Leadership Chapter 10, Sullivan, Chapter 6 Managing and Improving Quality, Leadership Ch. 5, Leadership Ch. 1, Chapter 4

In order to delegate, which must be present? A. Accountability for the assignment on the part of the delegate B. Accountability for the assignment on the part of the delegator C. Authority by the delegator to assign the task to the delegate D. Responsibility for task completion on the part of the delegator E. Authority of the delegate to accomplish the task as assigned

A. Accountability for the assignment on the part of the delegate B. Accountability for the assignment on the part of the delegator C. Authority by the delegator to assign the task to the delegate E. Authority of the delegate to accomplish the task as assigned

The nursing supervisor is assessing a unit that has received several written complaints. The nurse manager seems overwhelmed and stressed trying to address many client situations. The charge nurse is trying to help everyone at once. Based on this assessment, what might this supervisor conclude? A. The nurse manager is inexperienced and needs time to adjust. B. The unit culture may foster distrust and poor communication among staff. C. Client complaints are usually an indicator of a larger unit problem. D. Nurses on the unit are in need of additional training and skills. E. The unit is short staffed.

B. The unit culture may foster distrust and poor communication among staff. C. Client complaints are usually an indicator of a larger unit problem. D. Nurses on the unit are in need of additional training and skills.

Which statement made by the nurse manager is an example of the first step of delegation? A. "I must choose a person with good time management skills to be the delegate for this task." B. "I plan to evaluate the outcomes of your work in 6 months." C. "I am going to delegate the responsibility of creating the vacation schedule." D. "I have some additional information that will help you in this task."

C. "I am going to delegate the responsibility of creating the vacation schedule."

What action is necessary by a delegate accepting delegation? A. Accept all aspects of the task delegated. B. Assume the delegator will serve as a mentor. C. Clarify the time line and expectations. D. Realize the delegate and delegator share responsibility.

C. Clarify the time line and expectations.

A newly licensed nurse is concerned about the legal aspects of delegation. What is the most important question for the nurse to consider prior to delegating a task? A. Do other nurses in the facility delegate similar tasks? B. How long has the assistant worked at the facility? C. Does this task involve nursing judgment? D. How busy is the delegate?

C. Does this task involve nursing judgment?

The nurse manager needs to delegate specific tasks to the charge nurse of the unit. Which action is an appropriate use of delegation? A. Instructing the charge nurse to assume a client team B. Asking the charge nurse to discipline a nurse on the unit C. Having the charge nurse lead a nursing quality assurance task force D. Evaluating all unlicensed personnel assigned to the unit

C. Having the charge nurse lead a nursing quality assurance task force

Which situation is an example of reverse delegation? A. The nurse manager asks the staff nurse to attend an in-service on a new product. B. The nursing supervisor asks the nurse manager to attend a meeting with the physicians. C. The licensed practical nurse asks the nurse manager to administer insulin to her client. D. The staff nurse asks the licensed practical nurse to record intake and output in his client's charts.

C. The licensed practical nurse asks the nurse manager to administer insulin to her client.

A staff nurse asks the nurse manager, "What assignment are you delegating to me today? I would like to begin to organize my day before shift report begins." What is the error inherent in this statement? A. There is no way for the nurse to know how to organize until the assignment is clear. B. The nurse manager would not make assignments. C. The nurse manager is not delegating but rather making daily assignments. D. Assignment occurs after shift report.

C. The nurse manager is not delegating but rather making daily assignments.

The nursing supervisor states, "I really don't have the time to delegate this task to a nurse manager. I can do it faster!" What is the most likely basis for this statement? A. The nursing supervisor does not have time to delegate. B. The nursing supervisor's job description needs to be redefined. C. The nursing supervisor feels that he or she can do the job faster. D. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

D. The nursing supervisor is concerned that staff is ill-prepared to assume additional responsibilities.

2. "Have we looked at all available data in order to make an informed decision?" 3. "What are the obstacles to implementing this change within the organization?" 4. "Are we including the opinions of all stakeholders in this decision?"

The nurse is working on a committee tasked with making a major organizational change. Which comments by the nurse would help to advance the work of this committee? Select all that apply.

3. "What is the exact clinical issue with which we are dealing?"

The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process?

1. Who is in control of the way holiday shifts are being assigned? 3. Who will lose when holiday shift assignments are changed? 5. Who is benefiting the most from the way holiday shifts are currently assigned?

The nurse manager has determined that changes are necessary in the way holiday shifts are assigned. When assessing the political climate surrounding this potential change, the nurse manager would ask which questions? Select all that apply.

