The nurse is concerned because a 77-year-old patient is weak ...

[sammy]

The nurse is concerned because a 77-year-old patient is weak after abdominal surgery. Which of the following should be done to ensure that one of the preventable conditions identified by the Centers for Medicare and Medicaid does not occur?
 
  a. Use the rights of medication adminis-tration.
  b. Provide frequent opportunities to use the bathroom.
  c. Document thoroughly.
  d. Complete discharge teaching as quickly as possible.

Question 2

The nurse works on the cardiac unit of a hospital. The health care provider has ordered 20 mEq of KCl per L to be added to the fluids that the patient is receiving. The patient currently has a bag of D5W IV fluid infusing.
 
  Which action is most appropriate? a. Administer 20 mEq KCl diluted in 5 mL of fluid by IV push in 5 minutes.
  b. Estimate the amount of fluid in the IV bag and add KCl to equal 20 mEq/L.
  c. Give the KCl undiluted by IV push in 5 minutes for the most rapid action.
  d. Check the patient's potassium level before hanging the new IV solution.

[Joy Chen]

Answer to Question 1

B
Providing frequent opportunities to use the bathroom helps prevent pressure ulcers, falls, trauma, and even may help prevent an infection from the insertion of a catheterall are listed on the preventable conditions. The Centers for Medicare and Medicaid Services (CMS) names select serious reportable events (SREs) as Never Events (adverse events that should never occur in a health care setting) (US Department of Health and Human Services, 2008). The CMS now denies payment to hospitals for any hospital-acquired conditions resulting from or complicated by the occurrence of certain Never Events that were not present on admission. Many of the hospit-al-acquired conditions are nurse-sensitive indicators, meaning that nursing interventions directly affect their development. Whereas the rights of medication administration demonstrates safety it does not relate to the preventable conditions identified by CMS, but does relate to the National Patient Safety Goals. Thorough documentation is a legal issue, not a CMS preventable condition. Discharge teaching is not listed on the preventable list and it should not be done quickly.

Answer to Question 2

D
Remember that failure to verify that a patient has adequate renal function and urine output before administering an IV solution containing potassium could cause hyperkalemia. Under no circumstances should KCl be given in an IV push. A direct IV infusion of KCl may be fatal. Intravenous administration of KCl requires dilution in solution and infusion slowly over a period of time. In most hospitals, nurses do not add KCl to IV bags. Usually a pharmacist prepares the solution.

[sammy]

TYSM

[bitingbit]

Gracias!