Incident Reporting And Quality Improvement
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NCLEX-RN › Incident Reporting And Quality Improvement
A 68-year-old client with osteoarthritis and mild cognitive impairment is hospitalized for pneumonia. The nurse hears a thud and finds the client on the floor next to the bed with the bed alarm turned off; the client reports hip pain but is awake and breathing normally. What is the nurse's PRIORITY in this situation?
Document in the health record that the bed alarm was off at the time of the fall
Complete an incident report with the time of the fall, location, and contributing factors
Notify the client's family of the fall and explain the plan of care
Assess the client for injury, obtain vital signs, and keep the client on the floor until help arrives to assist with safe transfer
Explanation
This question tests understanding of incident reporting and quality improvement following a patient fall. The priority aspect of incident management is ensuring patient safety through immediate assessment and stabilization. Assessing for injury, obtaining vital signs, and keeping the client safely on the floor (A) is the best choice because it addresses immediate safety needs and prevents further harm from improper movement. Completing an incident report (B) is required but comes after patient stabilization, notifying family (C) occurs after assessment and stabilization, and documenting the bed alarm status (D) is important for the report but not the immediate priority. The decision-making principle is that patient assessment and safety always precede documentation in adverse events. When finding a patient after a fall, remember the ABC priority: Assess first, Be safe in movement, then Complete documentation.
A 79-year-old client with cataracts is hospitalized for cellulitis and is confused at night. The client falls while walking to the bathroom; the nurse finds the client sitting on the floor stating, “I slipped.” Which action should the nurse take FIRST?
Notify risk management to determine whether the family should be contacted
Complete an incident report and include the client’s statement about slipping
Assess the client for injury, including pain, range of motion, and neurologic status, before assisting back to bed
Review the chart to see whether the client had a fall risk armband applied
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is thorough assessment to avoid aggravating injuries post-fall. Assessing the client for injury, including pain, range of motion, and neurologic status, before assisting back to bed is the best choice for a confused client with cataracts. Completing a report (B), notifying risk management (C), or reviewing the chart (D) are less optimal without initial evaluation. In quality improvement, decision-making integrates assessment data for fall protocol updates. This aids in identifying confusion-related risks. A transferable strategy is to perform head-to-toe checks before movement in falls for comprehensive care.
A 60-year-old client with congestive heart failure is on a low-sodium diet. Dietary services delivers a tray labeled for the client that contains high-sodium foods; the nurse notices before the client eats. Which detail is MOST important to include in the near-miss report for quality improvement?
The tray contents, label information, time discovered, and that the incorrect tray was removed before consumption
A request that the provider discontinue the low-sodium diet order due to confusion
The nurse’s opinion that dietary staff are careless and need discipline
A statement that the client would have had fluid overload if the tray had been eaten
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is detailing near-misses objectively for dietary process improvements. Including the tray contents, label information, time discovered, and that the incorrect tray was removed before consumption is most important to analyze errors in heart failure care. Opinions on staff (A), hypothetical outcomes (C), or diet discontinuation requests (D) are less optimal due to irrelevance. In quality improvement, decision-making uses specifics to enhance labeling accuracy. This supports nutritional safety. A transferable strategy is to document preventive actions in near-misses for systemic enhancements.
A 29-year-old client in the emergency department is prescribed cefazolin 1 g intravenous. The nurse notices the medication label reads “ceftriaxone 1 g,” and the client has a documented severe allergy to cephalosporins; the medication has not been started. What is the nurse’s PRIORITY in this situation?
Ask the provider to remove the allergy from the chart if the client cannot recall the reaction
Stop the process and verify the correct medication order and allergy status before administering anything
Complete an incident report after administering the correct antibiotic to avoid delaying treatment
Start the infusion slowly while monitoring closely because the client may tolerate it
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is preventing administration of allergens through verification. Stopping the process and verifying the correct medication order and allergy status before administering anything is the best choice to avoid reactions in cephalosporin allergy. Starting slowly (B), completing a report after (C), or removing allergy (D) are less optimal and dangerous. In quality improvement, decision-making stresses double-checks for labeling errors. This enhances allergy protocols. A transferable strategy is to halt and confirm in mismatches for safety assurance.
A 82-year-old client with history of falls is using a bedside commode in the hospital. The nurse finds that the commode’s locking mechanism is broken and the commode shifts when weight is applied; the client has not fallen. Which action should the nurse take FIRST?
Remove the commode from use and provide a safe alternative, then report the equipment issue per policy
Continue to use the commode with staff assistance since the client has not fallen
Complete an incident report and wait for maintenance before offering toileting assistance
Document in the medical record that the commode was defective and an incident report was filed
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is removing hazards and ensuring alternatives for client needs. Removing the commode from use and providing a safe alternative, then reporting the equipment issue per policy is the best choice to prevent falls in a high-risk client. Continuing use (B), completing a report first (C), or documenting the defect (D) are less optimal without immediate removal. In quality improvement, decision-making prioritizes safety substitutions before reporting. This improves equipment maintenance. A transferable strategy is to isolate faulty devices and report after securing alternatives in safety risks.