1. The manager distributes a handout explaining the new system and how to use it.

The nurse manager is facilitating change to a new documentation system in the unit. If the manager wants to use the most common method to overcome resistance to the change, which strategy would be chosen?

3. Resistance can negatively impact future client care.

The nurse manager is facing resistance to change from many staff nurses. Why should the manager work hard to address this resistance?

2. Solutions are identified to create change.

The nurse manager is planning to initiate new policies in the department and is reviewing several change theories. Which step of Havelock's model will the nurse find most closely resembles Lewin's moving stage?

3. Pay attention to the people above and below this person on the organizational chart.

The nurse manager knows that maximum power will be needed to achieve a desired change and has identified a key person on the organizational chart who will be affected by the change. What is important for the nurse manager to do?

4. The change will lead to improved client care on the unit.

The nursing committee is planning a change in the unit's organization. Which statement reflects the priority expected outcome of these change agents' work?

2. Nurses are doing both the old work and the new work. 3. A nurse says, "I guess everything we've done for years is wrong." 5. Nurses are doing parts of the old procedure and parts of the new procedure.

The staff is transitioning to a major change in the provision of nursing care in a large hospital. Which behaviors should the nurse manager watch for that would indicate possible problems? Select all that apply.

1. "We must follow the federal guidelines in the way we bill for our services." 2. "If we don't reduce our nosocomial infection rate, Medicare won't reimburse us." 3. "Administration has to make this change or our accreditation status will be at risk."

Which statements by a hospital executive reflect power-coercive strategies to implement change? Select all that apply.

4. "We cannot lose sight of the mission and values of our institution as we begin to integrate these changes." 5. "Although this task is going to be difficult, we have the full support of our hospital administration."

Which statements by the nurse manager would demonstrate effective change management? Select all that apply.

Which is the most important reason that practicing and mastering effective delegation skills is essential for nurses? A. Higher job satisfaction B. Greater confidence in skills C. Higher client satisfaction D. Increased time for other tasks

C. Higher client satisfaction

For the nurse to effectively and legally delegate, which document must be consulted and followed to reduce the likelihood of liability? A. The American Nurses Association Bylaws B. The National Council of State Boards of Nursing C. The regulations of the state nurse practice acts D. The rules of the governing specialty organization

C. The regulations of the state nurse practice acts

Which situation represents an obstacle to delegation? A. Most of the nursing staff deliver highly skilled care B. The entire organization has a team-centered culture C. There is a budget shortfall for the current fiscal year D. Each employee knows and executes job responsibilities

C. There is a budget shortfall for the current fiscal year

Anecdotal

The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence?

2. Collect and analyze information about how the current system is working.

The nurse manager feels that changing the unit's method of assigning break times would benefit the flow of client care. What should be the manager's first action associated with this idea?

2. The supervisor has gradually withdrawn from the role of change agent.

The nursing supervisor identifies ineffective communication as a problem among the managers. According to Lippitt's phases of change, which action by the supervisor reflects the final stage of improving this issue?

1. We will compare outcome indicators with other health care conglomerates of similar size and organization.

The quality management director of a large health care conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?

1. Disperse information about the change as quickly as possible. 3. Remind staff that change is part of the health care environment. 4. Talk about the change in positive terms.

A major change has occurred in the governance of the hospital. How can the nurse manager help staff cope with this change? Select all that apply.

4. "I have information to share with you about the new IV pump we are considering for the unit."

A new IV pump has just been purchased by the facility. Which statement by the nurse manager reflects Rogers' first step in making the change to this new equipment?

3. The United States spends more money on health care than any other country.

A nurse has been invited to discuss health care costs at a senior citizens' club. What information should the nurse plan to include in this discussion?

1. "I don't care what they say; I'm not giving care that way." 4. "I bet I can make it very difficult for this change to occur."

A nurse manager is faced with the task of introducing an unpopular change to a staff that includes several nurses who have acted as rejecters to previous changes. The manager expects resistance but hopes to identify these rejecters early in the process. The manager should be particularly alert to which statements? Select all that apply.

1. Cost of care

A nurse manager is participating in the health care organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?

1. "I know that suggesting this change may backfire on me." 3. "I see an opportunity to make a difference in the way this facility provides nursing care." 5. "This change is certainly going to be a challenge, but that's okay."

A nursing administrator overhears nurses conversing during a break in a seminar on change. The administrator would interpret which statement as meaning that the nurse who made it is ready to become a change agent? Select all that apply.

1. Meet with the supervisor and discuss modification of the proposed change. 2. Slow down the change process. 4. Work together to identify strategies to overcome resistance. 5. Proceed with the change.

