Final Exam - Leadership

ANS: B With federal funding, many controversial health care services will be covered and provided as part of patient care when desired by the patient; therefore, whether a nurse has autonomy to refuse to provide care may not be as clear even when one might request another patient.

The Health Care Reform Act provides insurance for all U.S. citizens and legal residents presenting far-reaching ethical considerations related to diverse individual patient health care beliefs for those delivering nursing care. Nurses must consider their civil rights under the rights of conscience and how new health care agendas such as the Patient Protection and Affordable Care Act (PPACA) could affect their practice in situations that may conflict with their own belief system. What action demonstrates a nurse attempt to act in accordance with this responsibility? a. Remembering it is one's professional duty to render patient-centered care—even when it is in direct conflict with the nurse's own beliefs—or be held liable for withholding treatment. b. Considering whether the right to act according to one's inner beliefs will continue to be permissible when federal health insurance becomes fully enacted. c. Discussing with the patient and family different options in hopes they will accept the nurse's health care beliefs. d. Suggesting to the hospital administration that they not accept federal funding to prevent controversial health practices.

ANS: D After completing all steps in the situation assessment procedure, the client is now ready to justify her selection. In this phase, the person will specify reasons for the action, will clearly present the ethical basis for these reasons, will understand the shortcomings of the justification, and will anticipate objections to the justification.

A client and her husband used in-vitro fertilization to become pregnant. The unused sperm was frozen so the couple could have more children later. The husband is killed while in combat, and the client journals her choices and the possible ramifications. She comes to the fertility clinic after looking at the situation from many perspectives and after considering many alternatives. She asks that the sperm be destroyed because her husband's faith prohibited remarrying, and allowing another person to use the sperm would conflict with her late husband's beliefs. When considering this scenario, the nurse realizes what? a. The client is in the second step of ethical decision making and that the client's value system is influencing her choices of alternative actions. b. A logical line of reasoning has led to validation of the decision to destroy the husband's sperm. c. The client has not been able to navigate the complicated issues inherent in this situation. d. A rational decision was reached that was based on reflection and on the value systems of the wife and the husband.

ANS: B Pareto charts are used to prioritize areas to reduce medication errors. Eighty percent of all errors were caused by interruptions, so this should be the area of priority.

A hospital is concerned that the number of medication errors has increased significantly in the past year. A project revealed four causes of medication errors. The above chart was used to help staff and administration know where to focus efforts to reduce errors. Which process improvement tool is used in this situation? a. Run chart b. Pareto chart c. Flowcharts d. Cause-and-effect diagrams

ANS: D The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision-making and change-implementation processes, and should clearly communicate goals and work expectations to all staff members.

A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication.

* Which statements concerning licensure as a registered nurse are correct? Select all that apply A. Candidates for licensure must present proof of graduation as required by the state B. It is illegal for states to ask about the mental or physical status of an applicant C. A nursing license cannot be revoked, only suspended D. Each nurse practice act describes requirements for initial licensure E. Candidates for licensure must complete a background check

A, D, E

* The RN is having a very busy morning. He is trying to find a doctor to ask a question when a family member of another patient stops him in the hallway. The RN has his arms crossed and is avoiding eye contact. This is an example of A. Blocking B. False Assurance C. Closed Communication Style D. Conflicting messages

A. Blocking

* What is the key element of success for a nurse manager as a leader? A. Including the direct care nurses in decision-making B. Leading a team with a limited number of team members C. Resolving the financial issues of the organization effectivley D. Allocating different nurses for specific tasks effectively

A. Including the direct care nurses in decision making

The staff on a nursing unit notes that patient satisfaction varies from month to month. They plot the degree of patient satisfaction each month for 1 year to determine when the periods of greatest dissatisfaction are occurring. The staff uses which type of graph to present this information? a. Time plot b. Fish bone diagram c. Flowchart d. Cause-and-effect diagram

ANS: A A run plot, or time plot, graphs data in time order to identify any changes that occur over time. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols.

The surgical team arrives in the operating room and one-member states, "Everyone stop. Let's identify the patient and operative site. Now does anyone have any questions or concerns?" This process is referred to by what term? a. Time-out b. A critical pathway c. Special cause variation d. Lean methodology

ANS: A A time-out occurs in the operating room to ensure the entire surgical team identifies the patient, operative site, and possible concerns or questions about the procedure.

The nurse who admits making a medication error and immediately files an incident report is demonstrating what ethical principle? a. Accountability b. Individuality c. An injustice d. Values clarification

ANS: A Accountability is an ethical duty that states that one should be answerable legally, morally, ethically, or socially for one's actions.

A nurse is completing the degree requirements for an advanced practice role as a nurse practitioner and is concerned about certification requirements. Which statement concerning certification for advanced practice is true? a. All states require certification for all specialty roles that are identified as advanced practice. b. Nurse anesthetists and nurse-midwives are the only advanced practice role that require certification in the state nurse practice acts. c. Scope of practice remains unclear in state nurse practice acts due to the increasing number of new advanced practice roles. d. Certification is automatic when the nurse applies for an advanced practice license.

ANS: A All states require evidence of certification in the specialty area, and many require periods of practice in the specialty prior to awarding certification status.

A patient returning from a procedure was somehow "skipped" when daily baths were performed and requests that care now be provided now. The nurse discovers the bed is rumpled and damp. The RN joins with some other staff to bathe the patient, change the bed, and help make the patient comfortable. These staff members are demonstrating what ethical concept? a. Altruism b. Veracity c. Autonomy d. Whistle-blowing

ANS: A Altruism is concern for the welfare of others, including willingness to help others when they are unable to get their assignments completed to ensure that the patient receives high-quality care.

An RN is consistently late to work, causing reassignment of patient care and the need for repeated shift reports. The nurse, who receives a warning for repeated tardiness, states, "My husband left me, I have no car, no family close by, and the bus is always late, which makes me late. The nurse manager doesn't care how hard I try to get here, and I am raising a child by myself." The nurse is using which type of logical fallacy? a. Appeal to emotion b. Appeal to tradition c. Hasty generalization d. Confusing cause and effect

ANS: A An appeal to emotion is an attempt to manipulate other people's emotions for the purpose of avoiding the real issue.

After keeping a log of activities designed to improve time management, the nurse divides the distractions into internal and external sources. The nurse would classify which distraction as internal? a. Responding to recurring crises at work or in one's personal life b. Unsuccessful attempts to communicate with the unit manager c. Talking with potential faculty candidates d. Being given unclear job responsibilities

ANS: A An internal distraction is one that can be controlled only by the person affected; it is important for each of us to recognize and understand the distracters that inhibit our ability to complete tasks and to meet our objectives and goals.

According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Authoritative b. Closed systems c. Open systems d. Trait

ANS: A Autocratic/authoritative management style revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place.

During a seminar on ethics, the educator realizes that more information is needed when a participant describes which situation as a violation of the ethical principle of autonomy? a. An older person with advanced stages of Alzheimer's disease is denied the right to ambulate in the hallway. b. A mentally competent adult refuses medical treatment for the autoimmune disease lupus erythematosus, stating that this condition reflects the will of a higher power. c. A mentally competent visitor fell during visiting hours but refused to be examined by the physician on call. d. A mentally competent adult with a broken wrist refuses to be given a local anesthetic prior to a procedure.

ANS: A Autonomy is defined as personal freedom, the right to make choices. However, in this case, the patient is not able to be fully informed so they can clearly understand the choices being offered.

A researcher calculated the risk-to-benefit ratio and concluded that no harmful effects were associated with a survey of college sophomores. The researcher was applying which ethical principle? a. Beneficence b. Human dignity c. Justice d. Human rights

ANS: A Beneficence is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good.

The nurse should consider delegating the task to which person? a. The one needing to develop related skills b. The one who is up for promotion c. The one who has failed with similar tasks d. The one deserving of a reward

ANS: A Delegating is giving other people tasks to be accomplished. The benefits of delegation involve (1) assisting in developing the initiative, skills, knowledge, and competence of others; (2) maintaining the level of responsibility and decision making of others; (3) freeing time for more important tasks; (4) extending results that can be accomplished from what one person can do alone to what he or she can manage through others; and (5) ensuring that completing the task is cost effective.

What should the nurse who is licensed in Georgia and moves to Oregon should do initially in preparation for seeking a nursing position as a pediatric nurse? a. Review Oregon's nurse practice act related to licensure for endorsement. b. Request application forms to be grandfathered in as a licensed registered nurse in Oregon. c. Request certification in Oregon rather than licensure, so as not to have to retake the NCLEX-RN®. d. Contact the American Nurses Credentialing Center to determine whether licensure in Georgia will transfer to Oregon.

ANS: A Endorsement refers to the original program whereby a nurse who is licensed in one state can apply and seek licensure in another without undergoing repeat examination, in accordance with the nurse practice act of that state. None of the other options effectively provide guidance for the nurse in this situation.

A nurse is assigned to a unit other than the one she is normally assigned due to increased census on the alternate unit. She is assigned to care for seven patients and participates in walking rounds where the patient's condition and needs are discussed between oncoming and off-going shifts of the interdisciplinary team. The nurse carefully makes notes of all pending orders and prioritizes needs. The nurse enters the cafeteria later and the notes accidentally fall from her pocket, which contain the above information that contains patient sensitive data. The liabilities arising from this incident would be covered under what issue? a. Compliance with the Health Insurance Portability and Accountability Act (HIPAA) b. Performance in accordance with the American Nurse's Association (ANA) Scope and Practice Act c. Nursing role in the securing of implied consent d. Personal liability with floating and cross-training

ANS: A HIPAA protects patient information and ensures confidentiality of data.

Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing

ANS: A In total patient care nurses provide all aspects of patient care. This is not true of the other options.

When considering online communication etiquette, which nurse demonstrates a primary rule that should be adhered to by all? a. "My friend's wedding was lovely and anyone wanting to see pictures can view them on my website." b. "I'm not familiar with the details so I'm not going to get into the discuss of whose right or wrong." c. "My cousin's prom dress costed $3,000 and worth every penny her parents spent on it." d. "I got this information at the workshop I attended last month; I'm posting the power points for everyone to review."

ANS: A Interactions online are guided by the same sense of decency that any other style of communication dictates. Certainly, don't fan the flame of conflict or anger. The other options are not respectful of privacy, or potentially copyright laws.

What statement presents accurate information concerning nurse practice acts? a. They are written and passed by state legislators. b. They cannot be influenced by special interest groups. c. They reflect the primary concerns of professional nurses. d. They are affected by other interprofessional practices.

ANS: A Just as other sections of state codes are written and passed by legislators, so is the nurse practice act of each state. None of the other statements are true when considering nurse practice acts.

Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader based on these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational

ANS: A Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertn ess, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.

When differentiating between slander and libel, the nurse knows that libel is characterized by what action? a. Defamation caused by subjective comments written in the nurse's notes b. Negative subjective comments made to those who are not providing care c. Verbally describing to the oncoming nurse assigned to the client objective data that place the client in a negative light d. Repeating prejudiced comments made by the primary caregiver to a neighbor at the local supermarket

ANS: A Libel is defined as comments that are written about a person that are defaming. Nurses may be subject to a charge of libel for subjective comments meant to denigrate the client that are placed in the medical record or in other written materials read by others. Slander refers to an injury to one's reputation caused by the spoken word.

A nurse holds a license in one state but wishes to practice in a second state that is not participating in a nurse licensure compact agreement. The nurse is granted licensure on payment of a fee but does not retake the licensure examination. The nurse has obtained licensure in the second state by what process? a. Licensure by endorsement b. Certification c. Statutory process known as being grandfathered d. Sunset legislation

ANS: A Licensure by endorsement allows a nurse licensed in one state to obtain licensure to practice in a second state without examination. None of the other options provide for nursing practice as described.

How can time be maximized to produce the best outcomes? a. Making the first hour of each workday productive b. Completing trivial tasks before performing important tasks c. Eliminating recreational activities in the work environment d. Omitting breaks until the entire task has been completed

ANS: A Making sure that the first hour of every workday is productive sets the tone for achieving goals. The order of task completion is reliant on priority. The remaining options are considered barriers to efficiency.

A nurse is caring for a client with malignant hypertension whose blood pressure has increased by 40 mm Hg during the past hour. The nurse goes to lunch and fails to report the change to the physician. The nurse is at risk for being charged with which legal claim? a. Negligence b. Assault c. Defamation of character d. Tort

ANS: A Negligence is defined as failure to act in a reasonable and prudent manner. The most frequent allegations of nursing negligence include failure to ensure client safety, improper treatment, failure to monitor the client and report significant findings, medication errors, and failure to follow the agency's policies and procedures.

