Nursing leadership and management for patient safety and quality care 1st edition murray test bank

Nursing Leadership and Management for Patient Safety and Quality Care 1st Edition Murray Test Bank Visit to download the full and correct content document: https://testbankdeal.com/dow nload/nursing-leadership-and-management-for-patient-safety-and-quality-care-1st-edi tion-murray-test-bank/

Chapter 7: Improving and Managing Safe and Quality Care Multiple Choice Identify the choice that best completes the statement or answers the question. ____

1. The nurse administrator is aware that the 1984 death of a college student from a drug-drug interaction resulted in what standard of medical care?

1.

2.

3.

4.

____

Computerized prescribing Time out required before beginning any surgery Limitation to the number of hours a resident in training may work Access to a rapid response team

2. The nurse manager of surgical operations knows that the Universal Protocol for Preventing Wrong Site, Wrong Procedure, and Wrong Person Surgery does not include which component?

1. A time out called immediately before surgery begins to ensure that all elements of the surgery are correct.

2. Two surgeons must confirm immediately prior to the surgery that the patient is receiving the correct procedure.

3. The surgeon must mark and sign the site of surgery immediately prior to the surgery while the patient is still awake.

4. The patient’s identification must be verified with at least two identifiers.

____

3. The nurse leader is observing a new graduate registered nurse and knows that which error would be considered an error of commission?

1. The nurse contaminated the IV Cathlon by touching the skin but continued the procedure and inserted it into the patient’s forearm.

2. The nurse was taking care of a patient who went to radiology for an x-ray. Upon the patient’s return, the nurse forgot to administer the patient’s medications.

3. The nurse is caring for a patient who is scheduled to be ambulated three times a day and neglects to walk the patient at all during the shift.

4. The nurse received an order to change the patient’s diet from clear liquid to NPO and forgot to enter the change. The patient ate a liquid meal and surgery had to be delayed until the next morning.

____

4. The nurse manager is aware that which incident would be classified as a sentinel event?

1. The patient receives an oral antidiabetic medication 6 hours after it should have been administered. His blood sugar is slightly elevated, but it returns to its normal range within 1 hour.

2. The patient receives a second-degree burn from a malfunction in a hypothermia blanket.

3. The patient got dizzy and sat down on the floor approximately 1 hour after the administration of an antihypertensive medication. The patient did not experience any injury.

4. The patient is using a continuous passive exercise machine after knee surgery when the machine quits working. The patient complains of pain when the knee is removed from the machine. The pain is relieved after the administration of pain medication.

Copyright © 2017 F. A. Davis Company

____

5. The nurse manager is discussing an error that occurred with a nurse and is using the person approach to human error if the manager makes which statement?

1.

2.

3.

4.

____

6. The nurse manager is conducting an investigation into a series of patient falls that have occurred on the nursing unit in the past 3 weeks. While investigating the issue, the nurse manager identified a number of factors that may have influenced the problem and knows that which one would be classified as a human factor?

1.

2.

3.

4.

____

No punishment is involved for reporting.

Policies are easily accessible.

All policies are communicated to all staff.

The policy is begun on all units at the same time.

8. The nurse manager knows that what is the most important focus of a culture of safety?

1.

2.

3.

4.

____

The unit does not have an adequate number of gait belts available to the staff.

Two unit staff members have been on extended sick leave.

Bedside rounding has been sporadic.

The charge nurse is new to the position.

7. The nurse manager is working to establish a culture of safety and knows that which element is the most important factor to its establishment?

1.

2.

3.

4.

____

“How many patients were you caring for when this error occurred?”

“What was the acuity level of the patients that you were caring for?”

“What else was happening on the unit when the error occurred?

“Didn’t you learn to do this procedure in school?”

Improving efficiency of patient care Increasing training of staff regarding basic elements of safety Looking at the reason for an error Praising staff when no errors are committed

9. The nurse leader is aware that which change in unit policy will have the most impact in creating a culture of safety on the unit?

