N454 Leadership Midterm

Which option describes a change agent that demonstrates a charismatic style of leadership? 1. The change agent can describe the vision, sets high expectations, and is a role model for the staff. 2. The change agent expresses personal views about the change, empathizes with the staff, and lets the staff members know they can survive the change. 3. The change agent shares and clearly communicates the vision that is required to meet the goal. 4. The change agent provides the staff members with the resources needed to do their job.

Correct Answer: 1 Rationale 1: The charismatic change agent is an envisioning leader. Rationale 2: These actions describe an enabling change agent. Rationale 3: These actions describe a missionary change agent. Rationale 4: This is an instrumental or transactional change agent.

What are the responsibilities of the nurse manager in most shared governance models? Select all that apply. 1. Staffing. 2. Direct patient care. 3. Program evaluation. 4. Allocation of resources. 5. Long-range planning.

Correct Answer: 1,3,4,5 Rationale 1: This is a responsibility of the nurse manager in most shared governance models. Rationale 2: In most shared governance models, the nurse manager is not responsible for providing direct patient care. Rationale 3: This is a responsibility of the nurse manager in most shared governance models. Rationale 4: This is a responsibility of the nurse manager in most shared governance models. Rationale 5: This is a responsibility of the nurse manager in most shared governance models.

Which phrase best explains the Institute of Medicine's (IOM) 21st century rule, "Care based on continuous healing relationships"? 1. Sharing of information. 2. Patient-centered care. 3. Access is critical. 4. Care based on evidence.

Correct Answer: 2 Rationale 1: Sharing of information is related to the critical nature of "Shared knowledge and the free flow of information." Rationale 2: Patient-centered care is related to the need for customization based on patient needs and values. Rationale 3: This IOM rule means that patients should receive care whenever they need it—access is critical. Rationale 4: Patient care that is based on the best possible evidence available relates to evidence-based decision making.

What is true of quality in health care? 1. It is easy to define. 2. It is easy to measure. 3. It is complex. 4. It is unachievable.

Correct Answer: 3 Rationale 1: Quality is difficult to define. Rationale 2: Quality is difficult to measure. Rationale 3: Quality is a complex concept, with many factors affecting it. Rationale 4: Total quality may be difficult to achieve in health care, but improvement of quality is possible.

The nurse has read about the concept of "dispersed leaders" in nursing. How should the nurse expect this concept to be operationalized at the unit level? 1. Leaders will be spread across different units so that each leader has responsibility for two or more units. 2. Leaders from the hospital will be "loaned" out into the community to improve community health services. 3. Each nurse in the unit will be expected to assume leadership responsibilities. 4. Leaders will divide the responsibilities of the unit among the nurses available each shift.

Correct Answer: 3 Rationale 1: This scenario is not an example of dispersed leadership. Rationale 2: This scenario is not an example of dispersed leadership. Rationale 3: Dispersed leaders means that there is not one leader in a unit or facility, but many leaders. Nurses will be called upon to assume leadership as individ

A problem has been identified in the health care facility. What should the nurse who has been assigned the task of change agent do first? 1. Develop an alternative plan. 2. Gather data. 3. Collaborate with others. 4. Empower staff.

Correct Answer: 2 Rationale 1: Developing alternative plans is done after a diagnosis is made. Rationale 2: Step 1 of the change process is to gather the data necessary to be able to define the problem and develop a plan of action. Rationale 3: Collaborating and empowering staff takes place throughout the change process after data is collected in the assessment phase. Rationale 4: Collaborating and empowering staff takes place throughout the change process after data is collected in the assessment phase.

Q18. Which option represents a situation exemplifying the need for nurses to become involved in health care planning? 1. The nurse omitted documentation of a surgical dressing change. 2. The nurse must have an advanced practice license to prescribe medications. 3. The nurse administered oral medications to the patient. 4. The nurse discussed do-not-resuscitate decisions with the patient and the family.

Correct Answer: 2 Rationale 1: This scenario represents a violation of standards and a potential malpractice issue, not an issue of health care planning. Rationale 2: Changes in legislation and regulation (which might be influenced by nurses involved in health care planning) affect nursing practice. Rationale 3: This scenario is unlikely to be altered by change in legislation or regulation. Rationale 4: This scenario is unlikely to be altered by change in legislation or regulation.

The vice president of nursing services in completing a budgetary report for the governing board meeting this week. In which category should this nurse place the total expenditure for health benefits for nursing employees? 1. Salary and wages. 2. Operations. 3. Capital. 4. Accounts receivable.

Correct Answer: 1 Rationale 1: Salary and wages include all salary and benefits to the employee. This includes sick time, vacation time, health benefits, premium time, merit raises, etc. Rationale 2: The operational budget includes the estimate of the volume, and the mix of activities and series and resources required to provide them. Rationale 3: The capital budget is the estimate of purchases of major capital items, such as equipment, building, and furniture. Rationale 4: Accounts receivable is the part of the budget report that indicates the amount due to the hospital for services rendered.

Which options can be used to describe U.S. hospitals? Select all that apply. 1. An organization with a purpose. 2. Provides continuous nursing services under the supervision of registered nurses. 3. Delivers predominantly primary care but also can provide secondary and tertiary care. 4. Follows standards established by laws, regulations, and accreditation. 5. Must be accredited by the Joint Commission.

Correct Answer: 1,2,4 Rationale 1: This statement could be used to describe a hospital. Rationale 2: This statement could be used to describe a hospital. Rationale 3: U.S. hospital care is primarily secondary care, though other services related to primary care such as clinic services and wellness programs also are services that a hospital may offer. Tertiary care could be delivered in a hospital, for example, in a hospital-based hospice unit. Rationale 4: This statement could be used to describe a hospital. Rationale 5: Hospitals do not have to be accredited by the Joint Commission. This accreditation is voluntary.

The quality improvement director is scheduling education sessions for new employees about Joint Commission Accreditation visits. The director should explain that which group is most likely to be interviewed during the accreditation visit? 1. Hospital Administration. 2. Nurse managers. 3. Department managers. 4. Direct care providers.

Correct Answer: 4 Rationale 1: The visitors will talk with administration, but will be most interested in interviewing direct care providers. Rationale 2: The visitors will talk with nurse managers, but will be most interested in interviewing direct care providers. Rationale 3: The visitors will talk with department managers, but will be most interested in interviewing direct care providers. Rationale 4: The most likely group to be interviewed is direct care providers. The visitors will want to talk to those who provide care, not those who have designed the systems of care.

Which payment method offers to pay the provider a specific percentage of the provider's usual charge? 1. Discounted fee-for-service. 2. Per diem rates. 3. Diagnosis-related groups. 4. Capitation.

Correct Answer: 1 Rationale 1: Discounted fee-for-service is a payment method that offers to pay the provider a specific percentage of the provider's usual charge, or a reduced rate. Rationale 2: A per diem rate is reimbursement that is fixed, based on each day in a health care facility. Rationale 3: DRGs are a statistical prospective payment system that classifies care or diagnose into groups that then are used to identify payment rates. Rationale 4: Capitation is a prepayment to a provider to deliver health care services to enrollees of a health plan.

Q19. Which strategy could the nurse use to avoid disparity in health care delivery? 1. Recognize the cultural issue related to patient care. 2. Request more health plan options. 3. Care for more patients even if quality suffers. 4. Campaign for fixed nurse-patient ratios.

Correct Answer: 1 Rationale 1: Disparities often occur because the health care professional does not recognize cultural differences or has a cultural bias. Rationale 2: This is a consumer demand related to managed care. The nurse has little effect on this issue. Rationale 3: This is an unacceptable strategy to nursing. Rationale 4: This scenario is unlikely to have impact on health disparities.

Q24. The nurse manager is coping with a staff member who is very resistant to change. Which strategy would be beneficial for this nurse manager? 1. Maintain open communication with this staff member to establish trust. 2. Help the staff member focus on parts of the change rather than on the whole change at one time. 3. Take over all of the processes of the change. 4. Ignore any hidden agendas brought by this staff member.

Correct Answer: 1 Rationale 1: Having an open and trusting relationship with staff will help to reduce resistance to change. Rationale 2: Focusing on parts and being unable to see the whole picture can result in territoriality. Rationale 3: Staff will not be innovative if managers over-direct, over-observe, or over-report. Rationale 4: Staff with hidden agendas or motives are barriers to change and should not be ignored.

The team is using a quality improvement process that involves a survey of the literature and inviting key stakeholders to sit on teams In which stage of a QI process is the team? 1. Planning 2. Doing 3. Studying 4. Acting

Correct Answer: 1 Rationale 1: In the Planning stage, the objective of the test is stated; predictions are made about what will happen and why; and a plan to test the change is developed. Rationale 2: In the Do stage, a small test is done with identification of problems encountered and first analysis of data. Rationale 3: In the Study stage, a more in depth analysis of test data is done with comparison to predictions. Rationale 4: In the last step Act, the change is revised based on what has been learned from the test.

