NSG 441 EAQ practice

A historic hospital study was completed in 1983, and the goal of the study was to discover factors attracting qualified professional nurse. Of these hospitals, 41 were identified by their ability to attract and retain professional nurses who provided quality care. What were these 41 "best hospitals" called? A. magnet hospitals B. tertiary care centers C. gold standard hospitals D. employee recognition hospitals

A

Several years ago the nurse moved to a new state to practice in a rural clinic. It was an adjustment at first, but now, the nurse feels part of the clinic's culture. Which concept describes the nurse's experience A. assimilation B. acculturation C. ethnocentrism D. cultural humility

A

Which nursing theorist does not specifically address leadership but addresses the nurse as the person who participates in patient care and educates patients? A. Ira Chaleff B. Patricia Benner C. Dorothea Orem D. Ida Jean Orlando

C. Dorothea Orem

The nurse manager wants to bridge differences between the many different cultures of staff and patients on the floor. Which concept is the nurse's goal demonstrating? A. multicultralism B. cultural diversity C. transcultrualism D. cross-culturalism

C. transculturalism

Which theory or group of theories arose late in the past millennium because of globalization and other related factors? A. expectancy B. two-factor C. transformational D. hierarchy of needs

C. transformational

In 2004, which organization developed the masters level clinical nurse leader (CNL) role in response to the need for more evidence-based, collaborative, cost-effective, patient-centered care? A. National League of Nursing (NLN) B. American Nurses Association (ANA) C. American Medical Association (AMA) D. American Association of Colleges of Nursing (AACN)

D

Which variables are forces of change that act as facilitators and barriers? SATA A. courage B. environment C. staff morale D. support services E. information technology

B, C, D, and E

Variations within the patient care environment (including the severity of patient conditions, changes in volume, or procedural requirements) are taken into account by which method of nurse staffing? A. fixed staffing B. flexible staffing C. centralized staffing D. decentralized staffing

B

Which organization advises the Centers for Medicare and Medicaid Services on measures that can be used to determine payment? A. TJC B. IOM C. NQF D. AHRQ

C. National Quality Forum

Which element reflects quality measures that produce the greatest positive effect on patient outcomes? A. quality management B. quality improvement C. accountability measures D. nursing-sensitive indicators

C. accountability measures

Which statement refers to a healthcare organization's view of what nursing practice should be within the organization and how it contributes to the health of individuals and communities? A. vision statement B. values statement C. mission statement D. philosophy statement

D Rationale: Vision statement is a future-oriented, purposeful statement designed to identify the desired future of an organization. A values statement expresses the core values as part of a strategic plan. A mission statement defines a healthcare organization's reason or purpose for being, identifies its costumers, and identifies the types of services offered.

Which initial strategy would nurses use to approach the management team with a request for alternative working hours? A. filing a grievance B. collective action C. shared governance D. collective bargaining

D Rationale: collective bargaining is a process of negotiations between employers and a group of employees aimed at reaching agreements to regulate working conditions.

Communication requires a leader to perform which tasks? Select all that apply. A. repeat the information in different forms and at different times B. provide clear instruction to avoid misinterpretation and frustration C. transfer patient-centered communication skills to leadership D. use negotiation procedures and processes such as ethics committees and other neutral entities E. provide necessary resources to those involved to offer support, information, and assistance

A, B, and C Rationale: The art of communication involves multiple steps including communicating and explaining repeatedly; providing clear instruction to avoid employees interpreting the message with their personal viewpoints; and applying patient-centered communication skills to the leadership role.

The 2010 Institute of Medicine (IOM, now NAM) report The Future of Nursing: Leading, Changing, Advancing Health discusses the need for the effective transition of new nurses, nurses to different specialty areas, and nurses to advanced practice. Which opportunity would support effective transition? A. provision of clinical ladders for nurses B. Residency programs for all levels of nursing C. monthly educational offerings on changes occurring in health care D. monetary support for membership in professional organizations

B

The nurse is asked to describe the five rights of delegation. Which response by the nurse is correct? A. The five rights are founded on the right circumstance B. the five rights are a useful tool for delegation decision making C. the five rights determine the legality authority of nurse delegation D. the five rights must be documented on every patient with delegated care.

