Preventing Medical Errors and Promoting Patient Safety, Exams of Advanced Education

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PS101 INTRODUCTION TO PATIENT SAFETY

COMPLETE EXAM LATEST QUESTIONS AND

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Take a guess: How many new drugs does the FDA's Center for Drug Evaluation and Research approve every year? a) 1 to 10 b) 10 to 20 c) more than 20 - ANS c) More than 20 Janet is especially busy because one of her colleagues called out sick, and she needs to collect blood samples for four patients. She collects one sample, and before she gets a chance to label it, another patient in an emergency situation needs her help. She leaves the unlabeled specimen on the nurses' station for a moment. When Janet returns, there is a second unlabeled vial of blood at the nurses' station. She realizes another nurse was obtaining blood samples and was also called away. Neither nurse knows which vial belongs to which patient. What about this scenario seems to make an adverse event likely to occur? (Choose all that apply.) A) Janet is juggling multiple tasks at once. B) There are not enough staff members to keep up with the demands of care. C) Janet was interrupted in the middle of a task with inherent room for error. D) Janet is not trying hard enough at her job. - ANS A) Janet is juggling multiple tasks at once. B) There are not enough staff members to keep up with the demands of care. C) Janet was interrupted in the middle of a task with inherent room for error. A patient is scheduled for surgery on her left leg. Initially, an intern prepares the patient by marking the correct surgical site on the dressing on the leg. The intern's teammate removes the dressing, but addresses the problem by marking the surgical site on the patient's skin. However, he uses a water-soluble marker. The ink becomes smeared and illegible. The attending surgeon is new and not familiar with the hospital's marking procedures. Meanwhile, the nurses helping with the surgery are busy preparing the patient and the operating room. Generally, the

operating room schedule is tight, and everyone is in a hurry to move the surgery forward. What type of adverse event in particular is more likely to occur because of the system failures in this scenario? a) Improper anesthesia dosing b) retained foreign body after surgery c) wrong-site surgery d) none of the above - ANS c) wrong site surgery Safety has been called a "dynamic non-event" because when humans are in a potentially hazardous environment: a) It requires the same kind of thinking that causes problems to set them right b) It takes significant work to ensure nothing bad happens c) There is generally a high prevalence of "near misses" d) It is natural to establish and follow safe practices - ANS b) It takes significant work to ensure nothing bad happens Isadora is a first-year surgery resident on her first pediatric rotation. Her attending (consultant) asks her to immediately start intravenous (IV) replacement fluids on a two-year-old girl who is experiencing vomiting and diarrhea. Isadora has recently learned the guidelines for calculating fluid replacement rates for very small children; however, she confuses them and picks a rate that is too high. To prevent this type of error from recurring in this unit, which of the following is MOST important? a) More severe, well-publicized consequences for providers who are reckless b) an improved culture of safety c) A change to the system, so that it does not rely as heavily on human memory d) clearer medical guidelines for fluid replacement in patients of all ages - ANS c) A change to the system, so that it does not rely as heavily on human memory Approximately what percentage of US adults have experienced a medical error in their own or a family member's care at some point in their life? a) 1% b) 5% c) 33% d) 66% - ANS c) 33%

James is a first-year surgery resident on his first pediatric rotation. His attending (supervising physician) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds, "You're the doctor. It's your job to decide this." James picks a rate that is much too high, putting the child into fluid overload. To prevent this type of error from recurring in this unit, which of the following is MOST important? a) More severe, well-publicized consequences for providers who are reckless b) Closer supervision of residents, especially in the first year c) Improved culture of safety and teamwork d) clear medical guidelines for fluid replacement in patients of all ages - ANS c) An improved culture of safety and teamwork Since the publication of To Err Is Human in 1999, the health care industry overall has seen which of the following improvements? a) Wider recognition that medical errors are most often attributable to individual performance b) a 75% reduction in preventable medical errors c) Stronger repercussions for provides who commit preventable medical errors d) Wider awareness that preventable errors are a problem - ANS d) wider awareness that preventable errors are a problem According to WHO, in developed countries worldwide, what is the approximate likelihood that a hospitalized patient will be harmed while receiving care? a) <1% b) 10% c) 50% d) >75% - ANS b) 10% "Patient safety" means: a) Eliminating errors and adverse effects to patients associated with health care b) Eliminating wast in health care services c) Eliminating health inequities in populations d) all of the above - ANS a) Eliminating errors and adverse effects to patients associated with health care

