Leadership Quiz 2

A nurse who is interested in graduate school wants to learn about recently passed legislation regarding changes in Medicare reimbursement for care provided by clinical nurse specialists. The best source for information on changes in federal programs is the ________________.

ANS: Federal Register The Federal Register is the best source of information about proposed rules and regulations for newly enacted legislation and about changes to existing rules for federal programs (www.fr.cos.com).

The financial plan required for the distribution of resources and expenses is a _________.

ANS: budget A budget is an organization's financial plan that expresses expected expenses (such as personnel and supplies) and anticipated revenues for products and services over a defined period, usually 12 months.

The greatest barrier to access to health care for a poor Hispanic person living in downtown Chicago is lack of health ____________________.

ANS: insurance Lack of health insurance is the greatest barrier to access to health care and it has a tremendous impact on an individual's health. Studies have consistently found that the uninsured receive less than adequate health care.

In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the _____ approach. a. top-down b. participatory c. iterative d. incremental

ANS: A Budget goals are established by administrators; unit managers do not contribute to goal setting, which is the primary principle of the top-down approach.

A group of nurses meet with a state representative to explain the importance of allowing registered nurses the right to sign death certificates for patients who were under their care. As constituents and nurses, they requested that the senator vote against the bill restricting this practice. These nurses are serving as: a. lobbyists. b. policymakers. c. officials with regulatory power. d. advocates for the Patient Safety and Quality Improvement Act.

ANS: A Lobbyists hope to educate and convince policymakers to respond positively to a particular position on an issue or to follow a particular course of legislative or regulatory action

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 delegatee'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.

The RN instructs the LPN to "Give an enema to the patient in room 327 who is being discharged but is complaining of 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.

The nurse managers of an organization are meeting with administration to plan the budget. The above graph shows last year's 2011 expenditures, and the team will trend the upcoming budget knowing that, with the slowdown in the economy, patient census will be lower. Which budget approach is being used? a. Incremental b. Zero-based c. Productivity metrics d. Capital

ANS: A The incremental approach is simply a forward trend of current or recent performance with adjustments for future growth or decline in revenues or expenses.

The nurse manager meets with upper administration and learns that the strategic plan for nursing is to have 80% BSN staff within the next 3 years. The nurse manager then built her budget to meet the organization's strategic goal by providing tuition reimbursement and flexible work hours, which required some agency staffing. Which approach to budgeting is used? a. Iterative b. Top-down c. Participatory d. Zero-based

ANS: A The iterative approach is a combination of the top-down and the participatory approach, with upper management defining strategic goals and then unit leaders developing their operating budgets to incorporate their individual goals in conjunction with the organization's strategic goals.

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. Use the blood pressure obtained in the ambulance, because it was assessed via electronic monitoring.

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

A nurse manager is preparing a budget that does not base annual budgets on the revenue and expenditures of the prior year and has the advantage that outdated information is not integrated into the budget. The manager is using which budget method? a. Zero-based b. Incremental c. Labor d. Operational

ANS: A The zero-based method is based on the assumption of no volume and no resources assigned; it essentially starts each new budget period at zero rather than building from past budgets.

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 at this time 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 the purpose of 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.

A nurse responsible for staffing a medical-surgical unit must consider: (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.

A nurse plans care knowing when specific recovery milestones are expected. The nurse is providing care via: 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 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.

A nurse is concerned about older persons living alone at home without telephone service to contact emergency services. The nurse is advised to take part in grassroots efforts to address the situation. The nurse would: (select all that apply) a. post signs to support the county's political candidates whose platform support services for poor and underserved person such as older adults. b. visit with local politicians running for office and ask specific questions such as, "Would you support providing free emergency telephone service for older adults living alone?" c. limit voting to only presidential elections in which a candidate promises to initiate health care reform related to Medicare for older adults. d. join the American Nurses Association and constituent member association. e. contact representatives from surrounding states to garner support for free medical alert systems for older adults.

ANS: A, B, D Working in local political campaigns is an effective grassroots effort. Visiting, e-mailing, calling, and faxing local politicians to support free emergency telephone service for older adults is a grassroots tactic. Joining ANA and state nursing associations supports these organizations' lobbying efforts and is thus a way for individual nurses to influence the issues that nursing associations support.

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.

