LS questions

Living will

A living will is a client's statement indicating the type of care he or she does or does not want should a terminal condition incapacitate the client.

Last will and testament

A last will and testament is a legal document that gives individuals the right to name others as possessors of property after the party has died.

The nurse educator explains to a group of new nurse orientees to expect which of the following benefits from staff development programs? Select one: a. Acquisition of technical skills. b. Personal development. c. Forum to share their views on client care issues. d. Opportunity to develop networks.

Acquisition of technical skills. Staff development gives nurses opportunities to improve technical skills such as venipunctures and central venous access line care.

Compassionate leaders

Compassionate leaders are driven by the needs of their employees.

The nurse leader is starting to work on a team project with members of a diverse agency workforce. The nurse is aware that which of the following will primarily influence communication among group members because they have different beliefs, practices, and assumptions? Select one: a. Gender. b. Culture. c. Time orientation. d. Ethnicity.

Culture. Culture plays a very vital role in communication.

Formal leaders

Formal leaders have legitimate power and the ability to reward and punish

Mentors

In mentoring, the leader shares skills with the staff.

Preceptors

Include training staff

Magnet status process

May take up to 2 years -First, creat and promote a professional practice culture in all aspects of nursing care -Apply to the ANCC (assesses the 14 forces of magnetism) Then is is awarded for a *4 year period* which then then organization must reapply

Flat organization challenges

Potential for inconsistent decision making Loss of growth opportunities Need to educate managers to communicate effectively and demonstrate creativity in working within these nontraditional structures

ad hoc structure

Put together to meet a short term goal -Functional structure -Hierarchical

Organizational chart- Dotted or Broken lines

Represent staff positions. These positions are advisory providing information and assistance to the manager, but has *limited organizational authority.*

Organizational chart- Solid Horizontal Line

Represents communication b/t people within similar spheres of responsibility of power but different fx.

Role modeling

Role modeling is the encouragement of self-management and assessment along with openness.

NQF/Quality Plus Program

The NQF and Quality Plus Program provide resources to evaluate standards of care and practice.

Flat structure

The term FLAT signifies the removal of hierarchical layers, thereby granting authority to act and placing authority at the action level. In a *flat organizational structure, decentralized decision making replaces the centralized decision making typical of functional structures* Staff has authority to make decisions at the place of interaction with patients is the hallmark of a flat organizational structure. Less formalized *MAGNET HOSPITALS* Decrease in strict adherence to rules allows individualized decisions that fit specific situations and meet the needs created by the increasing demands associated with consumerism, change, and competition (supported by the Institute for Healthcare Improvement)

Systems theory

This theory views the system as a whole, not a series of unrelated parts. "Individual components of any system interact with each other and with their environment" -Closed system -Open system

Organizational structure- Philosophy

Values and beliefs needed to accomplish the mission.

Unity of command

an employee should report to no more than one manager. Because of the organizational chart, Unity of Command is difficult to maintain in some large healthcare organizations because the nature of healthcare requires a multidisciplinary approach. Nurses feel as though they have many bosses including their immediate supervisor, patient, patient family, physicians, administration. Weber identified that lack of unity of command results in conflict and loss of productivity

Types of Budgets

operating budget Capital Expenditure Budget Cash Budget Budgeting is done annually and in relation to the organization's fiscal year Major steps in the budgeting process include gathering info and planning, developing unit budgets, developing the cash budget, negotiating and revising, and using feedback to control budget results and improve future plans

Organizational chart- Solid Vertical Line

*Chain Of Command- the formal paths of communication and authority (Hierarchy is at the highesst).* Those with the greatest decision making authority are at the top and those with the least are at the bottom. *The level of position on the chart signifies status and power*

Matrix structure examples

-Patient focused care delivery model -Program focused on specialty services such as geriatrics, womens, and cardiovascular services. -DC planning, quality management, and cardiopulmonary resuscitation teams

Organizational structure

-The way in which groups are formed -Its lines of communication -Its means of channeling authority -Its means of making decisions

Determining optimal span of control is dependent on...

-the manager's ability -control in the organization -employees' maturity -task complexity -geographic location -level in the organization.

DNR order

A do-not-resuscitate order is a physician order based on a client's decision to not be resuscitated. This is an informed decision.