A nursing supervisor has introduced a needed change in policy to the nurse managers. The managers have met maximum resistance when attempting to gain support for the change. Which options reflect valid strategies for the nurse managers? Select all that apply.

1. "Well, we don't want to rock the boat too much." 2. "Do you think we can get enough support from the nurses to make this change?" 3. "We tried making a change like this before and it didn't work out well."

A nursing supervisor would like the nurse manager to serve as change agent for a needed revision to unit policy. Which statements would alert the supervisor that this manager is not the best choice for this assignment? Select all that apply.

2. Normative-reeducative

A proposed change in a health care organization is controversial and will require cooperation from all parties involved. Which change strategy should the change agent use?

The nurse has attended a "how to" refresher course on successful delegation. Which statement indicates successful learning has taken place? A. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital." B. "The clients on our unit come and go so frequently that delegation is of little benefit." C. "I just don't understand why people think delegation is difficult; all you have to do is tell other people what to do." D. "Now I know that effective delegation means telling my nursing staff when they need to have their regular work done."

A. "I knew that effective delegation made my job easier, but I never thought about how it could benefit the hospital."

Which statements would be important for the charge nurse to make when delegating a responsibility? A. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." B. "I have assigned you to be the unit's representative because I don't have enough time to go." C. "I think your attendance at the task force meeting will be a good reflection on our unit." D. "I chose you to attend the meeting because it seems as though you have the lightest assignment." E. "I would like you to be the unit's representative on the client education task force committee."

A. "I think it would be important to our organization if you represent the unit on the policy and procedure committee." C. "I think your attendance at the task force meeting will be a good reflection on our unit."

Which situations are examples of ineffective delegation? A. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. B. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. C. The nurse manager asks the staff nurse to collect information about a new type of hospital bed being considered for purchase. D. The staff nurse asks the UAP to provide simple discharge instructions to a client. E. The staff nurse often bathes clients because "I like to give bed baths."

A. After delegating committee attendance to a staff nurse, the nurse manager also attends the meetings. B. The unit clerk asks the nurse manager to "listen for the phones" so the clerk can go to the hospital's celebration of hospital week. D. The staff nurse asks the UAP to provide simple discharge instructions to a client. E. The staff nurse often bathes clients because "I like to give bed baths."

During the first staff meeting, a newly promoted nurse manager says, "I would like a commitment from all the nurses to review and improve the way delegation is done on the unit." Why would the manager be interested in delegation? A. Effective delegation allows the manager to focus more time on management tasks. B. Efficiency is increased by effective delegation. C. If the manager has more time to focus on managerial duties, there is more chance of career advancement. D. The nurse manager thinks unlicensed assistive personnel (UAPs) provide better bedside care than nurses. E. The manager is interested in developing the entire staff to its maximum potential.

A. Effective delegation allows the manager to focus more time on management tasks. B. Efficiency is increased by effective delegation. C. If the manager has more time to focus on managerial duties, there is more chance of career advancement. E. The manager is interested in developing the entire staff to its maximum potential.

A health care organization has provided intensive education to staff regarding benefits and correct methods of delegation. Why has the organization spent the time and money to sponsor these sessions? A. Good delegation helps to reduce overtime. B. Absences decrease when delegation is used correctly. C. Delegation is required by state boards of nursing. D. Patient satisfaction scores increase when care is efficient and effective. E. Good delegation increases productivity.

A. Good delegation helps to reduce overtime. B. Absences decrease when delegation is used correctly. D. Patient satisfaction scores increase when care is efficient and effective. E. Good delegation increases productivity.

Which statement represents a situation is which delegation is ineffective or inappropriate? A. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms. B. The RN delegates administration of oral medications for a group of clients to the LPN. C. The LPN directs the unlicensed assistant to report vital sign changes on a post-operative client to the RN. D. The nurse manager asks the RN to act as chairperson for today's unit council meeting since the charge nurse went home sick.

A. The RN asks the LPN to assist with admissions by assessing the clients as they get to their rooms.

Which situations would cause concern about liability with regard to delegation? A. The nurse asks the LPN to change a central line dressing. B. The nursing supervisor asks the nurse for details about a client's history. C. The nursing assistant asks a nurse to check the status of a client on the team. D. The supervisor asks the charge nurse to give a nurse a difficult assignment. E. The charge nurse asks a staff nurse's opinion on the client's surgical incision.

A. The nurse asks the LPN to change a central line dressing. B. The nursing supervisor asks the nurse for details about a client's history. D. The supervisor asks the charge nurse to give a nurse a difficult assignment.

