Phillips's Manual of I.V. Therapeutics: Evidence-Based Practice for Infusion Therapy 6th Edition by Lisa Gorski MS, RN, HHCNS-BC, CRNI®, FAAN SAMPLE Chapter 1. An Overview of Professional Practice Issues and Infusion Therapy Identify the choice that best completes the statement or answers the question. 1. A nurse is attempting to initiate I.V. therapy for a client diagnosed with gastroenteritis. The client is combative and resists the nurse’s efforts to start the I.V. Which action by the nurse would result in an intentional tort? A. Failing to document the client’s combativeness B. Refusing to wear gloves while starting the I.V. C. Failing to report the client’s combativeness to a physician D. Starting an I.V. on a coherent client against the client’s wishes 2. A nurse who is caring for clients understands that he or she should provide care that meets at least the minimum standards of practice for nursing. Which phrase regarding standards of practice is most accurate? A. Standards of practice focus on the care provider and define needed activities and behaviors. B. Standards of practice focus on the recipient of care and describe the outcomes of care. C. Standards of practice are written laws enacted by the legislature. D. Standards of practice are the result of the performance of a function or process. 3. Which incident would cause a nurse to be named as a defendant in a malpractice suit? A. The nurse notes blood return noted in a peripheral IV catheter line. B. The nurse reports early signs of infection from a peripheral line inserted by a nurse on another unit C. The nurse places two peripheral IV catheters in a patient requiring emergency IV fluids, but only uses one D. The nurse records nerve damage caused by a peripheral IV catheter inserted the previous shift nurse 4. The intravenous route is the most commonly used infusion route. The nurse notes that a client diagnosed with metastatic cancer is receiving an intraosseous infusion. Should the nurse question the healthcare pro- vider’s order? A. Yes; the healthcare provider is not following INS recommendations. B. No; the nurse should never question the healthcare provider’s order when it comes to chemotherapy. C. Yes; this route of infusion is dangerous and not accepted by the INS. D. No; other routes might be appropriate for administration in certain situations and with selected fluids and medications. 5. Which competency assessment method is acceptable for nursing competencies which will occur once per year in the skilled nursing facility? A. Client Evaluation B. Clinical Data C. Sentinel Event Report D. Skills Checklist 6. One of the primary values of the INS designation of CRNI (certified registered nurse, infusion) is to: A. Protect the public B. Attain competence C. Reflect a measurable goal D. Hold nurses accountable 7. Which problem-solving approach to clinical practice is the nurse manager applying when determining patient preference and values for successful clinical outcomes? A. Effective health-care practice B. Evidence-based practice (EBP) C. Answering a burning clinical question D. One’s own clinical expertise 8. Seven days ago the PICC nurse inserted a PICC line into the right forearm of a client diagnosed with cancer. When the nurse checks the client's site today, which nursing process outcome is determined? A. Evaluating cancer treatment B. Implementing asepsis maintenance C. Planning for complication prevention D. Discussing prior cancer therapy 9. Which compensatory model has been applied if the hospitalization rate for CLABSIs (central line-associated bloodstream infections) decreased significantly over the last quarter? A. VBP B. HHRP C. HAC D. HHVBP 10. When called as an expert witness in an upcoming case, the nurse manager employs which techniques? A. Examines evidence and give advice B. Reviews charts and assesses jury selection C. Gives deposition and notifies lawyers of discrepancies D. Testifies and establishes standards of care Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. A nurse is caring for multiple clients in a rehabilitation facility. During the shift, the nurse notes that several clients are on high-risk medications. According to the Risk Evaluation and Mitigation Strategy (REMS) program, when can the U.S. Food and Drug Administration (FDA) require a REMS? (Select all that apply.) A. Before FDA drug approval B. After FDA drug approval C. During a client evaluation D. At an ethics committee meeting E. After client informed consent 2. A new infusion clinic is being started. The nursing supervisor of the new clinic must conform to specific standards of practice when developing nursing policies and procedures for the new program. To which organizational standards of practice must the nurse manager adhere? (Select all that apply.) A. Centers for Disease Control