tb+CS trends exam 3

The nurse arrives at Ms. R's home as arranged, and the patient is waiting at the door. Her respiratory effort seems a little labored, and she looks anxious. The nurse asks Ms. R how she has been feeling since her discharge from the hospital yesterday. Which response indicates a need for immediate intervention?1."I have been a bit short of breath."2."I feel some left-sided chest pressure."3."I don't understand why I need to take all these pills."4."I am confused about why you are here to see me."

2."I feel some left-sided chest pressure." Rationale:The chest pressure indicates that Ms. R may be experiencing myocardial ischemia and requires immediate assessment and intervention (e.g., administration of sublingual nitroglycerin). The shortness of breath requires further investigation and is likely to related to the chest pressure and myocardial ischemia. The other responses also indicate the need for further assessment and interventions such as teaching but do not require immediate action.

Which action should the nurse take next? 1.Schedule the next home visit with the patient.2.Assist the patient to take the prescribed medications.3.Call the HCP to report the patient's condition.4.Remind the patient about the importance of medication compliance.

2.Assist the patient to take the prescribed medications. Rationale:Because the patient has not taken the prescribed medications to control coronary artery disease and angina, the nurse's first action will be to ensure that the medications are taken. Scheduling the next home visit, educating about the medications, and communicating with the HCP are all appropriate but can be done later in the visit.

A nurse is caring for a recent Asian immigrant client and is overheard making the following comment, "These rituals you believe in are false. You live in America now and must believe in realistic health practices, like Americans do." The nurse is exhibiting behavior associated with what belief? a. Stereotyping b. Ethnocentrism c. Cultural accommodation d. Empathy

b. Ethnocentrism Rationale:Ethnocentrism is the belief that one's own ethnic group, culture, or nation is best.

A nurse is submitting a grant application to improve access to health care and mortality for minority groups. The grant focuses on the six causes of death that are identified as priorities for minorities, which include what medical diagnosis? a. Chronic obstructive pulmonary disease (COPD) b. Malnutrition c. Cirrhosis of the liver d. Breast cancer

d. Breast cancer Rationale:Cancer is identified as a leading cause of excessive death among minority group members. The six leading causes are cancer, cardiovascular disease and stroke, chemical dependency, diabetes, homicides/accidents, and infant mortality.

After arriving, the nurse learns about a required case management in-service scheduled for 2:00 pm, which will leave time for only four home visits. Which four patients should be scheduled for today? 1.Ms. A2.Mr. D3.Ms. F4.Mr. I5.Ms. R6.Mr. W

1,4,5,6 rationale:Ms. A's dyspnea and increased use of oxygen require rapid assessment. Mr. I's sample for a CBC must be drawn when the bone marrow is most suppressed to accurately assess the impact of chemotherapy on bone marrow function. Ms. R should be seen as soon as possible after discharge to determine the plan of care. Mr. W needs to receive the scheduled dose of risperidone. Mr. D and Ms. F do not have urgent needs, and these visits can be rescheduled for the following day.

The oxygen saturation is 99% per pulse oximeter. Which action is appropriate next? 1.Discontinue the patient's oxygen.2.Draw a sample for arterial blood gas analysis.3.Call the HCP and obtain an order to transport Ms. A to the hospital. 4.Remind the patient's husband about the reasons for using oxygen at low flow rates.

1.Discontinue the patient's oxygen. Rationale:Since the goal for oxygen saturation for a patient with COPD is usually 90% to 94% (0.90 to 0.94), because high oxygen levels can decrease respiratory drive and lead to increases in Paco2, the nurse's first action should be to discontinue the oxygen for this patient. The next step is to notify the HCP, who may want to admit the patient to the hospital or order arterial blood gas analysis. It will be important to discuss appropriate home oxygen use with the patient and her husband but not until the immediate situation is resolved.

After adjusting the schedule to see these four patients, which patient should be seen first? 1.Ms. A, the patient who has COPD and increased shortness of breath2.Mr. I, the patient receiving chemotherapy who will need blood drawn3.Ms. R, the patient with coronary artery disease who will need an initial assessment4.Mr. W, the patient with schizophrenia who will need a risperidone injection

1.Ms. A, the patient who has COPD and increased shortness of breath Rationale:Ms. A's increased shortness of breath indicates a need for rapid assessment. In addition, high oxygen flow rates can cause an increase in the partial pressure of carbon dioxide (Paco2) and suppression of respiratory drive in patients with COPD, so Ms. A should be seen as soon as possible. The other patients can be scheduled according to criteria such as location or patient preference about visit time.

