Clinical Nurse Specialist Risk Assessment & Management 2 — Questions and Answers
Question 1: A CNS is reviewing a patient's medication reconciliation list on admission. Which action best reduces polypharmacy-related risk in elderly patients?
- Discontinue all non-essential medications immediately
- Use the Beers Criteria to identify potentially inappropriate medications (Correct answer)
- Limit the patient to a maximum of five medications
- Defer medication review to the attending physician only
Correct answer: Use the Beers Criteria to identify potentially inappropriate medications
The Beers Criteria provides an evidence-based list of medications that are potentially inappropriate for older adults and guides risk reduction in polypharmacy.
Question 2: Which validated tool is most appropriate for a CNS to use when assessing a hospitalized patient's risk for venous thromboembolism (VTE)?
- Braden Scale
- Caprini Score (Correct answer)
- AUDIT-C
- PHQ-9
Correct answer: Caprini Score
The Caprini Score is a validated risk assessment model widely used to stratify VTE risk in hospitalized patients and guide prophylaxis decisions.
Question 3: A CNS notices that post-operative infection rates on a surgical unit have increased over three months. What is the FIRST priority in addressing this patient safety risk?
- Implement mandatory antibiotic prophylaxis for all surgical patients
- Conduct a root cause analysis to identify contributing factors (Correct answer)
- Report the trend to The Joint Commission immediately
- Replace all current wound care protocols
Correct answer: Conduct a root cause analysis to identify contributing factors
A root cause analysis is the first step to systematically identify the underlying causes of an adverse trend before implementing solutions.
Question 4: When using failure mode and effects analysis (FMEA) in risk management, the CNS is primarily focused on:
- Investigating errors that have already caused patient harm
- Prospectively identifying potential failure points before harm occurs (Correct answer)
- Calculating the financial cost of adverse events
- Assigning accountability for past medication errors
Correct answer: Prospectively identifying potential failure points before harm occurs
FMEA is a proactive risk management technique that identifies potential failure modes and their effects before an adverse event occurs.
Question 5: A patient with a history of substance use disorder is prescribed opioids for post-operative pain. Which risk assessment tool should the CNS use to evaluate opioid misuse risk?
- Glasgow Coma Scale
- Opioid Risk Tool (ORT) (Correct answer)
- CAGE questionnaire
- CIWA-Ar protocol
Correct answer: Opioid Risk Tool (ORT)
The Opioid Risk Tool (ORT) is validated for predicting aberrant drug-related behaviors in patients prescribed opioids for chronic pain.
Question 6: A CNS is implementing a handoff communication protocol to reduce information loss between shifts. Which standardized framework is MOST appropriate?
- SBAR (Situation, Background, Assessment, Recommendation) (Correct answer)
- PDSA (Plan, Do, Study, Act)
- SOAP (Subjective, Objective, Assessment, Plan)
- RACE (Rescue, Alarm, Confine, Evacuate)
Correct answer: SBAR (Situation, Background, Assessment, Recommendation)
SBAR provides a structured framework for healthcare communication during handoffs, reducing information gaps and improving patient safety.
Question 7: Which factor most significantly increases a patient's risk for hospital-acquired pressure injuries according to current CNS practice guidelines?
- Age over 40 years
- Impaired sensory perception combined with limited mobility (Correct answer)
- BMI greater than 25
- History of diabetes mellitus without neuropathy
Correct answer: Impaired sensory perception combined with limited mobility
The combination of impaired sensory perception and limited mobility prevents patients from detecting and relieving pressure, dramatically increasing pressure injury risk.
Clinical Nurse Specialist Risk Assessment & Management 2
A CNS is reviewing a patient's medication reconciliation list on admission.
Which action best reduces polypharmacy-related risk in elderly patients?