Quality & Safety
A nurse is reviewing a patient's chart and notices that a medication error occurred, but it did not result in any harm to the patient. According to the classification of safety events, how should this error be categorized?
A) Adverse event
B) Sentinel event
C) Near miss
D) Error of commission
Answer: C
Rationale: A near miss is an event that could have resulted in harm but did not reach the patient. In this case, the medication error did not harm the patient, making it a near miss. An adverse event results in harm to the patient. A sentinel event is a serious event that results in death or serious injury. An error of commission is a type of error, not a classification of a safety event
A nurse is caring for a patient who has limited English proficiency. Which action best demonstrates the nurse's commitment to reducing health disparities?
A) Speaking loudly and slowly to the patient.
B) Using hand gestures and pointing to objects when communicating.
C) Providing written materials in the hospital's standard language.
D) Arranging for a qualified interpreter to assist with communication.
Answer: D
Rationale: Language barriers are a significant avoidable and unacceptable health disparity. Arranging for a qualified interpreter is the most effective way to ensure accurate communication and reduce this disparity. Options A, B, and C do not address the complexity of language differences and may lead to misunderstandings or inaccurate information exchange.
A nurse is teaching a patient about type 1 diabetes mellitus. Which statement by the patient indicates a correct understanding of the disease process?
A) "In type 1 diabetes, my body is resistant to the insulin I produce."
B) "I will need to take oral medication to manage my blood sugar."
C) "Type 1 diabetes is caused by the destruction of the beta cells in my pancreas."
D) "I can control my blood sugar with diet and exercise alone."
Answer: C
Rationale:
A nurse is using a computerized system to enter patient data. Which of the following actions demonstrates the nurse is maintaining patient privacy and security?
A. Sharing their computer password with a colleague to expedite data entry.
B. Leaving the computer unattended after logging in to quickly assist another patient.
C. Ensuring they log off the computer when they are finished.
D. Discussing patient information in the hallway while entering data on a mobile device.
Answer: C
Rationale: Maintaining patient privacy and security is a critical aspect of informatics. Logging off the computer when finished ensures that unauthorized personnel cannot access patient information. Sharing passwords (A) and leaving the computer unattended (B) are direct violations of security protocols. Discussing patient information in public areas (D) breaches confidentiality.
A nurse is assessing an elderly patient's skin and notices it is very dry and flaky. The patient reports frequent itching. Which of the following conditions is the patient most likely experiencing?
A) Eczema
B) Psoriasis
C) Xerosis (dry skin)
D) Cellulitis
Answer: C
Rationale: Xerosis is the medical term for excessively dry skin, common in the elderly, and is frequently associated with pruritus (itching). Eczema and psoriasis are distinct dermatologic conditions, and cellulitis is a skin infection
The Donabedian model is used to assess health care quality. Which of the following is a component of this model?
A) Health policy
B) Process
C) Safety
D) Technology & Informatic
Answer: B
Rationale: The Donabedian model includes structure, process, and outcomes. Health policy, safety, and technology & informatics are interrelated concepts but not direct components of the Donabedian model.
A community health nurse is developing a program to address health disparities in a local neighborhood. Which factor should the nurse prioritize as a key social determinant of health?
A) The patient's age
B) The patient's genetic predisposition to disease
C) The availability of healthy food options in the neighborhood
D) The patient's personal health choices
Answer: C
Rationale: Social determinants of health are conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. The availability of healthy food options directly relates to the environment and has a significant impact on health outcomes. While age and genetics can influence health, they are not social determinants. Personal health choices are important but are influenced by social determinants.
The nurse is assessing a patient with a history of hypothyroidism. Which of the following findings is consistent with this condition?
A) Increased appetite and weight loss
B) Heat intolerance and tachycardia
C) Constipation and fatigue
D) Increased libido and insomnia
Answer: C
Rationale:
A healthcare facility is implementing a new Electronic Health Record (EHR) system. Which of the following is a benefit of using an EHR?