A brain surgeon was about to perform a difficult procedure on a high-risk patient. Several of the surgical team members had just met for the first time.The surgeon walked into the room and announced, "Good morning, team. This is a difficult case, and I'm human like everyone in this room. Please speak up if you see me about to make a mistake or have a suggestion to help."She then went around the room and introduced herself to everyone by her first name. Is the surgeon showing good leadership? a) Yes b) No - ANS a) Yes For which of the above categories do you think Marx recommended disciplinary action? a) Human error b) At-risk Behavior c) Reckless behavior d) None of the above - ANS c) reckless behavior One hospital CEO insists on including performance data in the hospital's annual report. "We do very well on most measures, except for one or two, but we put those in anyway," she says. "We want to hold ourselves accountable." Does this practice demonstrate effective or ineffective leadership? a) Ineffective leadership: Because results are an important indication of leadership, publicly sharing poor results in an unwise practice. b) Effective leadership: It is good to share results in the annual report, but the leadership would be even more effective if it shared only the strongest results c) Ineffective leadership: Leaders are people who have followers, and sharing poor results might cause the leader to lose some followers d) Effective leadership: Being transparent, even about poor results, is a mark of a good leader - ANS d) Effective leadership: Being transparent, even about poor results, is a mark of a good leader At the large multi-specialty clinic in which you work, there have been two near misses and one medical error because various clinicians did not follow up on patient results. Different caregivers were involved each time. When asked why they failed to follow up, each caregiver said he or she forgot. Based on what you know, how would you classify the caregivers' behavior?

a) Human error b) At-risk behavior c) reckless behavior d) None of the above - ANS a) Human error What is most likely to happen if a health system punishes an individual for an unintended error that was the result of a systems problem? a) Staff may be less likely to talk openly about and learn from errors b) Staff will be more careful and errors will decrease c) The response will weaken the safety culture d) Both staff may be less likely to talk openly about and learn from errors AND the response will weaken the safety culture - ANS d) Both staff may be less likely to talk openly about and learn from errors AND the response will weaken the safety culture At the large multi-specialty clinic in which you work, there have been two near misses and one medical error because various clinicians did not follow up on patient results. Different caregivers were involved each time. After the second near miss, the physician involved was asked to leave the clinic. A nurse who realized that his colleagues weren't consistently following up on patient results reported the problem to the clinic leadership right away. Which response would be most consistent with a culture of safety? a) Investigating the problem and seeking systems solutions b) Placing the item on the agenda for the leadership meeting next year c) Thanking the nurse and asking him to keep quiet about it d) Transferring the nurse to another clinic - ANS a) Investigating the problem and seeking systems solutions A medical unit in a hospital is in the midst of hiring some new physicians. During an orientation for new employees, a senior leader stands up and says, "We expect that the same rules apply to everyone on the unit, regardless of position." Which aspect of a culture of safety does this unit seem to value? a) Psychological safety b) Accountability c) Negotiation d) None of these - ANS b) Accountability

On a hectic day at work, imagine you mistakenly hook up a patient's oxygen supply to compressed room air instead of forced oxygen. You realize and correct the mistake before any harm comes to the patient. Should you report the error? a) Yes b) No - ANS a) Yes You're an administrator at a hospital in a fast-growing suburb. Your hospital has hired three new orthopedic surgeons, including a new chief. These new hires are likely to triple the number of knee replacements done in your hospital. Currently, this procedure is done infrequently, and each time it feels a bit chaotic. As you consider the number of individuals with specialized skills required to execute a safe, effective knee replacement (nurses, surgeons, and anesthesiologists, as well as pre-operative, operating room, and post-operative staff), you realize that this process has the properties of a complex system.A few weeks after the new chief of orthopedic surgery comes on board, she has a moment of inspiration and sketches out a new, radically different way for patients to "flow" through the pre- operative, intra-operative, and post-operative phases. She sends you an email saying that she wants you to meet with her Monday morning to begin implementing it. Which of the following should you keep in mind as your hospital redesigns the way it handles knee replacements? a) Planning by a multidisciplinary team should allow for the development of an excellent, high functioning system on the first try. b) To ensure buy-in, the leader of the design process should be as high up in the organizational hierarchy as possible c) How system components are integrated with one another is an important as how well they function independently d) Planning a new complex system for health care delivery has a little in common with planning an industrial production process - ANS c) How system components are integrated with one another is an important as how well they function independently Which of these is a behavior providers should adopt to improve patient safety? a) Follow written safety protocols, even if they slow you down b) Develop ways to work around broken systems c) Ignore patients' individual preferences when they disagree with "best practice"