Which data in the table are most important to report to the HCP? Select all that apply. 1.Temperature2.Heart rate3.Respiratory rate4.Blood pressure5.Weight6.Glucose level

1.Temperature4.Blood pressure6.Glucose level Rationale:The elevated temperatures and blood glucose levels suggest a possible infectious process and should be reported to the HCP so that interventions can be quickly implemented to prevent complications such as sepsis, diabetic ketoacidosis, or hyperglycemic hyperosmolar nonketotic coma. The blood pressures should also be reported because current national guidelines indicate that blood pressure for patients with diabetes should be maintained at a level of less than 130/80 mm Hg to decrease cardiovascular risk. The pulse, respiratory rate, and weight are stable and in appropriate range.

Which nursing action should the nurse take next? 1.Auscultate Ms. A's anterior and posterior lung sounds.2.Check Ms. A's oxygen saturation using pulse oximetry.3.Continue to stimulate Ms. A until she can respond to you.4.Notify the health care provider (HCP) about Ms. A's change in status.

2.Check Ms. A's oxygen saturation using pulse oximetry. Rationale:The patient has symptoms and risk factors that could indicate that her oxygen saturation is either excessively high or too low, so checking oxygen saturation is the first action that should be taken. The other actions may also be appropriate, but assessment of oxygen saturation will determine which action should occur next.

The nurse still has visits to make to Mr. D and Mr. I before the mandatory in-service session. Which patient should be visited first?1.Mr. D, who has diabetes and has an elevated glucose and fever 2.Mr. I, who has lung cancer and is receiving chemotherapy

2.Mr. I, who has lung cancer and is receiving chemotherapy Rationale:Because Mr. I is in the nadir period after his chemotherapy, he is at high risk for infection. Avoidance of any cross-contamination from Mr. D's leg infection is essential.

When will the nurse schedule the next home visit with Ms. R? 1.Later today because Ms. R's condition is very unstable and she may require hospital readmission2.Tomorrow because Ms. R's assessment indicates that she needs frequent evaluation or interventions3.In 3 days because the home health aide will see Ms. R every day and will call if there are any further problems4.Early next week so that there will be enough time to evaluate the effect of the medications on Ms. R's symptoms

2.Tomorrow because Ms. R's assessment indicates that she needs frequent evaluation or interventions Rationale:The focus in home health nursing is empowering the patient and family members by teaching self-care. Ms. R's condition is not so unstable that she needs to be reassessed today because her chest pain did resolve after she took two nitroglycerin tablets, she has taken her medications, and her daughter will be available. The patient's symptoms of chest discomfort and confusion about how to take her medications do indicate a need for reassessment the next day. Although the home health aide will visit, the education and role of the home health aide do not include evaluating the patient's response to prescribed therapies and planning changes in care based on the evaluation.

Five minutes after taking a nitroglycerin sublingual tablet, Ms. R says that the chest pressure is "almost gone." Which action should the nurse take next? 1.Proceed with assessing her and completing the admission documentation.2.Have her rest for another 5 minutes and then reassess the chest pressure.3.Check her blood pressure and administer another nitroglycerin tablet.4.Call the HCP, anticipating an order to readmit her to the hospital.

3.Check her blood pressure and administer another nitroglycerin tablet. Rationale:National guidelines for patients with coronary artery disease indicate that, if the chest pain is improving after nitroglycerin administration, giving another nitroglycerin tablet is the first action to take. Completing the admission assessment, having her rest, and notifying the HCP about her chest pain are also appropriate actions, but administration of another nitroglycerin tablet and resolution of the chest discomfort are the priorities.

When the nurse arrives at Mr. I's condominium, his wife says that Mr. I is very lethargic and a little confused today. Usually he is well oriented and cheerful despite his diagnosis of right-sided lung cancer. Which information noted during the assessment is the best indicator that rapid nursing action is needed? 1.Breath sounds are decreased on the right posterior chest.2.Mr. I says that his appetite has not been very good recently.3.Mr. I's oral temperature is 101°F (38.3°C).4.The oral mucosa is pale and dry.

