CNL EXAM (Mock Exam)

Survey results of the nursing staff reflect poor perceptions and a discomfort with addressing spiritual issues with patients. The ultimate success of focused staff education can be measured by: A) ! Trending quarterly patient satisfaction scores pertaining to spiritual care during hospitalization B) A follow-up survey of the staff after the education to solicit feedback C) An open discussion of how the nurse would address spiritual care in a given scenario D) Feedback shared during discharge phone calls

A. Application of knowledge that impacts patient outcomes is the most significant indicator.

What is the first essential key to implementing a change in a microsystem? A) A clear vision of what outcomes are to be accomplished B) A strategic plan C)Persistence on the change implementation to be successful D)Belief the change will be a success

A: A clear vision of what is to be accomplished by the change is the first element to a successful outcome. The others come after the vision is made.

A process improvement project charter or establishment of specific aims can help a project group to avoid which difficulty: A) Scope creep B) Meeting time confusion C) Budget constraints D) Team communication problems

A: Scope creep occurs when a group identifies an additional problem that may need fixing. A clear project charter defines the goal, objectives, and scope of the original project and will help the team not to divert its attention to other issues.

What is the best way for the CNL to analyze systems and outcome datasets to anticipate individual client risk and improve quality care? A)Perform a root cause analysis of all postoperative patients who have been readmitted to your unit within the last year B) Perform a FMEA. C)Utilize the Complexity Theory to make the needed changes to the defective systems D) Perform a PDSA.

ANS B: A FMEA is proactive and anticipates potential risks rather than looking back on events that have happened that need to be changed.

Which most demonstrates advocacy toward a patient? A) Led interdisciplinary rounds on a group of patients B) Consulted a diabetic instructor for a patient who was found to have an HgB A1C of 13.1 C) Met with the trauma team of physicians to update patient plans of care D) Conducted an in-service with the nursing staff on how to reduce falls for the unit

ANS B: This is an example of a specific action by the CNL to improve care on a particular patient.

You are considering using a new type of Foley catheter in your setting when the sales representative mentions a study that the manufacturer conducted that showed a reduction of catheter-associated infections with the use of the new device. Which type of study would be most convincing of this new product's potential value: A)Case study B) Randomized controlled trial C) Expert opinion D) Nonrandomized controlled trial

ANS B: This type of study would provide the highest level of evidence.

Who can function as an important ally to the CNL in engaging frontline staff in a major initiative? A) Content expert B) Unit champion C) Initiative sponsor D) Senior leadership

ANS B: Unit champions are individuals who work along frontline staff and have earned the respect and trust of their coworkers. Staff will follow their lead. The use of a physician champion is an especially useful strategy for engaging physicians in an initiative. Senior leadership and sponsors must also be engaged, especially financially, but are not as effective at the microsystem level as a unit champion.

The manager on the unit where you work really encourages the staff to learn and grow professionally as individuals and as a group. Several of the staff have earned advanced degrees and moved onto other roles in the hospital. Her goals always seem to be aligned with the organization's vision. This is what type of leadership style: Charismatic leadership Relational leadership Transformational leadership Transactional leadership

ANS C: Transformational leadership style focuses on change in the organization through a commitment to its vision.

You are using failure mode and effect analysis (FMEA) to anticipate the risk of medication errors in the ICU related to invasive lines. You begin your FMEA analysis with: A) The effects of each failure B) The potential cause of each failure C) Process mapping D) Specific defects and delays in the medication administration process

ANS C: Utilizing tools for process improvement can provide new insights into routine practices.

Jen is an obese patient admitted with COPD and CHTN. Part of her social history is that she smokes 2 ppd. Her CNL, Erika, makes a goal for her to decrease by one cigarette a day until there are no more by August 1st. This goal will not work because: A)There is not a measurable outcome B)Jen should decrease by two cigarettes a day C)The patient has COPD D) Jen should help make the goal

ANS D: In order for a goal to be effective and the patient to be compliant, it should be mutually set by the CNL and patient.

Medicaid covers which population: Employed Underinsured Unemployed Poor and disabled

ANS D: Medicaid is a publicly funded insurance provided to the poor and disabled in each state.

To confirm a scope of practice question, the CNL should consult which administrative body guidelines: A) The Joint Commission B) Centers for Medicare and Medicaid Services C) Hospital Policy and Procedure Manual D) State Nursing Practice Act

ANS D: Scope of practice is defined according to each individual state. The CNL must have a full understanding of licensure standards of practice according to role before delegation of tasks.

Several near misses were identified by ICU nurses who had mistaken invasive lines for intravenous ports for medication administration. You have completed an analysis of the issue. Your recommendations include: A) A double-check system for medication administration B) To facilitate a critical incident reporting structure that fosters a "without blame" unit culture C) A visual signal on all ports not intended for intravenous drugs D) All of the above

ANS D: The CNL should support the staff to identify all opportunities for improving safety in this situation

The concept that an organization is in a continued state of change describes which organizational theory: A) systems theory B) classical theory C) contingency theory D) Chaos theory

ANS D: The chaos theory is based on the principle that a system can maintain itself only if change is occurring somewhere in the organization all the time. Chaos and change are seen as means of survival.

