CNL Questions 101-150
*A nurse on the CNL's unit asks about accessing patient education materials via the electronic health record (EHR), as well as the availability of education on Cambodia. As the CNL guides the nurse in locating these materials, she or he recognizes this as an effective use of:* A. Health care informatics B. Research utilization C. Clinical knowledge D. Evidence-based research
Answer A—Rationale: Accessing appropriate education in patients' native language is culturally competent; however, the ability to locate and provide these materials is effective use of health care informatics.
*You are in the process of initiating a mobility team and protocol on your unit. What members of the interdisciplinary team should be considered?* A. Nursing staff, physical therapist, nurse manager, occupational therapist, CNL, clinical nurse specialist, and physician B. Physical therapist, physician, nursing assistants, manager, and CNL C. Medical social worker, physician, nursing staff, physical therapy staff, and CNL D. Physical therapist, occupational therapist, nursing staff, and the discharge coordinator
Answer A—Rationale: An interdisciplinary team must include all key stakeholders so that patients can have the best outcomes.
*You are a CNL 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?* A. Capital budget B. Cash flow budget C. Operating budget D. Revenue
Answer A—Rationale: Capital budget involves large dollar amounts and long-term investments like equipment.
*Which statement best describes the CNL acting as a client advocate for a domestic violence victim hospitalized in her microsystem?* A. Consult domestic violence health care professional (DVHP) and ensure the patient has an alias name B. Ensure all the staff members are aware that she is a domestic violence victim C. Consult the master of social work (MSW) and call the patient's partner to ensure that he or she will not come to the hospital D. Consult the psychiatric physician and inform the primary care nurse
Answer A—Rationale: Consulting DVHP and ensuring the patient has an alias name is the best approach in providing patient advocacy. The CNL is advocating for patient safety.
*You are a CNL on a medical-telemetry unit and orienting a new graduate nurse. Critical thinking is best demonstrated by which of the following?* A. Calling the rapid response nurse when a patient's oxygen saturation drops to 79% on 2L of oxygen B. Drawing scheduled hemoglobin and hematocrit C. Delegating tasks to the nursing assistant D. Creating a script to welcome patients to the medical-telemetry unit
Answer A—Rationale: Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, interference, inductive and deductive reasoning, intuition, application, and creativity.
*The CNL recognizes the importance of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in driving hospital reimbursement. These scores measure:* A. Core measures and patient experience B. Core measures, patient experience, and clinical outcomes C. Core measures, patient experience, clinical outcomes, and readmission rates D. Patient experience, clinical outcomes, and readmission rates
Answer A—Rationale: HCAHPS measure core measures and the patient experience, but do not assess actual clinical outcomes, patient mortality, or readmission rates.
*Use of electronic health records (EHRs) can aid the CNL to conduct quality improvement (QI) efforts in which of the following ways?* A. Allow rapid access to informatics data, provide a way of ongoing monitoring, organize data into meaningful groups, and aid in the dedication of errors B. Allow rapid access to informatics data, ensure all staff follow protocols and policies, add second checks to medication administration, and aid in the detection of errors C. Provide a way of ongoing monitoring, add second checks to medication administration, organize data into meaningful groups, and aid in detection of errors D. Provide a way of ongoing monitoring, ensure all staff follow protocols and policies, add second checks to medication administration, organize data into meaningful groups, and aid in the detection of errors
Answer A—Rationale: Many EHR products can achieve each of these functions; however, not all are a part of QI efforts. Also, an EHR cannot ensure people act within established policies and procedures. Additionally, while an EHR can provide additional safeguards to medication administration and may improve safety, it does not help the CNL conduct QI efforts.
*A staff nurse is thinking about becoming a CNL. The unit CNL discusses with the staff nurse about the CNL's role and the importance of evidence-based practice (EBP). After further discussions, the staff nurse questions the CNL about what barriers she may face when implementing EBP. Which of the following do not describe barriers that have been recognized with initiating EBP?* A. EBP is readily available for staff and low patient loads B. Lack of knowledge regarding EBP strategies and misperceptions about EBP C. Lack of time and resources to search for and appraise evidence D. Peer pressure to continue with practices that are steeped in tradition and inadequate content
Answer A—Rationale: Nurses, physicians, and other health professionals cite a number of barriers to EBP including: lack of knowledge regarding EBP strategies, misperceptions or negative views about research and evidence-based care, lack of belief EBP will result in more positive outcomes than traditional care, voluminous amounts of information in professional journals, lack of time and resources to search for and appraise evidence, overwhelming patient loads, organizational constraints, demands from patients for a certain type of treatment, peer pressure to continue with practices that are steeped in tradition, and adequate content and behavioral skills regarding EBP in educational programs.
