Analyze each question and choose the best response. Record your rationale for each choice.

Transcription

1 Analyze each question and choose the best response. Record your rationale for each choice. Here is an example of a run chart demonstrating a trend is it showing you that the infection rate is improving or worsening? What happened from Feb-May? What happened from May-Dec? 1. What should an MSN do first after identifying the trend that occurred over the Feb-May timeframe? (For this question, disregard the data presented from the May-Dec timeframe.) a. Review the literature to identify current best practices in CAUTI reduction. b. Observe nursing staff completing catheter insertions for proper technique. c. Bring the information to the attention of the QI team. d. Revise policy to ensure proper insertion of urinary catheters. e. Continue monitoring to ensure sustained improvement in patient outcomes. From Feb-May, we see a marked increase in the infection rate (which is higher in May than what we started with in January). So response E can be eliminated; we ll need to continue monitoring but not because we ve achieved any improvement at this point. The problem with response A is that it makes an assumption that there is no problem with our current core knowledge of catheter placement. Here is an article that helps address what needs to happen: uce.27.aspx Step Zero in this article is interesting. It implies that this is our background information or a set of basic nursing skills & core knowledge, not part of the main steps of the EBP implementation

2 process. Step Zero indicates pre-work a refresher or review of what we already know about catheter insertion. We could think of this as what we should already be doing. B should likely be done first to eliminate any obvious problems with our insertion technique. The rationale would be to provide remediation and correct practice as quickly as possible to protect patients from harm the other responses might result in further delay (if indeed we have a problem with insertion technique). Then armed with information about our current practice (as in Step One of the article), we could ask our clinical question and then go to the literature to see what best practices we might implement to achieve (additional) reduction in CAUTI (as in Step Two of the article). Response A is an excellent and appropriate follow up to Response B. We might then revise policy to help communicate the new practices (Response D) and also bring the project to the attention of the QI team (Response C) so the organization as a whole can learn from this experience. 2. What should the MSN anticipate will be the next step in the QI process following the trend that occurred over the May-Dec timeframe? Choose the best response. a. Establish a new goal of reducing CAUTI by an additional 25% in the next year. b. Examine the data to determine which units experienced the highest rates of CAUTI. c. Maintain current process improvement activities and continue monitoring CAUTI. d. Identify new process improvement goals and activities for the unit. e. C then D f. A and B only CAUTI from May-December are trending down, indicating a reduction in the infection rate. It is reasonable to continue current practices. And with CAUTI being included in the National Patient Safety Goals (one of our nursing standards), the organization will want to ensure that monitoring is continued and improvement is sustained. With most of our data points at or below the median over the past six months, it s probably time to look for some new improvement goals as well. Goal 7 of the National Patient Safety Goals (NPSGs) can be found here: 3. For which population-based change would there be a need for education of the population? a. Guidelines for placing babies to sleep on their sides at night. b. Recommendations to administer vaccines no matter how long the interval between doses. c. A new drug to treat BPH. d. A new lab test for HIV e. A less-invasive method for performing bariatric surgery While all of these changes will impact the health of these particular populations, only response A will require education of the population to effectively implement the change. The other changes would primarily or initially entail education of the health care providers who care for

3 the population. The target populations in Responses B through E can only receive these new interventions if the health care providers know about them. 4. When working with an inter-professional team, what should you (as an advanced practice nurse) do if you are not certain that an assignment is consistent with your personal values? a. Speak with the team leader about the values conflict. b. Work with the team members to propose a new direction. c. Convince the team members that your perspective is correct. d. Argue with team members who disagree with you. e. Publish your disagreement with the assignment on the hospital intranet. f. Resign immediately from the team. All responses except A involve some unethical, unconstructive, and/or potentially negligent action. Consider this definition: Cultural Imposition - A situation where one culture forces their values and beliefs onto another culture or subculture. Here s the article for more information: lumns/ethics/culturalvaluesandethicalconflicts.html 5. What is the most-defining or unique characteristic of a masters prepared nurse as compared to a BSN or associate degree nurse? The MSN: a. Can be promoted to management positions in patient care settings. b. Acts as a mentor and expert clinician for other nursing staff. c. Provides indirect patient care for individuals and populations. d. Is academically prepared with an expanded range of nursing knowledge. BSNs can (and do) perform the roles of mentor, manager, and indirect care provider. Nurse clinicians (NP, CRNA, CNM, etc.) generally must have a masters or higher degree, but not all MSNs are certified as clinicians (independent practitioners). On the other hand, if we think of the word clinician as meaning a person who has expert knowledge of a particular specialty, that would not be specific to an MSN prepared nurse. D is the best response. 6. A staff nurse asks a MSN for help in addressing a patient care concern. Which course of action is best for the MSN to take? a. Work with the staff nurse to identify appropriate nursing interventions. b. Remind the staff nurse that patient safety is the first priority of care. c. Tell the staff nurse where to find evidence-based practice guidelines. d. Ask the staff nurse for additional detail about the patient care concern. e. Follow the chain of command and bring the complaint to the supervisor.