A Korean patient is admitted who speaks little English. An example of culturally competent care is: A) Finding a nurse who speaks some Korean B) Transferring that patient to a floor that has a Korean-speaking secretary C)Calling the patient's family to see if they speak any English D) Obtaining a Korean translator

ANS D: The translator is the most effective way to deliver culturally competent care, the admission will be complete, the staff will be able to accurately assess the patient, and dietary staff will be able to find out any specific dietary concerns the patient may have.

As the CNL on a medical unit, which of the following interventions would you support to reduce the readmission rate on your unit? A) Keep patients one extra day to ensure they are prepared for discharge home B) Arrange for all patients to have at least 1 week of visiting nursing post discharge C) Review discharge instructions with the patient and one family member D) Begin discharge planning and teaching on the day of admission

ANS D: Using every opportunity to communicate to and educate the patient and family on their care and planning for discharge will better prepare the patient and family for returning home.

Advocacy can be a challenging role for the CNL, as sometimes a patient or the healthcare proxy makes a decision with which the CNL does not agree. If a well-informed decision is made to refuse or stop care, the CNL should: Try to talk the patient/proxy into continuing treatment Select a trusted religious leader to visit and assist the patient/proxy to change the decision Move the patient to another microsystem because the CNL does not agree with the decision Support the right of the patient/proxy to refuse care

ANS- D: Advocacy includes all nurses and interprofessional team members appropriately communicating the treatment options to the patients and families/proxies. This includes the right to accept, refuse, or terminate treatment, and the team members then providing support once the decision is made.

When CNLs are in school they learn that the best theory used to understand a rapidly changing, unpredictable healthcare environment is called? A) Complexity Theory B) Change Theory C) Systems Theory D) Leininger's Culture Care Diversity and Universality Theory

ANS: Complexity Theory is used to understand a rapidly changing, unpredictable healthcare environment.

An elderly patient is admitted to your unit with a diagnosis of urinary tract infection. Which of the following is generally not a symptom of a urinary tract infection in the elderly? A) Confusion B)Disorientation C)Agitation D)Decrease appetite

ANS: Confusion, disorientation, and agitation are all symptoms of urinary tract infection in the elderly.

A patient on your unit is receiving an antibiotic and begins to develop a rash on their face, neck, and upper torso. You identify this to be a common adverse reaction to which antibiotic? Zosyn Levaquin Keflex Vancomycin

ANS: Vancomycin. The development fo a rash on the face, neck, and upper torso is characteristic of Red Man Syndrome, a serious adverse reaction to vancomycin.

Carey, a CNL, thinks utilizing volunteers in a microsystem will benefit the staff and the patients. She performs a literature review and does not find much literature evaluating volunteers being effective in a health care setting. She decides to go ahead and implement a volunteer program and collects data to see whether this is an effective change. Should Carey have implemented this? No, there was no evidence volunteers would be beneficial Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective Yes, it is always good to try something new

ANS: Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective

Strategies for advancing evidence based practice in health care settings include: - skill building workshops - evidence based practice poster presentations - evidence based practice rounds - all of the above

All of the above

You are working in a unit that has recently seen an influx of patients with substance related disorders. The nurses on the unit are complaining that frequently these patients are "drug seeking" and often signing out against medical advice in order to receive drugs elsewhere. What is an intervention that a CNL may implement to improve the treatment for this patient population? AEducate the staff on not labeling the patients as drug seekers because they often require higher doses of pain medications to achieve an acceptable level of comfort B)Provide an in service to the staff about patients' withdrawal symptoms C)Follow each patient that comes in with a diagnosis of a substance related disorder in order to identify trends in mistreatment D) Research on whether the hospital uses an evidence based tool that may help with the assessment of patients for alcohol addiction and/or withdrawal

Answer D is correct because patients' withdrawal symptoms must be acknowledged and treated appropriately.

Your geriatric unit shows the highest average restraint episode duration in the hospital. You have been asked to lead an improvement project to reduce duration. What would be your first step? A)obtain national restraint episode duration benchmark data B) conduct a full assessment of your unit, including all restraint-related data and processes C)conduct a literature search to obtain current best practices for geriatric patients in restraints D) speak with staff and leadership of other units with lower restrain episode durations

B- A unit assessment should be performed first. This allows the CNL to see current process and how this compares to best practices found in the literature and other units.

Which terms are most important to the topic of ethics? A) Beliefs, autonomy, and authority B)Respect for others, authority, and tradition C)Maleficence, values, and beliefs D) Beneficence, nonmaleficence, and justice

D- Beneficence, nonmaleficence, and justice are considered to be three of the basic ethical principles commonly used in healthcare ethics, while the others are an aspect of a principle.

Core competencies of the CNL include all but: A)Critical thinking B) Advocacy C) Educator D)Outcomes manager

D- Educator is considered a CNL role, not a competency.

You are trying to reduce admission time to your unit from the emergency department. You have completed several PDSA cycles and have reduced the time by 21 minutes. But in the most recent PDSA, the time actually increased by 6 minutes. What stage of the PDSA cycle should the team go to in order to plan the next steps? Act Plan Do Study

D- The information at this stage should tell you where the barriers are.