*Ongoing risk reduction and patient safety efforts are an important component of:* A. Quality improvement (QI) B. Knowledge management C. Change theory D. Complexity theory
Answer A—Rationale: Ongoing risk reduction and patient safety monitoring are components of QI.
*Tara, a CNL on a pediatric medical-surgical unit, conducted a 5P assessment and discovered that the discharge process was fragmented and parents were not satisfied with the process. Tara created a team to develop a change in order to improve the process. What model can Tara use to rapidly implement this change and test it to determine effectiveness?* A. Plan-Do-Study-Act (PDSA) B. Strengths, weaknesses, opportunities, and threats (SWOT) analysis C. Fishbone diagram D. Gap analysis
Answer A—Rationale: PDSA is a model used to conduct rapid cyclical review of a process change to encourage continuous and ongoing efforts to improve.
*You are the unit-based council chair for shared governance of a high-acuity progressive care unit. You notice that the staff is not aware of new evidence in caring for this patient population. You discuss this with the management team and the CNL to determine what can be done to increase the staff awareness and knowledge of EBP. What strategy can best be used to increase evidence into practice?* A. Start a journal club with help from CNL B. Learn how to determine if an article is peer-reviewed C. Encourage nurses to conduct research D. Discuss the importance of EBP in staff meeting
Answer A—Rationale: Strategies to increase evidence into practice include ensure policies/procedures are based upon the latest literature, journal club, nursing grand rounds, update staff on latest evidence in short gatherings, link quality indicators in EBP, and mentor staff to complete EBP activities for school and clinical ladder.
*As a CNL on your unit, you are rounding on your microsystem. Jen, a 70-year-old patient with stage IV cancer, chronic obstructive pulmonary disease (COPD), diabetes mellitus (DM), and chronic kidney disease, is currently on an Ativan drip and morphine drip. She has a do-not-resuscitate (DNR) order and is a hospice patient. You notice she has multiple grieving family members in her room. You speak with the family and collaborate with the palliative care unit (PCU) CNL and charge nurse and decide to move the patient to a bigger room in the PCU. What CNL role was demonstrated in this scenario?* A. Advocate B. Outcomes manager C. Team manager D. Risk analys
Answer A—Rationale: The CNL acted as a client advocate to ensure the best situation for the patient and family by coordination of care through the use of resources and services.
*As a CNL on a very busy medical-telemetry unit, you have noticed that nurses are not utilizing incentive spirometry for patients with acute or chronic lung conditions. To ensure that patients are given the best care, you ask the electronic order entry representative to allow incentive spirometry to be entered as a nursing task. This will be used as a reminder for the nursing staff to perform this task. What action of the CNL is this?* A. Demonstrates use of health care technologies to maximize health care outcomes B. Understands your microsystem and uses available resources C. Unfreezes D. Identifies unwanted variation, rework, and waste
Answer A—Rationale: The CNL is on the frontline at the point of care delivery, making recommendations to management and other providers about disease management and use of standardized protocols, ensuring that all charges incurred are assessed and tracked to the appropriate cost center. The CNL should be involved in health care technologies and informatics.
*Ranesha, a nurse on the unit, has just finished receiving bedside report on a patient, Mr. Smith, admitted with pneumonia. She told the patient his goal was to ambulate in the hallway three times that day. The CNL, Valerie, walked in the room while Ranesha discussed his goal. Valerie recognized that the goal will not work because Mr. Smith was not involved in deciding on the goal. In what way can Valerie act as a client advocate?* A. Involve the patient in setting the goal with Ranesha, to discuss the reason for setting goals, barriers, and concerns, and determine the best time for Mr. Smith to ambulate in the hallway B. Do not discuss setting the goal and involving Mr. Smith as the nurse has already told the patient the plan for the day C. Tell Ranesha that Mr. Smith should be in the driver's seat of his own care D. Involve the patient by asking him what he wants to do for the day and if he replies "Nothing" then let him rest
Answer A—Rationale: The CNL keeps the patient informed and ensures he understands the reason for setting goals and involves him in making health care decisions.
