Leadership Back of Book
In 2000, the Institute of Medicine's report To Err Is Human recommended system changes to reduce the high number of people who died each year due to adverse events and medical errors in hospitals. What has been the overall effect of these changes on client mortality? 1. The number of deaths due to adverse events and medical errors has risen. 2. The number of deaths due to adverse events and medical errors has decreased. 3. The number of deaths has stayed the same, but the number of adverse events and medical errors has decreased. 4. The number of deaths has decreased, but the number of adverse events and medical errors has increased.
1
Of the four types of health-care systems, which is the oldest? 1. Type 1 2. Type 2 3. Type 3 4. Type 4
1
Since 2017, changes were made to the ACA that shortened and reduced funding for the open-enrollment period and reduced funding for the navigator program that helps people select the right policy. Which aspect of health-care reform has been primarily affected by these changes? 1. Accessibility to care 2. Affordability of care 3. Quality care 4. Satisfaction with care
1
Technology allows telehealth nurses to remotely monitor clients for falls, sleep apnea, and a variety of other concerns. What principle of nursing ethics could potentially be violated by the use of these technologies? 1. Autonomy 2. Beneficence 3. Justice 4. Fidelity
1
To help his students review for a quiz, an instructor asks his class to name causes of the nursing shortage. Which answer given by a student indicates a need for clarification? 1. Historically low wages for nurses 2. Stressful working conditions 3. Increased career opportunities for women 4. Lack of nursing faculty to teach students
1
What is the main difference between a nurse case manager and a nurse navigator? 1. Case managers help clients with a variety of health issues; nurse navigators focus on one specialty area. 2. A case manager advocates for clients, but a nurse navigator does not. 3. A nurse navigator helps the client obtain high-quality, cost-effective care; the case manager's focus is on reducing readmissions. 4. Nurse case managers work for the facility; nurse navigators work for the client.
1
Which of the following is an example of a quality metric (QM)? 1. Employee satisfaction 2. Year-end profits 3. Winning a best-in-city award 4. Low staff turnover rates
1
Which of the following statements best summarizes the American Nurses Association's overall position on health-care reform? 1. Health care is a human right, so universal access should be our goal. 2. Health-care costs are increasing rapidly, so cost containment is essential. 3. Reform should include a greater emphasis on high-tech medical and nursing care for chronic illness. 4. Encouraging competition among payers is the best way to finance a reformed health-care system.
1
Which statement BEST describes the effect of HIPAA on nursing informatics? 1. HIPAA accelerated the development of electronic safeguards for transmitting and storing clients' medical data. 2. HIPAA made previously public medical information confidential. 3. The first generation of HIPAA required that paper medical records be turned into electronic files. 4. HIPAA recognized the valuable contribution of informatics nurses to nursing knowledge.
1
Yolanda, an RN, says that asking clients for two identifiers—name and birthdate—every time she gives them medication is a waste of time. Isn't one identifier enough? What response by the charge nurse is most appropriate? 1. It does take a little extra time, but the safety of our clients is worth it. 2. I agree, but that's our policy. 3. If you don't follow the rules, I'll write you up. 4. After the first time, you can just scan their wrist band.
1
A 2019 tax bill removes the individual mandate, the requirement that all citizens must purchase some type of health insurance, from the ACA. What is a likely effect of this change? Select all that apply. 1. Healthy young people will opt out of buying health insurance. 2. The cost of health insurance premiums will go up. 3. The number of citizens who have health insurance will go down. 4. The quality of health care provided will decrease. 5. People will engage in more unhealthy behaviors.
1, 2, 3
To become a nursing informatics specialist, what credentials and/or experience does a person need to have? Select all that apply. 1. A bachelor of science in nursing (BSN) degree 2. A master or doctoral degree in nursing informatics 3. Informatics certification through the ANCC 4. A bachelor of science in computer science degree 5. At least 5 years' experience working as an informatics nurse
1, 2, 3
Which of the following statements about how education relates to quality and safety in nursing care is true? Select all that apply. 1. Education in quality and safety begins in nursing school. 2. Continuing education allows nurses to update their knowledge and skills to improve quality and safety. 3. Increasing nursing education levels has been shown to improve client outcomes and quality. 4. The type of quality and safety education a nurse receives depends on the hospital or facility in which the nurse works. 5. Hospitals are unwilling to spend money on quality and safety education for nurses.
