Chapter 10- Safety Concerns in Healthcare My Nursing Test Banks

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Information Field: Client Needs

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Highest Answer Letter: E

Multiple Keywords in Same Paragraph: No

Chapter: Chapter 10: Safety Concerns in Healthcare

Multiple Choice

1. Several national organizations have addressed the issue of adverse events in healthcare settings. The National Quality Forum (NQF) of 2002 included which of the following?

A) A list of serious reportable events that was aimed at increasing public accountability

B) A cross reference of standards for nursing care with the most common adverse events in healthcare

C) A list of aims for improving the overall quality of the American healthcare system

D) An algorithm for responding appropriately to safety violations in healthcare settings

Ans: A

Client Needs: A-2

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 1

Page and Header: 374, The National Quality Forum

Feedback: In 2002, The National Quality Forum (NQF) created and endorsed a list of serious reportable events (SREs)also referred to as adverse or never eventsto increase public accountability and consumer access to critical information about healthcare performance. This did not encompass standards for nursing care, appropriate responses to specific adverse events, or a list of general aims for the healthcare system.

Multiple Selection

2. A nurse is aware that sentinel events that occur in the care setting must be followed up in a timely and thorough way. Which of the following occurrences would be considered a sentinel event? (Select all that apply.)

A) A nurses shift is cancelled at short notice.

B) A patient accesses the medication chart and takes a medication.

C) The family member of a patient physically threatens a nurse.

D) A physician makes sexually inappropriate comments to a nurse.

E) A nurse places a patient on a bedpan despite the fact that the patient can ambulate with assistance.

Ans: B, C, D

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Nursing Process

Objective: 4, 5

Page and Header: 375, Display 10.2

Feedback: Sentinel events encompass a wide variety of events that threaten the safety of patients, families, and care providers. Examples include patient access to secured drug storage and inappropriate or threatening conduct. Late cancellation of a shift would be unlikely to constitute a sentinel event. Substandard care, such as the inappropriate use of a bedpan, requires correction but would not be considered a sentinel event.

Multiple Choice

3. One of the safe practices identified by the National Quality Forum (NQF) is to match healthcare needs with service delivery capability. This practice is demonstrated by

A) matching the health status of a community with the specific mandate of the local hospital.

B) conducting high-risk procedures in hospitals that perform a large numbers of the same procedure.

C) encouraging Americans to seek care in healthcare institutions that have the fewest number of adverse events.

D) ensuring that hospitals are equipped and staffed to provide neither too much nor too little care.

Ans: B

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 2

Page and Header: 378, Matching Needs with Delivery Capability

Feedback: A practice identified by the NQF was to match healthcare needs with service delivery capability. Research has consistently demonstrated that patients undergoing certain high-risk procedures have lower-than-expected mortality rates in hospitals that perform large numbers of those procedures, and conversely, higher-than-expected mortality in institutions that perform low volumes of those procedures.

4. The nursing leadership in the local hospital has recognized the need to minimize the number of sentinel events that occur in the hospital by implementing a number of practice improvements. These nurse leaders should recognize that the largest proportion of sentinel events involve which of the following?

A) Lapses in communication

B) Violence

C) Violations of care providers scopes of practice

D) Gaps in education and training

Ans: A

Client Needs: A-2

Cognitive Level: Comprehension

Difficulty: Easy

Integrated Process: Communication and Documentation

Objective: 2

Page and Header: 378, Communications

Feedback: It has been estimated that communication errors are factors in more than 70% of sentinel events.

5. The Joint Commission has taken action to encourage healthcare organizations to reduce the incidence and impact of errors. How has the Joint Commission acted to facilitate these improvements in care?

A) By delineating the scope of practice for registered nurses and practical (vocational) nurses

B) By providing a forum for patients to report errors and substandard care

C) By funding safety education in medical schools and nursing schools

D) By standardizing the measures by which safety in hospitals is gauged

Ans: D

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 3

Page and Header: 375, The Joint Commission

Feedback: In 2004, the Joint Commission and the Centers for Medicare & Medicaid Services (CMS) began working together to align measures common to both organizations. These standardized common measures, called Hospital Quality Measures, are integral to improving the quality of care provided to hospital patients and bringing value to stakeholders by focusing on the actual results of care. The Joint Commission has not directly addressed the scope of nursing practice, the healthcare education, or the reporting process.

