Deck 2: Patient Safety and Risk Management

Question 1

A healthy 32-year-old nursing student is scheduled for excision of a left-sided subglottal cyst with frozen section and possible radical neck dissection.The preoperative verification process provides the opportunity to collect and verify information about the patient to ensure patient safety.Among the patient data that must be verified are:

A) emergency contact name.
B) laboratory and imaging results.
C) advance directive on file.
D) immunization records.

Answer 1

B
Preprocedure verification process ensures that all relevant documents (e.g.,the history and physical examination,surgical consent,required laboratory studies)and imaging studies (properly labeled and displayed)are available before the start of the procedure.Preprocedure verification is best conducted when the patient can be involved and should be completed before the patient leaves the preprocedure area.

Question 2

Proper handling of specimens is crucial for patient safety.What is the most serious negative outcome that could occur as a result of the loss,mislabeling or mishandling of a surgical specimen?

A) The medical facility could be sued for negligence.
B) The patient might be unsatisfied with the treatment received.
C) The patient's condition could be misdiagnosed.
D) The medical facility's reputation could be damaged.

Answer 2

C
A mislabeled specimen may result in misdiagnosis and consequently inappropriate treatment of the patient.Communication errors pose significant risks to patients in the misidentification of a surgical specimen before its arrival in the pathology laboratory.

Question 3

Informed consent is both a requirement and a patient right.The perioperative nurse's responsibility in terms of informed consent is to:

A) ensure the consent is completed properly to prevent legal liability.
B) report to the physician any doubts or concerns regarding the patients understanding.
C) obtain the informed consent.
D) answer questions related to risks and benefits.

Answer 3

B
The perioperative nurse's role as a patient advocate means the nurse has a responsibility for identifying and addressing expressed fears and determining the patient's ability to understand.The informed consent process does not prevent legal liability if adverse events occur.The perioperative nurse is not responsible for obtaining the informed consent but is responsible for verifying the consent is correct and complete.

Question 4

Demands of the perioperative environment impact how staff dispense and administer medications.Safe perioperative medication practices include:

A) optimizing use of automated dispensing cabinets to obtain medications for multiple patients at one time.
B) retrieving medications well ahead of a planned use to prevent delays.
C) preloading syringes to improve efficiency.
D) transferring medications to the sterile field without distractions and one medication at a time.

Question 5

A patient was positioned,prepped,and draped following general endotracheal anesthesia induction.The team assembled to perform the time-out as described in the WHO surgical checklist.Successful employment of the time-out can only be ensured when:

A) the time-out is initiated by the surgeon.
B) each member of the team has an equal role and voice.
C) perioperative services have a physician champion and surgeon buy-in.
D) the checklist is committed to memory by all team members.

Question 6

The Joint Commission (TJC)designates sentinel events as unexpected occurrences involving death or risk of serious physical or psychologic injury.In 2003,TJC mandated the Universal Protocol to address perioperative sentinel events.This protocol includes:

A) improving the safety of using medications.
B) reporting critical results of tests in a timely manner.
C) performing a preprocedure verification process.
D) establishing alarm system safety as a priority.

Question 7

Fires and explosions in the perioperative setting require three components,described as the "fire triangle." The element of the triangle the perioperative nurse has the most control over is:

A) the ignition sources.
B) the fuel.
C) the oxidizer.
D) static electricity.

Question 8

Laparoscopic procedures that emergently convert to open procedures place the patient at risk for unintentional retained surgical items (RSIs).What new and evolving risk reduction strategy could prevent RSIs and frustrating,time-consuming miscount adventures at the end of these procedures?

A) Creating precounted laparotomy sets with only the few necessary instruments
B) Performing radiologic surveillance on all conversion procedures at closure
C) Counting all instruments including a laparotomy set before the laparoscopy
D) Replacing or tagging sponges and laparotomy instruments with radiofrequency identification (RFID) chips

Question 9

Governmental and professional agencies and organizations,whether voluntary or involuntary,have a significant influence on patient safety policies in the healthcare setting.Select the agency or organization statement that presents a true reflection of its focus or purpose.