*Nicole, a nurse of 5 years, comes to you with an idea for a medication administration safety zone. How can you best support Nicole with this project?* A. Guide Nicole through a literature search to determine if evidence exists to support such a change B. Help Nicole design the medication administration safety zone C. Set up a meeting with the manager and Nicole to discuss the project D. Encourage Nicole to implement the project
Answer A—Rationale: The CNL serves as a horizontal leader by assisting nursing staff in using EBP principles to design care for individuals. The CNL helps Nicole to search for the best evidence by conducting a literature review
*Recently, your unit replaced all of its current beds with air beds, designed to help prevent skin breakdown in your patients. Using informatics, what is the best way to evaluate the effectiveness of this intervention?* A. Review the electronic health record (EHR) for new pressure ulcer incidence since the new beds were utilized B. Complete a pressure ulcer prevalence study on all currently admitted patients C. Gather data on all patient Braden scale scores since implementation D. Review all nurse skin integrity assessments since implementation
Answer A—Rationale: The best way to evaluate the effectiveness of the implementation of air beds is to review the incidence of new pressure ulcers. A prevalence study only assesses pressure ulcers at the current time. The Braden scale does not necessarily indicate effectiveness of preventing skin breakdown. Reviewing all assessments is unneeded, as the data regarding pressure ulcers is the only meaningful data.
*What best describes an elevator speech about the CNL's role?* A. Succinctly define, advocate, and explain the CNL's role B. Briefly educate peers on current issues in the nursing profession C. Provide a summary presentation on specific measured outcomes of the CNL D. Convince peers and stakeholders to create buy-in for the CNL
Answer A—Rationale: The elevator speech should define, advocate, and explain the CNL role. A summary of the specific outcomes does not address the role itself. While the elevator speech may work to create buy-in, it should do so by defining and explaining the role.
*During morning report, you observe a new staff member you have been mentoring struggling to identify which of her patients she will assess first. As the CNL, you identify the priority patient as:* A. The 72-year-old patient with a chest tube to wall suction and unstable vital signs B. The 19-year-old patient with family demanding to speak with you regarding discharge plans C. The 57-year-old postoperative patient with patient-controlled analgesia (PCA) pump D. The 92-year-old patient who is a high-fall risk
Answer A—Rationale: The priority assessment is the patient with a chest tube to ensure both patency of the tube and adequate airway.
*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
Answer A—Rationale: This would measure the number of new cases of colon cancer in the area during a specific period.
*You are precepting a CNL student. She discusses her capstone project with you. She needs help determining the design of her study. She states that she will be working with diabetes patients on a medical unit. She intends to collect basic data and do a pre- and postintervention questionnaire based on the diabetes survival skills. She wants to compare the pre- and postdata to determine if her educational intervention was effective. She will not use randomization. What option best describes her study design?* A. Well-designed randomized controlled trial (RCT) B. Quasi-experimental C. Meta-analysis D. Quality study
Answer B—Rationale: A quasi-experiment is not a true experiment. A quasi-experiment does not have randomly assigned groups, but would include pre- and postmeasures.
*How can a CNL help to identify the general discharge needs of patients on his or her unit?* A. Coordinate outpatient care and follow-up appointments B. Assess protective and predictive factors of patient health C. Discuss with each team's doctors the anticipated discharge needs of their patients D. Approach staff nurses about their patients' discharge needs.
Answer B—Rationale: Assessing protective and predictive factors of patient health is the best way a CNL can identify potential needs or issues with patient discharges
*Lisa, a CNL, is educating the staff on the effects of long-term bed rest. A majority of these patients have been on bed rest with a shortened cervix since 25 weeks gestation. Which of the following statements is true?* A. Bed rest is psychologically healthy. B. Music therapy can ease the psychological effects of bed rest. C. Bed rest prevents deep vein thrombosis (DVT). D. Bed rest has been proven to prevent preterm labor.