3.Mr. I's oral temperature is 101°F (38.3°C). Rationale:Chemotherapy decreases the patient's ability to mount a fever in response to infection, so even a minor increase in temperature (especially in combination with symptoms such as lethargy and confusion) can be an indicator of a serious infection, including sepsis. The decreased right-sided breath sounds are consistent with the patient's diagnosis of lung cancer. The poor appetite and dry oral mucous membranes also require assessment and intervention, but infection is one of the most serious complications of chemotherapy.

Because Mr. D will be visited today, which of the three patients that are scheduled for today is best to reschedule for tomorrow? 1.Mr. I, who is receiving chemotherapy and needs a blood specimen drawn2.Ms. R, who needs an initial home health visit after coronary artery stenting3.Mr. W, who is scheduled for an injection of risperidone to treat schizophrenia

3.Mr. W, who is scheduled for an injection of risperidone to treat schizophrenia Rationale:Although the risperidone is scheduled for today, the medication is absorbed gradually, and rescheduling the dose for tomorrow will not have an adverse impact on control of the patient's schizophrenia. The other patients have more urgent needs and should receive visits today.

Which action by the nurse is most appropriate? 1.Suggest that Mr. D take acetaminophen to treat pain and fever. 2.Arrange to see Mr. D as the first patient on tomorrow's schedule. 3.Reorganize today's schedule so that Mr. D can be seen and assessed.4.Reassure the aide that these findings are normal for patients with diabetes.

3.Reorganize today's schedule so that Mr. D can be seen and assessed. Rationale:Generalized aches and pains, an elevated temperature, and an elevated glucose level are signs of infection in patients with diabetes, indicating a significant change in the patient's status and need for further assessment. Acetaminophen may be indicated for discomfort but will not treat infection. Because diabetes decreases immune function and increases the risk for serious infections, the nurse should not wait another day before seeing the patient.

When the nurse calls Ms. R to schedule a visit, the patient says that she doesn't have much time today but will be available for a longer visit tomorrow. What is the best response? 1."The visit will not take very long, so I will plan on seeing you today."2."I have rescheduled other patients because it is essential that I assess you today."3."Perhaps you are feeling that you do not really need any help at home."4."Because of the recent angioplasty and stenting, I would like to visit as soon as possible."

4."Because of the recent angioplasty and stenting, I would like to visit as soon as possible." Rationale:In the home health setting, the patient is in control of health management, so enlisting the patient's cooperation for the visit is essential. In this response, the nurse indicates that the patient has a choice about whether the visit is scheduled for today but educates the patient about why it is important that the visit occur as soon as possible. Because the initial visit requires a multidimensional assessment, it is usually quite lengthy. The patient's comments do not indicate a lack of need or desire for home health services.

Which staff member will the nurse suggest as the best person to make the initial home visit for this new patient? 1.An experienced and knowledgeable LPN/LVN who has worked for 10 years in home health2.A respiratory therapist who regularly works with patients who are receiving home oxygen therapy3.An RN who usually works in the maternal-child division of the public health agency4.An on-call RN who works in the home health agency for a few days each month on an as-needed basis

4.An on-call RN who works in the home health agency for a few days each month on an as-needed basis Rationale:The initial assessment and development of the plan of care, including interventions such as oxygen therapy, are the responsibility of RN staff members. The RN with the most experience in caring for patients with emphysema is the on-call part-time RN. Some patient care activities are assigned to staff members from other disciplines, such as LPN/LVNs and respiratory therapists, after the plan of care is developed by the RN.

The Metropolitan Medical Response System (MMRS) is accurately described by which statement? a. It is totally financed by the federal government national disaster fund. b. It consists of responders who have obtained specialized training and equipment to deal with mass casualty events. c. It has a storehouse of medications and antidotes to be used during response in times of national emergencies. d. It arranges for patient admissions to federal hospitals.

ANS: B The MMRS responds to disaster with trained individuals who have expertise in this type of situation and who have the equipment required to be effective.