1, 2, 3
Why is it important to reduce the number of uninsured people in the United States? Select all that apply. 1. To make health care more affordable for all citizens 2. To reduce costs passed on to hospitals and taxpayers when uninsured people receive care in the emergency department 3. To encourage those currently uninsured to take more accountability for their health 4. To improve public health by ensuring access to preventive care 5. To reverse the trend of rising costs for inpatient care and pharmaceuticals
1, 2, 3, 4
Who benefits from the data gathered, analyzed, and disseminated by nursing informatics specialists? Select all that apply. 1. Health-care providers 2. Creators of public health policy 3. Insurance companies 4. Clients 5. Nursing educators and students
1, 2, 3, 4, 5
How has the profession of nursing in the US affected and been affected by hc reform (SATA) 1. Nurses participated in the planning of the Affordable Care Act (ACA). 2. Nurses were vital to the initial implementation of the ACA. 3. Thousands of new nurses have been recruited to ease the nursing shortage. 4. Nursing's historic commitment to health maintenance and disease prevention are reflected in the preventive-care provisions of the ACA. 5. Because of the ACA, nurse practitioners play an increasingly important role as primary care providers.
1, 2, 4, 5
Mrs. Jones is a 78-year-old African American woman with diabetes whose kidney function has decreased significantly over the past year. After seeing the nephrologist, Mrs. Jones is scheduled for surgery to create an A-V fistula. She will begin dialysis 6 weeks later. Mrs. Jones lives with her daughter, who travels often for her job, and grandchildren, whom Mrs. Jones helps care for. Which factors in the scenario indicate the need for case management for Mrs. Jones? Select all that apply. 1. She is 78 years old. 2. She has diabetes. 3. She is getting an A-V fistula. 4. She is a caregiver for her grandchildren. 5. She lives with her daughter. 6. Her daughter travels for work.
1, 2, 4, 6
What are the MAIN reasons nurses become politically active? Select all that apply. 1. To improve their working environments 2. To advocate for their clients and for public health 3. To assume high government office 4. To express their dissatisfaction with nursing as a career 5. To influence legislation that affects their ability to practice
1, 2, 5
What are the main issues that health-care reform has traditionally targeted? Select all that apply. 1. Access to care 2. Cost of care 3. Client satisfaction 4. Retention of nurses 5. Quality of care
1, 2, 5
In 2001, the Institute of Medicine (IOM) identified six aims for improving health care in the United States. Which of the following are NOT characteristics the IOM identified? Select all that apply. 1. Affordable 2. Safe 3. Effective 4. Local 5. Client-centered 6. Timely 7. Efficient 8. Equitable
1, 4
Ernesto Vazquez, RN, was an ICU nurse for several years and is now a legal nurse consultant. In which of the following facilities is he most likely to work? 1. A cardiology group practice 2. A law firm 3. An outpatient clinic 4. A small rural hospital
2
How did the meaningful use program encourage providers and facilities to switch from paper to electronic health records (EHRs)? 1. It required providers and facilities to enroll in the Medicare Electronic Health Records Incentive Program. 2. It offered providers and facilities that participated in the program incentive payments for improved outcomes. 3. It withheld payment to providers and facilities that refused to switch from paper to EHRs. 4. It published a list of providers and facilities that refused to switch from paper to EHRs in newspapers around the country.