4 What does patient care concern mean? The patient has a concern about his/her care? Are we dealing with a patient complaint? Or the nurse or other healthcare provider has a concern about the patient s care? It would be important to define the problem first, and then assist the staff nurse in developing a targeted course of action. As an example, in response A, a nursing intervention might not cure the problem potentially a medical intervention or a customer service intervention is required. We don t know until we identify the actual problem. The other responses make assumptions about the problem (in regards to patient safety, EBP, complaint ) 7. Which practice should the MSN recommend as the first step in decreasing the infection rate for CAUTI in a med-surg ICU? a. Insert urinary catheters using aseptic technique. b. Insert urinary catheters only when medically necessary. c. Insert urinary catheters only by trained RNs. d. Maintain placement of urinary catheters for 36 hours or less. e. Insert urinary catheters only in the OR. All of these responses refer to processes one way to differentiate a process from an outcome is to think about steps in a plan. For example, you could easily see these particular statements put into a care plan (but a couple of them would be wrong). The outcome measure of this plan of course would be our infection rate this is the actual result of our interventions & tells us what is happening to our patients. This question is a follow up from the first 2 in this quiz. In principle, we know that it is an infection control best practice to refrain from performing any invasive procedure unless absolutely necessary. Response B will help us improve our CAUTI rates by limiting our population of susceptible hosts (to infection). Correct observance of aseptic technique (a basic nursing skill for short term invasive procedures) will be augmented by more informed decision-making to reduce the number of patients who will be subjected to catheter insertion in the first place. Use of sterile technique to perform urinary catheterization in the OR (or other controlled environment) is going a little overboard in terms of infection control for this procedure (and not very cost effective) sterile of course means free from all microorganisms while aseptic means free from disease-causing organisms. We know that MDs and PAs (for example) are trained to insert catheters not just RNs. So we can eliminate that response. Limiting the length of time urinary catheters are retained may also help us reduce our CAUTI rate. However, limiting the population as an early step, inserting catheters using appropriate technique, then limiting the time catheters are retained would be the best set of options for these patients.

5 8. An MSN in the Quality Management department is working to improve the culture of safety of an organization. Which of the following would not be a systematic approach to patient safety? a. Establishing an effective reporting system. b. Developing procedures to deal with medical negligence. c. Creating a care environment that doesn t blame individuals. d. Making the assumption that every person intends to do the right thing Procedures that deal with medical negligence would generally hone in on individuals (potentially to punish them) rather than focusing attention on system improvements. The other responses (a, c, and d) clearly refer to improvement methods and attitudes that direct activities away from individuals. This will help support efforts to create and sustain a culture of safety. We want individuals to be upfront in reporting errors so we have a chance to improve our systems. We also need to start with the assumption that our people intend to do right by our patients. The IHI states that only about 5% of medical harm is caused by incompetent care or intentional harm. In contrast, 95% of medical harm involves conscientious, competent individuals involved in circumstances that lead to a catastrophic result. For more, click here: %20Summaries.pdf We definitely do not want to create a culture in which it is assumed (or that it appears we assume) that most people intentionally do the wrong thing. We ultimately want to create systems that make it easy for people to do the right thing and hard to do the wrong thing. This helps keep the intent well aligned with the action and the results. So while addressing medical negligence (when it occurs) is a serious concern, such procedures are not a systems-focused approach to patient safety or to creation of a culture of safety. 9. Which of the following would be the least important action for an MSN to take when attempting to prioritize intervention measures after an adverse patient event? a. Determine which staff member made the error that caused patient harm. b. Determine the historical error rate for the event that occurred. c. Determine the frequency of the events and the level of harm. d. Determine the feasibility of implementing a particular intervention. Again, we want to focus on systems improvement and avoid blaming individuals. Response A is the least important action to take. The IHI states: accidents in health care almost never stem from a single, linear cause or from the action/inaction of a single individual. Below is Reason s Swiss Cheese Model of error causation. The holes in the cheese are places that a process can fail despite everyone s good intentions. Each cheese slice is a defensive layer in the process. When an error passes through one of the gaps in the line of defense, it usually