Which activities in the patient's care plan will the nurse delegate to a home health aide? Select all that apply. 1.Setting up Ms. R's medications in a multidose pill box twice a week 2.Instructing the daughter how to set up Ms. R's daily medications 3.Teaching Ms. R and her daughter the purpose of each medication 4.Assisting Ms. R with a bath and personal hygiene every day 5.Measuring vital signs daily6.Weighing the patient daily7.Checking for any peripheral edema weekly

4.Assisting Ms. R with a bath and personal hygiene every day5.Measuring vital signs daily6.Weighing the patient daily Rationale:Home health aide education and scope of practice include assisting with personal hygiene and obtaining routine data such as vital sign values and daily weights. It is the RN's responsibility to evaluate these data and plan individualized care using the data. Assessments, medication preparation, and patient teaching about medications require more education and broader scope of practice and should be performed by the RN.

The nurse calls the oncologist to discuss Mr. I's condition and receives directions to have the patient transported to the hospital emergency department (ED) for evaluation. Which information is most important to communicate when calling a report to the ED? 1.Mr. I has lung cancer and decreased breath sounds.2.Mr. I's appetite and oral intake are decreased.3.Mr. I needs a CBC today.4.Mr. I is receiving chemotherapy and has a fever.

4.Mr. I is receiving chemotherapy and has a fever. Rationale:Mr. I's immunosuppression, fever, and possible sepsis diagnosis indicate that he should be assessed and treated immediately when he arrives in the ED. The other information will also be helpful but will not ensure that Mr. I is assessed and that treatment with antibiotics is initiated rapidly.

The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph to present this information? a. Time plot b. Fish bone diagram c. Flowchart d. Cause-and-effect diagram

ANS: A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols.

The surgical team arrives in the operating room and one-member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is referred to by what term? a. Time-out b. A critical pathway c. Special cause variation d. Lean methodology

ANS: A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure.

In the preparedness phase for disasters, the community plans for a possible terrorist attack using anthrax as the weapon of destruction. What treatments and/or preparations would be needed? a. Vaccines and Level B Personal Protection Equipment (PPE) b. Treatment for burns, decontamination, and Level A PPE c. Social distance determination, decontamination for radioactive fallout d. Identify and detect incendiary devices, treatment for burns and propellants

ANS: A Anthrax is a biologic weapon and requires Level B protection since it is a known agent and can be carried in wind or surfaces. Timing of treatment is critical and vaccines are available.

While completing a masters nursing degree in Virginia, a nurse who is interested in teaching in Laredo, Texas, enrolls in Spanish classes for 4 years, knowing that a high number of Mexican-Americans live there. This nurse is demonstrating what social value? a. Cultural competence b. Ethnocentrism c. Prejudice d. Stereotyping

ANS: A Cultural competence is the responsibility of all nurses to become knowledgeable about the values, beliefs, and health care practices of the culturally diverse groups that are dominant in the nurse's practice area.

What is the focus of care during the relief response phase of a disaster resulting from a "dirty bomb"? a. Treatment for burns and poisoning is provided for victims. b. Emergency plans are coordinated between agencies. c. Reconstruction of destroyed facilities and homes begins. d. Food stores are collected for potential victims.

ANS: A During the relief response phase of a disaster, emergency responders aid victims and stabilize the scene; with a dirty bomb, radioactive material causes burns and poisoning.

1. Nurses and community officials are working together to ensure that churches and schools have needed supplies to provide shelter for large numbers of individuals in the event of a natural or manmade disaster. These activities represent which phase of a disaster continuum? a. Preparedness b. Relief response c. Recovery d. Crisis intervention

ANS: A Every disaster response begins as a local event known as the preparedness phase, which consists of planning, preparedness, prevention, and warning.

According to the Quality Chasm report what statement is true? a. Health care providers should be proactive rather than reactive to patient needs. b. Common needs rather than individual preferences should be the priority. c. Medical information should be confined to the primary care provider. d. Specialized providers or case managers should control health care decisions.

ANS: A Quality is based on predicting patient needs rather than reacting to needs.

A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care

ANS: A Standardization contributes to safety and improves individual performance of care providers.