You are trying to get literature on using music to relieve pain. One research article uses methods you forget how to interpret. You should: A) not use this article B)google the methods to try and figure it out C) look at the conclusion and just use that information D) ask a mentor to assist you, so you understand the data

D- it might be a valid study so it is important to ask for assistance with understanding the data. Having mentors is important throughout your career

A Highly Reliable Organizations (HRO) has the following characteristics: loose alignment with team members a need for infrequent communication undefined roles hyper-complexity and a high degree of accountability

D-HROs demonstrate tight alignment with team members, a need for frequent communications, and all roles are defined.

You are a CL working in a very busy 980-bed tertiary hospital. The hospital only has one MRI machine. This often causes delays in patient care. You write a proposal for the administrative team to advocate for more MRI scanners. If the proposal is approved, the money will come out of which budget? Capital budget Cash flow budget Operating budget Revenue

Capital budget involves large dollar amounts and long-term investments like equipment.

By leading which unit initiative can the CNL directly impact the financial health of the entire institution? reducing readmissions recruitment of new nursing staff improving documentation compliance encouraging staff to report safety events and near misses

Reducing readmission

Calculate the drip rate for1 liters of IV Fluids to be given over 5 hours via a tubing set which delivers 10 drops/ml. 3 gtts/min 20 gtts/min 67 gtts/min 33 gtts/min

D: 33 (No calculation)

ou have been charged with examining the heart failure 30-day readmission rate of your unit. In doing so, it is important for you to examine data from what other sources: A) National and state readmission rates B) National benchmarks C) Readmissions to other units in your hospital D) All of the above

D: The 30-day readmission rates are a key factor in CMS reimbursement rates to hospitals. A CNL should have a broad perspective of readmission rates across multiple settings. The CNL can then resource share with other areas to gain insight into best practices and pre-existing initiatives at the microsystem, hospital, state, and national levels.

A client is ordered 35 milligrams of Codeine phosphate by subcutaneous injection. 50 milligrams in 1 milliliter of liquid for SC Injection is available. How many milliliters will you administer? 1.5 mls 0.7 mls 0.5 mls 10 mls

0.7

Which of the following is not a part of the epidemiological triad? A) Environment B)Host C)Disease D) Agent

A

As a CNL on a high-risk oncology unit, you recognize the need for regular access to chaplaincy services among your client population. You work with your unit and chaplaincy department to bring these services to your unit regularly. This is primarily an example of: Lateral integration Advocacy CNL role integration Leadership

A- Acessing resources across disciplines to meet the needs of a client population in a patient-centered manner addresses specifically lateral integration.

A nurse approaches you and expresses her knowledge deficit regarding the difference between signs and symptoms of left- and right-sided heart failure. You explain the physiology between the two types of failure and identify which of the following has a primary symptom of right-sided heart failure? Peripheral edema Shortness of breath on exertion Heart murmur and distended veins Cool extremities and weak peripheral pulses

A- Right-sided heart failure leads to congestion of systemic capillaries. This generates excess fluid accumulation in the body and usually affects the dependent parts of the body first.

The health care team determines that the discharge process is ineffective and must be changed. The team determines the stakeholders and utilizes a force field analysis to weigh the pros and cons of the change. This was then used to motivate other team members and encourage buy in. Utilizing Lewin's theory of change, what stage is the team in? - Unfreezing -Sustaining -Moving - Refreezing

A- The first step of Lewin's theory of change is the unfreezing stage. In order to battle the resistance of change, the leader must assess readiness for change and motivate others to see the reason for change

One morning as you, the CNL, are walking into the nurses' lounge, you hear a lot of talk about a nurse who has called out sick that day. The nurses are griping about how this nurse always calls out, especially on Fridays. The best response is to: A)Sympathize with your team, saying you have no idea how she does not get in trouble or fired. This kind of behavior should not be tolerated B)Tell the nurses to stop talking about one of their teammates, especially in front of a new employee C) Listen to what the nurses are saying, and notify the manager to address it D) Listen to what the nurses have to say, and then address that it is not our business to discuss someone else's personal life. That nurse's sick days and disciplinary action are up to that nurse and the manager. Ensure they have adequate staffing to make up for the sick call/help to adjust assignments

AND D: It is good to show an empathetic ear, but it is not helpful for a team to speak badly about one of the teammates. Adequate staffing is a big concern for the team, so ensure that this is addressed.

As a member or leader of a team, a CNL remembers essential qualities of the CNL role and therapeutic use of self, genuineness, warmth, empathy, maturity, and self-awareness. These qualities support the CNL role in: A) Leading the interprofessional team to align the unit goals with hospital goals B) Education of staff nurses in the microsystem on the importance of these qualities C) Working with the team to develop policies and procedures D) Establishing trust and promoting interprofessional communication within the team

ANS - D: The essential qualities of a CNL support establishing trust and promoting communication within interprofessional teams, as well as coordinating of care. Those qualities are not necessary for developing policies and procedures, educating nurses, or aligning goals.

A 5Ps assessment was completed by each CNL in the hospital. As a CNL, you know this is an assessment of the: Microsystem Mesosystem Macrosystem Health care system

ANS A: A 5Ps assessment is an analysis of the microsystem. It consists of analyzing the purpose, patients, professionals, processes, and patterns of the microsystem.

What is the purpose of a fishbone diagram? A) To identify the cause and effect of multiple factors that lead to a result B) To identify the root cause of a serious safety event C) To aid in the development of an improvement project timeline D) To create the goals and objectives of an improvement project

ANS A: A fishbone diagram, also known as an Ishikawa diagram, is a visual display of the multiple causes and effects of any problem.

