nclex chapt 12 apply quality improvement and Anita Finkelman

A nurse is caring for a client who has suction equipment in their room. The client asks the nurse, "Why do you check my suction equipment every day even though I am not using it?" Which of the following statements should the nurse make?

"It is part of the quality assurance plan of the unit."

A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds: "You are right. Care does cost more with RNs." "Costs rise because nurses waste supplies." "The cost of care is caused by decreased technology, not increased nurses." "Studies show that costs are decreased with an RN staff."

"Studies show that costs are decreased with an RN staff." Rationale: Studies show that lengths of stay decrease, which decreases overall costs, when more RNs are used for client care. The client is incorrect about RNs increasing the cost of care, and the nurse would provide appropriate information in a professional manner. Technology is on the rise and, in some cases, reduces cost by utilizing more efficient ways to deliver care, such as computer charting. Costs would rise if nurses waste supplies; however, many initiatives have been instituted in that area to contain costs. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

A client is being discharged to a rehabilitation facility and asks if nurses evaluate the quality of care that clients receive. The nurse responds that: "We each contribute by collecting data for evaluation." "The hospital administration is responsible for determining quality." "We have a quality management program here." "Nurses are responsible for monitoring nonprofessionals."

"We each contribute by collecting data for evaluation." Rationale: One role of nursing is collecting the data that is evaluated by the quality management team. Quality improvement is the responsibility of every employee of the agency, not just administration. Stating that there is a quality program does not answer the client's question. Nurses are responsible for monitoring nonprofessional caregivers but not other occupations of nonprofessionals such as engineers or housekeepers. Nursing Process: Implementation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse recognized making a medication error and immediately reported it to the unit supervisor. Which response from the supervisor should the nurse expect in an environment that promotes quality? "Why are you reporting that to me without completing an incident report?" "You need to report directly to the Chief Nursing Officer." "You have reported this to me, so you do not need to file an incident report." "We have a blame-free environment so you can report errors without fearing punishment."

"We have a blame-free environment so you can report errors without fearing punishment." Most errors in health care are a result of the healthcare system and not the fault of a single individual. If a clinic is afraid to report errors for fear of punishment or because reporting does not result in positive change, then problems within the system cannot be identified or addressed. A key component in quality improvement is establishing a blame-free environment in which healthcare providers can report errors or near misses without the fear of punishment. This helps identify problems, so that corrections can be made, and future events can be prevented. An incident report will be completed as a part of the investigation.

In the following data set the relative frequency for 102/min would be _______. Data and Time Pulse Rate Recorded Jan. 5, 8:00 am 100/min Jan. 5, 12:00 noon 102/min Jan. 5, 4:00 pm 99/min Jan. 5, 8:00 pm 99/min Jan. 5, 12:00 pm midnight 102/min Jan. 6, 4:00 am 98/min Jan. 6, 8:00 am 99/min Question options: 42.9 28.6 14.3 57.1

28.6

In the following data set the absolute frequency 99/min is: Data and Time Pulse Rate Recorded Jan. 5, 8:00 am 100/min Jan. 5, 12:00 noon 102/min Jan. 5, 4:00 pm 99/min Jan. 5, 8:00 pm 99/min Jan. 5, 12:00 pm midnight 102/min Jan. 6, 4:00 am 98/min Jan. 6, 8:00 am 99/min 1 2 3 4

3

What percent of observations occur in the interval under the bell curve from -2 SD from the mean to +2 SD from the mean? Question options: 50 percent 80 percent 95 percent 100 percent

95 percent

B

A client asks the nurse if the staff members make many mistakes because there are so many posters and signs about safety on the walls. Which response by the nurse is​ best? A."You don't need to worry about posters on the wall. Our primary concern is getting you​ well." B."There is a potential for errors in all healthcare settings. The posters remind the staff and the clients of the need to work together to prevent​ them." C."The nurses here are safe. The posters are directed at certain members of the healthcare team who have been making more mistakes than​ usual." D."We never make mistakes here. We want the public to know that we have client safety goals​ here."

A

A client in the intensive care unit is combative and pulling at the endotracheal​ tube, which must remain in place. After exhausting all​ alternatives, the nurse applies soft restraints to protect the​ client's airway. Which action should the nurse take​ next? A. Notify the primary healthcare provider. B. Notify the family of the need for restraints. C. Reassess the need for the restraints in 8 hours. D. Document the application of restraints in the chart.

B

A client who is living independently but needs skilled nursing services may take advantage of what type of​ healthcare? A. Telehealth B. Home healthcare C. Long-term care D. Assisted living

A

A complaint about unsafe working conditions should be reported to which​ agency? A. Occupational Safety and Health Administration B. National Institute for Occupational Safety and Health C. American Nurses Association D. State board of nursing

C

A hospital has created a culture of safety by providing organizational support for safety initiatives and by training and encouraging healthcare employees in the area of safety. What other step is needed to promote safety for everyone in the healthcare​ environment? A .Be a safety advocate for others B. Keep a mindset for quality of safe practice C. Engage clients in their own safety D. Post signs related to safety on the walls

D

A hospital has had higher than average reports of client handling and movement injuries. What could the nurse advocate for that could most help reduce the number of client handling​ injuries? A. Hire more nurses B. Keep the clients restricted to bed C. Encourage clients to lose weight D. Purchase lifting devices

B

A novice nurse has accepted a position on a​ medical-surgical unit at a local university hospital. In order to provide safe care to​ clients, the nurse should plan to develop which​ competency? A. Creating a culture of trust within the hospital B. Functioning as a member of the healthcare team C. Promoting appropriate values that clients should adopt D. Reporting families for bringing food to the​ client's room

A nurse is assisting with teaching a class about incident reports. The nurse should include that which of the following situations requires an incident report?

A nurse administers the wrong medication to a client.

D

A nurse conducted a class on fall prevention for a group of older adult clients in the community. Which observation during a client home visit indicates that teaching on fall prevention was​ effective? A. The locks were changed on the doors. B. All meat is placed in the freezer. C. Scatter rugs are placed in the kitchen. D. A shower seat was placed in the shower.

A nurse is assisting with teaching a class about sentinel events. The nurse should include that which of the following situations is a sentinel event?

A nurse infused an incompatible blood product to a client.

D

A nurse is assessing the hospital environment in order to decrease the risk for client falls. Which intervention should the nurse implement to decrease the risk of client​ falls? A. Encourage the client to wear diapers. B. Lower side rails on client beds. C. Read label directions. D. Clean the environment of clutter.

A nursing instructor is explaining quantitative systems in quality improvement. The students have understood the lecture when a student states that Six Sigma is: A process that uses quantitative data to monitor progress A process that determines waste in the agency An overall philosophy regarding quality A team designed to evaluate processes.

A process that uses quantitative data to monitor progress Rationale: Six Sigma is a process that uses quantitative data to monitor the progress of quality management. Lean Six Sigma is a process aimed at reducing a waste of resources. The team designated to evaluate the processes is the Continuous Quality Improvement team. TQM is the overall philosophy regarding quality management of an agency. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Remembering

An operating room nurse is present when a client is injured permanently during a procedure. The nurse expects to participate in: A root cause analysis The quality management program An increased number of nursing audits A criminal investigation

A root cause analysis Rationale: When a client experiences a permanent unexpected negative reaction due to an error, the Joint Commission requires that the healthcare agency perform a root cause analysis with a focus on the prevention of future such events. The nurse would expect to participate in the analysis because the nurse was present during the procedure. A quality management program is ongoing and is not the same as a root cause analysis. Nursing audits will not necessarily reveal the sentinel event error or prevent future incidents. A criminal investigation may or may not result from a root cause analysis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

A nurse is assisting with teaching a class about types of research studies. The nurse should include that which of the following is an example of a randomized controlled trial (RCT)?

A study arbitrarily assigning people who smoke into either an experimental group or a control group to determine the effects of a new therapy to reduce smoking

Examples of sentinel events include (select all that apply): a.Forceps left in an abdominal cavity. b.Patient fall, with injury. c.Short staffing. d.Administration of morphine overdose. e.Death of patient related to postpartum hemorrhage.

ABDE

Which National Quality Strategy should the nurse understand focuses on the​ community? (Select all that​ apply) Effective prevention and treatment Care coordination Client safety Affordability Healthy living

Affordability Healthy living Affordability covers the community as the healthcare industry works to make healthcare more affordable to​ individuals, families,​ employers, and governments. Healthy living also covers the community because this​ strategy's main aim is to work with communities to promote wide use of best practices to promote healthy living. Client​ safety, care​ coordination, and effective prevention and treatment are all more focused on the individual client.

A

After completing an​ assessment, the nurse determines a client is at risk for safety issues. Which data supports the​ nurse's conclusion? A. Occasional dizziness with walking B. Follows a vegetarian diet C. Lives with adult married daughter and family D. Receives an annual ophthalmologic examination

B

An experienced nurse has accepted a new position in the mental health unit after working in the​ medical-surgical floor for the past 4 years. What training would be beneficial for the nurse to refresh before starting her new​ position? A. How to properly use respirators B. How to manage aggressive behaviors C. How to safely lift and move clients D. How to prevent needlestick injuries

The nurse is studying the National Patient Safety Goals to ensure that the nurse delivers safe care to assigned clients and is aware that these goals are revised: Every two years Once a month Annually Every five years

Annually Feedback Rationale: The Joint Commission is responsible for assessing and revising goals for client safety on an annual basis. Nursing Process: Assessment Client Need: Safe, Effective Care Environment Cognitive Level: Remembering

The nurse manager is reviewing a quality improvement study conducted on a client care issue. List the order in which the steps should be evaluated to determine that the study was completed correctly. 1. Research factors that contribute to better outcomes. 2. Compare outcomes to benchmarks. 3. Identify areas for improvement. 4. Analyzing current protocols of care and associated outcomes. 5. Implement changes to improve outcomes. 6. Analyze client outcomes to determine effectiveness of changes.

Answer: 4, 2, 3, 1, 5, 6 Explanation: Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.

The nurse is participating in a quality improvement process related to improving care for clients at risk for skin breakdown. Which best describes the purpose of this process? A) To improve client outcomes B) To advance the nurse's career C) To fulfill legal requirements D) To maintain accreditation

Answer: A Explanation: A) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care, including overall outcomes. Participation may help the nurse advance in his or career, but that is usually accomplished by returning to school for a higher degree. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so. Although maintaining accreditation is important, it is not the primary reason for engaging in quality improvement processes.

Which statement correctly describes quality management? A) Quality management compares nursing processes to accepted standards to prevent errors in treatment. B) Quality management refers to systematic actions that lead to improvements in healthcare services. C) Quality management is the degree to which health services increase the likelihood of desired health outcomes. D) Quality management provides clients with appropriate service in a technically competent manner.

Answer: A Explanation: A) Quality management includes evaluation of medical and nursing processes for quality and effectiveness compared to accepted standards in order to correct problems before they harm clients and to prevent errors in treatment. Quality improvement refers to systematic actions that lead to improvements in healthcare services. Quality is the degree to which health services increase the likelihood of desired health outcomes. High-quality care provides clients with appropriate service in a technically competent manner.

The nurse on a medical-surgical unit is asked to participate in data collection on skin care for the unit. What purpose will it serve for the nurse to cooperate with this request? A) Participate in the quality improvement process B) Advance the nurse's practice C) Prevent problems from arising in the unit D) Fulfill legal requirements

Answer: A Explanation: A) Quality improvement is the name for the processes used by an agency to measure and improve aspects of client care. The nurse may advance practice, but that is usually accomplished by returning to school for a higher degree. Preventing problems from arising is only one benefit of quality management. Nurses are encouraged to participate in quality improvement programs but are not legally required to do so.

The nurse conducting nursing audits to help increase efficiency and reduce costs wants to suggest a better contribution to quality care. What should the nurse suggest be performed instead? A) Conduct a wound care study to enhance client outcomes. B) Install cameras to detect abuse of the clients. C) Acquire new client care equipment. D) Decrease staffing on the unit.

Answer: A Explanation: A) The top goal of any quality improvement program is to improve client outcomes of care. Increasing the RN staff, purchasing new equipment, and installing cameras may be found to be means to reach that goal, but studies must first be conducted to identify those means.

Which of the following would be considered sentinel events? Select all that apply. A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a client while at the facility E) Administration of a compatible blood transfusion

Answer: A, B, C, D Explanation: A) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, and homicide of a staff member or client while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.

The nurse manager at an acute care facility is educating her staff nurses on the definition of a sentinel event and providing examples. Which would be appropriate for the nurse manager to present to the staff nurses as examples of a sentinel event? Select all that apply. A) Delivery of radiation to the wrong body region B) Invasive surgical procedure at the wrong site C) Homicide of a staff member while at the facility D) Homicide of a patient while at the facility E) Administration of a compatible blood transfusion

Answer: A, B, C, D Explanation: A) A sentinel event is an unexpected occurrence causing serious injury or death. According to the Joint Commission, the following are sentinel events: delivery of radiation to the wrong body region, invasive surgery at the wrong site, homicide of a staff member or patient while at the facility. Administration of a compatible blood transfusion would be desired. Administration of an incompatible blood transfusion would be a sentinel event.

The nurse is asked to participate in a record review to verify accuracy and proper use of certain interdisciplinary resources. Which best describes the nature of this process? A) Peer review B) Interdisciplinary audit C) Utilization review D) Benchmarking

Answer: B Explanation: A) An audit is an examination of records to verify accuracy and proper use. Because this audit is focused on resources used by multiple disciplines, it would be classified as an interdisciplinary audit. A peer review is a professional critique of a colleague's work on the basis of predetermined standards. A utilization review analyzes the use of resources to identify areas of overuse, misuse, and underuse. Benchmarking is a method that is used to compare the performance of an individual or organization to industry standards.

The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. Based on this data, to which benchmarking issue should the quality assurance officer pay particular attention during the review process? A) Structure B) Process C) Outcome D) Competency

Answer: B Explanation: A) Process standards focus on the steps used to lead to a particular outcome, including whether a set of steps exists and whether those steps are being followed. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on organizational structure and resources. Outcome evaluation focuses on the performance of a process, such as the number of bedridden clients who develop a pressure injury.

The quality assurance officer notes that one particular nursing unit has received a higher-than-usual number of negative client responses about aspects of the nursing care during the previous quarter. To which component of care should the quality assurance officer pay particular attention when benchmarking this issue? A) Structure B) Process C) Outcome D) Competency

Answer: B Explanation: B) Process evaluation focuses on how the care was given in regard to relevance, appropriateness, completeness, and timeliness. Process standards focus on the manner in which the nurse uses the nursing process. Competency is not one of the components of quality assurance evaluation. Structure evaluation focuses on the setting in which the care is given. Outcome evaluation focuses on demonstrable changes in the client's health status as a result of nursing care.

A nurse is participating in an intradisciplinary assessment as part of a quality improvement process. Which of the following should the nurse anticipate will be included in this assessment? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management

Answer: B, C, E Explanation: A) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.

The nurse instructor is preparing a teaching session for staff nurses on intradisciplinary assessments. Which information should the instructor consider when preparing this presentation? Select all that apply. A) Utilization reviews B) Peer review C) Audits D) Performance appraisals E) Outcomes management

Answer: B, C, E Explanation: B) Intradisciplinary assessment occurs within a group of individuals with a similar position in the healthcare system, such as a group of nurses. An intradisciplinary assessment is important for identifying areas of improvement at each level of care and includes peer review, audits, and outcomes management. Utilization reviews are completed when conducting an interdisciplinary assessment. Performance appraisals are not a part of either intra- or interdisciplinary assessments.

Which statement regarding standards of care in the hospital setting is inaccurate? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."

Answer: C Explanation: A) "Process standards focus on human resources and general organizational structure" is incorrect, and indicates that the student needs further education. The rest of the statements are correct.

What major nursing concept has the strongest relationship to the identification of areas for quality improvement, such as tracking data on healthcare-associated infections? A) Ethics B) Safety C) Informatics D) Evidence-based practice

Answer: C Explanation: A) Informatics can be used to identify areas for improvement, such as tracking healthcare-associated infections. Without informatics, tracking adverse outcomes would be time-consuming and potentially cost-prohibitive. With the advent of technology and informatics, statistics and client outcomes are easier to track, making quality improvement more efficient. Ethics, safety, and evidence-based practice can all contribute to quality improvement, but not by easily tracking poor client outcomes.