The culture of a healthcare organization is changing. Nurses are allowed to self-schedule, and administrators seek input from the staff on major decisions. A nurse who has been interviewed for a nursing position in this organization concludes that there has been a shift to which type of managerial model. Select one: a. Shared governance. b. Empowerment. c. Compassionate leadership. d. Workforce support.

A shared governance model is characterized by input from all employees of the facility and a culture of "this is the workplace of the employees." Employees are treated as associates. Empowerment is considered a feature of shared governance.

Participative Management

An open form of management where employees are actively involved in organizational decision making. -Strong relationships with employees -Employees as facilitators -Employees deal directly w/ customers and satisfy their needs -Welcome innovative ideas from employees -Open and honest communication -Freedom and transparency

Budgeting budget

An operating budget is a combination of known expenses, expected future costs, and forecasted income over the course of a year. Operating budgets are completed in advance of the accounting period, which is why they require estimated expenses and revenues. Operating budgets are focused on facilitating income. The first and perhaps most crucial component of the operating budget is the sales and collections budget. This is followed by the projected cost of goods sold budget, the inventory and purchasing budget, and the budget for operating expenses

Functional structure (Bureaucratic)

Arrange departments and services according to specialty. This approach is common in healthcare where departments providing similar fx are to report to a common manager or executive. This structure tends to support professional expertise and encourage advancement BUT may result in delays in decision making if a silo mentality develops within groups (issues that require communication across functional groups need to typically go to a senior management level before a decision is made).

The nurse leader who is trying to build an effective work team tries to motivate staff nurses by explaining that which of the following are benefits of a productive team. Select all that apply. Select one or more: a. Diverse solutions to problems. b. Personal satisfaction. c. Solitary work. d. Efficiency of services. e. Use of resources.

Benefits of a productive team include diverse solutions to problems, personal satisfaction, and efficiency of services. T

The vision statement of a healthcare system is "Provide quality, cost-effective care to clients in our region." The nurse manager best demonstrates the vision statement by: Select one: a. Instituting a cost-center checklist containing the unit's direct care costs to assist charge nurses. b. Instituting care maps for patients with diabetes mellitus. c. Purchasing fewer personal items and eliminating office supplies. d. Providing a series of in-services dedicated to cost containment.

Care maps are guides to provide nationally accepted, standardized care. The care is scheduled, aggressive care to prevent increased length of hospital stay while maintaining satisfactory client outcomes.

After an incident occurred that involved the use of a medical device and the incident resulted in a serious injury to a client, the nurse manager explains to staff that the report will be forwarded to which federal agency? Select one: a. Food and Drug Administration (FDA). b. Centers for Disease Control and Prevention (CDC). c. Centers for Medicare and Medicaid Services (CMMS). d. National Institute of Health (NIH).

Centers for Medicare and Medicaid Services (CMMS). Facilities that receive Medicare and Medicaid funding must report sentinel events to the Centers for Medicare and Medicaid Services (CMMS)

A nurse leader who is working on developing unit staff regarding teamwork explains in a staff meeting that what characteristics are noted in an effective team? Select all that apply. Select one or more: a. Trustworthiness. b. Respect for each other. c. Open Communication. d. Tolerance of each other's flaws. e. Eagerness to get the job done.

Characteristics of a productive are trustworthiness among each other, respect for each other and open communication. Effective teams are eager to get the job done.

Charismatic leaders

Charismatic leaders empower their employees, foster participation in decision-making and attempt to transform individuals.

Which of the following is an example of a third-party payer? Select one: a. Centers for Medicare and Medicaid Services (CMS). b. Cigna Insurance Company. c. Medicaid. d. Medicare.

Cigna Insurance Company Cigna (#2) is a private insurance company that collects premiums from enrollees for coverage. Third-party payers provide a variety of services, which depend on the type of coverage granted by the company. Medicare (#4) and Medicaid (#3) are part of the prospective payment system. CMS (#1) is the abbreviation for Centers for Medicare and Medicaid Services.

The nurse leader is aware that which of the following are internal factors that impact staffing? Select all that apply. Select one or more: a. Client acuity. b. State regulations. c. Availability of staff. d. Accreditation standards. e. Levels of competence.

