N224: Final

11. A nurse is self-educating on the role of the informatics nurse/informatics nurse specialist. The nurse has an adequate understanding when listing which as a primary success indicator? a. "Making sure that information technology did no harm to the patient." b. "There were no primary success indicators listed for the IN/INS." c. "There are not enough data on primary success indicators for the IN/INS role." d. "Primary success indicators include excellence in bedside patient care."

ANS: A A primary success indicator for the IN/INS role is making sure that information technology did no harm to the patient. Excellence in bedside patient care is not listed as a primary success indicator for the IN/INS role. PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

15. Which of the following statements by the nurse indicates an understanding of Quality and Safety for Nurses (QSEN)? a. "QSEN helps prepare future nurses for improving patient safety." b. "QSEN helps prepare future nurses for working mandatory overtime." c. "QSEN helps train nurses in the clinical setting." d. "QSEN provides nurses with strategies for passing the NCLEX exam."

ANS: A Quality and Safety for Nurses (QSEN) was developed to help prepare future nurses who will be needed in their health care environment to improve patient safety. QSEN does not prepare nurses to work mandatory overtime, train them in the clinical setting, or provide them with strategies to pass the NCLEX exam. PTS: 1 DIF: Cognitive Level: Application REF: p. 515 OBJ: Incorporate successful process improvement strategies. TOP: QSEN MSC: NCLEX®: Not applicable

15. A nurse believes to be bullied at work. Which of the following actions by the perpetrator lead them to believe this? a. Offering to help with their assignment b. Asking them to switch a shift c. Asking them to cover for a break d. Being given the "silent treatment"

ANS: D Being given the "silent treatment" is a sign of bullying. Offering to help with an assignment and asking to switch a shift or cover a break are not considered signs of bullying. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 580 OBJ: Understand workplace bullying and harassment. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

2. What can be suggested to a nurse wanting to protect back health while caring for patients? (Select all that apply.) a. Use proper body mechanics. b. Use assistive patient-handling devices. c. Use ergonomic equipment. d. Only care for patients that can move independently. e. Be aware of potential risk.

ANS: A, B, C, E The nurse should use proper body mechanics, assistive patient-handling devices, and ergonomic equipment and be aware of potential risk. Only caring for patients that can move independently is not realistic. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 576 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system. TOP: Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment

10. A manager told a nurse to float to another unit. The nurse is nervous about floating. Which of the following actions would be the best to take? (Select all that apply.) a. Remain calm. b. Refuse to float. c. Focus on the patients. d. Ask for a quick tour of the unit. e. Inquire about the units standards of care.

ANS: A, C, D, E The nurse should remain calm, focus on the patients, ask for a quick tour of the unit, and inquire about the units standards of care. The nurse should not refuse to float because this may place patients in an unsafe situation. PTS: 1 DIF: Cognitive Level: Application REF: p. 589 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

8. Determine which of the following situations would be a provider barrier to the nurse developing cultural competence? a. A nurse who is unaware of personal biases to other ethnic groups b. No family rooms to accommodate a critically ill patient's family c. A nurse who seeks encounters with individuals from other cultures d. A health care provider who incorporates alternative therapies in health care

ANS: A A nurse who is unaware of personal biases to other ethnic groups represents a provider barrier. "No family rooms" is an example of a system barrier. Nurses who seek encounters with individuals from other cultures and incorporate alternative therapies into health care have a developed sense of cultural competence. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 490 OBJ: List practice issues related to cultural competence. TOP: Culture MSC: NCLEX®: Psychosocial integrity

6. A nurse manager is providing education to a new nurse on barriers to the implementation of quality improvement processes. The manager judges the teaching to be effective when the new nurse states: a. "Expense is a primary barrier." b. "Resistance to change is a primary barrier." c. "One of the primary barriers is complacency with the status quo." d. "Not identifying the correct problem is a primary barrier."

ANS: A A primary barrier to implementing effective quality improvement (QI) programs is the cost. The cost of providing health care has greatly increased over the past few decades. However, through quality improvement measures, overall health care costs can be reduced. Other barriers (but not the primary one) to QI are nurses' loyalty to old practices and failure to recognize that changes are needed. Hospital administrators often oppose change of any kind because they may value traditional practices, have an authoritative management style, or may not value innovators. Nurses are often unaware or unwilling to change their practice from the way they have always done things—complacency with the status quo. Many practicing nurses remain resistant to change because it seems threatening and because it requires effort, retraining, and restructuring of habits, but cost still remains the primary barrier to implementing QI. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 514 OBJ: Describe your role in quality and performance improvement. TOP: Barriers to quality improvement MSC: NCLEX®: Safe and effective care environment—management of care

5. Based on assessment data, the nursing diagnosis for a patient is spiritual distress related to loneliness or social alienation. What would be included in spiritual nursing interventions? a. Participate in active listening. c. Assist with activities of daily living. b. Identify level of functioning. d. Evaluate ability to understand events.

ANS: A Active listening is an example of a spiritual nursing intervention. Other interventions include the following: prayer, presence, scripture reading, peaceful environment, meditation, music, pastoral care, inspiring hope, validation of the patient's thoughts and feelings, values' clarification, sensitive responses to patient beliefs, and developing a trusting relationship. Identifying level of functioning and ADLs address basic human needs. Evaluating the ability to understand events is addressing cognitive function. PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Spiritual nursing interventions MSC: NCLEX®: Psychosocial integrity

9. A nurse is interested in becoming credentialed as a Certified Professional in Health Care Quality. Which action would the nurse take to achieve this? a. Take an exam. b. Complete a 6-week internship. c. Have at least a bachelor's degree. d. Have at least 1 year of experience in quality management.

ANS: A Although there is no longer a minimum education requirement, those who test should have worked in quality management for a minimum of 2 years. Approximately 75% of those who apply to test actually achieve certification. PTS: 1 DIF: Cognitive Level: Application REF: p. 527 OBJ: Consider the value and requirements of quality credentialing. TOP: Credentialing for a CPHQ MSC: NCLEX®: Safe and effective care environment—management of care

3. Which of the following actions cause health care disparities? a. Refusal of treatment c. Trust in the health care system b. Provider-patient relationships d. Provider bias and discrimination

ANS: A Disparities in health care can include both provider and patient variables. Patient variables are mistrust of the health care system and refusal of treatment. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Health care disparities MSC: NCLEX®: Psychosocial integrity

14. Which action takes place during the design phase of the DMAIC process? a. A charter is developed. b. Key performance indicators are agreed upon. c. Analyze baseline data. d. Determine whether measures reflect the true problems.

ANS: A During the design phase of the DMAIC process, a charter is developed. Key performance indicators are agreed upon during the measure phase, baseline data are analyzed during the analyze phase, and it is determined whether measures reflect the true problems during the improve phase. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC MSC: NCLEX®: Not applicable

13. A nurse is explaining to another nurse about the contributions of Edward Deming. The nurse judges that the explanation is effective when the nurse states: a. "Quality is the responsibility of everyone within an organization." b. "Quality is the responsibility of the quality control inspector." c. "Quality is the responsibility of the CEO of the organization." d. "Quality is the responsibility of the manager of the organization."

ANS: A Edward Deming embraced the philosophy that quality is the responsibility of everyone within an organization. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 518 OBJ: Describe the history and evolution of quality in health care. TOP: History and evolution of quality in health care MSC: NCLEX®: Not applicable

20. The nurse knows that in this culture the older adult is respected and makes the decisions. a. Asian c. Native American b. Hindu d. African American

ANS: A In the Asian ethnic group, older family members are honored and respected, and their authority is unquestioned. The oldest man is the decision maker and spokesman. Native Americans have strong tries to family and tribe. African Americans and Hindus do not have any specific practices related to the importance of older family members. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ: Assess spiritual needs of patients in the health care setting. TOP: Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity

4. Which of the following actions would have little to no impact in helping resolve health care disparities? a. Research on life stressors b. Access to basic health care c. Increasing diversity of health care workers d. Health promotion and wellness programs

ANS: A Some solutions to help resolve health care disparities include the following: increasing the diversity of health care providers; ensuring that all people have access to affordable, basic health care; promoting wellness and a healthy lifestyle; strengthening provider-patient relationships; increasing cultural competency of health care providers; and conducting research to determine why certain diseases affect minorities so greatly and to discover effective intervention strategies. Research on life stressors does not have an impact on resolving health care disparities. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Resolving health care disparities MSC: NCLEX®: Psychosocial integrity

8. A nurse is a team member assisting with the define-measure-analyze-improve-control (DMAIC) process. Which action would the nurse take during the define phase? a. Identify the stakeholders. b. Agree on the key performance indicators. c. Identify gaps between performance and goals. d. Identify those responsible for data collection.

