7Th_ED Test Bank Contemporary Nursing_Issues_Trends & Management by Barbara Cherry_Susan R.Jacob

7Th_ED Test Bank Contemporary Nursing_Issues_Trends & Management by Barbara Cherry_Susan R.Jacob



Contemporary Nursing, Issues, Trends & Management Test-Bank 5 ed by Barbara Cherry, Susan R.Jacob


Authors: Barbara Cherry, Susan R.Jacob

Edition: 7th

Product Description

7Th_ED Test Bank Contemporary Nursing_Issues_Trends & Management by Barbara Cherry_Susan R.Jacob

Chapter 21: Quality Improvement and Patient Safety

Test Bank


1.A 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.


Correct: A top-down flowchart shows the sequence of steps in a job or process such as medication administration.


a. 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. 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. A control plot is a run chart that has a center-line and added statistical control limits; it helps reveal specific types of change within a process, rather than providing a sequencing of steps.

DIF:ApplicationREF:p. 375 | p. 382

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.


Correct: 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. The Institute for Safe Medication Practices is a nonprofit organization that is an educational resource only for the prevention of medication errors.

c. The National Committee for Quality Assurance is the accrediting body for health maintenance organizations.

d. The Joint Commission is a national agency that conducts surveys and certifies compliance with established standards for inpatient and ambulatory facilities.

DIF: Comprehension REF: p. 376

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.


Correct: A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay.


a. 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. 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. Causal factors are the underlying causes of the event, not the actual event.

DIF: Application REF: p. 376

4.A nurse is assisting with the delivery of twins. 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.


Correct: 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 future occurrences.


a. 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. Process variation looks at the steps in a process to determine how variation affects each step but does not identify causal events.

d. 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:ApplicationREF:p. 376 | p. 388

5.Each month data on admission assessments that are based on the following standard are entered: “All patients will be assessed by an RN within 2 hours of admission.” The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is a:

a. Pareto chart.

b. control chart.

c. deployment chart.

d. top-down flowchart.


Correct: The control chart is a run chart that has a center-line and added statistical control limits that help to detect specific types of change needed to improve a process.


a. The Pareto chart is used in quality improvement to identify 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.

c. A deployment flowchart shows the detailed steps involved in a process and the people or departments that are involved at each step.

d. A top-down flowchart shows the sequence of steps in a job or process such as medication administration at a particular site, but it does not show variation limits.

DIF:ApplicationREF:p. 376 | p. 384

6.Regardless of the term used to describe high-quality health care, the focus of quality is:

a. what the consumer needs and wants.

b. economical care.

c. having the greatest technologic advancement.

d. services equally distributed among populations.


Correct: The customer determines quality on the basis of his or her unique perception of high-quality care.


b. High-quality health care can be inexpensive, but if it does not meet the criteria established by the consumer, then it is not high-quality health care.

c. Although technologic advancements may indeed facilitate superior diagnostics, unless the patient perceives that the technology was an indicator of quality or that it improved quality, then it is not the focus.

d. The perception of quality is unique among individuals.

DIF: Knowledge REF: p. 379

7.In differentiating between early efforts of quality assurance and present-day quality improvement efforts, which statement is correct? Quality assurance:

a. had a broad focus.

b. promoted problem-solving by all members of the health care team.

c. was preventive in nature.

d. tended to occur as a reaction to a specific problem.


Correct: Early efforts focused on identified problems and were reactive rather than proactive.


a. Quality assurance focused on specific incidents rather than on broad system improvements.

b. With quality assurance, only a few people such as auditors focused on problems, and administration only later recognized the importance of proactive initiatives involving all members of the health care team.

c. Early efforts of quality assurance focused on identified problems rather than on avoiding future problems.

DIF: Application REF: p. 380

8.An organization’s emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to as a:

a. Pareto chart.

b. control chart.

c. top-down flowchart.

d. deployment chart.


Correct: A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety.


a. The Pareto chart displays data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.

b. A control chart distinguishes between common and special cause variations and is basically a run chart with added statistical control limits.

c. The top-down flowchart simply lists the main steps and substeps of a process in a linear fashion and does not detail the departments or people needed.

DIF:ApplicationREF:p. 375 | p. 382

9.Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of “road map” that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to as a(n):

a. benchmark.

b. critical pathway.

c. algorithm.

d. case management.


