Reducing Medical Errors

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You must score 70% or better to pass this course. Select one answer for each question by clicking the circle at the left of your choice. To change your selection, click a different circle. Do not skip any questions.

Test Question

1. Which of the following results in the most deaths?

a. Motor vehicle accidents
b. Medical errors
c. Breast cancer
d. AIDS

Test Question

2. In 2008, Medicare discontinued reimbursement for which of the following preventable complications incurred during an inpatient stay:

a. Viral pneumonia, hypovolemic shock
b. Pressure ulcer, foreign object left in place after surgery
c. Sinusitis, tendonitis
d. Hypertension, osteopenia

Test Question

3. Medical errors are usually the result of an individual's carelessness or misconduct.

a. True
b. False

Test Question

4. An adverse event (AE) is defined as:

a. The failure of a planned action to be completed as intended.
b. The use of the wrong plan to achieve a certain aim.
c. An injury caused by medical management rather than the underlying condition of the patient.
d. The need to ask why the error occurred and make changes.

Test Question

5. Research on why humans make errors reveals that latent errors:

a. Are likely to be beyond the control of the individual.
b. Often originate with intake procedures.
c. Arise from misuse of medical equipment.
d. Often occur at the level of the individual.

Test Question

6. Which of the following is an example of a potential adverse event (AE)?

a. The improper marking of the surgical site leads to the amputation of the wrong foot.
b. An undetected design flaw in an airplane causes the pilot to lose control of the plane.
c. A dead battery on an automatic external defibrillator (AED) leads to the death of a patient.
d. A nurse recognizes a potential drug overdose in a prescription and calls the error to the physician's attention rather than administering the medication.

Test Question

7. An example of an omission error is:

a. Dispensing the wrong medication strength.
b. Dispensing a medication not authorized by the prescriber.
c. Dispensing the wrong drug.
d. Failure to administer an ordered medication dose.

Test Question

8. According to the U.S. Pharmacopeia (USP), the medications most often associated with errors are:

a. Insulin, heparin, warfarin, and albuterol.
b. Insulin, chemotherapy drugs, lidocaine, and Apresoline.
c. Albuterol, epinephrine, atropine, and sodium bicarbonate.
d. Heparin, aspirin, nitroglycerine, and codeine.

Test Question

9. Design flaws, misuse, and malfunction of medical devices are all considered causes of medical errors.

a. True
b. False

Test Question

10. All of the following are examples of practice errors except:

a. Causing physical harm to the patient.
b. Clear and legible documentation of treatments.
c. Creating unrealistic treatment expectations.
d. Failure to provide needed services.

Test Question

11. Cost containment is a systems-level factor that can impact medical errors, and financial pressures at hospitals are associated with an increased rate of adverse events (AEs).

a. True
b. False

Test Question

12. Which of the following is a way to help reduce the medical error rate?

a. Showing up for work no matter how you feel.
b. Using computerized medication ordering.
c. Working double shifts to help your agency cope with heavy patient loads.
d. Working without complaint in noisy environments despite many distractions.

Test Question

13. Which of the following characteristics may be seen in older patients and potentially can contribute to medical errors?

a. Vision or hearing impairment
b. Anxiety about illness or surgery
c. The body's declining ability to metabolize drugs
d. All of the above

Test Question

14. One way for a parent to help ensure that their child gets the correct medication dose is to know the child's current weight in kilograms and confirm with the healthcare provider that the correct weight has been used for medication calculations.

a. True
b. False

Test Question

15. More than 20% of patients admitted to two ICUs at a teaching hospital experienced an adverse event (AE), almost half of which were preventable. When did most of the AEs occur?

a. Upon admission
b. During routine care
c. During an emergency
d. During the shift change

Test Question

16. The most common types of adverse events (AEs) in the ICU are "line, tube, and drain" events.

a. True
b. False

Test Question

17. Reducing medical errors in the ICU always requires a high-tech solution rather than something as simple as the use of a checklist of evidence-based procedures.

a. True
b. False

Test Question

18. A risk factor for falls is:

a. Need for assistance in getting out of bed or transferring to and from a chair.
b. Inability to "know one's own strength."
c. Unwillingness to take prescribed medications.
d. An introspective personality.

