chapter 22 Flashcards
A new graduate is asked to serve on the hospital’s quality improvement (QI) committee.
The nurse understands that the first step in quality improvement is to:
a. Collect data to determine whether standards are being met.
b. Implement a plan to correct the problem.
c. Identify the standard.
d. Determine whether the findings warrant correction.
C
The chief executive officer asks the nurse manager of the telemetry unit to justify the
disproportionately high number of registered nurses on the telemetry unit. The nurse
manager explains that nursing research has validated which statement about a low
nurse-to-patient ratio?
a. “It promotes teamwork among health care providers.”
b. “It increases adverse events.”
c. “It improves outcomes.”
d. “It contributes to duplication of services.”
C
A nurse manager wants to decrease the number of medication errors that occur in her
department. The manager arranges a meeting with the staff to discuss the issue. The
manager conveys a philosophy of total quality management (QM) by:
a. Explaining to the staff that disciplinary action will be taken in cases of additional
errors.
b. Recommending that a multidisciplinary team assess the root cause of errors in
medication.
c. Suggesting that the pharmacy department explore its role in the problem.
d. Changing the unit policy to allow a certain number of medication errors per year
without penalty.
B
The nurse educator of the pediatric unit determines that vital signs are frequently not being
documented when children return from surgery. According to QI, to correct the problem the
educator, in consultation with the patient care manager, would initially do which of the
following?
a. Talk to the staff individually to determine why this is occurring.
b. Call a meeting of all staff to discuss this issue.
c. Have a group of staff nurses review the established standards of care for
postoperative patients.
d. Document which staff members are not recording vital signs, and write them up.
B
A nurse is explaining the pediatric unit’s QI program to a newly employed nurse. Which of
the following would the senior nurse include as the primary purpose of QI programs?
a. Evaluation of staff members’ performances.
b. Determination of the appropriateness of standards.
c. Improvement in patient outcomes.
d. Preparation for accreditation of the organization by The Joint Commission.
C
Before beginning a continuous QI project, a nurse should determine the minimal safety level
of care by referring to which of the following?
a. The procedure manual.
b. Nursing care standards.
c. The litigation rate of unsafe practice.
d. Job descriptions of the organization.
B
The nurse gives an inaccurate dose of medication to a patient. After assessment of the
patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of
the medication error and calls the physician to report the occurrence. The nurse who
administered the inaccurate medication understands that:
a. The error will result in suspension.
b. An incident report is optional for an event that does not result in injury.
c. The error will be documented in her personnel file.
d. Risk management programs are not designed to assign blame.
D
The nurse manager is concerned about the negative ratings that her unit has received on
patient satisfaction surveys. The first step in addressing this issue from the point of view of
quality improvement is which of the following?
a. Assemble a team.
b. Establish a benchmark.
c. Identify a clinical activity for review.
d. Establish outcomes.
C
With the rise of workplace violence in the emergency department, the nurse manager
decides that she should work with the risk manager in violence prevention. The nurse
manager should:
a. Request all staff to accept new risk management practices.
b. Hold staff accountable for safe practices.
c. Document inappropriate behaviour.
d. Hire more police security.
B
The nurse manager is performing a root-cause analysis related to medication administration
errors with insulin. A root-cause analysis is very similar to the QI process except that a
root-cause analysis is:
a. Retrospective.
b. Prospective.
c. Legislated for completion with all near-miss events.
d. Conducted by only one person.
A
Hospital ABCD is a Magnet hospital. This designation has been applied to Hospital ABCD
because it:
a. Facilitates active staff participation in decision-making related to quality nursing
care.
b. Has implemented a graduate nurse orientation program.
c. Espouses commitment to excellence in patient care.
d. Is establishing career ladders for nurses.
A
In determining the relationship between injury-producing falls and proposed preventive
measures as part of the QI process, a QI team might turn to which of the following for
confirmatory evidence?
a. Best Practice Guidelines (BPGs).
b. North American Nursing Diagnosis Association (NANDA).
c. National Quality Institute.
d. Agency for Healthcare Research and Quality.
A
As a nurse manager, you know that the satisfaction of patients is critical in making QI
decisions. You propose to circulate a questionnaire to discharged patients, asking about their
experiences on your unit. Your supervisor cautions you to also consider other sources of
data for decisions because:
a. The return rate on patient questionnaires is frequently low.
b. Patients are rarely reliable sources about their own hospital experiences.
c. Hospital experiences are frequently obscured by pain, analgesics, and other factors
affecting awareness.
d. Patients are reliable sources about their own experiences, but are limited in their
ability to gauge clinical competence of staff.
D
An example of an effective patient outcome statement is:
a. “Eighty percent of all patients admitted to the emergency department will be seen
by a nurse practitioner within 3 hours of presentation in the emergency
department.”
b. “Patients with cardiac diagnoses will be referred to cardiac rehabilitation
programs.”
c. “The hospital will reduce costs by 3% through the annual budget process.”
d. “Quality is a desired element in patient transactions.”
A
Patient perceptions are useful in:
a. Determining disciplinary actions in QI.
b. Establishing the competitive advantage of QI decisions.
c. Establishing priorities among possible changes to care identified in QI.
d. Establishing blame for poor-quality care.
C