B

The nurse manager is planning delegations and assignments for a shift on his or her unit. Which actions will the nurse manager take for unstable patient whose past two blood pressure readings were high? A. take on care of the patient B. assign an RN to care for the patient C. delegate care of the patient to an RN D. assign a certified nursing aide to care for the patient.

B

The nurse manager is reviewing documentation and notices several nurses are not using approved abbreviations. The nurse manager's review is an example of which process? A. benchmarking B. quality assurance C. risk management D. quality improvement

B

Which level of care is appropriate for a patient who needs hemodialysis? A. primary care B. tertiary care C. secondary care D. health maintenance

B

Which organization is responsible for issuing annual patient safety goals? A. IOM B. TJC C. IHI D. QSEN

B. The Joint Commission

Which components of the nursing process are included in the elements of care for "right supervision"? SATA A. intervention B. diagnosis C. evaluation D. assessment E. planning

A and C

A patient became disoriented and fell after being given the incorrect medication by the nurse. Which instruction will the nurse manager give the nurse for completing the incident report? SATA A. write the time and location of the fall B. include subsequent examination for injuries C. note the incident report in the patient record D. enter any medications that were given after the fall E. discuss the cause and effect of the medication error and fall.

A, B, and D Write the time and location of the fall Include subsequent examination for injuries Enter any medications that were given after the fall.

Which factors describe the inherent characteristics of culture? SATA A. culture develops over time B. culture does not change over time C. culture is responsive to the environment D. members of a culture learn it and share it E. culture is essential for survival and acceptance.

A, C, D, and E

The nurse is preparing a presentation to review team member characteristics that result in challenges in delegation. Which topics should the nurse include in the presentation? SATA A. age B. salary C. gender D. ethnicity E. communication

A, C, and D

According to California's mandated nurse-to-patient ratios, which units are examples of safe nurse/patient ratios? SATA A. 1:5 med-surg units B. 1:3 in intensive care units C. 1:6 in psychiatric units D. 1:4 in pediatric units E. 1:1 in labor and delivery units

A, C, and D Rationale: ICU ratios are 1:2 and labor and delivery are 1:3

Nursing research identifies which as a main model of nurse staffing? SATA A. patient acuity B. nurse skill mix C. nurse-to-patient ratio D. budget-based staffing E. nurse experience levels

A, C, and D Rationale: Mensik's 3 models: patient acuity, nurse-to-patient ratios, and budget-based staffing

Which member of the healthcare team is primarily responsible for early warning monitoring? A. the nurse B. the physician C. the pharmacist D. unlicensed personnel

A.

What should the nurse understand about the Nurse License Compact (NLC) that offers multi-state licensure? A. the nurse can legally practice in any state. B. each state has its own Nurse Practice Act C. The state in which the nurse holds a license determines the regulating practice act D. the nurse must obtain additional licenses for each state that belongs to the NLC.

B

Which tool is widely used by healthcare organizations to determine harm to patients? A. TeamSTEPPS B. Global Trigger C. Choosing Wisely D. Magnet Recognition Program

B

Which part of Medicare provides for durable medical equipment? A. Part A B. Part B C. Part C D. Part D

B Rationale: Part B covers doctor's services, testing, outpatient care, home health services, and medical supplies. Medicare Part A covers inpatient and hospice care. Part C allows private health insurance companies to provide Medicare benefits. Medicare Part D is the prescription drug supplement.

Which principle would the nurses focus on to improve the process of transferring patients to other units? A. accountability B. collective action C. shared governance D. workplace advocacy

B Rationale: collective action is used to improve a process.

