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CPHRM practice questions

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Question 1Claims & Litigation

What is the primary purpose of a litigation hold in a healthcare organization?

  1. To reduce the organization's professional liability premium
  2. To speed the settlement of an open claim
  3. To limit patient access to their own medical records
  4. To preserve relevant documents and electronic evidence Correct answer.

Explanation

A litigation hold instructs staff to suspend routine destruction and preserve documents and electronically stored information once litigation is reasonably anticipated. Failure to preserve evidence can result in spoliation sanctions regardless of the claim's merits.

Question 2Claims & Litigation

In a claims-made professional liability policy, what triggers coverage?

  1. The date the policy was originally issued
  2. The date the alleged injury occurred
  3. The date the claim is made or reported Correct answer.
  4. The date the claim is finally settled

Explanation

Claims-made coverage responds when the claim is made and reported during the policy period, subject to any applicable retroactive date. Occurrence policies, by contrast, are triggered by the date of injury.

Question 3Claims & Litigation

Which document commonly grants a risk manager or adjuster authority to settle a claim up to a stated amount?

  1. A certificate of insurance
  2. A reservation of rights letter
  3. A consent-to-settle clause
  4. A settlement authority letter Correct answer.

Explanation

Settlement authority is delegated in writing and specifies the maximum amount the representative may commit. Consent-to-settle clauses protect insureds from settlement without their agreement, while reservation of rights letters preserve coverage defenses.

Question 4Claims & Litigation

To prevail on a negligence claim, what must a patient establish?

  1. A report to the liability insurer
  2. An intent to cause harm
  3. A breach of the standard of care Correct answer.
  4. A billing dispute over the care

Explanation

Negligence requires duty, breach, causation, and damages; breach is measured against the applicable standard of care. Intent is not required, and billing or insurance reporting is not an element of the claim.

Question 5Claims & Litigation

When a risk manager receives a subpoena for a patient's medical record in a malpractice case, what should be done first?

  1. Ignore the subpoena until the patient gives verbal permission
  2. Release the entire record immediately to the requesting attorney
  3. Destroy the record to protect patient privacy
  4. Verify the subpoena's validity and scope with counsel Correct answer.

Explanation

The initial step is to validate the subpoena and determine whether it was properly issued, served, and scoped, while involving counsel. Releasing records without validation can violate privacy laws, and destroying records invites sanctions.

Question 6Claims & Litigation

How should an incident report be written?

  1. Factually and objectively, without speculation or blame Correct answer.
  2. Only after a lawsuit has been served
  3. With speculative conclusions about who caused the event
  4. As a substitute for the medical record

Explanation

Incident reports should document facts, time, persons involved, and immediate actions in objective language. Speculative or blaming language undermines credibility and may complicate defense of the organization.

Question 7Claims & Litigation

Which event is most likely an early warning sign of a potential malpractice claim?

  1. A staff member completes annual training
  2. A patient sends a complimentary letter about nursing care
  3. A routine billing statement is mailed
  4. An attorney requests the patient's records Correct answer.

Explanation

Attorney requests for medical records often precede a formal claim and should trigger review, preservation, and notification to the appropriate parties. Compliments, billing, and training are routine and are not claim indicators.

Question 8Claims & Litigation

What does an extended reporting endorsement (tail coverage) provide?

  1. It extends the time to report claims after expiration Correct answer.
  2. It covers injuries that occurred before the retroactive date
  3. It increases the policy's per-claim limit
  4. It reduces the insured's deductible

Explanation

Tail coverage extends the period for reporting claims after a claims-made policy ends, typically for claims arising from acts during the policy period. It does not increase limits, reduce deductibles, or move the retroactive date.

Question 9Claims & Litigation

A hospital receives notice of a claim alleging negligent credentialing of a surgeon. What is the most appropriate initial risk management action?

  1. Contact the surgeon's personal attorney to coordinate the defense
  2. Revise the informed consent form for all surgical procedures
  3. Initiate peer review of every clinical department
  4. Review the credentialing file and related policies Correct answer.