Client acuity Availability of staff Levels of competence

A nurse is assigned to the care of a client with an unsteady gait. The client is later found by the certified nursing assistant (CNA) lying on the floor; the client reports right hip pain. How should the nurse document this incident? Select one or more: a. Complete an incident report and file a copy in the client's medical record. b. Complete an incident report and document the fall in the client's medical record. c. Record the incident in the client's chart and place a copy in the nurse's record. d. Complete an incident port and the client's caretakers a copy for their records.

Complete an incident report and document the fall in the client's medical record. The nurse should complete an incident report and document the fall in the client's record. The nurse should never place an incident report in the client's chart. The incident report is an internal risk management tool to monitor incidents within the facility. A copy of the incident report does not enter the nurse's record, nor does the client's caregiver receive a copy.

Matrix structure

Complex and designed to reflect both fx and service in an integrated organizational structure. In this structure, the manager of a unit responsible for a service, reports to both a functional manager and a service or product line manager. Ex. A director of pediatric nursing could report to both a vice president for peds. services (service line manager) and a vice president of nursing (functional manager) Advantage: Enables timely response to the forces in the external environment that demand continual programming, and it facilitates internal efficiency and effectiveness through the promotion of cooperation among disciplines. Matrix structures combine both a *bureaucratic structure* and a *flat structure* to carry out specific programs or projects. *Horizontal program rather than the traditional vertical hierarchy* *This approach creates an interdisciplinary team* *Well developed collaboration and coordination skills are essential to effective functioning in a matrix structure*

On admission to the hospital a client gives the nurse a document naming an individual to make choices in the case of the client becoming incapacitated. The document also includes the client's end-of-life wishes. The nurse communicates during intershift report that the client has a copy of which document in the medical record? Select one: a. Living will. b. Durable power of attorney. c. Last will and testament. d. Do not resuscitate order.

Durable power of attorney. The Durable Power of Attorney gives an individual the authority to make decisions on behalf of another; in addition, clients may choose to add their wishes to this document.

A well structured committee should have...

Enough to accomplish the task, but not too many to inhibit discussion Varied work experience and educational backgrounds to ensure expertise sufficient for the assigned task Increase staff participation to generate new ideas and foster creative thinking and facilitate upward communications

A nurse leader collaborates with team members to establish new goals. Which of the following is the best action for the nurse leader to take to foster success in this project. Select one: a. Establish "buy in" from other team members. b. Only supervise when necessary. c. Analyze the structure of the organization. d. Reorganize the group.

Establish "buy in" from other team members. Whenever planning new ideas, it is beneficial to get support from other members of the team because the action may decrease resistance (

Organizational structure- Vision

Future oriented- "Where do we want to go?"

Organizational Chart

Graphing representation of work units and reporting relationships, which is related to the division and specialization of labor fx attended by specialists. *Formal relationships, line of communication and authority are depicted on a chart by UNBROKEN solid lines*

A nurse manager would draw on knowledge in which of the following areas to balance human and fiscal resources in fulfilling role responsibilities? Select all that apply. Select one or more: a. Healthcare financing. b. Government resources. c. Consumer demographics. d. Nursing process. e. Adaptive equipment.

Healthcare financing Government resources Consumer demographics nurse manager needs knowledge about healthcare financing (#1) to manage budgets, government resources (#2)for funding and reimbursement, and consumer demographics (#3) to identify trends and types of future services that will be needed.

Flat organization example

Home care organization where nurses manage themselves, control their schedules, and operate with few policies or procedures.

A nurse has been employed by a healthcare organization for 20 years. The nurse is knowledgeable, has excellent ideas, and actively participates in meetings. The nurse manager submits the nurse's name for an agency award to reward which type of leadership exemplified by the nurse? Select one: a. Informal. b. Formal leaders. c. Charismatic. d. Compassionate.

Informal leaders do not hold an official title in the organization, but demonstrate profound efficiency influencing others.

Which of the following strategies would be best for the nurse leader to use when communicating with team members at the beginning of a team project? Select one: a. Give clear directions about the nature and scope of the project. b. Start with constructive criticism. c. State that something isn't working and needs to be fixed. d. Take ownership of the project.

Leaders should be very clear and concise when providing directions and goals at the beginning of a project so that members have a clear vision about what is to be accomplished and the processes that will be used in the group.

