Chapter 4

A hospital has been informed that their reimbursement from the Centers for Medicare & Medicaid Services (CMS) will be increased. Which of the following is the most likely cause for this increase in funding?

exceeding the safety targets that the CMS specifies

A nurse is preparing a client's scheduled medications on the medication cart, which is currently positioned in the hallway, next to the client's door. The nurse is going through the six rights of the client's scheduled ibuprofen when the client's call light illuminates. The nurse should:

finish preparing the medication and then assist the client when bringing the medication into the room.

The residential home nurse is caring for a client who lives in an assisted living unit. In designing a plan of care to prevent fires, the nurse identifies which as the highest risk to the client?

gas stove

A hospital client's urine output is 35 mL over the past 5 hours, so the nurse has chosen to inform the client's primary care provider by telephone. The nurse will use the SBAR tool to communicate, so will begin the dialogue by:

giving an overview of the client's circumstances and the exact reason for the call.

A client's hemoglobin level has been found to be 7.6 g/dL (normal range 13.8 to 17.2 g/dL) and the primary care provider has ordered a blood transfusion. A unit of blood has come up from the hospital's blood bank and the client's nurse has received it. In order to best promote the client's safety, the nurse should:

have a colleague double-check the blood and the client's identity.

A nurse is struggling to provide adequate care during an exceptionally busy shift. Which action is most likely a violation of Occupational Safety and Health Administration (OSHA) regulations?

The nurse manually lifts a heavy client rather than using a mechanical lift.

A nurse is using the QSEN competency of evidence-based practice when caring for clients. What is an example of this competency?

The nurse researches best current practices for prevention of the spread of infection in physician offices.

A hospital is being evaluated by the Centers for Medicare & Medicaid Services. Which of these findings from the evaluation may result in a reduction in the hospital's reimbursement under the value-based purchasing (VBP) program?

The rate of postoperative complications is significantly higher than national averages.

In which of the following clinical situations would redundancy be a necessary safety strategy?

The surgical team is identifying which of a client's breasts has a tumor before surgery.

The poison control nurse receives a call from the caregiver of a young school-age child who may have ingested a poisonous substance. Which is the priority response by the nurse?

"Check breathing and heart rate."

Two nurses are discussing a well-known adverse event in the hospital in which a wrong site surgery was performed. One of the nurses states, "Someone had better lose their job over this. How that could happen is beyond me." What is the other nurse's most appropriate response?

"I understand what you're saying, but a focus on punishment doesn't really make things safer in the future."

The nurse is teaching an unlicensed assistive personnel (UAP) about fire safety. Which UAP statement demonstrates that teaching has been effective?

"I will rescue clients from harm before doing anything else."

A nurse committed a medication error and follow-up assessment revealed that the client did not experience harmful effects. The nurse is preparing to complete an incident report, but a colleague has cautioned the nurse, stating, "Be very careful with what your write there, since you might be admitting legal liability." What is the nurse's most appropriate response?

"I've got to be clear about what happened. Besides, incident reports usually aren't used against nurses in legal matters."

The poison control nurse receives a call from the parent of a 2-year-old child. The parent states, "I just took a quick shower, and when I finished, I walked into the kitchen and found my child with an open bottle of household cleaner." What is the poison control nurse's appropriate response?

"Is your child breathing at this time?"

A nurse mistakenly documented a client's vital signs and assessment findings in the health record of a client who has since been discharged. The nurse tells a colleague, "I'm wary of filing an incident report because I don't know what the consequences will be." What should the colleague tell the nurse?

"It sounds like it was an honest mistake, and maybe a report will lead to improvements."

A neonate was born by vaginal birth and initial assessment revealed no distress. However, the infant soon developed dyspnea and then apnea. The care team in the room attempted to manage the infant's distress independently and neglected to call an emergency code, which was later determined to be necessary. Root cause analysis of this event should begin by asking what question?

"Why did no one in the room choose to call a code?"

The nurse is teaching a nursing student about proper latex glove use. Which nursing student action requires intervention by the nurse? Select all that apply.

"snapping" the gloves when applying them to ensure proper fit wearing gloves for long periods of time after procedure ends

The community health nurse is talking with four clients. Who does the nurse identify that would most benefit from teaching about alcohol and drug use?