Which temr is used to describe connecting thoughts and inner driving forces that give purpose, direction, and precedence to life priorities? A. Goals B. Values C. Visions D. Theories

B values

Which descriptions can be applied to systems? SATA A. all systems are intricate B. systems are interconnected C. systems often have subsystems D. all systems have inputs that develop outputs E. open systems do not interact with the external environment

B, C, and D

Which processes are include in Bleich's tasks of management? Select all that apply. A. demonstrating accountability to the team effort B. recommending ways to improve systems or processes C. eliminating barriers and obstacles to work effectiveness D. offering knowledge, skills, and abilities to accomplish the task at hand E. identifying systems and processes that require responsibility and accountability

B, C, and E

Which concepts are included in the Registered Nurse Safe Staffing Act? SATA A. prohibited mandatory overtime B. public reporting of staffing information C. additional monetary compensation D. ability to investigate complaints E. allowance of imposed civil monetary penalties for known violations

B. D. and E

Which is the ultimate goal of nursing delegation? A. cost savings B. public safety C. nursing satisfaction D. increased nurse-patient ratios

B. public safety

Which theory states the survival of an organization is based upon its evolutionary ability to adapt to environmental change? A. chaos B. systems C. complexity D. contingency

B. systems Rationale: Systems theory attempts to explain productivity in terms of a unifying whole as opposed to a series of unrelated events. Systems theory suggests the survival of an organization depends on its evolutionary response to changing environmental forces. Chaos theory describes complex systems as being highly sensitive to slight changes, giving rise to potential chaos when such changes occur. Complexity theory is similar to chaos theory in that it describes complex systems and how they behave. Contingency theory encourages managers to consider the situation and all its elements when making a decision.

One strategy to develop personal empowerment is developing a powerful image. Which actions contribute to this process? SATA A. following through on promises B. learning to be comfortable with conflict C. treating people with courtesy and respect D. thinking of oneself as powerful and effective E. ensuring that clothing, hair, and general appearance are appropriate

C. D. E

Which are the three categories of healthcare quality and standards? A. structure, process, and goals B. process, goals, and outcomes C. structure, process, and outcome D. goals, outcome, and benchmark

C

Which aspect is a frequently voiced concern about retail clinics? A. limited hours of operation B. lack of chronic disease care C. fragmentation of patient care D. lack of primary preventative care

C

Which content would be included when clarifying role expectations for an employee? A. inform employees verbal warnings are an initial disciplinary action B. remind employees that a written note will be placed in their employment file C. ensure that employees understand they are accountable for the agency's policies D. ask the employee to sign a form acknowledging the policies have been reviewed and discussed

C

Which dimension of the Quadruple Aim can be achieved through shared decision-making programs and providing outreach and education before service? A. improve population health B. reduce the per capita cost of care C. enhance the patient experience care D. improve the experience of providing care

C

Which healthcare organization is under private ownership? A. public hospitals B. VA C. academic medical centers D. The Women's and Infant's Project

C

Which right of delegation is addressed with feedback related to the task? A. task B. person C. supervision D. communication

C

Which strategy will the nurse manager use to ensure new staff nurses understand how performance is measured? A. provide a copy of the state nurse practice act B. give new nurses a copy of the organization's mission statement C. make sure all new nurses receive a copy of the position description D. refer new nurses to the ANA Code of Ethics

C

Which action would the nurse manager take to initiate the process of progressive discipline? A. verbal reprimand B. written reprimand C. counsel the employee D. referral to human resources

C. Rationale: First counsel the employee, then verbal and written reprimands. Human resources is notified about the initiation of disciplinary action.

Conflict occurs in which broad categories? SATA. A. values B. relationship C. intrapersonal D. interpersonal E. organizational

C. D. and E.

For which primary purpose will the nurse manager contact the human resources department with concerns about an emotionally troubled employee? A. to notify the department of the impending termination B. to provide a referral for the employee assistance program C. to determine whether the employee is protected under the ADA D. to make an appointment for the employee to meet with a human resource representative

C. To determine whether the employee is protected under the ADA Rationale: The human resource department will be contacted if an employee appears emotionally troubled. If an employee has a documented mental illness, the organization may be under certain legal constraints as specified in the ADA.

