Deck 2: The Nurses Role in Healthcare Quality and Patient Safety

Question 1

A client is being treated for community-acquired pneumonia and has experienced respiratory distress and hypoxia on several occasions since being admitted. The nurse can best prevent adverse outcomes during this client's care by:

A) collaborating closely with members of the interdisciplinary team.
B) vigilantly monitoring the client's oxygenation status.
C) involving the client when identifying goals for care.
D) educating the client about self-care as it relates to respiratory health.

Answer 1

vigilantly monitoring the client's oxygenation status.

Question 2

Hourly neurovital signs have been ordered for a client who has been admitted after experiencing an ischemic stroke. The client's neurological status has declined over the past few hours. Which nursing action best prevents an adverse outcome in this client's care?

A) Initiating rehabilitation as soon as possible
B) Arranging for STAT computed tomography of the client's head
C) Documenting any changes in the client's status in a detailed and timely manner
D) Assessing the client's neurological status more frequently than ordered

Answer 2

Assessing the client's neurological status more frequently than ordered

Question 3

A near miss has taken place on a medical unit in which a client nearly received a unit of packed red blood cells of an incompatible blood type. In the follow-up to this event, which action should be prioritized?

A) Identifying systemic factors on the unit that may have contributed to the event
B) Reinforcing the standards for nursing care to staff members who were involved
C) Ensuring that the client's nurse is held accountable and educated about best practice
D) Communicating the potential consequences of the near miss to the client involved

Answer 3

Identifying systemic factors on the unit that may have contributed to the event

Question 4

A nurse failed to document the administration of a client's warfarin and the nurse on the next shift administered the drug again, believing that it had been overlooked. When performing root cause analysis in order to identify the essential cause of this error, what question should be asked first?

A) "Has this, or something very similar, ever happened on the unit before?"
B) "Why did the second nurse administer this drug to the client?"
C) "What could the two nurses have done to ensure this didn't happen?"
D) "What were the possible adverse outcomes that could have resulted from this error?"

Question 5

Root cause analysis is being performed after a client who was supposed to be on falls precautions fell while trying to walk to the toilet. Which finding of the investigation would be considered to be a latent error?

A) The documentation forms on the unit have no specified location where falls precautions should be noted.
B) The client's primary nurse went on a scheduled break without reporting off to a colleague.
C) The nurse manager mistakenly admitted the client into a room far out of site of the nurses' station.
D) A nursing assistant on the unit admitted to ignoring the client's call light before the client fell.

Question 6

A large healthcare organization has committed to promoting a just culture when adverse events and near misses take place. Which question will guide the organization's response when a nurse commits an error?

A) "How did the nurse's actions contribute to this error?"
B) "How have other organizations responded to nurses in events like this?"
C) "Have the client and the family been informed about this?"
D) "What is the organization's legal liability in this matter?"

Question 7

A client's surgical wound dehisced when a nurse mistakenly removed the staples before this had been ordered. The nurse is distraught and acknowledges forgetting to check the client's orders and assumed the client was on a later postoperative day than the client actually was. Following root cause analysis, which organizational response is appropriate? Select all that apply.

A) The nurse's actions will be categorized as being intentionally reckless.
B) The nurse will be found to have committed a human error.
C) Systems around the documentation of orders will be reviewed.
D) The nurse will be disciplined by an impartial review board.
E) The nurse's at-risk behavior will be weighed according to standards of practice.

Question 8

Which nurse would most likely be determined to have performed an at-risk behavior?

A) An obstetrical nurse who forgot to check a newborn infant's car seat before the mother and infant were discharged.
B) A nurse who pre-poured a client's medications at the beginning of a shift, but then suddenly had to go home sick, creating confusion.
C) A nurse who disconnected a client's call light in order to "punish" the client, resulting in a client fall.
D) A nurse who falsely documented a safety check before a client's suicide attempt.

Question 9

Which action directly addresses one of the Joint Commission 2010 Hospital National Safety Goals?

