Chapter 09: Care and Safety Standards, Competence, and Nurse Accountability My Nursing Test Banks

Chapter 09: Care and Safety Standards, Competence, and Nurse Accountability

Test Bank

MULTIPLE CHOICE

1. A new graduate has been working as an RN for 6 months and is no longer working with a preceptor. However, she still frequently checks with an experienced nurse to validate that she is following the rules and the policies she is still learning. The new graduate in this scenario exhibits the actions of what theoretical level of skill?

a.

Expert

b.

Competent

c.

Proficient

d.

Novice

ANS: D

In general, a novice is rule driven, is a concrete thinker, and believes and trusts whomever has authority or whatever direction is perceived to have come from someone in authority. Benner (1984) suggests that with experience and practice, nurses advance through the different levels of nursing knowledgenovice, competent, proficient, and expert.

DIF: Cognitive Level: Analysis REF: Page 133

OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

2. An RN has been working on a cardiac unit for 1 year and has settled comfortably into an efficient, safe, and organized routine for each shift. However, whenever an urgent issue arises, the nurse feels uncomfortable. It is most likely that this nurse is functioning at which skill level?

a.

Novice

b.

Proficient

c.

Competent

d.

Expert

ANS: C

A competent nurse has some experience and has developed safe organizational skills to get through the days tasks efficiently. Flexibility within the nursing role is difficult to manage at this point, and when deviations from the schedule occur, the nurse generally has a feeling of unease.

DIF: Cognitive Level: Analysis REF: Page 133

OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

3. Which action would indicate that the RN is practicing at the proficient level?

a.

Asks another nurse to be present while a Foley catheter is inserted

b.

Becomes frazzled when two patients are unexpectedly admitted at the same time

c.

Thinks critically about situations and is able to anticipate patient needs

d.

Assumes the role of charge nurse while managing a tough patient assignment

ANS: C

A proficient nurse is experienced and has a beginning ability to recognize patterns and think critically. This allows her to think critically about situations and anticipate the needs of her patients. Novice nurses may ask the help of other more experienced nurses. Competent nurses have developed skills and are routine driven, often struggling with flexibility. Expert nurses are skilled critical thinkers and handle challenges with ease.

DIF: Cognitive Level: Application REF: Page 133

OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

4. An RN has been practicing for 12 years in pediatrics. Peers often seek out this nurse to help them with complex problems. This experienced nurse is assigned the patients with the highest acuity, and the nurse accepts these assignments with confidence. This nurse is likely practicing at which skill level?

a.

Novice

b.

Competent

c.

Proficient

d.

Expert

ANS: D

An expert nurse has had a great deal of experience and is flexible and adaptable, responding to change with ease. According to Benner (1984), the expert nurse is a skilled critical thinker who has gained experience and skills through practice.

DIF: Cognitive Level: Analysis REF: Page 133

OBJ: Compare the theoretical classifications of nursing skill.

TOP: Classification of Nursing Skill

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

5. The nurse is working on a busy cardiac floor. While preparing medications, the nurse is interrupted by a co-worker, who has a question about another patient. After administering the medication, the nurse realizes that she gave the medication to the wrong patient. Which action by the nurse would indicate accountability?

a.

Shifting blame to the co-worker who interrupted her

b.

Attempting to hide the medication error to avoid getting into trouble

c.

Accepting partial responsibility for her own actions

d.

Taking responsibility for her own actions and interventions by immediately assessing the patient and reporting the error to a physician

ANS: D

Accountability is being answerable for the actions or interventions one performs as a nurse. Immediately assessing the patient and reporting the error to a physician demonstrate accountability. Shifting blame, attempting to hide the error, and accepting only partial blame do not.

DIF: Cognitive Level: Application REF: Page 135

OBJ: Describe accountability as it applies to nursing practice. TOP: Accountability

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

6. An RN realizes that she inadvertently gave a patient who was NPO for surgery his otherwise normally scheduled PO medications. Which action would she take if she were exhibiting professional accountability?

a.

Report the error to the charge nurse and follow up with the patients surgeon.

b.

Report the incident to the charge nurse and blame the co-worker who interrupted her medication pass.

c.

Keep the incident to herself so that the patients surgery will not be canceled.

d.

Report the incident the next day that she works.

ANS: A

Accountability is being answerable for the actions or interventions one performs as a nurse. Accountability also means taking responsibility for ones other actions and growth. Although individuals are ultimately accountable to themselves, the RN is particularly accountable to the patient, society, and the profession. The RN should report the incident immediately to the charge nurse and surgeon, in the best interest of the patient.

DIF: Cognitive Level: Application REF: Page 135

OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Accountability

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

7. While passing noon meds, an RN notes that one of her patients did not receive his 0600 dose of antibiotic during the prior shift. She calls the prior nurse to try to determine whether the medication was given or not, then fills out an occurrence or care aberrance report, and follows through as institutional policy indicates. What is the best explanation for why the RN who found the error took action?

a.

