Test Bank for Effective Leadership and Management in
Nursing, 9th Edition, Eleanor J. Sullivan
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Effective Leadership & Management in Nursing, 9e (Sullivan)
Chapter 6 Managing and Improving Quality
1) Which situation is an example of the overall goal of quality management in today's healthcare activities?
1. The nurse manager realizes a policy was ineffective in reducing incidents.
2. The administrator walks around making a list of potential problems.
3. The human resources department fires nonproductive employees.
4. The nurse wipes up a spilled drink before clients are allowed to enter a room.
Answer: 4
Explanation: 1. The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive.
2. The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past.
3. The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive.
4. The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
2) As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step?
1. Benchmarking
2. Outcome standard
3. Indicator
4. Process standard
Answer: 1
Explanation: 1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement.
2. Standards are written statements that define a level of performance. An outcome standard involves the end results of care given.
3. An indicator is a tool to measure the performance of structure, process, and outcome standards.
4. Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
3) The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen?
1. Continuous quality improvement (CQI)
2. Total quality management (TQM)
3. Plan, Do, Check, Act (PDCA cycle)
4. Six Sigma
Answer: 2
Explanation: 1. CQI is the actual process, not the philosophy, used to improve quality and performance.
2. TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement.
3. The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy.
4. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
4) The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management?
1. Indicator
2. Structure standard
3. Benchmark
4. Process standard Answer: 4
Explanation: 1. An indicator is a tool used to measure the performance of a structure, process, or outcome standard.
2. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care.
3. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care.
4. A process standard is a written statement that defines actual delivery of nursing care to a specific population.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
Copyright © 2018 Pearson Education, Inc.
5) Which situation would be included in reporting for Joint Commission mandatory national client safety goals?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The average wait time in the emergency department has increased by 5 minutes over last year's average.
2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse.
3. A nurse gives a medication by the wrong route.
4. A client developed sepsis after insertion of a urinary catheter.
5. Surgery is done on a client's right eye instead of the left eye.
Answer: 2, 3, 4, 5
Explanation: 1. Increased wait times are not included as a client safety goal.
2. Improving staff communication is one of The Joint Commission's national client safety goals.
3. Using medications safely is one of The Joint Commission's national client safety goals.
4. Preventing infection is one of The Joint Commission's national client safety goals.
5. Preventing mistakes in surgery is one of The Joint Commission's national client safety goals.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.
6) Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. "I'm not interested in this program."
2. "I don't have time to finish everything I already have to do each shift."
3. "I don't want to practice nursing just like everyone else."
4. "The library at our hospital doesn't have many journals."
5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."
Answer: 2, 3, 4, 5
Explanation: 1. Lack of interest on the part of nurses is not a reason EBP is not used.
2. Lack of time is a barrier to using EBP that is consistent across settings.
3. The need for autonomy over the nurse's own practice can be a barrier to using EBP.
4. Inability to find and assess evidence is a barrier to using EBP.
5. Lack of support from administration is a barrier to using EBP.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
7) A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation?
1. Non-reportable incident
2. Medical-legal incident
3. Client dissatisfaction with care
4. Medication error
Answer: 2
Explanation: 1. Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident.
2. A medical-legal incident occurs when a client or family refuses treatment as ordered.
3. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed.
4. A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
8) Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident?
1. Medication error
2. Medical-legal incident
3. Procedure complication
4. This incident does not fall into a risk category. Answer: 3
Explanation: 1. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client.
2. A medical-legal incident occurs when a client or family refuses treatment as ordered.
3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication.
4. Complications from diagnostic or treatment procedures are a high-risk area in healthcare and are reported as incidents.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Coordination of Care
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
9) After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record?
1. IV heparin restarted. Physician notified. Client's vital signs unchanged.
2. IV heparin restarted at a rate to catch up dosage accidentally deleted.
3. IV heparin turned off by previous shift. Restarted.
4. IV heparin restarted and incident report completed.
Answer: 1
Explanation: 1. The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident.
2. The word "accidentally" should not be used to document incidents.
3. The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used.
4. The fact that an incident report was completed should not be documented.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
10) The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation?
