Deck 4: Patient Safety and Quality Improvement

Question 1

The nurse participates in the investigation of an incident in the facility.As a result of the root cause analysis,what would the nurse expect as the ultimate outcome?

A) Identification of the person at fault
B) An appropriate punishment for the individual who caused the event
C) Reason the event occurred
D) A plan for the prevention of this event

Answer 1

A plan for the prevention of this event

Question 2

A patient has been wandering and is at risk for falling.Which approach by the nurse regarding the use of chemical and physical restraints in the long-term care setting should be considered initially?

A) Use nonprescription restraints first.
B) Obtain with a telephone prescription.
C) Implement alternative measures first.
D) Notify patient's family within 24 hours.

Answer 2

Implement alternative measures first.

Question 3

The nurse is caring for a 79-year-old male who has a non-weight-bearing cast on the left lower extremity.The patient ambulates without using a walker despite repeated instruction from the nurse to call for assistance.Which response by the nurse is most likely to keep the patient from falling?

A) Apply a vest restraint and offer frequent toileting.
B) Plan fall prevention with patient, family, and healthcare provider.
C) Inform family that the patient needs physical restraints.
D) Document that the patient has a high potential for falling.

Answer 3

Plan fall prevention with patient, family, and healthcare provider.

Question 4

The patient sustains a minor leg abrasion and stops breathing for a few seconds during a grand mal seizure.Which is the best nursing documentation after the patient's seizure?

A) Type of muscle contractions
B) Size and description of the abrasion
C) Length of the patient's apneic episode
D) Description of the seizure in detail

Question 5

The nurse is orienting a group of new nurses and explaining the concept of sentinel events and their causes.What should the nurse explain as the number one root cause of all sentinel event reports to The Joint Commission?

A) Medication errors
B) Falls
C) Communication failures
D) High patient-to-nurse ratios

Question 6

A patient at risk for falling is being ambulated.Which action by the nurse is most important to prevent the patient from falling?

A) Raising the bed to an appropriate working height
B) Placing nonskid shoes on the patient
C) Dangling the patient on the side of the bed for 10 minutes
D) Turning on the brightest lights in the room

Question 7

The nurse is instructing a male patient who has a difficult-to-control seizure disorder on home care issues.Which issue affecting safety is most important for the nurse to address with patient teaching before discharge?

A) Avoiding substances containing alcohol
B) Maintaining a current list of medications
C) Keeping a supply of medications at work
D) Purchasing lawn equipment with a safety switch

Question 8

The patient is having a generalized tonic-clonic seizure.To maintain the airway,which intervention should the nurse implement after the patient's motor activity ceases?

A) Apply chin-lift position.
B) Insert a curved oral airway.
C) Sit the patient in upright position.
D) Turn the patient on his side.

Question 9

The nurse plans a fall prevention program for a confused patient.Which task from the program is suitable for the nurse to delegate to nursing assistive personnel (NAP)?

A) Evaluating patient understanding of fall prevention plan
B) Keeping the patient's bed in the low position at all times
C) Assessing the patient's circulatory and respiratory status
D) Instructing the patient's family about alternatives to restraints

Question 10

Although the interdisciplinary team is responsible for the safety of the patient,who has the ultimate responsibility for making the patient's bedside area safe?

A) The nurse
B) Housekeeping
C) Nursing assistive personnel (NAP)
D) The maintenance department

Question 11

The nurse plans a restraint-free environment but cannot find activities to engage an agitated middle-aged patient.Which should the nurse implement to maintain the patient's safety?

A) Request help from interdisciplinary team members.
B) Transfer the patient to a private room to protect others.
C) Document that the patient is uncooperative and hostile.
D) Ask the healthcare provider for a sedation prescription.

Question 12

The nurse finds the patient pulling on the nasogastric tube (NGT)and surgical drain and fears that the patient will pull them out.Which nursing intervention should the nurse implement to maintain the patient's self-esteem and avoid applying restraints?

A) Cover or camouflage tubes and drains.
B) Provide constant activity for the patient.
C) Instruct family members to watch the patient.
D) Keep the patient close to the nurses' station.

Question 13

The nurse plans care for a patient who requires physical restraint.Which is a suitable goal for this patient?

A) The patient remains free of any injury.
B) The nurse checks the restraint every hour.
C) The nurse uses the least restrictive restraint.
D) The patient allows the nurse to apply restraints.

Question 14

A child had surgery on his face and needs to keep his hands away from it.Which restraint should the nurse use to accomplish this outcome?

A) A jacket restraint
B) Mitten restraints
C) A mummy restraint
D) Elbow restraints

Question 15

The nurse plans a safety program for the patients on a medical-surgical unit.Which patient has the greatest likelihood of falling?

A) A 79-year-old after a pacemaker battery replacement
B) A 68-year-old anemic who is dehydrated and has heart failure
C) A 21-year-old fresh postarthroscopy after a college football injury
D) A 33-year-old post-right salpingectomy for ectopic pregnancy

Question 16

The nurse applies a physical restraint to the patient.Which entry should the nurse make after applying physical restraints?

A) Performed restraint application reluctantly
B) Applied bilateral soft lamb's wool wrist restraints; skin pink, moist, and intact
C) Will perform a neurovascular assessment every 4 hours
D) Checked provider's prescription for prn restraints

Question 17

The nurse discovers smoke in the second floor utility room.What intervention should he or she implement first?

A) Find the fire extinguisher and try to extinguish the fire.
B) Evacuate the entire second floor to the first floor lobby.
C) Rescue any patients, visitors, or staff in immediate danger.
D) Pull the nearest alarm box and call the telephone operator.

Question 18

The nurse listens to a family's request to bring a few familiar items into the room of a patient who is confused.How does the nurse justify the decision to allow personal items?

