Leadership exam 2
In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours. a. 12,480 productive b. 10,820 productive c. 12,480 paid d. 10,800 patient care
c. 12,480 paid
As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of: (Select all that apply.) a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education. d. potential damage to reputation through learner error.
a. increased salary costs. b. duplication of tests and procedures. c. graduate medical education.
Politics is identified in what areas? a. Confined to legislatures b. Seen in dysfunctional workplaces c. Found in all social organizations d. A representation of self-interest
c. Found in all social organizations
To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. units that provide only primary care services. b. owned by the institutions. c. a feature of all public institutions. d. units that serve large populations.
d. units that serve large populations. The term healthcare network refers to interconnected units that either are owned by the institution or have cooperative agreements with other institutions to provide a full spectrum of wellness and illness services
A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager: a. concludes that the complexity of care in each visit has arisen. b. concludes that patient volume has been decreased. c. decides that more information is needed before a conclusion can be reached. d. initiates a training session regarding the importance of ensuring that visits are made.
c. decides that more information is needed before a conclusion can be reached.
The clinic nurse has just accessed a client's chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client's chart. She should say: a. "No problem. Just log me off when you're done." b. "I'll put the note in for you. What do you want to say?" c. "Just make sure that you sign your note because it's under my log in ID." d. "I'm sorry, but you will have to enter the information using your own log in ID."
d. "I'm sorry, but you will have to enter the information using your own log in ID."
Amy has worked in the dialysis unit as a staff RN for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using? a. Position power b. Expert power c. Personal power d. Competency power
b. Expert power Based on one's reputation for expertise and ones' credibility. The knowledge and skills the nurse possesses that are needed by others.
What has the literature on oppression in nursing demonstrated? a. Verified the presence of behaviors associated with oppression within nursing. b. Suggested that oppression leads to bullying but has little or no effect on patient outcomes. c. Failed to establish that oppression is present in nursing groups. d. Indicated that nurses use oppression negatively.
a. Verified the presence of behaviors associated with oppression within nursing.
You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from: a. a clinical database. b. biomedical technologies. c. e-mail. d. Internet sources.
a. a clinical database.
The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is: a. a contractual allowance. b. a profit. c. a flat rate. d. revenue.
a. a contractual allowance.
A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. a healthcare network. b. a tertiary care institution. c. rehabilitative. d. long-term care.
a. a healthcare network.
In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve: a. biomedical technology. b. telecommunications. c. retrieval of patient history information. d. Internet.
a. biomedical technology.
The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. clinical expertise. b. leadership ability. c. communication style. d. conflict-resolution skills.
a. clinical expertise.
As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes: (Select all that apply.) a. reduction in incidents of medication error. b. immediate documentation of care. c. comparison of patient data with previous data. d. immediate access to staffing schedules.
a. reduction in incidents of medication error. b. immediate documentation of care. c. comparison of patient data with previous data.
In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. reflect the culture of the unit and its values. b. be developed by the nursing manager on the unit. c. identify the clients that will be served on the unit. d. replicate the organization's philosophy.
a. reflect the culture of the unit and its values. A philosophy expresses the values and beliefs that members of the organization hold about the nature of their work, about the people to whom they provide service, and about themselves and others providing the services.
A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position? a. 0.6 b. 0.7 c. 0.8 d. 1
b. 0.7
A strategy to increase RN staff retention at Valley Hospital includes: a. better compensation and benefits. b. clearer position descriptions. c. lay-offs of nursing assistants. d. adequate staffing to meet acuity levels.
d. adequate staffing to meet acuity levels.
The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. acculturation. b. ethnocentricity. c. cultural diversity. d. cultural sensitivity
d. cultural sensitivity Cultural sensitivity: Affective behaviors (the capacity to feel, convey, or react) to culture unique to a group of people. A set of skills to learn about & understand different cultures
Lucy, charge nurse on the surgical unit, works with her staff to find ways in which they can work together with other disciplines to provide more effective care for patients on the unit. Lucy likely knows her power is: a. limited, thereby necessitating involvement of others in implementing ideas. b. restricted, which necessitates finding alternative means to achieve strong patient outcomes. c. directed primarily toward those who are subordinate to her. d. of unlimited capacity when shared with others.
d. of unlimited capacity when shared with others.
A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. pay dividends to stockholders. b. can refuse clients who are unable to pay. c. have no paid employees. d. pay no taxes.
d. pay no taxes. Historically, nonprofit organizations have been exempt from paying taxes because they commit to providing an important community service
A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. mission b. goal c. vision d. philosophy
d. philosophy
A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. lower salary compensation for staff. b. rising expectations of impoverished and indigent individuals for services. c. poor orientation and retention practices for staff. d. an overwhelming emphasis on accepting learners from health disciplines.
a. lower salary compensation for staff
Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: a. eye contact. b. personal space. c. harassment. d. expressions of feeling.
b. personal space
A nursing informatics specialist hired by Blue Cross/Blue Shield Insurance System (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. critical pathways. b. healthcare networks. c. health maintenance organizations. d. managed care.
d. managed care.
In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. diabetes. b. cardiovascular disease. c. cancer. d. asthma.
a. diabetes
A busy neurologic ICU and step-down unit most likely would use which patient-classification system? a. Factor evaluation b. Prototype evaluation c. Hybrid system d. AHRQ system
a. Factor evaluation
As a nurse manager in a hospital, you would expect what to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield
a. The federal government
Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings? a. Training nurses on accurate documentation of supplies used for patient care b. Reducing the number of overtime hours worked by staff c. Reducing the number of staff on a unit d. Making decisions for patients about which care is important to their health
a. Training nurses on accurate documentation of supplies used for patient care
With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. increasingly seen as primary care sites for children. b. providing only health education programs for children and their parents. c. capable only of providing referrals for health problems to primary care providers. d. funded exclusively by local authorities.
a. increasingly seen as primary care sites for children. School health programs whose funds are also allocated to them by local, state, and federal governments traditionally have been organized to control infectious disease outbreaks; to detect and refer problems that interfere with learning; to treat on-site injuries and illnesses; and to provide basic health education programs. Increasingly, schools are being seen as primary care sites for children.
As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system: a. involves screen displays that are best configured for nonclinical users. b. requires an upgrade to servers in the facility. c. requires staff orientation and training during implementation of the software. d. minimizes the amount of data entry necessary.
a. involves screen displays that are best configured for nonclinical users.
A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90%. b. 85%. c. 75%. d. 60%.
b. 85%. 34/40=0.85=85%
To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average nonproductive hours c. Minimum benefit hours d. Maximum vacation time
b. Average nonproductive hours
The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method
b. Case management method
The institution where you are a nurse manager has resisted the adoption of a new document management software, citing cost as a concern. You meet with other nurse managers who are in favor of the software and prepare a proposal to take to the senior executive with the goal of persuading the executive to adopt the software. This is an example of: a. collaboration. b. a coalition. c. networking. d. policy building.
b. a coalition relating to or involving shared responsibility, as among a group of colleagues.