The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role? 1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible." 2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately." 3. "Give your best nurses extra attention and rewards for their help." 4. "Never get into a disagreement with a staff member."

Correct Answer: 1 Rationale 1: Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff. Rationale 2: When errors occur, the manager should use the opportunity for improvement, not punishment. Rationale 3: When staff feel some staff are given extra credit, staff will feel uncomfortable with the manager and resentment will build. Rationale 4: Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

Which situation is most likely to result in the nurse making a medication error? 1. The nurse has worked three 12-hour shifts in three days. 2. The nurse uses an online program to access medication information. 3. The nurse insists on documenting medication administration immediately after giving the medication. 4. The nurse prepares medications for administration in a secluded area.

Correct Answer: 1 Rationale 1: Some of the reasons for errors in this area are time pressures, fatigue, understaffing, lack of knowledge about the drug and/or the patient, documentation, and systems failure. This nurse may be fatigued secondary to long work hours and decreased sleep time. Rationale 2: Lack of knowledge about the drug is a common reason for medication errors. This nurse is using an acceptable method to learn about the medication. Rationale 3: The standard is to document the medication administration immediately after giving the medication. This nurse is trying to follow policy. Breakdowns in policy or systems can encourage error. Rationale 4: Time pressure and constant interruption lead to error. This nurse has attempted to decrease these factors by working in a secluded area.

Which statement about change in hospitals reflects the impact on nursing? 1. Nurses need to gather more data about the positive effects that nursing care has on patient outcomes in the acute care setting. 2. Nurses need to advocate for more unlicensed assistive personnel (UAP) to help nurses provide quality, low-cost care. 3. Nurses need to be more assertive in obtaining longer hospital stays for patients who have not reached their expected outcomes due to complications. 4. Nurses continue to provide patient education without difficulty despite changes occurring in hospitals.

Correct Answer: 1 Rationale 1: Some studies support the positive effects nursing care has on patient outcomes in the acute care settings; nurses need data to demonstrate that decreasing nursing staff in hospitals will increase patient complications and affect outcomes negatively. Rationale 2: An increasing number of UAPs has increased staff stress and concern for errors and potential legal consequences. Rationale 3: Rather than advocating for longer hospital stays, nurses should be more focused on the prevention of complications. Rationale 4: Providing patient education in acute care has become even more difficult with the decreasing length of stay. Patients are sicker when they enter the system and their length of stay is shorter, so they are not able to absorb patient education information.

What has been the historical importance of the Institute of Medicine (IOM) reports since 1999? 1. They stimulated the development of strategies that will improve quality of care. 2. They are responsible for accrediting hospitals and other types of health care organizations. 3. They establish minimum standards and benchmarks for health care organizations. 4. They support research designed to improve the outcomes and quality of health care.

Correct Answer: 1 Rationale 1: The IOM reports stimulated the development of strategies that will improve quality of care. Rationale 2: Accrediting of health care organizations and establishing minimum standards are the responsibilities of The Joint Commission. Rationale 3: Accrediting of health care organizations and establishing minimum standards are the responsibilities of The Joint Commission. Rationale 4: Supporting research designed to improve health care outcomes and quality is the focus of the Agency for Healthcare Research and Quality.

The chief nurse executive (CNE) is addressing an orientation class of newly hired, newly licensed nurses. Throughout this address the CNE refers to "the forces of magnetism." How should the new nurses interpret this information? 1. These forces are elements of excellence in nursing care that are supported by the organization. 2. The CNE is speaking of a program designed to improve the quality of care delivered by ancillary departments. 3. The CNE's address is focuses on leadership potential in these new nurses. 4. These forces describe a new management theory that is being adopted in health care administration.

Correct Answer: 1 Rationale 1: The forces of magnetism are the critical elements that make a difference in the hospital receiving or not receiving Magnet status. These elements must be supported by the organization. Rationale 2: Magnet recognition is focused on nursing quality. Rationale 3: Leadership is only one of the components of quality nursing care. Rationale 4: While health care administration is certainly aware of and adopting many of the initiatives of the Magnet recognition program, this is not a good description of the "forces of magnetism."

Describe the primary focus of a manager in a knowledge work environment. 1. Developing the most effective teams. 2. Taking risks. 3. Routine work. 4. Understanding the history of the organization

Correct Answer: 1 Rationale 1: The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many. Rationale 2: Risk taking is a part of knowledge work, but is not the most important of this manager's tasks. Rationale 3: Knowledge work is a combination of routine and non-routine work, so the manager will have focus on the routine. This is not the manager's most important focus. Rationale 4: Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus.

Which statement should be included in a classroom discussion about organizational process? 1. It is a philosophy that becomes the basis for operationalizing the mission of the institution. 2. It answers the questions of "what does the organization look like." 3. It directs staff as to whom they report. 4. It is a graphical representation of an organization's flow of responsibility.

Correct Answer: 1 Rationale 1: The organizational process focuses on how the organization operates. Rationale 2: The organizational process answers the question of "why" for the organization. Rationale 3: This statement describes chain of command. Rationale 4: This is a description of an organizational chart.

Information from To Err is Human: Building a Safer Health System (Institute of Medicine, 1999) indicates that at least 44,000 Americans die each year as a result of a medication error. Nurses from which setting could closely apply this information to their personal practice? 1. Hospitals. 2. Long-term care. 3. Home health. 4. Intensive care units. 5. Ambulatory care.

Correct Answer: 1 Rationale 1: To date the focus has only been on hospital errors. Rationale 2: This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings. Rationale 3: This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings. Rationale 4: This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings. Rationale 5: This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings.

The unit has been so understaffed that the nurse has been unable to attend education sessions on new medications that physicians will be prescribing for the treatment of hypertension. This situation is likely to result in a medication error resulting from which contributing factor? 1. Work environment. 2. Task. 3. Individual staff member. 4. Organization and management.

Correct Answer: 1 Rationale 1: Work environment issues are problems such as staffing levels and mix, patterns of workload; work design, availability and maintenance of equipment, and administrative and managerial support. This nurse has been unable to get necessary education because of staffing issues. Rationale 2: Task issues are problems such as availability and use of protocols and availability and accuracy of test results. Rationale 3: Individual staff member factors include knowledge and skills, motivation and attitude, and physical and mental health. This nurse does lack essential knowledge, but the reason for this lack is a staffing problem, which speaks to work environment. Rationale 4: Organization and management issues are such factors as financial resources and constraints, policy standards and goals, safety culture, and priorities

Q85. The hospital Administrative team holds an employee meeting to announce that the hospital will support the use of quality report cards. What should the employees expect from this announcement? Standard Text: Select all that apply. 1. This report card will provide specific performance data about the organization at specific intervals. 2. The goal of using these report cards is to improve the organization's services. 3. These report cards will be an inexpensive way to let the community know about the organization's quality. 4. Using these report cards will increase the average daily census of the organization. 5. These report cards will be used internally as a means of documenting performance evaluations.

Correct Answer: 1,2 Rationale 1: Quality report cards are used to track and report performance data. Rationale 2: The goal of using these report cards is to increase the transparency of quality data. The idea is that this transparency will encourage providers and organizations to work harder to provide quality care. Rationale 3: Report cards are costly from the perspective of collection of data, analysis, and sharing the results with others. Rationale 4: There is no guarantee that publishing quality data will impact patient choices for health care. Rationale 5: These report cards are not individual, but rather are organization wide reports on quality.

The nurse manager is aware of a significant change that will occur sometime in the next six months. How can this manager begin to prepare the staff for this change? Select all that apply. 1. Keep the staff apprised of as much information about the change as is possible. 2. Attempt to keep the unit staffing as stable as possible during the time of change. 3. Insist that all discussions about the change be conducted in a respectful manner. 4. Let the initial information about the change come "through the grapevine." 5. Avoid surprises by telling the staff about how the change will increase workload very early in the process.

Correct Answer: 1,2,3 Rationale 1: Fear of the unknown is a primary reason people resist change. Rationale 2: Stability will help the staff cope with the idea of a change. Rationale 3: All discussions should be respectful and professional. Rationale 4: Being upfront with information will prevent staff from believing the manager is trying to hide the change. Rationale 5: Focusing on what the staff will lose (having to work harder) will likely increase resistance.

Which factors are evidence of an increased interest in quality care? Select all that apply. 1. Increased legislation. 2. A change in focus of the major purchasers of health care. 3. Initiatives by health care professional organizations. 4. An increased number of accreditation organizations. 5. A major decrease in the number of malpractice lawsuits.

Correct Answer: 1,2,3 Rationale 1: Increased legislation is one indication of increased interest in quality care, which shows public concern for care. An example of this legislation is the Patient Safety and quality improvement Act that was signed into law in 2005. Rationale 2: Businesses want value for the money they spend on health care, and employers are the major purchasers of care because they provide health care coverage for their employees. Rationale 3: Health care professional organizations also are involved in the increased interest in health care quality. Rationale 4: There has not been an increase associated with health care quality. Rationale 5: This has not occurred.