1. Establishing a patient admission checklist to ensure that all important information related to safety is communicated to the patient 2. Conducting bedside rounds for nurse-to-nurse end-of-shift handoff 3. Encouraging discussion of errors between staff members 4. Working with staff to improve memory skills to improve documentation

____ 10. The nurse leader plans to use the Patient Safety Network (PSNet) Web site for information to assist in improving patient safety on the nursing unit and knows that which information is not one of the resources found at this site?

1. The resources focus on patient safety that relates to both medical professionals and laypersons.

2. All of the resources found on the Web site provide insight into patient safety.

3. All of the resources are from experts in the field of safety.

4. Nurses have written all of the material found on the Web site.

Copyright © 2017 F. A. Davis Company

____ 11. The nurse leader is referencing the American Nurses Association’s nursing-sensitive quality indicators and knows that structure indicators include which element?

1.

2.

3.

4.

Job satisfaction Changes in patient health-care status Hours of nursing care per patient Deliverance of nursing care

____ 12. The nurse leader references the National Quality Forum (NQF) for information about patient safety and is aware that which statement is not a goal of this forum?

1. Reduction of preventable hospital admissions and readmissions 2. Advancement of electronic measurement to capture necessary data for performance measurement 3. Reduction of the incidence of adverse health care–associated conditions 4. Reduction in harm from inappropriate or unnecessary care Multiple Response Identify one or more choices that best complete the statement or answer the question. ____ 13. The nurse leader is beginning to create a culture of safety on the nursing unit and is aware that which tasks must be accomplished in Stage 3 of this process? Select all that apply.

1.

2.

3.

4.

5.

Safety is an external requirement imposed by regulatory bodies.

Safety performance is viewed as dynamic and in need of continuous improvement.

Strong emphasis is placed on improving efficiency.

Safety performance is expressed in terms of goals.

Communication and training are important features.

____ 14. The director of nursing is aware that the Institute for Healthcare Improvement 100,000 Lives Campaign asks hospitals to implement which interventions? Select all that apply.

1.

2.

3.

4.

5.

Use medication reconciliation to prevent adverse drug events Administer preoperative antibiotics to prevent surgical site infection Ensure that congestive heart failure patients receive evidence-based care Focus attention on medications such as opioids and insulin that can cause harm Implement the “Central Line Bundle” to prevent central line infections

____ 15. The nurse leader is aware that which of the five standard operating protocols of the World Health Organization have been implemented globally? Select all that apply.

1.

2.

3.

4.

5.

Communication during patient handovers Use of concentrated injectable medicines Correct procedure at the correct body site Health care–associated infections Medication accuracy at transitions in care

Copyright © 2017 F. A. Davis Company

Chapter 7: Improving and Managing Safe and Quality Care Answer Section MULTIPLE CHOICE 1. ANS: 3 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2

3

4

The impetus for computerized prescribing resulted from the death of a cancer patient from a massive overdose of a chemotherapeutic agent.

Surgery standards were upgraded, including the addition of the “Time Out” before surgery begins because of a case where a diabetic patient had the wrong foot amputated.

The 1984 death of Libby Zion, a college student, from a drug-drug interaction led to the belief that the fatigue of the resident assigned to her case contributed to her death. This led to the standard that residents in training could work no more than 80 hours/week and no more than 30 hours/shift.

The death of a 15-year-old after a routine surgical procedure led to the formation of and access to rapid response teams.

PTS: 1 CON: Safety 2. ANS: 2 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3

A time out is one of the components of the Universal Protocol.

It is not necessary for two surgeons to confirm the correctness of the patient’s procedure.

Verification of the site is a requirement of the Universal Protocol.

Copyright © 2017 F. A. Davis Company

4

Patient identification is a requirement of the Universal Protocol.

PTS: 1 CON: Safety 3. ANS: 1 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1

2 3 4

An error of commission results when a wrong action is taken. In this case, the nurse contaminated the Cathlon and instead of getting a sterile one, used the contaminated one and inserted it into the patient’s arm.

