1
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Quality and Safety in Nursing: A
Competency Approach to Improving
Outcomes (Sherwood & Barnsteiner)
Test Bank
Edition: 3rd (2021)
Chapters:
1. Driving Forces for Quality and Safety : Changing Mindsets to Improve Health
Care
2. Policy Implications Driving National Quality and Safety Initiatives
3. A National Initiative : Quality and Safety Education for Nurses
4. Patient/Family-Centered Care
5. Teamwork and Collaboration
6. Quality Improvement
7. Evidence-Based Practice
8. Safety
9. Informatics
10. Transforming Education to Transform Practice : Integrating Quality and Safety
in Interactive Classrooms Using Unfolding Case Studies
11. Reflective Practice : Using Narrative Pedagogy to Foster Quality and Safety
12. Quality and Safety Education in Clinical Learning Environments
13. Integrating Quality and Safety Competencies in Simulation
14. Interprofessional Approaches to Quality and Safety Education
15. Improving Quality and Safety with Transition-to-Practice Programs
16. Leadership to Create Change
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Chapter 1: Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care
Question 1. A nurse leader is introducing a new initiative related to "Driving
Forces for Quality and Safety : Changing Mindsets to Improve Health Care".
Which first action best establishes a strong foundation for implementation?
A. Announce the change and require immediate compliance across all Chapters
B. Identify measurable outcomes, baseline data, and frontline input before rollout
C. Delegate full responsibility to one charge nurse to speed adoption
D. Focus only on budget impact and defer clinical metrics until later
✅ Correct Answer: B. Identify measurable outcomes, baseline data, and frontline
input before rollout
Rationale: Establishing baseline data, clear outcomes, and frontline engagement
creates shared ownership and allows meaningful evaluation. Immediate top-down
mandates, single-person ownership, or finance-only planning usually undermine
adoption and sustainability.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Implementation planning
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Management of Care
Question 2. During staff education on "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care", which teaching strategy is most
likely to improve transfer of learning into bedside practice?
A. One-time lecture without opportChapteries for feedback
B. Case-based discussion with scenario rehearsal and debriefing
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C. Distribution of a policy memo only
D. Optional self-study with no competency check
✅ Correct Answer: B. Case-based discussion with scenario rehearsal and
debriefing
Rationale: Case-based rehearsal with debriefing supports clinical reasoning,
retention, and behavior change. Passive approaches without practice or
competency validation rarely produce consistent practice improvement.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Education strategy
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Safety and Infection Control
Question 3. A quality dashboard for "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care" shows variation across Chapters.
Which interpretation by the nurse manager is most appropriate?
A. Variation always means individual nurse negligence
B. Variation should be examined for system contributors before individual blame
C. Chapter differences are expected and should be ignored
D. Only annual data are useful for quality decisions
✅ Correct Answer: B. Variation should be examined for system contributors
before individual blame
Rationale: Quality science emphasizes identifying process and system factors first.
Assuming negligence prematurely discourages reporting and learning; ignoring
variation or waiting for annual data delays timely correction.
DIF: Moderate
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TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Data interpretation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
Question 4. Which outcome best indicates that a "Driving Forces for Quality and
Safety : Changing Mindsets to Improve Health Care" intervention is patient-
centered?
A. Policy compliance increased even though patient goals were not reviewed
B. Patients report that care plans reflect their priorities and values
C. Documentation volume increased for all disciplines
D. Average length of stay decreased regardless of readmission trends
✅ Correct Answer: B. Patients report that care plans reflect their priorities and
values
Rationale: Patient-centered success is demonstrated when care aligns with patient-
defined goals, preferences, and values. Administrative metrics alone cannot
confirm true person-centered care quality.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Patient outcomes
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 5. In an interprofessional huddle about "Driving Forces for Quality and
Safety : Changing Mindsets to Improve Health Care", which communication
behavior best supports safety?
A. Relying on implied understanding to save time
B. Using closed-loop communication to confirm key information
C. Allowing only physicians to summarize the plan
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D. Postponing clarification until after rounds are complete
✅ Correct Answer: B. Using closed-loop communication to confirm key
information
Rationale: Closed-loop communication confirms that critical information is heard
and understood, reducing error risk. Delayed clarification and hierarchy-limited
discussion increase miscommunication.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Team communication
MSC: NCLEX Client Needs Category: Physiological Integrity – Basic Care and
Comfort
Question 6. A nurse identifies a near miss related to "Driving Forces for Quality
and Safety : Changing Mindsets to Improve Health Care". What is the best
immediate response?
