Module 3 Safety, Including Hygiene, Infection Control, Asepsis and Medication Administration

Workplace violence, which consists of actions that cause psychological or physical damage, can occur by which of the following? Select all that apply.

A customer, client, or patient Someone who has no relationship with the victim Someone involved in a personal relationship with the victim A co-worker

Which of the following is true regarding basic principles of a surgical field? Select all that apply.

Allow only a sterile object to touch another sterile object. Avoid talking, coughing, sneezing, or reaching over a sterile field or object.

Place in order providing perineal care for a female patient.

Assemble supplies and provide for privacy. Explain the procedure to the patient, perform hand hygiene, and put on disposable gloves. Use a small amount of a mild non-soap cleaning agent and water, or disposable cleaning cloths. Spread the labia and move the washcloth from the pubic area toward the anal area to prevent carrying organisms from the anal area back over the genital area. Always proceed from the least contaminated area to the most contaminated area. Use a clean portion of the washcloth for each stroke. Rinse the washed areas well with plain water. Dry the cleaned areas and apply an emollient as indicated. Avoid the use of powder. Powder may become a medium for the growth of bacteria. Turn the patient on his or her side and continue with cleansing the anal area. Continue in the direction of least contaminated to most contaminated area. In the female, cleanse from the vagina toward the anus. Remove gloves and perform hand hygiene. Continue with additional care as necessary.

Place in order providing perineal care for a male patient.

Assemble supplies, and provide for privacy Explain the procedure to the patient, perform hand hygiene, and put on disposable gloves clean the tip of the penis first, moving the washcloth in a circular motion from the meatus outward Wash the shaft of the penis using downward strokes toward the pubic area Always proceed from the least contaminated area to the most contaminated area. Rinse the washed areas well with plain water Wash and rinse the male patient's scrotum. Handle the scrotum, which houses the testicles, with care because the area is sensitive Dry the cleaned areas and apply an emollient as indicated Remove gloves and perform hand hygiene. Continue with additional care as necessary

Nurses are responsible for ensuring the safety and comfort of the patient at the bedside. To promote bed safety while maintaining patient comfort, ensure the following before leaving the patient's bedside. Select all that apply.

Call light is functioning and always within reach Bed controls are functioning The bed is in its lowest position

Things to assess for a patient's hygiene status and risk factors regarding their feet include which of the following? Select all that apply.

Determine if they have peripheral vascular disease History of nail or foot problems and their treatments Type of footwear worn Determine if they have diabetes

Question 3 Which of the following steps are crucial in performance improvement? Select all that apply.

Discover a problem Assess the change; if the outcome is not met, plan a new strategy Implement a change Plan a strategy using indicators

The common types of child abuse or maltreatment include which of the following? Select all that apply.

Emotional abuse Physical abuse Sexual abuse Neglect

Eye care for the unconscious patient who has diminished blinking reflexes or whose eyelids remain open require frequent eye care at least how often?

Every 4 hours

Restraints may not be applied without a provider's order even if the situation is an emergency and the threat to safety is imminent.

FALSE

Creating a culture of safety within the profession of nursing and our workplaces promotes positive interpersonal and interprofessional relationships and improves the physical and psychological well-being of nurses.

False

Good ventilation in patient rooms is not necessary to limit pathogens and unpleasant odors associated with body secretions and excretions such as urine, stool, vomitus, draining wounds, or body odors.

False

Hygienic practices only include mouth, feet, and perineal area.

False

Many HAIs can be traced to patients getting an elective surgery.

False

Nursing measures for patients receiving medication are not concerned about the following goals: Expected therapeutic effects will be demonstrated within a specific time frame, Expected change in symptoms, Maintenance of therapeutic blood level of medication, Patient will demonstrate knowledge regarding his or her medications.

False

Procedures requiring the use of a sterile field and other sterile items can be delegated to nursing assistive personnel (NAP) or unlicensed assistive personnel (UAP).

False

Avoiding patient contact is the most effective way to help prevent the spread of infectious agents

False: Handwashing

Incivility encompasses rude or discourteous actions that negatively affect others. Incivility does not escalate to bullying.

False: Rationale Incivility Does Escalate Into Bullying

Many HAIs can be traced to a patient with an amputation.

