NUR 45200 Ch. 4 (1-10), 5 (11-19), 7 (20-29), 8 (30-39)
the nurse attends an interprofessional meeting to discuss the care of the pt who is a paraplegic after an MVC. which of the following best describes the purpose of assembling an interprofessional team? A. to provide multiple perspectives to contribute to the pt's care and well-being B. to divide the work appropriately among disciplines C. to ensure that the Dr controls the pt outcomes D. to provide support in the difficult pt care situations
.A.
A nurse is asked how quality, safety, and performance improvement are addressed in an HRO. Which response demonstrates the best understanding? A. "We have an interfprofessionals committe on our unit that looks at pt outcomes, practice issues, and most recently, the # of falls on our unit. Together, we figure out the best way to fix the problem and suggest changes" B. "A couple of nurses got together last night to look at the # of falls on our unit. We are concerned about the problem and think there is a better way to do it" C. "I saw an article about falls on a unit like ours. I took the article to work to show my unit director but she said the solution isn't feasible on our unit" D. "Our fall rates are so high that the PT formed a committee to address the issue and came back to the nursing staff with some recommendations for changes in our care delivery"
A.
Healthcare can learn about high reliability from a variety of other industries. Which of the following statements is false? A. Commercial aviation found that the most common cause of error was mechanical failure B. The Institute of Nuclear Power Operations believes that trust and respect are needed in an HRO C. Human beings can make skill-based, rule-based, and knowledge-based errors D. Commercial Aviation embraced CRM training programs in an effort to enhance communication in the cockpit
A.
Inez, RN, didn't put the bedside rails up on a confused pt. The pt fell and was injured. When there is a connection between the nurse omitting a duty and the damages occurring to the pt, it's an example of which of the following? A. Breach of duty B. Duty C. Causation D. Damages
A.
Leadership plays an important role in creating an HRO. Which of the following statements demonstrates the best understanding of the role of leadership? A. Leaders are accountable for the provision of effective and efficient care while protecting the safety of patients, employees, and visitors B. Leaders must ID system problems and ask employees to fix them C. While fostering a learning environment, leaders must never discipline employees for their behaviors D. Leaders may rely soley on technology to build and reinforce accountability
A.
Which of the following elements is not necessary for a nurse to be found negligent in a court of law? A. A duty or obligation for the nurse to act in a particular way B. A breach of that duty or obligation C. The nurse's intention to be negligent D. Physical, emotional, or financial harm to the patient
A.
following serious med error that resulted in pt injury, a nurse is assigned to a team assembled to investigate the cause. the nurse knows which of the following represents the best method for doing so? A. root cause analysis B. debriefing C. six sigma D. crew resource management
A.
non-english-speaking pt arrives in ED and is noted to be crying quietly. which of the following is the most important for the nurse to consider in initially providing care for the pt? A. expressions and interpretations of caring may be perceived differently across cultures B. therapeutic touch is a universal communication of caring C. cultural competence includes looking pts in the eye and communicating in their language even if through interpreter D. when pts have specific cultural beliefs, nurses should consider them as part of the pt's care.
A.
the nurse is informed that an RRT will be initiated at hospital to better meet needs of pts. which of the following best describes the way in which the nurse should utilize RRT? A. provide support for med-surg nurses and decrease the # of patients arrested requiring an ICU bed B. rapidly move pts through hospital system at time of transfer C. notify attending Dr of pt's deteriorating status D. provide immediate assistance to patients in ICU
A.
the nurse on the oncology unit cares for a pt who frequently comments that she would like better pain control through the night. the nurse tells the pt that a note will be placed on the front of the pt's chart alerting Dr in case the nurse misses the Dr during her rounds. which of the following represents better process to ensure the pt's needs are met? A. nursing rounds B. team huddle C. debriefing D. root cause analysis
A.
Which of the following methods are helpful for assessing the culture of an HRO? Select all that apply. A.Observe the behaviors of employees when they think no one is watching to determine if they are adhering to the policies and expectations of the organization B. Review safety event reports, including near miss, precursor, and serious safety events. C. Use a standard tool to assess the pt safety of the organization D. Assume the culture exists if process improvement activities are underway
A. B. C.
Which of the following external organizations strongly influence hospitals to change to become HROs? Select all that apply. A. CMS B. Magnet recognition by the American Nurses Credentialing Center C. The National Labor Relations Board and Office of Human Subjects Protection D. Accreditation agencies, such as TJC and DNV E. Consumer groups, such as Leapfrog F. Vendors of EHRs
A. B. D. E.
Which statement about an HRO is false? Select all the apply. A. HROs avoid discussing failures B. HROs explore a variety of reasons for errors and are reluctant to simpify explanations C. HROs are aware of the many factors that influence the care environment D. HROs understand that decisions should be made by the highest ranking official E. HROs know that when small things go wrong it is often a sign of a larger problem
A. D.
80 y/o M, lives with son, is brought in because "he just isn't acting right." Physical exam shows pt is malnourished, noncommunicative, and poor hygiene. When you ask pt some questions, he avoids eye contact and doesn't respond. The son is answering questions for the pt and refuses to leave the room. You suspect elder abuse. Choose the most appropriate documentation of situation. A. the pt is very thin and doesn't make eye contact with the nursing or medical staff. it is obvious that he has been abused and neglected by his family. B. pt is thin elderly male who presents to unit wearing clothing that is soiled. he doesn't make eye contact with staff or answer our questions. Social services notified. C. it appears that pt's son manipulates his father by refusing to let his father answer any questions. we suspect elder abuse. D. pt's son states the pt "isn't acting right" the pt doesn't answer questions from staff due to his abuse
B.