A nurse is caring for a client who just consented to an elective abortion. The nurse is unsure of his or her own values as they relate to this issue. What action should the nurse take to address this barrier to providing effective care to the client? a. Reflect on one's personal values and how these values relate to beliefs and the philosophy of nursing b. Be prepared to defend his or her value system c. Ignore his or her own values and provide care d. Realize that values do not change and that they cannot be influenced by others and so decline this assignment

ANS: A Nurses must make a deliberate effort to recognize their own values and must learn to consider and respect the values of others. Health care decisions are seldom made independently of other people. Decisions are made with the client, the family, other nurses, and other health care providers.

The task of completing and signing the initial assessment on a newly admitted patient who is about to undergo minimally invasive procedures on an outpatient basis can be delegated to whom? a. The registered nurse (RN) b. The licensed practical/vocational nurse (LPN/LVN) c. Unlicensed assistive personnel (UAP) d. All levels of staff, because the information is about the past and cannot change

ANS: A Only the RN can perform and sign the admission assessment, although some components such as monitoring vital signs may be delegated.

When a nurse uses a criteria such as "high risk for falls," "infection protocols," and "special communication needs" to determine the mix and number of staff needed on a telemetry unit, what is the nurse is using? a. A patient classification system b. Diagnostic-related groups c. Case management d. Clinical pathways

ANS: A Patient classification systems group patients according to care needs to determine safe staffing levels.

According to the Quality Chasm report what statement is true? a. Health care providers should be proactive rather than reactive to patient needs. b. Common needs rather than individual preferences should be the priority. c. Medical information should be confined to the primary care provider. d. Specialized providers or case managers should control health care decisions.

ANS: A Quality is based on predicting patient needs rather than reacting to needs.

A staff nurse provides care based on intuition and always seems to be in control of her personal and professional life—serving on the board of the state nurses association, serving as the nursing unit's representative on the ethics committee, and coaching her daughter's soft ball team. Many of the staff observes how she manages time and provides care. This nurse's power comes from which type of power? a. Referent b. Legitimate c. Information d. Connection

ANS: A Referent power comes from the followers' identification with the leader. Referent leaders are admired and respected and able to influence other nurses because of their desire to emulate her.

A nurse testifies at trail that a professional with the knowledge and skill of an RN should understand that, before administering digoxin, the client's potassium level and pulse level is always checked to prevent negative effects on cardiac output. The nurse's testimony as to what constitutes reasonable care is based on what criteria source? a. The legal definition of standard of care b. The legal definition of the informed consent process c. The doctrine of res ipsa loquitur d. The concept of governmental immunity

ANS: A Standard of care is the legal criteria against which the nurse's (and primary care provider's) conduct is compared to determine whether a negligent act or malpractice occurred. Nurses are specialists in hospital care who, in the final analysis, hold the well-being—in some instances, the very lives—of patients in their hands.

A team of experienced nurses work together to develop algorithms that are converted into checklists to ensure standardization of commonly performed procedures. The focus of this team is primarily on which Institute of Medicine (IOM) competency? a. Safety b. Timely c. Equitable d. Patient-centered care

ANS: A Standardization contributes to safety and improves individual performance of care providers.

A client arrives in active labor and exhibits toxemia with irregular fetal heart tones. The client is an immigrant and is uninsured. Which act would prevent the client from being transferred to another facility? a. The Emergency Medical Treatment and Active Labor Law b. Health Insurance Portability and Accountability Act c. Patient Self-Determination Act d. The Patient Safety and Quality Improvement Act

ANS: A The Emergency Medical Treatment and Active Labor Law is a federal statute that was enacted in 1986 to prohibit the transfer of unstable clients, including women in labor, from one facility to another. This law also prohibits refusal of care for indigent and uninsured clients who seek medical assistance in the emergency department.

Which task is most likely to be considered in a state's practice act as appropriate to delegate to a LPN/LVN if the patient's condition is stable and competence in the task has been established? a. Administer an enema for an elective surgery patient. b. Administer an antiarrhythmic medication IV while interpreting the patient's rhythm on the cardiac monitor. c. Develop a plan of care for a stable patient admitted for observation after a head injury. d. Teach a patient how to instill eye drops for glaucoma.

ANS: A The RN who is delegating must consider the following: (1) the delegate's current workload and the complexity of the task, (2) whether the staff member is familiar with the patient population and with the task to be performed, and (3) whether the RN is able to provide the appropriate level of supervision. The delegation decision-making tree would also support delegation of this task.

What entity establishes the "rules" for nursing practice? a. Individual state boards of nursing b. Employer, based on area of practice c. United States Department of Health and Human Services d. Local health officials

ANS: A The State Practice Act of each state establishes the rules for practice within that state.

As part of a quality assurance project, a nurse is to round on every patient daily for 1 month to ensure the intravenous tubing is labeled with date hung and nurse's initials. The nurse is hoping to be promoted to a full-time position within the quality department, and success on this project is very important to receiving the position. The nurse retains all other assignments, and is often interrupted to help other staff or answer call lights. The nurse discusses these concerns with the manager, who frees him/her for 1 hour each day to make rounds. During this 1 hour each day the nurse will organize herself/himself and environment by practicing what organizational method? a. Art of "no detourism" b. Reducing stacked-desk syndrome c. Art of "wastebasketry" d. Managing e-mail and memo mania

ANS: A The art of "no detourism" focuses on one task until completed.

A nurse is concerned about the risk of delegating tasks to licensed practical nurses and unlicensed assistive personnel. What is the best way for the nurse to determine competency of an inexperienced delegatee? a. Personally observe the delegatee perform the assigned task. b. Ask the delegatee how many times he/she has performed the task. c. Question the patient to confirm that the care provided was satisfactory. d. Ask other nurses if they feel the delegatee is competent.

ANS: A The best way for the nurse to determine the competency of LPNs or UAPs is to observe them perform the task.

Regardless of the term used to describe high-quality health care, what is the primary focus of quality? a. Meeting consumer needs and wants b. Providing economical care c. Utilizing technologic advancements d. Equally distributed care

ANS: A The customer determines quality based on his or her unique perception of high-quality care.

The RN instructs the LPN to "Give an enema to the discharged patient in room 327 who is reporting being constipated. Then be sure to document on the medication administration record when given." Which of the five rights was missing in this situation? The right of a. direction and communication. b. task. c. person. d. circumstances.

ANS: A The directions were not clear. The RN did not specify which type of enema to give and what outcome to expect. And the RN gave no instructions related to reporting back.

An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent

ANS: A The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. These are characteristics of the autocratic style.

When deciding whether to say no to a request that involves a time commitment, the professional nurse must consider what initially? a. The cost-benefit ratio b. The time commitment of coworkers c. Ways to buffer saying no d. Personal preference

ANS: A The first step in learning the art of saying no is determining when to say it. The cost/benefit ratio of each opportunity must be evaluated in relation to the overall goal. If the activity will provide an overall benefit, obviously it must be given careful consideration. If it will not result in significant benefit, decline gracefully but emphatically. Personal preference may be a consideration but it is not the initial consideration. Neither of the remaining options are significant factors to making a personal decision.

When assessing an ethical issue, what is the nurse's first intervention? a. Ask, "What is the issue?" b. Identify all possible alternatives. c. Select the best option from a list of alternatives. d. Justify the choice of action or inaction.

ANS: A The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Assessment can be applied to all areas of patient care, including ethics. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort.

What action is considered a nursing responsibility when participating in a nurse licensure compact? a. Complying with the nursing practice laws in the state where practicing at the time care is rendered b. Purchasing a license in each state or retaking the licensure examination c. Determining residency based on the state where educated as registered nurse d. Practicing only in states or territories that recognizes the NCLEX as the source of licensure

ANS: A The nurse is accountable for practicing according to the state practice laws where patient care was provided, although disciplinary action is the responsibility of the state of the nurse's residency. None of the other options accurately reflect nursing responsibilities in the situation described.

The nurse manager is planning staffing levels and realizes that the first step is to focus on what activity? a. Knowing the intensity of care needed by patients according to physical and psychosocial factors b. Examining the educational level of the staff c. Assessing the skill level of caregivers d. Reviewing the budget to determine the financial consequences of past staffing patterns

ANS: A The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients.

A patient is admitted with hypotension, shortness of breath, flushing, and hives. All levels of staff have been trained to assess vital signs. Given budget restrictions and proper delegation rules, to which care provider would the RN delegate the task of obtaining the initial blood pressure reading? a. RN b. LPN/LVN c. Unlicensed assistive personnel (UAP) d. Since all are trained, the task can be delegated to anyone

ANS: A The patient's condition is not stable; therefore, the skills of an RN are required.

A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary

ANS: A The transactional leader is concerned with the day-to-day operations of the facility; like those described in the question.

A nurse practicing in the early 1900s was awarded a permissive license. What action was required by this type of license? a. While licensure was voluntary; if you failed the examination, you could not use the title RN. b. To qualify for licensure, you were required to complete a maximum of 1 year of formalized nurse training. c. All candidates were required to take and pass an exam provided by the state board of nursing. d. The nurses were required to select either a written or an oral form of the licensure examination.

ANS: A These permissive licenses permitted but did not require nurses to become registered. Nurses not passing the examination could not use the title of RN. Under permissive licensure, educational standards were set at a minimum of 2 years of training for nurses. State boards of nursing were established with rules for examinations as well as revocation of the license. Under permissive licensure, educational standards were set at a minimum of 2 years of training for nurses. State boards of nursing were established with rules for examinations as well as revocation of the license. Nurses not passing the examination could not use the title of RN.

A nurse manager wants his nursing unit to be a place where all nurses want to work, where patient satisfaction is high, and care is innovative and interdisciplinary. Staff are encouraged to chair taskforces to improve quality of care and he counsels staff in areas of measuring patient outcomes. Other managers want to mimic this manager's approach to improve their own units. This nurse is which type of leader? a. Transformational b. Transactional c. Laissez-faire d. Authoritative

ANS: A Transformational leaders mentor followers through a vision and are admired and emulated.

To persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance

ANS: A Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change.

Which statement made by an RN regarding delegation indicates the need for additional teaching? (Select all that apply.) a. Unlicensed assistive personnel (UAP) can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction now is unlikely. b. An LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD. c. When dopamine is ordered continuously, the LPN/LVN can administer dopamine at a low dose for increasing renal perfusion. d. UAPs can transfer a patient who is being discharged home from the wheelchair to the bed if they have received training and demonstrated competency. e. Responsibility can be delegated to the UAP, but the delegator retains accountability.

ANS: A, B, C The statement "UAPs can assess vital signs during the first 5 minutes for a patient who is receiving a blood transfusion because a reaction at this time is unlikely" indicates the need for further teaching because the patient is at highest risk of a reaction during the first few minutes of a blood transfusion; thus, the assessment skills of an RN are required. The statement "an LPN/LVN can administer a PPD (tuberculin skin test) if there is no history of a positive PPD" indicates the need for further teaching because administration of intradermal medication requires the skill of an RN. Dopamine is a vasoactive drug that can have a profound effect on a patient's blood pressure and cardiac output; administration requires the assessment and evaluation skills of an RN.

Throughout their careers, nurses are in an ongoing state of acculturation, gaining experience from formal nursing school classes, clinical experiences, and the ethical issues they encounter in their clinical practice. What are the ideal outcomes of these ongoing experiences with cultural decision making? (Select all that apply.) a. Increased trustworthiness b. Enhanced ability to take into consideration many aspects of ethical situations c. Confidence to make decisions based on experience and ethical intelligence d. Improved clinical decision making and advocacy for patient autonomy e. Authority to make ethical decisions independently that meet personal moral beliefs

ANS: A, B, C, D The desired outcomes of ethics acculturation across the years are integrity, personal growth, practical wisdom, and effective problem solving on behalf of patients and their families. These are the qualities that are characteristics of an ethically sensitive and morally mature person. Trustworthiness is a characteristic of integrity. The ability to take into consideration many aspects of ethical situations is due in part to personal growth and practical wisdom. The confidence to make ethically sensitive decisions comes from experience founded on personal growth and personal wisdom. The ability to be the patient's advocate in ethical decision making is one test of cultural acculturation.