A. Do not report because no harm reached the patient
B. Report the near miss and participate in system-focused analysis
C. Privately warn peers but avoid formal documentation
D. Wait for repeated events before escalating
✅ Correct Answer: B. Report the near miss and participate in system-focused
analysis
Rationale: Near misses are high-value learning opportChapteries. Reporting
enables proactive system correction before harm occurs. Informal or delayed
responses miss opportChapteries to strengthen safety.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Safety reporting
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MSC: NCLEX Client Needs Category: Physiological Integrity – Reduction of Risk
Potential
Question 7. Which indicator is the strongest process measure for evaluating
"Driving Forces for Quality and Safety : Changing Mindsets to Improve Health
Care" implementation?
A. Percentage of eligible encounters where the protocol was completed correctly
B. Total hospital census for the month
C. Staff parking utilization rate
D. Age distribution of all admitted patients
✅ Correct Answer: A. Percentage of eligible encounters where the protocol was
completed correctly
Rationale: Process measures evaluate whether the intended care steps are
performed as designed among eligible patients. Census, parking, and demographic
totals do not directly evaluate intervention fidelity.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Measurement
MSC: NCLEX Client Needs Category: Physiological Integrity – Physiological
Adaptation
Question 8. A Chapter tests a "Driving Forces for Quality and Safety : Changing
Mindsets to Improve Health Care" change for one week using Plan-Do-Study-Act.
Which action reflects the “Study” phase?
A. Assigning leaders to enforce permanent adoption immediately
B. Comparing predicted versus actual results and identifying lessons
C. Designing the initial change idea
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D. Implementing the change across every hospital Chapter simultaneously
✅ Correct Answer: B. Comparing predicted versus actual results and identifying
lessons
Rationale: The Study phase analyzes data, compares outcomes with predictions,
and identifies what was learned. Broad implementation belongs after iterative
testing demonstrates effectiveness.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - PDSA
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Management of Care
Question 9. When applying evidence to "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care", which source should the nurse
prioritize first for decision making?
A. Single anecdotal story from a colleague
B. Current high-quality syntheses and guidelines integrated with patient
preferences
C. Outdated textbook chapter without recent references
D. Social media opinion poll among clinicians
✅ Correct Answer: B. Current high-quality syntheses and guidelines integrated
with patient preferences
Rationale: Evidence-based practice integrates best current evidence, clinical
expertise, and patient values. Anecdotes, outdated sources, and informal polls are
weaker foundations for clinical decisions.
DIF: Moderate
, 2
Quality and Safety in Nursing: A
Competency Approach to Improving
Outcomes (Sherwood & Barnsteiner)
Test Bank
Edition: 3rd (2021)
Chapters:
1. Driving Forces for Quality and Safety : Changing Mindsets to Improve Health
Care
2. Policy Implications Driving National Quality and Safety Initiatives
3. A National Initiative : Quality and Safety Education for Nurses
4. Patient/Family-Centered Care
5. Teamwork and Collaboration
6. Quality Improvement
7. Evidence-Based Practice
8. Safety
9. Informatics
10. Transforming Education to Transform Practice : Integrating Quality and Safety
in Interactive Classrooms Using Unfolding Case Studies
11. Reflective Practice : Using Narrative Pedagogy to Foster Quality and Safety
12. Quality and Safety Education in Clinical Learning Environments
13. Integrating Quality and Safety Competencies in Simulation
14. Interprofessional Approaches to Quality and Safety Education
15. Improving Quality and Safety with Transition-to-Practice Programs
16. Leadership to Create Change
, 3
Chapter 1: Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care
Question 1. A nurse leader is introducing a new initiative related to "Driving
Forces for Quality and Safety : Changing Mindsets to Improve Health Care".
Which first action best establishes a strong foundation for implementation?
A. Announce the change and require immediate compliance across all Chapters
B. Identify measurable outcomes, baseline data, and frontline input before rollout
C. Delegate full responsibility to one charge nurse to speed adoption
D. Focus only on budget impact and defer clinical metrics until later
✅ Correct Answer: B. Identify measurable outcomes, baseline data, and frontline
input before rollout
Rationale: Establishing baseline data, clear outcomes, and frontline engagement
creates shared ownership and allows meaningful evaluation. Immediate top-down
mandates, single-person ownership, or finance-only planning usually undermine
adoption and sustainability.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Implementation planning
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Management of Care
Question 2. During staff education on "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care", which teaching strategy is most
likely to improve transfer of learning into bedside practice?
A. One-time lecture without opportChapteries for feedback
B. Case-based discussion with scenario rehearsal and debriefing
, 4
C. Distribution of a policy memo only
D. Optional self-study with no competency check
✅ Correct Answer: B. Case-based discussion with scenario rehearsal and
debriefing
Rationale: Case-based rehearsal with debriefing supports clinical reasoning,
retention, and behavior change. Passive approaches without practice or
competency validation rarely produce consistent practice improvement.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Education strategy
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Safety and Infection Control
Question 3. A quality dashboard for "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care" shows variation across Chapters.
Which interpretation by the nurse manager is most appropriate?
