1.

The concept of "patient safety" applies most

appropriately to

a. environmental safety measures.

b. serious patient injuries.

c. patient complaint management.

d. risk prevention.
1. The concept of "patient safety" applies most
appropriately to

a. environmental safety measures.

b. serious patient injuries.

c. patient complaint management.

d. risk prevention.
2. Nurses and pharmacists are encouraged to report
medication errors upon first knowledge of
occurrence. What is the most important thing the
organization can do to support them in this effort?

a. Instill a culture of accountability.

b. Instill a culture of no blame.

c. Provide computerized physician order entry.

d. Provide adequate nurse staffing.

2. Nurses and pharmacists are encouraged to report
medication errors upon first knowledge of
occurrence. What is the most important thing the
organization can do to support them in this effort?

a. Instill a culture of accountability.

b. Instill a culture of no blame.

c. Provide computerized physician order entry.

d. Provide adequate nurse staffing.

3. An organization has achieved a culture of patient
safety when
a. fear of reprisals for reporting incidents has been
eliminated.
b. its patient safety goals have been implemented.
c. patient safety training of employees has
completed.
d. reports of incidents and near misses have
decreased.
3. An organization has achieved a culture of patient
safety when
a. fear of reprisals for reporting incidents has been
eliminated.
b. its patient safety goals have been implemented.
c. patient safety training of employees has
completed.
d. reports of incidents and near misses have
decreased.
4. An organization has established a culture of
patient safety when

a. Reports of potential errors have decreased

b. Patient safety goals are implemented

c. Employee education is completed

d. Fear of retaliation is eliminated

4. An organization has established a culture of
patient safety when

a. Reports of potential errors have decreased

b. Patient safety goals are implemented

c. Employee education is completed

d. Fear of retaliation is eliminated

5. Root cause analysis is the most appropriate PI
process for

a. determining costs/benefits.

b. evaluating dental care.

c. analyzing sentinel events.

d. performing peer review.

5. Root cause analysis is the most appropriate PI
process for

a. determining costs/benefits.

b. evaluating dental care.

c. analyzing sentinel events.

d. performing peer review.

6. If a problem arises involving patient care
management, the first step is to
a. decide how to prevent a recurrence.
b. collect as much data as possible from those
involved in the care.
c. distinguish the motives and intentions of all
parties.
d. resolve the immediate problem.
6. If a problem arises involving patient care
management, the first step is to
a. decide how to prevent a recurrence.
b. collect as much data as possible from those
involved in the care.
c. distinguish the motives and intentions of all
parties.
d. resolve the immediate problem
7. In a cost-benefit analysis of a bar-code medication
administration system, implemented as part of a
patient safety program, which of the following would be
the best indicator of success:
a. A decrease in adverse drug events from dispensing
errors.
b. A decrease in adverse drug events from
administering errors.
c. A decrease in total medication errors.
d. A decrease in total adverse drug events.
 Bar-code Medication Administration
(BCMA)
• BCMA is a barcode system
designed to prevent medication
errors in medication
administration.

• It consists of a barcode reader, a

computer with wireless
connection, a computer server,
and some software.
7. In a cost-benefit analysis of a bar-code medication
administration system, implemented as part of a
patient safety program, which of the following would be
the best indicator of success:
a. A decrease in adverse drug events from dispensing
errors.
b. A decrease in adverse drug events from
administering errors.
c. A decrease in total medication errors.
d. A decrease in total adverse drug events.
8. Red Rules are few and are different from
organizational policy and procedures, even
crucial ones. An example of a Red Rule is:
a) Administer aspirin for all acute myocardial
infarctions
b) Time out before an invasive procedure
c) Weekly Executive WalkRounds
d) Establish Joint Commission readiness plan
 Red Rules Examples
• "No hospitalized patient can
undergo a test of any kind,
receive a medication or blood
product, or undergo a procedure
if they are not wearing an
identification bracelet.“