Which components must be included regarding informed consent? (Select all that apply.) a. Identification of risks for non-treatment b. Discussion of expected benefits c. Identification of known risks d. Acknowledgement of alternative therapy e. Communication of the estimate cost involved

ANS: A, B, C, D The information that constitutes informed consent for the client includes the nature of the therapy or procedure, expected benefits and outcomes of the therapy or procedure, potential risks of the therapy or procedure, alternative therapies to the intended procedure and their risks and benefits, and risks of not having the procedure. Cost is not a component of informed consent.

A nurse responsible for staffing a medical-surgical unit must consider what factors (Select all that apply.) a. The patient census b. Physical layout of the unit c. Complexity of care required d. Educational level of all staff e. Task preferences of the nurses

ANS: A, B, C, D The primary considerations for staffing a specific nursing unit are the number of patients; the level of intensity of care required by those patients (commonly referred to as patient acuity); contextual issues, such as architecture, geography of the environment, and available technology; level of preparation and experience of the staff members providing the care; and the quality of the nurses' work life.

Which functions can be delegated only to another RN with appropriate experience and training? (Select all that apply.) a. Assessment of skin integrity on third day of hospitalization b. Evaluation of patient teaching related to turn, cough, and deep breathing exercises c. Nursing judgment related to withholding medication based on vital signs d. RNs do not delegate to other RNs, they delegate only to licensed practical nurses or unlicensed assistive personnel. e. Formulation of nursing diagnosis "potential for fall"

ANS: A, B, C, E Activities like assessing skin integrity—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like evaluating patient teaching—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like deciding to withhold medication based on vital signs—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN. Activities like formulating a nursing diagnosis—which include the core of the nursing process and require specialized knowledge, judgment, and/or skill—can be delegated only to another RN.

The National Database of Nursing Quality Indicators (NDNQI) identifies what client focused events as outcome indicator? (Select all that apply.) a. A patient falls and fractures a hip. b. A patient develops bilateral pressure ulcers on their heels. c. A patient develops a catheter-associated urinary tract infection. d. A patient develops post-surgical delirium. e. A patient develops pneumonia related to ventilator use.

ANS: A, B, C, E Outcome indicators include patient falls, pressure injuries, catheter-associated urinary tract infections, and ventilator-associated pneumonia. Post-surgical delirium is not identified by this organization.

Which nursing situation demonstrates the greatest need for individual malpractice insurance to help manage professional legal risk? (Select all that apply.) a. Accepting the role of weekend unit manager b. Delegating health care responsibilities to nursing staff c. Working for the federal government attending to embassy staff d. Being licensed in a state where sovereign immunity is in effect e. Regularly working in the facility's float pool

ANS: A, B, D, E Reasons given for the purchase of malpractice insurance by RNs include the following; expanding functions of RNs and advanced practice nurses; floating and cross-training mandates; increasing responsibility for supervising subordinate staff; working in states where sovereign immunity makes health care workers not health care facilities liable for neglect. Being employed by the federal government can shield the nurse from personal liability by federal tort statutes in some cases.

Which factors would be considered in the first steps in developing an effective patient classification system? (Select all that apply.) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients

ANS: A, B, E The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements.

What duties are assumed by a state's board of nursing? (Select all that apply.) a. Grants nursing licensure. b. Constructs the licensure examination. c. Assigns disciplinary action when the nurse acts in a manner that results in harm to a patient. d. Assures qualified members are appointed to the board. e. Conducts certification examinations for advanced practice nurses.

ANS: A, C, D The board of nursing ensures that nursing licenses are granted and renewed. The board of nursing assigns disciplinary action when provisions of the nurse practice act are violated. Members are appointed to the board with attention to their qualifications. The boards are not responsible for the creation of licensure or certification examinations.

A patient with complicated diabetes is scheduled for a below the knee amputation at 7 AM. The surgical team adheres to the 2018 National Patient Safety Goals by implementing which protocols? (Select all that apply.) a. The surgical team asks the patient to verify his or her name, type of surgery, and limb to be removed. b. Ask each member of the surgical team to provide a copy of licensure and, if applicable, certification to patient and family. c. The surgical team uses the chart number and name/hospital number to ensure they have the correct patient. d. Mark the procedure site with "X" and again ask the patient to verify correct site. e. After arrival in the operating room, perform a "time-out" for final identification of patient and operative site along with agreement of what procedure is scheduled.

ANS: A, C, D, E The 2018 National Patient Safety Goal includes universal precautions to ensure patient safety and prevent sentinel events. Methods to identify patient and surgical procedure are required.

Registered nurses who are entering the workforce will have expanded leadership responsibilities that include what tasks? (Select all that apply.) a. Serving on interdisciplinary care teams b. Being competent to work in several areas independently when dictated by patient census c. Attending a meeting to plan advanced training for unlicensed assistive personnel d. Evaluating outcomes of care that are reported to a standing committee e. Managing units with higher acuity, shorter length of stay, and more diverse patients and staff

ANS: A, C, D, E The new nurses will be placed in many situations that require leadership and management skills: for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. Diverse patients have comorbidities and require complex interventions delivered during shorter stays with an ever-increasing diverse staff. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.

While participating in a task force to proactively plan for nursing care delivery over the next 20 years, a nurse learns that dramatic changes will occur because of what factor? (Select all that apply.) a. The increases in the number of minimally invasive procedures being performed for disease treatment b. Care provided for patients over an extended period in acute care settings c. The reduction in the number of nurses and other health care professionals who are available to provide care d. The widespread illiteracy and decreased self-efficacy of the aging patient population e. The need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient f. The devaluing of nursing as a means of improving patient outcomes

ANS: A, C, E Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyles and values of a diverse population.

A nursing student is in the final term of an Associate Science of Nursing (ASN) program and is preparing for licensure. Prior to licensure the candidate must provide evidence that they have fulfilled what requirements? (Select all that apply.) a. Graduation from a nursing program b. Graduation from high school or high school equivalency c. Possess current malpractice insurance d. A plan to continue study to obtain a minimum of a BSN within 2 years e. Validation of skills competence provided by a certifying agency

ANS: A,B Candidates for licensure must provide evidence of graduation through transcripts of course work or letter from the Dean/Director of the nursing program. All candidates must show evidence of graduating from high school or earning a GED.

The first task assigned by the time management coach is for the nurse to list all external distractors that prevent organization and completion of tasks. What would the nurse include on this list? (Select all that apply.) a. Waiting for oncoming shift to start walking rounds b. Failing to delegate tasks to the team members but instead, completing task herself c. Talking with a patient's family member who is also a personal friend d. Spending time thinking about the vacation to the beach e. Using the Internet to read about a new drug that will be administered

ANS: A,C Waiting, such as for meetings or oncoming shift, is an external distraction. Socializing with visitors is an external distraction.

A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to by what term? a. Patient classification system b. Clinical pathway c. Patient-centered plan of care d. Diagnosis-related group (DRG)

ANS: B A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition.

Patients with heart failure have extended lengths of stay and are often readmitted shortly after they have been discharged. To improve quality of care, a type of "road map" that included all elements of care for this disease and that standardized treatment by guiding daily care was implemented. This road map is referred to using what term? a. Clinical protocol b. Critical pathway c. Algorithm d. Case management

ANS: B A critical pathway determines the best order and timing of interventions provided by health care team members for a particular diagnosis. Clinical protocols or algorithms are different from clinical pathways because they represent more of a decision path that a practitioner might take during a particular episode or need. Case management is a nursing care delivery system.

When using the ABC system of managing time, which event should be coded A? a. Calling the pharmacy to see whether a drug insert is available for a patient b. Checking to see why a ventilator is alarming c. Organizing the medication cart d. Writing memos to remind everyone to contribute to the boss's birthday gift

ANS: B A items should stand out from other items because of their worth and high level of importance. A items are most urgent and may require more energy and time, but they should be completed before any of the B or C items are performed. Client safety is a consideration for A items.

An inexperienced nurse feels that all tasks must be performed faultlessly, which leads to his/her inability to complete all assigned tasks. This nurse would benefit from the seminar focusing on what potential obstacle to efficiency? a. Creativity b. Perfectionism c. Failure d. Downtime

ANS: B A perfectionist feels that everything should be completed at the same level of excellence. If you demand extremely high standards for every single task you undertake, you simply will not get everything done. None of the other options present this specific type of barrier to efficient time management.

A male nurse hired to work in the emergency department is observed throwing a contaminated needle into the trash can. The team leader reprimands the nurse for not appropriately disposing of sharps. The nurse states, "You don't care that I threw the needle in the trash. You just want an all-female staff," putting the team leader in a defensive position. This communication technique is referred to by what term? a. Straw man b. Red herring c. Slippery slope d. Confusing cause and effect

ANS: B A red herring is the introduction of an irrelevant topic for diverting attention away from the real issue.

A nurse is assisting with the delivery of twins. The first infant is placed on the scale to be weighed. The physician requests an instrument stat. The nurse turns to hand the instrument to the physician, and the infant falls off the scale. When evaluating the incident, the nurse and her manager list contributory factors such as the need for two nurses when multiple births are known, and the location of the scale so far from the delivery field. These nurses are engaged in what process? a. Standardization of care b. Root cause analysis c. Process variation d. Analysis of a deployment flowchart

ANS: B A root cause analysis is a process by which factors that underlie variation in performance, including the occurrence or possible occurrence of a sentinel event, are identified. The purpose of root cause analysis is to identify improvements that can be implemented to prevent future occurrences. Standardization of care is process improvement that involves developing and adhering to best-known methods and repeating key tasks in the same way, time and time again, until a better way is found, thereby creating exceptional service with maximal efficiency. Process variation is a difference in how the steps in a work process might be accomplished and/or the variables that may affect each step in the process. Variation results from the lack of perfect uniformity in the performance of any process. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. This type is especially helpful when dealing with processes that cross multiple areas or caregivers and when there is a need for common under-standing of what the process is doing as a whole.

A nurse is removing a saturated dressing from an abdominal incision and must cut the tape to remove the dressing. The nurse accidentally cuts the sutures holding the incision, and evisceration occurs. In quality improvement, this incident is best identified using what term? a. Root cause b. Sentinel event c. Variation in performance d. Causal factor

ANS: B A sentinel event is an unexpected occurrence that could result in serious physical or psychological injury to the patient, including the possibility of returning to surgery and a prolonged length of stay. A root cause or causal factor is the factor that resulted in a sentinel event. A variation in performance is the action that includes the occurrence or possible occurrence of a sentinel event.

A nurse is preparing to administer a medication by using the vastus lateralis site and is unfamiliar with the process. A step-by-step reference that shows how to complete the process is referred to by what term? a. Deployment flowchart b. Top-down flowchart c. Pareto chart d. Control chart

ANS: B A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A deployment flowchart maps out the steps of a process under headings that designate the people or departments who carry out each step. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added.

A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG). According to the clinical pathway the patient should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically because of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation results in what type of event? a. Patient outcome b. Variance c. Care goal d. Nursing standard

ANS: B A variance is a deviation from the planned path.

An RN delegates to the unlicensed assistive personnel (UAP) the task of performing blood pressure checks for a group of patients on a nursing unit. The UAP accepts the task and is responsible for what associated task? a. Delegating the task to another UAP if he or she does not have the time or skill to complete the task b. Keeping the RN informed of any abnormal blood pressure readings c. Calling the physician when the patient's vital signs are not within established parameters d. Informing the dietary department to initiate a low-sodium diet for patients who are hypertensive

ANS: B After accepting the assignment, the UAP is responsible for completing the task and reporting any patient concerns to the RN. The remaining options are the responsibility of the RN.

A group of registered nurses with associate nursing (and) degrees are concerned that the minimum educational standard for licensure as a registered nurse is being raised to the bachelor's (BSN) level. After contacting the American Nurses Association, they learn they will be "grandfathered" in. Under the "grandfather clause," what action will be required of nurses with associate degrees? a. They will be required to complete a bridge program to earn a BSN and then be tested only on material that was not part of the ASN curriculum. b. They will continue to use the title "registered nurse" earned by their original success with the licensure process. c. They will have 10 years to obtain a BSN or the license will be revoked. d. They will use whatever title is established by their state's board of nursing for associate degree nurses.

ANS: B All ASNs licensed before the change would be "grandfathered" in, allowing them to use the title of RN.

A family requests that no additional heroic measures be instituted for their terminally ill mother who has advance directives in place. The nurse respects this decision in keeping with the principle of what client right? a. Accountability b. Autonomy c. Nonmaleficence d. Veracity

ANS: B Autonomy is the principle of respect for the individual person. Within the concept of autonomy, people are free to form their own judgments and perform whatever actions they choose. They are self-determining agents who are entitled to decide their own destiny.