A. It decreases the portability of patient information.
B. It may help to lower costs.
C. It hinders communication between healthcare providers.
D. It reduces the need for secure communication and connectivity.
Answer: B
Rationale: EHRs are intended to improve quality of care, lower costs, and facilitate research. They also enhance the portability of patient information and improve communication between providers. Secure communication and connectivity are essential components of EHR systems.
When assessing a patient for skin turgor, which location is most appropriate to obtain an accurate finding?
A) Forearm
B) Abdomen
C) Clavicle area
D) Dorsal surface of the hand
Answer: C
Rationale: The clavicle area is the preferred site for assessing skin turgor. The abdomen is not ideal due to potential variations in adipose tissue, and the dorsal hand may not provide as accurate a representation of overall hydration status.
A hospital is implementing a new quality improvement initiative focused on reducing errors. Which of the following strategies would be most effective in preventing errors according to the concept of a "Just Culture"?
A) Punishing individuals who make errors to deter future mistakes.
B) Implementing stricter rules and protocols to minimize deviations.
C) Encouraging staff to report errors without fear of reprisal.
D) Focusing solely on identifying and replacing error-prone individuals.
Answer: C
Rationale: A "Just Culture" emphasizes learning from mistakes and encourages reporting errors without punishment. This approach helps to identify system failures and improve overall safety. Punitive measures, rigid rules, and focusing on individual blame are counterproductive to creating a safe environment.
A nurse is assessing a patient with cardiovascular disease. Which factors in the patient's history would the nurse identify as potential avoidable health disparities? (Select all that apply)
A) The patient is 65 years old.
B) The patient lacks health insurance.
C) The patient has a family history of heart disease.
D) The patient reports difficulty accessing transportation to medical appointments.
Answer: B, D
Rationale: Avoidable health disparities are those that could be mitigated with appropriate interventions. Lack of health insurance and lack of transportation are systemic issues that create barriers to healthcare access and are considered avoidable. Age and family history of heart disease are unavoidable factors.
A patient with type 2 diabetes is scheduled for a follow-up appointment. The nurse reviews the patient's most recent lab results. Which result would indicate the need for further intervention?
A) Fasting blood glucose of 95 mg/dL
B) Hemoglobin A1c of 6.0%
C) Post-prandial blood glucose of 150 mg/dL
D) Presence of microalbuminuria
Answer: D
Rationale:
A nurse is evaluating the reliability of a source for evidence-based practice. Which questions should the nurse consider?
A. “When was this article published?”
B. “What are the author’s credentials?”
C. “Does the author cite reliable sources?”
D. “What is the purpose of this article?”
Answer: C
Rationale: When evaluating the reliability of a source, it is important to consider if the author cites reliable sources. Currency, authority, accuracy and purpose are all part of the CRAAP test for evaluating sources.
A patient has a wound on their lower leg that is 3 cm long, 2 cm wide, and 0.5 cm deep. The wound bed is red, and there is a moderate amount of thick, yellow drainage. Which of the following should the nurse document?
A) Wound dimensions, color of wound bed, and type of exudate.
B) Wound dimensions only.
C) Wound depth and presence of tunneling.
D) Wound color and presence of slough.
Answer: A
Rationale: Accurate wound assessment includes documenting the wound's dimensions (length, width, and depth), the color of the wound bed, and the characteristics of any exudate (drainage). The yellow drainage suggests purulent exudate.
Which of the following are examples of "latent errors" in the healthcare setting? (Select all that apply)
A) A nurse administers the wrong medication due to misreading the prescription.
B) A surgeon operates on the wrong patient.
C) Inadequate staffing levels contribute to increased patient falls.
D) Lack of standardized procedures for equipment maintenance leads to malfunctions.
Answer: C, D
Rationale: Latent errors are organizational or system-level errors that create conditions for active errors to occur. Inadequate staffing and lack of standardized procedures are examples of latent errors. Administering the wrong medication and operating on the wrong patient are active errors, which occur at the point of care.
