Professional Development (Exam Four) Flashcards
1
Q
When the Institute of Medicine (IOM) published “To Err Is Human” in 2000, it estimated that ___________ people die per year in hospitals.
A
98,000
2
Q
The Institute of Medicine (IOM) began the quality cares movement due to what?
A
- Adverse events
- Medical errors
3
Q
List the three accepted elements of quality.
A
- Structure
- Process
- Outcome
4
Q
The 2001 report, “Crossing the Chiasm” concluded that care should be _________, __________, _________, ________, ___________, and __________.
A
- Safe
- Effective
- Client centered
- Timely
- Efficient
- Equitable
5
Q
The report, “To Err Is Human” focused on what?
A
Faulty systems, processes, and conditions that led to mistakes
6
Q
________ recommended changes for advocacy strategies to reduce errors and improve the quality of health care by recommending a four-tiered approach.
A
The Institute of Medicine Report: To Err Is Human
7
Q
Define quality assurance in health care.
A
An action is performed correctly the first time and each time thereafter
8
Q
What individuals are considered external customers?
A
- Patient(s)
- Patient(s) family
9
Q
What individuals are considered internal customers?
A
Individuals working within the health care setting
10
Q
Continuous quality improvement (CQI) is also known as what?
A
Total Quality Management (TQM)
11
Q
Describe the concept of exceeding expectations.
A
Organizations with a higher-quality service will capture a greater share of the market opposed to those with lower quality-service
12
Q
Which organization uses quality indicators (QI) as measures of health-care quality from easily accessible inpatient hospital administration data?
A
Agency for Healthcare Research and Quality (AHRQ)
13
Q
What electronic tool acts as a scoreboard to assess quality?
A
Dashboards
14
Q
Which organization serves as the gold standard for comparisons of hospital performance, facilitates transparency, and allows for easy access to health-care information?
A
Leapfrog Group
15
Q
What is the goal of the Leapfrog Group?
A
To promote high-quality health care through incentives and rewards
16
Q
There are _________ ___________ for all units and all types of patients with almost every condition, even patients who die during hospitalization.
A
Quality improvements
17
Q
What does risk management do?
A
- Identify, analyze, and evaluate risks
- Reduce those risks to decrease harm to patients
18
Q
Describe a sentinel event.
A
Unexpected occurrence involving death or serious physical or psychological injury
19
Q
T/F: Not all sentinel events are due to errors, and not all errors cause sentinel events.
A
True
20
Q
List the five distinct phases of the Six Sigma.
HINT: DMAIC
A
- Define
- Measure
- Analyze
- Improve
- Control
21
Q
Using the Six Sigma process, which variation must be detected before applying the five-step statistical process?
A
Assigned variation
22
Q
Which program or hybrid focuses on identifying and eliminating waste?
A
Lean Six Sigma
23
Q
Which model is designed to promote competency for clinical practice at all levels?
A
Competency Outcomes and Performance Assessment (COPA) model
24
Q
What competency was later added to the QSEN project, as a direct result of technology in health care?
A
Informatics
25
What is the mission of the Quality Improvement Organization (QIO)?
Improve the effectiveness, efficiency, economy, and quality of services delivered to Medicare beneficiaries
26
What organization assists Medicare and Medicaid beneficiaries with complaints about quality of care?
Quality Improvement Organization (QIO)
27
Medicare payment programs are to disallow payment for reasonably preventable medical errors that occur in the hospital known as _______ ________.
Never events
28
Who is responsible for covering the cost of never events if they do occur?
The hospital
29
Transforming care at the bedside addresses what four categories?
- Safe and reliable care
- Vitality and teamwork
- Patient-centered care
- Value-added care processes
30
List the ideas for change under the framework transforming care at the bedside.
- Rapid response teams
- Specific communication models
- Professional support programs
- Liberalized diet and meals times
31
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In 2001, the Institute of Medicine (IOM) identified six aims for improving health care in the United States. Which of the following are NOT characteristics the IOM identified? (SATA)
A. Affordable
B. Safe
C. Effective
D. Local
E. Client-centered
F. Timely
G. Efficient
H. Equitable
```
A, D
32
One system of quality improvement that has been tried in health care is ______ ________, which was originally developed to improve quality in manufacturing but has since been used to identify problems and find effective solutions in health care.