The nursing Policy and Procedure Committee has issued the procedure for implementing the use of a new type of equipment. What information should be included in this procedure? Select all that apply. 1. Effective date of the procedure. 2. The date the procedure will be reviewed in the future. 3. Who is responsible for the final review of the procedure. 4. The date that policy was approved by the Joint Commission. 5. The name and credentials of all members of the committee that approved the procedure

Correct Answer: 1,2,3 Rationale 1: It is essential for the procedure to list the date it becomes effective. Rationale 2: By setting a future review date, it is more likely that the procedure will be reviewed in a timely manner and not overlooked. Rationale 3: The responsibility for final review of the procedure is required. Rationale 4: It is not necessary for the Joint Commission to approve this procedure. Rationale 5: The name and credentials of the members of the committee are a part of the committee records, not a part of each procedure.

The Institute of Medicine (IOM) uses two dimensions in the quality matrix to describe quality. Which factors are included in the first dimension? Select all that apply. 1. Patient-centeredness. 2. Effectiveness. 3. Timeliness. 4. End-of-life care. 5. Staying healthy.

Correct Answer: 1,2,3 Rationale 1: The first dimension focuses on the delivery of health care and includes factors such as patient-centeredness, safety effectiveness, and timeliness. Rationale 2: The first dimension focuses on the delivery of health care and includes factors such as patient-centeredness, safety effectiveness, and timeliness. Rationale 3: The first dimension focuses on the delivery of health care and includes factors such as patient-centeredness, safety effectiveness, and timeliness. Rationale 4: The second dimension of quality focuses on the consumer perspective of health care needs and includes staying healthy, getting better, living with illness or disability, and coping with palliative or end-of-life issues. Rationale 5: The second dimension of quality focuses on the consumer perspective of health care needs and includes staying healthy, getting better, living with illness or disability, and coping with palliative or end-of-life issues.

Q22. A staff nurse in a small rural hospital is concerned about the future of health care in the rural environment. How can this nurse be involved in health care policy development? Select all that apply. 1. Join local and national nursing organizations. 2. Contact elected representatives regarding nursing and health care. 3. Act as a patient advocate. 4. Use the Internet to keep current on health care policy issues. 5. Serve on the Infection Control committee of the local hospital

Correct Answer: 1,2,3,4 Rationale 1: Joining nursing organizations, contacting legislators, acting as patient advocate, and using the Internet are all ways the nurse can be involved in health care policy development. Rationale 2: Joining nursing organizations, contacting legislators, acting as patient advocate, and using the Internet are all ways the nurse can be involved in health care policy development. Rationale 3: Joining nursing organizations, contacting legislators, acting as patient advocate, and using the Internet are all ways the nurse can be involved in health care policy development. Rationale 4: Joining nursing organizations, contacting legislators, acting as patient advocate, and using the Internet are all ways the nurse can be involved in health care policy development. Rationale 5: While this is considered service to the institution, it is not as likely to impact health care policy on a state or national level.

Identify typical health care areas in which the states have input. Select all that apply. 1. Public health and safety. 2. Provision of indigent care. 3. Purchase care. 4. Regulation. 5. Resource allocation.

Correct Answer: 1,2,3,4,5 Rationale 1: These are all areas in which states have input into health care policy, legislation, and regulation. Rationale 2: These are all areas in which states have input into health care policy, legislation, and regulation. Rationale 3: These are all areas in which states have input into health care policy, legislation, and regulation. Rationale 4: These are all areas in which states have input into health care policy, legislation, and regulation. Rationale 5: These are all areas in which states have input into health care policy, legislation, and regulation.

The health care facility has received a grant to develop programs to increase patient access to care. Which initiatives would likely meet criteria to be funded by this grant? Select all that apply. 1. Opening a drop-in child care center to be used when parents have a medical appointment. 2. Establishment of a free medical clinical with pharmacy services. 3. Development of an education program outlining when care is needed. 4. Designing a method of automatic assignment of patients to a primary care provider. 5. Building a program that focuses on health care literacy.

Correct Answer: 1,2,3,5 Rationale 1: Childcare concerns can keep parents from seeking their own health care. Rationale 2: Ability to pay for care is a factor that impacts access to care. Rationale 3: It is important to educate people about when care is needed and when they can care for themselves. Rationale 4: Access to care includes the ability to choose one's own primary care provider. Rationale 5: Inability to understand health care terminology is a factor in decreasing access to care

The risk manager has noted an increase in error rate for a nursing unit over the last year. Which factors should the risk manager investigate? Select all that apply. 1. How strong is the unit leadership? 2. Are nurses being asked to fulfill unreasonable work assignments? 3. How well does the unit staff function as a team? 4. Who on the unit is making the most mistakes? 5. Does an environment of learning exist on the unit?

Correct Answer: 1,2,3,5 Rationale 1: Strong leadership helps to provide a safe health care system. If the unit leadership is weak all processes of the unit are affected, including safety. Rationale 2: There are limits to which people can be expected to work. Exceeding those limits increases the likelihood of error. Rationale 3: Effective team functioning can work to improve safety as nurses "look out for one another" even during times of maximum workload. Rationale 4: This is the punitive, traditional method of dealing with error. Rationale 5: A learning environment encourages all staff members to perform at their highest level.

The hospital's quality improvement department focuses on measuring structure, process, and outcomes and identifying errors and hazards in the care provided. What other foci should the department develop to become an effective quality improvement program? Select all that apply. 1. Assessing current practices and comparing them to what is done in other facilities. 2. Designing and testing interventions to improve quality. 3. Finding better resources for funding of initiatives. 4. Helping practitioners identify methods of improving personal practice. 5. Helping the facility recruit and retain qualified nurses.

Correct Answer: 1,2,4 Rationale 1: Assessing current practices and comparing them with relevant better practices elsewhere is a means of identifying opportunities for improvement. Rationale 2: Designing and testing interventions to change the process of care can improve quality and is part of an effective QI department. Rationale 3: While this is an important aspect of health care administration, it is not the major work of a QI program. Rationale 4: Both acting as an effective member of an interprofessional team and working to improve the quality of one's own performance through self-assessment and personal change are important aspects of quality improvement. An effective QI department will serve to encourage these activities. Rationale 5: This is the work of the human resources department

Several small rural hospitals have been acquired by a large nationwide health care organization. Six months after the acquisition, the rural hospitals remain in conflict with the management team and with one another. Choose the questions that the management team should ask in order to identify the reasons for this continued discord. Select all that apply. 1. How are the hospitals communicating with the organization and with one another? 2. Are the goals of the hospitals aligned with those of the organization? 3. Are the rural hospitals too focused on patient-centered care and safety? 4. How is the organization handling decision making with the hospitals? 5. Aren't buyouts always this way?

Correct Answer: 1,2,4 Rationale 1: Communication is paramount in successfully working in a large organization. Rationale 2: When subsections of the organization are separated by distance, it is easy for goals to be out of alignment. Rationale 3: There can never be too much focus on being patient-centered and safety-minded. Rationale 4: If the organization is making all of the decisions and passing them down to the hospitals, discord is likely to occur and continue. Rationale 5: This question minimizes the issue and does not address the problems. If management takes this attitude, the problems will likely continue.

The staff nurse is invited to join the organization's Strategic Planning committee. Which topics can the nurse expect to address as part of this committee? Select all that apply. 1. Planning for the next 3-5 years. 2. Changes in the core values of the organization. 3. Changes in regulations governing the organization. 4. Changes in the departmental structure of the organization. 5. Suggestions about how to change the staff-mix ratios in a department.

Correct Answer: 1,2,4 Rationale 1: Strategic planning is concerned with long-term issues and goals. Rationale 2: Long-term issues and core values are considered during strategic planning. Rationale 3: This is an example of policy planning. Rationale 4: Strategic planning is concerned with long-term issues and goals. Rationale 5: This is an example of project planning.

Which options reflect key factors affecting health care delivery? Select all that apply. 1. Problems with patient access. 2. The aging population. 3. A decrease in new drug therapies. 4. An increase in specialty usage. 5. An increase in the number of single parent families.

Correct Answer: 1,2,4,5 Rationale 1: Eligibility for government benefits such as Medicaid, transportation, hours of operation, number and type of providers, child care, and cost of care are examples of patient access problems. Rationale 2: Changing demographics are a key factor in the changing face of health care. Rationale 3: There has been an increase in new drug therapies. Rationale 4: Increase in specialty usage can lead to fragmentation of care and increased cost. Rationale 5: Changing demographics are a key factor in the changing face of health care.

Which organizations are subject to accreditation by the Joint Commission? Select all that apply. 1. Hospitals. 2. Long-term care facilities. 3. Schools of nursing. 4. Home care agencies. 5. Office-based surgical practices.

Correct Answer: 1,2,4,5 Rationale 1: The Joint Commission accredits hospitals. Rationale 2: The Joint Commission accredits long-term care facilities. Rationale 3: Schools of nursing are accredited by the National League for Nursing or the American Association of Colleges of Nursing. Rationale 4: The Joint Commission accredits home care agencies. Rationale 5: The Joint Commission accredits office-based surgical practices.

