Evolve Case Study: Management of a Medical Unit

Initial Priorities At the beginning of his shift, Mr. Young identifies several problems that need attention. 1. Which client situation requires the most immediate intervention by the charge nurse? A) New onset ST segment elevation is observed on the telemetry monitor of a client admitted with angina. Feedback: CORRECT This electrocardiogram (ECG) finding indicates ischemic changes which require immediate client assessment and management to prevent myocardial damage. B) A client with hyponatremia is becoming increasingly confused, disoriented, and agitated. Feedback: INCORRECT This client does require assessment and intervention to ensure client safety. However, another client requires immediate intervention. C) The white blood cell count (WBC) of a client with cellulitis increases from 8,000 to 15,000 mm3. Feedback: INCORRECT This lab result indicates a worsening of the client's infection, so assessment and intervention are indicated. However, another client requires immediate intervention. D) A client starting treatment for tuberculosis develops a productive cough of mucopurulent sputum. Feedback: INCORRECT This is an expected finding for a client with tuberculosis. Therefore, this client does not require immediate intervention. Points Earned: 1.0/1.0 Correct Answer(s): A As he enters the client's room, Mr. Young hears his name paged over the intercom. He learns that the emergency department needs to give report on a client to be admitted to the medical unit as soon as possible. 2. What action should Mr. Young take? A) Return to the nursing unit desk to obtain report. Feedback: INCORRECT This action does not have the highest priority. B) Take the report over the telephone from the client's room. Feedback: INCORRECT This action does not allow the charge nurse to give his full attention to the unstable client. C) Request that another staff RN obtain the report. Feedback: CORRECT Another RN can obtain the report, while the charge nurse gives his full attention to assessment of the unstable client.  D) Advise the unit secretary to write down the report. Feedback: INCORRECT The unit secretary does not have sufficient knowledge or the expertise to obtain a report on a client. Points Earned: 0.0/1.0 Correct Answer(s): C Delegation of Care While Mr. Young is assessing the client with ECG changes, the client reports that he just experienced an episode of chest pain and took a dose of nitroglycerine that he brought from home. The UAP enters the room and informs Mr. Young that the confused client with hyponatremia is attempting to climb over the bedrails. 3. How should the charge nurse respond to this situation? A) Instruct the client with angina to call if further assistance is needed, and advise all available staff to help with the confused client. Feedback: INCORRECT This response does not ensure safe continued care of the client with angina. B) Remain with the client who has angina and assign an PN to monitor the confused client while the UAP obtains a bed alarm. Feedback: CORRECT The client with angina and ECG changes remains unstable and requires the expertise of the charge nurse to assess and manage his care. The PN, assisted by the UAP, can safely monitor a confused client to prevent injury. C) Assess the confused client and assign the UAP to take the vital signs of the client with angina. Feedback: INCORRECT The client with angina and ECG changes remains unstable and requires nursing care beyond the scope of the UAP. D) Implement fall precautions for the confused client and assign the PN to assess the client with angina. Feedback: INCORRECT This assignment does not demonstrate the best utilization of the available nursing staff. Points Earned: 0.0/1.0 Correct Answer(s): B A newly licensed nurse is assigned to the unit, obtains the vital signs of the client with cellulitis whose WBC has increased from 8,000 to 15,000 mm3. The nurse reports the vital signs to Mr. Young as: T 102° F, P 112, R 28, and BP 84/42. 4. Who should the charge nurse assign to care for this client? A) An experienced PN. Feedback: INCORRECT The client’s manifestations require a different level of expertise than that provided by an PN. B) The newly licensed nurse, assisted by an experienced UAP. Feedback: INCORRECT The newly licensed nurse and the experienced UAP do not have the expertise to care for a client with these manifestations. C) The newly licensed nurse and staff nurse preceptor. Feedback: CORRECT The client is exhibiting manifestations of septic shock, a potentially fatal problem. The newly licensed nurse does not yet have the expertise to respond to this situation independently, and will best obtain the needed experience by working closely with the staff nurse preceptor. D) The newly licensed nurse alone. Feedback: INCORRECT The newly licensed nurse does not yet have the expertise to respond to this situation independently. Points Earned: 1.0/1.0 Correct Answer(s): C Staff Communication After the immediate problems are resolved, Mr. Young completes client care assignments for the staff. He assigns an PN to provide care to a client with pneumonia caused by methicillin-resistant staphylococcus aureus (MRSA). Airborne precautions are required to prevent transmission to healthcare providers and other clients. The PN requests a change in assignment, stating that, due to her pregnancy, she is concerned about entering isolation rooms. 