2
Luís, a nursing informatics specialist, is interviewing nurses and support staff who work in the hospital's emergency department to find out if the facility's electronic health record system adequately meets its needs. What nursing informatics role is Luís performing? 1. Software developer 2. Coordinator 3. Tester 4. Trainer
2
Malia, an RN, educates herself about upcoming legislative initiatives, writes and calls her representatives to share her opinions, and votes in every election. However, she feels as though she is not making much of a difference. What simple action would give Malia more political clout as a nurse? 1. Organizing a nurses' union at her hospital 2. Joining the American Nurses Association 3. Running for government office 4. Encouraging coworkers on her unit to share their opinions on health-care legislation their representative
2
Telehealth is a growing field in nursing. Which of the following is of special concern in telehealth? 1. The qualification of nurses and other providers 2. The confidentiality of client information 3. Nurses practicing outside their scope of practice 4. The inability of technology to accommodate the nursing process
2
Tobias, an RN in a busy medical-surgical unit, wants to change his work situation so that he can be at home with his infant daughter. Tobias is extremely detail oriented and has excellent computer skills. Which nursing role best suits Tobias's abilities and his desire to be a home with his daughter? 1. Nurse navigator 2. Nurse coder 3. Client safety officer 4. Case manager
2
What makes modern home health care a viable option for many clients with serious health concerns and medical needs? 1. The improved training of home-health aides and other providers of life assistance services 2. The availability for home use of technology that was once limited to hospitals 3. The closing of small rural hospitals that would have cared for these clients in the past 4. The greater availability of family members nowadays to care for clients at home
2
Which American president first supported a nationwide mandate requiring all citizens to have and pay for health insurance? 1. John F. Kennedy 2. Richard Nixon 3. Bill Clinton 4. Barack Obama
2
Which of the following best describes Leapfrog Group's approach to improving the quality and safety of health care and making it more affordable? 1. Reimbursing low-performing hospitals at a lower rate than other facilities and publishing this information to alert the public 2. Financially rewarding hospitals that implement significant improvements in quality and safety and offering incentives for consumers who choose high-performing hospitals 3. Requiring that consumers use only certain low-cost hospitals and submit reports on their quality 4. Refusing to reimburse hospitals if a client is readmitted within 30 days of discharge
2
A group of representatives supports a bill to allow APRNs to practice independently nationwide. What process must be followed for this bill become a law? Place the steps in the correct order. _____ 1. The chief clerk assigns the bill a number. _____ 2. A representative introduces the bill. _____ 3. The bill is debated by the full House and passed. _____ 4. The bill is referred to a committee where hearings are held and revisions are made. _____ 5. The bill is sent to the Senate for debate and approval. _____ 6. The president signs the bill. _____ 7. The approved bill is sent to the president for signature.
2, 1, 4, 3, 7 , 6
Root-cause analysis, an essential part of risk management, is conducted after an adverse event. What are the components of root-case analysis? Select all that apply. 1. Identifying who caused the adverse event 2. Tracking the events that led to the error 3. Identifying any faulty systems or processes 4. Developing a plan to prevent further errors
2, 3, 4
What are state governments responsible for regarding nursing and health care? Select all that apply. 1. The Medicare program 2. Nursing licensure and certification 3. How Medicaid funds are used 4. Nurse practice acts 5. The Affordable Care Act (ACA)
2, 3, 4
Zavyon, an RN in the cath lab, has decided to become more politically active. What can Zavyon do to convince his senator to take him and his agenda seriously? Select all that apply. 1. Write the senator a letter presenting his agenda. 2. Donate to the senator's election campaign. 3. Volunteer to phone bank for the senator. 4. Organize a block of voters to support the senator. 5. Offer to endorse the senator in campaign ads.
2, 3, 4, 5
Omar and Joleen, two nursing students, are arguing about the effects of the media on the legislative process. Omar points to the negative effects of soundbites and social media memes that oversimplify or, even worse, misrepresent candidates' positions. What positive examples of media's effects might Joleen respond with? Select all that apply. 1. Media shape public opinion. 2. Transcripts of candidates' speeches are available online. 3. News media focus on sensational or "click-bait" stories. 4. Audio or video files of speeches may be watched or listened to any time. 5. Candidates can use social media to communicate in real time directly with their constituents.
