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.	Failure to document the client’s combativeness	
b.	Refusing to wear gloves while starting the I.V.	
c.	Failure 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.	

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 medical devices are not functioning properly. According to the Safe Medical Devices Act, which problems should be reported to the U.S. Food and Drug Administration (FDA)? SELECT ALL THAT APPLY.
a.	Outdated medication	
b.	Misleading packaging	
c.	Cracked or leaking I.V. solution bag	
d.	Defective infusion pump tubing	

____	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	

____	3.	A staff nurse is serving on a hospital’s quality-assurance task force. On which quality-assurance 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	

____	4.	A nurse is planning for the discharge of a hospitalized client. The nurse reviews the client’s plan of care to determine whether all client outcomes were achieved. Which methods should the nurse use to evaluate the client’s outcomes? 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	

____	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	

____	7.	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	

Chapter 1: Professional Practice Concepts for Infusion Therapy
Answer Section

MULTIPLE CHOICE

	1.	ANS:	D
Intentional torts include assault and battery, false imprisonment, using restraints as a form of false imprisonment, defamation of character, and breach of confidentiality.
Reference: Cockburn, T., & Madden, B. (2006). Intentional torts claims in medical cases. J Law Med, 13(3), 311–335.

PTS:	1	KEY:	Cognitive Level: Application

	2.	ANS:	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.

PTS:	1	KEY:	Cognitive Level: Application

MULTIPLE RESPONSE

	1.	ANS:	B, C, D
Misleading packaging, cracked or leaking I.V. solutions bags, and defective infusion pump tubing should all be reported to the FDA because these problems indicate product integrity issues. Ensuring that medical devices in domestic commercial distribution are safe and effective for their intended purposes is a professional responsibility. Outdated medication should be discarded and reported to the facility pharmacy.
Reference: U.S. Food and Drug Administration, MedWatch. (2005). Voluntary reporting by health professionals. Retrieved from www.fda.gov/medwatch/report/hcp.htm March 11, 2013.

PTS:	1	KEY:	Cognitive Level: Application

	2.	ANS:	A, B, D
The nurse manager must adhere to the guidelines of the CDC, INS, and ONS. The AMA does not provide guidelines for nursing standards of practice.
Reference: The Joint Commission

PTS:	1	KEY:	Cognitive Level: Application

	3.	ANS:	A, C, D
The task force is most likely to focus on standards of practice, performance improvement, and continuous quality improvement. These quality-assurance models focus on the recipients of care. Standards of practice focus on the provider, and define the activities and behaviors needed to achieve patient outcomes.
Reference: Phillips, L. (2010). Manual of I.V. therapeutics: Evidence-based infusion therapy (5th ed.). Philadelphia, PA: F.A. Davis.

PTS:	1	KEY:	Cognitive Level: Application

	4.	ANS:	A, B, C, D
Methods used to collect and determine outcomes for clients parallel the nursing process. Collection, identification, problem solving, and re-evaluation are part of the nursing process. TJC is a nonprofit organization that accredits health-care facilities and works to improve client care and safety.
Reference: Ackley, B., & Ladwig, G. (2011). Nursing diagnosis handbook: An evidence-based guide to planning care (9th ed.). St. Louis, MO: Mosby/Elsevier.

PTS:	1	KEY:	Cognitive Level: Application

	5.	ANS:	A, C, D
A complete written account of care given to the client, written unusual occurrence reports, and professional liability insurance to protect the nurse are risk-management strategies.
Reference: Alexander, M., & Webster, H. K. (2010). Legal issues of infusion nursing. In M. Alexander, A. Corrigan, L. Gorski, J. Hankins, & R. Perucca (Eds.), Infusion nursing: An evidence-based approach (pp. 49–59). St. Louis, MO: Saunders Elsevier.

PTS:	1	KEY:	Cognitive Level: Application

	6.	ANS:	A, B, C
The constitution, statutes, and state Nurse Practice Acts all provide laws that govern nursing practice. The Joint Commission, along with the American Nurses Association and specialty organizations, establishes standards of nursing care.
Reference: Alexander, M., & Webster, H. K. (2010). Legal issues of infusion nursing. In M. Alexander, A. Corrigan, L. Gorski, J. Hankins, & R. Perucca (Eds.), Infusion nursing: An evidence-based approach (pp. 49–59). St. Louis, MO: Saunders Elsevier.

PTS:	1	KEY:	Cognitive Level: Application

	7.	ANS:	A, B, D
The nurse manager must adhere to the guidelines of the CDC, INS, and ONS. The AMA does not provide guidelines for nursing standards of practice.
Reference: The Joint Commission. (2012). Comprehensive accreditation manual for hospitals. Oakbrook Terrace, IL: The Joint Commission.

PTS:	1	KEY:	Cognitive Level: Application