Deck 11: The Nurses Role in Quality and Safety

Question 1

The vice president of nursing is curious about the quality performance of the cardiovascular intensive care program as compared with other major city hospitals.Which resource should the vice president use to determine this performance?

A)National Quality Forum
B)Quality and Safety Education for Nurses
C)Agency for Healthcare Research and Quality
D)National Database of Nursing Quality Indicators

Answer 1

National Database of Nursing Quality Indicators

Question 2

At the completion of orientation the new graduate is completing a written test that focuses on the QSEN competencies.Which statements should the nurse identify as describing these competencies? (Select all that apply. )

A)Minimizes the risk of harm
B)Functions within interprofessional teams
C)Follows time-out protocols as appropriate
D)Uses data to monitor the outcomes of care processes
E)Integrates the best current evidence with clinical expertise

Answer 2

Minimizes the risk of harm
Functions within interprofessional teams
Uses data to monitor the outcomes of care processes
Integrates the best current evidence with clinical expertise

Question 3

The Quality Improvement committee is identifying indicators as measures of health care.What should the committee identify as characteristics of quality indicators? (Select all that apply. )

A)Identify nurses' roles
B)Readily available data
C)Focus on priority areas
D)Scientifically acceptable
E)Useful for decision making

Answer 3

Readily available data
Focus on priority areas
Scientifically acceptable
Useful for decision making

Question 4

A client with a nasogastric tube to suction has been prescribed tracheostomy suctioning as needed to maintain airway integrity.While rounding after report the nurse notes that the tubing for the nasogastric suction has been switched with that to be used for the tracheostomy suctioning.How should the charge nurse categorize this error?

A)Latent
B)Active
C)Technical
D)Organizational system

Question 5

The quality improvement committee is creating materials to use when implementing Six Sigma into the organization.In which order should the steps of this process be presented to the staff?

A)Identify desired outcomes
B)Analyze data of new processes
C)Monitor ongoing improvements
D)Identify process revisions required
E)Collect data on the defined process

Question 6

The nurse is completing an occurrence report for a client in the intensive care area.The client's medications were accidentally switched with another client necessitating extending mechanical ventilation.Prior to the occurrence the client's hemodynamic parameters were stable,however they have been tenuous for the last 16 hours.What collected data should the nurse identify as nursing work environment variables that contributed to this occurrence? (Select all that apply. )

A)The nurse was interrupted twice while preparing the client's medications.
B)The nurse was preparing information to share with the family prior to visiting hours.
C)The nurse did not secure the prepared medications prior to vacating the medication room.
D)The nurse worked until midnight the previous day and returned to work a twelve-hour shift.
E)The nurse was called to the telephone to take verbal orders on another client while preparing the client's medications.

Question 7

A major urban hospital is adopting the practices of high reliability organizations.Which behaviors indicate that nursing staff are incorporating these practices? (Select all that apply. )

A)Staff development trains all on algorithms created to address system errors.
B)Human resources prepares materials to use prior to issuing staff suspensions.
C)Nurse manager intercedes before an error with intravenous medication occurs.
D)Vice president of nursing meets with staff to learn ways to reduce the incidence of sharps occurrences.
E)Staff nurses analyze the steps that occurred to determine why a client had an adverse reaction in the operating room.

Question 8

The director of nursing is searching for information about the Consumer Assessment of Health Plans.Which organization website should the director access for this information?

A)Joint Commission (TJC)
B)Centers for Medicare and Medicaid Services (CMS)
C)National Association for Healthcare Quality (NAHQ)
D)Agency for Healthcare Research and Quality (AHRQ)

Question 9

The hospital administrator is considering the implementation of the Lean model as the framework for quality improvement in an organization.In which order should the administrator explain the elements of this model?

A)Identify value
B)Improve the flow
C)Perfect the process
D)Test the new process
E)Determine the value stream

Question 10

The Quality Improvement director is reviewing the number of medication errors that occurred in a skilled nursing facility over the last month. The total number of medication doses provided equals 625,500. The total number of medication errors was 7. If using the Six Sigma statistical measure to limit defects to 3.4 per million opportunities, what should be the goal for the number of medication errors for this care area? (Round the answer to the nearest whole number.)

Question 11

The staff on a care area expresses dissatisfaction with participating in data collection of quality indicators.What should the manager explain as reasons to measure quality? (Select all that apply. )

A)Pay for performance
B)Public accountability
C)Determine staffing needs
D)Drive quality improvement
E)Inform consumer decisions

Question 12

The nurse manager is reviewing an occurrence report written after a client fall.For which personal factors should the manager consider as contributing to this occurrence? (Select all that apply. )

A)Patient consumed 75% of last meal
B)Patient's team leader a new graduate
C)Unlicensed assistive personnel assigned working a double shift
D)"Ambulate with assistance" not written on the Kardex care plan
E)Patient being discharged to a skilled nursing facility the next day

Question 13

A staff nurse accidentally provided a client with an incorrect stock medication,however did not report the occurrence to anyone.What behavior is this staff nurse demonstrating?