• Time Out.
8. Red Rules are few and are different from
organizational policy and procedures, even
crucial ones. An example of a Red Rule is:
a) Administer aspirin for all acute myocardial
infarctions.
b) Time out before an invasive procedure.
c) Weekly Executive WalkRounds.
d) Establish Joint Commission readiness plan.
9. A Failure Mode and Effects Analysis (FMEA) is
performed
a. to immediately investigate an incident that
occurred.
b. as a preventative measure before an incident
occurs.
c. if the severity of an incident led to a patient
death.
d. when there is a chance of an incident reoccurring.
9. A Failure Mode and Effects Analysis (FMEA) is
performed
a. to immediately investigate an incident that
occurred.
b. as a preventative measure before an incident
occurs.
c. if the severity of an incident led to a patient
death.
d. when there is a chance of an incident reoccurring.
10. Failure mode and effects analysis (FMEA) is
what type of review or improvement tool?

a. Concurrent

b. Focused

c. Prospective

d. Retrospective
10. Failure mode and effects analysis (FMEA) is
what type of review or improvement tool?

a. Concurrent

b. Focused

c. Prospective

d. Retrospective
11. Patient safety is promoted in an organization
through
a. encouragement of error reporting, staff education,
and reliable systems.
b. reliable systems, open communication, and
performance reviews.
c. performance reviews, encouragement of error
reporting, and willingness to pay overtime.
d. willingness to pay overtime, open communication,
and staff education.
11. Patient safety is promoted in an organization
through
a. encouragement of error reporting, staff education,
and reliable systems.
b. reliable systems, open communication, and
performance reviews.
c. performance reviews, encouragement of error
reporting, and willingness to pay overtime.
d. willingness to pay overtime, open communication,
and staff education.
12. Most commonly the primary purpose for
incident/occurrence reporting is to

a. record infection rates.

b. identify medication errors.

c. identify adverse patient events.

d. identify patient grievances.

12. Most commonly the primary purpose for
incident/occurrence reporting is to

a. record infection rates.

b. identify medication errors.

c. identify adverse patient events.

d. identify patient grievances.

13. Concerning the surgical "time-out", which of the
following statements is FALSE?
a. The surgical "time-out" reduces the risk of wrong-site
surgery.
b. The surgical "time-out" reduces the risk of
preventable surgical mistakes
c. The surgical "time-out" is a component of the World
Health Organization (WHO) Safe Surgery Checklist.
d. The surgical "time-out" requires involvement of the
patient.
13. Concerning the surgical "time-out", which of the
following statements is FALSE?
a. The surgical "time-out" reduces the risk of wrong-site
surgery.
b. The surgical "time-out" reduces the risk of
preventable surgical mistakes
c. The surgical "time-out" is a component of the World
Health Organization (WHO) Safe Surgery Checklist.
d. The surgical "time-out" requires involvement of the
patient.
14. A patient in an acute psychiatric unit
committed suicide by hanging himself with his
shoelaces. To prevent this from occurring again,
the most appropriate action is to institute
a. patient checks every 15 minutes.
b. a policy allowing only non-laced shoes.
c. a 24-hour video monitoring system.
d. a buddy system for the patients.
14. A patient in an acute psychiatric unit
committed suicide by hanging himself with his
shoelaces. To prevent this from occurring again,
the most appropriate action is to institute
a. patient checks every 15 minutes.
b. a policy allowing only non-laced shoes.
c. a 24-hour video monitoring system.
d. a buddy system for the patients.
15. A team has been tasked with developing a program
to prevent patient falls. Which of the following data
elements from an incident/occurrence report provides
the most useful information for the team when
evaluating the program's success?
a. patient demographics
b. record of the time of the fall
c. documentation of nursing assessment
d. staffing ratio at the time of the fall
15. A team has been tasked with developing a program
to prevent patient falls. Which of the following data
elements from an incident/occurrence report provides
the most useful information for the team when
evaluating the program's success?
a. patient demographics
b. record of the time of the fall
c. documentation of nursing assessment
d. staffing ratio at the time of the fall
16. Which of the following National Patient
Safety Goals is applicable to everyone in a
healthcare facility?