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via what delivery model? a. Patient classification systems b. Clinical pathways c. Functional nursing d. Case management

ANS: B Clinical pathways plans patient care activities and interprofessional interventions and desired patient outcomes within a specified time period for a particular diagnosis or health condition.

Which nurse is demonstrating a common, productive conflict resolution style? a. The nurse who does not express feelings or ideas that conflict with those of the administration b. The nurse who states," If I cover for you this weekend will you cover for me the weekend before my vacation?" c. The nurse overheard saying, "There is no use fighting this; one solution is as good as another." d. The nurse who regularly insists they have the most insight into the problem being discussed.

ANS: B Compromise occurs when people give up something to get partial goal attainment; such as in the scenario presented. The other options demonstrate avoidance, accommodation, and force as a conflict resolution technique.

Two individuals with no health insurance or money sustained life-threatening injuries during an automobile accident. The decision was made to provide extended care in the trauma center after emergency surgery was performed to save their lives. The care of the two critical clients was based on what ethical principle? a. Utilitarianism b. Deontology c. Autonomy d. Veracity

ANS: B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty.

When the client is unable to make medical decisions, authorization that allows another person to make these decisions is referred to by what term? a. A living will b. Durable power of attorney c. Informed consent d. Immunity

ANS: B Durable power of attorney involves preselection by the client of a person who has been authorized legally to make health care decisions once the client becomes incompetent to do so. Several states have enacted a Uniform Durable Power of Attorney Act, which sanctions a durable power of attorney for health care. None of the remaining options address the inability to autonomously make effective medical choices.

A patient's spouse was just diagnosed with lung cancer although there was no history of tobacco use. The spouse states, "I am so mad. How can you get cancer without smoking?" Which statement by the nurse represents empathy? a. "Research is identifying many risk factors for cancer besides smoking." b. "I understand how you could feel angry about the diagnosis." c. "He is still a good husband." d. "Why do you think he got cancer?"

ANS: B Empathy is feeling what the other person is feeling and seeing the situation as they see it; entails believing that the other person's feelings are valid, legitimate, and justified. The nurse is placing herself in the wife's position and sharing her emotions.

A teenage patient is using earphones to listen to hard rock music and is making gestures in rhythm to the music. The nurse assesses the amount of urine output in the Foley catheter and leaves the room. What communication technique is demonstrated in both situations? a. Blocking b. Filtration c. Empathy d. False assurance

ANS: B Filtration is the unconscious exclusion of extraneous stimuli in communication.

During a health history interview, the nurse listens to a patient relating the precipitating events that led to the onse t of chest pain. She focuses her attention on the patient, makes eye contact, and acknowledges what the patient has to say. The nurse is exhibiting what communication technique? a. Assertive communication b. Active listening c. Empathy d. Passive communication

ANS: B In active listening a number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A hospital converts to a system of care delivery in which RNs, LPNs, and unlicensed assistive personnel (UAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. What term is used to describe this type of delivery system? a. Total patient care b. Functional nursing c. Team nursing d. Primary nursing

ANS: B In functional nursing members of the team are assigned specific tasks such as assessment or medication administration. This is not true for the other options.

A nurse is unable to concentrate on any one task or issue and is unable to view the health care milieu sensibly. Which source of energy is missing in this nurse? a. Physical b. Mental c. Spiritual d. Emotional

ANS: B Mental energy is the ability to maintain sustained concentration on a task, to move flexibly between broad and narrow issues, and to be internally and externally focused, as needed by the situation. It includes mental preparation, visualization, positive self-talk, effective time management, and creativity.

What statement accurately describes what it means to practice in a compact state? a. The nurse must abide solely by the practice act of the largest state. b. Patients' rights in relation to the nurse practice act are protected by the mutual recognition model. c. The nurse must pay for a license in all states that participate in the mutual recognition model. d. The nurse must refer to the nurse practice act for the list of skills that can be performed.

ANS: B Nurses who practice in a compact state are responsible for following the laws and regulations of each state in which they practice. None of the other options accurately reflect practice in a compact state.

A nurse manager is mentoring a novice nurse manager in determining staffing needs. The mentor explains that the acuity level of the patient is determining by implementing what process? a. "Assessing patient satisfaction with nursing care." b. "Quantifying the amount and intensity of care required." c. "Examining the skill mix and educational preparation of the staff." d. "Determining the number of hospital days required by the patients."

ANS: B Patient acuity is measured by determining the amount and intensity of care required.

A patient has decided to stop hemodialysis because his renal failure progresses and he wishes to spend more time with family. Palliative care will continue, and the approach will be discussed with the patient and family as needed and at change of shift. The care delivery model in this situation is referred to by what term? a. Partnership b. Patient-centered c. Case management d. Total patient care

ANS: B Patient-centered care models entail the health care team partnering with the patient and family to ensure that patients' wants, needs, and preferences are the priority while allowing the patient and family to participate in decisions and educational needs.

Although a hospital reversed all charges when a client was the victim of wrong site surgery, the court awarded the client $1.5 million. The client could return to work in 6 weeks and had no permanent damages. This monetary compensation is referred to by what term? a. Lability b. Punitive damages c. Vicarious liability d. Immunity

ANS: B Punitive damages are monetary compensation to an injured client that is greater than amount of loss. It is monetary compensation awarded to an injured person (patient) that goes beyond that which is necessary to compensate for losses (e.g., the ability to function, death, income) and is intended to punish the wrongdoer.

A nurse takes a day to travel to a state park where she/he can sit by the river alone to reflect over recent events and put things into perspective. Time is spent recalling the time he/she was complimented for the ability to deal with a difficult patient and another time when he/she was criticized for lack of teamwork. This nurse is improving which source of energy? a. Emotional b. Spiritual c. Physical d. Mental

ANS: B Spiritual energy can be increased by taking time to reflect over events in one's life and allowing time to understand feelings associated with events/happenings. A quiet environment is essential for reflection.

The nurse manager determines that four RNs, five LPN/LVNs, and two unlicensed assistive personnel (UAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with what related process? a. Assignments b. Staffing c. Output d. Productivity

ANS: B Staffing is the activity of determining that an adequate number and mix of health care team members are available to provide safe, high-quality patient care.

Nursing legislation is to be current and reviewed annually by specific dates. If a nurse practice act fails to be reviewed, it is automatically rescinded under which law? a. Nurse review act b. Sunset legislation c. Mandatory revocation d. Grandfathering

ANS: B Sunset legislation may be included in a state's nurse practice act, and this means that the act must be reviewed by a specific date; if not, it is automatically rescinded.

Nurses working on an orthopedic unit use personal digital assistants (PDAs) to review medications prior to administration to reduce potential drug interactions. Software is also installed that provides video clips of common procedures performed by nurses. Nurses on this unit are best demonstrating which QSEN competencies? a. Patient-centered care b. Informatics c. Teamwork d. Quality improvement

ANS: B Technology (PDA) is used to aid decision making and reduce errors.

A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe, high-quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in high-quality, safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost-effective; thus, is it important for staffing models to limit the number of RNs assigned per shift.

ANS: B The ANA recommends that nurses have time to exercise professional judgment; that would include the achievement of outcomes?

What nonprofit organization distributes knowledge related to health care for the purpose of improving health to governmental agencies, the public, business, and health care professionals? a. Institute for Safe Medication Practices b. Institute of Medicine (IOM) c. National Committee for Quality Assurance d. The Joint Commission. (TJC)

ANS: B The Institute of Medicine is a nonprofit organization whose mission is to advance and disseminate to the government, the corporate sector, the professions, and the public scientific information that will improve human health.

An RN delegates to an experienced LPN/LVN the task of administering oral medications to a group of patients. The RN then observes the LPN/LVN recording a patient's medication administration just before entering the patient's room. What is the RN's initial intervention? a. Checking the patient's drug packages to ensure that the correct drugs were given. b. Stopping the LPN/LVN immediately and nonjudgmentally discuss the possible consequences of this action. c. Contact the nurse manager and ask that the LPN/LVN's license be suspended. d. Call the pharmacy and ask for replacement medications for the patients.

ANS: B The LPN/LVN has the competency but violated one of the rights of medication administration and is practicing unsafe care. The RN's initial responsibility requires that he or she intervene and identify concerns with the LPN/LVN.

On which website would a nurse find a list of current compact states that allow for a single license recognized in multiple states? a. National League for Nursing (NLN) b. National Council of State Boards of Nursing (NCSBN) c. American Association of Colleges of Nursing (AACN) d. Commission on Collegiate Nursing Education (CCNE)

ANS: B The NCSBN website contains this information.

A nursing unit comparing team nursing to the partnership model would find what statement to be true? a. With the partnership model, an RN does not have to be part of the mix. b. Leadership abilities of the RN are a major determinant of effectiveness of care for both models. c. The RN teaches the LPN/LVN or unlicensed assistive personnel (UAP) how to apply the nursing process in team nursing. d. With team nursing the RN cares for the patient while the team members work with the family or significant others.

ANS: B The RN leads regardless of whether partnership model or team nursing is practiced.

A student nurse is concerned about delegation practices and wonders why hospitals employ unlicensed assistive personnel (UAP) and LPN/LVNs. The student nurse refers to the National Council of State Boards of Nursing and learns that the role of these personnel is to focus on what? a. Supplementing the staffing pattern when an RN is not available b. Aiding the RN by performing appropriately delegated care tasks c. Replacing the RN when the health care facility provides long-term care d. Providing patient teaching, allowing more direct care to be provided by the RN

ANS: B The UAP and LPN/LVN can increase productivity of the RN by performing those tasks that fall within their scope of practice.

What title identifies a nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers? a. Nurse manager b. Case manager c. Coordinator of patient-centered care delivery d. Team leader in team nursing care delivery

ANS: B The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness.

Each month data on admission assessments that are based on the following standard are entered: "All patients will be assessed by an RN within 2 hours of admission." The target goal for this standard is 97% compliance. Data are displayed on a graph that shows number and time of admission assessments and compliance variation limits. This pictorial representation is documented using what tool? a. Pareto chart b. Control chart c. Deployment chart d. Top-down flowchart

ANS: B The control chart is a run chart that has a centerline and added statistical control limits that help to detect specific types of change needed to improve a process. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

A nurse who was recently certified in chemotherapy administration fails to check compatibility of phenytoin before injecting into a continuous infusion of D5W leading to occlusion of the line. Which statement by the nurse demonstrates a red herring? a. The nurse is upset and states, "I am sure I have injected this before without a problem" and the supervisor interprets this to mean the nurse often take shortcuts. b. The nurse states, "You are just upset because I am certified in chemotherapy administration and you are not." c. "The nurse who started the IV didn't get a blood return but determined the IV was the patient's—that is the problem." d. "This drug always occludes the line because it is so viscous."

ANS: B The nurse diverts attention away from the issue of not checking compatibility to introduce an irrelevant topic of chemotherapy administration certification which is not related to this situation.

What is the first step in both the nursing and problem-solving processes? a. Identifying the problem b. Gathering relevant information c. Considering the consequences of change d. Implementing appropriate interventions

ANS: B The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation.

A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional

ANS: B The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present.

What situation demonstrates a nurse engaging in active listening? a. While assessing the patient's vital signs, the nurse records the data and states, "You are improving, your vital signs are normal." b. Eye contact is maintained while focusing on the patient as the patient describes the current pain level and location. c. The nurse states, "I know how you feel, I recently lost my father and I am still hurting." d. The nurse has cultural values that are in opposition to the patient but shares that "I agree with your decision to use herbs rather than the prescribed medications."

ANS: B This behavior demonstrates active listening. A number of techniques can be used by the receiver to enhance the ability to listen; these include (1) providing undivided attention, (2) giving feedback (rephrasing), (3) making eye contact, (4) noting nonverbal messages (body language), and (5) finishing listening before one begins to speak.

A 13-year-old female is brought to the family planning clinic by her enraged father, who has just learned that she is pregnant. The pregnant client states, "I want to have this baby and give it up for adoption." However, the father is adamant that she will disgrace the family and demands that the health care providers tell his daughter that she has a physical condition that would prohibit her from carrying this baby to a viable stage. The nurse realizes that this is a conflict that involves what ethical principle? a. Deontology b. Veracity c. Autonomy d. Beneficence

ANS: B Veracity is telling the truth in personal communication as a moral and ethical requirement.

