Tag: Clinical-Nursing

  • Chapter 2, Quality and Safety – Quality Improvement Process and Customer Satisfaction in Healthcare

    Chapter 2, Quality and Safety – Quality Improvement Process and Customer Satisfaction in Healthcare

    Question 1 of 6

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    Which factor differentiates the unique focus of risk management from other quality activities?

    Prevents severe harm

    Risk management focuses on protecting the organization from malpractice and other financial claims but does not directly prevent harm.

    Incorrect

    Correct

    Prevents damage to the organization

    Risk management identifies and attempts to mitigate situations that put the organization’s finances or public image at risk.

    Removes unsafe clinicians

    Risk management is focused mainly on the organization’s well-being. Removing unsafe clinicians is a function that is shared in risk and quality activities.

    Fulfills requirements of The Joint Commission (TJC)

    Risk and quality management programs both work to achieve TJC National Patient Safety Goals, but that is a similarity and not a difference.

    Question 2 of 6

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    Which manager’s recommendation would likely face resistance from the nursing staff?

    Better staffing ratios are associated with decreased mortality.

    Advocacy for better nurse-to-patient ratios will likely be met with support from nurses who are accustomed to the nursing shortage.

    Correct

    Twelve-hour shifts will increase errors due to fatigue.

    Twelve-hour shifts and the associated 3-day workweek are popular among nurses, and proposals to eliminate the 12-hour option for safety will be met with some resistance.

    Nurses must function at top of license and avoid work that can be delegated.

    Advocating for nurses to do the work they were trained to do is a popular recommendation that nurses will support.

    Nurses must use their vacation time to avoid burnout.

    Vacation time is difficult to grant when staffing is low, but the decision to encourage the use of vacation time will be embraced by nurses.

    Question 6 of 6

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    To effectively promote diversity, which intervention would the manager take?

    Mandating staff’s respect for cultural differences

    Culture is deeply ingrained, so simply telling staff to respect other cultures is not likely to be effective.

    Correct

    Inviting a culturally different patient to speak at a staff meeting

    Having a patient speak about their experience is effective because it helps nurses become aware of the feelings and difficulties the patient experienced during their care.

    Providing staff lists of common cultural differences

    Lists of differences may not be effective in promoting diversity because it is difficult to apply one list to any given culture.

    Including cultures of admitted patients during the morning report

    Culture may not be obvious, so nurses must be aware and integrate culture into their assessment. Simply reporting a patient’s culture is not likely to give enough information.

    Question 3 of 6

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    Which strategy is used by nurses to prevent events leading to permanent disability of a patient?

    Instituting a zero-tolerance policy for errors

    Zero-tolerance policies deal with behaviors that are not allowed. They cannot be applied to errors which are not avoidable.

    Correct

    Designing processes that anticipate adverse events and protect patients

    Implementing measures to anticipate complications and reduce harm, such as requiring reversal agents at the bedside during sedation, is the best strategy for nurses to prevent disability.

    Performing root cause analysis after events that result in severe patient harm

    Root cause analysis occurs after harm has occurred, so it is not a good strategy for prevention.

    Avoiding performing interventions that pose risk to the patient

    Most nursing and medical interventions pose some risk to patients and cannot be avoided.

    Question 4 of 6

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    Which nurse’s action enhances quality improvement efforts?

    Educating staff on handoff procedures for helicopter transport occurring two to three times per year

    This is a high-risk procedure but occurs rarely, so there is little impact if the nurse focuses on it as an improvement opportunity.

    Correct

    Reinforcing education for emergency transport to ICU that occurs once or twice times per week

    Transfers to the ICU are relatively frequent and potentially high-risk and thus would have a strong impact on nurses and patient safety. This is the most appropriate area on which to focus improvement efforts.

    Providing education for post-mortem care that is performed once or twice times per month

    Post-mortem care is a low-risk procedure and will not be an impactful area to focus improvement efforts.

    Inservice organ donation procedure that occurs one to three times per year

    Organ donation is important to do correctly but is an extremely low-volume procedure, which would not be best for improvement efforts since education will be forgotten between events.

    Question 5 of 6

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    To compensate for healthcare disparities, which group would need the 
    most
     support?

    Russian immigrants who speak limited English

    Limited English proficiency is easily overcome with today’s technology, allowing almost any language to have a qualified translator on demand.

    Correct

    Non-English–speaking Guatemalan refugees with a 4th-grade education level

    A combination of not speaking English and having a low education level, along with refugee status, means that this group would most need support since they may not know how to access healthcare and need resources to understand their condition and treatment.

    Iranian immigrants reluctant to seek care due to discrimination

    Reluctance to seek care may improve over time with positive interactions, so this group is not in the greatest need of support.

    Haitian immigrants seeking care only after home remedies have failed

    Using home remedies may cause this group to present with more advanced conditions, but the support they require is less than other groups with multiple barriers.

  • Chapter 22, Quality Improvement and Patient Safety

    1.Which nonprofit organization was created as an educational resource specifically for the prevention of prescription errors?

     

    Institute of Medicine

     

    American Nurses Association

     

     

    The Institute for Safe Medication Practices

    Correct answer

     

     The Joint Commission

     

    Rationale

    The Institute for Safe Medication Practices was formed with the intention of providing educational resources to prevent medication errors. The Institute of Medicine and the American Nurses Association were not formed with that specific purpose, and The Joint Commission is an accrediting body.

    p.401

     

    2.Which event is a significant quality issue in health care that may contribute to poor client outcomes or death?

     

    Needlesticks

     

    Skin tears

     

    Falls

    Correct answer

     

    IV pump failure

     

    Rationale

    Falls have been identified as a quality issue that continues to contribute significantly to poor client outcomes and/or death. Needlesticks, skin tears, and IV pump failure have not been identified as significant issues.

    p.391

     

     

    3.Which accrediting body evaluates health care organizations’ evidence of performance and continued work for improvement?

     

     

    Centers for Medicare and Medicaid Services

     

    National Academy of Medicine (formerly the IOM)

  • NSG 633 Chapter 2, Quality and Safety quiz

    NSG 633 Chapter 2, Quality and Safety quiz

    Which level of education does the Institute of Medicine (IOM) suggest 80% of nurses should have by 2020?

    Diploma

    Master’s degree

    Associate’s Degree

    Baccalaureate degree

    Rationale

    In the report Future of Nursing: Leading Change, Advancing Health (2010), the Institute of Medicine (IOM) recommends that 80% of nurses have a baccalaureate degree by 2020. The diploma, associate’s degree, and master’s degree were not identified by the IOM as needing to change proportionally with other academic levels.

    51 p. 23.

     

    2. Which percentage of the registered nurse workforce, according to the 2010 Institute of Medicine (IOM, now known as the National Academy of Medicine) report The Future of Nursing: Leading Change, Advancing Health, should beeducated at the baccalaureate level ?

    65%

    70%

    80%

    100%

    Rationale

    The 2010 Institute of Medicine report The Future of Nursing: Leading Change, Advancing Health recommended that at least 80% of registered nurses be baccalaureate prepared, because evidence supports lower morbidity and mortality rates with a better-educated nursing workforce. The percentages 65% and 70% are lower than recommended, and 100% is higher than recommended.

    * p. 23.

     

    3. Which statement describes cultural diversity?

    Adaptation to a particular culture of a dominant group

    A vast range of cultural differences among individuals or groups

    The belief that one’s own ways are the best or preferred way to behave

    The capacity to feel, convey, or react to ideas, habits, or traditions unique to a group of people

    Rationale

    Cultural diversity, is a vast range of cultural differences among individuals or groups. Acculturation is the process of adapting to a particular culture.

    Ethnocentrism is the belief that one’s own ways are the best or preferred way to behave. The capacity to feel, convey, or react to ideas, habits, customs, or traditions unique to a group of people is the definition of cultural sensitivity.

    Test-Taking Tip: Identify option components as correct or incorrect. This may help you identify a wrong answer.

    0 p. 43

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    4. Which education recommendation was made by the Institute of Medicine(IOM, now known as the National Academy of Medicine)in the 2010 report
    The Future of Nursing: Leading Change, Advancing Health
    ?

    Doubling the number of nurses with a doctorate by 2020

    Requiring a baccalaureate degree for all registered nurses by 2020

    Increasing the percentage of nurses enrolled in advanced practice programs by 30%by 2030

    Changing the entry level requirement for initial preparation of nurses to a master’s degree by 2050

    Rationale

    The 2010 IOM (now known as the National Academy of Medicine)report
    The Future of Nursing: Leading Change, Advancing Health
    recommended   that, by 2020,the number of nurses with doctorate degrees should be doubled. The report recommended that by 2020,80%of nurses should have a  baccalaureate degree. The report did not make any recommendations concerning the percentage of nurses enrolled in advanced practice programs o the entry-level requirement for nurses.

     

    NSG 633 Chapter 2, Quality and Safety quiz 5. Which term refers to an unexpected occurrence involving death or serious physical or psychological injury or the risk thereof?

    Medication error

    Risk adjustment

    Sentinel event

    Near Miss

    Rationale

    A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. A medication error may cause death or serious injury, but not all medication errors lead to death or serious injury. Risk adjustment is a process by which differences among patients or variables such as age or disease severity are weighted or adjusted for outcomes analyses or benchmarking efforts. A near miss is when an error almost occurs.

     

    6. Which factor would the Consumer Assessment of Healthcare Providers and Systems Hospital Survey identify regarding patient perspectives on care experienced during a hospital stay? Select all that apply.
    One, some, or all responses may be correct.

    Communication with physicians

    The cost of hospital stay and billing accuracy

    Cleanliness of the hospital environment

    Discharge information

    Medication Errors

    Rationale

    The Consumer Assessment of Healthcare Providers and Systems Hospital Survey includes patient perspectives about communication with physicians, discharge information, cleanliness of the hospital environment, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, and quietness of the hospital environment. Billing is a patient concern, but HCAHPS does not assess financial or billing issues, nor does it address medication errors.

    5 p. 30

     

    7. Which core concern of any healthcare organization, and therefore nurses, drives aspects of leading and managing?

    Safety

    Documentation

    Communication

    Infection Control

    Rationale

    The core concern of any healthcare organization, and therefore the core concern for nurses, is safety. Safety, and subsequently quality, should drive aspects of leading and managing such as staffing and budgeting decisions, personnel policies and change, information technology, delegation decisions, workplace environment, and personal practice. Communication is an important aspect of safety. Documentation is the recording of data that can be clustered and used to improve patient care services. Infection control is another important aspect of safety; the prevention of infection decreases hospital stays and the complications associated with other health conditions.

    Test-Taking Tip:
    Pace yourself during the testing period and work as accurately as possible. Do not be pressured into finishing early. Do not rush!

    Students who achieve higher scores on examinations are typically those who use their time judiciously.

    8 p. 19

     

    8. Which organization is responsible for issuing annual patient safety goals?

    Institute of Medicine (IOM)

    The Joint Commission (TJC)

    Institute for Healthcare Improvement (IHI)

    Quality and Safety Education for Nurses (QSEN)

    Rationale

    The organization responsible for issuing annual patient safety goals is The Joint Commission (TJC). The Institute of Medicine (IOM) is a non-profit organization devoted to providing leadership on healthcare and serves as an excellent source for leaders and managers to gain access to current research and publications devoted to healthcare. The Institute for Healthcare Improvement (IHI) is dedicated to rapidly improving care through a variety of mechanisms including rapid cycle change projects. Quality and Safety Education for Nurses (QSEN) is a project addressing the challenges of preparing future nurses with the knowledge, skills, and attitudes necessary to continuously improve the quality and safety of the healthcare systems within which they work.

    51 pp. 20-22

     

    NSG 633 Chapter 2, Quality and Safety quiz 9. Which is a competency identified by Quality and Safety Education for Nurses (QSEN)? Select all that apply.
    One, some, or all responses may be correct.

    Skills

    Emotions

    Reactions

    Attitudes

    Knowledge

    Rationale

    Competencies identified by Quality and Safety Education for Nurses (QSEN) include skills, attitudes, and knowledge learners need to develop to serve as safe practitioners. Emotions and reactions are not competencies identified by the QSEN program.

    5 pm 20-22

    10. Which organization emphasizes outcomes, including data and efforts related to patient safety?

    Institute of Medicine

    The Joint Commission

    National Quality Forum

    Magnet Recognition® Program

    Rationale

    The Magnet Recognition® Program emphasizes outcomes, including data and efforts related to patient safety. The Institute of Medicine identifies practices that have negative effects on patient safety and quality issues. The Joint Commission is a not-for-profit organization that accredits healthcare organizations internationally. The National Quality Forum is a membership-based organization related to quality measurement and reporting.

    * pp. 20-22

     

    11. Which task would be appropriate for the nurse manager to delegate to a staff nurse when working with the quality improvement team?

    Generate ideas for quality improvement efforts

    Share information with other units about efforts being used

    Your answer is incorrect

    Provide support for a unit after a sentinel event has occurred

    Schedule the rest of the staff for quality improvement measures

    Rationale

    The staff nurse would be capable of generating ideas for quality improvement efforts. Sharing information with other units and scheduling time for quality improvement measures is a task best suited to nurse managers. Providing support after a sentinel event should be the task of a senior leader, not the staff nurse.

    p. 28

    12. Which action is best for the quality improvement team to take after meeting with representatives from the hospital to discuss the increasing rate of medication errors and collecting data from the past 10 years?

    13. Which action is best for the quality improvement team to take after meeting with representatives from the hospital to discuss the increasing rate of medication errors and collecting data from the past 10 years?

    14. Which statement needs correction when discussing a recent near-miss event during a quality improvement meeting?

    15. Which organization would a consumer contact to review information regarding the quality of care of a healthcare agency?

    16. Which statement would be included in a presentation about the nurse manager’s benchmarking review of the occurrence of postoperative infections on the surgical unit compared with other organizations?

    17. Which process would the nurse anticipate participating in after a sentinel event?

    NSG 633 Chapter 2, Quality and Safety quiz …

  • NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

    NSG 633 Unit 1: Discussion: Quality Improvement Herzing University sample 1

    Please begin by describing why quality improvement is an ongoing process.

    Quality improvement within healthcare is an ongoing process that involves systematic efforts to enhance patient care and outcomes. This process encompasses various strategies, including the implementation of best practices, the use of data analytics to identify areas needing improvement, and fostering a culture of continuous feedback among healthcare professionals. By prioritizing quality improvement, healthcare organizations aim to reduce errors, enhance patient safety, and ensure that all patients receive the highest standard of care possible. Ultimately, this commitment to ongoing improvement not only benefits individual patients but also contributes to the overall effectiveness and efficiency of the healthcare system as a whole.

