Management Final Exam

Leaders do what?

- Elevate other people - Grow from within - For the people

Managers do what

- Has assigned tasks - Punitive - Organizational goals

TJC original core measures?

- MI - Community acquired PNA - HF - Surgical

According to theories of transformational leader ship, which characteristic would the nurse leader possess?

- empower staff - creating enthusiasm for practice - promoting scholarship of practice at the client side

20. The manager of a busy emergency department is primarily concerned with the practical, day-to-day operations of the department. This manager is most clearly demonstrating what type of leadership? a. Transactional b. Transformational c. Interactional d. Bureaucratic

A

A nurse-manager is focusing on management controlling functions that are associated with quality control. What task best addresses this goal? A. Periodically evaluating the unit mission and philosophy B. Creating the daily client care assignments to distribute workload evenly Contributing to the development of the annual budget Distributing staffing policies related to the choice of vacation time

ANS: A Feedback: Examples of management controlling functions include the periodic evaluation of unit philosophy, mission, goals, and objectives; the measurement of individual and group performance against preestablished standards; and the auditing of patient goals and outcomes. Scheduling and budgeting are less directly related to controlling functions related to quality control.

A client was treated in the hospital for a stroke and was the client's family members assert that the client was discharged too early and did not receive sufficient rehabilitation. The client's early discharge may have been attributable to: A. the effect of diagnosis-related groups. B. a sentinel event. C. the application of total quality management. D. deliberate malpractice.

ANS: A Feedback: As a result of DRGs, hospitals became part of the prospective payment system (PPS), whereby providers are paid a fixed amount per patient admission regardless of the actual cost to provide the care. This system has been criticized as promoting abbreviated hospital stays. Early discharge would most likely be incompatible with the principles of TQM. Deliberate malpractice would be highly unlikely. The client's early discharge would only be considered to a sentinel event if it were an overt error.

A nurse-manager is orienting a new graduate nurse to the unit and has found this individual's charting regarding assessment to be inadequate. What is the most appropriate statement to initiate a discussion with the new RN? A. "I'm concerned that your assessment charting seems to be unclear. Can I help you with this?" B. "Unfortunately, your charting is inadequate in every way." C. "Do you think a refresher course in charting would help you?" D. "Are you having difficulty assessing your client?"

ANS: A Feedback: Assertive communication is not rude or insensitive, nor is it passive-aggressive. Backing up the communication to focus on the RN's intention is respectful and solution-oriented. The manager should not presume that the nurse is having difficulty with assessment unless there is evidence of this. The manager should avoid accusatory descriptors such as "inadequate in every way." Suggesting remediation would likely be premature before trying to work collaboratively with the nurse.

Which action is associated with the nursing leadership role in quality improvement? A. Inspiring staff to establish and maintain high standards regarding patient care B. Being aware of the changes in quality control regulations C. Reviewing research results upon which to base changes D. Identifying outcomes that support quality nursing care

ANS: A Feedback: Inspiring subordinates to establish and achieve high standards of care is a leadership skill. The remaining options are management roles.

A nurse is considering applying for employment at a new health-care facility. How should the nurse best identify the aims and priorities of the organization? A. Review the organization's mission statement. B. Speak with as many front-line workers as possible. C. Ask interviewers about recent responses to consumer satisfaction surveys. D. Review the organization's policy and procedures documents.

ANS: A Feedback: The purpose or mission statement is a brief statement identifying the reason that an organization exists. The mission statement identifies the organization's position regarding ethics, principles, and standards of practice. The nurse should be able to infer the organization's aims and priorities from this statement. Consumer feedback will not necessarily reveal the organization's aims and priorities. Similarly, workers are often unable to identify these priorities. Policies and procedures identify the preferred ways of completing tasks but not the organization's aims and priorities.

Which nurse could face discipline for committing an intentional tort? Select all that apply. a. A nurse who slapped a client when the client became verbally abusive b. A nurse who applied restraints to a client as a punitive measure c. A nurse who increased a client's analgesia dosage without a prescription d. A nurse who neglected to supervise a client, leading to a fall e. A nurse who threatened an elderly client when the client did not participate in care

ANS: A, B, E

A nurse is preparing for a job interview. The nurse should prepare responses to what types of interview questions because they are difficult to respond to without advance thought? Select all that apply. A. Personal philosophy of nursing B. Professional organizations membership C. Individual strengths and weaknesses D. Career goals E. Days and times of availability

ANS: A, C, D Feedback: It is difficult to spontaneously answer interview questions about a personal philosophy of nursing, individual strengths and weaknesses, and career goals without giving them advance thought. Question about availability and professional organizations are less open-ended and likely require less forethought and preparation.

6. High-achieving nursing students were found to have studied in small groups, attended class 100% of the time, took frequent rest breaks during study sessions, and ate a balanced diet for 1 week before the examination. What type of audit provided data about the students' preparation? a. Structure b. Process c. Outcome d. Concurrent

ANS: B Feedback: A process audit assumes that a relationship exists between the process used and the quality of the result. The details of the students' preparation are not an outcome or a structure. These data are retrospective and not concurrent.

An experienced nurse-manager describes a recently hired nurse as "very promising." The manager can best promote this nurse's career development by: A. asking other nurses to model their behavior on the new nurse's behavior. B. providing the nurse with increasingly challenging work assignments. C. removing the nurse from client care responsibilities and assigning management tasks. D. providing the nurse with positive feedback.