The staff nurse is considered to be a leader by nursing peers on the unit. What characteristics does this nurse likely possess? Select all that apply. 1. Awareness of happenings throughout the hospital. 2. Ability to encourage newly hired nurses. 3. Skepticism about using technology for standard nursing tasks. 4. Adaptability. 5. Collaboration skills.

Correct Answer: 1,2,4,5 Rationale 1: The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. Rationale 2: The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. Rationale 3: An important aspect of being a leader is being able to see the benefits of technology. Rationale 4: The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level. Rationale 5: The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

The hospital has purchased software that prints patient education material for numerous situations. What is the nurse's responsibility regarding these materials? Select all that apply. 1. The nurse should read the material and assess it carefully for accuracy. 2. If possible, nursing should participate in the development of these materials. 3. The nurse has no responsibility outside distributing the material to the correct patient. 4. The nurse should carefully document that these materials were given to the patient. 5. The nurse should adapt the material to the individual patient.

Correct Answer: 1,2,4,5 Rationale 1: This is a critical action anytime the nurse gives any information to the patient. Rationale 2: This is a good idea if possible. Rationale 3: The nurse always has responsibility for the care of the patient. Rationale 4: This is a critical action anytime the nurse gives any information to the patient. Rationale 5: This is a critical action anytime the nurse gives any information to the patient.

Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in health care financing? Select all that apply. 1. Third-party payers have the power to influence care and reimbursement. 2. Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan. 3. Third-party payers carry all the financial risk for health care. 4. Third-party payers pay or underwrite coverage for health care for another entity. 5. Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

Correct Answer: 1,2,4,5 Rationale 1: This is a true statement regarding the third-party payer system. This power can be misused or can be misinterpreted by the insured. Rationale 2: When individuals decide to join an insurance plan, they put a specific amount of money into the pool or the insurance fund. The third-party payer is responsible for managing and administering this money. Rationale 3: The financial risk for health care is carried by the clients, the providers, and the third-party payers. Rationale 4: The third-party payer is the organization that pays or underwrites coverage for health care for another business or entity. Rationale 5: These strategies have been developed for this very purpose.

Critical thinking is key to successful planning. Which statements are evidence that the nurse manage is a critical thinker? Select all that apply. 1. I need to research the topic before I comment. 2. Let's be fair in our consideration of this change. 3. Let's go ahead and make the change, I have a feeling it is correct. 4. I'm trying to understand your point of view. 5. I have to take back something I said in the last meeting; it was wrong.

Correct Answer: 1,2,4,5 Rationale 1: This is an example of intellectual humility or admitting what is not known. This is a trait of a critical thinker. Rationale 2: This is an example of intellectual courage or awareness of the need to confront ideas fairly. This is a trait of a critical thinker. Rationale 3: This statement reflects a jump to action and is not reflective of critical thinking. Rationale 4: This is an example of intellectual empathy or the person making a conscious effort to understand others. This is a trait of a critical thinker. Rationale 5: This is an example of intellectual integrity or admitting when one is wrong. This is a trait of a critical thinker.

A key skill in today's health care environment is the ability to collaborate with others. A nurse identifies need to improve in this area. Which skills or traits would be essential for an effective nurse manager to develop to improve collaboration with others? Select all that apply. 1. Flexibility. 2. The ability to share information and ideas. 3. A service orientation. 4. A desire to work hard. 5. The ability to listen to others.

Correct Answer: 1,2,5 Rationale 1: In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and work together toward the best solution to any problems that might arise. Rationale 2: In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise. Rationale 3: While a service orientation is common among nurses, it is not an essential trait for collaboration. Rationale 4: This is not an essential skill for ability to collaborate. Rationale 5: In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise.

Select common external factors that drive change in a health care organization. Select all that apply. 1. Changes in reimbursement by third party payers. 2. Changes in the demographics of employees in the facility. 3. Changes in local, state, or national laws. 4. Changes in professional standards of care. 5. Changes in the organization's salary structure.

Correct Answer: 1,3, 4 Rationale 1: This is a common external factor causing change to be necessary. Rationale 2: This is an internal change. Rationale 3: Any changes in these laws acts as an external force necessitating change in the organization. Rationale 4: Changes in these standards will require change in the way the organization provides care. Rationale 5: This is an internal change.

Which options reflect key components of nursing leadership needed to build a strong and successful nursing staff? Standard Text: Select all that apply. 1. Ensuring that the staff has adequate resources. 2. Taking quick action whenever there are complaints about nurses from physicians or ancillary staff. 3. Ensuring that nursing leaders hold an important role in hospital organization. 4. Maintaining a position of advocacy for the nursing staff. 5. Exemplifying strength by eliminating staff members who are not team players.

Correct Answer: 1,3,4 Rationale 1: Leadership should ensure that staff has adequate resources, ensure that nursing leaders hold an important role in hospital organization, and should maintain a position of advocacy for the nursing staff. Magnet hospitals have demonstrated that nursing leadership needs to be strong and supportive of the nursing staff. Rationale 2: This is a punitive action and does not serve to support the nursing staff. Rationale 3: Leadership should ensure that staff has adequate resources, ensure that nursing leaders hold an important role in hospital organization, and should maintain a position of advocacy for the nursing staff. Magnet hospitals have demonstrated that nursing leadership needs to be strong and supportive of the nursing staff. Rationale 4: Leadership should ensure that staff has adequate resources, ensure that nursing leaders hold an important role in hospital organization, and should maintain a position of advocacy for the nursing staff. Magnet hospitals have demonstrated that nursing leadership needs to be strong and supportive of the nursing staff. Rationale 5: The good leader will work with staff members to help them become team players.

The nursing unit is being asked to decrease costs by 10% this year. The manager takes this request to the nursing staff for suggestions to meet the goal. Which suggestions would be helpful in this endeavor? Choose all that apply. 1.Decreasing the amount of overtime by using better time management during the shift. 2. Limiting the use of disposable supplies for patients. 3. Being careful with the use of equipment to prevent breakdown. 4. Asking nurses who are ill to stay home from work. 5. Cutting salary expenses by eliminating breaks and cutting lunch hours to 45 minutes.

Correct Answer: 1,3,4 Rationale 1: This is a valid request that would help reduce expenses. Rationale 2: It would be better to phrase this suggestion as "use supplies wisely and eliminate waste of supplies." Limiting use of supplies could impact patient care quality. Rationale 3: Repair costs are expensive. Staff should be careful with the use of supplies. Rationale 4: On first review, this appears not to be a cost saver, but if nurses who are ill stay home and do not give the illness to other nurses, a savings in sick leave expenses can occur. Rationale 5: Staff members still need breaks and lunch. This is also against wage and hour laws in many states or situations.

The nurse manager is developing a staff education session on change in health care. Which concepts should be included in this information? Select all that apply. 1. Oftentimes, before one change in health care is completed, another is taking place. 2. Most changes are focused on the organization's structure. 3. Change has been the normal state for health care providers for some time. 4. Change disturbs the organization's equilibrium 5. Sometimes multiple changes occur together in health care.

Correct Answer: 1,3,4,5 Rationale 1: This is certainly a pertinent topic in today's health care environment. Rationale 2: Important examples of change are related to the organization's structure, but change is also affecting roles and responsibilities, communication methods and systems, policies and standards, culture, leadership and management approaches, and competencies and attitudes. Rationale 3: This is certainly a pertinent topic in today's health care environment. Rationale 4: The equilibrium does become disturbed, so staff must learn to tolerate this equilibrium in order to be effective. Rationale 5: This is certainly a pertinent topic in today's health care environment.

What was the American Nurses Association's stance on the health care reform plan supported by the Obama administration? Select all that apply. 1. This law is a significant victory for patients. 2. The debate over health care reform is finally over. 3. There is need to help nurses understand the significance of this law. 4. Access to primary care will be more difficult for most Americans. 5. There will be greater protection against being denied health insurance.

Correct Answer: 1,3,5 Rationale 1: "ANA strongly believes that this law is a significant victory for the patients we serve." Rationale 2: "...we recognize that the debate over reform is not over." Rationale 3: "We are committed to helping nurses and the public understand how this change affects their lives." Rationale 4: "...they'll have better access to primary care." Rationale 5: "They'll have greater protection against losing or being denied health insurance coverage...."

Which factors influence the financing of health care in the United States? Select all that apply. 1. Political factors. 2. Increasing length of stay. 3. Social expectations. 4. Public indifference. 5. The national economy.

Correct Answer: 1,3,5 Rationale 1: The health care industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy. Rationale 2: Length of stay has been decreasing. Rationale 3: The health care industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy. Rationale 4: Overall, the public is intensely interested in health care financing. Rationale 5: The health care industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

The chief nurse executive of a hospital is often responsible for supervising nurses that do not work only in nursing services. In which other departments might these nurses work? Select all that apply. 1. Diagnostic procedures. 2. Finance and budget. 3. Material and resource management. 4. Infection control. 5. Infusion therapy.