Six Sigma
33
Root-cause analysis, as essential part of risk management, is conducted after an adverse event. What are the components of root-case analysis? (SATA)
A. Identifying who cause the adverse event
B. Tracking the events that led to the error
C. Identifying any faulty systems or processes
D. Developing a plan to prevent further errors
B, C, D
34
Which of the following is the best definition of quality as it relates to healthcare?
A. The extent to which clients are satisfied with their health outcomes and the care they received
B. The provision of as much safe, effective care as the client can afford
C. The degree to which health services increase the likelihood of desired outcomes and reflect current professional knowledge
D. The extent o which outcomes can be quantified and compared to industry standards
C. The degree to which health services increase the likelihood of desired outcomes and reflect current professional knowledge
35
Which of the following statements about how education relates to quality and safety in nursing care is true? (SATA)
A. Education in quality and safety begins in nursing school
B. Continuing education allows nurses to update their knowledge and skills to improve quality and safety
C. Increasing nursing education levels has been shown to improve client outcomes and quality
D. The type of quality and safety education a nurse receives depends on the hospital or facility in which the nurse works
E. Hospitals are unwilling to spend money on quality and safety education for nurses
A, B, C
36
What is civility?
Underlying principal that recognizes all human beings are important
37
Civility is based on what?
- Good manners
| - The Golden Rule
38
Civility in the nursing profession enables nurses to do what?
Make caring the focal point of their practice
39
________ __________ is the ability to be aware of feelings and thought of others by using behavioral cues.
Emotional intelligence
40
What concept promotes personal growth of the nurse?
Emotional intelligence
41
What concept is viewed as a continuum of impolite behaviors?
Incivility
42
List examples of classroom incivility.
- Inattentiveness
- Coming unprepared
- Not listening
- Interrupting
- Tardiness
- Cheating
43
What is the ultimate consequence of incivility in the health-care setting?
Jeopardizes quality of care and client safety
44
What is a type of incivility that encompasses physical abuse, emotional abuse, verbal abuse or any combination of the three?
Bullying
45
What is the goal of bullying?
Coerce or intimidate another person or group of people into doing something they do not want to do
46
List examples of overt lateral violence.
- Name calling
- Intimidation
- Gossip
- Shouting
- Blaming
- Raised eyebrows
- Rolling of the eyes
- Sarcasm
47
List examples of covert lateral violence.
- Refusing to help someone
- Ignoring someone
- Making faces
- Refusing to work with certain people
- Whining
- Sabotage
48
What is vertical violence?
Bullying from a superior
49
What is bottom-up vertical violence?
Bullying from a subordinate to a superior
50
Oppression theory describes ____________ as a key contributing factor to lateral violence.
Marginalization
51
Nurses sometimes use ________ ________ to attack one another as a means of venting their frustrations and anger against a supervisor or institution.
Horizontal/lateral violence
52
How is academic incivility displayed by faculty?
- Not addressing students correctly
- Belittling
- Demeaning
- Not keep schedule
- Grading procedures
53
What is lateral violence?
Bullying from faculty-to-faculty
54
List examples of student-to-faculty incivility.
- Cheating
- Cutting class
- Complaining behind teachers back
- Harassing and threatening
- False complaint
55
List examples of student-to-student incivility.
- Bullying
- Two-faced behavior
- Cutting each other off
- Obtaining previous years notes
56
Nurses "eating their young" is an example of which type of violence?
Vertical violence
57
What characteristic is key to recognizing how others might want to be treated?
Empathy
58
What type of violence most often occurs amongst health-care providers?
Lateral violence
59
List the types of incivility in nursing education.
- Student-to-student
- Student-to-instructor
- Instructor-to-student
60
Student incivility is increased by what?
Stress
61
What is a key element in reversing incivility in the academic or workplace environment?
Transformational leadership
62
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Which of the following behaviors are characteristic of both bullying and lateral violence? (SATA)
A. Can escalate to physical actions
B. Intimidation
C. Name calling
D. Verbal sarcasm
E. Use of social media to attack target
```
A, B, C, D, E
63
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Which of the following behaviors would be considered civil in both the classroom and the clinical setting? (SATA)
A. Assume goodwill
B. Listen to and respect others
C. Be on time
D. Do not ask questions
E. Do not share information
```
A, B, C
64
What is the main difference between bullying and lateral violence?
