NR-392 – Quality and Safety Nursing Quality
Improvement Study Guide, Patient Safety Standards,
Risk Management, Clinical Excellence, and
Comprehensive Review
Q1. A nurse is participating in a quality improvement initiative on a medical-
surgical unit. Which of the following best defines quality improvement in
healthcare?
A) A one-time audit of nursing documentation
B) A systematic, continuous process to improve patient outcomes and system
performance
C) A punitive measure for staff who make errors
D) A method to reduce staffing costs
Answer: B — A systematic, continuous process to improve patient outcomes
and system performance
Rationale: Quality improvement (QI) is a systematic, continuous process that
uses data-driven approaches to improve patient outcomes, system performance,
and professional development. QI is not a one-time event, punitive, or cost-
cutting measure. It is an ongoing cycle of planning, implementing, evaluating, and
modifying interventions to achieve better outcomes. QI is grounded in the
principles of PDSA (Plan-Do-Study-Act) cycles.
Q2. The nurse is reviewing the National Patient Safety Goals (NPSGs) . Which
organization establishes these goals?
A) Centers for Disease Control and Prevention (CDC)
B) The Joint Commission (TJC)
C) World Health Organization (WHO)
D) American Nurses Association (ANA)
Answer: B — The Joint Commission (TJC)
Rationale: The National Patient Safety Goals (NPSGs) are established by The
Joint Commission (TJC) to address specific areas of concern in patient safety.
,The goals are updated annually and focus on high-risk areas such as patient
identification, medication safety, infection prevention, and fall prevention.
Healthcare organizations seeking TJC accreditation must implement strategies to
meet these goals.
Q3. A nurse is reviewing the AHRQ Patient Safety Indicators (PSIs) . Which of
the following is an example of a PSI?
A) Hospital-acquired pressure injury rate
B) Postoperative pulmonary embolism or deep vein thrombosis rate
C) Patient satisfaction scores
D) Nurse-to-patient staffing ratios
Answer: B — Postoperative pulmonary embolism or deep vein thrombosis
rate
Rationale: The Agency for Healthcare Research and Quality (AHRQ) Patient
Safety Indicators (PSIs) are a set of measures that identify preventable
complications that occur after hospitalization. Examples include postoperative
pulmonary embolism or DVT, postoperative sepsis, postoperative wound
dehiscence, and postoperative respiratory failure. These indicators are used to
track and improve patient safety in hospitals. Hospital-acquired pressure injury
rates are tracked by other quality measures (e.g., NDNQI).
Q4. A nurse is implementing a fall prevention program on a medical-surgical
unit. Which action is the priority intervention to prevent falls?
A) Apply physical restraints
B) Conduct a fall risk assessment on admission and daily
C) Keep bed rails up at all times
D) Ambulate all patients three times daily
Answer: B — Conduct a fall risk assessment on admission and daily
Rationale: The priority intervention for fall prevention is to conduct a fall risk
assessment on admission and daily using a validated tool (e.g., Morse Scale). This
allows the nurse to identify patients at high risk and implement targeted
interventions (e.g., bed alarms, non-slip socks, call light within reach). Physical
,restraints should be avoided as they can increase injury risk. Bed rails should not
be fully raised on all patients, as this can be a restraint. Ambulation is beneficial
but should be based on the patient's mobility status and fall risk assessment.
Q5. A nurse is participating in a root cause analysis (RCA) after a patient fall
with injury. Which statement best describes the purpose of an RCA?
A) To assign blame to the staff involved
B) To identify the underlying causes of an adverse event and develop
corrective actions
C) To document the incident for legal purposes
D) To determine if the patient was negligent
Answer: B — To identify the underlying causes of an adverse event and
develop corrective actions
Rationale: A root cause analysis (RCA) is a systematic process used to identify
the underlying causes of an adverse event or near miss. The goal is not to assign
blame but to understand the contributing factors (e.g., system failures,
communication breakdowns, environmental hazards) and develop corrective
actions to prevent recurrence. RCA is a key component of high-reliability
organizations and is required by The Joint Commission for sentinel events.
