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1. A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are:
Data, information, and knowledge.
2. The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months so as to modify practice is an example of:
3. Mr. Cruiser has been surfing the web. He is looking for healthcare information on low back pain. He shows the clinic nurse a Webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted five years earlier and was last updated three years before. The clinic nurse advises Mr. Cruiser to:
Avoid this site.
4. A nurse practitioner who manages his own practice offers his clients the option of contacting him via e-mail between visits. This allows his clients to request prescription renewals and educational materials and to ask nonemergency questions about their conditions. At times, this is convenient for both the clients and himself. Additionally, he should tell his clients that they:
Should wait up to 24 hours for a response from him.
5. The clinic nurse has just accessed a client’s chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client’s chart. She should say:
“I’m sorry, but you will have to enter the information using your own password.”
6. A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home and will need daily contacts for the next week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day. This type of technology is called:
7. At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a:
8. Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:
9. The chief nursing officer understands that to be able to compare data across client populations and sites, it is important that nurses use:
Structured nursing languages.
10. Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by:
Participating in organizational information technology committees.
11. You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from:
A clinical database.
12. You document your patient’s vital signs into a bedside documentation device and are able to compare your patient’s vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing:
13. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve:
14. As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that:
Physiologic monitoring systems enable detection of early changes before an adverse event occurs.
15. As a home health nurse, you use e-mail to communicate with some of your clients about their needs. You attend a conference for three days, and when you return, Mrs. S. is very upset because she sent you an email two days ago, and when you visit, she asks why you didn’t respond, since she did not know what to do with her insulin dosage for that morning. As a result, she ended up with an overdose of insulin and in the ER. To prevent such occurrences in the future, it would be important to:
Advise patients as to how long you will be unavailable for responses to e-mails.
16. As a nurse manager in a multisite facility, you are comparing the effectiveness of prompted voiding training programs for staff by examining the impact of prompted voiding on the frequency of incontinence in patients. To do this, you access an NMDS, which allows you to:
Retrieve standardized information regarding patient care and trends.
17. Nurses on your unit struggle with the application of terminology associated with nursing diagnoses. As a nurse manager and leader you provide information and education related to the value of standardized (rather than localized) terminology, which includes:
Computerized storage and retrieval of nursing data to support and describe nursing practice.
18. A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using intranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Health Information and Management Systems Society (HIMSS)?
19. As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system:
Involves screen displays that are best configured for non-clinical users.
20. When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to consider the advantages, which include:
Lower cost relative to PCs.
21. A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point for this. What would lead to this conclusion?
The type of speech required for voice recognition is unlikely in a pressured situation.
22. As a nurse manager, one challenge is to orient new staff to your agency’s policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be:
Linking policies and procedures to the network for access when required at the point-of-care.
23. A necessary, basic condition for successful integration of clinical information systems is:
Strong interdisciplinary cultures.
24. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to:
Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence.
25. As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include:
Developing rules that support inferences.
1. As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes (select all that apply):
Reduction in incidents of medication error.
Immediate documentation of care.
Immediate summons for bedside help.
1. The chief nursing office of a Magnet™ hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients:
2. The difference between a nurse practitioner’s charge of $45 for an office visit and the insurance company’s payment of $34 is:
A contractual allowance.
3. The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by:
Using fewer services per client.
4. In a nurse managers’ meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing:
5. The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a:
6. A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item?
7. A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position?
8. After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from:
Higher than expected client acuity.
9. An example of an initiative that may reduce total healthcare costs would be:
Offering nurse practitioner–led clinics that educate parents about nonpharmacologic strategies for managing ear infections.
10. Which of the following factors is not implicated in rising healthcare costs?
Rising Medicare costs
11. An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option?
12. After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method?
13. Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators?
The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.
14. Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to:
Balance value-added services against costs and revenues.
15. Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in:
Advocacy for patients with regard to services required and services utilized.
16. Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?
Training nurses on accurate documentation of supplies used for patient care
17. In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours.
18. In Question 17, the nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education, and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget?
19. The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to:
Determine the number of hours available for patient care.
