Question 1

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit.The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?
A) "It promotes teamwork among health care providers."
B) "It increases adverse events."
C) "It improves outcomes."
D) "It contributes to duplication of services."

Accepted Answer

Findings related to staffing and patient outcomes suggest that patient outcomes are improved with a low ratio of nurses to patients and especially with a low ratio of registered nurses to patients.

Question 2

A new graduate is asked to serve on the hospital's quality improvement (QI)committee.The nurse understands that the first step in quality improvement is to
A) collect data to determine whether standards are being met.
B) implement a plan to correct the problem.
C) identify the standard.
D) determine whether the findings warrant correction.

Accepted Answer

Identifying standards most important to the user of health care services is the first step in a six-step process for quality improvement.

Question 3

Hospital ABCD is a Magnet™ hospital.This designation has been applied to Hospital ABCD because it
A) facilitates active staff participation in decision-making related to quality nursing care.
B) has implemented a graduate nurse orientation program.
C) espouses commitment to excellence in patient care.
D) is establishing career ladders for nurses.

Accepted Answer

Magnet™ hospitals are particularly successful in implementing excellence in patient care through use of standards,evidence,and participatory decision-making in quality improvement.Organizations that cannot pursue Magnet™ status can implement strategies such as career ladders.

Question 4

The nurse gives an inaccurate dose of medication to a patient.After assessment of the patient,the nurse completes an incident report.The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence.The nurse who administered the inaccurate medication understands that
A) the error will result in suspension.
B) an incident report is optional for an event that does not result in injury.
C) the error will be documented in her personnel file.
D) risk management programs are not designed to assign blame.

Accepted Answer

QM emphasizes improving the system,rather than focusing on staff errors.If errors occur,reeducation of staff is emphasized rather than imposition of punitive measures such as disciplinary action or blaming.

Question 5

As a nurse manager,you know that the satisfaction of patients is critical in making QI decisions.You propose to circulate a questionnaire to discharged patients,asking about their experiences on your unit.Your supervisor cautions you to also consider other sources of data for decisions because
A) the return rate on patient questionnaires is frequently low.
B) patients are rarely reliable sources about their own hospital experiences.
C) hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness.
D) patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

Accepted Answer

Patients are reliable and motivated sources of their own experience but often do not have sufficient knowledge of clinical procedures to provide feedback about clinical competence.

Question 6

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process,a QI team might turn to which of the following for confirmatory evidence?
A) Best Practice Guidelines (BPGs)
B) North American Nursing Diagnosis Association (NANDA)
C) National Quality Institute
D) Agency for Healthcare Research and Quality

Accepted Answer

The Registered Nurses' Association of Ontario launched the Nursing Best Practice Guidelines (BPGs)program.To date,the program team has developed and disseminated 41 guidelines covering clinical topics in five broad areas: gerontology,primary health care,home health care,mental health care,and emergency care.

Question 7

A method commonly used in quality assurance to monitor adherence to established standards is
A) a Pareto chart.
B) brainstorming.
C) patient interviews.
D) chart audit.

Accepted Answer

Chart audits are a common method of addressing process standards.Chart audits over time yield trend charts.

Question 8

Patient perceptions are useful in
A) determining disciplinary actions in QI.
B) establishing the competitive advantage of QI decisions.
C) establishing priorities among possible changes to care identified in QI.
D) establishing blame for poor-quality care.

Accepted Answer

Quality and patient dissatisfaction are useful indicators of which areas are of greatest concern to patients and of what then matters to nurses and organizations.Patient perceptions guide areas of inquiry; however,they do not establish which disciplinary decisions would be made.

Question 9

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin.A root-cause analysis is very similar to the QI process except that a root-cause analysis is
A) retrospective.
B) prospective.
C) legislated for completion with all near-miss events.
D) conducted by only one person.

Accepted Answer

A root-cause analysis is very similar to the QI process described in this chapter except that the root-cause analysis is a retrospective review of an incident to identify the sequence of events with the goal of identifying the root causes of the incident and may lead to the development of specific risk-reduction strategies.

Question 10

The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveys.The first step in addressing this issue from the point of view of quality improvement is which of the following?
A) Assemble a team.
B) Establish a benchmark.
C) Identify a clinical activity for review.
D) Establish outcomes.

Accepted Answer

In theory,any and all aspects of clinical activity could be improved through the QI process.However,QI efforts should be concentrated on changes to patient care that will have the greatest effect.

Question 11

A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?
A) Histogram
B) Flowchart
C) Fishbone diagram
D) Pareto chart

Accepted Answer

Histograms are bar graphs that are useful in outlining and identifying frequency.

Question 12

A nurse manager wants to decrease the number of medication errors that occur in her department.The manager arranges a meeting with the staff to discuss the issue.The manager conveys a philosophy of total quality management (QM)by
A) explaining to the staff that disciplinary action will be taken in cases of additional errors.
B) recommending that a multidisciplinary team assess the root cause of errors in medication.
C) suggesting that the pharmacy department explore its role in the problem.
D) changing the unit policy to allow a certain number of medication errors per year without penalty.

Accepted Answer

QM emphasizes improving the system,rather than focusing on staff errors.If errors occur,reeducation of staff is emphasized,rather than imposition of punitive measures such as disciplinary action or blaming.