An older adult client is comatose and had one electroencephalogram that indicated no activity. The daughter is very distraught and notices her mother's hand moves when she is talking to her. The daughter asks the nurse, "Is mother responding to my voice?" The nurse, attempting to console the daughter, knows the movement was involuntary but states, "It does appear she did." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology

ANS: B Veracity is the principle of telling the truth in a given situation.

In today's world of fast, effective communication, what is the most commonly used means of societal communication? a. Facial expression b. Spoken word c. Written messages d. Electronic messaging

ANS: B Verbal communication, which involves talking and listening, is the most common form of interpersonal communication. An important clue to verbal communication is the tone or inflection with which words are spoken and the general attitude used when speaking.

Which situation would be appropriate for the supervisory level of initial direction and/or periodic inspection? a. Experienced RNs work together to provide care for a group of patients newly diagnosed with meningitis. b. The RN assigns the LPN tasks within her scope of practice and checks back during the shift to ensure the tasks are completed correctly. c. A new graduate nurse is assigned care to a male patient with a hematocrit of 11.0 g of hemoglobin per deciliter and is receiving a blood transfusion. The charge nurse checks on the patient status every 15 to 30 minutes and asks the graduate to explain "next steps." d. No supervision is necessary since both are registered nurses.

ANS: B When a working relationship is established and competencies of the delegate established, the delegator may check in during intermittently during the shift.

In which case does the nurse act as "whistle-blower"? a. One staff member on the unit covers for another nurse, who leaves the premises to purchase illegal substances. b. The nurse reports that another nurse is taking medications out of stock medicine for herself or himself. c. A nurse informs respiratory therapy that a patient is now due a treatment. d. The nurse delegating care to unlicensed assistive personnel makes rounds to ensure all care was rendered properly.

ANS: B Whistle-blowing is the reporting of acts or situations that violate the principle of beneficence such as a chemical impairment, negligence, abusiveness, incompetence, or cruelty.

A new mother is experiencing pain after delivering an infant with Down syndrome. The staff nurse states, "I don't think she is really hurting. Let the next shift give the pain medication." The team leader notices the staff nurse looks agitated and anxious and asks about any concerns in providing care to this new mom. The staff nurse admits having a stillborn infant with Down syndrome. This is an example of which component of communication? a. Personal perception b. Past experiences c. Filtration d. Preconceived idea

ANS: B With past experiences that include a variety of positive, neutral, and negative events, the influence that these experiences can and will have on communication may be positive, neutral, or negative. The importance of recognizing that any reaction from the receiver may be biased by previous experience cannot be overstated.

A nurse learns in orientation that an incident report does not "blame" anyone but concisely documents the events leading up to an occurrence. Which events would warrant completion of an incident report? (Select all that apply.) a. The client is crying and distraught when learning of a diagnosis of cancer. b. An intravenous antibiotic given preoperatively does not infuse because of a faulty pump. c. The nurse is unable to carry out orders written by the specialist because of illegibility. d. A client falls while in the shower, after being instructed not to get up alone. e. The registered nurse is not available to complete the preoperative checklist.

ANS: B, C, D, E Nurses are legally bound to report critical incidents to their nurse managers, agency administration, and risk manager through a formal intra-agency document generally titled the "incident report." Circumstances under which an incident report should be filed include malfunction or failure of medical equipment.

A nurse educator is explaining to licensed staff that health care is no longer safe and describes The Quality and Safety for Nursing (QSEN) recommended competencies for educating nursing professionals. What competency is included? (Select all that apply.) a. Advanced health assessment techniques b. Patient-centered care c. Prescriptive pharmacology content d. Quality improvement e. Safety

ANS: B, D, E Patient-centered care is a recommended competency, along with teamwork and collaboration, evidence-based practice, and informatics. Quality improvement is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics. Safety is a recommended competency, along with patient-centered care, teamwork and collaboration, evidence-based practice, and informatics.

A nurse hopes to improve time management skills using the ABC prioritization approach. Which tasks would be prioritized as "B"? (Select all that apply.) a. Turn in time sheet due in 3 days. b. Review dress code policy to give feedback before appointment in the morning. c. Perform blood glucose test on a patient admitted with Kussmaul respirations and change in level of consciousness. d. Complete patient teaching prior to discharge in 2 hours. e. Review procedure for inserting a PIC line to assist with procedure later this morning.

ANS: B, D, E Task that falls within Priority B includes the medium-value items, such as tasks that are not urgent but most likely will not "fall" off the list. Since the dress code must be reviewed and feedback constructed for a morning appointment, this would be level B, it is not urgent nor will it likely fall off the list. Completing patient teaching for a patient to be discharged in 2 hours must be completed but does not take priority over "A" tasks. Reviewing a procedure to be performed later in the day is Level "B."

What examples should the nurse provide to best describe an advance directive? (Select all that apply.) a. Preserving cord blood for possible future needs of a child b. Providing instructions about personal preferences regarding life-sustaining medical procedures c. Giving someone the legal right to act on one's behalf when one becomes incapacitated d. Completing hospital admission paperwork before being admitted to the hospital

ANS: B,C Advance directives document an individual's desires regarding end-of-life care. These wishes are generally stated through the execution of a formal document known as the living will. Right-to-die statutes vary from state to state; therefore, nurses must become familiar with their state-specific statute.

What actions should a nurse who wishes to practice in another state take initially? (Select all that apply.) a. Prepare to retake the NCLEX-RN for that state. b. Determine whether the state is a compact state. c. Inquire about obtaining licensure by endorsement. d. Prepare to revoke the original licensure. e. Petition the state to be "Grandfathered" a state license.

ANS: B,C If the state is a member of a compact state, that state has established an agreement with other states under which nurses are permitted to practice within the state without additional licensure. Licensure by endorsement refers to the original program whereby nurses who are licensed in one state seek licensure in another state without repeat examination. None of the other options are accurate descriptions of the process required for the situation described.

A nurse is having difficulty managing assignments at work, which results in a feeling of "failure" and tasks that are not completed or that are not completed satisfactorily. The mentor should suggest what tips for time management? (Select all that apply.) a. Focusing on activities to be completed, rather than on objectives b. Planning today for tomorrow's activities and needs c. Making certain that the last hours are the most productive in tying up loose ends d. Maintaining a log of how the nurse spends time e. Picking five major objectives for the day and not stopping until they are achieved

ANS: B,D Planning for the future is an effective time management strategy. Maintaining a log of how you spend your time is an effective time management strategy.

Which types of abuse are the nurse required to report or be subject to fines and imprisonment for not reporting? (Select all that apply.) a. Animal b. Child c. Alcohol d. Infant e. Emotional

ANS: B,D State laws have been created because of the 1973 Child Abuse Prevention and Treatment Act. These laws dictate that health professionals must report infant and child abuse and specified communicable diseases. Failure by the nurse to comply can result in fines and/or imprisonment.

Nurses, physicians, and social workers finalize the plan of care and coordinate discharge for a homeless person who will need wound care and follow up over the next 4 weeks. Each member contributes based on his or her area of expertise but also recognize other members' strengths. Which of the QSEN competencies are being demonstrated? a. Quality improvement b. Evidence-based practice c. Teamwork and collaboration d. Patient-centered care

ANS: C An interdisciplinary team is working to prevent hand-off errors on discharge.

Which of the following occurrences would be classified as a sentinel event? a. A postpartum patient who elects to breastfeed only twice daily develops mastitis. b. A newly diagnosed diabetic patient self-injects insulin in the abdominal area rather than the upper thigh as instructed by the patient educator. c. A nurse assisting with the delivery of twins places the "Twin 1" name tag on the second-born twin, causing the first-born twin to undergo surgery that was scheduled for the other twin. d. A nurse administers 3 units of regular insulin rather than 3 units of NPH insulin subcutaneously, resulting in a drop in the patient's serum glucose from 160 to 100 mg.

ANS: C Any procedure performed on a wrong person or organ constitutes a sentinel event.

A client is in extreme pain after he was involved in a motor vehicle accident, and morphine has been ordered every hour for pain. The nurse injects saline into the client's IV line and takes the morphine for herself. The nurse is violating which principle of ethics? a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas

ANS: C Beneficence is providing benefit to others by promoting their good. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the client's pain medication and substituting saline, the nurse did harm, not good, for this client.

A nurse is listening to a patient's apical heart rate. The patient asks, "Is everything okay?" The nurse says nothing and shrugs her shoulders. The nurse is demonstrating what form of negative communication? a. Ad Hominem Abusive b. Filtration c. Blocking d. False assurance

ANS: C Blocking occurs when the nurse responds with noncommittal or generalized answers.

Institute for Healthcare Improvement (IHI) proposed a process for quality improvement with steps known as "PDCA." What statement should be made when explaining the steps to a group of nurses interested in improving the process of medication reconciliation for heart failure patients with high rates of recidivism? a. P stands for process. Following a top-down flowchart provides the steps for reviewing patient medications taken at home compared to those prescribed during hospitalization. b. D stand for deviation, which is an alteration in the expected drugs ordered. c. C is for check if the process for change worked. Was there an improvement in accurate reconciliation? And what was learned? A stands for algorithm, which includes all steps of the process. d. A stands for algorithm, which includes all steps of the process.

ANS: C C stands for check if the change improved the process and what was learned.

A staff nurse states, "I really enjoyed having dinner with the Chief of Medical Staff and the President of the hospital. We hope to meet again soon." Which source of power does this nurse possess? a. Expert b. Legitimate c. Connection d. Reward

ANS: C Connection power results from knowing or associating with power people such as the upper administration.

A physician shares with the patient's family that, while a central line was being inserted, the patient's lungs were inadvertently punctured, which required oxygen administration. The physician also explains that a chest x-ray indicated the lung remained intact and no additional treatment was required. The physician's role in this instance is based on what legal principle? a. Comparative negligence b. Gross negligence c. Disclosure d. Emergency Medical Treatment and Active Labor Act (EMTALA)

ANS: C Disclosure is a process in which the patient's primary provider (physician or advanced practice nurse) gives the patient, and when applicable, family members, complete information about unanticipated adverse outcomes of treatment and care.

An older adult is unable to reach the telephone and is found dead at home several hours later. The son of the deceased person arrives at the hospital and asks, "Can I just please stay and hold my dad's hand? He was so afraid of dying alone." Which response by the nurse shows empathy? a. "Of course, you can. I'll let you know when the funeral home is here to transport his body." b. "It must be very hard to know he died alone." c. "I'll close the door so you can spend time with your dad. I will check back in a few minutes." d. "I lost my dad last year. He died alone. He was a policeman. I am just like you. Let me stay here and console you."

ANS: C Empathy is demonstrated by the ability to mentally place oneself in another person's situation to better understand the person and to share the emotions or feelings of the person.

A nursing student planning to apply for licensure knows that being charged with which offense would result in a misdemeanor criminal offense? a. Solicitation of illegal drugs b. Stealing a car c. Failing to report elder abuse d. Billing Medicare for services not rendered

ANS: C Failing to report elder abuse can lead to penalty of fine or imprisonment and is tried as a misdemeanor offense.

A nurse is overhead saying, "I don't mind working during the election and holiday. My parents are divorced, money is tight, and honestly, I don't trust any politicians anyway. I plan to take a few weeks off next month." She works independently to research strategies to improve patient-centered care for the large number of immigrants that arrived in the area and then works with the team to share ideas. She recommends, "Let's think the suggestions over and come back together next week." This nurse's communication style is consistent with which generation? a. Baby Boomers b. Traditionalist c. Generation X d. Millenniums

ANS: C Generation X individuals grew up in when there was a high rate of divorces; they tend to be more cynical and value work-life balance and teamwork. Holidays are often associated with family gatherings which may have been absent in this generation's family; belief that ALL politicians are untrustworthy may be viewed as cynical. The need to take time to form suggestions to save time and come together to reach team decision are reflective of this generation.

When deciding which staffing option to use on a nursing unit that will open soon, the manager recognizes what basic fact related to this issue? a. Continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on three consecutive days per week. b. The use of part-time nurses provides the variability needed to meet diverse patient needs. c. Satisfaction of the staff equates to satisfaction of patients. d. Nurses provide the same level of care, regardless of the work environment.

ANS: C High nurse satisfaction is generally equated with high patient satisfaction and positive patient outcomes.

A nurse moves from California to Arkansas and due to having 20 years of experience as a registered nurse is immediately placed in charge of the telemetry unit. The staffing consists of LPNs and two unlicensed assistive personnel. The RN is unsure of the scope of practice of the LPNs and reviews the nurse practice act for Arkansas, which lacks clarity on some tasks. What should the RN do to best acquire the necessary information? a. Query the state nursing association to determine their stance on the role of LPNs. b. Ask the LPNs on the unit to list what tasks they routinely performed. c. Contact the state board of nursing to determine legal scope of practice for LPNs. d. Refer to California's nurse practice act because the scope of LPNs/LVNs is consistent across the United States.