Correct Answer: 1,4,5 Rationale 1: Nurses often work in areas such as endoscopy, which is a diagnostic procedure. Rationale 2: Nurses should be well aware of the issues and concepts in finance and budget, but are generally not employed in that specific department. Rationale 3: Nurses should be well aware of the issues and concepts in material and resource management, but are generally not employed in that specific department. Rationale 4: Nurses are very involved in the infection control department, with a nurse often serving as the department head. Rationale 5: Nurses are very involved in the infusion therapy department, with nurses often serving as those who start and manage IV therapy.

The nurse made a medication error. Which statement reflects the traditional "blame game" approach to such errors? Select all that apply. 1. The nurse manager says, "You have to complete the incident report and notify the patient's physician. You made the error, not me." 2. The nurse says, "Why did I make this error?" 3. The physician says, "Is there some way we can prevent this type of error from happening again?" 4. The nurse thinks, "The patient is okay, so I won't tell anyone this happened." 5. The risk manager says, "How many errors has this nurse made this year?"

Correct Answer: 1,4,5 Rationale 1: The traditional approach to medication error has been punitive and blaming. This manager's response is not supportive of the nurse who made this error. Rationale 2: This nurse is trying to discover what in the system allowed the mistake to be made. This is the quality improvement approach to error. Rationale 3: The physician is trying to discover how the mistake occurred and is trying to find ways to prevent further error. This is the quality improvement approach to error. Rationale 4: Unfortunately, this is a common thought for nurses and is related to the punitive nature of many medication error policies. Rationale 5: This risk manager is also looking for blame and not focusing on the system problem that allowed the errors to occur.

The nurse manager has repeatedly tried to convince a staff nurse that changing to a new scheduling format is necessary. The staff nurse continues to be negative and argumentative about the need to change. How should the nurse manager interpret this response? Standard Text: Select all that apply. 1. Some staff will never be ready to change. 2. The change cannot go forward until this nurse is convinced. 3. The nurse is being negative for the sake of negativity. 4. The nurse will have to be terminated in order for the change to occur. 5. The nurse may be concerned about loss of routine in personal scheduling.

Correct Answer: 1,5 Rationale 1: Some people are very threatened by the idea of change. This fear may make them respond negatively. Rationale 2: The change may go forward with or without this staff nurse's approval. Rationale 3: Generally, this is not the case if the nurse manager is genuinely trying to establish rapport with the staff nurse and explain why the change in necessary. Rationale 4: The change can go forward without terminating the nurse. If the nurse is indeed fearful of change, the nurse will probably not resign as that is also a change. Rationale 5: Resisters to change are often fearful of losing something they value. Scheduling changes are a particular issue when nurses have established their personal schedules based upon a routine work schedule.

The organizational analysis documentation describes the organization as one with centralized leadership with a clearly defined organization chart hierarchy. The organization is divided into departments and follows detailed rules and regulation. This organization follows which theories? Select all that apply. 1. Classical. 2. Systems. 3. Integrated delivery system. 4. Vertical integration theory. 5. Bureaucratic

Correct Answer: 1,5 Rationale 1: The first principle of classical organization theory is division of labor, which is done in this organization through establishing departments. This theory is also demonstrated by the clear delineation of the policies and procedures and a defined hierarchy. Rationale 2: In systems theory there is one entity with multiple elements that interact independently. Rationale 3: This system focuses on a continuum of care, using a decentralized leadership style. There is a merging (horizontal of vertical) of various components of the system. Rationale 4: This is an organizational style that is part of an integrated delivery system. Rationale 5: Bureaucratic organizations incorporate the key principles of classical theory with a division of labor, clearly defined hierarchy, and detailed rules and regulations.

The nurse executive wishes to be a transformational leader. What should this nurse focus on to become effective in this role? Select all that apply. 1. Improving interpersonal skills. 2. Advancing personal formal education. 3. Identifying mentors. 4. Becoming an expert clinician. 5. Creating a vision for the future of nursing in the facility.

Correct Answer: 1,5 Rationale 1: Transformational leadership requires interpersonal skills and having a vision for the future. Rationale 2: While formal education might increase the nurse's knowledge base for decision making, it is not a requirement for transformational leadership. Rationale 3: Having a mentor is not a requirement of transformational leadership. Rationale 4: This does not guarantee that the nurse will be a transformational leader

The nurse manager has asked that all staff nurses develop effective leadership competencies. How should the staff nurses interpret this request? 1. This is an unrealistic expectation, because only managers are leaders. 2. If the nurses learn about and use relevant leadership and management theories and styles this is possible. 3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done. 4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

Correct Answer: 2 Rationale 1: A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders. Rationale 2: In today's health care environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices. Rationale 3: Control, competition, and getting the job done are past theories and styles and are not as useful in today's environment. Rationale 4: Leadership is a skill that can be learned.

A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority? 1. Use critical thinking to solve problems on the unit. 2. Give assignments clearly, taking staff expertise into consideration. 3. Understand complex health care environments. 4. Maintain an autocratic approach to influence results.

Correct Answer: 2 Rationale 1: Critical thinking is important for every RN, not just a manager and will not distinguish the manager's authority. Rationale 2: Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group. Rationale 3: Nurse managers do work in complex health care environments but must create an appropriate organizational environment as a way of exercising authority. Rationale 4: In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

The hospital has adopted a medication administration system that has a series of checks and balances designed for patient safety. The system works well, but is time consuming. Nurses have discovered short cuts around the safeguards. This is an example of which situation? 1. A handoff. 2. A workaround. 3. An effects analysis. 4. A "never event."

Correct Answer: 2 Rationale 1: Handoffs are times in the care process when a patient is moved from one care setting to another. Rationale 2: When there is a breakdown or problem, staff often figure out ways to get the work done without really analyzing what is going on. The staff may think this saves time, but it often does not. This is often a time of increased errors. Rationale 3: This is part of the Failure Modes and Effects Analysis (FMEA) system, which provides a systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process that are in most need of change. Rationale 4: A "never event" is an event identified by Medicare that occurs to extend the patient's hospitalization, but that should have been avoidable.

During a meeting with nurse managers the risk manager for the hospital says, "Approximately 60% of our patient care errors can be directly attributed to poor handoffs." What situation should the nurse managers address to improve these statistics? 1. One person per shift should be responsible for receiving medications that are delivered from the pharmacy. 2. The staff should work on clarity of information communicated when a patient is transferred from one care setting to another. 3. More care should be taken in interpreting physician orders. 4. The nursing staff must complete admission history and physicals in a timelier manner.

Correct Answer: 2 Rationale 1: Handoffs do not refer to delivery of medication from pharmacy. Rationale 2: Handoffs occur when a patient is transferred from one care setting to another. Communication is essential at these times. Rationale 3: Handoffs are not associated with physician orders. Rationale 4: Handoffs are not associated with admission H&Ps.

The chief nurse executive (CNE) of a small rural hospital would like to pursue Magnet recognition for the facility. How should this CNE begin the process? 1. Request funding for this special certification. 2. Conduct an environmental assessment of the hospital. 3. Make application to the American Nurses Association. 4. Choose another goal since this program is only available to larger metropolitan or suburban hospitals.

Correct Answer: 2 Rationale 1: Magnet status is a recognition, not a certification. Rationale 2: The first step of achieving Magnet recognition is to complete an environmental assessment of the hospital and begin the Pathway to Excellence. Rationale 3: Magnet recognition is a program through the American Nurses Credentialing Center (ANCC). The hospital must first determine what gaps exist between the current status of the hospital and what is expected for Magnet recognition. Rationale 4: Magnet recognition is open to facilities of all sizes and in all locals.

The quality improvement nurse is working to increase the efficiency of resource utilization in the medical center. This nurse is focusing on which element of health care quality? 1. Process. 2. Structure. 3. Outcome. 4. Function.

Correct Answer: 2 Rationale 1: The three accepted elements of quality are process, structure, and outcome. Process is the manner in which services are provided. Rationale 2: The three accepted elements of quality are process, structure, and outcome. Structure is the environment in which services are provided. Resource utilization has to do with creating the environment. Rationale 3: The three accepted elements of quality are process, structure, and outcome. Outcome is the result of services. Rationale 4: Function is not one of the accepted elements of quality.

The hospital has announced the intention to achieve Magnet Nursing Services Recognition. What information do staff nurses need about this goal? 1. This goal will require that staff nurses return to school to earn a master's degree. 2. This program was begun in the 1980s to recognize hospitals that provide quality nursing care or excellence in nursing care. 3. This program is designed to recognize Emergency Department nurses who provide quality, cost-effective nursing care. 4. This program does not affect staff nurses, but recognizes nursing administrators for their excellence in leadership.

Correct Answer: 2 Rationale 1: There is no requirement that staff nurses return to school to earn a master's degree. Rationale 2: The Magnet Nursing Services Recognition Program was developed in the 1980s to recognize hospitals that provide quality nursing care or excellence in nursing care. Rationale 3: Recognition is not given to individual nursing units, but to the hospital as a whole. Rationale 4: Excellence in leadership is just one factor that contributed to nurse recruitment and retention.

