A client is admitted to the hospital with the diagnosis of cancer of the thyroid, and a thyroidectomy is scheduled. What is important for the nurse to consider when caring for this client during the postoperative period?

1. Hypercalcemia may result from parathyroid damage.
2. Hypotension and bradycardia may result from thyroid storm.
3. Tetany may result from underdosage of thyroid hormone replacement.
4. Hoarseness and airway obstruction may result from laryngeal nerve damage.

D. Hoarseness and airway obstruction may result from laryngeal nerve damage.

The primary healthcare provider instructs the client to increase their intake of seafood and protein in the diet. What could be the reason for this instruction?

1. The client has vitiligo.
2. The client has hypothyroidism.
3. The client has diabetes mellitus.
4. The client has a urinary infection.

B. The client has hypothyroidism.

What is the cause of this condition in the client?

1. Hypofunction of adrenal gland
2. Hyperfunction of adrenal gland
3. Hypofunction of pituitary gland
4. Hyperfunction of pituitary gland

A. Hypofunction of adrenal gland

An elderly adult with Parkinson’s disease falls while going to the bathroom and gets injured. The nurse taking care of the client informs the primary healthcare provider. What step should the nurse take to alert the risk management system?

1. The nurse should document the incident in the occurrence report tool.
2. The nurse should provide information in the medical record about the occurrence.
3. The nurse should document in the client’s medical report that an occurrence report has been filed.
4. The nurse should document in the client’s medical report that the primary healthcare provider has been contacted.

A. The nurse should document the incident in the occurrence report tool.

A registered nurse is educating a nursing student about the importance of nursing documentation for performing risk management. What information should the nurse give? Select all that apply.

1. "A nurse’s documentation is the evidence of care that a client receives."
2. "Nurses’ notes should not be given to attorneys in the event of a lawsuit."
3. "The nurse should note down assessments and significant changes in the client’s health."
4. "In case an occurrence report is filed, nurses should enter the information the client’s charts."
5. "Nurses should always document the primary healthcare providers’ responses whenever they are contacted."

A. "A nurse’s documentation is the evidence of care that a client receives."

C. "The nurse should note down assessments and significant changes in the client’s health."

E. "Nurses should always document the primary healthcare providers’ responses whenever they are contacted.

A nursing student is examining different scenarios to understand Quality and Safety Education for Nurses (QSEN) competencies. Which scenarios are examples of the QSEN competency called quality improvement? Select all that apply.

1. A nurse studies old medical cases about clients with Alzheimer's disease before formulating the care plan for a client.
2. A nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional healthcare practices.
3. A nurse demonstrates the method of using electronic health records to assure a client about confidentiality of the records.
4. A nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators.
5. A nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights.

B. A nurse prepares a graph to compare the effectiveness of regular nursing practice with traditional healthcare practices.

D. A nurse designs a new method for ensuring surgical asepsis on the basis of information obtained from facility administrators.

E. A nurse prepares a flow chart to show the decline in client injuries after implementing a weekly client education program on the use of nurse call lights.

What are the roles and responsibilities of a senior nurse leader while implementing strategies for improving the quality of the organization? Select all that apply.

1. Participating actively in the quality improvement activities
2. Setting priorities for staff effectiveness and client health outcomes
3. Providing support systems for staff who have been involved in a sentinel event
4. Building infrastructure, providing resources, and removing barriers for improvement
5. Meeting regularly with staff to monitor their progress and help them improve their work

B. Setting priorities for staff effectiveness and client health outcomes

C. Providing support systems for staff who have been involved in a sentinel event

D. Building infrastructure, providing resources, and removing barriers for improvement

A registered nurse is educating a nursing student about quality and performance improvement measures. Which activity mentioned by the nurse is an example of a performance improvement?

1. Installing new nurse call bells beside every bed in the healthcare facility
2. Evaluating the effectiveness of client-teaching programs conducted before discharge
3. Initiating new strategies to speed up the process of obtaining consent forms from clients
4. Analyzing the new technique for counting sponges and instruments in the operating room

D. Analyzing the new technique for counting sponges and instruments in the operating room

A registered nurse is informing a nursing student that nurses play an important role in helping hospitals to meet requirements for quality, efficiency, and client satisfaction. Which points mentioned by the registered nurse are accurate? Select all that apply.

