Exam Prep Ch.9 Improving And Managing Safe And Quality Care

Chapter 9: Improving and Managing Safe and Quality Care

MULTIPLE CHOICE

1. The nurse administrator is aware that the 1984 death of a college student from a drug-drug interaction resulted in what standard of medical care?

1. Computerized prescribing

2. Time-out required before beginning any surgery

3. Limitation to the number of hours a resident in training may work

4. Access to a rapid response team

ANS:

2. The nurse manager of surgical operations knows that the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery does not include which component?

1. A time-out called immediately before surgery begins to ensure that all elements of the surgery are correct.

2. Two surgeons must confirm immediately before the surgery that the patient is receiving the correct procedure.

3. The surgeon must mark and sign the site of surgery immediately before the surgery while the patient is still awake.

4. The patient’s identification must be verified with at least two identifiers.

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3. The nurse leader is observing a new graduate registered nurse and knows that which error would be considered an error of commission?

1. The nurse contaminated the IV catheter by touching the skin but continued the procedure and inserted it into the patient’s forearm.

2. The nurse was taking care of a patient who went to radiology for an x-ray. Upon the patient’s return, the nurse forgot to administer the patient’s medications.

3. The nurse is caring for a patient who is scheduled to be ambulated three times a day and neglects to walk the patient at all during the shift.

4. The nurse received an order to change the patient’s diet from clear liquid to NPO and forgot to enter the change. The patient ate a liquid meal and surgery had to be delayed until the next morning.

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4. The nurse manager is aware that which incident would be classified as a sentinel event?

1. The patient receives an oral antidiabetic medication 6 hours after it should have been administered. His blood sugar is slightly elevated, but it returns to its normal range within 1 hour.

2. The patient receives a second-degree burn from a malfunction in a hypothermia blanket.

3. The patient got dizzy and sat down on the floor approximately 1 hour after the administration of an antihypertensive medication. The patient did not experience any injury.

4. The patient is using a continuous passive exercise machine after knee surgery when the machine quits working. The patient complains of pain when the knee is removed from the machine. The pain is relieved after the administration of pain medication.

ANS:

5. The nurse manager is discussing an error that occurred with a nurse and is using the person approach to human error if the manager makes which statement?

1. “How many patients were you caring for when this error occurred?”

2. “What was the acuity level of the patients that you were caring for?”

3. “What else was happening on the unit when the error occurred?

4. “Didn’t you learn to do this procedure in school?”

ANS:

6. The nurse manager is conducting an investigation into a series of patient falls that have occurred on the nursing unit in the past 3 weeks. While investigating the issue, the nurse manager identified a number of factors that may have influenced the problem and knows that which one would be classified as a human factor?

1. The unit does not have an adequate number of gait belts available to the staff.

2. Two unit staff members have been on extended sick leave.

3. Bedside rounding has been sporadic.

4. The charge nurse is new to the position.

ANS:

7. The nurse manager is working to establish a culture of safety and knows that which element is the most important factor to its establishment?

1. No punishment is involved for reporting.

2. Policies are easily accessible.

3. All policies are communicated to all staff.

4. The policy is begun on all units at the same time.

ANS:

8. The nurse manager knows that what is the most important focus of a culture of safety?

1. Improving efficiency of patient care

2. Increasing training of staff regarding basic elements of safety

3. Looking at the reason for an error

4. Praising staff when no errors are committed

ANS:

9. The nurse leader is aware that which change in unit policy will have the most impact in creating a culture of safety on the unit?

1. Establishing a patient admission checklist to ensure that all important information related to safety is communicated to the patient

2. Conducting bedside rounds for nurse-to-nurse end-of-shift handoff

3. Encouraging discussion of errors between staff members

4. Working with staff to improve memory skills to improve documentation

ANS:

10. The nurse leader is referencing the American Nurses Association’s nursing-sensitive quality indicators and knows that structure indicators include which element?

1. Job satisfaction

2. Changes in patient health-care status

3. Hours of nursing care per patient

4. Deliverance of nursing care

ANS:

11. The nurse leader references the National Quality Forum (NQF) for information about patient safety and is aware that which statement is not a goal of this organization?

1. Reduction of preventable hospital admissions and readmissions

2. Advancement of electronic measurement to capture necessary data for performance measurement

3. Reduction of the incidence of adverse health care–associated conditions

4. Reduction in harm from inappropriate or unnecessary care

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12. The nurse manager has formed a QI committee to review several medication errors and identify the causes. The QI Committee would use which QI tool to explore the causes of the errors?

1. Histogram

2. Run chart

3. Flow chart

4. Fishbone diagram

ANS:

MULTIPLE RESPONSE

13. The nurse leader is beginning to create a culture of safety on the nursing unit and is aware that which tasks must be accomplished in Stage 3 of this process? Select all that apply.

1. Safety is an external requirement imposed by regulatory bodies.

2. Safety performance is viewed as dynamic and in need of continuous improvement.

3. Strong emphasis is placed on improving efficiency.

4. Safety performance is expressed in terms of goals.

5. Communication and training are important features.

ANS:

14. The director of nursing is aware that the Institute for Healthcare Improvement 100,000 Lives Campaign asks hospitals to implement which interventions? Select all that apply.

1. Use medication reconciliation to prevent adverse drug events

2. Administer preoperative antibiotics to prevent surgical site infection

3. Ensure that congestive heart failure patients receive evidence-based care

4. Focus attention on medications such as opioids and insulin that can cause harm

5. Implement the “Central Line Bundle” to prevent central line infections

ANS:

15. The nurse leader is aware that which of the five standard operating protocols of the World Health Organization have been implemented globally? Select all that apply.

1. Communication during patient handovers

2. Use of concentrated injectable medicines

3. Correct procedure at the correct body site

4. Health care–associated infections

5. Medication accuracy at transitions in care

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16. The nurse manager is investigating a medication error that occurred on two separate shifts. Who should the nurse manager involve in the investigation? Select all that apply.

1. A nurse manager of another unit

2. All nurses working the shifts when the error occurred

3. The nurses who committed the errors on both shifts

4. Risk manager

5. Pharmacist

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