NSG 1650- EAQ Quiz #4

The home health nurse is educating a client with adrenal insufficiency regarding the disease process and medication safety. Which statement made by the client indicates a need for further education? 1. "I should not skip any doses of my medication." 2. "It is important to never switch brands of medication." 3. "I should weigh myself every day and report weight gain." 4. "I only need a medical alert bracelet when in the hospital."

4. "I only need a medical alert bracelet when in the hospital." RAT: A client with adrenal insufficiency must take adrenal hormone replacement medication for life and must always wear a medical alert bracelet with the name of the condition and the medication. Therefore the statement about needing to wear the bracelet only in the hospital requires further education. The client is correct to avoid skipping any medication doses, to avoid switching brands of medication, and to perform daily weight checks and report weight gain.

Which distinguishes evidence-based practice from quality improvement? 1. Evidence-based practice is a part of a regular clinical practice. 2. Evidence-based practice aims to improve client care and outcomes. 3. Evidence-based practice focuses on the implementation of evidence already known into practice. 4. Evidence-based practice consists of internal funding and can be conducted by practicing nurses.

3. Evidence-based practice focuses on the implementation of evidence already known into practice. RAT: Evidence-based practice focuses on the implementation of evidence already known into practice whereas quality improvement measures the effect of changing practices on a specific population. Both evidence-based practice and quality improvement are a part of regular clinical practice. Both aim to improve client care and outcomes. Both evidence-based practice and quality improvement consist of internal funding and can be conducted by practicing nurses and other health care professionals.

Which risk factor(s) regarding fall prevention and safety for older adults would the nurse manager include in a presentation to a group of nurses? Select all that apply. One, some, or all responses may be correct. 1. Medications 2. Visual changes 3. Urinary retention 4. Decreased appetite 5. Orthostatic hypotension

1. Medications 2. Visual changes 5. Orthostatic hypotension RAT: Factors that place older adults at risk for falls include the effects of medications, changes in vision, and orthostatic hypotension. Urinary incontinence, not retention, places an older adult at risk for falls. Decreased appetite does not lead to falls.

The registered nurse (RN) is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a health care setting. Which statement made by the nursing student indicates the need for further teaching? 1. "I would check the new medication prescription against the current list of medicines." 2. "I would avoid asking about the client's over-the-counter medications." 3. "I would obtain a comprehensive and current list of the client's medications." 4. "I would avoid distractions and go slowly when reconciling the client's medications."

2. "I would avoid asking about the client's over-the-counter medications." RAT: During medication reconciliation, the nurse would ask about all over-the-counter medications the client may be taking. The nurse would compare the new medication prescription with the current list to ensure accuracy. Comprehensive and current lists of the client's medications should be obtained to make sure that there is not a risk of negative medication interactions. The nurse would eliminate distractions and go slowly when reconciling the client's medications to avoid errors.

The nurse recognizes that which advisory bodies aim to improve the quality, safety, efficiency, and effectiveness of health care? Select all that apply. One, some, or all responses may be correct. 1. The Joint Commission (TJC) 2. Institute of Medicine (IOM) 3. National Quality Forum (NQF) 4. National Center for Nursing Quality (NCNQ) 5. Centers for Medicare & Medicaid Services (CMS) 6. Association for Healthcare Research and Quality (AHRQ)

2. Institute of Medicine (IOM) 3. National Quality Forum (NQF) 4. National Center for Nursing Quality (NCNQ) 6. Association for Healthcare Research and Quality (AHRQ) RAT: Institute of Medicine (IOM), National Quality Forum (NQF), National Center for Nursing Quality (NCNQ), and Association for Healthcare Research and Quality (AHRQ) are the advisory bodies. They aim to improve the quality, safety, efficiency, and effectiveness of health care. The Joint Commission (TJC) and Centers for Medicare and Medicaid Services (CMS) are the regulatory bodies that aim to improve the quality of care.

The nurse completes medication reconciliation in preparation for discharge of a client recovering from osteomyelitis and a ruptured Achilles tendon. For which medication would the nurse contact the primary health care provider? 1. Gentamicin 2. Levofloxacin 3. Acetaminophen 4. Cyclobenzaprine

2. Levofloxacin RAT: Tendon rupture (especially the Achilles tendon) can occur with use of the fluoroquinolones (e.g., ciprofloxacin, levofloxacin). Aminoglycosides such as gentamicin do not cause rupture of the Achilles tendon; instead, gentamicin can cause ototoxicity and nephrotoxicity. Acetaminophen is a nonopioid analgesic used to manage pain; it does not cause rupture of the Achilles tendon. Cyclobenzaprine is a muscle relaxant; it does not cause tendon rupture.

