N122 Review

Created by tmde 

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Midterm and Final Review combined.

Sentinel Events

Any procedure performed on a wrong person or organ, or death or permanent loss of function. occurrence that results in death or serious illness and requires immediate investigation

psychological

Nurses who are expected to work overtime as dictated by their employer are being subjected to a ____________________ hazard in the workplace.

check back

repeating what is heard.
During resuscitation efforts, a provider states, "I need to give a 1.5 mg/kg bolus of lidocaine because the patient is in ventricular tachycardia." The nurse responds, "I have a lidocaine bolus equal to 1.5 mg/kg." This communication model is known as:

quality

defined by the customer

scientific approach

the way changes are made to achieve quality.
Based on: sound, valid data, and those who manage have a clear understanding of the nature of the variation in process.

SBAR

shares information during patient hand-offs

run chart/time plot

graphs information over time

Pareto chart

bar graph. show causes contributing to a problem in descending order so leading cause is easily recognized.

Administrative support

important for any quality improvement initiative to be successful

Flowchart

chart that shows the sequence of steps in a process

cause and effect diagram

lists all potential causes, arranged by categories to show their potential impact.
NOT arranged by time or frequency of occurrence

competency

having the skill set to provide safe care within the scope of practice and context

human factor

what factor: cognitive ability and social influences that affect practices.

Evidence based practice

type of practice that uses scientific information to inform practice

Workarounds

what are nonstandard work processes used when standard work is blocked by dysfunctional processes such as unavailability of supplies or lack of information.

authority

the criterion that is related to an author's credentials and background that have prepared him or her to publish on the subject. Common with websites. Author has this.

Quality Assurance

this focused on specific incidents/identified problems rather than on broad system improvements/avoiding future problems
-only a few people such as auditors focused on problems
-administration only later recognized the importance of proactive initiatives involving all members of the health care team.

Early efforts

What time frame regarding quality assurance identified problems and Were reactive rather than proactive.

Objectivity

the criterion that is related to the site's purpose, intended audience, and sponsorship and to whether the information is FACT or OPINION.

Usability

the criterion that is related to the maneuverability and overall arrangement of the website. Research studies are referenced.

Currency

the criterion that is related to updated information required because of the dynamic state of health care. The study was conducted within the last year.

educational site

.edu

government site

.gov

commercial site

.com

internet provider

.net

Patient focused

Which CIS: order entry
results reporting (patient specific)
clinical documentation
care planning
clinical pathways/guidelines
Ex: A multidisciplinary tool that prescribes routine interventions for a group of patients with similar diagnoses is a critical pathway that is patient-focused.
Physician orders are patient specific

Department focused

Which CIS:Contains information on a particular department
Early billing systems that stood alone
Must protect and maintain confidentiality.

Focuses on nursing retention and safety enhancement grants

What is the purpose of the Nursing Reinvestment Act of 2002?

Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse patient relationship

With the crisis in health care and the nursing shortage, why is the image of nursing still important?

Responding to recurring crises at work or in one's personal life

After keeping a log of activities designed to improve time management, the nurse divides the distractions into internal and external sources. The nurse would classify which distraction as internal

patient-focused CIS.

When patient-focused clinical information systems (CISs) are compared with department-focused CISs :the nurse who wishes to review how a patient's plan of care deviated from the established criteria would use the

more secure

Consumers are concerned with security issues related to their confidential health information when placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is:

authority

A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author's credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing?

decision support

An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as:

Confidentiality

A consumer is learning about electronic health records at a local health fair and states, "I am worried that someone can read my health information and I really don't understand the difference between privacy and confidentiality." The nurse explains that this is an example of confidentiality or privacy??? :a pledge states, "I will hold matters pertaining to my patients in strict intimacy."

objectivity

A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information's:

Department focused

A nurse who is majoring in informatics learns that clinical information systems (CISs) can be department focused rather than patient focused. Would the following be in a department or clinical info system?
Blue Cross/Blue Shield, point of service #TN09874.

guidance from a trusted individual

A nurse is concerned about safe staffing levels at her facility and observes that several units have no RN coverage but instead have RNs who float among several units. In determining whether this staffing concern should be reported to an outside agency, the nurse understands that with whistle blowing one should seek what?

Brand, how and where injury occurred

According to the Needlestick Safety and Prevention Act (1991) employers are required to document what about a sharps incident?

C and E

What are some of the driving forces for change to improve the quality and safety competencies for nursing in the United States? (Select all that apply.)

a. The U.S. health care system is one of the world's least technically advanced systems.
b. Health care has led other industries in establishing quality and safety standards.
c. System failures occur regularly.
d. The U.S. public has confidence in its system to reduce morbidity and mortality rates.
e. Outcomes are unpredictable and costly.

A sentinel event

This is classified as what?

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.

(based on best choice. It could be 2 things but both possibilities wont be in answer.)

sentinel

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 _______ event.

individual and system approaches

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?
They address both what to transform care?

quality

A patient was admitted to the outpatient surgery unit for a urinary stent placement. The patient was cheerfully greeted, paperwork was promptly completed by the admission clerk, an intravenous (IV) line was quickly inserted, and preoperative medications were administered in a timely manner. The procedure was completed as planned with no complications. The patient rated the experience as poor because when discharged, the hospital transporter refused to place the patient's bag in the trunk of the car and stated, "It is not my job to pack your personal items." Which aspect of Joiner's triangle was applied?

specific problem

In differentiating between early efforts of quality assurance and present-day quality improvement efforts, which statement is correct? Quality assurance tends to occur as a response to what?

Time plot

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?

