Leadership Final

A key advantage that a nurse manager has in terms of delegating is that: a. Team skills can be used more effectively. b. Clients receive less attention because too many staff make it difficult to coordinate care. c. Administration can predict overtime more accurately. d. Nurses report less pressure to perform necessary tasks themselves.

ANS: A

A nurse has several tasks to delegate to an assistive personnel (AP). Which of the following tasks should the nurse ask the AP to perform first? a. Take an arterial blood gas specimen to the laboratory. b. Transport a client to the radiology department for an x-ray. c. Pass fresh water to each client who is not NPO. d. Obtain a routine urine sample from a newly admitted client.

ANS: A

A nurse in a long-term care facility is making assignments for an assistive personnel (AP). The AP is refusing to accept an assignment that is different from what the AP usually gets. Which of the following is an appropriate statement for the nurse to make? a. "I need to talk to you about the unit policies regarding client assignments." b. "I have to let the nurse manager know about this situation." c. "I feel that you are being inconsiderate of the other assistive personnel." d. "You always get your choice of assignment and don't work your fair share."

ANS: A

A nurse in the intensive care unit is caring for a client who has a tracheostomy and is on a ventilator. The client also has an indwelling urinary catheter to gravity drainage and a central venous catheter, and is on a heparin drip for a thrombophlebitis of the left leg. Which of the following specimens can the nurse delegate to assistive personnel (AP) to collect? a. Fecal occult blood b. Blood culture c. Arterial blood gas (ABG) d. Sputum culture

ANS: A

A nurse is notified that a client has filed a complaint about care received on the nursing unit from one of the assistive personnel (AP). The nurse should understand that the delivery of quality care to a specific client is primarily the responsibility of the a. staff member providing care. b. the nurse manager for the unit. c. admitting provider. d. institution where care is provided.

ANS: A

An assistive personnel (AP) comes to work with a new set of highly polished acrylic nails. The nurse takes the AP aside and explains that acrylic nails are not permitted on the health care unit. Which of the following statements should the nurse tell the AP? a. "There is a higher risk of infection associated with acrylic nails." b. "Acrylic nails may contribute to contact dermatitis." c. "Polished acrylic nails have a very unprofessional appearance." d. "Acrylic nails can break and injure the client."

ANS: A

During a fire drill, the nurse manager becomes very assertive and directive in her communications with staff. This type of situational leadership depends on: a. The development level of the followers and the type of behavior of the leader. b. Well-developed followers combined with a strong leader who acts quickly. c. Supportive behavior by the leader and immature followers. d. The leader's ability to evaluate personnel and communicate that evaluation.

ANS: A

During staff development programs, staff nurses verbalize their frustration about their workloads and having to delegate so many tasks to others. One of the main reasons that delegation has emerged as an issue is because of: a. The complexity of client care. b. Earlier discharge practices. c. The amount of paperwork required to complete care. d. The numbers of other disciplines present on a given unit.

ANS: A

You are a member of a team assigned to care for 15 general medical/surgical clients. You have all worked well together in the past in this same type of care. If you are assigned to coordinate this team's work, your best strategy, based on the Hersey and Blanchard model, would be to: a. Provide minimal direction and let them come to you with questions. b. Encourage people to discuss their frustrations in providing this care. c. Ignore them—they've done it before. d. Have a list of tasks to be accomplished and tell each member of the team what he or she must do.

ANS: A

The number of patient days on a 28-bed unit in September is 618. What is the average daily census (ADC)? a. 20.6 b. 30 c. 22 d. 23.5

ANS: A Formula for average daily census is number of patient days divided by the number of days in the time period.

There were 525 patient days accrued in September on a 28-bed unit. There were 100 discharges during this same time period. What is the Average Length of Stay? a. 5 b. 3 c. 6 d. 7

ANS: A Formula for average length of stay is number of patient days divided by number of discharges.

