Med-Surg- Ch. 1

Ethics is:

"a theoretical and reflective domain of human knowledge that addresses issues issues and questions about morality in human choices, actions, character, and ends."

The nurse is appointed to a hospital committee whose goal is to "improve the safety of nursing practice." Which areas of practice are included in the committee's task? (Select all that apply) A: Attentiveness/surveillance of clients B: Mandatory reporting C: Medication administration D: Participation in professional organizations E: Prevention of errors or complications F: Teaching clients about their care regimens

A, B, C, and E

When transferring a client who was admitted with chest pain from the emergency department (ED), which information is essential for the ED nurse to communicate to the nurse on the medical-surgical unit? Select all that apply. A: "The client is being admitted for ongoing monitoring of pain and vital signs." B: "The client has private insurance and is also covered by Medicare." C: "Nitroglycerin and morphine sulfate were given to relieve the pain." D: "Frequent reassurance is needed because the client has a high anxiety level." E: "The client has a family history of heart disease and hypertension." F: "A coronary arteriogram should be scheduled as soon as possible."

A, C, D, E, and F

Which nursing actions possess a high risk for contributing to error and patient harm? (Select all that apply) A: Caring for several unstable patients who require complex nursing and medical interventions B: Requesting the assistance of another staff member to turn a patient C: Administering cardiac medications before assessing vital signs D: Preparing medications while trying to answer a students questions about lab results E: Recognizing a patient's change in mental status but assuming that it is transitory F: Taking a verbal order over the phone from a health care provider regarding a patients code status

A, C, D, E, and F

Which tasks should the nurse delegate to unlicensed assistive personnel? (Select all that apply) A: Turn the patient every 2 hours B: Evaluate the patient's skin during bathing C: Feed patient breakfast and lunch D: Assist patient with morning care E: Take and record the patient's vital signs F: Discontinue IV infusion

A, C, D, and E

The nurse educator is instructing newly hired registered nurses about patient-centered care. Which competency categories are included in this content? A: Attitudes B: Environments C: Judgement D: Knowledge E: Skills F: Values

A, D, and E

Which health care workers are likely to be members of a rapid response team? (Select all that apply) A: Critical care nurse B: Respiratory therapist C: Phlebotomist D: Social worker E: Intensivist F: Pastoral caregiver

A,B, and E

The nursing student has been assigned to the hospital's Rapid Response Team (RRT). Which statement by the student indicates a correct understanding of the RRT member's purpose? A: "I will be caring for clients in the hospital." B: "I will be riding along in the hospital's ambulance." C: "I will be admitting clients to the hospital." D: "I will be participating in Code Blue resuscitations."

A: "I will be caring for clients in the hospital."

Which occurrence would be considered a sentinel event? A: A 23-year old post partum woman is admitted for abdominal pain and dies of sepsis B: A 69-year old man has a cardiac arrest in the cafeteria and is admitted to intensive care C: A 5-year old is admitted for injuries and the father admits to repeatedly beating the child D: A 28-year old man commits vehicular homicide and is accompanied by police to the hospital.

A: A 23-year old post partum woman is admitted for abdominal pain and dies of sepsis

Which patient is MOST LIKELY to experience inequality in health care? A: A 73-year old transgender female who is asking for directions to the public restroom B: A 56-year old woman who has liver failure and wants to be on the transplant list C: A 34-year old man seeking treatment for a broken wrist sustained by falling from a motorcycle D: A 17-year old female who wants pregnancy test but is unaccompanied by a parent

A: A 73-year old transgender female who is asking for directions to the public restroom

According to ethical principles, which patient has been provided social justice? A: A Patient with no health insurance receives the same care as all other patients B: Patient gets a bath and a back rub at the exact time the nurse promised C: Patient decides what will be included in the advanced directives D: Patient agrees with the nurse's advice to eat a healthy and balanced diet

A: A Patient with no health insurance receives the same care as all other patients

When developing a standardized plan of care for clients with a diagnosis of pneumonia, how does the nurse find the best information about providing optimal nursing care? A: Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia. B: Research the most recent articles in nursing magazines that discuss care for clients with pneumonia. C: Review the chart to determine what primary health care provider's prescriptions are frequently written for clients with pneumonia. D: Survey experienced RNs about which nursing actions are effective when caring for clients with pneumonia.

A: Access a website that reports on randomized controlled studies on nursing care for clients with pneumonia.

A previously stable postoperative client on the medical-surgical unit now has a blood pressure of 88/40 mm Hg and a heart rate of 124 beats/min. After placing the client in Trendelenburg position, which action does the nurse perform next? A: Activate the Rapid Response Team. B: Call for a Code Blue. C: Determine the cause of the changes. D: Re-check the vital signs in 5 minutes.

