Chapter 02: Safe Care: The Core of Leading and Managing(FREE) Nursing School Test Banks

Chapter 02: Safe Care: The Core of Leading and Managing
Yoder-Wise: Leading and Managing in Nursing, 6th Edition

MULTIPLE CHOICE

1. In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. This may be attributable to:
a. The overload of staff nurses.
b. Resistance to change by staff.
c. A change in reporting systems.
d. Fewer clinical leaders to remove barriers to care.
ANS: D
Eliminating barriers to the implementation of best practices is the role of managers and leaders. When there are insufficient resources for leadership to encourage a culture in which evidence-based practice is embraced, frontline nurses recognize this as a stumbling block for delivering quality care.

REF: Page 24 TOP: AONE competency: Knowledge of the Health Care Environment

2. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following interventions might assist to reduce the number of falls on the unit?
a. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls
ANS: C
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.

REF: Page 27 | Page 32 TOP: AONE competency: Professionalism

3. To increase safety in patient care areas of the Valley Hospital, the executive begins by:
a. Asking the community what the safety issues are.
b. Consulting with a management expert about staffing schedules.
c. Ensuring that the senior nursing officer attends the board meetings.
d. Instituting improved practices to reduce needle-stick injuries.
ANS: C
The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.

REF: Page 25 | Page 26
TOP: AONE competency: Knowledge of the Health Care Environment

4. During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.
ANS: A
The IOM report (2004) points to the need to involve nurses in decisions that affect them and the provision of care.

REF: Page 25 | Page 26
TOP: AONE competency: Communication and Relationship-Building

5. The IOM Health Professions Education report highlighted patient safety concerns as:
a. A normal risk in professional practice.
b. A result of disciplinary silos.
c. A reflection of frontline staff.
d. Related to systems errors.
ANS: B
The IOM Health Professions Education report (2004) highlighted the education of health disciplines in silos as a major concern in patient safety and endorsed five recommendations.

REF: Pages 25-27 TOP: AONE competency: Knowledge of the Health Care Environment

6. If you are supporting the steps in the AHRQ document Five Steps to Safer Health Care, you would ensure that:
a. Patients are actively encouraged to make decisions related to care.
b. Rules and decisions are made through centralized processes.
c. You monitor the performance of each staff member closely.
d. Preference is given to increasing staff numbers rather than staff credentials.
ANS: A
The Agency for Healthcare Research and Quality (AHRQ) outlines Five Steps to Safer Health Care, which suggests that safe, patient-centered care is facilitated by assisting patients to become active partners in their own care.

REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment

7. After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops:
a. A nursing program that emphasizes the development of a strong disciplinary identity.
b. Programming that stresses discipline-based research.
c. Partnerships with health care to develop software for the reporting of adverse events.
d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.
ANS: D
Health Professions Education identified that education related to health disciplines in silos leads to compromised communication and inability to function as an integrated whole for patient-centered care.

REF: Pages 25-27 TOP: AONE competency: Knowledge of the Health Care Environment

8. In designing a quality, safe healthcare environment, the primary emphasis needs to be on:
a. Evidence-based practice.
b. Informatics.
c. Staffing.
d. The patient.
ANS: D
Focusing on the patient moves care from concern about who controls care to a focus on what care is provided to and with patients, which was an aim identified in the IOM report Crossing the Quality Chasm.

REF: Page 25 | Page 26
TOP: AONE competency: Knowledge of the Health Care Environment

9. As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about:
a. The need to understand and record all medications being taken.
b. Bringing their own linens and other personal items to the hospital.
c. Washing hands frequently while in a healthcare environment and using a hand sanitizer.
d. Following closely the directions and orders of healthcare providers.
ANS: A
The Five Steps to Safer Health Care for patients include keeping a list of medications that patients are taking.

REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment

10. As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report?
a. Careful screening of nursing staff for substance use and abuse
b. Increased RN staffing on the unit
c. Salary and benefits that reflect nursing accountabilities
d. Increase in the percentage of baccalaureate-prepared nurses to 80%
ANS: D
The Future of Nursing advocates for having 80% of the nursing population at a baccalaureate-prepared level. This recommendation reflects research that suggests that improved mortality and morbidity rates occur with a better educated workforce.

REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment

11. On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. Which of the following strategies may assist with rapid adoption of the technology and system?
a. Employ a centralized decision-making approach.
b. Use simulators for initial practice to build confidence.
c. Bring in a nurse consultant who is familiar with the technology.
d. Use early adopters among the staff as leaders and role models in implementation.
ANS: D
The Institute for Healthcare Improvement (IHI) is dedicated to rapid improvement in patient care through a variety of mechanisms such as rapid cycle change. Rapid cycle change diffuses innovation and changes quickly through early adopters who share information and energy over time and act as role models for others.

REF: Page 26 | Page 29
TOP: AONE competency: Knowledge of the Health Care Environment

12. To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?
a. Evidence-based practice to reduce the prevalence of pressure sores
b. Implementation of informatics at the bedside
c. Staff-manager conferences to review reporting of adverse medical events
d. Patient councils to review food, recreation, and nurse-patient relations
ANS: A
The National Quality Forum (NQF) outlines nursing-centered intervention measures related to prevalence of pressure sores, ventilator-associated pneumonias, volunteer turnover, nursing care hours per day, and skill mix of staff.

REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment

13. You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient went and:
a. Encourage her to ask the patient if he has questions or concerns about the procedure.
b. Advise her to consider providing the patient with more information.
c. Suggest that she leave some brochures on the procedure with the patient.
d. Suggest that she also provide teaching to the adolescents parents.
ANS: A
The Five Steps to Safer Health Care for Patients includes the step of asking questions if there are doubts or concerns. The nurse can encourage patients to take a larger role in care by taking these steps and by providing patients with coaching in the steps.

