LEADERSHIP EXAM 3

An experienced LPN is working under the supervision of the RN. Th e LPN is providing nursing care for a patient who has a respiratory problem. Which activities should the RN delegate to the experienced LPN? Select all that apply. 1. Auscultate breath sounds. 2. Administer medications via metered-dose inhaler (MDI). 3. Complete in-depth admission assessment. 4. Initiate the nursing care plan. 5. Evaluate the patient ' s technique for using MDIs.

1. Auscultate breath sounds. 2. Administer medications via metered-dose inhaler (MDI).

. Stephanie Beals was a little nervous during her fi rst week of work as a licensed nurse. Distracted by a lead nurse behind her, her hand slipped, and she was stuck by the needle she had just used. What is most important for Stephanie to do? 1. Disinfect the site of the needlestick. 2. Apologize to the patient, clean the site, and properly dispose of the needle. 3. Update her hepatitis B immunization. 4. Report the incident and obtain post exposure prophylaxis (PEP) within 2 hours

1. Disinfect the site of the needlestick. 4. Report the incident and obtain post exposure prophylaxis (PEP) within 2 hours

Th e HHS is charged with protecting the health of all Americans and providing essential health services. Which of the following HHS quality initiatives is currently under way? 1. Post-acute care reform initiative 2. National health-care research and quality indicators aimed at helping improve access to care 3. NDNQI 4. Health IT

1. Post-acute care reform initiative

An incident of sexual harassment as identifi ed by the EEOC is: Select all that apply. 1. Telling jokes about sexual identity issues 2. Separate restrooms 3. Providing coff ee and doughnuts to the nursing staff 4. Demanding a daily kiss for writing a favorable evaluation

1. Telling jokes about sexual identity issues 4. Demanding a daily kiss for writing a favorable evaluation

To achieve safe patient care, a culture of safety must exist. What are characteristics of an organization with a culture of safety? 1. Transparency, openness, reporting of errors is rewarded, blame-free environment 2. Honesty, studying of serious events 3. Privacy, reporting of errors appreciated 4. Blame-free environment, openness, error reporting is encouraged

1. Transparency, openness, reporting of errors is rewarded, blame-free environment

Which of the following is the best indication that a change has been integrated? 1. When no one talks about it anymore 2. If adoption occurred rapidly 3. When resistance turns from active to passive 4. When a full year has passed since the change was introduced

1. When no one talks about it anymore

According to NIOSH, a common reaction to latex allergy is: 1. Increased appetite 2. Allergic contact dermatitis 3. Increased falls 4. An increase in violent outbursts

2. Allergic contact dermatitis

When is it most appropriate to dictate (order) change? 1. When the change is very complicated 2. In an emergency 3. When resistance is very high 4. If the change is unimportant

2. In an emergency

When evaluating the quality of care, a health-care organization must consider structures, processes, and outcomes of care delivery. Which of the following is a good example of an organizational process? 1. Budgeting adequate money for nursing salaries 2. Preparing a patient for discharge 3. Monitoring for infections 4. Increasing time between clinic visits

2. Preparing a patient for discharge

h e purpose of learning how to negotiate confl ict is to: 1. Eliminate confl ict entirely 2. Resolve confl icts more eff ectively 3. Win 4. Reduce stress

2. Resolve confl icts more eff ectively

A new nurse manager plans to implement a new scheduling process. Th is was met with resistance from the staff who were very happy with the current scheduling process. How can the nurse manager lower their resistance to this change? 1. Tell the staff that their concerns about the new schedule are unfounded and plan to post the new schedule. 2. Share information about the new schedule and discuss its impact on the unit. 3. Post the schedule and deal with staff on an individual basis. 4. Ask the

2. Share information about the new schedule and discuss its impact on the unit.

ISBARR provides a framework for communicating critical client information. ISBARR is an acronym for: 1. Identify, Study, Background, Assess, Recognize, Readback 2. Issue, Situation, Better, Advise, Refer with Recommendations 3. Introduce, Situation, Background, Assess, Recommend, Readback 4. None of the above

3. Introduce, Situation, Background, Assess, Recommend, Readback

Jane is a new nurse manager who will be holding her fi rst staff meeting tomorrow. She has learned that the staff members have not been following important patient care policies. What is the most important communication skill that she should use at the meeting? 1. Talking to the staff 2. Laughing with them 3. Listening 4. Crying

3. Listening

Who is responsible for accepting, transcribing, and implementing physician orders? 1. Unit clerk 2. Medical intern or resident 3. Professional nurse 4. Medical assistant

