Marquis Leadership Chapter 11, 15, 19, 20

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. Supplies. b. Staffing. c. Fixed costs. d. Medication costs.

B

What would BEST support the capital request in Question 21? a. Number of patient care hours anticipated for the year b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. Outline of cost for each pump d. Estimation of total cost; no further details

B

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget

C

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. Advocacy for patients with regard to services required and services utilized. b. Increasing the volume of services and decreasing the number of patients served. c. Accomplishing more with each visit and decreasing the volume of services used. d. Decreasing the volume of services used and the number of return visits.

A

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. Cost-based reimbursement b. Charges c. Contractual allowance d. Prospective reimbursement

A

An example of an initiative that may reduce total healthcare costs would be: a. Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections. b. Educating seniors about the comparative costs of medications that are prescribed to them. c. Lowering copayments for prescription drugs for seniors. d. Advocating for more readily available MRI services to ensure early diagnosis.

A

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health

A

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators? a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care. b. Local home care services are expressing concern about the increased acuity of patients being discharged into their care. c. The resource-based relative scale for physicians does not account for the increased length of stay. d. Acute care patients are being denied entry to the hospital because of the increased stay of patients.

A

The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is: a. A contractual allowance. b. A profit. c. A flat rate. d. Revenue.

A

2. Anew graduate who began their nursing career 6 months ago and who completed orientation 3 months ago is in what stage of professional development? A) Experimentation B) Entry C) Mastery D) Disengagement

Ans: B Feedback: The nurse is still in the entry stage and will be until necessary skills are learned. It generally takes an extended period of time to obtain the skills necessary for mastery. The remaining options are not relevant to this questions.

8. A nurse has been transferred to another unit in the hospital to perform the same type of duties. What type of transfer is this called? E) Accommodating F) Lateral G) Diagonal H) Downward

Ans: B Doing the same type of duties in another location is called a lateral transfer

During the budgeting process, nurse managers are typically responsible for which of the following (select all that apply)? a. Calculating workload b. Developing unit operation objectives c. Justifying capital equipment requests d. Predicting cash flow e. Calculating patient load

ABC

The rising cost of health care in the United States is stimulated by which of the following (select all that apply)? a. Consumers' attitudes b. Population demographics c. Managed care d. Medical treatment patterns e. Attitudes of healthcare staff

ABD

How can the Internet be best used as a means of improving one's personal nursing practice? a. Accessing the latest research and best practice information b. Communicating with other health-care team members c. Minimizing the need for paper documentation d. Securing client information for confidentially

ANS: A Feedback: As an information source, the Internet allows nurses to access the latest research and best practice information so that their care can be evidence-based. It is not a secure form of communication in many cases. Electronic health records (not the Internet) replace paper records. It is not secure, so the Internet is not used as a confidential repository of client information.

A nurse-manager is orienting a new graduate nurse to the unit and has found this individual's charting regarding assessment to be inadequate. What is the most appropriate statement to initiate a discussion with the new RN? a. "I'm concerned that your assessment charting seems to be unclear. Can I help you with this?" b. "Unfortunately, your charting is inadequate in every way." c. "Do you think a refresher course in charting would help you?" d. "Are you having difficulty assessing your client?"

ANS: A Feedback: Assertive communication is not rude or insensitive, nor is it passive-aggressive. Backing up the communication to focus on the RN's intention is respectful and solution-oriented. The manager should not presume that the nurse is having difficulty with assessment unless there is evidence of this. The manager should avoid accusatory descriptors such as "inadequate in every way." Suggesting remediation would likely be premature before trying to work collaboratively with the nurse.

A nurse-manager has recently established a "best practice committee" at the clinic. Which behavior by the committee members suggests that it is in the "storming" stage? a. Members attempt to impress each other with their credentials. b. The short- and long-term goals for the group are agreed upon. c. Group members achieve their stated goals. d. The members receive their instructions and mandate from the manager.

ANS: A Feedback: Competition and posturing characterize the storming stage. Agreeing on goals occurs during norming, and these are accomplished during the performing stage. Initial instructions are given during the forming stage.

Janice is assigned to pass medications this shift. Mary is assigned to do wound care, Jennifer will give all the baths, and Jim will take all the vital signs. This model of nursing care is called _____ nursing. a. team b. primary c. modular d. functional

ANS: D In functional nursing the division of labor is assigned according to specific tasks and technical aspects of the job. It has been defined as work allocation by functions or tasks, such as passing medicine, changing dressings, giving baths, or taking vital signs. Under functional nursing, the nurse identifies the tasks to be done for a shift. The work is divided and assigned to personnel, who focus on completing the assigned tasks.