1. "Pay for performance programs promote quality, effectiveness, and safe client care."
2. "Six Sigma is used to analyze the collected data and to identify unnecessary steps in the processes."
3. "Balanced scorecards are used to report data on the key performance indicators and are published publicly."
4. "Organizations are using outcomes like employees’ satisfaction to redesign how they manage and deliver care in hopes of improving quality in the long term."
5. "The Picker Institute focuses on improvement of processes to determine if current or recommended steps add value and reduce the health care organization’s time, costs, and resources."

A. "Pay for performance programs promote quality, effectiveness, and safe client care."

B. "Six Sigma is used to analyze the collected data and to identify unnecessary steps in the processes."

C. "Balanced scorecards are used to report data on the key performance indicators and are published publicly."

A group of nurses is preparing strategies to improve the quality of health care provided by the nursing team in the hospital. Which points should the nurse consider while preparing the strategies? Select all that apply.

1. The nurse should determine the root causes of the adverse events.
2. The nurses should focus chiefly on the process of the care delivery system.
3. The nurses should ensure that all adverse events are well documented.
4. The nurses should be prepared to deal with events that may cause harm to a client.
5. The nurses should use failure mode effective analysis to assess the root cause of a sentinel event.

A. The nurse should determine the root causes of the adverse events.

C. The nurses should ensure that all adverse events are well documented.

D. The nurses should be prepared to deal with events that may cause harm to a client.

The quality analysis team has implemented the root cause analysis (RCA) tool in the hospital. The nurse recognizes that the tool will be useful in which case?

1. A client died after end-stage lung cancer.
2. A client died due to nosocomial infection.
3. A client was rescued while falling from the bed.
4. A client developed skin rashes after receiving medication.

B. A client died due to nosocomial infection.

A client who underwent open heart surgery died 2 days after the surgery due to septicemia. Which tool will the nurse use to determine the cause of the client’s death?

1. Plan-do-study-act (PDSA)
2. Root cause analysis (RCA)
3. Failure mode effective analysis (FMEA)
4. Computerized physician order entry (CPOE)

B. Root cause analysis (RCA)

A nurse is heading a performance improvement team. The nurse collects records of needlestick injuries due to improper needle recapping techniques used during medicine administration. What is the next step to be followed by the nurse, if he or she is using the "plan, do, study, act (PDSA)" model?

1. Evaluate data regarding the number of needlestick injuries after providing proper training
2. Conduct training programs to teach proper needle recapping techniques on a weekly basis
3. Implement new training programs on needle recapping techniques in all units of the hospital
4. Facilitate a training program for all nurses to teach the proper technique of recapping needles

D. Facilitate a training program for all nurses to teach the proper technique of recapping needles

Which system is used by a health care facility to determine certain aspects of client satisfaction?

1. Six Sigma
2. Value Stream Analysis
3. Health Care Effectiveness Data and Information Set (HEDIS)
4. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS)

D. The Hospital Consumer of Assessment of Healthcare Providers and Systems (HCAHPS)

A registered nurse is teaching a student nurse about quality improvement processes to improve client outcomes and efficiency of health systems. Which statement of the student nurse indicates effective learning? Select all that apply.

1. "Quality improvement processes receive funding from external sources such as grants."
2. "Quality improvement processes sometimes require institutional review board (IRB) approval."
3. "Quality improvement processes measure the effects of practice on a specific client population."
4. "Quality improvement processes store data from client records or clients who are in a specific area."
5. "Quality improvement processes focus on the implementation of already known evidence into practice."

B. "Quality improvement processes sometimes require institutional review board (IRB) approval."

C. "Quality improvement processes measure the effects of practice on a specific client population."

D. "Quality improvement processes store data from client records or clients who are in a specific area."

The Magnet Recognition Program for health care organizations is based on fourteen forces of magnetism related to five magnet model components. Which force of magnetism is assessed to review the structural empowerment of the organization?