A)At-risk
B)Human error
C)Recklessness
D)Fear of punishment

Question 14

The nurse manager is curious as to how the client care staff is meeting process outcomes.On what should the manager focus when making this determination? (Select all that apply. )

A)Work flow
B)Quality of life
C)Patient education
D)Tasks and activities
E)Satisfaction with care

Question 15

The Shared Governance committee is tasked with creating an approach to introduce Just Culture to the nursing staff.When creating the materials,which duties should be emphasized? (Select all that apply. )

A)Report errors
B)Support autonomy
C)Avoid risk or harm
D)Follow procedures
E)Produce an outcome

Question 16

A series of medication errors occurred on a care area and are believed to be caused by the redesign of the unit dose delivery system.Who should the nurse manager expect to participate when conducting a root cause analysis of these occurrences? (Select all that apply. )

A)Nurse manager
B)Pharmacy director
C)Nurses who made the medication errors
D)Person who delivered the unit dose device
E)Pharmacist responsible for filling the unit dose device

Question 17

The nurse receives the report for a client recovering from a repair of a fractured hip,who is being transferred to the orthopedic care area.The following information was obtained in the telephone report:
Report received 14:00 hours: 76-year-old female;ORIF of right hip caused by falling in the home;receiving Morphine sulfate 2 mg IV every 4 to 6 hours for pain;difficult to keep turned on non-operative site;indwelling urinary catheter in place;Hgb 10 after 2 units PRBCs post-operatively.
Which National Patient Safety goals should the nurse make a priority for this client? (Select all that apply. )

A)Prevent wrong site/procedure/person surgery.
B)Prevent health-care associated pressure ulcers.
C)Improve the accuracy of patient identification.
D)Reduce the risk of patient harm resulting from falls.
E)Reduce the risk of health care-associated infections.

Question 18

During an emergency room visit a client refuses to be admitted because of information learned over the internet about the care of clients with the same health problem.To what should the nurse realize that the client is referring?

A)Report card
B)KSA behaviors
C)Health care claims
D)QSEN competencies

Question 19

The charge nurse is beginning rounds after attending morning report.Which clients should the nurse be concerned for developing a never event? (Select all that apply. )

A)Client with hemophilia receiving Factor replacement transfusions
B)Client recovering from a stroke with foul-smelling urine in a catheter drainage bag
C)Client recovering from total knee replacement surgery complaining of right calf pain
D)Client with heart failure being fitted for a C-pap mask for use at home for sleep apnea
E)Client with renal failure with a newly diagnosed stage III pressure ulcer on the left heel

Question 20

The staff development trainer is preparing information for a seminar on the Quality and Safety Education for Nurses (QSEN)initiative as part of the National Safety Week celebration.Which attributes should the trainer emphasize as being an integral part of this initiative? (Select all that apply. )

A)Skills
B)Caring
C)Attitudes
D)Education
E)Knowledge

Question 21

The nurse manager is counseling a staff nurse who demonstrated reckless behavior.What should the manager say when meeting with this nurse?

A)"I have a handout that can help you."
B)"I realize that the design of the patient rooms contributed to the error."
C)"What outcomes do you think can occur if this happens again in the future?"
D)"This is the second time this has occurred and I think a few days off might be needed."

Question 22

The nurse manager has plans to improve teamwork among the nurses and other health care providers.What actions should the manager take to achieve this goal? (Select all that apply. )

A)Used standardized team processes
B)Monitor team members' performance
C)Reinforce the three duties when providing care
D)Observe for behaviors that encourage occurrence
E)Understanding all team members' responsibilities

Question 23

The healthcare organization is planning to implement patient-centered care.What aspects of this delivery model should be emphasized when training the staff? (Select all that apply. )

A)Supports client autonomy
B)Focuses on dignity and respect
C)Adheres to principles of client privacy
D)Care is organized around the client's needs
E)Partnering with the client and families occurs

Question 24

The charge nurse is overheard yelling at a new graduate who mixed a tube feeding with the incorrect volume of water.What would be the expected outcome from this exchange?

A)The other staff will make sure that no errors occur.
B)The human resources department will be contacted.
C)The new graduate will hesitate to report errors in the future.
D)The charge nurse will create a guide sheet for all staff to use

Question 25

The nurse is preparing information to use when conducting SBAR communication.In which order should the nurse perform the following actions?

A)Explain chief complaints
B)Overview of patient needs
C)Discuss what could be the problem
D)Provide objective data and vital signs

Question 26

The department of nursing has updated a policy that outlines actions that must be taken routinely to facilitate client safety.Which actions should be emphasized on this document? (Select all that apply. )

A)Mandatory reading back of all verbal orders.
B)Posting actions to take when preparing medications.
C)Implementing an algorithm identifying the punitive steps for client care errors.
D)Charge nurse to notify health care providers of critical morning laboratory values by 10 a.m.
E)Implementing a checklist for change of shift report,identifying critical information required.

Question 27

The staff development trainer is preparing material as part of a teambuilding seminar.What should the trainer include in the teaching material? (Select all that apply. )

A)Importance of setting goals
B)Honoring individual talents
C)Strategies to support group cohesion
D)Methods to ensure good communication
E)Reviewing structure,process,and outcomes