Answer B—Rationale: Bed rest can be detrimental to a mother's psychological well-being, because there is separation between the patient and her family. The patient can also experience financial burdens, which put a strain on the family. Currently, there is no evidence that bed rest prevents preterm labor.
*Lateral integration is one of the main functions of the CNL, incorporating multiple disciplines into the care of clients and populations. Which of the following ongoing components constitute lateral integration?* A. Advocacy, assessment, clinical knowledge, evaluation B. Collaboration, communication, coordination, evaluation C. Altruism, benchmarking, cost reduction, evaluation D. Advocacy, collaboration, coordination
Answer B—Rationale: Communication, collaboration, coordination, and evaluation—while all the components listed make up important aspects of different CNL roles, only these four address lateral integration.
*B.F. is a 52-year-old female recently placed with the palliative care team. The CNL makes sure that B.F. is transferred to another unit with a specific palliative care section. How is this a demonstration of advocacy?* A. Physicians understand when to transfer patients. B. It ensures that the system meets the needs of the population. C. It advocates for the professional nurse. D. It applies ethics toward patient care.
Answer B—Rationale: Make sure the patient is placed where the most optimal outcomes and palliative care can be delivered.
*As a CNL, you are asked to speak to a local church group, mostly elderly, regarding the importance of annual influenza shots and pneumonia vaccines. You want to be well prepared for the talk as you know the leaders have several questions about the relationship in developing pneumonia and vaccination. You decide to develop a PICOT question and initiate a literature review. Which of the following statements best exemplifies the PICOT method?* A. For patients 65 years and older, the use of an influenza/pneumonia (PNA) vaccine vaccine will reduce the risk of developing pneumonia. B. For patients 65 years and older, the use of an influenza/PNA vaccine will reduce the risk of developing pneumonia when compared to patients not receiving vaccination within a year. C. For patients 65 years and older, the use of an influenza/PNA vaccine will reduce the pneumonia. D. For patients in a church, the use of an influenza/PNA vaccine will reduce the risk of developing pneumonia in a year
Answer B—Rationale: PICOT is a process in which clinical questions are phrased to reveal the most relevant information (P = patient population; I = intervention, C = comparison; O = outcome).
*With health care reform, the CNL recognizes that evidence-based practice (EBP) is imperative. The CNL decided that her staff should be knowledgeable about health care reform. She collaborated with the educator and administration team to educate the staff about health care reform and pay for performance. What statement best reflects the definition of pay for performance?* A. It is a voluntary program that encourages hospitals nationally to report quality measures for heart attacks, heart failure, and pneumonia. B. It is a national program in which physicians and hospitals receive more money if their quality measures exceed certain benchmarks or if the measures improve year to year. C. It is a process that involves the surveillance of and intervention in clinical activities of physicians for the purpose of controlling costs. D. It is a Medicare program that began the physician quality reporting initiative.
Answer B—Rationale: Pay for performance gained widespread acceptance in health care; it goes one step above pay for reporting, as it requires physicians or hospitals to report quality measures, in which they receive more money if their quality measures exceed certain benchmarks or if the measures improve year to year.
*What level of prevention are you providing by performing screenings?* A. Primary B. Secondary C. Tertiary D. Quaternary
Answer B—Rationale: Secondary prevention involves activities that help increase early identification of disease.
*During a unit-based council meeting, the chair states that the unit has had 10 falls this year related to bathroom needs. Frank, a staff nurse, states he conducted observations and determined these falls are likely related to a lack of purposeful hourly rounding. Judy, a nursing assistant, states she has heard everyone is doing hourly rounding but it does not help because patients still get out of bed. Which of the following is the most appropriate response by the CNL?* A. Encourage the staff to stop hourly rounding B. Educate the staff on the importance of utilizing evidence-based practice (EBP) like hourly rounding to prevent falls and show the evidence C. Instruct the staff to utilize new chair alarms for all patients as these have been proven to reduce falls D. Ask the team to search the literature for evidence related to fall prevention
Answer B—Rationale: The CNL coaches and leads teams to sustain a culture of safety by utilizing EBPs.