and Prevention (CDC) guidelines B. Infusion Nurses Society (INS) standards C. American Medical Association (AMA) standards D. Oncology Nursing Society (ONS) standards E. U.S. Food and Drug Administration (FDA) 3. A staff nurse is serving on a hospital’s quality-assurance improvement task force. On which qualityassurance improvement models is the task force most likely to focus? (Select all that apply.) A. Standards of care B. Standards of practice C. Performance improvement D. Continuous quality improvement E. Total Quality Management (TQM) 4. Which methods should the nurse use to evaluate achievement of client outcomes prior to discharge? (Select all that apply.) A. Collect data to determine whether standards were met. B. Identify controllable or uncontrollable variables. C. Determine the cause of the problem by comparing actual care with established standards. D. Re-evaluate to determine whether corrective action is effective and improvement in service is obtained. E. Contact The Joint Commission (JCAHO) Web site for standards. 5. While caring for a client, a nurse administers an incorrect dose of medication, causing the client to become ill. The nurse reports the incident to the nurse manager on the unit. The nurse manager then notifies risk management. Which risk-management strategies should be used by the nurse in this situation? (Select all that apply.) A. Documentation B. Physical assessment C. Unusual occurrence reports D. Professional liability insurance E. Systemic analysis of serious adverse events 6. When nurses provide care to clients, nursing actions are governed by established standards of nursing care, as well as both state and federal laws. Which are sources of law? (Select all that apply.) A. Constitution B. Statutes C. State Nurse Practice Acts D. Joint Commission standards E. Centers for Disease (CDC) standards. 7. The nursing supervisor of a new infusion clinic must conform to specific standards of practice when developing nursing policies and procedures for the new program. Which INS risk management strategies help decrease the risk of potential liability to the new clinic? (Select all that apply.) A. Analysis of unusual occurrences B. Root cause analysis of sentinel events C. Evaluation of all patient data and surveys D. Comprehensive and thorough documentation E. Reduction of CLABSI related complications 8. While taking care of a client with multiple sclerosis, the infusion nurse inadvertently gives the client too much alemtuzumab by infusing longer than the recommended two hours. The nurse is proven negligent by which elements of the malpractice claim? (Select all that apply.) A. The nurse has a duty to provide safe, effective treatment. B. The nurse allows the client’s family to watch the infusion. C. The client suffers difficulty breathing and chills during the infusion. D. A breach of care occurs because the nurse administered too much medication. E. The nurse should have offered the P.O. form of alemtuzumab. 9. With in-depth knowledge of community resources, which skill will help the home care infusion nurse provide the best care? (Select all that apply.) A. Meticulous evidence-based care B. Interprofessional communication and collaboration C. Appropriate parenteral nutrition and IV medication D. Ability to write home infusion therapy policy and procedures E. Safe, effective, and competent care 10. A nurse fails to document that an injectable heparin has been given to a client for two weeks. Upon investigation it is determined that the heparin was not given and the nurse was reported to the state board of nursing. Which type of law is the state board using? (Select all that apply.) A. Public law B. Administrative law C. Common law D. Constitutional law E. Statutory law Chapter 1: Professional Practice Concepts for Infusion Therapy Multiple Choice Identify the choice that best completes the statement or answers the question. 1. A nurse is attempting to initiate I.V. therapy for a client diagnosed with gastroenteritis. The client is combative and resists the nurse’s efforts to start the I.V. Which action by the nurse would result in an intentional tort? A. Failing to document the client’s combativeness B. Refusing to wear gloves while starting the I.V. C. Failing to report the client’s combativeness to a physician D. Starting an I.V. on a coherent client against the client’s wishes ANS: D Page: 28 Feedback A. Failure to document does not result in direct injury or harm to a client and is, therefore, not an intentional tort. B. Refusing to wear gloves may inadvertently result in injury or harm, but is not considered an intentional tort. C. Failure to report the behavior to a physician does not result in direct injury or harm to the client and is not considered an intentional tort. D. Intentional torts include assault and battery, false imprisonment, using restraints as a form of false imprisonment, defamation of character, and breach of confidentiality. 