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 as a result of: (select all that apply.) a. the increase 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 nurse has recently been appointed to the position of nurse manager. To become successful in managing the unit's budget, the new nurse manager should: (select all that apply) a. read the financial policy manual to learn more about the organization's budgeting process. b. allow the nursing administration office to manage the unit's budget until he or she is able to complete an online financial management course. c. communicate regularly with a person in the hospital's finance office about interpreting budget reports. d. pay attention to only the bottom-line numbers in budget reports rather than trying to understand each line in these reports. e. discuss the process of developing budgets with other members of the management team.

ANS: A, C, E Knowing the organization's financial policies is an important step toward understanding the organization's budget process. Building a relationship with the finance office is fundamental to learning about the budgeting. As one participates more in the budget process, one's understanding of the process and related responsibilities is enhanced.

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 as a: 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.

A concerned nursing student calls the office of an elected official to voice support for the bill to ban smoking in all public places. The secretary asks, "Are you a constituent?" What does the term constituent mean? a. A member of a professional organization who supports the organization's political issue b. A citizen who is registered and is eligible to vote for a representative c. An elected official who proposes legislation to be considered as a potential law d. A member of the House of Representatives who is seeking support for a particular bill

ANS: B A constituent is a citizen who has the opportunity to vote for candidates in elections for representation at local, state, and federal government levels

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. This type of delivery system is: 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.

A bill is pending in the state legislature that will mandate teaching health promotion related to smoking cessation. Which action by the nurse should have the greatest impact on passage of the bill? a. Explain the rationale for the bill to the school board. b. Contact the elected representative's office by telephone to request support for the bill. c. Support a health advocate to run for election as state representative. d. Tell all students about the bill.

ANS: B Telephone calls are an effective means of communicating your support for a bill, next to a face-to-face meeting; ask to speak to the staff person assigned to the bill or issue for which the call is being made. After introducing yourself, give a brief and simple message such as, "Please tell Senator/Representative [name] that I support [bill number]."

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.

Throughout the history of health care in our nation, one particular piece of federal legislation provided funds for hospital construction. As the number of hospitals rapidly increased, the need for nurses to staff hospitals also increased, and the shift from community-based nursing care to hospital-based nursing care began. This fundamental piece of legislation was the: a. Sheppard-Towner Act. b. Hill-Burton Act. c. Veterans Bill. d. Access to Health Care Bill.

ANS: B The Hill-Burton Act, also known as the Hospital Survey and Construction Act, was enacted in 1950. This act provided funding that resulted in a boom in the construction of hospitals across the country. As the number of hospitals increased rapidly, so did the need for nurses to staff the hospitals. Thus the nurse's role was shifted from community and public health settings to the acute care setting.

When the policy process is compared with the nursing process, identifying the issue is consistent with which step of the nursing process? a. Assessment b. Diagnosis c. Planning d. Implementation

ANS: B The diagnosis step in the nursing process is consistent with identification of the targeted issue in the political process. As politically active nurses soon discover, effective involvement in policy development and political activities requires efforts similar to those used in the nursing process. The policy process and the nursing process are systematic approaches that use the nursing process for decision making.

It is important for nurses to know the functions of the branches of the federal government. At a local meeting of the state nurses' association, an officer reminds members that the branch that is capable of originating major policy initiatives is the _____ branch. a. executive b. legislative c. judicial d. administrative

ANS: B The legislative branch possesses the sole federal power to enact legislation; the legislative branch originates and promotes major policy initiatives and has the power to override a presidential veto.

A nurse would like to obtain background information and learn the political platform of a candidate who is running for national office. The nurse should contact the: a. National Registry for Candidates. b. American Nurses Association Nurses Strategic Action Team (N-STAT). c. National League of Nurses. d. National Council of State Boards of Nursing.

ANS: B Through legislative updates, N-STAT keeps members up-to-date about background information and the platforms of candidates who are running for national office; N-STAT also provides updates about key bills as they move through the legislative process

A nurse manager has calculated that providing 75 hours of direct nursing care per day requires that 120 hours must actually be worked by nursing staff. The manager is involved in: (select all that apply) a. developing the capital budget. b. applying productivity metric. c. monitoring the labor budget. d. incremental budgeting processes. e. addressing budget assumptions.

ANS: B, C The nurse manager is determining the amount of work produced by calculating the actual number of nursing hours worked, which is productivity metric. Budgets use productivity metrics.