*Jennifer, a CNL student, is shadowing a CNL on a busy medical-telemetry unit. The CNL encourages Jennifer to follow up on a 24-year-old patient admitted with diabetic ketoacidosis (DKA) for the fourth time in a 2-month period. Which statement best describes the CNL student acting as a client advocate for this patient?* A. Round on the patient and consult a diabetes educator B. Round on the patient and discuss reasons for frequent readmissions, discuss concerns with the primary nurse, order a HgA1c, and consult a diabetes educator and social worker C. Round on the patient, and tell the primary nurse to educate the patient on diabetes D. Discuss with the primary care nurse that the patient has been again readmitted and the patient needs more education on diabetes and preventing readmissions
Answer B—Rationale: The CNL demonstrates advocacy for the patient by involving the patient and discussing possible reasons for readmission and taking an interdisciplinary approach to address patient concern.
*The CNL knows in order to serve as a lateral integrator she or he must conduct ongoing evaluation of care delivery systems and processes. Which of the following is the best example of how the CNL demonstrates evaluation?* A. Ensures each member of the team clearly understands each member's role B. Conducts an ongoing analysis of risk to promote patient safety C. Synthesizes gathered information to find common goals and shares this with the team D. Fosters open rapport across professional boundaries
Answer B—Rationale: The CNL monitors not only the final outcomes of care, but also the implementation and ongoing progression of care. By analyzing and evaluating risk, adjustments can be made to improve the overall outcomes while promoting patient safety.
*The CNL works in a medical intensive care unit (MICU) at a level one trauma center. The CNL conducts a comprehensive assessment of the microsystem. All of the following are vital aspects that the CNL would need to identify within the microsystem except:* A. The rate of ventilator-associated pneumonia B. The organization's operating budget C. The top three diagnoses D. The average age of patients
Answer B—Rationale: The assessment of the microsystem focuses on the small, frontline unit, which does not include the organization's operating budget. The rate of nosocomial infections, top diagnoses, and age of patients within the microsystem are vital information for the CNL.
*During a client's admission medication reconciliation, the admitting nurse comes to you for assistance. On review of the client's case, you discover the client has several separate opioid prescriptions from multiple different providers. When you discuss the issue with the patient, the patient tells you he or she thought each prescriber had been consulting with the others. Which function of the CNL best addresses this issue?* A. Client advocacy B. Lateral integration C. Injury prevention D. Advanced clinical assessment
Answer B—Rationale: While aspects of each of these functions could be used to address parts of this issue, only lateral integration addresses coordinating multiple players across multiple disciplines, collaboratively, toward the common goal of proper, safe management of pain for this complex patient through improved communication among these stakeholders and with the client, as well as collaboration for proper ongoing monitoring and evaluation of the client.
*The CNL works in a small primary care practice and has identified that several patients have missed appointments. After investigating why the patients were not going to appointments, the CNL determines that the patients made the appointments so far in advance that they forgot them. The CNL discusses these findings with the team and they decide to implement a program with reminder calls 2 days prior to the appointment. The CNL wants to be sure to identify aspects that may positively or negatively affect the project, so the CNL suggests the team utilize which of the following?* A. 5P (persons, patients, professionals, processes, patterns) assessment B. Plan-Do-Study-Act (PDSA) cycle C. Strengths, weaknesses, opportunities, and threats (SWOT) analysis D. 5S methodology
Answer C—Rationale: A SWOT analysis is a vital assessment for successful planning and implementation of a change. A SWOT analysis is used to determine strengths, weaknesses, opportunities, and threats that may affect the project.
*As a CNL, you recognize a sentinel event as which of the following?* A. Any unintended event that results in ANY harm, physical or psychological, to a patient B. Any unintended event that has the POTENTIAL to result in ANY harm, physical or psychological, to a patient C. Any unintended event that results in SIGNIFICANT harm, physical or psychological, to a patient D. Any unintended event that has the POTENTIAL to result in SIGNIFICANT harm, physical or psychological, to a patient
Answer C—Rationale: A sentinel event only occurs if the event reaches and significantly harms a patient.
*As the CNL, you assess the needs of your unit on an ongoing basis. You notice while rounding on the nursing staff that nurses are complaining about the demands of patient care. The nurses state that the patients are requiring more help than usual. This prompts you to look at the level of intensity of care required by patients. Level of intensity of care required by patients is referred to by, which of the following?* A. Volume B. Case mix C. Acuity D. Staffing mix
Answer C—Rationale: Acuity is the level of intensity of care required by patients.