As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that Veterans hospitals provide: a. primary care and are privately funded. b. a range of services and are responsible to government and taxpayers. c. secondary care only and are publicly administered and funded. services to Veterans under an HMO
b. a range of services and are responsible to government and taxpayers
In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. is increased. b. is decreased. c. is relinquished. d. remains the same.
b. is decreased.
In a job interview for a staff position, which of the following indicates your knowledge of patient safety? a. "Will I be able to get overtime hours on your unit?" b. "If there is an opportunity to work extra shifts, I would really like that." c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" d. "I see no reason why I wouldn't be able to work overtime."
c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" Individual nurses must consider their responsibilities for patient safety when voluntarily working overtime.
A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item? a. Cash budget b. Capital budget c. Operating budget d. Supply and expense budget
c. Operating budget
A 39-year-old patient awaits a kidney transplant. Because he must immediately arrange to get to the hospital when a donor kidney is available, it is important that he can be reached anywhere and at any time. To ensure that he receives the message, what type of technology is most effective? a. Internet b. Telecommunications c. WL pager d. CDS
c. WL pager
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget? a. Operating b. Strategic c. Unit of service d. Capital
d. Capital
Sondra, a new graduate, recently began a position as a registered nurse in a rural hospital, where she is the youngest and newest staff member. Although she has limited experience, she has a strong knowledge base, is confident, and was considered to have strong entry-level skills on graduation. Sondra meets with her former instructor and confides that she is very frustrated that others do not seem to accept her leadership. What might you suggest that would help Sondra to understand what is happening in terms of power and influence? a. As a new graduate, it is unlikely that she has acquired the experience and knowledge of other staff, including aides and practical nurses. b. Rural settings tend to be closed systems and therefore are, not welcoming of those who are not from their community. c. Morale on her unit can be improved by engaging in shared decision making. d. Identify the informal leaders on her unit and how they affect care decisions.
d. Identify the informal leaders on her unit and how they affect care decisions.
A nurse belongs to several professional organizations, serving on a state-level committee of one group and on two task forces at work. The nurse is committed to a range of health issues and knows the state senator from the nurse's district, as well as the name of the representative in Washington, DC. This nurse exemplifies which level of political activism in nursing? a. Gladiator b. Buy-in c. Self-interest d. Political astuteness
d. Political astuteness Build a relationship with a legislator. Be an active member of an organization. i.e. APHA Run for office in your organizations, your community, & your legislature. Develop expertise in shaping policy. Seek appointed positions
Which of the following are considered variable costs? (Select all that apply.) a. Salaries for the minimum number of staff b. Utilities and rent c. Managed care d. Supplies e. Medication and treatment supplies
d. Supplies e. Medication and treatment supplies
The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. function through influence. b. take complete responsibility for the care of clients. c. interview and hire staff nurses for designated nursing units. d. be granted functional authority to determine standards of nursing care and enforce them.
a. function through influence.
When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's gesture of respect. You are exhibiting: a. acculturation. b. cultural sensitivity. c. ethnocentrism. d. transculturalism.
b. cultural sensitivity Cultural sensitivity: Affective behaviors (the capacity to feel, convey, or react) to culture unique to a group of people. A set of skills to learn about & understand different cultures
In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing: a. supplies. b. staffing. c. fixed costs. d. medication costs.
b. staffing.
Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of: a. JCAHO standards. b. information systems. c. informatics competencies. d. requirements for nursing licensure.
c. informatics competencies.
In the Unity Healthcare organization, communication flows: a. laterally. b. bottom to top. c. top to bottom. d. intermittently.
c. top to bottom.
Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. On what is the concept of differentiated nursing practice is based? a. Licensure status b. Experience in the agency c. Leadership capabilities d. Education and expertise
d. Education and expertise
As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include: a. ensuring that the system is reliable. b. ensuring that patient information is reliable. c. developing unique identifiers for individuals. d. developing rules that support inferences.
d. developing rules that support inferences.
A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: a. "How long have you been using acupuncture treatment?" b. "Do you think acupuncture relieves your pain satisfactorily?" c. "What have you told your heart specialist about your migraines and treatment?" d. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"
a. "How long have you been using acupuncture treatment?"
In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension, and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000? a. $78,000 to $93,600 b. $62,400 to $78,000 c. $46,800 to -$93,600 d. $31,200 to $46,800
a. $78,000 to $93,600
In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.) a. Ensure unit productivity reports. b. Develop policy and legislation to protect nurses' well-being. c. Plan staffing of UNPs only. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.
a. Ensure unit productivity reports. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.
Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. breakdown in function and communication across specialties. b. lack of congruence in culture and organizational values. c. highly centralized decision making and authority. d. wide span of control.
a. breakdown in function and communication across specialties.
In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. can be effective in recognizing individual strengths and backgrounds of staff. b. promotes autonomy and independence for the RN. c. avoids conflict because of role clarity. d. is efficient in delivering care to a large group of patients, utilizing a staffing mix.
a. can be effective in recognizing individual strengths and backgrounds of staff. Nurse manager's role -Aware of competencies of RNs & their interest in being charge nurse or team leader -Provides adequate staff mix & orientation of leadership skills -Ensures charge nurses support each team to solve problems independently
The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. develops over time. b. maintains a strong work ethic. c. changes easily. d. develops quickly.
a. develops over time. Culture: A way of life conveyed strongly enough for a group of people to describe its meaning. It consists of values, beliefs, attitudes, practices, rituals, & traditions. -Develops over time, -Members learn & share it -Essential for survival -Difficult to change
To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to: a. enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence. b. gain quick access to literature based on studies of patients and families who have experienced stroke. c. develop a list of articles that could be accessed to address clinical issues and problems with stroke patients. d. advance the development of staff who are able to conduct independent nursing research on stroke outcomes.
a. enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence.
Case managed care may enhance profit in a for-profit health organization by: a. minimizing costs in high resource consumption areas. b. combining licensed and unlicensed care providers in delivering patient care. c. increasing reimbursement from third-party payers. d. reducing the amount of technology used to support clinical decision making.
a. minimizing costs in high resource consumption areas.
When assessing the appropriateness of adopting WL COWs for a nursing unit, you need to consider the advantages, which include: a. mobility of the carts. b. small display screen. c. font size. d. speed of operation.
a. mobility of the carts.
Organizational culture includes: (Select all that apply.) a. norms. b. traditions. c. behaviors. d. values.
a. norms. b. traditions. c. behaviors. d. values.