To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Vacation time, holiday time, and sick time. b. Paid hours minus meeting time. c. Paid hours minus worked hours. d. Work time, educational time, and holiday time.

ANS: A Nonproductive hours are hours of benefit time and include vacation, holiday, and personal or sick time.

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. An increase in uncompensated care events. b. Decisions of the government agency. c. An increase in veterans as clients. d. The possibility of violence.

ANS: A Not-for-profit organizations are obliged to provide care for patients regardless of capacity to pay. These organizations provide the majority of uncompensated care in the United States. Nonprofit organizations located in impoverished urban and rural areas are often economically disadvantaged by the amount of uncompensated care they provide. Although some states have charity pools to which all not-for-profit organizations contribute to offset the potential hardships of uncompensated care, when the percentage of uncompensated care in a not-for-profit organization increases, the viability and sustainability of the service may be an issue. Not for profit organizations are controlled by voluntary boards or trustees to provide care to a mix of paying and charity patients.

The nurse manager on a skilled nursing unit notices that the number of patient falls in his unit has escalated over the past year, resulting in a fall rate that is below the target projected for this unit. The best evidence-based approach to reducing the number of falls is to: a. Increase the number of total nursing hours on the unit. b. Institute a safety restraint policy. c. Purchase side rails that are easy to raise and lower. d. Place patients at risk for falls close to the nursing station.

ANS: A Research supports the idea that patient falls increase when there is insufficient staffing on a unit. While putting patients who are at risk for falls close to the nursing station is often appropriate, it is not the most effective strategy. Restraints are a poor nursing strategy for preventing falls, and although side rails may be helpful, they do not stop patients from falling when getting out of bed or in other situations.

A cost-based system consists of: a. The cost of providing a service plus a mark-up for profit. b. A method in which the cost associated with the service is attributed in advance by a third party. c. A method of reimbursement based on outcomes.

ANS: A Response option B describes a prospective payment system defined as a method in which the third-party payer decides in advance what will be paid for a service or episode of care. Response option C describes a pay for performance system that reimburses hospitals and eventually providers based on performance and outcomes and not on the cost associated with providing the care.

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. Professional Nursing Association standards. c. Consumer feedback and expectations. d. State regulations and standards.

ANS: A State licensing standards outline what a nurse can do. Internal policies determine what a nurse may do in a particular setting as well as the amount of flexibility that is allowed to manage times of high and low volumes, as well as changes in acuity. Organizational policies can put the nurse manager in a situation where patient safety cannot be maintained or financial obligations met.

Regulations in most states require that the number of patients a nurse should care for in a particular setting should be determined by a staffing plan developed by registered nurses, some of whom are direct patient caregivers. The rationale for this approach is: (Select all that apply.) a. Multiple factors, such as patient acuity and nurse experience, influence the time required to adequately care for the patient. This requires nursing judgment to determine the standard. b. Having nurses who provide direct care involved in developing a staffing plan will prevent cost from being the major influence on determining the number of staff required on a unit. c. Mandated staffing ratios may prevent an adequate staffing pattern in some circumstances, when unusual resources are required for a particular patient. d. Decisions by staffing committees made up of registered nurses are more likely to be accepted by the nursing staff.

ANS: A, B, C, D

Healthcare organizations that wish to develop a comprehensive workplace violence prevention program should do which of the following? (Select all that apply.) a. Commit to a zero tolerance policy for workplace violence and ensure that managers, supervisors, co-workers, clients, patients, and visitors know about this policy. b. Conduct a worksite analysis of risk for workplace violence of both physical and psychological nature. c. Ignore safety concerns identified through reporting of violent incidents. d. Develop a plan for workplace safety, prevention, and control of violence. e. Collect and analyze data and evaluate the effectiveness of the program. f. Provide training for staff on conflict management and de-escalation techniques. g. Address horizontal violence at all levels of the organization. h. Assign responsibility or accountability for a violence prevention program to individuals or teams with inadequate training and skills in workplace violence. i. Withhold adequate resources for this effort from the team responsible for developing workplace violence prevention in health care.