Which of the following factors are considered unacceptable health disparities that nurses should work to address? (Select all that apply)
A) Lack of access to essential health services
B) Health-damaging behavior that is freely chosen
C) Biased clinical decision-making by healthcare providers
D) Exposure to unhealthy living and working conditions
Answer: A, C, D
Rationale: Unacceptable health disparities are those deemed unfair and unjust. Lack of access to health services, biased clinical decision-making, and unhealthy living/working conditions are considered unacceptable disparities. Health-damaging behavior that is freely chosen, while potentially detrimental to health, is a more complex issue involving individual choice
The nurse is teaching a patient about lifestyle modifications to manage their risk for impaired glucose regulation. Which of the following should be included in the teaching? (Select all that apply)
A) Maintain a sedentary lifestyle
B) Consume a balanced diet
C) Engage in regular physical activity
D) Manage stress effectively
Answer: B, C, and D
Rationale:
Which of the following are appropriate nursing actions to protect patient information according to HIPAA guidelines? (Select all that apply)
A. Sharing your computer password with a trusted colleague when they need to access patient data.
B. Discarding printed patient worksheets in a general wastebasket.
C. Avoiding taking pictures of patients or patient information on personal devices.
D. Accessing the records of patients who are not under your direct care to learn more about their conditions.
Answer: C
Rationale: HIPAA sets rules and limits on who can access a patient's records and gives patients the right to view their own records. Nurses should not share passwords, should shred documents with patient information, and should not take pictures of patients or patient information on personal devices. Accessing records of patients not under your care is a breach of confidentiality.
A nurse is teaching a group of caregivers about preventing pressure ulcers in bedridden patients. Which of the following interventions should the nurse include in the teaching? (Select all that apply)
A) Turn the patient every 4 hours.
B) Encourage the patient to sit in a chair for meals.
C) Apply barrier cream after episodes of incontinence.
D) Massage bony prominences to increase circulation.
Answer: B, C
Rationale:
Which of the following factors contribute to a high-reliability organization (HRO)? (Select all that apply)
A) Emphasis on individual blame for errors.
B) Focus on predicting and preventing errors.
C) Decentralization of decision-making.
D) Culture of safety that encourages reporting errors.
Answer: B, D
Rationale: High-reliability organizations are characterized by their ability to consistently avoid errors. They focus on preventing errors and foster a culture of safety where errors are reported and analyzed to improve the system. Emphasis on individual blame is the opposite of HRO principles. Decentralization may or may not be a feature, but the key is the focus on prevention and safety culture.
A nurse is participating in a community health fair. Which activities promote health equity and address health disparities? (Select all that apply)
A) Providing health education materials only in English.
B) Offering free blood pressure screenings.
C) Advocating for policies that improve access to affordable housing.
D) Conducting culturally sensitive assessments of community members' needs.
Answer: B, C, D
Rationale: Health equity is the ability to recognize differences in resources and knowledge needed for individuals to fully participate in healthcare and achieve optimal outcomes. Offering free screenings increases access, advocating for affordable housing addresses social determinants of health, and conducting culturally sensitive assessments ensures that care is tailored to diverse needs. Providing materials only in English creates a language barrier and exacerbates health disparities.
A patient is admitted with hyperthyroidism. Which of the following clinical manifestations would the nurse expect to observe? (Select all that apply)
A) Weight gain
B) Bradycardia
C) Heat intolerance
D) Exophthalmos *Buldging eyes*
Answer: C and D
A nurse is participating in an evidence-based practice project. Which of the following steps are essential to this process? (Select all that apply)
A. Formulating a PICOT question.
B. Searching for the best evidence.
C. Integrating the evidence with clinical expertise and patient preferences.
D. Relying solely on personal clinical experience to make decisions.
Answer: A, B, C
Rationale: The steps of evidence-based practice include formulating a PICOT question, searching for the best evidence, and integrating the evidence with clinical expertise and patient preferences. Relying solely on personal clinical experience does not incorporate evidence-based practice principles.
The nurse is assessing a patient who has a large, deep wound. Which of the following findings would the nurse document as a normal finding? (Select all that apply)
A) Wound edges approximated
B) Presence of tunneling
C) Wound size decreasing
D) Serous drainage
Answer: A, C, D
Rationale: