause analysis - is a quality assurance or performance improvement technique that is used to identify the underlying root causes of a problem - in this case the lack of understanding of an important process of child/elder abuse reporting - Root cause analysis focuses on process flaws (NOT on people who have erred or made a mistake)

The charge nurse is making assignments for the next shift. Which patient should be assigned to the new graduate nurse who has just successfully completed her unit orientation? a. A 60-year-old who needs teaching about the use of incentive spirometry b. A 38-year-old just admitted on airborne precautions for tuberculosis (TB) c. A 58-year-old with Guillain-Barre syndrome who is ventilator dependent d. A 38-year-old just returned from bronchoscopy with biopsy

a. teaching about incentive spirometer

An older adult patient recently had a hip replacement with an indwelling catheter inserted. The patient developed symptoms of a urinary tract infection (UTI) postoperatively, and the nurse placing the catheter was reeducated by the nurse leader regarding avoidance of UTIs when inserting catheters. Which quality approach did the nurse leader use? a. Quality assurance techniques b. Continuous quality management techniques c. Continuous quality improvement techniques d. Total quality management techniques

a. quality assurance techniques The leader reacted and reviewed proper procedure, which is in keeping with quality assurance. Total quality management and continuous quality improvement are tools that the nurse leader can use to prevent any nurse in the system from making this error in the future. Continuous quality management is not a term used in quality management.

A chemically impaired nurse asks the nurse manager to serve as treatment counselor. What is the nurse manager's best response to the nurse? a. I'm sorry but I can't help you. You need to find help, or you may lose your job. b. It is important that you receive counseling from someone with expertise in this area. Here are some resources we have. c. I am happy that you trust me to assist in your recovery. Let's set up a regular schedule to meet. d. I'm glad you came to me. Let's talk about what has led you to this point and what I can do to help.

b. nurse manager CANNOT be the treatment counselor... but be nice :) DONT MAKE IT AN ENABLING RELATIONSHIP by nurturing them

A root cause analysis (RCA) is a process during which participants: a. Identify the individuals who are at fault in the incident. b. Identify one primary factor that may have contributed to the event c. Include consideration of all relevant literature related to the incident d. Identify risk points before, during, and after the event and the impact on the incident

d. ID risk points before, during, after the incident RCA focuses on an in-depth review of all possible system factors that contributed to an event, exploring one factor at a time. The goal of an RCA is to delve deeper into problems that have occurred to find out the root cause of why the problem occurred. This often means that RCA reveals more than one root cause. The RCA process builds on the idea of risk analysis to identify points where a process could fail.

structure audits

assume that a relationship exists between quality care and appropriate structure - DOES NOT address actual care provided - FOCUS: on resources and environment - Goal: ensure adequate resources are available for patient needs

A health care team has been challenged to determine what other facilities are doing to decrease the number of hospital-acquired infections so that an action plan can be created to decrease the rate in their facility. What will the health care team do to achieve this challenge? a. Patient outcome evaluation b. Root cause analysis c. Benchmarking d. Best practices

benchmarking Best practices are the determination of what type of process produces the best results after gathering information from multiple sources. Root cause analysis or critical event analysis helps to identify the process of error and to make sure that it does not reoccur. Patient outcome evaluations isolate the outcomes that are related to something the nurse does.

A nurse leader is trying to bring about change on the unit. Which intervention is associated with the nurse leader role? a. Reviewing research results upon which to base changes b. Identifying outcomes that support quality nursing care c. Inspiring staff to maintain high standards regarding patient care d. Being aware of the changes in quality control regulations

c. inspiring Being aware of changes in quality control regulations, reviewing research, and identifying outcomes are all management roles.

A nurse educator is providing an in-service on substance abuse among nurses. Which substance does the nurse educator stress is the most frequently abused? a. Oxycodone b. Morphine c. Alcohol d. Meperidine

c. alcohol Meperidine (Demerol) is one of the more common drugs of choice BUT alcohol is #1

After a patient had a negative outcome related to a medical error, the nurse follows the policy for sentinel events. What organization does the nurse recognize monitors the adherence to this type of policy for accreditation? a. Institute of Medicine (IOM) b. American Nurses Association (ANA) c. The Joint Commission (JC) d. Leapfrog

c. joint commission The JC maintains one of the nation's most comprehensive databases of sentinel events by health-care professionals and their underlying causes.

process audits

- measure how nursing care is provided against standard guidelines - task-oriented - documented in patient care plans - medication reconciliation: comparing medication orders to all the medications the patient has been taking

TQM steps

1. ID focus of improvement 2. organize the team 3. diagram the process (of current protocol) 4. ID variations (what would cause to modify protocol?) 5. select improvement strategy 6. implement 7. check results (compare present to past) 8. innovate/restart the cycle (should it be revised or look for other opportunities)

A nurse manager is implementing a quality control tool that is systematic and will allow the official examination of a record for patients with postoperative infections. What type of tool is the nurse manager using to collect and evaluate this data? a. An evaluation b. An examination c. An audit d. A review

c. an audit An audit is a systematic and official examination of a record, process, structure, environment, or account to evaluate performance.