5. How should the charge nurse respond? A) "As a staff member, you have to care for your fair share of the clients just like everyone else." Feedback: INCORRECT Another response demonstrates a more considerate, caring approach to the concerns voiced by the PN. B) "No one likes to care for clients in isolation. How do you expect me to change assignments now?" Feedback: INCORRECT Another response demonstrates a more considerate, caring approach to the concerns voiced by the PN. C) "What concerns do you have about your pregnancy and this client care situation?" Feedback: CORRECT The charge nurse should first determine what concerns the PN has related to the situation before making a decision about changing the assignment. D) "I did not consider your pregnancy in making assignments. I will change your assignment." Feedback: INCORRECT It should not be necessary to consider the nurse's pregnancy in making this assignment. There is a better response. Points Earned: 1.0/1.0 Correct Answer(s): C The PN continues to express fear that this client care situation will place her pregnancy at risk. The PN states, "I know that my fear is ungrounded if I follow isolation precautions, but this situation makes me really uncomfortable." 6. When adhering to the ethic of caring in a leadership role while still maintaining client safety, what is the best action for the charge nurse to implement? A) Assign another PN to care for the client and reassign the pregnant PN to other clients. Feedback: CORRECT Since the PN is not refusing the assignment, and because her request is not based on discrimination or lack of knowledge, the charge nurse may choose to respond to the PN’s concern in a caring manner by changing the assignment.  B) Advise the PN that the UAP can do the majority of the client care in the room. Feedback: INCORRECT While this option may be caring, it affects client safety. The nurse assigned to the client must be prepared to spend time in the client's room to ensure safe effective care. C) Continue to reassure the pregnant PN that it is safe for her to care for the client with MRSA. Feedback: INCORRECT The charge nurse may choose to encourage the PN to keep the original client care assignment, but another action demonstrates a more caring decision. D) Assume primary care of the client with MRSA so the PN does not need to go in the room. Feedback: INCORRECT This action demonstrates caring toward the PN, but jeopardizes overall client safety on the unit. The charge nurse needs to be available to manage the overall care on the unit, rather than that of individual clients. Points Earned: 0.0/1.0 Correct Answer(s): A Client Care Assignments Another PN agrees to assume care of the client in isolation and will also be assigned the care of a second client. 7. Which diagnosis and upcoming procedure can best be assigned to this LPN, rather than an RN? A client with: A) Unstable angina scheduled for a cardiac catheterization that day. Feedback: INCORRECT This client is physiologically unstable and requires client teaching before the procedure, and close monitoring after the procedure. B) Osteoporosis scheduled for a bone mineral density test that day. Feedback: CORRECT This client is the most stable of the clients and is scheduled for a test requiring minimal client teaching and preparation. Additionally, the PN will not require a high level of expertise to monitor the post-procedure condition. C) Hepatic encephalopathy scheduled for a liver biopsy that day. Feedback: INCORRECT This client is physiologically unstable and requires client teaching before the procedure, and close monitoring after the procedure. D) Deep vein thrombosis scheduled for a vena cava filter insertion that day. Feedback: INCORRECT This client is physiologically unstable and requires client teaching before the procedure, and close monitoring after the procedure. Points Earned: 1.0/1.0 Correct Answer(s): B A UAP is assigned to assist the PN who is caring for the client with MRSA and the client with osteoporosis. The UAP is also assigned to assist an RN who is caring for a client with cirrhosis, esophogeal varices, and delirium tremens, as well as a client with chronic obstructive pulmonary disease (COPD). 