    Choose a national safety and quality resource and consider a topic from that resource.

    National safety and quality resources cover areas like medication safety, which is crucial for ensuring that patients receive the correct medications in the right dosages, thereby minimizing the risk of adverse effects and interactions. These resources provide guidelines and best practices for healthcare professionals to follow, ensuring that they are well-informed about the latest safety protocols and innovations in medication management.

    Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

    Nurses can utilize various national and government resources, such as guidelines, research studies, and funding programs, in addition to their clinical expertise to improve patient outcomes. By staying informed about the latest evidence-based practices and leveraging available tools, they can enhance their care strategies and implement effective interventions. Collaborating with public health initiatives and accessing educational materials can further empower nurses to address the diverse needs of their patients, ultimately leading to better health results and a more efficient healthcare system (Hajizadeh, A. 2021). Thus, leading to better patient outcomes within the healthcare system.

    References

    Hajizadeh, A. (2021). Factors influencing nurses participation in the health policy-making process: a systematic review. BMC nursing, 20(1), 128. https://doi.org/10.1186/s12912-021-00648-6

     

    NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

    Instructions

    It is anticipated that the initial discussion post should be in the range of 250-300 words. Response posts to peers have no minimum word requirement but must demonstrate topic knowledge and scholarly engagement with peers. Substantive content is imperative for all posts. All discussion prompt elements for the topic must be addressed. Please proofread your response carefully for grammar and spelling. Do not upload any attachments unless specified in the instructions. All posts should be supported by a minimum of one scholarly resource, ideally within the last 5 years. Journals and websites must be cited appropriately. Citations and references must adhere to APA format.

    GET WRITING HELP HERE

    Classroom Participation

    Students are expected to address the initial discussion question by Wednesday of each week. Participation in the discussion forum requires a minimum of three (3) substantive postings (this includes your initial post and posting to two peers) on three (3) different days. Substantive means that you add something new to the discussion supported with citation(s) and reference(s), you are not just agreeing. This is also a time to ask questions or offer information surrounding the topic addressed by your peers. Personal experience is appropriate for a substantive discussion, however should be correlated to the literature.

    All discussion boards will be evaluated utilizing rubric criterion inclusive of content, analysis, collaboration, writing and APA. If you fail to post an initial discussion or initial discussion is late, you will not receive points for content and analysis, you may however post to your peers for partial credit following the guidelines above.

    Initial Response

    Instructions:

    In this next discussion, please begin by describing why quality improvement is an ongoing process. Then follow these instructions:

    Choose a national safety and quality resource and consider a topic from that resource.

    Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

    Please be sure to validate your opinions and ideas with citations and references in APA format.

    The post and responses are valued at 40 points. Please review post and response expectations. Please review the rubric to ensure that your response meets criteria.

    Your initial response is due by Wednesday at 11:59 pm CT.

    Estimated time to complete: 2 hours

    Peer Response

    Instructions:

    Please read and respond to at least two of your peers’ initial postings. You may want to consider the following questions in your responses to your peers:

    Compare and contrast your initial posting with those of your peers.  How are they similar or how are they different?

    What information can you add that would help support the responses of your peers?

    Ask your peers a question for clarification about their post. What most interests you about their responses?

    Please be sure to validate your opinions and ideas with citations and references in APA format.

    All peer responses are due by Sunday at 11:59 pm CT.

    Estimated time to complete:  1 hour

    Quality improvement is an ongoing process due to the nature of there being avenues for continued improvement regardless of how successful past or current interventions are. Part of continual quality improvement is evaluating success and being able to appropriately measure such success (O’Donnell & Gupta, 2023). Another reason for this being an ongoing process is the need to answer questions like “how are we doing? and ‘Can we do it better?’” (O’Donnell & Gupta, 2023).

    The Joint Commission has a chapter in its patient safety goals centered on rural health. This chapter focuses in on being able to identify patients correctly through standardized processes, appropriate labeling of medications before any and all procedures, improved handwashing standards, and preventing mistakes within the surgical process (Joint Commission, 2025). This is just one of the many chapters that were shared through TJC, but it highlights the ways in which nurses can implement changes to improve the quality of the care that patients receive in these rural areas.

    Nurses can use resources like that of The Joint Commission in conjunction with their own expertise to be able to improve patient outcomes through critical thinking and implementation of national goals. Along with this, nurses are at the center of the feedback loop surrounding patient outcomes and patient care. As nurses engage with patients, their expertise on what is needed grows and can be used to support what the national and government resources. Through this support, nurses can effectively implement and then report changes as they occur, which drives the ongoing nature of continued quality improvement.

     

    Joint Commission. (2025). 
    National Patient Safety Goals (NPSGs)
    . Jointcommission.org. https://www.jointcommission.org/en-us/standards/national-patient-safety-goals

    O’Donnell, B., & Gupta, V. (2023, April 3). 
    Continuous quality improvement
    . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559239/

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    Jami McTague

    Jan 7 10:53pm
    | Last reply Jan 11 9:20pm

    Reply from Jami McTague

    Hello everyone. I am particularly excited about this course. In my opinion, quality improvement is an ongoing process because there is never a “good enough”. What I mean by that is in healthcare there is always the ability to find a better, safer, more effective way of doing something. The bar should never stop rising. Our patients are our top priority, and it’s vital that we do everything we can to take care of them to the best of our ability. I view myself as a permanent student, meaning I understand that I will never stop learning. I think it’s important for any healthcare professional to have this mind set. NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

    There are many national safety and quality resources available to healthcare professionals, and my choice was the Agency for Healthcare Research and Quality (AHRQ). The topic I chose from that resource is catheter associated urinary tract infections. I found multiple resources within that resource including research, tools, and resources. I found a peer-reviewed journal under the research resource titled 
    A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care
     (
    Saint et al., 2016
    ). There was study conducted in which educational materials and tool kits were distributed to hospitals and organizations, and then the rates of CAUTI’s were collected at a baseline, 2 months after, and 12 months after. They found that their intervention seemed to reduce the need for catheters and CAUTI’s in non-ICU’s (
    Saint et al., 2016
    ). This is an example of the student mindset. There was education provided to these healthcare professionals in order to improve patient safety and quality improvement.

     

    Resources:

    Saint, S., Greene, M.T., Krein, S.L., Rogers, M.A., Ratz, D., Fowler, K.E., Edson, B.S., Watson, S.R., Meyer-Lucas, B., Masuga, M., Faulkner, K., Gould, C.V., Battles, J., & Fakih, M.G. (2016). A Program to Prevent Catheter-Associated Urinary Tract Infection in Acute Care. 
    PubMedCentral.

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    Dawn Sullivan

    Jan 7 10:11pm
    | Last reply Jan 11 9:27pm

    Reply from Dawn Sullivan

    A national safety and quality resource is the Centers for Disease Control and Prevention (CDC), which has guidelines for the management, treatment and prevention of community-acquired pneumonia (CAP), which is one of the leading causes of death in the United States. One of those practices is the use of corticosteroids, a topic mentioned by the CDC and in recent research, such as a systematic review by Cheema et al. (2024), which analyzes the effectiveness and safety of corticosteroids in various clinical trials. By using these resources, nurses can make sure that their clinical practices match up with the latest scientific evidence and national standards.

    Nurses play an important role in improving patient outcomes by using national and government resources in their clinical practice. By educating themselves on CDC guidelines and similar government and national recommendations, nurses can work with other healthcare professionals to use best practices, such as utilizing corticosteroids when appropriate, monitoring for potential reactions, and educating patients and their families about treatment and possible outcomes. Nurses can use resources like risk stratification tools and health promotion strategies as described by Severson et al. (2014) to identify patients at risk for hospitalization due to CAP and use interventions to reduce those risks. Through education, advocacy, and patient-centered care, nurses help bridge the gap between research and clinical practice, making sure that care is not only evidence-based but also personalized to the needs of the patient as an individual. This resource-informed approach leads to better health outcomes and reduced rates of complications and hospitalizations.

    Cheema, H. A., Musheer, A., Ejaz, A., Paracha, A. A., Shahid, A., Rehman, M. E. U., Hermis, A. H., Singh, H., Duric, N., Ahmad, F., Ahmad, S., Torres, A., & Szakmany, T. (2024). Efficacy and safety of corticosteroids for the treatment of community-acquired pneumonia: A systematic review and meta-analysis of randomized controlled trials. 
    Journal of Critical Care, 80
    , 154507. https://www.sciencedirect.com/science/article/pii/S0883944123002563

    Severson, C., Renstrom, C., & Fitzhugh, M. (2014). Health promotion, risk stratification, and treatment options to decrease hospitalization rates for community-acquired pneumonia in adults. Journal of the American Association of Nurse Practitioners, 26(10), 537–549. https://doi.org/10.1002/2327-6924.12072

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    Desteny Anderson

    Jan 7 9:17pm
    | Last reply Jan 11 3:49pm

    Reply from Desteny Anderson

    Quality Improvement

    Quality improvement (QI) is an ongoing process because healthcare environments, patient needs, and evidence based practices are constantly evolving. As new research emerges, technologies advance, and patient populations change, healthcare organizations must continually evaluate and refine processes to maintain safety, effectiveness, and high quality care. Rather than being a one time initiative, quality improvement relies on continuous monitoring, feedback, and adjustment to reduce errors, improve outcomes, and enhance patient experiences.

    A key national safety and quality resource is the 
    Agency for Healthcare Research and Quality
     (AHRQ). One important topic emphasized by AHRQ is medication safety, particularly the prevention of medication errors. Medication errors remain a significant cause of patient harm, making this an essential focus area for nursing practice. AHRQ provides evidence based tools, safety guidelines, and educational resources designed to help healthcare professionals identify risks and implement safer medication practices.

    Nurses play a vital role in quality improvement by combining clinical expertise with national and government resources. By using tools such as AHRQ’s medication safety protocols, checklists, and root cause analysis frameworks, nurses can identify system-level issues that contribute to errors and advocate for process improvements. For example, nurses can apply standardized medication administration practices, participate in safety huddles, and report near misses to support organizational learning. These actions, supported by national guidelines, help reduce variability in care and improve patient outcomes.

    In addition, nurses contribute to quality improvement through data collection, patient education, and interdisciplinary collaboration. When nurses align their clinical judgment with nationally recognized safety standards, they help create a culture of safety and accountability. Overall, integrating national quality resources with bedside nursing practice strengthens patient safety initiatives and supports continuous improvement in healthcare delivery.

    References 

    Agency for Healthcare Research and Quality. (2023). 
    Medication safety
    .

    Yoder-Wise, P. S. (2022). 
    Leading and managing in nursing
     (8th ed.). Elsevier.

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    Renae Daniels

    Jan 7 9:10pm
    | Last reply Jan 10 12:16pm

    Reply from Renae Daniels

    Quality Improvement and National Safety Resources

    Quality improvement (QI) is a continuous process because healthcare is constantly evolving. Advances in research, technology, and emerging patient safety concerns require healthcare providers to regularly evaluate and improve how care is delivered. Ongoing QI efforts are essential for reducing errors, improving patient safety, and enhancing patient outcomes over time (Institute of Medicine [IOM], 2001).

    A key national resource that supports QI initiatives is the Agency for Healthcare Research and Quality (AHRQ). AHRQ focuses on improving the safety and quality of healthcare through evidence-based tools and research. One important area addressed by AHRQ is the prevention of hospital-acquired infections (HAIs). HAIs pose serious risks to patients, increase hospital stays, and contribute to higher healthcare costs, making prevention a major priority across healthcare settings (AHRQ, 2022).

    Nurses play a critical role in quality improvement by applying national safety guidelines and integrating evidence-based practices into daily care. Resources from organizations such as AHRQ and the Centers for Disease Control and Prevention (CDC) provide nurses with guidance on infection prevention strategies, including proper hand hygiene, use of personal protective equipment, and adherence to standardized care protocols. Nurses also contribute by educating patients and families about infection prevention and safety practices.

    Evidence shows that implementing evidence-based infection prevention interventions significantly reduces infection rates and improves patient safety outcomes (Storr et al., 2017). By actively participating in QI initiatives and utilizing national safety resources, nurses help promote consistent, high-quality care. Overall, the use of national safety and quality resources supports safer healthcare environments and leads to improved patient outcomes.

    References:

    Agency for Healthcare Research and Quality. (2022). Patient safety and quality improvement. https://www.ahrq.gov

    Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press.

    Storr, J., Twyman, A., Zingg, W., Damani, N., Kilpatrick, C., Reilly, J., & Allegranzi, B. (2017). Core components for effective infection prevention and control programmes. Antimicrobial Resistance & Infection Control, 6(1), 6. https://doi.org/10.1186/s13756-016-0149-9

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    Phoebe Tateronis

    Jan 7 8:20pm
    | Last reply Jan 11 8:08pm

    Reply from Phoebe Tateronis

    Quality improvement is ongoing process as healthcare is always changing. New evidence, patient needs, as wsell as safety standards constantly emerge, so organizations must continuously evaluate and refine their practices. Without ongoing improvement, care quickly becomes outdated and less effective.

    A helpful national resource is the Agency for Healthcare Research and Quality (AHRQ). One major topic AHRQ focuses on is preventing hospital‑acquired infections. Their evidence-based toolkits and guidelines give nurses practical steps to reduce risks such as poor hand hygiene or improper catheter care.

    Nurses can use these national resources alongside their clinical expertise to improve outcomes. AHRQ and CMS provide data that help nurses compare their unit’s performance to national benchmarks, identify gaps, as well as to guide improvement efforts. Nurses can also apply their own judgment to tailor these guidelines to individual patient needs. By combining these national standards with real‑world clinical insight, nurses help reduce preventable harm as well as strengthen patient safety.

    References Agency for Healthcare Research and Quality. (n.d.). 
    https://www.ahrq.gov

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    Tess Perkins

    Jan 7 5:51pm
    | Last reply Jan 7 9:20pm

    Reply from Tess Perkins

    Tess Perkins

    Unit 1 Discussion

    NSG633

    1/7/26

    Quality improvement (QI) is a continuous effort since healthcare is ever-changing. New research, developing technologies, patient populations, and safety data all suggest potential areas for improvement. (Comfere et, al. 2020) What works today may not be the greatest practice tomorrow, thus quality improvement necessitates ongoing evaluation, feedback, and adjustment to ensure that patient treatment is safe, effective, and evidence-based. Errors, near-misses, and result data also provide continual learning opportunities, reinforcing the notion that quality and safety are never “completed,” but rather necessitate continuous attention and improvement.