19-year-old male college student majoring in physics

A hospital administrator is preparing a report that will be submitted to the relevant authorities regarding a sentinel event. Which of these events is the most likely subject of the report?

A client had a transfusion reaction because of a labeling error in the hospital's blood bank.

The Centers for Medicare & Medicaid Services (CMS) is unlikely to reimburse a hospital for treatment of which adverse event?

A client suffers a hip fracture after falling off of a commode.

A hospital's communication department has reiterated the hospital's commitment to ensuring that "never events" do not take place. Which adverse event may violate the hospital's commitment? Select all that apply.

A client who is recovering from a stroke develops a pressure ulcer on her heel. A client falls while attempting to use a 2-wheeled walker for the first time. A client becomes infected with vancomycin-resistant enterococci (VRE) during his admission.

For which of the following clients should the nurse have a colleague double check to prevent an adverse incident?

A client with a bleeding disorder will receive unit of platelets .

The nurse is providing safety teaching to the family of an older adult client. Which finding in the client's home will the nurse teach the family to address?

A hair dryer is placed next to the sink.

Which action by hospital nurses is the best example of an at-risk behavior?

A nurse brings two clients' medications into their room to save time and makes a drug error.

Root cause analysis would identify an active error in which adverse event?

A nurse drew up 20 units of insulin rather than 2 units by misreading the lines on the syringe.

A nursing educator is encouraging nurses on a unit to evaluate their practice in light of the Quality and Safety Education for Nurses (QSEN) project. What nursing action best demonstrates the QSEN competencies?

A nurse regularly asks clients and their families about their preferences for care.

A care facility has introduced care bundles for clients who have indwelling urinary catheters. When describing the use of care bundles, what benefit should be explained?

ensuring that each necessary element of catheter care is consistently provided

As members of the quality improvement committee of a large health care institution, a group of nurses are reviewing recent incident reports. Which staff member has most likely committed an intentionally reckless behavior?

A nurse who signed for the administration of a client's anti-seizure medication after realizing that she forgot to give it.

The nurse is teaching the caregiver of a school-age child about safety. Which teaching will the nurse include?

Buy protective sporting equipment.

A hospital's policies and procedures are being reviewed in light of the Joint Commission 2015 Hospital National Patient Safety Goals. What change in practice most directly addresses these goals?

Care of clients with indwelling catheters will be tracked more closely to reduce the incidence of UTIs.

An experienced nurse has a reputation for being conscientious and caring, so the nurse is shocked and embarrassed to have committed a medication error for the first time in her career. The nurse's supervisor should use what approach when responding to this event?

Collaborate with the nurse to identify any supplementary education that would be beneficial.

The school nurse is evaluating a school's response to a fire drill. Which action requires the school nurse to provide teaching to the schoolteachers, staff, and students? Select all that apply.

Doors of classrooms and offices are open. Elevators are used to increase the speed of vacating the building.

A client has gone into cardiac and respiratory arrest and resuscitation is being attempted at the client's hospital bedside. The nurse recognizes the high potential for errors in this emergency setting. Which action is most likely to prevent adverse incidents in this situation?

Ensure clear, accurate communication between each of the team members.

A nurse manager has issued a formal reprimand to a nurse who accidentally discharged a client before a discharge order was received and documented. What is a potential, unintended consequence of this approach to an adverse incident?

Factors that made the nurse's error possible may remain unchanged.

Creating a "culture of blame" is a mechanism that has been successfully used to reduce healthcare errors.

False

A client suffered an acute kidney injury following a hypotensive episode. A review of the client's chart reveals that the client's blood pressure was within acceptable range less than an hour before the event. Later investigation, however, reveals that the nurse took the client's blood pressure nearly 90 minutes earlier than she documented, and that the discrepancy was an effort to cover this up. What is the most appropriate response to this nurse's action?

Formal discipline

Two male clients with the same surname were waiting for admission in an outpatient clinic. The nurse began the admission assessment of one of the clients for the procedure that the other client was scheduled for. What is the most appropriate response to this incident?

Formally document and report this near miss so that systems and procedures can be improved.

Which statement is true of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys that many clients complete after receiving hospital care?

HCAHPS surveys are one set of data considered in the value-based purchasing (VBP) program.

A nurse is pouring a client's scheduled medications at the medication cart outside the client's room when a colleague asks for assistance with transferring another client from the commode. What is the nurse's most appropriate response?