2. A nurse who is caring for clients understands that he or she should provide care that meets at least the minimum standards of practice for nursing. Which phrase regarding standards of practice is most accurate? A. Standards of practice focus on the care provider and define needed activities and behaviors. B. Standards of practice focus on the recipient of care and describe the outcomes of care. C. Standards of practice are written laws enacted by the legislature. D. Standards of practice are the result of the performance of a function or process. ANS: A Page: 16 Feedback A. Standards of practice are criteria for measuring performance against the optimal achievable degree of clinical excellence. These standards are formulated to communicate expectations of nursing practice. Agencies are influential in developing standards of practice. B. Standards of practice criteria focus on the care provider, not the care recipient C. Standards of practice are evidence-based guidelines, policies, or protocols not written laws. D. Standards of practice may occur in response to unanswered questions, limited research, and/or performance issues; not necessarily the result of the performance or process. 3. Which incident would cause a nurse to be named as a defendant in a malpractice suit? A. The nurse notes blood return noted in a peripheral IV catheter line. B. The nurse reports early signs of infection from a peripheral line inserted by a nurse on another unit C. The nurse places two peripheral IV catheters in a patient requiring emergency IV fluids, but only uses one D. The nurse records nerve damage caused by a peripheral IV catheter inserted the previous shift nurse ANS: D Page: 29 Feedback A. Blood return at the catheter site is normal. B. Reporting early signs of infection is expected. C. Using one peripheral IV catheter may be warranted. D. The nurse had a duty to do no harm to the client and the client suffered actual harm or injury. 4. The intravenous route is the most commonly used infusion route. The nurse notes that a client diagnosed with metastatic cancer is receiving an intraosseous infusion. Should the nurse question the healthcare provider’s order? A. Yes; the healthcare provider is not following INS recommendations. B. No; the nurse should never question the healthcare provider’s order when it comes to chemotherapy. C. Yes; this route of infusion is dangerous and not accepted by the INS. D. No; other routes might be appropriate for administration in certain situations and with selected fluids and medications. ANS: D Page: 3 Feedback A. Infusion Nurses Society (INS) Standards, infusion therapy is provided with attention to safety and quality with individualized care that is collaborative, culturally sensitive, and age appropriate. B. If there are questions about care the nurse (and client) should feel comfortable enough to ask the healthcare provider and evidence-based criteria should be the basis for practice answers. C. This is an acceptable router per INS standards. There are risks, some complications are serious and even life-threatening, and many complications are preventable with sound nursing care. The nurse must have a thorough understanding and knowledge of the type of access device being utilized, potential complications of infusion solutions, and safe infusion administration. D. The intravenous (I.V.) route is the most commonly used infusion route; however, other infusion routes include intraosseous, subcutaneous, and intraspinal. In this case, the intraosseous route might be appropriate for administration with the selected fluids and medications. 5. Which competency assessment method is acceptable for nursing competencies which will occur once per year in the skilled nursing facility? A. Client Evaluation B. Clinical Data C. Sentinel Event Report D. Skills Checklist ANS: D Page: 4 Feedback A. Client evaluation is concern that may drive competency validation, but is not a method of competency assessment. B. Clinical data is based on outcome criteria that drives competency validation, but is not a method of competency assessment. C. Sentinel event reports are another form of competency validation, but they are not methods of competency assessment. D. Competency assessment methods include performance measures related to patient care, such as skills, knowledge, ability, and judgement that includes objective, measureable assessment of the actual performance in the form of checklists. 