a. Communication

b. Medication Safety

c. Healthcare-related Associated Infections

d. Prevention of fall.
16. Which of the following National Patient
Safety Goals is applicable to everyone in a
healthcare facility?

a. Communication

b. Medication Safety

c. Healthcare-related Associated Infections

d. Prevention of fall.
17. Which of the following patient safety goals
is applicable to everyone in a healthcare
facility?

a. hand-off communication

b. medication safety

c. hand hygiene

d. prevention of falls
17. Which of the following patient safety goals
is applicable to everyone in a healthcare
facility?

a. hand-off communication

b. medication safety

c. hand hygiene

d. prevention of falls
18. Which of the following is an example of a
"never event" or sentinel event?

a. missed dose of an antibiotic

b. patient fall that results in a bruised tailbone

c. fever of 101.2 °F after a blood transfusion

d. patient suicide in the psychiatric ward

18. Which of the following is an example of a
"never event" or sentinel event?

a. missed dose of an antibiotic

b. patient fall that results in a bruised tailbone

c. fever of 101.2 °F after a blood transfusion

d. patient suicide in the psychiatric ward

19. In a facility which allows verbal/telephone orders, a nurse is
asked to take a telephone order for the sedative medication
Zoplicone to help a patient with insomnia. The nurse should
a. ask the physician to write the order himself before she administers
the medication as it is not an emergency.
b. record the order word-for-word on the medication order sheet,
read back the order and get confirmation from the physician who
gave the order.
c. ask another nurse to take the order.
d. record the order word-for-word on the order sheet, ask another
nurse to verify it is correct, and then administer the medication to
the patient.
19. In a facility which allows verbal/telephone orders, a nurse is
asked to take a telephone order for the sedative medication
Zoplicone to help a patient with insomnia. The nurse should
a. ask the physician to write the order himself before she administers
the medication as it is not an emergency.
b. record the order word-for-word on the medication order sheet,
read back the order and get confirmation from the physician who
gave the order.
c. ask another nurse to take the order.
d. record the order word-for-word on the order sheet, ask another
nurse to verify it is correct, and then administer the medication to
the patient.
20. Prof. James Reason’s “Swiss Cheese Model”
is widely used to explain which of the following?

a) Failure to achieve a Just Culture

b) How organizational accidents occur

c) Lack of medical error reporting

d) Opportunities to improve safety through

patient engagement
 James Reason's Swiss Cheese Model
• Each slice of Swiss cheese has

holes in it, but the hole location

will not be consistent to allow a

straight line to be drawn from

the front to the back. There is a

barrier preventing further

passage through the cheese.

20. Prof. James Reason’s “Swiss Cheese Model”
is widely used to explain which of the following?

a) Failure to achieve a Just Culture

b) How organizational accidents occur

c) Lack of medical error reporting

d) Opportunities to improve safety through

patient engagement
21. A Quality Council has created a Patient Safety Council. The council
is concerned that staff may see this as another program that has
been added to their busy schedules that will eventually go away. The
best way for the organization to establish patient safety as an
ongoing part of the organization's culture is to

a. display the number of incident reports monthly with lessons

learned.
b. identify the patient safety goals and how they will be monitored.
c. integrate patient safety into all employees' job expectations.
d. include a presentation on patient safety in employee orientation.
21. A Quality Council has created a Patient Safety Council. The council
is concerned that staff may see this as another program that has
been added to their busy schedules that will eventually go away. The
best way for the organization to establish patient safety as an
ongoing part of the organization's culture is to

a. display the number of incident reports monthly with lessons

learned.
b. identify the patient safety goals and how they will be monitored.
c. integrate patient safety into all employees' job expectations.
d. include a presentation on patient safety in employee orientation.
22. Which of the following is the most effective way to
prevent accidental intravenous administration of epidural
bupivacaine (a local anaesthetic) due to epidural catheters
being inadvertently attached to intravenous lines?
a. Redesigning epidural catheters so that they cannot be
attached to an intravenous line.
b. Regular reminders to doctors and nurses to be careful
when administering epidural bupivacaine.
c. Affixing stickers that state epidural catheters are for
epidural use only.
d. Training of doctors and nurses.
 Mistake proofing
• Mistake proofing, or its Japanese

equivalent poka-yoke, is the use

of any automatic device or

method that either makes it

impossible for an error to occur

or makes the error immediately

obvious once it has occurred.