A new nurse-manager has been warned by colleagues about the prevalence of "the grapevine in the organization's communication." What is the manager's best initial response to this phenomenon? a. Seek to understand the patterns and contributors of this pattern of communication. b. Inform subordinates about the harmful effects of grapevine communication and that it will not be tolerated. c. Instruct subordinates to use formal patterns of communication rather than informal patterns. d. Use grapevine communication to disseminate messages that are accurate and respectful.

ANS: A Feedback: Given the frequency of grapevine communication in all organizations, all managers must attempt to better understand how the grapevine works in their own organization as well as who is contributing to it. It cannot normally be dictated into nonexistence, and the manager should avoid using this form of informal communication because messages can be easily distorted.

Feedback from a nurse-manager's peers suggests that the manager's face-to-face communication is often ineffective. The manager should consider what potential cause of this problem? a. Incongruence between the manager's verbal and nonverbal messages b. Ineffective listening skills on the part of subordinates and colleagues c. Inadequate formal training on communication skills d. Career stagnation by the nurse-manager

ANS: A Feedback: The incongruence between verbal and nonverbal messages is the most significant barrier to effective interpersonal communication. Ineffective listening skills on the part of the receivers may contribute to a perception of poor communication by the manager, but this would be unlikely to be the case among many different individuals. Many people never receive formal training on communication, but this does not necessarily inhibit them from becoming reasonably skilled communicators. Career stagnation would be a problem, but it would be less likely to affect overall communication skills.

What strategy best increases the likelihood that a nurse-manager's communication will be accurately interpreted? a. Using more than one mode of communication b. Using face-to-face communication c. Producing clear, simple, written communication d. Repeating the message as often as possible

ANS: A Feedback: Using various communication methods in combination increases the likelihood that everyone in the organization who needs to hear the message actually will hear it. The other options are single methods. Repeating a message is often not as effective as communicating it in a different way using a different mode.

Functional nursing: a. divided and distributed nursing tasks. b. enhanced client-oriented care. c. provided a smooth care delivery system. d. was expensive once implemented.

ANS: A Functional nursing focused on task accomplishment rather than individualized and holistic care. The division of labor was assigned according to specific tasks and technical aspects of the job, such as medication administration and taking vital signs.

A professional practice model is a: a. conceptual framework and philosophy of nursing within an organization. b. staffing grid that outlines nursing unit work schedules. c. mechanism by which care is actually provided to patients and families. d. blueprint for developing specific measurable objectives and actions.

ANS: A Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization.

A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? a. Case management b. Group nursing c. Functional nursing d. Private duty nursing

ANS: A The Case Management Society of America (CMSA) definition of case management is "a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes"

An example of a traditional nursing care delivery model is: a. case management. b. patient- and family-centered care. c. transitional care. d. patient-centered medical home.

ANS: A There are five traditional nursing models of care: (1) private duty, (2) functional, (3) team, (4) primary, and (5) case management. Of these, functional, team, primary, and case management were and are currently associated with hospital nursing practice. Private duty and case management were associated with public health, home health care, and community health but have been adapted to the inpatient setting.

A well-known conceptual framework by Donabedian (1988) is used to promote positive outcomes in an organization. The framework is composed of concepts related to: (Select all that apply.) a. structure. b. outcomes. c. processes. d. values. e. quality.

ANS: A, B, C One well-known conceptual framework by Donabedian (1988) frequently is used to "map" or determine what structures and processes promote positive outcomes. The three-concept framework is composed of structures, processes, and outcomes (S-P-O), and these three components are causally linked.

Which of the following nursing care models are hospital based? (Select all that apply.) a. Case management b. Functional c. Private duty d. Team

ANS: A, B, D Case management, functional, primary, and team are nursing care models that are hospital based.

Policies and procedures are two functional elements of an organization that are extensions of the mission statements. The similarities between policies and procedures include: (Select all that apply.) a. a need for regular, periodic reviews. b. a means for accomplishing goals and objectives. c. general guidelines for decision making about actions. d. a need for the smooth functioning of any work group or organization. e. a need to be very detailed as to how to perform a specific procedure on a specific unit.

ANS: A, B, D The similarities between policies and procedures are that both need regular, periodic reviews and that both are a means for accomplishing goals and objectives. Both are necessary for the smooth functioning of any work group or organization.

The determination of a care delivery model or system of care delivery depends on: (Select all that apply.) a. fiscal responsibility. b. accountability to the consumer. c. government reimbursement. d. the organization's philosophy. e. quality and safety considerations.

ANS: A, B, E Care delivery model redesign is influenced by fiscal responsibility, accountability to the consumer, available resources, and quality and safety considerations. The appropriate care delivery model is the one that maximizes existing resources while meeting organizational goals and objectives (i.e., the mission).