In which time frame would the nurse ensure a medication reconciliation is completed for a client being admitted for a total hip replacement? Select all that apply. One, some, or all responses may be correct. 1. After reporting severe pain 2. On admission to the hospital 3. Upon entering the operating room 4. Before transfer to a rehabilitation facility 5. At the time of scheduling for the surgical procedure

2. On admission to the hospital. 4. Before transfer to a rehabilitation facility. RAT: Medication reconciliation involves creating a list of all medications the client is taking and comparing it with the health care provider's prescriptions on admission, when there is a transfer to a different setting or service, or upon discharge. A change in status does not require medication reconciliation. A medication reconciliation should be completed long before entering the operating room. Total hip replacement is elective surgery, and scheduling takes place before admission; medication reconciliation takes place when the client is admitted.

Which scenarios are examples of the Quality and Safety Education for Nurses (QSEN) competency called quality improvement? Select all that apply. One, some, or all responses may be correct. 1. The nurse studies old medical cases about clients with Alzheimer disease before formulating the care plan for a client. 2. The nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional health care practices. 3. The nurse demonstrates the method of using electronic health records to assure a client about confidentiality of the records. 4. The nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators. 5. The nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights.

2. The nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional health care practices. 4. The nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators. 5. The nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights. RAT: According to the Quality and Safety Education for Nurses (QSEN) competency called quality improvement, the nurse would use data to monitor the outcomes of care processes. The nurse would also use improvement methods to design and test changes to improve the quality of health care services. The nurse who uses data to compare the effectiveness of two different types of health care practices is an example of quality improvement. The nurse who complies with quality improvement would design a method of ensuring surgical asepsis to bring about a qualitative change in health care delivery. After implementing a weekly client education program about the use of nurse call lights, the nurse notes a decline in client injuries. The nurse then prepares a flow chart to show the improvement in the safety of the health care delivery system. This is another example of quality improvement. The nurse adheres to evidence-based practice by referring to old cases of Alzheimer disease to formulate a care plan for a new client. The concept of informatics requires the nurse to use information and technology to communicate, manage knowledge, mitigate errors, and support decision-making. The nurse complies with this competency by demonstrating to a client that the proper use of electronic health records helps in maintaining confidentiality of medical information.

A group of nurses are assessing the quality of health care provided in a women's health hospital. Which would the nurse consider when performing this assessment? Select all that apply. One, some, or all responses may be correct. 1. The number of employees working in the hospital 2. The number of clients admitted in the hospital per day 3. The satisfaction of the client with regard to the treatment provided 4. The safety measures taken while using the equipment in the hospital 5. The implementation of recent evidence-based treatment approaches in the hospital

3. The satisfaction of the client with regard to the treatment provided. 4. The safety measures taken while using the equipment in the hospital. 5. The implementation of recent evidence-based treatment approaches in the hospital. RAT: The main role of the hospital is to provide good-quality health care to clients. Various factors determine the quality of the health care organization. Client satisfaction is one of the important factors that determine health care quality. The better the treatment facilities, the greater the client satisfaction. The safe use of equipment in the hospitals is very important. The failure to ensure the safety of the client may result in health complications in the client, and this indicates poor health quality. Treatment strategies that are based on evidence ensure the good prognosis of the client. The implementation of recent evidence-based treatment approaches in the hospital is also an important factor for determining quality. The number of employees does not determine the quality of the care provided. The skills of the employees affect the quality of health care. The number of clients admitted per day is also dependent on many factors. It does not determine the quality of health care.

The nurse leader actively participates in the quality improvement process. Arrange the steps in order that the nurse leader will follow while implementing the quality improvement process. 1. Select a plan to meet the outcomes. 2. Collect the data on the current status of the service. 3. Collect the data for evaluating the plan. 4. Collaborate with the interprofessional team to review needs. 5. Identify the important needs of the consumer. 6. Establish the outcomes and quality indicators.

5. Identify the important needs of the consumer. 4. Collaborate with the interprofessional team to review needs. 2. Collect the data on the current status of the service. 6. Establish the outcomes and quality indicators. 1. Select a plan to meet the outcomes. 3. Collect the data for evaluating the plan. RAT: The first step of the quality improvement process involves identifying the needs that are important to the consumer of health care services. Collaborating with the interprofessional team to review the needs that are identified is done to avoid bias. The next step is confirming the needs and collecting the data on the current position of the service that helps in the improvised plan. This is followed by implementing the process and establishing the outcomes for which quality indicators are required. The next step is to select and implement the plan to meet the outcomes and objectives of quality improvement. Evaluating the plan is the last step and is necessary for quality improvement.