The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model? 1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest-ranking member. 2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions. 3. The mission statement of the hospital describes centralized power. 4. A staff nurse mentions that each individual staff member has complete autonomy.

Correct Answer: 2 Rationale 1: This documents that the hospital follows the classical theory of organization. Rationale 2: Shared governance increases each nurse's influence over the organization, empowering staff. Rationale 3: This is a classical organizational model. Rationale 4: Although the shared governance model does provide some autonomy, there is also an understanding that staff are expected to collaborate and function cooperatively with both management and colleagues.

The nurse executive of a health care organization wishes to prepare and develop nurse managers for several new units that the organization will open next year. What should be the primary goal for this work? 1. Focus on rewarding current staff for doing a good job with their assigned tasks by selecting them for promotion. 2. Prepare these managers so that they will focus on maintaining standards of care. 3. Prepare these managers to oversee the entire health care organization. 4. Prepare these managers to interact with hospital administration.

Correct Answer: 2 Rationale 1: This is an illustration of the "Peter Principle," which is promoting people to management positions just because they are doing a good job in their current position. Management level employees should be selected based upon the potential ability to manage and their desire to do so. Rationale 2: Nurse managers are directly responsible for maintaining standards of care, and managing fiscal resources and development of staff. Rationale 3: This is not the responsibility of most nurse managers. In this question it is clear that managers of nursing units are being prepared and developed. Rationale 4: Interacting with hospital administration is a rare requirement for a unit nurse manager and, if it is required, it is not as important as maintaining standards of care.

A serious medication administration error occurred on the unit last night. What statement, made by the nurse manager, reflects the current focus of quality improvement (QI) related to this situation? 1. "Was this a nursing error or a physician error?" 2. "How did the error occur?" 3. "Who gave the medication?" 4. "What pharmacist was on duty?"

Correct Answer: 2 Rationale 1: In this statement, the nurse manager is trying to discover who to blame for the error. Today's emphasis is on system failure, rather than on an individual. Rationale 2: This statement reflects concern about how the system allowed the error to occur. This is the current view of errors. Rationale 3: The nurse manager is trying to discover the individual to blame in this statement. Today's emphasis is on fixing the system, not on blaming an individual. Rationale 4: This statement is one of determining blame for the error. Today's focus is on the system, not on the individual.

What is different about today's health care environment that makes it crucial that nurses are involved in the development of health care policy? Select all that apply. 1. The focus of this new environment is on the one-to-one nursing care. 2. There has been a shift from curing patients to prevention of illness. 3. Care must be cost-effective. 4. There is a need to reinvent nursing's professional culture. 5. High quality care will again be provided primarily in acute care settings.

Correct Answer: 2,3,4 Rationale 1: The focus is on care of populations. Rationale 2: Prevention is now becoming the focus of much of health care. Rationale 3: Cost-effectiveness is a primary issue in health care. Rationale 4: Nursing must reinvent its culture in light of the new health care environment. Rationale 5: There is a call for high quality care in all types of settings and by all providers.

Which options are included in the six dimensions of shared governance? Standard Text: Select all that apply. 1. Informal authority base. 2. Access to information about the organization. 3. Delegation of care to others. 4. Ability to set goals and negotiate conflict. 5. Control over professional practice.

Correct Answer: 2,4,5 Rationale 1: Shared governance requires formal authority granted by the organization. Rationale 2: This is a part of shared governance. Rationale 3: This is not a part of shared governance though it occurs in a shared governance organization. Rationale 4: This is a part of shared governance. Rationale 5: This is a part of shared governance.

The risk manager is providing education on identifying sentinel events for the nursing staff. Which scenarios would be good examples for the risk manager to use? Select all that apply. 1. A patient is received dead on arrival from an automobile accident. 2. An inpatient attempts to jump from the hospital's roof-top garden. 3. A patient dies after being assigned do not resuscitate (DNR) status. 4. A woman suffers cardiac arrest during the delivery of a viable infant. 5. A patient who suffered head trauma was admitted to the regular medical unit and dies.

Correct Answer: 2,4,5 Rationale 1: The arrival of a patient DOA is not a sentinel event. Rationale 2: Suicide attempts are classified as sentinel events. Rationale 3: This patient was assigned a DNR status, so the patient's death is not a sentinel event. Rationale 4: Cardiac arrest in labor and delivery is a sentinel event. Rationale 5: This patient was not referred to specialist care and then died. This is a sentinel event.

Typically the nurse manager of a unit uses a participatory style of leadership. Today a patient suffered a cardiac arrest; the manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply. 1. Bureaucratic. 2. Autocratic. 3. Permissive. 4. Directive. 5. Authoritarian.

Correct Answer: 2,4,5 Rationale 1: This style is focused on organizational rules and policies. Rationale 2: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. Rationale 3: This is a "hands-off" approach. Rationale 4: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest. Rationale 5: Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

Select information that should be included in a presentation on the Magnet Nursing Services Recognition Program. Select all that apply. 1. This program has been in existence since the 1950s. 2. The program is based in research. 3. This is a nationally recognized accreditation program. 4. The program focuses on the hospital's efforts toward quality care. 5. A critical variable addressed by this program is adequacy of nursing staff.

Correct Answer: 2,5 Rationale 1: This program was established in 1993. Rationale 2: The program was developed as a result of a research study conducted in 1981. Rationale 3: This is a recognition program, not an accreditation program. Rationale 4: The focus of this program is on nursing. Rationale 5: Nursing staff adequacy is a critical variable addressed by this program.

There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing? 1. Autocratic. 2. Bureaucratic. 3. Laissez-faire. 4. Authoritarian.

Correct Answer: 3 Rationale 1: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur. Rationale 2: Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur. Rationale 3: This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients. Rationale 4: Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is likely the complaints in this scenario would occur.

The obstetrics department, which is composed of labor and delivery, postpartum, nurseries, and the neonatal intensive care unit, operates under what organizational structure? 1. Decentralized structure. 2. Matrix organizational structure. 3. Departmentalization. 4. Line authority.

Correct Answer: 3 Rationale 1: Decentralized structure spreads tasks and authority out over components of the organization. Rationale 2: Matrix organization is used when staff members belong to a functional department, such as nursing, and to a service or product department, such as radiology. Rationale 3: Departmentalization occurs when divided tasks are grouped based on related responsibilities or location. Rationale 4: Line authority or chain of command identifies to whom each staff member reports up through the chain of command.

The newly licensed nurse asks a more experienced nurse if it is advisable to carry personal malpractice insurance. Which reply, made by the experienced nurse, is the most accurate? 1. "It is not necessary since the hospital carries a blanket policy." 2. "It is necessary only for advanced practice nurses like nurse midwives and certified registered nurse anesthetists." 3. "Every nurse should carry personal independent malpractice insurance." 4. "Carrying insurance is a good way to get sued."

Correct Answer: 3 Rationale 1: Even though the hospital carries blanket insurance, the nurse should protect him- or herself with individual coverage. If the nurse does make an error, the hospital may not cover the nurse or may sue the nurse to recover monetary damages. Rationale 2: All nurses should carry individual insurance. Rationale 3: This is a widely held opinion. Rationale 4: There is no evidence that a nurse with insurance is more likely to get sued.

. A 43-year-old patient who has sustained an accidental laceration to the forearm is brought to the Emergency Department by family. It is determined that the laceration will need repair with sutures, but the patient refuses treatment saying, "I'll just pull it together with some tape when I get home." What action should be taken by the nurse? 1. Insist that the patient have the suture repair. 2. Tell the patient that the family will have to make that decision. 3. Have the patient sign a refusal of treatment form. 4. Tell the patient that it is a violation of the Emergency Medical Treatment and Active Labor Act of 1986 to allow a patient to leave without treatment.

Correct Answer: 3 Rationale 1: Medical personnel cannot insist that a competent adult patient receive care. Rationale 2: The patient makes this decision. Rationale 3: The nurse should have the patient sign this document as a part of the record of the visit. Rationale 4: This Act was passed to prevent the hospital from refusing to treat patients without insurance and to prevent hospitals from "dumping" these patients in other Emergency Departments.

The nurse is looking for a formal, approved description of how a clinical care process is carried out in the facility. Where should this nurse look for this information? 1. Professional performance standards. 2. Nurse Practice Act. 3. Policy and procedure manual. 4. Joint Commission manual.

Correct Answer: 3 Rationale 1: Professional nursing standards will offer some description of the how the clinical care process should be carried out, but the nurse should look for how it is to be carried out in this facility. Rationale 2: Each state or province's Nurse Practice Act defines the practice of nursing within that area. This document does not describe how to carry out specific nursing processes. Rationale 3: The policy and procedure manual will give a description of the nursing care process and directions on carrying it out for a specific health care organization. Rationale 4: The Joint Commission sets global performance standards for nursing and other departments in the hospital, but does not give specific direction on the completion of nursing activities

The health care corporation is considering using benchmarking as a way to improve quality. What concept is essential to this process? 1. The corporation should choose unique, corporation-specific areas to include in benchmarking. 2. Benchmarking is designed to work best on management-level initiatives. 3. In order for benchmarking to be effective, the corporation must be willing to share information. 4. This process will build an internal database on which future decisions will be based.