Explanation

Negligent credentialing claims require review of the credentialing and privileging process for the specific practitioner. A focused review preserves relevant evidence and identifies whether standards were followed.

Question 10Claims & Litigation

A physician obtained a signed consent form but did not discuss a known material risk. In an informed consent claim, what fact is most central?

  1. Whether the hospital billed separately for the consent discussion
  2. Whether the consent form was notarized
  3. Whether the physician documented the risk in the progress note
  4. Whether the patient would have refused if informed Correct answer.

Explanation

Informed consent requires disclosure of material risks, and causation turns on whether a reasonable person in the patient's position would have refused the procedure if informed. Documentation is evidence, but it is not the central legal test.

Question 11Claims & Litigation

In litigation, the plaintiff requests the hospital's root cause analysis of a sentinel event. What should the risk manager do first?

  1. Shred the analysis before it can be produced
  2. Provide only the corrective action plan
  3. Assert applicable privilege and consult counsel Correct answer.
  4. Produce the entire analysis immediately

Explanation

Root cause analyses may be protected by peer review or patient safety privilege depending on state law, so counsel should evaluate any privilege claim before production. Destroying the document would risk spoliation sanctions.

Question 12Claims & Litigation

Which type of damages is designed to punish the defendant and deter similar conduct?

  1. Punitive damages Correct answer.
  2. Compensatory damages
  3. Economic damages
  4. Nominal damages

Explanation

Punitive damages are awarded in addition to compensatory damages to punish egregious conduct and deter others. Compensatory and economic damages make the plaintiff whole, while nominal damages acknowledge a technical violation without substantial loss.

Question 13Claims & Litigation

A risk manager notices that one physician has been named in three similar malpractice suits within six months. What action is most appropriate?

  1. Analyze the trend and consider peer review Correct answer.
  2. Ask the insurer to cancel the physician's coverage
  3. Ignore the suits because each claim is legally separate
  4. Remove the physician from staff without any review

Explanation

A cluster of similar claims may signal a quality-of-care or communication issue and warrants trend analysis and, if indicated, peer review. Canceling coverage or removing a physician without due process is not an appropriate first response.

Question 14Claims & Litigation

In a pure comparative negligence state, a jury finds total damages of $100,000, the plaintiff 30% at fault, and the defendant 70% at fault. What amount does the defendant owe?

  1. $30,000
  2. $0
  3. $70,000 Correct answer.
  4. $100,000

Explanation

Under pure comparative negligence, the plaintiff's recovery is reduced by the plaintiff's percentage of fault, so the defendant pays 70% of $100,000. A $0 result would apply only under contributory negligence or a modified rule barring recovery above a threshold.

Question 15Claims & Litigation

What is the function of a self-insured retention (SIR) in a professional liability program?

  1. The amount the insured funds before coverage responds Correct answer.
  2. A mechanism that transfers all claim costs to the commercial insurer
  3. A substitute for establishing claim reserves
  4. A statutory cap on punitive damages

Explanation

An SIR is a retained layer the insured pays before the insurer responds, often applying to defense and indemnity. It does not transfer all risk to the insurer or replace the need for claim reserves.

Question 16Claims & Litigation

A plaintiff's attorney sends a preservation letter to a hospital. What should the risk manager do first?

  1. Delete duplicate electronic records to reduce storage costs
  2. Issue a litigation hold to the relevant departments Correct answer.
  3. Forward the letter to the patient named in the claim
  4. Wait for a formal complaint to be filed

Explanation

A preservation letter signals anticipated litigation, so the organization should promptly suspend destruction and preserve relevant records, including electronic data. Waiting or deleting records risks spoliation sanctions.

Question 17Claims & Litigation

Which privilege generally protects confidential communications between defense counsel and the insured healthcare organization from disclosure to the plaintiff?