    The Agency for Healthcare Research and Quality (AHRQ) is an important national source of safety and quality information. AHRQ’s mission is to improve patient safety, reduce medical errors, and improve healthcare quality. AHRQ focuses on patient safety culture, which stresses teamwork, communication, and systems-based approaches to harm prevention. (AHQR, 2024) AHRQ’s Hospital Survey on Patient Safety Culture assists institutions in assessing staff views of safety, identifying shortcomings, and guiding targeted improvement efforts.

    Nurses can improve patient outcomes in a variety of ways by combining their clinical skills with national and federal resources such as AHRQ. National guidelines and evidence-based tools, like as checklists, safety bundles, and communication frameworks, offer nurses with standardized best practices to use at the bedside. For example, AHRQ’s TeamSTEPPS program assists nurses in improving communication and collaboration, which directly minimizes errors associated with handoffs and miscommunication. (Battles et. al, 2021) Nurses can also utilize these tools to advocate for system-wide changes, such as policy revisions or staff training, by basing their suggestions on nationally recognized research. NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

    Nurses play an important role in putting quality improvement programs into practice by combining hands-on clinical judgment with data, research, and direction from national safety groups. This integration ensures that care is not only compassionate and patient-centered, but also consistently safe, measurable, and in line with national standards.

    Cited Sources:

    AHRQ. (2024). 
    Agency for Healthcare Research & Quality
    . Ahrq.gov; Agency for Healthcare Research and Quality. https://www.ahrq.gov/

    ‌King, H. B., Battles, J., Baker, D. P., Alonso, A., Salas, E., Webster, J., Toomey, L., & Salisbury, M. (2021). 
    TeamSTEPPS
    TM
    : Team Strategies and Tools to Enhance Performance and Patient Safety
    . Nih.gov; Agency for Healthcare Research and Quality (US). https://www.ncbi.nlm.nih.gov/books/NBK43686/

    ‌Comfere, N. I., Matulis, J. C., & O’Horo, J. C. (2020). Quality improvement and healthcare: The mayo clinic quality academy experience. 
    Journal of Clinical Tuberculosis and Other Mycobacterial Diseases
    , 
    20
    (1), 1–5. https://doi.org/10.1016/j.jctube.2020.100170

    ‌

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    Anthony Adelakun

    Jan 7 3:34pm
    | Last reply Jan 11 11:43pm

    Reply from Anthony Adelakun

     

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    Maya Ahmad

    Jan 7 3:08pm
    | Last reply Jan 8 9:02pm

    Reply from Maya Ahmad

    Maya Ahmad 
     

    Safety and Quality 
     

    Discussion #1: Quality Improvement 
     

    Dr. Hayden 
     

    Quality improvement is an ongoing process because the healthcare system is always evolving and adapting to the needs of patients. The medical field is always improving in the aspects of safety and patient care. “
    The goal of CQI may include improvement of operations, outcomes, systems processes, improved work environment, or regulatory compliance” (O’Donnell, 2023). 
     

    A national safety and quality resource is the Agency for Healthcare Research and Quality (AHRQ). A key topic AHRQ gives attention to is preventing hospital acquired infections mainly due to poor hand hygiene. These are a major concern in the hospital environment because of the harm it can cause to patients, the extended hospital stays, and the increase in hospital costs. “The Agency for Healthcare Research and Quality (AHRQ), the National Quality Forum, the Joint Commission, and many other national organizations endorse the use of valid and reliable measures of quality and patient safety to improve health care” (Hughes, 2008). Nurses can use national and government resources from organizations such as AHRQ to help treat and improve the health of their patients. Evidence-based practice along with their own clinical judgement can help nurses provide more effective care to their patients. These resources can direct nurses to better implement preventative interventions and patient safety protocols in a patient treatment course. 
     

    Quality improvement will continue to be an ongoing process since healthcare demands are always changing and requiring updates in the healthcare system. The Agency for Healthcare Research and Quality along with other resources help guide nurses to improve the quality of patient care and improve the healthcare organization as a whole. 
     

    References
     

    O’Donnell B, Gupta V. Continuous Quality Improvement. [Updated 2023 Apr 3]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: 
    https://www.ncbi.nlm.nih.gov/books/NBK559239/
    Links to an external site.
     

    Hughes RG. Tools and Strategies for Quality Improvement and Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 44. Available from: 
    https://www.ncbi.nlm.nih.gov/books/NBK2682/
    Links to an external site.
     

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    Matthew Baldwin

    Jan 7 2:49pm
    | Last reply Jan 11 7:47pm

    Reply from Matthew Baldwin

    In this next discussion, please begin by describing why quality improvement is an ongoing process.

                    
    Quality improvement (QI) is an essential component in nursing. “As a consistent 24-hour presence in hospitals, nurses play a pivotal role in ensuring the quality and safety (Q&S) of patient care” (Patrician, 2024). This systematic approach ensures the highest care and safety for patients, and there is always room for improvement and learning.

    QI is an ongoing process because with every patient encounter, information and statistics are being recorded, which helps hospitals improve future patient outcomes. For example, if an error or near miss occurs, nursing staff can learn from this incident in the future. Hospitals and nurses continually adapt to patient outcomes and strive to improve them.

    Choose a national safety and quality resource and consider a topic from that resource.

                    
    One national safety and quality resource I found is the Nursing Alliance for Quality Care (NAQC), which is managed by the American Nurses Association. According to the American Nurses Association, the NAQC “has become the ‘go to’ organization in the field for advancing high-quality, patient-centered health care. The NAQC is continuously working to achieve quality and safety for all patients” (ANA, 2019).

    A topic of discussion from the NAQC describes the importance of fostering successful patient and family engagement. “It believes that (1) the active engagement of patients, families, and others is essential to improving quality and reducing medical errors and harm to patients; and that (2) nurses at all levels of education and across all health care settings must play a central role in fostering successful patient and family engagement” (Sofaer, 2013). After reading this article, it is clear that engaging with the patient and their family is imperative in the care and treatment process. Clear communication between the patient and their family helps establish a rapport, making them feel more comfortable, which in turn aids in the assessment.

    Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

    Nurses can utilize national and government resources in conjunction with their clinical expertise and experience to enhance patient outcomes. They achieve this by utilizing quality improvement and continuing education to enhance their knowledge and skills on a daily basis. National and government studies and research are often conducted, and clinical guidelines are refined and improved to enhance patient experience and outcomes. They also rely upon their experience and expertise gained from nursing school and patient contacts to help their patients.

    References

    Patrician, P. A., Campbell, C. M., Javed, M., Williams, K. M., Foots, L., Hamilton, W. M., House, S., & Swiger, P. A. (2024). Quality and Safety in Nursing: Recommendations From a Systematic Review. 
    Journal for healthcare quality: official publication of the National Association for Healthcare Quality
    , 
    46
    (4), 203–219. 
    https://doi.org/10.1097/JHQ.0000000000000430
    Links to an external site.

    Quality improvement
    . (2022, March). Johns Hopkins Center for Nursing Inquiry. 
    https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement
    Links to an external site.

    Sofaer, S., & Schumann, M. J. (2013). Patient Engagement: a white paper. In Nursing Alliance for Quality Care, 
    Nursing Alliance for Quality Care
    . https://www.nursingworld.org/globalassets/naqc/naqc_patientengagementwhitepaper.pdf

    Welcome to Nursing Alliance for Quality Care – NAQC | ANA
    . (2019, October 18). ANA. https://www.nursingworld.org/practice-policy/naqc/

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    Jessup Schiks

    Jan 7 2:07pm
    | Last reply Jan 10 10:23pm

    Reply from Jessup Schiks

    Continuously improving quality of care is an ongoing process in healthcare that improves the quality of care provided by healthcare professionals, as well as for the patients they serve. The field of healthcare is continuously changing through new research, new illnesses, and new needs from patients. Even if the quality of care appears to be good, quality improvement identifies opportunities for care to be delivered in a safer, more effective manner or in a more efficient way. Quality improvement also promotes healthcare professionals to continually learn and improve their practices over time.

    The Centers for Disease Control and Prevention is one example of a national organization that supports quality improvement through safe and high-quality care, particularly through the prevention of healthcare associated infections. Infections acquired in healthcare facilities can result in extended hospitalization, prolonged recovery times, and an increased risk of developing complications.  However, many of these infections could be prevented using established evidence-based practices.

    In recent years, the need for CDC resources has become apparent. During the COVID-19 pandemic, the CDC provided guidance for healthcare providers throughout the country. Many healthcare workers were reminded of the role of the CDC during both routine care and mass casualty events.

    Another benefit of the CDC is the manner in which the information is presented. The guidelines are written clearly and concisely allowing healthcare providers to access the information needed quickly, without having to read lengthy scientific documents. The resources developed by the CDC are used by nurses to make decisions regarding the delivery of care, educating patients and reinforcing the implementation of safe practices among the healthcare team.

    References

    Centers for Disease Control and Prevention. (2023). Guidelines for Infection Prevention in Healthcare Settings. https://www.cdc.gov/infectioncontrol/guidelines

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    Ayla Rose Marisa Yarbrough
     (She/Her)

    Jan 7 1:49pm
    | Last reply Jan 11 11:51pm

    Reply from Ayla Rose Marisa Yarbrough

    My apologies if this is redundant, but I am posting here as well as attaching my response. I couldn’t find the preferred document naming in the rubric and wanted to eliminate confusion.

    Quality improvement is an ongoing process in healthcare because patients’ needs, clinical evidence, and system-level risks are constantly evolving. As care environments grow more complex, organizations must continuously evaluate outcomes, identify safety gaps, and adjust practices to protect patients. Quality improvement isn’t a one-time initiative but a continuous effort to reduce harm and improve outcomes over time (Yoder-Wise & Sportsman, 2023).

    One national safety and quality resource that supports this ongoing process is The Joint Commission (TJC). TJC establishes National Patient Safety Goals each year based on emerging safety risks. One key goal for hospitals is reducing the risk of healthcare-associated infections (HAIs), which remain a significant cause of patient harm and increased healthcare use (Yoder-Wise & Sportsman, 2023).

    Nurses play a critical role in reducing HAIs by integrating national safety standards with clinical expertise at the bedside. The Joint Commission emphasizes evidence-based practices such as hand hygiene, aseptic technique, proper use of personal protective equipment, and adhering to isolation precautions. Nurses apply these guidelines through daily clinical judgment by assessing patient risk factors, monitoring for early signs of infection, and ensuring safe management of invasive devices. Furthermore, nurses use national safety resources to educate patients and families, advocate for timely device removal, and participate in quality improvement efforts. From a leadership perspective, The Joint Commission’s use of unannounced accreditation visits and annual patient safety goals reinforces continuous readiness and highlights the nurse’s role in sustaining infection prevention as part of everyday practice (The Joint Commission, 2021).

     

    References

    The Joint Commission. (2021). 
    National patient safety goals for hospitals
    . https://www.jointcommission.org

    Yoder-Wise, P. S., & Sportsman, S. (2023). Quality and safety. In 
    Leading and managing in nursing
     (8th ed.). Elsevier.

    Unit 1 Discussion_Quality Improvement.docx

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    LarissaAlexander

    Jan 7 1:16pm
    | Last reply Jan 7 2:17pm

    Reply from LarissaAlexander

    Quality improvement will always be an ongoing process because of new diseases and sickness, evolving patient needs, and consistently updated technology. Clinical practices change as well as contribute to the fact that healthcare is a constantly changing and updating environment to ensure that we are providing the best care according to the patient’s needs. Models such as the Plan-Do-Study-Act (PDSA) cycle support this ongoing approach by encouraging small, incremental changes that can be tested and adjusted based on outcomes (Institute for Healthcare Improvement, 2023). As all these changes are made, it is important to ensure that all healthcare treatments are safe, effective, and efficient for patient care.

    One valuable national safety and quality resource is the Agency for Healthcare Research and Quality. This national agency focuses on improving the safety and quality of healthcare by offering evidence-based guidelines, toolkits, and data reports. A topic discussed by this agency is the prevention of hospital-acquired infections (AHRQ, 2022).  Nurses can use national and government resources in addition to their clinical experience to improve patient outcomes by intergrating these ideas in their clinical pratice. They use the provided data and research to determine if incorporating these recommend changes can improve patient outcomes. They also can present the research and evidence to the your direct supervisor and recommend that we include their facilities protocol.

    References:

    Agency for Healthcare Research and Quality. (2022). 
    Toolkit for reducing central line-associated bloodstream infections
    . U.S. Department of Health & Human Services. 
    https://www.ahrq.gov/
    Links to an external site.

    Institute for Healthcare Improvement. (2023). 
    Science of improvement: How to improve
    . 
    https://www.ihi.org/
    Links to an external site.

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    Isabel Gautier

    Jan 7 12:22pm
    | Last reply Jan 11 9:37pm

    Reply from Isabel Gautier

    Discussion: Quality Improvement

    Isabel Gautier

    Herzing University

    NSG633: Safety & Quality

    Dr. Teri Hayden

    January 07, 2026

     

     

     

    Discussion: Quality Improvement

    National safety & quality

    Established under the auspices of the American Nurses Association (ANA) in April 2013, the Nursing Alliance for Quality Care (NAQC) has emerged as the primary organization for promoting high-quality, patient-centric healthcare. Its mission remains steadfast: to achieve quality and safety for all patients.

    The NAQC and QSEN Institute’s Practice Strategies Repository houses nurse-led and innovative solutions to ongoing patient quality and safety concerns. This repository, a peer-reviewed practice strategy submission process, mirrors the QSEN Teaching Strategies repository. This initiative aligns QSEN competencies, which are essential for patient-centered care, teamwork, collaboration, evidence-based practice, quality improvement, safety, and informatics, with nursing education. The project’s objective is to enhance this alignment.

    National & government

    Nurses frequently encounter challenges necessitating the implementation of new or revised policies in their daily practice. Healthcare trends are profoundly influencing the workforce and workplace environment. Policies exert substantial influence on nurses and patients across these healthcare concerns at various levels. A policy is defined as a comprehensive set of intricate actions meticulously designed to achieve specific objectives. It encompasses actions taken by both governmental and nongovernmental entities, including guidelines, standardized practices, procedures, and more. Nurses frequently presume that policy implementation is synonymous with public policymaking; however, it is crucial to recognize that policy permeates professional practice and extends beyond public policymaking. Healthcare, akin to nursing, is subject to stringent regulatory frameworks governed by policies. Nurses are held accountable for addressing policy concerns related to patient care and professional conduct. Nurses’ scope of practice encompasses the advocacy for health and well-being.

    “Successful nurses know that better patient care involves more than administering treatment. To provide quality care to patients, nurses must offer emotional support and empathy. They also need to be resourceful, innovative, and collaborative with other members of the health care team. Explore practical ways to improve patient care.

