Deck 21: Managing Quality and Risk

Question 1

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit.The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?

A) "It promotes teamwork among health care providers."
B) "It increases adverse events."
C) "It improves outcomes."
D) "It contributes to duplication of services."

Answer 1

"It improves outcomes."

Question 2

A new graduate is asked to serve on the hospital's quality improvement (QI)committee.The nurse understands that the first step in quality improvement is to

A) collect data to determine whether standards are being met.
B) implement a plan to correct the problem.
C) identify the standard.
D) determine whether the findings warrant correction.

Answer 2

identify the standard.

Question 3

Hospital ABCD is a Magnet™ hospital.This designation has been applied to Hospital ABCD because it

A) facilitates active staff participation in decision-making related to quality nursing care.
B) has implemented a graduate nurse orientation program.
C) espouses commitment to excellence in patient care.
D) is establishing career ladders for nurses.

Answer 3

facilitates active staff participation in decision-making related to quality nursing care.

Question 4

The nurse gives an inaccurate dose of medication to a patient.After assessment of the patient,the nurse completes an incident report.The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence.The nurse who administered the inaccurate medication understands that

A) the error will result in suspension.
B) an incident report is optional for an event that does not result in injury.
C) the error will be documented in her personnel file.
D) risk management programs are not designed to assign blame.

Question 5

As a nurse manager,you know that the satisfaction of patients is critical in making QI decisions.You propose to circulate a questionnaire to discharged patients,asking about their experiences on your unit.Your supervisor cautions you to also consider other sources of data for decisions because

A) the return rate on patient questionnaires is frequently low.
B) patients are rarely reliable sources about their own hospital experiences.
C) hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness.
D) patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Question 6

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process,a QI team might turn to which of the following for confirmatory evidence?

A) Best Practice Guidelines (BPGs)
B) North American Nursing Diagnosis Association (NANDA)
C) National Quality Institute
D) Agency for Healthcare Research and Quality

Question 7

A method commonly used in quality assurance to monitor adherence to established standards is

A) a Pareto chart.
B) brainstorming.
C) patient interviews.
D) chart audit.

Question 8

Patient perceptions are useful in

A) determining disciplinary actions in QI.
B) establishing the competitive advantage of QI decisions.
C) establishing priorities among possible changes to care identified in QI.
D) establishing blame for poor-quality care.

Question 9

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin.A root-cause analysis is very similar to the QI process except that a root-cause analysis is

A) retrospective.
B) prospective.
C) legislated for completion with all near-miss events.
D) conducted by only one person.

Question 10

The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveys.The first step in addressing this issue from the point of view of quality improvement is which of the following?

A) Assemble a team.
B) Establish a benchmark.
C) Identify a clinical activity for review.
D) Establish outcomes.

Question 11

A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?

A) Histogram
B) Flowchart
C) Fishbone diagram
D) Pareto chart

Question 12

A nurse manager wants to decrease the number of medication errors that occur in her department.The manager arranges a meeting with the staff to discuss the issue.The manager conveys a philosophy of total quality management (QM)by

A) explaining to the staff that disciplinary action will be taken in cases of additional errors.
B) recommending that a multidisciplinary team assess the root cause of errors in medication.
C) suggesting that the pharmacy department explore its role in the problem.
D) changing the unit policy to allow a certain number of medication errors per year without penalty.

Question 13

A health care organization is committed to improving patient outcomes as part of the QI process and examines its executive structure and organizational design.This approach recognizes which model of QI?

A) Donabedian's
B) Benchmarking
C) Employee involvement and innovation
D) Quality and safety education for nurses

Question 14

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because

A) total organizational involvement is critical in QI.
B) data generated by a single, separate department are generally flawed.
C) monitoring and commitment to QI can come only from senior-level managers.
D) staff members resent suggestions for improvement that originate outside of their unit.

Question 15

A nurse is explaining the pediatric unit's QI program to a newly employed nurse.Which of the following would the senior nurse include as the primary purpose of QI programs?

A) Evaluation of staff members' performances
B) Determination of the appropriateness of standards
C) Improvement in patient outcomes
D) Preparation for accreditation of the organization by The Joint Commission

Question 16

With the rise of workplace violence in the emergency department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should

A) request all staff to accept new risk management practices.
B) hold staff accountable for safe practices.
C) document inappropriate behaviour.
D) hire more police security.

Question 17

Through the QI process,the need to transform and change the admissions process across administrative and patient care units is identified.In this particular situation,what method of data organization will be most effective?

A) Flowchart
B) Histogram
C) Narrative
D) Line graphs

Question 18

An example of an effective patient outcome statement is

A) "Eighty percent of all patients admitted to the emergency department will be seen by a nurse practitioner within 3 hours of presentation in the emergency department."
B) "Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs."
C) "The hospital will reduce costs by 3% through the annual budget process."
D) "Quality is a desired element in patient transactions."

Question 19

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery.According to QI,to correct the problem,the educator,in consultation with the patient care manager,would initially do which of the following?

A) Talk to the staff individually to determine why this is occurring.
B) Call a meeting of all staff to discuss this issue.
C) Have a group of staff nurses review the established standards of care for postoperative patients.
D) Document which staff members are not recording vital signs, and write them up.

Question 20

Before beginning a continuous QI project,a nurse should determine the minimal safety level of care by referring to which of the following?

A) The procedure manual
B) Nursing care standards
C) The litigation rate of unsafe practice
D) Job descriptions of the organization

Question 21

Your institution has identified a recent rise in postsurgical infection rates.As part of your QI analysis,you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics.Such a determination is known as

A) quality assurance.
B) sentinel data.
C) benchmarking.
D) statistical analysis.

Question 22

At Hospital Ajax,staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame.This culture demonstrates

A) QM principles that emphasize customer safety.
B) a deep concern with improvement of quality and processes.
C) effective employee orientation and development in relation to QM.
D) goals that are inconsistent with QM.

Question 23

Examples of sentinel events include

A) forceps left in an abdominal cavity.
B) patient fall, with injury.
C) short staffing.
D) administration of morphine overdose.
E) death of patient related to postpartum hemorrhage.

Question 24

The outcome statement "Patients will experience a 10% reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is

A) physician sensitive and nonmeasurable.
B) measurable and nursing sensitive.
C) precise, measurable, and physician sensitive.
D) patient care centred and nonmeasurable.