ANS: A, B, D, E, F, G Options A, B, D, E, F, and G are all appropriate steps in developing a comprehensive workplace violence prevention plan. An organization would not ignore safety concerns, would assign responsibility and accountability to adequately trained staff, and would provide resources for those developing a plan.

The nurse on the 3-11 shift is assigning a patient care task to an unlicensed nursing personnel (UNP) employee. The nurse should remain: a. Task oriented and responsible. b. Accountable. c. Responsible. d. Authoritative and liable.

ANS: B

The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. Staff and RN hours per patient. b. Number of RNs and number of RNs with experience on the unit. c. Total number of staff, and implementing 12-hour shifts. d. Total number of staff on the unit.

ANS: B A number of studies have identified that adverse events such as falls and pressure ulcers can be reduced by increasing the number of RNs on a unit (relative to other personnel) and utilizing experienced RNs. Overtime and 12-hour shifts are linked to greater incidence of errors.

In a landmark study regarding nursing staffing, Aiken, Clarke, Cheung, Sloane, and Silber found that: a. BSN-prepared nurses provide safer care than nurses prepared at other educational levels. b. The greater the proportion of BSN-prepared nurses or higher employed by a hospital, the lower the risk-adjusted mortality. c. The greater the proportion of RNs with 5 years' experience or more employed by a hospital, the lower the risk-adjusted mortality. d. There is no difference in the care delivery by RNs regardless of their educational or experience level.

ANS: B Aiken and her colleagues found, using a Pennsylvania nurse survey and patient discharge data from 1999 and 2006, that a 10-point increase in the percentage of nurses holding a baccalaureate degree in nursing within a hospital was associated with an average reduction of 2.12 deaths for every 1000 patients—and for a subset of patients with complications, an average reduction of 7.47 deaths per 1000 patients.

Delegation, a multifaceted decision-making process, is implemented for all of the following reasons EXCEPT to: a. Improve the work performance of staff. b. Decrease the registered nurses' accountability. c. Achieve nursing goals. d. Improve patient care outcomes.

ANS: B Delegation is a multifaceted decision-making process implemented to improve the work performance of staff, improve nursing care, and achieve nursing goals. The registered nurses maintain accountability for delegation decisions.

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. Staffing models. b. Department of Health Licensing standards. c. Changes in services that will be offered. d. Organizational staffing policies.

ANS: B Licensing regulations of the state can determine staffing models. Staffing regulations can dictate the number of professional nurses required on a unit at any given time.

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. A health maintenance organization: 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.

ANS: B Managed care involves prospective pay for care received over a specified length of time or a prepaid payment period rather than a retrospective system that pays physicians for services actually rendered through fee-for-service. Health maintenance organizations are a form of managed care that is administered centrally.

Ms. Viola questioned if her staffing ratios demand the use of high-level delegation strategies. What "delegation right" is she assessing? a. Task b. Circumstances c. Person d. Communication/Direction

ANS: B Ms. Viola is assessing the circumstances (environment) on the unit to determine if she needs to use high-level delegation strategies to provide high-quality patient care.

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. Statement of revenues and services. b. Financial plan. c. Day-to-day plan for operations. d. Unit of service.

ANS: B The budget is an overall financial plan that reflects organizational assumptions, objectives, and standards, and various types of budget planning, including operational and capital budgets, which, in turn, reflect revenues and costs. AONE competency: Business Skills and Principles

When the leader observes the employee has a significant increase in errors and may have some emotional problems, the most appropriate response is: a. Schedule a series of meetings with the employee to support and assist the employee in addressing the problem. Incorrect b. Ask the employee some questions ending with a suggestion that Employee Assistance might be an option. c. Put the employee on the first steps of disciplinary action.