1. Quality of care
2. Quality improvement
3. Interdisciplinary relationships
4. Personnel policies and programs

D. Personnel policies and programs

A nurse is working in a health care organization that has Magnet status. What specific responsibility does the nurse have in this organization?

1. The nurse must follow best-practices for quality improvement.
2. The nurse must use research-based practice to provide client care.
3. The nurse must collect data for comparison against a national level.
4. The nurse must refrain from taking independent actions during client care.

C. The nurse must collect data for comparison against a national level.

Which nursing intervention helps to prevent medication errors in children? Select all that apply.

1. Encouraging the use of brand names
2. Promoting the use of abbreviations and acronyms
3. Minimizing the use of verbal and telephone orders
4. Carefully reading all labels for accuracy and checking expiration dates
5. Recording the client’s weight before carrying out the medication order

C. Minimizing the use of verbal and telephone orders

D. Carefully reading all labels for accuracy and checking expiration dates

E. Recording the client’s weight before carrying out the medication order

The nurse is caring for a client who got discharged from the hospital. The nurse finds that the client is having difficulty in determining which medications to take. What would be the best nursing intervention in this situation?

1. The nurse fills and labels the medication bottles.
2. The nurse advises the caregiver to support the client in taking medication.
3. The nurse recommends the client’s pharmacy to re-label the medication in large letters.
4. The nurse shows the client examples of pill organizers that will help the client to sort the medication.

C. The nurse recommends the client’s pharmacy to re-label the medication in large letters.

The registered nurse is teaching a nursing student about the process of medication reconciliation for a client who was admitted in a healthcare setting. Which statement made by the nursing student indicates a need for further education?

1. "I should check the new medication order against the current list of medicines."
2. "I should avoid asking about the over-the counter medications."
3. "I should obtain a comprehensive and current list of the client’s medications."
4. "I should avoid distractions and go slowly when reconciling the client’s medications."

A. "I should check the new medication order against the current list of medicines."

A nurse is assessing two clients. One client has ulcerative colitis, and the other client has Crohn disease. Which is more likely to be identified in the client with ulcerative colitis than in the client with Crohn disease?

1. Inclusion of transmural involvement of the small bowel wall
2. Higher occurrence of fistulas and abscesses from changes in the bowel wall
3. Pathology beginning proximally with intermittent plaques found along the colon
4. Involvement starting distally with rectal bleeding that spreads continuously up the colon

D. Involvement starting distally with rectal bleeding that spreads continuously up the colon

A client is admitted to the hospital with a diagnosis of Crohn disease. What is mostimportant for the nurse to include in the teaching plan for this client?

1. Controlling constipation
2. Meeting nutritional needs
3. Preventing increased weakness
4. Anticipating a sexual alteration

B. Meeting nutritional needs

After many years of coping with ulcerative colitis, a client makes the decision to have a colectomy as advised by the primary healthcare provider. Which is mostlikely the significant factor that impacted on the client's decision?

1. It is temporary until the colon heals.
2. Surgical treatment cures ulcerative colitis.
3. Ulcerative colitis can progress to Crohn disease.
4. Without surgery, eating table foods is contraindicated.

B. Surgical treatment cures ulcerative colitis.

A nurse is assessing a client with Crohn disease who is to have an upper gastrointestinal series. Which condition necessitates the cancellation of the upper gastrointestinal series?

1. Hemorrhoids
2. Hyperkalemia
3. Inflamed colon
4. Colon perforation

D. Colon perforation

A client, experiencing an exacerbation of Crohn disease, is admitted to the hospital for intravenous steroid therapy. The nurse should not assign this client to a room with a roommate who has which illness?

1. Pancreatitis
2. Thrombophlebitis
3. Bacterial meningitis
4. Acute cholecystitis

C. Bacterial meningitis

A nurse is performing the physical assessment of a client admitted to the hospital with a diagnosis of cirrhosis. The nurse expects to observe what skin conditions? Select all that apply.