1. Appropriately written
2. Inappropriate because it places blame on an individual
3. Inappropriate because it does not include that the client's family was notified
4. Appropriately written because it only documents the facts
Answer: 2
Explanation: 1. Documentation in the chart following an incident should be a statement of the facts; no blame should be placed.
2. The documentation is not appropriately written because it implies that someone was to blame for the incident.
3. The documentation must indicate that the physician was notified, not that the client's family was notified.
4. The documentation is not appropriately written; no blame should be placed.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Communication
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
11) The nurse is assigned to the Risk Management Team. Which events would be addressed by this team?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. A client's hand is injured during an arterial blood gas draw.
2. A client's family is dissatisfied with the breakfast just served.
3. A client leaves the hospital against medical advice (AMA).
4. A client claims he is not ready to be discharged.
5. The family does not want a client to be transferred from the intensive care unit (ICU).
Answer: 1, 3
Explanation: 1. Any reaction or injury associated with a diagnostic test must be reported as an incident.
2. The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed.
3. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition.
4. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition.
5. The physician and healthcare team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
12) Which statement reflects a characteristic common to all methods of quality management?
1. Each method uses all staff members in the organization.
2. None of the methods are designed to place blame on an individual.
3. All methods provide clinical information.
4. Most methods focus on cost containment.
Answer: 2
Explanation: 1. All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities.
2. Quality management is not designed for the purpose of placing blame on an individual.
3. Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement.
4. The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
13) The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information?
1. Surveyors are driving to clients' homes to collect data on hospital visits.
2. This electronic tool makes it easy to aggregate and display data.
3. "Dashboard" is an acronym for the topics covered in client satisfaction surveys.
4. The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information.
Answer: 2
Explanation: 1. The "dashboards" in this scenario are not associated with automobiles.
2. Dashboards are electronic tools that provide ease of access to real-time or retrospective data.
3. Dashboard is not an acronym.
4. Dashboards are not part of the electronic medical record.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
14) In which ways can nurse managers reduce risks for the organization?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Investigating a complaint about nursing care from a client's spouse
2. Encouraging nurses to cut corners when possible
3. Talking to physicians about ways to improve client care
4. Keeping staff members on task throughout the workday
5. Making sure staff members work minimal overtime
Answer: 1, 3, 4, 5
Explanation: 1. By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint.
2. Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous.
3. The nurse manager is in a position to discuss improvement of client care across disciplines.
4. The nurse manager can help make work more efficient by keeping staff members on task throughout the workday.
5. When staff members are tired from working overtime, they are more likely to make errors.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
15) Which part of Six Sigma is vastly different from other quality management programs?
1. Six Sigma has a client focus.
2. Data drive the program.
3. Failure is tolerated.
4. Management is proactive.
Answer: 3
Explanation: 1. Most quality improvement programs are client focused.
2. Data drive most quality improvement programs.
3. One of the Six Sigma themes is aiming for perfection but tolerating failure.
4. Proactive management is common in most quality improvement initiatives.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
16) Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The amount of material opened and wasted for surgical procedures will drop by 25% this fiscal year.
2. The number of nurses who hold a bachelor's degree will increase by 10% this year.
3. Wait times in the emergency department will decrease by 15% this year.
4. Employee absences will drop by 10% this year.
5. Fewer than 5% of clients will report inadequate pain control while hospitalized.
Answer: 1, 3, 5
Explanation: 1. No waste is an IHI goal.
2. Increasing the educational preparation of nurses is not an IHI goal.
3. No unwanted waiting is an IHI goal.
4. Employee attendance is not an IHI goal.
5. No needless pain or suffering is an IHI goal.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Quality of Practice
Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.
17) The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy?
1. "If I make a mistake and report it, I will not be reprimanded or punished."
2. "When I make a mistake, I should immediately fill out an incident report."
3. "It is left up to each employee to self-monitor so we do not report others' mistakes."
4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."
Answer: 4
Explanation: 1. If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken.
2. Incident reports are not the first step after making a mistake.
3. Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment.
4. Mistakes should be reported and reflected upon so that the same mistakes will not be made again.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
18) Which situation represents an exception to the blame-free environment?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. A nurse routinely changes nursing notes after a client is discharged.