ANS: A In the define phase, a charter is developed; goals, team leaders, membership, and team roles and responsibilities are identified; and the stakeholders affected by the process are identified. In the measurement phase, everyone within the team needs to agree on what is to be measured, which are called key performance indicators (time, costs, distance, numbers of incidents, or items). The analyze phase is usually a short phase, but it can be longer depending on the issue because analysis of baseline data is collected. It is important to be objective in identifying where the real problems exist during this phase. The improve phase is a good place to determine whether measures reflect the true problems. The problem statement and goal statement may need to be revised based on the findings. The data collected may have shown that no real problem exists or that the problem involves other issues. During the control phase, controls are established to keep things going in the right direction. Controlling and sustaining the improvement is not easy and requires the development, documentation, and implementation of an ongoing monitoring plan. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Incorporate successful process improvement strategies including DMAIC. TOP: Define phase of the define-measure-analyze-improve-control (DMAIC) process MSC: NCLEX®: Safe and effective care environment—management of care

11. A nurse is attending a lecture on health disparities. The education has been effective when the nurse states: a. "Inequalities in income and education are the root of many health disparities." b. "Today, there are no longer inequalities preventing access to health care." c. "Low education and low income levels are related to lower rates of health disparities." d. "Higher income is associated with more health disparities then lower income."

ANS: A Inequalities in income and education are the root of many health disparities. Individuals with low education and low income levels often have higher rates of health disparities, and higher income is associated with less health disparities. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Health disparities MSC: NCLEX®: Psychosocial integrity

4. Which statement by the nurse indicates understanding of general systems theory in regards to nursing informatics? a. "General systems theory organizes interdependent parts that, when working together, can produce a product that none used alone could produce." b. "General systems theory provides theory support for a system that maintains confidentiality when handling patient data and information." c. "General systems theory incorporates external databases from state agencies to allow for performance comparison within a specific institution." d. "General systems theory is a nursing theory regarding the use of nurse informatics to integrate the systems within health care for support of nursing education and practice."

ANS: A Nursing informatics uses a theoretical foundation. This theory organizes interdependent parts that, when working together, can produce a product that none of the interdependent parts used alone could produce. Nursing informatics uses this theoretical foundation for analysis and design, implementation and support, and testing and evaluation of automated systems. It is used as a basis for decision making, education curriculum needs, and foundation for system and project management. HIPAA defines standards that were developed to ensure that health care organizations collect the right data in a common format so that the data can be shared, as well as protect the privacy and security of patient data. Systems theory consists of six elements: (1) Interdependent parts—elements of the system that interact for processing (2) Input—any outside element or factor that is brought into the system (3) Process—the activity within the system (4) Output—any product that is produced from the processing activity (5) Control—rules or procedures within the system (6) Feedback—reusing output from the system as input back into the system for validation or correction There is no mention of external databases in these six elements. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 539 OBJ: Discuss the history of nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Safe and effective care environment—management of care

4. The Occupational Safety and Health Administration (OSHA) provides guidelines to protect health care workers from needlesticks. Which action by the nurse manager shows the use of the guidelines in practice? a. Purchasing safety devices b. Providing a safe working environment c. Working with the local health department d. Establishing guidelines for safe nursing practice

ANS: A OSHA has established guidelines that employers must follow to protect their workers. The Needlestick Safety and Prevention Act became law in November 2000, requiring the use of safer devices to protect workers from sharps injuries. Advocating for workplace safety, the ANA was very instrumental in having this piece of federal legislation passed. This act amends the Blood-Borne Pathogen Standard (administered by OSHA) to require the use of safer devices to protect from sharps injuries. It also requires that employers solicit the input of nonmanagerial employees who are responsible for direct patient care regarding the identification, evaluation, and selection of effective engineering and work-practice controls. Providing a safe working environment is a good option, but it does not specifically address the safety devices required for prevention of needlestick injuries. OSHA does not provide for safe nursing practice guidelines. PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Discuss the importance of personal protective devices and how to use them. TOP: OSHA worker protection guidelines MSC: NCLEX®: Safe and effective care environment—safety and infection control

2. After completing a crisis intervention course, the nurse recognizes the signs of escalating violence as:\ a. pacing and cursing. b. repeatedly pushing the call bell. c. crying and complaining of no pain relief. d. staring out the window and not responding to questions.

ANS: A Signs of escalating violence include pacing, using foul language, cursing, raising of fists, and threats. The other options are typical behaviors that are noted in the hospital setting that do not reflect a situation where the person is escalating out of control. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk. TOP: Workplace violence MSC: NCLEX®: Safe and effective care environment—safety and infection control

12. A nurse is educating students on the history of quality improvement. The teaching has been effective when one of the students states that the historically, quality improvement focused on a. "controlling process by inspection so that errors were prevented." b. "quality improvement did not begin until recently." c. "proactive approaches to lessen errors." d. "error prevention strategies."

ANS: A Teaching is effective when the student states that historically, quality improvement focused on controlling process by inspection so that errors were prevented. Later, the emphasis changed from inspection to proactive approaches to error prevention. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 510 OBJ: Describe the history and evolution of quality in health care. TOP: History and evolution of quality in health care MSC: NCLEX®: Not applicable

2. What are examples of regulatory agencies that will affect health care policy with regard to informatics? a. Health Insurance Portability and Accountability Act (HIPAA) b. American Nursing Credentialing Center (ANCC) c. American Nurses Association (ANA) d. Medicare/Medicaid authorization

ANS: A The Joint Commission (TJC) and the Health Insurance Portability and Accountability Act (HIPAA) are two regulatory and governmental agencies instituting health care policy. The American Nurses Association (ANA) is the professional nursing organization. Medicare and Medicaid are governmental organizations that provide services. They do not regulate health care policy. PTS: 1 DIF: Cognitive Level: Comprehension REF: pp. 535-537 OBJ: Describe regulatory issues that affect the profession of nursing. TOP: Regulatory agencies MSC: NCLEX®: Safe and effective care environment—management of care

6. The nurse manager is teaching a new nurse about computer monitoring on a telemetry unit. The nurse manager judges the teaching to be effective when the new nurse states: a. "Computer monitoring provides continuous streaming of data that allows nurses to respond to patient changes quickly." b. "Computer monitoring provides for continuous around-the-clock direct observation of patients." c. "Computer monitoring improves documentation of patient care." d. "Computer monitoring reduces the need for additional nurses to provide patient care."

ANS: A The continuous flow of data from a computer allows nurses to respond to patient changes very quickly. Timely nursing responses and actions are crucial in leading to positive outcomes when caring for critically ill patients. Computer monitoring is not a substitute for patient observation. The number of nurses required to care for patients is not reduced because of computer monitoring, nor does it improve documentation, but rather provides a means to document data. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 548 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care

Chapter 25: Workplace Issues MULTIPLE CHOICE 1. Ergonomic hazards are a major safety risk for nurses, causing serious musculoskeletal injuries. To reduce the risk, nurses should a. use assistive devices. c. never lift or move patients. b. take up weight lifting. d. stretch out after pulling or reaching.

ANS: A The current recommendations by the American Nurses Association (ANA) include the use of assistive patient-handling devices for lifting, transferring, and turning patients. According to the ANA, there is no safe way to manually lift or turn a physically dependent person (i.e., proper lifting techniques or good body mechanics) without risking back and shoulder injuries. Becoming stronger by lifting weights would not reduce the risk of injury. It is not rational to think that patients would never need lifting or moving, which is why having assistive patient-handling devices is so important for risk reduction in nurse injuries. PTS: 1 DIF: Cognitive Level: Application REF: p. 575 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system. TOP: Ergonomic hazards MSC: NCLEX®: Safe and effective care environment—safety and infection control

12. Which statement by the nurse is true regarding the focus of nursing informatics? The focus of nursing informatics a. "is to improve patient care with health care technology." b. "is to improve patient care by increasing health care expertise." c. "is to improve patient care by improving nursing performance." d. "is to improve patient care by allowing the patient access to medical records."

ANS: A The focus on nursing informatics is to improve patient care with health care technology that encourages clinicians to make more accurate and timely decisions. The focus is not on increasing health care expertise, improving nursing performance or access to medical records. PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

14. A nurse is working on a unit with short staffing. The nurse has voiced concerns to the charge nurse, who appears to brush them off. Which action would be the most appropriate for the nurse to take? a. Document the concerns. b. Raise a voice to get the point across. c. Talk about the charge nurse to coworkers. d. Keep the issues to themself.

ANS: A The most appropriate action for the nurse to take would be to document the concerns. Raising a voice, talking about the charge nurse to coworkers, or keeping the issue to themself will not help resolve the short staffing. PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

16. The nurse manager has an adequate understanding of Six Stigma when making which of the following statements? a. "The primary goal of Six Stigma is to increase profits and reduce problems." b. "The primary goal of Six Stigma is to attract physicians to an organization." c. "The primary goal of Six Stigma is advertisement of the organization." d. "The primary goal of Six Stigma is to attract nursing to an organization."