Positive work environments are often found in Magnet-designated organizations. Organizational structures associated with Magnet-like healthy work environments are: (Select all that apply.) a. professional development opportunities. b. interdisciplinary collaboration. c. top-down approach to governance. d. decreased workloads. e. culture of safety.

ANS: A, B, E Organizational structures associated with Magnet-like healthy work environments include effective leaders at all levels of the organization, professional development opportunities, staffing structures that consider nurse competencies, patient needs, and teamwork; interdisciplinary collaboration; empowered, shared decision making; patient-centered culture/culture of safety; quality improvement infrastructure; evidence-based practice; and a visible acknowledgment of nursing's unique, valued contributions (e.g., professional practice model, vision/mission/philosophy statements).

The presence of a nurse professional practice model (PPM) is the nurse's: (Select all that apply.) a. control over practice. b. career focus. c. job satisfaction. d. psychological needs.

ANS: A, C One important predictor of RN job satisfaction is the presence of a nurse professional practice model (PPM). Nurse job satisfaction is directly associated with nurse turnover, a significant human resource challenge for management (Hayes et al., 2012). Professional practice models consist of structures, processes, and values that support nurse control over practice and enhance job satisfaction and retention

Which principle should guide the nurse-manager's use of nonverbal communication? a. It is generally consistent across cultures, unlike verbal communication. b. It supersedes verbal communication when the two are incongruent. c. Nonverbal communication should be minimized because it confuses the receiver regarding the true intent of the message. d. Nonverbal communication is a significant part of the communication exchange only when it is not congruent with the verbal exchange.

ANS: B Feedback: Because nonverbal communication indicates the emotional component of the message, it is generally considered more reliable than verbal communication. It varies widely between cultures, and the manager does not normally have to make a conscious effort to minimize it. It is always significant regardless of how it aligns with the verbal message.

The nurse-manager has consulted the hospital information system to address a clinical issue. What characteristic is the hospital information system most likely to have? a. It is likely based on a social media platform. b. It is probably not freely available from the Internet. c. There is a high likelihood that it is out of date. d. It is probably accessible only from desktop computers, not wireless devices.

ANS: B Feedback: For security and confidentiality purposes, hospital information systems are typically not available to all on the Internet. However, they have the advantage of being easy to update and are more likely to be up to date than paper-based equivalents. These systems would not be hosted on a social media platform due to security risks. They can often be accessed wirelessly, provided the user has access to the secure network.

A hospital is downsizing, but the RNs have been assured that everyone on the unit will keep their jobs and that downsizing will occur through normal attrition. Today, the evening charge nurse reported to the manager that the staff was discussing rumors about mass layoffs. What is the best approach to take? a. Tell an informal leader the truth and let the leader spread the news informally. b. Hold a meeting for all staff members and tell them that the rumor is not true. c. Ignore the rumor because it will soon pass. d. Find out who started the rumor and correct the information.

ANS: B Feedback: Nurse-leaders should intervene appropriately when communication problems (in this case, rumors) arise. It is not particularly important who started the rumor if all staff members are now privy to it. Direct action is preferred to indirect action, such as introducing a competing message. Inaction would likely fuel the rumors.

The nurse is caring for a client with a diagnosis of chronic obstructive pulmonary disease and who is experiencing a new onset of dyspnea. When contacting the client's care provider, the nurse should state the client's admitting diagnosis in what stage of the SBAR tool? a. S b. B c. A d. R

ANS: B Feedback: The "B" in the SBAR tool denotes "background." This is the stage of the tool where the nurse communicates the clinical context, including the client's diagnosis.

Which nursing action demonstrates compliance with the American Nurses Association (ANA) principles for social networking by nurses? a. Strictly avoiding the use of social networking in a professional setting b. Participating in the development of institutional policies governing online conduct c. Ignoring any information that appears to have the potential to harm a patient's welfare d. Realizing that social networking is not related to a nurse's professional boundaries

ANS: B Feedback: The ANA has developed principles for social networking that include participation in policy development, nurse-patient boundaries, separating personal and professional online information, and reporting to authorities when patient welfare has been potentially harmed. There is not an absolute prohibition against the use of social media in a professional setting, but it must adhere to strict guidelines.

A member of a work group that the nurse-manager leads is aloof and dismissive of the group's role. The member has occasionally made jokes during serious discussions and seems skeptical that the group will meet its goals. What role is this member playing? a. Blocker b. Playboy c. Dominator d. Recognition seeker

ANS: B Feedback: The playboy remains uninvolved and demonstrates cynicism, nonchalance, or horseplay. The blocker persists in expressing negative points of view and resurrecting dead issues. The dominator attempts to control and manipulate the group, whereas the recognition seeker works to focus positive attention on himself or herself.

