A nurse is assessing a client who has heart failure two months after the implementation of a quality improvement initiative to reduce the hospital readmission rate. Which of the following findings should the nurse identify as an indication the quality improvement initiative is successful?

Presence of jugular vein distention

Increased weight of 2.27 kg (5 lb) in one week

Decreased brain natriuretic peptide levels

Development of S3 heart sounds

Answer and Explanation

The Correct Answer is C

A. The presence of jugular vein distention indicates fluid overload and is a sign of worsening heart failure, which would not suggest a successful initiative.

B. An increased weight of 2.27 kg (5 lb) in one week is indicative of fluid retention, a common sign of heart failure exacerbation, suggesting the initiative is not effective.

C. Decreased brain natriuretic peptide (BNP) levels indicate improved cardiac function and a reduction in heart failure symptoms, reflecting the success of the quality improvement initiative aimed at reducing hospital readmissions.

D. The development of S3 heart sounds is often associated with heart failure and fluid overload, indicating a worsening condition rather than improvement.

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Correct Answer is D

Explanation

A. Taking over the client's care may temporarily solve the problem but does not address the conflict or facilitate a resolution between the two nurses.

B. Termination is an extreme action and is not warranted in this situation. Conflict resolution should be attempted before considering disciplinary actions.

C. While mediation may be helpful, it is not the most immediate solution in this situation. The charge nurse can initially intervene directly to de-escalate the situation.

D. Escorting the nurses to the lounge allows them to continue the conversation in a more private setting, away from patients and other staff, reducing disruption to the work environment. It also gives the charge nurse a chance to mediate and calm the situation.

A. Notify the provider. B. Complete an incident report. C. Inform the nursing supervisor. D. Observe the client's condition.

Correct Answer is D

Explanation

A. Notifying the provider is essential, but the immediate priority is to assess the client's current condition to determine if there are any adverse effects from the additional dose.

B. Completing an incident report is necessary for documentation and accountability but should follow the immediate assessment of the client's condition.

C. Informing the nursing supervisor is important for communication and oversight, yet the nurse must first observe the client to evaluate any immediate effects of the medication error.

D. Observing the client's condition is the first action because it helps to identify any potential complications or adverse reactions resulting from the additional dose of medication.

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A nurse is assessing a client who has heart failure two months after the implementation of a quality improvement initiative to reduce the hospital readmission rate. Which of the following findings should the nurse identify as an indication the quality improvement initiative is successful?

Nursing Test Bank

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