A: Activate the Rapid Response Team.

Which action does the nurse take first when preparing to do discharge teaching for the 73-year-old client who is being discharged after prostate surgery? A: Ask what the client knows about self-care after prostate surgery. B: Have family members available during the teaching. C: Provide written information about postdischarge care. D: Plan to teach early in the morning after the client has eaten.

A: Ask what the client knows about self-care after prostate surgery.

Which important aspect of coordinating care within the interdisciplinary team is facilitated by use of the "SBAR" and "PACE" procedures? A: Communication B: Implementation C: Policymaking D: Protocol development

A: Communication

Bedside computers are an example of informatics used in health care primarily for which purpose? A: Documenting interdisciplinary care B: Enhancing collaboration and coordination of care C: Offering clients access to e-mail and the Internet D: Retrieving data for evidence-based practice

A: Documenting interdisciplinary care

Which nursing activity is best for the charge nurse on the medical-surgical unit to delegate to staff members who are unlicensed assistive personnel (UAPs)? A: Feeding a client whose hands are affected by rheumatoid arthritis B: Increasing the oxygen flow rate for a client who has wheezes C: Positioning a client who has just returned from hip surgery D: Taking vital signs for a client who is having acute chest pain

A: Feeding a client whose hands are affected by rheumatoid arthritis

Which of these hospital staff members will the nurse manager assign to coordinate the discharge of a client who will need community-based rehabilitation services after a traumatic injury? A: The nurse responsible for the client's case management B: The physical therapist who developed the client's exercise program C: The health care provider assigned as the client's medical resident D: The unit-based RN who has cared for the client during the hospital stay

A: The nurse responsible for the client's case management

Teams and Teamwork:

Apply relationship-building values and the principles of team dynamics to perform effectively in different team roles to plan and deliver patient-/population-centered care that is safe, timely, efficient, effective, and equitable.

Attribute of Clinical Judgement:

Assessment: noticing Analysis: interpreting Planning/Implementation: responding Evaluation: reflecting

______________ is also referred to as self-determination or self-management.

Autonomy

The nurse is asked to collaborate with others to implement an interdisciplinary plan of care for a client. Which health care team members are essential for the client's daily care regimen? (Select all that apply) A: Anesthesiologist B: Case manager C: Health care provider D: Occupational therapist E: Chaplain

B and C

Which principal nursing actions best support a focus on client safety? (Select all that apply) A: Client restraints B: Handwashing C: Preoperative checklists D: Respect for others E: Five rights of drug administration

B, C, and E

Which nursing action demonstrates use of the principle of justice? A: A 32-year-old client is prevented from falling during the initial postoperative period following her hysterectomy. B: A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer. C: An 82-year-old client is provided access to the hospital Patient Advocate for processing of a complaint. D: The parents of a 13-year-old are included in discussions about the course of their teen's treatment and care.

B: A 67-year-old client with dementia is shown the same respect as his 47-year-old roommate with prostate cancer.

What is the BEST way for the nurse to assess the patient's understanding after teaching? A: Have the patient teach important points to the family B: Ask the patient to repeat back the information C: Quiz the patient on relevant points of the information D: Repeat the important points to the patient

B: Ask the patient to repeat back the information

Which nursing action BEST exemplifies the concept of patient centered care? A: Uses sterile technique to establish a peripheral IV catheter B: Assess patient's values and attitudes about advanced directives C: Checks the patient's vital signs compares them to baseline values D: Administers breathing treatments according to the scheduled time

B: Assess patient's values and attitudes about advanced directives

Which role of the medical-surgical nurse is demonstrated when writing a plan of care for a client who is newly admitted to the hospital? A: Advocate B: Caregiver C: Communicator D: Educator

B: Caregiver

Which nursing action exemplifies the goal of case management in an acute care setting? A: Making sure the patient's dietary choices meet prescribed nutritional needs B: Coordinating inpatient and community based care before discharge C: Monitoring the patient's vital signs and noting trends of change over time D: Reviewing the patient's hospital bill for accuracy and any excessive charges

B: Coordinating inpatient and community based care before discharge

The nursing student asks the supervising nurse whether a certain fall protocol used on the nursing unit is effective. To demonstrate effectiveness, what does the supervising nurse identify? A: Information about how to implement a fall protocol and what nurses need to document B: Data about the number of falls after the protocol was introduced compared with previous fall rates C: The number of clients who currently have a fall protocol in place D: National statistics about the use of fall protocols to prevent serious injury from falls

B: Data about the number of falls after the protocol was introduced compared with previous fall rates

