Ch 22 Quality Improvement And Patient Safety

Question 1

**A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred by what term?

A. Deployment flowchart
B. Top-down flowchart
C. Pareto chart
D. Control chart

Answer 1

B. Top-down flowchart

Question 2

**What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals?

A. Institute for Safe Medication Practices
B. Institute of Medicine (IOM)
C. National Committee for Quality Assurance
D. The Joint Commission (TJC)

Answer 2

B. Institute of Medicine (IOM)

Question 3

**A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term?

A. Root cause
B. Sentinel event
C. Variation in performance
D. Causal factor

Answer 3

B. Sentinel event

Question 4

A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument STAT. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are engaged in what process?

A. Standardization of care
B. Root cause analysis
C. Process variation
D. Analysis of a deployment flowchart

Answer 4

B. Root cause analysis

Question 5

Each month data on admission assessments that are based on the following standard are entered: “All patients will be assess by an RN within 2 hours of admission.” The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool?

A. Pareto chart
B. Control chart
C. Deployment chart
D. Top-down flowchart

Answer 5

B. Control chart

Question 6

**Regardless of the term used to describe high-quality health care, what is the primary focus of quality?

A. Meeting consumer needs and wants
B. Providing economical care
C. Utilizing technological advancements
D. Equally distributed care

Answer 6

A. Meeting consumer needs and wants

Question 7

**A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?

A. Safety
B. Timely
C. Equitable
D. Patient-centered care

Answer 7

A. Safety

Question 8

An organization’s emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term?

A. Pareto chart
B. Control chart
C. Top-down flowchart
D. Deployment chart

Answer 8

D. Deployment chart

Question 9

**Patients with heart failure have extended lengths of stay and are often re-admitted shortly after they have been discharged. To improve quality of care, a type of “road map” that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term?

A. Clinical protocol
B. Critical pathway
C. Algorithm
D. Case management

Answer 9

B. Critical pathway

Question 10

*The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph to present this information?

A. Time plot
B. Fish bone diagram
C. Flowchart
D. Cause and effect diagram

Answer 10

A. Time plot

Question 11

A group of nurses are presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that supports what?

A. Being insured has little effect on a person’s longevity and the quality of care received
B. Lobbyists for the drug companies can gain permission for the use of new drugs within 1 year of their discovery
C. Although a greater number of lawsuits stem from medication errors, more people actually die from HIV and AIDS
D. Medication-related errors place a tremendous financial burden on the US health care system

Answer 11

D. Medication-related errors place a tremendous financial burden on the US health care system

Question 12

According to the Quality Chasm report what statement is true?

A. Health care providers should be proactive rather than reactive to patient needs
B. Common needs rather than individual preferences should be the priority
C. Medical information should be confined to the PCP
D. Specialized providers or case managers should control health care decisions

Answer 12

A. Health care providers should be proactive rather than reactive to patient needs

Question 13

During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter’s wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was special cause variation?

A. Failure to take time to put on shoes due to urgency
B. Unsteady gait due to narcotic administration
C. Poor lighting that led to decreased vision
D. Improper construction that cause the leak and towel placement

Answer 13

D. Improper construction that cause the leak and towel placement

Question 14

*The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what?

A. Cause and effect diagram
B. Run chart
C. Pareto chart
D. Flowchart

Answer 14

C. Pareto chart

Question 15

The surgical team arrives in the operating room and one-member states, “Everyone stop. Let’s identify the patient and operative site. Now does anyone have any questions or concerns?” This process is referred to by what term?

A. Time-out
B. A critical pathway
C. Special cause variation
D. Lean methodology

Answer 15

A. Time-out

Question 16

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as “PDCA.” What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism?

A. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization
B. D stand for deviation, which is an alteration in the expected drugs ordered
C. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned?
D. A stands for algorithm, which includes all steps of the process

Answer 16

C. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned?

Question 17

A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation?

A. Run chart
B. Pareto chart
C. Flowcharts
D. Cause and effect diagrams

Answer 17

B. Pareto chart

Question 18

*Which of the following occurrences would be classified as a sentinel event?

A. A postpartum patient who elects to breastfeed only twice daily develops mastitis
B. A newly diagnosed diabetic patient self injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator
C. A nurse assisting with the delivery of twins places the “Twin 1” and tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin
D. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin SQ, resulting in a drop in the patient’s serum glucose from 160 to 100 mg

Answer 18

C. A nurse assisting with the delivery of twins places the “Twin 1” and tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin

Question 19

A patient is ordered a low-protein, low-calorie diet but the patient’s family bring fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation?

A. A sentinel event
B. An adverse event
C. Patient-centered care
D. The communication technique of “call-out”

Answer 19

C. Patient-centered care

Question 20

**Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members’ strengths. Which of the QSEN competencies are being demonstrated?

A. Quality improvement
B. Evidence-based practice
C. Teamwork and collaboration
D. Patient-centered care

Answer 20

C. Teamwork and collaboration

Question 21

**Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct?

A. Each competency is mutually exclusive
B. The competencies focus on individual efforts to reduce errors
C. Physicians lead the team to achieve each competency
D. The competencies address both individual and system approaches to transform care

Answer 21

D. The competencies address both individual and system approaches to transform care

Question 22

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies?

A. Patient-centered care
B. Informatics
C. Teamwork
D. Quality improvement

Answer 22

B. Informatics

Question 23

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? SATA.

A. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed
B. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family
C. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient
D. Mark the procedure site with “X” and again ask the patient to verify correct site
E. After arrival in the OR, perform a “time out” for final identification of patient and operative site along with agreement of what procedure is scheduled

Answer 23

A. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed

C. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient
D. Mark the procedure site with “X” and again ask the patient to verify correct site
E. After arrival in the OR, perform a “time out” for final identification of patient and operative site along with agreement of what procedure is scheduled

Question 24

The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? SATA.

A. A patient falls and fractures a hip
B. A patient develops bilateral pressure ulcers on their heels
C. A patient develops a catheter-associated urinary tract infection
D. A patient develops post-surgical delirium
E. A patient develops pneumonia related to ventilator use

Answer 24

A. A patient falls and fractures a hip
B. A patient develops bilateral pressure ulcers on their heels
C. A patient develops a catheter-associated urinary tract infection
E. A patient develops pneumonia related to ventilator use

Question 25

**A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for education nursing professionals. What competency is included? SATA.

A. Advance health assessment techniques
B. Patient-centered care
C. Prescriptive pharmacology content
D. Quality improvement
E. Safety

Answer 25

B. Patient-centered care
D. Quality improvement
E. Safety

Question 26

Quality is defined by the _____________

Answer 26

Patient

Question 27

While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient’s walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a ____________ event.

Answer 27

Sentinel