A healthcare provider issued a DNR order for your pt, 55 y/o M with cancer. You spoke with pt and he clearly wishes to be resuscitated in the event he stops breathing. What is the MOST appropriate course of action? A. Ignore pt's wishes because healthcare provider ordered DNR B. Consult hospital's policies and procedures, speak to healthcare provider, and discuss matter with your nurse manager C. Attempt to talk the pt into agreeing to the DNR D. Contact the medical licensing board to complain about the healthcare provider
B.
Errors occur when there is a deviation from generally acceptable performance standards. Which of the following is not an example of a generally acceptable performance standard? A. Professional practice standard B. Article published in the Wall Street Journal C. Evidence-based policy D. Evidence-based order set
B.
Many barriers keep healthcare organizations from becoming HROs. Which of the following statements is false? A. Culture, history, and tradition may be a barrier to becoming an HRO B. Information systems always serve as a barrier to creating an HRO C. Workplace intimidation and disruptive behavior cannot be tolerated in an HRO D. The hierarchical roles of physicians, nurses, and organizational leadership creat a challenge to implementing HRO principles
B.
The HIPPA protect which of the following? A. A pt's right to be insured regardless of employment status or ability to pay B. The confidentiality of certain protected health information C. The nurse's right to health insurance D. The hospital's right to disclose protected health information
B.
Which of the following recommendations was not made by the Institute of Medicine's publication To Err Is Human? A. ID and learn from errors B. Avoid talking about errors C. Improve safety D. Ensure safe practice at the delivery level
B.
a nurse is reviewing D/C instructions with pt. pt asks about cardiac meds he forgot to mention to the Dr because the med is not listed on the D/C instructions. which action by the nurse is most appropriate when reconciling D/C instructions? A. explain that pt should follow up with primary Dr within 7 days to review med regimen B. contact Dr. to notify of discrepancy and receive direction regarding the D/C instructions before D/C'ing pt C. instruct pt to take only meds listed on D/C instructions D. advise pt to continue taking med until he sees his primary Dr.
B.
the nurse is transferring a pt from the ICU to the step-down pt care unit. when the ICU nurse calls report to the receiving unit, what is the best way for the nurse to provide the handoff info? A. situation, background, assessment, requirements B. situation, background, assessment, recommendations C. systems, background, activities, recommendations D. systems, background, activities, requirements
B.
when rounding, a nurse discovers isolation pt has soiled bed. pt indicated he did not want to bother the nurse because she was busy. the nurse tells the pt to use the call bell any time. how can the nurse most effectively communicate that she is available to the pt? A. remind pt frequently to use call bell B. ensure all pt's needs have been met before leaving room, avoid appearing rushed, and let pt know when the nurse will return C. go in and out of pt's room to ensure the pts are aware that the nurse is available D. make sure call bell is within pt's reach every time nurse leaves the room.
B.
which of the following processes would best assist the nurse to increase expertise, adjust practice, and improve self-regulation? A. conduct a RCA B. elicit constructive feedback from others C. participate in debriefing D. use the CUS technique
B.
A healthcare provider has ordered you to discharge Mr. Jones from the hospital despite a new temp of 102F. The provider refuses to talk with you about the pt. In this situation, which of the following is an appropriate nursing action? A. Administer an antipyretic medication and D/C the pt B. D/C pt with instructions to call 911 if he has any problems C. Do not D/C pt until you have discussed the matter with your nursing manager and are satisfied regarding pt safety D. D/C pt and tell pt to take acetaminophen when he gets home
C.
Nurse is given a written order by HCP to administer an unusually lg dose of pain medications to a pt. In this situation, which of the following is an appropriate nursing action? A. Administer medication because it was ordered by HCP B. refuse to administer med, and move on to another pt C. speak with HCP about concerns, and clarify whether dose is accurate D. select a dose that you feel comfortable with and administer that dose
C.
The nurse wants to use a pt-centered approach to perform pt care. Which of the following best describe the nurse's approach? A. Developing friendship with pts as a means to providing better care B. creating environment of coworkers committed to helping each other C. providing care through the eyes of the pt D. understanding the nurse's role and its relation to other care providers
C.