6. One of the primary values of the INS designation of CRNI (certified registered nurse, infusion) is to: A. Protect the public B. Attain competence C. Reflect a measurable goal D. Hold nurses accountable ANS: A Page: 6 Feedback A. Certification is a mark of excellence, validates nursing knowledge and skills, and protects the public. B. An INS Standard is that the clinician is responsible and accountable for attaining and maintaining competence with infusion therapy administration and venous access device insertion/management. C. Competency statements need to reflect a measurable goal. D. All professional nurses are accountable and responsible for all parts of the tasks associated with infusion therapy. 7. Which problem-solving approach to clinical practice is the nurse manager applying when determining patient preference and values for successful clinical outcomes? A. Effective health-care practice B. Evidence-based practice (EBP) C. Answering a burning clinical question D. One’s own clinical expertise ANS: B Page: 7 Feedback A. Effective health-care practice is an essential characteristic of evidence-based practice. B. EBP is a problem-solving approach to clinical practice and administrative issues that integrates patient preference and values. C. EBP is a systematic search for and critical appraisal of the most relevant evidence to answer a burning clinical question. D. EBP is a problem-solving approach that integrates one’s own clinical expertise. 8. Seven days ago the PICC nurse inserted a PICC line into the right forearm of a client diagnosed with cancer. When the nurse checks the client's site today, which nursing process outcome is determined? A. Evaluating cancer treatment B. Implementing asepsis maintenance C. Planning for complication prevention D. Discussing prior cancer therapy ANS: A Page: 13 Feedback A. As the cancer treatment begins, the evaluation phase begins. The plan of care should be based on the conclusion that the outcome has not been met at this time. B. Maintenance of asepsis is the implementation or action plan of the nursing process. C. Planning utilizes techniques to prevent complications D. Discussion of prior cancer therapy is a subjective assessment. 9. Which compensatory model has been applied if the hospitalization rate for CLABSIs (central line-associated bloodstream infections) decreased significantly over the last quarter? A. VBP B. HHRP C. HAC D. HHVBP ANS: C Page: 18 Feedback A. Value-based purchasing (VBP) is a pay-for-performance program mandated by the Affordable Care Act (ACA). B. Hospital readmissions reduction program (HRRP) is a pay-for-performance program mandated by the Affordable Care Act (ACA). C. Hospital-acquired conditions (HAC) pay-for-performance program mandated by the Affordable Care Act (ACA). CLABSIs are hospital acquired. D. Home health value-based purchasing is a model pay-for-performance program implemented for home health. 10. When called as an expert witness in an upcoming case, the nurse manager employs which techniques? A. Examines evidence and give advice B. Reviews charts and assesses jury selection C. Gives deposition and notifies lawyers of discrepancies D. Testifies and establishes standards of care ANS: A Page: 30 Feedback A. Serving as an expert witness involves examining evidence, reviewing nursing literature, giving depositions, and testifying in court. B. Reviewing charts and assessing jury selection are not functions of an expert witness. C. Expert witnesses do not notify lawyers of discrepancies. D. Establishing standards of care is not a function of an expert witness. Multiple Response Identify one or more choices that best complete the statement or answer the question. 1. A nurse is caring for multiple clients in a rehabilitation facility. During the shift, the nurse notes that several clients are on high-risk medications. According to the Risk Evaluation and Mitigation Strategy (REMS) program, when can the U.S. Food and Drug Administration (FDA) require a REMS? (Select all that apply.) A. Before FDA drug approval B. After FDA drug approval C. During a client evaluation D. At an ethics committee meeting E. After client informed consent ANS: A, B Page: 19 Feedback A. Before approval of the drug if the FDA determines a REMS is necessary to ensure that the benefits of the drug outweigh the risks. B. Postapproval if the FDA becomes aware of new safety information and determines that a REMS is necessary to ensure that the benefits of the drug outweigh the risks. C. The FDA does not require a REMS during a client evaluation. D. The FDA does not require a REMS at an ethics committee meeting. E. The FDA does not require a REMS after client informed consent. 