False: Rationale: Many HAIs can be traced to an invasive device, such as a urinary catheter or venous access catheter.

The nurse is required to document the changing of bed linens.

False: Rationale: The nurse is not required to document the changing of bed linens.

Student nurses experience stress related to the difficulty of adapting to the requirements and responsibilities of caring for others. Other factors causing stress for student nurses may include which of the following? Select all that apply.

Fear of failing the course Fear of injuring patients Fear of failing the licensure examination The need to meet financial and family responsibilities

The following is the first national, standardized, publicly reported survey of patients' perspectives of hospital care:

HCAHPS Survey.

An offensive breath odor, called __________________ , is often systemic in nature.

Halitosis

The following are organizations that operate in complex, high-hazard domains for extended periods without serious accidents or catastrophic failures.

High-reliability organizations

The following factors may influence personal___________________ behaviors: culture, socioeconomic class, spiritual practices, developmental level.

Hygiene

Workplace stress is often the most stressful for the following types of nurses:

ICU RN, Emergency Department RN,

The four key principles of Quality__________________ , include the following: Focus on systems and processes, Focus on patients, Focus on being part of the team, Focus on use of the data.

Improvement

When performing the physical assessment of the oral cavity, examine which of the following? Select all that apply.

Lips- color moisture, ulcers, lesions Oropharynx- movement of uvula and condition of tonsils Teeth- any loose, missing, or decayed teeth Buccal mucosa- color, moisture, lesions, bleeding

Some patients may need minimal assistance brushing their teeth. Place the steps of assisting a patient in correct order.

Moisten toothbrush and apply toothpaste to bristles. Place brush at a 45-degree angle to gum line. Brush from gum line to crown of each tooth. Brush tongue gently with toothbrush. Brush outer and inner surfaces. Brush back and forth across biting surface of each tooth. Have patient rinse vigorously with water and spit into emesis basin. Repeat until clean.

According to the WHO, which of the following are moments to do hand hygiene? Select all that apply.

Moment 1 - Before touching a patient Moment 2 - Before a clean or aseptic procedure Moment 3 - After a body fluid exposure risk Moment 4 - After touching a patient Moment 5 - After touching patient surroundings

The Joint Commission created the following to reduce error and promote safety in health care settings.

National Patient Safety Goals

There are common types of safety risks according to developmental age, along with sample teaching tips to discuss with parents. The following discussions of developmental stages need to be considered when developing a teaching plan for a neonate or infant. Select all that apply.

Never leave infant unsupervised on a raised surface without side rails Select toys appropriate for developmental age Wash hands frequently Use appropriate infant car seat that is secured in the back seat facing the front of the car.

Which of the following is true regarding basic principles of a surgical field? Select all that apply.

Never walk away from a sterile field. Allow only a sterile object to touch another sterile object. Avoid talking, coughing, sneezing, or reaching over a sterile field or object.

Indicators specific to nursing that identify structures of care and care processes that influence care outcomes

Nursing-sensitive quality indicators

A ______________ review is the evaluation of one staff member by another staff member on the same level in the hierarchy of the organization. This is an important mechanism nurses can use to improve their professional performance.

Peer

Put the following in order of how to don sterile gloves.

Perform hand hygiene and put on PPE. Identify the patient. Explain the procedure to the patient. Check that the sterile glove package is dry and unopened. Place sterile glove package on a clean, dry surface at or above your waist. Open the outside wrapper by carefully peeling the top layer back. Remove inner package, handling only the outside of it. Place the inner package on the work surface with the side labeled "cuff end" closest to the body. Carefully open the inner package. Fold open the top flap, then the bottom and sides. With the thumb and forefinger of the nondominant hand, grasp the folded cuff of the glove for the dominant hand, touching only the exposed inside of the glove. Keeping the hands about the waistline, lift and hold the glove up and off the inner package with fingers down. Carefully insert dominant hand palm up in to glove and pull glove on. Leave the cuff folded until the opposite hand is gloved. Hold the thumb of the gloved hand outward. Place the fingers of the gloved hand inside the cuff of the remaining glove. Lift it from the wrapper, taking care not to touch anything with the gloves or hands. Carefully insert nondominate hand into glove. Pull the glove on, taking care that the skin does not touch any of the outer surfaces of the glove. Slide the fingers of one hand under the cuff of the other and fully extend the cuff down the arm, touching only the sterile outside of the glove. Repeat for remaining hand. Adjust gloves on both hands if necessary, touching only sterile areas with other sterile areas. Continue with procedure as indicated.