*Part of your hospital's pre-op admission process is to collect a urinalysis (UA), hemoglobin A1c (HgA1c), comprehensive metabolic panel (CMP), and complete blood count (CBC). You review the HgA1c results of these patients. As the CNL, how can you best work with your health care team to ensure health promotion of clients with elevated HgA1c results?* A. Inform patients of elevated HgA1c results, as well as implications of those results B. Provide diabetes education to patients with elevated HgA1c results postoperatively C. Place a consult for the diabetes educator to meet and evaluate patients with an elevated HgA1c during this admission D. Inform the surgeons of these elevated HgA1c results and ask them to consider what the next step should be
Answer C—Rationale: CNLs should work to incorporate other members of the interdisciplinary team in the patient's care when needed and appropriate.
*A Native American patient is admitted with sepsis from a urinary tract infection. The patient is very weak and unable to ambulate much further than her room. The patient tells the CNL that she is very discouraged and feels that she is not able to get better because she is unable to touch "mother earth" with her feet. The CNL gathers some dirt, grass, and flowers from outside the hospital and places it in a bucket. The CNL brings the bucket in the patient's room and helps her to stand on the dirt. Which of the following best describes what the CNL is demonstrating?* A. Cultural knowledge B. Cultural awareness C. Cultural skills D. Cultural management
Answer C—Rationale: Cultural skills are described as the ability to identify, assess, and incorporate the values, beliefs, and cultural customs of an individual.
*As the CNL on a surgical unit, nurses have expressed to you their concern over conflicting orders regarding patient intravenous fluids (IVFs). Most patients have conflicting order sets for fluids and rates, as ordered by the surgeons and hospitalists. From a health care informatics perspective, what is the best action you can take as the CNL?* A. Coordinate with the surgical and hospitalist groups to alert them of this clinical concern B. Instruct the nurses to discontinue the older orders per protocol to clean up the order set within the electronic health record (EHR) C. Work with the computer specialists to create a hard stop in the system requiring physicians to verify or modify IVF orders when new orders are placed D. Discuss with the pharmacy if there is a way to prevent more than one IV fluid order from being allowed in the EHR at a time
Answer C—Rationale: From the health care informatics perspective, creating a hard stop that requires doctors to evaluate the current orders would be most beneficial. There are times when multiple fluid orders may be clinically appropriate, and changes to the system to not allow more than one order under any circumstance would not be beneficial.
*As the CNL on a medical floor, you recognize the importance of annual flu vaccinations, especially considering your geriatric population. How can you promote vaccination rates within your population?* A. Organize a flu clinic for staff and visitors B. Ask a physician to order flu shots for all admitted patients, and organize a flu clinic for staff and visitors C. Within the hospital, develop a nurse-driven protocol that allows nurses to place an order for flu shots for your population D. Ask the physician to order flu shots for all admitted hospital patients
Answer C—Rationale: Nurse-driven protocols are an excellent way to ensure that the population receives vaccinations. Flu shots may not be appropriate for all hospitalized patients, based on personal beliefs or current treatment, and should not be mass ordered.
*Which of the following best demonstrates how the CNL exhibits collaboration?* A. Sets and shares clear goals for teams B. Keeps all team members informed by e-mailing updated minutes C. Includes all contributors to the health care delivery process in the team, including patients/family, and seeks consultation from all members when making decisions D. Monitors and evaluates the use of technology and information systems
Answer C—Rationale: The CNL seeks collaboration and consultation with all contributors to the health care delivery process, including the patient and family.
*A nurse comes to you with a concern about a telephone order she received from a doctor. The doctor asked her to review a physician order for life-sustaining treatment (POLST) form with a client, then sign and place it in his chart. The nurse is uncertain if this is in her scope of practice. You advise the nurse to:* A. Complete the form as ordered by the MD B. Review the hospital's policy and procedure manual, and handle per policy C. Review the State Board of Nursing Scope of Practice and handle according to your scope of practice D. All of the above
Answer C—Rationale: The CNL should identify the State Board of Nursing as the correct source of any scope of practice questions, and advise the nurse that it is not within her scope.
