Deck 14: Health Planning for Acute Care Settings

Question 1

A nurse is reviewing the Healthy People objectives related to cardiovascular disease and stroke and decides to develop an intervention to reduce hospitalizations of older people with heart failure. Which of the following is an example of an intervention at the level of secondary prevention?
1)Conducting a screening program at local senior centers to help identify persons who may have early stages of heart failure.
2)Developing a family-based discharge program for heart failure patients with a history of readmissions in less than thirty days.
3)Having patients who have been diagnosed with heart failure complete a chronic disease self-management program once they have been discharged from the hospital.
4)Conducting a good nutrition and exercise program at the local older adult housing complex.

Answer 1

1

Question 2

Adam is writing a proposal for a performance improvement study related to care of adolescent patients presenting in the emergency department (ED) with suicidal ideation. As part of his study, he wishes to conduct chart reviews for all adolescent patients seen in the ED over the past 6 months. How should he proceed?
1)Obtain the records from the EMR or the medical records department as required by the hospital.
2)Inform the physicians caring for the patients why he needs to review the records prior to conducting the medical record review.
3)Present the proposal to the hospital Institutional Review Board for review and obtain permission from them prior to doing the study.
4)The nurse is not able to use the records because it is a violation of HIPAA.

Answer 2

3

Question 3

A nurse is planning specific interventions aimed at reducing the rate of complications due to uncontrolled blood sugar levels in the diabetes population with repeat admissions to hospital. The word population is primarily being used from the perspective of:
1)Public health context.
2)Hospital setting.
3)Cultural context.
4)None of the above.

Answer 3

2

Question 4

One of the concerns at a large urban hospital is the increase in Ventilator Associated Pneumonia (VAP) and the hospital board has asked the Infection Control Committee to look into it. Major risk factors for VAP that the infection control nurse states must be included in their initial assessment of the problem include: (Select all that apply.)
1)Length of stay before onset of the disease.
2)Multiple drug-resistant pathogens.
3)Type of ventilator equipment used at the institution.
4)Patient-nurse ratio.

Question 5

Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital's community health outreach program team with a focus on cardiovascular disease. The team finds that a major issue is treatment of women especially those who present with atypical symptoms. The team asks Megan to partner with the local television station to create a public service announcement (PSA) discussing heart disease in women. Megan incorporates into the PSA the fact that women often experience the symptoms of a heart attack differently than men. These symptoms can include:
1)Abdominal pain.
2)Nausea.
3)Difficulty breathing.
4)All of the above.

Question 6

A nurse is caring for a young child who is suspected of having meningitis. A spinal tap culture is pending. If it comes back positive for N. meningitidis, from a public health perspective it is important that the nurse:
1)Provide his family with information about the disease in simple to understand language.
2)Inform the public health department, the child's day care, and other caregivers so they can monitor for symptoms of the infection.
3)Promptly admit the child to the ICU.
4)Double the dose of antibiotics.

Question 7

A nurse is answering telephone calls from a triage line. A call comes in from a 62-year-old woman who has complaints of unusual fatigue, abdominal pain, and nausea. She denies eating anything unusual that day. What should the nurse advise her to do?
1)Rest and take an antacid.
2)Call her physician in the morning.
3)Go to the nearest emergency department.
4)Schedule an appointment with a cardiologist next week.

Question 8

At a large urban hospital, the nursing council is concerned with optimizing post-hospital discharge outcomes for patients. Which of the following actions would the nurses most likely recommend as standard of care?
1)Performing a discharge assessment before each patient leaves the hospital.
2)Performing a home health visit before the patient is discharged to assess if it is a safe environment.
3)Making a referral for post-discharge home health visits for all patients who have been hospitalized.
4)Making a referral to social services for all patients prior to discharge.

Question 9

A nurse manager is presenting an in-service to the rest of the nurses on the floor. They are discussing the recent spread of vancomycin-resistant enterococci (VRE) within the hospital and how to prevent transmission on their floor. Which of the following are recommended procedures for reducing transmission?
1)Use of disposable gloves, negative pressure rooms, the use of a disposable gown if washing or turning the patient, or changing diapers
2)Use of disposable gloves, hand washing, reverse isolation
3)Use of masks, hand washing, the use of a disposable gown if washing or turning the patient, or changing diapers
4)Use of disposable gloves, hand washing, the use of a disposable gown if washing or turning the patient, or changing diapers

Question 10

Susan has been assigned a 56-year-old patient in the intensive care unit who is recovering from bypass cardiac surgery. She is primarily providing what level of prevention?
1)Primary
2)Secondary
3)Tertiary
4)Selected

Question 11

A nurse is reviewing the hospital's statistics in comparison with the Institute for Healthcare Improvement (IHI) "100,000 Lives Campaign" to see what the facility could do to improve safety within the organization. What statistics should the nurse look at? (Select all that apply.)
1)Use of rapid response teams
2)Central line infections
3)Ventilator-assisted pneumonia
4)Pressure ulcers/wounds
5)Number of falls

Question 12

A nurse working on a medical surgical unit in a large urban hospital is evaluating the hospital's discharge rate for congestive heart failure and wants to see how it compares with national statistics. Which national resource is available that specifically tracks hospital discharge data?
1)Healthcare Cost and Utilization Project
2)Healthy People 2020
3)Centers for Disease Control and Prevention
4)Institutional Review Board

Question 13

During her orientation, a new graduate nurse is attending a lecture by the Infection Control Nurse on the prevention of health care-associated infections (HAI). She learns that the following are the major issues related to HAIs:
1)Pneumonia, urinary tract infections, and ventilator-associated infections
2)Sepsis/bacteremias, pneumonia, and urinary tract infections
3)Sepsis/bacteremias, pneumonia, Clostridium difficile infections
4)Pneumonia and urinary tract infections

Question 14

A nurse is looking to develop a new policy to address the rising rate of central line infections in their medical ICU. The nurse speaks with the nurse manager about utilizing the Plan-Do-Study-Act (PDSA) approach instead of simply developing new ICU protocols. Which of the following is not a benefit of using this system?
1)New protocols can be tested before implementing them throughout the hospital ICUs.
2)The staff can work with manufacturers of the medical equipment to determine how the central line trays can be arranged more efficiently.
3)They can figure out what works on the large scale fairly quickly.
4)The nurses can figure out what other processes need to be addressed with the new policy changes.

Question 15

Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital's community health outreach program team with a focus on cardiovascular disease. Megan's report to the performance improvement committee at the hospital results in the decision to examine whether a specific protocol is needed for the care of women presenting to the emergency department (ED) with atypical symptoms of a heart attack. The nurse finds that the average door-to-balloon time - the interval that starts with the patient's arrival in the emergency department and ends when a catheter guidewire crosses the culprit lesion in the cardiac catheter lab - in their hospital is 64 minutes with the longest time being 84 minutes. How does Megan proceed?
1)No need to address this-the average door-to-balloon time is well within the desired guidelines.
2)Perform a hospital and ED assessment to see where these patients are being held up.
3)Mandate EKGs for every patient who comes into the emergency room.
4)Create a separate wing of the ED especially for suspected cardiac patients.

Question 16

Megan is the nurse chair of the performance improvement committee for a small community hospital. She has been asked to work with the hospital's community health outreach program team with a focus on cardiovascular disease. Megan begins by reviewing hospital discharge data as part of the initial review of patients with cardiovascular disease. Because she wants to use a taxonomy that categorizes diagnoses into mutually exclusive groups, which taxonomy should she use?
1)ICD10 codes
2)Major diagnostic categories (MDCs)
3)Recidivism rates
4)ALOS statistics