20. In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000?
21. A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget?
22. What would BEST support the capital request in Question 21?
Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps
23. As an experienced nurse manager who is new to an organization, it would be important to:
Understand the budget timetable and level of involvement expected of individual managers in budget preparation.
24. A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager:
Decides that more information is needed before a conclusion can be reached.
1. The rising cost of health care in the United States is stimulated by which of the following (select all that apply)?
Medical treatment patterns
2. During the budgeting process, nurse managers are typically responsible for which of the following (select all that apply)?
Developing unit operation objectives
Justifying capital equipment requests
1. The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the:
Number of RNs and number of RNs with experience on the unit.
2. A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being:
3. To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers:
Paid hours minus worked hours.
4. An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to:
Outline the number of individuals by classification on a per-shift basis.
5. A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit’s staffing needs. An external variable to be considered is:
Department of Health licensing standards.
6. A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is:
Organizational staffing policies.
7. A nurse manager uses many sources of data when planning the unit’s workload for the year. Which of the following data must be considered in the planning?
Trends in acuity on the unit
8. Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule:
A variety of scheduling options.
Puts the right person in the right position.
11. In Question 10, the classification system that is used:
Combines interventions and time required for interventions to determine levels of care required.
12. Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to:
Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours.
13. A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities such as prompted voiding require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of:
Concern related to the validity of classification systems.
14. In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for:
An increased number of RN positions.
15. A strategy to increase RN staff retention at Valley Hospital includes:
Adequate staffing to meet acuity levels.
16. In evaluating mortality rates on the weekend, the head nurse on the cardiac unit is surprised to find that it is higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on:
Communication with on-call providers.
17. A nurse staffing plan takes into account:
Participation of nurses in projecting staffing needs.
18. As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at:
19. To maintain patient safety, studies suggest that scheduling should avoid:
20. In a job interview for a staff position, which of the following indicates your knowledge of patient safety?
“Is there a strategy in place to reduce the number of overtime hours on the unit?”
21. To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization:
Develops a centralized pool of float nurses.
22. To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following?
Average nonproductive hours
23. Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to:
Submit the schedule to a centralized staffing office for review.
1. In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager’s role is complex. Which of the following duties are required of a nurse manager (select all that apply)?
Responsibility for nursing benchmarks
Preparing a unit budget
Changing staffing plans based on service needs
1. The nurse manager schedules evaluations of staff members using a newly developed performance appraisal tool. The development of a performance appraisal tool should include:
Organizational mission, philosophy, and position requirements.
2. John, a new graduate, reviews the employee evaluation for his new position. The first section requires that he list his own specific objectives to be accomplished. This is an example of:
Learning goals, or management by objectives.
3. John notes that the next section is specific to the organizational philosophy and has a four-point ordinal scale that describes performance from “always meets expectations” to “does not meet expectations.” This type of evaluation is most commonly known as:
A traditional rating scale.
4. On your unit, despite efforts to build a strong sense of team, conflict between some of the staff is ongoing. Nonetheless, you want to proceed with developing a systematic and effective performance appraisal system. Which of the following approaches would be most appropriate for you to implement?
A combination of tools
5. As part of orientation to your unit, you decide to administer Kolb’s Learning Style Inventory (LSI) to new staff. The most likely reason for your decision is that the use of Kolb’s LSI:
Enables individualization of learning to the learner’s needs.
“I will be in contact with all candidates by telephone by next Friday. It has been a pleasure to meet you.”
7. In addressing the primary challenge in recruitment of new staff, which of the following interview questions might be asked?
“We have a number of older adult patients on this unit. If you noticed another staff member addressing one of these patients impatiently, how would you respond?”
8. The biggest challenge in the recruitment of staff is:
Finding well-qualified candidates who can function well within your particular work culture.
9. Anecdotal notes:
Can be used to support and justify fairness in termination discussions.
10. An outpatient clinic advertised for RN positions. Before authorizing an open position, the nurse manager should:
Review the position description and performance expectations for the opening.
11. Joanne is a likable and popular staff member. Despite occasional complaints from patients about inappropriate comments and rough handling of patients, Joanne continues to receive positive performance appraisals. This is an example of:
12. The validity of comments and ratings related to performance is enhanced by:
Maintenance of anecdotal notes over the entire evaluation period.