To maintain patient safety, studies suggest that scheduling should avoid: a. rotating shifts. b. weekends. c. 8-hour shifts. d. mandatory overtime.
a. rotating shifts. Rotating shifts may have a negative effect on nurses' stress levels and job performance, and working longer hours may have a negative effect on patient outcomes
For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. rotation of task assignments. b. frequent opportunities for in-service education. c. orientation to job responsibilities and performance expectations. d. team social events in off hours.
a. rotation of task assignments.
At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a: a. nursing information system. b. central data repository. c. nurse expert system. d. handheld device.
b. central data repository.
Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: a. cultural marginality. b. circle of familiarity. c. cultural understanding. d. acculturation.
b. circle of familiarity. By talking with people outside their "circle of familiarity," nurses can enhance their understanding of personally held prejudices. Prejudices "enable us to make sense of the situations in which we find ourselves, yet they also constrain understanding and limit the capacity to come to new or different ways of understanding.
Nurses who engage in infighting, seek physician support against nursing colleagues, and avoid political advocacy through membership in nursing organizations: a. refuse to believe that they are acting like members of groups that suffer socioeconomic oppression. b. do not understand how their failure to exercise power can limit the power of the whole profession. c. purposefully choose to exercise their power in the workplace through indirect means. d. suffer from learned helplessness as a result of abuse by powerful nurse executives
b. do not understand how their failure to exercise power can limit the power of the whole profession.
The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. care for the specific needs of individual families in the community. b. focus on the treatment of community-wide problems rather than on individual health problems. c. do not include services provided by public health departments. d. provide personal health follow-up for all acute care hospitalizations.
b. focus on the treatment of community-wide problems rather than on individual health problems. Community services, including public health departments, are focused on the treatment of the community rather than that of the individual
In matrix organizational structures, a nurse manager understands that this type of structure: a. is a simplified organizational structure. b. has both a functional manager and a service or product-line manager. c. arranges departments strictly according to function. d. promotes harmony in organizational decision making.
b. has both a functional manager and a service or product-line manager. In a matrix organization, the manager of a unit responsible for a service reports to both a functional manager and a service or product line manager.
After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from: a. overestimation of inflation. b. higher than expected client acuity. c. net revenue exceeding net expenses. d. not replacing staff who called in sick.
b. higher than expected client acuity.
Two nurses approach their manager about a conflict regarding the next month's schedule. The nurses are talking loudly at the same time. The manager most effectively uses communication skills to resolve the conflict by: a. taking both nurses aside, separately and then together, and charging them with resolving the problem without her direct intervention. b. listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves. c. separating the nurses, instructing each to decide how the problem can be resolved, and meeting with them the next day. d. calling an emergency scheduling committee meeting and asking volunteers to resolve the conflict between the two nurses.
b. listening to each nurse speak to the other without interruption and asking clarifying questions to help them resolve the issue themselves
The chief nursing office of a Magnet® hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients: a. accomplish healthcare goals. b. minimize costs. c. decrease the number of services used. d. use high-technology treatments.
b. minimize costs.
"At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. vision statement. b. mission statement. c. goal statement. d. statement of philosophy.
b. mission statement. An organization's mission, or reason for the organization's existence, influences the design of the structure (e.g., to meet the healthcare needs of a designated population, to provide supportive and stabilizing care to an acute care population, or to prepare patients for a peaceful death).
A nurse staffing plan considers: a. specific nurse-to-patient ratios per shift. b. participation of nurses in projecting staffing needs. c. compensation and benefits for each level of staff. d. the occupancy load of a unit.
b. participation of nurses in projecting staffing needs. The staffing plan, which is based on the unit's approved personnel budget and the projected staffing needs to ensure patient safety, as previously discussed, serves as a guide for creating the unit's schedules for the upcoming year
As an experienced nurse manager who is new to an organization, it would be important to: a. know the difference between operating and capital budgets. b. understand the budget timetable and level of involvement expected of individual managers in budget preparation. c. know why a budget is essential to the well-being of an organization. d. understand what factors drive up healthcare costs in the healthcare system.
b. understand the budget timetable and level of involvement expected of individual managers in budget preparation.
The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by: a. providing fewer services to fewer clients. b. using fewer services per client. c. using high-technology treatments. d. requiring second opinions.
b. using fewer services per client.
A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is related to the past. In the early decades of the profession, nurses lacked power because: a. nurses freely chose to defer to physicians and administrators with more education. b. women lacked legal, social, and political power because of legal and cultural barriers. c. the first nursing licensure laws prohibited nurses from making most decisions. d. nurses astutely recognized the risks of grabbing too much power too soon.
b. women lacked legal, social, and political power because of legal and cultural barriers. As previously noted, in nursing's formative years, the exercise of power was considered inappropriate, unladylike, and unprofessional.
An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option? a. Hospice care b. Custodial nursing home care c. Home care d. Hospital care
c. Home care
What would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors
c. Pain management for patients with low back pain
A hospital is working toward becoming a Magnet® hospital. The chief nursing officer is aware that professional nursing departments in Magnet® hospitals will: a. not be directed by nurses. b. be virtual organizations. c. be designed to maintain nursing standards of practice. d. be entitled to have client care departments.
c. be designed to maintain nursing standards of practice.
An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. assign staff on the unit on a daily basis. b. ensure that days off are planned for the staff. c. outline the number of individuals by classification on a per-shift basis. d. predict the numbers and classifications of float staff needed to augment regular staff.
c. outline the number of individuals by classification on a per-shift basis.
A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. hierarchical. b. bureaucratic. c. service-line. d. matrix
c. service-line. In service-line structures (sometimes called product lines), the functions necessary to produce a specific service or product are brought together into an integrated organizational unit under the control of a single manager or executive
A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home following bowel surgery and has a new colostomy. She will need daily contacts for at least 2 weeks and then regular weekly contact following that week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day and is able to view the colostomy site. This type of technology is called: a. distance learning. b. knowledge software. c. telecommunications. d. biomedical technology.
c. telecommunications.
In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on healthcare delivery systems of the future is: a. changes in staffing patterns. b. increasing reports of violence in the workplace. c. the increasing percentage of the population that will be over age 65. d. escalations in the cost of health care.
c. the increasing percentage of the population that will be over age 65.
To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. work time, educational time, and holiday time. b. paid hours minus worked hours. c. vacation time, holiday time, and sick time. d. paid hours minus meeting time.
c. vacation time, holiday time, and sick time.
What would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."
d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain."
In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. The nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget? a. 12,480 b. 11,200 c. 10,848 d. 10,688
d. 10,688
Which of the following factors is not implicated in rising healthcare costs? a. Rising expectations of consumers for cure and care b. Marketing of drugs to consumers c. Large administrative staffs to process medical billings d. Rising Medicare costs
d. Rising Medicare costs
A nurse is participating in a baccalaureate course. For the class, she has to attend the legislative session regarding the new role of medication assistants. Why is it important for nurses to be involved in shaping public policy? a. Involvement will enable nurses to take over the healthcare system at some point in the future. b. Other healthcare professions are less concerned about the essential needs of clients. c. Such activities are important career builders for nurses who seek top-level executive positions. d. They are closest to the front line of health care and see how it affects clients and families
d. They are closest to the front line of health care and see how it affects clients and families
You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. the possibility of violence. b. an increase in prescription drugs available for abuse. c. decisions of the public board. d. an increase in uncompensated care events.
d. an increase in uncompensated care events.
In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. higher patient care hours. b. safer facilities. c. institution of a patient-classification system. d. an increased number of RN positions.
d. an increased number of RN positions.
During a unit meeting, you notice that Vivian listens attentively when Mary is speaking and offers support and advice when Mary presents ideas to the group. You are surprised because Vivian has often confided that she does not like Mary. Vivian's behavior is best described as: a. insincere. b. networking. c. politically sophisticated. d. collegial.
d. collegial relating to or involving shared responsibility, as among a group of colleagues.
As a nurse manager, one challenge is to orient new staff to your agency's policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be: a. development of new learning modules and software to support document retrieval. b. e-mail distribution to staff home e-mail addresses regarding important policies. c. preparation of DVDs that can be viewed on computers at the nursing station during "down times." d. linking policies and procedures to the network for access when required at the point-of-care.
d. linking policies and procedures to the network for access when required at the point-of-care.
1. The number of adverse events such as falls and pressure ulcers on the unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. total number of staff on the unit. b. staff and RN hours per patient. c. total number of staff and implementing 12-hour shifts. d. number of RNs and number of RNs with experience on the unit.
d. number of RNs and number of RNs with experience on the unit.
In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. department. b. unit. c. staff. d. patient.
d. patient. -Continuously assess quality improvement & patient satisfaction -Facilitate interdepartmental communication -Educate staff of other departments about the importance of NCM's role and responsibilities for effectiveness of the NCM system
During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" b. "Sean, your approach to appraisal is completely off track and does not reflect available evidence." c. "The system that has been developed needs to be implemented. We have already spent enough time in discussion." d. "Forget about change in this policy. It is fine as it is."
a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" (of a person or their manner or speech) direct and outspoken; straightforward and honest.
As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a "family" and that staff members take pride in saying that they are from Unit 4. d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit
a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. Acculturation: Adapting to a dominant culture. The minority culture changes but is still able to retain unique cultural markers of language, food and customs.
A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LVN
a. Baccalaureate
Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following a. Behavior b. Love for people c. Shared vision d. Genetic predisposition
a. Behavior Culture: A way of life conveyed strongly enough for a group of people to describe its meaning. It consists of values, beliefs, attitudes, practices, rituals, & traditions. -Develops over time, -Members learn & share it -Essential for survival -Difficult to change
During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management
a. Case method Pros: Ø ↑ Trust between nurse & patient/family Ø Early detection of pt's status change Ø Patient-centered, comprehensive, continuous, & holistic care Cons: Ø If the nurse delivers w/ task orientation, holistic care will be lost. Ø Cost ineffective care due to expensive care by RN Ø Not all the care needs highly skilled & extremely knowledgeable professional nurse Ø Unrealistic in times of nursing shortages
A recent nursing graduate in a busy Emergency Department triages a patient who has sustained a large, deep puncture wound in his foot while working at a construction site. He is bleeding and is in pain. The nurse enters the triage data that she has obtained from the patient into a computerized, standard emergency patient-classification system. After she enters the assessment data, she notices an alert on the computer screen that prompts her to ask the patient about the status of his tetanus immunization. What system of technology is involved in generating the alert? a. Clinical decision support b. WL technology c. Computerized provider order d. Electronic health record
a. Clinical decision support
After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method? a. Cost-based reimbursement b. Charges c. Contractual allowance d. Prospective reimbursement
a. Cost-based reimbursement
A nurse manager must implement a 2% budget cut on the nursing unit. What approach would the manager use to most effectively empower the staff of the unit? a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate. b. Inform the staff of the budget cuts in a series of small group meetings and accept their ideas in writing only. c. Provide the staff with handouts about the budget cuts and let them make recommendations in writing. d. Hold a series of mandatory meetings on the budget cuts, asking staff for ideas on the cuts.
a. Discuss the guidelines for the budget cuts with the staff, making the decisions with those who participate Empowerment: The nurse is a source of shared power to build the exercise of power by others
Your organization made a decision to implement TCAB (Transforming Care At the Bedside) in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.
a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. e. Present ideas based on best practices and ask staff for advice on implementation.
During orientation of new nurse managers, the chief nursing officer stresses strategies that help nurse managers to achieve a powerful image. What behaviors best contribute to a powerful image for the nurse manager? a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise b. For men, no facial hair, always wearing a suit and tie; for women, always wearing a suit and high-heeled shoes c. Maintaining a soft voice during times of conflict; making unbroken eye contact during interactions d. Smiling all the time; always wearing a suit, carrying a briefcase, and, if a woman, wearing no jewelry
a. Greeting patients, families, and colleagues with a handshake and a smile; listening carefully when problems arise Developing a Powerful Image Self-confidence • Body language • Self-image, including grooming, dress, & speech • Career commitment & continuing professional education • Attitudes, beliefs, & values
Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators? a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care. b. Local home care services are expressing concern about the increased acuity of patients being discharged into their care. c. The resource-based relative scale for physicians does not account for the increased length of stay. d. Acute care patients are being denied entry to the hospital because of the increased stay of patients.
a. The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.
Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in: a. advocacy for patients with regard to services required and services utilized. b. increasing the volume of services and decreasing the number of patients served. c. accomplishing more with each visit and decreasing the volume of services used. d. decreasing the volume of services used and the number of return visits.
a. advocacy for patients with regard to services required and services utilized.
Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted 5 years earlier and was last updated 3 years before. The clinic nurse advises Mr. Cruiser to: a. avoid this site. b. check with his primary healthcare provider. c. continue with the exercises. d. contact the author for additional exercise and feedback.
a. avoid this site.
A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates: a. coercive use of power. b. appropriate application of control. c. use of informatory power. d. use of power to provide coaching.
a. coercive use of power Stems from fear of someone's real or perceived fear of another person.
A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. creating more jobs in the community for registered nurses. b. resulting in an overall loss of jobs for registered nurses. c. controlled by the federal and state governments. d. controlled by the insurance agency.
a. creating more jobs in the community for registered nurses.
With revenue reductions and cost-saving measures, the number of managers has been reduced, this has increased the number of team members supervised by managers by as many as three. This change may result in: a. decreased patient satisfaction. b. increased efficiency in costs. c. a more positive perception of managers. d. little change to manager-staff relationships.
a. decreased patient satisfaction.