d) Obey your superiors without question - ANS a) Follow written safety protocols, even if they slow you down According to Steve Spear, the first step in building a system in which problems are routinely "seen and solved" is: a) Replacing middle managers who are not focused on improvement b) Performing a root cause analysis c) Escalating system-wide problems d) Defining normal and helping workers to recognize abnormality - ANS d) Defining normal and helping workers to recognize abnormality You meet with the nurse administrator responsible for improvement when issues in the process of care are identified by those on the wards. She listens carefully to your concern, but in the end says she can only try to help improve nursing issues, and not those that extend to pharmacy or transport. The primary reason your meeting is unlikely to lead to an adequate solution is: a) No one is identified as responsible for improvement when abnormalities in the process of care and identified b) The nurse administrator did not have the appropriate span of responsibility to engage the system components needed to solve the problem c) The responsible individual belittled the nurse reporting the problem d) Since things have been going along without a serious adverse event for several months, it appears that the current word-around is effective - ANS b) The nurse administrator did not have the appropriate span of responsibility to engage the system components needed to solve the problem The term "normalized deviance" refers to: a) Innovation based on observing positive outliers in a production process b) the increase in distributing song lyrics in modern music c) Acceptance of events that are initially allowed because no catastrophic harm appears to result d) The standard deviation of a variable in a "bell curve" distribution - ANS PPE required to administer medications to a client who is on contact precautions.

• ANS - gloves
• gown

PPE for performing wound irrigation where splashing is expected in the facial area. - ANS - gloves

• gown
• face shield PPE required for transporting a client who is on droplet precautions to the x-ray department - ANS - face mask The six parts of the chain of infection - ANS 1) Infectious agent

2. reservoir
3. portal of exit
4. mode of transmission
5. portal of entry
6. susceptible Type of precautions used on all clients - ANS standard precautions Three Lins of defense in the body - ANS 1) physical and chemical barriers
7. nonspecific immunity
8. specific immunity steps of inflammation - ANS 1. Pattern receptors on cell surfaces recognize harmful stimuli

2. Inflammatory pathways are activated
3. Inflammatory markers are released
4. Inflammatory cells are recruited Expected WBC count - ANS 5,000 to 10,000/mm Medical asepsis (clean technique) - ANS minimizes the presence of disease- causing micro-organisms Type of room needed for a client requiring airborne precautions - ANS airborne infection room (AIIR) also referred to as a negative pressure room PPE needed for a client requiring droplet precautions - ANS Mask

multidrug-resistant organisms (MDROs) - ANS organisms that are resistant to one or more classes of antimicrobial drugs Infection control bundles (care bundles) - ANS Guidelines for practice that are bundled together to help prevent HAIs such as CAUTIs, CLABSIs, VAPs, and SSIs A nurse is assisting with teaching a newly licensed nurse about airborne infection isolation rooms (AIIR). Which of the following information should the nurse include? a) the door to the AIIR should remain closed b) Clients who are on contact precautions require AIIR c) An AIIR has at least 4 air exchanges each hour d) A mask is not needed to care for clients who are in an AIIR - ANS a) the door to the AIIR should remain closed A nurse is assisting with teaching a newly licensed nurse about infection control. The nurse should include in the teaching that which of the following types of precautions requires the use of an N95 mask? a) protective isolation b) contact c) droplet d) airborne - ANS d) airborne A nurse is wearing gloves while caring for a client. In which of the following situations should the nurse obtain a new pair of gloves? a) after donning a gown and before collecting vital signs on the client. b) after removing food items off the client's tray and before removing the soiled linens from the client's bed c) After helping the client stand up and before helping them brush their teeth d) After changing a dressing on the client and before documenting findings on a computer - ANS d) After changing a dressing on the client and before documenting findings on a computer A nurse is planning to admit a client who has respiratory syncytial virus (RSV). Which of the following transmission-based precautions should the nurse plan to implement? a) Protective

b) Contact c) Standard d) Airborne - ANS b) Contact A nurse is assisting with teaching a newly licensed nurse about infectious agents. The nurse should include in the teaching that pertussis is transmitted by which of the following modes of transmission? a) direct contact b) droplet c) Airborne d) Indirect contact - ANS B) droplet A nurse is caring for a client who states, "I am feeling so much better. My fever is gone, and I have a good appetite." The nurse should identify the client is likely in which of the following stages of infection? a) Incubation b) Convalescence c) Acute Infection d) prodromal - ANS b) Convalescence A nurse is performing a throat culture on a client. Which of the following actions should the nurse take? a. swab the back of the clients pharyngeal wall b. place the swab in a clean container after obtaining the culture c. insert the swab in the culture medium within 1 hours of obtaining the sample d. don sterile gloves to obtain the culture from the client - ANS a) swab the back of the client's pharyngeal wall. A nurse is performing hand hygiene after caring for a client who has Clostridium difficile. Which of the following hand hygiene methods should the nurse use? a. alcohol-based sanitizer b. soap and water c. iodine solution d. chlorhexidine solution - ANS b) soap and water