Q6. A nurse manager is implementing a Just Culture approach on the unit. Which
statement best reflects this philosophy?
A) "Any error will result in immediate termination."
B) "Errors are viewed as opportunities for learning, but reckless behavior is
addressed with accountability."
C) "All errors are acceptable as long as the patient is not harmed."
D) "Staff should never report errors."
Answer: B — "Errors are viewed as opportunities for learning, but reckless
behavior is addressed with accountability."
Rationale: A Just Culture balances the need for a learning
environment with accountability. Errors are viewed as opportunities to improve
systems, but reckless behavior, willful violations, or gross negligence are
, addressed with progressive discipline. A Just Culture encourages reporting of
errors and near misses without fear of punishment, which is essential for improving
patient safety. It distinguishes between human error, at-risk behavior, and reckless
behavior.
Q7. A nurse is reviewing the Institute of Medicine (IOM) report "To Err Is
Human." Which of the following was a key finding of this report?
A) Healthcare is one of the safest industries
B) Medical errors are the 8th leading cause of death in the United States
C) Most errors are due to incompetent staff
D) The healthcare system has no room for improvement
Answer: B — Medical errors are the 8th leading cause of death in the United
States
Rationale: The landmark IOM report "To Err Is Human" (published in 2000)
found that medical errors are a leading cause of death in the United States,
resulting in approximately 44,000–98,000 deaths annually. The report emphasized
the need for a systems approach to improve patient safety, rather than blaming
individual healthcare providers. This report was a catalyst for the patient safety
movement and the development of quality improvement initiatives in healthcare.
Q8. A nurse is participating in a PDSA cycle to improve medication administration
accuracy. The "P" in PDSA stands for:
A) Practice
B) Plan
C) Process
D) Procedure
Answer: B — Plan
Rationale: The PDSA cycle (Plan-Do-Study-Act) is a systematic framework for
quality improvement. The steps are: Plan (identify the problem, develop a plan for
improvement, and define measurable objectives), Do (implement the plan on a
small scale), Study (evaluate the results, compare to objectives), and Act (modify
Improvement Study Guide, Patient Safety Standards,
Risk Management, Clinical Excellence, and
Comprehensive Review
Q1. A nurse is participating in a quality improvement initiative on a medical-
surgical unit. Which of the following best defines quality improvement in
healthcare?
A) A one-time audit of nursing documentation
B) A systematic, continuous process to improve patient outcomes and system
performance
C) A punitive measure for staff who make errors
D) A method to reduce staffing costs
Answer: B — A systematic, continuous process to improve patient outcomes
and system performance
Rationale: Quality improvement (QI) is a systematic, continuous process that
uses data-driven approaches to improve patient outcomes, system performance,
and professional development. QI is not a one-time event, punitive, or cost-
cutting measure. It is an ongoing cycle of planning, implementing, evaluating, and
modifying interventions to achieve better outcomes. QI is grounded in the
principles of PDSA (Plan-Do-Study-Act) cycles.
Q2. The nurse is reviewing the National Patient Safety Goals (NPSGs) . Which
organization establishes these goals?
A) Centers for Disease Control and Prevention (CDC)
B) The Joint Commission (TJC)
C) World Health Organization (WHO)
D) American Nurses Association (ANA)
Answer: B — The Joint Commission (TJC)
Rationale: The National Patient Safety Goals (NPSGs) are established by The
Joint Commission (TJC) to address specific areas of concern in patient safety.
,The goals are updated annually and focus on high-risk areas such as patient
identification, medication safety, infection prevention, and fall prevention.
Healthcare organizations seeking TJC accreditation must implement strategies to
meet these goals.
Q3. A nurse is reviewing the AHRQ Patient Safety Indicators (PSIs) . Which of
the following is an example of a PSI?
