Ch. 2 The Nurse's Role in Healthcare Quality and Patient Safety

A recent nursing graduate is completing a safety orientation to the hospital. Which actions are responsibilities of the nurse? Select all that apply. -Closely monitor clients who are at high risk for injury. -Make suggestions for systems improvements that will promote safety. -Assess the care environment for safety violations. -Conduct root cause analysis of any sentinel events that take place. -Ensure that the care of unsafe clients is not delegated to licensed practical nurses.

-Closely monitor clients who are at high risk for injury. -Make suggestions for systems improvements that will promote safety. -Assess the care environment for safety violations.

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 -25-year-old female who just accepted her first job -34-year-old male who does not use a seat belt -40-year-old female who is working two jobs

19-year-old male college student majoring in physics

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 disciplinary hearing under the scope of the Occupational Safety and Health Administration (OSHA). -a reduction in the facility's funding from the Centers for Medicare & Medicaid Services (CMS). -a safety audit by the state's board of nursing. -fines levied by the Centers for Disease Control and Prevention (CDC).

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

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 -drawing a blood sample for analysis of hemoglobin levels -inserting a peripheral intravenous catheter in the client's forearm -placing the client on "NPO." (nothing by mouth) status

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 -assessing the client's functional status and mobility for the first time -providing the client with partial assistance with hygiene in the shower -informing the client that a referral has been made to social work and spiritual care

administering the client's oral analgesics and intravenous antibiotics

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. -nursing care plan. -nursing policy. -standard of care.

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 an electrical fire, what will the nurse identify? -class A -class B -class C -No fire extinguisher should be used to attempt to extinguish an electrical fire.

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. -safe medication administration. -prevention of healthcare-acquired infections. -the use of standard precautions.

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: -a suspension for the nurse, pending the completion of remedial education. -completing an incident report describing this near miss. -documenting this latent error and reporting it to relevant state agencies. -revising the procedures by which medications are distributed on the unit.

completing an incident report describing this near miss.

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 -prioritizing the client's preferences in the catheter care that is provided -aligning practices with the Patient Protection and Affordable Care Act (ACA) -designating one nurse who is ultimately accountable for catheter care in the facility.

ensuring that each necessary element of catheter care is consistently provided

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? -places bed at lowest setting -provides slippers for ambulation -clears a path from bed to bathroom -has client sit in bed for a few moments before standing

provides slippers for ambulation

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? -Correct the abbreviations in the EHR. -Ask another nurse to fix the abbreviations. -Contact the facility's information technology department to delete abbreviations. -Suggest to the nurse manager that an in-service on abbreviation use would be helpful.

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

The nurse is teaching the caregiver of a 8-month-old infant about safety. Which teaching will the nurse include? -Supervise your child on the changing table. -Keep medications out of reach. -Buy protective sporting equipment. -Peer pressure causes children of this age to take risks.

Supervise your child on the changing table.

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." -"What do you think that the child might have ingested?" -"At what time did the child ingest the substance?" -"Induce vomiting while you wait for emergency personnel to arrive."

"Check breathing and heart rate."

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." -"I will sound the alarm before I start moving a patient from a room." -"I will leave all doors open after rescuing patients." -"I know that nurses are the only ones who can extinguish a fire."

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

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? -"Did you leave the household chemical in reach of your child?" -"Is your child breathing at this time?" -"You should not have left your child alone while you showered." -"Induce vomiting and call 911 right away."

"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? -"You're very likely to lose your license if you don't report this." -"It sounds like it was an honest mistake, and maybe a report will lead to improvements." -"Now that you've told me about this, it's best if I actually fill out the incident report." -"There's nothing you could possibly have done to prevent this, so you've got nothing to fear."

"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?" -"Was this team experienced in dealing with neonatal distress?" -"Would a cesarean birth have been more appropriate than vaginal birth?" -"How would an emergency code have prevented harm to this infant?"

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

A nurse attempted to delegate a portion of a client's care to another member of the care team. A lapse in communication resulted in the client missing a number of scheduled assessments and medications. When completing an incident report about this event, what should the nurse include? Select all that apply. -the assessments that the nurse performed after the error was discovered -the other members of the care team who the nurse contacted once the error was discovered -the time and content of the nurse's initial communication with the other member of the care team -a summary of the differences in scope of practice between the nurse and the other member of the care team -a summary of the client's health status after the event

-the assessments that the nurse performed after the error was discovered -the other members of the care team who the nurse contacted once the error was discovered -the time and content of the nurse's initial communication with the other member of the care team -a summary of the client's health status after the event

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. -A unit has been chronically short-staffed because of recruitment challenges and nurses' refusing to work overtime. -A visitor misrepresented himself at the nurses' station in an attempt to access his ex-partner, who has a restraining order against him. -A nurse committed a medication error in giving a client 975 mg of acetaminophen instead of 650 mg as ordered.

