Fy16 Primary care RN Annual Policy Review

1. When a patient in the CBOC shows signs and symptoms of a stroke, nursing staff will call 911 for transport to the nearest Acute Ischemic Stroke center (facility).

True

False

T:\Clinical Guidelines & Protocols\Protocols\Nursing Protocol Signs and Symptoms of Acute Ischemic Stroke (04-24-15)

Explanation

T:\Clinical Guidelines & Protocols\Protocols\Nursing Protocol Signs and Symptoms of Acute Ischemic Stroke (04-24-15)

2. I pledge to demonstrate the core values of the American Nurses Association Code of Ethics by upholding the standards of honesty and integrity. By answering "Yes", I certify that I am the person taking this test.

Yes

No

The given correct answer is "Yes" because by choosing this option, the person is affirming their commitment to uphold the standards of honesty and integrity as outlined in the American Nurses Association Code of Ethics. Additionally, by selecting "Yes", they are certifying that they are the person taking the test, indicating their understanding of the importance of personal accountability in their professional role.

Explanation

The given correct answer is "Yes" because by choosing this option, the person is affirming their commitment to uphold the standards of honesty and integrity as outlined in the American Nurses Association Code of Ethics. Additionally, by selecting "Yes", they are certifying that they are the person taking the test, indicating their understanding of the importance of personal accountability in their professional role.

3. The Primary Care LPN/RN must use the Hypoglycemia Protocol Note to document all FSBG results, treatments, and patient responses to treatment when hypoglycemia is identified in a patient.

True

False

Hypoglycemia - Outpatient Clinic Protocol; This policy is located on the T drive--Clinical Guidelines and Protocols. Type in the search box "hypoglycemia" and this will bring up the policy.

Explanation

Hypoglycemia - Outpatient Clinic Protocol; This policy is located on the T drive--Clinical Guidelines and Protocols. Type in the search box "hypoglycemia" and this will bring up the policy.

4. Protocols for Patient Aligned Care Team (PACT) Nursing Staff in Primary Care Service Line establishes guidelines for RNs/LPNs to initiate specific diagnostic tests and consultations based on patient's presenting history and/or symptoms.

True

False

Protocol for Patient Aligned Care Team (PACT) Nursing Staff in Primary Care Service Line; This protocol is located on the T drive--Clinical Guidelines and Protocols. Type in the search box "PACT" and this will bring up the policy.

Explanation

Protocol for Patient Aligned Care Team (PACT) Nursing Staff in Primary Care Service Line; This protocol is located on the T drive--Clinical Guidelines and Protocols. Type in the search box "PACT" and this will bring up the policy.

5. Primary Care nursing staff will document a foot screening for patients at risk of lower limb loss or history of amputation that includes: (select all which apply)

Visual inspection of skin surfaces

Circulation to include palpation of pedal pulses

Sensory testing for loss of protective sensation

Provide patient education and patient level of understanding on foot care

Management of Diabetic Patients for the Preservation and Treatment of Lower Limbs Primary Care Program Memorandum 11C-12-05 located on the T-Drive

Explanation

Management of Diabetic Patients for the Preservation and Treatment of Lower Limbs Primary Care Program Memorandum 11C-12-05 located on the T-Drive

Submit

6. It is VHA policy that any Veteran receiving care at more than one VHA facility must have that care coordinated by the preferred facility, and that non-preferred facilities must expedite care provided to traveling veterans with unexpected medical needs.

True

False

CPM 11-C-11-11 Coordinated Care Policy for traveling Veterans located on the T-drive

Explanation

CPM 11-C-11-11 Coordinated Care Policy for traveling Veterans located on the T-drive

7. Your Clinic Emergency Plan can be found on the T-Drive under Service Policies by selecting Primary Care 11-C, Primary Care Supplemental (Select specific CBOC location).

True

False

T:drive> Search "Primary Care Supplemental" and select your clinic

Explanation

T:drive> Search "Primary Care Supplemental" and select your clinic

8. What would you do if your SCI patient was showing symptoms of Autonomic Dysreflexia?

Sit patient upright

Loosen any restrictive clothing

Palpate patient's bladder for distention

Do a general survey to seek and eliminate the cause of symptoms

All of the Above

CPG 12-2013 Spinal Cord Injury Treatment Guidelines for Physicians and Nurses. Located on the T drive--Clinical Guidelines and Protocols---Clinical Practice and Guidelines. Type "spinal" in the search box.