13. A nurse manager in ICU works with his staff to develop an appraisal instrument that includes quantitative data and respects standards for an RN working on that unit. This type of appraisal is a:
Behaviorally anchored rating scale.
14. The primary disadvantage of the appraisal tool in Question 13 is that it is:
Expensive to develop.
15. Sue, a nurse manager, discusses her concerns about the hospital’s employee appraisal system with her work group, noting that all that it includes is one rating scale, and that it means nothing unless the manager is effective in her job. Sue’s concerns reflect which best practices associated with performance appraisal?
BARS is considered superior to simple rating scales in terms of performance appraisal.
16. During a performance appraisal, Joanne, the nurse manager, indicates that Alysha has difficulty mentoring students on the unit. Alysha responds that this is not her responsibility. In responding to Alysha, Joanne needs to consider:
Whether mentoring is included in the position description.
17. The final section of a performance appraisal is a rating scale. This scale is very detailed and relates to competency standards specific to surgical clients. The scale is a summary of performance directly observed or documentation reviewed and is specific to client care situations in which the employee has been involved. This type of evaluation is most commonly known as:
A behavior-anchored rating scale.
18. John’s performance was satisfactory during the first month, but after that time, he was found to be very inconsistent in the provision of nursing care. One month before the end of the rating period, he cared for a very wealthy and influential client, who is best friends with the clinical manager. This client donated new furniture for the staff lounge in John’s name to show appreciation for his care. John’s subsequent performance appraisal resulted in outstanding ratings in all areas. This is an example of:
A bias related to recent events.
19. As a manager, you are interested in developing behavioral questions for an interview. Knowing that there is team conflict at times on your unit, which of the following questions would satisfy your interest in behavioral questions?
“Tell me about a time you were involved in a conflict related to a project. What was your role in the conflict? In the resolution of the conflict?”
20. Which of the following strategies might be effective in empowering staff?
Monthly staff meetings during which a portion of the agenda is devoted to sharing ideas and presentations on best practices for implementation on the unit.
21. The chief nursing officer establishes a shared governance model to help empower the nursing staff, thus empowering the organization. Common characteristics of empowered organizations are:
Shared values, flexibility, and a human-capital focus.
22. Joanne, a new nurse manager, writes certain assumptions regarding the organization’s objectives into her budget. Her supervisor tells her that the objectives implied in her assumptions are not entirely consistent with the organization, and that she needs to clarify these objectives with her supervisor. Joanne apologizes and says she had more latitude with the budget where she previously worked. This is an example of:
23. A survey of staff satisfaction is conducted. The survey indicates that staff members are satisfied, are loyal to the organization, and feel that they have reasonable control in their individual responsibilities. The findings best exemplify:
Clarity in roles and valuing of contributions.
24. You have hired Chelsea as a new staff member on your unit. Although she is an experienced ICU nurse, this is her first educator role. A month into her new position, she confides that she feels really incompetent in her new position and bursts into tears. Your response is based on application of your understanding of:
1. During the performance appraisal session, the manager should (select all that apply):
Maintain a relaxed and professional manner.
Allow the employee to express opinions orally and in writing.
1. When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed:
2. The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as:
3. The nurse manager frequently interacts with staff and other hospice facility employees. Communication was purposeful because the manager assessed current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathered available staff members to address similar learning needs. Many times, staff members were found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are:
Dialogue, team learning.
4. The clinical coordinator expects the position description of the new wound care specialist to change nurses’ responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to:
Apply both planned and nonlinear approaches.
5. Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to:
Consciously evaluate invisible mental models.
6. To effectively achieve a change goal/outcome in a change situation, the wound care specialist will:
Strengthen facilitating forces.
7. The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in:
8. The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is:
Integrating the change.
9. An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejectors is to:
Delegate the roles and tasks of change.
10. An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to:
Share change experiences early in the process.
11. As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin’s stages of change?
12. To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach?
13. In Question 12, staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers’ decision-making process?
14. Elizabeth, an RN with approximately 15 years of service on your unit (Question 11), walks away from one of the learning sessions on IV care, and you overhear her telling a colleague that she thought the session was a waste of time because “the unit has been using heparin for years and there has never been any adverse effect.” According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change?