Correct Answer: 3 Rationale 1: The areas that are being evaluated should be ones that are common to similar institutions. Commonality is essential to make sharing of information possible. Rationale 2: Benchmarking is designed to work on all aspects of the operations of the institution. Rationale 3: Benchmarking uses information from different but similar health care institutions. Everyone involved in benchmarking must be willing to share information about their institution. Rationale 4: The idea is to share data so that an external database and best practice information can be developed.

The nurse commits an error while caring for a patient who receives Medicare benefits. The error results in a complication that is on the Centers for Medicare and Medicaid Services' "never list." What is the implication of this error? 1. The nurse will be investigated by the state's Board of Nursing. 2. The nurse's employment will be terminated. 3. Medicare will not pay for the cost of the complication. 4. The patient will have to share the cost of the care for the complication with Medicare.

Correct Answer: 3 Rationale 1: The occurrence of a "never event" does not necessitate investigation by the Board of Nursing. These events are usually related to failure of a system, rather than individual failure. Rationale 2: There is no requirement to terminate the nurse's employment. Rationale 3: This is the Medicare rule. The cost of caring for the complication will not be covered. Rationale 4: The patient cannot be billed for this cost and Medicare will not cover the cost of this care. The cost must be absorbed by the health care organization.

Which statement about the effect of health care quality report cards is accurate? 1. They have been shown to have a direct influence on consumer health care decisions. 2. These report cards are generally not accessible to consumers. 3. Releasing information via these report cards does not guarantee changes in quality. 4. Most consumer health care choices are now based on facts from these report cards rather than opinion.

Correct Answer: 3 Rationale 1: There is no evidence that these report cards have influenced consumer health decisions. Rationale 2: These report cards are accessible to consumers via websites. Rationale 3: This is the primary issue with these report cards. There is no guarantee that publishing negative report cards will have any influence on how the employees of a facility do their jobs. Rationale 4: Many health care decisions are still based upon geography, tradition, or personal beliefs about a facility.

The chief nurse executive (CNE) of a hospital frequently visits with on-staff physicians, both in a formal and informal manner. What is the primary purpose of this interaction? 1. This interaction is a job requirement of the CNE. 2. The CNE believes that socializing with physicians builds social status. 3. This interaction can help to build strong, positive work relationships with the medical staff. 4. Interacting with physicians helps to strengthen the image of nursing.

Correct Answer: 3 Rationale 1: This may be true, but it is not the most important reason for this action. Rationale 2: This may be true, but it is not the most important reason for this action. Rationale 3: While all of these options may be in some ways true, the most important reason for this socialization is to build a strong, positive relationship with the medical staff. Rationale 4: This may be true, but it is not the most important reason for this action.

Place the key steps of the continuous quality improvement (CQI) process in their most logical order. Number the options below in the correct order. Choice 1. Collect data. Choice 2. Implement the plan. Choice 3. Develop a plan. Choice 4. Analyze and summarize data. Choice 5. Implement corrective actions. Choice 6. Share data with staff.

Correct Answer: 3,2,1,4,6,5 Rationale 1: After data is generated in step two, data collection occurs in step three. Rationale 2: The second step is implementation. This implementation will generate data for the next step. Rationale 3: The first step of this process is to work within the units, services, departments, and organization to develop a CQI plan. Rationale 4: The fourth step is to analyze and summarize the data collect in the previous step. Rationale 5: The final step before the process starts again is to implement corrective action on any identified problems. This will direct the beginning of the new CQI cycle. Rationale 6: Once data has been analyzed and summarized, the fifth step is to share the information with staff.

Compare and contrast transformational leaders and transactional leaders by choosing the options that are examples of transformational leadership. Select all that apply. 1. The leader is very concerned with the critical organizational functions that are required to provide services in the health care facility. 2. The most common type of leader in today's health care arena. 3. This leader follows the leadership style that is recommended by the Institute of Medicine. 4. The leader allows the staff to take risks to improve. 5. The leader seeks to guide staff in their understanding of their importance to the work of the facility.

Correct Answer: 3,4,5 Rationale 1: This is a characteristic of transactional leadership. Rationale 2: The is the transactional leader. Rationale 3: The IOM recommended transformational leadership in its report Leadership by Example (2003). Rationale 4: This is a quality of transformational leadership. Rationale 5: This is a quality of transformational leadership.

Which statements are true about the evaluation step of the decision making process? Select all that apply. 1. Only the change agent is responsible for the evaluation phase. 2. Management is usually not involved in the evaluation phase. 3. Evaluation needs to be incorporated in all the steps of the change process. 4. All members of the team are required to evaluate the process at the end of the project. 5. Neglecting this step has long-term consequences.

Correct Answer: 3,5 Rationale 1: All members of the team are involved. Rationale 2: All members of the team are involved, including management. Rationale 3: Evaluation does not happen just at the end of the project, but needs to be incorporated all the way through the project. Rationale 4: While all members of the team are involved in evaluation, this evaluation should take place throughout the project, not just at the end. Rationale 5: If the team does not evaluate the results of decisions, valuable information can be lost or mistakes can be made in the next change.

Choose the statements that are correct about not-for-profit health care organizations. Select all that apply. 1. There are stockholders who own stock in the organization. 2. These organizations do not have to make a profit to survive. 3. Typically these organizations are funded by charitable institutions, the government, or churches as well as by the typical reimbursement sources. 4. These organizations experience more ethical and legal problems. 5. Organizations are called voluntary or public health organizations.

Correct Answer: 3,5 Rationale 1: Stockholders or shareholders own stock or shares in for-profit organizations. Rationale 2: Both for-profit and not-for-profit organizations have to make a profit to survive. The not-for-profit organizations invest all profits back into the organization. Rationale 3: This is the typical funding source for not-for-profit health care organizations. Rationale 4: Since for-profit organizations have a need for financial success, as a group they typically have more ethical and legal problems. Rationale 5: Not-for-profit health care organizations are also known as voluntary or public health organizations.

Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply. 1. Focus is change. 2. Have the ability to influence others. 3. Control the environment. 4. Focus is on people. 5. Focus on efficiency.

Correct Answer: 3,5 Rationale 1: The manager accepts the status quo, while the leader challenges it. Rationale 2: The manager controls people, while the leader influences others. Rationale 3: The manager controls the environment, patient care, and the staff that deliver that care. Rationale 4: The leader focuses on people while the manager focuses on systems and structure. Rationale 5: Managers focus on efficiency, while leaders focus on effectiveness.

Which statement, made by a staff nurse, indicates that the nurse understands the meaning of Medicare "never events"? 1. "I am a very good nurse, so it is unlikely that one of my patients would experience one of these events." 2. "It is so hard when a patient experiences one of these events since they are not survivable." 3. "Thankfully, most nurses will never see a patient experience one of these events." 4. "I am working on the safety committee to help prevent the occurrence of these events."

Correct Answer: 4 Rationale 1: Despite good nursing care, patients may suffer a "never event." They often indicate a safety system problem, not a specific provider problem. Rationale 2: In order to be placed on the "never list," the event must be adverse. There is no requirement for the event to be lethal. Rationale 3: These events are not that uncommon, but most nurses will experience "never events" with patients such as falls, decubiti. Rationale 4: These events are indicative of a problem in the health care facility's safety system.

Select the reason the transformational leadership sometimes fails in an organization. 1. The need to change is addressed urgently. 2. The coalition guiding the facility is too diverse. 3. Working on the change long after a victory should have be declared. 4. Poor recognition of organizational culture.

Correct Answer: 4 Rationale 1: Failure often results from a lack of urgency. Rationale 2: Failure often results from a lack of a guiding coalition. Rationale 3: Failure often results from declaring a victory too soon. Rationale 4: This is a reason for failure of transformational leadership.

Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization? 1. The control of the organization is centralized, and decisions are made by upper-level management. 2. Staff nurses are expected to provide support and nurturing for management's decisions. 3. The organization's approach to leadership is autocratic and bureaucratic. 4. Staff nurses provide input into planning and changes for their own unit.

Correct Answer: 4 Rationale 1: In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization. Rationale 2: The theory is that the staff should be nurtured to promote greater leadership competency. Rationale 3: According to Drucker, when staff participate in the core functions of management, the organization is more effective. Rationale 4: According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

Which statement, made by a staff nurse, reflects correct identification of the primary goal of quality improvement (QI)? 1. "This process will save us money." 2. "I like that this intervention saves time." 3. "It seems as if the physicians like our new charting system." 4. "My patients do better since we are using this system."

