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A new nurse is working with a preceptor on an inpatient medical-surgical unit. The preceptor advises the student that which is the priority when working as a professional nurse?
- A. Attending to holistic client needs
- B. Ensuring client safety
- C. Attending to medical-surgical errors
- D. Providing client-focused care
Correct Answer: B
Rationale: All actions are appropriate for the professional nurse. However, ensuring client safety is the priority. Up to 98,000 deaths result each year from errors in hospital care, according to the 2000 Institute of Medicine report. Many more clients have suffered injuries and less serious outcomes. Every nurse has the responsibility to ensure the client's safety.
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The nurse is reviewing the core competencies for health care providers outlined by the Institute of Medicine (IOM). Which of the following are included? (Select all that apply.)
- A. Collaborating with an interdisciplinary team
- B. Implementing evidence-based care
- C. Providing family-focused care
- D. Routinely using informatics in practice
- E. Using quality improvement in client care
Correct Answer: A,B,D,E
Rationale: The IOM report lists five broad core competencies that all health care providers should practice. These include collaborating with the interdisciplinary team, implementing evidence-based practice, providing client-focused care, using informatics in client care, and using quality improvement in client care. Providing family-focused care is not explicitly listed as a core competency.
A nurse wishes to provide client-centered care in all interactions. Which action by the nurse best demonstrates this concept?
- A. Assesses for cultural influences affecting health care
- B. Ensures that all the clients basic needs are met
- C. Tells the client and family about all upcoming tests
- D. Thoroughly orients the client and family to the room
Correct Answer: A
Rationale: Competency in client-focused care is demonstrated when the nurse focuses on communication, culture, respect, compassion, client education, and empowerment. By assessing the effect of the client's culture on health care, the nurse best demonstrates this concept. Simply telling the client about all upcoming tests is not providing empowering education. Orienting the client and family to the room is an important safety measure, but not directly related to demonstrating client-centered care.
The nurse utilizing evidence-based practice (EBP) considers which factors when planning care? (Select all that apply.)
- A. Cost-saving measures
- B. Nursing expertise
- C. Client preferences
- D. Research findings
- E. Values of the client
Correct Answer: B,C,D,E
Rationale: The IOM reports utilizing current evidence, the client's values and preferences, and the nurse's expertise when planning care. It does not include cost-saving measures, as these are not a primary focus of evidence-based practice.
A nurse is caring for a postoperative client on the surgical unit. The client's blood pressure was 142/76 mm Hg 30 minutes ago, and now is 89/50 mm Hg. What action by the nurse is best?
- A. Call the Rapid Response Team
- B. Document and continue to monitor
- C. Notify the primary care provider
- D. Repeat blood pressure measurement in 15 minutes
Correct Answer: A
Rationale: The purpose of the Rapid Response Team (RRT) is to intervene when clients are deteriorating before they suffer respiratory or cardiac arrest. Since the client has experienced a significant change in blood pressure, the nurse should call the RRT. Changes in blood pressure, mental status, heart rate, and pain are particularly significant. Documentation is vital, but the nurse must do more than document. Notifying the primary care provider is important but does not address the immediate need for intervention. Repeating the blood pressure measurement delays necessary action.
A nurse manager wants to improve hand-off communication among the staff. What actions by the manager would best achieve this goal? (Select all that apply.)
- A. Attend hand-off rounds to coach and mentor
- B. Conduct audits of staff using a new template
- C. Hand-off rounds to coach and mentor
- D. Encourage staff to ask questions during hand-off
- E. Give raises based on compliance with reporting
Correct Answer: A,B,C,D
Rationale: A protocol for standardizing hand-off reports and other critical communication is the SHARE model. Attending hand-off rounds gives the manager opportunities to educate and coach. Conducting audits is part of reinforcing quality. Creating a template is standardizing within the system. Encouraging staff to ask questions and think critically about the information is allowing opportunities to ask questions. Giving raises based on compliance is not part of the SHARE model.