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Content for exam 2 NMNC 1110 Questions and answers.
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Content for exam 2 NMNC 1110James 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.
Who is likely to be negatively affected by this medical error?
1. The patient and his family
2. James (the first-year surgery resident)
3. Maria (the nurse on the unit)
4. All of the above
4. All of the above
-The best answer is all of the above. Patients and families are not the only ones affected
when a medical error occurs. In this case, James is likely to be devastated, and Maria may
be affected as well. Some providers even leave their profession after committing errors
leading to a death.
"Patient safety" means:
1. Eliminating errors and adverse effects to patients associated with health care
2. Eliminating waste in health care services
3. Eliminating health inequities in populations
4. All of the above
1. Eliminating errors and adverse effects to patients associated with health care
-Although all of these are important aims for health care systems, the concept of patient
safety refers specifically to eliminating harm to patients. According to the World Health
Organization (WHO), patient safety is "the prevention of errors and adverse effects to
patients associated with health care."
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,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?
1. Psychological safety
2. Accountability
3. Negotiation
4. None of these
2. Accountability
-Holding all employees to the same standards of professional behavior, regardless of
position, is an example of accountability.
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?
1. Staff may be less likely to talk openly about and learn from errors.
2. Staff will be more careful and errors will decrease.
3. The response will weaken the safety culture.
4. Both staff may be less likely to talk openly about and learn from errors AND the response
will weaken the safety culture
4. Both staff may be less likely to talk openly about and learn from errors AND the response
will weaken the safety culture
- Punishing individuals for blameless errors has a weakening effect on a health system's
culture of safety (an environment in which providers can discuss errors and harm openly
because they know they won’t be unfairly punished and have confidence that reporting
safety events will lead to improvement). Staff may view the punishment as unfair, and worry
that they will be punished if they make an error. This fear decreases the chances of staff
reporting errors so that the system can learn from them. Staff trying to be more careful will
ultimately not eliminate errors caused by faulty systems.
Why is psychological safety a crucial component of a culture of safety?
1. Without it, patients will not follow their doctors' advice.
2. Without it, people won't be interested in improvement work.
3. It allows people to remove unsafe members of the team quickly.
4. It allows people to learn from mistakes and near-misses, reducing the chances of further
errors.
4. It allows people to learn from mistakes and near-misses, reducing the chances of further
errors.
-In psychologically safe environments, people understand that making mistakes is rarely a
sign of incompetence, and that they won't be judged for discussing mistakes. Because of
, that, people are able to call out errors - whether their own or others' - and improve the
processes that made the errors possible.
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?
1. Investigating the problem and seeking systems solutions
2. Thanking the nurse and asking him to keep quiet about it
3. Transferring the nurse to another clinic
4. Placing the item on the agenda for the leadership meeting next year
1. Investigating the problem and seeking systems solutions
-The best answer is investigating the problem and seeking systems solutions. An
organization must develop a method to surface and learn from defects and harm that occurs
to patients. We know that incident reports are one way to learn. They can also be an
indicator of the culture of the organization. That is, the more people are willing to report, the
safer they feel.
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?
1. Human error
2. At-risk behavior
3. Reckless behavior
4. None of the above
1. Human error
-The best answer is human error, as there is no reason to believe the caregivers' acted with
intentional disregard for safety. The fact that multiple people made the same mistake further
suggests the problem was due to a poorly designed system rather than at-risk or reckless
behavior by individuals.
What is one of the major attributes of health care law?
-The law or rule is easy to interpret and comply with.
-It is established by any health care authority.
-It defines the expected behavior of persons in the business of health care.
-The creator must be an expert in health care.
It defines the expected behavior of persons in the business of health care.
An obstetric nurse comes across an automobile accident. The driver seems to have a
crushed upper airway, and while waiting for emergency medical services to arrive, the nurse
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