Help the colleague after administering and documenting the medication.

What teaching will the community health nurse include for parents of toddlers?

Household cleaners must be kept out of reach.

Municipal authorities have requested that the local hospital become more environmentally responsible. Which action best promotes environmental sustainability in a hospital setting?

Implementing a system to sort recyclables from waste that contains toxins or body fluids.

A hospital visit by an accreditation body has revealed that many of the clients in a hospital are not receiving the daily assistance with hygiene that they are entitled to. Which strategy is most likely to ensure that all necessary care is consistently provided?

Introduce a checklist where daily hygiene tasks are specifically listed.

A memorandum has been distributed in a hospital reminding staff of the need to respond promptly to audible alarms and to never disable the audible alarm capabilities of equipment. This memorandum directly addresses:

Joint Commission 2015 Hospital National Patient Safety Goals.

A nurse makes a medication error and fills out an incident report. What will the nurse do with the incident report once it is filled out?

Maintain it according to agency policy.

A hospital is in the process of integrating Tall Man Letters into all of documentation that is used at the facility. When promoting this change in practice, what potential benefit should be described?

Medication errors involving drugs with similar names can be reduced.

Local media reports have focused on the large amounts of waste that are produced by a local hospital, and there is public pressure to reduce waste. What principle should guide the hospital's waste-reduction efforts?

Much hospital waste is considered a biohazard, but much other waste can be conventionally recycled.

A system of automated drug dispensing cabinets has been introduced throughout a hospital. It has come to the attention of the nurse manager that some nurses are using a "work around" in which a supply of common p.r.n. (as needed) medications are being removed for a shift, rather than removing individualized doses. How should this practice be addressed?

Nurses should be educated about the risks to client safety posed by this practice.

A nurse observed a client fall in the hallway. After assessing the client's status, the nurse assisted the client off the floor and in doing so sustained a back injury. This injury primarily falls within the scope of what government agency?

OSHA

An individual calls the telehealth nurse and reports that a family member was just found on the floor of an enclosed garage while a car was still running. The family member is unconscious and cherry red in color. What direction will the telehealth nurse provide?

Open garage doors and windows, and call 911.

Analysis is being conducted of a sentinel event that result in injury to a client. When putting forward recommendations to prevent future similar events, the safety committee should prioritize which of the following?

Recommended changes are consistently implemented at the point of care.

The use of successive checks prior to high-risk procedures is known as:

Redundancy

The nurse is providing discharge teaching to the family of an older adult client. Which teaching will the nurse include to decrease the risk for electric shock?

Refrain from using extension cords.

A nurse was covering for a colleague during the colleague's scheduled break and nearly administered an intravenous antibiotic to the wrong client, catching the error while programming the IV pump. What is the nurse's best response to this adverse incident?

Report the event using the appropriate documentation so processes can be examined to promote safety.

There has been a recent increase in the number of adverse incidents at a hospital and plans are in place to address this problem. The need to foster a culture of safety has been identified. Which statement most closely relates to a culture of safety?

Safety is a collective responsibility shared by all members of the care team.

The nurse is teaching the caregiver of an infant about safety. Which teaching will the nurse include?

Supervise your child on the changing table.

Organizations to which healthcare institutions report quality and safety issues include:

The Centers for Medicare and Medicaid Services (CMS)

The manager of a geriatric medicine unit is reviewing some of the incident reports that have been filed over the past several months. One report describes an event where a nurse raised all four side rails of a confused client's bed, causing the client to fall when he tried to climb over them to go to the restroom. Which of the following statements about this incident is most accurate?

The client's nurse committed an active error by raising all four of the side rails.

The results of a quality improvement audit reveal that a hospital's rate of healthcare-acquired infections is lower than 90% of other hospitals. What is a potential consequence of this finding?

The hospital may be entitled to extra funding from the Centers & Medicare and Medicaid Services (CMS)

A Medicare client who was being treated in the hospital for major depression attempted suicide by hanging and suffered brain damage due to hypoxia. The Centers for Medicare & Medicaid Services (CMS) has classified this as a "never event." The nurse should recognize what consequence of this classification?

The hospital will have to bear the cost of treating the client's brain injury.

A confused client entered the dirty supply room on the unit and was found rummaging through trash that contained blood and body fluids. An incident report has been completed about this event by the nurse who discovered the client. Which statement about the incident report is most accurate?