The job description of the staff nurse states the nurse is responsible for attending hospital committee meetings as assigned. The nurse manager asking the staff member to attend a risk management meeting is an example of which concept? A. Work assignment B. Overdelegation C. Ineffective delegation D. Transfer of authority

A. Work assignment

2. "Thankfully we can treat this with an antibiotic."

A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?

4. The hospital with the highest performance ratings for this procedure

A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?

2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 5. The client can make a public report through the Agency for Healthcare Research and Quality.

A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Select all that apply.

The nurse supervisor would like to delegate accreditation preparation activities to the nurse manager. The manager is unsure of what is expected and has no experience with accreditation. How should the manager respond? A. "I'll be glad to work on this task." B. "I will need some education on the accreditation process before I can accept this task." C. "I don't have time to add that to my work." D. "Please tell me more about what this assignment entails." E. "I'm not interested in working on this project."

B. "I will need some education on the accreditation process before I can accept this task." D. "Please tell me more about what this assignment entails."

Which situations are examples of the nurse directing rather than delegating? A. A nurse manager asks a staff nurse to participate in a standing hospital committee. B. A staff nurse asks the assistant to sit with the roommate of a client who has just died. C. During a code blue situation, a nurse tells another nurse to start an IV. D. A nurse tells an assistant to move a client into the hallway during severe weather. E. A nurse reminds assistants of standard protocol for evacuation in case of fire.

B. A staff nurse asks the assistant to sit with the roommate of a client who has just died. C. During a code blue situation, a nurse tells another nurse to start an IV. D. A nurse tells an assistant to move a client into the hallway during severe weather.

The nurse prepares the medication ordered for the client. The nurse asks the nurse assistant to give the medication when the client receives breakfast and to report on the task at its completion. The nurse assistant agrees. Which component of the steps of delegation was violated by this request? A. Defining the task B. Deciding on the delegate C. Determining the task D. Reaching agreement

B. Deciding on the delegate

A nurse asks an unlicensed assistant to help with discharging clients since so many are going home at one time. The nurse states, "Can you help get these clients ready to go home by helping them pack?" Which option best describes the statement with regard to effective delegation? A. The delegation is ineffective since the nurse has no responsibility to pack the client's belongings. B. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed. C. The delegation is ineffective because the nurse has no authority to ask the unlicensed assistant to help with client discharge. D. Delegation could have more effective had the nurse gone with the assistant to ensure the assistant did the packing as requested.

B. Delegation would have been more effective had the nurse been more specific about which clients and when it should be completed.

A nurse manager is delegating a new, complex task to the unit secretary. Which strategies should the manager use? A. Begin the instruction with a statement such as "It would be good if you could help me with this project." B. Make eye contact with the secretary when explaining the task. C. Talk to the secretary in person rather than by telephone or in e-mail. D. Introduce the generalities of the task with a promise that details such as a time line will follow shortly. E. Discuss the importance of the task to the organization.

B. Make eye contact with the secretary when explaining the task. C. Talk to the secretary in person rather than by telephone or in e-mail. E. Discuss the importance of the task to the organization.

The nurse manager gave the unit secretary complete responsibility for the unit's staffing, including finding replacements for call-ins and disciplining nurses with excessive call-ins. This is an example of which type of delegation? A. Effective delegation B. Overdelegation C. Reverse delegation D. Underdelegation

B. Overdelegation

Which situation indicates the nurse needs additional training on effective delegation? A. The charge nurse tells the unlicensed assistant to help prepare rooms for new clients. B. The office nurse calls in orders for admission on a client following a surgical complication. C. A rehabilitation nurse asks a physical therapy assistant to assist a client with ambulation around the facility. D. A home health nurse calls the office and asks another nurse to make the visit on her next client.

B. The office nurse calls in orders for admission on a client following a surgical complication.

The novice nurse manager is hesitant to delegate tasks to competent, experienced staff nurses. Fear of which factor is most likely to explain this hesitancy? A. Overburdening others B. Decreased personal satisfaction C. Increased liability D. Competition and criticism

D. Competition and criticism

3. Empirical-rational model

Computerized charting will be initiated on select units of the hospital. Orientation to this new system will be provided to each nurse by a team of nurses educated in nursing informatics. This is an example of which type of change strategy?

Question 19 Type: MCSA Which is the most effective method of creating a blame-free environment? 1. Work to develop a just culture within the organization. 2. Make sure all nurses agree to report every mistake. 3. Set up a self-reporting board so that all employees will know that everyone makes mistakes. 4. Ensure nurse managers keep a list of how often each employee makes a mistake.