The National Academy of Medicine and the Robert Wood Johnson Foundation Report acknowledges nurses contribute to the health and well-being of the populations they serve in which way? A. providing direct patient care B. educating patients and families C. advocating for improved outcomes D. collaborating with other health team members

C. advocating for improved outcomes

Which type of technology involves the use of equipment in the clinical setting for diagnosis, physiologic monitoring, testing, and administering therapies to patients? A. innovative B. knowledge C. biomedical D. information

C. biomedical

The daughter of a health plan's CEO recently graduated with a degree in nursing and was immediately hired as the Director of Disease Management. The positions description states applicants should have at least 5 to 10 years of clinical experience. Which type of power helped the new graduate nurse attain the position? A. expert B. position C. connection D. information

C. connection

Which right of delegation takes into account the knowledge and skill of any individual to whom the RN may delegate elements of care? A. right task B. right direction C. right person D. right supervision

C. right person

The nursing instructor is teaching students the five rights of delegation and asks which elements should be explored when assessing the right circumstance. Which response by a student indicates the need for further teaching? A. "The right circumstance assesses the appropriateness of the situation" B. "A safe environment is ensured in the assessment of right circumstance" C. "The right circumstance identifies if there are available equipment and resources" D. "Knowledge and experience of the delegate is assessed in the right circumstance"

D

What action by the nurse manager during a period of change promotes acceptance of the change by staff members? A. compensating them with raises B. making major decisions without their input C. assisting them in completing daily documentation D. sending weekly emails with up-to-date information

D

Which action requires the leader to specify a desired organizational outcome and engage members of the organization to work together to achieve the objective? A. managing B. motivating C. affirming values D. envisioning goals

D

Which application of information technology verifies the five rights of medication administration? A. "Smart" infusion pumps B. automated dispensing unit/cabinet C. pharmacy automation and robotics D. bar coding and radiofrequency identification scanning

D

Which of Gardner's tasks of leading and managing are demonstrated when the nurse inspires patients and families to achieve their visions? A. managing B. explaining C. renewing D. motivating

D

Which organization is likely to be run as a nurse-owned and nurse-organized service? A. subacute facility B. long-term care facility C. public health department D. university health services

D

Which organization proposed replacing nurses with registered care technologists in 1988 during a nursing shortage? A. The Joint Commission B. American Nurses Association C. National League for Nursing D. American Medical Association

D

Which skill involves nimbly responding to changing situations and roles with little or no fanfare? A. leadership B. serving as a symbol C. systemic thinking D. emotional intelligence

D

Which statement describes emotional intelligence? A. the ability to plan, direct, control, and evaluate others B. each member contributing optimally but acquiescing to a peer C. the use of individual traits to interpret the environment and define a plan D. social skills and interpersonal competence to create harmony in the workplace

D

Which type of care is defined as "secondary care"? A. long-term care B. first-access care C. rehabilitative care D. disease-restorative care

D Rationale: tertiary care can be described as long-term care. Primary care is described as first-access care. Tertiary care can also be described as rehabilitative care

Which statement indicates the nurse leader understands the concept of coaching? SATA A. used to punish employees who break rules B. only useful when addressing individual employees C. uses one-way communication form the manager to the employee D. encourages optimal employee performance E. not useful in promoting team-building F. enhances communication between the manager and employee

D and F

Which activity applies the chaos theory to nursing practice? A. the budgeting process B. tracking of systems patterns C. analysis of the healthcare system D. occurrence of an adverse event such as a nosocomial infection

D. Rationale: The occurrence of an adverse event such as a nosocomial infection illustrates chaos theory, because such events are unpredictable and random. The other options represent the systems theory, which demonstrates exchange between inputs, throughputs, and outputs.

A healthcare team member is trapped in distress and reacting at the unconscious reactive level and making quick judgments. Which type of statement will help the individual think compassionately? A. I want... B. I feel... C. I can't... D. I think...

D. I think... Rationale: I think statements are beneficial to think compassionately. I want statements are the conscious reflective response to emotional distress. I feel is at the accountability level. I can't statements are negative, reactive responses rather than positive, reflective responses

Which characteristic is retained by the delegator in every delegation situation? A. payment B. efficiency C. responsibility D. accountability

D. accountability

Which is an example of a sentinel event? A. hand hygiene B. wrong site surgery C. severe pressure ulcer D. patient suicide on the unit

D. patient suicide on the unit Rationale: sentinel events are serious unexpected events that cause death or physical/psychological harm, such as an inpatient suicide. Hand hygiene is an ALWAYS event because it should occur 100% of the time. Wrong site surgery and a severe ulcer are NEVER events. Never events are preventable and therefore should never happen.