3. Professional nurse

As Jane speaks with the team, she learns why the staff members have had diffi culty following policies. Which of these would be considered barriers to eff ective communication? 1. Th e charge nurse is unavailable to help the nurses when they have questions about policies. 2. Some staff are afraid to ask particular charge nurses for help for fear of retribution. 3. Th e use of acronyms is confusing to staff members who are new to the unit. 4. All of the above

4. All of the above

A nurse is helping an NAP provide a bed bath to a comatose patient who is incontinent. Which of the following actions requires the nurse to intervene? 1. The nursing assistant answers the phone while wearing gloves. 2. The nursing assistant log-rolls the client to provide back care. 3. The nursing assistant places an incontinence diaper under the client. 4. The nursing assistant positions the client on the left side, head elevated

Answer: 1 Rationales: 1. The gloves are contaminated and should be removed before answering the phone

A surprisingly dangerous job in the United States is working: a. In a coal mine b. As a window cleaner in New York City c. In a health-care facility d. As a police offi cer

c. In a health-care facility

In which of the following situations would a personal change probably be the hardest to make? 1. When the need is immediate 2. If the benefi ts will be realized years from now 3. When the reward is immediate 4. If it is change that keeps you in your comfort zone

2. If the benefi ts will be realized years from now

TJC attributes 80% of all medical errors to: 1. Poor hygiene and hand washing 2. Poor hand-off communication 3. Poor work environment 4. Lack of care

2. Poor hand-off communication

Studying errors and identifying how they occur helps organizations improve patient safety. Which category of errors is the most useful in identifying and remedying vulnerabilities in an organization? 1. Sentinel event 2. Adverse event 3. Near miss event 4. Wrong procedure event

3. Near miss event

What is the most desirable result of a problem resolution? 1. Win-lose 2. Lose-lose 3. Win-win 4. None of the above

3. Win-win

When designing a technical change, which of the following should be considered? 1. Will it work better than the old way? 2. Is this change needed? 3. Is there a simple way to do this? 4. All of the above

4. All of the above

h e hospital has recently reorganized; therefore, several departments were closed. Th e patient census on the unit has increased. Th e staff have always had a strong team spirit, but the nurse manager knows that workfl ow changes can cause confl ict. What can the nurse manager do to reduce the possibility of confl ict among her team? 1. Monitor the quality of patient care. 2. Ensure that supplies and equipment are readily available. 3. Assess the equity of nursing assignments. 4. All of the

4. All of the above

A federal agency that partners with other agencies throughout the nation to investigate health problems, conduct research, implement prevention strategies, and promote safe and healthy environments is known as the: 1. FDA 2. IOM 3. ANA 4. CDC

4. CDC

1. OSHA, a federal government agency, is responsible for: 1. Providing training to handle diffi cult clients and their families 2. Providing research and education training 3. Upholding the standards of nursing practice 4. Developing and enforcing workplace safety and health regulations

4. Developing and enforcing workplace safety and health regulations

New graduates usually experience a "honeymoon" period at their fi rst job, which is characterized by: 1. Extreme criticism from colleagues 2. Long hours and low pay 3. Feeling undervalued 4. Excitement about the new position

4. Excitement about the new position

Th e occurrence of sexual harassment may be reported to: 1. IHI 2. ANA 3. EEOC 4. CDC

3. EEOC

A nurse is assigned to care for the following patients. Which patient should the nurse assess fi rst? 1. A 60-year-old patient on a ventilator for whom a sterile sputum specimen must be sent to the laboratory 2. A 55-year-old with COPD and a pulse oximetry reading from the previous shift of 90% saturation 3. A 70-year-old with pneumonia who needs to be started on IV antibiotics 4. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator

4. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator

An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been fl oated from the surgical unit to the medical unit? 1. A 58-year-old on airborne precautions for tuberculosis (TB) 2. A 68-year-old who just returned from bronchoscopy and biopsy 3. A 69-year-old with COPD who is ventilator dependent 4. A 72-year-old who needs teaching about the use of incentive spirometry

4. A 72-year-old who needs teaching about the use of incentive spirometry

2. Your new organization is committed to quality patient care. Which of these are considered characteristics of quality health care? 1. Th e nurses use evidence-based research to guide care delivery. 2. Th e nurses are respectful and responsive to their clients' individual preferences. 3. Th e nurses perform an independent double check when administering chemotherapy medication. 4. All of the above

4. All of the above

Which of the following issues may be addressed in a collective bargaining agreement? 1. Shift diff erentials 2. Safe working environment 3. Grievance procedures 4. All of the above