Building a relationship
15. You follow up with Elizabeth (Question 14) and discover that she is really quite angry about the information sessions because she feels that you are implying that “what she has been doing all these years means that she is incompetent and doesn’t care about her patients.” Your response to her indicates that:
Change involves emotions rather than intellect.
16. Which of the following would be the most effective response to Elizabeth (Question 14)?
“It is difficult sometimes to change what we know very well. Sometimes it can be frightening.”
17. Elizabeth is an example of a(n):
18. After speaking with Elizabeth, a few days later, you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. This type of campaign is best described as:
19. Based on Elizabeth’s insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is:
20. Resistance is most likely when change:
Threatens personal security.
21. As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an:
Informal change agent.
22. As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches. On the basis of this feedback, you:
Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.
23. The situation in Question 22 is best captured in which theory of change?
24. Sarah, RN, is one of your most enthusiastic staff and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah’s suggestion would be:
“There is a great group here that meets to look at technology pilots. Let’s see if you can join them and discuss your idea further.”
25. Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the “old system” would have been just fine. In facilitating change, your best approach to Edith would be to:
Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change.
1. Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.)
1. A nurse manager is experiencing conflicts between herself and staff members. She had tried to develop a team by using a shared leadership model to empower the staff. Staff members are functioning:
As a group.
2. The nurse manager used a mediator to help resolve conflicts on the unit. During the mediation process, the nurse manager saw signs of potential team-building. One key concept of an effective team is:
3. A mediator suggested that the nurse manager and staff members decide on a method to resolve conflicts. It is important to have agreements about how team members will work together because:
If there are no agreements, each member will make up his or her own procedures without consensus.
4. By following a shared leadership model, the nurse manager believes that staff members will learn to function synergistically. Some teams function synergistically because members:
Actively listen to each other.
5. The chief nursing officer decided that the nurse managers need a series of staff development programs on team-building through communication and partnerships. She understood that the nurse managers needed to build confidence in ways of handling various situations. The greatest deterrent to confidence is:
Fear that one can’t handle the consequences.
6. The mediator noticed that tension was still evident between the nurse manager and staff members. He informed the chief nursing officer that to begin team-building, it would be important that everyone:
Work together in a respectful, civil manner.
7. The state of being emotionally impelled, demonstrated by a sense of passion and dedication to a project or event, describes:
8. The mediator suggested to the unit staff that a group agreement needed to be made so meetings could become productive. For example, the group agreement, “We will speak supportively,” prevents:
Gossip and backbiting.
9. The mediator asked each staff member to reflect on his or her communication style. Which of the following best describes communication? Communication:
Consists of thoughts, ideas, opinions, emotions, and feelings.
10. The staff development educator developed strategies to help nurse managers actively listen. Guidelines for active listening include which of the following?
Cultivate a desire to learn about the other person.
11. The nurse manager was upset with the staff nurse and said, “You did not understand what I said.” Which element in the communication process was she referring to?
A set of barriers that may occur between sender and receiver
12. The nurse educator was giving a workshop on team building. She noted that effective communication is essential for team building. One of the key questions in the workshop was, “What is the best way to check to see if what you have communicated to a team member is understood the way you meant it to be understood?” The correct response is which of the following options?
Active listening and feedback
13. Sally (RN) and Melissa (RN) have shared an ongoing conflict since the first day that Melissa worked on the unit. Sally has confided to another colleague that she doesn’t even know why the conflict started or what it was about. This is an example of:
The enduring nature of first impressions.
14. After staff meetings lately, Sharon, the head nurse, observes her staff in small groups, having animated discussions that end abruptly when she approaches. Sharon reflects on this observation and realizes that:
Staff members are very committed to the team and have strong opinions.
15. You are charged with developing a new nursing curriculum and are committed to developing a curriculum that reflects the needs of the profession and of the workplace. To address deficits that may already be present in nursing curricula related to the workplace, you include more content and skills development related to:
Effective communication in the workplace.
16. The SBAR system of communications is one of the most used communication systems in health care because:
It focuses on a system in which information is provided and gleaned in an honorable way.