  1. Journalist's shield privilege
  2. Clergy-penitent privilege
  3. Attorney-client privilege Correct answer.
  4. Physician-patient privilege

Explanation

Attorney-client privilege protects confidential legal communications between the client and counsel, including the insured and defense counsel. Physician-patient privilege protects clinical information, not legal advice.

Question 18Claims & Litigation

A settlement agreement includes a confidentiality clause. Which statement is most accurate?

  1. The clause eliminates the need to establish a claim reserve
  2. The clause may be limited by state law and public policy Correct answer.
  3. The clause always binds the court and overrides state law
  4. The clause prevents the patient from reporting to licensing boards

Explanation

Confidentiality clauses are generally enforceable between the parties but may be limited by statutes, court rules, or public policy, especially in healthcare. They do not override regulatory reporting duties.

Question 19Claims & Litigation

A risk manager is preparing a nurse for a deposition. What is the most appropriate step?

  1. Tell the nurse to alter the medical record before testifying
  2. Instruct the nurse to answer only yes or no
  3. Review the medical record and likely questions with counsel Correct answer.
  4. Advise the nurse not to review the chart

Explanation

Deposition preparation should include reviewing the relevant record and understanding the scope of likely questions with counsel, while testifying truthfully. Altering records is improper, and avoiding chart review increases the risk of inconsistent testimony.

Question 20Claims & Litigation

What is the purpose of establishing a claim reserve?

  1. To pay staff bonuses at year-end
  2. To satisfy Joint Commission accreditation
  3. To estimate the expected cost of a claim Correct answer.
  4. To increase patient satisfaction scores

Explanation

A claim reserve is an estimate of the ultimate cost of a reported or anticipated claim, including indemnity and defense. It supports financial reporting and solvency, not staff incentives or accreditation.

Question 21Claims & Litigation

A hospital has a claims-made policy with a retroactive date of January 1, 2020. An alleged injury occurred on December 15, 2019, and the claim is first made in 2021 while the policy is in force. What is the likely coverage outcome?

  1. Coverage for defense costs only, regardless of indemnity
  2. Coverage, because the policy is occurrence-based
  3. No coverage, because the injury predates the retroactive date Correct answer.
  4. Full coverage, because the claim was made during the policy period

Explanation

Claims-made coverage requires that the claim be made during the policy period and that the act occur on or after the retroactive date. Because the injury predates the retroactive date, the policy likely excludes coverage even though the claim was reported during the policy period.

Question 22Claims & Litigation

Under the Medicare Secondary Payer Act, what must a liability insurer consider when settling with a Medicare beneficiary?

  1. Whether the beneficiary has private supplemental insurance
  2. Protecting Medicare's interest in medical costs Correct answer.
  3. Whether the hospital holds Joint Commission accreditation
  4. Whether the settlement is kept confidential

Explanation

The Medicare Secondary Payer Act prohibits Medicare from paying when another payer is responsible and requires protection of Medicare's interest, including consideration of past and future medical costs. Confidentiality and accreditation are irrelevant to this obligation.

Question 23Claims & Litigation

A jury awards $500,000 in economic damages and $1,000,000 in noneconomic damages. The state caps noneconomic damages at $750,000. What is the total award after applying the cap?

  1. $1,500,000
  2. $750,000
  3. $1,250,000 Correct answer.
  4. $500,000

Explanation

Economic damages are not reduced by the noneconomic cap, so the award is $500,000 plus the capped $750,000, totaling $1,250,000. The cap applies only to noneconomic damages.

Question 24Claims & Litigation

A plaintiff sues a hospital and an independent contractor physician, claiming the hospital held the physician out as its agent. Which legal doctrine is most relevant?

  1. Ostensible agency Correct answer.
  2. Charitable immunity
  3. Res ipsa loquitur
  4. Contributory negligence

Explanation

Ostensible agency, or apparent agency, may make a hospital liable when it holds a practitioner out as its agent and the patient reasonably relies on that representation. Res ipsa loquitur is an inference of negligence; charitable immunity and contributory negligence address different issues.

Question 25Claims & Litigation

At trial, the plaintiff's expert witness is challenged for lack of qualifications. What is the judge's role under most state evidence rules?

