Question 1

During team rounds, a member states, "Ms. Jones has a positive tuberculin skin test and is scheduled for sputum cultures." The nurse notices that the antibiotic infusing has the wrong patient name and the patient is allergic to this particular medication. The nurse tells the team, "I need some clarity" to alert the team:

Accepted Answer

Correct:The phrase "I need some clarity" is used to alert the team that there is a problem.
Incorrect:a.All members are involved in patient care and privileged to patient information.
b.The phrase "I need some clarity" is not used to alert the team to a lack of knowledge by the patient.
c.The phrase "I need some clarity" is not used to indicate the risk of contracting a contagious disease.

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

Correct:Technology (PDA) is used to aid decision making and reduce errors.
Incorrect:a.Patient-centered care considers values and diversity of patients and their families.
c.The emphasis is on the use of technology to ensure high-quality care.
d.The use of technology does continue to improve quality,but it does not analyze data or processes for improvement.

Question 3

A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency?

Accepted Answer

Correct:Standardization contributes to safety and improves individual performance of care providers.
Incorrect:b.The focus of the team was on standardization rather than timeliness,and timeliness is not an IOM competency.
c.The focus is not on providing care that is impartial,and equitable is not an IOM competency.
d.The focus is on safety rather than cultural or patient preferences.

Question 4

During resuscitation efforts, a provider states, "I need to give a 1.5 mg/kg bolus of lidocaine because the patient is in ventricular tachycardia." The nurse responds, "I have a lidocaine bolus equal to 1.5 mg/kg." This communication model is known as:

Accepted Answer

Correct:Check-back is the process of repeating what was heard.
Incorrect:a.SBAR shares information during patient hand-offs.
c.No checklist was used and no hand-off or transfer of care is occurring.
d.No problem was identified.A critical-language exchange would have included a phrase such as "I need some clarity."

Question 5

The ability to clearly demonstrate the knowledge, skills, attitudes, and professional judgment required to practice safely and ethically in a designated role and setting is termed:

Accepted Answer

Correct:Competency is having the skill set to provide safe care within the scope of practice and context.
Incorrect:a.Human factors include the cognitive ability and social influences that affect practices.
c.Evidence-based practice is the use of scientific information to inform practice.
d.Workarounds are nonstandard work processes used by nurses and other health care professionals when standard work is blocked by dysfunctional processes such as unavailability of supplies or lack of information.

Question 6

"Ninety-five percent of all patients presenting to the emergency department with chest pain will receive aspirin 80 mg within 15 minutes of arrival unless contraindicated." Top hospital emergency departments use this standard to eliminate sudden death related to chest pain. Hospitals desiring to replicate these results establish compliance rates known as:

Accepted Answer

Correct:A benchmark is a standard for other providers or institutions to replicate.
Incorrect:a.A competency is the ability to practice safely based on knowledge,skills,and attitudes for a certain role.
c.Driving forces promote change.In this example they may be a desire to be a magnet hospital or simply to be recognized as a safe place to receive care.
d.TeamSTEPPS is a team training and communication approach that enhances patient safety.

Question 7

A nurse receives a verbal order which was understood to be for Avert 6. The physician actually ordered Antivert 25 mg daily. The patient is also taking Prozac/Sarafem (fluoxetine), which when taken with Avert can be life threatening. The patient's condition stabilizes and an interdisciplinary team meets to perform a root cause analysis hoping to learn from the mistake. The nurse was part of the group formed to help identify ways the system could be changed to prevent similar errors. This situation describes:

Accepted Answer

Correct:Just culture is an organizational culture that promotes patient safety by acknowledging that competent health care professionals may make mistakes; incidents are analyzed through root cause analysis to determine where system changes can prevent future occurrences.
Incorrect:b.Standard of care is the expected level and type of care based on the knowledge and skill the average prudent clinician would possess and exercise in the same or similar circumstances based on evidence; standards are based on expert consensus derived from research or documentation in scientific literature.
c.In a call-out the provider calls out critical information during urgent situations so all team members can hear to help anticipate next steps.
d.Benchmarking is using an attribute or achievement that serves as a standard for other providers or institutions to emulate.

Question 8

Following a complicated surgery, a patient who was received in the recovery room suddenly loses consciousness and becomes unstable. The nurse who arrives at the scene performs assessments and makes the following comments, "The patient is nonresponsive to verbal stimuli," "The patient is not initiating any spontaneous respiration," and "I am unable to palpate a femoral pulse," and other members of the health care team react to the comments. The team is using the mental model for communication known as:

Accepted Answer

Correct:The nurse is providing critical information so the team can anticipate what is needed next for the patient.
Incorrect:a.There is no indication to stop and there was no evidence of language such as "I am concerned" to indicate a concern.
c.Members of the team were not repeating what was heard.
d.The patient is not being transferred to another unit or provider at this time.

Question 9

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

Correct:An interdisciplinary team is working to prevent hand-off errors on discharge.
Incorrect:a.The focus is on the functioning and coordination of team efforts to support care of the patient across the continuum rather than on data and improvement methods,although a well-functioning team does contribute to high-quality care.
b.Best practices based on current evidence are not the focus.
d.This scenario the caregivers are not considering patient preferences or incorporating the family into care.