17. Marcy, a new staff nurse, is very concerned about “fitting in” on the rehabilitation unit. She addresses her concerns and speaks with the head nurse. The head nurse speaks with the rest of the staff and reminds them how important it is for a staff member to feel that he or she is part of the group. Which of the following statements would she not include in her talk? “Staff members who feel included:
Are part of the 50% who feel their strengths are used.”
18. From the information presented in this chapter, which of the following statements best defines an accomplished team? Effective teams:
Can create a form of synergism in which the outcome is greater than the sum of the individual performances.
19. “I really wish that my supervisor would realize and acknowledge all the things I do well…” In nursing, this has been identified as a problem. Which statement is part of the solution? Focus on:
The strengths of the individual rather than the weaknesses.
20. Trust is an important aspect of helping relationships, therapeutic communications, and the positive communications model. Which statement does not involve or operationally define trust? Trust:
Can be described as a belief that although the nurse is capable of helping in times of distress, the nurse is unlikely do so.
21. Healthcare agencies and hospitals expect their practitioners to be effective team members. Two key players in the healthcare team are nurses and physicians. Which of the following statements accurately defines the roles and responsibilities of nurses and physicians?
Physicians are the first point of contact. They focus on the disease process, whereas nurses focus on the holistic needs of patients.
22. The unit manager was addressing nursing students in the lounge area and was discussing team leadership and team effectiveness. She stated, “One can agree to disagree with another team member’s perspective even when one doesn’t necessarily see that perspective as being the correct one.” In being creative, which of the following basic rules was she talking about?
Committing to resolution
23. Which of the following would not be a characteristic of an effective team nurse leader?
An autocratic perspective
24. Which of the following is not a necessary requirement for formation of a team? In forming a team, the leader should keep in mind that the team:
Should include only members with similar personalities.
25. What is not a key concept in a well-functioning team?
Absence of disagreement or conflict
26. Bennis, a researcher and writer, posits that effective leaders share three fundamental qualities. Which of the following is not a fundamental quality?
1. The staff members in a local emergency department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the:
Number of people who are involved in health care.
2. The emergency department nurses’ decision to organize for the purpose of collective bargaining is being driven by a desire to:
Create a professional practice environment.
3. The emergency department staff decides to use a collective bargaining model for negotiation, rather than a traditional trade union model. A traditional trade union model is characterized by:
An adversarial relationship.
4. The chief nursing officer utilizes the hospital’s Workplace Advocacy to help the overwhelmed emergency department staff. Workplace Advocacy is designed to assist nurses by:
Equipping them to practice in a rapidly changing environment.
5. A group of staff nurses and a nurse manager in an unrepresented facility have been unable to resolve a conflict regarding a change in protocol. Their agreeing to have a nurse from another unit assist them in their group process is an example of:
6. A Magnet™ hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with:
Client satisfaction with the healthcare organization.
7. In a nurse managers’ meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is:
Taking the opportunity to work with a mentor.
8. While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she:
Recommends transferring a nurse to another service.
9. The emergency department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management:
Delays responding to repeated efforts to provide safe care.
10. As a new nurse manager who has “inherited” a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to:
Conduct an organizational assessment of the unit.
11. In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary children. This is an example of:
12. In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate. Leanne is exemplifying:
13. Awareness and use of power have been challenging for nurses in general because of:
A tradition of obedience to authority.
Amplifying the influence of individuals.
15. Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near misses in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to:
Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention.
16. Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin’s follow-up to complaints from the community is:
Indicative that he does not clearly understand the concept of accountability.
17. Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient’s discharge. This action exemplifies which of the four historical concepts identified by Lewis and Batey?
18. In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer’s comments reflect:
An awareness of how organizational culture is reflected in organizational structure.
19. Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with:
A tendency to concentrate decision making during economic downturns at the top administrative level.
20. In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration:
Represent separate subcultures in the institution.
21. On Unit 62, the nurses and the unit manager have been involved in shared decision making to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that:
This will contribute to widespread skepticism among the staff about the probability of success.
22. Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to mission statement, goals, and objectives. For true shared governance to be seen as part of this approach:
It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions.