Correct Answer: 1 Rationale 1: A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution. Rationale 2: Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free. Rationale 3: A self-reporting board is a form of punishment and placing blame. Rationale 4: The manager should not be keeping lists in a blame-free environment. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-5: Discuss how to create a blame-free environment.

Question 2 Type: MCSA As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step? 1. Benchmarking 2. Outcome standard 3. Indicator 4. Process standard

Correct Answer: 1 Rationale 1: Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement. Rationale 2: Standards are written statements that define a level of performance. An outcome standard involves the end results of care given. Rationale 3: An indicator is a tool to measure the performance of structure, process, and outcome standards. Rationale 4: Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 9 Type: MCSA After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record? 1. IV heparin restarted. Physician notified. Client's vital signs unchanged. 2. IV heparin restarted at a rate to catch up dosage accidentally deleted. 3. IV heparin turned off by previous shift. Restarted. 4. IV heparin restarted and incident report completed.

Correct Answer: 1 Rationale 1: The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident. Rationale 2: The words accidentally should not be used to document incidents. Rationale 3: The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used. Rationale 4: The fact that an incident report was completed should not be documented. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 30 Type: MCMA A risk manager generally uses root cause analysis to investigate incidents. What are the likely outcomes of this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents. 3. The system or process causing the incident is identified and corrected. 4. Improvements to the system are widespread. 5. Sufficient evidence is acquired so that management is comfortable in making needed changes.

Correct Answer: 1,2 Rationale 1: Professional disagreements often occur as root cause analysis is being conducted. Rationale 2: Often the root cause analysis takes up so much time and so many resources that no changes are ever made. Rationale 3: Root cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur. Rationale 4: Root cause analysis generally does not result in widespread system improvement. Rationale 5: Root cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-5: Discuss how to create a blame-free environment.

Question 25 Type: MCMA The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 3. The CQI coordinator has used the process in practice for over 2 years. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.

Correct Answer: 1,2,4,5 Rationale 1: The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation. Rationale 2: Quality measures should document that evidence-based practice was given. Rationale 3: Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure. Rationale 4: The monitor is written in the "positive," meaning that the process is desirable. Rationale 5: The process should have minimal or no unintended adverse effects. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

Question 11 Type: MCMA The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A client's hand is injured during an arterial blood gas draw. 2. A client's family is dissatisfied with the breakfast just served. 3. A client leaves the hospital against medical advice (AMA). 4. A client claims he is not ready to be discharged. 5. The family does not want a client to be transferred from the intensive care unit (ICU).

Correct Answer: 1,3 Rationale 1: Any reaction or injury associated with a diagnostic test must be reported as an incident. Rationale 2: The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed. Rationale 3: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. Rationale 4: The physician and health care team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. Rationale 5: The physician and health care team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 14 Type: MCMA In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Investigating a complaint about nursing care from a client's spouse 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

Correct Answer: 1,3,4,5 Rationale 1: By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint. Rationale 2: Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous. Rationale 3: The nurse manager is in a position to discuss improvement of client care across disciplines. Rationale 4: The nurse manager can help make work more efficient by keeping staff members on task throughout the workday. Rationale 5: When staff members are tired from working overtime, they are more likely to make errors. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 16 Type: MCMA Which quality improvement initiatives would help the health care organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The amount of material opened and wasted for surgical procedures will drop by 25 percent this fiscal year. 2. The number of nurses who hold a bachelor's degree will increase by 10 percent this year. 3. Wait times in the emergency department will decrease by 15 percent this year. 4. Employee absences will drop by 10 percent this year. 5. Fewer than 5 percent of clients will report inadequate pain control while hospitalized.

Correct Answer: 1,3,5 Rationale 1: No waste is an IHI goal. Rationale 2: Increasing the educational preparation of nurses is not an IHI goal. Rationale 3: No unwanted waiting is an IHI goal. Rationale 4: Employee attendance is not an IHI goal. Rationale 5: No needless pain or suffering is an IHI goal. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

Question 10 Type: MCSA The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently the restraints were improperly applied." Which statement best describes this documentation? 1. Appropriately written 2. Inappropriate because it places blame on an individual 3. Inappropriate because it does not include that the client's family was notified 4. Appropriately written because it only documents the facts

Correct Answer: 2 Rationale 1: Documentation in the chart following an incident should be a statement of the facts; no blame should be placed. Rationale 2: The documentation is not appropriately written because it implies that someone was to blame for the incident. Rationale 3: The documentation must indicate that the physician was notified, not that the client's family was notified. Rationale 4: The documentation is not appropriately written; no blame should be placed. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 18 Type: MCMA Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. A nurse routinely changes nursing notes after a client is discharged. 2. A physician order is overlooked on a newly admitted client. 3. An unlicensed assistant drops a client. 4. A nurse does not complete an incident report after a medication error. 5. A nurse miscounts narcotics.