The nurse is administering medications to a client. Which action is most likely to lead to an adverse event? A) The nurse verifies tube placement prior to administering the medications. B) The nurse checks for known allergies prior to administering the medications. C) The nurse combines medications with the same active ingredient. D) The nurse has a second nurse check the medication order.

Answer: C Explanation: A) It is not appropriate to combine medications with the same active ingredient, as this is likely to increase medication errors. Verifying tube placement prior to administering medications, checking for known allergies prior to administering medications, and having a second nurse check the medication order are all appropriate actions and are considered methods to reduce medication errors.

The nursing instructor is speaking to a group of nursing students about standards of care. Which comment made by the nursing student indicates the need for further education about the standards of care? A) "Standards of care are based on models of high-quality performance." B) "Process standards focus on the steps used to lead to a particular outcome." C) "Process standards focus on human resources, and general organizational structure." D) "Outcome standards focus on the performance of a process."

Answer: C Explanation: C) "Process standards focus on human resources and general organizational structure" is incorrect, and indicates that the student needs further education. The rest of the statements are correct.

A newly licensed nurse is passing medications with a nurse preceptor. Which action taken by the newly licensed nurse would be inappropriate and require the nurse preceptor to intervene? A) The newly licensed nurse verifies tube placement prior to administering medications. B) The newly licensed nurse checks for known allergies prior to administering medication. C) The newly licensed nurse combines medications with the same active ingredient. D) The newly licensed nurse has a second nurse check the medication order.

Answer: C Explanation: C) It is not an appropriate action to combine medications with the same active ingredient. Combining medications with the same active ingredient is not considered a method to reduce medication errors. Verifying tube placement prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Checking for known allergies prior to administering medications is an appropriate action and is considered a method to reduce medication errors. Having a second nurse check the medication order is an appropriate action and is considered a method to reduce medication errors.

Which statements best describe how a quality improvement process can contain healthcare costs? Select all that apply. A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased readmission rates." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."

Answer: C, D Explanation: A) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because readmission rates and infection rates, as well as client mortality, are reduced with RN care. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

A client who has read several articles about the need to contain healthcare costs asks how a quality improvement program can contain cost of care. What should the nurse respond to this client's question? Select all that apply. A) "Promoting safety increases the cost of care." B) "Medication errors decrease the cost of care." C) "High nurse-to-client ratios result in decreased length of stay." D) "Increased nursing staff has been linked to decreased infection rates." E) "Use of computers increases the number of lawsuits."

Answer: C, D Explanation: C) Studies have shown that increasing the nurse-to-client ratio can decrease overall cost because the length of stay, as well as mortality rate, is reduced with RN care. Other studies have shown that increased nursing staff has been linked to a decrease in client infection rates. Medication errors increase cost due to harm to the client and increased length of stay. Promoting safety is a cost-containment measure because it decreases injury to the client and the consequent risk of lawsuits. Computers increase efficiency and reduce cost as a result. Lawsuits do not increase because of computer use; they increase when computers are used improperly.

While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. Which sentinel event is this action intended to prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly oversedated D) The removal of the wrong arm

Answer: D Explanation: A) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client's incorrect arm would be a sentinel event. Mild oversedation is not a sentinel event, as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in some clients, such as clients with diabetes. Pain control is individual and is not a sentinel event.

The nurse is working in a healthcare setting that has implemented Lean Six Sigma. Which of the following should the nurse anticipate with regard to this model? A) Shorter breaks B) Ordering extra supplies C) Replacing licensed with unlicensed personnel D) Decreasing staff when the census is low

Answer: D Explanation: A) Lean Six Sigma focuses on eliminating waste and improving process flow. Thus, when a unit's census decreases, the unit's manager would decrease the number of staff. Replacing licensed staff members with unlicensed personnel may not be safe. The unit would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered reducing waste.

Which best describes the desired outcome of decreased readmission rates? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care

Answer: D Explanation: A) Research has shown that an increase in RN staff decreases a unit's readmission rate. Because readmission is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase in RN staff. Decreasing readmission rates will likely decrease the use of client care supplies, not increase it.

Which federal initiative contains the three broad aims of better care, healthy people/healthy communities, and affordable care? A) National Database of Nursing Quality Indicators B) Patient Safety and Quality: An Evidence-Based Handbook for Nurses C) National Patient Safety Goals D) National Quality Strategy

Answer: D Explanation: A) To improve the health of the population, the USDHHS has developed the National Quality Strategy, which contains three broad aims: better care, healthy people/healthy communities, and affordable care. The National Database of Nursing Quality Indicators (NDNQI), Patient Safety and Quality: An Evidence-Based Handbook for Nurses, and the National Patient Safety Goals by the Joint Commission aim to collect and provide data that identify areas for improvement and encourage facilities to meet quality goals.

The nurse working in a blame-free environment provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error, and the nurse files a report about the medication error. Which action by the risk management team should the nurse anticipate? A) Taking disciplinary action B) Reporting to the board of nursing. C) Monitoring all nurses on the unit. D) Suggesting system changes to prevent future errors

Answer: D Explanation: A) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.

While preparing a client for surgery, the nurse marks the arm that is to be amputated and participates in a "time out" procedure before the surgery begins. What sentinel event should the "time out" procedure prevent? A) Ineffective control of the client's pain B) The lack of healing of the stump C) The client being mildly over-sedated D) The removal of the wrong arm

Answer: D Explanation: D) A sentinel event is an unexpected event that causes death or severe physical or psychological injury. The removal of the client's incorrect arm would be a sentinel event. Mild over-sedation is not a sentinel event as the client is most likely on a ventilator during surgery. The inability to heal properly is an expected event in a diabetic client. Pain control is individual and is not a sentinel event.

The nurse manager is planning to implement the Lean Six Sigma system on the care area to improve the quality of care. When following this model, what should the manager implement? A) Shortening break time B) Ordering more supplies than needed on the unit to ensure they never run out C) Replacing a licensed staff member with unlicensed assistive personnel D) Decreasing staff when the census is low

Answer: D Explanation: D) Lean Six Sigma focuses on eliminating waste and improving process flow. When the census decreases, the nurse manager should also decrease the number of staff. Replacing licensed staff members with unlicensed assistive personnel may not be safe. The nurse manager would cut back on ordering supplies that are not needed when following this model. A shortened break time would not be considered as reducing waste.

The nurse manager is considering increasing the number of RN staff because studies have shown that it decreases infection rates. What purpose will decreasing infection rates serve? A) An increased use of overtime B) A decrease in client satisfaction C) An increase in client care supplies D) A decreased cost of care

Answer: D Explanation: D) Research has shown that an increase in RN staff decreases a unit's infection rate. Because infection is reduced, cost of care is also reduced. Overtime is not necessarily reduced by an increase in staff, depending on the number of nurses available at any given time. Studies show that client satisfaction increases with an increase of RN staff. There is no research that suggests that decreased infection rates will increase the need for client care supplies.

The nurse provides medication to a client at the wrong time. No harm came to the client as a result of the nurse's error and the nurse files a report about the medication error. What should the risk management team do? A) Discipline the nurse appropriately. B) Report the nurse to the board of nursing. C) Monitor all nurses on the unit to ensure this does not occur again. D) Attempt to implement policy changes to prevent future errors.

Answer: D Explanation: D) When a nurse makes an error and reports it, the risk management team will investigate to discover causes for the error and effect policy changes that can prevent future errors, improving the level of client care. The situation does not warrant reporting the nurse to the board of nursing. The risk management team would not be responsible for implementing any disciplinary actions. It is not prudent for the risk management team to monitor all nurses who administer medications on the unit.

In which order should the steps of the quality improvement process be reviewed to determine whether it was completed correctly? A) Research factors that contribute to better outcomes. B) Compare outcomes to benchmarks. C) Identify areas for improvement. D) Analyze current protocols of care and associated outcomes. E) Implement changes to improve outcomes. F) Analyze client outcomes to determine effectiveness of changes.

Answer: D, B, C, A, E, F Explanation: Quality improvement involves analyzing current protocols of care and their associated outcomes, comparing those outcomes to leaders in high-quality care through benchmarking, identifying areas for improvement, researching factors that contribute to better outcomes, and implementing changes to improve outcomes. Client outcomes must then be analyzed to determine the effectiveness of the changes and identify areas for further improvement.

The nurse is a member of the utilization review committee that is composed of members from various disciplines within the hospital. Which patient situation should the nurse understand will be of interest to the utilization review committee? Each inpatient provided with an admission kit Routine use of sterile packs in surgery Application of adult diapers on every older adult patient Routine maintenance of medical equipment

Application of adult diapers on every older adult patient A utilization review analyzes the use of resources to identify overuse, misuse, and underuse. The application of adult diapers on each older adult patient in the event of incontinence is a red flag because not all older adult patients will be incontinent. This is a possible overuse of supplies. It would be expected for surgery to routinely use sterile packs, for each inpatient to be provided with an admission kit, and for routine maintenance to be scheduled for medical equipment. This utilization review committee uses interprofessional assessment to review situations and cases. An interprofessional assessment involves the input of more than one discipline, such as nursing or physical therapy.

Patient perceptions are useful in: a.Determining disciplinary actions in QI. b.Establishing the competitive advantage of QI decisions. c.Providing one source of data for QI initiatives. d.Establishing blame for poor-quality care.

Assisting to establish priorities among possible changes to care identified in QI

The nurse is discussing social determinants addressed by Healthy​ People/Healthy Communities. Which factor should the nurse​ include? (Select all that​ apply.) Availability of resources to meet daily needs Social norms and​ attitudes, such as discrimination Physical​ barriers, especially for people with disabilities Public safety Exposure to toxic substances and other physical hazards

Availability of resources to meet daily needs Social norms and​ attitudes, such as discrimination Public safety Healthy​ People/Healthy Communities is another aim the U.S. Department of Health and Human Services​ (HHS) has developed to improve the health of the population. The​ aim's focus is to health. Examples of social determinants​ include, but, are not limited​ to: (1) availability of resources to meet daily​ needs, such as educational and job​ opportunities, living​ wages, or healthful​ foods; (2) social norms and​ attitudes, such as​ discrimination; (3) social support and social​ interactions; (4) socioeconomic​ conditions, such as concentrated​ poverty; (5) quality​ schools; (6) transportation​ options; and​ (7) public safety.

The nurse is discussing the purpose of a just culture. Which information should the nurse include? Balancing quality with justice Balancing the blame-free environment with appropriate accountability Balancing discipline with accountability Balancing the blame-free environment with discipline

Balancing the blame-free environment with appropriate accountability A just culture attempts to balance a blame-free environment with appropriate accountability by focusing on correcting problems that lead individuals to engage in unsafe behavior while maintaining individual accountability by establishing zero tolerance for reckless behavior. A just culture differentiates among human error, at risk behavior, and reckless behavior in contrast to the no-blame approach of the no-blame environment.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as: a.Quality assurance. b.Sentinel data. c. Benchmarking. d.Statistical analysis

Benchmarking

A newly hired nurse made a medication error in her first week on the job. The nurse soon learned that her facility had a strong policy in which errors or near misses could be reported without the fear of punishment. Which concept supports this attitude toward​ mistakes? Responsibility ​Blame-free environment Just culture Accountability

Blame-free environment Learning Objective Describe the process of quality improvement. Rationale In a​ blame-free environment, errors or near misses can be reported without fear of punishment. Just culture balances accountability with correcting system problems. Responsibility and accountability both call for admitting​ mistakes, but without guarantees of how they will be handled.

The nurse is part of a Continuous Quality Improvement (CQI) team measuring the number of times a patient's blood pressure is incorrect due to a defect. Which defect should the nurse and team define in such a situation? Blood pressure is taken on the nondominant arm. Blood pressure is taken with the wrong size cuff. Blood pressure is taken when the patient is seated. Blood pressure is taken with the patient's legs uncrossed.

Blood pressure is taken with the wrong size cuff. A defect is defined as anything that could lead to patient dissatisfaction. Defects in health care can range from the wrong-size gown to a major problem such as an amputation performed on the wrong limb. In the case outlined, only using a too large or small cuff would cause an incorrect blood pressure reading. Blood pressure defects are not related to dominant or nondominant arm. Being seated with the patient's arm at their side gives the most accurate reading. Patients should not have their legs crossed.

The nurse failed to give a medication to a patient at the right time. Which type of scenario should the nurse understand this demonstrate? Standards of care Risk management Breach of care Sentinel event

Breach of care A breach of care occurs when a nurse deviates from the standard of care. This occurs when the nurse does something that should not have been done or does not do something that should have been done. Standard of care can be defined as the amount of care that a reasonable person would have exercised in the same circumstances. Risk management is the process in which vulnerabilities are identified and changes are made to minimize the consequences of adverse patient outcomes and liabilities. A sentinel event is an unexpected occurrence involving death or physical or psychologic injury, or risk thereof.

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs, and write them up

Call a meeting of all staff to discuss this issue

The client satisfaction rate is at​ 60% for two consecutive​ months, and staff morale is at its lowest. The nurse manager decides to plan changes that will improve conditions on the unit. Which should be the priority​ action? Ignoring the issues since these will be resolved naturally Calling for a staff meeting placing this issue on the agenda Developing a strategic action on how to deal with these concerns Seeking help from another manager

Calling for a staff meeting placing this issue on the agenda Calling for a staff meeting to address the issue will allow for the participation of every staff member in the unit. If they contribute to the solutions of the​ problem, they will own the​ solutions; hence the chance for compliance would be greater. Ignoring the issue with a perception that these will be naturally resolved is not a correct approach. Developing strategic action on dealing with these concerns and seeking help from his manager will be the next​ steps, or can wait for some time at this juncture.

A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: An individual, unit, or facility must understand their baseline performance records. Can be used to discover areas for improvement and to analyze areas of excellence. Performance can be assessed on an intradisciplinary level or an interdisciplinary level. Peer review

Can be used to discover areas for improvement and to analyze areas of excellence. Rationale: Quality improvement is a continuous multi-step, multi-level process that identifies areas for improvement based on performance and industry standards. One step in quality improvement involves analyzing current protocols of care and their associated outcomes. This includes: an individual, unit, or facility must understand their baseline performance records; performance can be assessed on an intradisciplinary level or an interdisciplinary level; this includes peer review. Outcomes management, another step of quality improvement, can be used to discover areas for improvement and to analyze areas of excellence. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Applying

The nurse is explaining the meaning of equitable care. Which explanation should the nurse include? Care that does not vary in quality because of personal characteristics Care that is respectful of and responsive to individual patient preferences, needs, and values Reducing wait times that may result in harmful delays for those who receive and give care Avoiding injuries to patients from the care that is intended to help them

Care that does not vary in quality because of personal characteristics Equitable care is defined as providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, or geographic location. Patient-centered care is described as providing care that is respectful of and responsive to individual patient preferences, needs, and values and ensuring patient values guide all clinical decisions. Efficient care involves decreasing wait times and avoiding waste, including waste of equipment, supplies, ideas, and energy. Safety is guided by avoiding injuries to the patients in the nurse's care.

A method commonly used in Quality Assurance to monitor adherence to established standards is: a.A Pareto chart. b.Brainstorming. c.Patient interviews. d.Chart audit.

Chart audit

The nurse manager is proactive when conducting risk management for a unit. Which key factor of risk management should be the​ nurse's primary​ concern? Client satisfaction Proper care and treatments Affordable care Client communication

Client satisfaction Client satisfaction is a key factor in risk management because a dissatisfied client presents a higher risk for liability than a satisfied​ client, which should be the concern for a manager. A nurse who becomes aware of client dissatisfaction should take steps to communicate with the client to clarify​ misunderstandings, advocate for the client to receive better​ care, and notify a supervisor about potential problems. Client​ communication, proper care and​ treatment, and affordable care are the concerns of the healthcare providers and respective departments.