A) A hospital implements evidence-based interventions for reducing the incidence of catheter-associated urinary tract infections.
B) A long-term care facility has put new measures in place to identify residents who may be aggressive.
C) A nurse has committed to exceeding the required amount of continuing education required for license renewal.
D) A public health agency has changed its policies so that two nurses are always present during a home visit.

Question 10

A client who was receiving care on a psychiatric unit committed suicide at a time when nurses are known to be handing off to nurses on the next shift. What is a responsibility of the organization when responding to this sentinel event?

A) Inform local healthcare institutions about the event in order to promote safety.
B) Change the institution's policies regarding supervision of clients.
C) Appropriately discipline the nurses who were participating in the shift change.
D) Report the event to the Joint Commission.

Question 11

A hospital is introducing a program that has the goal of aligning practices more closely with the Quality and Safety Education for Nurses (QSEN) project. What initiative best exemplifies QSEN competencies?

A) New systems are introduced to increase communication between nurses and the members of other health disciplines.
B) Systems are reviewed with the goal of achieving the best client outcomes at the lowest cost.
C) Hiring practices are reviewed in order to maximize the proportion of nurses who possess baccalaureate or graduate degrees.
D) New partnerships are established between the hospital and local schools of nursing.

Question 12

A client has been diagnosed with a glioblastoma, and the care team has determined that this brain tumor is inoperable. Which aspects of the client's subsequent care demonstrate adherence to the Quality and Safety Education for Nurses (QSEN) competencies? Select all that apply.

A) The care team meets with the client and family promptly to identify their preferences for treatment.
B) The care team balances the best available evidence about glioblastoma treatment with the client's preferences.
C) Nurses proactively identify threats to the client's safety that may occur as treatment is provided.
D) Each member of the care team uses the best available technology to organize and provide care.
E) Treatments are chosen with the goal of minimizing the financial burden on the healthcare institution.

Question 13

A nurse on a medical unit recognizes the need to demonstrate Quality and Safety Education for Nurses (QSEN) competencies in clinical practice. Which action best demonstrates the skills necessary to meet the QSEN competency of safety?

A) Filling out an incident report accurately after a client went missing from the unit
B) Appreciating the relationship between continuing education and client safety
C) Understanding the functions of a new automated intravenous pump that has been introduced to the unit
D) Valuing the contributions of clients and their families who suggest possible improvements in care

Question 14

A client on a hospital unit has been infected with hepatitis C virus (HCV) because a nurse mistakenly connected an HCV-positive client's intravenous pump and tubing. What is an appropriate response by the hospital to this incident?

A) Report this sentinel event to the Joint Commission and to relevant state agencies
B) Inform the public that the incident occurred, while protecting the confidentiality of the clients.
C) File an incident report with the American Nurses Association describing plans for preventing similar events in the future.
D) Offer compensation to the affected client in a timely manner, while maintaining the client's confidentiality.

Question 15

A nurse was injured when a client with Alzheimer disease struck the nurse on the side of the head during a transfer. The nurse has completed an incident report. Which statement about an incident report is most accurate?

A) The report becomes a confidential part of the client's health record once it is reviewed by hospital administration.
B) The incident report is reviewed by state agencies and the Occupational Safety and Health Administration rather than by hospital administration.
C) The report provides a detailed and objective account of the circumstances before, during, and after the event.
D) The client and the client's family will be required to sign the report, acknowledging that they read it before it was filed.

Question 16

A client went missing from a long-term care facility and an emergency code was called. After a search of 1 hour, the client was discovered in a utility room that should have been inaccessible. When responding to this event, staff should:

A) complete an incident report in order to determine who was primarily responsible for the event.
B) document strategies in the client's health record for preventing future incidents.
C) fill out an incident report, with the goal of preventing a similar event in the future.
D) hold a facility-wide meeting to identify strategies for making improvements to the safety of residents.