22. Which of the following is the most effective way to
prevent accidental intravenous administration of epidural
bupivacaine (a local anaesthetic) due to epidural catheters
being inadvertently attached to intravenous lines?
a. Redesigning epidural catheters so that they cannot be
attached to an intravenous line.
b. Regular reminders to doctors and nurses to be careful
when administering epidural bupivacaine.
c. Affixing stickers that state epidural catheters are for
epidural use only.
d. Training of doctors and nurses.
23. A patient with no prior history of major medical problems was
admitted for an elective cholecystectomy. On the second
postoperative day, the patient started to experience pain at the
operative site and high fevers. Blood cultures were positive for
Escherichia coli and other investigations confirmed the presence of a
surgical site infection. The patient died of overwhelming septicaemia
in the Intensive Care Unit 7 days after his operation. From a quality
standpoint, this case is best classified as a
a. clinical mishap.
b. adverse event.
c. near miss event.
d. sentinel event.
23. A patient with no prior history of major medical problems was
admitted for an elective cholecystectomy. On the second
postoperative day, the patient started to experience pain at the
operative site and high fevers. Blood cultures were positive for
Escherichia coli and other investigations confirmed the presence of a
surgical site infection. The patient died of overwhelming septicaemia
in the Intensive Care Unit 7 days after his operation. From a quality
standpoint, this case is best classified as a
a. clinical mishap.
b. adverse event.
c. Near miss event.
d. sentinel event.
24. A Quality Council has chartered a Failure Mode and Effects
Analysis (FMEA) team to examine the best method of preventing
medication errors after the installation of a new medication
dispensing system. The team's first major task should be to

A. identify ways to detect the likelihood of the equipment

breaking

B. brainstorm on potential failure modes of the equipment.

C. multi-vote on the severity of the potential equipment

breakdowns.

D. develop a flow chart of how the equipment will be installed.

24. A Quality Council has chartered a Failure Mode and Effects
Analysis (FMEA) team to examine the best method of preventing
medication errors after the installation of a new medication
dispensing system. The team's first major task should be to

A. identify ways to detect the likelihood of the equipment

breaking

B. brainstorm on potential failure modes of the equipment.

C. multi-vote on the severity of the potential equipment

breakdowns.

D. develop a flow chart of how the equipment will be installed.

25. A panel of care providers decided on a certain treatment plan for
a patient, the plan included some indispensable drugs that may
cause some adverse reactions. The best choice in such a situation is:

a. Avoid informing the patient about the possible adverse reactions

to ensure his compliance.

b. Inform the patient of the whole plan and discard it if he disagrees.

c. Apply the treatment plan and inform the patient if any of the
expected adverse reactions did occur.

d. Discard the whole plan without informing the patient and shift to
other medications even if it did not produce the desired effect.
25. A panel of care providers decided on a certain treatment plan for
a patient, the plan included some indispensable drugs that may
cause some adverse reactions. The best choice in such a situation is:

a. Avoid informing the patient about the possible adverse reactions

to ensure his compliance.
b. Inform the patient of the whole plan and discard it if he disagrees.
c. Apply the treatment plan and inform the patient if any of the
expected adverse reactions did occur.
d. Discard the whole plan without informing the patient and shift to
other medications even if it did not produce the desired effect.
26. A patient is transferred to a neighboring hospital for
a magnetic resonance imaging (MRI) exam. Due to a
misinterpretation of orders, the procedure is performed
on the wrong part of the body. Which of the following
should the healthcare quality professional do?
a. Report this as a sentinel event to the transferring
hospital.
b. Do nothing since it happened at another facility.
c. Conduct an analysis to reduce future occurrences.
d. Recommend disciplinary action for the offenders.
26. A patient is transferred to a neighboring hospital for
a magnetic resonance imaging (MRI) exam. Due to a
misinterpretation of orders, the procedure is performed
on the wrong part of the body. Which of the following
should the healthcare quality professional do?
a. Report this as a sentinel event to the transferring
hospital.
b. Do nothing since it happened at another facility.
c. Conduct an analysis to reduce future occurrences.
d. Recommend disciplinary action for the offenders.
27. In failure mode and effects analysis, what
does the Risk Priority Number refer to?
a. Each failure mode and the process
b. Likelihood of occurrence, likelihood of
detection, and severity of impact.
c. The potential causes of each failure mode
only
d. None of the above
27. In failure mode and effects analysis, what
does the Risk Priority Number refer to?
a. Each failure mode and the process
b. Likelihood of occurrence, likelihood of
detection, and severity of impact.
c. The potential causes of each failure mode
only
d. None of the above
28. Following a non-fatal overdose of intravenous heparin (a blood
thinner) in a 43 year old man in a cardiac care unit, which of the
following is LEAST like to prevent the occurrence of a similar event?

a. Requiring an additional member of the clinical team to check all

intravenous administrations of heparin.
b. Taking disciplinary action against any nurse found to have
administered an incorrect dose of medication.
c. Introducing a combined heparin order form and documentation
tool.
d. Encouraging low molecular weight heparin (administered
subcutaneously) in lieu of intravenous heparin.
28. Following a non-fatal overdose of intravenous heparin (a blood
thinner) in a 43 year old man in a cardiac care unit, which of the
following is LEAST like to prevent the occurrence of a similar event?

a. Requiring an additional member of the clinical team to check all

intravenous administrations of heparin.
b. Taking disciplinary action against any nurse found to have
administered an incorrect dose of medication.
c. Introducing a combined heparin order form and documentation
tool.
d. Encouraging low molecular weight heparin (administered
subcutaneously) in lieu of intravenous heparin.
29. Clinical decision support systems can best
support medication safety by alerting
prescribers to
a. patient compliance and allergies.
b. the need for dose adjustments and patient
weight changes.
c. drug interactions and patient weight changes.
d. allergies and drug interactions.
 Computerized Physician Order Entry (CPOE)
• Most systems interface with
clinical decision support systems
(CDSSs), which include
suggestions for drug doses,
routes, and frequencies and may
also check for drug allergies,
drug- drug interactions, drug-
laboratory values, drug
guidelines.
29. Clinical decision support systems can best
support medication safety by alerting
prescribers to
a. patient compliance and allergies.
b. the need for dose adjustments and patient
weight changes.
c. drug interactions and patient weight changes.
d. allergies and drug interactions.
30. A Quality Council is preparing a Patient Safety Plan.
A key factor that needs to be considered for the long-
term success of the patient safety program is to
a. determine which patient safety goals need to be
monitored.
b. involve the entire organization in the program.
c. review incident reports to identify what disciplinary
action should occur.
d. research how technology can be used to prevent
errors.
30. A Quality Council is preparing a Patient Safety Plan.
A key factor that needs to be considered for the long-
term success of the patient safety program is to
a. determine which patient safety goals need to be
monitored.
b. involve the entire organization in the program.
c. review incident reports to identify what disciplinary
action should occur.
d. research how technology can be used to prevent
errors.
31. One of the best ways for a patient safety
program to be effective is to provide anonymity

in

a. root cause analysis.

b. individual case review.

c. occurrence/incident reporting.

d. decision making.
31. One of the best ways for a patient safety
program to be effective is to provide anonymity

in

a. root cause analysis.

b. individual case review.

c. occurrence/incident reporting.

d. decision making.