Pareto chart

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include inconsistent methods of cleaning the site, dressing frequently becomes wet when patient showers, IV tubing not changed every 48 hours per protocol, and inadequate handwashing of RN prior to insertion. A bar graph demonstrates the frequency in descending order with 80% of infections being attributed to inadequate handwashing. The quality tool used is a:

competency

The ability to clearly demonstrate the knowledge, skills, attitudes, and professional judgment required to practice safely and ethically in a designated role and setting is termed:

medication-related errors

A group of nurses is presenting the importance of quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that what places a tremendous financial burden on the US health care system?

patient

Quality is defined by the

homicide

The occupational health and safety nurse would like to develop programs designed to decrease mortality and morbidity among the workforce. When considering factors related to mortality among female workers, the nurse should focus her efforts on prevention of:

higher-paying clinical sites

Along with the shortage of enrollment reported in nursing schools is a shortage of faculty, which is attributed to several factors, including:

teamwork and collaboration

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 their area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated?

individual and system approaches

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?
The competencies address both what to transform care.

benchmarks

"Ninety-five percent of all patients presenting to the emergency department with chest pain will receive aspirin 80 mg within 15 minutes of arrival unless contraindicated." Top hospital emergency departments use this standard to eliminate sudden death related to chest pain. Hospitals desiring to replicate these results establish compliance rates known as:

top down flowchart

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 called a:

sentinel event

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 as a:

IOM

A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:

wait to seek care

A young mother has detected a lump in her breast, and because she lives at the poverty level, she is covered under Medicaid. This individual is more likely to do what about her care?
- will result in negative effects (masectomy) and hospitalization that could have been avoided.

Preferred provider organization (PPO)

A contractual agreement between the insurer and the provider in which covered members are encouraged to use specific health care providers in return for reduced rates is which type of arrangement?

cost shifting

Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as:

retrospective

A physician bills the insurance company for a computed tomography (CT) scan, laboratory tests, chest x-ray, and an extended visit and receives revenue for each procedure billed. This type of payment system is a:

insurance company

In the triad of health care, which would be considered the third-party payer?

never events

A 72-year-old client is admitted to have the right kidney removed after a diagnosis of cancer. The surgeon removed the left kidney. Medicare will no longer pay for preventable medical errors known as ________________.

France, Canada, UK

Which industrialized countries have a national health insurance system? (Select all that apply.)

length of hospital stay

Diagnosis-related groups (DRGs) have attempted to reduce health care costs by decreasing:

cost shifting

Lack of insurance, uninsured populations, and uncompensated care are covered by charging more to those who can pay. This practice is referred to as:

effective

performing the correct test or intervention

efficient

refers to the wise use of supplies and resources for the desired outcome.

Diagnosis Related Group (DRG)

An older adult client was admitted to the hospital with the condition classified as "pneumonia." Reimbursement was based on a predetermined fixed price. This classification system is referred to as:

Capitation

A nurse is offered several health care plans as part of employee benefits. Which plan is based on a monthly fee per participant and offers a range of preventive, diagnostic, and treatment services?

Utilization review nurse

The precise classification of clients according to the highest diagnosis-related group (DRG) has created a new role for nurses, referred to as:

decontamination

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 known as:

persuading policy makers

Political action committees (PACs) are established for the purpose of:

Hill-Burton Act

Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the:

the same ground rules apply

A novice nurse learns of a mass casualty disaster following a known terrorist attack. On arriving at the scene, the nurse knows that in comparison to smaller crises:

The Metropolitan Medical Response System (MMRS)

consists of responders who have obtained specialized training and equipment to deal with mass casualty events.

Medical Reserve Corps

A group of local volunteers respond to a tornado. 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 the:

Preimpact

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 stage of a disaster scale?

Strategic National Stockpile

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 the:

Center for American Nurses (CAN)

Nurses in a nonunionized health care facility are concerned about patient safety because of the requirement for nurses to work overtime. Which organization can address the needs of these nurses?

Learn the platform

A nurse would like to advocate for increased protective services and reporting mechanisms for elder abuse and attends the "meet the candidate" session at the town hall meeting. This is an important time for the nurse to do what regarding the candidate?

diagnosis

When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process?

legislative

It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that is capable of originating major policy initiatives is the:

registered and eligible to vote

A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean?

The community is the first responder

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?" The correct response by the DMAT is:

red herring

throwing in an unrelated issue to distract from the real problem

straw man

when someone mistakes someone position on an issue.

appeal to tradition

"its always been done this way"

appeal to emotion

appeals to the emotion of the person.

competency

able to perform your task and know what youre doing in your role

Burn out

bottling up emotions and problems leads to this. symptoms = extreme fatigue, headaches, difficulty sleeping, mood swings, anxiety, poor work quality, depression, and anger. More intelligent/hardworking are prone to this.

Benchmarks

meet a certain set standard compared to other people. usually used in hopsital

open ended question

Not a yes or no question.

closed ended question

A yes or no question.

Compact states

need to get licensure by endorsement if not in this. However, license carries over between all states in this agreement/group.

Cultural Biological variations

Certain cultures/races are predisposed to different health risks

Pubhealth, medline, cinhal

Most reliable sources online for med info.

nurse demographics

The change change in economy is causing less nurses to retire than before. This new info indicates that there will not be a nurse shortage. This is a change in

Autonomy

ability and freedom to make decisions regarding self.

Justice

doing what is right

veracity

Telling the truth

Utilitarianism

best decision is the greatest good for most people

Deontology

ethical theory that moral rule is binding, and doing what is right is your duty, your actions are judged to see if you're moral.

construct

measurable and very real! The in depth parts of concepts.

theoretical model

the picture made by concepts variables and constructs

appeal to common practice

"everyone does it this way"

care coordinator

coordination an integration of the clinical and administrative requirements of patients.

Occupational Health nurse

work within a specific occupational group to maintain employee health and assess the workplace

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