Correct: A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis.


a. A benchmark is a process used in quality improvement to evaluate different aspects of a process in relation to best practices, with the goal of improving performance.

c. An algorithm represents a decision path that a practitioner might take for a particular condition.

d. Case management is a type of health care delivery that matches the most appropriate services to the patient’s care needs in the most efficient, effective manner, often with the use of a critical pathway or a clinical guideline.

DIF: Knowledge REF: p. 385

10.The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph?

a. Time plot

b. Pareto chart

c. Flowchart

d. Cause-and-effect diagram


Correct: A run plot, or time plot, graphs data in time order to identify any changes that occur over time.


b. A Pareto chart is used in quality improvement to display data so that a few problems that cause the greatest variance are easily depicted and facilitates improvement that focuses on those few.

c. A flowchart provides pictures of the sequence of steps in a process.

d. A cause-and-effect diagram lists potential causes, arranged by categories, to show their potential impact on a problem. It is not arranged by time.

DIF:ApplicationREF:p. 376 | p. 384

11.A group of nurses is presenting the importance of high-quality care during a systemwide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that:

a. being insured has little effect on a person’s longevity and the quality of care received.

b. lobbyists for the drug companies are able to gain permission for the use of new drugs within 1 year of their discovery.

c. although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS).

d. medication-related errors place a tremendous financial burden on the U.S. health care system.


Correct: Medication-related errors for hospitalized patients cost roughly $2 billion annually.


a. Uninsured Americans exhibit consistently worse clinical outcomes than the insured, and they are at increased risk for dying prematurely.

b. The lag between the discovery of more effective forms of treatment and their incorporation into routine patient care averages 17 years.

c. Medical errors kill more people per year than breast cancer, AIDS, or motor vehicle accidents.

DIF: Comprehension REF: p. 378

12.According to the Quality Chasm report:

a. health care providers should be proactive rather than reactive to patient needs.

b. common needs rather than individual preferences should be the priority.

c. medical information should be confined to the primary care provider.

d. specialized providers or case managers should control health care decisions.


Correct: Quality is based on predicting patient needs rather than reacting to needs.


b. Care that is based on individual needs and preferences predicts satisfaction with care.

c. Providers and the patient should have access to information so they can make well-informed decisions.

d. The patient, not the providers/managers, should have control over health care decision-making.

DIF: Comprehension REF: p. 379

13.During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter’s wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation?

a. Failure to take time to put on shoes due to urgency

b. Unsteady gait due to narcotic administration

c. Poor lighting that led to decreased vision

d. Improper construction that caused the leak and towel placement


Correct: A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.


a. Urinary urgency is not an uncommon or unpredictable variation.

b. Safety measures should be instituted when a narcotic is administered, especially to older adult patients whose ability to metabolize and eliminate the drug may be altered.

c. Lighting was available, but it was not used.

DIF: Application REF: p. 379

14.The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is a:

a. cause-and-effect diagram.

b. run chart.

c. Pareto chart.

d. flowchart.


Correct: Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized.


a. With the cause-and-effect diagram, all causes are listed but not in frequency of occurrence.

b. Run charts show data over time.

d. Flowcharts show steps in a process.

DIF: Application REF: pp. 383-384

15.The surgical team arrives in the operating room and one member states, “Everyone stop. Let’s identify the patient and operative site. Now does anyone have any questions or concerns?” This process is known as:

a. time-out.

b. a critical pathway.

c. special cause variation.

d. lean methodology.


Correct: A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure.


b. A critical pathway defines the optimal sequencing and timing of interventions by physicians, nurses, and other interprofessional team members when providing care for a patient with a particular diagnosis or procedure.

c. Special cause variation is a deviation that is unstable, unpredictable, and not in statistical control.

d. Lean methodology is a system that focuses on reducing waste, synchronizing workflows, and managing variability in production flows.

DIF: Application REF: p. 389

16.Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as “PDCA.” When explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism, the instructor states:

a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization.

b. D stand for deviation, which is an alteration in the expected drugs ordered.

c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process.

d. A stands for algorithm, which includes all steps of the process.


Correct: C stands for check if the change improved the process and what was learned.


a. P stands for plan. The process is determined.

b. D stands for do, or implement.

d. A stands for act to standardized quality processes.