The nurse is discharging a client who has had an organ transplant. To accurately summarize the client​'s complex​ treatments, the nurse is carefully entering data into an electronic health record​ (EHR). How does that activity affect continuity of​ care? The EHR documents actions at the point of care. Clinical information is available to collaborating healthcare providers. The software will scan for grammatical errors. The nurse follows guidelines encouraging use of EHRs.

Clinical information is available to collaborating healthcare providers. Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Entering data into an EHR makes clinical information available to collaborators. It is not important that the software corrects grammatical errors. The EHR documents actions at the point of care.​ However, it is the availability of that information to others that affects the continuity of​ care, not its being recorded. Support for continuity of care is one​ reason, but not the only​ one, for encouraging the use of EHRs.

Continuous Quality Improvement​ (CQI) is a​ client-driven process. In a rehabilitation​ facility, which individuals are examples of internal clients who drive the CQI​ process? ​(Select all that​ apply.) Clinical nurse specialist Client after hip replacement Head of Management of Information Systems​ (MIS) department Physical therapist Parents of a child with spina bifida

Clinical nurse specialist Client after hip replacement Physical therapist Learning Objective Compare the components of various quality management programs. Rationale Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip​ replacement, and parents of a child with spina bifida.

When a physician is appointed to the medical staff of a healthcare organization, the physician's scope of practice is determined by: Question options: Clinical Knowledge Credential Position on the staff Clinical privileges

Clinical privileges

The nurse chairs a committee tasked with improving the number of hospital-acquired infections and is asked for a definition of "benchmarking." Which response should the nurse give? Minimum starting point used for comparisons Comparison of the performance of an individual or organization to industry standards Process to identify vulnerabilities within an organization Analysis used to prevent certain events from repeating

Comparison of the performance of an individual or organization to industry standards Benchmarking is a process used to compare the performance of an individual or organization to industry standards. It uses indicators, or statistics, of an organization's performance in a specific area, to use in a comparison to industry standards. The indicators or statistics are a baseline or a starting point for improvement. Risk management is the process by which an organization looks into vulnerable areas and makes changes to improve outcomes and avoid making repeated mistakes.

A nurse is assisting on a quality improvement committee to decrease the number of client falls occurring at night. After identifying the problem, which of the following is the next step the nurse should take?

Complete a literature review.

The mental health nurse enjoys working at a community health center​ (CHC). Part of the nurse​'s satisfaction comes from helping provide the required services for CHC facilities. Which services are​ required? ​On-site pharmacy Comprehensive primary care Emergency Department​ (ED) Chemotherapy

Comprehensive primary care Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The regulations for CHCs require that they provide comprehensive primary care. They are not required to have an​ ED, offer​ chemotherapy, or stock an​ on-site pharmacy.

The rehabilitation department is conducting an audit on the efficacy of a new treatment protocol by examining the client report and status upon discharge. Which type of audit is the department​ conducting? (Select all that​ apply.) Interprofessional assessment Concurrent audit Intraprofessional assessment Utilization review Retrospective audit

Concurrent audit Intraprofessional assessment An audit is an examination of records to verify accuracy and proper use. If the audit is focused on one​ discipline, it is an intraprofessional assessment. If the audit is focused on multiple​ disciplines, it becomes an interprofessional assessment. A concurrent audit is performed while the client is still undergoing care at the healthcare facility. A retrospective audit is performed after a​ client's discharge. A utilization review analyzes the use of resources to identify areas of​ overuse, misuse, and underuse.

A healthcare organization is committed to improving patient outcomes as part of the quality improvement (QI) process and examines its executive structure and organizational design. This approach recognizes which model of QI? a.Donabedian b.Benchmarking c.Employee involvement and innovation d. QSEN

Donabedian

An example of an effective patient outcome statement is: a.Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse practitioner within 3 hours of presentation in the Emergency Department. b.Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs. c.The hospital will reduce costs by 3% through the annual budget process. d.Quality is a desired element in patient transactions

Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse. Practitioner within 3 hours of presentation in the Emergency Department

The nurse is discussing the purpose of utilization review with colleagues. Which statement should the nurse​ include? Working with a social worker to make sure the​ client's family has resources for care Ensuring that the​ client's medications and treatments are appropriate for his or her diagnosis Working with members of the interdisciplinary team to provide comprehensive care for the client Contacting the insurance company to facilitate payment for services

Ensuring that the​ client's medications and treatments are appropriate for his or her diagnosis The utilization review​ nurse's role is designed to ensure that a client is receiving the necessary treatments and procedures for his or her condition without undergoing any unnecessary therapies. By reviewing these​ terms, the utilization review nurse saves the healthcare center money by avoiding payments on expensive treatments that are unwarranted. The​ nurse's role also saves the client from undergoing possibly painful and expensive tests and procedures that are not needed. All the other options are not a part of the utilization review process.

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it: a. Facilitates active staff participation in decision making related to quality nursing care. b. Has implemented a graduate nurse orientation program. c. Espouses commitment to excellence in patient care. d. Is establishing career ladders for nurses.

Facilitates active staff participation in decision making related to quality nursing care

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective? a. Flowchart b.Histogram c.Narrative d.Line graphs

Flowchart

The hospital management is concerned about feedback regarding long waiting times for treatment in the emergency department and forms a committee to resolve the issue. Which should be the first task by the leader of the committee to solve the problem? Form a Continuous Quality Improvement team to define the desired outcome. Reevaluate emergency room waiting times. Collect baseline data to determine if a problem exists. Ask the director of operations for solutions.

Form a Continuous Quality Improvement team to define the desired outcome. The first step in the Continuous Quality Improvement (CQI) process is to assemble a team of individuals who are stakeholders in the problem to form a CQI team to define the desired outcome. From there, the nurse can measure performance against the desired outcome, analyze the results, provide feedback, implement a solution, and evaluate its effectiveness. If the nurse were to collect baseline information without determining the desired outcome, they might not measure the relevant indicators. CQI is about including the team in the problem-solving process, rather than dictating what needs to be accomplished. By including the team in the problem solving, it is more likely they will buy into the solutions. Asking the operations manager for solutions is not the best way to resolve the issue, and reevaluating the wait time will only help after implementation of the first plan of action to reduce that issue.

A project management tool used to schedule important activities is called a ________. Question options: cause-and-effect diagram Pareto chart Gantt chart fishbone diagram

Gantt chart

At Hospital Ajax, staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame. This culture demonstrates: a.QM principles that emphasize customer safety. b.A deep concern with improvement of quality and processes. c.Effective employee orientation and development in relation to QM. d.Goals that are inconsistent with QM

Goals that are inconsistent with QM

This survey was developed and initiated to provide a consistent format and process for gathering patient satisfaction and perspectives on hospital care: Question options: HCAHPS Compulsory reviews SWOT analysis Meaningful Use

HCAHPS

Which of the following represents a list of potential blood-borne pathogens? Question options: HIV and Hepatitis B Colorado tick fever and pertusis mumps and HIV Hepatitis B and pertussis

HIV and Hepatitis B

The nurse is responsible for continuous quality improvement at a rehabilitation hospital. Which internal client should the nurse interview for​ suggestions? (Select all that​ apply.) Parents of a child with spina bifida Client after hip replacement Head of Management of Information Systems Physical therapist Clinical nurse specialist

Head of Management of Information Systems Physical therapist Clinical nurse specialist Internal clients are employees of the rehabilitation facility. They could be a physical​ therapist, the head of the MIS​ department, and a clinical nurse specialist. External clients include a client after hip replacement and parents of a child with spina bifida.

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate? a.Histogram b.Flowchart c.Fishbone diagram d.Pareto char

Histogram

This type of data display tool is used to display data proportionally and to identify problems or changes in a system or process. Question options: Bar graphs Histogram Pie charts Line graphs

Histogram

With the rise in workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should: a.Request all staff to accept new risk management practices. b.Hold staff accountable for safe practices. c.Document inappropriate behavior. d.Hire more police security

Hold staff accountable for safe practices

This act established a quality reporting program for skilled nursing care in the United States. Question options: ARRA HITECH IMPACT PPACA

IMPACT

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to: a.Assemble a team. b.Identify a clinical activity for review. c.Establish a benchmark. d.Establish outcomes

Identify a clinical activity for review

A nurse is using evidence-based practice (EBP) to address the incidence of catheter-associated infections on a surgical unit. According to EBP, which of the following actions should the nurse take first?

Identify a clinical problem.

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to: a.Collect data to determine whether standards are being met. b.Implement a plan to correct the problem. c.Identify the standard. d.Determine whether the findings warrant correction.

Identify the standard

Which statement should the nurse use to describe the purpose of the root cause analysis? Brainstorming preferred outcomes Identifying risks causing financial loss Providing a report to the leader of the committee Identifying the root cause of the problem through problem solving

Identifying the root cause of the problem through problem solving The purpose of a root cause analysis is to determine the root cause of a problem. Brainstorming outcomes and reporting to the leader would be part of the task force to implement quality improvements. Identifying risks of financial loss is part of an audit.

A nurse is assisting a quality improvement team that is using the Plan-Do-Study-Act (PDSA) model to address an increase in pressure injuries on a medical unit. Which of the following actions should the nurse identify as an example of the "Do" step of the PDSA model?

Implementing a new evidence-based practice protocol

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs? a. Evaluation of staff members' performances b. Determination of the appropriateness of standards c. Improvement in patient outcomes d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

Improvement in patient outcomes

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It: a.Promotes teamwork among healthcare providers. b.Increases adverse events. c.Improves outcomes. d.Contributes to duplication of services

Improves outcomes

A nurse is explaining National Patient Safety Goals (NPSGs) to a newly licensed nurse. The nurse should include that which of the following is a goal addressed in the NPSGs?

Improving staff communication

An organization is using Six Sigma to determine why discharge instructions given to a group of clients were below national standards. Which step should the nurse understand applies to this quality management​ process? Meeting with the discharge planners Improving the knowledge level of the staff with​ one-on-one training Standardizing the discharge process with the healthcare providers Standardizing and simplifying the discharge instruction process Improving the knowledge level of the staff​ unit-by-unit

Improving the knowledge level of the staff with​ one-on-one training Standardizing and simplifying the discharge instruction process Improving the knowledge level of the staff​ unit-by-unit Six Sigma is a quality improvement program that aims to produce a​ near-perfect product. Sigma is used to measure deviation from a standard. In this​ system, a defect is defined as anything that could lead to client dissatisfaction. Defects in healthcare could range from relatively minor problems to major problems. Six Sigma primarily uses the​ Define, Measure,​ Analyze, Design, and Verify system to improve outcomes. For this​ instance, the organization is aiming to increase the percentage of heart failure clients for compliance.

A nurse is a member of a committee that is using evidence-based practice (EBP) to decrease the incidence of central line infections. The nurse should identify that which of the following interventions is part of the implementation step of EBP?

Incorporating the new practice into client care

Which term describes an assessment occurring within a group of individuals with similar positions within a healthcare system? Six Sigma audit Interprofessional Internal audit Intraprofessional

Intraprofessional An intraprofessional assessment is one occurring within a group of individuals with similar positions within a healthcare system. A peer audit is a review used to professionally critique a colleague's work, based on a predetermined set of standards. An audit is an examination of records to verify accuracy and proper use. Outcomes management uses patient experiences to improve all areas of health care.

The nurse organized a staff meeting to address morale issues and improve the level of care on the unit. Which assessment practice is the nurse​ demonstrating? Utilization review Interprofessional Benchmarking Intraprofessional

Intraprofessional Intraprofessional assessment occurs within a group of individuals who have similar positions within a healthcare​ system, such as a group of nurses or a group of surgeons. Such an assessment is important for identifying areas of improvement at each level of care. Interprofessional assessment would take place if different units provided feedback. Benchmarking is comparing outcomes of two different departments. A utilization review looks at areas of​ misuse, overuse, or underuse of​ resource, not a moral issue.

Root-cause analysis is a key technique used in this quality improvement methodology? Question options: HRO Lean Six Sigma Systems thinking

Lean

The nurse in the blood bank is part of a team effort to reduce the cost of collecting and storing blood components. The nurse conducts an inventory check for expired sterile supplies. Which quality improvement method is the team using in seeking to reduce waste? Utilization review Root cause analysis Quality assurance Lean Six Sigma

Lean Six Sigma The objective of Lean Six Sigma, the quality improvement method used by the blood bank team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

The nurse in the blood bank is part of a team effort to reduce the costs of collecting and storing blood components. The nurse conducts an inventory to check for expired sterile supplies. In seeking to reduce​ waste, which quality improvement​ (QI) method is the team​ using? Quality assurance Lean Six Sigma Root cause analysis Utilization review

Lean six sigma Learning Objective Compare the components of various quality management programs. Rationale The objective of Lean Six​ Sigma, the QI method used by the blood bank​ team, is to reduce waste. Quality assurance determines whether standards are met. Root cause analysis explores a sentinel event. Utilization review collects data about resource use.

This status is conferred by a state regulatory agency giving an individual permission to practice their trade. Question options: Credential Certificate License Degree

License

Governmental agencies and the healthcare industry have partnered to improve the quality of care. Which action should the nurse recognize is aimed at providing better​ care? Reducing the cost of quality healthcare to all consumers Making healthcare more​ client-centered, reliable,​ accessible, and safe Delivering care to underserved clients Addressing​ behavioral, social, and environmental determinants of health

Making healthcare more​ client-centered, reliable,​ accessible, and safe To improve the health of the​ population, the U.S. Department of Health and Human Services​ (HHS) has developed the National Quality​ Strategy, which contains three broad aims. One of the aims is Better Care to improve the overall quality by making healthcare more client​ centered, reliable,​ accessible, and safe. The other two aims are Healthy​ People/Healthy Communities and Affordable Care.

The practice of reporting patient outcomes to the Hospital Board of Trustees was begun at which of the following hospitals? Question options: Massachusetts General Mayo Clinic Pennsylvania Hospital Bellevue Hospital

Massachusetts General

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is: a.Physician-sensitive and nonmeasurable. b.Measurable and nursing-sensitive. c.Precise, measurable, and physician-sensitive. d.Patient care-centered and nonmeasurable

Measurable and nursing-sensitive

In 1965, the United States Congress passed Public Law 89-97, an amendment to the Social Security Act of 1935. This law established: Question options: Children's Health Insurance Plan Funds for hospital construction Hospital accreditation Medicare and Medicaid

Medicare and Medicaid

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA. b. AHRQ. c. NIOSH. d. Nursing process.

NANDA

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence? a.NDNQI b.NANDA c.NIOSH d.AHRQ

NDNQI

This database maintains reports on medical malpractice settlements, clinical privilege actions, and professional society membership actions against licensed healthcare providers. Question options: National Practitioners Data Bank National Physician Database Healthcare Integrity and Protection Data Bank Healthcare Security of Physicians Data Bank

National Practitioners Data Bank

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as: a.Sentinel events. b.Medically sensitive events. c.Nurse-sensitive events. d.Never events.

Never-events

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

Nursing care standards

OSHA: Question options: Occupational Sensitivity Health Association Official Sensitivity Health Association Occupational Safety and Health Administration Official Safety and Health Administration

Occupational Safety and Health Administration

Which activity should the nurse recognize as a way for state and local entities to make healthcare more​ affordable? Require hospitals to track readmission rates for​ low-income clients Develop new healthcare delivery models Coordinate care through the use of effective communication Offer basic health coverage for all citizens living in their state

Offer basic health coverage for all citizens living in their state Developing new healthcare delivery models is a state and local initiative that can lower healthcare costs. Coordinating care through effective communication would be the responsibility of the healthcare institution. States and local entities are not required to provide affordable healthcare to all their citizens. Local hospitals are not just responsible to track the readmission​ rates, but are encouraged to actively try to reduce readmission rates through broad based teaching and​ follow-up as a way to lower costs.

The nurse working in the assisted living facility is reviewing the weekly report of the number of bedridden clients who developed pressure ulcers. The facility uses the Donabedian model of QI. Which standard is the nurse using with this data​ review? Process standard Structure standard Outcome standard Decubiti standard

Outcome standard Learning Objective Describe the process of quality improvement. Rationale The nurse is examining data about an outcome​ standard, pressure​ ulcers, which is a negative result of the care process. A process standard would look at steps to achieve a positive result. A structure standard would look at the organization. There is no decubiti standard.

Which committee has a leadership role in the organization's medication safety efforts and consists of pharmacists, physicians, nurses, hospital administrators, and other healthcare professionals? Question options: P and T Committee Ethics Committee Risk Management Committee Procedure Review Committee

P and T Committee

The emergency department nurse manager is sharing the most recent client satisfaction data and statistics with the evening shift staff. As a​ team, they are using the total quality management​ (TQM) approach. Which process organizes their​ efforts? DMADV DMAIC LEED PDSA

PDSA Learning Objective Compare the components of various quality management programs. Rationale TQM uses the PDSA approach of​ Plan-Do-Study-Act. The DMAIC and the DMADV methods are used in Six Sigma. LEED is not a QI method.

Which of the following is a common standing committee in most healthcare organizations responsible for coordinating and reporting PI and safety activities? Question options: risk management committee incidence response committee PI and patient safety committee ethics committee

PI and patient safety committee

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because: a.The return rate on patient questionnaires is frequently low. b.Patients are rarely reliable sources about their own hospital experiences. c.Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness. d.Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff

In the 1700 - 1800s, this hospital became a model for the development of hospitals in other communities. Question options: Massachusetts General Mayo Clinic Pennsylvania Bellevue Hospital

Pennsylvania

A nurse is assisting with using the Plan-Do-Study-Act (PDSA) model to decrease client falls in a long-term care facility. The nurse should identify that developing guidelines to decrease falls is included in which of the following steps of the PDSA model?

Plan

The nursing team is using the Total Quality Management (TQM) approach to improve patient satisfaction on the unit. Which process should the team follow to organize their efforts? Define-Measure-Analyze-Improve-Control Continuous Quality Improvement plan Plan-Do-Study-Act Define-Measure-Analyze-Design-Verify

Plan-Do-Study-Act TQM uses the PDSA approach of Plan-Do-Study-Act. The Define-Measure-Analyze-Improve-Control and the Define-Measure-Analyze-Design-Verify methods are used in Six Sigma.

The nurse is preparing to present the goals of risk management. Which should the nurse​ include? (Select all that​ apply.) Prevent breach of care Occurs on a monthly basis Conduct root cause analysis Prevent adverse events Minimize damage from adverse events

Prevent adverse events Minimize damage from adverse events Risk management is the process of identifying vulnerabilities to minimize the consequences of adverse client outcomes. Risk management includes both proactive components to prevent adverse events and reactive components to minimize damage from adverse events. Risk assessment must occur​ daily, and all individuals must be dedicated to keeping clients safe from harm.

Which statement should the nurse understand describes the primary goal when conducting a root cause analysis? Gaining group consensus Mandating solutions to problems Producing ideas by holding a group discussion Preventing problem recurrence

Preventing problem recurrence The goal of a root cause analysis is entirely preventing problem recurrence. Gaining group consensus will be a tool used during the analysis to agree upon indicators. Ideas will be produced during the root cause analysis by the process of brainstorming. During a collaborative process such as root cause analysis, mandating solutions will not foster a collaborative approach.

A nurse is discussing quality measurement with a newly licensed nurse. The nurse should include that medication reconciliation is an aspect of which of the following parts of quality measurement?

Process

The nurse is evaluating the effectiveness of changes made to improve quality of care. Which procedure is the nurse conducting? Quality assurance Total quality management Continuous quality improvement Quality management plan

Quality assurance Implemented changes must be evaluated to assess their impact on patient care, patient outcomes, patient and clinical satisfaction, and resource utilization. Data related to the original problem must be collected and are then analyzed on the basis of benchmark standards to determine whether standards are being met. This is called quality assurance. A quality management plan is used to help healthcare facilities integrate new programs, models, and technologies with the primary care services that are already in place. Total quality management (TQM) is a comprehensive management philosophy used to improve quality and productivity by using data and statistics to improve processes. Continuous quality improvement (CQI) is a structured organizational process for including personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations.

A nurse is assisting with teaching a class about quality core measures. Which of the following information should the nurse include?

Quality core measures are a standard of care for treatment.

The graduate nurse understands that the five rights of medication administration are part of: Quality management Environmental safety Anticipatory guidance Care coordination

Quality management Feedback Rationale: Quality management includes the prevention of errors for client safety. Checking the five rights when administering medication has been shown to reduce medication errors. An example of environmental safety might include placing signs around a wet floor. Anticipatory guidance is the nurse working with the client to effect changes in the client's lifestyle. Care coordination is a method of preventing duplication of services, usually accomplished by a case manager. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

The dialysis nurse manager decides to evaluate the sterility processes the renal unit staff​ follows, compared to accepted standards of care. Which term best describes that​ effort? Performance improvement Quality improvement Process standards Quality management

Quality management Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale Quality management compares specific nursing​ processes, like​ sterilization, to accepted standards of care. Quality improvement is one method of improving the processes of care. Performance improvement matches positive changes with participating staff. Process standards record​ step-by-step client care activities.

The nurse is responsible for the implementation of an electronic system of documentation involving the use of tablets by the nursing staff when seeing patients. Which program should the nurse use? Quality management plan Plan-Do-Study-Act (PDSA) Continuous quality improvement Total quality management

Quality management plan A quality management plan is used to help healthcare facilities integrate new programs, models, and technologies with the primary care services already in place. Total quality management (TQM) is a comprehensive management philosophy used to improve quality and productivity by using data and statistics to improve processes. Continuous quality improvement (CQI) is a structured organizational process for including personnel in planning and executing a continuous flow of improvements to provide quality health care that meets or exceeds expectations. PDSA is a system of quality improvement most often associated with TQM. In the Do phase, the plan is implemented on a small scale to determine whether it will be effective. This is followed by the Study phase, in which the outcomes of the Do phase are analyzed and compared to the expected outcomes. In the Act phase, the team must decide whether the goal was met, plan further changes, and decide whether the original goal is attainable based on the results of the previous interventions.

The nurse manager's review revealed that the increased number of nursing hours was associated with reduced patient mortality. Which nursing-sensitive indicator area, as it relates to quantity or quality, should the nurse understand to be reflected by this review? Quality of structure related to quality of outcome Quantity of structure related to quantity of outcome Quantity of structure related to quality of process Quality of structure related to quantity of process

Quantity of structure related to quantity of outcome The example of increased nursing hours shown to decrease patient mortality is a quantity structure to quantity outcome relationship (number of nursing hours compared to quantity of mortalities). An example of quality structure to quantity process would be more proficient nurses completing more repeat assessments per hour. Quantity structure related to quality structure would be related to reduction in nursing staff leading to less job satisfaction. A quality structure related to quality outcome example could be the good mix of staff that results in better patient outcomes and satisfaction.

This acronym is used to train healthcare staff the proper methods for fire responses. Question options: RACE PASS FATHOM RATS

RACE

A nurse is assisting with developing a quality improvement (QI) plan to reduce the incidence of medication errors in an acute care unit. The nurse should recognize that which of the following actions is included in the identifying step of the QI process?

Recognizing a need for a change

A nurse is reviewing a health care facility's policy that states to use a gauze dressing over IV insertion sites. After completing a literature review, the nurse discovers that evidence-based practice (EBP) indicates to use a transparent dressing over IV sites. Which of the following actions should the nurse take next?

Recommend changing the procedure to the policy and procedure committee.

The nurse manager conducts nurse evaluations based on standards of care. The manager understands that standards of care are based on established models of high-quality performance and may reflect all except: Recommendations of professional organizations Scientific or clinical research Recommendations of hospital physicians The performance of industry leaders

Recommendations of hospital physicians Rationale: Benchmarking is a method used to compare the performance of an individual or organization to industry standards. Standards of care are based on established models of high-quality performance and may reflect the performance of industry leaders, scientific or clinical research, or recommendations of professional organizations such as the ANA. Recommendations of hospital physicians are not necessarily standards of care. Nursing Process: Evaluation Client Need: Safe, Effective Care Environment Cognitive Level: Understanding

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by: a.Explaining to the staff that disciplinary action will be taken in cases of additional errors. b.Recommending that a multidisciplinary team should assess the root cause of errors in medication. c.Suggesting that the pharmacy department should explore its role in the problem. d.Changing the unit policy to allow a certain number of medication errors per year without penalty.

Recommending that a multidisciplinary team should assess the root cause of errors in medication

Which statement should the nurse understand as reflecting the aim of affordable care in the United States? Improving health by addressing behavioral, social, and environmental determinants Reducing the cost of quality health care for individuals, families, employers, and government Improving the quality of care by making care more patient centered, reliable, accessible, and safe Reducing wait times that may result in harmful delays for those who provide or receive care

Reducing the cost of quality health care for individuals, families, employers, and government Affordable care is meant to reduce the cost of quality health care for individuals, families, employers, and government. Better care is to improve the quality of care by making care more patient centered, reliable, accessible, and safe. The aim of healthy people/healthy communities is to improve the health of the U.S. population by supporting proven interventions to address behavioral, social, and environmental determinants.

A

Reducing the risk of functional decline in older adults can help prevent which​ complication? A. Pressure ulcers B. Macular degeneration C. Hyperglycemia D. Hearing loss

The urology nurse is reviewing medical records of the last five clients discharged after transurethral resection of the prostate​ (TURP). The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief. Which activity is the nurse participating in with this review​ process? Utilization review Concurrent audit Retrospective audit Root cause analysis

Retrospective audit Learning Objective Describe the process of quality improvement. Rationale The nurse is conducting a retrospective​ audit, looking back in time. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

The nurse uses a checklist to look at the completeness of documentation of postsurgical pain relief for clients discharged after a specific surgical procedure. Which term best describes the​ nurse's activity of this review​ process? Utilization review Retrospective audit Root cause analysis Concurrent audit

Retrospective audit The nurse is conducting a retrospective audit by looking back in time. A retrospective audit compares care provided to clients with similar​ conditions, and recommendations are made to change procedures if needed. A concurrent audit takes place when clients are still hospitalized. Utilization review looks at the use of​ resources, not documentation. A root cause analysis is triggered by a sentinel​ event, rather than by routine client care documentation.

A client called Patient Relations after being discharged to report that a skin infection developed around the IV catheter insertion site on the client​'s right arm. Which process would likely prevent a similar recurrence in the​ future? Peer review Utilization review Root cause analysis Risk management

Risk management Learning Objective Describe the process of quality improvement. Rationale Risk management could add this complaint to its data about client​ satisfaction/outcomes, and work with the relevant clinical unit about prevention. A skin infection is not a sentinel​ event, so no root cause analysis needs to be initiated. An isolated event would not prompt peer review. Utilization review looks at resource​ use, not postdischarge outcomes.

While in the hospital, a patient fell in the shower, had an allergic reaction to the hospital gown, and spiked a high temperature. Which type of assessment should the nurse understand will be used to collect data about the three complications the patient experienced? Risk management Blame-free environment Root cause analysis Utilization review

Risk management Risk management, which looks at past adverse events, would most likely be used to collect data. With no evidence of overuse, misuse, or underuse, the data would not be flagged for utilization review. Even with complications, the patient did not have a sentinel event, so no root cause analysis would be initiated. The events might or might not take place in a blame-free environment, but no errors or near misses are part of the known story.

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that: a. The error will result in suspension. b. An incident report is optional for an event that does not result in injury. c. The error will be documented in her personnel file. d. Risk management programs are not designed to assign blame.

Risk management programs are not designed to assign blame

The nurse manager calls for a meeting to identify and discuss the cause of a recent problem in the facility so that the incident does not happen again. Which term should the nurse use to describe this​ process? ​Blame-free environment Reducing medical errors Root cause analysis Resource utilization

Root cause analysis Root cause analysis is the correct answer. The goals of the root cause analysis are to identify the reasons for failures or problems and to develop an action plan for improvement to decrease the likelihood of future adverse events. Reducing medication errors involves interventions specifically help nurses prevent medication errors. Resource utilization is increasing the value of healthcare by reducing costs. A​ blame-free environment is established to maintain or improve the quality of care in which healthcare providers can report errors or near misses without the fear of punishment.

The oncology nurse is reviewing the Department of Health and Human Services​ (HHS) National Strategy for Quality Improvement in Health Care. In evaluating the nurse​'s cancer center​ facility, which descriptions of that healthcare system fit the HHS​ criteria? ​(Select all that​ apply.) Safe Compliant Reliable Sensitive Accessible

Safe Reliable Accessible Learning Objective Discuss the role of quality improvement initiatives in health care. Rationale The HHS criteria expect the healthcare system to be​ client-centered, reliable,​ accessible, and safe. The HHS does not discuss compliance or sensitivity.

The nurse is discussing the six aims of improvement in healthcare systems. Which term should be used to describe the goal of avoiding patient injuries from the care that is intended to help them? Efficient Patient-centered Safety Equitable

Safety According to the six aims of healthcare, safety is described as avoiding injuries to patients from the care that is intended to help them. Equitable care is related to providing care that does not vary in quality. Efficiency is related to avoiding waste. Patient-centered care is care that is tailored to the individual patient needs and preferences.

D

Several nurses are discussing the Joint​ Commission's 2016 National Patient Safety Goals during a staff meeting. Which element of performance should the nurses implement to meet the goal of identifying clients​ correctly? A. Asking the​ client's name before conducting assessments B. Labeling all medications with the​ client's name C. Marking the intended surgical site on the client D. Consistently using two methods to identify the client

This quality improvement methodology uses statistics for measuring variation in a process with the intent of producing error-free results? Question options: HRO Lean Six Sigma systems thinking

Six Sigma

The nurse manager complimented the night staff on recent data about reducing noise. The day shift nurses asked each client about obstacles to sleep the previous night. They recorded the clients​' responses as either achieving the goal of sleep or being disrupted by the defect of loud sounds or other obstacles. Which kind of quality improvement activity is taking​ place? Six Sigma Performance improvement Continuous quality improvement Benchmarking

Six Sigma Learning Objective Compare the components of various quality management programs. Rationale Six Sigma considers factors leading to client dissatisfaction as open double quote"defects.close double quote" Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

To address client complaints of disrupted sleep due to noise on the​ floor, the nurse manager formed three teams who implemented various processes to reduce the noise. Another team is collecting sleep data from the clients and analyzing the effectiveness of the​ solution, based on which they intend to develop better methods and improve the facility. Which quality improvement process is the manager​ implementing? Benchmarking Continuous quality improvement Six Sigma Performance improvement

Six Sigma Six Sigma considers factors leading to client dissatisfaction as​ "defects." Disrupted sleep qualifies as a defect. Defect is not a concept used in continuous quality improvement or performance improvement. Benchmarking uses industry​ standards, which do not exist for disrupted sleep.

Which type of agency should the nurse recognize as being responsible for providing health insurance for low-income individuals and families? Centers for Disease Control and Prevention Office of the Surgeon General State agency Office of Medicare

State agency Even with the advent of the Affordable Care Act, state agencies are partially responsible for providing health insurance programs for low-income individuals and families. The Surgeon General reports to the Assistant Secretary for Health (ASH), who may be a four-star admiral in the commissioned corps, and who serves as the principal adviser to the Secretary of Health and Human Services on public health and scientific issues. As the nation's health protection agency, the Centers for Disease Control and Prevention (CDC) saves lives and protects people from health, safety, and security threats. Medicare is the federal health insurance program for people who are 65 or older, certain younger people with disabilities, and people with end-stage renal disease.

Which of the following is NOT a type of managed care? Question options: HMO PPO TQM POS

TQM

A nurse is assisting with teaching a newly licensed nurse about the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) tool. Which of the following information should the nurse include?

The HCAHPS tool is issued to measure client satisfaction about health care service.

The nurse is reviewing yearly national patient safety goals. For which organization is the nurse retrieving this​ information? The Food and Drug Association The Joint Commission Institute for Safe Medical Practices The American Medical Association

The Joint Commission The Joint Commission is the organization that identifies client safety goals every year for medical facilities to focus on. The goals​ include, but are not limited​ to, ensuring clients are identified​ safely, improving staff​ communication, using alarms​ safely, and preventing infections. The American Medical Association​ (AMA) promotes the betterment of public health by enhancing the delivery of care and enabling physicians and healthcare teams to partner with clients to achieve better health. The Institute for Safe Medication Practice​ (ISMP) maintains a list of high alert medications such as​ look-alike, sound-alike medications to assist clinicians with identifying medications that can either look similar or have similar​ names, but that have very different chemical properties that can cause harm to the client if the medications are mixed up. The Food and Drug Administration​ (FDA) is responsible for advancing the public health by helping to speed innovations that make medical products more​ effective, safer, and more affordable and by helping the public get the​ accurate, science-based information they need to use medical products and foods to maintain and improve their health.

B

The home health nurse is talking with the parents outside the bathroom door while their​ 1-year-old twins are playing in the tub. Which client statement would require further safety​ teaching? A. "Let me get the children out of the tub so we can​ talk." B. "Why don't we talk in the living​ room?" C. "I do not like to leave the children alone in the​ bathroom." D. "I often bathe the children​ together."

D

The home healthcare nurse is traveling to a​ client's home for the first time. What observation would suggest a safety hazard for the​ nurse? A. Client medications on the kitchen counter B. Absence of street lights in the neighborhood C. Neighbor walking a dog on a leash D. Porch steps that are broken and rotting

A

The nurse is assessing a​ 12-year-old male client. The client is within the normal range for​ height, weight, and body mass index​ (BMI) for his age. The client plans to play contact sports at school this year. He lives with his mother and attends​ after-school events when she is working late. What education should the nurse identify as a priority for this client to promote​ safety? A. The importance of using safety equipment when playing contact sports B. The importance of learning how to feel secure when he is at home alone C. The importance of maintaining a normal weight and participating in physical activity D. The importance of good hygiene practices and healthy diet

B

The nurse is caring for a client with a​ self-reported latex allergy. Which strategy can the nurse use to ensure the safety of this​ client? A. Wear hypoallergenic gloves B. Wash hands after taking gloves off C. Wear gloves with powder D. Keep beta adrenergic agonists on hand

C

The nurse is caring for a​ 230-lb client who needs to be repositioned every 2 hours. While repositioning the​ client, the nurse injured a muscle in her back. To prevent the injury and ensure safety for both the nurse and​ client, what should the nurse have done differently in this​ situation? A. She should have questioned the physician about the need to reposition the client. B. She should have repositioned the client only if the client requested it. C. She should have asked for help from another nurse. D. She should have used proper lifting techniques.

C

The nurse is caring for a​ 3-year-old child who is in the hospital for the first time. The child appears frightened and is clinging to her parents. What action can the nurse take to help the child feel more secure if the child needs to stay at the hospital without her​ parents? A. Make sure the child wears proper identification at all times B. Stay with the child when the parents go home C. Have the parents bring comfort items from home to leave with the child D. Keep dangerous medications and equipment out of the​ child's reach

D

The nurse is caring for a​ 43-year-old client. What education should the nurse implement to best address the overall health promotion needs of someone in this age​ group? A. Encourage the client to not drive while distracted B. Teach the client about ergonomic aids for computer use C. Tell the client to seek medical help for injuries D. Teach the client about​ age-appropriate medical screenings

A

The nurse is conducting a class for a group of pregnant clients. Which topics should the nurse include when teaching this group about safety of the​ fetus? A. Alcohol consumption B. Suffocation in the crib C. Drowning D. Pedestrian accidents

B

The nurse is conducting a home risk assessment for a family with toddler and​ preschool-age children. Which should the nurse identify as the priority safety​ hazard? A. Child locks on the doors B. Medications on the kitchen counter C. Lack of helmets next to bicycles D. Safety plugs in electrical outlets

A,B,E

The nurse is developing a plan of care for a client who is at risk for falls. Which interventions would be appropriate for the nurse to include in the plan of​ care? Select all that apply. A. Assess the​ client's vision and make sure he is using any prescribed eyewear. B. Keep frequently used items within easy reach. C. Apply physical restraints if the client gets out of bed. D. Provide slippers for the client to wear while ambulating. E. Use side rails on client beds.

B

The nurse is providing care to a pregnant client who has type 2 diabetes mellitus. The client has asked about how the medications she is taking will affect her fetus. How should the nurse​ respond? A."The medications you are taking will not adversely affect your fetus. You should continue taking them as you did before your​ pregnancy." B."If you have any concerns about how your medication will affect your​ fetus, you should talk to your primary care​ physician." C."The medications you are taking have a risk of causing fetal defects. You should stop taking your medications while you are​ pregnant." D."The medications you are taking will not work as well when you are​ pregnant, so you should increase the dose of your​ medications."

D

The nurse is providing care to a​ 12-year-old child with special needs and his caregiver. What strategies should the nurse help the caregiver teach the child to improve the​ child's safety? A. Teach the child to schedule routine immunizations B. Teach the child to maintain airway with suctioning C. Teach the child to avoid secondhand smoke exposure D. Teach the child how to use a telephone to call for help

D

The nurse working in a healthcare setting is charged with inappropriate delegation after asking an unlicensed assistive personnel​ (UAP) to change the IV bag for a client. To which agency should this action be​ reported? A. Health Hazard Evaluation Program B. Occupational Health Safety Network C. Occupational Health and Safety Administration D. Board of nursing

Which scenario describes an adverse medication event? The nurse gives the patient the wrong medication. The nurse is late with the patient's medication by 1 hour. While waiting for a surgery, a patient stops breathing and resuscitation attempts fail. The patient's tongue swells and breathing is difficult after taking a new medication.

The patient's tongue swells and breathing is difficult after taking a new medication. An adverse drug event is defined as harm to a patient as a result of receiving a medication, such as an allergic reaction. The nurse must respond promptly to make sure the respiratory status of the patient does not deteriorate. A medication error is any preventable event that may cause or lead to inappropriate medication use or patient harm while the medication is in control of the healthcare professional, patient, or consumer. The patient waiting for surgery who stopped breathing had not yet received any medication.

The nurse is preparing a training program to introduce quality management. Which information should the nurse include? Staff will plan in silos. Staff satisfaction surveys will be used to track the effectiveness of changes. The purpose is to improve the experience of patient care, population, and value. Programs will be staff focused.

The purpose is to improve the experience of patient care, population, and value. Quality management plans address the needs of engagement (improving the experience of care), population health, and value (per capita costs). These plans are patient focused, and collect and evaluate data for improvement of patient outcomes, expectations, and satisfaction. Patient satisfaction surveys are used to track the effectiveness of changes from the patient's perspective. Most organizations will develop quality management plans that require cooperation between departments as well as unit-specific plans. Teams will work cooperatively, not in silos.

D

The staff nurses are discussing interventions to reduce the risk of infection for the client population. Which intervention is the most important to decrease client​ infection? A. Raise the temperature in the​ client's room. B. Assess vital signs once daily. C. Wear a mask for all client care. D. Practice appropriate hand hygiene.

The nurse is preparing a presentation of the major goals of the National Database of Nursing Quality Indicators (NDNQI). Which goal should the nurse include? To assist nurses in reducing medication errors To determine the root causes of sentinel events To identify patient safety goals every year To use data to help nurses and other leaders to improve the quality of care

To use data to help nurses and other leaders to improve the quality of care The goal of the NDNQI is to use data to provide nurses and other leaders with information needed to improve quality of care. The Institute for Safe Medication Practice reduces nursing medication errors by identifying high-risk medications. The Joint Commission, which accredits hospitals and agencies, requires root cause analysis of sentinel events; it also identifies patient safety goals every year.

A specialty trauma center is adopting the concept of Plan-Do-Study-Act to improve their quality and productivity. Which quality assurance program should the nurse identify that the organization is trying to adopt? Total Quality Management Lean Six Sigma Quality management Continuous Quality Improvement

Total Quality Management Total Quality Management uses the PDSA approach of Plan-Do-Study-Act. The Define-Measure-Analyze-Improve-Control and the Define-Measure-Analyze-Design-Verify methods are used in Six Sigma. Quality management is more a concept than a plan. Continuous Quality Improvement is a system-organized program. Lean Six Sigma combines the strategies of Six Sigma, described above, with the Lean system. The objective of the Lean system is to eliminate waste to maximize value.

A hospital administrator wants to improve quality care and workflow process within the organization by involving the whole​ organization, suppliers, and customers in the process. Which quality management program should the nurse understand the manager is​ using? Lean Six Sigma Six Sigma Total quality management Continuous quality improvement

Total quality management Total quality management​ (TQM) is a comprehensive management philosophy that is used to improve quality and productivity by using data and statistics to improve systems processes. TQM involves teamwork throughout the​ organization, involving all departments and employees and including both suppliers and customers. Its essential elements include​ communication, feedback,​ fact-based decision​ making, and a focus on continual improvement.

A facility quality indicator profile shows what proportion of a long-term care facility's residents have deficits in each area of assessment during a reporting period. Question options: True False

True

Certification and licensing processes usually require an applicant to pass an examination to initially obtain the certification or license. Question options: True False

True

Healthcare leaders and their boards of directors are responsible for the quality of the organization's services. Question options: True False

True

Many organizations treat near misses in the same way that they treat sentinel events, using error-reduction tools such as root-analysis or failure mode and effects analysis in an effort to prevent future occurrences. Question options: True False

True

Proper hand-washing has been identified by the CDC as one of the single most important methods for preventing the spread of infection. Question options: True False

True

Safety data sheets are documents that give detailed information about a material, including any associated hazards. Question options: True False

True

Which should the nurse recognize as being the best resource to keep abreast to the changes of the insurance and healthcare​ laws? ​Physicians' groups U.S. Department of Health and Human Services American Medical Association American Nurses Association

U.S. Department of Health and Human Services Keep abreast of the changes in healthcare and insurance laws by visiting the U.S. Department of Health and Human Services.​ Physicians' groups, the American Nurses Association​ (ANA), and the American Medical Association​ (AMA) are not the best place to keep oneself​ up-to-date about the changes in insurance and healthcare laws.

Which governmental agency should the nurse recognize as being instrumental in developing indicators of high-quality care and measures? U.S. Red Cross Centers for Disease Control and Prevention (CDC) U.S. Department of Health and Human Services (HHS) National Institutes of Health (NIH)

U.S. Department of Health and Human Services (HHS) HHS works with the American Medical Association (AMA) and the American Nurses Association (ANA) to develop indicators of high-quality care and measures to document the quality of care. The U.S. Red Cross works to provide support for disaster relief and blood donations. The CDC conducts and supports health promotion, prevention, and preparedness in an effort to improve health, but not actually measurements. The NIH's primary responsibility is biomedical and public health research.

Several medication errors occurred at a facility. Which method should the nurse anticipate being suggested to avoid future​ errors? (Select all that​ apply.) Use smart infusion pumps for intravenous medications. Conduct medication reconciliation at every transition in care. ​Double-check the​ "seven rights" every time medication is administered. Have a second nurse check the medication order. Combine medications with the same active ingredient.

Use smart infusion pumps for intravenous medications. Conduct medication reconciliation at every transition in care. ​Double-check the​ "seven rights" every time medication is administered. Have a second nurse check the medication order. The correct answers to avoid such errors are​ (1) double-check the​ "seven rights" every time medication is​ administered, (2) conduct medication reconciliation at every transition in​ care, (3) use smart infusion pumps for intravenous​ medications, and​ (4) have a second nurse check the medication order. Combining medications with the same active ingredient is incorrect and is not a method in reducing medication errors.

D

What nursing intervention is appropriate for a client with dry and cracked​ feet? A. Provide slippers for the client to wear at all times B. Soak the​ client's feet in water several times daily C. Massage the​ client's feet daily D. Apply lotion to the​ client's feet after bathing

D

When a nurse performs or observes nursing practices that are not​ safe, the nurse has a responsibility to report those actions. This principle ties the concept of safety to what other nursing​ concept? A. Clinical Decision Making B. Advocacy C. Assessment D. Accountability

D

Which action by a nurse would require immediate intervention by another healthcare team​ member? A. Disposing of a needle in the sharps container. B. Recapping a needle using the scoop method. C. Recapping a needle with the use of a hemostat. D. Recapping a needle while holding the cap.

B,C,E

Which practices support promotion of health​ safety? Select all that apply. A. Eliminate all foods containing fat B. Wear seat belts C. Exercise every day D. Only see healthcare providers when sick E. Avoid driving when sleepy or tired

A

While reviewing safety precautions with the staff in a​ long-term care​ facility, which step should the nurse emphasize that helps to promote a safe environment for the​ clients? A. Have the client wear shoes with rubber​ skid-resistant soles. B. Turn off alarms to reduce noise. C. Provide dim lighting. D. Keep clutter out of the hallway and inside the​ client's room.

The process of benchmarking against an organization's established norm, which may be based on best practice, state or national standards, or some combination of these thresholds, helps the organization determine whether its processes fall within the acceptable standard deviations of the norm. When items fall outside the norm this signals that ________. Question options: a PI project may be appropriate the organization must contact their accrediting organization immediately to report this the organization is on target the organization should benchmark against hospitals that are located at a greater distance.

a PI project may be appropriate

A high school nurse is counseling parents of teenagers who are beginning high school. Which issues would be priority topics of discussion for this age group? Select all that apply. a.The influence of peer groups b.Bullying c.Water safety d.Eating disorders e.Risk taking behavior f.Immunizations

a, b, d, e. Appropriate topics of discussion for parents of adolescents include peer groups, bullying, eating disorders, and risk-taking behaviors.

A nurse caring for older adults in a long-term care facility knows that several physical changes occur in the aging adult. Which characteristics best describe these changes? Select all that apply. a.Fatty tissue is redistributed. b.The skin is drier and wrinkles appear. c.Cardiac output increases. d.Muscle mass increases. e.Hormone production increases. f.Visual and hearing acuity diminishes.

a, b, f. Physical changes occurring with aging include these: fatty tissue is redistributed, the skin is drier and wrinkles appear, and visual and hearing acuity diminishes. Cardiac output decreases, muscle mass decreases, and hormone production decreases, causing menopause or andropause.

The nurse collects objective and subjective data when conducting patient assessments. Which patient conditions are examples of subjective data? Select all that apply. a.A patient tells the nurse that she is feeling nauseous. b.A patient's ankles are swollen. c.A patient tells the nurse that she is nervous about her test results. d.A patient complains of having a rash on her arm that is itchy. e.A patient rates his pain as a 7 on a scale of 1 to 10. f.A patient vomits after eating supper.

a, c, d, e. Subjective data are information perceived only by the affected person; these data cannot be perceived or verified by another person. Examples of subjective data are feeling nervous, nauseated, itchy, or chilly and experiencing pain.

A nurse is attempting to improve care on the pediatric ward of a hospital. Which nursing improvements might the nurse employ when following the recommendations of the Institute of Medicine's Committee on Quality of Health Care in America? Select all that apply. a.Basing patient care on continuous healing relationships b.Customizing care to reflect the competencies of the staff c.Using evidence-based decision making d.Having a charge nurse as the source of control e.Using safety as a system priority f.Recognizing the need for secrecy to protect patient privacy

a, c, e. Care should be based on continuous healing relationships and evidence-based decision making. Customization should be based on patient needs and values with the patient as the source of control. Safety should be used as a system priority, and the need for transparency should be recognized.

A new nurse who is being oriented to the subacute care unit is expected to follow existing standards when providing patient care. Which nursing actions are examples of these standards? Select all that apply. a.Monitoring patient status every hour b.Using intuition to troubleshoot patient problems c.Turning a patient on bed rest every 2 hours d.Becoming a nurse mentor to a student nurse e.Administering pain medication ordered by the physician f.Becoming involved in community nursing events

a, c, e. Standards are the levels of performance accepted and expected by the nursing staff or other health care team members. They are established by authority, custom, or consent.

A nurse is using critical pathway methodology for choosing interventions for a patient who is receiving chemotherapy for breast cancer. Which nursing actions are characteristics of this system being used when planning care? Select all that apply. a.The nurse uses a minimal practice standard and is able to alter care to meet the patient's individual needs. b.The nurse uses a binary decision tree for stepwise assessment and intervention. c.The nurse is able to measure the cause-and-effect relationship between pathway and patient outcomes. d.The nurse uses broad, research-based practice recommendations that may or may not have been tested in clinical practice. e.The nurse uses preprinted provider orders used to expedite the order process after a practice standard has been validated through research. f.The nurse uses a decision tree that provides intense specificity and no provider flexibility.

a, c. A critical pathway represents a sequential, interdisciplinary, minimal practice standard for a specific patient population that provides flexibility to alter care to meet individualized patient needs.