    At the heart of quality patient care is clinical competence. Care must be timely, efficient, and built on evidence-based practices. These practices let nurses stay attuned to new protocols and intervention methods so they can make well-informed decisions regarding patient care. Nurse leaders and their teams should review guidelines, best practices, and current research regularly and put them to use daily”. (Ana Nursing Resources Hub, 2023, July 11)”.

     

    References

    Ana Nursing Resources Hub. (2023, July 11), Ways Nurses Can Improve Patient Care.

    https://www.nursingworld.org/content-hub/resources/nursing-leadership/ways-nurses-can-improve-patient-care

     

     

     

     

     

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    Logan Evans
     (She/Her)

    Jan 7 11:41am
    | Last reply Jan 11 6:55pm

    Reply from Logan Evans

    Quality and Dately: Discussion Post 1

    Quality improvement is an ongoing process, as medicine is constantly evolving. New medications are developed, new research is completed and analyzed, leading to innovations or breakthroughs in healthcare. (O’Donnell & Gupta, 2023) The medical conditions change in specificity, or new conditions are added as they are observed. Even patients themselves change their lifestyle, as well as environmental and social factors that influence their health. Technology is another example in healthcare that is constantly improving, which requires the system to adapt to it to maintain quality care for our patients. (O’Donnell & Gupta, 2023) These evolving technologies and patients require consistent and continuous reevaluation of procedures to maintain the highest level of positive patient outcomes.

    I chose the Institute for Healthcare Improvement (IHI) as my resource for the national organization of safety and quality. Within the IHI, I decided to focus on their community and education efforts. IHI has national as well as global connections and networks to promote growth, educate, and share expertise and strategies for the shared purpose of improving healthcare for our patients. (
    Communities
    , 2026) The IHI offers conferences and classes that facilitate professional and personal development, as well as opportunities for collaboration on the knowledge gained. For example, the leadership and professional education provided by the IHI can encourage nurses to identify gaps in their current workplace and find ways to remedy them. (
    Communities
    , 2026) These resources, combined with clinical expertise, can provide them with a better understanding of patient health and enhance their bedside manner. This, in turn, helps nurses explain things more effectively and allows patients to understand better, becoming an active participant in their own healthcare. The resources provided by the IHI directly translate to how nurses care for and interact with patients.

    References:

    Communities
    . (2026). Ihi.org. 
    https://www.ihi.org/connect/communities
    Links to an external site.

    O’Donnell, B., & Gupta, V. (2023, April 3). 
    Continuous quality improvement
    . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK559239/

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    Kylisha Banks

    Jan 7 8:35am
    | Last reply Jan 11 9:34pm

    Reply from Kylisha Banks

    Hello class, my name is Kylisha Banks, and I am excited about being on this journey to obtain my nursing degree.

    Choose a national safety and quality resource and consider a topic from that resource.

    A widely used national safety and quality resource is the Agency for Healthcare Research and Quality, which provides evidence-based guidelines, toolkits, and national data to support safer, higher quality care. One important topic within AHRQ is fall prevention, a persistent patient‑safety challenge across acute and long‑term care settings.

    AHRQ’s Preventing Falls in Hospitals Toolkit offers structured strategies such as standardized risk assessments, environmental safety checks, and patient specific interventions. Nurses can integrate these national resources with their own clinical expertise to strengthen patient outcomes in several ways.

    Describe how nurses can use national and government resources in addition to their clinical expertise to improve patient outcomes.

    Nurses can use national and government resources by applying clinical judgment to personalize care. While national guidelines provide structure, nurses use their clinical reasoning to adapt recommendations to each patient’s unique needs. For example, a patient with orthostatic hypotension may require more frequent monitoring than the standard protocol suggests. When nurses blend national validated resources with clinical expertise, they create care plans that are both evidence‑based and patient‑centered. It strengthens safety practices, reduces preventable harm, and improves patient outcomes across the continuum of care.

    Reference:

    Agency for Healthcare Research and Quality. (2017). Preventing falls in hospitals: A toolkit for improving quality of care. U.S. Department of Health and Human Services. 
    https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
    Links to an external site.

     

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    Hi everyone! My name is Jas and I’m based in Nashville, TN. I’m transitioning into nursing after a career in fintech, where a lot of my work focused on quality improvement. At a basic level, my job was often to figure out where systems were breaking down, why that was happening, and how to improve processes in a way that actually held up over time. One thing that became very clear to me is that improvement is never really done. If you stop paying attention, things will quickly get off track.

    That’s why I see quality improvement as an ongoing process.n any high-stakes environment, and especially in healthcare, variables are constantly shifting. Patient acuity, staffing levels, and environmental stressors change, and new risks emerge regardless of whether we are actively looking for them. Even a robust process requires regular iteration because a solution that worked six months ago may not address the complexities of the current clinical landscape. In psychiatric-mental health nursing, where the stakes involve human lives, failing to continuously monitor and adapt these systems allows small gaps to evolve into significant patient harm.

    Effective QI depends on using data to identify risk and reduce variation before a sentinel event occurs. A critical national resource for this is the American Psychiatric Nurses Association (APNA) Key Components of Safety. To look deeper into this resource, the domain of Assessment and Monitoring provides a sophisticated framework for reducing risk. Specifically, the APNA advocates for a shift from passive observation, such as standard 15-minute safety checks, to active therapeutic engagement. From a QI perspective, passive checks are often a procedural exercise that can fail to detect subtle clinical changes. By implementing engagement-based monitoring, a facility moves toward a proactive safety model that identifies escalating distress before it reaches a crisis point (American Psychiatric Nurses Association, 2025).

    Nurses are the primary drivers who operationalize these national standards by merging evidence-based guidelines with clinical expertise. While the APNA provides the structural framework of safety, the nurse’s expertise provides the execution. For instance, a national competency might mandate standardized suicide risk assessment, but it is the nurse’s clinical judgment that identifies the mask of wellness, a phenomenon where a patient’s sudden calm actually signals a finalized suicide plan rather than true clinical improvement. Research confirms that safety initiatives are most effective when nurses use these national competencies as a foundation for their own critical thinking rather than following a rigid script (Lu et al., 2024). Sustainable improvement occurs when a strong, evidence-based system supports frontline nursing judgment, ensuring that care is both standardized and highly individualized.

    References

    American Psychiatric Nurses Association. (2025). 
    Key Components of Safety
    . APNA. 

    Key Components of Safety


    Links to an external site.

    Lu, C., Beckstead, J. W., Ye, J., & Chiu Yueh Yang. (2024). Psychometric evaluation of Suicide Management Competency Scale for nursing students: A cross‐sectional study. 
    International Journal of Mental Health Nursing
    . 
    https://doi.org/10.1111/inm.13348
    Links to an external site.

     

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    Iveline Pierre

    Jan 6 10:22pm
    | Last reply Jan 7 3:45pm

    Reply from Iveline Pierre

    Quality improvement is an ongoing process because healthcare is always changing. New research, updated guidelines, and advances in technology mean that what works today might need to be adjusted tomorrow. Nurses and other healthcare professionals have to constantly evaluate patient outcomes, identify areas for improvement, and make changes to provide the safest and most effective care (Agency for Healthcare Research and Quality [AHRQ], 2023). This continuous process helps prevent errors and ensures patients get the best care possible.

    One resource that supports quality and safety in healthcare is The Joint Commission. They set national standards and provide guidelines to help reduce risks, like hospital-acquired infections, through practices such as proper hand hygiene and staff education (The Joint Commission, 2023). Nurses can use these national resources along with their clinical experience to identify problems on their unit and develop solutions that fit their patients’ needs. (Centers for Disease Control and Prevention [CDC], 2022).

    By combining evidence-based guidelines from national and government resources with their own clinical judgment, nurses can improve patient outcomes and make care safer. Using these tools doesn’t replace experience, it enhances it, helping nurses make informed decisions and advocate for changes that benefit patients. Quality improvement is not something you do once it’s a continuous effort that keeps healthcare moving forward

    References

    Agency for Healthcare Research and Quality. (2023). 
    Quality improvement and patient safety
    . 
    https://www.ahrq.gov/patient-safety/resources/resources.html
    Links to an external site.

    Centers for Disease Control and Prevention. (2022). 
    Catheter-associated urinary tract infections (CAUTI) prevention
    . 
    https://www.cdc.gov/infectioncontrol/guidelines/cauti/index.html

    The Joint Commission. (2023). 
    National patient safety goals
    . 
    https://www.jointcommission.org/standards/national-patient-safety-goals
    Links to an external site.

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    Tarikah Butler

    Jan 6 8:54pm
    | Last reply Jan 11 10:10am

    Reply from Tarikah Butler

    Quality improvement is an approach to evaluate the quality of servicing given in healthcare and finding measurable ways to make this service better for all, making it an  ongoing since it requires continuous evaluation of performance, effectiveness and efficiency of different strategies, to find ways always improve on outcomes of a continuously changing systems, patients and new clinical research. The Agency for Healthcare Research and Quality (AHRQ) is an agency which focuses its mission on improving safety and quality in healthcare and provides evidence-based resources to improve the outcome.

    One interesting topic from their resources is the programs and resources in place to help combat hospital infected infections. We go to the hospital to receive care and feel better so imagine if we went in and got another infection, we wouldn’t agree that it was quality care that we received, right? The AHRQ has multiple tools to prevent these hospital- acquired infections like MRSA, Central Line Associated Blood Stream Infection (CLABSI) and Catheter Associated Urinary Tract Infection (CAUTI), which can in return have a more positive mortality and morbidity rate of patients, less burn out of employees due to collaboration and coordination and overall patient satisfaction from efficiency in handling their care.

    Nurses can use both national and government resources, along to improve patient outcomes by using these tools as the baseline when they provide care as these tools and resources are based on evidence-based research and trials to have these practices be so safe and efficient in providing quality care. While utilizing these tools, they can use their clinical judgements to improve these strategies and tailor them to each individual patient.

    References

    AHRQ’s healthcare-associated infections program
    . (2025, November). | Agency for Healthcare Research and Quality. 
    https://www.ahrq.gov/hai/index.html
    Links to an external site.

    Quality improvement
    . (2022, March). Johns Hopkins Medicine. 
    https://www.hopkinsmedicine.org/nursing/center-nursing-inquiry/nursing-inquiry/quality-improvement
    Links to an external site.

    A scoping review of continuous quality improvement in healthcare system: Conceptualization, models and tools, barriers and facilitators, and impact
    . (2024, April 19). PMC Home. 
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11031995/
    Links to an external site.

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    Shonda Salisbury

    Jan 6 6:41pm
    | Last reply Jan 11 10:10am

    Reply from Shonda Salisbury

    Quality Improvement as an Ongoing Process

    Quality improvement (QI) is an ongoing process because healthcare delivery is dynamic, influenced by evolving patient populations, emerging evidence, and changing safety standards. As new research becomes available and clinical environments grow more complex, healthcare organizations must continually assess and refine care processes to maintain safe, effective, and patient-centered outcomes. Quality improvement is not a single intervention but a continuous cycle of identifying gaps, implementing changes, evaluating outcomes, and making adjustments as needed. The Plan-Do-Study-Act (PDSA) model exemplifies this iterative approach by emphasizing continuous testing and refinement of interventions to achieve sustained improvements in care quality (Taylor et al., 2014).

    National Safety and Quality Resource: Patient Falls Prevention

    The Agency for Healthcare Research and Quality (AHRQ) is a national organization focused on improving healthcare safety and quality through evidence-based research and practical tools. One key safety topic addressed by AHRQ is patient falls prevention, which remains a significant concern across healthcare settings. Patient falls are associated with increased risk of injury, extended hospital stays, higher healthcare costs, and reduced quality of life.

    AHRQ’s 
    Preventing Falls in Hospitals Toolkit
     provides nurses and healthcare teams with structured, evidence-based strategies to reduce fall risk. These strategies include standardized fall-risk assessments, individualized care planning, patient and family education, environmental safety modifications, and consistent communication among care team members (Agency for Healthcare Research and Quality [AHRQ], 2013). By offering practical tools grounded in research, AHRQ supports the translation of evidence into everyday nursing practice.

    Using National Resources to Improve Patient Outcomes

    Nurses play a vital role in leveraging national quality and safety resources alongside their clinical expertise to improve patient outcomes. Resources from AHRQ and The Joint Commission provide nurses with standardized guidelines, safety benchmarks, and best-practice recommendations that support consistent, high-quality care.

    For example, nurses can apply AHRQ fall-prevention tools in conjunction with bedside assessment skills to identify patients at increased risk and implement targeted interventions such as frequent rounding, mobility assistance, and patient education. In addition, The Joint Commission’s 
    National Patient Safety Goals
     emphasize the prevention of patient harm through improved communication, accurate patient identification, and reduction of safety risks, including falls (The Joint Commission, 2024).

    By integrating these national resources with clinical judgment and interdisciplinary collaboration, nurses enhance decision-making, promote a culture of safety, and support continuous quality improvement. This alignment of evidence-based guidelines with individualized patient care ultimately leads to improved patient outcomes and reduced adverse events.

     

    References

    Agency for Healthcare Research and Quality. (2013). 
    Preventing falls in hospitals: A toolkit for improving quality of care
    . 
    https://www.ahrq.gov/patient-safety/settings/hospital/fall-prevention/toolkit/index.html
    Links to an external site.

    Taylor, M. J., McNicholas, C., Nicolay, C., Darzi, A., Bell, D., & Reed, J. E. (2014). Systematic review of the application of the Plan-Do-Study-Act method to improve quality in healthcare. 
    BMJ Quality & Safety, 23
    (4), 290–298. 
    https://doi.org/10.1136/bmjqs-2013-001862
    Links to an external site.

    The Joint Commission. (2024). 
    National Patient Safety Goals
    . 
    https://www.jointcommission.org/standards/national-patient-safety-goals/
    Links to an external site.

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    Emily Linden
     (She/Her)

    Jan 6 6:28pm
    | Last reply Jan 6 6:44pm

    Reply from Emily Linden

    In our nation today, quality improvement is evolving every day. Quality improvement is the process to make services safer, more effective, efficient, and patient-centered while trying to focus on reducing errors. One program that supports research to improve healthcare quality is The Agency for Healthcare Research and Quality (AHRG). This is a U.S. Department of Health and Human Services that contributes research to improve health care quality, safety and efficiency. It is based on evidence-based practices, patient centered care and services like publications and funding. A key topic for this resource is the Prevention of Healthcare-Associated Infections (HAIs).