DIF: Analysis REF: p. 387


A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation?

a. Run chart

b. Pareto chart

c. Flowcharts

d. Cause and effect diagrams


Correct: Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority.


a. Run charts help identify any changes that occur over time; also called a time plot.

c. Flowcharts reflect on a problem.

d. Cause and effect diagrams list all possible causes of an error or sentinel event.

DIF:ApplicationREF:p. 389 | pp. 383-384

18.A nurse is asked to “float” to a telemetry floor and is to place a patient on telemetry monitor. The nurse is unfamiliar with placement of EKG leads and would consult which type of chart to learn the correct placement?






Correct: The Pareto chart is used to prioritize interventions that caused the majority of the problems.


a. Time plots trend data over time.

b. Time plots trend data over time.

d. The cause and effect diagram lists possible causes of the problem.

DIF:ApplicationREF:p. 375 | p. 382


1.A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2012 National Patient Safety Goals by implementing which protocols? (Select all that apply.)

a. The surgical team asks the patient to verify his/her name, type of surgery, and limb to be removed.

b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family.

c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient.

d. Mark the procedure site with “X” and again ask the patient to verify correct site.

e. After arrival in the operating room, perform a “time-out” for final identification of patient and operative site along with agreement of what procedure is scheduled.

ANS: A, C, D, E

Correct: The 2012 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required.


b. The health care providers do not provide copies of license and certification to patient or family: verification is the responsibility of the employing agency.

DIF:ApplicationREF:p. 389; Box 21-3

2.An interdisciplinary team is evaluating the hospital’s care of patients admitted with a myocardial infarction (heart attack) compared to national standards. The team analyzes the hospital’s clinical indicator, which would be: (Select all that apply.)

a. aspirin order within 24 hours of discharge.

b. patient teaching related to stopping smoking completed prior to discharge.

c. beta blocker administered upon arrival.

d. support of employer to modify stress in workplace.

e. patient’s willingness to adhere to a strict cardiac diet after discharge.

ANS: A, B, C

Correct: Clinical indicators are measurable items that reflect the quality of care provided and demonstrate the degree to which desired clinical outcomes are accomplished. National benchmarks are established according to guidelines related to quality care for patients admitted with heart attack and include: aspirin within 24 hours of admission, Angiotensin receptor blocker at discharge, stop smoking instruction given, and beta blocker administered upon arrival and discharge. These are all measurable.


d. It is not possible to measure the support of the employer to modify stress.

e. The patient may adhere to the cardiac diet while hospitalized but postdischarge behavior is not measurable and does not reflect on the quality of care provided in hospital.

DIF:ApplicationREF:p. 375 | p. 382

3.A nurse educator is explaining the differences in early efforts at quality improvement for health care compared to today’s quality assurance efforts. She asks participants to move items that related to quality assurance to a list on the right leaving items related to quality improvement on the left. Which items would be moved to the right under “Quality Assurance”? (Select all that apply.)

Quality Improvement                        Quality Assurance

a. Inspection oriented (detection)

b. Leadership: actively leading quality efforts

c. Problem solving by authority

d. Correction of common causes

e. Responsibility of few people


Correct: Leadership: actively leading quality efforts and Correction of common causes would be listed under Quality Assurance.

Incorrect: Inspection oriented (detection), Problem solving by authority, and Responsibility of few people describe quality improvement efforts.

DIF:ComprehensionREF:p. 381; Box 12-1


1.Quality is defined by the ____________.



Quality is based on the perspective of the consumer or, in this instance, the patient.

DIF: Knowledge REF: p. 379



A group of nurses brainstorm about why patients are not being discharged by 2 PM. Failure to discharge on time has led to decreased patient satisfaction, physician complaints, and a backlog of patients in the emergency department awaiting a hospital bed. The nurses list possible causes of delayed charges on the graph above. The nurses utilized which quality improvement tool?


Cause-and-effect diagram

A cause-and-effect diagram is a quality improvement tool used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fish-bone diagram because it looks like the skeleton of a fish.

DIF:ApplicationREF:p. 375 | p. 384



7Th_ED Test Bank Contemporary Nursing_Issues_Trends & Management by Barbara Cherry_Susan R.Jacob