The nurse has recently been assigned to a medical-surgical clinical rotation. According to the scope of medical-surgical nursing, what type of client assignments does the nurse expect to see? A: Hospitalized children with acute and chronic illnesses B: Hospitalized adults with acute and chronic illnesses C: Older adults in a nursing home D: Working adults in a corporate setting

B: Hospitalized adults with acute and chronic illnesses

An older client who has had a total hip replacement will be transferred to a rehabilitation center for continuing care before going home. The Joint Commission, along with National Patient Safety Goal standards, mandates communication between hospital nurses and other providers to ensure adequate transition management. Which aspects of this client's care plan are most important for the nurse to communicate to the rehabilitation center care team? A: Third-party payer information B: Pain medication needs C: Primary care provider D: Medical history of osteoarthritis

B: Pain medication needs

For which circumstance would the nurse alert the rapid response team? A: Patient newly diagnosed with multiple organ failure B: Patient has difficulty breathing and intense chest pain C: Patient in severe pain ordered medication is not available D: Patient is threatening to leave the hospital against medical advise

B: Patient has difficulty breathing and intense chest pain

_______________ encourages the nurse to to good for the patient.

Beneficence

Which occurrence does The Joint Commission's National Patient Safety Goals designate as a high risk issue? A: Being exposed to infectious diseases in the workplace B: Violating privacy of a patient's confidential information C: Administering medication that is not familiar to the nurse D: Failing to review patient's food allergies before serving meals

C: Administering medication that is not familiar to the nurse

When using the Situation, Background, Assessment, Recommendation (SBAR) method of communication, the nurse would include which information in the B section? A: Recommend finger-stick glucose monitoring B: Patient states that he feels dizzy and lightheaded C: Admission diagnosis is new-onset Type 2 Diabetes D: Blood pressure is 130/90 mm Hg; Heart rate is 89 beats per minute

C: Admission diagnosis is new-onset Type 2 Diabetes

Which situation is an example of a nursing intervention that addresses the Institute of Medicine/Quality and Safety Education for Nurses (IOM/QSEN) health care disparities competency? A: Nurse recognizes that the patient's mannerisms are sexually offensive B: Nurse administers pain medication as scheduled, before the patient requests it C: Nurse listens sensitively while a lesbian patient talks about discrimination D: Nurse advises an abused woman about legal protection, such as a restraining order

C: Nurse listens sensitively while a lesbian patient talks about discrimination

TeamSTEPPS is another effective way to promote safety, it stands for:

CUS words: I'm concerned, uncomfortable, or don't feel like this is safe Check backs: restate what a person says for verification Call outs: shout out important information out loud for other team members to hear at one time Two-challenge rule: state concern twice, if ignored, follow chain of command for reporting

________ _______________ is the deliberate organization of and communication about patient care activities between two or more members of the health care team (including the patient) to facilitate appropriate and continuous health care to meet that patient's needs.

Care coordination

The ________ ______________ is in charge of care coordination and discharge planning (usually nurse or social worker).

Case manager

Interprofessional Communication:

Communicated with patients, families, communities, and other health professionals in a responsive and responsible manner that supports a team approach to the maintenance of health and treatment of disease.

____________ ___________ is a part of relational inquiry and practice and is valued in Canada as a major attribute in professional nursing.

Cultural safety

Which type of evidence would be rated HIGHEST on a level of evidence scale? A: A nurse researcher studies a select number of nutritional factors among childhood B: A nurse teacher randomly selects children from a walk-in-clinic and describes their daily dietary intake C: A nurse researcher studies selected children with specific dietary needs and instructs them about nutritious meals D: A nurse researcher conducts a meta-analysis of all randomized and controlled dietary studies among children

D: A nurse researcher conducts a meta-analysis of all randomized and controlled dietary studies among children

The nurse is working in the intensive care unit. When does the nurse call the Rapid Response Team (RRT)? A: An 87-year-old client awakens confused, then reorients quickly. B: A newly admitted client requests pain medication. C: A postoperative client's dressing has bloody drainage. D: A postoperative client's blood pressure suddenly drops.

D: A postoperative client's blood pressure suddenly drops.

An older patient, who was treated for a hip fracture, is being discharged from the hospital and transferred to a long-term care facility. What would be included in managing the transition of this patient? A: A list of the patient's valuables and property that were at the hospital B: Available balance of Medicare benefits after hospital costs are covered C: Family's preferences regarding advanced directives and living will D: Discharge care instructions related to the hip fracture and surgical site.

D: Discharge care instructions related to the hip fracture and surgical site.

The nurse supports the client and family in deciding on a "Do Not Resuscitate" order. Which ethical principle that guides nursing clinical decision making is demonstrated in this situation? A: Beneficence B: Justice C: Legality D: Self-determination

D: Self-determination

___________________ is the process of transferring to a competent person the authority to perform a selected nursing task or activity in a selected patient care situation.

