Leadership Exam #2

Examples of indirect costs SATA

(Overhead, regardless if there are patients or not) - Admin salary - Supplies - Electricity

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy?

"I understand how you could feel angry about the diagnosis."

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy?

"I'll close the door so you can spend time with your dad. I will check back in a few minutes."

When considering online communication etiquette, which nurse demonstrates a primary rule that should be adhered to by all?

"My friend's wedding was lovely and anyone wanting to see pictures can view them on my website."

A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

"What exercise practices do you participate in?"

Examples of variable costs SATA

*They vary directly with changes in volume of units or services, fluctuation of immunizations* (Changes with the number of patients we have) -staff wages and benefits -necessary supply costs

Which functions can be delegated only to another RN with appropriate experience and training? (select all that apply)

- Assessment of skin integrity on third day of hospitalization - Evaluation of patient teaching related to turn, cough, and deep breathing exercises - Nursing judgment related to withholding medication based on vital signs - Formulation of nursing diagnosis "potential for fall"

A nursing administrator who is considering the feasibility of an all-RN staff reviews the report, Keeping Patients Safe: Transforming the Work Environment of Nurses (2003) and determines that RNs: (select all that apply)

- Have a positive effect on patient outcomes when managing patient care - Are effective overseers of patients' overall health condition.

Examples of mixed signals (SATA)

- Unavailable - Lack of management

Which statement made by an RN regarding delegation indicates the need for additional teaching? (select all that apply)

- Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely. - An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD - When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for the purpose of increasing renal perfusion.

A nurse manager has calculated that providing 75 hours of direct nursing care per day requires that 120 hours must actually be worked by nursing staff. The manager is involved in: (select all that apply) a. developing the capital budget. b. applying productivity metric. c. monitoring the labor budget. d. incremental budgeting processes. e. addressing budget assumptions.

- applying productivity metric. - monitoring the labor budget.

A nurse has recently been appointed to the position of nurse manager. To become successful in managing the unit's budget, the new nurse manager should: (select all that apply) a. read the financial policy manual to learn more about the organization's budgeting process. b. allow the nursing administration office to manage the unit's budget until he or she is able to complete an online financial management course. c. communicate regularly with a person in the hospital's finance office about interpreting budget reports. d. pay attention to only the bottom-line numbers in budget reports rather than trying to understand each line in these reports. e. discuss the process of developing budgets with other members of the management team.

- read the financial policy manual to learn more about the organization's budgeting process. - communicate regularly with a person in the hospital's finance office about interpreting budget reports - discuss the process of developing budgets with other members of the management team.

Recommended timeline to begin developing a budget

3-4 months, before fiscal year begins

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onset of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting what communication technique? a. Assertive communication b. Active listening c. Empathy d. Passive communication

Active listening

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee?

Actually observe the delegatee perform the assigned task

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established?

Administer an enema for an elective surgery patient.

A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to:

Aid the RN by performing appropriately delegated care tasks.

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation?

An unlicensed assistive person is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway.

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

Appeal to emotion

A nurse on the unit is heard saying, "I am not going to document that I used four catheters to start that IV; it doesn't matter anyway." What action can help the staff nurse understand the financial budget goals of the unit? a. Have the nurse work in payroll for a week. b. Enroll the staff in continuing education units (CEU) for personal finance. c. Ask the nurse to represent the unit on the budget planning committee. d. Make the nurse responsible for monitoring all disposable equipment and supplies.

Ask the nurse to represent the unit on the budget planning committee

The healthiest form of communication is the ________ style.

Assertive

The nursing executive team met to review last year's productivity metric to strategize for the upcoming year's metric. The team wants to be certain the productivity metric shows productivity was: a. high. b. low. c. balanced. d. iterative.

Balanced

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of negative communication? a. Ad Hominem Abusive b. Filtration c. Blocking d. False assurance

Blocking

Which component of an e-mail shown below would be both effective and concise?

Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

A nursing unit's census consists primarily of long-term residents with a high risk for falls. To meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with new beds equipped with Fall Watch electronic sensors that will detect when patients get out of bed. The manager will be involved in which type of budgeting to replace the beds? a. Fiscal b. Labor c. Operational d. Capital

Capital

A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation?

Circumstance

A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. The RN should:

Contact the state board of nursing to determine legal scope of practice for LPNs.d. refer t

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision?

Continual supervision is being provided until the RN determines competency.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of:

Direction and communication

A primary function of the budgeting process is to provide managers with an opportunity to: a. insist that salary increases for all nurses are included in the annual budget. b. discuss concerns about resource allocation with leaders of the organization who are capable of resolving issues. c. develop a mechanism for changing from zero-based budgeting to incremental budgeting. d. develop for all staff an educational program related to supply usage.

Discuss concerns about resource allocation with leaders of the organization who are capable of resolving issues.

Organizations measure the effectiveness of their budgets by examining actual revenues and expenditures versus: a. planned variances. b. incremental budgets. c. productivity metrics. d. expected performance.

Expected performance

What situation demonstrates a nurse engaging in active listening?

Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both situations? a. Blocking b. Filtration c. Empathy d. False assurance

Filtration

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly, I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation?

Generation X

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN knows that:

He or she must review the state's nurse practice act for LPN/LVNs, because each state defines the role and scope of practice of the LPN/LVN.

Question about top-down budgeting, answer is:

Implement

The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse's action has what possible outcome?

Increasing the risk for HIPAA violations

The nurse managers of an organization are meeting with administration to plan the budget. The above pie chart graph shows last year's 2011 expenditures, and the team will trend the upcoming budget knowing that, with the slowdown in the economy, patient census will be lower. Which budget approach is being used? a. Incremental b. Zero-based c. Productivity metrics d. Capital

Incremental

The nurse manager meets with upper administration and learns that the strategic plan for nursing is to have 80% BSN staff within the next 3 years. The nurse manager then built her budget to meet the organization's strategic goal by providing tuition reimbursement and flexible work hours, which required some agency staffing. Which approach to budgeting is used? a. Iterative b. Top-down c. Participatory d. Zero-based

Iterative

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for:

Keeping the RN informed of any abnormal blood pressure readings.

Which component of budgeting might normally be addressed in the annual performance evaluation for a nurse manager? a. Including in the labor budget costs for overtime and benefits b. Managing variances in nursing overtime costs and supply usage c. Accurately predicting revenues on the basis of unit-of-service d. Providing qualitative analysis for variances in the capital budget

Managing variances in nursing overtime costs and supply usage

Which budget result could impact a nurse manager performance evaluation

Nursing overtime and supply use

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegatee has had experience and training?

Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

The nurse manager meets with upper management to share strategic goals agreed upon by her staff for their individual nursing unit as the first step to begin budget negotiations. One strategic goal is that staff will have access to technology that will allow them to incorporate point-of-care devices for all RNs. The second goal is to improve RNs' ability to recognize critical indicators that a patient's health status is deteriorating through advanced health assessment skills. During the meeting the manager discusses the strategy options and selecting the one that works for the unit. Which type of budget development is used? a. Iterative b. Top-down c. Participatory d. Zero-based

Participatory

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style?

Passive-aggressive

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

Past experiences

A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of what communication associated process? a. Interpretation b. Context c. Precipitating event d. Preconceived idea

Preconceived idea

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading?

RN

An RN is counseled by the nurse manager regarding inappropriate delegation when the:

RN assigns the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube.

When the nurse manager conducts a qualitative analysis of budget variances, he or she is: a. determining the percentage increase of supply usage from the last quarter to the current quarter. b. identifying the overall increase in the dollar amount of salaries paid for overtime. c. comparing productivity metrics across all nursing units in the facility. d. reconciling with current conditions the underlying assumptions on which the budget was based.

