Chapter 26: Quality Management Nursing School Test Banks

Stanhope: Public Health Nursing, 8th Edition

Chapter 26: Quality Management

Test Bank

MULTIPLE CHOICE

1. What is the purpose of implementing total quality management?
a. To provide quality care within an organization
b. To provide cost-efficient care across all age groups
c. To provide necessary care to clients in a cost-effective system
d. To provide efficient systems of primary care
ANS: A
Total quality management is a management philosophy that focuses on the statistical processes by which to assess work done with the goal of organization wide quality effectiveness.

DIF: COG: Understanding REF: 575 OBJ: 1

2. What is the purpose of the National Health Quality Report (NHQR)?
a. To report on the Agency for Healthcare Research and Qualitys goals for the year
b. To describe the yearly activities of the agency
c. To ensure national quality of services
d. To document if health care quality is stable, improving, or declining over time
ANS: D
The NHQR is intended to serve a number of purposes, including the documentation of whether health care quality is stable, improving, or declining over time; demonstrating the validity (or lack) of concerns about quality; and providing national benchmarks against which specific states, health plans, and providers can compare their performance.

DIF: COG: Understanding REF: 575 OBJ: 1

3. What is one performance area where quality improvement is used to effect process and outcomes of health care?
a. Provision of appropriate and effective care
b. Elimination of access barriers
c. Reduction of unjustified geographic variation in care
d. Application of managed care to all citizens
ANS: C
The application of quality improvement strategies specific areas of performance can affect both process and outcomes of health. These include: reducing unjustified geographic variation in care; consistently providing appropriate and effective care; eliminating avoidable mistakes; lowering access barriers; improving responsiveness to clients; and eliminating racial/ethnic, gender, socioeconomic, and other disparities and inequalities in access and treatment.

DIF: COG: Understanding REF: 576 OBJ: 2

4. How can public health nurses provide the core function of assurance to the community?
a. By providing the same services to all citizens
b. By maintaining quality in the public health workforce
c. By eliminating low-quality services
d. By contracting with outside agencies to evaluate effectiveness
ANS: B
Public health must maintain quality in its workforce and continually evaluate service effectiveness whether delivered to the individual, the community, or the population.

DIF: COG: Analyzing REF: 577 OBJ: 2

5. Which statement about the quality assurance process is accurate?
a. Processes are implemented to maintain quality.
b. Community needs are assessed while implementing quality programs.
c. Accountability of the provider is the primary concern.
d. Standards for care are established and evaluated.
ANS: C
Quality assurance is concerned with the accountability of the provider, and it is only one tool in achieving the best client outcomes.

DIF: COG: Understanding REF: 578 OBJ: 3

6. A nurse is concerned that there is an overuse of services by clients receiving care from a local physician. What is occurring in this situation?
a. Treatment decisions are made conservatively.
b. Disability and mortality are being reduced.
c. Disparities in quality of care provided are increasing.
d. Unnecessary tests, surgeries, and treatments are being ordered.
ANS: D
The overuse of service group in the AHRQ problems of quality of care refers to the ordering of unnecessary tests, surgeries, and treatments.

DIF: COG: Applying REF: 578 OBJ: 3

7. A public health agency is transitioning from a traditional management model for quality assurance to a total quality management (TQM) approach. What change will occur within the agency?
a. Increased administrative authority
b. Increased participation by all staff
c. Additional focus on quality assurance
d. Specialized accountability for services provided
ANS: B
The TQM approach includes increased participation by all staff, process accountability (rather than specialized accountability), and focus on continuous improvement (rather than quality assurance).

DIF: COG: Analyzing REF: 585 OBJ: 4

8. Which organization monitors implementation of the prospective reimbursement system for Medicare clients?
a. Professional Review Organizations (PROs)
b. Joint Commission on Accreditation of Healthcare Organizations (JCAHO)
c. National Health Quality Improvement Act
d. Diagnostic Related Groups (DRGs)
ANS: A
PROs monitor implementation of the prospective reimbursement system for Medicare clients.