Correct Answer: 1,4 Rationale 1: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis. Rationale 2: Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error. Rationale 3: Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors. Rationale 4: Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Rationale 5: Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-5: Discuss how to create a blame-free environment.

Question 21 Type: MCMA A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Newly hired radiology technicians 2. People who are visiting clients admitted within the last 2 days 3. Physicians who have admitting privileges 4. Nurses who have worked at the facility over 5 years 5. Vendors who supply disposable medical equipment to the hospital

Correct Answer: 1,4 Rationale 1: Internal customers include employees and departments within the organization. Rationale 2: Visitors are considered external customers. Rationale 3: Physicians are considered external customers. Rationale 4: Nurses are hospital employees and are therefore considered internal customers. Rationale 5: Vendors are not employed by the hospital and are considered external customers. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 12 Type: MCSA Which statement reflects a characteristic common to all methods of quality management? 1. Each method uses all staff members in the organization. 2. None of the methods are designed to place blame on an individual. 3. All methods provide clinical information. 4. Most methods focus on cost containment.

Correct Answer: 2 Rationale 1: All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities. Rationale 2: Quality management is not designed for the purpose of placing blame on an individual. Rationale 3: Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement. Rationale 4: The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 7 Type: MCSA A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the intravenous hydration and demands to go home. How would the nurse best categorize this situation? 1. As a nonreportable incident 2. As a medical-legal incident 3. As client dissatisfaction with care 4. As a medication error

Correct Answer: 2 Rationale 1: Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident. Rationale 2: A medical-legal incident occurs when a client or family refuses treatment as ordered. Rationale 3: When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed. Rationale 4: A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 3 Type: MCSA The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen? 1. Continuous quality improvement (CQI) 2. Total quality management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma

Correct Answer: 2 Rationale 1: CQI is the actual process, not the philosophy, used to improve quality and performance. Rationale 2: TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. Rationale 3: The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy. Rationale 4: Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 13 Type: MCSA The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information? 1. Surveyors are driving to clients' homes to collect data on hospital visits. 2. This electronic tool makes it easy to aggregate and display data. 3. "Dashboard" is an acronym for the topics covered in client satisfaction surveys. 4. The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information.

Correct Answer: 2 Rationale 1: The "dashboards" in this scenario are not associated with automobiles. Rationale 2: Dashboards are electronic tools that provide ease of access to real-time or retrospective data. Rationale 3: Dashboard is not an acronym. Rationale 4: Dashboards are not part of the electronic medical record. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

Question 31 Type: MCSA The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action? 1. Call the nurse from the last shift to participate in a conference call about the complaint. 2. Ask the daughter to explain what happened. 3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred. 4. Ask the daughter what can be done to improve the situation.

Correct Answer: 2 Rationale 1: The manager should collect more information before contacting the nurse from the previous shift. Rationale 2: The nurse manager must first assess the situation. Rationale 3: The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter's concerns. Rationale 4: Until the manager has assessed the issue, intervention cannot be provided. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 28 Type: MCSA Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement? 1. EMR has strong linkage to improving quality. 2. Much more research must be done before the impact of EMR on quality can be determined. 3. EMR does not affect the quality of care provided. 4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated.

Correct Answer: 2 Rationale 1: There is not enough research to prove a strong linkage. Rationale 2: There is not enough research on using EMR and the quality of care provided to determine the impact. Rationale 3: Not enough research has been done to make this statement. Rationale 4: Research does exist, but it is insufficient to measure correlation. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

Question 23 Type: MCMA The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The CQI coordinator 2. The hospital CEO 3. The vice president in charge of finance 4. Members of the CQI team 5. The team leader

Correct Answer: 2,3 Rationale 1: The CQI coordinator is appointed by a member of the resource group. Rationale 2: The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. Rationale 3: The resource group is made up of senior management such as the CEO and vice presidents. Rationale 4: Team members are not part of the resource group. Rationale 5: The team leader is not a part of the resource group. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 22 Type: MCMA The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The hospital CEO 2. A representative from pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain 5. A representative from social services

Correct Answer: 2,3,4 Rationale 1: The CEO is not involved in the process of managing clients' pain and would not be part of this investigation. Rationale 2: As pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting. Rationale 3: As the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting. Rationale 4: The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group. Rationale 5: It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 26 Type: MCSA Which statement reveals the most dangerous result of using measured standards as part of the CQI process? 1. A nurse complains, "Collecting this data takes so much time." 2. A radiology technician says, "CQI is lots of work." 3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors." 4. The laboratory technician says, "Writing these CQI reports is boring."