Individual consults by many different health disciplines represent which type of approach: A) multidisciplinary B) Interdisciplinary C) Team D) Intradisciplinary

ANS A: A multidisciplinary approach is composed of individual consults, occurring independently of each other. Typically the disciplines do not meet to work toward a common goal as in an interdisciplinary approach.

Your hospital has just completed a study comparing outcomes in rehospitalization rates for CHF patients who either received predischarge teaching from an APRN with those who received predischarge teaching from an RN. In the analysis of data, what resulting p-value would indicate that the intervention had a significant result? <.05 <0.8 <.10 <.22

ANS A: A value less than 0.05 is a significant statistical finding in research.

While admitting a patient for COPD, a nurse notices the patient has had two other admissions this month for the same diagnosis and is homeless. A key part of this admission is: A) Consult a social worker on admission B) Notify the physician C) Consult a clinical case manager upon discharge D) Consult financial counseling

ANS A: As a CNL, it is imperative to notice any reoccurring admissions and patterns—the social worker will be able to start working with the patient on day 1 for supportive services, to help the patient decrease the chance of this happening again.

After careful review of unit processes, you have determined that the self meal order program was introduced 3 months ago. With this program, patients have the ability to order meals when they are ready to eat rather than eating at predetermined times set by the hospital. This change has altered the timing of medications previously given with meals. What does the CNL do to improve the process? A) Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, and meal service team members to investigate the self meal order program B) Have the nurse or nursing assistant order meals with patients; this way the nurse knows what time the patient orders meals C) When explaining the self meal order program to patients, instruct patients to notify staff when they order meals D) Have the meal service notify the unit secretary when meal orders are placed by patients

ANS A: Having an interdisciplinary team look at the entire process of the self meal order program will provide the team with innovative solutions to the problem.

Over the past few weeks, nurses on the 30-bed medical unit have been complaining the MD orders related to oxygen do not match what the patient is receiving. Often the patient has more than one oxygen order at the same time. This leads to confusion for nursing and respiratory care staff and could harm the patient. How can the CNL improve the practice? A) Using the informatics team as support, create a hard stop in the computer that does not allow the physician to activate a new oxygen order without discontinuing the previous order B) Tell the nurses they need to remind the doctors to keep orders up to date and have the nurses review orders at rounds with the team C) Meet with the unit hospitalist to make a plan to address the problem D) Do nothing since CNLs cannot write patient care orders

ANS A: Having the informatics team develop a hard stop in the computer will allow the patient to have only one active oxygen order at a time. It is imperative that nurses and CNLs work with informatics professionals in the design of safe care.

U are the CNL on a busy medical-surgical unit. One of your patients, Mr. T, a Type 2Diabetic, has been on Ur unit for 5 days following a right foot amputation due to necrosis. He has been on IV antibiotics and has now been afebrile for 24 hours. Mr. T., 67 years old, lives alone, but his son lives two miles away and says he will be able to check on his dad at least daily once he is discharged home. In preparation for discharge, you realize Mr. T will need someone to assist him with his dressing changes and to check his vital signs for several days. U think he will also need outpatient physical therapy. U discuss with the physician your thoughts on discharging Mr. Thompson home with home health. The physician agrees with your plan of care, so u consult the case manager to set up home health and outpatient physical therapy. U also consult with the physical therapist for recommendations on home needs. U assist with ma

ANS A: Lateral integration of care involves the delivering and coordination of care using a multidisciplinary approach.

As the CNL on a medical-surgical unit, you are asked to participate in a root cause analysis of a group of sentinel events that have occurred recently throughout the hospital. Your team determines that a lack of effective communication in emergent situations is the root problem. Now what? A) Lead the team in researching evidence-based practice improvements to implement a better way of communicating during emergencies B) Submit your findings to the administration that assigned you this task C)Share the findings with the units that had these sentinel events and instruct them to come up with better, research-based communication techniques D) Take the findings directly to the individuals involved in the sentinel events and show them what they need to improve to prevent these adverse outcomes

ANS A: Once you discover what the problem is, a solution needs to be created. This is something that should be nonpunitive and benefit the whole hospital. Focusing on individuals will not be beneficial to the big picture.

The result of a workflow diagram of a clinician illustrates an excessive amount of walking to obtain supplies. Reducing the waste of motion adds value-added time that ultimately benefits: A) The patient B) The clinician C) Documentation D) None of the above

ANS A: Process improvement enhances patient safety and nursing time at the bedside for the patient and family.

Your unit has recently had an increase in fall rates. When you compare what other units in your department are doing, you identify that each unit is using a different fall risk assessment tool. You research each tool and identify which one has the strongest evidence-based research in preventing patient falls. This tool is later standardized throughout the hospital. What is this an example of? A) Applying tools for risk analysis B) Patient advocacy C) Benefit-risk analysis D) Demonstrating accountability for the delivery of high-quality care

ANS A: Researching and presenting evidence-based data to apply tools for prevention of falls (risk analysis).

How can the CNL make the greatest impact on the health care organization? A) By representing the microsystem B) By representing the mesosystem C) By representing the patient and family D) By representing the nursing profession

ANS A: The CNL functions as the change agent at the microsystem level, engaging frontline staff in best practices to better patient outcomes.