ANS: B The leader is not a psychotherapist and should not attempt to address an employee's possible depression. Most organizations have Employee Assistance as a part of the benefit package. A limited number of visits are at no cost to the employee and could be of great benefit.

A female teen volunteer is assigned to the pediatric unit for the day and reports to the charge nurse for an assignment. Which of the following assignments is unsafe for the volunteer? a. Reading a book to a 4-year-old client who has AIDS b. Playing a computer video game with a 15-year-old male client in skeletal traction c. Helping a 7-year-old client who has celiac disease make out the next day's menu d. Refilling the ice pitchers for clients on the unit for the charge nurse

ANS: C

A nurse in a medical-surgical unit is planning to delegate tasks to an adult volunteer. Which of the following tasks should the charge nurse avoid assigning to the volunteer? a. Assisting a client who has difficulty seeing the foods on the tray while eating b. Delivering meal trays to clients in their rooms c. Observing a postoperative client who is confused d. Delivering a routine urine specimen to the laboratory

ANS: C

A nurse is on a client care team with a practical nurse and a nursing assistant. The nurse has noted that the practical nurse has been taking long breaks and spending time on the phone. In addition, the nursing assistant has complained that the practical nurse delegates an unfair share of tasks, and the next shift has commented that the practical nurse frequently leaves tasks uncompleted. Which of the following statements should the nurse make to attempt to resolve this conflict? a. "Several staff members have commented that you don't do your fair share of the work." b. "If you don't do your share of the work, I will have to inform the nurse manager." c. "I need to talk to you about unit expectations regarding delegating and completing tasks." d. "You have been very inconsiderate of others by not completing your share of the work."

ANS: C

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. Weekend requirements b. Maximum work stretch for each employee c. Trends in acuity on the unit d. Hours of operation of the unit

ANS: C Acuity levels are determined through classification systems, which determine the nursing resources required.

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. Charges b. Prospective reimbursement c. Cost-based reimbursement d. Contractual allowance

ANS: C Because the agency is submitting costs after the campaign is completed and in accordance with an established schedule of allowable costs, a retrospective, cost-based reimbursement payment method is being utilized. If a desire for profit was indicated, then the answer would be "charges."

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 flat rate b. A profit c. A contractual allowance d. Revenue

ANS: C Because the amount that is allowed for an office visit is less than the amount that the NP charges, this is known as a contractual allowance or discount. If the amount allowed was more than what the NP charges, then a profit would be realized. All of the answers represent sources of revenue.

In reviewing staffing patterns on a unit, the nurse manager finds that in the last 2-week pay period, one of the nurses has worked seven 12-hour shifts. Two of these shifts were 7 AM to 7 PM; the remainder were 7 PM to 7 AM. The nurse manager should have an individual discussion with the nurse to: a. Let her know how much her work is appreciated in a time when there is a shortage of staff. b. Ask her to share her work schedule, since other staff may complain about a lack of opportunity to work overtime. c. Review the research regarding the relationship between patient errors and fatigued nurses. d. Put her on "warning" for putting patients' safety at risk.

ANS: C Beginning evidence is emerging that working more than 12 hours and rotating shifts can lead to errors that compromise patient safety.

A newly hired nurse has observed bullying behaviors on her new unit that include gossip, demeaning, criticizing, and intimidation. She also feels other nurses are avoiding her or giving her the silent treatment. The unit manger does little to address these behaviors. The consequences of this toxic culture include all of the following EXCEPT: a. Loss of productivity and potential for high staff turnover b. Potential for patient safety errors that may increase the cost of care c. An increase in teamwork and communication d. Increase in anxiety, low self-esteem, and sleep disorders among the staff

ANS: C Bullying behaviors negatively impact teamwork and communication and can contribute to all of the other issues listed.

The California staffing law requires that a nurse should care for no more than a certain number of patients in specific units at any one time. The correct ratio of patients to unit type is: a. Three patients in the intensive care unit. b. Six or seven patients in a medical-surgical unit. c. Three patients in a labor and delivery unit. d. Ten patients in a psychiatric unit.