Which of the following is true about team nursing? a. It includes only registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs). b. Each team member has his or her own patient assignments. c. Team members must have dual degrees. d. The nurse with a bachelor's of science in nursing degree is the leader of the team.

ANS: B Team nursing is a delivery approach that provides care to a group of patients by coordinating a team of RNs, licensed practical nurses, and care aides under the supervision of one nurse, called the team leader. Each team member has his or her own patient assignments, and team members are expected to assist and support each other as needed.

A large health-care organization has struggled to meet mandated electronic health record (EHR) standards. What actions address the likely challenge that this organization is facing? Select all that apply. a. Improving communication between managers at the organization's various sites b. Increasing the organization's budget for technology c. Investing more in employee training d. Engaging clients and families with the process e. Increasing the use of evidence-based practice

ANS: B, C Feedback: Many of the challenges faced during the adoption of EHRs involve inadequate technology and training. Communication between managers has not been identified as a major hurdle. Evidence-based practice enhances client care but does not directly address challenges around EHRs. Similarly, engaging clients and families greatly benefits the care that nurses provide but not the adoption of EHRs.

Disadvantages of private duty nursing include: (Select all that apply.) a. private duty nurses have a great degree of autonomy. b. private duty being a costly model. c. job security being tenuous and irregular. d. the nurse's focus being entirely on one client's needs. e. nurses maintaining close relationships with colleagues.

ANS: B, C One disadvantage was that private duty is a costly model because of its low efficiency. Furthermore, job security was tenuous and irregular. Other disadvantages were that nurses had little job mobility and were relatively isolated from colleagues.

Professional practice models (PPMs) refer to the conceptual framework and philosophy of nursing within an organization. The core elements of a PPM include: (Select all that apply.) a. goals. b. values. c. leadership. d. collaborative relationships. e. care delivery model.

ANS: B, C, D, E The core elements of a PPM include nursing values, leadership, the care delivery model, collaborative relationships and decision making, and professional development opportunities

Nurses still struggle to create a healthy work environment. The standards of a healthy work environment include: (Select all that apply.) a. staffing ratios. b. true collaboration. c. powerful leadership. d. meaningful recognition. e. skilled communication.

ANS: B, D, E The six standards of a healthy work environment are skilled communication, true collaboration, effective decision making, meaningful recognition, appropriate staffing, and authentic leadership. They have direct relevance to PPMs.

Critical paths: a. are designed only for critical care or trauma patients. b. determine lifesaving interventions for a specific population. c. outline optimal care and time milestones for the routine patient. d. provide a list of supplies and equipment needed for care.

ANS: C A critical path is a written plan that identifies key, critical, or predictable incidents that must occur at set times to achieve client outcomes during an appropriate length of stay in a hospital setting.

A nurse-manager has a reputation as being an assertive communicator. How does this manager most likely communicate? a. Through confrontation and intimidation b. In an unfeminine way that is clear and direct c. Directly and honestly, while respecting the rights of others d. In a clear, but occasionally offensive, manner

ANS: C Feedback: Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another's rights. It is a myth that assertiveness is "unfeminine," offensive, or confrontational.

The RN overhears the nurses' aide speaking in a harsh tone to a client with early Alzheimer's memory loss. Which statement should the RN make to begin addressing this issue? a. "You must remember to watch your tone of voice with clients. Someone might overhear." b. "Do you think it would be a good idea to have an in-service on dealing with Alzheimer's patients?" c. "I am concerned about your conversation with the client. It sounded short and impatient." d. "I have decided to reassign that client to another aide."

ANS: C Feedback: Assertive communication effectively identifies and addresses an issue without being rude, insensitive, or passive-aggressive. None of the remaining options actually identifies the specific communication problem.

Electronic health records (EHRs) have recently been introduced in a health-care organization, and the steering committee is ensuring that the system meets the criteria for meaningful use. This characteristic of the EHR ensures that the system: a. is readily accessible in any care setting, nationwide. b. uses language that is accessible to and understandable by clients. c. contains data that has the potential to improve client outcomes. d. means the same thing to every user.

ANS: C Feedback: EHRs must meet meaningful use requirements, which involve capturing the right data that can improve client outcomes. This characteristic of EHRs does not specify their accessibility or require that they mean the same thing to all users.

What principle should guide the nurse-manager's understanding of gender differences in communication? a. Research has disproven any gender-based differences in communication that were thought to exist. b. Gender is the variable that has the greatest effect on an individual's communication style. c. Men and women communicate and use language differently. d. In contrast with stereotypes, women have been shown to be more competitive communicators.

