Legal or Illegal?
A nurse administers a medication to a client who clearly refused it. What legal violation may have occurred?
What is battery?
A nurse manager reviews the projected costs of salaries, supplies, and routine unit operations for the upcoming fiscal year. What type of budget is being developed?
What is an operating budget?
A hospital measures the number of client falls per 1,000 client-days each month. What type of measurement is being monitored?
What is a quality indicator?
A nurse discusses a client's diagnosis with a friend who is not involved in the client's care. What legal protection has potentially been violated?
What is client confidentiality under HIPAA and applicable privacy laws?
A nurse manager reviews expenses related to RN salaries, employee benefits, and overtime. Which portion of the operating budget is being examined?
What is the personnel budget?
A nursing unit identifies an increase in medication administration errors. What should the team do before implementing a corrective intervention?
What is collect and analyze data to identify the problem and contributing factors?
A nurse tells a competent client that they cannot leave the unit and physically blocks the exit without legal justification. What legal concern does this create?
What is false imprisonment?
A hospital plans to purchase new cardiac monitors to use for several years. Which type of budget should the nurse manager use to request this purchase?
What is a capital budget?
A nurse manager wants to determine whether a new intervention has reduced medication errors over several months. Which quality improvement tool would best display performance over time?
What is a run chart?
A nurse administers the wrong medication, and the client experiences an adverse reaction. What type of civil wrong may apply when the nurse fails to meet the expected standard of care?
What is negligence or professional malpractice?
A hospital pays a predetermined monthly amount to lease equipment, regardless of how many clients are admitted. What type of cost does this represent?
What is a fixed cost?
A quality improvement team maps every step of the medication administration process to identify delays, unnecessary steps, and potential failure points. What tool is being used?
What is a flowchart or process map?
A nurse documents that a medication was administered before actually giving it. The client subsequently experiences a change in condition. What legal and professional concern is raised by the documentation?
What is falsification of the medical record?
A nurse manager notices that the cost of disposable supplies increases as more clients are admitted to the unit. What type of expense does this represent?
What is a variable cost?
A quality improvement team wants to identify which medication error categories account for the largest share of reported events. Which chart would be most useful?
What is a Pareto chart?
A nurse witnesses another nurse making a medication error. The coworker asks the nurse not to report it because the client appears unharmed. What professional responsibility takes priority?
What is ensuring client assessment and reporting the error according to organizational policy?
A nurse manager is developing a staffing budget and must estimate the number of nursing hours needed based on client census and acuity. What staffing measurement is commonly used to support this calculation?
What are nursing hours per patient day (NHPPD), also called nursing hours per client day?
A hospital compares its fall rates and prevention practices with those of high-performing healthcare organizations. What quality improvement strategy is being used?
What is benchmarking?
An off-duty RN witnesses a motor vehicle accident and stops to assist an injured driver. The nurse provides emergency care within their training level until EMS arrives. The driver later develops complications and sues the nurse. What law may protect the nurse, provided the nurse acted in good faith and did not engage in gross negligence or willful misconduct?
What is the Good Samaritan Law?
A nursing unit spends $12,000 more on overtime than originally budgeted because of unexpected staffing shortages. What financial concept describes the difference between the planned and actual expenses?
What is a budget variance, specifically an unfavorable variance?
A unit experiences an increase in falls. The team wants to organize potential contributing factors into categories such as staffing, environment, equipment, and communication. Which quality improvement tool should the team use?
What is a cause-and-effect diagram, also called a fishbone or Ishikawa diagram?
A client with decision-making capacity refuses a prescribed blood transfusion despite understanding the potential consequences. What ethical and legal principle supports the client's decision?
What is autonomy and the right to refuse treatment?
A nurse manager is allocated $50,000 for annual supply expenses. At year-end, actual expenses total $44,000. What type of budget variance occurred?
What is a $6,000 favorable variance?
A client experiences a serious, preventable safety event. Leadership assembles an interdisciplinary team to identify underlying system failures and contributing factors. What formal process is appropriate?
What is root cause analysis (RCA)?
A nurse fails to implement prescribed fall precautions for a high-risk client. The client falls and sustains a fracture. What four elements must generally be established to prove negligence?
What are duty, breach of duty, causation, and damages?
A nurse manager is preparing the upcoming year's budget. Rather than automatically increasing last year's expenses by a set percentage, the manager requires justification for every proposed expense. What budgeting approach is being used?
What is zero-based budgeting?
A hospital implements a new bedside handoff process on one nursing unit, evaluates the results, modifies the process, and then expands it to additional units. What quality improvement model is being demonstrated?
What is the Plan-Do-Study-Act (PDSA) cycle?
A nurse delegates ambulation of a high-fall-risk client to assistive personnel without communicating the client's mobility restrictions. The client falls during ambulation. What aspect of the nurse's professional responsibility may have been breached?
What is appropriate delegation, including communication, supervision, and evaluation?
A nurse manager must choose between purchasing additional equipment and providing specialized staff training. Both would benefit the unit, but funding allows only one initiative. What budgeting concept describes the value of the alternative that must be given up?
What is opportunity cost?
A nurse manager implements hourly rounding to reduce falls. Fall rates improve initially but then begin to rise again after several months. What should the manager evaluate before introducing another intervention?
What are the consistency of intervention implementation, staff adherence, and process sustainability?
A client scheduled for surgery states, "I signed the consent, but I don't understand what the surgeon is going to remove." The surgeon is unavailable, and the procedure is scheduled to begin shortly. What is the nurse's priority responsibility?
What is withholding progression toward the procedure and notifying the surgeon that the client needs further explanation before proceeding?
A nurse manager discovers that supply expenses have increased significantly despite stable client census and acuity. Before requesting additional funding, the manager reviews purchasing patterns, supply utilization, waste, and inventory practices. What financial management process is being demonstrated?
What is variance analysis to identify the causes of increased expenses?
A hospital reports fewer pressure injuries after implementing a prevention bundle. However, the quality improvement team finds that nurses document skin assessments more often but do not consistently perform the required interventions. What should the team evaluate before concluding that the initiative is successful?
What are process measures, outcome measures, and the reliability of documentation and data collection?
A nurse receives an order for a medication dose significantly higher than the usual recommended range. The nurse questions the order, but the provider insists it is correct. The nurse administers the medication without further verification, and the client experiences serious harm. What legal principle explains why the nurse may still be held accountable?
What is the nurse's independent duty to practice according to the professional standard of care?
A nurse manager is reviewing a proposed staffing budget. The unit has experienced increased overtime expenses, higher client acuity, and several vacant RN positions. Administration recommends reducing the staffing budget by 10%. What should the nurse manager evaluate before agreeing to the reduction?
What are staffing needs based on client acuity, projected nursing hours, overtime trends, vacancy rates, and the potential impact on client safety and quality outcomes?
A hospital identifies a recurring pattern of medication errors during shift change. The team discovers inconsistent handoff practices, frequent interruptions, and unclear responsibility for time-sensitive medications. Leadership proposes mandatory medication education for all nurses. What would be a more comprehensive quality improvement response?
What does it mean to redesign the handoff and medication administration processes to address communication gaps, interruptions, and accountability, while monitoring outcomes?