8. Which task can be delegated to the UAP who is assisting the PN and RN in the care of these four clients? A) Notify the respiratory therapist about the oxygen needs of the client with COPD. Feedback: INCORRECT The nurse should communicate treatment needs to the respiratory therapist. The UAP does not have sufficient expertise to convey this information. B) Deliver and prepare the meal tray of the client who is in isolation with MRSA-induced pneumonia. Feedback: CORRECT The UAP is trained in the precautions needed to provide basic care to clients in isolation.    C) Measure and record the abdominal circumference of the client with cirrhosis. Feedback: INCORRECT The UAP does not have sufficient expertise to perform this assessment. D) Review teaching materials about foods that are high in calcium. Feedback: INCORRECT Review of teaching materials should be done by the assigned PN. It is beyond the scope of practice of the UAP. Points Earned: 1.0/1.0 Correct Answer(s): B Team Collaboration The PN notifies the charge nurse that the oxygen saturation level of the client in isolation has decreased to 88%. Mr. Young contacts the unit respiratory therapist immediately about this change. 9. Which action should the respiratory therapist take? A) Write a prescription for an inhaled bronchodilator. Feedback: INCORRECT The respiratory therapist does not have the authority to write prescriptions. B) Increase the rate of oxygen being administered. Feedback: CORRECT The respiratory therapist can evaluate the oxygenation needs of the client and, within defined parameters, adjust oxygen administration accordingly. C) Evaluate the sputum culture and sensitivity report. Feedback: INCORRECT This is not the responsibility of the respiratory therapist. D) Turn and position the client every two hours. Feedback: INCORRECT This is the responsibility of the nursing staff, not the respiratory therapist. Points Earned: 1.0/1.0 Correct Answer(s): B The client with cirrhosis is preparing for discharge the following day. The RN caring for this client seeks Mr. Young's assistance in coordinating discharge plans. 10. Mr. Young consults with the case manager about which aspect of the client's care? A) Evaluating the client's risk of liver failure after discharge. Feedback: INCORRECT This responsibility is not within the role of the case manager. B) Providing discharge teaching about the medications to be taken at home. Feedback: INCORRECT Discharge teaching is typically the responsibility of the staff nurse, not the case manager. C) Initiating a referral for durable medical equipment and home health care. Feedback: CORRECT The case manager initiates referrals and helps the client to manage resources effectively. This is the team member most qualified to initiate referrals for client discharge. D) Establishing the plan of care to be implemented by the home care nurses. Feedback: INCORRECT The home care nurses will establish the plan of care after assessing the client's home care needs. Points Earned: 0.0/1.0 Correct Answer(s): C A newly licensed nurse is assigned the care of a client with an intravenous heparin infusion. The client has a prescribed heparin protocol, and based on the lab results just obtained by the newly licensed nurse, the client's heparin dosage should be increased by 200 units/hour. 11. It is best for the newly licensed RN to collaborate with which team member to ensure that the dosage is adjusted correctly? A) The medical unit charge nurse, Mr. Young. Feedback: INCORRECT Although the unit charge nurse can assist the newly licensed RN with dosage calculation, another team member is a better choice. B) The pharmacist assigned to the medical unit. Feedback: INCORRECT Although the unit pharmacist can assist the newly licensed RN with dosage calculation, another team member is a better choice. C) The staff nurse who is the newly licensed nurse's preceptor. Feedback: CORRECT The staff nurse preceptor has the time, expertise, and responsibility to assist newly licensed RNs through their orientation as they adjust to their new role and work environment. The staff nurse preceptor is also responsible for helping the newly licensed RN to resolve problems, to guide decision-making, and to supervise the care provided by the newly licensed RN. D) The RN who cared for the client the previous day. Feedback: INCORRECT This nurse can assist the newly licensed RN, but another team member is a better choice. Points Earned: 0.0/1.0 Correct Answer(s): C Change in Assignments Late in the afternoon, one of the staff RNs notifies Mr. Young that she is ill and needs to go home. Mr. Young determines that the nurse's client load can be safely reassigned to the present staff, and he chooses not to call in a replacement nurse for the rest of the shift. 