A) The Joint Commission (TJC): Nonvoluntary bureau that tests healthcare institutions against evidence-based elements of performance
B) Surgical Care Improvement Project (SCIP): Trends surgical site infection statistics
C) American Society of Anesthesiologists (ASA): Professional organization of anesthesia providers and technologists
D) World Health Organization (WHO): United Nations (UN)-based and supported authority on health throughout most of the world

Question 10

Surgical patients are at risk for development of pressure injuries due to extrinsic factors such as length of surgery and intrinsic factors such as co-morbidities and age.The most important factor in prevention of such pressure injuries is:

A) use of a transfer sheet to decrease friction.
B) use of sheets or blankets to position patients.
C) completion of a preoperative risk assessment and skin assessment.
D) reviewing the guidelines for patient positioning in surgery.

Question 11

The OR is a danger-prone area for both patients and staff.Providing a safe environment of care for the patient involves identifying,mitigating,and managing the hazards inherent in surgical care.Choose the answer below that completes the blanks in this sentence: the risk of the surgical hazard of _________________ can be mitigated through _______________________.

A) wrong patient, wrong site, and wrong side surgery; site marking and presurgical checklists
B) electrical and thermal burns; alcohol-free prep solution
C) surgical site infection; flash sterilization
D) surgical airway fire; fire extinguishers in every OR

Question 12

Since its organization and establishment as a professional nursing association in the early 1950s,the Association of periOperative Registered Nurses (AORN)continues its endeavor to:

A) promote guidelines influencing patient safety.
B) create professional operating room (OR) nursing care delivery models.
C) interpret healthcare statistics critical to perioperative nursing care.
D) ensure risk reduction strategies are the foundation of perioperative education.

Question 13

A patient was presented with the prepared informed consent form during the discussion with her surgeon concerning her scheduled vaginal-assisted laparoscopic hysterectomy.She demonstrated and verbalized that she understood the procedure,risks,expected outcome,complications,and procedural process.Before she signed the consent form,she informed the surgeon that she did not want any medical students or surgical residents performing any parts of the procedure other than assisting and did not want any photographs of her body taken.The surgeon agreed,and she crossed out those portions of the form and initialed them before she signed.The patient was exercising her:

A) understanding and rights under the Patient Self-Determination Act (PSDA).
B) right to informed consent.
C) autonomy to protect herself from negligence and malpractice.
D) hope that everyone would honor the Health Insurance Portability and Accountability Act (HIPAA).

Question 14

Which of the following situations requires informed consent from the patient/family?

A) Emergent surgery
B) Organ procurement
C) Starting an IV
D) Discharge to home

Question 15

Early on,during the preliminary sponge count on closure of a repair of a ruptured abdominal aortic aneurysm,the circulating nurse was unable to account for 2 lap sponges.He had maintained accountability for all sponges and instruments discarded from the sterile field and bagged each sponge carefully.He immediately turned and addressed the entire team in a clear voice.Select the appropriate communication that the circulating nurse must employ during this count discrepancy.

A) "Stop everything. I'm missing a couple of sponges. They are not in the trash or back table. Check the wound."
B) "I think you are missing 2 sponges. Shall I call X-ray while the scrub person checks her table again? Doctor, please check the incision."
C) "We have a count discrepancy. We started with 70 sponges and find only 68. We are missing 2 lap sponges. Everyone, please check your areas.
D) "I've called X-ray because we are short 2 sponges. I've called the charge nurse to get someone to help me check the trash and linen."

Question 16

Proper care and handling of surgical specimens is imperative for correct diagnosis,treatment,and prognosis planning of the patient.Select the response that best reflects correct specimen care and handling.

A) Label consecutive specimens in alphabetical order for laboratory efficiency.
B) Send all specimens to the laboratory together as one pickup, including frozen sections.
C) Avoid placing specimens for frozen section in formalin.
D) Neutralize formalin/formaldehyde spills with glycerin sulfate, and call the hazmat team.

Question 17

When unexpected events occur that have,or could have,compromised patient safety,a systematic investigatory process takes place.Significant information is gained through this meticulous exploration.The primary motive for carrying out a root cause analysis is to:

A) establish cause and trends based on who was involved.
B) determine precisely what happened and why.
C) find out what needs to take place to prevent a recurrence of the event.
D) uncover factors that contributed to the environment and the event.