ANS: C If the nurse practice act lacks clarity, the state board of nursing can provide guidance

A hospital recently learned that their scorecard did not meet the national benchmark for patient satisfaction and brought in a professional change agent to determine what their issues were and how they could improve their score. The agent collected data and recommended that nurses participate in interdisciplinary walking rounds and allow the patient and family to be participants. Nurses now round every shift and perform "huddles to update the team" as needed throughout the shift as part of best practices. Random visits are made to nursing units to ensure all nurses are participating and patients are interviewed for their involvement. These practices are associated with which stage of Lewin's change process? a. Unfreeze b. Moving c. Refreeze d. Resistance

ANS: C In the refreezing stage, change becomes status quo and the agent reinforces until the change is part of the daily process as in the above situation.

A blood reaction occurrence is noted in a client who did not receive pretransfusion care as clearly documented in the facility's policies and procedures. The nurse providing care is liable for which legal tort? a. Comparative negligence b. Punitive damages c. Criminal negligence d. Involuntary tort

ANS: C In this case, criminal negligence charges would be based on "reckless and wanton" disregard for the safety, well-being, or life of an individual; behavior that demonstrates a complete disregard for another, such that death is likely in the transfusion reaction.

What is customer satisfaction primarily based upon? a. Access to modern, up-to-date facilities b. Availability of an extensive menu selection c. Personal interactions with employees d. Having to undergo fewer invasive procedures

ANS: C Interactions between employees and patients/families affect clinical outcomes, functional status, and even physiologic measures of health.

A nurse who is infected with human immunodeficiency virus (HIV) while working in the operating room seeks revenge by deliberately placing clients at risk by not adhering to universal precautions. This nurse is violating what ethical principle? a. Veracity b. Beneficence c. Nonmaleficence d. Autonomy

ANS: C Nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. The nurse is definitely violating this principle through her actions.

How is the term Ethics as applied to nursing best defined? a. Doing what is best for the client b. Making good decisions about care c. Care based on keeping with the values of the client d. Rules for providing competent care that is based on scientific principles

ANS: C Nursing ethics is a system of principles intended to guide the actions of the nurse in his or her relationships with clients, clients' family members, other health care providers, policymakers, and society as a whole. A nurse must make an attempt to understand what values are inherent in the situation.

An RN is counseled by the nurse manager regarding inappropriate delegation when the RN engages in what activity? a. Instructing the nursing assistant to greet ambulatory surgery patients and show them to their rooms b. When asking a novice nursing assistant to collect a sputum specimen, the RN states, "I will show you this time and you can show me the next time." c. Assigning the float LPN/LVN the task of completing a plan of care for a stable patient who was admitted for routine replacement of a feeding tube d. Asking an LPN/LVN who has demonstrated competence to perform a dressing change before the patient is discharged home

ANS: C Only an RN can initiate and complete a new plan of care; this does not fall within the scope of practice of the LPN/LVN. The RN has violated one of the five rights of delegation.

The number of IV site infections has more than doubled on a nursing unit. The staff determine common causes include the site is cleaned using inconsistent methods, dressing frequently becomes wet when patient showers, IV tubing is not changed every 48 hours per protocol, and inadequate hand washing of RN prior to insertion. A bar graph demonstrates the frequency in descending order, with 80% of infections being attributed to inadequate hand washing. The quality tool used is referred to as what? a. Cause-and-effect diagram b. Run chart c. Pareto chart d. Flowchart

ANS: C Pareto charts are bar graphs that show causes contributing to a problem in descending order so the leading cause is easily recognized. A cause-and-effect diagram is used for identifying and organizing possible causes of a problem in a structured format. It is sometimes called a fishbone diagram because it looks like the skeleton of a fish. Flowcharts?4 are pictures of the sequence of steps in a process. Different steps or actions are represented by boxes or other symbols. Run charts, also known as time plots, are graphs of data points as they occur over time.

What tactic is the inexperienced novice nurse using when prioritizing a client's bed bath before the need to insert a nasogastric tube (NG) into a client vomiting coffee ground emesis? a. Energy management b. Priority setting c. Procrastination d. Introspection

ANS: C Procrastination is evident when a person is faced with an unpleasant task, a difficult task, or a difficult decision. Usually procrastination is easily recognizable because it involves completing low-priority tasks rather than high-priority ones, and it always welcomes interruptions. Priority setting would consider the more important task to be the NG tube insertion. Introspection is the examination of one's own conscious thoughts and feelings. Energy management ensures that the right amount of effort matches the right task to optimize an outcome.

What is the primary purpose of licensure for professional registered nurses? a. Preventing the misuse of the title nurse b. Demonstrating a specialized body of knowledge c. Protecting the public from physical and emotional harm d. Enhancing recognition for the nursing profession

ANS: C Protecting the public is one of the essential purposes of the state board of nursing, which regulates licensure. While appropriate none of the other options address the primary focus of nursing licensure.

A nurse gives phenytoin intravenously with lactated Ringer's solution containing multivitamins. The drug precipitates and obstructs the only existing line. When the team leader informs the nurse that these drugs cannot be mixed, the nurse states, "You've disliked me since I refused to switch my vacation time last month." Which type of logical fallacy has influenced the nurse? a. Ad hominem abusive b. Appeal to common practice c. Red herring d. Appeal to tradition

ANS: C Red herring is the introduction of an irrelevant topic in order to divert attention away from the real issue.

An RN makes the following assignments at the beginning of the shift. Which assignment would be considered high-risk delegation? a. A novice RN is assigned a patient with diabetes mellitus requiring mixing of regular and NPH insulin. b. An LPN is assigned an older adult with pneumonia and who requires dressing changes on a foot wound. c. An unlicensed assistive person (UAP) is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate. d. A float RN from the oncology unit is assigned a patient with a white blood cell count of 4000 mm3.

ANS: C Risk of falling is great in later stages of Huntington's disease due to chorea movements; this makes it inappropriate to delegate ambulation to the UAP.

Managers who exhibit an authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward

ANS: C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished.

An RN with excellent assessment and psychomotor skills would derive power based on which source? a. Rewards b. Coercion c. Expert d. Legitimate

ANS: C Seven primary sources of power are known. Expert power is based on knowledge, skills, and information.

A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To best enhance employee satisfaction related to staffing, what intervention should the management team implement? a. Begin negotiating for additional agency nurses. b. Propose hiring more part-time employees. c. Adopt the concept of participatory staff involvement. d. Regularly use "float" nurses to cover vacancies.

ANS: C Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction.

What action is appropriate when deciding whether and when a task should be completed? a. Completing all tasks as they are received b. Arranging according to the tasks' time requirements c. Asking, "What will happen if I don't complete the task now?" d. Viewing large projects holistically and not as many small pieces

ANS: C Stopping to evaluate what is going on is important because you may have to readjust your plan and reprioritize to reach your goal. None of the other options allow for effective prioritization.

A group of nurses are meeting to decide how to staff the upcoming holidays. Each of the four members freely expresses thoughts about fair staffing but is willing to listen to other thoughts and reconsider their first recommendations. The nurses are avoiding conflict and supporting professional communication through implementation of what communication technique? a. Empathy b. Positiveness c. Supportiveness d. Accommodation

ANS: C Supportive communication occurs when each person's opinion/position is valued and each participant has the freedom to express a position but is willing to change that opinion/position.

A primary health provider prescribes a drug for a patient with a known allergy, it is administered and results in anaphylactic shock. What statement is accurate regarding disclosure of this event? a. Disclosure of the error will result in more severe ramifications for the agency than if the negligence is discovered by the patient or family. b. Disclosure of the occurrence should occur before notification of the prescribing health provider c. Disclosure as an essential component of the national patient safety movement. d. Disclosure to the patient's insurance company is focused on decreasing costs.

ANS: C The National Quality Forum identified the process of disclosure as a key element of the national patient safety movement. None of the other options accurately describe the focus of the disclosure.

Care delivery using the team-based approach is used on a telemetry nursing unit. The team consists of one registered nurse (RN), two licensed practical nurses (LPNs), and one unlicensed assistive personnel (UAP). Staff have been charged to improve quality of care while ensuring cost containment. Which assignments would meet both criteria? a. The RN administers all medications to all patients. b. The LPN performs sterile dressings and IV tubing changes on all central lines. c. The experienced UAP places telemetry electrodes and attaches to cardiac monitor. d. The RN administers an enema to a stable patient who has an order "administer fleet enema PRN when no bowel movement in 2 days."

ANS: C The UAP, when properly trained, can place patients on telemetry. This meets quality and cost containment goals because the LPN and RN have higher salaries.

All hospitals receiving Medicare and Medicaid funds must ask clients whether they have a living will or a durable power of attorney. What legislative act makes this action mandatory? a. Emergency Treatment and Active Labor Law b. Americans with Disabilities Act c. Uniform Health Care Decisions Act d. Patient Self-Determination Act

ANS: C The Uniform Health Care Decisions Act of 1993 is a federal statute that was established to support individuals in expressing their preferences about medical treatment and making decisions about end-of-life care.

A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet its goal to "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic

ANS: C The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement.

A patient is ordered a low-protein, low-calorie diet but the patient's family brings fish, lentils, and unleavened bread for a meal to observe a cultural practice. The nurse works with the dietitian to adjust the next few meals to accommodate for this variance. What term should be used to identify this situation? a. A sentinel event b. An adverse event c. Patient-centered care d. The communication technique of "call-out"

ANS: C The nurse and dietitian are respecting patient values, preferences, and expressed needs.

A client states, "I am leaving. No one here knows what they are doing." The nurse completing the Against Medical Advice form must implement what intervention to best assure client safety? a. Notify the primary health care provider of the client's wish to leave. b. Alert family that the client will be leaving the facility. c. Inform the client that leaving could result in complications and impairment. d. Require security staff to accompany the client to the facility's main entrance.

ANS: C The nurse must articulate to the client the dangers associated with leaving the facility if the primary provider is not present. The nurse's notes on this form should reflect the specific advice given to the client, which should include the fact that leaving the facility could aggravate the current condition and complicate future care, resulting in permanent physical or mental impairment or disability, or resulting in complications that can cause death. None of the other options address the client's known safety risks.

The advanced practice nurse who is seeking information about requirements for practice in a specialized area should contact what nursing organization? a. American Nurses Association (ANA) b. National League for Nursing (NLN) c. American Nurses Credentialing Center (ANCC) d. National Council of State Boards of Nursing (NCSBN)

ANS: C The nurse should contact the ANCC to determine the education, experience, and examination requirements that must be met if one is to become certified.

An RN recently relocated to another region of the country and immediately assumed the role of charge nurse. When determining the appropriate person to whom to delegate, the RN bases decisions on what fact? a. The role of the LPN/LVN is the same from state to state. b. The LPN/LVN can be taught to perform all the duties of an RN if approved by the employer and if additional on-the-job training is provided. c. Review of the state's nurse practice act for LPN/LVNs is vital since it defines the role and scope of practice of the LPN/LVN. d. The Joint Commission has certified and established roles for the LPN/LVN.

ANS: C The scope of practice of the LPN/LVN varies significantly from state to state; RNs should know the LPN/LVN nurse practice act in the state in which they practice and should understand the legal scope of practice of the LPN/LVN.

What is the difference between a leader and a manager? a. A leader has legitimate authority. b. The manager motivates and inspires others. c. A manager focuses on coordinating resources. d. The leader focuses on accomplishing goals of the organization.

ANS: C The terms leadership and management are often used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes.

An LPN/LVN has transferred to a nursing unit and arrives for the first day. The RN checks with the LPN/LVN often throughout the shift to provide support and determine if assistance is needed. The RN is providing which level of supervision? a. There is no supervision, because at times the LPN/LVN is not with the RN. b. Periodic inspection is being used. Because the LPN/LVN is licensed, the RN is relieved of the need to evaluate care. c. Continual supervision is being provided until the RN determines competency. d. Initial supervision is being provided because this is the LPN/LVN's first day on the unit.

ANS: C This level of supervision is required when the working relationship is new, the task is complex, or the delegate is inexperienced or has not demonstrated an acceptable level of competence.

In attempting to decide which services should be offered to a community, the public health nurse decides to implement hypertension screening and treatment because most of the residents are hypertensive. This decision is based on what ethical principle? a. Veracity b. Values c. Utilitarianism d. Autonomy

ANS: C Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. On the basis of this principle, an attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the situation.