12. When changing client care assignments, Mr. Young knows that it is important to assign the client on which medication/solution to the care and expertise of another RN rather than a PN? A) Clopidogrel (Plavix) following a transient ischemic attack (TIA). Feedback: INCORRECT This client does not require as great a level of expertise as another client. B) Lactated Ringer’s solution following a barium swallow procedure. Feedback: INCORRECT This client does not require as great a level of expertise as another client. C) Pantoprazole (Protonix) for newly diagnosed peptic ulcer disease. Feedback: INCORRECT This client does not require as great a level of expertise as another client. D) An insulin/potassium infusion to treat diabetic ketoacidosis (DKA). Feedback: CORRECT This client is the most physiologically unstable and is most likely to experience complications from the treatment being provided. An RN should be assigned to care for the client requiring the highest level of expertise and effective critical thinking to ensure safe client care. Points Earned: 1.0/1.0 Correct Answer(s): D In order to do this, one of the clients will be reassigned to a PN who discharged one of her assigned clients an hour earlier. 13. Which one of the RN's clients can best be assigned to the PN? A) A 56-year-old female client with anemia due to long-term chronic renal failure who is scheduled for a hemodialysis treatment that afternoon. Feedback: CORRECT This client is stable. Of these four clients, this client is best to be assigned to the PN.  B) A 47-year-old male client who has been receiving meperidine (Demerol) via patient-controlled analgesia (PCA) for six days to treat intractable low back pain. Feedback: INCORRECT This client requires a high level of professional expertise to prevent the potential complications of this treatment. C) A 62-year-old female client newly diagnosed with emphysema who needs instruction on breathing techniques and inhaler use. Feedback: INCORRECT The RN has the responsibility and expertise to provide initial client teaching. The PN can then reinforce the instruction initially provided by the RN. D) A 42-year-old male client with coronary artery disease who returned to the unit one hour ago following cardiac catheterization and stent placement. Feedback: INCORRECT This client requires a high level of expertise to effectively assess for post-procedure complications and provide needed client teaching and support. This level of care is best provided by the RN. Points Earned: 0.0/1.0 Correct Answer(s): A Supervision of Care A UAP is assisting the RN in the care of the client with low back pain who is receiving meperidine (Demerol) via patient-controlled analgesia (PCA) pump. 14. Which instruction should the nurse convey to the UAP? A) "Notify me if the client’s pain becomes excessive." Feedback: INCORRECT This instruction is too vague. It requires a level of assessment expertise beyond the scope of the UAP. B) "Let me know if the client does not use the PCA correctly." Feedback: INCORRECT The UAP does not have the expertise to determine if the client is using the PCA pump correctly. C) "Tell me if the PCA pump is providing adequate pain control." Feedback: INCORRECT This instruction is too vague. It requires a level of assessment expertise beyond the scope of the UAP. D) "Report any change in mental status, such as disorientation." Feedback: CORRECT This instruction is specific and provides clear direction as to what to report. The UAP is not asked to discriminate between varying levels of confusion or disorientation, but to report any change observed, and is given an example. Points Earned: 0.0/1.0 Correct Answer(s): D The RN then enters the room of the client who underwent cardiac catheterization one hour ago and observes that the UAP is assisting the client to sit on the side of the bed. The UAP states that the client wanted to sit up for a few minutes. 15. What action should the nurse implement? A) Advise the UAP to stay with the client until the client is ready to lie back down. Feedback: INCORRECT This action places the client at risk for post-procedure complications. B) Instruct the UAP to assist the client to a supine position in the bed. Feedback: INCORRECT Another action will more effectively ensure client safety. C) Stay with the client while the client sits on the side of the bed. Feedback: INCORRECT This action places the client at risk for post-procedure complications. D) Assist the client in returning to a supine position in the bed. Feedback: CORRECT By assisting the client to a sitting position too soon after the procedure, the UAP has placed the client at risk for post-procedure complications. The nurse should assist the client back to a supine position and complete an assessment of the catheter site and distal circulation. Points Earned: 0.0/1.0 Correct Answer(s): D 16. In reviewing the situation with the UAP and RN assigned to the client, Mr. Young needs to emphasize which problem? A) Task delegation to an unqualified staff member. Feedback: INCORRECT The UAP is qualified to assist clients with sitting on the side of the bed. B) Insufficient instruction and supervision by the RN. Feedback: CORRECT Supervision includes the provision of instruction as indicated. Since this client requires specific post-procedure care, the nurse should have provided pertinent instruction to the UAP.  