Forgetting to administer a medication is an error of omission.

Forgetting to ambulate a patient is an error of omission.

Neglecting to put in a diet change order that resulted in a delay in surgery is an error of omission.

PTS: 1 CON: Safety 4. ANS: 2 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1

2 3 4

For something to be a sentinel event, it must have resulted in death, permanent harm or severe temporary harm, or intervention was needed to sustain life. This patient did not experience any permanent or severe temporary harm from the late medication administration.

This patient experienced a permanent or severe temporary harm from the malfunction of the hypothermia machine.

The patient did not experience any type of harm from the dizziness that resulted from the medication.

Though the patient experienced pain when the machine malfunctioned, it was very short term and would not be considered severe.

Copyright © 2017 F. A. Davis Company

PTS: 1 CON: Safety 5. ANS: 4 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1

2 3 4

Human errors from a person approach focus the attention on the person who committed the error. In this statement, the nurse manager is using the system approach where the focus is on the system that led to the error.

This statement indicates the use of the system approach to human error where the focus is on the system and not the individual.

This statement indicates the use of the system approach to human error where the focus is on the system and not the individual.

This statement is an example of the person approach where the individual is the focus of the attention for the error.

PTS: 1 CON: Safety 6. ANS: 2 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Discuss the prevalence of medical errors in today’s health-care environment, and identify the types of medical errors.

Chapter page reference: 144 Heading: Medical Errors Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3 4

The lack of adequate gait belts is a leadership factor that includes organizational structure, policies and procedures, and practice guidelines.

Inadequate staffing is a human factor. Lack of adequate staffing leads to problems with patient safety.

Sporadic bedside rounding is a communication factor.

An inexperienced charge nurse would be a leadership factor.

PTS: 1 7. ANS: 1

CON: Safety

Copyright © 2017 F. A. Davis Company

Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe a culture of safety and strategies to promote a culture of safety.

Chapter page reference: 148 Heading: Creating a Culture of Safety Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3 4

A culture of safety must be a blame-free environment.

While easily accessible policies are important to the establishment of any new policy, it is not the most important element to the establishment of the culture of safety.

Communication is very important, but the most important would be that the staff who commit or report errors are not afraid of being punished.

Timing is not as important as the fact that the policy is nonpunitive.

PTS: 1 CON: Safety 8. ANS: 3 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe a culture of safety and strategies to promote a culture of safety.

Chapter page reference: 148 Heading: Creating a Culture of Safety Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3 4

Improving efficiency is important to a culture of safety if the focus is reduction of steps that lead to a safer environment, but it is not the most important focus.

Training of staff is an element of a culture of safety though it may not involve the basic elements of safety, and it is not the major focus of the culture.

The culture of safety is created to look at the reason for an error rather than at the person who made the error and is the major focus of the culture.

Encouragement of staff is an important part of a culture of safety but is not the most important focus of that culture.

PTS: 1 CON: Safety 9. ANS: 4 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe a culture of safety and strategies to promote a culture of safety.

Chapter page reference: 149 Heading: Culture of Blame Versus Culture of Safety (Learning Activity 7-1) Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care

Copyright © 2017 F. A. Davis Company

Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1

2 3 4

A key aspect to preventing errors is to avoid automatic actions. Nurse leaders can intervene by using standardized procedures and checklists rather than relying on memory Bedside rounds are better than taped end-of-shift handover, but the establishment of a standardized checklist to use at bedside rounds would be better.

The discussion of errors between staff members should only be done in association with nurse leaders present to ensure that only relevant issues are discussed.

A key aspect to preventing errors is to avoid automatic actions. Nurses should use standardized checklists rather than memory.

PTS: 1 CON: Safety 10. ANS: 4 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe initiatives by organizations to promote patient safety and how nurse leaders can use these initiatives to improve patient care.