ANS: C Feedback: Gender is a significant factor in organizational communication, as men and women communicate and use language differently. Women are generally perceived as being more relationship-oriented than men, but this is not always the case. Gender is significant but is not seen as the most significant variable in communication.

A nurse-manager is having a difficult conversation with a subordinate whose performance has long been inadequate. The emotional component of the manager's message will be most clearly conveyed by: a. the formality or informality of the words the manager chooses. b. the pace and pitch of the manager's speech. c. facial expressions, body movements, and gestures. d. the amount of time that the manager lets the employee speaks before interrupting.

ANS: C Feedback: Nonverbal communication is considered more reliable because it conveys the emotional part of the message. The other variables are not as significant communicators of emotion.

The nurse-manager is using the GRRRR model of listening when interacting with a colleague who exhibits challenging behaviors. What is the final action that the manager should implement when using this model? a. Confirm an action plan. b. Request any necessary information from the colleague. c. Thank the colleague for the collaborative conversation. d. Reflect privately on the quality of the interaction.

ANS: C Feedback: The final phase of the GRRRR model of listening involves reward, when both parties reward each other by recognizing and thanking each other for a collaborative exchange. The model does not explicitly prescribe a time of reflection. Confirming an action plan and requesting information take place in earlier phases of the model.

The nurse-manager is sitting on a practice committee and has adopted the role of gatekeeper. What action should the manager perform in this role? a. Acknowledge and praise each member's contributions. b. Mediate, harmonize, and resolve conflict when it arises. c. Facilitate and promote participation by all group members. d. Record the group's process and provide feedback to the group.

ANS: C Feedback: The gatekeeper makes sure all voices in the group are heard in order to facilitate and promote open communication. Acknowledging and praising each member's contributions is the role of the encourager. The recorder records the group's process and provides feedback to the group. The harmonizer mediates, harmonizes, and resolves conflict.

A nurse-manager is communicating with a subordinate. What component of this communication would be considered as part of the external climate? a. The clarity of the message b. The subordinate's personality c. The culture of the organization d. The manager's stress level

ANS: C Feedback: The organizational climate and culture would be considered part of the external climate of this communication. The sender's and receiver's personality and stress levels are components of the internal climate. The clarity of a message is not a component of the external climate.

An RN is a team leader for a small module of clients. While listening to a recorded report on a client, one of the team members remarks, "My mother lives near him, and she says his home life is in chaos." How should the RN best respond? a. Politely ask the team member to be quiet. b. Include the information in report for the next shift. c. Ask the team member how this information relates to the client's care. d. Ignore the team member's comment.

ANS: C Feedback: The role of the leader is to encourage communication that is appropriate and discourage communication that is inappropriate among staff. The RN's question about the purpose of this communication helps to determine whether it was appropriate or not. This should be clarified before deciding how to proceed.

Which vocal delivery suggests to a listener that a person is asking a question rather than making a statement? a. Loudness b. Frequent pauses c. Tentativeness d. Rapid delivery

ANS: C Feedback: Vocal clues such as tone, volume, and inflection add to the message being transmitted. Tentative statements sound more like questions than statements, leading listeners to think that you are unsure of yourself, and speaking quickly may be interpreted as being nervous. Loud and frequent pauses can be barriers to communication but do not suggest questioning.

Primary nursing is a type of care delivery in which the nurse: a. cares for a patient 24 hours a day. b. is responsible for the client's daily care. c. monitors care from admission to discharge. d. provides total care for the patient.

ANS: C In the primary nursing model, the primary nurse has 24-hour-per-day accountability for the patient's plan of care from admission to discharge. Associate nurses oversee patient care delivery when the primary nurse is not on shift, although associate nurses are expected to follow the primary nurse's plan of care.

Stakeholders are informed of an organization's key goals through its: a. vision. b. values statement. c. mission statement. d. organizational philosophy.

ANS: C Publicly posted mission statements inform key stakeholder groups, such as the public and employees, of the organization's key goals.

Mary Lou is a nurse in the critical care unit. She works 12-hour shifts. Each shift she is assigned to one or two critical care patients. She is responsible for planning and delivering the care and treatment for each one of the patients she is assigned to. This is an example of which nursing model? a. Team nursing b. Managed care c. Total patient care d. Functional nursing

ANS: C The term total patient care has come to mean the assignment of each client to a nurse who plans and delivers care during a work shift

10. The responsibility for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services lies with: a. staff nurses. b. care councils. c. the nurse manager. d. executive leadership.

ANS: D Executive leadership is responsible for making decisions about and designing strategies to create a climate and environmental context around the provision of nursing and health care services.