State boards of nursing protect the public from incompetent nurses. The safety of the public is secured by which of the following? Select all that apply. Select one or more: a. National licensure examination. b. Practice regulation. c. Definition of practice by each state. d. Differentiated education. e. Continuing education credits.

National licensure examination Practice regulation Definition of practice by each state Continuing education credits Each nursing graduate must apply to take the national licensure examination with the appropriate state board of nursing. The state board regulates nursing practice and provides a definition of practice in each state. States require that practicing nurses take continuing education courses to maintain competency

Third party financing organizations

Normally private health insurance carriers Cigna (#2) is a private insurance company that collects premiums from enrollees for coverage. Third-party payers provide a variety of services, which depend on the type of coverage granted by the company.

Which elements of the organizational structure should the nurse leader consider when planning change on the nursing unit? Select all that apply. Select one or more: a. People. b. Resources. c. Structure. d. Materials management. e. Rate of admissions.

Planned change should include situational elements of the organization such as people, resources, and structure.

Organizational structure- Mission

Purpose statement- "why are we here?" *Defining a collective mission is a critical first step in creating the team efforts that drive collaborative and productive work and communication!!!!!*

Bureaucracy

Referees to the *centralization* of authority in administrative bureaus or government departments. It is an inflexible approach to decision making or an agency encumbered by red tape that adds little value to the organizational process. *Limits autonomy and thus the potential for innovations* -Functional Structure -Centralization of authority -Inflexible approach to decision making -Need to control workers -Clear division of labor/Specialization -Rules/Protocols to ensure uniform action -Top/Down communication

Accreditation

Refers to approval, recognition, or certification by an official review board that an organization has met certain standards. •Centers for Medicare and Medicaid Services (CMS) -Advocate, control payment •Magnet -"Nurse-Friendly" •The National Committee for Quality Assurance (NCQA) -Quality •The Joint Commission on the Accreditation of Healthcare Organizations (JCAHO) -Safety, standards

Span of control

Refers to the number of subordinates a supervisor manages. Optimal span of control ranges from 3-50 employees. -Too many reporting to a single manager *delays decision making* -Too few people reporting to a single manager results in an *inefficient, top heavy organization*

The nurse manager who is attempting to increase client safety should work on which of hte following within the nursing unit and as a representative on various hospital committees. Select all that apply. Select one or more: a. Setting clear expectations. b. Developing an intricate approach to problem solving. c. Establishing consistent policies across disciplines. d. Developing maximum levels of expectations. e. Rewriting policies and procedures yearly.

Setting clear expectations Establishing consistent policies across disciplines

Shared Governance

Shared governance goes beyond participatory management through the creation of organizational structures that facilitate nursing staff having *more autonomy* to govern their practice. This organization demonstrates higher levels of satisfaction, enhanced productivity, and improved retention. Magnet Studies (which found characteristics of hospitals successful in recruiting and retaining nurses) found that the major contributing characteristic to success was a nursing department structured to provide nurses the opportunities to be *accountable* for their own practice. In addition to recruiting and retaining nurses, this characteristic also meets consumer demands and remaining competitive. Nurses practice is the responsibility of the nurses not the manager. Nursing councils are used to organize governance via joint practice committees (organizational level and unit-based level)

When interviewing for a position on a hospital nursing unit, the nurse learns that members of the nursing staff are allowed to develop and deliver in-services and participate on hospital committees. The nurse concludes that this nursing unit uses which of the following models? Select one: a. Nurse manager decision-making model. b. Decision-making model. c. Client accountability model. d. Shared governance model.

Shared governance is a leadership model that involved employees in decision-making and fosters open communication with staff.

Agency Healthcare Research & Quality (AHRQ)

The AHRQ provides evaluation tools for inventory of standards of practice.

A nurse manager plans to start data collection about venipuncture as it is performed on the nursing unit. Which tool should the manager use to facilitate this process? Select one: a. Plan-Do-Study-Act (PDSA) b. National Quality Forum (NQF). c. Agency Healthcare Research & Quality (AHRQ) d. Quality Plus Program.

The PDSA is a tool used for data collection. It measures the current status of procedures. This guideline provides quick and easy direction in data collection.

A registered nurse (RN) delegates complicated wound care to a licensed practical/vocational nurse (LPN/LVN). The LPN/LVN has only changed this type of dressing once. Which component of delegation has the RN neglected? Select one: a. Authority. b. Competency. c. Communication. d. Responsibility.