    HAIs are a significant source of preventable harm in healthcare settings worldwide caused by bacteria, viruses, and yeast. They are more common than we think and can occur in any healthcare setting ranging from extending hospital stays, long-term care facilities to invasive procedures such as catheter-associated urinary tract infections, central line-associated bloodstream infections and so on. To help prevent as much HAIs as possible the nurses have access to agencies that release new protocols to help prevent said infections and to create a better working environment for not only the nurses but for the patients as well. The nurses can look at the data that was recently collected and determine the best course of action to help prevent HAIs. No matter what the setting or the severity of the situation all nurses in healthcare should be able to address the social factors that influence health and provide care that meets the people’s needs and where they are safe.

     

    Work Cited:

    National Academies of Sciences, Engineering, and Medicine; National Academy of Medicine; Committee on the Future of Nursing 2020–2030; Flaubert JL, Le Menestrel S, Williams DR, et al., editors. The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity. Washington (DC): National Academies Press (US); 2021 May 11. 4, The Role of Nurses in Improving Health Care Access and Quality. Available from: 
    https://www.ncbi.nlm.nih.gov/books/NBK573910/
    Links to an external site.

    Tobin EH, Zahra F. Nosocomial Infections. [Updated 2025 Aug 2]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from: 
    https://www.ncbi.nlm.nih.gov/books/NBK559312/
    Links to an external site.

    Yoder-Wise, P. S., & Sportsman, S. (2022). Leading and Managing in Nursing (8th ed.). Elsevier – Evolve. 
    https://online.vitalsource.com/books/9780323792080
    Links to an external site.

     

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    Jennifer Price

    Jan 6 7:19am
    | Last reply Jan 11 7:16pm

    Reply from Jennifer Price

    Jennifer Price

    Herzing University

    NSG 633 Quality and Safety

    Unit 1: Discussion: Quality Improvement

    Professor: Dr. Teri Hayden

    1/5/2026

     

    Quality improvement isn’t a one-and-done task in healthcare, it’s a continuous process that evolves as we learn more and gain experience. Early in nursing education, we are taught that best practice is not fixed and will continue to evolve as research advances and patient outcomes are evaluated.

    To me, quality improvement truly reflects the realities of everyday healthcare. Patients don’t stay the same, and the systems meant to care for them have to change along with them. According to Potter et al. (2023), quality improvement allows nurses and healthcare teams to adjust care practices in ways that promote safer and more effective patient outcomes (Ch. 22, Quality and Safety, pp. 448–452).

    One national resource that supports ongoing quality improvement efforts is the Agency for Healthcare Research and Quality (AHRQ). AHRQ places a strong focus on patient safety by looking at how methods can be adjusted to avoid errors as a substitute to placing blame on individuals. Tools like Patient Safety Indicators (PSIs) and TeamSTEPPS, AHRQ supports healthcare teams recognize possible safety issues, make improvements to  communication, and develop stronger teamwork. These show that standardizing care and using research-based methods can greatly reduce preventable and unsafe events (AHRQ, 2023). As discussed in 
    Fundamentals of Nursing
    , because nurses spend the most time with patients, they are often the first to recognize small changes that could point to safety concerns. (Potter et al., 2023, Ch. 22, pp. 453–456).

    Nurses enhance patient results by mixing their clinical skills with national and government means such as AHRQ guidelines, particular safety benchmarks, and quality statistics. Clinical assessment permits nurses to identify patient needs, while national resources support evidence based contexts that support reliable, high quality care.

    For instance, nurses are able to use AHRQ safety tools to advance handoff interaction, decrease medication oversights, and improve collaboration during risky situations. This allows for safe practice standards to implemented and help decrease adaptability in care delivery. Cherry and Jacob (2022) highlight that combining national quality advantages into daily nursing practice improves responsibility and establishes better patient outcomes (Ch. 14, Quality Improvement and Patient Safety, pp. 417–423).

     

     

    References

    Agency for Healthcare Research and Quality. (2023). 
    Patient safety and quality improvement
    . 
    https://www.ahrq.gov
    Links to an external site.

    Cherry, B., & Jacob, S. R. (2022). 
    Contemporary nursing: Issues, trends, & management
     (9th ed.). Elsevier.

    Chapter 14: Quality Improvement and Patient Safety (pp. 417–423)

    Institute of Medicine. (2001). 
    Crossing the quality chasm: A new health system for the 21st century
    . National Academies Press.

    Chapter 2: Improving the 21st-Century Health Care System (pp. 39–45)

    Potter, P. A., Perry, A. G., Stockert, P. A., & Hall, A. M. (2023). 
    Fundamentals of nursing
     (11th ed.). Elsevier.

    Chapter 22: Quality and Safety (pp. 448–456)

     

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    Eli Belschner

    Jan 6 2am
    | Last reply Jan 6 9:02pm

    Reply from Eli Belschner

    Discussion 1

    Quality improvement is the process of continuously making efforts to improve care (Cho & Kim, 2025). Quality improvement must be a continuous process, as it enhances various aspects of the workplace, from encouraging innovation and improvement to fostering trust and respect within the organization (Endalamaw et al., 2024). It promotes programs to broaden their perspective from avoiding mistakes to striving for the highest standards possible (Endalamaw et al., 2024). Medicine is a constantly evolving field, and continuous quality improvement enables programs to maintain the highest standards of care (Endalamaw et al., 2024).

    Numerous national safety and quality resources are available for nurses. One of these is Quality and Safety Education for Nurses (QSEN). QSEN defines several essential competencies that nurses must possess to deliver the best care to their patients. One of these is patient-centered care. In today’s world, this is a crucial concept to keep in mind. In the ICU nurses can begin to focus more on the technology that is keeping the patient alive instead of the patient attached to the machines (Secunda & Kruser, 2022). Nurses must keep in mind that even if a patient is unable to communicate, they still have wishes, preferences, and values that must be considered (Secunda & Kruser, 2022). There are numerous tools that hospitals and nurses can utilize to maintain a patient-focused approach (Secunda & Kruser, 2022). These range from questions such as “What do I need to know about you as a person to give you the best care possible?” to boards in the room that display personal information about the patients (Secunda & Kruser, 2022). All of these contribute to keeping the patient at the forefront of our minds, rather than losing their humanity in the multitude of machines. This facilitates a better connection between nurses and patients, while also making patients and their families feel cared for and receive the best care possible.

    This highlights how nurses can utilize government resources to enhance patient outcomes. These resources highlight areas that we may not consider due to high workloads or complex daily tasks. The information outlined in the resources is essential to consider, along with clinical experience, to ensure the best possible clinical outcome.

    Cho, S., & Kim, E. M. (2025). 
    Quality improvement interventions for peripheral intravenous catheter nursing practices: A systematic review
    . Journal of nursing care quality. 
    http://pmc.ncbi.nlm.nih.gov/articles/PMC12594121/
    Links to an external site.

    Endalamaw, A., Khatri, R. B., Mengistu, T. S., Erku, D., Wolka, E., Zewdie, A., & Assefa, Y. (2024, April 19). 
    A scoping review of continuous quality improvement in healthcare system: Conceptualization, models and tools, barriers and facilitators, and impact
    . BMC health services research. 
    https://pmc.ncbi.nlm.nih.gov/articles/PMC11031995/
    Links to an external site.

    Secunda, K. E., & Kruser, J. M. (2022, September). 
    Patient-centered and family-centered care in the Intensive Care Unit
    . Clinics in chest medicine. 
    https://pmc.ncbi.nlm.nih.gov/articles/PMC9885766/#S4
    Links to an external site.

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    KH

    Ketelia Honeycutt

    Jan 5 1:27pm

    Reply from Ketelia Honeycutt

    Quality improvement (QI) is an ongoing process because healthcare care delivery involves many moving parts such as people, workflows, and systems, and problems can reappear if processes are not continuously monitored and refined. The Centers for Medicare & Medicaid Services (CMS) explains that performance improvement/quality improvement is the continuous study and improvement of processes with the intent to improve services or outcomes and reduce the likelihood of problems by identifying opportunities and testing new approaches that address underlying causes (CMS, 2024). In other words, QI is not a one-time fix; it is repeated, ongoing work to make care safer and more effective.
     

    A national safety and quality resource nurses can use is the CMS Quality Improvement Organization (QIO) Program. CMS describes the QIO Program as a major federal effort dedicated to improving health quality for people with Medicare (CMS, 2024). Nurses can use QIO materials and improvement support to strengthen unit-level outcomes by helping teams implement evidence-based changes, track performance measures, and reduce preventable harm.
     

    Nurses also use government guidance to support daily bedside practice, especially infection prevention. The CDC states that handwashing is “one of the most effective ways to prevent the spread of germs” (CDC, 2024). Nurses can apply this directly by reinforcing hand hygiene before and after patient contact, teaching patients and families, and supporting unit compliance initiatives. When nurses combine clinical expertise with national resources like CMS QI guidance and CDC infection prevention education, QI becomes practical and measurable which leads to better patient outcomes and safer care.
     

    References
     

    Centers for Disease Control and Prevention. (2024, February 27). About handwashing. 
    https://www.cdc.gov/clean-hands/about/index.html
    Links to an external site.
     

    Centers for Medicare & Medicaid Services. (2024, September 10). QAPI description and background. 
    https://www.cms.gov/medicare/provider-enrollment-and-certification/qapi/qapidefinition
    Links to an external site.
     

     

    Centers for Medicare & Medicaid Services. (2024, September 10). Quality Improvement Organizations (QIOs). 
    https://www.cms.gov/medicare/quality/quality-improvement-organizations
    Links to an external site.
     

     

     

     

     

     

     

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    Chandrea Green
     (She/Her)

    Jan 5 1:19am
    | Last edited Jan 5 1:23am
    | Last reply Jan 11 2:48pm

    Reply from Chandrea Green

    Utilizing National Safety and Quality Resources

    Hi everyone, 
     

    I plan to use 
    ​
    the National Healthcare Quality and Disparities Report
    ​
     
    ​
    (NHQDR
    ​
    ) to guide my nursing practice, with a focus on equity and care transitions. The NHQDR provides national and state-level dashboards on patient safety, care coordination, and readmissions, allowing nurses to find disparities across racial, socioeconomic, and geographic groups. For example, NHQDR data show higher readmission and adverse event rates among Black, Hispanic, rural, and low-income populations, highlighting the need for targeted interventions (Agency for Healthcare Research and Quality, 2024). 
     

    Nurses can use NHQDR findings alongside CMS Care Compare data to find safety gaps, benchmark outcomes, and support quality improvement efforts. Practical strategies include implementing culturally sensitive discharge education, using teach-back methods to address health literacy barriers, and improving medication reconciliation and follow-up care during transitions. Evidence-based tools from AHRQ’s Patient Safety Network (PSNet) can further support these interventions. 
     

    A concrete example is reducing post-discharge adverse events among older, low-income patients by standardizing discharge education in preferred languages, conducting follow-up calls, and using transition-of-care checklists. Monitoring readmissions and patient understanding through unit dashboards allows nurses to evaluate impact and refine interventions. Overall, using national data resources enables nurses to translate evidence into practice and promote safer, fairer patient outcomes. 
     

    Discussion Question: 

    Based on NHQDR data and your patient population, which disparities or safety measures are most relevant in your setting, and how could you apply a focused PDSA cycle to address them? 
     

    Reference  

    Agency for Healthcare Research and Quality. (2024). 
    ​
    National Healthcare Quality and Disparities Report data
    ​
     
    ​
    tools. 
    https://www.ahrq.gov/data/nhqdr.html NSG 633 Unit 1: Discussion: Quality Improvement Herzing University

  • Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

    Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

    Overview

    Blood chemistry tests measure the amounts of chemical substances in blood. Routine blood chemistry tests help evaluate function of major organs and indicate a person’s overall state of health. They are usually prescribed as a panel, a group of tests that can be done at one time. Tests included in a panel as well as the names of panels can differ from laboratory to laboratory. Reference ranges of expected values for tests can also differ because of the way a test is done in a specific laboratory.

    Common blood chemistry tests include:

    Electrolyte studies

    Plasma glucose

    Hemoglobin A1c

    Lipid profile

    Liver function tests

    Kidney function tests

    Cardiac markers

     

     

     

    Electrolyte Panel

    An electrolyte panel (also referred to as 
    electrolytes
    , 
    serum electrolytes,
     or 
    “lytes”
    ) measures the four main electrolytes found in the blood:

    Sodium (Na
    +
    )

    Potassium (K
    +
    )

    Chloride (Cl
    –
    )

    Bicarbonate (HCO
    3
    –
    ) or total carbon dioxide (CO
    2
    )

    The panel is performed on a sample of venous blood.

    Reasons for Prescribing

    An electrolyte panel is done to identify:

    Fluid imbalance

    Abnormal numbers of electrolytes

    Abnormalities in acid-base balance

    Expected Value Range

    Na
    +

    136–145 mEq/L

    K
    +

    3.5–5 mEq/L

    Cl
    –

    98–106 mEq/L

    CO
    2

    23–30 mEq/L

    Interpretation of Abnormal Values

    Abnormal values are often due to dehydration from excessive heat, vomiting, or diarrhea.

     

     

     

    Plasma Glucose

    Plasma glucose (blood sugar) is a measure of the amount of glucose circulating in the blood. A plasma glucose test is done in the laboratory on a sample of venous blood or at the point of care on a sample of capillary blood. It may be a fasting test (no food or drink, except water, usually for 8 to 12 hours) or a nonfasting test.

    Reasons for Prescribing

    Plasma glucose, or blood sugar, is measured to:

    Detect abnormal glucose metabolism

    Monitor effectiveness of treatment regimens for diabetes and other disorders of glucose metabolism

    Expected Value Range

    Plasma glucose: 74 to 106 mg/dL

    Interpretation of Abnormal Values

    Values are elevated with obesity and in diabetes mellitus.

    Values are decreased with malabsorption, too much insulin, anxiety, and excessive exercise.

     

     

    Hemoglobin A1c

    Hemoglobin A1c (HbA1c, A1c test, glycosylated hemoglobin) is a measure of average plasma glucose level over 60 to 90 days. It is done on a sample of venous blood, no fasting required.

    Reasons for Prescribing

    HbA1c is done to:

    Diagnose prediabetes, type 1 diabetes, and type 2 diabetes

    Monitor effectiveness of diabetes treatment plans

    Expected Value Range

    People without diabetes: HbA1c 4% to 5.9%

    People with diabetes: HbA1c ≥6.5%

    Interpretation of Abnormal Values

    People with diabetes that has been well controlled over the past 2 to 3 months have values below 7%. If diabetes is poorly controlled, values are 9% or higher.

     

     

     

    Lipid Profile (Lipid Panel)

    A lipid profile is a measure of four fats circulating in the blood:

    Total cholesterol

    Low-density lipoprotein (LDL) cholesterol

    High-density lipoprotein (HDL) cholesterol

    Triglycerides

    It is performed on a fasting (no food or drink, except water, usually for 8 to 12 hours) sample of venous blood.