What statement about the maintenance of confidentiality is true? a. It is the right of every client and must never be breached. b. It is made easier with electronic technology. c. It is primarily the duty of the medical records staff. d. It can be violated when there is a legitimate professional need.

ANS: D Feedback: Confidentiality is a right that must be upheld, unless there is a legitimate professional need to know, such as when a provider must share information about a client with another provider so that the other provider can assume care. New technologies pose new threats to confidentiality, and every health-care provider shares responsibility for it.

What is the best example of downward communication by a nurse-manager? a. The manager reports a nurse's serious error to the chief nursing officer. b. The manager seeks advice from a colleague about how to deal with an employee who is chronically late. c. The manager contacts a client's physician to confirm the client's scheduled transfer. d. The manager reviews the results of a nurse's performance appraisal with the nurse.

ANS: D Feedback: In downward communication, the manager relays information to subordinates. Reporting to the chief nursing officer would be upward communication; communication with a fellow manager would be horizontal. Communication with a physician would be diagonal.

A nurse-manager is drafting a memo that will be distributed within the organization. When using this form of communication, the manager should: a. send it to everyone in the organization to ensure equal access to information. b. begin with at least one page of background information to ensure clarity. c. avoid using headings so the reader is not confused. d. include only essential information.

ANS: D Feedback: Only essential information is included in a memo because extraneous information will detract from the message. Headers should be used to make the memo easier to read, and it should only be sent to a small to moderate number of people. Brevity is valued, so one page of background information would be excessive.

10. Research supports that which factor may lead nurses to become disengaged in their careers? A) They do not feel that nursing is valued as a career B) Boredom increases with time on the same job C) Many nurses interrupt their careers for childrearing D) Nursing is low paying compared with ot her careers

Ans: B Feedback: Research has shown that boredom and job indifference leading to disengage ment increase with time on the same job. While the o the r options may be factors they are not research supported.

9. The conceptual framework and philosophy under which the method of delivery of nursing care is a component is known as: a. core values. b. mission statement. c. care delivery model. d. professional practice model (PPM).

ANS: D PPMs refer to the conceptual framework and philosophy under which the method of delivery of nursing care is a component. PPMs describe the environment and serve as a framework to align the elements of care delivery. The PPM can be thought of as a link between the problems presented by client populations, the purposes of professional occupations, and the purposes of health care organizations.

Which nursing care model was prominent before the Great Depression? a. Functional nursing b. Group nursing c. Hospital staffing d. Private duty nursing

ANS: D Private duty nursing is the oldest care model in the United States. Between 1890 and 1929 in the United States, graduate nurses acted as private duty nurses, caring for patients in their homes

Lilly, an RN, works full time in her client's home providing total care for him. She bathes and dresses him, provides tracheostomy care and wound care, and feeds him. She is paid directly by her client. This type of nursing care is commonly known as: a. primary nursing. b. functional nursing. c. case management. d. private duty nursing.

ANS: D Private duty nursing, sometimes called case nursing, is the oldest care model in the United States. Private duty nursing is defined as one nurse caring for one client. In this model, complete and total care is provided by one nurse, but the nurse carries only one client assignment.

22. What is the purpose of competency assessment regarding a nurse's career? A) Identifying ways to exceed minimal licensing requirements B) Fulfilling state requirements for minimal nursing practice C) Facilitating advancement up the facility's career ladder D) Satisfying institutional employment qualification

Ans: A Feedback: Competency assess ment and goal setting in career planning should help the employee identify how to exceed the minimum levels of competency required by federal, state, or organizational standards. The remaining options do not describe the purpose of competency assessments.

11. Why would an experienced nurse voluntarily opt for a self-selected downward transfer? A) Doing so increases the chances of long- term career success B) It allows for keeping a similar salary while decreasing energy expenditure C) lo times of downsizing, it al lows a nurse to stay employed D) It occurs when a nurse is physically impaired and productivity is affected

Ans: A Feedback: For individuals to gai n experience in a new area and to enhance long-term career goals, a self-selected downward transfer may be used. None of the other options accurately describe the reason for a self-selected downward transfer.

13. What is the focus of the entry job stage? A) Skill development B) Job es tee m C) Sense of purpose D) Indifference

Ans: A Feedback: During the entry phase of learning a job, an individual concentrates on skill development. None of the other options is the focus of this stage.

24. An effective transition program for new nursing graduates will address which issue? Select all that apply. A) Supporting practice autonomy B) Strengthening new clinical skills C) Introducing time management skills D) integrating into the nursing unit environment

Ans: A, B, C, D Feedback: A well-designed transition-to-practice program strengthens new graduates skills and competencies and prepares the new nurse for the demands of caring for patients. Fu11hermore, a systematic app roach to transition not only facilitates ion-boarding (integration into staffing on the nursing unit to prov ide direct patient care), it reduces turnover by decreasing the toll associated with insufficient preparation for the work environment. Satisfying nursing position needs is not a focus of a transition program for new graduates.