The RN did not consider the LPN/LVN's skills and knowledge of complicated dressing changes if the LPN/LVN had only completed complicated wound care once before. Thus the RN did not consider competency

The registered nurse (RN) has completed making assignments for the shift and is preparing to delegate appropriate nursing care activities to the staff. Whish tasks may the RN delegate to the certified nursing assistant (CNA)? Select all that apply. Select one or more: a. Ambulating the client in the hallway. b. Recording input and output from meal trays. c. Measuring and recording vital signs. d. Completing a skin risk assessment using the Braden scale. e. Recording a client's oxygenation saturation measurements.

The RN may delegate nursing care activities that are skill-based and with the scope of practice of the CNA. Ambulating the client in the hallway Recording input and output from meal trays Measuring and recording vital signs Recording a client's oxygenation saturation measurements.

A charge nurse often provides guidance to the staff and helps with problem-solving as challenges arise. The charge nurse uses which strategy to develop staff members? Select one: a. Personal attention. b. Role modeling. c. Precepting. d. Mentoring.

The definition of personal attention includes providing support and problem-solving. Employees are treated as associates.

A nurse leader attempts to resolve conflict between two nurses. Which communication skill should the leader use first? Select one: a. Clarification. b. Confrontation. c. Nonverbal acknowledgement. d. Active listening.

The first action by the nurse manager is active listening. The leader needs to listen to both nurses separately and then together (meeting). During the meeting, the nurse should clarify issues that are ambiguous.

What strategy should the nurse leader use to help develop critical thinking skills in the nursing staff? Select one or more: a. Coach nurses to think about care measures. b. Role model the use of biases in decision-making. c. Reward the ability to memorize and recall information. d. Foster the effective use of the nursing process.

The nursing process is a guide that assists in developing critical thinking skills. Critical thinking skills may also be developed by the formation of specific questions, use of case study analyses and reading clinical journals focused on critical thinking. Nurses should be coached to think about their thought processes in relation to frames of reference, assumptions, and cues.

A nurse who aspires to be a nurse manager understands that which of the following will be one of the competencies that will be needed in the new role? Select one: a. Ability to demonstrate virtual instruction technology to staff. b. Visioning and strategic planning for the nursing unit. c. Use of technological devices. d. Proficiency in the use of nursing process.

Visioning and strategic planning for the nursing unit. The leader should show proficiency in providing and articulating the vision of the unit and/or facility and the strategic plan.

Service Line Structures (Product Lines)

When functions that are necessary to produce a specific service or product, are brought together into an integrated organizational unit under control of a single manager or executive. The benefits: Coordination of services, an expedited decision making process, and clarity of purpose. The limitations: increased expense associated with duplication of services, loss of professional or technical affiliation and lack of standardization. Ex. A cardiology service line at an acute care hospital might include all professional, technical, and support personnel providing services to the cardiac patient population. The manage in this service line would be responsible for the chest pain eval. center situated within the ED, the coronary care unit, the telemetry unit and the outpatient cardiac rehabilitation unit. In addition to managing the budget and the facilities for those areas, the manage would be responsible for coordinating services for physicians and other providers who care for these patients.

A charge nurse begins the shift overwhelmed by many nursing care activities that need to be completed. The staff has been working short-handed for months, and the charge nurse has become reluctant to delegate nursing activities such as checking the code cart and performing narcotic counts to other qualified staff. When questioned by the nursing supervisor about insufficient delegation, the nurse explains which barrier is of key concern at this time? Select one: a. Inadequate support. b. Disorganization. c. Hostile Environment. d. Incompetence.

With insufficient numbers of healthcare workers, the nurse is handicapped in the ability to delegate because of inadequate support.

Matrix Structure require nurses with ______ & ______ in ________________

With the expansion of accountable care organizations, the nature of these organizations with their complex interrelationships requires *High level of knowledge and skill in interprofessional collaborative practice*.

A nurse leader attempts effective collaboration with charge nurses. Which components of effective leadership should the leader use? Select all that apply. Select one or more: a. Downward communication. b. Trust. c. Administrative support. d. Accountability. e. Dominant decision-making.

a. Downward communication. b. Trust. c. Administrative support. d. Accountability. Effective collaboration includes communication, trust, support from administration, and accountability of leadership and staff.