  1. Settle the claim before the expert testifies
  2. Determine whether the expert testimony is admissible Correct answer.
  3. Review the expert's malpractice insurance coverage
  4. Cross-examine the expert on behalf of the plaintiff

Explanation

The judge acts as gatekeeper and decides whether expert testimony is relevant and reliable enough to assist the jury. Cross-examination is conducted by opposing counsel, and settlement or insurance review is not the judge's role in this context.

Question 26Claims & Litigation

What is the primary function of a statute of limitations in a healthcare malpractice claim?

  1. It establishes the standard of care the defendant must meet.
  2. It caps the amount of noneconomic damages a jury may award.
  3. It requires the plaintiff to hire a testifying expert.
  4. It sets the time limit for filing a claim after accrual. Correct answer.

Explanation

A statute of limitations defines the period after a claim accrues during which suit must be filed; missing it generally bars the claim. It does not establish clinical standards, cap damages, or impose expert-witness requirements, which come from other statutes or procedural rules.

Question 27Claims & Litigation

A patient's spouse files a claim seeking compensation for loss of companionship and household services after the patient is seriously injured. What is this claim called?

  1. Loss of consortium Correct answer.
  2. Contribution
  3. Subrogation
  4. Indemnification

Explanation

Loss of consortium is a derivative claim by a spouse for loss of companionship, society, and household services resulting from injury to the patient. Subrogation, contribution, and indemnification concern recovery or allocation of loss among insurers or tortfeasors, not a spouse's personal damages.

Question 28Claims & Litigation

Which document formally commences a civil lawsuit and must generally be served on the defendant along with notice of the suit?

  1. A preservation letter
  2. A summons and complaint Correct answer.
  3. A demand letter
  4. A subpoena duces tecum

Explanation

A complaint sets out the plaintiff's claims, and a summons gives the defendant formal notice and the duty to respond, together commencing the action. Demand letters typically precede litigation, subpoenas compel evidence, and preservation letters request retention of evidence.

Question 29Claims & Litigation

Which statement best describes a typical court-ordered mediation in a malpractice case?

  1. It is nonbinding unless the parties sign a settlement. Correct answer.
  2. It automatically admits liability if the defendant participates.
  3. It produces a binding jury verdict that the parties cannot appeal.
  4. It is a formal discovery device used to question witnesses under oath.

Explanation

Mediation is a facilitated negotiation, and any resolution becomes binding only when the parties execute a settlement agreement. It is not a jury proceeding, a sworn discovery deposition, or an admission of liability.

Question 30Claims & Litigation

A patient had surgery in 2018, but a retained surgical sponge is not discovered until 2021. The state follows the discovery rule. When does the malpractice claim generally accrue?

  1. On the date of the patient's last postoperative office visit.
  2. On the date the surgery was performed, regardless of when the patient discovered the injury.
  3. When the patient knew or should have known of the injury and cause. Correct answer.
  4. Only on the date the lawsuit is formally filed in court.

Explanation

Under the discovery rule, accrual is postponed until the patient knows or reasonably should know of the injury and its cause. The surgery date or last visit may be evidence, but neither automatically fixes accrual, and filing the lawsuit does not determine when the claim accrued.

Question 31Claims & Litigation

In a malpractice case based on res ipsa loquitur, which element must the plaintiff generally establish?

  1. The injury would not ordinarily occur without negligence and the instrumentality was controlled by the defendant. Correct answer.
  2. No expert witness will be needed to explain the applicable standard of care because the negligence is obvious to laypersons.
  3. The defendant has already admitted liability in the medical record and has paid the patient's outstanding hospital bill.
  4. The defendant intended to cause the patient's injury and acted with malice or reckless disregard for the patient's safety.

Explanation

Res ipsa loquitur permits an inference of negligence when the injury is of a type that ordinarily does not occur absent negligence and was caused by an instrumentality within the defendant's control. Intent, an admission, or the absence of expert testimony is not a required element.