To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. develops a centralized pool of float nurses. b. assigns nurses from less busy units to ones with increased acuity levels. c. floats nurses only between units on which the nurses have been cross-trained. d. assigns float nurses to basic care only.
a. develops a centralized pool of float nurses. . Another strategy that may be used to deal with unanticipated staff vacancies involves "floating" nurses from one clinical unit to another to fill the vacancy. In practice, the use of float nurses may be effective if the nurses are deployed from a centralized flexible staffing pool and they have the competencies to work on the unit to which they are assigned. Nurses willing to work as float nurses are generally experienced nurses who maintain a broad range of clinical competencies. They often receive added compensation for their willingness to be flexible and to float to a variety of units on short notice
A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who made the assessment. As the nurse manager, you clarify that: a. it is the role of the primary nurse to make alterations based on assessment data and input. b. the associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. neither the primary nor the associate should make changes without first consulting you as the manager. d. it really does not matter who alters the nursing care plan as it depends on situation and time to do so.
a. it is the role of the primary nurse to make alterations based on assessment data and input.
An example of an initiative that may reduce total healthcare costs would be: a. offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections. b. educating seniors about the comparative costs of medications that are prescribed to them. c. lowering copayments for prescription drugs for seniors. d. advocating for more readily available MRI services to ensure early diagnosis.
a. offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections.
A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. organizational staffing policies. b. state licensing standards. c. American Nurses Association. d. consumer expectations.
a. organizational staffing policies.
Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by: a. participating in organizational information technology committees. b. submitting written requests for needed information systems. c. requesting budgetary funds needed for systems. d. sending staff nurses to conferences that discuss cutting-edge technologies.
a. participating in organizational information technology committees.
The work group on Nursing Unit 23 is marked by apathy toward the ward's patients, high absenteeism, open conflict among team members, and high turnover of personnel, including managers. The underlying behavior in this situation may be characterized as: a. powerlessness. b. anger. c. apathy. d. oppression.
a. powerlessness
The difference between staffing and scheduling is that staffing: a. puts the right person in the right position. b. puts the right person in the right time and place. c. refers to the number of nursing hours per patient per day. d. looks after interpretation of benefits and compensation.
a. puts the right person in the right position.
The chief nursing officer is given the task of reviewing and proposing revision of the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. the organizational structure. b. line and staff responsibilities. c. the policies and procedures. d. government regulations.
a. the organizational structure.
A staff nurse asks the nurse manager for a few days off for personal reasons. The nurse manager turns in the request to the human resources office with a note indicating that the staff nurse has demonstrated excellent working skills and is a valued employee. The nurse manager has used the influence of her position to help this staff member. Influence is the process of: a. using power. b. empowering others. c. understanding power. d. moving past apathy
a. using power Influence is the process of using power.
"Georgia Hospital will provide care that is a national example of consumer service" is a: a. vision statement. b. statement of philosophy. c. mission statement. d. rationale for care.
a. vision statement. A vision statement conveys an inspirational view of how the organization wishes to be described at some future time
One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: a. "Who cares what she is?" b. "What did you think when you learned she was Jamaican?" c. "Why did you assume she was black?" d. "We have never had a Jamaican on this unit."
b. "What did you think when you learned she was Jamaican?"
In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice
b. Competent A group of nurses who are all at the novice or advanced beginner stage would be less likely than their more experienced counterparts to implement any type of delivery model effectively.
A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. What would BEST support the capital request? a. Number of patient care hours anticipated for the year b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps c. Outline of cost for each pump d. Estimation of total cost; no further details
b. Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps
As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager's attributes would assist you in addressing the cultural needs of your staff? (Select all that apply.) a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others
b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff
As a new manager in the ED, you meet with each of the staff to ask about their priorities and what they think is going well in the department or what is of concern to them. Almost all of the staff express frustration and distress at being treated rudely or disrespectfully by patients, staff from other departments, and physicians and complain that they feel that nurses in the ED are not valued. With the staff, you brainstorm to raise the profile of nurses. Which of the following strategies would be most effective? (Select all that apply.) a. Requesting increased compensation b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names e. Submitting a written complaint to senior administration regarding rude behaviors f. Developing a code of conduct for the ED staff
b. Speaking positively about one's work c. Dressing and grooming in a clean and neat manner d. Using titles (e.g., Mr., Mrs., Ms.) and last names f. Developing a code of conduct for the ED staff
A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point. What would lead to this conclusion? a. SR systems are not available outside pilot projects. b. The type of speech required for voice recognition is unlikely to occur in a pressured situation. c. The hands-free function has not been perfected in SR technology. d. Wireless communications are prone to unreliability in transmission.
b. The type of speech required for voice recognition is unlikely to occur in a pressured situation. The speaker must use staccato-like speech, pausing between each clearly spoken word, and these systems must be programmed for each user so that the system recognizes the user's voice patterns.
A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. Hours of operation of the unit b. Trends in acuity on the unit c. Maximum work hours for each employee d. Weekend requirements
b. Trends in acuity on the unit Mensik (2014) notes three main models for nurse staffing exist: (1) patient acuity, in which patient characteristics are used to decide the level of staffing; (2) budget-based staffing, in which the number of nurses is determined compared with historical nursing hours per patient days on a unit and on national benchmarks; or (3) a nurse-patient ratio, in which the number of nurses on each unit is designated by policy, based on the type of patients served.
Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to: a. maintain a clear vision of how to trim healthcare costs. b. balance value-added services against costs and revenues. c. consistently delete programs that are of high cost. d. implement programs that bring in additional revenues.
b. balance value-added services against costs and revenues.
A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. bureaucracy. b. concern related to the validity of classification systems. c. inadequate reliability of classification systems. d. inappropriate subjectivity in making judgments about staffing.
b. concern related to the validity of classification systems. Numerous potential problems exist with patient classification systems. The issue most often raised by administrators relates to the questionable reliability and validity of the data collected through a self-reporting mechanism. Another concern with patient classification data relates to the inability of the organization to meet the prescribed staffing levels outlined by the patient classification system.
During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. bias. b. cultural awareness. c. cultural diversity. d. ethnocentricity.
b. cultural awareness. Cultural awareness is the self-examination and in-depth exploration of one's own cultural and professional background. It involves the recognition of one's bias, prejudices, and assumptions about the individuals who are different
A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are: a. hardware, software, and printers. b. data, information, and knowledge. c. decision making, data gathering, and reporting. d. wireless technology, voice recognition, and handheld devices.
b. data, information, and knowledge. core components of informatics: data, information, and knowledge
When interviewing an applicant for an RN position, the nurse manager describes the unit's care delivery system as one in which the nursing assistants are cross-trained to perform specific tasks and the RNs complete all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. the case method. b. functional nursing. c. primary nursing. d. nurse case management.
b. functional nursing.