From which database would the CNL collect the most useful nursing-sensitive indicator metrics? A) NDNQI B) Hospital Compare C) TJC D) NQF

ANS A: The NDNQI (National Database of Nursing Quality Indicators) evaluates unit and hospital-specific nursing-sensitive data. NDNQI also provides benchmarks that can be used for comparison.

One of ur patients, a widow, is reaching end of life. The physician has adamantly suggested to the patient's family to plan for death and to make the decision to remove life support, as he feels it is futile at this point and most likely causing more agony to the patient. The patient has three children, and they cannot agree on a decision. The oldest daughter feels that they should abide by the doctor, as he knows best. The middle child does not agree with "killing" his mother. The youngest child just wants to be with her mother and cannot make a decision. You decide the best thing to do now is hold a patient-care conference. Whom do U invite? A) The family, the team of physicians, the primary nurse, the case manager, the chaplain, an ethics committee member, and the social worker B)The family, the team of physicians, the primary nurse, the nurse manager, the chaplain, the respiratory therapist, and the nutri

ANS A: The family/patient is a necessity for a patient-care conference; the team of physicians will be able to talk about the patient's prognosis and medical care; the primary nurse can address how the patient is responding/doing on a daily basis; the case manager and social worker can help the family with funeral/end-of-life planning; the chaplain can be a support to the family and even the staff; and an ethics committee member can ensure that an ethical decision is being made.

When trying to implement a change in the outpatient family clinic, which group of staff should the CNL focus on more? A) Late majority B) Early majority C) Laggards D) Innovators

ANS A: The innovators and early majority are going to be supportive of change and become champions for the project. The laggards make up a minority portion of the group and will be the last to adopt change. However, the late majority, which makes up a large percentage of the group, is the percentage that will need the most support during a change and they will be resistant.

In your role as a CNL, you have implemented some practice changes on your unit that have resulted in an overall reduced LOS for the pneumonia patients. The cost savings will be reflected in which budget: Operating budget Capital budget Cash-flow budget Long-term budget

ANS A: The operating budget reflects the revenue and expenses for the nursing unit. Capital budget refers to larger purchases that may be planned over long periods.

A patient who has been diagnosed with colon cancer remarks that since his diagnosis, many people he knows have mentioned someone they know who has colon cancer. Most of these people live nearby. The patient asks you if colon cancer rates in the area have been increasing recently. The patient is asking about what type of measure: A)! Incidence B) Prevalence C) Mortality D) Correlation

ANS A: This would measure the number of new cases of colon cancer in the area during a specific period.

Julie, a CNL, hears that another hospital does hourly rounding and thinks this is a great idea to reduce falls on her unit. She meets with her interdisciplinary team and they decide to try this on their unit. She informs the rest of the staff and makes a start date. What did Julie forget to do? A) Look at the latest evidence/literature review B)Ask her nurse manager C) Ask other units if they do hourly rounding D) Get data from the other hospital

ANS A: When making a change, it is important to look at the EBP by performing a literature review and then decide whether there is sufficient evidence to make the change or whether there is not much literature on the topic to collect data to see if the change is effective.

The manager of the medical unit where you work has just shared some data with you. She is concerned because the 30-day readmission rate for COPD patients is 15%. Your next step should be to: A)Schedule a meeting with the staff to discuss the problem B) Compare your hospital's 30-day readmission rate with other like hospitals on the CMS website C) Perform a literature review in preparation for making changes to the current COPD pathway at your hospital D) Monitor the data over the next 6 months to see if there really is a problem

ANS B: A CNL should find out what this number means before you can act on it.

One of the nurses on your unit was involved in a medication error. She revealed the error to both you and the nurse manager and documented the error in the online safety event reporting system. You meet with her and begin the process of identifying causes that led to this event, so the risk for future medication errors can be minimized. As evidenced by these actions, what is the culture of your hospital? A) A laissez-faire culture B) A just culture C) A punitive culture D) A structural culture

ANS B: A just culture recognizes that humans are fallible, and errors may happen in systems that are flawed. A nonpunitive culture fosters patient safety principles, encouraging practitioners to report errors and near misses, which in turn enables organizations to address and correct flawed processes and systems. Errors that result from willfully negligent behavior are not a part of a just culture.

Your unit has worked hard to maintain a very low fall rate. There has now been a sharp increase over the last 2 months. In looking at control chart data related to falls, you see that all of these falls occur on the night shift. What is the most likely reason for this shift? A) a common cause B) special cause C) a coincidence D) a trend

ANS B: A special cause occurs outside of a stable process and is attributed to a factor that is not commonly part of the process. The CNL would need to investigate whether there are special circumstances that are present on the night shift that have resulted in the increasing number of falls.

Which of the following actions illustrates the CNL professional value of altruism? A) Leading an interdisciplinary team looking at the remote cardiac monitoring process B) Sponsoring a meeting with the monitor technicians to understand their barriers in the cardiac monitoring process C) Flow mapping the admission process of the remote cardiac-monitored patient D) Editing the policy for the remote cardiac monitoring process

ANS B: Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the CNL's concern for the welfare of clients, other nurses, and other health care providers.

A team approach utilizing the integration of many different roles working toward common patient and family goals describes the objective of which type of team: A) Multidisciplinary team B) Interdisciplinary team C) Patient advocacy team D) Care coordination team

ANS B: An interdisciplinary team is composed of many disciplines that all gather together at the same time to work toward a common patient and family goal, such as discharge coordination.

