Leadership Chapter 23

16. A client was treated in the hospital for a stroke and was the client's family members assert that the client was discharged too early and did not receive sufficient rehabilitation. The client's early discharge may have been attributable to: a. the effect of diagnosis-related groups. b. a sentinel event. c. the application of total quality management. d. deliberate malpractice.

A

20. Which practice has the U.S. Food and Drug Administration (FDA) suggested in order to decrease the risk of medication errors? a. Computerized order entry with a drug bar code system b. Medications automatically dispensed to clients at predetermined times c. Use of medication nurses to administer all ordered medications d. Have clients' medications secured at the bedside for self-administration

A

25. Which action is associated with the nursing leadership role in quality improvement? a. Inspiring staff to establish and maintain high standards regarding patient care b. Being aware of the changes in quality control regulations c. Reviewing research results upon which to base changes d. Identifying outcomes that support quality nursing care

A

27. A hospital system is trying to address some of the deficits in care that were described in To Err Is Human. When addressing the errors that this report identified, the hospital's leaders should focus on what factor? a. Systemic flaws in health-care delivery b. Malice on the part of some health-care providers c. Lack of education for health-care workers d. Increased use of nursing assistive personnel

A

3. A nurse-manager is focusing on management controlling functions that are associated with quality control. What task best addresses this goal? a. Periodically evaluating the unit mission and philosophy b. Creating the daily client care assignments to distribute workload evenly c. Contributing to the development of the annual budget d. Distributing staffing policies related to the choice of vacation time

A

19. A health-care organization has experienced a rise in medical errors and has committed to implementing Leapfrog initiatives. What aspects of health care should the organization address? Select all that apply. a. Expanding the use of computerized physician-provider order entry b. Increasing the budget for continuing education for nurses c. Ensuring that hospital referrals are evidence-based d. Utilizing the National Quality Forum-endorsed Safe Practices scores e. Ensuring that adequately trained intensive care physicians are easily accessible

A,C,D,E

22. The nurse is admitting a new client and is reviewing the results of the medication reconciliation. What data will be included in the client's medication reconciliation? Select all that apply. a. The medications that the client was taking prior to admission b. The client's expectations for treatment with medications during admission c. The client's medication administration record from any previous admissions d. The results of the nurse-manager's review of the client's treatment plan e. The list of medications the client has been prescribed by the admitting physician

A,E

12. What is the greatest limitation of the Health Plan Employer Data Information Set (HEDIS)? a. The Joint Commission has not updated the HEDIS since 2009. b. Managed care organizations are not required to collect HEDIS data. c. Performance indicators are exclusively process focused rather than outcome focused. d. HEDIS performance measures focus on medical interventions and do not address nursing actions.

B

17. A nurse-manager has referred staff members to a clinical practice guideline (CPG) that addresses the prevention of pressure ulcers. What is a characteristic of this CPG? a. The CPG will lay out the criteria that the health-care organization must meet in order to be reimbursed for treating a client's pressure ulcer. b. It will describe interventions for nurses to follow in an effort to provide evidence-based care. c. It will describe the treatment for pressure ulcers that is provided at the best performing organizations. d. The CPG will summarize the etiology and diagnosis of pressure ulcers.

B

21. When creating a clinical practice guideline for the management of aggressive behavior on a mental health unit, the nursing committee should perform what action first? a. Interviewing senior staff for practice suggestions b. Conducting a search of the literature for research results c. Reviewing client satisfaction data to identify the unit's strengths and weaknesses d. Educating all unit nursing staff on the need to adhere to established guidelines

B

24. During a quality improvement initiative, the leadership of a health-care organization has worked with senior managers to implement the principles of Lean Manufacturing. This initiative will focus on what factor? a. Identifying sentinel events b. Identifying and preventing waste c. Engaging all staff members d. Performing root cause analysis of errors

B

29. A nurse-manager and several colleagues are reviewing the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These results will allow the team to make what assessment? a. The root causes of adverse incidents b. Clients' perspectives on the care they received c. Consumers' health outcomes at 3 and 6 months after discharge d. Clients' health status at admission versus at discharge

B

6. High-achieving nursing students were found to have studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided data about the students' preparation? a. Structure b. Process c. Outcome d. Concurrent

B

9. Which of the following would be considered sentinel events that should be reported to The Joint Commission? Select all that apply. a. A client with ischemic heart disease dies of a myocardial infarction. b. A client with dementia falls and suffers a hip fracture while trying to walk to the bathroom. c. A client files a formal complaint about the inattention of staff while he was in the hospital. d. A client experiences nephrotoxicity and requires dialysis because of a medication error. e. A client experiences a transfusion reaction after receiving the wrong type of packed red blood cells.

B,D,E

1. A novice nurse-manager is a member of a team that will oversee quality control in a health-care organization. What action should the nurse and the other members off the team perform first? a. Take corrective action to address standards that are known to be challenging. b. Collect the essential data that will give a general overview of performance data. c. Determine the specific criteria and standards by which quality will be measured. d. Assign tasks between the team members to address identified standards.