Question 18

As the placenta was delivered and the uterus prepared for closure,the scrub person gathered up all of the sponges and dropped them in the kick bucket while the circulating nurse frantically stuffed them into sponge bag pockets.Sharps,sponges,and instrument counts were correct on closure of the uterus and again on closure of the peritoneum.On final sharps and sponge counts before skin closure,a needle was missing.Select the appropriate order of corrective action for the team.

A) Count and verify suture packs, dump and count packs in sterile suture bag, check floor, check back table and Mayo stand, notify surgeon, and check linen and clean and red trash bags. Open clean trash bags tied up in the corner from sterile table setup.
B) Recalculate numbers on whiteboard, check back table and Mayo stand, dump and check linen and trash, verify suture packs, notify team of possible missing needle.
C) Notify team of needle discrepancy; recount needles on and off sterile field and whiteboard; check sterile field, Mayo stand, and back table; check floor, under OR table, bottoms of shoes, pants' cuffs, and sterile sleeve cuffs; check sponge bags and kick bucket.
D) Recount needles on and off sterile field, check sterile field and Mayo stand and back table; check floor, wait to notify team until miscount verified; check red bag trash, compare empty suture packs, total number on whiteboard.

Question 19

A patient was transferred to the postanesthesia care unit (PACU)by the anesthesia provider and perioperative nurse.A hand-off report was given,using situation,background,assessment,recommendation (SBAR)format,to the accepting PACU nurse.The first element of information that should be presented in the hand-off report is:

A) the expected discharge criteria.
B) the names and roles of the nurse and anesthesia provider.
C) patient identification and procedure performed.
D) pain management orders.

Question 20

During a simulation on intraoperative counts in which peer "teams" competed,Team 2 was determined to have demonstrated best practice in performing surgical counts.This team,whose members included a RN,CNOR,and CST,reviewed the unit practice standard and current AORN evidence-based guidelines.Select the appropriate order of counts that they demonstrated to their peers.

A) The CST counted the back table, Mayo stand, and sterile field, while the RN counted the sponge bags and the items in the kick bucket.
B) The RN and CST counted aloud together as RN pointed to the sponges in the sponge bag and then as the CST touched each sponge, moving from back table to Mayo stand to sterile field.
C) The RN and the CST each counted aloud as the CST pointed to items on the floor and kick bucket, and back table. To expedite the count, the RN counted aloud as she pointed out the sponges in the sponge bag while the CST completed the back table.
D) The surgeon searched the wound as the RN and the CST counted the floor, sponge bag, kick bucket, back table, Mayo stand, sterile field, and the sponge wrapped around the new ostomy.

Question 21

Which nonprofit organization improves patient care through applied research into effectiveness and safety of devices,drugs,procedures,and processes?

A) The Joint Commission (TJC)
B) National Institute for Occupational Safety and Health (NIOSH)
C) Consumers Advancing Patient Safety (CAPS)
D) Emergency Care Research Institute (ECRI)

Question 22

A female patient with end-stage pancreatic cancer was admitted from hospice for a celiac plexus block to treat intractable pain.She wanted to be able to complete "getting her things in order" and saying good-bye to her friends and family while enjoying her last days pain-free.The patient insisted that her Do Not Resuscitate (DNR)status NOT be rescinded.She was conscious and competent and knew what was best for herself.The patient was taking full advantage of what provision for her care?

A) PSDA
B) Advance directives
C) Informed consent
D) PSDA and advance directives

Question 23

Researchers in the area of patient safety have proposed an emphasis on transparent systems,asserting that adverse patient events cannot be effectively prevented until the legal and professional licensure systems discontinue their focus on individual error and blame.In order for a transparent system to exist and thrive,it requires:

A) human factor reliance.
B) confidentiality.
C) open reporting.
D) disciplinary guidelines.

Question 24

In the perioperative environment,patient hand offs occur at multiple points during the continuum of care.Best practices for patient hand offs include:

A) completing urgent tasks before beginning the hand-over process.
B) tailoring communication steps as needed to manage efficiency.
C) using a structured tool to facilitate consistency.
D) using a broad definition for hand offs.
E) integrating technology into the hand-off process.

Question 25

A key factor in promoting patient safety is:

A) emphasis on individual responsibility.
B) elimination of distractions and noise from the perioperative environments.
C) standardized checklists.
D) continuous monitoring.