A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first?

Require staff nurses to demonstrate competency by passing a medication administration examination

Provide an in-service on medication administration to at the nurses

Develop a quality improvement program for nurses involved in medication administration errors

Renew the events lead up to each medication administration error

Answer and Explanation

The Correct Answer is D

A. Requiring staff nurses to demonstrate competency by passing a medication administration examination: While competency assessments are essential, initiating this as the first strategy may not address the root causes of medication administration errors. It's important to first understand the specific factors contributing to errors by reviewing the events leading up to each error before implementing competency assessments. This allows for a targeted approach to addressing gaps in knowledge or skills related to medication administration.
B. Providing an in-service on medication administration to all nurses: While education and training are valuable components of error reduction strategies, providing an in-service as the first step may not address the underlying system issues contributing to medication errors. Education should complement other interventions aimed at improving the medication administration process, such as system redesign or standardization of practices.
C. Developing a quality improvement program for nurses involved in medication administration errors: Implementing a quality improvement program for nurses involved in errors is important for learning from mistakes and preventing recurrence. However, developing such a program should be informed by a thorough analysis of the events leading to errors. Without understanding the root causes, it may be challenging to develop effective improvement initiatives.
D. Reviewing the events leading up to each medication administration error: This strategy is the most appropriate initial step. Conducting a detailed review of each error allows the committee to identify patterns, common factors, and system issues contributing to medication errors. By understanding the specific circumstances surrounding each error, the committee can develop targeted interventions to address root causes and prevent future errors. This approach aligns with the principles of continuous quality improvement, focusing on data-driven analysis and proactive problem-solving.

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Correct Answer is C

Explanation

A. Secure the restraints to the lowest bar of the side rail:
This is incorrect. Restraints should not be secured to the side rails of the bed because the client may injure themselves by attempting to climb over the side rail or if the bed adjusts, it can cause excessive pressure on the restrained limb.
B. Ensure four fingers under the restraints to prevent constriction:
This is incorrect. The nurse should be able to slide two fingers under the restraint to ensure it is not too tight, rather than four fingers. Restraining too loosely may allow the client to slip out, while restraining too tightly can cause tissue damage or compromise circulation.
C. Secure the restraints using a quick-release tie:
This is the correct action. Restraints should always have quick-release ties to allow for quick removal in case of an emergency or if the client needs to be repositioned or assisted. Velcro or buckle restraints with quick-release mechanisms are commonly used to ensure easy removal.
D. Anticipate removing the restraints every 4 hr:
While it's essential to regularly assess the need for continued restraint use and ensure restraints are not overly restrictive, there's no set time interval for removing restraints. Restraints should be removed as soon as they are no longer necessary to ensure the client's safety and comfort.

A. Do not palpate abdomen B. Contact precautions C. Collect all urine D. No venipuncture or blood pressure in left arm

Correct Answer is A

Explanation

A. Do not palpate abdomen: Wilms tumor, also known as nephroblastoma, is a type of kidney cancer that primarily affects children. Palpation of the abdomen in a child with Wilms tumor can potentially rupture the tumor capsule and lead to dissemination of cancer cells or cause bleeding. Therefore, it is essential to instruct healthcare providers and caregivers not to palpate the child's abdomen to avoid complications.
B. Contact precautions: Contact precautions are not typically indicated for Wilms tumor. Contact precautions are implemented to prevent the transmission of infectious agents that are spread by direct or indirect contact with the client or their environment. Wilms tumor is not contagious and does not require contact precautions.
C. Collect all urine: While collecting urine may be necessary for diagnostic purposes and monitoring kidney function in a child with Wilms tumor, it is not the primary warning associated with the condition. The priority warning for Wilms tumor focuses on avoiding palpation of the abdomen to prevent potential complications.
D. No venipuncture or blood pressure in left arm: While venipuncture or blood pressure measurement in the left arm may be contraindicated in some situations, such as when a client has a central venous catheter or arteriovenous fistula, it is not specifically associated with Wilms tumor. The primary concern with Wilms tumor is to avoid palpation of the abdomen due to the risk of tumor rupture and dissemination of cancer cells.

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A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first?

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A newly licensed nurse is applying prescribed wrist restraints on a client. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A child is admitted with a suspected diagnosis of Wilms tumor. The nurse should place a sign with which of the following warnings over the child's bed?

Correct Answer is A

Explanation

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