REF: Page 27 TOP: AONE competency: Communication and Relationship-Building

14. The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and:
a. Staffing.
b. Funding.
c. Composition of executive councils.
d. Composition of consumer-based councils.
ANS: B
The Centers for Medicare & Medicaid Services (CMS) have adopted a policy based on the NQFs never events. The CMS will no longer pay for patient conditions or events that result from poor practice while patients are under the care of a health professional.

REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment

15. In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize:
a. Safety goals specific to Pleasant Valley.
b. Decision-making processes.
c. Sufficient staffing for safe care.
d. Increased numbers of baccalaureate-prepared RNs.
ANS: A
When the TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.

REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment

16. Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety?
a. Appropriateness of charting terms and abbreviations
b. Nursing hours per patient
c. Acuity of patient admissions
d. Wait times for care
ANS: A
The Joint Commission issues setting-specific patient goals annually, as well as a list of do-not-use terms, abbreviations, and symbols and sentinel events.

REF: Page 28 TOP: AONE competency: Knowledge of the Health Care Environment

17. In preparation for redesignation as a MagnetTM Hospital, how would you prepare?
a. Commit staff resources over a 6-month period to updating procedure manuals.
b. Educate staff through meetings and training sessions regarding appropriate answers to questions.
c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed.
d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.
ANS: D
Through the MagnetTM model, organizations must demonstrate how they provide excellence in five areas. Between designation and redesignation as a MagnetTM organization, greater emphasis is placed on empirical quality results.

REF: Page 29 TOP: AONE competency: Knowledge of the Health Care Environment

18. Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she always checks patients bracelets before giving medication and she is not sure how the nurses on the unit get away with not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by:
a. QSEN.
b. IHI.
c. DNV/NIAHO.
d. AHRQ.
ANS: A
The Quality and Safety Education for Nurses (QSEN) project provides resources related to competencies that prelicensure and graduate students need to develop to serve as safe practitioners. These competencies include leading and managing, teamwork and collaboration.

REF: Page 29 TOP: AONE competency: Knowledge of the Health Care Environment

19. The SBAR approach to patient safety encourages:
a. Consistency in assessment and practices.
b. Continuing education.
c. Multidisciplinary approaches.
d. Patient feedback.
ANS: A
The use of SBAR (Situation, Background, Assessment, and Recommendation) checklists are designed to decrease omission of important information and practices.

REF: Page 30 TOP: AONE competency: Knowledge of the Health Care Environment

20. As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices?
a. Hospitals
b. Business
c. Industry
d. Outpatient clinics
ANS: A
Practices that were once mostly studied in hospital settings are now scrutinized for implementation in other settings, such as outpatient clinics, rural settings, and nursing homes.

REF: Page 30 TOP: AONE competency: Knowledge of the Health Care Environment

21. As a manager, the development of your decision-making skills related to safe patient care is facilitated by:
a. Regular reflection on decisions.
b. A culture of perfectionism.
c. Recognition of who should be held responsible for individual errors.
d. A culture of trust between the staff and you.
ANS: A
Reflection on how well decisions were enacted enables knowledge of the complexity of situations and ramifications of the decisions made. Reflection enables elimination of strategies and methods that are inappropriate in meeting needs and aids in narrowing choices of best actions to take.

REF: Page 30 TOP: AONE competency: Leadership

22. Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be:
a. Setting up a nursing team meeting to review practices.
b. Calling the family to inform them of the practice.
c. Initiating a multidisciplinary and family meeting to focus on Marys needs.
d. Restraining Mary to satisfy the familys wishes.
ANS: C
Crossing the Quality Chasm emphasizes the importance of rendering care with the client (client-centered) rather than to the client. In this situation, the patient includes family in transparent discussions about quality needs and takes a team approach that involves healthcare professionals, the family, Marys needs, and evidence associated with safe practice.

REF: Pages 24-26 TOP: AONE competency: Knowledge of the Health Care Environment

23. A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. As a nurse, you would:
a. Suggest that an interpreter explain the procedure to the client and answer any questions.
b. Ask the client if he has any questions.
c. Draw a picture to show the incision.
d. Not intervene.
ANS: A
The Five Steps to Safer Patient Care identifies that encouraging patients to ask questions when there are doubts and concerns and ensuring understanding before surgery is performed are ways in which nurses can support patients in having greater influence in their own care. In this situation, asking an interpreter to help enables access to information for the patient and active assessment of his understanding.

REF: Page 27 TOP: AONE competency: Knowledge of the Health Care Environment

24. As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to
a. Re-visit reporting standards for medication errors in your organization.
b. Ensure that medication errors are consistently reported.
c. Provide staff with additional education related to safe practice in medication administration.
d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.
ANS: D
Keeping Patients Safe: Transforming the Work Environment of Nurses (2004) identified many past practices that had a negative impact on nurses, and thus on patients, and recommended the inclusion of nurses in direct care in decision making involving their practice. Future of Nursing: Leading Change, Advancing Health (2010) also emphasizes the role of nurses as leaders in changes that improve health.

REF: Page 25 | Page 27 TOP: AONE competency: Professionalism

MULTIPLE RESPONSE

1. Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)?
a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement.
b. George is very shy and withdrawn. He asks the nurse to leave him alone.
c. Sarah is a new parent who finds that nurses on the childrens unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand.
d. Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesnt know what the doctor meant by colostomy.
ANS: A, C, D
Safer health care involves the patient as an active consumer who keeps and brings a list of all medications, including natural remedies, and questions if there are doubts, concerns, or lack of understanding.

REF: Page 25 | Page 27
TOP: AONE competency: Knowledge of the Health Care Environment

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