The nurse needs to be aware of restrain alternatives. Which of the following would be the best option for the nurse to implement?

Placing the patient in a geri-chair with a side table attached. Rule out causes for agitation. Assess respiratory status, vital signs, blood glucose level, fluid and electrolyte issues, and medications. Placing all four side rails up. Calling the doctor for a medication order to control the patient's behavior.

Which of the following statements is correct in defining quality improvement? Select all that apply.

QI focuses on processes and standards that lead to quality care. QI helps determines whether nursing standards are being upheld. QI focuses on processes rather than individuals. QI utilizes a collaborative multidisciplinary approach.

The degree to which health services for people and populations increase the likelihood of desired health outcomes and are consistent with professional knowledge.

Quality

The following is a systematic and continuous process that leads to measurable improvements in the healthcare setting: ______________improvement.

Quality

An important resource for nurses committed to performance improvement is which of the following?

Quality and Safety Education for Nurses (QSEN) project The overall goal of the QSEN Institute initiatives is to prepare nurses with the KSAs necessary to continuously improve the quality and safety of their health care systems.

Who can procedures requiring the use of a sterile field and other sterile items be delegated to?

RN

When patients require nursing assistance with personal hygiene, provide this care at which of the following? Select all that apply.

Regular intervals Around the same time each day

Contributing factors to workplace stress for nurses may include which of the following? Select all that apply

Shortage of nursing staff Patients in hospitals are more acutely ill today than in the past Health care policies that impact health care access and resources Working longer hours and overtime

is an inflammation of the oral mucosa, has numerous causes, such as bacteria, virus, mechanical trauma, irritants, nutritional deficiencies, and systemic infection. Symptoms may include heat, pain, increased flow of saliva, and halitosis.

Stomatitis

The IOM (Institute of Medicine) identified safety as an organizational priority and emphasized that medical errors are more frequently due to which of the following problem?

System problems

Which of the following domain areas are aligned with the key quality priorities for a health care system? Select all that apply.

The following domain areas that are aligned with the key quality priorities for a health care system are: Mortality, Readmissions, Length of stay, Hospital Consumer Assessment of Healthcare Providers and Systems, Hand hygiene, Prevention of C diff, Prevention of surgical site infections, Prevention of catheter-associated urinary tract infections

Surgical asepsis techniques are used regularly in the operating room, labor and delivery areas, and in certain diagnostic testing areas. They are also used at the patient's bedside for procedures such as which of the following? Select all that apply.

They are also used at the patient's bedside for procedures such as the following: Inserting a urinary catheter, Sterile dressing changes and preparing an injectable medication.

Part of the National Patient Safety Goals includes the need for nurses to implement evidence -based practices in which of the following areas? Select all that apply.

To prevent infections that are difficult to treat To prevent infections of the urinary tract that are caused by catheters To prevent infection after surgery To prevent infection of the blood from central lines

A patient can request that side rails to be used at night if they can raise and lower the side rail themselves.

True

A person's general health influences the health of that person's mouth and teeth, and proper care of the mouth and teeth lend to overall health.

True

A popular approach to patient handoffs, transferring responsibility for a patient from one caregiver to another, is the following approach: Continuity of care

True

All 50 U.S. states mandate the use of infant carriers and car seats when transporting a child in a motor vehicle.

True

Assessment of the patient receiving medications begins during a nursing history. A nurse needs to adapt the questions to meet the patient's needs and level of understanding. Information to be assessed and collected includes the following: Current and past illnesses, Known drug allergies, Patient's health status, Medication history.

True

Basic principles of medical asepsis include the following: Allow only a sterile object to touch another sterile object, Hold sterile objects above the level of the waist, Never walk away or turn your back on a sterile field, Consider the edge (outer 1 inch) of a sterile field to be contaminated

True

Continuity of care is a process by which healthcare providers give appropriate, uninterrupted care and facilitate the patient's transition between different settings and levels of care. Continuity of care ensures a smooth transition between ambulatory or acute care and home health care, or other types of health care in community settings.

