Deck 22: Quality Patient Care

Question 1

The nurse manager is educating a new hire on The Joint Commission (TJC).The manager tells the new hire that TJC mandates the use of continuous quality improvement and measurement of specific quality outcomes for patients with certain diagnoses.The teaching has been effective when the new hire makes which of the following statements?

A)"These mandates include patients admitted with acute MI and COPD."
B)"Outcome measures are mandated for patients with a diagnosis of congestive heart failure and brain attack."
C)"Acute renal failure and deep vein thrombosis have mandated outcomes by The Joint Commission."
D)"Outcome measures are mandated for patients admitted with community-acquired pneumonia and congestive heart failure."

Answer 1

"Outcome measures are mandated for patients admitted with community-acquired pneumonia and congestive heart failure."

Question 2

A nurse manager wants to implement changes based on the IOM's 2010 report of the future of nursing.What action by the manager will best help meet these outcomes?

A)Arrange a flexible staffing plan so nurses can return to school.
B)Institute a policy for bedside provider-nurse rounding.
C)Investigate "noisesless" paging systems to replace overhead paging.
D)Advocate for the initiation of patient-centered care units.

Answer 2

Arrange a flexible staffing plan so nurses can return to school.

Question 3

Which of the following are considered core measure sets and monitored by The Joint Commission? (Select all that apply.)

A)Code rates
B)Venous thromboembolism
C)Pneumonia
D)Nurse staffing and vacation patterns
E)Congestive heart failure
F)Numbers of hospital admissions

Answer 3

Venous thromboembolism
Pneumonia
Congestive heart failure

Question 4

A nurse manager is brainstorming quality improvement methods.Which action would help implement these methods on the assigned unit?

A)Inform staff of the changes to be made.
B)Resist imposed change from upper management.
C)Empower employees to carry out needed strategies for change.
D)Agree to change what is directly beneficial.

Question 5

A nurse is reviewing the technique used to identify the factors involved in an error.Which statement indicates the nurse has an adequate understanding?

A)"The rapid cycle test is a technique that is widely used."
B)"A root cause analysis is a process designed to investigate and categorize the root cause of the event."
C)"A failure mode and effects analysis is a procedure to investigate the cause of the error."
D)"Define,measure,analyze,improve,control prevents events from occurring."

Question 6

A nurse is interested in becoming credentialed as a Certified Professional in Health Care Quality.Which action would the nurse take to achieve this?

A)Take an exam.
B)Complete a 6-week internship.
C)Have at least a bachelor's degree.
D)Have at least 1 year of experience in quality management.

Question 7

The continuous quality improvement (CQI)committee has performed a retrospective chart audit to investigate whether outcomes recorded in each nursing care plan are patient centered and written in behavioral terms.The expected standard is 98% compliance.The sample size was 200.Results showed that 180 charts met the standard.What assessment can be made?

A)The standard was met.No action plan is necessary.
B)The standard was not met,but no action plan is necessary because the rate of compliance was close to the standard.
C)The standard was not met.An action plan should be developed.
D)The standard was not met.An immediate re-audit is necessary.

Question 8

Which action takes place during the design phase of the DMAIC process?

A)A charter is developed.
B)Key performance indicators are agreed upon.
C)Analyze baseline data.
D)Determine whether measures reflect the true problems.

Question 9

A nurse manager is providing education to a new nurse on barriers to the implementation of quality improvement processes.The manager judges the teaching to be effective when the new nurse states which of the following?

A)"Expense is a primary barrier."
B)"Resistance to change is a primary barrier."
C)"One of the primary barriers is complacency with the status quo."
D)"Not identifying the correct problem is a primary barrier."

Question 10

The nurse manager has an adequate understanding of the continuous quality improvement process of Six Sigma when doing which of the following?

A)Uses Six Sigma to identify errors
B)Uses Six Sigma to increase profits
C)Uses Six Sigma to keep standard policies and procedures consistent
D)Uses Six Sigma to improve patient-provider communication

Question 11

A nurse is a team member assisting with the define-measure-analyze-improve-control (DMAIC)process.Which action would the nurse take during the define phase?

A)Identify the stakeholders.
B)Agree on the key performance indicators.
C)Identify gaps between performance and goals.
D)Identify those responsible for data collection.

Question 12

A nurse is educating students on the history of quality improvement.The teaching has been effective when one of the students states that,historically,quality improvement focused on

A)"controlling process by inspection so that errors were prevented."
B)"quality improvement did not begin until recently."
C)"proactive approaches to lessen errors."
D)"error prevention strategies."

Question 13

The primary role of The Joint Commission (TJC)is

A)granting magnet status to excellent hospitals.
B)lobbying Congress on behalf of Medicare/Medicaid patients.
C)ensuring that medical facilities meet patient safety guidelines.
D)inspecting hospitals for compliance of infection control standards.

Question 14

The nurse manager has an adequate understanding of Six Sigma when making which of the following statements?