ANS: A The primary goal of Six Stigma is to increase profits and reduce problems. The primary goal is not to attract physicians or nurses to an organization or advertise. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Identify tools and processes for continuous quality improvement. TOP: Tools and processes for continuous quality improvement MSC: NCLEX®: Not applicable

8. How does the federal government affect environmental safety in the hospital setting? a. Requires employers to provide a safe working environment b. Identifies those nurses who are not implementing standard precautions c. Works with the state boards of nursing in disciplining nurses d. Requires employers to establish guidelines for safe nursing practice

ANS: A The purpose of the Occupational Safety and Health Administration (OSHA), a federal agency, is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. OSHA is part of the United States Department of Labor. OSHA does not work on discipline issues because that is the function of the state board of nursing. Guidelines for safe nursing practice are provided by accepted nursing standards. The CQI group at the hospital would identify issues or violations of not implementing standard precautions. PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Identify potential threats to your health. TOP: Environmental safety MSC: NCLEX®: Health promotion and maintenance—prevention and early detection of disease

6. The nurse has an adequate understanding of Japanese culture when stating which of the following? (Select all that apply.) a. "The Japanese believe that contact with blood, skin diseases, and corpses causes illness." b. "The Japanese believe in healers and herbalists." c. "The Japanese have high regard for physicians." d. "The Japanese tend to not question the care of the physician." e. "The Japanese verbally express pain."

ANS: A, B, C, D The nurse has an adequate understanding of Japanese culture when stating that the Japanese believe that contact with blood, skin diseases, and corpses causes illness; have high regard for physicians; and often do not question their care. The Japanese do not express pain, believing that it is a virtue to bear pain. PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

4. Which statement by the nurse shows understanding of the Vietnamese culture? (Select all that apply.) a. "Vietnamese are slow to trust authority figures." b. "Vietnamese have a very patriarchal society." c. "Vietnamese will try home remedies before seeking Western medicine." d. "Vietnamese are often compliant with Western treatment one sought." e. "Vietnamese are generally noncompliant with health care."

ANS: A, B, C, D The nurse shows understanding of Vietnamese culture by stating that the Vietnamese are slow to trust authority figures, a very patriarchal society, will try home remedies before seeking Western medicine, and are often compliant with Western treatment once sought. PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

4. A nurse is listening to a pharmacist lecture about factors that contribute to medication errors. The teaching has been effective when the nurse states: (Select all that apply.) a. "Problems within the system contribute to medication errors." b. "Human factors contribute to medication errors." c. "Work-design problems contribute to medication errors." d. "Environmental factors contribute to medication errors." e. "The nurse alone contributes to medication errors."

ANS: A, B, C, D The teaching has been effective when the nurse states that contributions to medication errors include problems within the system, human factors, work-design problems, and environmental factors. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 514 OBJ: Define quality standards in health care management. TOP: Standards of quality health care management MSC: NCLEX®: Not applicable

6. A nurse manager is educating unit staff about HCAHPS. The manager judges the teaching to be effective when a staff nurse states that the HCAHPS survey contains rating about (Select all that apply.) a. communication. b. pain management. c. responsiveness. d. cost of hospital stay. e. discharge information.

ANS: A, B, C, E Teaching has been effective when the nurse states that HCAHPS survey contains rating about communication, pain management, responsiveness, and discharge information. HCAHPS does not include the cost of the hospital stay. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 507 OBJ: Discuss the use of key indicators to measure performance. TOP: HCAHPS MSC: NCLEX®: Not applicable

2. Which of the following are considered core measures and monitored by The Joint Commission? (Select all that apply.) a. Code arrests infection rates b. Advance directives c. Medication error rates d. Nurse staffing and vacation patterns e. Restraint use f. Numbers of hospital admissions

ANS: A, B, C, E The Joint Commission mandates that organizations continuously track certain core measures in order to monitor quality care. Some of these include advance directives, autopsy rates, leaving against medical advice (AMA) and elopement rates, blood product use rates, blood transfusion reaction rates, code blue rates, conscious sedation complication rates, fall rates, medication error rates, mortality rates, pain management effectiveness, restraint use, perinatal care, rates of deep vein thrombosis, and surgical-site infection rates. Nurse staffing and vacation patterns and tracking hospital admissions are not core measures. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 507 OBJ: Describe factors that influence staffing and scheduling in nursing care delivery. TOP: Quality patient care—continuous quality improvement MSC: NCLEX®: Safe and effective care environment—management of care

MULTIPLE RESPONSE 1. If the nurse had an adequate understanding of continuous quality improvement, which of the following statements would the nurse? (Select all that apply.) a. "The accountability for quality is vested in quality circles that function along service lines to improve patient care." b. "After quality standards are achieved, the nurse strives to maintain that standard of care." c. "Quality standards must incorporate the expectations of patients and their families." d. "Systems within the hospital must be reviewed to determine how care can be enhanced." e. "Reducing costs to provide for substantial pay increases for nursing staff is an example of continuous quality improvement." f. "Computerized electronic documentation systems that provide continuous assessment of patient charges are an example of continuous quality improvement."

ANS: A, B, D Quality improvement (QI) refers to the process or activities that are used to measure, monitor, evaluate, and control services so that nurses can provide some measure of confidence to health care consumers. It includes reports that must be generated to track progress. This approach emphasizes continually looking for opportunities to improve. QI looks not only at what the nurse does in the pursuit of quality but also at how the systems of the units in the hospital can be improved to provide better care at lower cost. Reducing costs by providing for pay increases for nursing staff and computerized documentation systems are not examples of QI. Although quality improvement affects patients, their expectations and their family members' expectations are not necessarily incorporated into quality circles and the work that they do. Nurses must monitor quality care compliance; otherwise, people tend to go back to their old ways of doing things. The QI department is typically the department that receives data, analyzes trends, and recommends actions to facilitate improvement in the organization. However, there should also be a continuous quality improvement (CQI) council as a primary decision-making nursing team, as well as quality circles (QCs) that function along service lines, collaborating to improve care for a group of patient types. PTS: 1 DIF: Cognitive Level: Application REF: p. 511 OBJ: Describe factors that influence staffing and scheduling in nursing care delivery. TOP: Quality patient care—continuous quality improvement MSC: NCLEX®: Safe and effective care environment—management of care

2. How does the IN/INS use HIPPA regulations and TJC requirements in daily practice? (Select all that apply.) a. Investigation of violations b. Writing of policies c. Involvement in the discipline process d. Writing of procedures e. Managing the nursing unit

ANS: A, B, D The IN/INS's use of HIPPA regulations and TJC regulations includes writing of policies and procedures and investigation of violations. It does not involvement in the discipline process or managing the nursing unit. PTS: 1 DIF: Cognitive Level: Application REF: pp. 534-535 OBJ: Discuss laws and regulations impacting nursing informatics. TOP: Professional practice, trends and issues MSC: NCLEX®: Not applicable

7. The new nurse has an adequate understanding of bullying when stating which of the following? (Select all that apply.) a. "The purpose of bullying is to control the target." b. "Bullying can verbal, behavioral, or sabotage." c. "Bullying usually occurs as a single event." d. "Bullying is initiated by the perpetrator." e. "The victim usually deserves the bullying."

ANS: A, B, D The new nurse has an adequate understanding when stating that the purpose of bullying is to control the target. It can be verbal, behavioral, or sabotage. Bullying is not a single event; rather, it occurs over time. It is initiated by the perpetrator and is not something that the victim deserves to have happen. PTS: 1 DIF: Cognitive Level: Application REF: pp. 580-583 OBJ: Understand the risk for violence at work and how to reduce your risk. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

6. A new nurse is preparing to start a new job. What actions should the nurse take to be prepared in case workplace violence occurs? (Select all that apply.) a. Take a crisis intervention course to understand signs of escalating violence. b. Become familiar with the organization's policy regarding violence. c. Be prepared to handle any violent situation alone. d. Be aware of procedures that can be used to defuse situations. e. Appear intimidating so that the violent person will back down.

ANS: A, B, D The nurse should take a crisis intervention course to understand signs of escalating violence, become familiar with the organization's policy regarding violence, and be aware of procedures that can be used to defuse situations. The nurse should never handle any violent situation alone or try intimidation to make a violent person back down because this could backfire. PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

6. A nurse manager is lecturing staff nurses on the barriers to the full integration health information technology. The nurse manager judges the teaching to be effective when a staff nurse states: (Select all that apply.) a. "Barriers include lack of standardization across care areas." b. "A barrier to the full integration is funding." c. "Currently there are no barriers." d. "A current barrier is privacy laws." e. "Barriers to full integration are not likely to be overcome."

ANS: A, B, D The teaching has been effective when a staff nurse states that barriers include a lack of standardization across care areas, funding, and privacy laws. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 545 OBJ: Review the steps in evaluating the validity of a website. TOP: What is meaningful use? MSC: NCLEX®: Not applicable

MULTIPLE RESPONSE 1. A nurse manager is educating a new nurse on how to prevent back injuries in the workplace. The teaching has been effective when the new nurse states: (Select all that apply.) a. "Back injuries can be caused by lifting." b. "Back injuries can be caused by transferring." c. "Back injuries are not common in the workplace." d. "Back injuries can occur when reaching for something." e. "Back injuries only occur when performing work incorrectly."

