Question 1

An interdisciplinary team is evaluating the hospital's care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital's clinical indicator, which would be: (select all that apply)

Accepted Answer

A)   aspirin order within 24 hours of discharge.
B)   patient teaching related to stopping smoking completed prior to discharge.
C)   beta blocker administered upon arrival.
D)   support of employer to modify stress in workplace.
E)   patient's willingness to adhere to a strict cardiac diet after discharge. A, B, C

Question 2

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?

Accepted Answer

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

Question 3

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 known as:

Accepted Answer

A)   time-out.
B)   a critical pathway.
C)   special cause variation.
D)   lean methodology. A

Question 4

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 a special cause variation?

Accepted Answer

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 caused the leak and towel placement

Question 5

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 as a:

Accepted Answer

A)   root cause.
B)   sentinel event.
C)   variation in performance.
D)   causal factor.

Question 6

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?

Accepted Answer

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

Question 7

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?

Accepted Answer

A)   Time plot
B)   Pareto chart
C)   Flowchart
D)   Cause-and-effect diagram

Question 8

A nurse is asked to "float" to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement?

Accepted Answer

A)   
B)   
C)   
D)

Question 9

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 called a:

Accepted Answer

A)   deployment flowchart.
B)   top-down flowchart.
C)   Pareto chart.
D)   control plot.

Question 10

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?

Accepted Answer

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

Question 11

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 as a:

Accepted Answer

A)   Pareto chart.
B)   control chart.
C)   top-down flowchart.
D)   deployment chart.

Question 12

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." 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, the instructor states:

Accepted Answer

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? A stands for algorithm, which includes all steps of the process.
D)   A stands for algorithm, which includes all steps of the process.

Question 13

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 educating nursing professionals. These include: (select all that apply)

Accepted Answer

A)   advanced health assessment techniques.
B)   patient-centered care.
C)   prescriptive pharmacology content.
D)   quality improvement.
E)   safety.

Question 14

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.

Accepted Answer

The answer of While taking a shower, a patient pushes...

Question 15

Patients with heart failure have extended lengths of stay and are often readmitted 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 as a(n):

Accepted Answer

A)   benchmark.
B)   critical pathway.
C)   algorithm.
D)   case management.

Question 16

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 a:

Accepted Answer

A)   cause-and-effect diagram.
B)   run chart.
C)   Pareto chart.
D)   flowchart.

Question 17

Regardless of the term used to describe high-quality health care, the focus of quality is:

Accepted Answer

A)   what the consumer needs and wants.
B)   economical care.
C)   having the greatest technologic advancement.
D)   services equally distributed among populations.

Question 18

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

Accepted Answer

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.

Question 19

A patient is ordered a low-protein, low-calorie diet but the patient's family brings 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. This situation would represent:

Accepted Answer

A)   a sentinel event.
B)   an adverse event.
C)   patient-centered care.
D)   the communication technique of "call-out."

Question 20

A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the:

Accepted Answer

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

Exam 22: Quality Improvement and Patient Safety