6. A senior nurse on a medical unit is aware of the role that she can play in establishing a culture of safety on the unit. What characteristic is most important to care settings that possess a culture of safety?

A) Anticoagulants, opioids, and insulin are cosigned by two nurses.

B) Physicians orders are entered into a computerized system rather than a handwritten section of patients charts.

C) Nurses feel that they can report errors, near misses, and adverse events without being punished or denounced.

D) Direct patient care is provided by ADN and baccalaureate nurses rather than practical (vocational) nurses.

Ans: C

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3

Page and Header: 377, Organizational Culture

Feedback: A central attribute of a culture of safety is the existence of trust and mutual respect. This encourages healthcare providers to report errors, near misses, and other adverse events without fear of retribution. Cosigning medications and eliminating handwritten orders are specific measures that may augment safety, but they are not characteristics of a culture of safety. Excluding PNs from care is not necessary to ensure safety.

7. A county hospital has recently implemented a practice change in which the SBAR technique is now used to communicate between nurses and physicians. The nurse has contacted an elderly patients physician to report the patients adventitious lung sounds and decreased oxygen saturation. Which of the following statements best exemplifies the R component of the SBAR tool?

A) Mr. Young has a do-not-resuscitate order.

B) Mr. Youngs oxygen saturation is 86% on oxygen at 3 liters per minute by nasal prongs.

C) Mr. Young was admitted on January 14 with a diagnosis of failure to thrive.

D) I think that we should decrease Mr. Youngs IV rate.

Ans: D

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 3

Page and Header: 378, Patient Safety During Handoffs

Feedback: The SBAR tool consists of four components: situation (S), background (B), assessment (A), and recommendation (R). A suggested course of action, such as reducing a patients IV rate, is an example of a recommendation. A patients code status and original diagnosis are examples of background and oxygen levels are assessment findings.

8. A busy operating room has begun using time outs in an effort to reduce errors and promote patient safety. What action will the care team perform during a time out?

A) Systematically teaching the patient about the risks of surgery while the patient is still in the preoperation area

B) Gathering each member of the surgical team to acknowledge and confirm that the correct surgery will be performed on the correct patient

C) Pausing to review the patients diagnosis and the indications for surgery

D) Completing a checklist that reviews the major areas for preoperative assessment and which contains the patients consent for the procedure

Ans: B

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6

Page and Header: 380, Adopting Safe Practices in Specific Clinical Care Settings

Feedback: All relevant members of the team actively communicate during the time-out and agree, at a minimum, that the patient identity is correct as is the site and the procedure to be done. Time outs do not normally involve preoperative teaching, assessment, or review of the patients diagnosis.

9. Failure to rescue has been defined as deaths per 1,000 patients having developed specified complications of care during hospitalization (AHRQ, 2007). A hospital that wishes to reduce the rate of failure to rescue should prioritize what measure?

A) Encouraging nurses to spend a greater amount of time at the bedside.

B) Implementing mandatory continuing education programs.

C) Improving the communication between members of different health disciplines.

D) Reducing distractions to nurses while they are providing care.

Ans: A

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 7

Page and Header: 382, Failure to Rescue and Nurses Time at the Bedside

Feedback: Failure to rescue has been tied to the amount of time that the nurse spends at the bedside with incidence of failure to rescue decreasing when nurses spend more time at the bedside and less on other activities. Being present at the bedside influences failure to rescue more than continuing education, improving communication, or reducing distractions, even though each of these measures has the potential to improve safety.

10. Alana is a registered nurse with an ADN degree who floats between several different medical and surgical units of a hospital. Today was Alanas fifth 12-hour shift in a row and she committed a medication error while providing care for one of the four patients to whom she was assigned. What factor is most likely to have contributed to this adverse event?