ANS: A, B, D The teaching has been effective when the new nurse states that back injuries can be caused by lifting, transferring, or reaching. Back injuries are very common in the workplace and can occur when work is performed both correctly and incorrectly. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 576 OBJ: Determine your risk for encountering a workplace issue that can affect your health or well-being. TOP: Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment

5. A nurse is preparing a presentation on core measures. Which medical diagnosis should the nurse plan on presenting during the lecture? (Select all that apply.) a. Myocardial infarction b. Congestive heart failure c. Diabetes d. Pregnancy-related conditions e. Deep vein thrombosis

ANS: A, B, D, E Core measures include those for patients admitted with myocardial infarction, congestive heart failure, pregnancy-related conditions, and deep vein thrombosis. Diabetes does not fall under these core measures. PTS: 1 DIF: Cognitive Level: Application REF: p. 513 OBJ: Define and discuss core measures. TOP: Core measures MSC: NCLEX®: Not applicable

9. A nurse manager is brainstorming creative solutions to mandatory overtime. Which of the following actions would help prevent the occurrence of mandatory overtime? (Select all that apply.) a. Create an on-call system with one or two extra nurses on per shift. b. Create an incentives system for part-time nurses to pick up extra shifts. c. Ask the nurses to take on extra patients during the short shifts. d. Reward nurses who put forth an extra effort for the organization. e. Create shifts for high-volume times.

ANS: A, B, D, E The nurse manager can create an on-call system, an incentive system, and shifts for high-volume times and can reward nurses who put forth an extra effort for the organization. Asking the nurses to take on extra patients may prevent mandatory overtime but can place the nurses and patients in an unsafe situation. PTS: 1 DIF: Cognitive Level: Application REF: p. 588 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

5. A nurse is educating a student nurse on African American culture. The nurse judges the teaching to be effective when the student nurse states that African Americans (Select all that apply.) a. "have extended family that has a great influence on the patient." b. "honor and respect older family members." c. "have the oldest woman as the decision maker." d. "do not disagree with health care recommendations." e. "don't always follow up with health care recommendations."

ANS: A, B, D, E The teaching has been effective when the student nurse states that African Americans have extended family that has a great influence on the patient, older family members are honored and respected, do not disagree with health care recommendations, and don't always follow up with health care recommendations. The oldest man is the decision maker. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 494 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

9. Which action would be occurring if a group of nurses were in the analyze phase of the DMAIC process? (Select all that apply.) a. Identify gaps between current performance and the goal. b. Identify possible sources of variation. c. Determine the goal. d. Write the problem statement. e. Determine where to begin making a change.

ANS: A, B, E If the nurses were in the analyze phase of the DMAIC process, they would identify gaps between current performance and the goal, identify possible sources of variation, and determine where to begin making a change. Determining the goal and writing the problem statement occur in the define phase. PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC process MSC: NCLEX®: Not applicable

MULTIPLE RESPONSE 1. A nurse is preparing to graduate with a degree in nursing informatics. The nurse is explaining career options to friends. The nurse understands the options when stating: (Select all that apply.) a. "I can work alongside engineers as they create new products." b. "I can work for a consulting firm and specialize in workflow improvement." c. "I cannot work for third-party payers." d. "I do not have the option of working for the government." e. "I am excited to work for an educational institution."

ANS: A, B, E The nurse graduating with a degree in nursing informatics has a variety of opportunities. These include working alongside engineers and for consulting firms, third-party payers, the government, and educational institutions. PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

8. A nurse manager is educating new hires on the different perpetrators of bullying. The teaching has been effective when the new hires state: (Select all that apply.) a. "A perpetrator can be a manager." b. "A perpetrator can be coworker." c. "A perpetrator is always the same licensure as the victim." d. "A perpetrator is never someone in management." e. "Perpetrators are sometimes supervisors."

ANS: A, B, E The teaching has been effective when the new hires state that perpetrators can be managers, coworkers, or supervisors. A perpetrator may or may not have the same licensure as the victim, and sometimes the perpetrator can be in management. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 580-583 OBJ: Understand workplace bullying and harassment. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

MULTIPLE RESPONSE 1. The nurse is creating a plan of care for a patient. Which would be important for to consider before implementing the plan? (Select all that apply.) a. The patient's lifestyle b. The patient's insurance coverage c. The patient's value system d. The patient's religious beliefs e. The patient's ability to pay for services

ANS: A, C, D When creating a plan of care for the patient, the nurse should consider the patient's lifestyle, value system, and religious beliefs. PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

5. Which action by the nurse incorporates standard practice for protecting patient privacy on mobile devices? (Select all that apply.) a. Keep careful physical control of the device at all times. b. Avoid use of mobile devices. c. Use a password and a time-out to authenticate the re-activation. d. Enable encryption. e. Keep security software up to date.

ANS: A, C, D, E The nurse can incorporate standard practice by doing the following: keeping careful physical control of the device at all times, using a password and a time-out to authenticate the reactivation, enabling encryption, and keeping security software up to date. Avoiding use of mobile devices may not be realistic in the health care setting. PTS: 1 DIF: Cognitive Level: Application REF: p. 537 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Use of mobile devices MSC: NCLEX®: Not applicable

3. A nurse manager is evaluating her computer chair. What should the nurse manager look for to make sure the chair is a good ergonomic design? (Select all that apply.) a. Appropriate padding b. Arm rests that are locked into place c. Strong lumbar support d. Easily adjustable e. Wheels that allow easy movement

ANS: A, C, D, E The nurse should look for appropriate padding, arm rests that can be removed, strong lumbar support, ease of making adjustments, and wheels that allow easy movement. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 578 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system. TOP: Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment

7. A nurse has an adequate understanding of barriers to quality improvement when stating which of the following? (Select all that apply.) a. "Cost is a barrier in quality improvement." b. "There are no barriers to quality improvement." c. "Nurses' loyalty to old practices is a barrier." d. "Failure to recognize that change is needed is a barrier." e. "Being unwilling to change is a barrier."

ANS: A, C, D, E There are several barriers to quality improvement. These barriers include cost, loyalty to old practices, failure to recognize that change is needed, and being unwilling to change. PTS: 1 DIF: Cognitive Level: Application REF: p. 514 OBJ: Describe your role in quality and performance improvement. TOP: Quality improvement MSC: NCLEX®: Not applicable

3. The nurse has adequate understanding of HIPAA when stating that the major impact from this privacy regulation is in (Select all that apply.) a. "health information privacy law." b. "bedside nursing care." c. "nursing report communication." d. "data security standards." e. "electronic transaction standards."

ANS: A, D, E The nurse has an adequate understanding of HIPAA when stating that the major impact from this privacy regulation is in health informatics privacy law, data security standards, and electronic transaction standards. Bedside nursing care and nursing report, communication is not included as an area of major impact. PTS: 1 DIF: Cognitive Level: Application REF: p. 535 OBJ: Discuss laws and regulations impacting nursing informatics. TOP: Professional practice, trends and issues MSC: NCLEX®: Not applicable

2. The Joint Commission publishes a Sentinel Event Alert every month. Which of the following is the best example of a sentinel event? a. Tylenol #3 is given to a patient when plain Tylenol was ordered. b. Code pink is called after a newborn is discovered missing from the nursery. c. After receiving the correct medication, the patient complains of itching all over, and a rash is noted on the patient's trunk. d. During a blood transfusion, the patient's temperature increases to 100.4° F, and the patient complains of generalized pruritus.

ANS: B A sentinel event is an unexpected occurrence involving death or loss of limb or function. Examples of sentinel events include serious medication errors, significant drug reactions, surgery performed on the wrong body site, blood transfusion reactions, and infant abductions. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 511 OBJ: Describe the history and evolution of quality in health care. TOP: Sentinel events MSC: NCLEX®: Safe and effective care environment—management of care

6. By asking, "How has being sick affected your spiritual practices?" the nurse is trying to determine the need in what spiritual dimension? a. Sources of hope and strength b. Spirit-enhancing practices or rituals c. Involvement in spiritual community d. Experience of God or transcendence

ANS: B According to Taylor in Spiritual Care: Nursing Theory, Research, and Practice (2002), asking the following assessment question helps determine the patient's spirit-enhancing practices or rituals: "How has being sick affected your spiritual practices?" As a testing strategy, note that the answer has the spiritual practices and so does the question. Other questions would assess sources of hope and strength, involvement in the spiritual community, and their experience of God or transcendence. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 494 OBJ: Assess spiritual needs of patients in the health care setting. TOP: Spiritual dimension MSC: NCLEX®: Psychosocial integrity

16. The nurse understands the benefits of Computerized Provider Order Entry (CPOE) when stating: a. "CPOE does not change the process of patient care." b. "CPOE averts problems with hand-written orders." c. "CPOE benefits only the nurses in the health care system." d. "CPOE benefits only the pharmacists in the health care system."

ANS: B Computerized Provider Order Entry benefits everyone in the health care system and greatly changes the process of patient care, as well as averts problems with handwritten orders. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 554 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Clinical information systems MSC: NCLEX®: Not applicable

9. A nurse professor is educating nursing students on The American Nurses Association's recommendation to use assistive devices for safe patient handling. The nurse professor judges the teaching to be effective when one of the students state: a. "Research indicated that patients were being injured by falls during transfers." b. "Research indicated that back injuries in staff nurses were occurring even with good body mechanics." c. "Research showed an increased number of lawsuits resulted from patient falls." d. "Research uncovered reports from state boards of nursing showed increased back injuries."