Question 17

The staff at a day-surgery clinic are meeting because there have been two significant medication errors committed over the past few weeks. In order to prevent future medication errors, the nurses at the clinic should:

A) take measures to ensure that they are not disturbed when pouring medications.
B) have each medication checked and cosigned by another nurse.
C) collaborate with the physicians to determine whether clients are being prescribed any nonessential medications.
D) cluster the timing of medication administration to reduce the number of times that a client is given medications.

Question 18

A program has been introduced at a hospital with the goal of improving client safety. The nurses participating in the program should recognize what event as posing the most significant threat to a client's safety?

A) Transferring the client from one location in the hospital to another
B) Electronically reporting the results of diagnostic testing to the client's primary care provider
C) Administering medications to the client
D) Admitting the client to the healthcare facility

Question 19

A nurse is administering a scheduled medication to a client using the institution's bar code system. The nurse has scanned the client's armband as well as the scheduled medication. The system has signaled a discrepancy between the dose ordered and the dose scanned. What is the nurse's most appropriate response?

A) Administer the dose specified by the computer system and document the event.
B) Consult the client's medication orders and then administer the dose originally poured.
C) Consult with a colleague and identify the source of the error signal before proceeding.
D) Document the discrepancy and place the medication on hold until the next scheduled dose.

Question 20

A nurse is a member of clinic's health and safety committee, and strategies for enhancing client and worker safety are being considered. How can the committee best implement the strategy of mistake-proofing?

A) Ordering new oxygen tubing that cannot be inadvertently connected to a medical air port
B) Placing reminders on all of the medication carts prompting nurses to the "rights" of medication administration
C) Providing supplementary education to nurses about safe client transfers
D) Assigning one nurse to administer all of the medication on a unit rather than dividing the task among the nurses

Question 21

The nurses on a critical care unit can utilize the safety strategy of redundancy by:

A) having two nurses independently check the dosage of high-risk medications.
B) ensuring the antidotes are readily available for certain high-risk medications.
C) introducing equipment that makes it more difficult for a nurse to commit an error.
D) introducing a brief waiting period between the time that a medication is ordered and the time that it is administered.

Question 22

A nurse is providing care for a client whose blood pressure has been gradually dropping over the course of a shift. The nurse has decided to inform the client's primary care provider by telephone using the SBAR tool. The nurse will end this communication by:

A) making a suggestion about what the nurse believes to be the best action.
B) reviewing the main events that the nurse has described to the care provider.
C) identifying the desired outcomes.
D) describing the main assessment results that have been gathered during the shift.

Question 23

The nurse is caring for a client who has an indwelling urinary catheter. A care bundle is being used to guide the client's catheter care. What are likely elements of the care bundle? Select all that apply.

A) Ensure that the client's meatus is cleansed at least once per day.
B) Evaluate the client's need for the catheter on a daily basis.
C) Irrigate the client's catheter daily to ensure patency.
D) Apply standard precautions when providing catheter care.
E) Replace the catheter every 48 hours to reduce the risk of infection.

Question 24

A client who is enrolled in Medicare and who has been recovering in the hospital from a stroke has developed a pressure ulcer on his coccyx, an event that the Centers for Medicare & Medicaid Services (CMS) has identified as a "never event." The nurse should recognize what implication of this CMS designation?

A) The hospital must bear any costs incurred for treating the client's ulcer.
B) The hospital will be fined by CMS because the client developed a pressure ulcer.
C) CMS will bear the hospital's costs if the client chooses to sue the hospital.
D) CMS may choose to divert clients to other healthcare facilities in the future.

Question 25

A client has been discharged from the hospital after being treated for a myocardial infarction. The client has been asked to evaluate the care received by completing the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). The results of this survey may affect:

A) the client's future qualification for Medicare and/or Medicaid.
B) the amount of money the hospital receives from the Centers for Medicare & Medicaid Services.
C) the hospital's evaluation by the Occupational Safety and Health Administration (OSHA).
D) the hospital's standing in the Magnet Recognition Program.