*As the CNL is integrated into practice, what best defines his or her level of practice?* A. Unit system B. Mesosystem C. Microsystem D. Macrosystem
Answer C—Rationale: The CNL works on the microsystem level.
*A client on your unit receives 10 times the ordered dose of an opioid, resulting in serious complications from which the patient fully recovered. In response to this occurrence, you as the CNL:* A. Reprimand the nurse who administered the medication in error to ensure it does not happen again B. Conduct a failure mode-effect analysis C. Conduct a root cause analysis (RCA) D. Apologize to the client and family
Answer C—Rationale: The priority is to conduct an RCA, which would include investigating what occurred with the nurse who administered the opioid and identify any issues in personal or unit process that may have affected the error, to prevent not only the individual nurse from making the same mistake again, but the whole unit from making a similar mistake. Errors should be met with investigation, not with punishment. If there is a performance issue, then it should be addressed by management.
*Recently, several major practice changes have been implemented hospital-wide at your facility. While all of these changes are evidence based, some of the practice changes have been received by the staff on your unit with strong resistance and poor compliance. As the CNL, you recognize that the best way to approach this issue is to:* A. Have the unit manager write-up noncompliant staff B. Advocate to have the policies altered or revoked C. Form a task force of involved parties to identify barriers to compliance D. Re-educate staff on the policies and their importance
Answer C—Rationale: While any of these interventions may be appropriate, when addressing any issue, especially issues with strong opinions and various stakeholders, it is critical that the CNL solicit input from all invested players.
*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:* A. Advocacy B. CNL role integration C. Leadership D. Lateral integration
Answer D—Rationale: Accessing resources across disciplines to meet the needs of a client population in a patient-centered manner addresses specifically lateral integration.
*In your cohort you work with all members of the team. You develop an effective plan of care across settings in collaboration with all disciplines, professions, and stakeholders, including patients. This would be an example of what component of lateral integration?* A. Communication B. Coordination C. Evaluation D. Collaboration
Answer D—Rationale: Collaboration is defined as the interdisciplinary process of problem solving that involves shared responsibility for decision making as well as the execution of specific plans of care while working toward a common goal. The CNL promotes collaboration and consultation with all contributors to the health care delivery process, including the patient and his or her family.
*The patient confides in you and states that she does not take her medications as prescribed and does not go to her doctor's appointments due to lack of transportation. As the CNL, you discuss your findings with the CCM, and place a financial counseling consult. The CCM orders a home safety evaluation, and a medical-social worker provides bus passes and community resources. This is an example of what key element of the CNL role?* A. Ongoing evaluation B. Communication C. Collaboration D. Coordination
Answer D—Rationale: Coordination requires intentional planning and direction. The CNL is responsible for coordinating the flow of communication, activities of the team members, and the services provided to the patients.
*In order to be successful while utilizing Kotter's change theory, you realize it is vital to spend time on the first step. Which of the following best represents the first step in Kotter's change theory?* A. Having celebrations for short-term wins B. Communicating the change vision C. Consolidating gains and producing more change D. Obtaining buy-in and creating a sense of urgency for change
Answer D—Rationale: Kotter's change theory emphasizes that adequate time be placed on the first step of change, which is establishing a sense of urgency in order to have adequate buy-in from stakeholders.
*The primary focus of the CNL is best defined as:* A. Delivery of high quality, evidence-based, culturally competent care at the patient's bedside B. Educating and mentoring peers to improve clinical competence C. Providing patient care management and leadership of the interdisciplinary team meetings D. Evaluating and supporting evidence-based practice (EBP) decisions to ensure best possible outcomes
Answer D—Rationale: The focus of the CNL is on ensuring outcomes, and the CNL does so by evaluating and implementing evidence-based research.
*The CNLs noticed that the supply room was cluttered and oftentimes supplies had expired. They created a team and conducted a 5S to organize the supply bins and reduce waste. Where will the CNLs see the cost savings with supplies reflected?* A. Capital budget B. Cash flow budget C. Cost-effectiveness analysis D. Operating budget
Answer D—Rationale: The operating budget is the day-to-day operations of the unit, including revenue, volume, and expenses. Cost savings related to supplies would be in the operating budget.