23. Nurses in an emergency department, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased. An appropriate action would be to:
Provide information about the decision related to recent changes in staffing.
24. The nurses in the emergency department in Question 23 continue to be concerned about safety levels. As the manager, you ask the nurses to:
Provide accurate, clear, concise data of incidents involving safety.
25. Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient’s history and of other medications that the patient has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating:
1. Potential outcomes of Martin’s actions (Question 16) include (select all that apply):
Poor morale on the unit.
Corruption of community relationships.
Corruption of patient-staff relationships.
Unmet patient outcomes for quality care.
1. A new graduate is asked to serve on the hospital’s quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:
Identify the standard.
2. The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It:
3. A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by:
Recommending that a multidisciplinary team should assess the root cause of errors in medication.
4. The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following?
Call a meeting of all staff to discuss this issue.
5. A nurse is explaining the pediatric unit’s quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?
Improvement in patient outcomes
6. Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:
Nursing care standards.
7. The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that:
Risk management programs are not designed to assign blame.
8. The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to:
Identify a clinical activity for review.
9. With the rise in workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:
Hold staff accountable for safe practices.
10. A healthcare organization is committed to improving patient outcomes as part of the quality improvement (QI) process and examines its executive structure and organizational design. This approach recognizes which model of QI?
12. Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:
Facilitates active staff participation in decision making related to quality nursing care.
13. A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:
14. In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence?
15. A method commonly used in Quality Assurance to monitor adherence to established standards is:
16. Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because:
Total organizational involvement is critical to QI.
17. As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because:
Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.
18. An example of an effective patient outcome statement is:
Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse. Practitioner within 3 hours of presentation in the Emergency Department.
19. Patient perceptions are useful in:
Assisting to establish priorities among possible changes to care identified in QI.
20. Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?
21. A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate?
22. The outcome statement “Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding” is:
Measurable and nursing-sensitive.
23. Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as:
24. At Hospital Ajax, staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame. This culture demonstrates:
Goals that are inconsistent with QM.
1. Examples of sentinel events include (select all that apply):
Forceps left in an abdominal cavity.
Patient fall, with injury.
Administration of morphine overdose.
Death of patient related to postpartum hemorrhage.
1. The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes concerning research utilization. What best describes research utilization?
Applying the results of a research study to practice
2. The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes about incorporating evidence-based nursing. What best describes evidence-based nursing?
Using research-based information to develop practice guidelines
3. The nurse manager decides to change staffing schedules in the intensive care unit. She chooses to use Rogers’ Diffusion of Innovations Theory to implement the change. What are the elements of Rogers’ Diffusion of Innovations Theory?
Knowledge, persuasion, decision, implementation, and evaluation
4. Understanding why it is important to provide certain strategies for the emotional support of parents of critically ill children is an example of:
Indirect research utilization.
5. The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. What type of research would provide the strongest evidence for this clinical issue?
A systematic review of research-based clinical guidelines
6. A strategic goal developed by the chief nursing officer is to implement an evidence-based practice program. What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program?
Soliciting input from staff members
7. The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care?
Conducting an interactive educational workshop
8. Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol?
Matching the appraisal tool to the type of evidence
9. To help staff nurses adjust to using research in practice, what strategy would the nurse manager use?
Establishing a journal club
10. What is a strategy that can be used by a small community hospital with limited resources to develop an evidence-based nursing practice program?
Partnering with nurse researchers at a local university
11. Tara, the unit manager, is telling her colleague about her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is:
A priority of all healthcare practitioners to better patient care.
12. After searching the literature, Tara (Question 11) develops a table that outlines the findings of studies on management of incontinence; it includes an appraisal of such criteria as risk and applicability to her particular population of moderately to severely cognitively impaired patients. This is which phase of Stetler’s research utilization model?
13. The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO):
Articulate practice recommendations developed from synthesis and review of evidence.
14. Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit. Marie’s response has been that she rarely has time to provide care to patients, let alone families. An approach that may gain Marie’s support of the idea is to:
Secure the support of her closest colleagues on the unit.