C) Lack of caring and client advocacy by the UAP. Feedback: INCORRECT There is no indication of a lack of caring or client advocacy in this situation. D) Inadequate client education and preparation. Feedback: INCORRECT While the client may not have received adequate instruction about post-procedure care, there is another more important concern that the charge nurse needs to address. Points Earned: 0.0/1.0 Correct Answer(s): B Client Transfer The telemetry-monitored beds on the unit are full, and the nursing supervisor who handles admissions and room assignments has requested that Mr. Young arrange the transfer of one of the clients from a telemetry-monitored bed to another general medical unit bed so that a new client can be admitted for monitoring. 17. The client with which telemetry pattern is best to consider for transfer? A) Sinus arrhythmia with rate fluctuation during respiration. Feedback: CORRECT This is a normal ECG pattern and does not require telemetry monitoring. B) Sinus bradycardia caused by digoxin (Lanoxin) toxicity. Feedback: INCORRECT This rhythm places the client at risk for decreased cardiac output and heart failure. This client requires telemetry monitoring until the heart rhythm is more stable. C) Third degree heart block resulting from loss of pacemaker capture. Feedback: INCORRECT This rhythm places the client at risk for decreased cardiac output. This client requires telemetry monitoring until the heart rhythm is more stable. D) Sinus tachycardia with multifocal PVCs being treated with amiodarone (Cordarone). Feedback: INCORRECT This rhythm reflects cardiac irritability and requires telemetry monitoring until the heart rhythm is more stable. Points Earned: 1.0/1.0 Correct Answer(s): A 18. After identifying the client that is most safe to transfer from the telemetry area, what action should Mr. Young take next? A) Notify the technician monitoring the telemetry patterns that the client's telemetry is being removed. Feedback: INCORRECT Another action must be taken first. B) Assess the client's vital signs and apical heart rate before removing the telemetry leads and equipment. Feedback: INCORRECT This is not necessary prior to discontinuing telemetry. C) Call the charge nurse of the unit where the client is being transferred to give a report of the client's condition. Feedback: INCORRECT Another action must be taken first. D) Contact the healthcare provider for a prescription to remove the telemetry and transfer the client. Feedback: CORRECT The charge nurse must obtain the consent of the healthcare provider before discontinuing a prescribed treatment such as telemetry monitoring.  Points Earned: 0.0/1.0 Correct Answer(s): D Mentoring a Newly Licensed Nurse After the client is transferred to a general unit bed, the new client is admitted and given the telemetry-monitored bed. The newly admitted client is assigned to the newly licensed RN and staff nurse preceptor, who are working together. 19. It is most important for the preceptor to supervise which nursing intervention performed by the newly licensed RN? A) Interpretation of the cardiac rhythm. Feedback: CORRECT This action requires expert knowledge and judgment generally beyond the scope of the new RN. By interpreting the cardiac rhythm with the newly licensed RN, the preceptor provides the supervision and mentoring needed. B) Insertion of the intravenous catheter. Feedback: INCORRECT This skill requires less expertise than another action. C) Measurement of orthostatic vital signs. Feedback: INCORRECT Although this skill requires less expertise than another action, the newly licensed RN may need the assistance of the preceptor to interpret the vital signs and determine a plan of care. D) Instruction regarding fluid restrictions. Feedback: INCORRECT The newly licensed RN can be expected to provide basic client teaching without supervision. Points Earned: 1.0/1.0 Correct Answer(s): A The newly admitted client has uncontrolled atrial fibrillation and is scheduled for elective cardioversion later in the day. The new RN tells the preceptor that he has never observed this procedure and would like to go with the client. 