ANS: C Correct ratios: Two patients in an intensive care unit Five patients in a medical-surgical unit Four patients in a psychiatric unit

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. Requiring second opinions. b. Providing fewer services to fewer clients. c. Using fewer services per client. d. Using high-technology treatments.

ANS: C In a capitated environment, a single fee is paid for all services provided. To be financially viable under this reimbursement model, organizations would be interested in decreasing the volume of services used and increasing the volume of patients. High-technology treatments and second opinions may increase the number of services used.

In the delegation process, all of the following factors need to be assessed EXCEPT: a. Patient's condition. b. Complexity of the task to be performed. c. Medical insurance of the patient. d. Predictability of outcomes

ANS: C In the delegation process, the three major factors that need to be assessed are the patient's condition, complexity of the task to be performed, and the predictability of outcomes. The patient's medical insurance is not a factor in the delegation process.

How can a leader deal fairly with employees who fail to meet established standards of care? a. First, determine if the employee issue is a will or skill issue. b. Conduct a chart review that reflects the care issue. c. Ask questions of the employee that can reflect the employee's knowledge base.

ANS: C It is appropriate to obtain more information and questions regarding the employee's knowledge base of both the standards of care and the evidence. Policies and procedures help add to this information so that the leader can make the best assessment possible. The leader could also use scenarios.

You are the nurse manager for a busy intensive care unit (ICU). Two patients are awaiting admission to the ICU; one is a 42-year-old bank president admitted through the emergency center with a diagnosis of an acute myocardial infarction, and the other is an elderly woman who experienced a cardiac arrest on the general medical unit. After reviewing the charts of all the patients already in the ICU, you contact the physician about a patient who can safely be discharged to a general medical unit so that two beds will be available for the two people awaiting admission. The ethical principle that you have most closely applied is that of: a. Respect for others b. Beneficence c. Justice d. Fidelity

ANS: C Justice concerns treating people equally and fairly. Both patients awaiting admission to the ICU are equally in need of the medical and nursing care available in this unit. The next best choice is respect for others, transcending culture differences, gender issues, racial concerns, and, in this instance, age differences. Though one of the patients is much younger and seemingly more affluent in the local society, both are deserving of the highest quality care. Beneficence could also be said to be applied in this instance; doing good by assuring that both patients are admitted to the unit. Fidelity is the least applicable principle in this instance as it pertains to keeping one promises and commitments and, given the facts of the scenario, there is no indication of any promise being made to either of the patients to be admitted.

When entering the postoperative care unit, the nurse manager notices that the temporary agency nurse has incorrectly entered the rate of infusion for the patient's vasopressor medication and that the arterial line is indicating a blood pressure of 76/40. Discontinuing the intravenous infusion, the nurse manager's next most appropriate action is to determine which of the following? a. The nurse in charge of the unit b. If there is an assigned resource nurse to serve as mentor for the temporary nurse c. If there are standing orders for interventions for hypotension d. If the temporary nurse has had an orientation to the unit

ANS: C Patient safety is always the first concern, and attention must first center on ensuring the patient's welfare. To prevent such an occurrence in the future, the nurse manager should next determine who is in charge of the unit. Questions to ask the charge nurse include asking about the temporary nurse's qualifications and experiences caring for critical postoperative patients, if a resource nurse was assigned to the temporary nurse so that the temporary nurse had a mentor and could ask questions if needed. Finally, the nurse manager should ask about the orientation to the unit and whether the temporary nurse was informed about the types of intravenous pumps used in this facility, how to set the appropriate drip rate, and the necessary monitoring of patients who are receiving vasopressor agents.

Which of the following is the most appropriate assignment involving asking a nurse to "float" to another unit? a. A nurse 9 months post licensure working on an orthopedic unit is asked to float to a cardiac step-down unit. b. An experienced psych nurse is asked to work on a palliative care unit. c. A nurse who has worked in the CCU for 2 years is asked to work on a cardiac step-down unit. d. An experienced nurse working on a medical-surgical unit is asked to work in a medical-surgical ICU.