DIF: COG: Understanding REF: 579 OBJ: 5

9. Which resource would a public health nurse measuring quality assurance in the 1960s most likely have used?
a. American Nurses Association Standards of Practice
b. Joint Commission of Accreditation of Hospitals Nursing Audit Criteria
c. Community Health Nursing Practice Standards
d. Phaneuf nursing audit method
ANS: D
Phaneufs nursing audit method was one of the first tools, developed in 1965, that has been used extensively in population-centered nursing practice. The ANAs Divisions on Practice was created in 1966; however, this did not provide practice standards. The JCAH began developing its standards in the mid-1980s. The Community Health Nursing Practice Standards was developed in 1973.

DIF: COG: Applying REF: 579 OBJ: 5

10. A student has obtained a Bachelor of Science in Nursing degree. Why must the student be licensed as a registered nurse before beginning practice?
a. To formally recognize the student as a competent professional
b. To define the scope of professional practice
c. To control the quality of professional practice
d. To establish standards for educational programs
ANS: C
Individual licensure is a contract between the profession and the state. Under this contract, the profession is granted control over entry into, and exit from, the profession and over quality of professional practice. The licensing process requires that written regulations define the scope and limits of the professionals practice.

DIF: COG: Applying REF: 580 OBJ: 6

11. A nurse is given formal recognition as a professional with technical competence in a certain area of nursing practice. This is known as:
a. Licensure
b. Accreditation
c. Registration
d. Credentialing
ANS: D
Credentialing is the formal recognition of a person as a professional with technical competence, or of an agency that has met minimum standards of a performance.

DIF: COG: Applying REF: 580 OBJ: 6

12. A nurse implements the Institute of Medicines definition of quality health care when providing care that is:
a. Licensedall health care workers must have a license
b. Safeavoiding injuries to patients from the care intended to help them
c. Timelyno waiting or delay for health care
d. Innovativenew innovations must be used when they become available
ANS: B
The Institute of Medicine states that quality health care is safeavoiding injuries to patients from the care that is intended to help them.

DIF: COG: Applying REF: 582 OBJ: 6

13. An example of a voluntary approach to quality control used primarily for institutions is:
a. Accreditation
b. Licensure
c. Certification
d. Credentialing
ANS: A
Accreditation is an example of a voluntary approach to quality control used primarily for institutions.

DIF: COG: Applying REF: 581 OBJ: 6

14. When a nurse assesses the necessity of receiving care before providing services, it is called a:
a. Concurrent audit
b. Retrospective audit
c. Prospective utilization review
d. Retrospective utilization review
ANS: C
Doing an assessment of the necessity of care before giving service is called a prospective utilization review.

DIF: COG: Applying REF: 586 OBJ: 6

15. An elderly female client was receiving home care after hospitalization for a cerebrovascular accident. After several weeks of physical and speech therapy, the client showed few signs of progress. The utilization review committee considered the clients condition to be stable and declined reimbursement for further home care. This client may reverse the decision through a process called:
a. Development of explicit criteria
b. Appeal mechanism
c. Concurrent utilization review
d. Medicare reversal process
ANS: C
This is a review of the necessity of services while care is being given.

DIF: COG: Applying REF: 586 OBJ: 6

16. A staff development program to teach nurses and other providers about how to reduce risk by properly documenting interventions provided is an example of which level of prevention?
a. Primary prevention
b. Secondary prevention
c. Tertiary prevention
d. Quality care
ANS: A
Primary prevention refers to those interventions aimed at preventing the occurrence of disease, injury, or disability. In this case, prevention is aimed at reducing risk.

DIF: COG: Applying REF: 578 OBJ: 6

17. A nurse is using a concurrent audit to review documentation following home health visits. Why is this type of audit most appropriate in this situation?
a. It is less costly than a retrospective audit.
b. It represents the total picture of care that the client receives.
c. It provides more accurate data for planning corrective action.
d. It identifies problems at the time that care is given.
ANS: D
One reason for using a concurrent audit rather than a retrospective audit is that it identifies problems at the time that care is given.