20. What is the best response by the preceptor? A) "You are no longer in school. You should not expect to see every procedure that the clients assigned to your care will experience." Feedback: INCORRECT The role of the preceptor is to ensure that the new RN gains the necessary knowledge and skills to practice safely. Another response better meets this goal. B) "As a staff nurse, you must learn to be responsible and take care of the other clients assigned to your care, rather than leave the unit." Feedback: INCORRECT The role of the preceptor is to ensure that the new nurse gains the necessary knowledge and skills to practice safely. Another response better meets this goal. C) "Because observation of the procedure will help you provide better care, I will manage our assigned clients while you go." Feedback: CORRECT The role of the preceptor is to ensure that the newly licensed nurse gains the necessary knowledge and skills to practice safely. Since the preceptor can assume the responsibilities of the new nurse, this allows the new nurse an excellent opportunity to learn about the procedure. It should be encouraged by the preceptor if at all possible.  D) "You seem uncomfortable about the care required by this procedure. Tell me more about your concerns." Feedback: INCORRECT This is a therapeutic response, but is not indicated in this situation. Points Earned: 0.0/1.0 Correct Answer(s): C The charge nurse and the preceptor meet to discuss the progress made by the newly licensed nurse orienting to the medical unit. 21. In planning a client care assignment independent of the preceptor for the next day, which client is best to assign the new RN? A client: A) Experiencing dysphagia following a CVA which necessitates the use of total parenteral nutrition via a central line. Feedback: CORRECT This client requires a level of skill that the newly licensed RN should be able to provide. B) Weighing decisions about anticipated home care versus continued hospitalization after a diagnosis of terminal liver cancer. Feedback: INCORRECT This client requires expert teaching and emotional support beyond the level of a new graduate. C) Receiving an intravenous infusion of dopamine (Intropin) while awaiting transfer to a critical care unit. Feedback: INCORRECT This client is physiologically unstable, requiring a greater level of expertise than that of a new RN. D) Exhibiting visual and auditory hallucinations while experiencing alcoholic delirium tremens. Feedback: INCORRECT These manifestations indicate the client is experiencing severe mental changes. A high level of nursing expertise is required to assess and respond to this unstable condition. Points Earned: 0.0/1.0 Correct Answer(s): A Staff Education Mr. Young and several staff nurses attend a mandatory inservice program on the use of insulin pens. The nursing staff will begin using the insulin pens immediately, and they will be responsible for teaching clients how to use them. 22. To ensure that all the staff are competent in the use of the new equipment, which action is most important for Mr. Young to implement? A) Review the inservice attendance records to determine if all nurses attended the class. Feedback: INCORRECT Attendance at a class is not the best method to determine competence. B) Bring the equipment to the medical unit to demonstrate its use to all the nurses. Feedback: INCORRECT This is not the best method to determine competence. C) Invite the unit pharmacist to make a presentation on the benefits of the insulin pens. Feedback: INCORRECT This is not the best method to determine competence. D) Schedule time for each nurse on the unit to practice using the insulin pens. Feedback: CORRECT Practice is the best method to ensure the successful learning of this skill, and it will help develop the nurse's competence in using it. Points Earned: 1.0/1.0 Correct Answer(s): D One of the PNs is having difficulty manipulating the insulin pen. 23. How should Mr. Young respond? A) Ask the PN if she attended the required inservice. Feedback: INCORRECT This action may be perceived as demeaning and aggressive. Additionally, attendance at a required inservice will not necessarily increase the skill of the PN. B) Offer to repeat a demonstration and allow the PN additional practice time. Feedback: CORRECT Repeating the demonstration and practicing the procedure is often an effective teaching strategy. C) Remind the PN that only RNs should administer insulin. Feedback: INCORRECT PNs may administer insulin. D) Advise the PN to continue using only insulin syringes. Feedback: INCORRECT To continue using only insulin syringes will not improve the ability of the PN to use the insulin pen. Points Earned: 1.0/1.0 Correct Answer(s): B Quality Improvement After using the insulin pens for two weeks, a staff nurse reports to Mr. Young that several clients have experienced difficulty using them and requests that insulin syringes be made available for client teaching instead of the pens. 24. Which action should Mr. Young implement first? A) Go with the nurse to observe the difficulty that clients are experiencing with the pens. Feedback: CORRECT To evaluate the need for a change in the protocol, the charge nurse should first gather as much data as possible about the problems encountered by those clients using the pens. B) Notify the unit pharmacist of the need for additional insulin syringes for client teaching. Feedback: INCORRECT This action may be indicated, but