2. A physician order is overlooked on a newly admitted client.
3. An unlicensed assistant drops a client.
4. A nurse does not complete an incident report after a medication error.
5. A nurse miscounts narcotics.
Answer: 1, 4
Explanation: 1. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis.
2. Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error.
3. Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors.
4. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors.
5. Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
19) Which is the most effective method of creating a blame-free environment?
1. Work to develop a just culture within the organization.
2. Make sure all nurses agree to report every mistake.
3. Set up a self-reporting board so that all employees will know that everyone makes mistakes.
4. Ensure nurse managers keep a list of how often each employee makes a mistake.
Answer: 1
Explanation: 1. A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution.
2. Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free.
3. A self-reporting board is a form of punishment and placing blame.
4. The manager should not be keeping lists in a blame-free environment.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
20) The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first?
1. Discuss it with the other nurses on duty.
2. Immediately report the incident to the supervisor.
3. Ensure the client's safety as fully as possible.
4. Say nothing as no one saw the incident.
Answer: 3
Explanation: 1. It is not appropriate to discuss errors with others.
2. Reporting the incident to the supervisor is appropriate only after the client's safety is protected.
3. The client's safety is always the priority.
4. Ignoring the mistake if no one saw it is not ethical and may be dangerous.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Communication
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
21) A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Newly hired radiology technicians
2. People who are visiting clients admitted within the last two days
3. Physicians who have admitting privileges
4. Nurses who have worked at the facility more than five years
5. Vendors who supply disposable medical equipment to the hospital
Answer: 1, 4
Explanation: 1. Internal customers include employees and departments within the organization.
2. Visitors are considered external customers.
3. Physicians are considered external customers.
4. Nurses are hospital employees and are therefore considered internal customers.
5. Vendors are not employed by the hospital and are considered external customers.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Communication
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
22) The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The hospital CEO
2. A representative from the pharmacy
3. A representative from the medical staff
4. A staff nurse who works with clients in pain
5. A representative from social services
Answer: 2, 3, 4
Explanation: 1. The CEO is not involved in the process of managing clients' pain and would not be part of this investigation.
2. Because the pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting.
3. Because the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting.
4. The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group.
5. It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Coordination of Care
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
23) The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The CQI coordinator
2. The hospital CEO
3. The vice-president in charge of finance
4. Members of the CQI team
5. The team leader
Answer: 2, 3
Explanation: 1. The CQI coordinator is appointed by a member of the resource group.
2. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI.
3. The resource group is made up of senior management such as the CEO and vice-presidents.
4. Team members are not part of the resource group.
5. The team leader is not a part of the resource group.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Leadership
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
24) Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement?
1. Almost 85% of call lights are answered within 4 minutes.
2. Results of pain medication administration are documented 95% of the time.
3. Nursing overtime hours increased by 25% in the last quarter.
4. In the last 6 months, overall client satisfaction scores have increased by 15%.
Answer: 3
Explanation: 1. Lean Six Sigma is focused on improving process flow and eliminating waste.
2. Lean Six Sigma is focused on improving process flow and eliminating waste.
3. Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur.
4. Lean Six Sigma focuses on improving process flow and eliminating waste.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.
25) The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The CQI coordinator has read two research studies that show the process improves client outcomes.
2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay.
3. The CQI coordinator has used the process in practice for more than two years.
4. The process being measured produces a desirable outcome.
5. There are very few unexpected bad effects from the process.
Answer: 1, 2, 4, 5
Explanation: 1. The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation.
2. Quality measures should document that evidence-based practice was given.
3. Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure.
4. The monitor is written in the "positive," meaning that the process is desirable.
5. The process should have minimal or no unintended adverse effects.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice
Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.
26) Which statement reveals the most dangerous result of using measured standards as part of the CQI process?
1. A nurse complains, "Collecting this data takes so much time."
2. A radiology technician says, "CQI is lots of work."
3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors."
4. The laboratory technician says, "Writing these CQI reports is boring."
Answer: 3
Explanation: 1. Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given.
2. The work of CQI should be balanced out by the improvements to care and reduction in waste.
3. When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization.
4. Boredom is not the biggest danger of using measured standards.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.
27) A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices?