Delegation

Medication reconciliation includes:

Drug name, dose, frequency, route, and purpose.

A culture of safety provides an environment of blaming to improve care in high-risk, error-prone health care organizations using interpersonal collaboration. (True or False)

False; Create a blame-free environment to improve care.

Showing respect for the patient and family's preferences and needs is not essential to ensure holistic or "whole person" approach to care? (True or False)

False; It is essential.

The majority of medical-surgical patients in most health care settings are younger than age 65? (True or False)

False; Most are older than 65-years.

The nurse coordinates inpatient and community-based care before discharge from a hospital or other facility. (True or False)

False; The case manager does this.

The nurse is never accountable for the task or activity that is delegated. (True or False)

False; the nurse is always accountable

___________ refers to the agreement that nurses will keep their obligations or promises to patients to follow through with care.

Fidelity

FOCUS-PDCA Model:

Find a process to improve Organize a team Clarify the current process Understand variations in current process Select the process to improve Plan the improvement Do the improvement Check for results Act to hold the gain

______________ __________________ is a formal evaluative process in which the patient in which the patient's actual current medications are compared to his or her prescribed medications at the time of admission, transfer, or discharge to identify and resolve discrepancies.

Medication reconciliation

_______________ emphasizes the importance of preventing harm and ensuring the patient's well-being.

Non-maleficence

Plan-Study-Do-Act:

Plan: Identify and analyze the problem Do: Develop and test an evidence-based solution Study: Analyze the effectiveness of the test solution, including possible further improvement Act: Implement the improved solution to positively impact care

SBAR Method of Communication:

Situation- what is happening Background- relevant background info Assessment- analysis of the problem or need Recommend/Request- what is needed or desired

_________ _____________ refers to the equality and fairness; that is all patients should be treated equally and fairly, regardless of age,gender identity, sexual orientation, religion, race, ethnicity, or education.

Social Justice

___________________ is guidance or direction, evaluation, and follow-up by the nurse to ensure that the task or activity is performed appropriately.

Supervision

The best source of evidence is research. Which type of research is of the highest level?

Systematic reviews or integrative or meta-analysis studies . The researcher conducts this research through literature search for appropriate studies and then analyzes findings of those studies to determine which best practices answer the research question.

________________ _________________ involves safe and seamless movement of patients among health care settings, health care providers, and the community for ongoing care to meet patient needs.

Transition management

Electronic mail (E-mail) should not replace face-to-face and phone communication. (True or False)

True

Family-centered care is used to emphasize the importance of including the patient's support system as part of the inter-professional collaboration process? (True or False)

True

Healthcare organizations receiving medicare/medicaid funding are obligated to follow the evidence-based interprofessional Core Measures to ensure best practices are followed for selected health problems. (True or False)

True

It is important to include questions about gender identity and sexual activity as part of your patients health assessment. (True or False)

True

Medical-Surgical nursing is often times referred to as "adult nursing"? (True or False)

True

Medication discrepancies can cause negative patient outcomes, including re-hospitalization for medical complications. (True or False)

True

Patients want to have their basic physical care and comfort needs met? (True or False)

True

The Joint Commission requires that health care organizations create a culture of safety. (True or False)

True

The Joint Commission requires that healthcare organizations create a culture of safety by following the National Patient Safety Goals. (True or false)

True

The National Academy of Medicine emphasize the need for all health care agencies to place the patient and their family at the center of the inter-professional team? (True or False)

True

The largest use of informatics in healthcare is the Electronic Health Record. (True or False)

True

The purpose of the case management process is to provide quality and cost-effective services and resources to achieve positive patient outcomes. (True or False)

True

Role-Responsibilities:

Use the knowledge of one's own role and those of other professions to appropriately assess and address the health care needs of patients and populations served.

____________ the nurse is obligated to tell the truth to the best of his/hers knowledge.

Veracity

Values/Ethics for Interprofessional Practice:

Work with individuals of other professions to maintain a climate of mutual respect and shared values.

Five Rights of Delegation

a) Right Task b) Right Circumstance c) Right Person d) Right Direction/Communication e) Right Supervision

Hospitalist is:

family practice physician or internist employed by the hospital.

Intensivist is:

physician who specializes in critical care.

Rapid Response Teams are for:

saving lives and decreasing the risk for harm by providing care before a medical emergency occurs by intervening rapidly when needed for patients who are beginning clinically to decline.

Sentinel event is:

when there is a severe variation in the standard of care that is caused by human or system error and results in avoidable patient death or major harm. - A reportable event (TJC requirement) in which serious adverse events take place.