A state is devastated by a tornado killing many people, destroying communication systems, utility services, homes, and medical facilities. The state requests immediate assistance from the U.S. Congress and from surrounding states. The affected state should first contact what agency? a. Emergency Management Assistance Compact (EMAC) b. Institute of Medicine (IOM) c. Red Cross d. Strategic National Stockpile

ANS: A The EMAC is an organization authorized by the U.S. Congress through which a state impacted by a disaster can request and receive assistance from other member states quickly and efficiently.

A group of local volunteers have completed an emergency response course and are able to assist with triage of injured citizens. They also participate in local health fairs to teach residents how to react during tornadoes. The responders are members of what organization? a. Medical Reserve Corps (MRC) b. Metropolitan Medical Response System (MMRS) c. National Disaster Medical System (NDMS) d. Commissioned Corps Readiness Force (CCRF)

ANS: A The MRC are local volunteers trained to respond to local emergencies. None of the other options are volunteers who work at the local level.

Troops from the United States participating in a peace mission in a foreign country were the victims of suicide bombers and many soldiers were evacuated back home to receive specialized medical care. The nation's medical responses will be augmented by what organization? a. The federally coordinated National Disaster Medical System b. Local homeland communities where troops receive care c. The Medical Reserve Corps, which organizes and utilizes public health, nursing, medical, and other volunteers d. The National Incident Management System, which guides government, nongovernmental organizations, and the private sector to work seamlessly during disaster situations

ANS: A The National Disaster Medical System supplements care for casualties evacuated back to the United States from overseas and federally declared disasters including national disasters, major transportation accidents, technologic disasters, and acts of terrorism.

Regardless of the term used to describe high-quality health care, what is the primary focus of quality? a. Meeting consumer needs and wants b. Providing economical care c. Utilizing technologic advancements d. Equally distributed care

ANS: A The customer determines quality based on his or her unique perception of high-quality care.

A nurse is interested in learning the phases of the disaster continuum and realizes it has many similarities to the nursing process. To better understand the phases of a disaster, which is true when comparing the phases of the disaster continuum to the nursing process? a. The preparedness phase of the disaster continuum is consistent with the assessment and planning steps of the nursing process. b. The recovery phase of the disaster continuum is consistent with the planning step of the nursing process. c. The recovery phase of the disaster continuum is consistent with the implementation step of the nursing process. d. The response relief phase of the disaster continuum is consistent with the evaluation step of the nursing process.

ANS: A The preparedness phase requires assessing possible needs of the community and planning appropriate interventions and is consistent with the assessment and planning steps of the nursing process.

Health care professionals have been activated to respond to a disaster, and the registered nurse who is coordinating the effort realizes that fact about the situation? (Select all that apply.) a. In the event of a mass casualty incident, care is prioritized to those who have the greatest chance of surviving. b. Communities should use their own resources first to attempt to stabilize and organize the response. c. State assistance occurs any time a disaster occurs, regardless of the community's resources. d. The emergency operating plan developed by one central agency rather than individual facilities should be put into operation. e. Strict protocols regarding the use of resources must be followed.

ANS: A, B Care is shifted to doing the most good for the most people. Efforts begin at the local level.

The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? (Select all that apply.) a. A patient falls and fractures a hip. b. A patient develops bilateral pressure ulcers on their heels. c. A patient develops a catheter-associated urinary tract infection. d. A patient develops post-surgical delirium. e. A patient develops pneumonia related to ventilator use.

ANS: A, B, C, E Outcome indicators include patient falls, pressure injuries, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Post-surgical delirium is not identified by this organization.

A nurse involved in researching the leading causes of death for minorities considers the federally defined minority groups, which include what populations? (Select all that apply.) a. Blacks b. Russians c. Hispanics d. Asians or Pacific Islanders e. Scandinavians

ANS: A, C, D The Federally defined minority groups include blacks, Hispanics, American Indians, and Asians or Pacific Islanders

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? (Select all that apply.) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

ANS: A, C, D, E The 2018 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required.

Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term? a. Clinical protocol b. Critical pathway c. Algorithm d. Case management

ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. Clinical protocols or algorithms are different from clinical pathways because they represent more of a decision path that a practitioner might take during a particular episode or need. Case management is a nursing care delivery system.

A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are engaged in what process? a. Standardization of care b. Root cause analysis c. Process variation d. Analysis of a deployment flowchart

ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. Standardization of care is process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again, until a better way is found, thereby creating exceptional service with maximal efficiency. Process variation is a difference in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. This type is especially helpful when dealing with processes that cross multiple areas or caregivers and when there is a need for common under-standing of what the process is doing as a whole.

