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Leadership and Management for Nurses, 3e (Finkelman)
Chapter 18 Implementing Healthcare Quality Improvement
1) Which situation is most likely to result in the nurse making a medication error?
1. The nurse has worked three 12-hour shifts in three days.
2. The nurse uses an online program to access medication information.
3. The nurse insists on documenting medication administration immediately after giving the
medication.
2) Which organizations are subject to accreditation by the Joint Commission? Select all that
apply.
1. Hospitals
2. Long-term care facilities
3. Schools of nursing
4. Home care agencies
3) The nurse has taken a position in the utilization review (UR) department of a hospital. This
nurse can expect to be involved in evaluating which care components? Select all that apply.
1. Was the care provided necessary?
2. How much medication did the patient receive?
3. How appropriate was the care provided?
4. How much did each procedure cost to provide?
5. How efficiently was care provided?
4) The hospital Administrative team holds an employee meeting to announce that the hospital
will support the use of quality report cards. What should the employees expect from this
announcement? Select all that apply.
1. This report card will provide specific performance data about the organization at specific
intervals.
2. The goal of using these report cards is to improve the organization's services.
3. These report cards will be an inexpensive way to let the community know about the
organization's quality.
4. Using these report cards will increase the average daily census of the organization.
5. These report cards will be used internally as a means of documenting performance
evaluations.
5) The nurse made a medication error. Which statement reflects the traditional "blame game"
approach to such errors? Select all that apply.
1. The nurse manager says, "You have to complete the incident report and notify the patient's
physician. You made the error, not me."
2. The nurse says, "Why did I make this error?"
3. The physician says, "Is there some way we can prevent this type of error from happening
again?"
4. The nurse thinks, "The patient is okay, so I won't tell anyone this happened."
5. The risk manager says, "How many errors has this nurse made this year?"
6) The unit has been so understaffed that the nurse has been unable to attend education sessions
on new medications that physicians will be prescribing for the treatment of hypertension. This
situation is likely to result in a medication error resulting from which contributing factor?
1. Work environment
2. Task
3. Individual staff member
7) The risk manager has noted an increase in error rate for a nursing unit over the last year.
Which factors should the risk manager investigate? Select all that apply.
1. How strong is the unit leadership?
2. Are nurses being asked to fulfill unreasonable work assignments?
3. How well does the unit staff function as a team?
4. Who on the unit is making the most mistakes?
5. Does an environment of learning exist on the unit?
8) The nurse executive announces to the nurse managers that the hospital will soon begin using
failure modes and effects analysis (FMEA) to analyze errors. What should the nurse managers
tell the staff about this new initiative?
1. If you make an error, expect that the FMEA system will investigate you.
2. If there are two errors in one category, such as falls, the nurses involved will be investigated.
3. We will not have to worry about this system until our turn comes up in the unit rotation.
9) Failure to rescue (FTR) is most commonly a result of which other failure?
1. Failure to understand the disease process.
2. Failure to understand the purpose of an intervention or treatment.
3. Failure to monitor patient status.
4. Failure to follow physician orders.
10) Which patient is most likely to benefit from using a rapid-response team (RRT)?
1. A 10-year-old in the Emergency Department
2. A 51-year-old in the Cardiac Intensive Care Unit
3. A 73-year-old on a urology unit
4. A 43-year-old in a physician's office
11) During a meeting with nurse managers, the risk manager for the hospital says,
"Approximately 60% of our patient care errors can be directly attributed to poor handoffs." What
situation should the nurse managers address to improve these statistics?
1. One person per shift should be responsible for receiving medications that are delivered from
the pharmacy.
2. The staff should work on clarity of information communicated when a patient is transferred
from one care setting to another.
3. More care should be taken in interpreting physician orders.
4. The nursing staff must complete admission history and physicals in a timelier manner.
12) The hospital has adopted a medication administration system that has a series of checks and
balances designed for patient safety. The system works well, but is time consuming. Nurses have
discovered shortcuts around the safeguards. This is an example of which situation?
1. A handoff
2. A workaround
3. An effects analysis
4. A "never event"