ANS: C The nurse who has worked in the CCU will have had the necessary competencies validated for this assignment.

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

ANS: C The operating budget includes a personnel budget, which takes into account productive and nonproductive paid work hours. Education hours are covered under nonproductive paid work hours in the operating budget. REF: AONE competency: Business Skills and Principles

A nurse overhears two assistive personnel (AP) discussing a hospitalized client while in the cafeteria. Which of the following is the most appropriate nursing action? a. Sit at the APs' table and change the subject. b. Report the incident to the nurse manager. c. After lunch, discreetly remind the APs about client confidentiality. d. Quietly tell the APs that this is not appropriate.

ANS: D

Sally is an experienced nurse on the unit and is very experienced with ICP monitoring. She is assigned David, a patient who has been admitted with a severe head injury. In communicating with Sally, you would: a. Tell her when she needs to provide an update about David's status. b. Provide a detailed explanation of what she needs to do with ICP monitoring. c. Ask her to tell you what she knows about ICP monitoring and share expectations about reporting. d. Advise her that you are available if she needs you.

ANS: D

The nurse has received her assignment for the day and notices that her peer has a much lighter assignment in both number and acuity of patients. This is not the first time the nurse has noticed this inequity in assignments. She also has seen her peer and the charge nurse go to lunch together and knows that they spend time outside of work socializing. The nurse feels that this constant inequity in assignment is not fair. What is the best course of action for the nurse to address this problem? a. Avoid the issue and say nothing but remain angry about the situation. b. Confront the charge nurse about the inequity in the assignment. c. Approach the peer and ask to switch assignments. d. Share concerns with the charge nurse and find a mutually acceptable compromise for the situation.

ANS: D Avoiding the situation creates feelings of powerlessness and frustration that can lead to the nurse feeling that she may not want to work in this environment, or may cause lack of focus that could result in patient safety concerns. Confrontation creates a power struggle and may escalate bad feelings for both parties. It may also affect the ongoing relationship between the charge nurse and the bedside nurse. Attempting to switch assignments without the charge nurse's involvement is unacceptable. The best solution to the problem is to initiate a dialogue with the charge nurse. This may shed light on the rationale behind the assignment and allows the charge nurse to acknowledge the nurse's concerns and negotiate an acceptable solution. It also allows the charge nurse to work on developing a better team environment.

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. Medication Costs b. Fixed Costs c. Supplies d. Staffing

ANS: D Because staffing constitutes the largest portion of any healthcare budget, managing the mix and numbers of staff required for patient care to meet identified outcomes will have the largest impact on budgets.

The ability to transfer selected nursing activities in a given situation to a competent individual is known as: a. Supervision. b. Accountability. c. Responsibility. d. Legal authority.

ANS: D Legal authority is the ability to transfer selected nursing activities in a given situation to a competent individual. Responsibility is the reliability, dependability, and obligation to accomplish work. Accountability determines if the actions taken were appropriate and provides a detailed explanation of what occurred. Supervision is the oversight of delegated work.

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. Have no paid employees. b. Pay no taxes. c. Pay dividends to stockholders. d. Have funds that are redirected to the organization for maintenance and growth.

ANS: D Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders.

An incident report of the incident described in Question 31 needs to be completed. The most appropriate wording to be included in the incident report is: a. Patient was noted to have a low arterial blood pressure (76/40) and the vasopressor medication was discontinued. b. Patient's vasopressor medication was infusing at a higher rate than ordered and the medication was discontinued when the patient's blood pressure dropped to 76/40. c. Nurse MJ started the vasopressor medication; the patient subsequently was noted to have a blood pressure reading of 76/40, the medication was discontinued, and the physician notified. d. Patient receiving vasopressor medication intravenously; blood pressure fell to 76/40 and intravenous infusion discontinued; physician notified and the patient given 500 mL of IV fluid over 15 minutes.

