🎯 High-Yield Points
- National Patient Safety Goals: use two patient identifiers, improve staff communication, use medicines safely
- High-alert medications: anticoagulants, insulin, opioids, chemotherapy — double-check required
- Root cause analysis (RCA): used AFTER a sentinel event to identify system failures
- Incident reports: for near-misses and adverse events; not part of the medical record
- SBAR: the communication framework for clinical handoffs and provider calls
[Concept Map: Safety & Infection Control NCLEX Questions — Clinical Manifestations, Nursing Interventions, Priority Actions]
Practice Questions
Question 1
A nurse receives a verbal order from a provider by phone for a new medication. Which action is CORRECT?
✓ Correct: Write the order, read it back to the provider, then obtain a countersignature within 24 hours
The read-back policy (JCAHO NPSG) requires the receiving nurse to: write down the verbal order, read it back to the prescriber, and receive confirmation that it was correctly received. This reduces verbal order transcription errors. Most institutions require co-signature by the provider within a defined timeframe (typically 24 hours). This process is mandatory for verbal and telephone orders.
The read-back policy (JCAHO NPSG) requires the receiving nurse to: write down the verbal order, read it back to the prescriber, and receive confirmation that it was correctly received. This reduces verbal order transcription errors. Most institutions require co-signature by the provider within a defined timeframe (typically 24 hours). This process is mandatory for verbal and telephone orders.
Question 2
A nurse discovers a medication error in which a client received the wrong dose of insulin. Which action does the nurse take FIRST?
✓ Correct: Assess the client's blood glucose and vital signs immediately
Following a medication error, client safety is always the first priority. Immediately assess the client for adverse effects — in an insulin dosing error, this means checking blood glucose and vital signs to identify hypoglycaemia or hyperglycaemia. Documentation, incident reporting, and notification of supervisors/providers follow after the client is stabilised. The principle: treat the patient first.
Following a medication error, client safety is always the first priority. Immediately assess the client for adverse effects — in an insulin dosing error, this means checking blood glucose and vital signs to identify hypoglycaemia or hyperglycaemia. Documentation, incident reporting, and notification of supervisors/providers follow after the client is stabilised. The principle: treat the patient first.
Question 3
A nurse is preparing to administer heparin and insulin from a medication cart. Which is a required safety check for these medications?
✓ Correct: Both are high-alert medications requiring independent double verification by two nurses
Heparin and insulin are both on the Institute for Safe Medication Practices (ISMP) high-alert medication list. Both require two-nurse independent verification before administration due to their high potential for serious harm if given incorrectly. High-alert medications: insulin, heparin, anticoagulants, concentrated electrolytes, chemotherapy, opioids, and neuromuscular blocking agents.
Heparin and insulin are both on the Institute for Safe Medication Practices (ISMP) high-alert medication list. Both require two-nurse independent verification before administration due to their high potential for serious harm if given incorrectly. High-alert medications: insulin, heparin, anticoagulants, concentrated electrolytes, chemotherapy, opioids, and neuromuscular blocking agents.
Question 4
A nurse identifies that a client was nearly given the wrong medication due to a labelling error. No harm occurred. Which action is MOST appropriate?
✓ Correct: Complete an incident (variance) report and report through the facility's safety reporting system
Near-misses (no-harm events) must be reported through the facility's safety reporting system. Near-miss reporting is critical to quality improvement because it identifies system vulnerabilities before harm occurs. Incident reports are confidential quality improvement tools, not placed in the medical record, and not used punitively. A just culture encourages near-miss reporting to create safer systems.
Near-misses (no-harm events) must be reported through the facility's safety reporting system. Near-miss reporting is critical to quality improvement because it identifies system vulnerabilities before harm occurs. Incident reports are confidential quality improvement tools, not placed in the medical record, and not used punitively. A just culture encourages near-miss reporting to create safer systems.
Question 5
A charge nurse needs to report a safety concern about a new hospital policy to administration. Which communication approach is MOST effective?
✓ Correct: Use SBAR format to present the concern clearly and concisely to the nurse manager
SBAR (Situation, Background, Assessment, Recommendation) provides a structured, concise communication framework that ensures critical information is conveyed clearly and professionally. It is the gold standard for clinical communication with providers and for escalating concerns to management. Anonymous complaints and informal communication lack the structure needed for effective advocacy. Waiting until annual review delays necessary change.
SBAR (Situation, Background, Assessment, Recommendation) provides a structured, concise communication framework that ensures critical information is conveyed clearly and professionally. It is the gold standard for clinical communication with providers and for escalating concerns to management. Anonymous complaints and informal communication lack the structure needed for effective advocacy. Waiting until annual review delays necessary change.
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