Explanation

CPG 12-2013 Spinal Cord Injury Treatment Guidelines for Physicians and Nurses. Located on the T drive--Clinical Guidelines and Protocols---Clinical Practice and Guidelines. Type "spinal" in the search box.

9. Nursing staff are responsible for documenting reported falls in CPRS. Falls will be tracked and reported quarterly.

True

False

T:drive---All CPMs---type "falls" in the search box.

Explanation

T:drive---All CPMs---type "falls" in the search box.

10. The Women Veterans Program Manager (WVPM) will coordinate with Primary Care Providers to ensure that all female veterans ages 50-64 and female veterans who present with a higher risk of breast cancer will receive mammograms consistent with the U.S. Preventive Medicine Task Force breast cancer screening recommendations.

True

False

CPM 114-14-04 Requests for Mammography Procedures located on the T-drive

Explanation

CPM 114-14-04 Requests for Mammography Procedures located on the T-drive

11. It is the policy for RHJVAMC and CBOCs where Primary Care, Women's Health and/or Mental Health services are provided, that access to clinically appropriate services extending beyond normal business hours are available at least once on weekdays (Wednesday) and once every weekend (Saturday), at times and venues that match Veteran demand and expectation.

True

False

Extended Hours Access for Veterans at Medical Centers and Selected Community Based Outpatient Clinics (CBOCs) CPM No. 11-14-51

Explanation

Extended Hours Access for Veterans at Medical Centers and Selected Community Based Outpatient Clinics (CBOCs) CPM No. 11-14-51

12. Proper identification of a patient prior to check-in or initiation of care is important in ensuring that care and information are given to the right patient. It is the policy at RHJ VAMC to use 2 unique patient identifiers such as:

Having the patient state their FULL Name and Room Number

Having the patient state their LAST Name and LAST 4 of their Social Security Number

Having the patient state their FULL Home Address

Having the patient state their FULL Name and FULL Social Security Number

CPM 118-14-23; Patient Identification

Explanation

CPM 118-14-23; Patient Identification

13. Who is responsible for contacting Veterans who meet inclusion criteria and delivering the MOVE program at the medical center and CBOCs?

Care Coordinator RN assigned to the Veteran's Primary Care PACT

MOVE Dieticians along with other ancillary staff and the MOVE Coordinator

Physician Champion in collaboration with the MOVE Coordinator

Bariatric Program Coordinator (Surgery Service)

T drive---CPM (all services)---Primary Care---MOVE! Weight Management Program for Veterans (MOVE) 11C-14-12

Explanation

T drive---CPM (all services)---Primary Care---MOVE! Weight Management Program for Veterans (MOVE) 11C-14-12

14. Breathalyzer testing may be used by clinical staff without the patient's informed consent, to aid in determining whether a patient is intoxicated.

True

False

Breathalization Procedure CPM 116-16-09 located on the T-drive

Explanation

Breathalization Procedure CPM 116-16-09 located on the T-drive

15. A patient is being seen in the clinic for a routine visit. Upon check in, he appears pale and sweaty. The patient complains of feeling shaky and dizzy, stating his appointment was early so he did not have time to eat this morning. He is found to have a fingerstick blood glucose (FSBG) <70mg/dL. Using the Hypoglycemia Outpatient Clinic Protocol, all of the following actions are taken EXCEPT:

Contact provider after treatment has been administered for blood glucose

T:drive>Clinical Guidelines & Protocols>Protocols>Hypoglycemia - Outpatient Clinic Protocol (06-03-15)

Explanation

T:drive>Clinical Guidelines & Protocols>Protocols>Hypoglycemia - Outpatient Clinic Protocol (06-03-15)

16. What are the signs and symptoms of blood transfusion reaction? (Select all that apply).

Dizziness

Chills

Fever

Flushing of skin

CPM 113-13-01. T drive---All CPMs, type "blood transfusion" in search box

Explanation

CPM 113-13-01. T drive---All CPMs, type "blood transfusion" in search box

Submit

17. According to The Missing Patient policy, an at-risk patient includes one who is (select all which apply):

Legally committed.