    Reasons for Prescribing

    A lipid profile is done to detect hyperlipidemia and to estimate risk for atherosclerotic heart and blood vessel disease.

    Expected Value Range

    Interpretation of Abnormal Values

    Cholesterol

    <200 mg/dL Elevated with obesity and atherosclerosis Low-Density Lipoproteins <130 mg/dL Elevated with a high-cholesterol diet and diabetes mellitus High-Density Lipoproteins Males: >45 mg/dL

    Females: >55 mg/dL

    Decreased with obesity, smoking, stress, and chronic inactivity

    Triglycerides

    Males: 40–160 mg/dL

    Females: 35–135 mg/dL

    Increased with alcohol abuse

     

     

    Liver Profile

    A liver profile is a set of liver function tests that typically include serum levels of:

    Albumin

    Bilirubin

    Four liver enzymes:

    Alanine aminotransferase (ALT)

    Alkaline phosphatase (ALP)

    Aspartate aminotransferase (AST)

    Gamma-glutamyl transpeptidase (GGTP)

    A liver profile is performed on a sample of venous blood.

    Reasons for Prescribing

    To screen for or monitor liver disease

    Levels of albumin and bilirubin indicate how well the liver is making protein and clearing bilirubin, which is a waste product. The enzyme levels are measures of liver disease because the enzymes are released from damaged liver cells. Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

    Expected Value Range

    Albumin

    3.5–5 g/dL

    Bilirubin (total)

    0.3–1.0 mg/dL

    Alanine Aminotransferase (ALT)

    4–36 units/L

    Alkaline Phosphatase (ALP)

    30–120 units/L

    Aspartate Aminotransferase (AST)

    0–35 units/L

    Gamma-Glutamyl Transpeptidase (GGTP)

    Males and females >45 yr: 8–38 units/L; females <45 yr: 5–27 units/L Interpretation of Abnormal Values All values, except albumin, are elevated in liver disease. Albumin is decreased.         Renal Function Studies Renal function studies consist of two basic measurements: Blood urea nitrogen (BUN) Serum creatinine As a measure of renal function, the BUN is interpreted in conjunction with the serum creatinine. Renal function studies are performed on samples of venous blood. Reasons for Prescribing To monitor renal function and to assess kidney damage Expected Value Range Blood Urea Nitrogen (BUN) 10–20 mg/dL Creatinine Males: 0.6–1.2 mg/dL Females: 0.5–1.1 mg/dL Interpretation of Abnormal Values Both BUN and creatinine are elevated in acute and chronic kidney disease.     Cardiac Markers Cardiac markers are proteins that are released from injured heart muscle cells into the bloodstream. Cardiac markers include: Creatine kinase (CK) and the CK-MB isoenzyme Myoglobin Troponin I Troponin T Cardiac markers are measured on a sample of venous blood. Reason for Prescribing To detect damage to the myocardium from occlusion of the coronary arteries Expected Value Range/Abnormal Values Blood levels of cardiac markers change in a predictable manner over time after damage to cardiac muscle. Marker Expected Values Abnormal Values Begins to Rise (h) Peak (h) Returns to Normal (days) Total creatine kinase Females: 30–135 units/L Males: 55–170 units/L Females: >150 units/L

    Males: >174 units/L

    6

    18

    2–3

    CK-MB

    <0% >3%

    4

    18

    2

    Myoglobin

    <90 ng/mL >90 ng/mL

    3

    8–12

    Within 1

    Troponin I

    <0.03 ng/mL >0.04 ng/mL

    4–6

    10–24

    4

    Troponin T

    <0.1 ng/mL >0.1 ng/mL

    4–6

    10–24

    10

    Clinical I NSG 522 – Laboratory Tests Performed on Blood and Body Fluids

  • Checkoff – Vital Signs & Pain Assessment

    Checkoff – Vital Signs & Pain Assessment

    VITAL SIGNS & PAIN ASSESSMENT

    SKILL
    VALIDATION

     

    Student Name: _____________________________________                                         Date: _____________________

     

    Points Allowed

    1
    st
    Attempt

     

    2
    nd
    Attempt

     

    Preparation

     

    Perform I-CHECK: Introduce yourself,
    Check armband (two patient identifiers),
    Hand hygiene, Explain procedure, Check order, Keep privacy

    +1

    Determine the appropriate arm
    for blood pressure measurement (i.e., consider presence of IV-line, mastectomy, fistula, or injury)

    +1

    Manual Blood Pressure

     

    Apply appropriately sized sphygmomanometer with a snug fit, correct alignment, and cuff placed 2-5 cm above the brachial artery

    +1

    Position patient with arm supported at heart level and feet flat on the floor

    +1

    Ask patient what their BP typically is
    (this step prevents overinflation of cuff & avoids auscultatory gaps)

    +1

    Obtain the patient’s blood pressure:

    ·        Put on the stethoscope with earpieces angled forward, place the diaphragm over the brachial artery & inflate cuff 30mmHg above estimated systolic pressure to avoid missing an auscultatory gap

    ·        Deflate cuff 2mmHg per second while listening for Korotkoff sounds noting when first Korotkoff sound appears (systolic BP) & the last audible Korotkoff sound (diastolic BP)

    GET HELP HERE

    ·        Continue to slowly deflate the cuff for a bit longer to make sure the Korotkoff sounds don’t reappear, and then rapidly deflate the cuff

    +3

    Correctly state blood pressure measurement (within 4 mmHg)

    +1

    Heart Rate

     

    Place fingertips on radial artery and press lightly until pulse is felt

    +1

    Count beats for 30 seconds if regular (then double it) or 60 seconds if irregular

    +1

    Correctly state the heart rate (within 2 bpm),
    noting rate, rhythm, and force

    (3+ = full, bounding, 2+ = normal, 1+ = weak, thread, 0 = absent)

    +1

    Respiratory Rate

     

    Watch the rise and fall of the chest or abdomen
    without letting the patient know
    you are counting (e.g., pretend to still be checking the pulse)

    +1

    Count breaths for 30 seconds if regular (then double it) or 60 seconds if irregular

    +1

    Obtain oxygen saturation

    Checkoff – Vital Signs & Pain Assessment

    +1

    Correctly state the respiratory rate (within 1 breath per minute)

    +1

    Temperature (Oral)

     

    Ask patient if they have recently eaten, consumed hot or cold liquids, or smoked. If yes, wait 15 minutes prior to assessing an oral temperature

    +1

    Attach a disposable cover to the thermometer and position the thermometer at the base of the tongue in either of the posterior sublingual pockets and ask the patient to close their lips around it

    +1

    Wait for the thermometer to beep, indicating the reading is complete and dispose of the cover and read the temperature accurately

    +1

    Pain

     

    Ask if the patient is experiencing any pain (the “patient” should report a common ailment like a headache) and assess using the OPQRST method:

    ·        Chief Complaint: Are you having any pain? Where is it located?

    ·        Onset: When the pain began?

    ·        Provocation: What makes the pain worse?

    ·        Quality: How do you describe the pain?

    ·        Radiation: Does the pain spreads elsewhere?

    ·        Severity Scale: Explain and use the 0-10 scale to assess intensity

    ·        Timing: Is the pain constant or intermittent? How long does it last?

    +7

    Post-Procedure

     

    Document patient’s vital signs (blood pressure, heart rate, respiratory rate, temperature) and pain assessment
    No points but required

    Total Points (successful/Unsuccessful) 21 out of 26 needed to be successful

    Comments

     

    Checkoff – Vital Signs & Pain Assessment

     

     

     

     

    Evaluator Initials or Signature: _____________________________________                Date: _____________________

    1
    ST
    Attempt Pass ____________/Needs Remediation___________________

     

    Evaluator Initials or Signature: _____________________________________                Date: _____________________

    2
    nd
    Attempt Pass ____________/Lab Fail_____________________________

    Checkoff – Vital Signs & Pain Assessment

  • NSG 522 Clinical I Chapter 29, Vital Signs Blood Pressure Quizlet

    NSG 522 Clinical I Chapter 29, Vital Signs Blood Pressure Quizlet

    Question 1 of 20

     Report content error

    Which description would the nurse use when discussing stroke volume?

    The elasticity of the arterial system

    Compliance refers to the elasticity of the arterial system rather than the description of stroke volume.

    The amount of pressure in the arteries in between beats

    Diastolic pressure is the amount of pressure in the arteries in between beats rather than the description of stroke volume.

    The numeric difference between systolic and diastolic pressure

    Pulse pressure is the numeric difference between systolic and diastolic pressure rather than the description of stroke volume.

    Correct

    The amount of blood injected into the arterial system with each heartbeat

    Stroke volume is the volume of blood injected into the arterial system with each heartbeat (ventricles contract).

    Question 2 of 20

     Report content error

    Which cues would the nurse observe in a patient with a blood pressure of 60/40 and shock?

    Correct

    Clammy skin

    Clammy skin is a cue for hypotension and shock resulting from a dangerous fall in blood pressure.

    Correct

    Thready pulse

    Thready pulse is a cue for hypotension and shock resulting from a dangerous fall in blood pressure.

    Increased urinary output

    Decreased, not increased, urinary output is a cue for hypotension and shock from a decrease in blood pressure.

    Correct

    Confusion

    Confusion is a cue for hypotension and shock because of the decreased blood flow to the brain.

    Bradycardia

    Tachycardia, not bradycardia, occurs with hypotension and shock.

    Question 3 of 20

     Report content error

    Which statement indicates the nurse understands possible errors in blood pressure assessment?

    Correct

    “A noisy environment can cause a false low reading.”

    A noisy environment can lead to a false low measurement.

    “If the cuff is too wide, a false high reading is possible.”

    A wide cuff could cause a false low blood pressure reading; conversely, a cuff that is too narrow can cause a false high reading.

    Correct

    “If pressure is released too slowly, a false high reading is possible.”

    Releasing pressure too slowly can result in a false high blood pressure reading.

    “A patient’s arm should be above heart level to avoid a false low reading.”

    A patient’s arm above heart level can lead to a false low reading.

    Correct

    “Reinflating the cuff bladder before it has completely deflated can cause a false high measurement.”

    A false high measurement can occur from reinflating the cuff bladder before it has completely deflated.

    Question 4 of 20

     Report content error

    Which factor would the nurse suspect is causing the blood pressure to fall when a patient who experienced a myocardial infarction (heart attack) is becoming cool and clammy?

    Extreme vasodilation

    Although extreme vasodilation can cause hypotension, it is caused by a severe allergic reaction, not from a heart attack.

    Increased blood volume

    Decreased, not increased, blood volume is a physiologic factor of hypotension and is caused by hemorrhage or blood loss, not from a myocardial infarction.

    Correct

    Decreased cardiac output

    Decreased cardiac output is a physiologic factor of hypotension and is caused by a myocardial infarction.

    Increased peripheral vascular resistance

    Decreased, not increased, peripheral vascular resistance is a physiologic factor of hypotension.

    Question 5 of 20

     Report content error

    Match the type of hypertension to its description.

    No known cause

    Primary hypertension

    Caused by a specific disease

    Secondary hypertension

    Systolic blood pressure over 140

    Hypertension stage 2

    Diastolic blood pressure 80–89

    Hypertension stage 1

    Question 6 of 20

     Report content error

    Which action by the nurse when caring for a patient with a left mastectomy would cause the charge nurse to intervene?

    Correct

    Takes the blood pressure in the left arm

    The charge nurse would intervene because a brachial blood pressure is not used on the arm that is on the side of the mastectomy as this would promote lymphedema (swelling).

    Uses a cuff width that is 40% of the circumference of the arm

    Using a cuff width that is 40% of the arm circumference is recommended practice.

    Listens for the first Korotkoff sound to record as the systolic pressure

    The first Korotkoff sound, or the first sound heard, is recorded as the systolic pressure and is recommended practice for measuring blood pressure.

    Makes sure the cuff bladder is 60% to 80% of the arm circumference

    Making sure the cuff bladder is 60% to 80% of the arm circumference is recommended practice for taking a blood pressure.

    Question 7 of 20

     Report content error

    Which interventions would the nurse implement to help an obese adult patient who smokes cigarettes successfully manage hypertension?

    Correct

    Arranging for nutritional support

    Nutritional support is needed because the patient is obese. Weight reduction can help decrease hypertension.

    Correct

    Encouraging cessation of smoking

    Encouraging cessation of smoking is necessary because smoking is a risk factor for hypertension.

    Correct

    Monitoring responses to prescribed antihypertensive medications

    Medication response is important to monitor to establish if the antihypertensive medication is working effectively and is well tolerated by the patient.

    Comparing current blood pressure readings to original readings

    Comparing current blood pressure readings to the original reading is an evaluation action, not an intervention.

    Listening while the patient expresses gratitude for care NSG 522 Clinical I Chapter 29, Vital Signs Blood Pressure Quizlet

    Listening to the patient express thankfulness is a part of the evaluation process; it is not an intervention.

    Question 8 of 20

     Report content error

    Which site would the nurse use to measure blood pressure when the patient’s upper body is severely burned?

    Correct

    Popliteal

    The popliteal artery, behind the popliteal space in the lower extremity, can be used to assess blood pressure if the upper extremities are injured and cannot be used.

    Brachial

    The brachial, located in the upper arm, cannot be used because the upper body is severely burned.

    Radial

    The radial, located in the wrist, cannot be used because the upper body is severely burned.

    Femoral

    Although the femoral is in the lower body, blood pressure cannot be taken at this site.

    Question 9 of 20

     Report content error

    Which adult patient’s blood pressure reading would the nurse realize is unexpected?

