Safety/Quality Practice Questions
The nurse is transferring his patient to the Post Anesthesia Care Unit (PACU) from the surgical unit. He is calling the receiving nurse with a patient handoff report. Ensuring patient safety by using the handoff report,he is careful to describe the SBAR for the patients continued care. Giving an accurate handoff report is an example of ensuring patient safety by using which QSEN competency? A. Teamwork and collaboration B. QI C. PCC D. Informatics
A Teamwork and Collaboration
The primary nurse is caring for a patient admitted to the unit from a nursing home with a stage III decubitus ulcer. In looking at the electronic nursing notes, she notes a discrepancy in the patients would care prodedures. The primary nurse calls the would care nurse to consult and ensure a consistent plan of care. The would care nurse assesses the patient and provides the necessary information reflecting the standard of care. The primary nurse is practicing which of the QSEN competencies. Select all that apply A. QI B. Safety C. Teamwork and collaboration D. PCC E. Informatics
A, B, C, D, E
Which statements about an HRO are false? select all that apply? A. HROs avoid discussing failures B. HROs explore a variety of reasons for errors and are reluctant to simplify explanations C. HROs are aware of the many factors that influence the care environment D. HROs understand that decisions should be made by the highest ranking official E. HROs know that when small things go wrong it is often a sign of a large problem
A, D
The nurse delegated to another nurse to disconnect an IV line from a patient once the nurse is complete. Which factor should the nurse consider prior to delegating this to another nurse. Select all that apply. A. Right Person B. Right supervision and evaluation C. Right direction and communication D. Right Task E. Right Circumstance
A, D, E
A nurse is asked how quality, safety, and performance improvement are addressed in an HRO. Which response demonstrates the best understanding? A. "We have an interprofessional committee on our unit that looks at patient outcomes, practice issues, and most recently, the number of falls on our unit. Together, we figure out the best way to fix the problem and suggest changes" B. "A couple of nurses got together last night to look at the number of falls on our unit. We are concerned about the problem and think there is a better way to do it" C. "I saw an article about falls on a unit like ours. I took the article to work to show my unit director but she said the solution isn't feasible on our unit" D. "Our fall rates are so high that the physical therapist formed a committee to address the issue and came back to the nursing staff with some recommendations for changes in our care delivery"
A. "We have an interprofessional committee on our unit that looks at patient outcomes, practice issues, and most recently, the number of falls on our unit. Together, we figure out the best way to fix the problem and suggest changes"
Which of the following elements is not necessary for a nurse to be found negligent in a court of law? A. A duty or obligation for the nurse to act in a particular way B. A breach of that duty or obligation C. the nurses intention to be negligent D. Physical, emotional, or financial harm to the patient
A. A duty or obligation for the nurse to act in a particular way
A patient asks a nurse what it means to have a hospital accredited by TJC. Which one of the following is not a joint commission quality compliance requirement? A. Billing models B. Core measures C. Safe practice measures D. process improvement effortss
A. Billing models
Healthcare can learn about high reliability from a variety of other industries. Which of the following statements is false? A. Commercial aviation found that the most common cause of error was mechanical failures B. the Institute of Nuclear Power Operations believes that trust and respect are needed in an HRO C. Human beings can make skill-based, rule-based, and knowledge-based errors D. Commercial Aviation embraced CMR training programs in an effort to enhance communication in the cockpit
A. Commercial aviation found that the most common cause of error was mechanical failures
Nurses need to increase awareness of the implementation of technology and informatics in patient care. Which of the following best represents a collaboration effort to ensure best practices in nursing informatics? A. HIPPA B. TIGER C. VISTA D. EHR
A. HIPPA
Leadership plays an important role in creating an HRO. Which of the following statements demonstrates the best understanding of the role of leadership? A. Leaders are accountable for the provision of effective and efficient care while protecting the safety of patients, employees, and visitors B. Leadership must identify system problems and ask employees to fix them C. While fostering a learning environment, leaders must never discipline employees for their behaviors D. Leaders may rely solely on technology to build and reinforce accountability
A. Leaders are accountable for the provision of effective and efficient care while protecting the safety of patients, employees, and visitors