A nurse is using the implementation step of the nursing process to provide care for patients in a busy hospital setting. Which nursing actions best represent this step? Select all that apply. a.The nurse carefully removes the bandages from a burn victim's arm. b.The nurse assesses a patient to check nutritional status. c.The nurse formulates a nursing diagnosis for a patient with epilepsy. d.The nurse turns a patient in bed every 2 hours to prevent pressure ulcers. e.The nurse checks a patient's insurance coverage at the initial interview. f.The nurse checks for community resources for a patient with dementia.

a, d, f. During the implementing step of the nursing process, nursing actions planned in the previous step are carried out. The purpose of implementation is to assist the patient in achieving valued health outcomes: promote health, prevent disease and illness, restore health, and facilitate coping with altered functioning.

In order to provide culturally competent care, nurses must be alert to factors inhibiting sensitivity to diversity in the health care system, including cultural imposition. Which examples exemplify cultural imposition? Select all that apply. a.A hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily. b.A nurse treats all patients the same whether or not they come from a different culture. c.A nurse tells another nurse that Jewish diet restrictions are just a way for them to get a special tray of their favorite foods. d.A Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. e.A nurse directs interview questions to an elderly patient's daughter even though the patient is capable of answering them. f.A nurse refuses to care for a married gay man who is HIV positive because she is against same-sex marriage.

a, d. Cultural imposition occurs when a hospital nurse tells a nurse's aide that patients should not be given a choice whether or not to shower or bathe daily and when a Catholic nurse insists that a patient diagnosed with terminal bladder cancer see the chaplain in residence. Cultural blindness occurs when a nurse treats all patients the same whether or not they come from a different culture.

The nurse uses blended competencies when caring for patients in a rehabilitation facility. Which examples of interventions involve cognitive skills? Select all that apply. a.The nurse uses critical thinking skills to plan care for a patient. b.The nurse correctly administers IV saline to a patient who is dehydrated. c.The nurse assists a patient to fill out an informed consent form. d.The nurse learns the correct dosages for patient pain medications. e.The nurse comforts a mother whose baby was born with Down syndrome. f.The nurse uses the proper procedure to catheterize a female patient.

a, d. Using critical thinking and learning medication dosages are cognitive competencies.

The nurse is admitting a 35-year-old pregnant woman to the hospital for treatment of preeclampsia. The patient asks the nurse: "Why are you doing a history and physical exam when the doctor just did one?" Which statements best explain the primary reasons a nursing assessment is performed? Select all that apply. a."The nursing assessment will allow us to plan and deliver individualized, holistic nursing care that draws on your strengths." b."It's hospital policy. I know it must be tiresome, but I will try to make this quick!" c."I'm a student nurse and need to develop the skill of assessing your health status and need for nursing care." d."We want to make sure that your responses to the medical exam are consistent and that all our data are accurate." e."We need to check your health status and see what kind of nursing care you may need." f."We need to see if you require a referral to a physician or other health care professional.

a, e, f The initial comprehensive nursing assessment results in baseline data that enable the nurse to make a judgment about a patient's health status, the ability to manage his or her own health care and the need for nursing. It also helps nurses plan and deliver individualized, holistic nursing care that draws on the patient's strengths and promotes optimum functioning, independence, and well-being, and enables the nurse to refer the patient to a physician or other health care professional, if indicated.

A nurse caring for culturally diverse patients in a physician's office is aware that patients of certain cultures are more prone to specific disease states than the general population.which patients would the nurse screen for diabetes mellitus based on the patient's race? Select all that apply. a.A Native American patient b.An African American patient c.A Pacific Island patient d.An Asian patient e.A White patient f.A Hispanic patient

a, e, f. Native Americans, Hispanics, and Whites are more prone to developing diabetes mellitus.

A school nurse notices that a female adolescent student is losing weight and decides to perform a focused assessment of her nutritional status to determine if she has an eating disorder. How should the nurse proceed? a.Perform the focused assessment. This is an independent nurse-initiated intervention. b.Request an order from Jill's physician since this is a physician-initiated intervention. c.Request an order from Jill's physician since this is a collaborative intervention. d.Request an order from the nutritionist since this is a collaborative intervention.

a. Performing a focused assessment is an independent nurse-initiated intervention, thus the nurse does not need an order from the physician or the nutritionist.

A mother tells the nurse that she is worried about her 4-year-old daughter because she is "overly attached to her father and won't listen to anything I tell her to do." What would be the nurse's best response to this parental concern? a.Tell the mother that this is normal behavior for a preschooler. b.Tell the mother that she and her family should see a counselor. c.Tell the mother that she should try to spend more time with her daughter. d.Tell the mother that her child should be tested for autism.

a. Preschoolers, according to Freud, are in the phallic stage, with the biologic focus primarily genital. The child has a sexual desire for the opposite-sex parent, but as means of defense strongly identifies with the same-sex parent. This is normal behavior for a preschooler

A nurse is assessing a 15-year-old female patient who is diagnosed with anorexia. Following the assessment, the nurse recommends that the patient meet with a nutritionist. This action best exemplifies the use of: a.Clinical judgment b.Clinical reasoning c.Critical thinking d.Blended competencies

a. the best choice is clinical judgment as it refers to the result or outcome of critical thinking or clinical reasoning

When the initial nursing assessment revealed that a patient had not had a bowel movement for 2 days, the student nurse wrote the diagnostic label "constipation." Which of the following comments is the nurse most likely to hear from the instructor? a."Hold on a minute . . . Nursing diagnoses should always be derived from clusters of significant data rather than from a single cue." b."Job well done . . . you've identified this problem early and we can manage it before it becomes more acute." c."Is this an actual or a possible diagnosis?" d."This is a medical, not a nursing problem."

a. A data cluster is a grouping of patient data or cues that points to the existence of a patient health problem.

An experienced nurse tells a beginning nurse not to bother studying too hard, since most clinical reasoning becomes "second nature" and "intuitive" once you start practicing. What thinking below should underlie the beginning nurse's response? a.Intuitive problem solving comes with years of practice and observation, and novice nurses should base their care on scientific problem solving. b.For nursing to remain a science, nurses must continue to be vigilant about stamping out intuitive reasoning. c.The emphasis on logical, scientific, evidence-based reasoning has held nursing back for years; it's time to champion intuitive, creative thinking! d.It's simply a matter of preference; some nurses are logical, scientific thinkers, and some are intuitive, creative thinkers.

a. Beginning nurses must use nursing knowledge and scientific problem solving as the basis of care they give; intuitive problem solving comes with years of practice and observation.

A nurse performing an assessment of a newborn in the neonatal unit records these findings: heart rate 85 bpm, irregular respiratory rate, normal muscle tone, weak crying, and bluish tint to skin. Using the APGAR scoring chart, what would be the score for this newborn? a.5 b.7 c.8 d.10

a. A newborn with a heart rate less than 100 bpm, irregular respiratory effort, normal muscle tone, weak cry, and bluish tint to the skin scores a 5 on the APGAR chart. APGAR chart shown on page 389

To determine the significance of a blood pressure reading of 148/100, it is first necessary for the nurse to: a.Compare this reading to standards. b.Check the taxonomy of nursing diagnoses for a pertinent label. c.Check a medical text for the signs and symptoms of high blood pressure. d.Consult with colleagues.

a. A standard, or a norm, is a generally accepted rule, measure, pattern, or model to which data can be compared in the same class or category.

A nurse is caring for an 80-year-old female patient who is living in a long-term care facility. To help this patient adapt to her present circumstances, the nurse is using reminiscence as therapy. Which question would encourage reminiscence? a."Tell me about how you celebrated Christmas when you were young." b."Tell me how you plan to spend your time this weekend." c."Did you enjoy the choral group that performed here yesterday? d."Why don't you want to talk about your feelings?"

a. Asking questions about events in the past can encourage the older adult to relive and restructure life experiences.

A nurse is preparing a clinical outcome for a 32-year-old female runner who is recovering from a stroke that caused right-sided paresis. An example of this type of outcome is: a.After receiving 3 weeks of physical therapy, patient will demonstrate improved movement on the right side of her body. b.By 8/15/15, patient will be able to use right arm to dress, comb hair, and feed herself. c.Following physical therapy, patient will begin to gradually participate in walking/running events. d.By 8/15/15, patient will verbalize feeling sufficiently prepared to participate in running events.

a. Clinical outcomes describe the expected status of health issues at certain points in time, after treatment is complete.

A nurse is teaching new mothers about infant care and safety. What would the nurse accurately include as a teaching point? a.Keep infants younger than 6 months out of direct sunlight. b.Use honey instead of sugar in homemade baby food. c.Place the baby on his or her stomach for sleeping. d.Keep crib rails down at all times.

a. Nurses should teach parents to keep infants younger than 6 months out of direct sunlight and cover them with protective clothing and hats.

A quality-assurance program reveals a higher incidence of falls and other safety violations on a particular unit. A nurse manager states, "We'd better find the folks responsible for these errors and see if we can replace them." This is an example of: a.Quality by inspection b.Quality by punishment c.Quality by surveillance d.Quality by opportunity

a. Quality by inspection focuses on finding deficient workers and removing them.

A student nurse is on a clinical rotation at a busy hospital unit. The RN in charge tells the student to change a surgical dressing on a patient while she takes care of other patients. The student has not changed dressings before and does not feel confident with the procedure. What would be the student's best response? a.Tell the RN that he or she lacks the technical competencies to change the dressing independently. b.Assemble the equipment for the procedure and follow the steps in the procedure manual. c.Ask another student nurse to work collaboratively with him or her to change the dressing. d.Report the RN to his or her instructor for delegating a task that should not be assigned to student nurses.

a. Student nurses should notify their nursing instructor or nurse mentor if they believe they lack any competencies needed to safely implement the plan of care. It is within the realm of a student nurse to change a dressing if he or she is technically prepared to do so.

A student nurse tells the instructor that a patient is fine and has "no complaints." What would be the instructor's best response? a."You made an inference that she is fine because she has no complaints. How did you validate this?" b."She probably just doesn't trust you enough to share what she is feeling. I'd work on developing a trusting relationship." c."Sometimes everyone gets lucky. Why don't you try to help another patient?" d."Maybe you should reassess the patient. She has to have a problem—why else would she be here?"

a. The instructor is most likely to challenge the inference that the patient is "fine" simply because she is telling you that she has no problems.

A nurse is telling a new mother from Africa that she shouldn't carry her baby in a sling created from a large rectangular cloth. The African woman tells the nurse that everyone in Mozambique carries babies this way. The nurse believes that bassinets are safer for infants. What term best describes what the nurse is doing? a.Cultural imposition b.Clustering c.Cultural competency d.Stereotyping

a. The nurse is trying to impose her belief that bassinets are preferable to baby slings on the African mother—in spite of the fact that African women have safely carried babies in these slings for years.

The nurse practitioner sees patients in a community clinic that is located in a predominately White neighborhood. After performing assessments on the majority of the patients visiting the clinic, the nurse notes that many of the minority groups living within the neighborhood have lost the cultural characteristics that made them different. What is the term for this process? a.Cultural assimilation b.Cultural imposition c.Culture shock d.Ethnocentrism

a. When minority groups live within a dominant group, many members lose the cultural characteristics that once made them different in a process called assimilation.

A nurse is prioritizing the following patient diagnoses according to Maslow's hierarchy of human needs: (1) Disturbed Body Image (2) Ineffective Airway Clearance (3) Spiritual Distress (4) Impaired Social Interaction Which answer choice below lists the problems in order of highest priority to lowest priority based on Maslow's model? a.2, 4, 1, 3 b.3, 1, 4, 2 c.2, 4, 3, 1 d.3, 2, 4, 1

a. 2, 4, 1, 3. Because basic needs must be met before a person can focus on higher ones, patient needs may be prioritized according to Maslow's hierarchy: (1) physiologic needs, (2) safety needs, (3) love and belonging needs, (4) self-esteem needs, and (5) self-actualization needs.

A tool used to ensure that every team member knows which items will be discussed or worked on during a meeting is called a: Question options: action plan agenda flow chart dashboard

agenda

Workplace violence includes: Question options: threatening behavior verbal threat domestic violence all the above

all the above

A nurse is planning care for a male adolescent patient who is admitted to the hospital for treatment of a drug overdose. Which nursing actions are related to the outcome identification and planning step of the nursing process? Select all that apply. a.The nurse formulates nursing diagnoses. b.The nurse identifies expected patient outcomes. c.The nurse selects evidence-based nursing interventions. d.The nurse explains the nursing care plan to the patient. e.The nurse assesses the patient's mental status. f.The nurse evaluates the patient's outcome achievement.

b, c, d. During the outcome identification and planning step of the nursing process, the nurse works in partnership with the patient and family to establish priorities, identify and write expected patient outcomes, select evidence-based nursing interventions, and communicate the plan of nursing care.

An RN working on a busy hospital unit delegates patient care to unlicensed assistive personnel (UAPs). Which patient care could the nurse most likely delegate to a UAP safely? Select all that apply. a.Performing the initial patient assessments b.Making patient beds c.Giving patients bed baths d.Administering patient medications e.Ambulating patients f.Assisting patients with meals

b, c, e, f. Performing the initial patient assessment and administering medications are the responsibility of the registered nurse. In most cases, patient hygiene, bed-making, ambulating patients, and helping to feed patients can be delegated to a UAP.

A nurse uses critical thinking skills to focus on the care plan of an elderly patient who has dementia and needs placement in a long-term care facility. Which statements describe characteristics of this type of critical thinking applied to clinical reasoning? Select all that apply. a.It functions independently of nursing standards, ethics, and state practice acts. b.It is based on the principles of the nursing process, problem solving, and the scientific method. c.It is driven by patient, family, and community needs as well as nurses' needs to give competent, efficient care. d.It is not designed to compensate for problems created by human nature, such as medication errors. e.It is constantly re-evaluating, self-correcting, and striving for improvement. f.It focuses on the big picture rather than identifying the key problems, issues, and risks involved with patient care.

b, c, e. Critical thinking applied to clinical reasoning and judgment in nursing practice is guided by standards, policies and procedures, and ethics codes.

A nurse is caring for an older adult patient who presents with labored respirations, productive cough, and fever. What would be appropriate nursing diagnoses for this patient? Select all that apply. a.Bronchial pneumonia b.Impaired gas exchange c.Ineffective airway clearance d.Potential complication: sepsis e.Infection related to pneumonia f.Risk for septic shock

b, c, f. Nursing diagnoses are actual or potential health problems that can be prevented or resolved by independent nursing interventions, such as impaired gas exchange, ineffective airway clearance, or risk for septic shock

A nurse who is caring for older adults in a senior daycare center documents findings as related to which normal aging process? Select all that apply. a.A patient's increased skin elasticity causes wrinkles on the face and arms. b.Exposure to sun over the years causes a patient's skin to be pigmented. c.A patient's toenails have become thinner with a bluish tint to the nail beds. d.A patient experiences a hip fracture due to porous and brittle bones. e.Fragile blood vessels in the dermis allow for more easy bruising of a patient's forearm. f.Increased bladder capacity causes decreased voiding in an older patient.

b, d, e. Exposure to sun over the years can cause a patient's skin to be pigmented. Bone demineralization occurs with aging, causing bones to become porous and brittle, making fractures more common. The blood vessels in the dermis become more fragile, causing an increase in bruising and purpura.

A nurse on a busy surgical unit relies on informal planning to provide appropriate nursing responses to patients in a timely manner. What are examples of this type of planning? Select all that apply. a.A nurse sits down with a patient and prioritizes existing diagnoses. b.A nurse assesses a woman for postpartum depression during routine care. c.A nurse plans interventions for a patient who is diagnosed with epilepsy. d.A busy nurse takes time to speak to a patient who received bad news. e.A nurse reassesses a patient whose PRN pain medication is not working. f.A nurse coordinates the home care of a patient being discharged.

b, d, e. Informal planning is a link between identifying a patient's strength or problem and providing an appropriate nursing response.