2. A new infusion clinic is being started. The nursing supervisor of the new clinic must conform to specific standards of practice when developing nursing policies and procedures for the new program. To which organizational standards of practice must the nurse manager adhere? (Select all that apply.) A. Centers for Disease Control and Prevention (CDC) guidelines B. Infusion Nurses Society (INS) standards C. American Medical Association (AMA) standards D. Oncology Nursing Society (ONS) standards E. U.S. Food and Drug Administration (FDA) ANS: A, B, D Page: 6, 9, 16 Feedback A. The nurse manager must adhere to the guidelines of the CDC. B. The nurse manager must adhere to the guidelines of the INS. C. The AMA does not provide guidelines for nursing standards of practice. D. The nurse manager must adhere to the guidelines of the ONS. E. The FDA does not provide guidelines for nursing standards of 3. A staff nurse is serving on a hospital’s quality-assurance improvement task force. On which qualityassurance improvement models is the task force most likely to focus? (Select all that apply.) A. Standards of care B. Standards of practice C. Performance improvement D. Continuous quality improvement E. Total Quality Management (TQM) ANS: B, C, D, E Page: 15–17 Feedback A. Standards of practice care focus on the provider, and define the activities and behaviors needed to achieve patient outcomes. B. The task force is most likely to focus on Standards of practice. This as a qualityassurance model focuses on the recipient of care. C. The task force is most likely to focus on Performance improvement. This quality-assurance model focuses on the recipient of care as a quality-assurance model. D. The task force is most likely to focus on Continuous quality improvement . This quality-assurance model focuses on the recipient of care. E. Total quality management (TQM) is a quality-assurance model that focuses on maximizing customer satisfaction. 4. Which methods should the nurse use to evaluate achievement of client outcomes prior to discharge? (Select all that apply.) A. Collect data to determine whether standards were met. B. Identify controllable or uncontrollable variables. C. Determine the cause of the problem by comparing actual care with established standards. D. Re-evaluate to determine whether corrective action is effective and improvement in service is obtained. E. Contact The Joint Commission (JCAHO) Web site for standards. ANS: A, B, C, D Page: 36 Feedback A. Collection is part of the nursing process. B. Identification is part of the nursing process. C. Determination of the cause of the problem is part of the nursing process. D. Evaluation of data to determine effective action is part of the nursing process. E. TJC JCAHO is a nonprofit organization that accredits health-care facilities and works to improve client care and safety. 5. While caring for a client, a nurse administers an incorrect dose of medication, causing the client to become ill. The nurse reports the incident to the nurse manager on the unit. The nurse manager then notifies risk management. Which risk-management strategies should be used by the nurse in this situation? (Select all that apply.) A. Documentation B. Physical assessment C. Unusual occurrence reports D. Professional liability insurance E. Systemic analysis of serious adverse events ANS: A, C, D, E Page: 29, 36 Feedback A. A complete written account of care given to the client is a risk-management strategy. B. Physical assessment is not considered a risk-management strategy. C. Written unusual occurrence reports are a risk-management strategy. D. Professional liability insurance to protect the nurse is a risk-management strategy. E. Systemic analysis of serious adverse events is a risk-management strategy. 6. When nurses provide care to clients, nursing actions are governed by established standards of nursing care, as well as both state and federal laws. Which are sources of law? (Select all that apply.) A. Constitution B. Statutes C. State Nurse Practice Acts D. Joint Commission standards E. Centers for Disease (CDC) standards. ANS: A, B, C Page: 27, 29 Feedback A. The constitution provides laws that govern nursing practice. B. Statutes provide laws that govern nursing practice. C. State Nurse Practice Acts provide laws that govern nursing practice. D. The Joint Commission, along with the American Nurses Association and specialty organizations, establishes standards of nursing care. E. The Centers for Disease (CDC) in conjunction with the American Nurses Association and specialty organizations, establishes guidelines and standards of nursing care. 7. A The nursing supervisor of a new infusion clinic must conform to specific standards of practice when developing nursing policies and procedures for the new program. Which INS risk management strategies help decrease the risk of potential liability to the new clinic? (Select all that apply.) A. Analysis of unusual occurrences B. Root cause analysis of sentinel events C. Evaluation of all patient data and surveys D. Comprehensive and thorough documentation E. Reduction of CLABSI related
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