A. Variation always means individual nurse negligence
B. Variation should be examined for system contributors before individual blame
C. Chapter differences are expected and should be ignored
D. Only annual data are useful for quality decisions
✅ Correct Answer: B. Variation should be examined for system contributors
before individual blame
Rationale: Quality science emphasizes identifying process and system factors first.
Assuming negligence prematurely discourages reporting and learning; ignoring
variation or waiting for annual data delays timely correction.
DIF: Moderate
, 5
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Data interpretation
MSC: NCLEX Client Needs Category: Health Promotion and Maintenance
Question 4. Which outcome best indicates that a "Driving Forces for Quality and
Safety : Changing Mindsets to Improve Health Care" intervention is patient-
centered?
A. Policy compliance increased even though patient goals were not reviewed
B. Patients report that care plans reflect their priorities and values
C. Documentation volume increased for all disciplines
D. Average length of stay decreased regardless of readmission trends
✅ Correct Answer: B. Patients report that care plans reflect their priorities and
values
Rationale: Patient-centered success is demonstrated when care aligns with patient-
defined goals, preferences, and values. Administrative metrics alone cannot
confirm true person-centered care quality.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Patient outcomes
MSC: NCLEX Client Needs Category: Psychosocial Integrity
Question 5. In an interprofessional huddle about "Driving Forces for Quality and
Safety : Changing Mindsets to Improve Health Care", which communication
behavior best supports safety?
A. Relying on implied understanding to save time
B. Using closed-loop communication to confirm key information
C. Allowing only physicians to summarize the plan
, 6
D. Postponing clarification until after rounds are complete
✅ Correct Answer: B. Using closed-loop communication to confirm key
information
Rationale: Closed-loop communication confirms that critical information is heard
and understood, reducing error risk. Delayed clarification and hierarchy-limited
discussion increase miscommunication.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Team communication
MSC: NCLEX Client Needs Category: Physiological Integrity – Basic Care and
Comfort
Question 6. A nurse identifies a near miss related to "Driving Forces for Quality
and Safety : Changing Mindsets to Improve Health Care". What is the best
immediate response?
A. Do not report because no harm reached the patient
B. Report the near miss and participate in system-focused analysis
C. Privately warn peers but avoid formal documentation
D. Wait for repeated events before escalating
✅ Correct Answer: B. Report the near miss and participate in system-focused
analysis
Rationale: Near misses are high-value learning opportChapteries. Reporting
enables proactive system correction before harm occurs. Informal or delayed
responses miss opportChapteries to strengthen safety.
DIF: Easy
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Safety reporting
, 7
MSC: NCLEX Client Needs Category: Physiological Integrity – Reduction of Risk
Potential
Question 7. Which indicator is the strongest process measure for evaluating
"Driving Forces for Quality and Safety : Changing Mindsets to Improve Health
Care" implementation?
A. Percentage of eligible encounters where the protocol was completed correctly
B. Total hospital census for the month
C. Staff parking utilization rate
D. Age distribution of all admitted patients
✅ Correct Answer: A. Percentage of eligible encounters where the protocol was
completed correctly
Rationale: Process measures evaluate whether the intended care steps are
performed as designed among eligible patients. Census, parking, and demographic
totals do not directly evaluate intervention fidelity.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - Measurement
MSC: NCLEX Client Needs Category: Physiological Integrity – Physiological
Adaptation
Question 8. A Chapter tests a "Driving Forces for Quality and Safety : Changing
Mindsets to Improve Health Care" change for one week using Plan-Do-Study-Act.
Which action reflects the “Study” phase?
A. Assigning leaders to enforce permanent adoption immediately
B. Comparing predicted versus actual results and identifying lessons
C. Designing the initial change idea
, 8
D. Implementing the change across every hospital Chapter simultaneously
✅ Correct Answer: B. Comparing predicted versus actual results and identifying
lessons
Rationale: The Study phase analyzes data, compares outcomes with predictions,
and identifies what was learned. Broad implementation belongs after iterative
testing demonstrates effectiveness.
DIF: Moderate
TOP: Driving Forces for Quality and Safety : Changing Mindsets to Improve
Health Care - PDSA
MSC: NCLEX Client Needs Category: Safe and Effective Care Environment –
Management of Care
Question 9. When applying evidence to "Driving Forces for Quality and Safety :
Changing Mindsets to Improve Health Care", which source should the nurse
prioritize first for decision making?
A. Single anecdotal story from a colleague
B. Current high-quality syntheses and guidelines integrated with patient
preferences
C. Outdated textbook chapter without recent references
D. Social media opinion poll among clinicians
✅ Correct Answer: B. Current high-quality syntheses and guidelines integrated
with patient preferences
Rationale: Evidence-based practice integrates best current evidence, clinical
expertise, and patient values. Anecdotes, outdated sources, and informal polls are
weaker foundations for clinical decisions.
DIF: Moderate
