Skip Navigation LinksHome > August 2013 - Volume 113 - Issue 8 > CE Test 2.4 Hours: Developing a Vital Sign Alert System
AJN, American Journal of Nursing:
doi: 10.1097/01.NAJ.0000432963.41504.83
Feature Articles

CE Test 2.4 Hours: Developing a Vital Sign Alert System

Contrada, Emily

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Continued Education
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* To take the test online, go to our secure Web site at .

* To use the form provided in this issue, record your answers in the test answer section of the CE enrollment form below. Each question has only one correct answer. You may make copies of the form.

* Complete the registration information and course evaluation. Mail the completed enrollment form and registration fee to: Lippincott Williams and Wilkins, CE Group, 74 Brick Blvd., Bldg. 4, Suite 206, Brick, NJ 08723. You will receive your certificate in four to six weeks. For faster service, include a fax number and we will fax your certificate within two business days of receiving your enrollment form. You will receive your CE certificate of earned contact hours and an answer key to review your results. There is no minimum passing grade.

* Registration deadline is August 31, 2015.

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* Send in together two or more tests from any nursing journal published by Lippincott, Williams and Wilkins (LWW), and deduct $0.95 from the price of each test.

* We also offer CE accounts for hospitals and other health care facilities online at Call 1-800-787-8985 for details.

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LWW, publisher of AJN, will award the number of contact hours indicated for each continuing nursing education activity. LWW is accredited as a provider of continuing nursing education by the Commission on Accreditation of the American Nurses Credentialing Center (ANCC).

These activities are also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for the number of contact hours indicated. LWW is also an approved provider of continuing nursing education by the District of Columbia and Florida #50-1223. Your certificate is valid in all states.

The ANCC's accreditation status of the LWW Department of Continuing Education refers to its continuing nursing educational activities only and does not imply Commission on Accreditation approval or endorsement of any commercial product.

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To describe the implementation of a nurse-designed, automated system for enhancing patient monitoring on medical–surgical and step-down nursing units.

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After reading this article and taking this test, you will be able to

* identify the need for an automated system for early detection of deteriorating patient status.

* summarize the implementation of the vital sign alert system at the author's facility.

* recognize the author's findings related to the evaluation and outcomes of the vital sign alert system.

1. Early warning scoring (EWS) systems are based on the premise that a decline in a patient's condition can be detected early

a. by summoning a rapid response team sooner in the downward trajectory.

b. after the nurse confers with the physician and starts stabilization measures.

c. with routine vital sign monitoring that does not increase the nurse's workload.

d. through the assessment of an aggregate set of critical physiologic variables.

2. The paper-based EWS system initiated at the author's facility in 2007 relied on 7 critical variables, including

a. the Glasgow Coma Score.

b. oxygen saturation level.

c. pain scale rating.

d. hemodynamics.

3. Which of the following variables was given greater weight because it was considered more indicative of deteriorating health?

a. level of consciousness

b. respiratory rate

c. urinary output

d. blood pressure

4. The nurses found wide variation among practitioners using the new system in determining which of the following scores?

a. temperature

b. respiratory rate

c. urinary output

d. blood pressure

5. What was the average time per patient each day for completion of the EWS tool?

a. 10 minutes

b. 12 minutes

c. 14 minutes

d. 16 minutes

6. Which of the following parameters did the technology committee at the author's facility consider most important to monitor and include on the screen savers they developed?

a. urinary output

b. arterial blood gases

c. fall risk score

d. Braden score

7. A literature review suggested that, besides vital signs, the best indicator of cardiopulmonary arrest, unplanned ICU admission, and unexpected death was

a. cardiac output.

b. oxygen saturation level.

c. hemoglobin level.

d. shortness of breath.

8. One of the most commonly recorded vital sign thresholds that warranted summoning the medical emergency team at a university-affiliated U.S. Department of Veterans Affairs (VA) hospital was

a. systolic blood pressure of less than 90 mmHg.

b. pulse rate of more than 90 beats per minute.

c. respiratory rate of more than 22 breaths per minute.

d. arterial oxygen saturation level of less than 94%.

9. Prospective analysis of VA data indicated that what proportion of patients meeting a single vital sign criterion would experience a critical event?

a. about one-quarter

b. more than one-third

c. about one-half

d. more than two-thirds

10. Data analysis of the use of an early warning system at a British hospital showed that the best predictor of high risk was

a. level of consciousness.

b. oxygen saturation level.

c. respiratory rate.

d. blood pressure.

11. A study of patients on medical, surgical, and orthopedic units in an Australian hospital showed that one of the two most common clinical abnormalities was a

a. systolic blood pressure of more than 200 mmHg.

b. pulse rate faster than 130 beats per minute.

c. respiratory rate faster than 30 breaths per minute.

d. oxygen saturation value of less than 90%.

12. A green vital sign alert (VSA) score means that

a. vital signs are “normal.”

b. the patient can be prepared for discharge.

c. the treatment is keeping vital sign values within a safe range.

d. the nurse should use caution in continuing the plan of care.

13. With an awareness of the multiple factors that can elevate systolic blood pressure during hospitalization, the author identified which of the following as an acceptable systolic blood pressure range?

a. 100 to 130 mmHg

b. 100 to 140 mmHg

c. 110 to 150 mmHg

d. 110 to 160 mmHg

14. The VSA system's program was designed to scan each patient's electronic medical record every

a. 15 seconds.

b. 30 seconds.

c. 45 seconds.

d. 60 seconds.

15. During the VSA pilot program, nurses suggested removing which of the following parameters owing to a large number of false alerts caused by abnormal readings that did not correlate with physiologic changes in the patient's condition?

a. pulse

b. urine output

c. temperature

d. respiratory rate

16. Over the course of the year after implementation of the VSA system at the author's facility, the pilot unit reduced the number of out-of-unit codes from 16 to

a. 3

b. 6.

c. 9

d. 12.

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