Question 1

A nurse asks the manager why the nursing staff seems to have the bulk of the responsibility for preventing errors in patient care.The manager explains that the primary reason nurses are best situated to recognize and prevent errors is because they

Accepted Answer

Nurses interact with patients on a frequent basis and so are positioned to prevent medical errors as much as 90% of the time.
Nurses should play a leadership role in all patient care situations,but this is not the best answer for this question because in many work environments,nurses still take a subservient role.
Nurses are taught communication skills in nursing school,but nurses and other health care providers are taught to communicate in very different ways.
Nurses do provide some care that is considered risky,such as medication administration,but physicians often provide the riskiest care,such as operations and invasive procedures.

Question 2

A nursing manager explains to the executive committee that reducing errors requires

Accepted Answer

A "just culture" encourages open and honest reporting when errors or near misses occur.The analysis that follows reporting should focus on system flaws and not individual fault.
Having a culture in which individuals are blamed and shamed for their errors reduces the probability of error reporting.If this occurs,no meaningful action can be taken to reduce the likelihood of errors.
A safe mechanism for reporting errors should be available,but if all reporting were anonymous,it would be difficult to track and trend data.
Individuals and organizations should be held accountable for errors if indicated,but most errors are the result of system flaws.

Question 3

A chief nursing officer (CNO)has been hired to develop a healthy work environment and culture of safety in a hospital with a long record of safety problems and poor patient outcomes.The best initial action by the CNO would be to

Accepted Answer

This culture or environment would be considered immature,so the CNO needs to start with basic building blocks of a safe environment,including teamwork and skilled communication.
Eventually,the CNO would want to implement policies similar to "Stop the Line," whereby all nurses have the authority to speak up and intervene before problems arise.However,in a facility where even basic safety is an issue (an immature environment),training needs to occur on more basic ideas of safety,such as skilled communication and teamwork.
A culture of safety includes focusing on system problems leading to safety issues,not on individual nurses.Having all nurses reapply for their jobs indicates that because of past problems,only the "best" nurses (or nurses with better safety records)will be retained.It would be better to start fresh by implementing the "just culture" philosophy and move forward without penalizing the staff for past problems.
Informing nurses that it is their job to report potential safety problems would be part of any drive to improve patient safety and outcomes,but this alone will not empower the staff to report problems,especially proactively.

Question 4

The nursing executive attempting to incorporate the American Association of Critical-Care Nurses' (AACN's)Healthy Work Environment Standards would formulate which policy? The manager would create a policy to

Accepted Answer

The AACN standards contain six areas,including skilled communication.Using a standardized handoff tool would improve nurses' communication skills.
Although important,encouraging all nurses to return to school to complete degrees is not related to the AACN standards.
Although important,limiting environmental hazards currently present in the facility is not related to the AACN standards.
Providing discounts to a local fitness center for all employees would be a nice benefit but is not related to the AACN standards.

Question 5

A manager is counseling a nurse who has violated safety protocols several times.The most appropriate action by the manager is to

Accepted Answer

Protection for nurses who commit errors or are involved in near-miss episodes is an important part of a "just culture." However,according to the Institute of Medicine,protection from disciplinary action from the facility and from regulatory agencies should not be granted in three specific situations: criminal misconduct,active malfeasance,or when reporting an incident has been delayed unnecessarily.This nurse would likely be seen as committing active malfeasance (actively or purposely violates safety protocols)and should be reported to the state board of nursing for discipline.
A nurse who has violated safety protocols on several occasions would most likely be seen as committing active malfeasance by continuing to violate the protocols.The nurse's behavior should be reported to the state board of nursing for discipline.
Having the nurse prepare an educational in-service on safety protocols might have been an option for the first offense,but continuing to violate safety protocols warrants a much more serious response.The nurse's behavior should be reported to the state board of nursing for discipline.
Confidentiality when making mistakes is an important part of a "just culture," in which reporting errors and near misses is institutionalized.However,in the case of repeatedly violating safety protocols,this nurse cannot expect to have the incidents remain confidential.The nurse's behavior should be reported to the state board of nursing for discipline.