    100/60

    100/60 is an expected blood pressure for an adult. It falls within the typical ranges of 90–<120 over 60–<80. 116/78 116/78 is an expected blood pressure for an adult. It falls within the typical ranges of 90–<120 over 60–<80. Correct 96/64 to 118/74 A 20 to 30 mm Hg change (either upward or downward) in either the systolic or diastolic reading when compared to an earlier reading is an unexpected finding, even though the individual readings are within the expected range. 108/70 to 118/79 Although there are changes in both the systolic and diastolic pressures, it is not a change of 20 to 30 mm Hg. Question 10 of 20  Report content error What is the patient’s pulse pressure (mm Hg) when the blood pressure is 130/70?  Record your answer as a whole number.  __ mm Hg Your answer:  60 Correct answer: 60 The pulse pressure is the difference between the systolic and diastolic blood pressure: 130 – 70 = 60. Question 11 of 20  Report content error Which actions would the nurse take when manually measuring the patient’s brachial blood pressure? Correct Deflate cuff at a rate of 2 mm Hg/second. Deflating the cuff at a rate of 2 mm Hg/second is recommended practice for measuring a brachial blood pressure. Correct Inflate cuff 30 mm Hg above the previous systolic reading. Inflating the cuff 30 mm Hg above the previous systolic reading is recommended practice for measuring a brachial blood pressure. Place cuff loosely around the upper arm. The cuff is placed snugly around the upper arm rather than loosely. A loosely placed cuff could result in an inaccurate blood pressure reading. Correct Position cuff 2.5 cm (1 inch) above the antecubital fossa. Positioning the cuff 2.5 cm (1 inch) above the antecubital fossa is recommended practice for measuring a brachial blood pressure. Allow the patient to sit and cross legs. Although the patient is allowed to sit, the patient’s legs are uncrossed, not crossed. Question 12 of 20  Report content error For which patients would the nurse measure blood pressure with an electronic device? Correct Has a regular heartbeat The nurse can use the electronic device with a patient who has a regular heartbeat; the electronic device is not used when the patient’s heartbeat is irregular. Is shivering The nurse cannot use an electronic device when the patient is shivering as it can produce an inaccurate reading. Experiences seizure activity The nurse cannot use an electronic device when the patient is experiencing seizure activity as it can produce an inaccurate reading. Has a previous systolic blood pressure reading of 86 mm Hg The nurse cannot use an electronic device when the patient has a previous systolic blood pressure reading of 86 mm Hg as it can produce an inaccurate reading; the systolic should be at least 90 or above. Correct Has a previous systolic blood pressure reading of 140 mm Hg The nurse can use the electronic device with a patient who has a previous systolic blood pressure reading of 140 mm Hg. Question 13 of 20  Report content error Which patient cue would the nurse identify as relevant for blood pressure? Correct Reports blurred vision Blurred vision is relevant because it could indicate high blood pressure. Is married Marital status is not relevant because it does not affect blood pressure. Had abdominal surgery 5 years ago Abdominal surgery is not relevant for blood pressure since it does not affect blood pressure. Has periods of intense hunger Hunger is irrelevant because it does not affect blood pressure. Question 14 of 20  Report content error Which information would the nurse share with a team member about the pathophysiology of hypertension? Vasoconstriction causes blood to pool in the lower extremities, making the heart pump harder. Vasodilation (not vasoconstriction) causes blood to pool in the lower extremities, making the heart pump harder; vasoconstriction does occur with hypertension, but it increases peripheral resistance, making the heart pump harder. Enlarging of the blood vessels with no rise in cardiac output leads to increased blood pressure. Enlarging (vasodilation) of the blood vessels with no rise in cardiac output leads to decreased, not increased, blood pressure. Narrowing of the arteries causes decreased peripheral resistance, leading to higher blood pressure. Narrowing of the arteries occurs in hypertension, but it causes increased (not decreased) peripheral resistance. Correct Overstimulation of angiotensin and aldosterone causes the blood pressure to increase. Overstimulation of angiotensin and aldosterone causes the blood pressure to increase from neurohormonal dysfunction, leading to hypertension. Question 15 of 20  Report content error Place the adult patients in the order in which the nurse would prioritize their care from highest priority to lowest priority. Patient with an occluded airway Patient who has a blood pressure of 76/40 Patient with chronic hypertension Patient with blood pressure of 110/64 The sequence is as follows: an occluded airway takes precedence because of airway, breathing, and circulation (ABCs). The patient with hypotension (76/40) is next, followed by the patient with chronic hypertension because this is chronic whereas the hypotension is acute. Last is the patient with an expected blood pressure (110/64). Question 16 of 20  Report content error Which hypothesis would the nurse select for a patient with a blood pressure of 130/70 who when sitting up becomes dizzy and the blood pressure is 108/60? Shock The patient does not have shock as this was sudden and a one-time event. Other factors would need to be assessed over time (e.g., blood pressure continues to fall) to determine shock. Correct Postural hypotension The patient has orthostatic, or postural, hypotension since this event of hypotension occurred when moving from a supine to a sitting position. Hypertension stage 1 The patient’s blood pressure does not indicate hypertension, which is abnormally elevated blood pressure. Hypotension The patient does not have hypotension as this was sudden and a one-time event. Other factors would need to be assessed over time (e.g., blood pressure continues to fall) to determine hypotension. Question 17 of 20  Report content error Which actions would the nurse take for a patient with low blood pressure from decreased peripheral vascular resistance? Administer prescribed antihypertensive medications. Antihypertensive medications are for treatment of hypertension, not for low blood pressure; in fact, this would make the situation worse. Correct Administer prescribed intravenous (IV) fluids. Fluids are needed to increase the low blood pressure. Correct Administer prescribed oxygen. Oxygen is needed to supply extra oxygen to the body during hypotension. Correct Position supine with legs elevated. This position increases blood back to the heart. Position prone with head on small pillow. Positioning in the prone position with the head on a small pillow will not improve low blood pressure. Question 18 of 20  Report content error Which factor would the nurse consider is likely causing hypertension in an older adult female who is 5’4”, weighs 100 lbs (45.4 kg), drinks an occasional glass of red wine before bed, and limits salt in her diet? Correct Age The patient is an older adult, which increases the chance for hypertension. Obesity Although obesity does increase the chance of hypertension, the patient is not obese at 5’4”, 100 lb (45.4 kg). Alcohol use Although alcohol can increase the chance of hypertension, the patient’s alcohol intake is within the acceptable guidelines of one drink per day for women. Salt intake Although salt can increase the chance of hypertension, the patient limits salt in her diet, thereby decreasing the chance of hypertension. Question 19 of 20  Report content error Which finding would alert the nurse that a patient with a blood pressure of 80/40 is improving? Correct Skin becomes warm and dry. The patient has hypotension (80/40); if the skin becomes warm and dry, the patient is improving because the skin is not cool and clammy. Blood pressure decreases. If blood pressure decreases, the patient with hypotension is declining, not improving. DASH diet is consumed. A DASH (Dietary Approaches to Stop Hypertension) diet is consumed for hypertension, not hypotension. Stress level decreases. A decreasing stress level indicates a patient with hypertension (not hypotension) is improving. Question 20 of 20  Report content error Which actions would the nurse take for a patient with the following blood pressures: 119/74, 125/78, 130/83, and 135/88? Correct Measure oxygen saturation level. The nurse would measure oxygen saturation levels because the patient is exhibiting an upward trend of the blood pressure. Monitor blood pressure every 4 hours. With a steady upward trend, blood pressure needs to be monitored more often than every 4 hours. Correct Reassess the circulatory system. The nurse would reassess the circulatory system (not just the vital signs) because the patient is exhibiting an upward trend of the blood pressure. Correct Perform a head-to-toe assessment. The nurse would perform a head-to-toe assessment because the patient is exhibiting an upward trend of the blood pressure. Correct Notify health care provider. The nurse would notify the health care provider because the patient is exhibiting an upward trend of the blood pressure. NSG 522 Clinical I Chapter 29, Vital Signs Blood Pressure Quizlet

  • Tracheostomy Suctioning Quiz with Answers

    Tracheostomy Suctioning Quiz with Answers

    Tracheostomy Suctioning

    1 / 5

    Question at position 1

    1

    Multiple Choice

    1 point

    Question at position 1

    After suctioning a tracheostomy patient, and completing your first pass, you reassess their breath sounds and still hear gurgling and coarse rhonchi. The patient’s oxygen saturation has not improved. What should you do next?

    Increase oxygen to 100%

    Stop suctioning and continue to monitor the patient

    Remove the tracheostomy inner cannula and replace it with a new one

    Repeat suctioning allowing for reoxygenation in between passes

    2

    Multiple Choice

    1 point

    Question at position 2

    A patient with a tracheostomy is being discharged home. Which statement by the caregiver indicates a need for further teaching?

    “I will clean the inner cannula with mild soap and tap water”

    “I will keep a spare tracheostomy tube and suction supplies at home”

    “I will wash my hands before and after tracheostomy care”

    “I will change the tracheostomy ties when they become soiled”

    GET HELP HERE

    3

    Multiple Choice

    1 point

    Question at position 3

    A nursing student is performing suctioning on a patient with a tracheostomy. Which action requires correction?

    Applying suction while inserting the catheter

    Applying suction while withdrawing the catheter

    Suctioning for 10-15 seconds per pass

    Rotating the catheter while suctioning

    4

    Multiple Choice

    1 point

    Question at position 4

    While suctioning a patient’s tracheostomy, you notice the patient becoming agitated, tachycardic and oxygen saturation dropping. What should you do?

    Readjust the pulse ox as it could be a false reading

    Continue suctioning to remove all secretions

    Increase suction pressure to remove secretions more quickly

    Stop suctioning immediately and provide oxygen

    5

    Multiple Choice

    1 point

    Question at position 5

    You are assessing a patient with a tracheostomy and notice increased respiratory rate, restlessness, and audible secretions. What should you do first?

    Immediately suction the patient

    Assess breath sounds and oxygen saturation

    Sit the patient up

    Increase the patient’s oxygen to 100%

     

    Your Answers:

    Results for question 1.

    1

    1 / 1 point

    Multiple Choice

    After suctioning a tracheostomy patient, and completing your first pass, you reassess their breath sounds and still hear gurgling and coarse rhonchi. The patient’s oxygen saturation has not improved. What should you do next? Tracheostomy Suctioning Quiz with Answers

    Increase oxygen to 100%

    , Not Selected

    Stop suctioning and continue to monitor the patient

    , Not Selected

    Remove the tracheostomy inner cannula and replace it with a new one

    , Not Selected

    Correct answer:

    Repeat suctioning allowing for reoxygenation in between passes

    Results for question 2.

    2

    1 / 1 point

    Multiple Choice

    A patient with a tracheostomy is being discharged home. Which statement by the caregiver indicates a need for further teaching?

    Correct answer:

    “I will clean the inner cannula with mild soap and tap water”

    “I will keep a spare tracheostomy tube and suction supplies at home”

    , Not Selected

    “I will wash my hands before and after tracheostomy care”

    , Not Selected

    “I will change the tracheostomy ties when they become soiled”

    , Not Selected

    Results for question 3.

    3

    1 / 1 point

    Multiple Choice

    A nursing student is performing suctioning on a patient with a tracheostomy. Which action requires correction?

    Correct answer:

    Applying suction while inserting the catheter

    Applying suction while withdrawing the catheter

    , Not Selected

    Suctioning for 10-15 seconds per pass

    , Not Selected

    Rotating the catheter while suctioning

    , Not Selected

    Tracheostomy Suctioning Quiz with Answers – Results for question 4.

    4

    1 / 1 point

    Multiple Choice

    While suctioning a patient’s tracheostomy, you notice the patient becoming agitated, tachycardic and oxygen saturation dropping.
    What should you do
    ?

    Readjust the pulse ox as it could be a false reading

    , Not Selected

    Continue suctioning to remove all secretions

    , Not Selected

    Increase suction pressure to remove secretions more quickly

    , Not Selected

    Correct answer:

    Stop suctioning immediately and provide oxygen

    Results for question 5.

    5

    1 / 1 point

    Multiple Choice

    You are assessing a patient with a tracheostomy and notice increased respiratory rate, restlessness, and audible secretions. What should you do first?

    Immediately suction the patient

    , Not Selected

    Correct answer:

    Assess breath sounds and oxygen saturation

    Sit the patient up

    , Not Selected

    Increase the patient’s oxygen to 100%

    Tracheostomy Suctioning Quiz with Answers – Tracheostomy Suctioning
    Quiz with Answers

  • Chapter 16, Nursing Assessment Focused Assessments Answers

    Chapter 16, Nursing Assessment Focused Assessments Answers

    Question 1 of 24

    In which order would the nurse perform an assessment of the integumentary system.

    Review the patient’s medical records for preexisting issues with skin, hair, or nails.

    Interview the patient to complete the general survey, health history, and review of systems.

    Complete physical examination of the skin, hair, and nails.

    The integumentary system assessment begins with review of medical records to identify potential areas of concern. The nurse then interviews the patient before completing the physical examination.

    Question 2 of 24

     Report content error

    Which components would the nurse assess during palpation of the skin?

    Clubbing

    Clubbing is assessed when examining the nails, not the skin.

    Correct

    Swelling

    Swelling should be assessed during the palpation phase of the examination.

    Correct

    Skin texture

    Skin texture should be assessed during the palpation phase of the examination.

    Discoloration

    Skin discoloration should be assessed during the inspection phase of the examination, not the palpation phase.

    Correct

    Skin temperature

    Skin temperature should be assessed during the palpation phase of the examination.

    Question 3 of 24

     Report content error

    When the nurse identifies clubbing of a patient’s nails, which type of medical condition would the nurse suspect as the cause?

    Correct

    Cardiac

    Clubbing is a condition in which there is enlargement of the ends of one or more fingers or toes and is associated with decreased peripheral perfusion due to cardiac or respiratory problems.

    Neurologic

    Problems in the neurologic system do not cause clubbing of the nails.

    Gastrointestinal

    Gastrointestinal problems are not associated with nail clubbing.

    Musculoskeletal

    Musculoskeletal conditions do not cause clubbing of the nails.

    Question 4 of 24

     Report content error

    Which part of the eye would the nurse palpate gently to assess for nodules or pain?

    GET EXAM, OR QUIZ HELP 

    Lens

    The lens helps refract light to be focused on the retina and should not be palpated to assess for nodules or pain.

    Correct

    Eyelid

    The eyelids should be gently palpated to feel for nodules and pain.

    Cornea

    The cornea is the transparent layer forming the front of the eye and should not be palpated to assess for nodules or pain.

    Orbital bone

    The orbital bone is located on either side of the nose and will not reflect nodules or pain to the eye upon palpation.

    Question 5 of 24

     Report content error

    Which part of the nose would the nurse palpate to assess for swelling, drainage, and tenderness?

    Nostrils

    Palpation of the nostrils is not part of the physical examination.

    Mucosa

    Palpation of the mucosa is not part of the physical examination.

    Correct

    Sinuses

    The nurse palpates the sinuses to assess for swelling, drainage, and tenderness during the physical examination of the nose.

    Septum

    The nasal septum is the bone and cartilage in the nose that separates the nasal cavity into the two nostrils. Palpation for swelling and drainage of the septum is not part of the physical examination.

    Question 6 of 24

     Report content error

    When examining the head and its associated structures, which unexpected findings would the nurse document?

    Correct

    Lumps

    The presence of lumps is an unexpected finding that should be documented by the nurse.

    Correct

    Edema

    Edema is an unexpected finding that the nurse would document.

    Correct

    Lesions

    The existence of lesions is an unexpected finding that the nurse would document.

    Symmetry

    Asymmetry, not symmetry, of the head and its associated structures would be an unexpected finding that the nurse would need to document.