The Institute of Medicine (IOM) would consider which behaviors as an indicator of quality care? (Select all that apply.) a. Nurses taking population-specific classes to keep their professional knowledge updated b. The implementation of a shared governance nursing model c. Nurses returning to school to obtain a baccalaureate degree in nursing d. The use of nationally developed and approved patient education materials e. A hospital requiring annual retraining for all staff in CPR and AED use

a, c, d, e

When a new nurse executive identifies the goal of creating a "just culture" environment in their healthcare organization, the staff understands that such an environment is characterized by a culture where: a. Each department reviews the work processes of another department. b. Constant questioning of the status quo is encouraged to prevent errors. c. The focus is on system processes that caused an error, not on individual blame. d. All team members share culpability for an error committed by one member of the team.

c. focus is on system error not individual each staff member is accountable for understanding and ensuring that all processes and interactions are patient oriented. This shifts the focus away from a punitive or "blaming" culture and moves the focus towards a "middle ground" with health care staff and systems.

The six aims for improving quality health care as directed by the Institute of Medicine include safe, effective, patient-centered, timely, efficient, and _____.

equitable

A nurse leader works at a facility that has total quality management (TQM) as the backbone of its organizational goals and objectives for quality control. Which activity reflects how the leader can practice TQM on their unit? a. Promote teamwork rather than individual accomplishments. b. Explain to the staff that "if it's not broke, don't fix it." c. Develop a quota system for number of patients cared for. d. Encourage employees to think of a unit slogan.

a. promote teamwork >individuality

A nurse manager would like to determine how well the team is doing in terms of meeting the hospital's goal of increased patient satisfaction. What action should the manager take after determining best practices? a. Reevaluate. b. Make a judgment about the quality of the team's work. c. Capture when the team is and is not using best practices and the outcomes. d. Take corrective action.

c. capture when the team is and is not using the best practices and outcomes After collecting and analyzing the data, there is a need to make an action plan to address quality gaps and start the process all over again.

What are the focus areas of the To Err is Human recommendations? (Select all that apply.) a. Identify errors and provide solutions for prevention b. Enhance leadership c. Implement safety systems d. Set performance standards for safety e. Enhance knowledge

all IOM's report To Err is Human addresses the need to educate leaders to enhance leadership roles regarding safety, to implement safety systems within health care organizations with the goal of identify errors, error prevention, and clear expectations of performance standards.

Quality control is the process of being reactive in order to minimize continued risks or hazards. FALSE TRUE

false The quality control process is intended to be proactive (NOT REACTIVE) to create an environment that minimizes the risk from errors.

A nurse is tasked with performing an audit on patients in the long-term care facility who are developing pressure ulcers. After identifying the information relevant to the criteria, what is the nurse's next action? a. Analyze the data b. Make a judgment about quality c. Reevaluate d. Determine ways to collect data

d. determine ways to collect the data criteria, info relevant, how to collect it, collect/analyze it, compare it, judgement, provide info/make changes, reevaluate

A nurse manager is attempting to ensure adequate resources are available in order to meet changing patient needs. What would be the best type of audit for the manager to perform? a. An outcome audit b. process audit c. A quality audit d. A structure audit

d. structure audit - structure audit assumes that a relationship exists between quality care and appropriate structure. It includes resource inputs such as the environment in which health care is delivered. - Process audits are used to measure the process of care or how the care was carried out and assume that a relationship exists between the process used by the nurse and the quality of care provided. - Outcome audit determines what results, if any, occurred as a result of specific nursing interventions for patients.

outcome audit

- determine what results occurred as a result of specific nursing interventions for patients - most valid indicators of quality care - cons: many factors contribute to patient outcomes so it can be difficult to separate what is directly related to the nursing intervention

Health care shifted focus from patient care to issues of cost and quality. FALSE TRUE

true The shift is due to consumer and provider complaints. Errors in health care delivery have resulted in the pressure from stakeholders to increase quality to reduce errors and costs.

quality: using standard quality measurement tools

national quality forum

Nurse leaders need to understand that in order to be effective, the quality control process must be _______. a. Ongoing b. Formative c. Cyclical d. Reflective

a. ongoing

A nurse leader at a long-term care facility wants to determine if vital signs are being checked according to policy. What can the leader do to measure this process of care? a. Patient outcome evaluation b. A critical event analysis c. A process audit d. Benchmarking

c. a process audit A process audit may be used to establish whether fetal heart rate or blood pressures were checked according to an established policy. Root cause analysis or critical event analysis help to identify the process of error and to make sure that it does not reoccur. Benchmarking is the process of measuring products, practices, and services against best performing organizations as a tool for identifying desired standards of organizational performance. Patient outcome evaluations isolate the outcomes that are related to something the nurse does.