A)"The primary goal of Six Sigma is to increase profits and reduce problems."
B)"The primary goal of Six Sigma is to attract physicians to an organization."
C)"The primary goal of Six Sigma is advertisement of the organization."
D)"The primary goal of Six Sigma is to attract nursing to an organization."

Question 15

A nurse is discussing the Pareto principle (80/20 rule),which leads to the idea of total quality management.Which person is given credit for this process in health care?

A)Peter Pareto
B)Joseph Juran
C)Phillip Crosby
D)Edward Deming

Question 16

The nurse manager has an adequate understanding of root cause analysis when stating which of the following?

A)"Root cause analysis determines who was most responsible for the error."
B)"Root cause analysis can identify some factors leading up to an error."
C)"Root cause analysis is rarely conducted effectively."
D)"Root cause analysis investigates the root causes of events that occur."

Question 17

The Joint Commission publishes a Sentinel Event Alert every month.Which of the following is the best example of a sentinel event?

A)Tylenol three tablets are given to a patient when Tylenol two tables were ordered.
B)Code pink is called after a newborn is discovered missing from the nursery.
C)After receiving the correct medication,the patient complains of itching all over,and a rash is noted on the patient's trunk.
D)The patient gets a meal tray intended for the roommate.

Question 18

If the nurse had an adequate understanding of continuous quality improvement,which of the following statements would the nurse make? (Select all that apply.)

A)"The accountability for quality is vested in quality circles that function along service lines to improve patient care."
B)"After quality standards are achieved,the nurse strives to maintain that standard of care."
C)"Quality standards must incorporate the expectations of patients and their families."
D)"Systems within the hospital must be reviewed to determine how care can be enhanced."
E)"Reducing costs to provide for substantial pay increases for nursing staff is an example of continuous quality improvement."
F)"Computerized electronic documentation systems that provide continuous assessment of patient charges are an example of continuous quality improvement."

Question 19

Which of the following statements by the nurse indicates an understanding of Quality and Safety for Nurses (QSEN)?

A)"QSEN helps prepare future nurses for improving patient safety."
B)"QSEN helps prepare future nurses for working mandatory overtime."
C)"QSEN helps train nurses in the clinical setting."
D)"QSEN provides nurses with strategies for passing the NCLEX exam."

Question 20

A nurse is explaining to another nurse about the contributions of Edward Deming.The nurse judges that the explanation is effective when the nurse states:

A)"Quality is the responsibility of everyone within an organization."
B)"Quality is the responsibility of the quality control inspector."
C)"Quality is the responsibility of the CEO of the organization."
D)"Quality is the responsibility of the manager of the organization."

Question 21

A nurse manager is educating unit staff about HCAHPS.The manager judges the teaching to be effective when a staff nurse states that the HCAHPS survey contains ratings for (Select all that apply.)

A)communication.
B)pain management.
C)responsiveness.
D)cost of hospital stay.
E)discharge information.

Question 22

A nurse manager is educating a group of nurses on common medication errors.The manager judges the teaching to be effective when one of the nurses states that common medication errors include (Select all that apply.)

A)good communication.
B)look-alike packaging.
C)wrong-dose errors.
D)inadequate monitoring.
E)rule violations.

Question 23

A nurse has an adequate understanding of barriers to quality improvement when stating which of the following? (Select all that apply.)

A)"Cost is a barrier in quality improvement."
B)"There are no barriers to quality improvement."
C)"Nurses' loyalty to old practices is a barrier."
D)"Failure to recognize that change is needed is a barrier."
E)"Being unwilling to change is a barrier."

Question 24

Which actions would be occurring if a group of nurses were in the analyze phase of the DMAIC process? (Select all that apply.)

A)Identify gaps between current performance and the goal.
B)Identify possible sources of variation.
C)Determine the goal.
D)Write the problem statement.
E)Determine where to begin making a change.

Question 25

Which statements by the nurse indicate understanding of the control phase of the DMAIC process? (Select all that apply.)

A)"In the control phase,only the leader should be informed of changes."
B)"Only those directly affected by the new process should be educated."
C)"In the control phase,steps in the new process should be standardized."
D)"Changes should be monitored to ensure compliance."
E)"Standard operating procedures should be written."

Question 26

A nurse is listening to a pharmacist lecture about factors that contribute to medication errors.The teaching has been effective when the nurse states (Select all that apply.)

A)"Problems within the system contribute to medication errors."
B)"Human factors contribute to medication errors."
C)"Work-design problems contribute to medication errors."
D)"Environmental factors contribute to medication errors."
E)"The nurse alone contributes to medication errors."

Question 27

A nurse is preparing a presentation on core measures.Which medical diagnoses should the nurse plan on presenting during the lecture? (Select all that apply.)

A)Myocardial infarction
B)Congestive heart failure
C)Diabetes
D)Perinatal care
E)Deep vein thrombosis

Question 28

Which action by a group of nurses involves brainstorming? (Select all that apply.)

A)List one solution to the problem.
B)Identify stakeholders.
C)Think about solutions to the problem.
D)Write the problem statement.
E)Write a goal statement.