    Correct

    Discoloration

    Discoloration is an unexpected finding that the nurse should document.

    Question 7 of 24

     Report content error

    Which techniques would the nurse utilize to auscultate the patient’s chest during the respiratory assessment?

    Correct

    Listen for a full respiratory cycle.

    At each auscultation site, the nurse listens for a full respiratory cycle (inspiration and expiration).

    Correct

    Use a systematic pattern.

    The breath sounds in each of the lobes of the lungs are auscultated using a systematic pattern.

    Assess at least two lobes.

    Each lobe needs to be assessed for airflow and any unexpected sounds. The right lung has three lobes, and the left lung has two lobes.

    Feel for depth of breathing.

    The nurse feels for depth of breathing during palpation, not auscultation.

    Correct

    Listen for unexpected sounds.

    The nurse listens to each lobe for airflow and any unexpected sounds.

    Question 8 of 24 – Chapter 16, Nursing Assessment Focused Assessments Answers

     Report content error

    Which aspects does the nurse assess while palpating the chest during the respiratory system assessment?

    Respiratory rate

    The nurse uses inspection, not palpation, to assess the patient’s breathing pattern (rate, rhythm, depth, and effort).

    Correct

    Masses

    The nurse palpates to assess for masses or tenderness.

    Correct

    Skin moisture

    The nurse palpates to assess for skin moisture and temperature.

    Front-to-back diameter

    The nurse uses inspection, not palpation, to assess the chest for shape as well as the front-to-back diameter.

    Breathing effort

    The nurse uses inspection, not palpation, to assess breathing effort to ensure that there is no shortness of breath or difficulty breathing.

    Question 9 of 24

     Report content error

    Which characteristic is the nurse assessing when placing thumbs on either side of the spine during the respiratory system assessment?

    Lung capacity

    Lung capacity is assessed using a spirometer.

    Lung shape

    This technique does not assess for lung shape. The chest is assessed for symmetry and shape during inspection, not palpation.

    Respiratory rate

    Respiratory rate is assessed by counting the number of inspirations and expirations.

    Correct

    Depth of respirations

    Depth of respirations is assessed by placing the thumbs on either side of the spine and noting thumb movement.

    Question 10 of 24

     Report content error

    Which additional body system would the nurse evaluate when assessing the cardiovascular and peripheral vascular systems?

    Correct

    Respiratory

    The heart and lungs share a common circulatory system, such that a problem affecting the cardiovascular system can also affect the respiratory system.

    Genitourinary

    The genitourinary system is not generally connected to assessment of the cardiovascular system.

    Gastrointestinal

    The gastrointestinal system is not generally connected to assessment of the cardiovascular system.

    Musculoskeletal

    The musculoskeletal system is not generally connected to assessment of the cardiovascular system.

    Question 11 of 24

     Report content error

    Which actions would the nurse implement during auscultation of the cardiovascular system?

    Listen at all three valves

    The nurse auscultates the heart at each of the four valves to determine blood flow through the chambers as well as Erb’s point.

    Evaluate for symmetry

    The nurse palpates peripheral pulses for symmetry, but heart sounds are not auscultated for symmetry.

    Correct

    Assess rate and rhythm

    The nurse listens for the rate and rhythm of the apical pulse.

    Feel for quality of pulses

    The nurse palpates the peripheral pulses to determine the pulse rate, rhythm, quality, and symmetry. This does not involve auscultation.

    Correct

    Use both sides of stethoscope

    The nurse uses both sides of the stethoscope to assess for both low- and high-pitched sounds.

    Question 12 of 24

     Report content error

    Which aspect of cardiovascular function does the nurse assess when inspecting the skin and lower extremities?

    Apical pulse

    The apical pulse is not located on the lower extremities.

    Peripheral pulses

    Peripheral pulses are assessed during the palpation phase.

    Correct

    Peripheral perfusion

    The skin and lower extremities are inspected for evidence of peripheral perfusion.

    Heart rhythm

    Assessment of heart rhythm occurs during palpation and auscultation, not inspection.

    Question 13 of 24

     Report content error

    Which action allows the nurse to focus questions about the musculoskeletal system during the health history interview?

    Correct

    Review of health records

    The review of health records provides information on any preexisting musculoskeletal problems. This knowledge assists the nurse in focusing questions during the health history interview and review of systems.

    Organization of equipment

    Organization of equipment does not facilitate focusing questions during the health history interview.

    Analysis of the review of systems

    The review of systems occurs after the health history, so it would not help focus questions during the health history interview.

    Completion of the physical examination

    The physical examination occurs after the health history, so it would not help focus questions during the health history interview.

    Question 14 of 24

     Report content error

    Which potential findings would the nurse assess during the palpation phase of the musculoskeletal examination?

    Correct

    Masses

    The nurse assesses for masses during the palpation phase of the musculoskeletal examination. Masses are indicative of musculoskeletal problems.

    Correct

    Crepitus

    Crepitus is a crackling or popping sound, and the nurse assesses for this during the palpation phase of a musculoskeletal examination.

    Correct

    Tenderness

    The nurse assesses for tenderness during the palpation phase of the musculoskeletal examination.

    Deep tendon reflexes

    The nurse assesses deep tendon reflexes with a reflex hammer after the palpation phase.

    Postural abnormalities

    Postural abnormalities are assessed during the inspection phase, not the palpation phase, of the musculoskeletal examination.

    Question 15 of 24

     Report content error

    Which physical assessment findings related to the musculoskeletal system would the nurse report to the health care provider?

    Correct

    Pain

    Pain is an unexpected finding that should be reported to the health care provider.

    Correct

    Lesions

    Lesions are unexpected findings that the nurse should report to the health care provider.

    Absence of crepitus

    Crepitus, a popping or crackling sound, is an unexpected finding and should be reported to the health care provider. Absence of crepitus is an expected finding and does not need to be reported.

    Correct

    Abnormal posture or gait

    Abnormal posture or gait is an unexpected finding that should be reported to the health care provider.

    Presence of deep tendon reflexes

    The absence or diminution of deep tendon reflexes should be reported to the health care provider. The presence of deep tendon reflexes is an expected finding that does not need to be reported.

    Question 16 of 24

     Report content error

    Which assessment technique would the nurse use during the neurologic assessment?

    Correct

    Inspection

    The nurse uses the assessment techniques of inspection and palpation during a neurologic examination.

    Reflexology

    Reflexology is not one of the four recognized assessment techniques used by nurses. It is a specialized massage technique involving pressure points and should not be confused with assessment of reflexes.

    Percussion

    Percussion is not utilized during a neurologic examination because the examination assesses the motor, autonomic, behavioral, sensory, and cognitive elements of neurologic function.

    Auscultation

    Auscultation is not utilized during a neurologic examination.

    Question 17 of 24

     Report content error

    Which nerve does the nurse assess when applying dull and sharp stimuli to different areas of the body?

    Motor nerve

    Motor nerve information is assessed through the performance of various tasks.

    Cranial nerve

    Cranial nerve assessment involves the eyes, upper nasal passages, pons, and medulla oblongata and does not require dull and sharp stimuli for assessment.

    Correct

    Sensory nerve

    Sensory nerve information is assessed through the use of dull and sharp stimuli to check for normal reactions from such stimuli.

    Accessory nerve

    The accessory nerve is a cranial nerve that controls certain muscles believed to originate in the brain.

    Question 18 of 24

     Report content error

    Which nerve does the nurse examine by evaluating eye movements and pupillary reflexes?

    Motor nerve

    Motor nerve information is assessed through the performance of various tasks.

    Correct

    Cranial nerve

    Cranial nerve assessment involves the eyes, upper nasal passages, pons, and medulla oblongata. Cranial nerves are assessed through evaluation of eye movements and pupillary reflex.

    Sensory nerve

    Sensory nerve information is assessed through the use of dull and sharp stimuli to check for normal reactions from such stimuli.

    Accessory nerve

    The accessory nerve is a cranial nerve that controls certain muscles believed to originate in the brain.

    Question 19 of 24

     Report content error

    Which assessment techniques would the nurse use during the abdominal assessment?

    Correct

    Palpation

    The nurse palpates the abdomen in each quadrant, starting with light pressure and then using deeper pressure. The nurse also palpates the bladder area. A palpable, firm bladder suggests that it is distended with urine.

    Correct

    Inspection

    The nurse inspects the abdomen for discoloration, bruising, edema, lesions, stretch marks, and scarring. Bulges, distention, or protruding masses are also noted.

    Percussion

    Percussion is not used in the abdominal assessment.

    Observation

    Observation is not considered an assessment technique; nurses do observe during the inspection phase.

    Correct

    Auscultation

    The nurse uses the diaphragm of the stethoscope to auscultate bowel sounds in all four quadrants of the abdomen.

    Question 20 of 24 – Chapter 16, Nursing Assessment Focused Assessments Answers

     Report content error

    The abdominal and gastrointestinal organs are assessed during the evaluation of which body systems?

    Correct

    Urinary

    The urinary system is assessed during an evaluation of the abdominal and gastrointestinal organs because it involves intake and elimination and affects the gastrointestinal system.

    Correct

    Digestive

    The digestive system is assessed during an evaluation of the abdominal and gastrointestinal organs because its malfunction will produce further problems in the gastrointestinal system.

    Endocrine

    The endocrine system is not assessed during an evaluation of the abdominal and gastrointestinal organs because it involves the adrenal, pituitary, and thyroid glands.

    Circulatory

    The circulatory system is not assessed during an evaluation of the abdominal and gastrointestinal organs because it is part of the cardiovascular system.

    Reproductive

    The reproductive system is not assessed during an evaluation of the abdominal and gastrointestinal organs; it is assessed during an evaluation of the genitals and reproductive health of the patient.

    Question 21 of 24

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    Which component of the gastrointestinal assessment does the nurse evaluate using the diaphragm of the stethoscope?

    Wheezes

    The nurse assesses for wheezes during the respiratory system assessment.

    Blood flow

    The nurse uses the bell of the stethoscope to listen for blood flow.

    Correct

    Bowel sounds

    The nurse utilizes the diaphragm of the stethoscope to listen to bowel sounds in all four quadrants of the abdomen.

    Breath sounds

    The nurse assesses for breath sounds during the respiratory system assessment.

    Question 22 of 24

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    Which findings would the nurse recognize as abnormal during assessment of the male genitalia?

    Correct

    Rashes

    Rashes can be indicative of contact dermatitis, psoriasis, or genital herpes, and other conditions.

    Correct

    Lesions

    Lesions of the male genitalia can indicate infection.

    Correct

    Masses

    Masses are assessed during the palpation phase of an assessment of the male genitalia.

    Dimpling

    Nurses assess breast tissue for dimpling.

    Correct

    Discharge

    Discharge is assessed during the inspection phase and may indicate testicular torsion or other genitalia-related problems.

    Question 23 of 24

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    Which technique would the nurse use to palpate the breast tissue?

    Both hands

    Using both hands to palpate breast tissue is incorrect technique, as the nurse will not be able to feel smaller masses within the breast.

    Palm of one hand

    Using the palm of one hand to palpate breast tissue will not allow the nurse to find small masses during the breast examination.

    Correct

    Two to three fingers

    The entire breast tissue should be palpated using two to three fingers.

    Thumb and forefinger

    Using just the thumb and forefinger to palpate breast tissue is incorrect technique, potentially causing the nurse to overlook important assessment findings.

    Question 24 of 24

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    During the breast and genital examination, which findings would the nurse document and report to the health care provider?

    Correct

    Lesions on the genitalia

    Lesions, growths, and masses on the genitalia can indicate systemic problems and should be documented and reported.

    Correct

    Presence of hemorrhoids

    The presence of hemorrhoids can cause rectal bleeding, which is an unexpected finding that the nurse should document and report.

    Correct

    Unusual odor or discharge

    Unusual odor or discharge is a sign of infection and should be documented and reported.

    Correct

    Excoriation of the breast tissue

    Rashes, lesions, or excoriation of the breast tissue could be indicative of breast cancer, and the nurse should document and report the findings.

    Symmetry of the breast tissue

    Extreme asymmetry, not symmetry, of the breast tissue should be documented and reported.

    Chapter 16, Nursing Assessment Focused Assessments Answers

  • Foley catheter insertion quiz

    Foley catheter insertion quiz

    Results for question 1.

    1

    1 / 1 point

    Multiple Choice

    A nurse is preparing a patient for Foley catheter insertion. Which of the following is the correct technique for cleansing the urethral area before catheter insertion?

    Do not cleanse the urethral area if the patient has recently showered

    , Not Selected

    Use the same swab for the entire cleansing process

    , Not Selected

    Correct answer:

    Clean from the urethral meatus in a circular outward in males

    Clean the area from back to front in females

    , Not Selected

     

    GET HELP HERE

    Results for question 2.

    2

    1 / 1 point

    Multiple Choice

    A nurse is inserting a Foley catheter and accidentally touches a non-sterile surface with the catheter. What is the best action?

    Proceed with insertion as long as the area touched is above the balloon

    , Not Selected

    Wipe the catheter tip with an alcohol swab and continue

    , Not Selected

    Correct answer:

    Discard the catheter and use a new sterile one

    Flush the catheter with sterile saline before insertion

    , Not Selected

    Foley catheter insertion quiz – Results for question 3.

    3

    1 / 1 point

    Multiple Choice

    What is the best way to prevent a catheter-associated urinary tract infection (CAUTI)?

    Flush the catheter with sterile saline every 8 hours

    , Not Selected

    Disconnect the drainage bag periodically to clean it

    , Not Selected

    Change the catheter every 24 hours

    Foley catheter insertion
    quiz

    , Not Selected

    Correct answer:

    Perform daily perineal hygiene and remove the catheter as soon as possible

    Results for question 4.

    4

    1 / 1 point

    Multiple Choice

    A nurse is educating a patient with an indwelling catheter on infection prevention. Which of the following statements by the patient indicates a need for further teaching?

    “I should perform perineal care daily and after bowel movements.”

    , Not Selected

    “I should drink plenty of fluids unless my provider tells me otherwise.”

    , Not Selected

    “I should keep the drainage bag below my bladder at all times.”

    , Not Selected

    Correct answer:

    “I can disconnect the catheter tubing from the drainage bag to clean it.”

    Results for question 5.

    5

    1 / 1 point

    Multiple Choice

    A postoperative patient with a Foley catheter reports discomfort and pressure in the lower abdomen. What should the nurse do first?

    Administer pain medication as prescribed

    , Not Selected

    Increase the patient’s IV fluids

    , Not Selected

    Remove the catheter immediately

    , Not Selected

    Correct answer:

    Assess the catheter for kinks or obstruction

    Foley catheter insertion quiz