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

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? -Reassure the nurse that future errors are highly unlikely, given her strong work history. -Collaborate with the nurse to identify any supplementary education that would be beneficial. -Allow the nurse to follow up the event independently, knowing that she possesses the necessary knowledge and experience. -Temporarily assign the nurse a mentor so that her confidence can be reestablished.

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

A nurse enters a client's room and finds that the client has fallen on her way to the bathroom. What is a prudent nursing intervention for this client? -Briefly leave the client to call the primary physician to assess the client's condition. -Order x-rays or CT scans for the client, as needed. -Document the incident, assessment, and interventions in the client's medical record. -Do not file an event report unless the client is seriously injured in the fall.

Document the incident, assessment, and interventions in the client's medical record.

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? -Remedial education -Formal discipline -Reconciliation with the client -A change in work site

Formal discipline

Which statement is true of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) surveys that many clients complete after receiving hospital care? -The results of HCAHPS surveys are used to determine hospitals' rates of adverse incidents. -HCAHPS surveys are one set of data considered in the value-based purchasing (VBP) program. -HCAHPS surveys are used to determine physicians' individual reimbursement rates from Medicare and Medicaid. -The Department of Health and Human Services uses HCAHPS results to select topics for nurses' continuing education.

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

Municipal authorities have requested that the local hospital become more environmentally responsible. Which action best promotes environmental sustainability in a hospital setting? -Ensuring that all waste is thoroughly and hygienically incinerated on-site. -Implementing a system to sort recyclables from waste that contains toxins or body fluids. -Obtaining an autoclave so disposable equipment can be safely sterilized for reuse. -Replacing washable bed linens with single-use sheets in order to save water.

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

A client with diabetes mellitus received a double-dose of insulin, with two nurses inadvertently administering a scheduled dose. What aspect of this adverse incident may be categorized as a systemic, root cause? -Insulin administration is documented on two separate flow sheets in clients' health records. -The client's blood glucose levels had been unstable for several hours preceding the incident. -The two nurses were well-known to one another but had not worked together for several weeks. -The client's blood glucose levels had previously been controlled with oral antihyperglycemics.

Insulin administration is documented on two separate flow sheets in clients' health records.

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. -Remind nurses of the standards of nursing practice and their relationship to care. -Report this situation to the Joint Commission. -Introduce a care bundle that includes hygiene tasks.

Introduce a checklist where daily hygiene tasks are specifically listed.

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. -Medication errors involving confusion between brand names and generic names can be prevented. -There may be fewer errors involving drugs that are marketed under several brand names. -There may be more precision in the medication reconciliation process.

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. -Hospital waste is distinctly different from other waste because it contains blood and body fluids. -Hospital waste can be recycled on-site, but the costs associated with this are prohibitive. -The technology does not yet exist for sorting hospital waste safely and efficiently.

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

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? -Occupational Safety and Health Administration (OSHA) -Joint Commission -Centers for Medicare & Medicaid Services (CMS) -Department of Health and Human Services (DHHS)

Occupational Safety and Health Administration (OSHA)

The nurse is teaching the caregiver of an adolescent child about safety. Which teaching will the nurse include? -Supervise your child on the changing table. -Place all household cleaners out of reach. -Buy protective sporting equipment. -Peer pressure causes children of this age to take risks.

Peer pressure causes children of this age to take risks.

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. -Proposed changes are based on current peer-reviewed evidence and clinical expertise. -Changes in practice are reflective of clients' and families' preferences. -The role of nurses in promoting overall safety in the hospital is acknowledged.

Recommended changes are consistently implemented at the point of care.

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? -Leave outlets and switches open so air circulates through them. -All machines that are used infrequently are to remain plugged in. -Remove the plug from the wall by pulling the electric cord. -Refrain from using extension cords.

Refrain from using extension cords.

The nurse is admitting a client to a medical-surgical unit who states, "If someone brings balloons to me, I might have trouble breathing." What is the appropriate nursing action? -Keep balloons on the opposite side of the client's room. -Remind the client that oranges and spinach can cause a cross-reaction. -Assure the client that balloons do not cause breathing difficulties. -Replace common health care items with latex-free equipment.

Replace common health care items with latex-free equipment.

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. -Discuss the matter with the colleague and explore ways of preventing future errors. -Describe the near miss to the other nurses on the unit so they can learn from it and prevent recurrence. -Choose continuing education offerings that focus on medication safety and communication during care.