2, 4
Which factors will affect the evolution of healthcare delivery in the United States in the future? Select all that apply. 1. The elimination of contagious illnesses 2. An aging population 3. An increase in public wellness due to preventive care 4. An increase in morbidity due to shorter hospital stays 5. The increase in the number of people with chronic illnesses
2, 5
Alan Turing is considered one of the founders of nursing informatics. What area of nursing informatics did Turing contribute to? 1. Computer science 2. Information science 3. Cognitive science 4. Nursing science
3
How does Medicare encourage facilities to provide high-quality, cost-effective health care? 1. It pays more if a client is discharged sooner than expected. 2. It limits the number of diagnostic tests and procedures a facility can provide. 3. It offers facilities incentives for shorter-than-expected hospital stays and penalizes them for longer-than-expected stays. 4. It requires clients to use physicians whose charges are below the national average.
3
How does the American Nurses Association (ANA) influence politics in the United States? 1. The ANA provides financial support for nurses who run for political office. 2. The ANA crafts health-policy legislation that the House and Senate then vote on. 3. The ANA lobbies Congress and regulatory agencies on health-care issues affecting nurses and the public. 4. The ANA uses social media to manipulate public opinion.
3
In what way do the Canadian and U.S. health-care systems differ? 1. In the United States, health insurance must be operated on a nonprofit basis. 2. The United States requires health-insurance coverage of all citizens; Canada does not. 3. Canadian health care is funded by federal tax dollars and administered by the provinces. 4. Canada is a type 4 system; the United States is a modified type 1 system.
3
Jenny is giving a presentation to her nursing class on the role of the sexual assault nurse examiner (SANE). Which of the following statements should her classmates question? 1. "The SANE interviews victims of sexual assault." 2. "An important task of the SANE is to complete a physical examination and collect specimens for forensic evidence." 3. "The SANE provides ongoing counseling to survivors of sexual assault." 4. "The SANE testifies in court about how evidence was collected and the physical and psychological condition of the victim."
3
Marla, a newly graduated RN, says she has no interest in understanding health-care policy and reform. What is the BEST reason for Marla to change her mind? 1. Nurses must pass a continuing education examination on changes in health-care policy. 2. Marla will be better prepared to debate healthcare reform if she understands it. 3. Health-care policy affects the clients Marla cares for, Marla herself and the staff she works with, and the facility she works in. 4. Marla's clients and their families may have questions for her related to health-care policy and reform.
3
Ming and Christy, two newly graduated RNs, are discussing the role of an informatics nurse. Christy says, "Our generation is really technology savvy. I don't see the need for a separate informatics nurse." Which statement by Ming is the most appropriate response? 1. "Yes, the need for informatics specialists is decreasing every year." 2. "Well, somebody has to be able to analyze and interpret all those statistics!" 3. "Technology is changing so fast that full-time floor nurses aren't able to keep up with the latest innovations." 4. "Nurses take care of people. The information technology folks take care of the machines."
3
Mrs. Vazquez had hip-replacement surgery yesterday at a large hospital. Today, her case manager stops by to discuss her planned transfer to another facility for rehabilitation and physical therapy. What level of health-care delivery will the new facility provide? 1. Primary care 2. Secondary care 3. Tertiary care 4. Outpatient care
3
The clinical instructor asks Darla to explain to a postoperative client the importance of using an incentive spirometer to inhale deeply. What Quality and Safety Education for Nurses (QSEN) competency is the instructor assessing? 1. Client-centered care 2. Teamwork and collaboration 3. Evidence-based practice 4. Quality improvement 5. Safety 6. Informatics
3
The insurance industry has tried to manage healthcare costs in a variety of ways. What do these plans have in common? 1. They require facilities providing services to Medicare clients to be reimbursed using a fixed-rate system and include monetary incentives to reduce the length of hospital stays. 2. They require participants to pay a flat rate, usually through their employer, to belong to a managed care organization for a specified period of time. 3. They seek to provide services to the maximum number of people at the lowest possible cost. 4. They set lifetime spending caps on individuals.
3
Which benefit of the ACA is most likely to endure even if the ACA itself is fully repealed? 1. Improved access to health care 2. More affordable health care 3. Widespread use of health information technology (HIT) 4. Coverage for citizens with preexisting conditions
3
Which of the following is the best definition of quality as it relates to health care? 1. The extent to which clients are satisfied with their health outcomes and the care they received 2. The provision of as much safe, effective care as the client can afford 3. The degree to which health services increase the likelihood of desired outcomes and reflect current professional knowledge 4. The extent to which outcomes can be quantified and compared to industry standards
3
Which of the following is true of nurse entrepreneurs? 1. They are required to have advanced degrees or certification. 2. They practice under the supervision of a physician. 3. They need business skills in addition to nursing skills. 4. There are very few options for nurses who want to be entrepreneurs.
