Chapter 11: The Nurse’s Role in Quality and Safety

Chapter 11: The Nurse’s Role in Quality and Safety

 

Complete Chapter Questions With Answers

 

Sample Questions Are Posted Below

 

Question 1

The nurse receives the report for a client recovering from a repair of a fractured hip, who is being transferred to the orthopedic care area. The following information was obtained in the telephone report:

Report received 14:00 hours:  76-year-old female; ORIF of right hip caused by falling in the home; receiving Morphine sulfate 2 mg IV every 4 to 6 hours for pain; difficult to keep turned on non-operative site; indwelling urinary catheter in place; Hgb 10 after 2 units PRBCs post-operatively.

Which National Patient Safety goals should the nurse make a priority for this client? (Select all that apply.)

1. Prevent wrong site/procedure/person surgery.
2. Prevent health-care associated pressure ulcers.
3. Improve the accuracy of patient identification.
4. Reduce the risk of patient harm resulting from falls.
5. Reduce the risk of health care-associated infections.

Correct Answer: 2, 4, 5

Rationale: Because the client is difficult to keep turned on the non-operative site, the goal to prevent health-care associated pressure ulcers (decubitus ulcers) should be a priority. Because the client has fallen in the home and is recovering from surgery to repair a fracture from a fall, the goal to reduce the risk of patient harm resulting from falls should be a priority. Because the client has an indwelling urinary catheter, the goal to reduce the risk of health care-associated infections should be a priority. Preventing wrong site, wrong procedure, and wrong person surgery would have been appropriate preoperatively. There is no reason to think that the accuracy of patient identification needs to be improved for this client.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: V.B.1. Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: II.5. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.

NLN Competencies: Quality and Safety; Knowledge; Factors that contribute to a system-wide safety culture; Importance of reporting hazards and adverse events; “Just culture“ approach to system improvement.

Nursing/Integrated Concepts: Implementation; Nursing Process

Learning Outcome: 1. Discuss regulatory and professional standards that guide patient safety and quality of care.

Page Number: p. 211

 

Question 2

The charge nurse is beginning rounds after attending morning report. Which clients should the nurse be concerned for developing a never event? (Select all that apply.)

1. Client with hemophilia receiving Factor replacement transfusions
2. Client recovering from a stroke with foul-smelling urine in a catheter drainage bag
3. Client recovering from total knee replacement surgery complaining of right calf pain
4. Client with heart failure being fitted for a C-pap mask for use at home for sleep apnea
5. Client with renal failure with a newly diagnosed stage III pressure ulcer on the left heel

Correct Answer: 2, 3, 5

Rationale: The Centers for Medicare and Medicaid Services (CMS) issued a ruling to deny reimbursement of federal funds to pay for services by physicians and hospitals for treatment of never events, which are preventable errors, injuries, and infections. These events include urinary tract infections, deep vein thrombosis, and pressure ulcers. The client with hemophilia and the client being fitted for a device to prevent sleep apnea are less at risk for developing a never event.

Cognitive Level: Analyzing

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: V.B.1. Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: II.5. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.

NLN Competencies: Quality and Safety; Knowledge; Factors that contribute to a system-wide safety culture; Importance of reporting hazards and adverse events; “Just culture” approach to system improvement.

Nursing/Integrated Concepts: Assessment; Nursing Process

Learning Outcome: 1. Discuss regulatory and professional standards that guide patient safety and quality of care.

Page Number: p. 213

 

Question 3

The director of nursing is searching for information about the Consumer Assessment of Health Plans. Which organization website should the director access for this information?

1. Joint Commission (TJC)
2. Centers for Medicare and Medicaid Services (CMS)
3. National Association for Healthcare Quality (NAHQ)
4. Agency for Healthcare Research and Quality (AHRQ)

Correct Answer: 4

Rationale: AHRQ is foundational in developing quality-of-care indicators and is responsible for the Consumer Assessment of Health Plans (CAHPS). The National Association for Healthcare Quality (NAHQ) is the professional organization for healthcare quality professionals, publishes the Journal for Healthcare Quality (JHQ), and provides a number of products focused on continuous quality improvement (CQI) in healthcare teams. The Joint Commission and Centers for Medicare and Medicaid do not participate in the Consumer Assessment of Health Plans.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: V.B.1. Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: II.5. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.

NLN Competencies: Quality and Safety; Knowledge; Factors that contribute to a system-wide safety culture; Importance of reporting hazards and adverse events; “Just culture” approach to system improvement.

Nursing/Integrated Concepts: Assessment; Nursing Process

Learning Outcome: 1. Discuss regulatory and professional standards that guide patient safety and quality of care.

Page Number: p. 214

 

Question 4

The staff development trainer is preparing information for a seminar on the Quality and Safety Education for Nurses (QSEN) initiative as part of the National Safety Week celebration. Which attributes should the trainer emphasize as being an integral part of this initiative? (Select all that apply.)

1. Skills
2. Caring
3. Attitudes
4. Education
5. Knowledge

Correct Answer: 1, 4, 5

Rationale: The focus of the QSEN Institute is to meet “the challenge of preparing future nurses with the knowledge, skills, and attitudes (KSAs) necessary to continuously improve the quality and safety of the healthcare systems within which they work.” Caring and education are not attributes within the QSEN Institute.

Cognitive Level: Applying

Client Need: Safe and Effective Care Environment

Client Need Sub: Safety and Infection Control

QSEN Competencies: V.B.1. Demonstrate effective use of technology and standardized practices that support safety and quality.

AACN Essential Competencies: II.5. Participate in quality and patient safety initiatives, recognizing that these are complex system issues, which involve individuals, families, groups, communities, populations, and other members of the healthcare team.

NLN Competencies: Quality and Safety; Knowledge; Factors that contribute to a system-wide safety culture; Importance of reporting hazards and adverse events; “Just culture” approach to system improvement.

Nursing/Integrated Concepts: Implementation; Teaching/Learning

Learning Outcome: 1. Discuss regulatory and professional standards that guide patient safety and quality of care.

Page Number: p. 215