Chapter 20 Quality Improvement and Patient Safety

Chapter 20  Quality Improvement and Patient Safety

Complete Chapter Questions And Answers
 

Sample Questions

MULTIPLE CHOICE

1. The nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is called a
A.
deployment flowchart.
B.
top-down flowchart.
C.
Pareto chart.
D.
control plot.

ANS: B
(B) is correct because a top-down flowchart shows the sequence of steps in a job or process such as medication administration. (A) is incorrect because a deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step in the process; this is not involved in this scenario. (C) is incorrect because the Pareto chart is used in quality improvement to indicate that 80% of problems usually stem from 20% of causes; it displays data so that a few problems are easily depicted and facilitates improvement that focuses on those few. (D) is incorrect because a control plot is a run chart that has a centerline and added statistical control limits; it helps to reveal specific types of change within a process, rather than providing a sequencing of steps.

DIF: Application REF: Pages 445, 453-454

2. A nonprofit organization that distributes to governmental agencies, the public, business, and health care professionals knowledge related to health care for the purpose of improving health is the
A.
Institute for Safe Medication Practices.
B.
Institute of Medicine.
C.
National Committee for Quality Assurance.
D.
The Joint Commission.

ANS: B
(B) is correct because the Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health. (A) is incorrect because the Institute for Safe Medication Pratices is a nonprofit organization that is an educational resource only for the prevention of medication errors. (C) is incorrect because the National Committee for Quality Assurance is the accrediting body for health maintenance organizations. (D) is incorrect because The Joint Commission is a national agency that conducts surveys and certifies compliance with established standards for inpatient and ambulatory facilities.

DIF: Comprehension REF: Page 445

3. A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified as a
A.
root cause.
B.
sentinel event.
C.
variation in performance.
D.
causal factor.

ANS: B
In this question, all the distracters are plausible, but you must pick the “best” answer. (B) is correct because this unexpected occurrence could result in serious physical or psychologic injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. (A) is incorrect because a root cause analysis is the process by which basic or causal factors that underlie variation in performance, such as a sentinel event, are identified, but this process is not the event itself. (C) is incorrect because a variation results from the lack of perfect uniformity in the performance of any process, but when the variation is this serious, it is referred to as a sentinel event. (D) is incorrect because causal factors are the underlying causes of the event, not the actual event.

DIF: Application REF: Pages 446, 461

4. A nurse is assisting with the delivery of twin infants. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are performing a(n)
A.
standardization of care.
B.
root cause analysis.
C.
process variation.
D.
analysis of a deployment flowchart.

ANS: B
(B) is correct because a root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent any future occurrences. (A) is incorrect because standardization of care is the process of developing and adhering to best known methods and repeating key tasks in the same way, thereby creating exceptional service with maximum efficiency. (C) is incorrect because process variation looks at the steps in a process to determine how variation affects each step but does not identify causal events. (D) is incorrect because a deployment flowchart analysis looks at the steps of a process and determines which department is responsible for each step, but it does not identify causal events.

DIF: Application REF: Pages 446, 461