3
A nursing instructor asks the class to name some of the arguments made against the Affordable Care Act (ACA). Which answer given by a student indicates the need for further instruction? 1. Health insurance, like car insurance, should be bought and sold in a competitive free market. 2. The ACA suppresses wages because companies will reduce employees' work hours to avoid the mandated employer-provided health insurance. 3. The ACA invades workers' privacy because employers need detailed household information to supply mandated health insurance. 4. The ACA eliminates cost shifting in which higher premiums and taxes are used to pay for uninsured people's health care.
4
An informatics nurse notices that a large number of data-entry errors occur on a surgical unit because nurses must type in the names of their clients' surgical procedures, such as cholecystectomy, the surgical removal of the gallbladder. What solution would the informatics nurse most likely suggest? 1. Require nurses to attend a medical terminology spelling class. 2. Reprogram the system to recognize common terms for procedures, such as "gallbladder removal." 3. Buy a voice-recognition system that turns nurses' speech into typed words. 4. Change the system so that nurses can select the names of the procedures from a drop-down menu.
4
In the United States, what trend in the incarcerated population mirrors the general population? 1. The rates of HIV and tuberculosis are increasing. 2. Obesity-related illnesses are increasing rapidly. 3. Correctional nurses focus on wellness rather than illness. 4. The population is aging and requires care for age-related health-care problems.
4
Miguel, an RN with 5 years' experience on a medical-surgical unit, is considering going to graduate school to become a family nurse practitioner (FNP). Assuming the ACA is not fully repealed, what effect is the ACA likely have on Miguel's career opportunities as an FNP? 1. Miguel likely will not be allowed to practice to the full extent of his education and abilities. 2. Miguel will probably have a long job search ahead of him. 3. Miguel should plan to pursue a degree in nursing education as well so that he can teach. 4. Miguel should easily be able to find a job as a primary care provider.
4
Richard, an RN, is preparing to receive Mr. Rocha, an elderly client who had a stroke two days ago, from the ICU. From report, Richard learns that Mr. Rocha is awake and oriented, is NPO because of swallowing problems, and is experiencing weakness on his right side. According to The Joint Commission's National Patient Safety Goals, which of the following is the most important thing Richard should do to prepare for Mr. Rocha's arrival? 1. Wipe down the room with strong disinfecting wipes. 2. Alert the nurse aide that Mr. Rocha is on his way. 3. Make sure that the room is properly stocked and ready. 4. Be sure there are signs in the room indicating that Mr. Rocha is NPO and a fall risk.
4
What do housekeeping bills and executive orders have in common? 1. They shape policy with minimal involvement from the legislature. 2. They involve revising and updating existing policies. 3. They are both initiated by the chief executive. 4. They can both be used to move forward a policy that faces strong legislative opposition.
4
One system of quality improvement that has been tried in health care is ___________, which was originally developed to improve quality in manufacturing but has since been used to identify problems and find effective solutions in health care.
6 Sigma
A _______________ works to lower the risk factors that cause poor or adverse client outcomes by eliminating health-care errors.
Client Safety Officer
In 1965, President Johnson signed the __________, which was the most ambitious health insurance advance in U.S. history at that time.
Medicare/Medicaid Act
Mr. Nguyen takes his toddler to a facility that provides __________ care services to receive her scheduled immunizations.
Primary
Rachel is a family nurse practitioner in private practice. She is concerned that her office's electronic medical records (EMR) system does not share information easily with the computer systems at the laboratory service the her practice uses or the insurers it seeks payment from. Rachel's EMR system lacks ___________.
integration
Mara has organized a meeting between a group of hospice nurses and their representative at the state capital. The group wants to persuade the representative to vote for legislation to expand Medicaid coverage of hospice care to pediatric clients who qualify for it. Mara and her group are engaged in ___________.
lobbying