Chapter page reference: 150 Heading: Agency for Healthcare Research and Quality Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3 4

The information is of interest to the patient safety community at large, both expert and novice.

All the resources are of value for gaining insight into and supporting patient safety.

All of the resources have been written and/or sponsored by credible sources.

The information on the Web site comes from a wide range of disciplines and resources, not just nurses.

PTS: 1 CON: Safety 11. ANS: 3 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe initiatives by organizations to promote patient safety and how nurse leaders and managers can use these initiatives to improve patient care.

Chapter page reference: 151 Heading: American Nurses Association Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate

Copyright © 2017 F. A. Davis Company

Feedback 1 2 3 4

Job satisfaction is a process quality indicator.

Changes in patient health status is an outcome quality indicator.

Hours of nursing care per day is a structure quality indicator.

Deliverance of nursing care is a process quality indicator.

PTS: 1 CON: Safety 12. ANS: 4 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe initiatives by organizations to promote patient safety and how nurse leaders can use these initiatives to improve patient care.

Chapter page reference: 151 Heading: National Quality Forum Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate Feedback 1 2 3 4

Reduction of preventable hospital admission and readmissions is a goal of the NQF. Advancement of electronic measurement is an activity that the NQF is involved in, but it is not an identified goal of the NQF. Reduction of the incidence of adverse health care–associated conditions is a goal of the NQF. Reduction in harm from inappropriate or unnecessary care is a goal of the NQF.

PTS: 1

CON: Safety

MULTIPLE RESPONSE 13. ANS: 2, 3, 5 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe a culture of safety and strategies to promote a culture of safety.

Chapter page reference: 148 Heading: Creating a Culture of Safety Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate

1.

2.

Feedback In Stage 1 of the creation of a culture of safety, organization safety is seen as an external requirement.

In Stage 3, safety performance is viewed by everyone as dynamic and in need of continuous improvement.

Copyright © 2017 F. A. Davis Company

3.

4.

5.

In Stage 3, there is a strong emphasis on communication, training, management style, and improving efficiency and effectiveness.

Safety performance is expressed in terms of goals in Stage 2.

In Stage 3, emphasis is on communication, training, management style, and improving efficiency and effectiveness.

PTS: 1 CON: Safety 14. ANS: 1, 2, 5 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe initiatives by organizations to promote patient safety and how nurse leaders and managers can use these initiatives to improve patient care.

Chapter page reference: 152 Heading: Institute for Healthcare Improvement Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate

1.

2.

3.

4.

5.

Feedback Medication reconciliation to prevent adverse drug events is an intervention of the 100,000 Lives Campaign.

Timely preoperative antibiotic administration is an intervention of the 100,000 Lives Campaign.

Evidence-based congestive heart failure care is an intervention of the IHI 1.5 Million Lives Campaign.

Attention given to high-alert drugs such as opioids and insulin is an intervention of the IHI 1.5 Million Lives Campaign.

Implementation of the “Central Line Bundle” is an intervention of the 100,000 Lives Campaign.

PTS: 1 CON: Safety 15. ANS: 3, 5 Chapter number and title: 7, Improving and Managing Safe and Quality Care Chapter learning objective: Describe initiatives by organizations to promote patient safety and how nurse leaders and managers can use these initiatives to improve patient care.

Chapter page reference: 155 Heading: World Health Organization Integrated Processes: Clinical Problem-Solving Process (Nursing Process) Client Need: Safe and Effective Care Environment: Management of Care Cognitive Level: Application [Applying] Concept: Safety Difficulty: Moderate

1.

2.

3.

4.

Feedback Communication during patient handovers has not been implemented on a global level.

Use of concentrated injectable medicines has not been implemented on a global level.

Correct procedure at the correct body site has been implemented globally.

Health care–associated infections have not been implemented on a global level.

Copyright © 2017 F. A. Davis Company

5.

Medication accuracy at transition in care has been implemented globally.

PTS: 1

CON: Safety

Copyright © 2017 F. A. Davis Company