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term? a. Root cause b. Sentinel event c. Variation in performance d. Causal factor

ANS: B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. A root cause or causal factor is the factor that resulted in a sentinel event. A variation in performance is the action that includes the occurrence or possible occurrence of a sentinel event.

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred to by what term? a. Deployment flowchart b. Top-down flowchart c. Pareto chart d. Control chart

ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added.

The disaster medical assistance team works quickly to contain contaminants from a chemical plant explosion. Afterward, personnel undergo a special process to remove harmful chemicals from equipment and supplies. This removal process is referred to by what term? a. Containment b. Decontamination c. Triage d. Scene assessment

ANS: B Decontamination is the physical process of removing harmful substances from personnel, equipment, and supplies. Containment is the limitation of an emergency situation within a well-defined area. Triage is the process of prioritizing which patients are to be treated first; first action in any disaster response. Scene assessment is the act of reviewing the location of an event to look for information that might help determine treatment options.

During a community health fair, the disaster medical assistance team (DMAT) informs participants that every community must be ready to provide disaster care. A participant asks, "In a disaster, the local community cannot possibly be effective, so why not have a plan to call federal agencies immediately to provide relief?" How should the DMAT respond to this question? a. "Unless known terrorist activities involving mass destruction occur, the federal government does not become involved." b. "The community is essentially the 'first responder' to any disaster." c. "The preparedness phase of a disaster is the responsibility of the community, the relief response phase is assigned to state agencies, and the recovery phase is the responsibility of federal agencies." d. "Unless local health care facilities are incapacitated, state and federal agencies will withhold assistance."

ANS: B Each disaster begins locally, and each community responds first and receives assistance from state and federal agencies when local resources are not adequate for the situation.

The emergency response team responded to a terrorist attack where hundreds of people died following symptoms of chest tightness, palpations, seizures, and finally paralysis. A colorless odorless liquid known as Sarin (GB) was the agent, which is primarily inhaled with limited exposure through the skin. The concentration of Sarin has not been measured. What level is the minimum level of personal protection and safety equipment (PPE) that would be needed? a. A b. B c. C d. D

ANS: B Level B requires a high level of respiratory protection, but less skin protection, providing a chemical splash-resistant suit with hood and self-contained breathing apparatus (SCBA). It provides maximum respiratory protection but less skin protection than level A equipment.

Which statement is true regarding health care for minorities? a. Federal legislation that provides free health insurance for minorities has resulted in fewer minorities than members of the general population who lack health insurance. b. Higher costs of health care coupled with lower wages for minorities have prevented most minorities from seeking health care. c. Because many Mexican Americans are highly skilled workers with comparable wages, they have the lowest uninsured rate. d. Asians, because of their quiet demeanor and unwillingness to challenge the health care system, have the highest rate of uninsured people.

ANS: B Most families with racially or ethnically diverse backgrounds have a lower socioeconomic status than is observed in the population at large. Dramatic changes in technology and specialization in the health care field have caused health care costs to skyrocket. Therefore, not everyone can afford health care services.

(picture with bar chart)A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation? a. Run chart b. Pareto chart c. Flowcharts d. Cause-and-effect diagrams

ANS: B Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority

An Asian teenager is admitted with an eating disorder which she contributes to not meeting the academic expectations of her parents. The nurse is overheard saying, "That isn't the reason; all Asians are really smart." This nurse is demonstrating is which cultural biases? a. Cultural humility b. Stereotyping c. Cultural assimilation d. Acculturation

ANS: B Stereotyping is associating certain behavior or competencies with an ethnic group without considering the individual.

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement

ANS: B Technology (PDA) is used to aid decision making and reduce errors.

What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals? a. Institute for Safe Medication Practices b. Institute of Medicine (IOM) c. National Committee for Quality Assurance d. The Joint Commission. (TJC)

ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.

Following a terrorist attack, victims are exhibiting posttraumatic stress syndrome, and care providers are exhibiting compassion fatigue. Which federal response system should be initiated to begin to address victim and provider psychosocial needs? a. Strategic National Stockpile b. Metropolitan Medical Response System (MMRS) c. Commissioned Corps Readiness Force d. National Disaster Medical System

ANS: B The MMRS is concerned with deploying trained responders who can provide mental health care for victims and health care providers.