A) Personal items can increase patient agitation.
B) Personal items can restore cognitive function.
C) Personal items are likely to alienate the patient.
D) Personal items can comfort a confused person.

Question 19

The daughter of a female patient tells the home health nurse that using the bathroom is embarrassing for the patient and she refuses to use a call light when she needs to get up.Which is the best response by the nurse?

A) Ask the patient why she does not use the call light.
B) Instruct the daughter to remain at the patient's side.
C) Tell the patient that home visits require patient cooperation.
D) Discuss call light alternatives with patient and daughter.

Question 20

The female patient wearing bilateral wrist restraints complains that her hands are numb; and the nurse assesses pale,cool fingers.Which is the nurse's priority intervention?

A) Notify the provider quickly.
B) Remove the wrist restraints.
C) Try another type of restraint.
D) Increase the restraint padding.

Question 21

The nurse is caring for a patient who has brought in his own CPAP device to use at night.What does the nurse need to do in addition to contacting Respiratory Therapy?

A) Have the device inspected by the appropriate hospital department for safety.
B) Have the patient take it home and get one from patient equipment.
C) Tell the patient he cannot use it.
D) Notify the physician.

Question 22

The following is an example of an alternative to restraint use in patient care.(Select all that apply.)

A) Frequent observation of patients
B) Involving patients and families
C) Frequent reorientation
D) Four side rails
E) Lap belt with quick release

Question 23

The nurse is giving report to the next shift and describes how it is important to maintain a regular schedule for Mr.Jones,a confused elderly man who wanders.Why is it important for this intervention to be maintained?

A) Regular routine helps nurses find the patient early if he wanders.
B) Regular routine decreases his confusion.
C) Regular routine decreases wandering.
D) Regular routine decreases stress.

Question 24

The nurse enters the room and finds the patient sitting in a chair and just beginning to have a seizure. Match the nursing interventions with the step, beginning with the nurse's first action.

5. Step 1

A)Call for additional help at the patient's side.
B)Maintain the patient's airway.
C)Clear away hazardous objects.
D)Guide the patient to the floor.

Question 25

The nurse enters the room and finds the patient sitting in a chair and just beginning to have a seizure. Match the nursing interventions with the step, beginning with the nurse's first action.

6. Step 2

A)Call for additional help at the patient's side.
B)Maintain the patient's airway.
C)Clear away hazardous objects.
D)Guide the patient to the floor.

Question 26

MATCHING
While walking in the hallway with the nurse, the patient has a seizure. Match the nursing interventions with the step.

4. Step 4

A)Remove nearby furniture.
B)Loosen restrictive clothing.
C)Maintain the patient's airway.
D)Ease the patient to a safe location.

Question 27

MATCHING
While walking in the hallway with the nurse, the patient has a seizure. Match the nursing interventions with the step.

1. Step 1

A)Remove nearby furniture.
B)Loosen restrictive clothing.
C)Maintain the patient's airway.
D)Ease the patient to a safe location.

Question 28

MATCHING
While walking in the hallway with the nurse, the patient has a seizure. Match the nursing interventions with the step.

3. Step 3

A)Remove nearby furniture.
B)Loosen restrictive clothing.
C)Maintain the patient's airway.
D)Ease the patient to a safe location.

Question 29

MATCHING
While walking in the hallway with the nurse, the patient has a seizure. Match the nursing interventions with the step.

2. Step 2

A)Remove nearby furniture.
B)Loosen restrictive clothing.
C)Maintain the patient's airway.
D)Ease the patient to a safe location.

Question 30

The Joint Commission restricts the use of restraints to the least restrictive device necessary to prevent disruption of needed care.The order for restraints must include which of the following? (Select all that apply.)

A) Type
B) Duration
C) Purpose
D) Location
E) Size

Question 31

The nurse is caring for a patient who just received a diagnosis of a seizure disorder.What supplies should the nurse gather to have at the bedside? (Select all that apply.)

A) A suction device with catheters
B) Extra pillows to pad the bed
C) A padded tongue blade
D) Oxygen source and nasal cannula

Question 32

A nurse notes smoke coming from a garbage can in an otherwise empty nursing station.Which actions should the nurse take? (Select all that apply.)

A) Activate the fire alarm.
B) Use a type A fire extinguisher.
C) Rescue the patients from the unit.
D) Put wet towels along the base of the doors.
E) Use a type B fire extinguisher.
F) Aim the nozzle at the top of the fire.

Question 33

Which of the following statements are examples of features that support a culture of safety? (Select all that apply.)

A) Acknowledging that hospitals are risk-free environments
B) Encouraging a high degree of teamwork and collaboration
C) Commitment of resources by the organization to address safety concerns
D) An environment where employees can report errors without punishment
E) A system that does not use incident reports

Question 34

The nurse enters the room and finds the patient sitting in a chair and just beginning to have a seizure. Match the nursing interventions with the step, beginning with the nurse's first action.

7. Step 3

A)Call for additional help at the patient's side.
B)Maintain the patient's airway.
C)Clear away hazardous objects.
D)Guide the patient to the floor.

Question 35

The nurse enters the room and finds the patient sitting in a chair and just beginning to have a seizure. Match the nursing interventions with the step, beginning with the nurse's first action.

8. Step 4

A)Call for additional help at the patient's side.
B)Maintain the patient's airway.
C)Clear away hazardous objects.
D)Guide the patient to the floor.

Question 36

The nurse is caring for a patient and is exposed to a chemotherapy drug during IV administration.Where can she obtain information about the drug that is necessary for an exposure-related incident?

A) The nurse's supervisor
B) Poison control center
C) MSDS sheets
D) Employee health services