ANS: B In many situations, proper body mechanics are not adequate to protect the nurse. The nurse cannot adjust body mechanics in a way that fully protects the back. Teaching nurses to use proper body mechanics to lift and turn patients has not resulted in fewer injuries. The current recommendations by the ANA include the use of assistive patient-handling devices for lifting, transferring, and turning patients. The state board of nursing would not necessarily be the agency tracking data regarding back injuries. This would more than likely be the local or state hospital association tracking this data. Even if there are increased lawsuits related to back injuries, there are also a great number of injuries that do not end up in litigation, so the data would be inaccurate to make the assumption. PTS: 1 DIF: Cognitive Level: Evaluation REF: pp. 576-577 OBJ: Determine your risk for encountering a workplace issue that can affect your health or well-being. TOP: Ergonomic hazards MSC: NCLEX®: Health promotion and maintenance

4. A nurse is discussing the Pareto principle (80/20 rule), which leads to the idea of total quality management. Which statement indicates an adequate understanding of this principle? a. Peter Pareto c. Phillip Crosby b. Joseph Juran d. Edward Deming

ANS: B Joseph Juran is one of the forefathers of quality initiatives. He stressed the meaning of the Pareto principle and how it applies to improving quality in all organizations. PTS: 1 DIF: Cognitive Level: Application REF: p. 506 OBJ: Describe the history and evolution of quality in health care. TOP: History of quality care MSC: NCLEX®: Safe and effective care environment—management of care

19. In what culture is it very important for females to be evaluated by female health care providers? a. Asian c. Hispanic b. Muslim d. Native American

ANS: B Muslims have a respect for modesty and avoid nakedness. Having a same-gender health care provider will help meet their spiritual needs. Native American, Asian, and Hispanic culture individuals do not have specific issues related to nakedness and modesty. PTS: 1 DIF: Cognitive Level: Comprehension REF: p. 495 OBJ: Assess spiritual needs of patients in the health care setting. TOP: Cultural and spiritual beliefs affecting nursing MSC: NCLEX®: Psychosocial integrity

14. A nurse is caring for a diabetic patient who frequently uses alternative medicine to manager ailments. The feels nauseous and requests ginger tea. What should the nurse be aware of before giving the patient ginger tea? a. Nothing; natural remedies do not cause unwanted side effects. b. Ginger can cause blood glucose levels to decrease. c. Ginger causes blood glucose levels to rise. d. Ginger can cause a diabetic patient to become more nauseous.

ANS: B Nurses should be aware of natural remedies and their interactions because more patients turn to these remedies as opposed to medication for management of ailments. In this scenario, the nurse should be aware of the fact that ginger can cause blood glucose levels to decrease, possibly causing harm to the diabetic patient. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 496 OBJ: Identify challenges in defining spirituality. TOP: Cultural/spiritual assessment MSC: NCLEX®: Psychosocial integrity

Chapter 23: Nursing Informatics MULTIPLE CHOICE 1. Which statement by the nurse indicates an understanding of the definition of nursing informatics? a. "Nursing informatics is a specialty area of hospital nursing in which management of patient care is done via computers." b. "Nursing informatics is the specialty practice of nursing integrating nursing science with computer science and information science." c. "Nursing informatics includes the input and retrieval of a patient's complete medical history via electronic data." d. "Nursing informatics is an area of computer system design and analysis to provide and retrieve patient health data during the period of hospitalization."

ANS: B The ANA has defined informatics as "a specialty that integrates nursing science, computer science, and information science to manage and communicate data, information, knowledge and wisdom in nursing practice." PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care

18. The nurse understands that the following organization believes that cultural competence in nursing is necessary? a. Nurse Practice Acts of state boards of nursing b. Code of Ethics of the American Nurses Association c. Accreditation standards of the National League of Nursing d. Accreditation standards of The Joint Commission (TJC)

ANS: B The American Nurses Association indicates in its Code of Ethics the necessity of the nurse to be sensitive to individual needs. State boards of nursing are involved in the regulation and licensure of nursing practices. The National League of Nursing is involved with accreditation of nursing programs. TJC is involved with hospital accreditation. PTS: 1 DIF: Cognitive Level: Knowledge REF: p. 490 OBJ: List practice issues related to cultural competence. TOP: Necessity of cultural competence MSC: NCLEX®: Psychosocial integrity

8. The nurse is educating a nursing student on the difference between the informatics nurse and the informatics nurse specialist. The teaching has been effective when the nursing student states: a. "The informatics nurse has a graduate degree." b. "The informatics nurse specialist has experience in informatics but no advanced degree." c. "The informatics nurse supports consumers." d. "The informatics nurse specialist has an advanced degree."

ANS: D The informatics nurse has experience in nursing informatics but does not have a degree in the specialty. The informatics nurse specialist does have an advanced degree. Both the informatics nurse and the informatics nurse specialist support consumers and nurses. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 555 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

12. A nurse is working in a disaster area as a volunteer with the local ambulance agency. The nurse is providing care to a Spanish-speaking patient. What actions can be taken to properly care for this patient? a. Use gestures to emphasize what he is saying. b. Obtain an interpreter. c. Provide wound care instructions written in English. d. Treat the patient without speaking to her.

ANS: B The Office of Minority Health and Disaster Preparedness launched an initiative in 2009 to help first responders better manage disaster and crises in diverse populations. The nurse can use this initiative by obtaining an interpreter and providing wound care instructions written in English. The nurse should not rely on gestures to get his point across or treat the patient without speaking to her. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Office of minority health and disaster preparedness MSC: NCLEX®: Psychosocial integrity

7. A nurse is educating students on how to evaluate a website. The nurse judges the teaching to be effective when the students can state: a. "Internet information must go through careful screening before it can be posted." b. "Credibility, accuracy, and reasonableness of the information should be considered." c. "It is important to have the hospital librarian verify the authenticity of the website." d. "Most Internet information can be downloaded or beamed to a smartphone or handheld device (personal digital assistant [PDA])."

ANS: B The credibility of the information that you obtain from Internet searches should be challenged. It is important to be skeptical because not all information that is posted on a website is accurate. Information should be evaluated and reevaluated on a regular basis. It is important to remember that Internet information is dynamic and fluid in nature compared with printed information. Although librarians can assist with the verification of the authenticity of the website, nurses need to understand how to evaluate information from various Internet sources. It is true that most information can be downloaded to a smartphone or handheld device; however, the question is asking about evaluating a website. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 550 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care

15. A nurse manager is looking for ways to improve the cultural competency of unit staff. Which action would help the manager accomplish this? a. Propose voluntary cultural competence training. b. Hire bicultural clinical and administrative staff. c. Hire staff from the same ethnic background. d. Avoid issues pertaining to cultural competence.

ANS: B The nurse manager can improve the staff's cultural competence by hiring bicultural clinical and administrative staff to improve education, care delivery, and outcomes. The nurse manager should also propose mandatory cultural competence training and hire staff from different ethnic backgrounds. PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

11. A nurse feels bullied at work. Which of the following actions should the nurse take first? a. Ignore the bullying. b. Report the bullying. c. Take action against the bully themself. d. Take time off from work.

ANS: B The nurse should first report the bullying to get the behavior to stop. The next step would be to take time off of work recover from the incident. The nurse should never ignore the bullying or take action against the other person by themself. PTS: 1 DIF: Cognitive Level: Synthesis REF: pp. 580-583 OBJ: Understand workplace bullying and harassment. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

7. The nurse manager has an adequate understanding of the continuous quality improvement process of Six Sigma when doing which of the following? a. "Uses Six Sigma to identify errors" b. "Uses Six Sigma to increase profits" c. "Uses Six Sigma to keep standard policies and procedures consistent" d. "Uses Six Sigma to improve patient-provider communication"

ANS: B The primary goal of Six Sigma is to increase profits and reduce problems by improving standard operating procedures, reducing errors (not just identifying them), and decreasing misuse of the system. Six Sigma methodology is based on strategies that focus on CQI and reducing variation in practice through the application of DMAIc. In other words, once a protocol is found to be effective, everyone is trained to do it the same way. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Although patient-provider communication is important, it is not the primary goal of Six Sigma. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Identify tools and processes for continuous quality improvement. TOP: Continuous quality improvement goals MSC: NCLEX®: Safe and effective care environment—management of care

15. Which action can the nurse take to evaluate an internet resource? a. Assume that the resource is credible if it is on an internet page. b. Determine if the resource provides evidence for claims made. c. Assess the popularity of the resource. d. Determine the date the resource was published; older material is more reliable.

ANS: B To evaluate an internet resource, the nurse should use the CARS checklist developed by Harris (2007). The nurse should assess credibility, accuracy, reasonableness, and support. The nurse assesses support by determining if the source provides evidence for claims made. The nurse should not assume that the resource is credible because it is on the internet, assess popularity, or rely on information that is old or outdated. PTS: 1 DIF: Cognitive Level: Application REF: p. 550 OBJ: Review the steps in evaluating the validity of a website. TOP: Evaluating internet resources MSC: NCLEX®: Not applicable

10. The continuous quality improvement (CQI) committee has performed a retrospective chart audit to investigate whether outcomes recorded in each nursing care plan are patient centered and written in behavioral terms. The expected standard is 98% compliance. The sample size was 200. Results showed that 180 charts met the standard. What assessment can be made? a. The standard was met. No action plan is necessary. b. The standard was not met, but no action plan is necessary because the rate of compliance was close to the standard. c. The standard was not met. An action plan should be developed. d. The standard was not met. An immediate re-audit is necessary.