C

10. Which is a true statement regarding TQM? a. It is based on the premise that the organization knows what is best for the consumer. b. Its guiding purpose is to save the organization money. c. It recognizes that the customer is the focal element on which production and service depend. d. It assumes that inspection and removal of errors lead to the delivery of quality services.

C

11. What action should the nurse-manager and other leaders in the health-care organization perform in order to ensure that a quality control program will be effective? a. Set a goal of meeting federal and state standards. b. Set quality control standards at minimum acceptable levels so the organization will score well on self-assessment audits. c. Integrate quality control through all levels of the organizational hierarchy. d. Focus quality improvement efforts on reacting to problems that have been identified.

C

14. What is the best course of action to stimulate broad participation of employees in quality control efforts? a. Encourage regular meetings between middle management and upper management. b. Educate staff about the relationship between the organization's accreditation and their own licensure. c. Engage closely with the frontline staff who provide client care. d. Educate staff about the correct way to document and report sentinel events.

C

15. A nurse-manager is participating in a hospital's quality control efforts and is collating data sources. What data source should the manager identify as a qualitative source? a. The hospital's rate of nosocomial infections b. The hospital's readmission rate c. Results of interviews with discharged clients d. The previous year's budget for continuing education initiatives

C

26. As part of a quality improvement initiative, administrators are conducting outcomes analysis and have included nursing-sensitive outcome measures. These outcome measures will: a. highlight the aspects of nursing that are contentious or controversial. b. cause the quality improvement process to prioritize nurses over other providers. c. separate out the unique contributions that nurses make to client outcomes. d. require other members of the health-care team to rate nurses' contributions.

C

28. A hospital is using the guidelines of the Leapfrog Group to inform safety improvements in the organization. What action will best incorporate these guidelines? a. Replacing practical nurses with registered nurses whenever possible b. Eliminating the use of high-risk medications and increasing the role of pharmacists c. Purchasing a computerized physician-provider order entry system d. Converting shared rooms to single-occupant rooms

C

4. What task will best allow a health-care organization to benchmark its performance? a. Comparing its performance on key indicators to its performance the previous year b. Setting ambitious but realistic goals for the coming year c. Comparing the organization's performance with that of best performing institutions d. Seeking input from clients and families about the organization's performance

C

5. Thirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after completing treatment. What type of audit provided this type of data? a. Structure b. Process c. Outcome d. Concurrent

C

7. A nurse-manager is overseeing an organization that uses the Nursing Minimum Data Set (NMDS). What will the use of the NMDS achieve? a. Comparing the quality of nursing care and medical care with reference to standardized data b. Identifying minimal levels of quality necessary for nurses to maintain licensure c. Standardizing the collection of nursing data for use by multiple users d. Identify only "nursing-sensitive" client outcome measures

C

8. What role has The Joint Commission assumed in ensuring quality at the organizational level? a. Establishing clinical practice guidelines b. Reducing diagnosis-related group reimbursement levels c. Standardizing clinical outcome data collection d. Assessing monetary fines for organizations that fail to meet standards

C

13. As part of the quality control, managers have set standards for performance and assessed whether these standards are being met. It has been determined that several standards are not being met. What is the priority response to this finding? a. Release the findings to the public to ensure transparency. b. Compare the organization's results to benchmarks. c. Determine whether similar organizations in the region are experiencing similar results. d. Perform interventions that will correct the deficiencies.

D

18. A nurse-manager is opposing the expansion of the prospective payment system (PPS). What argument against the PPS should the manager cite? a. Diagnosis-related groups have caused an increase in health-care costs. b. The PPS has unnecessarily increased the length of hospital stays. c. The PPS is linked to increased prices for pharmaceuticals. d. The PPS has been linked to a decline in the quality of care.

D

2. An RN is a supervisor in an organization that has total quality management (TQM) as the basis for its organizational goals and objectives for quality control. How should the RN practice TQM on the unit? a. Encourage colleagues to create vision and mission statements. b. Develop a quota system for number of clients cared for. c. Explain to the staff that "if it's not broke, don't fix it." d. Promote teamwork rather than individual accomplishments.

D

23. In order to improve the likelihood that errors in the health-care system will be reported, nurse-managers should: a. give professionals the choice of whether or not to report errors. b. establish firm and meaningful punishments for staff who commit an error. c. assign "safety officers" whose exclusive role is to monitor for, identify, and follow up errors. d. foster a climate where analysis of errors is not solely focused on blame.

D

30. What piece of data should the nurse-manager include in an outcome audit? a. Nursing handoffs occur at the client's bedside and include family input. b. Client-nurse ratios are capped at 3:1 in the day and 4:1 at night. c. Technology is acquired so documentation can be completed at the bedside. d. At discharge, a client was able to ambulate 40 feet unassisted.

D