NURS4035 – Patient Safety & Quality
Care Examination Questions & Answers
Question 1
A hospital is implementing a “just culture” approach after a medication error.
Which statement best reflects the principles of just culture?
A) All errors result in disciplinary action to ensure accountability
B) Human error is managed by console/coach, at-risk behavior by coaching and
removing incentives, reckless behavior by discipline
C) Only reckless behavior requires system changes; human error is ignored
D) Errors are always the result of system failures, so individuals are never held
accountable
Answer: B) Human error is managed by console/coach, at-risk behavior by
coaching and removing incentives, reckless behavior by discipline
Just culture distinguishes among human error (unintentional slip/lapse → console
and system redesign), at-risk behavior (behavioral choice without malice → coach
and remove at-risk incentives), and reckless behavior (conscious disregard of
substantial risk → discipline). It balances accountability with learning.
Question 2
A nurse manager is conducting a root cause analysis (RCA) after a patient fall.
What is the primary goal of RCA?
A) Assign blame to the nurse responsible for the patient
B) Identify latent system failures and contributing factors to prevent recurrence
C) Document the event for legal purposes only
D) Discipline all staff involved in the patient's care
,Answer: B) Identify latent system failures and contributing factors to prevent
recurrence
RCA is a systematic process to identify underlying system vulnerabilities (e.g.,
staffing, equipment, policies, communication) that contributed to an adverse event.
The goal is to develop corrective actions, not to assign individual blame.
Question 3
A hospital uses the “Swiss Cheese Model” to understand patient safety events. In
this model, an adverse event occurs when:
A) There is a single failure in one layer of defense
B) Holes in multiple layers of defense align, allowing a trajectory of harm
C) All layers of defense are perfect
D) There is no active failure, only latent conditions
Answer: B) Holes in multiple layers of defense align, allowing a trajectory of
harm
Reason's Swiss Cheese Model illustrates that multiple defensive layers (e.g.,
policies, checklists, training) have weaknesses (holes). An adverse event occurs
when the holes align, allowing a hazard to pass through all defenses. Reducing
holes and strengthening layers improves safety.
Question 4
A nurse identifies that a patient's intravenous pump is programmed with the wrong
rate and corrects it before any harm occurs. This is an example of:
A) Adverse event
B) Near miss (close call)
C) Sentinel event
D) Root cause
Answer: B) Near miss (close call)
,A near miss is an error or unsafe condition that reaches the patient but does not
cause harm because it is caught in time. Near misses should be reported because
they reveal system vulnerabilities without causing patient injury.
Question 5
The Institute of Medicine (IOM) report “To Err is Human” (1999) estimated that
preventable medical errors cause approximately how many deaths annually in the
United States?
A) 1,000
B) 10,000
C) 44,000 to 98,000
D) 500,000
Answer: C) 44,000 to 98,000
The IOM report estimated that between 44,000 and 98,000 people die each year in
U.S. hospitals due to preventable medical errors. This landmark report catalyzed
the modern patient safety movement.
Question 6
A hospital is implementing a “safety huddle” at the start of each shift. What is the
primary purpose of a safety huddle?
A) Assign blame for previous errors
B) Briefly discuss potential safety risks, staffing, equipment issues, and high-risk
patients for the upcoming shift
C) Complete all patient documentation
D) Replace formal safety reporting systems
Answer: B) Briefly discuss potential safety risks, staffing, equipment issues,
and high-risk patients for the upcoming shift
, Safety huddles are brief (5-10 minute) team meetings to share information about
safety concerns, plan for the day, and improve situational awareness. They are a
key tool for high-reliability organizations.
Question 7
A patient is transferred from the emergency department to the intensive care unit.
The receiving nurse receives a handoff report. Which handoff method has been
shown to reduce communication errors?
A) Leaving a written note at the bedside
B) Using a standardized communication tool such as I-PASS or SBAR with
opportunity for questions
C) Giving report over the phone without documentation
D) Having the patient repeat their history
Answer: B) Using a standardized communication tool such as I-PASS or
SBAR with opportunity for questions
Standardized handoff tools (I-PASS: Illness severity, Patient summary, Action list,
Situation awareness, Synthesis by receiver) reduce omitted information and errors.
Interactive handoffs with read-backs improve safety.
Question 8
A nurse discovers that a colleague administered a medication to the wrong patient
but the patient suffered no harm. According to a just culture, the most appropriate
response is:
A) Terminate the nurse immediately
B) Report the error, investigate system factors, provide coaching, and redesign
processes to prevent recurrence
C) Ignore the error since no harm occurred
D) Transfer the nurse to another unit
Care Examination Questions & Answers
Question 1
A hospital is implementing a “just culture” approach after a medication error.