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

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. -Malpractice insurance will not cover any staff members who participated in the client's care immediately before the event. -The hospital will no longer be reimbursed for the care of Medicare and Medicaid clients. -Staff members will likely be found negligent and may face criminal charges.

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 nurse's priority in completing the report is justifying and explaining her initial response to the incident. -The incident report becomes an attachment to the client's health record. -The incident report will be used to inform changes so that the dirty supply room becomes less accessible to clients. -The incident report is completed anonymously, allowing the nurse to be frank with suggestions.

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

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. -The unit was exceptionally busy during the shift when the nurse made the error. -The nurse manager suspects that the nurse is not telling the truth about the timing of the error. -The nurse is a recent graduate and began working on the unit only 5 months ago.

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

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 is unable to begin documentation until 3 hours into the shift. -The nurse delegates administration of a client's oral medications to a licensed practical nurse. -The nurse manually lifts a heavy client rather than using a mechanical lift. -The nurse flushes a client's intravenous line with 0.45% NaCl rather than 0.9% NaCl.

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

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. -The ratio of registered nurses to licensed practical nurses is significantly lower than in other similar-sized hospitals. -The hospital is not using the latest version of its electronic health records software. -The hospital has a policy of using generic drugs rather than brand-name drugs whenever possible.

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

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? -A root cause analysis will determine which staff member committed this error. -This action is a violation of Occupational Safety and Health Administration (OSHA) regulations. -This action is a serious breach of protocol that could possibly result in criminal charges. -The hospital where this occurred is likely to lose Centers for Medicare & Medicaid Services (CMS) funding.

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

The goal of evidence-based practice related to restraints is to avoid the use of restraints. -True -False

True

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? -Screen every new client for intimate partner violence. -Use two unique client identifiers before giving medications. -Eliminate the use of shared client rooms to prevent healthcare-acquired infections (HAIs) -Identify clients at high risk of developing postoperative complications.

Use two unique client identifiers before giving medications.

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 -describing the correct use of a new type of venous access device that will soon be introduced -introducing a new group of student nurses who will soon begin a rotation on the unit -eliciting feedback about a proposed change in the scheduling procedures on the unit

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

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 -working with the pharmacy to avoid the use of medications that have similar names -banning the practice of nurses' delegating medication administration to other nurses -ensuring that no nurse is responsible for more than four clients

eliminating interruptions to nurses while they are preparing medications

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. -describing the major objective signs that the client is exhibiting. -explaining the client's symptoms and suggesting a preliminary plan. -introducing the client and listing the client's current medications.

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. -disinfect the outside of the blood bag to reduce the client's risk of infection. -perform a medication reconciliation to make sure that no drugs will react with the blood. -assess whether the client has ever been tested for hepatitis C or human immunodeficiency virus (HIV).

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

New intravenous (IV) access ports are being introduced in a hospital that are described as being "mistake-proof." The nurse should understand that these new ports may: -have a design that makes it difficult to attach incorrect tubing to the ports. -prevent adverse reactions associated with IV medications. -make it easy for nurses to follow the six rights of safe medication administration. -reduce nurses' risks of being exposed to bloodborne pathogens.

have a design that makes it difficult to attach incorrect tubing to the ports.

A sentinel event involving a client's suicide attempt on a hospital unit is being analyzed by the hospital's quality and safety committee. The committee should prioritize what consideration when performing this analysis? -identifying strategies for preventing a repeat of this event -mapping the chain of command that existed immediately before the event -apportioning blame fairly and providing supplementary education -identifying the hospital's and staff members' liability in the case

identifying strategies for preventing a repeat of this event

An adverse incident occurred in which no nurse was assigned to one of the clients on the unit, and the client received no care for an 8-hour shift. A meeting has been convened where the chairperson has begun by asking, "Why did this client not receive any care during the shift?" What is the chairperson most likely doing? -initiating a root cause analysis -beginning to identify guilt -identifying a latent error -launching a disciplinary investigation

initiating a root cause analysis

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. -includes visual cues that prompt a nurse to double-check before connecting. -has "Mistake Proof" certification from the Joint Commission. -has been designed for safety rather than efficiency.

is designed so incompatible tubes cannot be connected.

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 -being aware of the signs of infiltration and other complications of therapy -having empathy for the client and recognizing that the procedure is painful -knowing the assessment findings that indicate therapy has been successful

selecting an appropriate vein and establishing access aseptically

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. -the needs of the client were prioritized over the needs of the nurse. -the nurse received ample support from colleagues during the discipline process. -the reprimand was legally documented.

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