You call surgeon for new post-op pt who is bleeding excessively. The pt's BP decreased 20 mmHg, and pulse rate increased 20 beats over past hour. The surgeon's response "Why did you wake me up at 2 AM for this? I am hanging up as I expect a postop pt to be oozing from operative site and these changes are not significant. Just watch him." You are quite concerned about your pt. What will you do next? A. go to nursing station and complain to other nurses about how rude the surgeon was on the phone B. document and quote the surgeon's response in your nurse's notes C. inform surgeon that you do not agree with continuing to just observe this pt and that you are going to initiate the chain of command D. tell the family what the surgeon said
C.
a pt's family is angry about their family member's deteriorating condition and tells the nurse that they are not satisfied with the pt's care. which of the following would be the most appropriate action by the nurse? A. notify hospital administration B. explain to family that pt's condition is complex and that the pt is receiving appropriate care C. convey understanding and notify members of healthcare team so family meeting with team can be provided D. ask family members why they feel that way
C.
nurse manager in surgical step-down unit at large metropolitan hospital would like to evaluate perceived effectiveness of pain management for prior pt on unit. the nurse knows which of the following measures would best assist the nurse manager in understanding past pt's experiences? A. home health compare data B. value-based performance data C. hospital consumer assessment of health care providers and systems (HCAHPS) data D. sentinel event reports
C.
nurse pages Dr due to pt's change in status. when the Dr calls unit, the Dr yells at the nurse for interrupting dinner. which of the following would be the nurse's best approach? A. tell the Dr that she is going to report him to the nursing supervisor B. tell the Dr. that she is doing her job and does not deserve to be yelled at C. refocus the communication on the pt and the reason for the call D. apologize for interrupting the dinner and page his partner
C.
skilled communication is essential to pt safety for which of the following reasons? A. a pt needs to be convinced to receive specific treatment B. nurses need to explain the procedures to pt C. miscommunication is responsible for many harmful events in the hospital D. poor quality is associated with poor communication
C.
A nurse will attend seminar discussing pts with family/SOs at the center for all nursing and interprofessional care services. The nurse knows that which of the following will most likely be primary topic? A. primary care B. medical homes C. interprofessional team approach D. pt-centered care (PCC)
D.
High reliability affects the entire organization. Which of the following statements is false? A. Quality often improves in HRO organizations B. An HRO improves patient and staff safety C. Enhanced communication and reliability helps to increase patient satisfaction in HROs D. Financial performance is negatively impacted in HROs
D.
Select the most appropriate documentation example in the following. A. Pt found covered in stool. The night nurses were too busy to change the bed B. The pt fell because we are short staffed C. The pt's family is difficult and argumentative D. Dr. Bresley notified through medical exchange at 0610 of pt's C/O difficulty breathing. Orders received for oxygen and ABG
D.
a nurse is caring for a pt with multiple chronic conditions and has been hospitalized twice in last month. pt has complex medication regimen, limited family support, and admits to missing last two Dr. appointments due to lack of transportation. what is the benefit of a referral to a health home for this pt? A. Dr's with lower rehospitalization rates operate health homes B. complex cases are managed through skilled nursing facilities until pts are independent again C. home care services are covered for pts regardless of ability to pay D. comprehensive care management enables access to and coordination of care E. none of the above.
D.
a nurse receives a telephone order from a DR for specific x-ray tests. the nurse established the identity of the patient involved and name of ordering DR. which of the following should she do next? A. write the order on the order sheet in the chart B. repeat what DR says and write it down on order sheet C. ask DR to directly place the order with radiology department D. write order on order sheet and perform a read back to the physician to verify order accuracy
D.
the nurse is preparing to review D/C instructions with a pt. the nurse instructs the pt regarding her meds and wound care for her foot. What indicates to the nurse the level of understanding the pt has regarding D/C instructions? A. the pt signs the D/C instruction sheet B. when asked by nurse, pt denies any questions or concerns C. pt asks for new prescriptions for the pharmacy D. nurse observes the pt changing the dressing on her foot wound
D.
pt newly Dx with breast cx is asking in-depth questions about dx and sharing what she found online that has worked for other pts. the nurse recognizes this pt represents growing # of informed healthcare consumers. which intervention by nurse demonstrates support for pt's involvement in her care? A. caution pt about inaccurate info that may be available on internet B. instruct pt to only follow advice of her medical provider C. advise pt to begin building personal health record (PHR) D. explain to pt the importance of reg. checkups to ID any changes in condition E. all of the above
E.
which of the following actions demonstrates understanding of the role of the nurse in pt satisfaction? Select all that apply. A. nurse discusses plan of care with pt and family B. nurse inquires about pt's comfort with room temp and desire for a meal because dinner has already been served on the unit prior to arrival C. at shift change, nurse makes rounds with oncoming nurse and introduces new nurse to pt D. the nurse obtains permission for pt's pet to visit after nurse overhears pt express that she misses her dog and is afraid she will not see it again E. the nurse tells the pt to fill out pt survey she will receive after D/C and to make sure to rate her experience as excellent if the nurse met her needs F. A, B, C, D G. none of the above
F.