DIF: COG: Analyzing REF: 586 OBJ: 6

18. A nurse is working with a team to learn more about what its most important accomplishments have been and to identify what changes are desired. What is the best method to use to accomplish this task?
a. Compare job descriptions.
b. Analyze mission and goals.
c. Brainstorm.
d. Develop charts and diagrams.
ANS: C
The best method of discovering what could be the most important accomplishments of the team and what changes are desirable is brainstorming.

DIF: COG: Evaluating REF: 583 OBJ: 6

19. Which action would a nurse take when using the specific approach to quality improvement?
a. Evaluate an agencys ability to meet criteria or standards.
b. Implement the plan/do/check/act cycle.
c. Provide care to individual citizens.
d. Use criteria set forth by regulatory agencies.
ANS: B
The specific approaches to quality improvement are methods used to manage a specific health care delivery system in an attempt to deliver care with outcomes acceptable to the consumer.

DIF: COG: Evaluating REF: 583 OBJ: 6

20. A quality assurance manager does an audit and six months later returns to see if the problem has been eliminated. This step:
a. Involves selecting explicit criteria for quality care
b. Includes the review of records
c. Requires a peer review of all cases that do not meet criteria
d. Completes the audit process
ANS: D
The final step in the audit process involves determining whether problems uncovered in an audit have been eliminated.

DIF: COG: Analyzing REF: 585 OBJ: 7

21. When developing a quality improvement program, what is the most important aspect of the program that should be considered?
a. Vision and values of the agency
b. Standards used to provide care
c. Results of nursing care
d. Evaluation of process changes
ANS: C
Outcome (results of nursing care) is the most important part of a quality improvement program because it is the key to evaluating providers and agencies by accrediting bodies, by insurance companies, and by Medicare and Medicaid through PROs, report cards, and other accrediting agencies.

DIF: COG: Evaluating REF: 591 OBJ: 8

22. While implementing Plan-Do-Check-Act, which action is the nurse most likely to perform?
a. Documentation of client care
b. Obtain certification in a specialty area
c. Review data after changing practice
d. Provide equal access to care
ANS: C
Reviewing data is part of the Check step, where data is reviewed, results are analyzed, and it is identified what has been learned through the process change.

DIF: COG: Evaluating REF: 591 OBJ: 8

23. A nurse records the number of clients seen daily as well as the mode of transportation and miles driven. What type of record is being used?
a. Clinical record
b. Provider service record
c. Financial record
d. Central index system
ANS: B
You can find information on the number of clients seen daily, the immunizations given, home visits made daily, and transportation and mileage in the provider service record.

DIF: COG: Applying REF: 594 OBJ: 9

24. Which type of record is most appropriate to use when profiling the clients who are served by an agency as well as documenting services requested and provided?
a. Clinical record
b. Provider service record
c. Financial record
d. Central index system
ANS: D
The central index system is a data-filing system that indicates the services requested, services offered, active and inactive clients of the agency, and a profile of the agencys clients.

DIF: COG: Analyzing REF: 594 OBJ: 10

MULTIPLE RESPONSE

1. In which situations would a nurse use a clinical practice guideline? Select all that apply.
a. When recommending the administration of the influenza vaccination to a client
b. When creating agency policies and procedures
c. When developing a program targeting obesity prevention
d. When researching interventions that would improve care for a tuberculosis client
ANS: A, C, D
Clinical practice guidelines are systematically developed statements to assist practitioner and client decisions about appropriate health care for specific clinical circumstances.

DIF: COG: Analyzing REF: 584 OBJ: 4

2. Which statement about records is true? Select all that apply.
a. Records provide complete information about the client.
b. Records resolve legal issues in malpractice suits.
c. Records provide information for education and research.
d. Records allow anyone interested in a clients progress to view a chart.
ANS: A, B, C
Records provide complete information about the client, resolve legal issues in malpractice suits, and provide information for education and research. Records are not available for anyone to view as that is a violation of client privacy.

DIF: COG: Understanding REF: 593 OBJ: 9

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