The nurse is informed that an RRT will be initiated at the hospital to better meet the needs of patients. Which of the following best describes the way in which the nurse should utilize the RRT? A. Provide support for medical-surgical nurses and decrease the number of patient arrests requiring ICU admission B. Rapidly move patients through the hospital system at time of transfer C. Notify the attending physician of the clients deteriorating status D. Provide immediate assistance to patients in the ICU
A. Provide support for medical-surgical nurses and decrease the number of patient arrests requiring ICU admission
QSEN has development multiple quality and safety competencies to gain nursing practice. Identify which of these are considered a part of the six key competencies. A. QI, teamwork and collaboration, and EBP B. Fact finding, mission statements, and strategic planning C. stakeholder feedback, budget reconciliation, and strategic planning D. Financial reporting, wait time measurements, and time delays in getting treatments
A. QI, teamwork and collaboration, and EBP
QSEN has developed multiple quality and safety elements to guide nursing practice. Identify which of these are considered a part of the six key elements A. QI, teamwork and collaboration, and evidence-based practice B. fact finding, mission statements, and strategic planning C. Stakeholder feedback, budget reconciliation and strategic planning D. Financial reporting, wait time measurement and time delays in getting treatments
A. QI, teamwork and collaboration, and evidence-based practice
Following a serious medication error that resulted in patient injury, a nurse is assigned to a team assembled to investigate the cause. The nurse knows which of the following represents the best methods for doing so? A. Root cause analysis B. Debriefing C. Six Stigma D. Crew resource management
A. Root cause Analysis
In administering medication to her patient, the nurse saw that the medication administration record indicated the dose amount to be 5 mg. She immediately double checks the order and confirmed that the dose was supposed to be 0.5 mg. The nurse remembered to always use a zero before a decimal when the dose is less than a whole unit and she updated the medication administrations record accordingly. Which QSEN competency applies? A. Safety B. QI C. PCC D. Teamwork and collaboration
A. Safety
A medical resident walks into a patients room to complete a physical assessment. The nurse notices that the resident did not wash her hands before entering the room. The nurse gently reminds the resident to use the hand sanitizer before touching the patient. This reminder is an example of using which of the following QSEN competencies? A. Safety B. QI C. PCC D. Teamwork and collaboration E. informatics
A. safety
You are the nurse caring for a patient who was recently told he has heart failure. The patient will be relocating next week to a different state. The patient has a primary care provider in his new state and intends to follow up as instructed upon discharge. however, he would like to identify an acute care hospital in his new state that is adept in caring for heart failure patients, in the event that he needs to be admitted. The patient asks for your recommendation. All of the suggestions below may give him good information. What would be your best suggestion to the patient so that he may make a well-informed, objective decision? A. Tell the patient that hospitals publicly report their quality data associated with caring for heart failure patients on a website and instruct him where he can retrieve this information B. Tell hum to ask members in the community or family and friends where they have had good experiences C. Tell hum to ask his primary care provider for a recommendation D. Tell him to visit the websites of hospitals in the community where he is moving.
A. Tell the patient that hospitals publicly report their quality data associated with caring for heart failure patients on a website and instruct him where he can retrieve this information
The nurse attends an interprofessional meeting to discuss the care of a patient who is a paraplegic after an automobile accident. Which of the following best describes the purpose of assembling an interprofessional team. A. To provide multiple perspectives to contribute to the patients care and well-being B. to divide the work appropriately among disciplines C. To ensure that the physician controls the patient outcome D. To provide support in difficult patient care situations
A. To provide multiple perspectives to contribute to the patients care and well-being
The patient assigned to a new graduate nurse has an order to have a nasogastric tube inserted. The nurse has never completed this type of procedure. How should the new graduate nurse proceed? A. request assistance form an experienced nurse B. Delegate the procedure to a UAP C. Notify the physician of the new grad nurses inexperience D. look-up the policy and procedure, then insert the tube
A. request assistance form an experienced nurse
You are an administrator working in an urban health system. You have been charged to lead the efforts of redesigning the patient-care delivery model. This model is intended to best represent patient expectations. As such, in developing the model, you recognize the importance of taking into account the patient's quality concerns. Which answer best represents the top patient quality concerns as described by the HFMA value project (2011)?