To conduct a productive meeting, the nurse should focus on what? a. Providing each person all the time needed to discuss desired topics b. Covering all emotional topics first c. Creating an agenda with specific times allotted for each agenda item d. Waiting for latecomers before starting the work of the meeting

ANS: C You need to preplan for the meeting so it can be conducted in a timely manner. One way to have a productive meeting is to prepare a meeting agenda with time allotted for each item and the name of the person responsible for reporting on each item. Send out the agenda prior to the meeting so attendees can come prepared. Meetings seldom have the luxury of unlimited time to discuss issues or to delay the start of the discussion. The agenda should be planned to accommodate emotional topics.

A nurse is having difficulty keeping up with the six assigned patients and serving on the ethics committee. To take charge of both personal and work life, what activities should the nurse focuses on improving physical energy? (Select all that apply.) a. Telling himself/herself, "I provide safe quality care and will provide this level of care to all my patients" b. Taking a deep breath and remaining calm to develop patience c. Keeping a bottle of water available to consume a minimum of 24 ounces each shift d. Going into the nurse's break room every 90 minutes to eat a healthy snack and prioritize remaining care e. Enrolling in the hospital-sponsored fitness program

ANS: C, D, E Drinking plenty of water promotes physical health. Taking a break every 90 minutes, especially during long shifts such as 12-hour shifts, provides a much-needed time to relax and reorganize. Proper and frequent exercise promotes physical health.

A nurse asks, "What is meant by 'internal' customers?" The correct response should identify which person or persons? (Select all that apply.) a. Insurance companies b. Accreditors such as The Joint Commission c. X-ray technicians d. Clinical pharmacist e. Chief financial officer

ANS: C, D, E Internal customers are employees of an organization at all levels. An x-ray technician is an example of an internal customer. Internal customers are employees of an organization at all levels. A clinical pharmacist is an example of an internal customer. Internal customers are employees of an organization at all levels. A chief financial officer is an example of an internal customer.

When considering the feasibility of an all-RN staff, a nursing administrator determines what fact concerning the RN's role? (Select all that apply.) a. They are generally costlier and less efficient than LPNs. b. They are usually more reactive than proactive to patient care errors. c. They have a positive effect on patient outcomes when managing patient care. d. They are effective overseers of patients' overall health condition. e. Their training makes them effective care delegators.

ANS: C, D, E RNs are effective at coordinating care that results in improved patient outcomes. RNs are valuable monitors of a patient's health status—a practice that results in improved patient outcomes and effective delegation of care.

Which statements concerning licensure as a registered nurse are correct? (Select all that apply.) a. Nurses who graduate from different types of nursing education programs are granted different types of licenses, those with a baccalaureate degree having the most expanded role. b. A nursing license cannot be revoked, only suspended. c. Each nurse practice act describes requirements for initial licensure. d. It is illegal for states to ask about the mental or physical status of an applicant. e. Students who graduate in the top 10% of their class are exempt from taking the NCLEX-RN for licensure. f. Candidates for licensure must present proof of graduation as required by the state.

ANS: C,F A section of each nurse practice act describes requirements and procedures that are necessary for initial licensure. Candidates for licensure must submit evidence of graduation as defined by each state.

A nurse is preparing an exercise program as part of a health promotion program for older adults with osteoporosis. Which question would retrieve the most valuable information about health practices? a. "Do you exercise?" b. "Do you like to exercise?" c. "When do you exercise?" d. "What exercise practices do you participate in?"

ANS: D "What exercise practices do you participate in?" is an open-ended question or statement that requires more information than just yes or no. This type of question augments the gathering of enough facts to build a more complete picture of the circumstances.

An organization's emergency preparedness task force meets to discuss how it should react in case of a terrorist attack and develops a disaster evacuation plan that details how each department will assist individuals in reaching safety. This type of diagram is referred to using what term? a. Pareto chart b. Control chart c. Top-down flowchart d. Deployment chart

ANS: D A deployment flowchart would show the detailed steps involved in the process and the people or departments that are to be involved at each step to assist individuals in reaching safety. A top-down flowchart shows the sequence of steps in a job or process such as medication administration. A Pareto chart is a type of bar graph, with the height of bars reflecting the frequency with which events occur or the effect events have on a process problem. A control chart is basically a run chart with statistical control limits added. A top-down flowchart shows the sequence of steps in a job or process such as medication administration.

To request licensure to practice in France, a nurse licensed in the United States must engage in what initial step? a. Contacting the Graduates of Foreign Nursing Schools to complete a special examination b. Realizing that licensure in the United States is recognized as sufficient for practice in most countries c. Passing a language proficiency examination for the primary language of that part country is required prior to licensure. d. Contacting the International Council of Nurses (ICN) or the nursing regulatory board of that country

ANS: D A nurse who is interested in practicing internationally may contact the International Council of Nurses or the nursing regulatory board of the country to familiarize themselves with the licensure requirements.

During the night, a patient fell in the bathroom and sustained a hip injury. The patient was very upset because of being unable to attend a granddaughter's wedding in 2 days. The team looked at the process and determined that the patient had been medicated with a narcotic, had urinary urgency so had not taken the time to put on shoes, failed to turn on the light because the door to the hall let in some light, and stumbled over a towel that had been placed to collect water leaks caused by construction that was in progress to replace damaged sinks. Which factor was a special cause variation? a. Failure to take time to put on shoes due to urgency b. Unsteady gait due to narcotic administration c. Poor lighting that led to decreased vision d. Improper construction that caused the leak and towel placement

ANS: D A special cause variation is an uncommon variation that is unstable and unpredictable, is not under statistical control, and is related to a clearly identified single source, which in this scenario is the construction project.

Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units

ANS: D A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future.

When can a nurse detain a client by implementing restraints? a. Staffing resources are insufficient to monitor a patient. b. The client is demonstrating behaviors associated with confusion. c. The family requests the restraints to prevent the client from leaving the facility. d. There are current prescribed instructions for their use.

ANS: D A written primary care provider's prescription that is timed and dated is required for the use of restraints. Renewal of orders must be accompanied by evidence of medical evaluation and nursing reassessment. Restraints can only be appropriately applied as a last resort to managing inappropriate behavior.

Which statement related to delegation is correct? a. The practice of unlicensed assistive personnel (UAP) is defined in the nurse practice act. b. Nursing practice can be delegated only when the LPN/LVN and UAP have received adequate training. c. Supervision is not required when routine tasks are delegated to a competent individual. d. The RN must be knowledgeable about the laws and regulations that govern nursing practice, as well as those that have no clearly defined parameters, such as for UAP.

ANS: D Accountability remains with the RN, and he or she is responsible for knowing what tasks can be delegated and what is defined as nursing practice.

How do accrediting agencies such as The Joint Commission address staffing? a. Imposing maximum staffing levels b. Requiring a specific staff mix c. Stipulating nurse-patient ratios d. Confirming delivery of satisfactory care

ANS: D Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing.

A new graduate from a master's entry program in nursing announces, "I just passed my clinical nurse leader certification examination." Certification as a clinical nurse leader provides acknowledgement of what nursing achievement? a. Earning the equivalence of a master's level nursing degree b. Attaining entry-level knowledge and skills c. The right to engage in an independent primary nursing practice d. Demonstrating advanced nursing skills and knowledge

ANS: D Certification provides validation of achievement of advanced education and competence. This certification does not acknowledge any of the achievements presented by the other options.

Which statement accurately describes communication? a. The components of communication are mutually exclusive. b. Communication is linear. c. Communication involves only the sender and the receiver; everything else is superficial. d. When the receiver becomes the sender, the subcomponent of communication that is in use is feedback.

ANS: D Communication is a process that requires certain components, including a sender, a receiver, and a message. Effective communication is a dynamic process: With a response (feedback), the sender becomes the receiver, the receiver becomes the sender, and the message changes.

A manager just finished the last annual performance review of the staff, reviews the unexpected expenditures for the month due to use of agency nurses, and shares the latest quality indicators with the staff nurses. This manager is performing which management function? a. Directing b. Planning c. Organizing d. Controlling

ANS: D Controlling is the final management function. It includes performance evaluations, financial activities, and tracking outcomes of care to ensure quality.

A nurse who functions in the role of team leader can be held negligent for matters involving what focus? a. Adequate training b. Policies and procedures c. Staff discipline d. Delegation

ANS: D Delegation of client care tasks falls within the role of the team leader, and inappropriate delegation of client care tasks could result in negligence. Team leaders, charge nurses, and managers are held to the standard of care of the reasonably prudent nurse employed in that role

Which of the following statements concerning the Institute of Medicine (IOM) competencies is correct? a. Each competency is mutually exclusive. b. The competencies focus on individual efforts to reduce errors. c. Physicians lead the team to achieve each competency. d. The competencies address both individual and system approaches to transform care.

ANS: D Errors and increased health care costs result from both the actions of health care workers and the nature of the system in which they deliver care.

A student nurse assigned to work with the charge nurse finds the work to be satisfying and receives several compliments from management and the nursing instructor for several creative suggestions. The student nurse enjoys the project and attention and begins to prolong the conclusion of the project. This behavior is indicative of what time management obstacle? a. Need for perfection b. Fear of losing creativity c. Unclear project goals d. Fear of completion

ANS: D Fear of completion is a time management obstacle that may occur if you are afraid of completing a project that is creative and fun. To overcome this obstacle, take the time to understand why you are not completing the task or major project that has been with you for some time. Need for perfection demands extremely high standards for every single task you undertake. The student has demonstrated creativity and has been complimented on it. There is no indication that the goals of the task have not been met.

What was the first field of nursing to certify advanced practitioners? a. Adult nurse practitioners b. Nurse-midwifery c. Clinical nurse specialist d. Nurse anesthesia

ANS: D In 1946, nurse anesthesia became the first field of nursing practice to certify advanced practitioners

A group of nurses are presenting the importance of high-quality care during a system-wide meeting of medical-surgical nurses. They point out a finding of the Quality Chasm that supports what? a. Being insured has little effect on a person's longevity and the quality of care received. b. Lobbyists for the drug companies can gain permission for the use of new drugs within 1 year of their discovery. c. Although a greater number of lawsuits stem from medication errors, more people actually die from human immunodeficiency virus (HIV) and acquired immunodeficiency disease syndrome (AIDS). d. Medication-related errors place a tremendous financial burden on the U.S. health care system.

ANS: D Medication-related errors for hospitalized patients cost roughly $2 billion annually.

A nurse makes patient care assignments as follows: RN1 has rooms 200-210; RN2 has rooms 211-221; RN3 has rooms 222-232. The two unlicensed assistive personnel have half the rooms, with one assigned to 200-215 and the second to 216-232. What term is used to identify the care delivery model being used? a. Team b. Primary c. Partnership d. Modular

ANS: D Modular (or geographic) assignments are based on a geographic location in the nursing unit.

Which task is appropriate for the RN to delegate to the unlicensed assistive personnel (UAP) provided the delegate has had experience and training? a. Evaluate the ability of a patient to swallow ice after a gastroscopy. b. Assist a patient who is postoperative hip replacement to ambulate with a walker for the first time. c. Change the disposable tracheotomy cannula for a new postoperative tracheotomy patient if secretions are thick and tenacious. d. Obtain a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system.

ANS: D Obtaining a sterile urine sample from a patient with a Foley catheter that is connected to a closed drainage system is not an invasive procedure, and risk to the patient is minimal, making the task appropriate for delegation.

What principle should a nurse apply to assure effective daily planning? a. Delay planning until the "first task of the morning" has been completed. b. Recognize that rewarding oneself has a negative consequence. c. Rotate between several tasks to stimulate creativity. d. Remember that most tasks take longer than anticipated to complete..

ANS: D One must consider many factors when planning a project. Some of the following factors influence how priorities should be established: (1) urgency of a situation, (2) demands of others, (3) closeness of deadlines, (4) existing time frame, (5) degree of familiarity with the task, (6) ease of task completion, (7) amount of enjoyment involved, (8) consequences involved, (9) size of the task, and (10) congruence with personal goals. When the use of time is considered, not all factors carry the same weight, and adjustments will be needed.

A nurse is asked to "float" to another area where the patients require total care. The nurse smiles, picks up her stethoscope, and says, "I'll come back and eat lunch with everyone here." When she enters the elevator she hits the wall and mutters, "Always me. Don't I have any rights"? The nurse is demonstrating which communication style? a. Assertive b. Aggressive c. Passive d. Passive-aggressive

ANS: D Passive-aggressive communication is represented by incongruent actions—the nurse shows friendly gestures by smiling and demonstrating she wants to have lunch with the staff on the original unit; however, she shows her anger by hitting the wall and muttering.