Question 32Claims & Litigation

Under the traditional collateral source rule, how are payments from the plaintiff's own health insurer treated in a malpractice damages analysis?

  1. They are treated as an admission that the defendant was not negligent.
  2. They must be repaid to the insurer before the plaintiff can recover anything.
  3. They generally are not deducted from the plaintiff's damages award. Correct answer.
  4. They automatically reduce the defendant's liability dollar for dollar.

Explanation

The collateral source rule prevents a tortfeasor from reducing damages by amounts the plaintiff received from independent sources such as health insurance. Repayment or subrogation is handled separately, reductions are not automatic, and payment by an insurer does not establish lack of negligence.

Question 33Claims & Litigation

A risk manager learns that surveillance video that may show a patient fall was automatically overwritten after a preservation letter arrived. What is the most likely consequence in litigation?

  1. The case must be dismissed against the hospital automatically.
  2. The insurer must pay punitive damages to the plaintiff.
  3. The court may impose sanctions, including an adverse inference instruction. Correct answer.
  4. No consequence follows if the system overwrote the video on a routine schedule.

Explanation

Failure to preserve evidence after notice can lead to spoliation sanctions, including an instruction that the jury may infer the lost evidence was unfavorable. Dismissal is possible but not automatic, a routine overwrite schedule does not necessarily excuse destruction after notice, and punitive damages against the insurer are not the standard remedy.

Question 34Claims & Litigation

A patient signs a valid, enforceable agreement to arbitrate any future malpractice dispute before receiving care. What is the general effect in most jurisdictions?

  1. The hospital may unilaterally select the arbitrator without patient input.
  2. The dispute is resolved through arbitration rather than a jury trial. Correct answer.
  3. The patient has waived all potential malpractice claims.
  4. The agreement is automatically unenforceable because healthcare is involved.

Explanation

A valid arbitration agreement routes disputes to arbitration and generally waives a jury trial, but it does not eliminate the underlying claim. Arbitrator selection and enforceability follow the agreement and state law, and healthcare is not an automatic exemption.

Question 35Claims & Litigation

What is the primary purpose of a hospital lien statute?

  1. It prevents a patient from filing a malpractice lawsuit against the hospital or its staff.
  2. It lets a hospital claim part of a patient's third-party recovery for unpaid care. Correct answer.
  3. It caps the amount a hospital may charge uninsured patients for emergency services.
  4. It requires hospitals to carry professional liability insurance as a condition of licensure.

Explanation

Hospital lien statutes allow a hospital to recover unpaid treatment costs from a patient's recovery from a liable third party. They do not bar malpractice suits, set charge caps, or mandate professional liability insurance.

Question 36Claims & Litigation

A professional liability policy contains a consent-to-settle clause. What does this generally require?

  1. The insured must approve the selection of defense counsel in every case.
  2. The patient must consent to any settlement amount.
  3. The insurer may never settle a claim without a jury verdict.
  4. The insurer generally must obtain the insured's consent before settling. Correct answer.

Explanation

Consent-to-settle provisions give the insured input before the insurer settles a claim, often subject to policy exceptions. Counsel selection and settlement authority are distinct issues, and the patient is not a party to the insurance contract.

Question 37Claims & Litigation

Several states require a plaintiff to file an affidavit or certificate of merit with a malpractice complaint. What is the primary purpose of this requirement?

  1. To ensure a qualified expert has reviewed the claim before it proceeds. Correct answer.
  2. To prove the exact amount of future medical expenses the plaintiff will likely incur.
  3. To waive the plaintiff's constitutional right to a jury trial in the malpractice action.
  4. To notify the defendant's liability insurer that a claim has been filed.

Explanation

Certificate-of-merit statutes screen malpractice claims by requiring expert review at the filing stage. They do not establish damages, waive jury rights, or replace the separate notice that may be given to an insurer.

Question 38Claims & Litigation

A state has a two-year statute of limitations and a six-year statute of repose for malpractice. A patient's injury occurred in 2015 but was not discovered until 2022. What is the likely result?