A) The fact that Alana has an ADN degree

B) The fact that Alana floats between several units

C) The fact that Alana was working overtime

D) The fact that Alana was responsible for four patients

Ans: C

Client Needs: A-2

Cognitive Level: Evaluation

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 385, Nurse Staffing

Feedback: While it is not possible to establish causative factors without knowing more details of this situation, there is known to be a close correlation between overtime and adverse events. Adverse events are not typically linked to having an ADN degree or providing care for four patients. Unfamiliarity with a unit is a safety risk, but overtime is a more likely cause of an error.

11. A nurse who provides care in a long-term care facility is charged with improving the safety of residents. Which of the following measures has the greatest potential to reduce the incidence of injuring among residents?

A) A comprehensive falls prevention program

B) A program aimed at eliminating resident-to-resident violence

C) An automated medication administration system

D) An algorithm that guides the delegation of tasks among the care team

Ans: A

Client Needs: A-2

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 7

Page and Header: 386, Preventing Falls

Feedback: Falls are a common cause of morbidity and the leading cause of nonfatal injuries and trauma-related hospitalizations in the United States. Nearly half of all residents in nursing homes fall each year, with many sustaining fractures. As a result, a falls prevention program is more likely to be of benefit than a violence-prevention program, automated medication administration, or a delegation tool.

12. A nurse is transcribing a physicians new drug order on to a patients medication administration record. In light of the potential for drug errors, how should the nurse best record the drug order?

A) Digoxin 0.125 mg PO daily

B) Digoxin .125 mg PO daily

C) Digoxin 0.1250 mg PO daily

D) Digoxin .1250 mg PO daily

Ans: A

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 387, Eliminating Ambiguous Abbreviations

Feedback: The Institute for Safe Medication Practices requires that leading zeros before the decimal point always be included and trailing zeros after a decimal point never be used.

13. A hospital has recently implemented a barcode point of care (BPOC) system. This system will require the nurse to

A) scan barcodes on patients charts and their wristbands before administering drugs.

B) cross-check physicians orders and patients medication administration records.

C) scan patient wristbands and medication containers prior to medication administration.

D) provide an electronic record of his or her nursing activities over the course of a shift.

Ans: C

Client Needs: D-2

Cognitive Level: Analysis

Difficulty: Easy

Integrated Process: Communication and Documentation

Objective: 8

Page and Header: 388, Barcode Point-of-Care (BPOC)

Feedback: BPOC systems cross-check bar codes printed on patient wristbands, nurse identification badges, and medication labels. The system matches the providers orders with the patient identification and verifies the six rights of medication safety by comparing the bar code on medications with the prescribed medications. Patients medical charts are not normally scanned and BPOC do not provide a record of most aspects of nursing care. Comparing physicians orders to MARs is not an activity that is limited to BPOC systems.

14. A nurse is aware that the incidence of medication errors at the hospital is much higher than it should be and that it is possible to reduce this incidence. Which of the following measures carries the greatest potential to reduce medication errors?

A) Implementing team nursing, whereby every medication is administered by a pair of nurses

B) Attaching physicians orders to medication administration records (MARs)

C) Keeping medication administration records (MARs) at the patients bedsides

D) Taking action to reduce distractions to nurses while they are administering medications

Ans: D

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 8

Page and Header: 389, Nurses Role in Medication Safety

Feedback: One of the causes of errors most frequently reported by nurses is that of interruptions while administering medications. Team nursing, attaching MARs to orders, and keeping MARs at patient bedsides are not measures that have been widely proposed or that have been shown to reduce medication errors.

15. A nurse who works in a busy, university hospital is committed to improving patient safety at the hospital. In order to meet this goal, what action should the nurse prioritize?

A) Advocating for continuing education programs and funding of nurse educators

B) Encouraging patients to be active participants in their care by communicating their expectations to caregivers

C) Critically examining systems and processes at the hospital with the aim of suggesting improvements

D) Teaching unlicensed care personnel about safety in the hospital setting

Ans: C

Client Needs: A-2

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 9

Page and Header: 391, Additional Responsibilities of the Nurse for Safety

Feedback: In order to promote a systematic culture of safety, nurses need to look at systems and processes to identify areas that need to be studied and changed to be safer. This broad and holistic approach to safety likely has a greater potential to effect change than the other cited efforts that have more narrow focuses.

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