Which statement best reflects the principles of just culture?
A) All errors result in disciplinary action to ensure accountability
B) Human error is managed by console/coach, at-risk behavior by coaching and
removing incentives, reckless behavior by discipline
C) Only reckless behavior requires system changes; human error is ignored
D) Errors are always the result of system failures, so individuals are never held
accountable
Answer: B) Human error is managed by console/coach, at-risk behavior by
coaching and removing incentives, reckless behavior by discipline
Just culture distinguishes among human error (unintentional slip/lapse → console
and system redesign), at-risk behavior (behavioral choice without malice → coach
and remove at-risk incentives), and reckless behavior (conscious disregard of
substantial risk → discipline). It balances accountability with learning.
Question 2
A nurse manager is conducting a root cause analysis (RCA) after a patient fall.
What is the primary goal of RCA?
A) Assign blame to the nurse responsible for the patient
B) Identify latent system failures and contributing factors to prevent recurrence
C) Document the event for legal purposes only
D) Discipline all staff involved in the patient's care
,Answer: B) Identify latent system failures and contributing factors to prevent
recurrence
RCA is a systematic process to identify underlying system vulnerabilities (e.g.,
staffing, equipment, policies, communication) that contributed to an adverse event.
The goal is to develop corrective actions, not to assign individual blame.
Question 3
A hospital uses the “Swiss Cheese Model” to understand patient safety events. In
this model, an adverse event occurs when:
A) There is a single failure in one layer of defense
B) Holes in multiple layers of defense align, allowing a trajectory of harm
C) All layers of defense are perfect
D) There is no active failure, only latent conditions
Answer: B) Holes in multiple layers of defense align, allowing a trajectory of
harm
Reason's Swiss Cheese Model illustrates that multiple defensive layers (e.g.,
policies, checklists, training) have weaknesses (holes). An adverse event occurs
when the holes align, allowing a hazard to pass through all defenses. Reducing
holes and strengthening layers improves safety.
Question 4
A nurse identifies that a patient's intravenous pump is programmed with the wrong
rate and corrects it before any harm occurs. This is an example of:
A) Adverse event
B) Near miss (close call)
C) Sentinel event
D) Root cause
Answer: B) Near miss (close call)
,A near miss is an error or unsafe condition that reaches the patient but does not
cause harm because it is caught in time. Near misses should be reported because
they reveal system vulnerabilities without causing patient injury.
Question 5
The Institute of Medicine (IOM) report “To Err is Human” (1999) estimated that
preventable medical errors cause approximately how many deaths annually in the
United States?
A) 1,000
B) 10,000
C) 44,000 to 98,000
D) 500,000
Answer: C) 44,000 to 98,000
The IOM report estimated that between 44,000 and 98,000 people die each year in
U.S. hospitals due to preventable medical errors. This landmark report catalyzed
the modern patient safety movement.
Question 6
A hospital is implementing a “safety huddle” at the start of each shift. What is the
primary purpose of a safety huddle?
A) Assign blame for previous errors
B) Briefly discuss potential safety risks, staffing, equipment issues, and high-risk
patients for the upcoming shift
C) Complete all patient documentation
D) Replace formal safety reporting systems
Answer: B) Briefly discuss potential safety risks, staffing, equipment issues,
and high-risk patients for the upcoming shift
, Safety huddles are brief (5-10 minute) team meetings to share information about
safety concerns, plan for the day, and improve situational awareness. They are a
key tool for high-reliability organizations.
Question 7
A patient is transferred from the emergency department to the intensive care unit.
The receiving nurse receives a handoff report. Which handoff method has been
shown to reduce communication errors?
A) Leaving a written note at the bedside
B) Using a standardized communication tool such as I-PASS or SBAR with
opportunity for questions
C) Giving report over the phone without documentation
D) Having the patient repeat their history
Answer: B) Using a standardized communication tool such as I-PASS or
SBAR with opportunity for questions
Standardized handoff tools (I-PASS: Illness severity, Patient summary, Action list,
Situation awareness, Synthesis by receiver) reduce omitted information and errors.
Interactive handoffs with read-backs improve safety.
Question 8
A nurse discovers that a colleague administered a medication to the wrong patient
but the patient suffered no harm. According to a just culture, the most appropriate
response is:
A) Terminate the nurse immediately
B) Report the error, investigate system factors, provide coaching, and redesign
processes to prevent recurrence
C) Ignore the error since no harm occurred
D) Transfer the nurse to another unit