A nurse manager is implementing a comprehensive program to prevent the chances of chemical impairment in the work setting. What should the nurse manager include as part of the program? a. Implement mandatory staffing ratios with mandatory overtime as necessary to meet ratios b. Develop a zero-tolerance policy that mandates immediate termination if impaired c. Provide continuing education on substance use and its detection in the workplace d. Train and assign a dedicated narcotic administration nurse for each shift

c. provide continuing education about use and detection nurse manager can create an environment that decreases the chances of chemical impairment by controlling or reducing work-related stressors and providing education on substance use, its detection, and available resources for impaired nurses. Implementing, monitoring, and enforcing policies related to medication distribution may also be effective.

A chemically impaired night shift nurse has completed a treatment program and is returning to the work setting. The nurse manager is reviewing reentry guidelines with the returning nurse. What should the returning nurse expect as part of these guidelines? (Select all that apply.) a. Peer mentoring and support from a successfully recovered nurse b. Consent to random urine screening for drugs and alcohol c. Provide evidence of continued involvement in support groups (e.g., Narcotics Anonymous) d. Give an in-service to unit nurses about his experience in the drug treatment program e. Assignment to the day shift for the first two months after returning to work

a, b, c Some generally accepted reentry guidelines include: (1) no use of psychoactive drugs (2) no assignment to patients with patient-controlled analgesia pumps for up to a year after reentry (3) assignment to the day shift for the first year (only two months is not long enough) (4) being paired with a successfully recovered nurse (5) consent for random drug and alcohol screening (5) providing proof of additional support (e.g., support groups, individual counseling)

A nurse manager who grew up in a home with an alcoholic father suspects an unlicensed assistive person (UAP) of alcohol abuse and possibly coming to work impaired. In order to fairly deal with the UAP, what should the nurse manager consider as an immediate priority? a. Examine personal biases related to chemical and alcohol dependence. b. Call the state board of nursing to inquire about nursing treatment programs. c. Review hospital policies and procedures on chemical impairment. d. Confront the UAP about suspicions of alcohol impairment.

a. i need to put my personal thoughts aside first Once the nurse manager understands these personal biases, it is possible to develop a fair plan of action as opposed to acting out based on these biases. The next steps may then include reviewing hospital policies and procedures regarding chemical impairment as well as state board of nursing treatment program opportunities. The nurse manager will need to confront the UAP about suspected alcohol impairment; however, the nurse manager must address personal biases before such a confrontation occurs.

There are hallmarks that are associated with effective quality control programs. Select those hallmarks from the following list: a. Annual process, community support, organizational support b. Administration support, organizational support, process is ongoing c. Fiscal support, administrative support, annual process d. Organizational support, community support, fiscal support

b. admin support, organizational support, process is ongoing Rationale: Vital to obtaining excellence in quality control programs includes - the need for organizational support from managers/leaders - fiscal and staff resources - goals strive for excellence in the organization - process must be ongoing. There must be evidence of true commitment from all the stakeholders involved at the organization in order to develop and maintain effective quality control program.

Nurse leaders make use of quality control tools to identify various types of errors as outlined by the IOM report. What are some of the most common types of errors reported in today's health care system? Select all that apply. a. Equipment errors b. Diagnostic errors c. Communication errors d. Medication errors e. Spelling errors

a, b, c, d Medication errors are the most common type of medical error and are a significant cause of preventable adverse events. Other common errors may include preventative errors (i.e. failure to provide treatment, inadequate monitoring), treatment errors (errors with performance of peroration, procedure or test, administering treatment, dose or method of drug, delay in treatment, incorrect treatment), diagnostic errors (delay in diagnosis, incorrect diagnostic testing, failure to act on diagnostic results), or other errors such as communication or equipment malfunction. - Spelling errors are not a significant concern for quality control.

A nurse manager suspects a staff nurse of being chemically impaired. Which changes may have prompted the nurse manager to suspect impairment? (Select all that apply.) a. Frequent breaks and leaving the unit without explanation b. Defensiveness related to high frequency of medication errors c. Reports that a patient's pain medication regimen is ineffective d. Increasing absences without adequate explanation e. Frequently volunteering to pull narcotics for other nurses f. Poor handwriting for nursing notes

a, b, d, e Rationale: An impaired nurse will demonstrate changes: - personality - job performance - attendance - use of time - frequent absences/lateness to work - frequent breaks and leaving the unit without explanation - medication errors and be very defensive about those errors - strong interest in narcotics - volunteering to always get these medications for fellow nurses - a pattern of stating that many patients report ineffective pain management (it could signal the diversion of narcotics and impairment) - illogical/poor charting (not handwriting)

Which statement about total quality management is correct? a. It is a process with a definitive endpoint. b. It considers the individual as the focal element on which production and service depend. c. It emphasizes that profit should be considered before quality. d. It involves only a select few employees in an organization.

b. TQM assumes: - production and service focus on the individual - quality can always be better. - It is a never-ending process - everything and everyone in the organization are subject to continuous improvement efforts. - quality is more important than profits, but the resultant increase in quality of a well-implemented TQM program attracts more customers, resulting in increased profit margins and a financially healthier organization.