Question 13

A health care organization is committed to improving patient outcomes as part of the QI process and examines its executive structure and organizational design.This approach recognizes which model of QI?
A) Donabedian's
B) Benchmarking
C) Employee involvement and innovation
D) Quality and safety education for nurses

Accepted Answer

Donabedian (1966)developed the structure,process,and outcomes framework to measure quality initiatives.Structural indicators include organizational design or staff characteristics that have an impact on an organization's performance and quality.

Question 14

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because
A) total organizational involvement is critical in QI.
B) data generated by a single, separate department are generally flawed.
C) monitoring and commitment to QI can come only from senior-level managers.
D) staff members resent suggestions for improvement that originate outside of their unit.

Accepted Answer

Decentralized approaches are effective in developing unit-level solutions,as well as in commitment to strategies and implementation of changes.

Question 15

A nurse is explaining the pediatric unit's QI program to a newly employed nurse.Which of the following would the senior nurse include as the primary purpose of QI programs?
A) Evaluation of staff members' performances
B) Determination of the appropriateness of standards
C) Improvement in patient outcomes
D) Preparation for accreditation of the organization by The Joint Commission

Accepted Answer

The primary purpose of QI is improvement of patient outcomes.Quality improvement refers to an ongoing process of innovation,prevention of error,and staff development that is used by institutions that adopt the QM philosophy.

Question 16

With the rise of workplace violence in the emergency department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should
A) request all staff to accept new risk management practices.
B) hold staff accountable for safe practices.
C) document inappropriate behaviour.
D) hire more police security.

Accepted Answer

Active involvement of staff in risk management activities is key to prevention of adverse events.Accountability for safety can be one aspect of performance evaluations.

Question 17

Through the QI process,the need to transform and change the admissions process across administrative and patient care units is identified.In this particular situation,what method of data organization will be most effective?
A) Flowchart
B) Histogram
C) Narrative
D) Line graphs

Accepted Answer

Flowcharts are useful in identifying and visualizing sequential steps,such as the admissions process.

Question 18

An example of an effective patient outcome statement is
A) "Eighty percent of all patients admitted to the emergency department will be seen by a nurse practitioner within 3 hours of presentation in the emergency department."
B) "Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs."
C) "The hospital will reduce costs by 3% through the annual budget process."
D) "Quality is a desired element in patient transactions."

Accepted Answer

Statements about patient outcomes must include measurable,specific,and patient-centred information.

Question 19

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery.According to QI,to correct the problem,the educator,in consultation with the patient care manager,would initially do which of the following?
A) Talk to the staff individually to determine why this is occurring.
B) Call a meeting of all staff to discuss this issue.
C) Have a group of staff nurses review the established standards of care for postoperative patients.
D) Document which staff members are not recording vital signs, and write them up.

Accepted Answer

Leaders must identify safety shortcomings and must locate resources at patient care levels to identify and reduce risks.One method of doing this is to invite all staff into a discussion related to solutions to an identified concern.This approach encourages teamwork.

Question 20

Before beginning a continuous QI project,a nurse should determine the minimal safety level of care by referring to which of the following?
A) The procedure manual
B) Nursing care standards
C) The litigation rate of unsafe practice
D) Job descriptions of the organization

Accepted Answer

Standards establish the minimal safety level of care.Within health care systems,QI combines the assessment of structure,process,and outcome standards.Policies should be reviewed frequently and updated so that they reflect best practice standards and do not become barriers to innovation.

Quiz 21: Managing Quality and Risk

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit.The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio?

A new graduate is asked to serve on the hospital's quality improvement (QI) committee.The nurse understands that the first step in quality improvement is to

Hospital ABCD is a Magnet™ hospital.This designation has been applied to Hospital ABCD because it

As a nurse manager,you know that the satisfaction of patients is critical in making QI decisions.You propose to circulate a questionnaire to discharged patients,asking about their experiences on your unit.Your supervisor cautions you to also consider other sources of data for decisions because

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process,a QI team might turn to which of the following for confirmatory evidence?

A method commonly used in quality assurance to monitor adherence to established standards is

Patient perceptions are useful in

The nurse manager is performing a root-cause analysis related to medication administration errors with insulin.A root-cause analysis is very similar to the QI process except that a root-cause analysis is

The nurse manager is concerned about the negative ratings that her unit has received on patient satisfaction surveys.The first step in addressing this issue from the point of view of quality improvement is which of the following?

A nursing unit is interested in refining its self-medication processes.In beginning this process,the team is interested in how frequently errors occur with different patients.To assist with visualizing this question,which organizational tool is most appropriate?

A nurse manager wants to decrease the number of medication errors that occur in her department.The manager arranges a meeting with the staff to discuss the issue.The manager conveys a philosophy of total quality management (QM) by

A health care organization is committed to improving patient outcomes as part of the QI process and examines its executive structure and organizational design.This approach recognizes which model of QI?

Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because

A nurse is explaining the pediatric unit's QI program to a newly employed nurse.Which of the following would the senior nurse include as the primary purpose of QI programs?

With the rise of workplace violence in the emergency department,the nurse manager decides that she should work with the risk manager in violence prevention.The nurse manager should

Through the QI process,the need to transform and change the admissions process across administrative and patient care units is identified.In this particular situation,what method of data organization will be most effective?

An example of an effective patient outcome statement is

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery.According to QI,to correct the problem,the educator,in consultation with the patient care manager,would initially do which of the following?

Before beginning a continuous QI project,a nurse should determine the minimal safety level of care by referring to which of the following?