exam 3

Question 1

In the care of clients with pain and discomfort. Which task is most appropriate to delegate to
UAP?

Answer 1

Assisting the client with preparation of Sitz bath

Question 2

The National Database of Nursing Quality Indicators (NDNQI) identifies what clients focused events as outcome indicators ? SATA

Answer 2

• A patient develops a catheter associated urinary tract infection
• A patient develops pneumonia related to ventilator use
• A patient develops bilateral pressure ulcers on their heels
• A patient falls and fractures a hip

Question 3

The charge nurse is reviewing the records of client who were assigned to a newly graduated RN. The RN has correctly documented dose and time of medication, but there is no
documentation regarding non pharmaceutical measures. What action should the charge nurse
take first?

Answer 3

Give praise for documenting dose and time and discuss documentation deficits

Question 4

The nurse is caring for a client with an open draining leg ulcer that is infected with (MRSA).
Which of the following nursing actions can be assigned to an LPN/LVN ? SATA

Answer 4

Collecting wound cultures from the site
Performing dressing changes as ordered

Question 5

A task force is considering factors that contribute to high quality safe staffing. Which statement
reflects an understanding of the American Nurses Associations (ANA) recommendations

Answer 5

Staffing should allow time for RN to apply the nursing process so decisions results in high quality safe patient outcomes.

Question 6

The nurse manager is working on a committee whose task is to review and revise job
descriptions for nursing employees. In which job description would the committee most likely include the phrase “ responsibilities include shift by shift coordination and promotion of quality client care”

Answer 6

charge nurse

Question 7

After shift change, the nurse discovers that a client’s IV heparin has been turned off at the IV
controller. The amount of fluid left in the bag indicate the client received half of the dose
ordered. Which statement should be documented in the client medical record ?

Answer 7

IV heparin restarted. Physician notified. The clients’ vital signs were unchanged

Question 8

The nursing committee is planning change in the unit’s organization. Which statement reflects
the priority expected outcome of these change agents work ?

Answer 8

The change will lead to improved client care on the unit

Question 9

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 experience but also recognize other members strengths. Which of the QSEN competencies are being demonstrated ?

Answer 9

Teamwork and collaboration

Question 10

The nurse administrator has been asked to work with other administrators to change a long- standing hospital policy. What should be the nurse first action?

Answer 10

Research the options that will work best for the nursing staff and the hospital

Question 11

The nursing staff notices that the number of urinary tract infections varies from month to month. They plot the number of infections for each month for 1 year to determine when the periods of the greatest number of infections are occurring. The staff uses which types of graph to present this information

Answer 11

Time plot

Question 12

The charge nurse work on the assignment list for the shift. Which clients should be assigned to an experienced RN

Answer 12

Client with a severe headache of unknown origin
Client who was in automobile crash and sustained multiple injuries
Client who has returned from surgery and has a chest tube in place

Question 13

The following documentation was entered in the client’s medical record. The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied. Which statement best describe this documentation?

Answer 13

Inappropriate because it places blame on an individual

Question 14

What would be the most appropriate method for the nurse to voice concern over unfair client workload assignment ?

Answer 14

Discuss the problem with the nurse’s team leader and then the charge nurse if the problem remains unsolved

Question 15

The team is providing emergency care to a client who received an excessive dose of opioid medication. Which task is best to assign to the LPN/LVN ?

Answer 15

Applying oxygen per nasal cannula as ordered

Question 16

The nurse manager has decided to use evidence base practice to solve an issue and has called staff nurses together for input. Which question reflects the first step of the EBP process

Answer 16

What is the exact clinical issue with we are dealing

Question 17

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?

Answer 17

Sentinel event

Question 18

The 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 protocols. SATA

Answer 18

• Mark procedure site with an X and again ask the patient to verify correct site
• The surgical team asks the patient to verify his or her name, type of surgery and limb to be
  removed
• 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
  -The surgical team uses the chart number and name/hospital number to ensure have the
  correct patient

Question 19

A patient admitted with CABG. According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patients oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently the patient remained on the ventilator an additional 2-day post op. according to the clinicals practice guideline for CABG, this situation results in what type of event?

Answer 19

Variance

Question 20

Which clients can be properly assigned to a newly graduated RN who has recently completed orientation SATA

Answer 20

• Client who is reporting pain at the site of a peripheral IV line
• Client on the second post op day who needs pain medication before dressing changes
• Client with kidney stone who needs frequent as needed (PRN) pain medication

Question 21

A nurse recently joined a quality and improvement committee at the hospital. The nurse is excited to get started with quality improvement but finds that staff on the unit are skeptical of change. How should the nurse respond

Answer 21

Explain the benefits of quality improvement on the unit and to the staff

Question 22

A nurse is looking for an opportunity to develop a quality improvement project. While discussing this with colleagues. One colleague suggests “we have had a couple medication errors lately both made by the same nurse you could work with the nurse to improve their medication safety”. Which factor explains why this is not an example of a quality improvement project?