The incident report will be used to inform changes so that the dirty supply room becomes less accessible to clients.

A nurse mistakenly gave a client an immediate dose of an opioid, rather than the extended release form of the drug. The client developed respiratory depression that required resuscitation. The nurse did not admit to the error until forced to weeks later by persistent rumors among colleagues. Which statement about this nurse's actions is most accurate?

The nurse demonstrated reckless behavior by not admitting the error.

A nurse has approached the unit manager and admitted to giving a client an incorrect dose of insulin. Which aspect of this event would suggest that it constitutes at-risk behavior rather than a human error?

The nurse made a similar insulin error 4 months ago and has also made an oral medication error.

A nurse manager has received an incident report that describes intravenous tubing containing chemotherapeutics being found in the regular trash, rather than in the specially designated receptacle. Which statement accurately describes an aspect of this situation?

This action is a violation of Occupational Safety and Health Administration (OSHA) regulations.

A safety audit has revealed that nurses are carrying used needles out of clients' rooms because there is a shortage of appropriate receptacles on the unit. A nurse on the unit should recognize what implications of this? Select all that apply.

This situation constitutes a violation of OSHA regulations. A root cause analysis may help identify the underlying factors.

The school nurse is educating 7th grade children about safety. Which recommendation is most appropriate for this age group?

Use protective sporting equipment.

A hospital's quality improvement committee is adapting the hospital's policies and procedures to align with the Joint Commission 2015 Hospital National Patient Safety Goals. Which of the following is an explicit focus of the 2015 goals?

Use two unique client identifiers before giving medications

A hospital has mandated screening for alcohol abuse for all newly-admitted clients. However, a chart audit reveals that this is rarely being done. Root cause analysis of this situation should begin with what question?

Why aren't nurses screening their clients for alcohol abuse?

A care facility has been the site of three Norovirus outbreaks over the past several months, resulting in the highest incidence and prevalence of this infection in the region. This phenomenon may result in:

a reduction in the facility's funding from the Centers for Medicare & Medicaid Services (CMS).

A client recently suffered burns in an industrial accident and is being treated in the intensive care unit. Which aspect of this client's care would require successive checks by two nurses in order to ensure safety?

administering a unit of fresh frozen plasma (FFP) to resuscitate the client

A client has been admitted with a gastrointestinal bleed. Two nurses should perform checks before which intervention is performed?

administering a unit of packed red blood cells

A client has been admitted to the hospital for the treatment of endocarditis. The nurse should be most aware of the potential for safety violations when providing what aspect of the client's care?

administering the client's oral analgesics and intravenous antibiotics

The nurse recognizes that assessment for sensory-perceptual alterations is a priority for which client?

an 84-year-old male with four recent driving violations

The nurse has delegated several parts of basic care for a client who is a fall risk to an unlicensed assistive personnel (UAP) member. Which UAP action requires nursing intervention?

assisting the client to put on slippers prior to ambulation

During a busy shift at a long-term care facility, three call lights are illuminated simultaneously. A nurse is walking toward the closest of the three rooms and notices a colleague preparing medications in the hallway. The nurse should:

avoid talking to the colleague unless there is evidence of an urgent client need.

The nursing leaders on an intensive care unit have introduced a new protocol for the care of clients who are receiving parenteral nutrition. All of the major nursing assessments and interventions relevant to parenteral nutrition have been combined into one list. This unit has introduced a:

care bundle

The nurse is teaching fire safety to members of a community. When a community member asks which type of fire extinguisher would be appropriate to put out a gasoline fire, what will the nurse identify?

class B

The nurse is teaching fire safety to members of a community. When a community member asks which type of fire extinguisher would be appropriate to put out an electrical fire, what will the nurse identify?

class C

A nurse will be attending an education event that will focus on the TeamSTEPPS (Strategies and Tools to Enhance Performance and Patient Safety) system. The nurse should anticipate that this event will address:

communication skills

A nurse prepared a client's medication, brought it to the client's bedside and then realized at the last minute that the medication was for another client of similar age and appearance. Follow-up to this event should include:

completing an incident report describing this near miss.

The nurse manager on a medical unit has scheduled a debriefing session. Which of the following is the most likely subject of this meeting?

discussing a recent event when a newly-admitted client went into cardiac and respiratory arrest

A nurse has begun working on a hospital unit where there are a large proportion of clients who have limited mobility and who require assistance with transfers. Nurses' risks for back injury can best be reduced by:

educating them about safe client handling practices.