ANS: C A threshold, or cutoff point, is determined for each indicator. This example represents a 90% compliance rate (180 divided by 200 = 0.9 or 90%), but the threshold or expected standard was set at 98%. Therefore, the standard was not met, and an action plan needs to be developed. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 508 OBJ: Discuss the impact that health care provider credentialing and quality improvement activities have on nursing practice. TOP: Continuous quality improvement (CQI) MSC: NCLEX®: Safe and effective care environment—management of care

3. A nurse is reviewing the technique used to identify the factors involved in an error. Which statement indicates the nurse has an adequate understanding? a. "The rapid cycle test is a technique that is widely used." b. "A root cause analysis is a process designed to investigate and categorize the root cause of the event." c. "A failure mode and effects analysis is a procedure to investigate the cause of the error." d. "Define, measure, analyze, improve, control prevents events from occurring."

ANS: B When an error is analyzed, the primary causes need to be determined so that a workable and effective solution can be developed. A root cause analysis is such a process designed to investigate and categorize the root cause of the event. The Six Sigma DMAIC process (define, measure, analyze, improve, control) is used primarily for improving existing processes that do not meet institutional goals or national norms. Rapid cycle tests are components of continuous quality improvement. A failure mode and effects analysis (FMEA) is a procedure in product development and operations management for analysis of potential failure modes within a system for classification by the severity and likelihood of the failures. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Identify tools and processes for continuous quality improvement. TOP: Causation of errors MSC: NCLEX®: Safe and effective care environment—management of care

3. Which statement by the nurse indicates an adequate understanding of violence in the health care setting? a. "Violence is a new problem." b. "Violence can occur anytime and anywhere." c. "Violence is a problem in the acute care setting." d. "Violence occurs mostly in mental health settings."

ANS: B Workplace violence is a growing risk and the second leading cause of occupational death in the United States. The nature of health care workers' jobs puts them at risk for workplace violence, which can result in injury or death. Health care workers are at risk for harm from coworkers, patients, families, and visitors in any health care setting at anytime. PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk. TOP: Violence in the health care setting MSC: NCLEX®: Safe and effective care environment—safety and infection control

2. A nurse manager is educating unit staff on cultural competence. The manager knows that the teaching has been effective when one of the staff members states that cultural competence is (Select all that apply.) a. "not important in health care." b. "accepting and respecting cultural differences." c. "demonstrating knowledge of the patient's culture." d. "demonstrating an understanding of the patient's culture." e. "adapting care to be congruent with the patient's culture."

ANS: B, C, D, E Purnell and Paulanka (2009) define cultural competence as accepting and respecting cultural differences, demonstrating knowledge of the patient's culture, demonstrating an understanding of the patient's culture, and adapting care to be congruent with the patient's culture. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 490 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

4. What action can the nurse take to reduce the risk of repetitive motion disorders? (Select all that apply.) a. Avoid frequent position changes. b. Frequently alternate between standing and sitting. c. Have a good understanding of ergonomic principles. d. Engage in routine stretching of shoulders, neck, arms, hands, and fingers. e. Attend training on how to reduce injury.

ANS: B, C, D, E The nurse can frequently alternate between standing and sitting; have a good understanding of ergonomic principles; engage in routine stretching of shoulders, neck, arms, hands, and fingers; and attend training on how to reduce injury. PTS: 1 DIF: Cognitive Level: Application REF: p. 579 OBJ: Understand ergonomics and ways to safeguard your musculoskeletal system. TOP: Ergonomic hazards for health care workers MSC: NCLEX®: Safe and effective care environment

3. Which action by the nurse shows cultural competence of Native American culture? (Select all that apply.) a. Refuse to allow rituals to be practiced at the bedside. b. Allow the family to bring in a medicine man for healing. c. Allow the family and patient time for prayer. d. Provide space for rituals. e. Work hard to gain trust.

ANS: B, C, D, E The nurse can show culturally competent care of an American Indian patient by allowing the family to bring in a medicine man, allowing time for prayer, providing space for rituals, and working hard to gain trust. PTS: 1 DIF: Cognitive Level: Application REF: p. 495 OBJ: Determine cultural and spiritual beliefs of patients in the health care setting. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

3. A nurse manager is educating a group of nurses on common medication errors. The manager judges the teaching to be effective when one of the nurses states that common medication errors include (Select all that apply.) a. good communication b. look-alike packaging c. wrong-dose errors d. inadequate monitoring e. rule violations

ANS: B, C, D, E The teaching has been effective when the nurse states that common medication errors include look-alike packaging, wrong-dose errors, inadequate monitoring, and rule violations. Common medication errors also include poor communication. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 513 OBJ: Define quality standards in health care management. TOP: Standards of quality health care management MSC: NCLEX®: Not applicable

8. Which action by a group of nurses involves brainstorming? (Select all that apply.) a. List one solution to the problem. b. Identify stakeholders. c. Think about solutions to the problem. d. Write the problem statement. e. Write a goal statement.

ANS: B, C, D, E To brainstorm, the nurses should think about solutions to the problem, identify stakeholders, list solutions to the problem, and write the problem statement as well as the goal statement. PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: Brainstorming MSC: NCLEX®: Not applicable

12. A nurse has been floated to another department, and things are not going well. What should the nurse do? a. Leave the unit. b. Refuse to provide care to the patients. c. Tell the immediate supervisor. d. Keep any problems to themselves.

ANS: C The nurse should tell the immediate supervisor if things are not going well on the new unit to ensure safe patient care. The nurse should not leave unit, refuse to provide patient care, or keep problems to themself. PTS: 1 DIF: Cognitive Level: Application REF: p. 589 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

5. Which of the following statements indicates the nurses understanding of the difference between the electronic health record (EHR) and electronic medical record (EMR) is: a. "EHR provides nursing with a standardized nomenclature of taxonomy to record nursing care." b. "EMR is the inclusion of only data collected by the patient (personal health record (PHR)." c. "EHR is a longitudinal record of the patient's health information." d. "EMR allows nurses to document nursing care in a system that is intuitive to their level of computer literacy."

ANS: C EHR is the longitudinal electronic record of patient health information generated by one or more encounters in any care delivery setting. Included in this information are patient demographics, progress notes, problems, medications, vital signs, past medical history, immunizations, laboratory data, and radiology reports. The EHR automates and streamlines the clinician's work flow. The EHR has the ability to generate a complete record of a clinical patient encounter—as well as supporting other care-related activities directly or indirectly via interface—including evidence-based decision support, quality management, and outcomes reporting. The EMR is composed of data from multiple software applications used by a facility such as a hospital or provider officer to order, document, and store patient information just as a paper medical record did in the past. The ability of the computer systems to combine data from various EMRs to form a more holistic view of a patient is one of the major benefits of electronic documentation. The inclusion of data collected by the patient into the EHR is called the personal health record (PHR). PTS: 1 DIF: Cognitive Level: Application REF: p. 541 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Informatics MSC: NCLEX®: Safe and effective care environment—management of care

14. How can the nurse expect to be impacted by nursing informatics? a. The nurse would not be directly impacted unless he or she worked in nursing informatics. b. Nurses at the bedside are minimally impacted. c. Nurses are impacted by the use of barcode medication administration. d. Nurse managers are the only hospital staff who are impacted.

ANS: C Everyone in the health care system is impacted by nursing informatics in one way or another. Nurses are directly impacted by the use of barcode medication administration. PTS: 1 DIF: Cognitive Level: Synthesis REF: p. 553 OBJ: Describe what a nurse specializing in nursing informatics might do. TOP: Nursing informatics and you MSC: NCLEX®: Not applicable

13. A nurse is caring for a patient experiencing spiritual distress. What nursing intervention would be appropriate for this patient? a. Asking the patient to reserve prayer for the hospital chaplain b. Placing the patient by the nurses' station because it is busy and will keep the patient entertained c. Developing a trusting relationship with the patient d. Allowing the patient's roommate to have visitors late into the night

ANS: C It is important that the nurse develop a trusting relationship with the patient, as well as being supportive of the patient's needs. The nurse should allow the patient a quiet environment that allows time for prayer and meditation. PTS: 1 DIF: Cognitive Level: Application REF: p. 493 OBJ: Identify challenges in defining spirituality. TOP: Culturally diverse workforce MSC: NCLEX®: Psychosocial integrity

9. A manager is educating a group of nurses on the importance of cultural competence. The manager knows that the teaching has been effective when one of the nurse's states: a. "Cultural competence does not impact patient care." b. "Cultural competence is not important in health care." c. "Lack of cultural competence leads to suboptimal patient outcomes." d. "Lack of cultural competence does not cause active harm to the patient."

ANS: C Lack of cultural competence is extremely important in health care because it directly impacts patient care. Lack of cultural competence leads to suboptimal care and can cause active harm to the patient. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 489 OBJ: Define cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

5. Which statement by the nurse manager indicates understanding of Magnet status? a. "Hospitals are granted Magnet status by the National League of Nursing." b. "The American Nurses Association grants Magnet status." c. "Hospitals are granted Magnet status by the American Nurses Credentialing Center." d. "The National Council of State Boards of Nursing grants Magnet status."