Following a fall that left an elderly male patient temporarily bedridden, the nurse is using the SPICES assessment tool to evaluate him for cascade iatrogenesis. Which are correct aspects of this tool? Select all that apply. a.S - Senility b.P - Problems with feeding c.I - Irritableness d.C - Confusion e.E - Edema of the legs f.S - Skin breakdown

b, d, f. The SPICES acronym is used to identify common problems in older adults and stands for: S - Sleep disorders P - Problems with eating or feeding I - Incontinence C - Confusion E - Evidence of falls S - Skin breakdown

A registered nurse is writing a diagnosis for a 28-year-old male patient who is in traction due to multiple fractures from a motor vehicle accident. Which nursing actions are related to this step in the nursing process? Select all that apply. a.The nurse uses the nursing interview to collect patient data. b.The nurse analyzes data collected in the nursing assessment. c.The nurse develops a care plan for the patient. d.The nurse points out the patient's strengths. e.The nurse assesses the patient's mental status. f.The nurse identifies community resources to help his family cope.

b, d, f. The purposes of diagnosing are to identify how an individual, group, or community responds to actual or potential health and life processes; identify factors that contribute to or cause health problems (etiologies); and identify resources or strengths the individual, group, or community can draw on to prevent or resolve problems.

A nurse assesses a patient and formulates the following nursing diagnosis: Risk for Impaired Skin Integrity related to prescribed bedrest as evidenced by reddened areas of skin on the heels and back. Which phrase represents the etiology of this diagnostic statement? a.Risk for Impaired Skin Integrity b.Related to prescribed bedrest c.As evidenced by d.As evidenced by reddened areas of skin on the heels and back

b. "Related to prescribed bedrest" is the etiology of the statement. The etiology identifies the contributing or causative factors of the problem.

A nurse is caring for an elderly male patient who is receiving fluids for dehydration. Which outcome for this patient is correctly written? a.Offer the patient 60 mL fluid every 2 hours while awake. b.During the next 24-hour period, the patient's fluid intake will total at least 2,000 mL. c.Teach the patient the importance of drinking enough fluids to prevent dehydration by 1/15/15 d.At the next visit, 12/23/15, the patient will know that he should drink at least 3 liters of water per day.

b. The outcomes in a and c make the error of expressing the patient goal as a nursing intervention. The outcome in d makes the error of using verbs that are not observable and measurable.

The nursing process ensures that nurses are person centered rather than task centered. Rather than simply approaching a patient to take vital signs, the nurse thinks, "How is Mrs. Barclay today? Are our nursing actions helping her to achieve her goals? How can we better help her?" This demonstrates which characteristic of the nursing process? a.Systematic b.Interpersonal c.Dynamic d.Universally applicable in nursing situations

b. conversation and thinking quoted best illustrates the interpersonal dimension of the nursing process.

A nurse makes a clinical judgment that an African American male patient in a stressful job is more vulnerable to developing hypertension than White male patients in the same or similar situation. The nurse has formulated what type of nursing diagnosis? a.Actual b.Risk c.Possible d.Wellness

b. A clinical judgment that an individual, family, or community is more vulnerable to develop the problem than others in the same or similar situation is a Risk nursing diagnosis.

The nurse records an APGAR score of 4 for a newborn. What would be the priority intervention for this newborn? a.No interventions are necessary; this is a normal score. b.Provide respiratory assistance. c.Perform CPR. d.Wait 5 minutes and repeat the scoring process.

b. A newborn who scores a 4 on the APGAR chart requires special assistance such as respiratory assistance.

A nurse working with adolescents in a group home discusses the developmental tasks appropriate for adolescents with the staff. What is an example of a primary developmental task of the adolescent? a.Working hard to succeed in school b.Spending time developing relationships with peers c.Developing athletic activities and skills d.Accepting the decisions of parents

b. Adolescence is a time to establish more mature relationships with both boys and girls of the same age.

A nurse is collecting more patient data to confirm a diagnosis of emphysema for a 68-year-old male patient. What type of diagnosis does this intervention seek to confirm? a.Actual b.Possible c.Risk d.Collaborative

b. An intervention for a possible diagnosis is to collect more patient data to confirm or rule out the problem.

A nurse is about to perform pin site care for a patient who has a halo traction device installed. What is the first nursing action that should be taken prior to performing this care? a.Administer pain medication. b.Reassess the patient. c.Prepare the equipment. d.Explain the procedure to the patient.

b. Before implementing any nursing action, the nurse should reassess the patient to determine whether the action is still needed.

A nurse is performing an initial comprehensive assessment of an 84-year-old male patient admitted to a long-term care facility from home. The nurse begins the assessment by asking the patient, "How would you describe your health status and well-being?" The nurse also asks the patient, "What do you do to keep yourself healthy?" Which model for organizing data is this nurse following? a.Maslow's human needs b.Gordon's functional health patterns c.Human response patterns d.Body system model

b. Gordon's functional health patterns begin with the patient's perception of health and well-being and progress to data about nutritional-metabolic patterns, elimination patterns, activity, sleep/rest, self-perception, role relationship, sexuality, coping, and values/beliefs.

A young Hispanic mother comes to the local clinic because her baby is sick. She speaks only Spanish and the nurse speaks only English. What should the nurse do? a.Use short words and talk more loudly b.Ask an interpreter for help c.Explain why care can't be provided d.Provide instructions in writing

b. Many agencies have a qualified interpreter who understands the health care system and can reliably provide assistance.

Based on Erikson's theory, middle adults who do not achieve their developmental tasks may be considered to be in stagnation. Which statement is one example of this finding? a."I am helping my parents move into an assisted-living facility." b."I spend all of my time going to the doctor to be sure I am not sick." c."I have enough money to help my son and his wife when they need it." d."I earned this gray hair and I like it!"

b. Middle adults who do not reach generativity tend to become overly concerned about their own physical and emotional health needs.

A student nurse attempts to perform a nursing history for the first time. The student nurse asks the instructor how anyone ever learns all the questions the nurse must ask to get good baseline data. What would be the instructor's best reply? a."There's a lot to learn at first, but once it becomes part of you, you just keep asking the same questions over and over in each situation until you can do it in your sleep!" b."You make the basic questions a part of you and then learn to modify them for each unique situation, asking yourself how much you need to know to plan good care." c."No one ever really learns how to do this well because each history is different! I often feel like I'm starting afresh with each new patient." d."Don't worry about learning all of the questions to ask. Every agency has its own assessment form you must use."

b. Once you learn what constitutes the minimum data set, you can adapt this to any patient situation.

The nurse encourages parents of hospitalized infants and toddlers to stay with their child to help decrease what potential problem? a.Problems with attachment b.Separation anxiety c.Risk for injury d.Failure to thrive

b. Separation anxiety, with crying initially and then appearing depressed, is common during late infancy in infants who are hospitalized.

Nurses use the Nursing Interventions Classification Taxonomy structure as a resource when planning nursing care for patients. What information would be found in this structure? a.Case studies illustrating a complete set of activities that a nurse performs to carry out nursing interventions b.Nursing interventions, each with a label, a definition, and a set of activities that a nurse performs to carry it out, with a short list of background readings c.A complete list of nursing diagnoses, outcomes, and related nursing activities for each nursing intervention d.A complete list of reimbursable charges for each nursing intervention

b. The Nursing Interventions Classification Taxonomy lists nursing interventions, each with a label, a definition, a set of activities that a nurse performs to carry it out, and a short list of background readings.

After one nursing unit with an excellent safety record meets to review the findings of the audit, the nurse manager states, "We're doing well, but we can do better! Who's got an idea to foster increased patient well-being and satisfaction?" This is an example of leadership that values: a.Quality assurance b.Quality improvement c.Process evaluation d.Outcome evaluation

b. Unlike quality assurance, quality improvement is internally driven, focuses on patient care

After assessing a patient who is recovering from a stroke in a rehabilitation facility, a nurse interprets and analyzes the patient data. Which of the four basic conclusions has the nurse reached when identifying the need to collect more data to confirm a diagnosis of situational low self-esteem? a.No problem b.Possible problem c.Actual nursing diagnosis d.Clinical problem other than nursing diagnosis

b. When a possible problem exists, such as situational low self-esteem related to effects of stroke, the nurse must collect more data to confirm or disprove the suspected problem.

A school nurse is preparing a talk on safety issues for parents of school-aged children to present at a parent-teacher meeting. Which topics should the nurse include based on the age of the children? Select all that apply. a.Child-proofing the home b.Choosing a car seat c.Teaching pedestrian traffic safety d.Providing swimming lessons and water safety rules e.Discussing alcohol and drug consumption related to motor vehicle safety f.Teaching child how to "stop, drop, and roll"

c, d, f. Important safety topics for school-aged children include pedestrian traffic safety, water safety, and fire safety.

A nurse performs nurse-initiated nursing actions when caring for patients in a skilled nursing facility. Which are examples of these types of interventions? Select all that apply. a.A nurse administers 500 mg of ciprofloxacin to a patient with pneumonia. b.A nurse consults with a psychiatrist for a patient who abuses pain killers. c.A nurse checks the skin of bedridden patients for skin breakdown. d.A nurse orders a kosher meal for an orthodox Jewish patient. e.A nurse records the I&O of a patient as prescribed by his physician. f.A nurse prepares a patient for minor surgery according to facility protocol.

c, d, f. Nurse-initiated interventions, or independent nursing actions, involve carrying out nurse-prescribed interventions resulting from their assessment of patient needs written on the nursing plan of care, as well as any other actions that nurses initiate without the direction or supervision of another health care professional.

A nurse caring for adults in a physician's office notes that some patients age more rapidly that other patients of the same age. The nurse researches aging theories that attempt to describe how and why aging occurs. Which statements apply to the immunity theory of aging? Select all that apply. a.Chemical reactions in the body produce damage to the DNA. b.Free radicals have adverse effects on adjacent molecules. c.Decrease in size and function of the thymus causes infections. d.There is much interest in the role of vitamin supplementation. e.Lifespan depends on a great extent to genetic factors. f.Organisms wear out from increased metabolic functioning.

c, d. The immunity theory of aging focuses on the functions of the immune system and states that the immune response declines steadily after younger adulthood as the thymus loses size and function, causing more infections. There is much interest in vitamin supplements (such as vitamin E) to improve immune function.

A female patient who is receiving chemotherapy for breast cancer tells the nurse, "The treatment for this cancer is worse than the disease itself. I'm not going to come for my therapy anymore." The nurse responds by using critical thinking skills to address this patient problem. Which action is the first step the nurse would take in this process? a.The nurse judges whether the patient database is adequate to address the problem. b.The nurse considers whether or not to suggest a counseling session for the patient. c.The nurse reassesses the patient and decides how best to intervene in her care. d.The nurse identifies several options for intervening in the patient's care and critiques the merit of each option.

c. Reassessing the patient helps to discipline thinking by directing all thoughts toward the goal.

The nurse practices using critical thinking indicators (CTIs) when caring for patients in the hospital setting. The best description of CTIs is: a.Evidence-based descriptions of behaviors that demonstrate the knowledge that promotes critical thinking in clinical practice b.Evidence-based descriptions of behaviors that demonstrate the knowledge and skills that promote critical thinking in clinical practice c.Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice d.Evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, standards, and skills that promote critical thinking in clinical practice

c. evidence-based descriptions of behaviors that demonstrate the knowledge, characteristics, and skills that promote critical thinking in clinical practice.

A nurse is teaching a novice nurse how to provide culturally competent care to patients in a culturally diverse community health clinic. Although all of the following are important to providing culturally competent nursing care, which one is most basic? a.Learning the predominant language of the community b.Obtaining significant information about the community c.Treating each patient at the clinic as an individual d.Recognizing the importance of the patient's family

c. In all aspects of nursing, it is important to treat each patient as an individual. This is also true in providing culturally competent care. This basic objective can be accomplished by learning the predominant language in the community, researching the patient's culture, and recognizing the influence of family on the patient's life.

A nurse uses the following classic elements of evaluation when caring for patients. Which item below places them in their correct sequence? (1) Interpreting and summarizing findings (2) Collecting data to determine whether evaluative criteria and standards are met (3) Documenting one's judgment (4) Terminating, continuing, or modifying the plan (5) Identifying evaluative criteria and standards (what one is looking for when evaluating, e.g., expected patient outcomes) a.1, 2, 3, 4, 5 b.3, 2, 1, 4, 5 c.5, 2, 1, 3, 4 d.2, 3, 1, 4, 5

c. The five classic elements of evaluation in order are (1) identifying evaluative criteria and standards (what you are looking for when you evaluate, e.g., expected patient outcomes), (2) collecting data to determine whether these criteria and standards are met, (3) interpreting and summarizing findings, (4) documenting your judgment, and (5) terminating, continuing, or modifying the plan.

A nurse writes the following outcome for a patient who is trying to stop smoking: "The patient appreciates or values a healthy body sufficiently to stop smoking." This is an example of what type of outcome? a.Cognitive b.Psychomotor c.Affective d.Physical changes

c. Affective outcomes pertain to changes in patient values, beliefs, and attitudes.

A nursing instructor teaching classes in gerontology to nursing students discusses myths related to the aging of adults. Which statement is a myth about older adults? a.Most older adults live in their own homes. b.Healthy older adults enjoy sexual activity. c.Old age means mental deterioration. d.Older adults want to be attractive to others.

c. Although response time may be longer, intelligence does not normally decrease because of aging.

What is the leading cause of cognitive impairment in old age? a.Stroke b.Malnutrition c.Alzheimer disease d.Loss of cardiac reserve

c. Alzheimer disease is the most common degenerative neurologic illness and the most common cause of cognitive impairment.

A nurse is interviewing a newly admitted patient. Which question would be considered culturally sensitive? a."Do you think you will be able to eat the food we have here?" b."Do you understand that we can't prepare special meals?" c."What types of food do you eat for meals?" d."Why can't you just eat our food while you are here?"

c. Asking patients what types of foods they eat for meals is culturally sensitive.

When helping a patient turn in bed, the nurse notices that his heels are reddened and plans to place him on precautions for skin breakdown. This is an example of what type of planning? a.Initial planning b.Standardized planning c.Ongoing planning d.Discharge planning

c. Ongoing planning is problem oriented and has as its purpose keeping the plan up to date as new actual or potential problems are identified.

A nurse is teaching parents of toddlers how to spend quality time with their children. Which activity would be developmentally appropriate for this age group? a.Playing video games b.Playing peek-a-boo c.Playing in a sand box d.Playing board games

c. Playing in a sand box with toys that emphasize gross motor skills and creativity is a developmentally appropriate activity for a toddler.

A nurse is caring for a patient who has complications related to type 2 diabetes mellitus. The nurse researches new procedures to care for foot ulcers when developing a plan of care for this patient. Which QSEN competency does this action represent? a.Patient-centered care b.Evidence-based practice c.Quality improvement d.Informatics

c. Quality improvement involves routinely updating nursing policies and procedures.

A nurse is providing nutritional counseling to culturally diverse patients with dietary restrictions. Which statement accurately describes a dietary concern based on a specific culture? a.Many Native Americans follow a diet that is alcohol- and pork-free. b.Many White Americans have a diet that is high in starch. c.Asians often eat a diet that is high in salt. d.Muslims may have special diets based on the hot/cold theory of treating illness.

c. The Asian diet is often high in salt due to cooking with soy sauce.

The nurse is surprised to detect an elevated temperature (102°F) in a patient scheduled for surgery. The patient has been afebrile and shows no other signs of being febrile. What is the first thing the nurse should do? a.Inform the charge nurse. b.Inform the surgeon. c.Validate the finding. d.Document the finding.

c. The nurse should first validate the finding if it is unusual, deviates from normal, and is unsupported by other data. Should the initial recording prove to be in error, it would have been premature to notify the charge nurse or the surgeon. The nurse should be sure that all data recorded are accurate, thus all data should be validated before documentation if there are any doubts about accuracy.

A new RN is being oriented to a nursing unit that is currently understaffed and is told that the UAPs have been trained to obtain the initial nursing assessment. What is the best response of the RN? a.Allow the UAPs to do the admission assessment and report the findings to the RN. b.Do his or her own admission assessments but don't interfere with the practice if other professional RNs seem comfortable with the practice. c.Tell the charge nurse that he or she chooses not to delegate the admission assessment until further clarification is received from administration. d.Contact his or her labor representative and complain about this practice.

c. The nurse should not delegate this nursing admission assessment because only nurses can perform this intervention. The nurse should seek clarification for this policy from the nursing administration.