True

Creating a culture of respect within the profession of nursing and our workplaces promotes positive interpersonal and interprofessional relationships and improves the physical and psychological well-being of nurses.

True

Evidence-based research has identified tools and techniques designed to facilitate the elimination of errors and promote a safer healthcare environment.

True

For a nurse that is changing the bed linen of a client admitted to the health care facility, they should use standard precautions.

True

Inadequate hygiene practices can contribute to alterations in a person's health.

True

Intimate partner violence (IPV), or domestic violence, can involve the following types of abuse: physical violence, Sexual violence, Stalking, Psychological aggression.

True

Many HAIs (Health Care Associated Infections) can be traced to an invasive device, such as a urinary catheter or venous access catheter.

True

Medications that are used to control behavior and are not included in the person's normal medical regimen can be considered chemical restraints.

True

Meeting the oral hygiene needs of patients with cognitive impairments may include the following: Choose a time of day when the patient is most calm and accepting of care, Enlist the aid of a family member or significant other, Break the task into small steps, Withdraw and try again later if the patient strongly refuses care.

True

Nurses committed to healthier patients, quality care, reduced costs, and the personal satisfaction of knowing that they are actually making a difference versus merely wishing things were different value research.

True

Once a sterile field is established, objects on a field may be handled only by using sterile forceps or with hands wearing sterile gloves.

True

Oral health is an important concern in relation to overall health and quality of life.

True

Preventing mistakes in surgery includes the following measures: Using a specific protocol for identification of correct surgical procedure, time-outs for procedures, and clear communication.

True

Procedures requiring the use of a sterile field and other sterile items are not delegated to nursing assistive personnel (NAP) or unlicensed assistive personnel (UAP).

True

Questioning a patient about any past or current skin problems and changes in their skin is essential, as well as asking about recent surgeries and wounds. When skin problems are present, ask the patient the following: How long have you had this problem? How does it bother you?, Does it itch?, Have you found anything that helps relieve the symptoms?

True

Restraints are physical devices used to limit a patient's movement.

True

Side rails, geriatric chairs with attached trays, and appliances tied at the wrist, ankle, or waist are types of physical restraints.

True

The 1999 IOM report, To Err Is Human, shocked the world when it claimed that at least 44,000 and perhaps as many as 98,000 people die in U.S. hospitals each year as a result of medical errors that could have been prevented.

True

The ANA describes the attributes of a positive safety culture as the following: Openness and trust, without individual blame, Appropriate resource allocation, A learning environment for health care professionals where errors are explored and systemic weaknesses identified, Transparency and accountability.

True

The American Nurses Association (ANA) defines the following as an organizational environment where core values and behaviors emphasize safety over competing goals: culture of safety.

True

The National Patient Safety Goal of reducing the risk of health care-associated infections can include the following measures: Use the hand cleaning guidelines from the Centers for Disease Control or the World Health Organization, Implement evidence-based practices to prevent infections difficult to treat, Identify, with the hospital, safety risks inherent in its patient population, Implement evidence -based practices to prevent infection after surgery

True

The National Quality Forum has endorsed safe practices to promote patient safety and reduce patient harm.

True

The following is a process by which health care providers give appropriate, uninterrupted care and facilitate the patient's transition between different settings and levels of care: continuity of care

True

The following issues national reports each year on quality and health disparities: AHRQ (Agency for Health Care Research and Quality).

True

The main developmental considerations for safety risks for adolescents including the following: Motor vehicle accidents, Distracted driving, Alcohol use, Substance abuse.

True

The making of an unoccupied bed may be delegated to nursing assistive personnel (NAP) or to unlicensed assistive personnel (UAP) as well as to licensed practical/vocational nurses (LPNs/LVNs).

True

The nurse uses aseptic techniques to halt the spread of microorganisms and minimize the threat of infection.

True

There are common types of safety risks according to developmental age, along with sample teaching tips to discuss with patients. The following discussions of developmental stages need to be considered when developing a teaching plan for an older adult: Identify safety hazards in the environment, Attend defensive driving courses or courses designed for older drivers, Wear appropriate footwear.