4. All of the above

A new nurse manager has observed several instances of horizontal violence between staff members on her unit, primarily verbal abuse and malicious gossip. What should she do? 1. Ignore it because it is not physical violence and will not hurt anyone. 2. Model this bullying behavior so that staff can see how it aff ects people. 3. Keep a log of observed bullying behavior to discuss during the employees' annual evaluation. 4. Confront the bullying behavior and discuss strategies for responding to

4. Confront the bullying behavior and discuss strategies for responding to it.

What is brainwriting? 1. A strategy to encourage the free fl ow of ideas 2. A mutually benefi cial negotiation result 3. A winning approach to formal negotiation 4. A devaluation reaction to negotiation

1. A strategy to encourage the free fl ow of ideas

Factors found to increase nurses' joy at work include: Select all that apply. 1. Ability to provide quality care 2. Consistently high workload 3. A pattern of continuous confl ict and disagreement 4. Civility and respect

1. Ability to provide quality care 4. Civility and respect

An eff ective way to help a diverse staff work together is to: 1. Provide equal opportunities for advancement 2. Pretend there are no cultural diff erences 3. Promote uniformity in communication styles 4. Establish an English-only policy institution-wide

1. Provide equal opportunities for advancement

A nurse is caring for a patient who is diagnosed with coronary artery disease and sleep apnea. Which action should the nurse delegate to the NAP? 1. Discuss weight-loss strategies such as diet and exercise with the patient. 2. Teach the patient how to set up the CPAP machine before sleeping. 3. Remind the patient to sleep on his side instead of his back. 4. Administer modafi nil (Provigil) to promote daytime wakefulness.

Answer: 3 Rationales:the nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient's plan of care.

Which of the following events should be reported? Select all that apply. 1. A patient is placed in a broken wheelchair that tips over. 2. A staff member tells a neighbor about the famous athlete who is a patient. 3. An employee reports to work under the infl uence of alcohol. 4. A patient spills her supplemental protein drink on the fl oor; the certifi ed nursing assistant (CNA; aide) mops it up.

1. A patient is placed in a broken wheelchair that tips over. 2. A staff member tells a neighbor about the famous athlete who is a patient. 3. An employee reports to work under the infl uence of alcohol.

Which of the following is a macro-level change? 1. Shift in Medicare payment policies 2. Change in shift diff erentials 3. Opening a new unit 4. Changing visiting hours

1. Shift in Medicare payment policies

Which of the following procedures and modifi cations contributes to reducing indoor air pollution? 1. Windows that may be opened by staff as needed 2. More powerful ventilation systems and air fi ltration 3. Selecti ofon products with more polyvinyl chloride (PVC) 4. Increased use of medical waste incinerators

2. More powerful ventilation systems and air fi ltration

Which of the following best describes what is most likely to be within a nurse ' s comfort zone? 1. A new assignment 2. Tasks she ' s done many times 3. Change to a diff erent shift 4. Addition of several new tasks

2. Tasks she ' s done many times

If an informal negotiation session becomes too highly emotional, what should the nurse manager do? 1. Let the feelings fl ow. 2. Cancel the negotiation. 3. Deal with the feelings fi rst. 4. Tell them to ignore the feelings and deal with the issues.

3. Deal with the feelings fi rst.

Nursing standards of care and the organization ' s policies and procedures greatly decrease risk to patient safety. Which of the following steps can a nurse take to further reduce risk? 1. Submit event or incident reports for near misses. 2. Follow medication administration policies and procedures. 3. Always report signifi cant data on care to patients and providers in a timely manner. 4. All of the above

4. All of the above

You are working on the trauma unit today, and your new patient with a femur fracture complains of leg pain and seems a little diaphoretic and short of breath. You assess the patient and prepare to contact the surgeon. In preparation for contacting the physician, you: 1. Immediately page the MD; it could be a pulmonary embolism, and time is of the essence. You will give him the particulars when the MD arrives. 2. Wait for the MD to round on his patient because it should be within the next hour

4. Jot down notes about the situation as it is presented to you, review the patient ' s history, focus your assessment, and determine what you need for the patient

Nursing and respiratory departments both experienced job cuts. Th e nurse manager notices that members of his staff are having more trouble getting a fast response from a respiratory therapist. What source of confl ict is probably operating here? 1. Union-management confl ict 2. Interpersonal problem 3. Cultural diff erences 4. Work intensifi cation

4. Work intensifi cation

Diff erences in status and authority within the health-care team can generate confl ict. What is the most common cause of confl ict? 1. Disrespect and incivility 2. Inappropriate language and sarcasm 3. Blaming and fi nger pointing 4. Physical violence

1. Disrespect and incivility

Burnout at work can be identifi ed best by: 1. Expressions of frustration and powerlessness 2. Fatigue and refusal to work double shifts 3. Allergic reactions 4. A preference for effi ciency