A community in the New Madrid fault zone experiences an earthquake resulting in injuries from propelled objects and abrasions for many victims. The local supply of antibiotics is quickly exhausted. Local authorities would contact which agency for access to the needed medication? a. Commissioned Corps Readiness Force. b. Strategic National Stockpile. c. Department of Homeland Security. d. Young Men's Christian Association (YMCA).

ANS: B The Strategic National Stockpile provides antibiotics, antidotes, and medical and surgical items when local and state supplies have been exhausted.

A terrorist incident has occurred, resulting in a possible exposure to smallpox. What term would be used to classify this incident? a. Chemical b. Biologic c. Radiologic d. Nuclear

ANS: B The biologic category refers to diseases such as plague or smallpox. Chemical is associated with organic agents that spread through the air. Radiologic require the introduction of ionizing radiation particles. Nuclear is associated with nuclear weapons.

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool? a. Pareto chart b. Control chart c. Deployment chart d. Top-down flowchart

ANS: B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

A nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that care will be based on what fact regarding these situations? a. The response of local hospitals will be dictated by the federal government. b. The same ground rules practiced in other settings and during smaller crises will be applicable. c. The least experienced nurses will be assigned to triage low-risk victims and victims who have no chance of survival. d. Multiple incident commanders ensure a quick, effective response.

ANS: B The fundamentals of nursing applied to other settings and situations can be used in a disaster. None of the other options accurately describe how the needed care will be determined or delivered.

When teaching community preparedness for a community group, the nurse explains that components of the National Disaster Medical System (NDMS) provide assistance in what form? (Select all that apply.) a. Making available a nationwide bomb disposal squad team for the rapid removal of explosive devices b. Creating teams of health care providers who are experts and have specialized supplies and equipment c. Facilitating patient evacuation from the disaster area to an unaffected area d. Arranging for hospitalization in federal and volunteer nonfederal acute care hospitals e. Providing mental health care for the community, for victims, and for health care providers

ANS: B, C, D The NDMS provides specially trained teams of people along with equipment designed for disaster relief. The NDMS is responsible for removing patients from unsafe to safe areas. The NDMS coordinates efforts to evacuate victims to federal or nonfederal volunteer hospitals that can care for disaster victims.

A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. What competency is included? (Select all that apply.) a. Advanced health assessment techniques b. Patient-centered care c. Prescriptive pharmacology content d. Quality improvement e. Safety

ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.

The Federal Bureau of Investigation (FBI) has determined from a reliable source that a bomb is in the possession of a known terrorist group and the likely target is a government building in the local community. What term is used to identify this situation? a. All-hazards approach b. Biologic event c. Credible threat d. Natural disaster

ANS: C A credible threat is a situation in which the Federal Bureau of Investigation (FBI) determines that a terrorist threat is probable and verifies the involvement of a weapon of mass destruction in the developing terrorist incident. All-hazards approach is a process approach for all sectors to prepare for any emergency or disaster that may occur. Biologic events involve microorganisms or toxins from living organisms with infectious or noninfectious properties that produce lethal or serious effects in plants and animals. A natural disaster is one that is a result of nature (flood, earthquake, tornado, etc.)

Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care

ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge.

Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.

ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event.

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what? a. Cause-and-effect diagram b. Run chart c. Pareto chart d. Flowchart

ANS: C Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols. Run charts, also known as time plots, are graphs of data points as they occur over time.

The crisis communication officer may first inform the public or health care facility of a disaster or an act of terrorism. What is the primary responsibility of this representative regarding information regarding the event? a. To contain the facts to within the administration group b. To facilitate the public to assist in obtaining the necessary emergency supplies c. To provide understandable and straightforward facts about the event within the facility and possibly to the news media d. To assure the public that information will be released as soon as it has been confirmed by state and federal agencies

ANS: C The crisis communication officer is the first contact for patients, families, and employees within the facility or news media, so they may better understand the situation and know how to react and protect themselves.

A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation? a. A sentinel event b. An adverse event c. Patient-centered care d. The communication technique of "call-out"

ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs.