Test Question

19. An intervention shown to reduce injuries from falls is:

a. A program for keeping the floors impeccably clean and polished.
b. Environmental modification combined with education and counseling.
c. Written instructions about how to reduce falls.
d. Increasing the use of psychotropic drugs and benzodiazepines.

Test Question

20. Restrained patients appear to have a modest decrease in fall risk and fall injuries based on several studies.

a. True
b. False

Test Question

21. Physical and occupational therapists have a duty to question medication orders they believe are below the accepted standard of care or in violation of an employer policy.

a. True
b. False

Test Question

22. Computerized physician order entry has helped many hospitals eliminate ADEs.

a. True
b. False

Test Question

23. All of the following are true about high-risk (high-alert) drugs except:

a. Black box warnings (BBWs) are sometimes ignored by physicians and pharmacists.
b. Practitioners are not always well-versed in the risks associated with high-alert drugs.
c. Limited access and segregated storage are especially important for the handling of neuromuscular blocking agents.
d. Computerized drug order management may actually increase errors involving high-risk drugs.

Test Question

24. Document staff opinions if necessary in order to give an accurate picture of the patient.

a. True
b. False

Test Question

25. According to JCAHO, a sentinel event is defined as:

a. A risk-reduction meeting to come up with a corrective action plan.
b. Any unexpected occurrence involving death or serious physical or psychological injury.
c. Any error in system design, faulty installation or maintenance of equipment, or ineffective organizational infrastructure.
d. Any error that could have caused harm but didn't because someone intervened.

Test Question

26. Root cause analysis (RCA) is:

a. A process for discovering basic and contributing causes of error with the continuing goal of preventing recurrence.
b. A preliminary analysis of serious patient injuries.
c. An exploration of all adverse incidents and malpractice actions at a facility.
d. A way of distinguishing injuries caused by medical management from all other injuries to patients.

Test Question

27. A thorough root-cause analysis must contain:

a. Final determination of who was at fault.
b. A report to the person's licensing board.
c. Examination of underlying cause-and-effect systems through a series of "why" questions.
d. Identification of others who may have contributed to the error.

Test Question

28. A practice that promotes a culture of safety is:

a. Willingness to commit agency resources to address safety concerns.
b. Clearly spelling out the penalties for reporting safety violations.
c. Filing incident reports at the end of every month.
d. Seeking solutions to vulnerabilities within the immediate work group.

Test Question

29. Goal 2 in the Joint Commission 2008 National Client Safety Goals is "Improve the effectiveness of communication among caregivers." Recommendations include all of the following except:

a. Verbal and phone orders that include a "read-back" to verify information.
b. Individualized approaches to "hand-off" communication.
c. Creation of a list of abbreviations, acronyms and symbols that are not to be used within the agency.
d. Actions to monitor and improve the timeliness of reporting and receipt of critical test results and values.

Test Question

30. Which of the following would be appropriate documentation of a medication according to the Joint Commission's Do-Not-Use List?

a. MS 10.0 mg
b. Morphine sulfate 10 mg
c. Regular insulin 2 U daily
d. Regular insulin 2 units QD

Test Question

31. Which of the following is among the most highly rated clinical opportunities for safety improvement?

a. Decreased use of antibiotic prophylaxis in surgical patients to prevent perioperative infections
b. Patient self-management for warfarin (Coumadin) to achieve appropriate outpatient anticoagulation and prevent complications
c. Delayed enteral nutrition in critically ill and surgical patients
d. Patient self-monitoring to prevent ventilator-associated pneumonia

Test Question

32. Which of the following steps can you take as a patient to help prevent medical errors?

a. When you pick up your medicine from the pharmacy, ask "Is this the medicine that my doctor prescribed?"
b. Assume that the pharmacist can read the physician's scribbled prescription even though you cannot.
c. Take for granted that "no news is good news" if you hear nothing about the results of a test or procedure.
d. Assume that everyone who is involved in your direct treatment washed their hands prior to caring for you.

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