Correct Answer: 3 Rationale 1: Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given. Rationale 2: The work of CQI should be balanced out by the improvements to care and reduction in waste. Rationale 3: When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization. Rationale 4: Boredom is not the biggest danger of using measured standards. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

Question 5 Type: MCMA Which situation would be included in reporting for Joint Commission mandatory national patient safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The average wait time in the emergency department has increased by 5 minutes over last year's average. 2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.

Correct Answer: 2,3,4,5 Rationale 1: Increased wait times are not included as a patient safety goal. Rationale 2: Improving staff communication is one of the Joint Commission's national patient safety goals. Rationale 3: Using medications safely is one of the Joint Commission's national patient safety goals. Rationale 4: Preventing infection is one of the Joint Commission's national patient safety goals. Rationale 5: Preventing mistakes in surgery is one of the Joint Commission's national patient safety goals. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-2: Describe national efforts to improve the quality of health care.

Question 6 Type: MCMA Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. "I'm not interested in this program." 2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

Correct Answer: 2,3,4,5 Rationale 1: Lack of interest on the part of nurses is not a reason EBP is not used. Rationale 2: Lack of time is a barrier to using EBP that is consistent across settings. Rationale 3: The need for autonomy over the nurse's own practice can be a barrier to using EBP. Rationale 4: Inability to find and assess evidence is a barrier to using EBP. Rationale 5: Lack of support from administration is a barrier to using EBP. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

Question 29 Type: MCMA A hospital increased its RN-to-client ratio 1 year ago. What effects is the hospital likely to see as a result of that choice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. The cost of providing care has decreased. 2. There has been a decrease in client deaths. 3. The average length-of-stay for clients has increased. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.

Correct Answer: 2,4,5 Rationale 1: Increasing RN-to-client ratio generally increases costs. Rationale 2: Increasing RN-to-client ratio has been shown to decrease client mortality. Rationale 3: Increasing RN-to-client ratio generally decreases length of stay. Rationale 4: Increasing RN-to-client ratio generally increases quality of care. Rationale 5: Increasing RN-to-client ratio generally results in few infections. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

Question 27 Type: MCMA A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Standard Text: Select all that apply. 1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices? 2. Can the manager find two or more research studies that support the use of the intervention? 3. Is the intervention one that the manager has seen used in the past? 4. Are the authors of the research articles well-known experts in the field? 5. Is the research study that recommends the intervention rigorous in design and execution?

Correct Answer: 2,5 Rationale 1: The size of the hospital is not significant in selecting evidence-based practice interventions. Rationale 2: Evidence-based practice is most reliable when more than one study has confirmed the results. Rationale 3: Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them. Rationale 4: While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field. Rationale 5: The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-3: Explain how evidence-based practice, electronic medical records, and dashboards can improve quality.

Question 8 Type: MCSA Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident does not fall into a risk category.

Correct Answer: 3 Rationale 1: A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client. Rationale 2: A medical-legal incident occurs when a client or family refuses treatment as ordered. Rationale 3: Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication. Rationale 4: Complications from diagnostic or treatment procedures are a high-risk area in health care and are reported as incidents. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-4: Point out how nurses are involved in reducing risks.

The nursing supervisor would like to delegate an information-gathering task. All the people listed have the ability to perform the task. In general, whom should the supervisor ask to do this work? A. A nurse manager B. A staff nurse C. A licensed practical nurse D. An unlicensed nursing assistant

D. An unlicensed nursing assistant

Question 20 Type: MCSA The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. Ensure the client's safety as fully as possible. 4. Say nothing as no one saw the incident.

Correct Answer: 3 Rationale 1: It is not appropriate to discuss errors with others. Rationale 2: Reporting the incident to the supervisor is appropriate only after the client's safety is protected. Rationale 3: The client's safety is always the priority. Rationale 4: Ignoring the mistake if no one saw it is not ethical and may be dangerous. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-5: Discuss how to create a blame-free environment.

Question 24 Type: MCSA Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement? 1. Eighty-five percent of call lights are answered within 4 minutes. 2. Results of pain medication administration are documented 95 percent of the time. 3. Nursing overtime hours increased by 25 percent in the last quarter. 4. In the last 6 months, overall client satisfaction scores have increased by 15 percent.