6 bumps into another defense. Sometimes however, the holes line up and the error reaches the patient. In this illustration, 4 holes or 4 errors line up, resulting in patient harm. If we wanted to attribute blame for this patient death, who would we say was deserving of such blame? We have at least 3 people involved but what of all the others who potentially handled the patient s record and missed the fact that no allergy history was obtained? What is important to note, is that even if the nurse at the sharp end of the model had realized the problem and prevented harm from reaching the patient, errors in the process had already occurred. Additional defenses or redundancies likely need to be created to prevent or help reduce the occurrence of the errors happening in this process. Another consideration for this question is how to perform risk assessment. As an example, infection control practitioners perform risk assessment in order to prioritize intervention measures to avoid adverse patient events. They do this by assessing: 1. The likelihood of occurrence/reoccurrence. 2. The severity of harm resulting from such events. 3. The feasibility of successfully implementing a new step/intervention and/or our ability to detect failures in these newly implemented steps/interventions. Risk assessment has the effect of helping us spend our resources wisely--on projects that will have a large positive impact (in terms of the number of patients it affects or the resultant mortality), and that we can successfully initiate and reliably implement over time. The IHI has more discussion on performing Failure Mode Effects Analysis (which is a systematic, proactive method of evaluating steps in a process) and assigning Risk Priority Numbers for potential failures in these steps located here: Analysis.aspx

7 10. After reviewing the National Patient Safety Goals, the MSN determines that all but one of the following interventions would be effective for reducing risks of patient harm due to medication errors: a. Require staff to ensure appropriate container labeling for medications. b. Document complete medical and medication history of the patient. c. Use the patient s room number to identify the patient when administering medications. d. Provide the patient (or family) with written information on the medications the patient should be taking when he or she is discharged. e. Store look-alike, sound-alike medications in the separate locations. f. Use only standardized abbreviations for medications. The NPSG for patient identification (Goal 1) requires us to use 2 unique patient identifiers (name, id number, etc.) to ensure we have the correct person before we administer medications, give blood, take lab specimens, or perform tests, treatments, & procedures. The patient s room number or physical location is not a unique identifier. All of the other responses have an important role in reducing risks of patient harm related to medication errors. 11. One of the following actions would contribute the most to reducing the risk of healthcare acquired infections. Which action would this be? a. Use disposable medical supplies at all times in treatment areas. b. Establish a multi-disciplinary infection control committee to perform risk assessment. c. Follow and monitor compliance with established hand sanitizing protocols. d. Implement appropriate CDC isolation precaution(s). While all of these responses could potentially reduce the risk of patient harm related to healthcare acquired infection, hand hygiene is the most encompassing measure we can take. Hand hygiene of healthcare staff is specifically mentioned in Goal 7 of the NPSGs. The impact of the other interventions (responses A, B, and D) would have limited scope. 12. An MSN is working as a hospital risk manager. What would be the primary reason for her to identify and analyze a medical error that did not result in patient injury or harm? a. To report the error to state medical and nursing boards. b. To identify and hold accountable the person or persons responsible. c. To notify the liability insurance carrier about possible future adverse events. d. To help identify flaws within a system. The role and responsibilities of a hospital risk manager could potentially include all of the responses listed here. Risk managers manage risk to the organization more than managing risk to patients managing risk to patients is the responsibility of healthcare providers in general. The

