PS 101 Questions and Answers 100%
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Safety has been called a "dynamic non-event" because when humans are in a potentially
hazardous environment: ✔✔It takes significant work to ensure nothing bad happens
Isadora is
...
PS 101 Questions and Answers 100%
Pass
Safety has been called a "dynamic non-event" because when humans are in a potentially
hazardous environment: ✔✔It takes significant work to ensure nothing bad happens
Isadora is a first-year surgery resident on her first pediatric rotation. Her attending (consultant)
asks her to immediately start intravenous (IV) replacement fluids on a two-year-old girl who is
experiencing vomiting and diarrhea. Isadora has recently learned the guidelines for calculating
fluid replacement rates for very small children; however, she confuses them and picks a rate that
is too high.
To prevent this type of error from recurring in this unit, which of the following is MOST
important? ✔✔A change to the system so that it does not rely so heavily on human memory
"Patient safety" means: ✔✔Eliminating errors and adverse effects to patients associated with
health care
James is a first-year surgery resident on his first pediatric rotation. His attending (supervising
physician) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is
having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid
replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds,
"You're the doctor. It's your job to decide this." James picks a rate that is much too high, putting
the child into fluid overload.
Who is likely to be negatively affected by this medical error? ✔✔All the above
James is a first-year surgery resident on his first pediatric rotation. His attending (supervising
physician) asks him to start intravenous (IV) replacement fluids on a two-year-old boy who is
having vomiting and diarrhea. Having trouble remembering the guidelines for calculating fluid
replacement rates for very small children, James asks Maria, a nurse on the unit. Maria responds,
"You're the doctor. It's your job to decide this." James picks a rate that is much too high, putting
the child into fluid overload.
To prevent this type of error from recurring in this unit, which of the following is MOST
important? ✔✔Culture of safety fostering better teamwork,
Isadora is a first-year surgery resident on her first pediatric rotation. Her attending (consultant)
asks her to immediately start intravenous (IV) replacement fluids on a two-year-old girl who is
experiencing vomiting and diarrhea. Isadora has recently learned the guidelines for calculating
fluid replacement rates for very small children; however, she confuses them and picks a rate that
is too high.
Which of the following reasons that errors often occur in health care most clearly played a role in
this scenario? ✔✔Diagnosing and treating patients is incredibly complex and often performed
under time pressure and/or with insufficient information.
Since the publication of To Err Is Human in 1999, the health care industry overall has seen
which of the following improvements? ✔✔Eliminating errors and adverse effects to patients
associated with health care
According to WHO, in developed countries worldwide, what is the approximate likelihood that a
hospitalized patient will be harmed while receiving care? ✔✔10%
Approximately what percentage of US adults have experienced a medical error in their own or a
family member's care at some point in their life? ✔✔33%
At the large multi-specialty clinic in which you work, there have been two near misses and one
medical error because various clinicians did not follow up on patient results. Different caregivers
were involved each time. After the second near miss, the physician involved was asked to leave
the clinic.
This appears to be an example of which of the following? ✔✔Unfair attribution of blame
At the large multi-specialty clinic in which you work, there have been two near misses and one
medical error because various clinicians did not follow up on patient results. Different caregivers
were involved each time. After the second near miss, the physician involved was asked to leave
the clinic. A nurse who realized that his colleagues weren't consistently following up on patient
results reported the problem to the clinic leadership right away.
Which response would be most consistent with a culture of safety? ✔✔Investigating the problem
and seeking systems solutions
One hospital CEO insists on including performance data in the hospital's annual report. "We do
very well on most measures, except for one or two, but we put those in anyway," she says. "We
want to hold ourselves accountable."
Does this practice demonstrate effective or ineffective leadership? ✔✔Effective leadership:
Being transparent, even about poor results, is a mark of a good leader.
What is most likely to happen if a health system punishes an individual for an unintended error
that was the result of a systems problem? ✔✔Both staff may be less likely to talk openly about
and learn from errors and the response will weaken the safety culture
A medical unit in a hospital is in the midst of hiring some new physicians. During an orientation
for new employees, a senior leader stands up and says, "We expect that the same rules apply to
everyone on the unit, regardless of position."
Which aspect of a culture of safety does this unit seem to value? ✔✔Accountability
Why is psychological safety a crucial component of a culture of safety? ✔✔It allows people to
learn from mistakes and near-misses, reducing the chances of further errors.
At the large multi-specialty clinic in which you work, there have been two near misses and one
medical error because various clinicians did not follow up on patient results. Different caregivers
were involved each time. When asked why they failed to follow up, each caregiver said he or she
forgot.
Based on what you know, how would you classify the caregivers' behavior? ✔✔Human error
The term "normalized deviance" refers to: ✔✔Acceptance of events that are initially allowed
because no catastrophic harm appears to result.
Which of these is a behavior providers should adopt to improve patient safety? ✔✔Follow
written safety protocols, even if they slow you down.
You have a safety concern and feel that you must escalate the problem. In this context,
"escalation" means: ✔✔Communicating the problem, including when and where it is occurring,
to the person who has the span of authority to fix system flaws.
Which of the following might be an appropriate system-level response to a "weak signal"?
✔✔Both changing the scheduling of shifts and having a different system for medication storage
and dispensing on each nursing unit
Which of the following is typically true of "weak signals"? ✔✔They can combine with other
human or environmental factors to result in catastrophe.
According to Steve Spear, the first step in building a system in which problems are routinely
"seen and solved" is: ✔✔Defining normal and helping workers to recognize abnormality.
You meet with the nurse administrator responsible for improvement when issues in the process
of care are identified by those on the wards. She listens carefully to your concern, but in the end
says she can only try to help improve nursing issues, and not those that extend to pharmacy or
transport.
The primary reason your meeting is unlikely to lead to an adequate solution is: ✔✔Follow
written safety protocols, even if they slow you down
After a team training system is implemented in an operating room (OR), a junior circulating
nurse notices that a particular anesthesiologist goes missing from the OR at odd times, often
seems sluggish, and occasionally slurs her words. Concerned that the physician might be
impaired due to medication abuse, the nurse ponders what to do next.
What would be the MOST appropriate way for the nurse to respond? ✔✔Talk to the medical
director now.
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