1. Vitiligo
2. Hirsutism
3. Melanosis
4. Ecchymoses
5. Telangiectasis

D. Ecchymoses

E. Telangiectasis

A nurse is taking care of a client with cirrhosis of the liver. Which clinical manifestations should the nurse assess in the client? Select all that apply.

1. Ascites
2. Hunger
3. Pruritus
4. Jaundice
5. Headache

A. Ascites

C. Pruritus

D. Jaundice

A nurse is providing discharge instructions to a client diagnosed with cirrhosis and varices. Which information should the nurse include in the teaching session? Select all that apply.

1. Adhering to a low-carbohydrate diet
2. Avoiding aspirin and aspirin-containing products
3. Limiting alcohol consumption to two drinks weekly
4. Avoiding acetaminophen and products containing acetaminophen
5. Avoiding coughing, sneezing, and straining to have a bowel movement

B. Avoiding aspirin and aspirin-containing products

D. Avoiding acetaminophen and products containing acetaminophen

E. Avoiding coughing, sneezing, and straining to have a bowel movement

A client with cirrhosis of the liver has a prolonged prothrombin time and a low platelet count. A regular diet is prescribed. What should the nurse instruct the client to do considering the client's condition?

1. Avoid foods high in phytonadione.
2. Check the pulse several times a day.
3. Drink a glass of milk when taking aspirin.
4. Report signs of bleeding no matter how slight.

D. Report signs of bleeding no matter how slight.

The registered nurse determines that the new graduate understands the type(s) of hepatitis that generally develop into a chronic hepatitis infection if the graduate identifies which disease(s)? Select all that apply.

1. Hepatitis A
2. Hepatitis B
3. Hepatitis C
4. Hepatitis D
5. Hepatitis E

B. Hepatitis B

C. Hepatitis C

D. Hepatitis D

A nurse is teaching a client about prophylactic measures that minimize the risk of contracting hepatitis B. Which actions should be included in this teaching plan? Select all that apply.

1. Preventing constipation
2. Screening of blood donors
3. Avoiding shellfish in the diet
4. Limiting hepatotoxic drug therapy
5. Maintaining a monogamous sexual relationship

B. Screening of blood donors

E. Maintaining a monogamous sexual relationship

A client is about to have a blood transfusion and asks the nurse which type of hepatitis is most frequently transmitted through food. Which type of hepatitis should the nurse teach the client about being most associated with food?

1. A
2. B
3. C
4. D

A. A

A nurse educator of a college health course is discussing tattoos with the class. Which type of hepatitis associated with tattoos should the nurse include in the teaching plan?

1. A
2. C
3. D
4. E

B. C

A child is born to a mother whose hepatitis B status is negative. While assessing the newborn, the nurse finds that the birth weight is 1.8 kg. Which action by the nurse is appropriate in this situation?

1. Administer HepB vaccine to the newborn 1 month after birth.
2. Administer monovalent HepB vaccine to the newborn during discharge.
3. Administer 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.
4. Administer HepB vaccine and 0.5 mL of hepatitis B immune globulin (HBIG) within 12 hours of birth.

A. Administer HepB vaccine to the newborn 1 month after birth.

A school nurse is teaching a health class of 12-year-olds about hepatitis C. Which statement by a student indicates an understanding of the origin of the disease?

1. "You can catch it while you're getting a tattoo."
2. "You're more likely to get it in crowded living conditions."
3. "The disease is passed from person to person by casual contact."
4. "People working at restaurants can give it to you if they don't wash their hands.

A. "You can catch it while you're getting a tattoo."

A client who experiences anorexia and fatigue develops jaundice. A diagnosis of hepatitis A is made. The client's spouse and adult children who still live at home ask whether they should receive gamma globulin. Which is the mostappropriate response by the nurse?

1. "Gamma globulin is unnecessary as long as you follow droplet precautions."
2. "Gamma globulin provides passive immunity for hepatitis B, not hepatitis A."
3. "You should call your primary health care provider immediately about getting gamma globulin."
4. "Your family member's type of hepatitis is no longer communicable, and gamma globulin is not required."

C. "You should call your primary health care provider immediately about getting gamma globulin."