Correct Answer: 3 Rationale 1: Lean Six Sigma is focused on improving process flow and eliminating waste. Rationale 2: Lean Six Sigma is focused on improving process flow and eliminating waste. Rationale 3: Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur. Rationale 4: Lean Six Sigma focuses on reducing waste. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 15 Type: MCSA Which part of Six Sigma is vastly different from other quality management programs? 1. Six Sigma has a client focus. 2. Data drive the program. 3. Failure is tolerated. 4. Management is proactive.

Correct Answer: 3 Rationale 1: Most quality improvement programs are client focused. Rationale 2: Data drive most quality improvement programs. Rationale 3: One of the Six Sigma themes is aiming for perfection but tolerating failure. Rationale 4: Proactive management is common in most quality improvement initiatives. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 4 Type: MCSA The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard

Correct Answer: 4 Rationale 1: An indicator is a tool used to measure the performance of a structure, process, or outcome standard. Rationale 2: A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care. Rationale 3: Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care. Rationale 4: A process standard is a written statement that defines actual delivery of nursing care to a specific population. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

Question 17 Type: MCSA The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy? 1. "If I make a mistake and report it, I will not be reprimanded or punished." 2. "When I make a mistake, I should immediately fill out an incident report." 3. "It is left up to each employee to self-monitor so we do not report others' mistakes." 4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."

Correct Answer: 4 Rationale 1: If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken. Rationale 2: Incident reports are not the first step after making a mistake. Rationale 3: Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment. Rationale 4: Mistakes should be reported and reflected upon so that the same mistakes will not be made again. Global Rationale: Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: 6-5: Discuss how to create a blame-free environment.

Question 1 Type: MCSA Which situation is an example of the overall goal of quality management in today's health care activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department fires nonproductive employees. 4. The nurse wipes up a spilled drink before clients are allowed to enter a room.

Correct Answer: 4 Rationale 1: The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive. Rationale 2: The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past. Rationale 3: The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive. Rationale 4: The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall. Global Rationale: Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

A nurse says, "I am always worried that I will be liable if someone I delegate a task to does something that hurts the client." What is the manager's best response to this concern? A. "You have lots of liability in your position as an RN." B. "The hospital will support you as long as you follow your job description." C. "You are at greater liability if you try to do everything yourself." D. "As long as you follow the five rights of delegation, your liability is minimal."

D. "As long as you follow the five rights of delegation, your liability is minimal."

3. The Institute of Medicine has proposed residency programs for nurses.

Hospital administration is working with a university school of nursing to establish a nursing residency program. Why is this a desired action?

2. A normative-reeducative strategy

Hospital administrators are considering changing from the traditional method of creating work schedules to a system in which the nurses will choose their own workdays. Choices will be made according to seniority. Which change strategy would likely be best for this endeavor?

3. Nurses routinely interact with multiple disciplines.

The CEO of the hospital approaches the chief nurse with a request that the nurse act as the primary change agent in the implementation of a new hospital-wide policy. Why would the nurse be a good choice for this assignment?

1. Disciplinarian 3. Fact manager 4. Liaison 5. Support person 6. Discussion leader

The health care facility has elected to make a significant change in organization strategy. The change has been thoroughly researched and all levels of leadership have been included in the decision. Which roles are commonly undertaken by the nurse manager when such a change is necessary? Select all that apply.

2. Include the staff in identifying problems related to teaching strategies.

The new chairperson of the nursing department has determined that the faculty's teaching is stagnant and outmoded. The chairperson would like to encourage the faculty to adopt more innovative teaching strategies. According to Lewin, what is the first step in initiating this plan?

4. "I think the implementation will go much better if I stay available the whole time."

The novice nurse manager is acting in the role of change agent for the unit. Which statement indicates that this manager needs further training in regard to change?

1. Research the options that will work best for the nursing staff and the hospital.

The nurse administrator has been asked to work with other administrators to make a change in a long-standing hospital policy. What should be the nurse's first action?

3. Early majority

When faced with the prospect of change, the nurse states, "We have always done it this way and never had any problems." A few weeks later, the same nurse remarks, "This new way seems to work better than the old way did." This statement is characteristic of which type of change response?

4. Creating a supportive environment for those undergoing the change

Which action will have the greatest impact on the successful implementation of a planned change?

4. A financial deficit of millions of dollars

Which factor best represents a driving force in the process of change?

2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from NPO status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.

Which health care situations reflect the philosophy of quality management as designed by Deming? Select all that apply.