Question 6

The nurse defends DHHS reporting of successful medical error reduction initiatives to Congress by summarizing that

Accepted Answer

The Patient Safety and Quality Improvement Act of 2005 was passed by Congress to address critical national patient safety issues and foster a culture of safety nationwide.
Congress does not begin the oversight process when safety records are poor.
Congressional representatives do not oversee individual state reporting.
Laws have been created to address patient safety issues,but this is not the main reason why patient safety data are eventually reported to Congress.

Question 7

The nursing manager understands that the phrase "active failure" in regard to patient safety means a(n)

Accepted Answer

An active failure is an unsafe act committed by a person in direct contact with the patient.This is directly opposite a latent failure,which is caused by a systems problem.
An active failure is caused by a person in direct contact with the patient,not by a systems process.
An active failure is caused by a person in direct contact with the patient,not by a workplace practice per se.
An active failure is an unsafe act committed by a person in direct contact with the patient.

Question 8

The nurse executive explains to a group of newly hired nurses that the major responsibility for preventing errors in patient care lies with the

Accepted Answer

Process design and implementation most often lead to the commission of errors.The nurse is a key member of the team to identify poor processes and to work on improvement of processes.
Professional staff does have a legal responsibility for safe care,but hospital systems are more often the root cause of errors.
Individuals do make each error,but often the error is the result of many problems within the system and processes of the health care facility.
The system is responsible for many of its employees' actions but not for all.

Question 9

The nurse knows that the purpose of the Department of Health and Human Services (DHHS)is to

Accepted Answer

Protecting the health of all Americans and providing services for people who cannot provide for themselves is the overarching goal of the DHHS.
Prioritizing safety regulations is not the main purpose of the DHHS.
Promoting research in practice is not the main purpose of the DHHS.
Providing guidance on hospital policies is not the main goal of the DHHS.

Question 10

A nursing manager is concerned about professional sanctions that might result if several near-miss episodes are reported to a Patient Safety Organization (PSO)under the Agency of Healthcare Research and Quality (AHRQ).The chief nurse executive explains to the manager that under the Patient Safety and Quality Improvement Act of 2005,

Accepted Answer

PSOs maintain strict confidentiality,and their work products are protected against legal action.This helps encourage reporting and a culture of safety.
Saying that certain critical errors or near misses can be penalized under law does not address the manager's concern.
Information about errors and near-miss episodes is handled through PSOs.
Saying that state legislatures are able to sanction facilities under the 2005 Act does not address the manager's concern.

Question 11

A nursing manager wants to investigate the best practice research on a specific patient safety issue.The best action by the nursing manager would be to

Accepted Answer

The manager should research the relevant literature,using such resources as the Agency for Healthcare Research and Quality (AHRQ).One of the goals of AHRQ is to promote research in everyday practice,and as part of that goal,this agency provides syntheses of current research.
Other facilities may not be using best practice.
It is premature to convene work groups before collecting data.This might be part of an action plan once the research has been done.
Journals of nursing management do carry some research articles and best practice articles but would not be the best location for this information.

Question 12

A nurse is working with a patient who seems changed from earlier in the shift.The nurse cannot pinpoint exactly what has changed but is concerned that the patient is getting worse.The best action by the nurse would be to

Accepted Answer

Nurses should listen to their inner voices and confidently voice concerns,in this case by calling the physician about the patient's status.
Consulting with someone who has more expertise is always a good idea,but the best option is for the nurse to voice concerns to the physician.
Waiting for distinct changes to occur before reporting the patient's status may lead to a poor outcome.Many times the patient deteriorates significantly before showing distinct symptoms.Nurses often report that "something was not right" with a patient who later worsens.
Documentation is important,but if the nurse feels the patient is getting worse,waiting an hour to reassess would not be in the interest of patient safety.

Question 13

A hospital has significantly reduced the number of errors and near-miss episodes it has in the past 2 years.An accreditation body visitor might conclude that error and near-miss reductions are most directly related to

Accepted Answer

Facilities that operate under a culture of safety encourage all employees to be vigilant in observing for conditions and processes that could potentially lead to errors and near misses.
Individuals who make errors may indeed be given additional education or training,but this is not the best answer because most errors come from system problems.
Facilities should have policies and procedures to help lessen the number of errors or near misses,but without vigilance in finding sources of potential problems,the policies created may not be maximally beneficial.
Educating the staff does not go far enough in preventing errors.The facility needs to make a concerted effort to detect and address potential system problems,as system problems are the most common cause of errors.