The results of a quarterly report identify an increase in patient falls on the telemetry unit. Your first action will be to: A) Implement hourly rounding B) Gain an understanding of patient care practices on the telemetry unit C) Assign patient personal alarms to all patients at risk D) Revise the current fall risk documentation form

ANS B: Assessment includes gathering information about the health status of the client and analyzing and synthesizing those making judgments about nursing interventions on the basis of findings, evaluation, and managing of individual care outcomes.

You, the CNL, work on an infectious disease unit in the hospital. Your patients tend to have long lengths of stays, sometimes weeks to months. During your 5Ps assessment, you discovered that the nursing staff is not satisfied with handoff communication. They feel like important information is often left out of report. As a leader of this team, the most appropriate next step would be to: A) Create a new process based on evidence and implement it B) Assess the current communication handoff process C) Ask the nursing staff what they think would be the best way to give report D) Bring this issue up at the next staff meeting

ANS B: Before going any further, you need to collect data and assess the situation. Manage group processes to meet care objectives and complete health care team responsibilities.

There has been disagreement regarding the suggested adoption of a patient transfer blackout period during change of shift. Staff on the inpatient units favor a 30-minute blackout period, while emergency department staff favor no blackout period. A team of stakeholders from all areas recently agreed on a universal blackout period of 15 minutes during shift change. What type of solution does this represent? A) avoidance B) collaboration C) accommodation D) confrontation

ANS B: Collaboration involves all parties working together to design optimal outcomes using mutually agreed upon solutions.

Currently Medicare is moving from a fee-for-service model to a: A) Managed care model B) Pay-for-performance model C) Private insurance model D) Advantage care model

ANS B: Increasingly Medicare is adjusting reimbursement rates to providers on the basis of their patient outcomes.

You are listening to report with a novice nurse. As part of mentoring new staff and supporting clinical decision making, you ask the new nurse which patient she would like to assess first. Which patient should this nurse assess first? A) 46-year-old receiving IV antibiotic therapy B) 60-year-old s/p liver biopsy C) 56-year-old with pneumonia D) 72-year-old hip replacement impatiently waiting for discharge

ANS B: Post-op liver biopsy patients have an increased risk of bleeding and need close monitoring after the procedure. The question does not indicate how recently the biopsy was done and therefore this is the best choice based on the information provided.

Which of the following is not part of the PDSA change model? Plan Assess Do Study

ANS B: The PDSA change model consists of plan, do, study, and act.

In assessing your organization for evidence-based practice environmental readiness, you would evaluate all of the following except: A) Do advance practice nurse and educators model evidence-based practice? B) Are the nurses expressing an interest in evidence-based practice? C) Are the librarians available to assist nurses with evidence-based practice research? D) Are computers readily accessible to staff?

ANS B: The organization is assessing environmental readiness, not interest.

In an effort to reduce central line infections, you have done some research and found evidence-based guidelines that you would like to implement at your organization. Your next step would be to: A) Gather data regarding central line infection rates at your institution B) Convene a team meeting to discuss the problem and impact of central line infections C)Run a PDSA of the new guidelines D) Share what you have found with the manager

ANS B: The team needs to be involved in the whole change process.

A lack of compliance with deep vein thrombosis (DVT) prophylaxis has been identified in retrospective chart reviews of all ischemic stroke patients in your organization. As a CNL on the neurological unit, your primary goal will include: A) Challenging the guidelines on primary prevention of ischemic stroke written by the American Stroke Association B) Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient on your unit C) Developing an organization-wide educational program on DVT prophylaxis D) Developing a unit-based team of nursing personnel to investigate the problem

ANS B: White Paper: One competency is that of a systems analyst. A CNL participates in a system review and conducts a microsystem analysis, identifying a clinical issue with a focus on a particular population.

You have evaluated the fall rate for the previous 12 months on the medical-surgical unit where you work as a CNL. You find that your fall rate is above the national benchmark. Your next step is to: A)Implement a new fall prevention tool B)Review the literature C) Review current hospital policy and find out what fall prevention strategies are currently being used on the unit D) Assemble a team from the unit to brainstorm ideas to reduce the fall rate

ANS C: A CNL needs to know what the current policy and processes are before making changes and improvements.

Your team is looking at the delays in the discharge process. Your cause and effect diagram includes: A) A run chart B) A Gantt chart C) A fishbone diagram D) A high-level flowchart

ANS C: A fishbone diagram is a useful tool to identify themes of clinical issues. Categories such as equipment, personnel, communication, and so on can be identified.

Patient satisfaction scores in the emergency department (ED) have shown a downward trend over the past three quarters. As a clinical nurse leader (CNL) in the ED, your focus is to: A) Create a script for the triage nurse in welcoming the patient B) Assign a volunteer to welcome patients to the hospital C) Compare desired outcomes with national and state standards D) Write a letter of apology to each dissatisfied patient

ANS C: Client care outcomes are a measure of quality practice. CNLs must know how to compare desired outcomes that will improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client centered.