The primary health care provider who insists on providing treatment in spite of the client's wishes because "I know best" is reflecting an attitude referred to as what? a. Autonomy b. Beneficence c. Justice d. Paternalism

ANS: D Paternalism is an action and an attitude wherein the provider tries to act on behalf of the client and believes that his or her actions are justified because of a commitment to act in the best interest of the client. Paternalism is a reflection of the "father knows best" way of thinking.

Positive time management skills include an effective approach to what aspect of planning? a. Maintaining an open-door policy b. Retaining copies of paperwork c. Returning telephone calls immediately d. Scheduling daily activities

ANS: D Planning is the most important step in time management. Scheduling activities allows people to better use their time and can lead to closure in relation to those goals that will produce the greatest internal satisfaction. An unregulated open-door policy can encourage interrupts that affect daily work flow. The retaining of paper copies is not always necessary and is determined by the organization and need of such references. Telephone calls need to be prioritized and returned according to importance.

A licensed practical nurse (LPN) has been practicing for 25 years on a unit where a newly graduated RN with a bachelor's degree is hired. Before the RN arrives on the unit, the LPN is heard saying, "She'll try to tell everyone what to do because she makes more money. She'll sit at the desk and let us do all the work." This is an example of what communication associated process? a. Interpretation b. Context c. Precipitating event d. Preconceived idea

ANS: D Preconceived ideas are conceptions, opinions, or thoughts that the receiver has developed before having an encounter. Such ideas can dramatically affect the receiver's acceptance and understanding of the message.

A nurse is delegating to the newly hired nursing unlicensed assistive personnel (UAP) the task of assisting with oral hygiene, knowing that this assignment "does not require decisions based on the nursing process." The nurse is correctly using which of the five rights of delegation? a. Supervision b. Communication c. Person d. Circumstance

ANS: D Right circumstance involves the delegation of tasks that do not require independent nursing judgments.

A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate

ANS: D The coordinator of the committee has an official position within the organizational committee; such as being on the quality improvement committee.

A nurse is caring for a client who just suffered a stroke and is medicated for pain. The nurse completes the following interventions: places the client on the examining table, completes a thorough history and physical, covers the client with a sheet, places the call button within reach, and goes out in the hall to speak with the client's primary care provider. The client tries to get up to speak with his family and falls, sustaining a hematoma on the head and a broken hip. The nurse's actions reflect which legal claim? a. Invasion of privacy b. Libel c. Slander d. Negligence

ANS: D The nurse is failing to ensure client safety after medication administration; this is defined as negligence.

When determining the scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP), which statement accurately describes the common policies which exist in most state practice acts? a. The RN is held accountable for the decision to delegate, but responsibility rests only with the delegatee. b. The RN may only delegate tasks that are not in the scope of practice of the LPN if the delegatee is certain they are competent to perform the task. c. Since the LPN is licensed, they practice professional nursing. d. To determine what tasks can be safely delegated, the RN must first assess the patient.

ANS: D The stability of the patient must be determined prior to delegation. Even routine tasks such as taking vital signs that are often delegated may need to be performed by the RN when the patient's condition is critical.

During orientation, an RN learns that LPN/LVNs in the facility receive additional training to perform some tasks such as hanging continuously infusing intravenous fluids that have no additives. It is important for the RN to understand that what is the basis for this practice? a. The health care facility can override the state practice act by having all LPN/LVNs and unlicensed assistive personnel (UAP) participate in on-site training. b. LPN/LVNs are licensed, and accountability for their own practice rests with each LPN/LVN. c. The RN can determine what tasks are legally delegable to the LPN/LVNs on his/her care team. d. The nurse practice act and state regulations related to delegation override the organization's policies.

ANS: D The state's nurse practice act is the deciding factor regarding what can legally be delegated.

A nurse realizes that much time is wasted during shift report when coworkers discuss personal items such as recent movies or department store sales. Which statement would help with time management during this critical interaction? a. "Let's talk only about only one movie you recently watched." b. "I like to know about department store sales, but we need to get through this report, so let's talk about sales as we walk between patient rooms." c. "I know your shift has been busy. What went wrong?" d. "I have the list of patients; let's start with revisions to the plan of care and scheduled activities for the next shift."

ANS: D The statement "I have the list of patients; let's start with revisions to the plan of care and scheduled activities for the next shift" focuses the conversation during report, keeping personal conversations to a minimum. None of the remaining options focus on solving the problem refocusing on the task at hand.

Which component of an e-mail shown below would be both effective and concise? a. Subject: A short concise subject line: Meeting. b. Body: I would like you to answer these questions before the next meeting: Where would you like to meet? Do you want all the staff to attend? Can we serve refreshments? What is one goal for our unit? c. Body: Dear Staff, As you know, each department must reduce staff by 2%. We will need to discuss how to inform unlicensed staff about the downsizing efforts of the hospital. d. Body: The next staff meeting is scheduled for Tuesday, January 19, at 5 PM in the first-floor auditorium. Please send items for the agenda. Sally Smith, MSN, RN, [email protected] or ext. 5582.

ANS: D This provides a message that is concise and accurate with a clearly conveyed message for the reader and contact information from the sender, all of which are important components of effective e-mail communication.

A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal.

ANS: D To be effective, positive reinforcement should (1) be specific, with praise given for a task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment.

Practicing nurses participate in employer-sponsored professional development classes that provide case studies related to ethical situations and decision making. Ethical considerations are debated among teams, and an expert helps the class arrive at the "best practices." The nurses are experiencing ethics ______________.

ANS: acculturation Ethics acculturation is the didactic and experiential process of developing ethical reasoning abilities as a part of ongoing professional education.

1. The healthiest form of communication is the ________ style.

ANS: assertive Assertive communicators are honest and direct while valuing and respecting other individuals' views and seeking a win-win solution without the use of manipulation or game-playing.

Quality is defined by the ____________.

ANS: patient Quality is based on the perspective of the consumer or, in this instance, the patient.

The most important step in time management is ____________.

ANS: planning It is important to plan before beginning any task, project, or day's activities. Planning involves (1) setting goals and establishing priorities, (2) scheduling activities, and (3) making to-do lists.

While taking a shower, a patient pushes the emergency light. When the nurse arrives, the patient complains of feeling dizzy and unsteady. The nurse turns to reach for the patient's walker and the patient falls, hitting the right side of the face resulting in loss of vision in the right eye. This scenario represents a _______ event.

ANS: sentinel A sentinel event is an occurrence that results in death or serious illness and requires immediate investigation.

ANS: D Functional care delivery models assign tasks to each provider. In the above visual, the LPN is responsible for oral medication administration, the unlicensed assistive personnel provide hygiene, and the RN is assigned to task that require the nursing process.

An orthopedic unit is considering different types of care delivery models and staff have an opportunity to ask questions about how the models differ. The nurse manager provides an overview and uses the above visual to demonstrate which model of care delivery? a. Team b. Partnership c. Primary d. Functional

* The nurse manager learns that the unit expenses have exceeded the budget allowance by $500,000 for the first half of the fiscal year. The nurse manager would use which of the following processes to most effectively prioritize client care activities and control the cost of care? A. Authoritative process B. Management process C. Time management process D. Total quality management process

B

* The nurse manager is reviewing ways that a nurse may risk disciplinary action related to licensure, Which action would put the nurse's license at risk? A. Maintaining a habit of excessive absences and tardiness B. Arriving to work with evidence of body odor. C. Inserting a central catheter under the direct supervision of a healthcare provider D. Participate in lateral violence and bullying on the unit.

C

* The nurse manager has been notified by central supply that many client items are missing from stock and have not been charged to the client. Which action should the nurse manager implement in regard to the lost charges? A. Send out a memo telling the staff to follow the charge procedures B. Determine whether the items in question are being restocked daily C. Schedule a staff meeting to discuss how to prevent further lost charges D. Form a performance improvement committee to study the problem

C. Schedule a staff meeting to discuss how to prevent further lost charges

ANS: B CE is important to ensure continued competency, and each state determines if CEs are mandatory for renewal and how many units are needed.

Nurses in Tennessee, Mississippi, and Arkansas gather for a conference related to improving quality and safety in practice and nursing education. They are awarded continuing education (CE) credit for participation and evaluation of the conference. One nurse from California states, "I need these CEs to renew my license." The nurse from Mississippi replies, "You do not need CEs for license renewal or advance practice certification renewal." Which statement about CEs would help these nurses? a. All states require proof of continuing education for renewal of license with the number of hours varying. b. The purpose of continuing education is to ensure competence of the workforce after graduation, but each state determines if CEs are required. c. Continuing education is required if nurses work across state lines. d. Initial licensure provides evidence of a minimum safety and competence, so it is illegal for states to require continuing education for renewal of license.

The primary purpose of licensure is protection of the ___________.

public

* During the management of a client's pain, the nurse should adhere to the code of ethics for nurses. Which of these actions should the nurse consider first when treating the client's pain? A. The client's self-report of pain is the most important consideration B. Cultural sensitivity is fundamental to client-centered pain management C. Nurses should not judge a client's pain based on the nurses's values D. Clients have the right to have their pain managed promptly

A. The client's self-report of pain is the most important consideration

A nurse wants to apply open communication to obtain a thorough history and to determine cognitive function. Which question represents the use of open communication? a. Is today Wednesday? b. Do you know what day it is? c. Tell me what day of the week today is. d. Do you know what the first day of the week is?

ANS: C The patient must be able to name the day of the week rather than use answer yes or no.

* A nurse tells the charge nurse that a terminally ill client has verbalized wanting to end all medical treatment. The client's family is concerned with the client's statement. The best charge nurse response is. A. "It is our duty to recognize the needs of both the client and their family." B. " Always do what is medically necessary to keep the client healthy." C. "A terminally ill client should not make decisions without the family's consent." D. "We need to respect the wishes of our client only."

A

* As a charge nurse, which client would you assign a new RN graduate who is on orientation? A. 67-year-old who had a stroke 3 days ago and has left sided weakness. B. 28-year-old newly admitted client with a spinal cord injury C. 85-year-old with dementia who is being transferred to a long term care facility today. D. 54-year-old with Parkinson's disease who needs assistance with bathing.

A

* The new nurse manager is preparing for a meeting with the staff to come up with ideas for how to reduce the number of falls on the unit. Which approach would be best for the nurse manager to use? A. Have the staff engage in brainstorming B. Conduct an anonymous staff survey C. Present a research article D. Show a presentation of fall data

A

* The nurse manager informs the nursing staff that the clinical nurse specialist will be conducting a research study about staff attitudes toward client care. All staff are invited to participate in the study if they wish. This type of research participation affirms which ethical principle? A. Justice B. Anonymity C. Beneficence D. Autonomy

D

* A patient on the medical surgical unit begins to code. The assigned registered nurse and the charge nurse are at lunch. The newly hired nurse manager begins to direct the resuscitation efforts until the code team arrives, using which one of the following as the basis of power in this situation? A. The manager's intelligence B. The manager's expertise and experience C. The manager's formal position or rank D. The staff's acceptance of direction

C

* The nurse is evaluating the completion of a client's wound dressing that was delegated to a licensed practical nurse. Which nursing action is appropriate? A. Ask the client if the dressing was done. B. Check the medical record C. Visualize the new dressing D. Obtain report from the LPN

C

ANS: B The National Council State Board of Nursing's policy on social media prohibits posting of patient information on social media sites. This patient could be identified by knowing where she works and the fact that she was seen in the ED the day before.

The nurse caring for a patient states, "Your blood pressure is dangerously high. Are you taking antihypertensive medicine?" The patient states, "I can't afford my medicine. I have no insurance." The nurse states "I feel really sorry for that patient. I wish it wasn't against policy to give her money." The nurse wants to help and places a note on Facebook that any donations would be appreciated to help a waitress who works at the cafeteria next door to the hospital buy her medications. The nurse posts that "She was so sick last evening when she came to the ED. I can't believe they don't provide insurance. I can't give her money but you all can help." This nurse's action has what possible outcome? a. Showing empathy and if she lets the patient know the money is not from her, she is not violating any social media guidelines. b. Increasing the risk for HIPAA violations c. No legal risk since she has properly followed policy and protected the patient by not using her name. d. The nurse is demonstrating the logical fallacy of slippery slope.