Physically or mentally impaired with increased risk of harm to self or others

Assigned a court appointed legal guardian.

Lacking cognitive ability (either permanently or temporarily) to make relevant decisions

CPM 07B-13-01 Missing Patient Policy located on the T-drive

Explanation

CPM 07B-13-01 Missing Patient Policy located on the T-drive

Submit

18. Who is the organ procurement agency for RHJ VAMC?

LifeCare

LifePoint

LifeChoice

LifeLine

CPM 00-14-16; T:drive>All CPMs> type "Organ" in the search box

Explanation

CPM 00-14-16; T:drive>All CPMs> type "Organ" in the search box

19. The following Service Lines are responsible for delivering care to at-risk patients identified by the PAVE program (select all that apply):

Podiatry---Podiatrist sees and treats all patients who are moderate and high risk for amputation per the Foot Risk Screening tool.

Diabetic Nurse Educators and the wound care nurse are PAVE members

CPM 117-13-03 Prevention of Amputation in Veterans Everywhere (PAVE) Program located on the T-drive

Explanation

CPM 117-13-03 Prevention of Amputation in Veterans Everywhere (PAVE) Program located on the T-drive

Submit

20. The following are nurses' actions in the event of a blood transfusion reaction except:

Collect 2 seven ml lavender tubes of blood from distant site from the transfusion.

Notify blood bank

Notify physician.

Label the tubes as immediate post-transfusion reaction

CPM 113-13-01. T drive- All CPMs—type “blood transfusion ” in the search box

Explanation

CPM 113-13-01. T drive- All CPMs—type “blood transfusion ” in the search box

21. Chest Pain: When a patient complains of chest pain, what are the first interventions an RN should perform before calling the MD?

Assessment of pain

Stat EKG

Initiate oxygen at 4L/min

All of the above

B & C only

T-drive--Guidelines and Protocols---Protocols Chest Pain or Chest Tightness Protocol

Explanation

T-drive--Guidelines and Protocols---Protocols Chest Pain or Chest Tightness Protocol

22. When a veteran/ caller is reporting suicidal or homicidal thoughts or other crises to the Ralph H. Johnson Department of Veterans Affairs Medical Center telephone operator or to other staff they should: (select all which apply)

When possible make a warm transfer (allows for all three parties to be on the line at the same time)

NEVER PLACE A CALL ON HOLD

ICPM116-11-06 NTERVENTION FOR SUICIDAL/HOMICIDALPATIENTS VIA TELEPHONE Located on the T-drive

Explanation

ICPM116-11-06 NTERVENTION FOR SUICIDAL/HOMICIDALPATIENTS VIA TELEPHONE Located on the T-drive

Submit

23. According to Medication Reconciliation policy (select all that apply)...

It is the primary responsibility of the nurse to update all medications

Over the counter medications do not need to be in the patients record

According to the Medication Reconciliation policy, the updated medication list will be provided to the patient or their surrogate at the end of the visit. Additionally, if the patient is receiving medical care outside of the VA system, they will be encouraged to share the updated medication list with their outside healthcare providers. This ensures that all healthcare providers involved in the patient's care have access to an accurate and up-to-date medication list, promoting patient safety and continuity of care.

Explanation

According to the Medication Reconciliation policy, the updated medication list will be provided to the patient or their surrogate at the end of the visit. Additionally, if the patient is receiving medical care outside of the VA system, they will be encouraged to share the updated medication list with their outside healthcare providers. This ensures that all healthcare providers involved in the patient's care have access to an accurate and up-to-date medication list, promoting patient safety and continuity of care.

24. Prostate cancer screening should occur with the following populations (Select all that apply)

Men older than 75 years of age

All men

Prostate Cancer Screening CPM NO.11C-14-10 Located on the T-Drive

Explanation

Prostate Cancer Screening CPM NO.11C-14-10 Located on the T-Drive

Submit

25. Labels should be prepared and applied at the time medications/solutions are prepared. Pre-labeling medication/solution containers in advance of the procedure is not acceptable.

True

False

CPM 11-15-19 Labeling Medications and Solutions On and Off the Sterile Field

Explanation

CPM 11-15-19 Labeling Medications and Solutions On and Off the Sterile Field