B.L. is a 91-year-old male who was transferred to a skilled nursing facility from an acute care hospital. Upon transfer, the patient's Lasix for CHF was not transferred with the patient. Once the medication error is found and restarted, it is the CNL's job to: A) Notify the hospital of the error B)Notify the skilled nursing facility of the error C) Go back through all pathways and find where the error in this transfer process occurred D) Notify the family

ANS C: Correcting processes that yield errors and negative outcomes for patients is a critical duty of the CNL.

Which type of evidence would you prefer to review and share with a team when trying to support whether an evidence-based intervention should be implemented on your unit? A) uncontrolled investigation B) quasi experimental C) experimental D) qualitative

ANS C: Experimental research is quantitative research, which is a formal, objective, rigorous, and systematic process for generating information about the world. Experimental research is an objective, highly controlled investigation for the purpose of predicting and controlling phenomena in nursing practice.

When incorporating evidence-based practice interventions into your health care setting, it would be best to: A) Do what everyone else is doing B) Do what you think would work in your setting C) Choose the interventions you think would work for your setting and perform a rapid cycle test to evaluate the impact D) Do everything the literature suggests to improve your chances of a good outcome

ANS C: Incorporating evidence-based practice and then performing rapid cycle tests will give you feedback on whether the changes are working well in your setting

Which group presents the highest challenge in attaining buy-in for a new innovation? A) early innovators B) early adopters C) late majority D) laggards

ANS C: Members of the late majority approach any new initiative with a high degree of skepticism and require a large amount of information before adopting change. They will adopt change only in the late stages. Laggards historically will not adopt change.

Before beginning data collection, what is the primary key factor to determine? A) Personnel to collect data B) A secure database for holding data C) Operational definitions of data D) A user-friendly collection method

ANS C: Operational definitions clearly define what is to be collected and avoid confusion for those collecting the data. Clear operational definitions also helps those who are interpreting the data. Failure to determine operational definitions may result in data that are inaccurate

The hospital has a goal for patient transfers from ICU to be completed by 12 noon. Your unit has a very low percentage for meeting this hospital goal. How can you best address this problem as the CNL? A) Tell the charge nurse to discharge patients in the morning B) Ask the manager to staff an extra nurse on day shift to be the discharge nurse C) Use process mapping to determine all the possible factors that contribute to patient discharge and what barriers there are to discharge D) Don't worry about the number; your unit meets the other hospital goals, so it is okay to miss one

ANS C: Process mapping is a tool to provide the team with an objective view of the problem being investigated. This view will help everyone to determine the barriers to transfer. Once the barriers are determined through process mapping, each barrier can be broken down further to determine solutions.

All of the following are components of evidence-based practice and clinical decision making except: A) Clinical expertise B)Information about patient preferences and values C) Research utilization D) Evidence from research and theories

ANS C: Research utilization uses knowledge typically based on only one study, whereas EBP looks at evidence from research, evidence-based theories, opinion leaders/expert panels, evidence from patient assessment and history, clinical expertise, and information about patient preferences and values.

A patient admitted to the hospital in hypertensive crisis is now receiving care at what level of prevention: Primary Secondary Tertiary None of these

ANS C: Tertiary - The patient already has a severe medical problem that now requires treatment; this is tertiary level of prevention focused on maximizing the patient's health, despite the presence of illness.

A new nurse on the medical/surgical unit approaches you with concerns about one of her patients. She states the patient has not turned on the lights or television all day and did not order breakfast or lunch. She had to ask the patient what meal they wanted and place the order. This nurse states she is concerned about the change in the patient's behavior. Looking at the patient's chart, you realize this patient is Jewish and it is Saturday. What is your best response to the nurse? A) "The patient is sick and needs extra support today" B) "The patient needs to be seen by the psychology team for an evaluation" C) "The patient may be following their religious practices and we need to support this" D) "The patient is depressed from being in the hospital"

ANS C: We need to support patients' religious practices whenever possible in the hospital. Considering it is Saturday and this patient is Jewish means the patient is recognizing the Sabbath. This means the patient will not use any electrical devices or ask to use them. The staff would have to ask whether a patient wants the television on or the lights turned on/off, and so on. Patients will also not use the phone or call bell system during the Sabbath. Staff need to be sensitive to patient needs and try to accommodate cultural and spiritual practices whenever possible.

What is the appropriate ending point of a root cause analysis (RCA)? A) When several possible reasons for the error have been identified B) When staff have identified what they think is the reason for the error C) When the list of causes is exhausted to no more possible causes D) The CNL can identify reasons for occurrence

ANS C: When performing an RCA, the CNL must ask "why to saturation," or until there are no more contributing root causes. This often consists of asking why five or more times.

You are working with a team to reduce patient waiting time for transport to diagnostic imaging. An effective goal would be to: A)Decrease waiting time during the evening shift B)Increase monthly patient satisfaction C)Improve communication between the ED and DI departments D) Decrease waiting time for diagnostic imaging by 5%

ANS D- Improvement goals must be specific and measurable. The team must have clear measurable results to indicate whether an implementation resulted in improvement.

When conducting a literature review, the publication that would provide a comprehensive summary of research on that topic would be: Nonexperimental Experimental Case study Meta-analysis

ANS D: A meta-analysis includes an analysis of multiple studies on that topic.