  1. The statute of limitations begins anew on the date of discovery and voids the repose period.
  2. The statute of repose applies only if the patient is a minor.
  3. The claim is barred by the statute of repose despite later discovery. Correct answer.
  4. The claim is timely because the discovery rule always overrides a statute of repose.

Explanation

A statute of repose sets an outer limit measured from the act or injury and can bar a claim even if discovery occurs later. Discovery rules may extend limitations, but they do not necessarily override a repose period, and minority exceptions vary but repose is not limited to minors.

Question 39Claims & Litigation

A hospital gives its liability insurer late notice of a claim, but the insurer suffers no actual prejudice. In a jurisdiction applying the notice-prejudice rule, what is the likely outcome?

  1. The insurer may deny coverage automatically because notice was late.
  2. The hospital's officers become personally liable for the judgment.
  3. The insurer must generally provide coverage absent actual prejudice. Correct answer.
  4. The claim is void and the patient cannot recover from anyone.

Explanation

The notice-prejudice rule prevents forfeiture of coverage for late notice unless the insurer was substantially prejudiced. Automatic denial, voiding the patient's claim, and personal liability of hospital officers are not the standard outcomes.

Question 40Claims & Litigation

A plaintiff settles with one of two defendants but wants to preserve the right to pursue the other defendant. Which agreement best accomplishes that result?

  1. A satisfaction of judgment filed with the court.
  2. A general release naming both defendants.
  3. A covenant not to sue the settling defendant. Correct answer.
  4. An indemnification agreement running to the settling defendant.

Explanation

A covenant not to sue one defendant generally preserves claims against other defendants, unlike a general release that may discharge all parties. Satisfaction of judgment ends enforcement of a judgment, and indemnification shifts loss rather than preserving claims against others.

Question 41Clinical Patient Safety

In healthcare risk management, a sentinel event is best defined as:

  1. Any patient complaint that triggers a service recovery conversation
  2. A patient's dissatisfaction with the food service during an inpatient stay
  3. An unexpected event involving death or serious injury, or the risk of such harm Correct answer.
  4. A medication error that reaches the patient but produces no detectable harm of any kind

Explanation

A sentinel event is an unexpected occurrence involving death or serious physical or psychological injury, or the risk thereof. The phrase 'or the risk thereof' is what allows events with serious potential for harm to be reviewed even when the patient escapes injury. Events without serious harm or serious potential are handled as other adverse events or near misses.

Question 42Clinical Patient Safety

The WHO 'Five Moments for Hand Hygiene' include which of the following?

  1. Before donning gloves for any patient care task
  2. After touching the patient's immediate surroundings Correct answer.
  3. Only after hands are visibly soiled
  4. Whenever moving between nursing units

Explanation

The five moments are before touching a patient, before a clean or aseptic procedure, after body fluid exposure risk, after touching a patient, and after touching patient surroundings. Hand hygiene is triggered by the contact moment, not by how the hands look. Glove use never substitutes for performing hand hygiene.

Question 43Clinical Patient Safety

The Universal Protocol for preventing wrong-site surgery consists of which three components?

  1. Surgical safety checklist, antibiotic prophylaxis, and DVT prophylaxis
  2. Consent verification, anesthesia timeout, and post-operative debrief
  3. Two-person identifier check, site marking, and post-operative radiograph
  4. Preprocedure verification, marking the operative site, and a time-out Correct answer.

Explanation

The Universal Protocol comprises preprocedure verification, marking of the operative or invasive site, and a time-out performed immediately before the procedure. The time-out is a final, team-wide confirmation of patient, procedure, and site. Prophylaxis and debrief items belong to broader surgical safety checklists, not to the Universal Protocol itself.

Question 44Clinical Patient Safety

When verifying patient identity before care, an accredited hospital must use:

  1. At least two patient identifiers Correct answer.
  2. The patient's room number together with the bed designation
  3. The patient's stated name and the name of the attending physician
  4. A verbal confirmation of the patient's full name at the bedside

Explanation

Identification requires at least two identifiers, such as name, medical record number, date of birth, or telephone number. The room or bed designation is never acceptable as an identifier. The identifiers must be actively matched to the patient or to the item being labeled.