A nurse is supervising a newly licensed nurse perform hand hygiene. Which of the following actions by the newly licensed nurse indicates an understanding of the procedure? a. washes their hands for 10 seconds b. turns off the faucet with a towel c. uses hot water to wash their hands d. holds their hands above their elbows while rinsing off the soap - ANS b. turns off the faucet with a towel A nurse is assisting with teaching a newly licensed nurse about hand hygiene for surgical asepsis. Which of the following instructions should the nurse include? a. use a brush to scrub the surface of the hands b. rinse the solution from the hands before it dries c. apply chlorhexidine and ethanol to the hands d. leave jewelry on the hands when cleansing them - ANS c. apply chlorhexidine and ethanol to the hands A nurse is assisting with teaching about personal protective equipment with a newly licensed nurse. Which of the following instructions should the nurse include? a. gowns can be reused on the same client b. masks should be removed after leaving a client's room c. gloves should be removed from the inside out d. eyeglasses can be used in place of goggles - ANS c. gloves should be removed from the inside out A nurse is assisting with teaching a newly licensed nurse about removing personal protective equipment (PPE). Which of the following items should the nurse instruct to remove first? a. mask b. gloves c. goggles d. face shield - ANS b. gloves A nurse is assisting with teaching a group of nurses on processes that can trigger an inflammatory response in the body. The nurse should include that which of the following is an infectious trigger?

a. burn b. frostbite c. bacteria d. radiation - ANS c. bacteria A nurse is admitting a client who has vancomycin-resistant enterococcus (VRE) of the urine. The nurse should place the client on which of the following precautions? a. protective b. contact c. droplet d. airborne - ANS b. contact A nurse in a clinic is caring for a client who reports generalized aches and fever for the past 12 hr. The nurse suspects the client has acquired an infection. Which of the following stages of infection is the client likely experiencing? a. incubation b. convalescence c. acute illness d. prodromal - ANS d. prodromal A nurse is setting up a sterile field to perform a dressing change on a client. Which of the following actions should the nurse take? a. open the first flap on the sterile package away from their body b. place objects on the sterile field at least 1.3cm (0.5in) from the edge c. unwrap both sides of the sterile package at the same time d. set up the sterile field next to a wall in the clients room - ANS a. open the first flap on the sterile package away from their body A nurse is assisting in providing an in-service about infectious agents to a group of nurses. The nurse should include in the teaching that tuberculosis is transmitted by which of the following modes of transmission? a. airborne b. droplet c. direct contact d. indirect contact - ANS a. airborne

A nurse is caring for a client who acquired an infection after touching a faucet that an infected person had touched. Which of the following links in the chain of infection does the faucet represent? a. reservoir b. susceptible host c. portal of entry d. portal of exit - ANS a. reservoir A nurse is caring for a client who has acquired an infection from a visitor. The client is an example of which of the following links in the chain of infection? a. reservoir b. susceptible host c. portal of entry d. portal of exit - ANS b. susceptible host A nurse is assisting with teaching a newly licensed nurse about surgical asepsis. Which of the following statements should the nurse make? a. "you can wear artificial fingernails if they are kept short" b. "leave rings on your fingers when performing surgical hand sepsis" c. "keep your fingernails less than half an inch in length" d. "remove nail polish on your fingernails if it is chipped" - ANS d. "remove nail polish on your fingernails if it is chipped" A nurse is caring for a client who is on contact precautions. Which of the following actions should the nurse take? a. wear an N95 respirator when caring for the client b. place the client in a private room c. place a mask on the client when they leave their room d. place the client in a negative airflow room - ANS b. place the client in a private room A nurse is caring for a client who has influenza. The client asks how they acquired the infectious agent. The nurse should inform the client that influenza is transmitted by which of the following modes? a. droplet b. indirect contact c. airborne

d. direct contact - ANS a. droplet A nurse is assisting with teaching a newly licensed nurse about laboratory tests that can indicate generalized inflammation. The nurse should include which of the following laboratory tests? a. c-reactive protein b. troponin c. creatine kinase d. lactic acid - ANS a. c-reactive protein A nurse is assisting with teaching a newly licensed nurse about needlestick injuries. Which of the following instructions should the nurse include? a. empty sharps containers when they become full b. report needlestick injuries to the nursing supervisor c. engage the safety device on a needle after documenting the medication administration d. recap needles after the medication administration - ANS b. report needlestick injuries to the nursing supervisor A nurse is assisting with implementing an infection control bundle for clients at risk for catheter-associated urinary tract infections (CAUTIs). Which of the following interventions should the nurse include in the bundle? a. try to use alternatives before inserting indwelling urinary catheters b. use clean technique for insertion of indwelling urinary catheters c. check client every 2 days to evaluate the need for indwelling catheters d. disconnect the system to obtain urine samples from indwelling urinary catheters - ANS a. try to use alternatives before inserting indwelling urinary catheters