Because the prior nurse needed to know she made an error

b.

Because she is accountable for not contributing to the error by ignoring it

c.

To keep the patient from suing the hospital

d.

To keep herself out of trouble

ANS: B

The RN must act judiciously and prudently in the delivery of care. By not going to the supervisor when a mistake is made and failing to demonstrate accountability for contributing to the mistake, the RN risks not only harm to the patient but also potential legal and ethical consequences.

DIF: Cognitive Level: Analysis REF: Page 139

OBJ: Distinguish the RNs role in managing care aberrances. TOP: Managing Care Aberrances

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

8. In a situation involving a medication error, the hospital policy is to use root-cause analysis to evaluate the situation fully. In the root-cause analysis process, which action would take place?

a.

A committee is formed to determine the risk of litigation.

b.

A committee is formed to determine the punishment for those involved.

c.

A committee is formed that can reconstruct the events leading to the error.

d.

A committee is formed that can correct the error and avoid damages.

ANS: C

In a root-cause analysis, a committee is formed, which in this case would include a facilitator (usually the risk manager or performance improvement director), the nurse or nurses involved, a pharmacist, the physician, and the team leader or supervisor. The purpose of the committee is to reconstruct the events leading up to the error. By looking at the process, the committee may discover that the physicians order was unclear, that two drugs with similar names were placed next to each other in the medication-dispensing unit, or that the unit of measure for the drug was unclear.

DIF: Cognitive Level: Application REF: Page 139

OBJ: Distinguish the RNs role in managing care aberrances.

TOP: Managing Care Aberrances: Root-Cause Analysis

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

9. There are a number of characteristics that will help a novice nurse find success in a mentoring relationship. Which action represents one of these positive characteristics?

a.

The novice nurse asks clear, thoughtful questions and seeks clarifications.

b.

The novice nurse is patient and waits for the mentor to approach with learning opportunities.

c.

The novice nurse is directive rather than open to dialogue.

d.

The novice nurse stays busy, and the mentor seeks the opportunities.

ANS: A

The novice nurse makes his or her learning needs known, is prepared to take on new learning experiences, and is thoughtful about the learning that is taking place. The novice nurse is confident enough to ask questions, seek clarification, and seek constructive input. The novice nurse understands the experience needed to gain expertise and will open a dialogue with the mentor. The novice nurse is clear, precise, and thoughtful in the questions asked and in the dialogue that follows. The novice nurse is hungry for learning experiences, demonstrates this through a sound plan, and is focused on the matters at hand.

DIF: Cognitive Level: Analysis REF: Page 133

OBJ: Differentiate the advantages of fostering a successful mentor relationship.

TOP: Mentoring Relationship

MSC: NCLEX: Safe, Effective Care Environment: Management of Care

10. An operating room nurse has returned from a conference on the impact of never events. Recognition of which of the following would lead her to believe that a never event could occur?

a.

The patient is losing an anticipated amount of blood during surgery.

b.

Toward the end of a surgical procedure, the sponge count does not match up with the beginning count.

c.

The procedure is taking longer than planned.

d.

The surgeon was late to the procedure.

ANS: B

Never events are preventable events that can cause illness, injury, or even death of a patient. Noticing a difference in the beginning and end sponge counts indicates that a never event could occur. Losing an anticipated amount of blood or a lengthy procedure does not necessarily indicate the possibility of a never event. Timeliness of the surgeon is not a factor.

DIF: Cognitive Level: Application REF: Page 140

OBJ: Identify the benchmarks for judging nursing care. TOP: Never Events

11. A nurse has just received training on the Quality and Safety Education for Nurses (QSEN) Project. What should the nurse do to show that she understands the importance of the project?

a.

After assessing the patient, determine a list of priorities for care and begin implementing them.

b.

Collaborate with medical personnel involved in the patients care to develop a treatment plan for the patient.

c.

Develop a treatment plan with the patient and medical personnel that best fits the patients needs and lifestyle.

d.

Develop a treatment plan based on what the patients wife says he needs.

ANS: C

Patient-centered care is one of the six primary competencies in the QSEN Project. Patient-centered care includes involvement of the patient as well as medical personnel. Treatment plans should be tailored to fit the patients needs and lifestyle. This sets the patient up for success.

DIF: Cognitive Level: Application REF: Page 135

OBJ: Identify the benchmarks for judging nursing care. TOP: QSEN Project

12. A nurse has just realized that her license is due to expire in 5 months. The nurse knows that she is responsible for maintenance of her license in order to continue practicing as a nurse. What would be the best action for her to take?

a.

Put off obtaining the continuing education credits until 1 month before the expiration date.

b.

Immediately begin working on obtaining the continuing education credits.

c.

Email the nursing board to inquire about why she was not notified earlier.

d.