ANS: C The American Nurses Credentialing Center is responsible for judging whether hospitals achieve Magnet status, which is an American Nurses Association subsidiary. The National League of Nursing accredits nursing programs. The National Council State Boards of Nursing is the national regulatory body for nursing practice and nurse licensure. PTS: 1 DIF: Cognitive Level: Application REF: p. 585 OBJ: Assess trends in the job market. TOP: Best places to work MSC: NCLEX®: Safe and effective care environment—management of care

Chapter 22: Quality Patient Care MULTIPLE CHOICE 1. The primary role of The Joint Commission (TJC) is a. granting magnet status to excellent hospitals. b. lobbying Congress on behalf of Medicare/Medicaid patients. c. ensuring medical facilities meet patient safety guidelines. d. inspecting hospitals for compliance of infection control standards.

ANS: C The Joint Commission (TJC) is the primary accrediting body for health care institutions. Its standards directly address patient safety issues. Magnet status is approved by the American Nurses Association. TJC does not lobby Medicare/Medicaid issues. The CDC is the agency that maintains standards regarding infection control for hospital compliance. PTS: 1 DIF: Cognitive Level: Application REF: p. 508 OBJ: Identify the role of regulatory standards and agencies. TOP: Role of The Joint Commission MSC: NCLEX®: Safe and effective care environment—management of care

10. The Needlestick Safety and Prevention Act of 2000 was implemented to prevent health care workers from experiencing needlestick injuries. Which of the following is required to be documented regarding a needlestick injury? a. Notify the patient's physician. b. Advise the hospital risk management department. c. Document the department or work area in which the exposure occurred. d. Send the injured staff person to the emergency room for documentation of the incident.

ANS: C The Needlestick Safety and Prevention Act requires documentation of the department and work area in which the needlestick injury occurred. It also requires employers to maintain a sharps injury log to document the type and brand of device involved and an explanation of how the incident occurred. The information is to be recorded and maintained in a way that protects the confidentiality of injured employees. The test question is asking for "required documentation," so notifying the doctor is not appropriate. More than likely, the person would be sent to the occupational safety department for follow-up and documentation. PTS: 1 DIF: Cognitive Level: Application REF: p. 584 OBJ: Determine your risk for encountering a workplace issue that can affect your health or well-being. TOP: Workplace safety MSC: NCLEX®: Not applicable

13. A nurse is passing medications when interrupted by a colleague. Upon resuming work, the nurse realizes a medication was given to the wrong patient. What should the first action be? a. Document the medication error according to hospital policy. b. Keep the medication error to themself. c. Tell her immediate supervisor or charge nurse. d. Keep the medication error to themself, but assess the patient every hour.

ANS: C The nurse should tell the immediate supervisor or charge nurse. Documentation of the error is important and should occur after the supervisor is contacted and the patient is cared for. The nurse should never keep the medication error to themself. PTS: 1 DIF: Cognitive Level: Application REF: p. 591 OBJ: Develop a personal plan to deal with workplace problems such as staffing shortages and floating to another unit. TOP: Other workplace issues MSC: NCLEX®: Safe and effective care environment

17. A nurse manager is brainstorming quality improvement methods. Which action would help implement these methods on the assigned unit? a. Continue without change. b. Resist change from upper management. c. Empower employees to carry out needed strategies for change. d. Agree to change what is directly beneficial.

ANS: C To implement and benefit from quality improvement methods, the nurse should encourage employees to carry out needed strategies for change. Continuing without change, resisting change, or only agreeing to change that is only directly beneficial would not be helpful. PTS: 1 DIF: Cognitive Level: Application REF: p. 516 OBJ: Identify tools and processes for continuous quality improvement. TOP: Monitoring quality of care MSC: NCLEX®: Not applicable

10. Which statement by the nurse indicates understanding of the control phase of the DMAIC process? (Select all that apply.) a. "In the control phase, only the leader should be informed of changes." b. "Only those directly affected by the new process should be educated." c. "In the control phase, steps in the new process should be standardized." d. "Changes should be monitored to ensure compliance." e. "Standard operating procedures should be written."

ANS: C, D, E In the control phase of the DMAIC process, everyone should be kept informed of changes, standard operating procedures should be written, everyone should be educated about the new process, the steps in the new process should be standardized, and changes should be monitored to ensure compliance PTS: 1 DIF: Cognitive Level: Application REF: p. 519 OBJ: Incorporate successful process improvement strategies. TOP: DMAIC process MSC: NCLEX®: Not applicable

5. A nurse manager is educating a group of new nurses on workplace violence. The nurse judges the teaching to be effective when one of the nurses states: (Select all that apply) a. "Workplace violence is uncommon in today's society." b. "Workplace violence does not include threats of assault." c. "Workplace violence includes physical assaults." d. "Workplace violence includes unwanted sexual advances." e. "At least 80% of nurses have experienced workplace violence."

ANS: C, D, E The teaching has been effective when the nurse states the following: workplace violence includes physical assaults and unwanted sexual advances, and at least 80% of nurses have experienced workplace violence. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 579 OBJ: Understand the risk for violence at work and how to reduce your risk. TOP: Workplace violence: a growing concern in health care MSC: NCLEX®: Safe and effective care environment

4. A nurse manager is educating a group of staff nurse on violation of HIPPA standards. The manager judges the teaching to be effective when one of the staff nurses states: (Select all that apply.) a. "Violations of HIPPA standards no longer occur because the consequences are so severe." b. "Violations of HIPPA standards can result in termination of employment." c. "Violations of HIPPA standards can result in an indictment." d. "Violations of HIPPA standards are waived if it is your first offense." e. "Violations of HIPPA standards can result in prison time."

ANS: C, E The teaching has been effective when one of the staff nurses states that violation of HIPPA standards can result in termination of employment, indictment, or prison time. Violations still occur, even in the face of consequences, and are not waived for first offenses. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 535 OBJ: Discuss laws and regulations impacting nursing informatics. TOP: HIPPA MSC: NCLEX®: Not applicable

18. The nurse understands that the following statement is true about patient classification systems? a. "The systems measure all the needs of patients." b. "The systems provide an absolute formula for unit staffing." c. "The systems should not be used to make patient care assignments because acuity systems are more accurate." d. "The systems provide historical data of the usage of nursing time, which is helpful when developing the department budget."

ANS: D A patient classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. It is helpful for developing a department budget. It is not a formula for unit staffing and does not measure all the needs of the patients. PTS: 1 DIF: Cognitive Level: Application REF: p. 508 OBJ: Describe strategies to coordinate care and reduce costs. TOP: Coordination of care and cost control MSC: NCLEX®: Not applicable

7. Using a spiritual assessment tool helps the nurse gain more understanding of the patient. What would be the best question to assess a patient's inner strengths? a. What gives your life meaning? b. Are you motivated to get well? c. What do you do to show love for yourself? d. What brings you joy and peace in your life?

ANS: D Asking what brings joy and peace to a person's life is an example of a reflective question to help increase the awareness of the inner strengths of a patient's spiritual process. Such a question assesses a person's ability to manifest joy. Asking about what gives meaning could address family and career and not necessarily a patient's inner strength. Asking about motivation and what a person does to show love for themself does not encourage reflection on inner strengths but asks a question that could be briefly answered. PTS: 1 DIF: Cognitive Level: Application REF: p. 494 OBJ: Assess spiritual needs of patients in the health care setting. TOP: Spiritual assessment MSC: NCLEX®: Psychosocial integrity

10. The nurse has an adequate understanding of the informatics nurse (IN) and informatics nurse specialist (INS) when making which of the following statements? a. "The IN/INS does not require any computer or network knowledge on entry into the profession." b. "The IN/INS does not interact directly with clinical staff." c. ""The IN/INS does not need prior knowledge of software or hardware implementation." d. "The IN/INS should be prepared to help with system implementation."

ANS: D The IN/INS should be prepared to help with system implementation, have computer and network knowledge on entry into the profession, and interact directly with staff. PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

10. A nurse has an adequate understanding of the barriers to cultural competence when making which of the following statements? a. "Barriers to cultural competence no longer exist in today's society." b. "The barriers to cultural competence cannot be broken down." c. "Provider barriers include having knowledge about a custom's culture regarding health care." d. "Systems barriers exist when an agency's structure and policies are not designed to support cultural diversity."

ANS: D Barriers to cultural competence exist in today's society and can be broken down with the help of health care providers. Provider barriers include having a lack of knowledge about a custom's culture regarding health care. Systems barriers exist when an agency's structure and policies are not designed to support cultural diversity. PTS: 1 DIF: Cognitive Level: Application REF: p. 490 OBJ: Define cultural competence. TOP: Barriers to cultural competence MSC: NCLEX®: Psychosocial integrity

16. A nurse is educating a patient's family on holistic nursing. The nurse judges the teaching as effective when the family states all of the following except: a. "Holistic nursing is an attitude." b. "Holistic nursing is a way of being." c. "Holistic nursing focuses on healing the person as a whole." d. "Holistic nursing focuses on healing the system causing ailment."