Which strategy would be best for the nurse to use to be an effective client advocate? Select one or more: a. Maintain knowledge of standards and regulations about client rights. b. Listen to the health care experiences of clients from different cultures. c. Learn to speak different languages to facilitate communication. d. Openly speak about cultural differences with clients and staff.

a. Maintain knowledge of standards and regulations about client rights. The nurse should accumulate a working knowledge of regulations and standards about client rights that should be applied to practice.

A nurse inserted a urinary drainage catheter without properly cleaning the client's perineal area according to agency policy and the directions on the prepackaged kit. Subsequently, the client developed urosepsis and died. The nurse understands that, in a court of law, these actions would be considered grounds for which of the following most specific charges? Select one: a. Negligence. b. A tort. c. A criminal action. d. Respondeat superior.

a. Negligence In healthcare, negligence is referred to as a failure to provide a standard of care other nurses or healthcare providers give in similar situations.

The nurse leader in a healthcare facility works with other organizational leaders to review and possibly revise the organization's mission statement. The nurse leader requests input from staff on the nursing unit, explaining that hte mission statement should do which of the following? Select one: a. Provide direction and keep the group focused. b. Foster open communication among members. c. Increase amount and diversity of problem-solving. d. Promote team building and personal bonding.

a. Provide direction and keep the group focused. The mission statement is a broad statement that describes the purpose of the organization to internal and external constituents and provides the team with guidance and focus.

A nurse is caught stealing narcotic pain medications. The nurse manager reports this incident to which of the following regulating bodies? Select one: a. State board of nursing. b. American Nurses Association. c. National League for Nursing. d. Department of Health and Environmental Control.

a. State board of nursing. The state board of nursing (#1) has authority by the governor to discipline nurses for behavioral problems as well as drug problems. The board investigates any violations of state statutes and regulations.

When determining the number of full-time equivalents (FTEs) needed for the unit, the nurse manager should start with: Select one or more: a. The number of hours of work for staff. b. Client safety factors. c. The time needed to account for staff breaks. d. The currently used client classification system.

a. The number of hours of work for staff.

A nursing unit shows little time for orderly change and order comes in the form of rapid and unplanned fluctuations. The nurse leader understands that this unit experiences change that is best described by which change theory? Select one: a. Lewin's Change Theory b. Chaos Theory. c. Havelock Model of Change d. Roger's Innovation-Diffusion Process

b. Chaos Theory. Chaos theory is characterized by order that emerges from rapid and unplanned fluctuations. Change is not orderly, but linear.

Which strategy should the nurse leader use to foster a climate of collaboration on the nursing unit? Select one: a. Place emphasis on tasks to be accomplished during each shift. b. Display an open attitude toward new ideas and suggestions. c. Focus on high-quality care and benchmarking results. d. Use firm communication about items of importance to the nurse leader.

b. Display an open attitude toward new ideas and suggestions. The best strategy the nurse can use to foster collaboration is developing openness towards ideas and suggestions of the nursing staff.

A nurse leader reviews the client's charts for which of the following because the indicate effectiveness of treatment and care? Select one: a. Indicators. b. Outcomes. c. Critical pathways. d. Standards.

b. Outcomes Client outcomes are key indicators of the effectiveness of treatment and care received during hospitalization.

A nurse is hired and scheduled for orientation. The nurse anticipates learning about which of hte following during orientation? Select all that apply. Select one or more: a. Unwritten agency policies. b. Policies. c. Benefits. d. Procedures. e. Role expectations.

b. Policies. c. Benefits. d. Procedures. e. Role expectations.

A nurse assists a client in room A with lunch. The charge nurse calls the nurse reports the client room C reports pain and is requesting pain medication. What is the nurse's best action? Select one: a. Finish feeding client in room A, then medicate for pain the client in room C. b. Stop feeding client in room A and medicate client for pain in room C. c. Finish feeding client in room A and ask charge nurse to medicate client for pain in room C. d. Ask charge nurse to feed client in room A while nurse medicates client for pain in room C.

b. Stop feeding client in room A and medicate client for pain in room C. The nurse should stop feeding the client in room A and medicate the client for pain in room C (#2). While eating is a priority, it does not take precedence over an individual with pain. The client in pain is experiencing discomfort that should be addressed immediately. The activity of feeding the client in room A can be delegated but it should be delegated to the appropriate person such as the nursing assistant. The charge nurse (#4) is busy overseeing the functions of the unit and feeding a client is not an appropriate activity for the nurse to reverse delegate to the charge nurse.