Reconciling with current conditions the underlying assumptions on which the budget was based.

A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is referred to by what term? a. Straw man b. Red herring c. Slippery slope d. Confusing cause and effect

Red herring

A nurse gives phenytoin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "You've disliked me since I refused to switch my vacation time last month." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Red herring d. Appeal to tradition

Red herring

Role of the nurse manager when using a top-down budget process

Senior leadersip/ management, sets the goals and then they come to us, participatory

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

Spoken word

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The LPN/LVN accepts the assignment, and the RN knows that the LPN/LVN has had the training and has acquired the skills needed to complete the task. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. The priority intervention by the RN is to:

Stop the LPN/LVN immediately and discuss the possible consequences of his actions in a nonjudgmental manner.

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through implementation of what communication technique?

Supportiveness

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

Tell me what day of the week today is.

Which of the following situations would be appropriate for the supervisory level of initial direction and/or periodic inspection?

The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly.

Which statement related to delegation is correct?

The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria?

The experienced UAP places telemetry electrodes and attaches to cardiac monitor.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that:

The nurse practice act and state regulations related to delegation override the organization's policies.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring?

The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not."

Which nurse is demonstrating a common, productive conflict resolution style? a. The nurse who does not express feelings or ideas that conflict with those of the administration b. The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?" c. The nurse overheard saying, "There is no use fighting this; one solution is as good as another." d. The nurse who regularly insists they have the most insight into the problem being discussed.

The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?"

The nurse supervisor states, "I really don't have the time to delegate. I can do it faster!" What is the most likely basis for this statement?

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

A nurse manager is working with the financial officer to develop the budget of the nursing unit for the next fiscal year. The nurse manager tells the financial officer that which of the following pieces of information will affect budget assumptions? a. The capital budget request for new emergency department equipment has been turned in for consideration by the hospital's administrative team. b. The patient census likely will increase during the next fiscal year because two large physician groups have transferred their admission privileges to this hospital. c. The participatory budgeting approach instituted last year has been helpful in controlling supply costs. d. Zero-based budgeting will help the managers to be more efficient in establishing next year's budget.

The patient census likely will increase during the next fiscal year because two large physician groups have transferred their admission privileges to this hospital.

1. The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to:

The registered nurse (RN).

A registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include:

To determine what tasks can be safely delegated, the RN must first assess the patient.

In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the _____ approach. a. top-down b. participatory c. iterative d. incremental

Top-down

Nurses on a unit met with the nurse manager as part of participatory budgeting. They ask, "What exactly is the difference between fixed and variable costs? Understanding this will help us better understand the budgeting process." The manager provides a definition and asks the staff to list types of direct and indirect cost. Which example would indicate a need for further teaching? a. Fixed costs would include accreditation fees. b. Fixed cost would include the cost for the automated medication-dispensing system. c. Variable cost would include the nurse manager's salary. d. Variable cost would include the salary expense for registered nurses.

Variable cost would include the salary expense for registered nurses

A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts with a patient census of 6 in the short-stay observation room. The nurse manager reviews the budget report 3 months later and notes that the salary expenses are higher than was budgeted because of higher-than-planned RN staff salaries. This additional RN staff is necessary to meet patient care needs because the census has remained constant at 10 patients rather than the 6 projected when the budget was developed. The difference between the planned budget and the actual cost is known as: a. revenue. b. variance. c. monitoring. d. capital expenditures.

Variance

A nurse manager is preparing a budget that does not base annual budgets on the revenue and expenditures of the prior year and has the advantage that outdated information is not integrated into the budget. The manager is using which budget method? a. Zero-based b. Incremental c. Labor d. Operational

Zero-based

18. The financial plan required for the distribution of resources and expenses is a _________.

budget A budget is an organization's financial plan that expresses expected expenses (such as personnel and supplies) and anticipated revenues for products and services over a defined period, usually 12 months. DIF: Comprehension REF: p. 316

Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.