Assess: makes care available and affordable. Safety: do not hurt me. Outcomes: make me better respect: respect me as a person, not a case
Errors occur when there is a deviation from generally acceptable performance standards. Which of the following is not an example of a generally acceptable performance standard? A. Professional practice standard B. Article published in the Wall Street Journal C. Evidence - Based Policy D. Evidence-Based order set
B Article published in the Wall Street Journal
An 87-year-old patient was admitted to an acute care hospital. The patient was in a severe automobile vehicle accident. He is unconscious in intensive care and on a ventilator. On day 3 of the patients hospitalization, the patient experiences a cardiac arrest and a code blue is called. The code blue lasts for an hour. The patients heart rhythm is restored. When the family is notified of the event, the wife is very upset. She states she had provided the hospital with the patient's advance directive, which clearly stated the patient should not be resuscitated. You are the nurse talking to the wife. What do you do? A. Apologize but state that the patient was a full code, which means he must be resuscitated B. Apologize, and assure the wife that you will be contacting the attending physician and your nurse manager that the problem occurred. The risk management department will probably review this case. C. Notify the wife that the advance directive is not legal or binding and that the wife needed to tell them specifically that the patient did not want to be resuscitated D. tell the wife to try to focus on the positive that had her 87-year-old husband is still alive
B. Apologize, and assure the wife that you will be contacting the attending physician and your nurse manager that the problem occurred. The risk management department will probably review this case.
Which of the following recommendations was not made by the institute of medicines publication to Err Is Human? A. Identify and learn from errors B. Avoid talking about errors C. Improve safety D. Ensure safe practices at the delivery level
B. Avoid talking about errors
The nurse is performing an assessment on a patient who is taking 400 mg of naproxen for abdominal pain. Which assessment can be delegated to the unlicensed nursing personnel? A. Review the results of the patients Hgb and hematocrit B. Collect and send a stool sample to the laboratory for guaiac testing C. auscultate the abdomen for bowel sounds D. ask the patient what other medications they are taking
B. Collect and send a stool sample to the laboratory for guaiac testing
A healthcare provider has issued a Do Not Attempt to Resuscitate (DNAR) order for your patient, a 55 year old man with cancer. You spoke with the patient this morning and he clearly wishes to be resuscitated in the event that he stops breathing. What is the most appropriate course of action? A. Ignore the patient's wishes because the healthcare provider ordered the DNAE. B. Consult your hospitals policies and procedures, speak to the healthcare provider and discuss the matter with your nurse manager C. Attempt to talk the patient into agreeing to the DNAR D. Contact the medical licensing board to complain about the healthcare provider
B. Consult your hospitals policies and procedures, speak to the healthcare provider and discuss the matter with your nurse manager
Which of the following processes would be best assist the nurse to increase expertise, adjust practice, and improve self-regulation? A. Conduct a RCA B. Elicit constructive feedback from others C. participate in debriefing from others D. use the CUS technique
B. Elicit constructive feedback from others
The nurse realizes that her patient's pain management is not effective. She has noticed this with other patients in the past and decides to analyze the unit-based pain control chart posted in the break room. She decides to explore additional pain management options for patients whose pain is not controlled with the usual pain management. Which QSEN competencies best describes her approach? A. Safety B. QI C. PCC D. Teamwork and collaboration
B. QI
The nurse is transferring a patient from the ICU to the step-down patient care unit. When the ICU nurse calls to report to the receiving unit, what is the best way for the nurse to provide the handoff information? A. Situation, Background, Assessment, Requirements B. Situation, Background, Assessment, Recommendations C. Systems, Background, Activities, Recommendations D. Systems, Background, Activities, Recommendations
B. Situation, Background, Assessment, Recommendations
The nurse on the oncology unit cares for a patient who frequently comments that she would like better pain control through the night. The nurse tells the patient that a note will be placed on the front of the patients chart alerting the physician in case the nurse misses the physician during her rounds. Which of the following represents a better process to ensure the patient's needs are met? A. Nursing Rounds B. Team huddle C. Debriefing D. root cause analysis
B. Team huddle
the health insurance portability and accountability act (HIPPA) protects which of the following? A. A patients right to be insured regardless of employment status or ability to pay B. The confidentiality of certain protected health information C. the nurses right to health insurance D. the hospitals right to disclose protected health information
B. The confidentiality of certain protected health information
An 80-year-old man who lives with his son is brought to your unit because he "just isnt acting right". On physical examination, you note that the patient is malnourished , non communicative, and has poor hygiene. When you ask the patient some questions, he avoids eye contact and does not respond. The son is answering questions for the patient and refuses to leave the room. You suspect elder abuse. Choose the most appropriate documentation of the situation. A. The patient is very thin and does not make eye contact with the nursing or medical staff. It is obvious that he has been abused and neglected by his family B. The patient is a thin elderly man who presents to the unit wearing clothing that is soiled. He does not make eye contact with the staff or answer our questions. Social services notified. C. It appears that the patients son manipulates his father by refusing to let his father answer any questions. We suspect elder abuse D. The patients son states that the patient isnt acting right. That patient does not answer questions from the staff due to his abuse
B. The patient is a thin elderly man who presents to the unit wearing clothing that is soiled. He does not make eye contact with the staff or answer our questions. Social services notified.