15. You are excited by evidence supporting the use of PDAs at the bedside to improve documentation and patient outcomes. You have disseminated the information through discussions and e-mails and are now ready to begin the process of considering implementation on the unit. To develop positive attitudes toward the use and implementation of the technology, you would discuss your ideas with (Rogers’ Diffusion of Innovation Theory):
Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice.
16. The implementation of saline flushes for capped angiocatheters is an example of:
How multilevel and interdisciplinary application of a procedure can slow adoption of EBP.
17. Which of the following would be most effective in implementing the findings of Dobbins et al. on treating problems associated with bowel motility?
Workshop for surgical nurses that involves discussion of case studies and application of evidence
18. Which of the following has been identified as a significant factor in moving EBP into patient care?
19. Within a multisite healthcare system, the most appropriate strategies for translation of research would be:
Establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.
20. At an organizational level, which of the following strategies would assist in ensuring that EBP is incorporated into nursing care?
Formation of a network of individuals doing research and/or interested in research utilization
21. Which of the following is most accurate regarding evidence-based practice?
EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.
22. Which of the following is a meta-analysis?
Review of 35 studies to determine the significance of research in contributing to nurse work satisfaction
23. Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to:
Consider whether patients’ families see this as necessary for the well-being of family members.
24. Which of the following would be considered research?
Interviews with terminally ill cancer patients regarding their experience of being terminally ill
25. Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n):
1. A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding (select all that apply):
Compatibility of this intervention with the values of staff on the unit.
Advantages of prompted voiding over incontinence products and catheterizations.
Usefulness of prompted voiding with the particular population of patients on the unit.
Feasibility of the program with respect to unit design.
1. The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by:
Empowering others by promoting self-determination.
2. As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution?
Allowing professionals greater influence over their practices
3. The nurse manager understands that the three Ps associated with client education include philosophy, priority, and performance. Effective client education programs start with a shared philosophy that such programs are worth the investment. Evidence of a philosophic commitment to client teaching is best represented by:
Investing time and energy in teaching clients.
4. The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the:
5. The nurse manager has to develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument?
Including items that are important from the patient’s perspective
6. In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy?
Providing instructional materials at appropriate reading levels
7. The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships?
Involve the staff in resolving consumer issues quickly and effectively.
8. Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service?
Assess the perceptions of the nursing staff regarding the particular service problem.
9. The chief nursing officer is pleased with the nurse manager’s strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers?
Recognition of the nursing staff for excellence in promoting consumer relationships
10. In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: “What is an important consideration in providing information to parents of a critically ill child?”
Assessing parents’ preferences for the amount of information desired
11. In designing a Web-based program for seniors with Parkinson’s disease, it is important to understand that:
The program will not be used by half of the target population.
Lack of health literacy.
13. John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn’t understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John’s experience represents what aspect of the current consumer experience?
Fragmentation of care results in lack of respect and trust.
14. The complexity of the healthcare environment for consumers is increased by:
Complex compensatory systems and a variety of delivery systems.
15. Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the:
Coordination of care, services, advocacy, and access for patients within the healthcare system.
16. In the situation described in the Multiple Response Question below, treating the patient with chest pain ahead of the patient with a migraine is a:
17. The patient in the Multiple Response Question eventually receives medication for his headache. Administration of the medication is:
18. Which of the following exemplifies a service orientation?
A children’s preoperative holding area promotes family interactions for those undergoing surgery.
19. As a head nurse, you are concerned about whether your unit is managing pain well and study the results of a recent patient satisfaction survey very closely. Which of the following findings and approaches might provide useful information for you?
Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution.
20. As a nurse manager, you see an opportunity for patients to be well-serviced through the medical home concept. You recognize that the concept of medical homes:
Currently does not include nurses in its vision of multifaceted primary care.
21. Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is:
Using high-tech–high-touch approaches.
22. Which of the following actions best exemplifies advocacy?
Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
23. During review of a patient’s progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are:
Advocating for the patient.
24. A nurse makes a medication error that is not serious and does not cause harm to the patient. As the head nurse, your best action would be to:
Educate the nurse on how to provide an apology to the patient.
25. An example of a factor that would impede a patient’s learning would include:
1. Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.)
Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician
Ensuring that birthing preferences are on file and available when a laboring mother comes in
Providing support to families when a family member is brought into trauma
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