NCLEX Clinical Safety: The Core of Leading, Managing, and Following Flashcards
In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had
doubled. How do the increase in adverse events relate to decreased managers?
a. The overload of staff nurse duties
b. Resistance to change by staff
c. A change in reporting system for everyone
d. Fewer clinical leaders facilitate best practice
ANS: D
Eliminating barriers to the implementation of best practices is the role of managers and leaders. When there are insufficient resources for leadership to encourage a culture in which evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.
The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. What interventions might assist to reduce the number of falls on the unit?
a. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.
How would the nurse executive begin to increase safety in patient care areas of the Valley Hospital?
a. Asking the community what the safety issues are
b. Consulting with a management expert about staffing schedules
c. Ensuring that the senior nursing officer attends the board meetings
d. Instituting improved practices to reduce needlestick injuries
ANS: C
The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.
During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:
a. meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
b. after consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.
c. blames the system for inadequate funding for resources.
d. reviews the system of reporting incidents to ensure that appropriate reporting is occurring.
ANS: A
The involvement of staff nurses in safety on the unit is imperative in improvement of quality and the provision of patient care. This is a relationship engagement by the manager to engage the nurses and building these relationships improves quality.
What did the IOM Health Professions Education report highlight as a concern for patient safety?
a. A normal risk in professional practice
b. A result of disciplinary silos
c. A reflection of frontline staff
d. Related to systems errors
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health disciplines in silos as a major concern in patient safety and endorsed five recommendations. One to be increased and improved communication between the health disciplines.
A nurse manager is implementing strategies to support the steps in the AHRQ document “Five Steps to Safer Health Care.” What does the manager include in the implementation?
a. Patients are actively encouraged to make decisions related to care.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credentials.
ANS: A
The Agency for Healthcare Research and Quality (AHRQ) outlines “Five Steps to Safer Health Care,” which suggests that safe, patient-centered care is facilitated by assisting patients to become active partners in their own care.
After consulting with practice environments about quality and safety concerns in health care, a dean in a health care program implements what to improve quality and safety in health care?
a. A nursing program that emphasizes the development of a strong disciplinary
identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse
events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners
that emphasizes collaborative learning teams.
ANS: D
Health Professions Education identified that education related to health disciplines in silos leads to compromised communication and inability to function as an integrated whole for patient-centered care.
What would be the primary emphasis in designing and implementing a quality, safe healthcare environment?
a. Evidence-based practice
b. Informatics
c. Staffing
d. The patient
ANS: D
Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.
The nurse is educating older adult patients on staying safe in the healthcare system. What information does the nurse include in the teaching?
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
ANS: A
The Five Steps to Safer Health Care for patients include keeping a list of medications that patients are taking.
As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. What recommendations would be consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate prepared nurses to 80%
ANS: D
The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated work force.
On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. What strategy may assist with rapid adoption of the technology and system?
a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation
ANS: D
The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovation and changes quickly through early
To achieve Nurse-Sensitive Care Standards developed by the NQF, you advocate for which of the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
The National Quality Forum (NQF) outlines nursing-centered intervention measures related to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing care hours per day, and skill mix of staff.
You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient. What is the appropriate response for you to give Sally?
a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescent’s parents
ANS: A
The Five Steps to Safer Health Care for Patients includes the step of asking questions if there are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking these steps and by providing patients with coaching in the steps.
The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. What does the use of this model by the Centers for Medicare and Medicaid Services specificity link with adverse patient events for healthcare facilities?
a. Staffing
b. Funding
c. Composition of executive councils
d. Composition of consumer-based councils
ANS: B
The Centers for Medicare and Medicaid Services (CMS) have adopted a policy based on the NQF’s “Never Events.” The CMS will no longer pay for patient conditions or events that result from poor practice while patients are under the care of a health professional
Pleasant Valley Hospital has amended its safety practices and policies. What has the hospital elected to emphasize accordance with changes by The Joint Commission (TJC)?
a. Safety goals specific to Pleasant Valley
b. Decision-making processes
c. Sufficient staffing for safe care
d. Increased numbers of baccalaureate-prepared RNs
ANS: A
When TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.