A. Bullying can result in physical violence; lateral violence does not
B. Lateral violence is a response to vertical violence; bullying is not
C. Lateral violence occurs primarily in the work setting
D. Targets of bullying are chosen because they have attributes that are foreign to the bullies; targets of lateral violence are chosen because the bullies see their own despised attributes in the target
C. Lateral violence occurs primarily in the work setting
65
Which statement about incivility in the educational setting is true? (SATA)
A. Incivility in the educational setting may involve administrators, faculty, and students
B. In the nursing classroom, instructors are responsible for policing uncivil behavior
C. Incivility among nursing educators is sometimes related to differences in educational backgrounds and professional preparation
D. Students are typically uncivil to one another , not to instructors
E. There is a correlation between increased students stress and student incivility
A, C, E
66
__________ is an essential component of client care and management of nursing units.
Delegation
67
When delegating a task, who is ultimately accountable for the task?
The RN who delegated the task
68
The RN knows what in regards to delegating a task to a licensed nurse (LPN/LVN)?
The delegated responsibility must be within the LPN/LVN's scope of practice as defined by the Nurse Practice Act (NPA)
69
What is an assignment?
Allocation of a task that each staff member is already authorized to perform
70
What is delegation?
Process of a nurse directing another health-care personnel to perform specific tasks that are beyond the persons traditional role
71
Define responsibility.
The duty of a person to complete tasks and assignments that are within their power, control, and authority
72
Define accountability.
The obligation or willingness to be answerable for one's own actions or the actions of another if delegated
73
T/F: Responsibility can be delegated.
True
74
T/F: Accountability can be delegated.
- False
| - Accountability can never be delegated
75
Any RN who has delegated care must ensure what?
The delegated activities have been carried out correctly by the delegatee
76
The assessment of a team members ability to complete the delegated or assigned tasks of patient care by the RN is known as what?
Evaluation
77
How is evaluation completed by the RN?
- Directly
| - Indirectly
78
Give an example of direct supervision.
RN directly observing a dressing change by an LPN
79
Give an example of indirect supervision.
RN reviewing a medication list to make sure the LPN was giving medications on time
80
What is a form of covert institutional licensure?
Indirect delegation
81
LPN's/LVN's should be assigned to care for what type of patients?
Patients with chronic conditions
82
What action can never be delegated?
Accountability
83
What are the five rights of delegation?
- Right task
- Right person
- Right direction/communication
- Right supervision
- Right circumstances
84
List the guidelines for delegation.
- Assess the client
- Know staff availability
- Know the job description
- Educate the staff members
85
Delegated tasks should not require what?
- Excessive supervision
- Complex decision-making
- Detailed assessment
86
________ are also held to the same standards as RN's when it comes to delegating.
Advanced Practice Registered Nurses
87
When a nurse delegates a task, the outcome of the task should be what?
- Clear
| - Predictable
88
What type of tasks should not be delegated to assistive personnel by the RN?
- Wound vac
- Admission assessments
- Care plan development
89
When should you avoid delegating tasks to assistive personnel?
- End of shift
| - Prior to discharge
90
Barriers caused by circumstances or the person being delegated to are known as ________ __________.
External barriers
91
List specific tasks that cannot be delegated.
HINT: MEATUS
```
M - Medications
E - Evaluation
A - Assessment
T - Teaching
U - Unstable patients
S - Skills
```
92
List internal barriers to effective delegation.
- Lack of experience
- Lack of confidence
- Personal insecurity
- Demanding perfection
- Indecision
- Poor communication
93
The Nurse Practice Act does NOT give delegation abilities to who?
- LPN's
- LVN's
- UAP
94
Describe direct delegation.
Specific decision made by the RN
95
Describe indirect delegation.
List of tasks produced by the facility
96
List tasks that CANNOT be performed by an LPN/LVN.