A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. provides more expensive care than other types of insurance plans. b. has a centralized administration that directs and compensates physician services. c. pays physicians on a fee-for-service basis. d. does not pay as much for acute care as other practice plans.
b. has a centralized administration that directs and compensates physician services. The HMO is a configuration of healthcare agencies that provide basic and supplemental health maintenance and treatment services to voluntary enrollees who prepay a fixed periodic fee without regard to the amount of services used. An HMO plan aims to coordinate all patient care services through an approved primary care provider, who belongs to a provider network.
Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid (CMS). Tracy's responsibilities most likely would include: a. managing physician-led research. b. monitoring physician documentation of the need for medical care. c. determining which services are designated fee-for-service. d. identifying errors in physician diagnoses.
b. monitoring physician documentation of the need for medical care. Nurse case managers can serve in a number of different roles, but they frequently serve as the organization's interface with the physician. In this role, these case managers routinely monitor for appropriate physician documentation of medical necessity and other required CoP elements.
The chief nursing officer and the dean of the School of Nursing create a partnership based on belief that by establishing rules and regulations and controlling the environment, this partnership will: a. promote professional medical authority, autonomy, and responsibility. b. need a degree of flexibility to engender success. c. be essential for self-governance. d. provide for the establishment of medical committees.
b. need a degree of flexibility to engender success.
Your colleague Mary, a recent graduate, announces that she intends to leave nursing in 3 to 4 months to pursue a position in marketing. While at your agency, she plans to give patients excellent care and to learn as much as she can, because "Who knows? Nursing is a great job with a great pay and I may return someday." Mary's statements most accurately exemplify which orientation to the concept of nursing? Nursing as a(n): a. profession. b. occupation. c. flexible discipline. d. career with off and on ramps.
b. occupation Some people still view nurses only as members of an occupation who drop in and out of employment, not as members of a profession with a long-term career commitment.
Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. implement a patient-classification system immediately. b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. c. provide increased numbers of staff to the unit. d. ignore such concerns because acuity is variable.
b. participate in databases that compare the outcomes and staffing levels versus those of similar institutions. Staff morale suffers both when acuity models indicate a gap between staffing and acuity and when there is no model but perceived acuity that is not being addressed. A truer approach is to monitor patient outcomes and participate in national databases that measure staffing levels through comparison with like institutions
A primary care clinic in a small urban center sees a high volume of cardiology patients. Patients who attend the clinic have smart cards that they use at hospitals, clinics, and Emergency Departments within that region of the state. A primary benefit of the smart card for these patients would be: a. rapid and accurate treatment in emergency situations. b. reduced wait times to see specialists. c. e-mail notification of test results. d. readily available information regarding medications.
b. reduced wait times to see specialists.
You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. implementation of an all-RN staff complement. b. significant changes in the physical structure of units. c. orientation of staff to new roles and responsibilities. d. testing and piloting technology at the bedside.
b. significant changes in the physical structure of units. Flagg (2015) defined the following as components necessary for the engagement, support, implementation, and sustainment of patient-centered care: • Leaders must show involvement, support, and buy-in. • The strategic vision must be defined and operationalized. • Patients, their family, and other support systems, as well as all involved employees, must be involved. • Evaluation and feedback processes must be in place. • Technology that supports communication between patients and healthcare providers must be available. • The physical environment must support the process.
Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: a. dominant versus nondominant behaviors. b. the need to recognize diversity within groups. c. the impact of cross-culturalism. d. how language separates subgroups.
b. the need to recognize diversity within groups. Cultural diversity: Cultural differences among individuals or groups
At Hospital XYZ, staff members on Y3 Unit have dealt with the third charge nurse in 3 years. Donna, the current charge nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. staff members will resolve the conflict on their own. b. the situation will lead to ongoing disgruntlement and attrition. c. no further discussion or concerns will come out of the situation. d. the head nurse will be able to resolve the conflict on her own.
b. the situation will lead to ongoing disgruntlement and attrition.
According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic that most likely to be without cultural imposition would be: a. abortion. b. wound management. c. blood transfusion. d. advance directives.
b. wound management.
Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill. b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia. c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.
c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying.
Despite the implementation of bar-code medication administration (BCMA) on your busy medical unit, you notice that the number of medication errors has not significantly decreased. Which of the following reasons might explain the lack of change in errors? a. A number of new medications have been introduced into the hospital pharmacy that are not yet recognized in the CDS. b. There have been an unusually high number of patients on the unit who have been unable to confirm their identity at the time of medication administration. c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times. d. Clinical data that have been entered into the system to guide administration of the medications are outdated.
c. Lack of staff understanding and support for BCMA has led to overrides or failures to scan bar codes during busy times.
A nurse manager recognizes the need to expand her professional network as she begins a job search for a middle-management position. What action is least likely to expand her job-searching network? a. Reviewing her address book or card file for names and phone numbers of former colleagues who are now in middle-management positions b. Making an appointment to meet with a former instructor from her graduate program in nursing administration c. Making a long overdue return call to a former colleague who is now a chief nurse executive d. Attending a state-level conferences for nurse managers and executives and volunteering to help with professional organizations' informal luncheons and receptionspand her professional network as she begins a job search for a middle-management position. What action is least likely to expand her job-searching network?
c. Making a long overdue return call to a former colleague who is now a chief nurse executive
As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation
c. Multiculturalism Definition: the presence of, or support for the presence of several distinct cultural or ethnic groups within a society
The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity
c. Pediatric intensive care unit that heavily involves families as well as patients Useful in patients w/ complex care: Hospice, ICU settings. This care delivery model requires the nurse who is assigned to total patient care to complete the complex functions of care, such as assessment and teaching the patient and family, as well as the less complex functional aspects of care, such as personal hygiene.
In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides
c. RN and medication assistants
In what situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.
c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships.
A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation? a. Expert, coercive, and referent b. Reward, connection, and information c. Referent, expert, and information d. Reward, referent, and information
c. Referent, expert, and information referent: Leader's ability that influence a follower because of the follower's admiration, respect, or identification with the leader expert: Based on one's reputation for expertise and ones' credibility. The knowledge and skills the nurse possesses that are needed by others. information: Stems from one's possession of selected information that is needed by others
A group of patients with early Alzheimer disease and their spouses approach you regarding help with the establishment of a local Alzheimer Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group? a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic. b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.
c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group.
You document your patient's vital signs into a bedside documentation device and are able to compare your patient's vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing: a. e-mail. b. telecommunications. c. a database. d. technology.
c. a database.
Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must incorporate into the schedule plan: a. all weekends off. b. all holidays off. c. a variety of scheduling options. d. rotating shifts.
c. a variety of scheduling options. Creating a flexible schedule with a variety of scheduling options that leads to work schedule stability for each employee is one mechanism likely to retain staff that is within the control of nurse managers.
Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. cultural awareness. b. cultural sensitivity. c. acculturation. d. cultural marginality.
c. acculturation Acculturation: Adapting to a dominant culture. The minority culture changes but is still able to retain unique cultural markers of language, food and customs.
Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. primary care, specialized. b. tertiary care, long-term. c. acute care, specialized. d. public care, specialized.
c. acute care, specialized Acute care facility: Average LOS < 30 days
To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. be able to effectively communicate with patients. b. build relationships with physicians. c. be able to adapt to daily changes in staffing. d. adapt in communicating information to her supervisor.
c. be able to adapt to daily changes in staffing.
In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. transformational leadership. b. transactional leadership. c. bureaucratic organization. d. Chaos theory.
c. bureaucratic organization. Bureaucracy -Definition: an administrative concept imbedded in how organizations are structured -Characterized by: • Formality • Low autonomy • Hierarchy of authority • Rule dominated environment • Division of labor • Specialization • Centralized decision making • High control -Assertions: High control and clear labor division promote efficiency and productivity -Drawbacks: Can lead to frustration and delays due to low autonomy on the front line
Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. task force formed to commemorate a New Year's celebration in the Western tradition. b. project to provide Christmas gifts to the children in a daycare program. c. celebration of National Nurses Week with the focus on cultural care. d. task force to develop a poster for the unit depicting religions of the world.
c. celebration of National Nurses Week with the focus on cultural care. Human cultures have material items or symbols such as artifacts, objects, dress, and actions that have special meaning in a culture
A factor evaluation system: a. utilizes financial data to determine number of staff-to-patient ratios. b. utilizes DRGs to determine acuity on a unit. c. combines interventions and time required for interventions to determine levels of care required. d. combines financial resources and nursing interventions to determine patient contact hours.
c. combines interventions and time required for interventions to determine levels of care required.
In evaluating weekend mortality rates, the charge nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the charge nurse focuses on: a. availability of diagnostic personnel. b. availability of physicians. c. communication with on-call providers. d. acuity level of patients.
c. communication with on-call providers.
You are the nurse case manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. nursing care plan. b. physician's orders. c. critical pathway. d. clinical practice guidelines.
c. critical pathway.
A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She is also vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. having cultural sensitivity. b. experiencing cultural diversity. c. experiencing cultural marginality. d. experiencing acculturation.
c. experiencing cultural marginality Cultural marginality is defined as "the resulting sense of being between two cultures or more, living at the edges of each, but rarely at the center"
In considering whether or not to accept a job offer as a nurse manager at a Magnet® hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. find it difficult to recruit new staff. b. see rapid turnover of staff on your unit. c. find nurses who exemplify interest in quality care. d. find limited interest in excellence in the nursing environment.
c. find nurses who exemplify interest in quality care.
A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. rehabilitative or long-term care. b. disease-restorative care. c. first access to care. d. only outpatient services.
c. first access to care. Primary : -Purpose • Entry into system • Health maintenance • Chronic care • Treatment of temporary nonincapacitating malfunction -Organization or Unit Providing Services • Ambulatory care centers • Physicians' offices • Preferred provider organizations • Nursing centers • Independent provider organizations • Health maintenance organizations • School health clinics
A patient complains to the charge nurse that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. differentiated practice. b. team nursing. c. functional nursing. d. case management.
c. functional nursing. Care delivered according to specific tasks
Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. has many divisions of labor. b. best fits long-term care units. c. has a mixture of the characteristics of various organizational types. d. places the authority for decision making closest to the places where workers perform.
c. has a mixture of the characteristics of various organizational types. In healthcare organizations, several common types of organizational structures exist: functional, service line, matrix, or flat. Nursing organizations often combine characteristics of these structures to form a hybrid structure.
A facility's department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. know that this challenge is their issue and that it has nothing to do with your unit. b. understand that such events are localized and do not have an impact on the organizational culture. c. know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. anticipate that your prior experiences with facilities have no effect on the current situation.
c. know that the nature of challenges and reorganization in facilities will have an impact on other areas. A system is an interacting collection of components or parts that together make up an integrated whole
One day, your co-worker suggests that you and she sit with unit members of the hospital research committee. She suggests that this would be an excellent way to get to know people who share her interest in research. Her actions are an example of: a. mentorship. b. politics. c. networking. d. empowerment.
c. networking Developing a network involves identifying, valuing, and maintaining relationships with a system of individuals who are sources of information, advice, and support.
A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place 10 years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision-making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. organizational redesign. c. organizational reengineering. d. restructuring.
c. organizational reengineering Reengineering, however, involves a total overhaul of an organizational structure. It is a radical reorganization of the totality of an organization's structure and work processes. In reengineering, fundamentally new organizational expectations and relationships are created.
In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: a. lack of understanding of the seriousness of the patient's illness. b. lack of communication between family members. c. the social organization of friendships and family networks in East Indian culture. d. lack of caring about the hospital environment by the friends and family
c. the social organization of friendships and family networks in East Indian culture
At Health Center XYZ, staff members on the rehabilitation unit have a charge nurse who is intolerant of error and publicly rebukes anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. ethnicity. b. work environment. c. work culture. d. marginalization.
c. work culture Because the culture of the workplace has been shown to be highly influential in people's perception of their work and their intent to stay, being sensitive to what else could be done to enhance the workplace, including inclusion, has potential for positive outcomes.
At Orangetown Hospital, the nursing department is developing a mission statement for nursing. What would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."
d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."
A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using intranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Healthcare Information and Management Systems Society (HIMSS)? a. 0 b. 1 c. 3 d. 6
d. 6 Stage-->Cumulative Capabilities: Stage 7 -->Complete EMR, data analytics to improve care Stage 6 -->Physician documentation (templates), full CDSS, closed-loop medication administration Stage 5 -->Full R-PACS Stage 4 -->CPOE, clinical decision support (clinical protocols) Stage 3 -->Clinical documentation, CDSS (error checking) Stage 2 -->CDR, Controlled Medical Vocabulary, CDS, HIE capable Stage 1 -->Ancillaries - Laboratory, Rad, Pharmacy - All Installed Stage 0 -->All Three Ancillaries Not Installed
The American Nurses Association has advocated for the Registered Nurse Safe Staffing Act. This legislation is based on ANA Safe Staffing Principles and takes what factors into consideration for planning staffing on a nursing unit? a. Patient acuity and complexity b. Education and training of the nurses c. Technology available and use on the unit d. All factors listed are to be considered
d. All factors listed are to be considered
What patients would most likely be covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health
d. Dan, who is 68 years of age and in good health The Medicare program is not limited to individuals age 65 years or older. Persons with certain permanent illnesses
You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level
d. Fifth level Consolidated systems tend to be organized along five levels. The first level includes the large national hospital companies, most of which are investor owned. The second level involves large voluntary affiliated systems, which provide members with access to capital, political power, management expertise, joint venture opportunities, and links to health insurance services or, as in Canada, to a national healthcare coverage program. The third level involves regional hospital systems that cover a defined geographic area, such as an area of a state. The fourth level involves metropolitan-based systems. The fifth level is composed of the special interest groups that own and operate units organized along religious lines, teaching interests, or related special interests that drive their activities. This level often crosses over the regional, metropolitan, and national levels already described
What is the best example of skilled negotiation? a. Linda, the manager on pediatrics, takes a proposal to her supervisor, outlining the benefits of a walk-in preoperative area for children. b. Kim, RN, asks for leave to pursue a semester of full-time study in her graduate program. She proposes to accept less popular rotations during peak vacation time, in return. c. George, the head nurse in ER, asks for additional staff for his department and points out the benefits of being able to keep patients for longer periods. d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process.