ANS: D The most complete incident report note is Option D because it states what was happening, why an intervention was needed, and the follow-up care for the patient. Option A is also correct but is less desirable as there is no mention of what follow-up measures were done to ensure the patient's welfare. Options B and C are incorrect; there should never be a mention or indication, however slight, of liability in the incident report, as it could later be used in a court of law to show liability against the healthcare providers and the institution.

Upon entering a patient's room, the Emergency Department nurse observes a visitor attempting to choke the patient. The visitor appears agitated and is screaming at the patient. The patient is gasping and looks cyanotic. What should the nurse do first? a. Attempt to remove the visitor from the room. b. Attempt to reason with the visitor and calm him or her down. c. Assess the patient for injuries. d. Call security for help.

ANS: D The nurse should not attempt to intervene in this situation with a clearly agitated and aggressive visitor. In this situation, the safety of the nurse is the primary concern. Assistance is needed to first control the situation, remove the aggressor, and then assess the patient and provide appropriate care.

A negative variance is the difference between the projected budget and the actual performance for a particular account. A nurse manager, after reviewing her monthly budget report, sees that she has a negative variance. From the following choices, select the reason for a negative variance. a. Not replacing staff who called in sick. b. Net revenue exceeding net expenses. c. Overestimation of inflation. d. Higher than expected client acuity.

ANS: D Variance reflects the difference between what was projected (including inflationary costs) and the actual performance in a budget. When the variance is negative or unfavorable, the amount spent is more than what was budgeted (expenses exceed revenue); this may be a result of higher acuity as opposed to overestimation of inflation (which would have resulted in a higher initial cost projection and might have resulted in a positive variance). A positive or negative variance cannot be interpreted as good or bad without further investigation. For example, if fewer supplies were used than were budgeted, this would appear as a positive variance and the unit would save money. This would be good news if it means , supplies were used efficiently and patient outcomes remained the same or improved. A problem might be, if using fewer or less-expensive supplies led to poorer patient outcomes.

Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contribution(s) by the nursing staff: a. Knowledge of patient goals, expected outcomes, and anticipated discharge date b. A comprehensive assessment of the patient and family c. Appropriate and timely interventions when the patient is not progressing as expected d. Ongoing patient and family education regarding discharge planning as well as identifying barriers to discharge e. All of the above

ANS: E Case management has become a very important role for all acute care organizations. Nurses must partner with case managers in reaching organizational goals. The ideal partnership includes the following contributions by the nursing staff: Knowledge of patient goals, expected outcomes, and anticipated discharge date; comprehensive assessment of the patient and family; appropriate and timely interventions when the patient is not progressing as expected; appropriate management of pain, activity, skin integrity, bowel and bladder integrity, and cognition; ongoing patient and family education regarding discharge planning and reducing the risk of readmission; and identifying barriers to discharge.

Healthcare prices are set using the same economic equilibrium found in all major industries. a. True b. False

ANS: False Prices in health care are not set by the same economic equilibrium found in all major industries. For the most part, healthcare pricing is highly influenced by the government and the reimbursement plans. For example, both Medicare and Medicaid impose pricing on hospitals and there is no room for negotiation.

The nurse manager responsible for two units has one vacancy on each unit for one shift. Unit A is a well-functioning unit, although the acuity level of half of the patients is very high. Unit B has a lesser acuity but a less experienced staff. There are two nurses in the PRN pool who are available to work. The first nurse is 6 months from graduation with a BSN; the second RN holds an ADN, is currently in an RN to MSN program, and has 10 years experience as an ER nurse. Which nurse should be assigned to unit A. a. The first nurse b. The second nurse

ANS: The first nurse Although Unit A has a high acuity level, the unit functions very well and can provide effective support for the inexperienced registered nurse.