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism? a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

ANS: C C stands for check if the change improved the process and what was learned.

Six cultural phenomena that vary among cultural groups are known to affect health care. The influence of the consequences of these phenomena can be seen in which of the following? (Select all that apply.) a. Asians and American Indians tend to be nonadherent with medications because they believe that the environment has no control over their fate. b. Some cancers such as stomach cancer occur less frequently among blacks. c. Blacks and American Indians often resist direct eye contact. d. Mexican Americans are more likely to stand close and touch health care providers. e. Whites are often late for health care appointments.

ANS: C, D The use of eye contact is a cultural communication phenomenon. Cultures such as black and American Indian may view direct eye contact as rude behavior. Space and touch are cultural phenomena factors. In some cultures, touching strangers is inappropriate. On the other hand, Mexican Americans tend to be comfortable with less space because they like to touch persons with whom they are talking.

A nurse plans to move to an area that is rich in immigrants from several countries and is concerned about respecting others' cultural beliefs. What is the nurse's first step to ensure cultural competence and sensitivity? a. Enrolling in a nursing theories course to increase knowledge about transcultural practices b. Becoming immersed in nursing literature about culturally diverse clients c. Participating in continuing education that focuses on health assessment variations among cultural groups d. Conducting a cultural self-assessment to identify biases or prejudices

ANS: D A cultural self-assessment allows the nurse to identify attitudes about individuals from different cultures

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term? a. Pareto chart b. Control chart c. Top-down flowchart d. Deployment chart

ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement

ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.

Nurses caring for the victims of a mass casualty incident based on what principle? a. Common terminology to be used by hospitals and participating agencies b. Nurses will take charge of communicating with the news media. c. Federal law enforcement will determine whether there is a credible threat of a terrorist attack. d. Triaging will give priority for care to those with the greatest chance of survival rather than those most critically ill.

ANS: D Care is shifted from categorizing patients at low, intermediate, and critical risk to using resources to serve those with the greatest likelihood of survival.

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care.

ANS: D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care.

A group of nurses are presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that supports what? a. Being insured has little effect on a person's longevity and the quality of care received. b. Lobbyists for the drug companies can gain permission for the use of new drugs within 1 year of their discovery. c. Although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS). d. Medication-related errors place a tremendous financial burden on the U.S. health care system.

ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually.

A nurse who is conducting a staff in-service on the phases of a disaster continuum teaches participants that, during the impact/response stage, activities focus on what? a. Community awareness in anticipation of a terrorist attack or natural disaster b. Determining the effectiveness of the disaster medical assistance team (DMAT) c. The use of an all-hazards approach d. Initiating effective, appropriate response activities

ANS: D Response activities during the relief response phase consist of immediate actions to save lives and meet basic human needs

The emergency preparedness term that is used to describe the process of limiting the emergency within a well-defined area is _____c______.

ANS: containment Containment is correct because the focus is to prevent the agent that caused the disaster from spreading.

Although communication varies among members of different cultures, the greatest obstacle to providing multicultural care is differences in __L___.

ANS: language

Quality is defined by the ___p_________.

ANS: patient

While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a __s_____ event.

ANS: sentinel A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation.

The term used during a pandemic disaster that refers to the attempt to contain germs by limiting socialization and personal interactions is _____s c______.

ANS: social distancing The term social distancing refers to the attempt to keep people as far apart as possible to limit the possibility of spreading germs.

A nurse is given a referral to make a home visit to a Russian immigrant. The nurse knows very little about the health beliefs of this ethnic group. To research this group, what term should the nurse use in an Internet search? a. Federally recognized minorities B. Marginalized populations c. Asian/Pacific Islander cultures d. Latino cultures

B. Marginalized populations Rationale:Marginalized populations include recently arrived immigrants. Their lives and health care needs are often kept secret and are understood only by them.

A priority action for the nurse who works with culturally diverse clients to complete initially is completion of additional form of support? a. A sign language course b. Cultural self-assessment c. Cultural client assessment d. A conversational Spanish course

Cultural self-assessment rationale:The first step to becoming a culturally sensitive and competent health care provider is to conduct a cultural self-assessment. Through identification of health-related attitudes, values, beliefs, and practices, the nurse can better understand the cultural aspects of health care from the client's perspective.