Lean

- customer focused - eliminate waste/what is not useful to the consumer - requires time commitment of top leader's time and resources - why? requires trainings and buy-in's for all employees - impossible to implement if not everyone is on board - to help the 5 Why's Root Cause Analysis is used:

Audit Process

1. establish control criteria (what do you want to know?) 2. ID the info relevant (know the training required, how often it needs to be renewed, dates of completion) 3. determine ways to collect info 4. collect/analyze 5. compare the collected info with the established criteria 6. make judgement about quality 7. provide info and if necessary provide a corrective action needed 8. reevaluation

What is the final step of the quality improvement process that the nurse leader must complete in order to improve patient care?

evaluation criteria, data needed, how to get the data, get data/analyze data, compare it, judgement, give data/provide solution, evaluation

A patient is planning to have a surgical procedure but is concerned about poor patient care quality at the local hospital, and performed a quality check and comparison of several hospitals. What conglomeration of non-healthcare Fortune 500 companies defined quality measurements to allow consumers to compare hospitals? a. Prevention of Medical Errors, Inc. b. Patient Safety Center c. Leapfrog d. National Quality Forum

leapfrog More info: -Leapfrog is a growing conglomeration of non-health-care Fortune 500 companies that defined quality measurements to allow consumers to compare hospitals. -This group built on the IHI's report cards by informing the public about their four evidence-based standards. -Provide easy-to-understand data on health care quality to all consumers. -Goal is to reduce costs through improved quality and efficiency.

quality: providing easy to understand data on health care quality to all members

centers for medicare and medicaid

The nurse in the emergency department should see which of these four patients first? a. A patient with an elevated temperature, sore throat, and upper respiratory symptoms. b. A patient who cannot bear weight without pain who has a bruised, edematous ankle after playing basketball. c. A patient reporting a headache, photosensitivity, and a stiff neck. d. A patient requesting ice chips for a sore throat and an earache.

c. headache, photosensitivity, stiff neck -The patient reporting a headache, photosensitivity, and a stiff neck has an actual, current problem; the nurse is expected to recall that those symptoms may suggest meningitis. -The patients with a potential ankle injury, sore throat, and upper respiratory symptoms are not as urgent a priority based on the information provided, as well as the knowledge that meningitis is a critical, time-sensitive clinical emergency.

The nurse should plan to see which patient first when planning morning care? a. A 15-year-old who is scheduled for discharge this morning pending teaching regarding prednisone therapy for an allergic reaction. b. An 11-month-old who is receiving oral rehydration therapy for an admission of dehydration with orders to progress to a regular diet. c. A 12-year-old who is 24 hours postoperative from an appendectomy awaiting orders for a full diet and discharge. d. A 12-year-old who was admitted for chemotherapy via a central venous catheter.

d. chemo via a central venous catheter - is a priority ongoing treatment with many associated risks and side effects. - The patient with dehydration taking oral rehydration fluids, the patient requiring prednisone teaching, and the patient post-appendectomy are all stable with no information given that suggests a new or acute problem requiring an immediate assessment.

A new graduate nurse plans to administer early morning medications after receiving change-of-shift report. Which medication should the nurse administer first? a. An antipyretic to a client who has a temperature of 37.9° C (100.7° F) b. A scheduled IV antibiotic for a client who has resolving pneumonia c. An antidiarrheal for a client who had one watery stool in the last hour d. A narcotic to a client who has a pain level of 6 on a 1 to 10 scale

b. scheduled IV abx to a pneumonia patient It is critical for the patient with resolving pneumonia to receive ongoing antibiotics to prevent a relapse. This is the priority as compared to the other clinical situations

A nurse manager discusses with the health care team the importance of performing core measures for the designated areas of implementation. What should the manager be sure to inform the team may be the consequence of noncompliance? a. A 2% reduction in the Medicare annual payment. b. The hospital will lose accreditation by The Joint Commission c. Discontinuation of participation in Medicaid and Medicare. d. A 5% reduction in the Medicaid annual payment

a. 2% reduction in medicare annual payment Hospitals that choose not to participate in the core measures initiative receive a reduction of 2% in their Medicare annual payment. The hospital will not lose accreditation or be denied initial accreditation. The reduction is for Medicare and not Medicaid annual payment.