d. Jerry speaks with his supervisor about his supervisor's concerns related to bedside reporting before presenting a proposal to change this process. Six persuasion techniques in negotiation: -Authority: Use an expert in the field, or an authoritative source of data ; e.g. "according to NASA", ..... -Reciprocity: To satisfy each party's needs (paying favor back) e.g. "I understand your position is not easy to fulfill everyone's needs." -Consensus: following a group of people. i.e. "Most of classmates use Kaplan" -Liking: Similar interests e.g. Physical & Sexual attraction to use -Consistency: small commitment target contribution e.g. sign petition to help the homeless food drive for them -Scarcity: related time & resources
What interaction is MOST consistent with the idea of networking? a. Meet with the same colleagues daily to have coffee and share concerns about the workplace and stories about colleagues. b. Join an online workplace forum to gain ideas about how to handle workplace conflict. c. Suggest that you and a new team member meet after work for coffee to review unit guidelines. d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.
d. Join a nurse executive interest group to meet other executives for support and for sharing ideas of expertise.
What is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.
d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.
Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. What is this position considered? a. Hierarchical position b. Ancillary c. Line position d. Staff position
d. Staff position
As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, what would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.
d. The facility is an older house that is more than 30 minutes away from the acute care center.
Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. direct responsibility for patient care. b. direct accountability for patient outcomes. c. an authority relationship to staff. d. an influence over patient outcomes.
d. an influence over patient outcomes.
As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: a. cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. b. plan for the smooth transition of patients from the emergency services department to other units in the hospital. c. ensure that funding follows the patient from acute care to long-term care services. d. bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.
d. bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer. Vertical integration Integration between organizations providing different services
A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. bureaucratic. b. decentralized. c. delegated authority and responsibility. d. delegated responsibility but no authority.
d. delegated responsibility but no authority.
A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is: a. organizational staffing policies. b. staffing models. c. changes in services that will be offered. d. department of Health licensing standards.
d. department of Health licensing standards.
The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to: a. anticipate total costs for patient care. b. know how much time staff will likely be unavailable because of illness. c. determine when orientation needs to occur for new staff. d. determine the number of hours available for patient care.
d. determine the number of hours available for patient care.
When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's: a. lack of confidence. b. professional behavior. c. cultural sensitivity. d. ethnicity.
d. ethnicity
The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months in order to modify practice is an example of: a. information. b. cost-effective care. c. meeting standards. d. evidence-based practice.
d. evidence-based practice.
The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a: a. day-to-day plan for operations. b. unit of service. c. statement of revenues and services. d. financial plan.
d. financial plan.
The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. cannot accept mental health patients who are Medicare beneficiaries. b. can care for only Medicaid and not Medicare beneficiaries. c. has not met the standards set by the CMS as determined by an external review panel. d. has been reviewed and accredited by the AOA, which is a deeming authority for CMS.
d. has been reviewed and accredited by the AOA, which is a deeming authority for CMS. Acute care healthcare organizations commonly seek accreditation by the American Osteopathic Association (AOA), TJC, or Det Norske Veritas Germanischer Lloyd Healthcare, Inc. (DNV GL Healthcare). These organizations have been granted deeming authority by CMS
When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. registered nurse with a master's degree. b. physiotherapist with a background in stroke rehabilitation. c. social worker with a background in counseling. d. health professional with advanced background who is client and outcome focused.
d. health professional with advanced background who is client and outcome focused.
The nurse manager is comparing functional nursing and primary nursing for potential adoption. The nurse manager determines that patient and nurse satisfaction in primary nursing are: a. similar to those in functional nursing. b. not of significance in either model. c. low by comparison with functional nursing. d. high when compared with functional nursing.
d. high when compared with functional nursing.
As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he: a. is sensitive to your culture?" b. wants to learn more about you?" c. has been hurt and wants to hurt others?" d. is stereotyping you without thinking?"
d. is stereotyping you without thinking?" a widely held but fixed and oversimplified image or idea of a particular type of person or thing
As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that: a. human error is significant in contributing to adverse events. b. documentation of patient data is often illegible and therefore, misinterpreted. c. data systems provide backup documentation with adverse events that staff cannot provide. d. physiologic monitoring systems enable detection of early changes before an adverse event occurs.
d. physiologic monitoring systems enable detection of early changes before an adverse event occurs. Data about adverse events in hospitalized patients indicate that a majority of physiologic abnormalities are not detected early enough to prevent the event, even when some of the abnormalities are present for hours before the event occurs (Scott, Considine, & Botti, 2015). Patient surveillance systems are designed to provide early warning of a possible impending adverse event.
The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization for this patient is to: a. implement the care pathway on admission. b. provide direct nursing care throughout the hospitalization. c. supervise the nursing staff members who implement the care map. d. prevent additional hospitalizations resulting from complications of the client's disease.
d. prevent additional hospitalizations resulting from complications of the client's disease. when acute care hospitals began to be reimbursed based on a certain diagnosis, nursing case management became a popular and effective method to manage shortened lengths of stay for patients while achieving desired patient outcomes and to prevent expensive hospital readmissions
A necessary, basic condition for successful integration of clinical information systems is: a. software. b. standard medical nomenclature. c. confirmatory evidence from nursing-led studies. d. strong interdisciplinary cultures.
d. strong interdisciplinary cultures. Working with integrated clinical information systems demands interdisciplinary collaboration at a high level.
Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: a. seek budgetary approval. b. balance personal schedules against institutional needs. c. negotiate the schedule with unit staff. d. submit the schedule to a staffing office for review.
d. submit the schedule to a staffing office for review.
Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. stereotyping. b. cultural diversity. c. ethnocentricity. d. transcultural care.
d. transcultural care concepts of transcultural care are discussed, we should consider differences in health beliefs and practices not only between and among countries but also between and among, for example, races, ethnic groups, genders, and different economic strata.