The facility us using a newly implemented electronic medical record in patient care. The nurses have expressed some frustrations with the high volume of system alerts that are generated throughout the day. Which of the following demonstrates the most appropriate response to excessive alerts by the nurse? A. Turn alerts off so they do not slow down the data processing capability B. report excessive alerts to the software designer C. Posting the patients questions to a social media website and compiling the response for the patient D. Referring the patient to his or her healthcare provider so the provider can answer the patients questions
B. report excessive alerts to the software designer
As a staff nurse you are interested in making QIs in the overall care of patients with heart failure. Where would be most helpful to look for data and information to help you get started with these improvements? A. Explore the IHI website (www.IHI.org) which includes white papers, evidence-based protocols, blogs, and improvement stories that can be applied to patients with heart failure B. review the national cancer institutes website, which includes facts and statistics related to cancer care, resources, and latest research developments C. Review drug companies' websites to see if there are any new medications available to treat heart failure D. Google "heart failure" to see if you can get access to the latest treatment options for this patient population
B. review the national cancer institutes website, which includes facts and statistics related to cancer care, resources, and latest research developments
What is the common cause of errors within healthcare settings ? A. Uncaring professionals B. Incompetent caregivers C. Communication problems between caregivers D. Phones not connecting to the nurse's station
C. Communication problems between caregivers
A patients family is angry about their family member's deteriorating condition and tells the nurse that they are not satisfied with the patient's care. Which of the following would be the most appropriate action by the nurse? A. Notify the hospital administration B. Explain to the family that the patient's condition is complex and that the patient is receiving appropriate care C. Convey understanding and notify members of the healthcare team so that a family meeting with the team can be provided D. Ask the family members why they feel that way
C. Convey understanding and notify members of the healthcare team so that a family meeting with the team can be provided
A healthcare provider has ordered you to discharge Mr. Jones from the hospital despite a new temperature of 102 degrees F. The provider refuses to talk with you about the patient. In this situation, which of the following is an appropriate nursing action? A. Administer an antipyretic medication and discharge the patient B. Discharge the patient with instructions to call 911 if he has any problems C. Do not discharge the patient until you have discussed the matter with your nursing manager and are satisfied regarding patient safety D. Discharge the patient and tell the patient to take acetaminophen (Tylenol) when he gets home
C. Do not discharge the patient until you have discussed the matter with your nursing manager and are satisfied regarding patient safety
You call the surgeon for your new post op patient who is bleeding excessively. The patients blood pressure has decreased 20 mmHg, and his pulse rate has increased by 20 beats over the past hour. The surgeons response to this information is "Why did you wake me up at 2 am for this? I am hanging up as I expect a post op patient to be oozing from the operative site and these changes are not significant, just watch him." You are quite concerned about your patient. What will you do next? A. Go to the nursing station and complain to the other nurses about how rude the surgeon was on the phone B. Document and quote the surgeons response in your nurses notes C. Inform the surgeon that you do not agree with continuing to just observe this patient that you are going to initiate the chain of command D. Tell the family what the surgeon said
C. Inform the surgeon that you do not agree with continuing to just observe this patient that you are going to initiate the chain of command
The nurse is using barcode administration technology to facilitate the administration of medications to her patients. This is an example of how barcode medication administration technology facilitates which of the following QSEN competencies? A. Teamwork and collaboration B. Safety C. Informatics D. EBP E. QI
C. Informatics
Which of the following is a responsibility of the employer and/or nurse leader when delegating nursing responsibilities to the UAP? A. assigning the UAP responsibilities B. Establishing licensure guidelines for UAP C. Making certain that appropriate policies and procedures for delegation are in place D. Encouraging staff to create a delegation sheet at the beginning of every shift
