Deck 17: Managing Quality and Safety

Question 1

An agency has not created a continuous quality improvement program. Which of the following actions should the agency take to help ensure quality care within the institution?

A)Ensure appropriate policies and procedures are followed.
B)Employ highly recommended and credentialed professionals to give care.
C)Use administrative action to ensure that quality care is given to clients.
D)Write quality care plans for the most typical problems of clients.

Answer 1

Ensure appropriate policies and procedures are followed.

Question 2

The pharmacist sent up the wrong medication for the patient. The nurse filled out an incident report when the error was discovered. Which of the following best describes the likely outcome when the quality improvement team reviews the incident report?

A)The nurse will receive a commendation for recognition of the error.
B)The pharmacist will be disciplined.
C)The pharmacist will be reported to the state pharmacy board.
D)The CQI team will try to determine how the error occurred.

Answer 2

The CQI team will try to determine how the error occurred.

Question 3

Which of the following best describes one of the main problems in ensuring quality for health care in the United States?

A)Consumers believe American health care is high-quality and the best in the world.
B)Every hospital and health care agency has its own approach to data collection and documentation.
C)Finances are the basis of clinical decisions, not quality of care.
D)We all agree on what quality is but not on how best to measure it.

Answer 3

Every hospital and health care agency has its own approach to data collection and documentation.

Question 4

What is the primary goal of total quality management?

A)To confirm the high standards desired in patient care
B)To discover and correct errors in task completion
C)To eliminate problems before negative outcomes occur
D)To enable organizations to publicize their quality approach to patient care

Question 5

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes this activity?

A)Accreditation review
B)Concurrent audit
C)Retrospective audit
D)Utilization review

Question 6

A nurse is invited to join the utilization review team to help the agency avoid giving unnecessary care. Which of the following difficulties would the nurse most likely confront as client records are reviewed?

A)Alternative care options rather than agency care are often encouraged.
B)Not all clients fit the pattern and need more care than guidelines suggest.
C)The nurse suggests the agency provide guidelines to professionals giving care.
D)The agency is now accountable to its clients and their families.

Question 7

The quality improvement team reviews the records of clients on a monthly basis to determine whether protocols for pain assessment were followed. Which of the following best describes the major drawback to the team's approach?

A)The client is no longer under the agency's care.
B)It is difficult to compare documentation of care to standards of care.
C)Records can be inaccurate or incomplete.
D)Team members may disagree on whether the standards of care were met.

Question 8

A home health care agency has major problems but does not want consumers to know about these problems while the agency decides what should be done to improve them. Employees are not told to lie, but they are advised not to share information. Which of the following is the most likely outcome of this situation?

A)As long as employees do not share what they know, the community will be uninformed.
B)By law, comparative information will be available to the public via the Internet.
C)Only a few informed persons will know about the problems.
D)Secrecy will prevail unless the local newspaper does an investigative report.

Question 9

How does continuous quality improvement (CQI) differ from quality assurance?

A)Quality assurance focuses on client care, whereas CQI focuses on system issues.
B)Quality assurance focuses on system issues, whereas CQI focuses on individual client care.
C)Quality assurance measures care at one point in time, whereas CQI is an ongoing issue.
D)Quality assurance focuses on families, whereas CQI focuses on agency issues.

Question 10

Stakeholders developing a new community-oriented clinic plan want to include a quality assurance (QA) program. Which of the following would be the first step in measuring the structure component?

A)Criteria that will be used to measure quality
B)Philosophy and objectives of the organization
C)Requirements of accrediting agencies
D)Standards the QA program wishes to achieve

Question 11

The nurse admits uncertainty over how to address the needs of a group of clients. The long-term nurse in the area suggests that the nurse review published evidence-based clinical guidelines. How can the nurse know these guidelines are reliable?

A)Because the agency supports their use
B)Because the guidelines have been published
C)Because the long-term nurse trusts them
D)Because they are based on research and expert opinion

Question 12

A home care nurse is encouraging the administration of the agency to increase their quality assurance efforts. Which of the following best describes a negative outcome from this activity?

A)An agency deficiency may become visible.
B)An individual may be found at fault and then become fearful of being involved.
C)Some agency processes may be questioned.
D)Employees at the agency will have to commit extra time to complete this process.

Question 13

Which of the following led to the development of the National Health Quality Improvement Act?

