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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.
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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.
A nurse is calling the on-call physician about a client who had a hysterectomy 2 days ago and has pain that is unrelieved by the prescribed narcotic pain medication. Which statement is part of the SBAR format for communication?
- A. Provide the client's current pain level and history
- B. Administer additional pain medication as needed
- C. Document the client's pain in the medical record
- D. Schedule a follow-up visit with the physician
Correct Answer: A
Rationale: The SBAR format (Situation, Background, Assessment, Recommendation) is used for clear and concise communication with healthcare providers. Providing the client's current pain level and history is part of the Background and Assessment components of SBAR, ensuring the physician has relevant information to make informed decisions. The other options are not part of the SBAR communication process.
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 newly graduated nurse at the hospital states that, since she is so new, she cannot participate in quality improvement (QI) projects. What response by the precepting nurse is best?
- A. All staff nurses are required to participate in quality improvement here
- B. Even being new, you can implement activities designed to improve care
- C. You are to identify what indicators should be used to measure quality
- D. You should ask to be assigned to the research and quality committee
Correct Answer: B
Rationale: The preceptor should reassure the nurse that implementing QI measures is not out of line for a newly graduated nurse. Even new nurses can contribute to quality improvement by implementing activities designed to enhance care, such as following evidence-based protocols or suggesting small process improvements. Requiring participation, assigning specific tasks like identifying indicators, or suggesting committee assignment may not address the nurse's concern about their capability as a new graduate.
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.