1. Expressions of frustration and powerlessness

A nurse is caring for a patient who has a pulmonary embolus. Th e patient is receiving anticoagulation with IV heparin. What instructions should the nurse give the NAP who will help the patient with activities of daily living? Select all that apply. 1. Use a lift sheet when moving and positioning the patient in bed. 2. Use an electric razor when shaving the patient each day. 3. Use a soft-bristled toothbrush or tooth sponge for oral care. 4. Use a rectal thermometer to obtain a more accurate

Answer: 1, 2, 3, 5 Rationales: 1, 2, 3, and 5. Th ese are appropriate to the care of a patient receiving anticoagulants.

Enhancing the quality of work life can be achieved by: 1. Encouraging critical thinking and new ideas 2. Discouraging a working relationship with one ' s peers 3. Being negative 4. Endangering a client ' s health or safety

1. Encouraging critical thinking and new ideas

A colleague tells you, "I ' m so burned out, I think it ' s time for me to resign." What can you tell your colleague? 1. "You probably need a break from work. Why don ' t you ask for a 6-month leave of absence?" 2. "Why don ' t you apply for a position at our rival hospital?" 3. "Tell me how you take care of yourself and what you like about your work." 4. "We ' re all burned out. Welcome to the club."

3. "Tell me how you take care of yourself and what you like about your work."

Medical errors account for 250,000 deaths per year. It is estimated that as many as 50% of these errors may be preventable. What steps would you take to avoid a medication error? 1. Review the patient ' s medication administration record during bedside shift report. 2. Ask your colleagues to get your medication so that you can give it on time. 3. Call the pharmacist. 4. Review the medication administration policy.

1. Review the patient ' s medication administration record during bedside shift report.

The nursing assistant tells a nurse that a patient who is receiving oxygen at a fl ow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should the nurse suggest to improve the patient ' s comfort for this problem? 1. Suggest that the patient ' s oxygen be humidifi ed. 2. Suggest that a simple face mask be used instead of a nasal cannula. 3. Suggest that the patient be provided with an extra pillow. 4. Suggest that the patient sit up in a chair

1. Suggest that the patient ' s oxygen be humidifi ed.

1. You are a new nurse. Th e hospital where you work is committed to providing safe, highquality care. Which of the following activities would let you know that your organization is committed to improving patient safety? 1. Th e hospital has a good catch program for staff who recognize errors and near misses. 2. Th e hospital subscribes to TJC safety publications. 3. Th e hospital measures performance every month, monitors quality indicators, and regularly reports on quality. 4. All of the above

1. Th e hospital has a good catch program for staff who recognize errors and near misses.

Nursing management and the nursing union are having diff erences on several issues. Th ere may be a need for negotiation. Which of the following is a serious disadvantage to using collective bargaining to resolve this confl ict? 1. Protecting the right to fair treatment 2. Creating an adversarial relationship between staff and management 3. Lacking professionalism on the part of the collective bargaining unit members 4. Failing to uphold important standards of care

2. Creating an adversarial relationship between staff and management

Florence has two team members who continually criticize each other despite being told to stop. Which approach is the most appropriate for this situation? 1. Refer each of them for employee counseling. 2. Engage in problem resolution. 3. Bring in a union representative. 4. Engage in a formal negotiation process.

2. Engage in problem resolution.

Structured care methodologies (SCM) are: 1. Nursing tools designed to identify best practices and facilitate standards of care 2. Used to create a stable set of performance indicators to measure outcomes 3. Used to assist employees with wellness and injury prevention 4. Helpful when making staffi ng assignments

2. Used to create a stable set of performance indicators to measure outcomes

A respiratory therapist performs suctioning on a patient with a closed head injury who has a tracheostomy. Afterward, the NAP obtains vital signs. Th e nurse should communicate that the NAP needs to report which vital sign value or values immediately? Select all that apply. 1. Heart rate of 96 beats/min 2. Respiratory rate of 24 breaths/min 3. Pulse oximetry of 95% 4. Tympanic temperature of 101.4°F (38.6°C)

4. Tympanic temperature of 101.4°F (38.6°C)

What type of resistance to a change is the hardest to overcome? 1. Th e resistance that comes from inertia: "We always do it this way." 2. Active resistance to changing a preferred procedure 3. Passive resistance to an unpopular change 4. Resistance based upon fear of losing one ' s job