C. Making certain that appropriate policies and procedures for delegation are in place
The licensed nurse delegated to the UAP to ambulate the patient to the bathroom. The UAP is having difficulties completing this delegated task. What is the proper action the UAP must take? A. Delegate the task to another UAP B. Notify the employer of the UAPs inability to complete this particular task C. Notify the licensed nurse of the UAPs difficulty with completing this task D. document that the patient was unable to ambulate to the bathroom
C. Notify the licensed nurse of the UAPs difficulty with completing this task
The nurse is participating in a team meeting with her patient, the dietician, physician, and social worker. The nurse cals that the patient had expressed that spirituality was important to her. A pastoral care representative is not present in the meeting. The nurse notices this and contacts pastoral care to be included in the meeting. This inclusion is an example of using which QSEN competency? A. Teamwork and Collaboration B. Safety C. PCC D. Informatics
C. PCC
The nurse is caring for a newly admitted patient. She introduces herself using her first and last names and asks the patient what his values, needs and preferences are for his hospital stay. The nurse is practicing which of the QSEN competencies? A. Evidence-Based Practice B. Safety C. Patient Centered Care D. Teamwork and collaboration
C. Patient Centered Care
who is legally responsible for nursing care provided to patients? A. Physician B. Nurse Manager C. RN assigned to the patient D. UAP providing care to the patient
C. RN assigned to the patient
The nurse pages a physician due to the patient's change in status. When the physician calls the unit, the physician yells at the nurse for interrupting dinner. Which of the following would be the nurses best approach? A. Tell the physician that she is going to report him to the nursing supervisor B.Tell the physician that she is doing her job and does not deserve to be yelled at C. Refocus the communication on the patient and the reason for the call D. Apologize for interrupting the dinner and page his partner
C. Refocus the communication on the patient and the reason for the call
The nurse is given a written order by a healthcare provider to administer an unusually large dose of pain medication to a patient. In this situation, which of the following is an appropriate nursing action? A. Administer the medication because it was ordered by a healthcare provider B. Refuse to administer the medication and move on to another patient C. Speak with the healthcare provider about your concerns and clarify whether the medication dose is accurate D. Select a dose that you feel comfortable with, and administer that does
C. Speak with the healthcare provider about your concerns and clarify whether the medication dose is accurate
A new grad nurse is caring for two patients during the fifth week of new employee orientation. The new grad nurse asks one of the unit nurses to see the poicy and procedure for delegation. The unit nurse looks at the new grad nurse with a puzzled look and says "I dont know if we have on" What is the best reason for the unit nurses reply? A. There probably is not a delegation policy and procedure B. The new graduate nurse should not be asking this question when caring for only two patients C. The unit nurse is not aware of a policy or procedure for delegation D. Delegation is something taught in nursing school, but is not practiced in the real world
C. The unit nurse is not aware of a policy or procedure for delegation
The nurse is caring for a patient and preparing to administer scheduled medications. Which of the following represents a benefit of using informatics technology with regard to medication administration? A. Automated medication systems alleviate the need for cross-checking allergies B. Using automated medication systems prevents medication errors C. automated medication systems provide decision-making aids that alert the nurse to potential problems D. automated medication administration systems prevent the nurse from administering the wrong medication
C. automated medication systems provide decision-making aids that alert the nurse to potential problems
The nurse is monitoring the telehealth computer and notices that the patients pulse oximetry reading drops below 90% which is the predetermined action criterion for this patient. Which of the following depicts the most appropriate need step the nurse should take? A. Call the patients family and alert them to administer oxygen immediately B. Call 911 to send emergency responders to the home C. call the patient and assess how the patient is feeling and what is currently happening. D. Call the primary care provider to obtain treatment orders