Which ethical committee structure would the nurse expect to be used for a patient who is considered incompetent to make decisions regarding treatment? A. autonomy model B. social justice model C. moral distress model D. patient-benefit model

D. patient-benefit model Rationale: The patient-benefit model uses substituted judgement and facilitates decision making for the incompetent patient. The social justice model considers broad social issues and is used for the overall institution. The autonomy model facilitates decisions for a competent patient. A moral distress model would address moral dilemmas.

Which term describes the practice of nurses viewing themselves as members of the discipline of nursing with an obligation to make a commitment and contribution to the profession? A. expertise B. professionalism C. self-actualization D. career commitment

D

Which report moved safety issues from the incident report level to an integrated patient safety report for the organization? A. To Err is Human (2000) B. Crossing the Quality Chasm (2001) C. health Professions Education: A Bridge to Quality (2003) D. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)

A

Which should the nurse manager consider when hiring new nursing staff? A. the applicant fits within the organization's culture B. the applicant has 80% of the qualifications required for the role. C. the applicant with the most experience should be hired for the role D. the role expectations must be reviewed after the new nurse is hired.

A

Which type of patient technology allows for healthcare information transmission using the Internet, cable lines, or telephone? A. telehealth B. smart cards C. speech recognition D. bar-code technology

A

During which orientation segment are employee performance goals identified? A. End B. midway C. beginning D. throughout

A Rationale: Employees must complete orientation before setting goals

Which statement is an accurate characterization of health maintenance organizations (HMOs)? A. HMOs do not provide for any dental services B. HMOs must offer treatment for drug and alcohol problems C. fees are discounted from their usual or customary charges D. physicians are paid on a fee-for-service basis by a prepaid pan to deliver care to enrolled members

B. HMOs must offer treatment for drug and alcohol problems. Rationale: must offer services to be federally qualified.

Which statement reflects the average length of stay for an acute hospital A. less than 10 days B. less than 30 days C. more than 50 days D. between 30 and 50 days

B. Less than 30 days

The nurse manager speaking with a nurse being promoted to a position with more responsibility says, "We can sit down and review the challenges and the benefits of taking the new position." What ethical principle is the manager demonstrating? A. veracity B. fidelity C. autonomy D. beneficence

A

The nurse manager takes a personal approach when interacting with a staff member, with the goal of improved employee performance. Which strategy is the nurse manager using with this approach? A. coaching B. assessing C. educating D. managing

A

Which does the Joint Commission recommend when planning and implementing health information technology that involves medication? A. involving pharmacists B. choosing a low-cost system C. limiting exposure to too many vendors D. ensuring a long period of time between training and implementation.

A

Which information must be documented in a written reminder of the attendance policy? A. statement of the problem B. an explanation for the employee's absence C. consequences for not following the reminder D. the employee's written decision to adhere to the reminder

A

Which is a benefit of graduate nurse residency programs? A. graduate nurse residency programs offer ongoing support and education for up to 1 year B. residency programs provide graduate nurses with content that was missing in their nursing education C. graduate nurses in residency programs are paid a lower wage, which saves the organization money D. graduate nurses are not competent to practice unless they complete a graduate residency program

A

Which leadership technique is being used by the nurse manager who acknowledges the values of his or her staff and trusts individuals to make decisions? A. empowerment B. team collaboration C. relationship building D. democratic leadership

A

Which are causes of health disparities among ethnic minority populations in the US? SATA A. environment B. poor education C. access to care D. health behaviors E. adequate financial resources

A, B, C, and D

Which actions are used by preceptors in a healthcare organization when working with new employees? SATA A. provide role modeling B. complete a needs assessment C. direct orientation activities D. conduct performance appraisals E. develop a supportive relationship

A, B, C, and E

How does the Code of Ethics for Nurses support the profession of nursing? SATA A. establishes ethical standards B. outlines professional responsibilities C. provides guidance for self-regulation D. provides interdisciplinary guidelines E. sets minimal educational requirements

A, B, and C.