8 primary focus for a hospital risk manager is to help ensure the continued viability of the organization. However, in this case, we re talking about an error that did not result in damages. The hospital risk manager is not dealing with an event that will result in a successful claim (lawsuit). So the focus for the hospital risk manager would be to help improve systems to manage future organizational risk. For a hospital risk manager, responses a and b generally refer to being an honest broker for the organization (and for patients) to responsibly deal with personnel who choose to engage in reckless behaviors these would be behaviors that peers deem to go beyond simple human mistakes and acts of omission. Response c would need to be very judiciously approached in order not to needlessly increase costs improving systems to avoid such costs in the first place would be a much more proactive activity for the organization. 13. An MSN working in the operating room is confronted by a surgeon who refuses to perform the Universal Protocol Time Out procedure due to lack of time. What is the best decision the nurse could make to protect the patient from harm? a. Identify the patient, procedure site, and procedure with the anesthesiologist while the procedure is being started. b. Instruct the surgical technician not to offer any instruments to the surgeon and notify hospital administration. c. Argue with the surgeon. d. Leave the OR to avoid being found at fault. Responses c and d are obviously off the mark and won t help to ensure the safety of the patient. It s tempting to circumvent (to work around) the Time Out procedure (as in response a) and try to avoid further conflict with the surgeon, but we don t have good assurance that harm won t occur anyway (the procedure is being started and only 2 participants are performing the verification). Response b is the right thing to do, not only for this patient but for this surgeon s future patients as well. 14. An MSN case manager discovers that a physical therapist is regularly billing one-hour sessions while providing 20 minutes of care. Which of the following actions of the case manager is most appropriate? a. Document the discrepancy in the patient record. b. Notify the patient of the discrepancy. c. Report the activity. d. Confront the physical therapist to highlight the discrepancy. e. Do nothing because patients will eventually complain. The MSN case manger needs to report the activity. Responses a and b will increase the risk to the organization by creating new problems, will likely not cure the original problem, and/or may create delays in dealing with this problem. Confronting the physical therapist (as in response d)

9 might be tempting but the case manager will not be able to exert any authority over this individual and this activity will also not help address the problem of what has already occurred in terms of fraud and abuse. Response e would place the case manager in the wrong as well. 15. The chief of surgery decides to address a quality problem among thoracic surgeons interacting directly with staff. Who should participate in the meetings to address the problem? a. Medical staff leadership. b. Nursing and risk management staff. c. Quality assurance committee. d. Relevant physicians, nurses and non-clinical staff. e. Thoracic surgeons only. The medical staff leadership, risk management staff, and the quality assurance committee might be good resources to go to for guidance but are not the people who can identify the problems and who will work on the solutions. The thoracic surgeons by themselves will likely not be able to provide the full scope of issues. D is the best response. Quality issues are best addressed by involving all stakeholders. 16. Spurred by the Institute of Medicine reports on medical errors, a hospital's governing body demands a crash program to reduce medical errors. The CEO orders the senior staff to immediately start nine patient safety projects. This decision will impede the likelihood of the organization lowering the rate of medical errors for which of the following reasons? a. Information technology implementation is required to efficiently start patient safety projects. b. Involvement of the medical staff is critical in all patient safety projects. c. Projects should focus on medical errors. d. The quality assurance committee should direct all patient safety efforts. e. Resources are allocated to too many projects. While IT and medical staff are great to have on board for a variety of patient safety projects, their involvement might not be critical depending on the issue. The quality assurance committee is also great to consult for guidance but should not direct all patient safety efforts. Patient safety for an organization is a job too big for one committee. Projects to improve patient safety should focus on preventing/reducing the incidence and impact of medical errors the IOM reports provide good information on where to look to improve. E is the best response. If organizational resources are spread too thin, none of the patient safety projects may succeed. It would be important to carefully review the nine proposals and choose those that are most cost effective and yield the greatest benefits to patients. (See the discussion in question 9 about performing risk assessment and assigning risk priority numbers.)

10 17. A chief nursing officer pulls together a Quality Improvement team to improve the efficiency of transferring patients from the emergency department to the patient floors. To ensure that the newly designed process is efficiently implemented, who must be part of the team? a. Chief information officer. b. Chief medical officer. c. Chief operating officer. d. Emergency department head nurse. e. President of the medical staff. The Emergency department head nurse is a stakeholder in this process. None of the other options reliably give us a person with the know-how or the vested interest in implementing this improvement. 18. Which adverse event will more often result in a longer length of hospital stay, higher charges, and a greater likelihood of mortality? a. Hospital-acquired infection. b. Medication error. c. Mislabeled lab specimen. d. Patient fall. While medication errors, mislabeled lab specimens, and patient falls are all very concerning events that could lead to patient death, healthcare associated infections (HAIs) are one of the top ten leading causes of death in the United States and are one of the leading causes of death and increased morbidity among hospitalized patients worldwide. HAIs increase medical costs and the length of hospital stays. Four categories of infections account for most HAIs in the acute care hospital setting: Surgical site infections (SSIs) Central line-associated bloodstream infections (CLABSIs) Ventilator-associated pneumonia (VAPs) Catheter-associated urinary tract infections (CAUTIs) HAIs are discussed in the NPSGs and in the Healthy People 2020 initiatives:

11 19. The most likely interpretation of the data presented in the run chart above is: a. Occurrence of medication errors increased during b. Severity of medication errors increased every quarter. c. No medication errors occurred in March d. Improvement in patient safety was demonstrated every quarter. e. Reporting of medication errors got worse during f. The organizational culture of safety improved during g. A, C, and E Responses a through e are incorrect. An overall increase in the reporting of medication errors is shown for While the number of reports received was low in March, it did not hit zero (response c). We also do not have good assurance that patient safety improved or worsened in the area of medication errors for 2002 or that the actual rate of occurrence or severity of errors increased (responses a, b, d, and e). We only know what people are willing and able to tell us. Personnel are voluntarily providing the information seen in the chart it is based on self-report and the number of self-reports is on the rise in This is likely an indicator that personnel increasingly felt more comfortable about reporting errors and/or had better knowledge of or better access to reporting mechanisms. The only thing we can really say is that we are receiving more (and potentially better) information about error causation and increasing our ability to identify areas for improvement. The increase in self-reports would tend to indicate that the organizational culture of safety has improved. The organization is receptive to getting the reports and individuals are increasingly willing and able to provide them.

12 20. All but one of the following would apply to the MSN in the role of preceptor to a novice nurse. Which best describes the MSN in a mentor role? a. Observes and evaluates skill performance to determine if the novice nurse is making progress. b. Meets regularly with a novice nurse to provide support and guidance on making the transition to professional practice. c. Advises the novice to complete learning modules that reinforce nursing skills. d. Demonstrates appropriate skills, knowledge, and attitudes required for success on the nursing unit. e. Fulfills duties to assist the novice as assigned and determined by a supervisor. A mentor typically holds an unofficial role as a new nurse s trusted advisor. The mentor supports and nurtures the new nurse, usually checking in frequently to see how he/she is progressing. But there are no specific milestones or deadlines that must be met. The mentor is concerned about the nurse becoming an asset to the nursing profession as a whole, more than becoming an asset to any specific organization, unit, or job. A preceptor typically has an assigned duty of monitoring the training and evaluating the performance of a new nurse. A preceptor works with the new nurse for a defined period of time to assist the novice in acquiring new competencies required for safe, ethical and quality practice on a particular unit or for a particular type of job. At the end of the defined period of time, the preceptor is usually asked to help evaluate the novice and determine whether the individual is ready to work independently or needs additional time to train and prepare (as in an extension of the probationary time for a new job). When things go well, a preceptor may become a mentor to the new nurse (assuming that a relationship of trust has developed). 21. A 64 year old woman is admitted to the hospital with fever. She is treated with antibiotics for pneumonia. On day 2, she develops a severe rash over her whole body, which is felt to be related to her infection. The antibiotic is continued and the rash progresses. On day 4 she is confused, gets out of bed at night, and she slips and falls on a wet area of the floor, fracturing her hip. She dies on day 7. Which of the following causes would not be considered a system failure for this incident? a. Insufficient nurse staffing. b. Insufficient housekeeping practices. c. The physician failed to recognize the cause of the rash. d. OR scheduling issues; no surgeon was available. Response c is the only one that focuses on the error or failure of the individual, rather than on systemic failures seen in the other responses.

