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A nurse working in a hospital setting discovers problems with the delivery of nursing care on the pediatric unit. Which of the following suggestions from the Institute of Medicines Committee on Quality of Health Care in America (Kohn, Corrigan, & Donaldson, 2000) could help redesign and improve care? Select all that apply.
- A. Base care on continuous healing relationships.
- B. Customize care based on available resources.
- C. Keep the nurse as the source of control.
- D. Share knowledge and allow for free flow of information
- E. Practice evidence-based decision making
- F. Emphasize safety as a system property.
Correct Answer: A,D,E,F
Rationale: The Institute of Medicine emphasizes continuous healing relationships (A), knowledge sharing (D), evidence-based practice (E), and safety as a system property (F) to improve care quality.
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Which of the following would not be part of the nurses decision about care after evaluating the patients responses to the plan of care?
- A. terminate the plan of care
Correct Answer: D
Rationale: The options are incomplete, but based on standard nursing practice, transferring medical orders (D) is not part of evaluation decisions, which focus on continuing, modifying, or terminating the plan.
The nursing staff on a hospital unit are using peer review to improve professional performance. Who performs the review?
- A. unit manager
- B. nurses
- C. patients
- D. visitors
Correct Answer: B
Rationale: Peer review is conducted by nurses evaluating each other's performance.
A nurse has developed a plan of care for the nursing diagnosis Risk for Loneliness for a recently widowed man. When evaluating the plan, the man tells the nurse new information about his active social life. What would the nurse do next?
- A. Continue with the plan.
- B. Delete the nursing diagnosis.
- C. Tell the patient he is lonely.
- D. Adjust the time criteria.
Correct Answer: B
Rationale: New information indicating an active social life negates the risk for loneliness, so the diagnosis should be removed.
Which of the following are major premises of a quality-improvement program? Select all that apply.
- A. It focuses on organizational structure.
- B. It is driven by external factors.
- C. It focuses on processes rather than individuals.
- D. It has no end points.
- E. Its outcome is focused on assuring quality.
- F. It focuses on data and statistical thinking.
Correct Answer: C,D,F
Rationale: Quality-improvement programs emphasize processes (C), continuous improvement without endpoints (D), and data-driven decision-making (F).
A nurse is evaluating an established plan of care. After identifying the evaluative criteria and standards (expected patient outcomes), what must the nurse do next?
- A. Interpret and summarize findings.
- B. Document his or her judgment.
- C. Collect data about patient responses.
- D. Formulate a new plan of care.
Correct Answer: C
Rationale: After setting criteria, the nurse collects data on patient responses to assess whether outcomes are met.