Question 45Clinical Patient Safety

After a reviewable sentinel event, the organization must complete a thorough and credible root cause analysis and action plan within:

  1. 30 calendar days
  2. 45 calendar days Correct answer.
  3. 24 hours
  4. 7 calendar days

Explanation

Accreditation standards require a root cause analysis and action plan to be completed within 45 calendar days of the event's occurrence or of the organization becoming aware of it. The 45-day window is measured in calendar days, not business days. Immediate patient safety actions are still expected long before that deadline.

Question 46Clinical Patient Safety

Which tool is a validated instrument for screening adult inpatients for fall risk?

  1. The Aldrete Score
  2. The Morse Fall Scale Correct answer.
  3. The Glasgow Coma Scale
  4. The Braden Scale

Explanation

The Morse Fall Scale is a widely used, validated fall risk screening tool that scores six items to stratify risk and trigger interventions. The Braden Scale screens for pressure injury risk rather than fall risk. The Glasgow Coma Scale and Aldrete Score measure level of consciousness and post-anesthesia recovery readiness, respectively.

Question 47Clinical Patient Safety

A patient's Braden Scale score is 12. The nurse should interpret this result as:

  1. High risk only if the patient is also receiving mechanical ventilation
  2. An inconclusive result that requires rescoring in 72 hours
  3. High risk, so intensive pressure injury prevention is needed Correct answer.
  4. Low risk, so routine skin care is sufficient

Explanation

Braden scores range from 6 to 23, and lower scores indicate greater risk. A score of 10 to 12 falls in the high-risk band, with 13 to 14 moderate, 15 to 18 mild, and 9 or below very high. High-risk scores trigger repositioning, support surface selection, moisture management, and nutrition referral.

Question 48Clinical Patient Safety

Immediately before starting a blood transfusion, the safest practice is for:

  1. The ordering physician to remain present at the bedside for the first 15 minutes of the infusion
  2. One nurse to verify the unit against the written order at the central nurses' station
  3. Two qualified staff to verify patient identity and unit compatibility at the bedside Correct answer.
  4. The blood bank to confirm compatibility by telephone with the unit

Explanation

Bedside verification by two qualified individuals confirms that the right unit is being given to the right patient using two identifiers matched to the blood bank tag. Verification performed away from the bedside or by a single person is a recognized contributor to mistransfusion. The patient is also monitored closely during the first 15 minutes for a transfusion reaction.

Question 49Clinical Patient Safety

A nurse transcribes an order incorrectly and pharmacy intercepts the error before administration. Under a just culture model, the most appropriate response is to:

  1. Refer the nurse to the state board of nursing for a formal review of practice
  2. Coach the nurse and examine system factors, since this is human error Correct answer.
  3. Discipline the nurse so the behavior is not repeated
  4. Take no action at all, because the error was intercepted before administration and no harm occurred

Explanation

Just culture separates human error, at-risk behavior, and reckless behavior and assigns a different response to each. Human error calls for consolation, coaching, and system redesign rather than discipline. At-risk behavior calls for coaching, and only reckless behavior warrants punitive action.

Question 50Clinical Patient Safety

When an unanticipated adverse event causes harm, the risk manager's best guidance on communication with the patient and family is to:

  1. Direct all questions from the family to hospital legal counsel
  2. Limit disclosure to what the involved physician is comfortable sharing
  3. Wait until the investigation is complete before any discussion occurs
  4. Provide a prompt, honest account of what is known and an apology Correct answer.

Explanation

Disclosure programs call for prompt acknowledgment, an expression of sympathy, a factual account of what is currently known, and a commitment to continue the conversation as facts emerge. Delaying all communication erodes trust and increases litigation risk. The apology and explanation are given in accordance with the organization's disclosure policy and with risk management support.