2. Can the manager find two or more research studies that support the use of the intervention?
3. Is the intervention one that the manager has seen used in the past?
4. Are the authors of the research articles well-known experts in the field?
5. Is the research study that recommends the intervention rigorous in design and execution?
Answer: 2, 5
Explanation: 1. The size of the hospital is not significant in selecting evidence-based practice interventions.
2. Evidence-based practice is most reliable when more than one study has confirmed the results.
3. Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them.
4. While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field.
5. The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Evidence-Based Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
28) Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement?
1. EMR has strong linkage to improving quality.
2. Much more research must be done before the impact of EMR on quality can be determined.
3. EMR does not affect the quality of care provided.
4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated.
Answer: 2
Explanation: 1. There is not enough research to prove a strong linkage.
2. There is not enough research on using EMR and the quality of care provided to determine the impact.
3. Not enough research has been done to make this statement.
4. Research does exist, but it is insufficient to measure correlation.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
29) A hospital increased its RN-to-client ratio one year ago. What effects is the hospital likely to see as a result of that choice?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. The cost of providing care has decreased.
2. There has been a decrease in client deaths.
3. The average length-of-stay for clients has increased.
4. The overall quality of care has increased.
5. The nosocomial infection rate has dropped.
Answer: 2, 4, 5
Explanation: 1. Increasing RN-to-client ratio generally increases costs.
2. Increasing RN-to-client ratio has been shown to decrease client mortality.
3. Increasing RN-to-client ratio generally decreases length of stay.
4. Increasing RN-to-client ratio generally increases quality of care.
5. Increasing RN-to-client ratio generally results in few infections.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Quality of Practice
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
30) A risk manager generally uses root-cause analysis to investigate incidents. What are the likely outcomes of this action?
Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.
1. There is disagreement over the cause of the incident.
2. There are insufficient resources to make needed changes to prevent similar incidents.
3. The system or process causing the incident is identified and corrected
4. Improvements to the system are widespread.
5. Sufficient evidence is acquired so that management is comfortable in making needed changes. Answer: 1, 2
Explanation: 1. Professional disagreements often occur as root-cause analysis is being conducted.
2. Often the root-cause analysis takes up so much time and so many resources that no changes are ever made.
3. Root-cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur.
4. Root-cause analysis generally does not result in widespread system improvement.
5. Root-cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Implementation/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
31) The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action?
1. Call the nurse from the last shift to participate in a conference call about the complaint.
2. Ask the daughter to explain what happened.
3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred.
4. Ask the daughter what can be done to improve the situation.
Answer: 2
Explanation: 1. The manager should collect more information before contacting the nurse from the previous shift.
2. The nurse manager must first assess the situation.
3. The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter's concerns.
4. Until the manager has assessed the issue, intervention cannot be provided.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Assessment/Leadership
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.
32) The nurse manager on the obstetrical unit is adopting Total Quality Management (TQM). Which characteristics are associated with TQM?
Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply.
1. Boundaryless collaboration
2. Involve the total organization
3. Focus on client
4. Identify key processes
5. Use quality tools and statistics for measurement
Answer: 2, 3, 4, 5
Explanation: 1. Boundaryless collaboration is one of the six themes of the Six Sigma quality management program.
2. Involving the total organization is a characteristic associated with TQM.
3. Focusing on the client is a characteristic associated with TQM.
4. Identifying key processes is a characteristic associated with TQM.
5. Using quality tools and statistics for measurement is a characteristic associated with TQM.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Planning/Leadership
Learning Outcome: 6-2: Delineate efforts to improve the quality of healthcare.
33) The nurse manager receives a report that a medication was given to the wrong client. This is called a(n) ________ and will be reviewed with the physician and risk management committee member.
Answer: reportable incident
Explanation: Reportable incidents include any unexpected or unplanned occurrences that affect or could potentially affect a client, family member, or staff.
Cognitive Level: Understanding
Client Need: Safe Effective Care Environment
Client Need Sub: Safety and Infection Control
Nursing/Int Conc: Nursing Process: Planning/Ethics
Learning Outcome: 6-3: Explain how nurses are involved in reducing risks.