it is not the best initial action in response to this situation. C) Advise the case manager that some clients will need referral to the diabetes educator. Feedback: INCORRECT This action may be indicated, but it is not the best initial action in response to this situation. D) Request that the quality improvement team evaluate the usefulness of the insulin pens. Feedback: INCORRECT This action may be indicated, but it is not the best initial action in response to this situation. Points Earned: 0.0/1.0 Correct Answer(s): A Mr. Young discovers that drawing up inaccurate insulin doses is occurring when pens are used. After having the pens checked by the pharmacy for accuracy, Mr. Young requests a further study be initiated. The next day, the quality improvement team, comprised of the unit manager, charge nurse, and two other nurses meet to develop a plan to further evaluate the problems clients are having with the insulin pens. 25. In preparing a study of this problem, which goal statement is best for the team to identify? A) All diabetic clients will select insulin pens as their preferred method of insulin administration. Feedback: INCORRECT This goal statement does not reflect the clients' ability to use the insulin pens correctly. B) All clients using insulin pens will measure an accurate dose 100% of the time. Feedback: CORRECT This is the best goal for this study because it reflects the desired outcome for use of the insulin pens. If the study indicates that this goal cannot be achieved, the quality improvement team may choose to recommend a change in the protocol. C) All clients will demonstrate the ability to use the insulin pens correctly. Feedback: INCORRECT Although this goal statement does address the clients' ability to use the insulin pens, another goal statement provides for a more accurate measure. D) Insulin pens will be available to all diabetic clients who are able to draw up accurate doses. Feedback: INCORRECT This goal statement does not reflect the clients' ability to use the insulin pens correctly. Points Earned: 1.0/1.0 Correct Answer(s): B Using Quality Improvement Data to Guide Clinical Practice As part of the study, clients are reinstructed on the use of the insulin pen and asked to demonstrate the pen's use. Review of this data indicates that one-half of the clients were unsuccessful in obtaining the correct dose of insulin. 26. What additional information is most important for the quality improvement team presenting a recommendation to the administration about teaching clients how to use insulin pens? A) The average number of medications taken by this group of clients. Feedback: INCORRECT This is not the most significant information related to the correct use of insulin pens. B) The inability of these clients to measure an accurate dose with a syringe. Feedback: CORRECT Clients who are unable to obtain an accurate dose with an insulin pen may also be unable to obtain an accurate dose with a syringe. This data is important in determining the best strategy for client teaching. C) The highest level of education achieved by this group of clients. Feedback: INCORRECT This is not significant information related to the correct use of insulin pens. D) A comparison of the costs of insulin syringes versus insulin pens. Feedback: INCORRECT This is not significant information related to the correct use of insulin pens. Points Earned: 1.0/1.0 Correct Answer(s): B Based on the data obtained by the quality improvement team, a recommendation is made that both insulin pens and syringes remain available for client teaching on the unit. After obtaining further data, the quality improvement team plans to make a recommendation regarding the use of the insulin pens. 27. In preparing the recommendation, it is most valuable to obtain input from which member of the healthcare team? A) Director of nursing. Feedback: INCORRECT The Director of nursing is not the best member of the healthcare team to provide information related to this recommendation. B) House supervisor. Feedback: INCORRECT Although involved in a variety of management decisions, the house supervisor is not the best member of the healthcare team to provide information related to this recommendation. C) Case manager. Feedback: INCORRECT The case manager is not the best member of the healthcare team to provide information related to this recommendation. D) Unit pharmacist. Feedback: CORRECT The pharmacist is responsible for dispensing medications and can provide valuable information related to policies and procedures involving medications.    Points Earned: 1.0/1.0 Correct Answer(s): D Case Outcome The newly licensed nurses are mentored until the nurse preceptor feels confident that they are able to provide care independently. Client care on the unit is provided with effective interdisciplinary team collaboration as the cornerstone to the provision of safe, effective care.