Answer 22

It focuses on individuals’ improvement. Rather than process improvement.

Question 23

Nurse is assisting with the delivery of twins. The first infant is placed on the scale to be waited. 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

Answer 23

root cause analysis

Question 24

When a nurse uses a criteria such as “high risk for falls”, “infection protocols” and a “special
communication needs” to determine the mix and number of staff needed on a lemon tree unit, what is the nurse using?

Answer 24

A patient classification system

Question 25

Procedural changes are being planned on the unit as the direct result of client satisfaction surveys. which person is most strategically to handle how these changes are initiated?

Answer 25

Nurse manager

Question 26

A nurse is preparing to administer and medication by using the vastus lateralis site and is unfamiliar with the process. As step-by-step reference that shows how to complete the process is referred to by what term?

Answer 26

Top down flow chart

Question 27

A patient is ordered a low protein, low calorie diet, but patient family brings fish, lentils and unleavened bread For a meal to observe a cultural practice. The nurse works with a dietitian to adjust the next few meals to accommodate for this variance. What terms should be used to identify the situation?

Answer 27

Patient centered care

Question 28

At 37-year-old female who Has just undergone allogeneic stem. Cell transplantation will need protective environmental stimulation. Which nursing task should the nurse delegate to the nursing assistant? SATA

Answer 28

-Posting the precautions for protective isolation on the door of the client room.
-Reminding the visitors to wear a face mask, gloves, and gown
-stock the client’s room with the required PPE items

Question 29

A client has severe pain and bladder distention related to urinary retention and possible obstruction. And experience unlicensed assistive personnel and states that she received training and indwelling catheter insertion at a previous job. Task can be delegated to the UAP

Answer 29

Measuring the urine output and obtain a specimen

Question 30

The nurse is delegating task to the team members on the medical unit. Which infection control activities can be assigned to the nursing assistant? SATA

Answer 30

-Remind visitor to wear proper PPE in isolation room
-Disinfecting blood pressure cuff after client discharged

Question 31

When delegating the RN assigns one nurse to care for a patient with shingles and a different nurse to care for a patient with HIV. This represents which category of nursing care.

Answer 31

Safe and effective care environment.

Question 32

Which client can be appropriately assigned to an LPN who will function under the supervision of an RN or team leader? SATA

Answer 32

-Client, who underwent an amputation and has diabetic neuropathic pain.
-Client with arthritis who needs schedule pain medication and heat application.
- Client, with a leg cast who needs circulation checks and as needed hydrocodone.

Question 33

A nurse discovers that the wrong patient has been transported to surgery for a procedure in the operating room. When examining the incident, the nurse manager list contributory factors such as having two patients with the same name, A new nurse in orientation and a new admission to the transferring unit at the same time. The nurse manager is engaged in what process?

Answer 33

Root cause analysis

Question 34

The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect?

Answer 34

One nurse has responsibility for all the medications on the unit.

Question 35

A successful nurse manager is mentoring a newly promoted nurse manager, which comment by the mentor. Reflects the most important consideration of all nurse managers .

Answer 35

your most important role is to ensure client care accountability.

Question 36

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 question or concern? This process is referred to by what term?

Answer 36

Time out

Question 37

A nurse manager is aware that medication errors at the hospital are much higher than it should be, and that it is possible to reduce this incidence. Which intervention carries the greatest potential to reduce medication errors?

Answer 37

Reducing distraction to nurses while they are administering medication.

Question 38

The charge nurse determines acuity levels of clients for staffing needs. Which factors should be considered when determining acuity of clients? SATA

Answer 38

• Psychosocial support needs.
• Instability of vital signs.
• Need for 1:1 psychiatric monitoring.
• Age and functional ability.

Question 39

29 item instrument measuring patients’ perception of their hospital experience – Patient
focus. Which tool can provide key data?

Answer 39

HCAHPS

Question 40

Healthcare organization is considering opening a new unit for patients with muscular dystrophy. What factor would be a primary driven force for the unit to open

Answer 40

Cost of care

Question 41

Patients are waiting 20 to 30 minutes for PRN medications via call light. Which tool can the leader use to identify key steps for needed change?

Answer 41

Process mapping

Question 42

Leader wants to implement a new evidence-based practice that reduces hospital acquired infections. However, the staff is reluctant. What is the best way for the leader to get acceptance

Answer 42

Discuss the benefits of quality improvement to the unit

Question 43

Which of the following is best to define a patient care system that establishes specific milestones throughout the pts hospital stay

Answer 43

Clinical Pathways

Question 44

Which of the following is best to define a patient care system that establishes specific milestones throughout the course of the patient’s hospital stay.

Answer 44

Clinical pathways.

Question 45

Which of the following scenarios is classified as a sentinel event

Answer 45

Incorrect infant twin undergoes surgery for a heart defect

Question 46

Which of the following competencies are included in the quality and safety for nursing (QSEN) initiative? SATA

Answer 46

• Patient centered care
• quality improvement
• safety