Sam is a homeless 59-year-old male admitted with CHF. He arrives alone and crying. His vitals are BP 173/96, HR 83, O2 86%, and temperature 98.9°F. During your assessment, you notice multiple bruises and lacerations. His clothes are torn and soiled. According to Maslow's Hierarchy of Needs, what should you do first? A) Inquire about his bruises and lacerations B)Call the social worker regarding shelter placement C)Ask why he is crying D) Apply oxygen

ANS D: According to Maslow's Hierarchy of Needs, physiological needs have to be met first, then safety, love/belonging, esteem and, finally, self-actualization.

As the CNL on a cardiothoracic step-down unit, what is the one recommendation you would make to decrease the chance of readmission of your patient population? A) Visiting nursing for all patients B) All follow-up appointments scheduled prior to patient discharge C) Pharmacy to visit with each patient prior to discharge home to review medications D) All patients should be enrolled in a cardiac rehabilitation program

ANS D: All patients should be enrolled in a cardiac rehabilitation program to assist the patient with making permanent lifestyle changes required to improve their health, well-being, and success after their illness. Because these programs provide ongoing support, teaching, and monitoring of health, it is the best choice.

When is an RCA performed? A) Prior to the initiation of a new treatment to anticipate possible problems B) During a process to evaluate ongoing problems C) As part of data analysis to understand why an intervention led to poor results D) After a serious safety event has occurred

ANS D: An RCA is performed as a way to gain insight into the factors that led to a serious safety event. It is a reactive activity with the intention of proactively designing solutions to processes that led to a problem.

You are the CNL at an outpatient care clinic providing care to families in the area. You have noticed it is difficult to get families to bring their children in for their immunizations, and children are often off schedule. How can the clinic best address this issue to meet the needs of their patient populations? A) Educate families on immunizations, their purpose, and their children's schedule B) Provide reminder phone calls to families the day before a scheduled appointment C) If possible, offer extended clinic hours 1 to 2 nights a week, so parents can come in after work D) Use the clinic data to determine why families are not coming to appointments

ANS D: Before making changes at the clinic, it would be best to look at the data objectively to determine what is causing the problem. Answers A, B, and C assume you know the families' reasons for not coming to appointments.

After completing unit audits, you have noticed the nurses are not completing AIR cycles documentation with pain management (AIR: assessment, intervention, reassessment). What should be done to improve documentation? A) Tell the unit management which staff are documenting inappropriately B) Reeducate staff on the hospital documentation policy C)Remind staff of pain documentation during staff meetings and charge report D) Provide staff with a self-audit sheet as a way to review their own documentation during their shifts

ANS D: Giving staff a checklist will assist them in staying organized during their busy day. This will provide them a way to double check all their documentation before ending a shift. It also empowers staff to take ownership of their work.

Per the epidemiology report, your unit's hand hygiene scores have steadily decreased over the past 3 months. When reporting these metrics at a staff meeting, most of the staff replies saying, "It's the doctors fault, we always wash our hands." How do you work to change the culture of the unit? A) Have secret shoppers monitor the staff and hand out tickets to hand hygiene offenders B) hand hygiene metrics related to the unit staff only and use these data to educate staff C) Have a hand hygiene campaign to reinvigorate staff D) Investigate the barriers to hand hygiene and collaborate with staff to reduce these barriers

ANS D: Giving staff warnings, presenting objective data, and highlighting a problem may improve compliance only slightly. Finding out the root cause for noncompliance and collaborating with staff to find viable solutions will change the unit culture over time and empower staff to make positive changes to their work environment.

The CNL role was developed to: A) Create another layer of accountability within the microsystem B)Primarily train new nursing graduates primarily the skill of evidence-based practice C) Lead, guide, and direct other nursing staff to provided patient-centered care D)Motivate nursing staff

C

The CNL has the potential to be a powerful catalytic role that advances patient - and - family-centered care in a constantly changing healthcare arena. What key messages helps support this? A)Participating as partial partners with physicians and other health professionals, in redesigning health care in the United States B)Practicing at a minimum level of education C)Effectively planning for workforce development through improved information infrastructure only D) Achieving a high level of education and practicing to the full extent of it

D

The CNL nursing informatics competencies include all the following except: A- Computer skills B-Informatices knowledge C-Informatics skills D- An understanding of Excel spreadsheets

D- An understanding of Excel spreadsheet is not required as a informatics competency for the CNL

A patient asks the CNL about the regulations on abortion in North Carolina. What should the CNL do? A) Tell the patient you cannot answer that because it is an ethical situation B)Let the doctor know the patient is asking about an abortion C) Inform the patient care nurse D) Look up the regulation in North Carolina and share them with the patient

Looking up policies is an important CNL role. Giving policy does not violate any ethical rules, it is only providing facts.

Ongoing risk reduction and patient safety efforts are an important component of: Quality Improvement (QI) Knowledge management Change theory Complexity theory

Ongoing risk reduction and patient safety monitoring are components of QI.

A small group has been formed on the medical-surgical unit to implement change. Team members also have struggles over decision-making and clarity of purpose. What stage of the Tuckerman and Jensen's model is represented by members communicating their feelings, but still viewing themselves as individuals rather than part of the team? Storming Performing Norming Forming

The storming phase is where competition and conflict are at their highest.

What type of study would not be included in evidence-based practice if the nurses were looking for quantitative research? meta-analysis experiemental quasi-experimental phenomenological

phenomenological studies are qualitative and are not directly included in in evidence based practice :(