A series of medication errors have prompted a reevaluation of the drug administration practices on a unit. Which of the following strategies is most likely to prevent errors and enhance safety?

eliminating interruptions to nurses while they are preparing medications

A hospital unit's safety committee is evaluating current practices while performing a root cause analysis of an error. Which initiative on the unit has the greatest potential to reduce the number of errors?

enhancing the communication that takes placed between team members

A health care institution's most recent strategic plan includes a commitment to creating a culture of safety. The organization can best meet this commitment by:

having every employee focus on safety, not only direct care providers.

The allergy status of a client who was diagnosed with suspected cellulitis was not documented and the client received a dose of an antibiotic that caused an allergic reaction. Root cause analysis (RCA) is consequently being performed. What goal should the team who is performing RCA prioritize?

identifying processes that may have made it possible for a client to receive a drug without having allergy status documented.

During which of the following nursing activities would a checklist be most appropriate for enhancing client safety?

inserting a client's indwelling urinary catheter

A safety audit is being conducted on a hospital unit and the factors that have contributed to medication errors on the unit are being explored. What are factors that are known to underlie medication errors? Select all that apply

interruptions to nurses who are in the process of preparing medications nurses' having to provide care for large numbers of clients nurse fatigue and caring for clients who have heavy care needs the incidence of emergencies and urgent situations on the unit

Root cause analysis was conducted for an incident in which a client's feeding tube was connected to the client's intravenous port. Recommendations from the analysis include the adoption of mistake-proof tubing. Tubing would be considered to be mistake proof if it:

is designed so incompatible tubes cannot be connected.

During a course on terrorism, a group of emergency room nurses learns about terrorists who use bombs or other explosives to inflict injury on numerous people and cause multiple fatalities. This is an example of:

mass trauma

A nurse is caring for a client who is being treated for complications of diabetes. Which action by the nurse best reduces the client's risk of experiencing an adverse outcome while receiving care?

monitoring the client's health status frequently and thoroughly

Which level of health care provider may make the decision to apply physical restraints to a client?

nurse practitioner

Which action by the unlicensed assistive personnel (UAP) requires intervention from the nurse when providing care to an older adult client who is at risk for falls?

provides slippers for ambulation

A client with dementia was assigned to a shared hospital room due to a shortage of private rooms. During the night, the client became acutely confused and attacked his roommate, seriously injuring him. When following up this adverse event, the institution must:

report this sentinel event to the Joint Commission and to relevant state agencies.

A nurse is preparing to insert a peripheral intravenous (IV) into a client who requires IV fluids. How can the nurse best demonstrate the skills that indicate the nurse meets the Quality and Safety Education for Nurses (QSEN) competency of safety?

selecting an appropriate vein and establishing access aseptically

The nurse is caring for a client who has been repetitively pulling at IV lines and the urinary catheter. After other methods of diverting the client's behaviors fail to prevent this behavior, and chemical restraints fail, which treatment does the nurse anticipate will be ordered?

temporary application of devices that reduce the client's ability to move arms

A nurse has completed an incident report after a client tripped on an electrical cord in the hospital hallway and had a fall. The incident report will most likely be analyzed by:

the hospital's health and safety committee.

Which of the following aspects of the care that is provided on a hospital unit most clearly falls within the scope of the Occupational Safety and Health Administration (OSHA)?

the manner by which intravenous tubing and soiled bed linens are handled or disposed of

A nurse who is a recent graduate has been formally reprimanded after administering a medication to the wrong client. This reprimand would be considered to be consistent with a just culture if:

the reprimand has been deemed appropriate and relevant to the nurse's actions.

Which aspect of a nurse's practice would fall under the control of the Occupational Safety and Health Administration (OSHA)? Select all that apply.

the specifications of the "sharps containers" where contaminated needles are disposed of the handling and disposal of wastes that are categorized as biohazards the maximum acceptable weights that nurses should be lifting during client transfers

The nurse is reading another nurse's notes that were recorded in the electronic health record (EHR) during the previous shift. What is the appropriate nursing action when numerous unapproved abbreviations are noticed in the previous nurse's notes?

uggest to the nurse manager that an in-service on abbreviation use would be helpful.