True

There are safety standards that are the foundation for all care delivered in the hospital setting and support accurate patient assessment. Nurses must do the following: Improve the accuracy of patient identification, Improve the effectiveness of communication among caregivers, Improve the safety of using medication, Reduce the risk of health care-associated infections.

True

To promote bed comfort, ensure the following before leaving a patient: Linens are clean and free of crumbs and wrinkles, Patient feels comfortably warm, Pressure areas are protected from rough sheets and water-repellent materials.

True

When administering medications, there are rights to ensure accuracy for medication administration right before administering. These "rights" include the following: Right patient, right time, right route, right assessment data and education, right to refuse

True

When caring for a patient who is frequently incontinent of stool or urine, the nurse can place more than one protective pad under the patient to protect the bed.

True

When performing general hygiene measures, respect the patient's personal preferences and encourage as much self-care as the patient can perform. Nurses should implement interventions to meet the patient's needs for privacy.

True

When performing the physical assessment of the oral cavity, examine the following: Lips- color moisture, ulcers, lesions. Buccal mucosa- color, moisture, lesions, bleeding. Teeth- any loose, missing, or decayed teeth. Oropharynx- movement of uvula and condition of tonsils.

True

the Joint Commission National Patient Safety Goals required hospitals to implement a standardized approach to handoff communications that includes: The handoff situation Who is, or should be, involved in the handoff communication Opportunities for people involved in handoffs to ask and respond to questions An outline for when to use certain communication techniques, such as repeat-back or read-back or the SBAR technique What print or electronic information should be available during the handoff (The Joint Commission, 2017) One popular approach to handoffs is the situation-background-assessment-recommendation (SBAR) strategy mentioned above and described. Ac

True

Which of the following is NOT an alterative to using restraints on a patient?

Use night light. Involve the family in patient's care Lorazepam Provide a warm beverage.

Hospital Value-based Purchasing (VBP) Program requires the Centers for Medicare and Medicaid Services (CMS) to redistribute a portion of the Medicare payments to hospitals for inpatient services based on performance on quality measure

Value-based purchasing

Secretions can adhere to the eyelashes and become dry and crusty.

Wear gloves during the cleaning procedure. Continue this technique, using a different section of the cleaning cloth for each stroke, until the eye is clean. Use water or normal saline and a clean washcloth or compress to clean the eyes. Never use soap to clean the eyes because soap is irritating to eye tissues. Dampen a cleaning cloth with the solution of choice and wipe once while moving from the inner canthus to the outer canthus of the eye. This technique minimizes the risk for forcing debris into the area drained by the nasolacrimal duct. Turn the cleaning cloth and use a different section for each stroke. If the eyelashes are matted with secretions or debris that cannot be removed by wiping, apply a warm, wet compress to the closed eye for 3 to 5 minutes to loosen the secretions so that they may be removed in a painless manner.

The practice of _____________includes all activities to prevent infection or break the chain of infection. There are two types of asepsis techniques: medical asepsis and surgical asepsis.

asepsis

An easy and effective way to promote the________________ function of the skin and keep the skin healthy is by the daily use of the following: Soap substitutes, Topical moisturizers, Barrier products.

barrier

Nursing _____________________ related to medications and medication administration can include the following: Ineffective health management of medication regimen related to adverse drug effects, cost of medications, confusion, lack of motivation, visual impairment, complexity of regimen, Risk for aspiration related to swallowing of oral medication, Constipation related to use of an opioid, Deficient knowledge related to interactions between herbal remedies and prescribed medications

diagnoses

This body part is a dark, warm, and often moist area providing conditions that favor bacterial growth. Neglecting cleaning this area for the patient who cannot provide self-care often results in physical and psychological discomfort for the patient, skin breakdown, and offensive odors:

perineal

The following responsibilities and_______________measures should be applied for assisting patients for bathing and showering: Showers should have mats or non-skid strips to prevent patients from slipping and falling, Provide a place for a weak or physically disabled patient to sit in the shower, Ensure privacy for patients who can safely shower or bathe independently, Keep the bathroom door unlocked. Correct

safety

The following is an unexpected occurrence involving death or serious physical injury or psychological injury, or the risk of death or injury: _____________event.

sentinel