ANS: D Holistic nursing is an attitude, a way of being and is focused on healing the person as a whole. It is not focused on the system causing the ailment. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 496 OBJ: Assess spiritual needs of patients in the health care setting. TOP: Holistic nursing MSC: NCLEX®: Psychosocial integrity

9. A nursing student is interested in the field of nursing informatics. What should the student do to prepare for a career in this specialty as a nurse leader? a. Obtain a baccalaureate degree in nursing, b. Complete 5 years on a medical-surgical unit, c. Obtain critical care experience, d. Obtain a graduate degree,

ANS: D Informatics nurses who want to hold a leadership role in nursing informatics will need graduate-level preparation. PTS: 1 DIF: Cognitive Level: Application REF: p. 553 OBJ: Define nursing informatics. TOP: Nursing informatics MSC: NCLEX®: Not applicable

3. What is the importance of using classification systems for nursing nomenclature to describe nursing practice? a. To provide a system to develop and use a patient care management system b. To allow nursing administration to project, define, and implement nursing care policies and guidelines c. To assist the quality control team to survey and gather data that will reflect the acuity classification of patients d. To facilitate collection of consistent data that can be accurately manipulated in an electronic medical record

ANS: D Nursing nomenclatures offer a recognized systematic classification and consistent method of describing nursing practice. Without a common language, data cannot be aggregated into a useful language. If the unique nomenclature of accepted classification systems is used consistently, gathered data elements can be captured, stored, and manipulated accurately in the electronic medical record. Acuity systems allow nursing administration to address ways to deal with issues such as shift-to-shift changes in patient care needs, admission-discharge-transfer volumes, and factors such as ancillary support and technology and equipment considerations to support CQI measures. Nursing classification systems do not assist in the use of a patient care management system or the writing of policies and guidelines. PTS: 1 DIF: Cognitive Level: Application REF: p. 538 OBJ: Discuss the necessity of using recognized taxonomies and nursing nomenclature in nursing documentation. TOP: Nomenclature and classification MSC: NCLEX®: Safe and effective care environment—management of care

Chapter 21: Cultural and Spiritual Awareness MULTIPLE CHOICE 1. What action by the nurse would indicate cultural competence? a. Displays no favoritism b. Tries to treat all patients the same c. Prioritizes care based on cultural needs d. Wants to learn more about other ethnic groups

ANS: D One model of cultural competence has five aspects. They include cultural awareness, cultural knowledge, cultural skill, cultural encounter, and cultural desire. Cultural knowledge is seeking and obtaining information regarding different cultural and ethnic groups. The other options are applicable to quality nursing care. PTS: 1 DIF: Cognitive Level: Application REF: p. 489 OBJ: Define cultural competence. TOP: Cultural competence MSC: NCLEX®: Psychosocial integrity

2. What is an example of a system barrier to cultural competence? a. No kosher diet options on menu b. No sinks in every patient room c. No privacy curtains in exam rooms d. A strict and enforced policy against more than one visitor in the ICU

ANS: D System barriers are due to the agency's structure and policies that do not support cultural diversity. A strict and enforced ICU visitor policy, for example, will impact those cultures with a strong emphasis on the extended family. Provider barriers are those such as a nurse may have, including lack of information about a culture. Including kosher diet options on the menu and making changes to room environments (including privacy curtains and sinks in every room) are provider barriers that can be addressed. PTS: 1 DIF: Cognitive Level: Analysis REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: System barriers to cultural competence MSC: NCLEX®: Psychosocial integrity

5. The nurse manager is educating a new hire on The Joint Commission (TJC). The manager tells the new hire that TJC mandates the use of continuous quality improvement and measurement of specific quality outcomes for patients with certain diagnoses. The teaching has been effective when the new hire states: a. "These mandates include patients admitted with Acute MI and COPD." b. "Outcomes measures are mandated for patients with a diagnosis of congestive heart failure and brain attack." c. "Acute renal failure and deep vein thrombosis have mandated outcomes by The Joint Commission." d. "Outcome measures are mandated for patients admitted with community-acquired pneumonia and congestive heart failure."

ANS: D TJC mandates outcome measures for patients admitted with a diagnosis of acute MI, congestive heart failure, community-acquired pneumonia, surgical infection prophylaxis, pregnancy-related conditions, and deep vein thrombosis. Keep in mind that each item in the option must be correct for the option to be correct, which is the reason acute MI and COPD as well as congestive heart failure and brain attack are incorrect. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 517 OBJ: Discuss the use of key indicators to measure performance. TOP: Specific quality outcome measurements MSC: NCLEX®: Safe and effective care environment—management of care

11. The nurse manager has an adequate understanding of root cause analysis when stating which of the following? a. "Root cause analysis determines who to place the blame on." b. "Root cause analysis can identify some factors leading up to an error." c. "Root cause analysis is rarely conducted effectively." d. "Root cause analysis investigates the root causes of events that occur."

ANS: D The nurse manager has an adequate understanding of root cause analysis when they state it involves investigation of the root causes of events that occur. Root cause analysis does not determine who to blame, identifies all factors leading up to an error, and is conducted effectively by trained professionals. PTS: 1 DIF: Cognitive Level: Application REF: p. 518 OBJ: Define quality standards in health care management. TOP: Standards of quality health care management MSC: NCLEX®: Not applicable

17. A nurse is gathering data on a patient of a different culture. Which action can the nurse take to enhance communication while gathering cultural data? a. Ignore the patient's culture and focus on the reason for hospital admission. b. Use hand gestures to get points across to a patient with poor English. c. Use close-ended questions to gather information. d. Determine the patient's level of fluency in English.

ANS: D The nurse should determine the patient's level of fluency in English to enhance communication. The nurse should not avoid the patient's culture during the assessment. Hand gestures should not be used because they could be offensive to the patient. The nurse should use open-ended questions or questions phrased in different ways as a method to gather data. PTS: 1 DIF: Cognitive Level: Application REF: p. 491 OBJ: List practice issues related to cultural competence. TOP: Culture and spirituality MSC: NCLEX®: Psychosocial integrity

13. Which statement by the nurse indicates understanding of the General Systems Theory? a. "It is a 5-step process of an individual's decision to adopt an innovation." b. "It is known as a change theory." c. "It includes knowledge, persuasion, decision, implementation, and confirmation." d. "It organizes interdependent parts working together to produce a product that none used alone could produce."

ANS: D The nurse understands the General Systems Theory when he or she states that it organizes interdependent parts working together to produce a product that none used alone could produce. Rogers' Diffusion of Innovation Theory is a 5-step process of an individual's decision to adopt an innovation. It includes the steps of knowledge, persuasion, decision, implementation, and confirmation. Kurt Lewin's theory is known as the Change Theory. PTS: 1 DIF: Cognitive Level: Application REF: p. 539 OBJ: Discuss trends associated with the computerized electronic record, e-health, mobile devices. TOP: Models and theories MSC: NCLEX®: Not applicable

7. A nurse manager is educating a coworker on agencies that oversee environmental hazards at ambulatory care centers. The nurse manager judges the teaching to be effective when the coworker states: a. "National Council of State Boards of Nursing has a role in overseeing any environmental hazard." b. "American Nurses Credentialing Center oversees all environmental hazards in the United States." c. "Ambulatory Care Nursing Administration and Practice oversees only local environmental hazards." d. " The Occupational Safety and Health Administration oversees all environmental hazards at ambulatory care centers."

ANS: D The purpose of the Occupational Safety and Health Administration (OSHA) and the state health department is to establish safety and health standards in the work environment. OSHA requires employers to provide a safe work environment for employees. The other options refer to agencies that regulate professional nursing practice (NCSBN) and provide credentialing (ANCC). Ambulatory Care Nursing Administration and Practice is not a recognized agency. There is the American Academy of Ambulatory Care Nursing (AAACN), which is the association of professional nurses and associates who identify ambulatory care practice as essential to the continuum of high quality, cost-effective health care. PTS: 1 DIF: Cognitive Level: Evaluation REF: p. 584 OBJ: Identify useful Internet sites to keep up-to-date with potential workplace issues (e.g., OSHA, CDC, ANA). TOP: Environmental hazards MSC: NCLEX®: Safe and effective care environment—management of care

6. The staff nurse, in the tenth hour of a 12-hour shift, is told by the house supervisor that the nurse replacement will be 2 hours late and the staff nurse must work these extra 2 hours. The nurse is unable to stay over. What is the best action for the nurse to talk? a. Talk to the person over the house supervisor. b. Refuse and go home on time because from being too tired to work. c. Fix some strong coffee and call home to explain the situation. d. Ask if the supervisor could work a double because the supervisor needs the money.

aaa ANS: A When nurses are concerned that their patients require more care than they can provide, they must report this. If the nurse does not get adequate direction or an answer from the immediate supervisor, then the nurse should follow the chain of command and report it to the person above the supervisor. It would not be advisable or prudent to go home and abandon the patient assignment without adequate staffing or to work a double shift when the nurse has admitted being too tired. Loading up on caffeine may give the nurse immediate energy, but the fatigue may impair judgment and reasoning in patient care. PTS: 1 DIF: Cognitive Level: Application REF: p. 588 OBJ: Determine your risk for encountering a workplace issue that can affect your health or well-being. TOP: Mandatory overtime MSC: NCLEX®: Safe and effective care environment—management of care