- Cannot do admission assessments
- Cannot give IV push medications
- Cannot write nursing diagnosis
- Cannot do most teaching
- Cannot do complex skills
- Cannot take care of acute conditions
- Cannot take care of unstable clients
97
You cannot delegate your __________.
MEATUS
98
Which action is most appropriate for the nurse to delegate to an UAP?
A. Assisting a client with a prosthetic leg to ambulate to the bathroom
B. Teaching a client with diabetes about the importance of eating an entire meal
C. Helping a client drink contrast media that was poured into a cup by a nurse
D. Asking a client who recently had surgery about the intensity of pain being experienced
A. Assisting a client with a prosthetic leg to ambulate to the bathroom
99
When caring for a client in pain, which activity is appropriate to delegate to unlicensed nursing personnel?
A. Coaching the client during painful procedures
B. Assessment using a self-report pain scale
C. Evaluating pain after giving medication
D. Bathing the client and performing hygiene measures
D. Bathing the client and performing hygiene measures
100
The RN is assigning tasks for the care of a client after surgery for colon cancer. Which of the following assignments should the RN reconsider?
A. The UAP is to check the clients new stoma for redness when assisting the client with a bed bath
B. The LVN is to report blood glucose readings that are outside a given range
C. The UAP is to assist the client in ambulating twice per shift
D. The LVN is to administer medications as ordered by the health care provider.
A. The UAP is to check the clients new stoma for redness when assisting the client with a bed bath
101
A nurse is in charge of a team consisting of a registered nurse (RN), a licensed practical nurse (LPN), and a nurse aid (NA). Which tasks should the nurse delegate to the LPN for the most effective use of the expertise of staff members? (SATA)
A. Take vital signs on a postoperative client one day after surgery
B. Perform a bed bath for a client on contact precautions
C. Obtain a blood glucose level on a client with diabetes
D. Provide client education regarding a dressing change
E. Discontinue tubing used to administer blood
A, C
102
A charge nurse is making assignments to staff members working on a surgical unit. Which client should be assigned to a recently registered nurse rather than an experienced registered nurse?
A. A woman with an elevated temperature after surgery for an ectopic pregnancy
B. A middle-aged client who had elective surgery for repair of an abdominal hernia
C. A young adult who had a fractured femur as well as multiple soft tissues injuries from an automobile accident
D. An older adult male who had a transurethral resection of the prostate who has cherry red drainage from the continuous bladder irrigation
B
103
A nurse in charge of a client care unit is considering staff member assignments. What criterion is most significant for the nurse to consider when delegating a task to another member of the nursing team?
A. Who will ultimately be responsible for the clients care?
B. Is the activity within the person's job description?
C. How much experience does the person have?
D. What is the acuity level of the client?
B
104
___________ is the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.
Delegation
105
The nurse is managing care of a school-age child with new-onset insulin-dependent diabetes. Which tasks must be performed only by the RN and cannot be delegated to and LPN/LVN or UAP? (SATA)
A. Teaching parents how to give subcutaneous injections of insulin
B. Performing blood glucose monitoring before meals and at bedtime
C. Evaluating the child's response to insulin doses
D. Determining the educational goals for the day
E. Teaching the child signs and symptoms for hyperglycemia and hypoglycemia
A, C, D, E
106
Assigning the risk task to the right person is a principal of nursing delegation and assignment. Which of the following scenarios meets this principal?
A. A 4-month-old with Down syndrome is assigned to a nurse whose own child died of heart disease due to Down syndrome 6 months ago
B. A child with a central IV line that occluded on the previous shift is assigned to a new LPN
C. A child with newly diagnosed acute leukemia ia assigned to an experienced pediatric oncology nurse who floated to the general pediatric unit
D. A child with new-onset insulin-dependent diabetes is assigned to an RN who has four other complex-care clients
C. A child newly diagnosed with acute leukemia is assigned to an experienced pediatric oncology nurse who floated to the general pediatric unit
107
When making assignments for the oncoming shift, the charge nurse assigns a float RN from another unit to care for a client with complex needs. What is the legal responsibility of the charge nurse in this situation?
A. Assurance of scope of practice
B. Duty to orient, educate, and evaluate
C. Patient's rights and responsibilities
D. Determination of nurse/client relationship
B. Duty to orient, educate, and evaluate