A nurse receives a call from a client's son who is requesting about the client's diagnosis for "insurance purposes." How should the nurse respond to the client's son? Select one: a. "Your mother is doing a lot better; she'll be discharged within the next few days." b. "You have no right to ask such questions about your mother's care." c. "Privacy regulations preclude me from disclosing information about our clients." d. "I can only provide you with your mother's surgical procedure, but that is all."

c. "Privacy regulations preclude me from disclosing information about our clients." The Health Information Portability and Accountability Act (HIPAA) has created regulations that do not permit healthcare workers to disclose information about the client unless the client has signed a release of information form. The nurse does not have a method to verify the person's identify over the phone (#3). The nurse should respond truthfully yet in a mild tone in an effort to make the son aware of confidentiality policies

Which strategy should the nurse use to facilitate the performance appraisal conference? Select one: a. Refrain from adding comments to the evaluation form. b. Include personal feelings in the comments section of the tool for clarity. c. Begin the evaluation interview with an open-ended question. d. Interview other staff about the employee's performance before meeting with the employee.

c. Begin the evaluation interview with an open-ended question. The performance interview is best started with an open-ended question, which draws the employee into the conversation and thus into the process.

The nurse manager would recommend which of the following as the best measure to improve the culture of safety on a nursing unit? Select one: a. A compromise occurs between two of the committee members. b. One member stands firm by a preset goal. c. There is effective negotiation among the committee members. d. All members uphold goals created by the administration.

c. There is effective negotiation among the committee members. This represents the best characteristic of collaboration because everyone has a voice that is heard and considered.

A client scheduled for cardiac catheterization in two hours requests more information about the risks and benefits of the procedure. The nurse calls the cardiologist who demands that the nurse provide client with the information and tell the client to sign the consent. What is the nurse's best response? Select one: a. "This is inappropriate. The client deserves the information from you." b. "Informed consent is the physician's responsibility. When are you coming in?" c. "I will refer this case to the medical director for further input and guidance." d. "My legal role in informed consent is to act as a witness, not to provide information the procedure and its risk and benefits."

d. "My legal role in informed consent is to act as a witness, not to provide information the procedure and its risk and benefits." The nurse should keep the dialogue professional but should also remind the physician of the legal responsibilities surround informed consent

A nurse manager needs to determine the staff mix for the unit. What should the manager do first? Select one: a. Schedule the staff to work when the needs are most critical. b. Consider mandated staff ratios. c. Identify staff competency to meet the needs of clients. d. Assess the type of care required by the clients.

d. Assess the type of care required by the clients. From a nursing process approach, the manager should *first assess the needs of the clients, which are determined by acuity*, THEN assess the competency of staff. The nurse must now schedule staff according to regulated ratios dictated by the regulating bodies.

The nurse manager would recommend which of the following as the best measure to improve the culture of safety on a nursing unit? Select one: a. Have certified nursing assistants monitor clients when nurses are busy with an emergency. b. Have two nurses verify warfarin (Coumadin) doses. c. Ask nurses to purchase back support devices to use for all lifting. d. Assist with a plan to install automated medication dispensing stations on the unit.

d. Assist with a plan to install automated medication dispensing stations on the unit. Automated medication dispensing stations provide safety features that help prevent medication errors

A nurse identifies a client at high risk for development of pressure ulcers and orders an air mattress for the client. This nurse is attempting to accomplish which of the following? Select one: a. Risk management. b. Culture of safety. c. Quality assurance. d. Risk reduction.

d. Risk reduction In risk reduction, the nurse identifies that the client may develop poor outcomes and takes measures to prevent negative client outcomes.

Organizational effectiveness

•Structure clearly defined -Enhances communication -Facilitates decision making •Fewest management levels/shortest chain of commands •Staff should have the ability to view their tasks as part of the common task of the organization •Staff organization develops a sense of community and belonging •Nursing services that facilitate development of future leaders