A nurse is interested in learning more about health policy and how it might impact nursing practice. She is especially interested in The Patient Protection and Affordable Care Act (PPACA) and how it will travel through the three branches of the federal government. She researches the roles of the legislative branch of the federal government and learns that this branch: (select all that apply) a. determines which laws are constitutional, such as recently deciding the PPACA is constitutional because it is a form of taxation. b. has the exclusive power to determine where federal dollars will be spent, such as supporting the PPACA. c. consists of the Office of the President and 15 executive departments that supported the PPACA. d. has the power to veto laws found constitutional by the Supreme court and therefore could veto the PPACA. e. can override a Presidential veto, making it possible to amend the PPACA even without approval of the President.

ANS: B, E The legislative branch possesses the sole power to enact legislation, tax citizens, and allocate federal spending. The legislature can override a presidential vote.

The nurse manager meets with upper management to share strategic goals agreed upon by her staff for their individual nursing unit as the first step to begin budget negotiations. One strategic goal is that staff will have access to technology that will allow them to incorporate point-of-care devices for all RNs. The second goal is to improve RNs' ability to recognize critical indicators that a patient's health status is deteriorating through advanced health assessment skills. During the meeting the manager discusses the strategy options and selecting the one that works for the unit. Which type of budget development is used? a. Iterative b. Top-down c. Participatory d. Zero-based

ANS: C In the participatory approach, the people responsible for achieving the budget goals are included in goal setting.

A nurse on the unit is heard saying, "I am not going to document that I used four catheters to start that IV; it doesn't matter anyway." What action can help the staff nurse understand the financial budget goals of the unit? a. Have the nurse work in payroll for a week. b. Enroll the staff in continuing education units (CEU) for personal finance. c. Ask the nurse to represent the unit on the budget planning committee. d. Make the nurse responsible for monitoring all disposable equipment and supplies.

ANS: C Participating on the committee will give the nurse ownership of the unit's budget and will provide insight into the unit's budgetary goals.

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 is assigned the task of assisting a patient with late stages of Huntington's disease to ambulate a short distance in the hallway. 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.

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.

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 delegatee is inexperienced or has not demonstrated an acceptable level of competence.

A nursing unit's census consists primarily of long-term residents with a high risk for falls. To meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with new beds equipped with Fall Watch electronic sensors that will detect when patients get out of bed. The manager will be involved in which type of budgeting to replace the beds? a. Fiscal b. Labor c. Operational d. Capital

ANS: D Capital budgets are concerned with major purchases such as equipment paid for over several years.

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

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.

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. The care delivery model used in this situation is: 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 delegatee 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.

When the nurse manager conducts a qualitative analysis of budget variances, he or she is: a. determining the percentage increase of supply usage from the last quarter to the current quarter. b. identifying the overall increase in the dollar amount of salaries paid for overtime. c. comparing productivity metrics across all nursing units in the facility. d. reconciling with current conditions the underlying assumptions on which the budget was based.

ANS: D Qualitative analysis of the budget explains why current conditions are different than they were when the budget was developed; new conditions might include greater patient acuity or additional physicians with increased admissions.

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 registered nurse (RN) is assigned as charge nurse for the first time. She knows to consult the state board of nursing to determine scope of practice for licensed practical nurses (LPN) and unlicensed assistive personnel (UAP). She also realizes there are common policies which exist in most state practice acts that include: 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: 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. UAPs cannot be held responsible for their own actions or inactions. 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.

Nurses on a unit met with the nurse manager as part of participatory budgeting. They ask, "What exactly is the difference between fixed and variable costs? Understanding this will help us better understand the budgeting process." The manager provides a definition and asks the staff to list types of direct and indirect cost. Which example would indicate a need for further teaching? a. Fixed costs would include accreditation fees. b. Fixed cost would include the cost for the automated medication-dispensing system. c. Variable cost would include the nurse manager's salary. d. Variable cost would include the salary expense for registered nurses.

ANS: D Variable costs would include the salary expense for registered nurses because their number can change.

Organizations measure the effectiveness of their budgets by examining actual revenues and expenditures versus: a. planned variances. b. incremental budgets. c. productivity metrics. d. expected performance.

ANS: D Variance analysis is the process by which deviations from budgeted amounts are examined by comparing actual performance results against expected, or budgeted, performance.

Another name for an eligible voter is a _________.

ANS: constituent