A 50-year-old client with newly diagnosed type 2 diabetes is ordered insulin glargine 20 units subcutaneous at bedtime. The nurse draws up 20 units of insulin lispro by mistake but notices the error before administration. What is the nurse’s PRIORITY in this situation?
Administer the insulin lispro now and provide a snack to prevent hypoglycemia
Wait to call the provider until after the client’s next blood glucose reading
Discard the incorrect insulin per policy, obtain the correct insulin, and report the near-miss per facility process
Document in the medical record that a near-miss occurred to show transparency
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is correcting near-misses to prevent harm and report for system improvement. Discarding the incorrect insulin per policy, obtaining the correct insulin, and reporting the near-miss per facility process is the best choice to ensure proper diabetes management. Administering the wrong type (B), documenting in the record (C), or waiting for glucose reading (D) are less optimal and could cause issues. In quality improvement, decision-making promotes reporting to refine dispensing. This enhances insulin safety protocols. A transferable strategy is to discard errors immediately and report to foster preventive cultures.
A 74-year-old client with Parkinson disease is admitted for urinary tract infection and has unsteady gait. The client falls when attempting to transfer from chair to bed; the nurse notes the chair alarm was turned off. Which action should the nurse take FIRST after ensuring the client is stable?
Call the family to explain that the chair alarm was off at the time of the fall
Wait to report the fall until the end of the shift when documentation time is available
Write an incident report focusing on who last turned off the chair alarm
Notify the provider and implement appropriate post-fall monitoring per policy
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is post-incident medical oversight and monitoring after stability. Notifying the provider and implementing appropriate post-fall monitoring per policy is the best choice for a Parkinson client with unsteady gait. Focusing the report on alarm responsibility (B), calling family (C), or waiting to report (D) are less optimal as they delay care. In quality improvement, decision-making incorporates monitoring to refine alarm usage. This prevents recurrent falls through education. A transferable strategy is to engage providers immediately post-fall for coordinated care plans.
A 63-year-old client with hypertension is prescribed metoprolol 25 mg by mouth. The nurse notices that the medication administration record lists metoprolol 50 mg, but the provider’s order is clearly 25 mg; the dose has not been given yet. Which action should the nurse take FIRST?
Administer 25 mg and then correct the medication administration record later
Hold the medication and clarify the discrepancy using the facility’s order verification process
Complete an incident report immediately and wait for management instructions before contacting the provider
Ask another nurse to co-sign the 50 mg dose so the medication can be given on time
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is verifying orders to prevent administration errors. Holding the medication and clarifying the discrepancy using the facility’s order verification process is the best choice to resolve the dosing conflict safely. Administering and correcting later (B), completing a report first (C), or asking for co-signature (D) are less optimal and risk harm. In quality improvement, decision-making ensures accuracy through checks and balances. This reduces transcription errors via audits. A transferable strategy is to withhold medications and seek clarification in order discrepancies for safety.
A 68-year-old client with chronic kidney disease is prescribed potassium chloride 20 mEq by mouth daily. The nurse discovers the client was given potassium chloride 40 mEq this morning; the client denies symptoms. Which detail is MOST important to include in the incident report?
The ordered dose, the dose given, the time administered, and the client assessment findings after discovery
A note that the family was upset and threatened to contact an attorney
A statement that the nurse who administered the medication is usually careless
A recommendation that the provider discontinue potassium for all clients on the unit
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is documenting precise, objective details for accurate review. Including the ordered dose, the dose given, the time administered, and the client assessment findings after discovery is most important to track the potassium error in kidney disease. Statements blaming the nurse (A), recommendations to discontinue (C), or notes on family reactions (D) are less optimal due to bias. In quality improvement, decision-making uses facts to prevent dosing issues. This improves medication processes. A transferable strategy is to record quantifiable data in reports for targeted improvements.
A 71-year-old client with hypertension and mild hearing loss is discharged from an acute care unit. The nurse later realizes the printed discharge instructions included another client’s medication list, but the correct instructions were verbally reviewed and the error was caught after the client left. Which action should the nurse take FIRST?
Notify the charge nurse and follow facility policy to contact the client to provide correct written instructions and protect privacy
Shred the incorrect copy in the unit and take no further action since teaching was done verbally
Document in the medical record that an incident report was completed to show compliance
Wait until the next day to see if the client calls with questions about the paperwork
Explanation
This question tests understanding of incident reporting and quality improvement in nursing practice. The priority aspect of incident management is correcting privacy breaches and ensuring accurate information post-discharge. Notifying the charge nurse and following facility policy to contact the client to provide correct written instructions and protect privacy is the best choice for the hypertension client. Waiting for a call (B), shredding without action (C), or documenting the report (D) are less optimal and neglect follow-up. In quality improvement, decision-making upholds confidentiality in error correction. This prevents misinformation through process reviews. A transferable strategy is to escalate and correct discharge errors promptly via policy.