Correct Answer: 4 Rationale 1: Quality improvement may save the hospital money, especially in the long term, but this is not the primary goal of the process. Rationale 2: Quality improvement may result in more efficient work, but this is not the primary goal of the process. Rationale 3: While quality improvement may result in everyone being happier and more satisfied with care, this is not the primary goal of the process. Rationale 4: The primary goal of the QI process is to improve patient outcomes.

What has caused some of the concern about the use of unlicensed assistive personnel (UAP)? 1. Supervision is provided by the registered nurse. 2. UAPs do not provide quality care. 3. Home health aides are not supervised. 4. There is variability of education and training of all types of UAPs.

Correct Answer: 4 Rationale 1: Supervision by the registered nurse is not a concern as long as the RN assures they are able provide safe care. Rationale 2: Most UAPs do provide quality care with appropriate supervision. Rationale 3: Home health aides, although they work more independently than do UAPs in other organizations, are supervised by the home health RN. Rationale 4: The amount of education and training of UAPs is highly variable, which has caused some concern about what they are able to do and the effect on the quality of care.

Which factor would least likely be included in the analysis of an organization? 1. Whether the organization's mission and vision match staff performance. 2. Results from a staff opinion survey regarding the organization's decision-making processes. 3. How the organization's communication patterns have affected the change process. 4. The turnover rate of nursing personnel in a given unit.

Correct Answer: 4 Rationale 1: The vision and mission statements are the driving forces behind all decision, and provide critical information about the organization's values and philosophy. Rationale 2: It is important to analyze how staff members believe decisions are made. Rationale 3: It is essential to analyze communication patterns because communication runs an organizations and its ability to function effectively. Rationale 4: Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

The nursing staff communicates that the new manager has a focus on the "bottom line," and little concern for the quality of care. What is likely true of this nurse manager? 1. The manager is looking at the total care picture. 2. The manager is communicating the importance of a caring environment. 3. The manager understands the organization's values and how they mesh with the manager's values. 4. The manager is unwilling to listen to staff concerns unless they have an impact on costs.

Correct Answer: 4 Rationale 1: This action would enable the manager to make a decision and not just evaluate the financial status of the environment. Rationale 2: If the manager is indeed focusing only on the "bottom line" the manager is not promoting a caring environment on the unit. Rationale 3: The organization may set great value on the "bottom line" but also must be concerned about quality of care. Problems with quality of care can impact the "bottom line." If the manager believes the financial status of the organization is the only organization value, a misunderstanding has probably occurred. Rationale 4: This manager has primary focus on the financial issues associated with provision of care. This will make the manager ineffective in the role.

The nurse managers of a hospital are working to identify the physical skills and actual nursing time spent to accomplish specific procedures. This work is most closely associated with which type of reimbursement strategy? 1. Discounted fee-for-service. 2. Diagnostic-related group. 3. Capitation. 4. Resource-based relative value scale.

Correct Answer: 4 Rationale 1: This is a payment method that offers to pay the provider a specific percentage of the provider's usual charge, or offers a reduced rate. Rationale 2: DRGs are per-stay reimbursement plans that focus on a single episode of care related to a diagnosis, and include all predetermined expected services delivered for that episode of care. Rationale 3: This is a prepayment to a provider to deliver health care services to enrollees of a health plan. Rationale 4: In this system, payments for services are determined by the resource needed to provide the service. Managers work to assure that practice approximates this scale.

An outside accreditation team is evaluating the organization's mission statement. Which action, taken by the organization, is the most important in regard to this statement? 1. The organization must provide a current copy of the mission statement. 2. The organization must be certain that the mission statement is prominently displayed in public access areas. 3. The organization must provide the team with a written plan about how the mission statement will be followed. 4. The organization must provide evidence of how the mission statement is being followed

Correct Answer: 4 Rationale 1: This is important, but not as important as evidence that the organization is actually following the mission. Rationale 2: This is important, but not as important as evidence that the organization is actually following the mission. Rationale 3: This is important, but not as important as evidence that the organization is actually following the mission. Rationale 4: The fact that the mission statement is indeed being followed is the most important evidence that the organization can provide.

Understanding the microlevel of health care financing is most important to which nurse? 1. The nursing student. 2. The new graduate. 3. The staff nurse. 4. The nurse manager.

Correct Answer: 4 Rationale 1: While microlevel health care finance is important to all nurses it is most important to the nurse manager. Rationale 2: While microlevel health care finance is important to all nurses it is most important to the nurse manager. Rationale 3: While microlevel health care finance is important to all nurses it is most important to the nurse manager. Rationale 4: The nurse manager will use the components of microlevel health care financing on a daily basis to manage the unit.

Failure to rescue (FTR) is most commonly a result of which other failure? 1. Failure to understand the disease process. 2. Failure to understand the purpose of an intervention or treatment. 3. Failure to monitor patient status. 4. Failure to follow physician orders.

Correct Answer: 3 Rationale 1: The nurse should understand disease process, but this is not the most frequent cause of FTR. Rationale 2: The nurse should never give a medication or provide an intervention or treatment without knowing its purpose. However, this is not the most common reason for FTR. Rationale 3: FTR is most often a result of failure to monitor the patient. If the patient is monitored adequately, failures such as the other options can be noted and acted upon quickly, perhaps effecting patient outcomes. Rationale 4: The nurse should understand and follow physician orders if accurate. However, failure to do so is not the most common reason for FTR.

The patient is being discharged from the hospital after having a coronary artery bypass graft (CABG). Which level of the health care system will best serve the needs of this patient at this point? 1. Primary care. 2. Secondary care. 3. Tertiary care. 4. Public health care.

Correct Answer: 3 Rationale 1: The patient already has coronary heart disease, so primary care would not be appropriate for this problem. Rationale 2: The patient has just been discharged from secondary care level services, where diagnosis and treatment was done. Rationale 3: A patient recovering from a CABG will best be served by rehabilitation services, which is at the tertiary care level. Rationale 4: There is no indication that the patient was having difficulty accessing health care prior to this episode, so public health care does not apply.

Which description explains the strategy used to combat rapidly rising health care costs prior to 1983? 1. The shifting from a retrospective or fee-for-service reimbursement approach to a new prospective payment system based on DRGs. 2. There was a move from prospective payment to retrospective payment. 3. There were financial incentives to provide as much care as possible using the most technically advanced methods. 4. A shift from a resource-based relative value scale to fee-for-service.

Correct Answer: 1 Rationale 1: The retrospective payment system based on fee-for-service did not put many incentives on the provider; consequently, there was little incentive to be cost-effective. The shift was to a prospective system based on DRGs. Rationale 2: The shift was to a prospective system. Rationale 3: The shift was to provide care as cost-effectively as possible. Rationale 4: The shift was from fee-for-service to a resource-based relative value scale.

The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient's IV rate while a colleague contacts the patient's physician. Which critical element of nursing is this nurse demonstrating? Select all that apply. 1. Autonomy. 2. Responsibility. 3. Delegation. 4. Accountability. 5. Relevance.

Correct Answer: 1,2,4 Rationale 1: Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them. Rationale 2: This nurse was entrusted with a particular function, in this case, caring for a post-op patient. Rationale 3: There is no indication that the nurse delegated care of this patient to anyone. Rationale 4: Accountability is the acceptance of responsibility of the outcomes of care. Rationale 5: This term is not one of the critical elements of nursing.

Which scenarios are examples of external environment issues facing nursing in this contemporary age of health care change? Select all that apply. 1. Six of the 18 nurses working on a unit speak English as their second language. 2. The hospital has decreased medication errors dramatically in each of the last two quarters. 3. The unit manager has been asked to use a creative strategy for scheduling with fewer staff. 4. There was a report on the nightly news about recruitment and retention of nurses. 5. An Emergency Room nurse was injured by a patient seeking drugs.

Correct Answer: 1,3,4,5 Rationale 1: An issue is the need for nurses to work as a team, despite differences in age, language, and culture. Rationale 2: There is a need to develop a culture of safety, which this hospital is doing already. Rationale 3: An issue is the need to be creative in doing more with less. Rationale 4: An issue is the increasing press coverage of recruitment and retention of nurses. Rationale 5: An issue is the increase in workplace violence.

The medical center quality improvement director issues a report on the "opportunity" costs of errors occurring in the organization. Which situation would be included in this report? Select all that apply. 1. A patient sustained a fracture when he falls after being incorrectly restrained. 2. A laboratory test must be repeated because the technician ran the specimen incorrectly. 3. A medicine error necessitates that the patient be dialyzed. 4. The patient says, "A nurse nearly let me die, so I don't trust nurses anymore." 5. The physician enters discharge orders incorrectly and the patient spends another day in the hospital.

Correct Answer: 2,3 Rationale 1: This is an instance of costs being increased because of a complication (fracture) due to error. Rationale 2: Opportunity costs occur when repeat diagnostic tests are required or interventions are needed to counteract adverse drug events. Rationale 3: Opportunity costs occur when repeat diagnostic tests are required or interventions are needed to counteract adverse drug events. Rationale 4: This statement reveals a patient's loss of trust in the health care system and its providers. This is a different critical concern. Rationale 5: This is an instance of costs being increased because of lack of communication or communication error.