A) Hospital-acquired pressure injury rate
B) Postoperative pulmonary embolism or deep vein thrombosis rate
C) Patient satisfaction scores
D) Nurse-to-patient staffing ratios
Answer: B — Postoperative pulmonary embolism or deep vein thrombosis
rate
Rationale: The Agency for Healthcare Research and Quality (AHRQ) Patient
Safety Indicators (PSIs) are a set of measures that identify preventable
complications that occur after hospitalization. Examples include postoperative
pulmonary embolism or DVT, postoperative sepsis, postoperative wound
dehiscence, and postoperative respiratory failure. These indicators are used to
track and improve patient safety in hospitals. Hospital-acquired pressure injury
rates are tracked by other quality measures (e.g., NDNQI).
Q4. A nurse is implementing a fall prevention program on a medical-surgical
unit. Which action is the priority intervention to prevent falls?
A) Apply physical restraints
B) Conduct a fall risk assessment on admission and daily
C) Keep bed rails up at all times
D) Ambulate all patients three times daily
Answer: B — Conduct a fall risk assessment on admission and daily
Rationale: The priority intervention for fall prevention is to conduct a fall risk
assessment on admission and daily using a validated tool (e.g., Morse Scale). This
allows the nurse to identify patients at high risk and implement targeted
interventions (e.g., bed alarms, non-slip socks, call light within reach). Physical
,restraints should be avoided as they can increase injury risk. Bed rails should not
be fully raised on all patients, as this can be a restraint. Ambulation is beneficial
but should be based on the patient's mobility status and fall risk assessment.
Q5. A nurse is participating in a root cause analysis (RCA) after a patient fall
with injury. Which statement best describes the purpose of an RCA?
A) To assign blame to the staff involved
B) To identify the underlying causes of an adverse event and develop
corrective actions
C) To document the incident for legal purposes
D) To determine if the patient was negligent
Answer: B — To identify the underlying causes of an adverse event and
develop corrective actions
Rationale: A root cause analysis (RCA) is a systematic process used to identify
the underlying causes of an adverse event or near miss. The goal is not to assign
blame but to understand the contributing factors (e.g., system failures,
communication breakdowns, environmental hazards) and develop corrective
actions to prevent recurrence. RCA is a key component of high-reliability
organizations and is required by The Joint Commission for sentinel events.
Q6. A nurse manager is implementing a Just Culture approach on the unit. Which
statement best reflects this philosophy?
A) "Any error will result in immediate termination."
B) "Errors are viewed as opportunities for learning, but reckless behavior is
addressed with accountability."
C) "All errors are acceptable as long as the patient is not harmed."
D) "Staff should never report errors."
Answer: B — "Errors are viewed as opportunities for learning, but reckless
behavior is addressed with accountability."
Rationale: A Just Culture balances the need for a learning
environment with accountability. Errors are viewed as opportunities to improve
systems, but reckless behavior, willful violations, or gross negligence are
, addressed with progressive discipline. A Just Culture encourages reporting of
errors and near misses without fear of punishment, which is essential for improving
patient safety. It distinguishes between human error, at-risk behavior, and reckless
behavior.
Q7. A nurse is reviewing the Institute of Medicine (IOM) report "To Err Is
Human." Which of the following was a key finding of this report?
A) Healthcare is one of the safest industries
B) Medical errors are the 8th leading cause of death in the United States
C) Most errors are due to incompetent staff
D) The healthcare system has no room for improvement
Answer: B — Medical errors are the 8th leading cause of death in the United
States
Rationale: The landmark IOM report "To Err Is Human" (published in 2000)
found that medical errors are a leading cause of death in the United States,
resulting in approximately 44,000–98,000 deaths annually. The report emphasized
the need for a systems approach to improve patient safety, rather than blaming
individual healthcare providers. This report was a catalyst for the patient safety
movement and the development of quality improvement initiatives in healthcare.
Q8. A nurse is participating in a PDSA cycle to improve medication administration
accuracy. The "P" in PDSA stands for:
A) Practice
B) Plan
C) Process
D) Procedure
Answer: B — Plan
Rationale: The PDSA cycle (Plan-Do-Study-Act) is a systematic framework for
quality improvement. The steps are: Plan (identify the problem, develop a plan for
improvement, and define measurable objectives), Do (implement the plan on a
small scale), Study (evaluate the results, compare to objectives), and Act (modify