A)A very famous movie and television star died as the result of a medical error.
B)The number of malpractice claims had increased.
C)Media such as films highlighted the reality of current medical care.
D)Publicity about a few unfortunate cases caused consumers to become concerned.

Question 14

Which of the following describes the principal problem with early efforts at ensuring quality of care?

A)No one knows how to measure quality care.
B)Professionals resisted and sabotaged such efforts.
C)Standards emphasized structure, not process.
D)There were no standards as to what represented quality care.

Question 15

Which of the following information can be gathered by reviewing a community health report card?

A)Utilization of health care services in the community
B)Demographic information of the community
C)Leading causes of morbidity in a community
D)Frequency of malpractice claims within a community

Question 16

A wealthy factory owner says, "I don't care about the poor. I just want the best care available for me and my family. Why should I care whether other people get health care or not?" Which of the following would be the most appropriate response by the nurse?

A)"If your employees are ill, who will do the work in your factory?"
B)"You might catch a contagious disease from one of your employees."
C)"You have a moral obligation to help those less fortunate."
D)"Your personal insurance and tax costs will go up if your employees have to use community resources when they're ill."

Question 17

Which of the components of the PDCA model and Donabedian's framework is the most crucial?

A)Standard
B)Outcome
C)Process
D)Structure

Question 18

An agency is beginning to implement a general approach for quality improvement. Which of the following activities would the agency most likely implement?

A)Customer satisfaction is assessed through the use of surveys provided to the client after each appointment.
B)The health maintenance organization (HMO) provides incentives to personnel who complete in-house programs on customer service.
C)The institution has received accreditation through The Joint Commission.
D)The total quality improvement (TQI) team meets to examine how to make the registration process more efficient.

Question 19

The staff was informed that a PRO (Professional Review Organization) would be making an unannounced visit in a few hours. Which of the following would the hospital nurse expect the PRO team to examine?

A)Records of hospital admissions and scheduled procedures
B)Nursing care plans of patients with unexpected problems (infections, falls)
C)Discharge paperwork of patients discharged in the past 30 days
D)Documentation of adherence to nursing standards of care

Question 20

Which of the following is accomplished through the use of traditional quality assurance?

A)Implementation of new techniques to improve outcomes
B)Implementation of appropriate interventions for diagnosed problems
C)Implementation of change when measured performance does not meet standards
D)Implementation of research findings to ensure appropriate clinical treatment

Question 21

A nursing committee is responsible for evaluating the process of health care agency in their quality assurance efforts. Which of the following techniques would most likely be used by the committee members? (Select all that apply.)

A)Client satisfaction survey data
B)Confirmation of credentials of all health care providers employed
C)Patient discharge data over the past one year
D)Peer review committee audit

Question 22

In which of the following ways does licensing differ from accreditation? (Select all that apply.)

A)Licensing applies to the individual, whereas accreditation applies to a program.
B)Licensing is required to practice, whereas accreditation is by choice.
C)Licensing is required by state law, whereas accreditation is required by federal law.
D)Licensing is required for all professions, whereas accreditation is only available for some.

Question 23

A nurse is implementing tertiary prevention strategies as part of the quality management process. Which of the following best describes a strategy the nurse would have used?

A)All new employees complete a program on fire safety that details what to do in the event of a fire.
B)At the yearly employee picnic, teams compete in putting out trash can fires and in racing while carrying mock victims, using safe evacuation techniques.
C)After evaluation of response to an actual fire, new procedures implemented in the fire response protocol are distributed to employees.
D)Mock fire drills are carried out twice a year to assess response and readiness in the event of a real fire.

Question 24

Which of the following best explains why evaluation of client outcomes resulting from nursing intervention is so difficult?

A)Client records may not include appropriate data.
B)Few tools exist to measure client outcomes.
C)Many other factors can also affect client outcomes.
D)Measuring client outcomes is extremely time consuming.

Question 25

A nurse has identified a need to increase the quality assurance efforts within the home care agency. Which of the following has most likely occurred?

A)Increased number of client complaints and injuries
B)Increased costs of providing care
C)Reduced number of incident reports
D)Reduced government reimbursement (Medicare and Medicaid)

Question 26

The management team of the Central County Community Health Agency wants to analyze the cost of homebound client services. Which of the following records are most likely to provide useful data?

A)Clinical records
B)Financial records
C)Morbidity and mortality records
D)Provider service records