Forgo obtaining the continuing education credits and hope that she does is not audited.

ANS: B

Personal responsibility indicates that the nurse is responsible for her own actions and for maintenance of her nursing license. The nurse should be aware of the expiration date and should plan to obtain continuing education credits accordingly.

DIF: Cognitive Level: Application REF: Page 136

OBJ: Describe accountability as it applies to nursing practice. TOP: Personal Accountability

13. On administering a medication, the RN realizes that she gave the incorrect amount. After assessing the patient, which action would not be appropriate for the nurse to take?

a.

Report the incident to the patients physician.

b.

Immediately report the incident to her manager.

c.

Keep the incident to herself and continue to monitor the patient.

d.

Continue to reassess the patient.

ANS: C

The RN has a duty to act judiciously and prudently in the delivery of care to the patient. Failure to report a medication error could cause harm or even death. Along with risk of harm to the patient, the RN also risks legal and ethical consequences. Keeping a medication error to herself would be inappropriate, even if the nurse continued to assess the patient.

DIF: Cognitive Level: Application REF: Page 139

OBJ: Describe accountability as it applies to nursing practice. TOP: Managing Care Aberrances

14. A nurse manager is reviewing an incident report submitted by the previous days charge nurse. The incident report indicates that the wrong IV antibiotic was given to a patient. What is the best way for the nurse manager to address this incident with the nurse involved so that it may be prevented in the future?

a.

Provide education to the nurse on how to assess the five rights before medication administration.

b.

Punish the nurse for the error by sending her home for the day.

c.

Allow the nurse one error, and educate her if the same mistake happens again.

d.

Ask the charge nurse to educate the nurse because she caught the error.

ANS: A

The nurse manager has the responsibility to meet with the nurse involved in the error and create a plan to help ensure that the error does not happen again. This can be done by setting up a time in which to educate the RN about the five rights of medication administration. The nurse should not ignore the error, ask someone else to handle it, or use the incident report in a punitive way.

DIF: Cognitive Level: Application REF: Page 139

OBJ: Identify the RNs role in managing care aberrances. TOP: Incident Reports

15. The medical team determines that a patient needs to be transferred to another facility to continue receiving the most appropriate and beneficial care. The transfer process has been slow and difficult, and the nurse is struggling to care for the transferring patient along with her other assigned patients. What is the best action the nurse can take to improve her situation?

a.

Continue to do the best that she can do for all of her patients.

b.

Inform the medical team that the transfer will have to wait for the next shift.

c.

Involve management so that the nurse can focus on patient care.

d.

Ask her co-workers to manage her patient assignment.

ANS: C

The best action the nurse can take is to involve management so that she can focus on patient care. Continuing to struggle takes away from the care she is able to provide and could be detrimental to her patients. Halting the transfer could possibly be detrimental to the patient in need of the medical transfer. Asking her co-workers to absorb her assignment could reduce the quality of care that they are able to provide as well.

DIF: Cognitive Level: Application REF: Page 140

OBJ: Identify the RNs role in managing care aberrances.

TOP: Involving Management in Decision-Making

16. A patient on a medical-surgical floor is unhappy with the care he is receiving from his physician and wants to speak to someone about it. Who should his nurse consult first?

a.

The director of medical-surgical nursing

b.

The patients physician

c.

The nurses immediate supervisor

d.

Another nurse on the floor

ANS: C

The nurse should consult the first person in the chain of command, her immediate supervisor. If the immediate supervisor is unable to assist, the next person in line should be consulted, and so on.

DIF: Cognitive Level: Knowledge REF: Page 141

OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Chain of Command

17. A nurse manager wants to assess quality of care over the last 6 months for her unit. How could the nurse manager best accomplish this?

a.

Interview each nurse about the patients on the unit for the last 6 months.

b.

Review the results of patient satisfaction surveys.

c.

Obtain charts from medical records for all of the patients.

d.

Ask the nurses to perform discharge phone calls on previous patients.

ANS: B

The nurse manager could best accomplish her goal by reviewing the result of patient satisfaction scores. It is not realistic for her to interview each nurse, obtain the charts for every patient over the course of 6 months, or ask the nurses to perform discharge phones calls on previous patients.

DIF: Cognitive Level: Application REF: Page 141

OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Quality of Care Measurement

MULTIPLE RESPONSE

1. Often, when patients are unhappy or behaving negatively, it is the result of which of the following? (Select all that apply.)

a.

Angst

b.

Sorrow

c.

Anxiety

d.

Pain

ANS: A, B, C, D

Patients who are unhappy or behaving negatively often are experiencing angst, sorrow, anxiety, or pain. It is important for the nurse to determine the cause of the patients behavior and assist in resolving the matter.

DIF: Cognitive Level: Knowledge REF: Page 141

OBJ: Describe how using the chain of command to resolve issues supports accountability.

TOP: Quality of Care Measurement

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