23. Which activity represents a commitment to career planning? Select all that apply. A) Introduces evidence-based practice changes regarding wound dressings B) Discussing the health needs of the homeless with local politicians C) Earning a bachelor r's degree(BSN) in nursing D) Working with a seasoned mentor

Ans: A, B, C, D Feedback: Career planning should include, at minimum, a commitment to the use of evidence based practice, learning new skills or bettering practice through the use of role models and mentors, staying aware of and being involved in professional issues, and furthering one's education. Full-time employ ment is not a necessary commitment.

25. Which activity is directed toward a new graduate's responsibility to their nursing career? SATA A) Earning a professional nursing certification B) Gaining expertise in a specific field of nursing C) Being a member of a professional nursing association D) Earning an advanced nursing degree within 5 years of initial licensure

Ans: A, B, C, D Feedback: New graduates also have responsibility during the crucial first few years of employment to gain the expertise they need to have more opportunities for career divergence in the future. This includes becoming an expert in one or more areas of practice, gaining professional certifications, and being well informed about professional nursing and health-care issues. This is also a time where participation in professional associations has great value as a result of the opportunities for mentoring and networking. Finally, all new graduates should consider at what point, continued formal education will be a part of their career ladder and professional journey.

15. How can a nursing professional demonstrate advanced achievement of competencies? A) Lateral transfer B) Professional specialty certification C) Transfer to a new department D) Professional registered nursing licensure

Ans: B Feedback: Professional specialty certification is one way that an employee can demonstrate advanced achievement of competencies. The transfer, when used appropriately, may be an effective way to provide career development but a lateral transfer does not demonstrate advancement. A transfer to a new department often requires the acquisition of new skills before advance can occur. A nursing license signifies entry-level skills.

1. What is the advantage of recruiting from outside the organization? A) Promotes long-term retention of employees B) Tends to increase the number of candidates C) Provides well-motivated candidates D) Attracts well-qualified candidates

Ans: B Feedback: Recruiting from outside the organization provides an opportunity to increase the pool of candidates for positions but is no guarantee that these candidates will be more qualified or motivated than those who come from within the organization.

20. What is the name of the stage of a career where nurses are experienced clinicians with expert knowledge, skills, abilities, credentials, and education base? A) Promise B) Momentum C) Harvest D) Legacy

Ans: B Feedback: Momentum is the middle career phase and typically reflects the nurse with 11 to 29 years of experience. Nurses in this phase are experienced clinicians with expert knowledge, skills, abilities , credentials, and education base.

14. What is the purpose of a cover letter? I. introduce the applicant 2. . Briefly highlight key points of career 3. Make a positive first impression 4. Always used when submitting a resume A) I, 2, 3 B) I, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: C Feedback: Cover letters (whether by mail or e- mail) should always be used when submitting a resume. Their purpose is to introduce the applicant, briefly highlight key points of the resume, and make a positive first impression.

4. Which statement is true regarding career planning? A) It is the emp lo ye r's responsibility B) It results in the spontaneous assessment of goals C) It requires the development of a long -term plan D) Functions best when the planning is episodic in nature

Ans: C Feedback: Effective career planning requires long-term planning; it is the responsibility of the individual and requires constant attention to function properly.

9. Which statement is accurate concerning management development classes? A} They are not cost-effective, but increase worker sat is faction B) They are necessary for advancement to management positions C) They require the inclusion of social learning activities D) They are a responsibility of middle-le vel management

Ans: C The inclusion of social learning activities in management development increases the possibility for employee retention. Management development is cost-effective for the organization but may not be necessary for all managers. Top executives in the organization have a responsibility to support the management development program.

16. What arc restraining forces for specialty certification in professional nursing? I . Decreased collaboration with other health-care providers 2. Cost 3. Lack of recognition 4. Increased retention A) 1, 2 B) 1, 4 C) 2,3 D) 3, 4

Ans: C Feedback: Cost coupled with lack of institutional reward and support kept some nurses from pursuing certification. The impact of certification on absenteeism and retention was unclear.

3. Which reason qualifies as organizational justification for a career development program?? A) Employee attrition can be reduced B) Personnel can be used more effectively C) Employee scan increase earning power D) Employment benefits are increased

Ans: C, D Feedback: Organizational justification for career development programs includes attrition reduction, improved productivity, and general improved quality of life. Although employees may earn more money and additional benefits as a result of career development they are not the reason that organizations undertake career development programs.