Question 14

The nurse knows that the primary purpose of the Patient Safety and Quality Improvement Act of 2005 was to

Accepted Answer

The primary purpose of this act was to encourage health care institutions to share information related to safety issues in a safe environment.This allows for trends to be identified that can be mitigated through safety programs and process improvement,thus creating a culture of safety.
The primary purpose of this act was not to create a new government agency to track safety problems.
The primary purpose of this act was to create a safe environment in which information can be shared to help create a culture of safety,not to penalize those who commit errors.
The Patient Safety and Quality Improvement act of 2005 does not require quality improvement initiatives.

Question 15

In the 2000 Institute of Medicine's milestone report To Err Is Human: Building a Safer Health System,how many patients were estimated to die each year as a result of errors occurring in a hospital setting?

Accepted Answer

A total of 98,000 people were estimated to have died each year from errors during hospital care.
The report estimated that more than 25,000 people,as many as 98,000,die each year from errors occurring during hospital care.
The report estimated that more than 35,000 people,as many as 98,000,die each year from errors occurring during hospital care.
The report estimated that more than 50,000 people,as many as 98,000,die each year from errors occurring during hospital care.

Question 16

A manager is concerned with the number of medication errors occurring on their unit.The manager determines that these errors represent latent errors when an investigation reveals that

Accepted Answer

Using bar codes that are unreadable to the computer scanner is a system problem,otherwise known as a latent failure.
Failure to use two different forms of patient identification is an error committed by individuals who have direct patient contact.This is known as an active failure.
Nurses failing to double check high-risk medications is an error committed by individuals who have direct patient contact.This is known as an active failure.
Nurses gathering all of their patients' medications at one time is an error committed by individuals who have direct patient contact.This is known as an active failure.

Question 17

A nursing executive wishes to implement a new policy based on initial National Patient Safety Goals 2002 to eliminate wrong patient,wrong site,and wrong procedure.Which action by the executive would best meet one of the goals?

Accepted Answer

One of the initial National Patient Safety Goals 2002 was to eliminate wrong patient,wrong site,and wrong procedure surgeries,so establishing a policy that requires a time-out to verify patient,site,and procedure before starting an operation would help meet this goal.
Timely reporting of lab values would not be closely related to any of the initial National Patient Safety Goals 2002.
Reducing falls is a laudable goal,but identifying high-risk patients was not one of the initial National Patient Safety Goals 2002.
Work flow design and patient-staffing ratios may be related to patient errors,but these measures would not closely align with any of the original National Patient Safety Goals 2002.

Question 18

A nursing manager explains to a group of newly hired graduate nurses that maintaining situational awareness means

Accepted Answer

The nurse must understand everyone's role in the complex health care situation and how each role contributes to patient outcomes.This also includes understanding how problems can occur related to everyone else's roles.
Being aware of possible problems encountered in patient situations is an important concept for patient safety,but this is not the meaning of situational awareness.
Remaining aware of patient status and how it can change quickly is an important concept for patient safety,but this is not considered situational awareness.
The ability to recover quickly from mistakes when they occur is the concept known as "resiliency."

Question 19

An accreditation body visitor is touring a facility that has been designated as a High Reliability Organization (HRO).The visitor could reasonably conclude that this facility's nursing staff

Accepted Answer

An HRO has employees who are constantly alert for things that could go wrong and ways to recognize and recover from mistakes if they are made.
An HRO is not defined by whether or not it employs nursing staff that is highly reliable in preventing errors.
An HRO is not defined by whether or not it has a reliable patient safety record or is a model for hospitals.
An HRO is not defined by whether or not it reliably reports all patient care errors to the appropriate body.

Question 20

A nurse manager in a hospital receives Joint Commission sentinel event alerts.When one is received that concerns a process that occurs in the manager's facility,the best action by this manager is to

Accepted Answer

The best answer would be for the nurse manager to begin a thorough investigation of how this process works in the specific facility and how it affects patient safety.
Although consulting with other managers would be part of the best response,this is not the most complete answer.
Whereas maintaining a file of information is a passive activity,responding to patient safety requires an active approach.
Initiating a policy may be needed,but first the manager needs to investigate how the process at this specific facility affects patient safety.

Quiz 20: Patient Safety