C. call the patient and assess how the patient is feeling and what is currently happening.
Skilled communication is essential to patient safety for which of the following reasons? A. Patients need to be convinced to receive specific treatments B. nurses need to explain procedures to patients C. miscommunication is responsible for many harmful events in the hospital D. Poor quality is associated with poor communication
C. miscommunication is responsible for many harmful events in the hospital
Inez, RN, did not put the bed rails up on a confused patient. The patient fell and was injured. When there is a connection between the nurse omitting a duty and the damages occuring to a patient, it is an example of which of the following? A. Breach of Duty B. Duty C. Causation D. Damages
D. Damages
Select the most appropriate documentation example in the following: A. Patient found covered in stool. The night nurses were too busy to change the bed B. The patient fell because we are short of staff C. The patients family is difficult and argumentative D. Dr. M Breasley notified through the medical exchange at 0610 of patients complaints of difficulty breathing. Orders received for oxygen and arterial blood gas
D. Dr. M Breasley notified through the medical exchange at 0610 of patients complaints of difficulty breathing. Orders received for oxygen and arterial blood gas
High reliability affects the entire organization. Which of the following statements is false? A. Quality often improves in HRO organizations B. An HRO improves patient and staff safety C. Enhanced communication and reliability helps to increase patient satisfaction in HROs D. Financial performance is negatively impacted in HROs
D. Financial performance is negatively impacted in HROs
A group of emergency department nurses are asked to develop an action plan to improve the time before patients who present with chest pain receive an ECG. Which of the following would not be helpful when working on a QI effort like this ? A. Identify an interprofessional group of individuals to help review current performance. B. Compare current hospital emergency department data results to benchmark comparison information reported on a national website C.Post current hospital performances data results openly to staff in the nursing lounge D. Identify whose fault it is that results are not very good
D. Identify whose fault it is that results are not very good
The nurse is concerned about his patient'a lab values and medication regimen. The nurse uses the electronic health record to obtain information about medication doses, lab results, and notes that the patients lab results are within normal limits. This use of the electronic health record is an example of using which QSEN competency? A. teamwork and collaboration B. Safety C. PCC D. Informatics
D. Informatics
The nurse uses the electronic medical record (EMR) to review key components of the patients health. What most directly impacts the nurses ability to effectively utilize the EMR? A. the functional design of the EMR system as described by the manufacture B. The national guidelines for every nurse using an EMR system C. the state and federal initiatives mandating the use of EMR systems D. Local policies, training, and institutional guidelines on the EMR
D. Local policies, training, and institutional guidelines on the EMR
The nurse notices that there was an earlier medication error that resulted in an adverse patient outcome. She asks for assistance from her manager in analyzing the error. This is an example of using which QSEN competency? A. Safety B. QI C. PCC D. Teamwork and collaboration
D. Teamwork and Collaboration
A nurse receives a telephone order from a physician for specific x-ray tests. The nurse established the identity of the patient involved and the name of the ordering physician. Which of the following should she do next? A. write the order on the order sheet in the chart B. Repeat what the physician says and then write it down on the order sheet C. Ask the physician to directly place the order with the radiology department D. Write the order on the order sheet and then perform a read back to the physician to verify the order is accurate.
D. Write the order on the order sheet and then perform a read back to the physician to verify the order is accurate.
Which of the following methods are helpful for assessing the culture of an HRO? select all that apply. A. observe the behaviors of employees when they think no one is watching to determine if they are adhering to the policies and expectations of the organizations B. Review safety event reports, including near miss, precursor and serious safety events C. Use a standard tool to assess the patient safety of the organization D. assume the culture exists if process improvement activities are underway
D. assume the culture exists if process improvement activities are underway
A patient reads that hospitals are not getting reimbursed by the CMS for certain never events and asks a nurse to explain. Which one of the following is an example of a never event? A. Absence of a hospice unit within the hospital B. Emergency department admissions of over 1.000 per month C. Nursing stations located at the end of the hall versus in the middle of the patient care unit D. stage IV hospital acquired pressure ulcer
D. stage IV hospital acquired pressure ulcer