Clinical Nurse Specialist Risk Assessment & Management 3 — Questions and Answers
Question 1: A CNS is assessing a newly admitted patient for suicide risk. Which element is the strongest predictor of future suicide attempt according to evidence?
- Verbal expressions of hopelessness
- A previous suicide attempt (Correct answer)
- Current diagnosis of major depressive disorder
- Recent job loss within the past month
Correct answer: A previous suicide attempt
A prior suicide attempt is the single strongest predictor of future suicidal behavior and must be weighted heavily in any risk assessment.
Question 2: When managing a patient with sepsis, the CNS identifies early-stage organ dysfunction. Which parameter from the Sequential Organ Failure Assessment (SOFA) score reflects renal function?
- Glasgow Coma Scale score
- Serum creatinine or urine output (Correct answer)
- PaO2/FiO2 ratio
- Mean arterial pressure
Correct answer: Serum creatinine or urine output
The SOFA score evaluates renal function using serum creatinine levels and urine output over a 24-hour period.
Question 3: A CNS is leading a team caring for a patient with a latex allergy scheduled for surgery. Which risk management action is MOST critical preoperatively?
- Scheduling surgery as the last case of the day
- Ensuring a latex-free environment and alerting all team members (Correct answer)
- Administering prophylactic antihistamines 24 hours before surgery
- Placing the patient in isolation to prevent latex exposure
Correct answer: Ensuring a latex-free environment and alerting all team members
Creating a latex-free environment and communicating the allergy to every team member is the primary prevention strategy to avoid anaphylaxis.
Question 4: A CNS observes that a nurse did not perform hand hygiene before patient contact. The BEST initial response is to:
- Document the incident in the employee's personnel file
- Immediately correct the behavior using a brief, respectful real-time reminder (Correct answer)
- Report the nurse to the charge nurse without intervening directly
- Wait to address the pattern during the next staff meeting
Correct answer: Immediately correct the behavior using a brief, respectful real-time reminder
Real-time, respectful correction is the most effective strategy to prevent patient harm from an ongoing infection control lapse.
Question 5: Which classification system does a CNS use to stage a pressure injury when the wound base is completely covered by slough or eschar?
- Stage 2
- Stage 3
- Unstageable (Correct answer)
- Deep tissue pressure injury
Correct answer: Unstageable
A pressure injury is classified as unstageable when slough or eschar obscures the wound base, preventing accurate depth determination.
Question 6: A CNS reviews fall incident reports and finds that 70% of falls occur during toileting at night. Which intervention addresses this specific risk pattern most directly?
- Placing all high-risk patients in physical restraints after 9 PM
- Implementing a scheduled hourly rounding and toileting program with nighttime emphasis (Correct answer)
- Locking bed wheels and raising all four side rails at night
- Increasing nursing staff on day shift to manage high-risk patients
Correct answer: Implementing a scheduled hourly rounding and toileting program with nighttime emphasis
Scheduled toileting and proactive rounding directly address the timing and activity patterns identified in the fall incident data.
Question 7: When assessing a patient's risk for contrast-induced nephropathy prior to a CT scan, which pre-existing condition is the most significant risk factor?
- Hypertension controlled with ACE inhibitors
- Pre-existing chronic kidney disease (Correct answer)
- Type 2 diabetes managed with diet alone
- Age over 65 with normal renal function
Correct answer: Pre-existing chronic kidney disease
Pre-existing chronic kidney disease is the strongest independent risk factor for contrast-induced nephropathy due to reduced renal reserve.
Clinical Nurse Specialist Risk Assessment & Management 3
A CNS is assessing a newly admitted patient for suicide risk.
Which element is the strongest predictor of future suicide attempt according to evidence?