13 22. An MSN has been assigned to the QI committee. If the primary concern of the committee is to improve patient safety, which set of data would be the top priority? a. Pain management satisfaction scores increased from 70% to 80%. b. Nurse turnover rate increased from 15% to 20%. c. Patient wait times in the ER increased from 5 minutes to 15 minutes. d. Surgical site infections increased from 2.1 to 4.2. e. Observations of hand hygiene compliance increased from 75% to 85%. An increase in satisfaction (response a) and an increase in hand hygiene compliance (response e) are both great! But probably neither of these would be at the top of our priority list at this point things are going well for these initiatives. Increases in nurse turnover rates and patient wait times in the ER are both concerning. These could have a negative impact on patient safety. But the incidence of surgical site infections is now twice the previous rate. This means that something is impacting our patients right now. As we saw in question #18, HAIs (of which surgical site infection is one) result in a longer length of hospital stay, higher costs, and a greater likelihood of patient death. D is the top patient safety priority. Additionally, we note that a, b, c and e all refer to process measures. Response d is the only outcome measure. 23. Which of the following aspects must a MSN nurse leader consider in creating a culture of safety? a. Teamwork. b. Ability to speak up about concerns. c. Leaders attitudes about safety. d. All of the above. All of these impact the development and sustainment of a culture of safety! 24. Which of the following would be the least useful in helping an MSN nurse leader know if her unit had learned from a mistake? a. Measure the effectiveness of a new policy or program. b. Test staff knowledge about a new policy or program. c. Observe directly to see if staff use a new policy or program appropriately. d. Interview the charge nurses to make sure the new policy or program was implemented.

14 Response d is the only one that relies completely on the knowledge base, interpretation, and motivations of others. Responses a, b, and c reflect steps the MSN would take to obtain the most objective data possible. 25. What evidence might not convince hospital leadership to invest in a patient safety intervention? a. An intervention improves patient safety and does not increase cost. b. An intervention improves patient safety and increases patient wait times. c. An intervention improves patient safety and decreases hospital length of stay. d. A few additional steps in a process can improve patient safety in several areas. Initiatives that keep costs the same, reduce costs (by decreasing hospital length of stay), or are efficient (have positive affects in several areas at once) would be easier to sell to hospital leadership than one that potentially creates a new problem. 26. In the IHI model for Improvement, what does PDSA stand for? a. Process, Delivery, Study, Activation b. Plan, Do, Study, Act c. Position, Deploy, Steady, Aim d. Patient, Doctor, Student, Administrator For more on this topic, refer to the learning community or review the information located here: After summarizing the evidence to determine effective interventions for an improvement project, which of the following steps would not assist the MSN nurse leader in translating evidence to make patient care safer on her unit? a. Engage a team to assume ownership of the improvement project. b. Identify and remove local barriers to implementing the interventions. c. Focus on the care of an individual patient. d. Ensure all patients get the interventions. e. Measure performance. Delivery of appropriate care to an individual patient is very important but monitoring the care of a single patient will not provide good assurance that care is safer for all patients on the unit. 28. Mentors and preceptors often work with new nurses. Which of the following statements about mentors and preceptors is least applicable?

15 a. A mentor s role would be to guide the activities of the new nurse; a preceptor s role is to direct the activities of the new nurse. b. A mentor would advise the new nurse; a preceptor corrects and evaluates the new nurse. c. A mentor is usually assigned (often by a supervisor); a preceptor is usually chosen (by the new nurse). d. A mentor provides encouragement and support; a preceptor provides opportunities to obtain training and improve practical skills. See also question #20. A mentor is usually chosen (by the mentee) while the preceptor is assigned (by a supervisor). 29. The Patient Safety Advisory Group that develops the National Patient Safety Goals is comprised of an inter-professional team of nurses, physicians, clinical engineers, and other healthcare professionals. Clinical engineering professionals play a key role in the National Patient Safety Goal involving which of the following practices? a. Identify patients correctly. b. Improve staff communication. c. Use medicines safely. d. Use alarms safely. Clinical engineers would of course not have a primary role in determining optimal practices for patient identification, staff communication, or medication usage. They do have a key role in advising on use of biomedical devices that involve clinical alarms. NPSG 6 involves the safe use of clinical alarm systems. Some of the issues impeding patient safety include use of too many devices with alarms, default settings that are not at an actionable level, and alarm parameters that are too narrow. The danger is that staff will hear these alarms going off too frequently thus becoming immune (desensitized) to them. 30. The lengths of stay for patients with healthcare associated infections are 12, 12, 12, 13, 15, 15, 16, 20, and 30 days. What is the median length of stay? a. 12 days b. 15 days c days d. 25 days The median is the value that occupies the middle position when all the observations are arranged in an ascending/descending order. It divides the frequency distribution exactly into two halves. Mode, mean, and median are the 3 measures of central tendency. The mode is the value that appears most often in a set of data in this data set, 12 is the mode.

16 The mean is the average--the sum of the values in a data set divided by the number of values. In this data set, we would add up all the values and divide by 9 to get 16.1.