Which concepts illustrate traits of an effective follower? SATA A. willing to be led B. creative C. passive D. professional E. permissive

A, B, and D

Which components form an organization's foundation for structure and performance in addition to the development of its professional practice models? SATA A. vision B. theory C. system D. mission E. philosophy

A. D. and E

Which professional organization published multiple key, evidence-based reports related to patient safety and quality of health care? A. IOM B. ANCC C. AONE D. NDNQI

A. Institute of Medicine

The nurse manager of the emergency department is trying to implement a new quality management (QM) program to eliminate unnecessary waste of time and resources. Which program would the nurse manager consider for this initiative? A. Lean Sigma B. Risk Management C. Root Cause Analysis D. Failure Mode and Effect Analysis

A. Lean Sigma Rationale: Lean Sigma and Six Sigma programs tend to work well in departments that work in a linear fashion, such as the emergency department. These programs encourage all healthcare staff to eliminate unnecessary steps and reduce wasted time and processes.

Which part of Medicare covers hospice care? A. Part A B. Part B C. Part C D. Part D

A. Part A Rationale: Medicare Part A covers inpatient care and hospice care. Part B covers doctor's services, testing, outpatient care, home health services, and durable medical equipment. Part C allows private health insurance companies to provide Medicare benefits. Medicare Part D is the prescription drug supplement.

Which statement describes transformational leadership? A. attending to the needs and motives of followers B. demonstrating a certain set of traits that inspire others C. motivating others through the hierarchy of human needs D. responding to patient and organization problems differently

A. attending to the needs and motives of followers Rationale: Trait theory states that leaders have a certain set of traits that inspire others. The hierarchy of needs theory states that leaders motivate others through hierarchy of human needs. In adaptive leadership, leaders respond to patient and organization problems differently

Which character trait is being exhibited by a nurse who giggles at a patient's diagnosis? A. immaturity B. indifference C. incompetence D. unproductivity

A. immaturity

Which member characteristic describes the charge nurse who is a practical, prudent, emotionally stable, level-headed, and hard-headed challenger of ideals and theories? A. pragmatic B. results-oriented C. relationship-focused D. process and rule follower

A. pragmatic

Which would the nurse manager do at the end of an interview? A. take the applicant on a tour of the entire healthcare facility B. introduce the applicant to staff and encourage him or her to ask questions C. before dismissing the applicant, say that the interview was enlightening D. let the applicant know when to expect to be notified about the hiring decision

D

Which information would the nurse manager communicate to an employee who is going to be suspended? A. the employer's benefits will be held B. the employee will be suspended without pay C. the manager will determine the length of the suspension D. the manager will make decisions about continued employment during the suspension period

B

Which is a potential problem with patient classification systems? A. outpatient surgical patients are appropriately classified using prototype systems B. there is questionable reliability and validity of data acquired through self-reporting mechanisms C. patients with more complex care needs cannot be appropriately evaluated using a factor system D. some patient types with a single healthcare focus, such as maternal deliveries, are not appropriate for a prototype system.

B

Which topic as become a major negotiating point to improve the work environment for unionized nurses? A. cultural diversity B. mandatory overtime C. baccalaureate degrees D. forty-hour work week

B

Which statement describes how culture and quality of life are interrelated? A. manifest rules of cultural behavior guide expectations for quality of life B. no matter the culture, all people have the same basic needs to achieve quality of life C. in shaping quality-of-life goals, the nurse should think about insider cultural viewpoints D. to provide quality of life, the nurse must consider both insider and outsider perspectives

D

Which team members at a healthcare organization will generally be the first people to address cultural diversity? A. physicians B. RN C. Human resources department D. the leadership and management team

D

A nurse manager uses a process to empower the associates to have a voice in decision making. Which term refers to a collective decision-making process at the point of service? A. ownership B. partnership C. senior leadership D. shared governance

D

A patient being discharged after complex wound care also requires dialysis for kidney failure. The nurse knows a patient with these needs would benefit from recovery under the care of a team of specialists. Which facility does the nurse suggest? A. home health B. long-term care C. daycare center D. long-term acute care hospital

D

A unit identifies a patient care issue that is limiting patient choice in the preparation for death. Which action should the nurse manager take? A. notify the hospital chaplain to provide staff counseling. B. inform the legal department manager of the situation. C. talk with every patient's family regarding the choices available. D. engage the hospital ethics committee to provide a recommendation

D

The delegator must consider which element of care for delegation when thinking about the right circumstances? A. competency B. monitoring C. expectation D. resources

D