4. Resistance based upon fear of losing one ' s job

A nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD) and is 2 days postoperative after a laparoscopic cholecystectomy. Which intervention for airway management should the nurse delegate to an NAP? 1. Assisting the patient to sit up on the side of the bed 2. Instructing the patient to cough eff ectively 3. Teaching the patient to use incentive spirometry 4. Auscultating breath sounds every 4 hours

Answer: 1 Rationales: 1. Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant

Which of the following are considered reasonable accommodations for an employee with a disability? Select all that apply. 1. Modifi cation of the work schedule 2. Salary reduction to refl ect lower output 3. Additional days off and extended vacations 4. Adjustment of work procedures

1. Modifi cation of the work schedule 4. Adjustment of work procedures

How can you increase your staff ' s receptivity to an important change in procedures? 1. Assign the new procedure to the newest staff member. 2. Apologize for making their work more complicated. 3. Provide them with a booklet on preparing for change. 4. Give them time to learn the new procedure.

4. Give them time to learn the new procedure.

Th e EMR has many advantages compared with paper charting. It helps track data through time and can help monitor things such as preventative care in primary care practices. Jane is the offi ce nurse in a local practice. She is meeting a new patient for the very fi rst time who informs her that he was recently hospitalized. Jane pulls up the patient ' s EMR and sees no information regarding his recent hospital stay. How could this have happened? 1. Th e patient ' s discharge was so recent th

2. EMRs are usually practice or hospital specifi c, so the patient ' s information would not be accessible to Jane.

Th e purpose of QI is to continuously improve the capability of everyone involved to provide safe, high-quality patient care. What is important to know about the QI process? 1. It is independent of teamwork. 2. It is a data-driven approach to improving process. 3. Common safety indicators are not used to evaluate quality of care. 4. Opportunities for QI are selected by organization leadership.

2. It is a data-driven approach to improving process.

Actions to address violence in the health-care workplace include: Select all that apply. 1. Identifying the factors that contribute to violence and controlling as many as possible 2. Allowing the violence to escalate 3. Assessing staff attitudes and knowledge regarding responses to violence 4. Providing weapons training to those identifi ed as having a potential for physical violence

1. Identifying the factors that contribute to violence and controlling as many as possible 3. Assessing staff attitudes and knowledge regarding responses to violence

Social media is commonly used to update friends and groups on things we have going on in our lives. Health-care organizations routinely use social media to promote medical facts, services, and recognitions. What is important for nurses to remember when deciding to post something work related on a social media site? 1. Nurses should never post protected health information on a social media site. 2. Stories with good outcomes can be posted to your media page. 3. Stories and photos can always be

1. Nurses should never post protected health information on a social media site.

Th e patient with COPD has a nursing diagnosis of Ineff ective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? 1. Observe how well the patient performs pursed-lip breathing. 2. Plan a nursing care regimen that gradually increases activity intolerance. 3. Assist the patient with basic activities of daily living. 4. Consult with the physical therapy department about reconditioning exercises.

1. Observe how well the patient performs pursed-lip breathing.

Bedside shift report is one of the things that Jane reviews at the staff meeting. She stresses the way she would prefer the report to start. Which of these would be the least important to share with the oncoming nurse? 1. Telling the oncoming nurse what happened on the unit during the shift 2. Introducing the client and his or her diagnosis to the oncoming nurse 3. Sharing the nurse ' s personal opinion of the client 4. Reviewing new medication orders and the medication administration reco

2. Introducing the client and his or her diagnosis to the oncoming nurse

Th ere has been a sudden increase in catheter-associated urinary tract infections that must be addressed on Jane ' s unit. What is the best way for Jane to persuade the staff to implement a new Foley catheter care protocol? 1. Tell them the change has been ordered by the administration. 2. Present statistics proving the need to change. 3. Tell a compelling story about why change is needed. 4. Explain the importance of the change in simple terms.

3. Tell a compelling story about why change is needed.

Implicit bias aff ects our understanding in an unconscious manner. A person ' s ability to recognize these biases can improve communication with patients and colleagues alike. Which of the following statements is true about implicit bias? 1. Implicit bias forms during a lifetime. 2. Implicit bias can infl uence clinical decision making and treatment. 3. Implicit bias contributes to an individual ' s social behavior. 4. All of the above

4. All of the above

A suburban hospital recently announced that staff nurses could no longer choose their shift. Instead, they would be assigned to either a 12-hour day shift or a 12-hour night shift on an as-needed basis. An informal group of staff nurses met to discuss this new policy. Th ey came up with several arguments against it. Which of the following suggestions would help to alleviate the deleterious eff ects of this new policy? 1. Allow self-scheduling by staff nurses in each unit. 2. Provide free dinner

1. Allow self-scheduling by staff nurses in each unit. 3. Allow staff members to request consistent days off