12. How is competency of an employee best determined? A} An examination of patient records by a review team B) Self-reporting on an administered skills checklist C) Evidence of attendance in continuing education classes D) Documentation of effectively meeting role demands

Ans: D Feedback: Competency relates to role and is determined by each role demand. None of the other options are able to determine competency as effectively as documentation of performance.

7. Which state ment is true regarding long-tem1coaching for career development? A) It occurs annually at performance appraisal reviews B) It focuses on employee performance deficits C) [I requires the same intensity as a mentoring relationship D) It occurs over the entire employment tenure of an employee

Ans: D Feedback: Long-term coaching should occur over the entire employment of the employee

18. What is a management function associated with career development? A) ls self-aware of personal values influencing career r development B) Encourages employees to lake responsibility for their own career planning C) Identifies, encourages, and develops future leaders D) Works cooperatively to arrange intra-organizational transfers

Ans: D Feedback: Management function is to work cooperatively with other departments in arranging for the release of employees to take other positions within the organization. Leadership functions associated with career development are self-aware of personal values influencing career development; encourage employees to take responsibility for their own career planning, and identifies, encourages, and develops future leaders.

6. Which activity is a personal responsibility for career management? A) Developing career ladders B) Establishing career paths C) providing challenging assignments D) Developing a career plan

Ans: D Feedback: Only the development of a career plan is the responsibility of the individual. The first 3 choices are management responsibilities.

5. Which principle le is key in resumes' construction? A) Emphasize strong and weak points equally B) Be at least four to five pages in length C) Reflect complex, schola rly language D) Be concise and easy to read

Ans: D Feedback: The content of a resume should be able to be grasped quickly by the individual doing the hiring, so conciseness and readability are of key importance.

17. The manager should have a well-developed, planned system for career development for all employees . What should be included in this program ? I . Policies communicated to administrators 2. Ap propriate use of transfers 3. How promotions are handled 4. Long-term coaching A) 1,2,3 B) 1, 2, 4 C) 1, 3, 4 D) 2, 3, 4

Ans: D Feedback: The manager should have a well-developed , planned system for a career development for all employees; this system should include the appropriate use of transfers, how promotions are to be handled, and long-term coaching. These policies should be fair and communicated effectively to all employees.

19. The promise phase of career development typically reflects how many years of initial nursing employment'? A) 1 B) 2 C) 5 D) 10

Ans: D Feedback: Promise is the earliest of the career phases and typically reflects the first 10 years of nursing employment.

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a. 0.6 b. 0.7 c. 0.8 d. 1

B

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. Overestimation of inflation. b. Higher than expected client acuity. c. Net revenue exceeding net expenses. d. Not replacing staff who called in sick.

B

As an experienced nurse manager who is new to an organization, it would be important to: a. Know the difference between operating and capital budgets. b. Understand the budget timetable and level of involvement expected of individual managers in budget preparation. c. Know why a budget is essential to the well-being of an organization. d. Understand what factors drive up healthcare costs in the healthcare system.

B

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a. Providing fewer services to fewer clients. b. Using fewer services per client. c. Using high-technology treatments. d. Requiring second opinions.

B

The chief nursing office of a Magnet™ hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. Accomplish healthcare goals. b. Minimize costs. c. Decrease the number of services used. d. Use high-technology treatments.

B

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. Maintain a clear vision of how to trim healthcare costs. b. Balance value-added services against costs and revenues. c. Consistently delete programs that are of high cost. d. Implement programs that bring in additional revenues.

B

A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager: a. Concludes that the complexity of care in each visit has arisen. b. Concludes that patient volume has been decreased. c. Decides that more information is needed before a conclusion can be reached. d. Initiates a training session regarding the importance of ensuring that visits are made

C

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a. Hospice care b. Custodial nursing home care c. Home care d. Hospital care

C

In Question 17, the nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education, and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget? a. 12,480 b. 11,200 c. 10,848 d. 10,688

C

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000? a. $78,000-$93,600 b. $62,400-$78,000 c. $46,800-$62,400 d. $31,200-$46,800

C

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care

C

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. Operating b. Strategic c. Unit of service d. Capital

D

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a. Day-to-day plan for operations. b. Unit of service. c. Statement of revenues and services. d. Financial plan.

D

The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to: a. Anticipate total costs for patient care. b. Know how much time staff will likely be unavailable because of illness. c. Determine when orientation needs to occur for new staff. d. Determine the number of hours available for patient care.

D

Which of the following factors is not implicated in rising healthcare costs? a. Rising expectations of consumers for cure and care b. Unintentional injuries c. Socioeconomic conditions d. Rising Medicare costs

D