A nurse develops a detailed plan of care for a 16-year-old female who is a new single mother of a premature infant. The plan includes collaborative care measures and home health care visits. When presented with the plan, the patient states, "We will be fine on our own. I don't need any more care." What would be the nurse's best response? a."You know your personal situation better than I do, so I will respect your wishes." b."If you don't accept these services, your baby's health will suffer." c."Let's take a look at the plan again and see if we can adjust it to fit your needs." d."I'm going to assign your case to a social worker who can explain the services better."

c. When a patient does not follow the plan of care despite your best efforts, it is time to reassess strategy.

In this case management step, the case manager confirms that the patient meets criteria for the care setting and that the services can be provided at the facility: Question options: preadmission care planning care planning at the time of admission review the progress of care discharge planning

care planning at the time of admission

An infection that was present in the patient before he or she was admitted to the facility is called ___________. Question options: healthcare-acquired infection hospital sickness community-acquired infection community sickness

community-acquired infection

Which section of the CRAF minutes should document the results of the discussion and any decisions the group makes? Question options: conclusions recommendations actions follow-up

conclusions

The symbol in flowcharting that is used to mark the point in the process where the analysis skips to another common point of the process is called _______. Question options: terminator icon line connector icon connector icon process icon

connector icon

The outcome of this flow of care is an improvement in the patient's condition that allows discharge to the patient's home or to a different care setting. Question options: assessing the patient's needs planning care, treatment, and services providing care, treatment, and services coordinating care, treatment, and services

coordinating care, treatment, and services

A multidisciplinary outline of anticipated care within an appropriate time frame to aid a patient in moving progressively through a clinical experience that ends in a positive outcome is called a ________. Question options: critical pathway care plan care assessment continuum of care pathway

critical pathway

The health information professional relies on the patient registrar to accurately identify the patient in the EHR. This is an example of a ______. Question options: benchmark customer expectation dashboard operational definition

customer expectation

Nurses caring for patients in health care facilities need to provide culturally competent care to an increasingly diverse population. Which statements accurately describe a characteristic of cultural diversity that exists in the United States? Select all that apply. a.The United States has become less inclusive of same-sex couples. b.Cultural diversity is limited to people of varying cultures and races. c.Cultural diversity is separate and distinct from health and illness. d.Individuals may be members of multiple cultural groups at one time. e.Culture guides what is acceptable behavior for people in a specific group. f.Cultural practices may evolve over time but mainly remain constant.

d, e, f. Each individual may be a member of multiple cultural, ethnic, and racial groups at one time. Culture guides what is acceptable behavior for people in a specific group. Cultural practices and beliefs may evolve over time, but they mainly remain constant as long as they satisfy a group's needs.

When you receive the shift report, you learn that your patient has no special skin care needs. You are surprised during the bath to observe reddened areas over bony prominences. What action is appropriate? a.Correct the initial assessment form. b.Redo the initial assessment and document current findings. c.Conduct and document an emergency assessment. d.Perform and document a focused assessment of skin integrity.

d. Perform and document a focused assessment on skin integrity since this is a newly identified problem.

A nurse is writing an evaluative statement for a patient who is trying to lower her cholesterol through diet and exercise. Which evaluative statement is written correctly? a."Outcome not met." b."1/21/15—Patient reports no change in diet." c."Outcome not met. Patient reports no change in diet or activity level." d."1/21/15—Outcome not met. Patient reports no change in diet or activity level."

d. The evaluative statement must contain a date; the words "outcome met," "outcome partially met," or "outcome not met"; and the patient data or behaviors that support this decision.

A student nurse is organizing clinical responsibilities for an 84-year-old female patient who is diabetic and is being treated for foot ulcers. The patient tells the student, "I need to have my hair washed before I can do anything else today; I'm ashamed of the way I look." The patient's needs include diagnostic testing, dressing changes, meal planning and counseling, and assistance with hygiene. How would the nurse best prioritize this patient's care? a.Explain to the patient that there is not enough time to wash her hair today because of her busy schedule. b.Schedule the testing and meal planning first and complete hygiene as time permits. c.Perform the dressing changes first, schedule the testing and counseling, and complete hygiene last. d.Arrange to wash the patient's hair first, perform hygiene, and schedule diagnostic testing and counseling.

d. As long as time constraints permit, the most important priorities when scheduling nursing care are priorities identified by the patient as being most important.

Following assessment of an obese adolescent, a nurse considers nursing diagnoses for the patient. Which diagnosis would be most appropriate? a.Risk for injury b.Risk for delayed development c.Social isolation d.Disturbed body image

d. Adolescents who are obese are at high risk for a disturbed body image.

A nurse is identifying outcomes for a patient who has a leg ulcer related to diabetes. An example of an affective outcome for this patient is: a.Within 1 day after teaching, the patient will list three benefits of continuing to apply moist compresses to leg ulcer after discharge. b.By 6/12/15, the patient will correctly demonstrate application of wet-to-dry dressing on leg ulcer. c.By 6/19/15, the patient's ulcer will begin to show signs of healing (e.g., size shrinks from 3″ to 2.5″). d.By 6/12/15, the patient will verbalize valuing health sufficiently to practice new health behaviors to prevent recurrence of leg ulcer.

d. Affective outcomes describe changes in patient values, beliefs, and attitudes.

An experienced nurse tells a younger nurse who is working in a retirement home that older adults are different and do not have the same desires, needs, and concerns as other age groups. The nurse also comments that most older adults have "outlived their usefulness." What is the term for this type of prejudice? a.Harassment b.Whistle blowing c.Racism d.Ageism

d. Ageism is a form of prejudice in which older adults are stereotyped by characteristics found in only a few members of their age group.

Which of the following nursing diagnoses would be appropriate for many middle adults? a.Risk for Imbalanced Nutrition: Less Than Body Requirements b.Delayed Growth and Development c.Self-Care Deficit d.Caregiver Role Strain

d. Many middle adults help care for aging parents and have concerns about their own health and ability to continue to care for an older family member. Caregivers often face 24-hour care responsibilities for extended periods of time, which creates physical and emotional problems for the caregiver.

A nurse is counseling a 60-year-old female patient who refuses to look at or care for a new colostomy. She tells the nurse, "I don't care what I look like anymore, I don't even feel like washing my hair, let alone changing this bag." The nurse diagnoses Altered Health Maintenance. This is an example of what type of problem? a.Collaborative problem b.Interdisciplinary problem c.Medical problem d.Nursing problem

d. Nursing Problem, because it describes a problem that can be treated by nurses within the scope of independent nursing practice.

The nurse practitioner is performing a short assessment of a newborn who is displaying signs of jaundice. The nurse observes the infant's skin color and orders a test for bilirubin levels to report to the primary care provider. What type of assessment has this nurse performed? a.Comprehensive b.Initial c.Time-lapsed d.Quick priority

d. Quick priority assessments (QPA) are short, focused, prioritized assessments nurses do to gain the most important information they need to have first.

A student health nurse is counseling a female college student who wants to lose 20 pounds. The nurse develops a plan to increase the student's activity level and decrease the consumption of the wrong types of foods and excess calories. The nurse plans to evaluate the student's weight loss monthly. When the student arrives for her first "weigh-in," the nurse discovers that instead of the projected weight loss of 5 pounds, the student has lost only 1 pound. Which is the best nursing response? a.Congratulate the student and continue the plan of care. b.Terminate the plan of care since it is not working. c.Try giving the student more time to reach the targeted outcome. d.Modify the plan of care after discussing possible reasons for the student's partial success.

d. Since the student has only partially met her outcome, the nurse should first explore the factors making it difficult for her to reach her outcome and then modify the plan of care.

A nurse states, "That woman is 78 years old—too old to learn how to change a dressing." What is the nurse demonstrating? a.Cultural imposition b.Clustering c.Cultural competency d.Stereotyping

d. Stereotyping is assuming that all members of a group are alike.

A nurse working in a long-term care facility bases patient care on five caring processes: knowing, being with, doing for, enabling, and maintaining belief. This approach to patient care best describes the theory of which theorist? a.Travelbee b.Watson c.Benner d.Swanson

d. Swanson (1991) identifies five caring processes and defines caring as "a nurturing way of relating to a valued other toward whom one feels a personal sense of commitment and responsibility.

A nurse is collecting evaluative data for a patient who is finished receiving chemotherapy for an osteosarcoma. Which nursing action represents this step of the nursing process? a.The nurse collects data to identify health problems. b.The nurse collects data to identify patient strengths. c.The nurse collects data to justify terminating the plan of care. d.The nurse collects data to measure outcome achievement.

d. The nurse collects evaluative data to measure outcome achievement.

When a nurse enters the patient's room to begin a nursing history, the patient's wife is there. What should the nurse do? a.Introduce oneself and thank the wife for being present. b.Introduce oneself and ask the wife if she wants to remain. c.Introduce oneself and ask the wife to leave. d.Introduce oneself and ask the patient if he would like the wife to stay.

d. The patient has the right to indicate whom he would like to be present for the nursing history and exam.

A nurse is caring for a patient who is diagnosed with congestive heart failure. Which statement below is not an example of a well-stated nursing intervention? a.Offer patient 60 mL water or juice (prefers orange or cranberry juice) every 2 hours while awake for a total minimum PO intake of 500 mL. b.Teach patient the necessity of carefully monitoring fluid intake and output; remind patient each shift to mark off fluid intake on record at bedside. c.Walk with patient to bathroom for toileting every 2 hours (on even hours) while patient is awake. d.Manage patient's pain.

d. This statement lacks sufficient detail to effectively guide nursing intervention. The set of nursing interventions written to assist a patient to meet an outcome must be comprehensive.

All of the following are Joint Commission core measure criteria sets except _________. Question options: heart failure diabetes mellitus acute myocardial infarction pneumonia

diabetes mellitus

If Sue has three children and Bob has two children, the value representing the number in their family is considered this type of data: Question options: nominal data ordinal data discrete data continuous data

discrete data

The removal of medication from its usual stream of preparation, dispensing, and administration by personnel involved in those steps in order to use or sell the medication in non-healthcare settings is called ________. Question options: prescribing adverse drug reaction sentinel event diversion

diversion

When a PI team first meets and discusses participation expectations, communication methods, and plans for decision making techniques to be used, these are examples of team _____. Question options: action plan agenda ground rules mission statement

ground rules

A family member of a patient is walking through the hall in the hospital and slips and falls on a recently mopped floor. A nurse observes the fall and helps the family member. This nurse should report this event to the risk manager using which of the following? Question options: failure mode and effect analysis root cause analysis cause and effect diagram incident report

incident report

When a hospital patient is diagnosed with one of the diseases from the health department's communicable disease list, who is responsible for notifying the health department? Question options: administrator attending physician compliance officer infection control team lead

infection control team lead

CLIA and the CDC have established protocols for _________ . Question options: core measures surgery protocols laboratory departments emergency departments

laboratory departments

This plan is based on the appropriate design and construction of the building, detection, alarm, and extinguishing systems, and training to provide appropriate training for all occupants: Question options: life (fire prevention) safety management plan security management plan hazardous materials and waste management plan emergency management plan

life (fire prevention) safety management plan

This record is used in the healthcare organization to document each dose of medication that is given to the patient during their hospitalization. Question options: occurrence report incident report medication administration record drug formulary record

medication administration record

A patient is transferred from the critical access hospital (CAH) to the university medical center. The CAH sent a list of her current medications with the transfer documents. This list is then compared to the physician's admitting orders at the university hospital for consistency in order to provide continuity of care. The process is called ______. Question options: drug formulary evaluation medication administration drug diversion medication reconciliation

medication reconciliation

The final results of care, treatment, and services in terms of the patient's expectations, needs, and quality of life, which may be positive and appropriate or negative and diminishing, are included in what area of performance measurement? Question options: outcomes processes systems benchmarks

outcomes

The organizations reputation for the quality of its services and consumer reaction to these services and products based on their experiences with the organization is called ______. Question options: reliability assurance features perceived quality

perceived quality

A quantitative tool that provides an indication of an organization's performance in relation to a specified process or outcome is a/an _____. Question options: performance measure improvement opportunity team-based process data measure

performance measure

Occurrences involving liability for injury or property loss are called ___________. Question options: potentially compensable events risk management risk occurrences potentially harmful occurrences

potentially compensable events

Caitlin's physician suspects that she has cholecystitis and has ordered gallbladder ultrasound to be performed. The staff at the physician office contacts Caitlin's third-party payer to determine benefits and coverage for this procedure prior to scheduling the cholecystectomy. What is this process called? Question options: utilization management explanation of benefits payment adjucication preauthorization

preauthorization

The percentage of antibiotics administered immediately prior to open reduction internal fixation (ORIF) surgeries or percentage of deliveries accomplished by cesarean section are both examples of a(n) __________. Question options: outcome measure data measure process measure system measure

process measure

The interrelated activities in healthcare organizations, which promote effective and safe patient outcomes across services and disciplines within an integrated environment, are included in what area of performance measurement? Question options: outcomes processes systems benchmarks

processes

During a hospitalization the case manager is concerned that Sam's intensity of service is not meeting the criteria for continued hospitalization. The case manager speaks to Sam's physician who updates the patient's care plan to reflect the high level of care being provided to the patient. Which part of the case management process is being performed? Question options: preadmission care planning care planning at the time of admission review of the progress of care discharge planning

review of the progress of care

In risk management terminology, an exposure to the chance of injury or financial loss and their associated liability is ________. Question options: incident occurrence rights risk

risk

Analysis of a sentinel event from all aspects to identify how each contributed to the occurrence of the event and to develop new systems that will prevent recurrence is called _______. Question options: flowcharting statistical analysis root-cause analysis nominal group technique

root-cause analysis

If there are 45 instances of patients with lung cancer last year and you need to draw an appropriate sample of these cases to abstract, how many patient charts should you abstract? Question options: no sampling is required 10% or 4.5 cases 20% or 9 cases sample of 30 cases

sample of 30 cases

A patient was taken into surgery at a local hospital for treatment of colon cancer. A large section of the colon was removed during surgery and the patient was taken to the medical floor after surgery. Within the first 24-hours post-op, the patient developed fever, chills, and abdominal pain. An abdominal CT scan revealed the presence of a foreign body. This situation describes a _____. Question options: near miss sentinel event security incident time out

sentinel event

Which of the following terms describes the occurrence of a lot of very high or very low values in the observations that distort the calculated mean in data? Question options: skewing standard deviation mean mode

skewing

The foundations of care giving, which include buildings, equipment, professional staff, and appropriate policies are included in what area of performance measurement? Question options: outcomes processes systems benchmarks

systems

A PI team role primarily responsible for ensuring that an effective performance improvement process occurs by serving as advisor and consultant to the PI team, remaining a neutral, nonvoting member, suggesting alternative PI methods and techniques to keep the team on target and moving forward, maintianing group dynamics acting as coach and motivator for the team, assisting i consensus building when necessary, and recognizing team and individual achievements is the _______ Question options: team leader team member team recorder or scribe team facilitator

team facilitator

A PI team role responsible for championing the effectiveness of PI activities in meeting customers' needs and for the content of a team's work is the ____________. Question options: team leader team member team recorder or scribe team facilitator

team leader

Each healthcare organization must identify and prioritize which processes and outcomes (in other words, which types of data) are important to monitor. This data collection should be based on the scope of care and services it provides and _______. Question options: the number of employees they employ their mission the QI methodology used their accreditation status

their mission

Signs, symptoms, or conditions suffered by a patient as the result of the administration of an incompatible blood products is called _______. Question options: blood verification core measure comorbidity transfusion reaction

transfusion reaction

In this type of interview the sequence of questions is not planned in advance and it is conducted in a friendly, conversational manner. Question options: structured interview unstructured interview planned interview unplanned interview

unstructured interview

This statement describes what the organization or PI initiative will look like in the future or may describe some milestone the PI team will reach in the future. Question options: mission statement purpose statement values statement vision statement

vision statement