Question 10

A nurse calls a physician and after identifying herself and the patient, the nurse informs the physician that the patient is vomiting and complaining of abdominal pain. Which component of SBAR communication is being used in this situation?

Accepted Answer

Correct:Situation contains the patient information and brief sentence of what is happening now.
Incorrect:b.Background contains the background information to include,such as relevant lab and assessment data and chief complaints
c.Assessment contains an analysis of the problem.
d.Recommendation involves a proposed solution or request for help.

Question 11

What are some of the driving forces for change to improve the quality and safety competencies for nursing in the United States? (Select all that apply.)

Accepted Answer

Correct:c.Although the U.S.system has the advantage of technologic advancement,system errors are not unusual.
e.Outcomes of care often fail to follow predicted outcomes,resulting in extended stays and increased death and illness.
Incorrect:a.The U.S.health care system is one of the world's most technically advanced systems.
b.Aviation,business,and nuclear power industries have outpaced health care in setting and achieving quality and safety standards.
d.The public has increased knowledge about morbidity and mortality related to health care errors resulting in a loss of confidence in the U.S.health care system.

Question 12

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 13

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

Accepted Answer

Correct:Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care.
Incorrect:a.Each concept overlaps,and what affects one competency often impacts other competencies.
b.Competencies focus on team efforts as well as individual members of the team.
c.Nurses have key roles in transforming health care through the IOM competencies.

Question 14

A nurse calls a physician and gives a brief statement about the situation, "The patient is having increasing chest pain and the ECG shows ST elevation." What component of SBAR communication would be used in the following statements: The nurse tells the physician that the patient's blood pressure is 190/100 and rates the pain as 9 on a scale of 10 (10 being most severe pain) with a nitroglycerin drip infusing at 5 mcg/min?

Accepted Answer

Correct:Background contains the supporting background information,including any laboratory/diagnostic tests and chief complaint.
Incorrect:a.Situation is the patient information and brief sentence of what is happening now.
c.Assessment contains an analysis of the problem.
d.Recommendation is a proposed solution or request for help.

Question 15

When planning a program to reduce the number of sentinel events in an organization, the program planner should focus on the leading cause of sentinel events, which is related to a problem with:

Accepted Answer

Correct:Approximately 65% of sentinel events are related to failed communication or problems with communication.
Incorrect:a.More than 10%,but less than 20%,are related to problems with leadership.
b.More than 20%,but less than 30% are related to problems with staffing.
c.Less than 20% are related to environmental safety.

Question 16

Which of the following occurrences would be classified as a sentinel event?

Accepted Answer

Correct:Any procedure performed on a wrong person or organ constitutes a sentinel event.
Incorrect:a.The infection was not due to negligence of provider.
b.The patient chose the site and,although not the one indicated by the nurse,it was an appropriate site.
d.Although a medication error occurred,death or permanent loss of function did not occur.

Question 17

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

Correct:b.Patient-centered care is a recommended competency,along with teamwork and collaboration,evidence-based practice,and informatics.
d.Quality improvement is a recommended competency,along with patient-centered care,teamwork and collaboration,evidence-based practice,and informatics.
e.Safety is a recommended competency,along with patient-centered care,teamwork and collaboration,evidence-based practice,and informatics.
Incorrect:a.Although it is important to know correct health assessment skills,advanced techniques are not an IOM competency.
c.Although a comprehensive pharmacology foundation is needed to administer and evaluate pharmacologic treatments,the IOM does not address prescriptive content.

Question 18

A nurse is the frequent target of lateral violence from a co-worker who is placed in charged this shift. The nurse receives an assignment that requires multiple intravenous infusions, care of a patient in isolation, and another receiving peritoneal dialysis. Later the nurse discovers a medication was hung on the wrong patient and one drug omitted entirely. The nurse in charge is heard saying, "I'll make sure the manager knows she made the error." The aspect of the work environment that led to the errors is known as:

Accepted Answer

Correct:Human factors include staffing,fatigue,interpersonal relationships,and the lack of preparation on quality and safety that contribute to poor patient outcomes.
Incorrect:a.A workaround is a temporary fix to a system problem that is not standard care.
c.Benchmark is an attribute or achievement that serves as a standard for other providers or institutions to emulate.
d.Just culture is culture that promotes patient safety by acknowledging that competent health care professionals may make mistakes; incidents are analyzed through root cause analysis to determine where system changes can prevent future occurrences.

Question 19

A nurse hung an intravenous antibiotic to infuse but failed to check patency of the IV resulting in infiltration causing pain and redness but no tissue damage. This situation would be a(n):

Accepted Answer

Correct:An adverse event is unintended harm caused by medical care,not by the underlying condition of the patient.A preventable adverse event is one that could have been avoided.
Incorrect:b.A workaround is a temporary fix to a system problem that is not standard care.This was not a system error.
c.A breach in patient-centered care would be actions taken without consideration of patient's wishes and respect for their beliefs.
d.A sentinel event is the result of error that leads to serious harm or death.This situation did not result in severe harm or death.

Question 20

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

Correct:The nurse and dietitian are respecting patient values,preferences,and expressed needs.
Incorrect:a.Death or permanent loss of function did not occur.
b.No injury occurred due to medical care.
d."Call-out" occurs during critical situations,so all members anticipate next steps in care.

Quiz 22: Quality and Safety in Nursing Education in Nursing: The QSEN Project