ANS: B Feedback: Providing challenging assignments is one way that the nurse's skills and knowledge can be enhanced, benefiting career development. Identifying the recent hire as a role model may place undue stress on the nurse and may create resentment from other nurses who have more experience. Giving the nurse positive feedback may validate the nurse's performance but will not necessarily promote career development. Removing the nurse from client care would be premature at this early stage.

A nurse-manager and several colleagues are reviewing the results of the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. These results will allow the team to make what assessment? A. The root causes of adverse incidents B. Clients' perspectives on the care they received C. Consumers' health outcomes at 3 and 6 months after discharge D. Clients' health status at admission versus at discharge

ANS: B Feedback: HCAHPS is a publicly reported survey of clients' perspectives of hospital care. These surveys do not address adverse incidents or clients' objective health outcomes.

24. During a quality improvement initiative, the leadership of a health-care organization has worked with senior managers to implement the principles of Lean Manufacturing. This initiative will focus on what factor? A. Identifying sentinel events B. Identifying and preventing waste C. Engaging all staff members D. Performing root cause analysis of errors

ANS: B Feedback: The main focus in Lean Manufacturing is the removal of waste from a value stream. It does not focus on sentinel events, staff engagement, or root cause analysis of errors.

14. The nurse who manages an ambulatory clinic is well known as being a visionary leader who is skilled at empowering others with this vision. What type of leader is this nurse? a. Transactional b. Transformational c. Interactional d. Bureaucratic

ANS: B Feedback: Transformational leadership is characterized by the presence of a vision. Transformational leaders impart this to others, creating a collective purpose. The traditional manager, concerned with the day-to-day operations, was termed a transactional leader. Transactional leaders are not typically known as being visionaries. Bureaucratic leaders are focused on functions and processes, not vision. The basic premise of interactional theory is that leadership behavior is generally determined by the relationship between the leader's personality and the specific situation; vision is not a central focus.

9. Which of the following would be considered sentinel events that should be reported to The Joint Commission? Select all that apply. A. A client with ischemic heart disease dies of a myocardial infarction. B. A client with dementia falls and suffers a hip fracture while trying to walk to the bathroom. C. A client files a formal complaint about the inattention of staff while he was in the hospital. D. A client experiences nephrotoxicity and requires dialysis because of a medication error. E. A client experiences a transfusion reaction after receiving the wrong type of packed red blood cells.

ANS: B, D, E Feedback: Drug errors causing harm, falls causing injury, and blood transfusion reactions are considered sentinel events. Deaths related to an underlying diagnosis and client dissatisfaction are not considered sentinel events.

What type of interview is the best predictor of job performance and overall effectiveness? a. Unstructured b. Semistructured c. Structured. d. Informal

ANS: C Feedback: As a predictor of job performance and overall effectiveness, the structured interview is much more reliable than the unstructured, semistructured, or informal interviews.

9. The RN overhears the nurses' aide speaking in a harsh tone to a client with early Alzheimer's memory loss. Which statement should the RN make to begin addressing this issue? A. "You must remember to watch your tone of voice with clients. Someone might overhear." B. "Do you think it would be a good idea to have an in-service on dealing with Alzheimer's patients?" C. "I am concerned about your conversation with the client. It sounded short and impatient." D. "I have decided to reassign that client to another aide."

ANS: C Feedback: Assertive communication effectively identifies and addresses an issue without being rude, insensitive, or passive-aggressive. None of the remaining options actually identifies the specific communication problem.

4. What task will best allow a health-care organization to benchmark its performance? A. Comparing its performance on key indicators to its performance the previous year B. Setting ambitious but realistic goals for the coming year C. Comparing the organization's performance with that of best performing institutions D. Seeking input from clients and families about the organization's performance

ANS: C Feedback: In benchmarking, an organization compares its performance with that of best performing institutions. Benchmarking is not achieved by comparing with the previous year's performance. Seeking input from clients and setting useful goals are valid components of quality improvement and quality control, but these actions are not part of benchmarking.

A nurse-manager is helping a newly graduated RN adjust to the professional nursing role. What is the manager's most appropriate action? A. Advise the new RN to avoid confrontations with health-care providers whenever possible. B. Advise the new RN that the "real world" of nursing is fundamentally different from the one described in textbooks. C. Be alert to signs and symptoms of the shock phase of the nurse's role transition. D. Be alert to signs that the new RN has not shed nursing school values.

ANS: C Feedback: Managers should be alert to signs and symptoms of the shock phase of role transition. Managers should also ensure that some of the new nurse's values are supported and encouraged so that work and academic values can blend, rather than being rejected. The nurse should learn to manage conflict appropriately, not avoid it at all costs.

13. The nurse-manager is working in a facility where two of the organizational goals are to increase physician satisfaction and reduce costs. A unit goal is to increase professional RN staffing. Which statement best supports all the stated goals? A. Increasing the RN staff will cut down on nursing errors, prevent burn out, and decrease the cost associated with staff turnover. B. Increasing the use of unlicensed assistive personnel will result in increased patient safety and quality care, and thus improve physician satisfaction. C. Increasing the RN staff will free more nurses to be available to address doctors' concerns during their rounds and will reduce our costly use of overtime. d. Increasing the RN staff will lead to improved patient education and a reduction in costly patient stays.

ANS: C Feedback: Politically wise requests should always be made using the goals of the organization; therefore, stating that increasing the staff would meet the organization's goals is most appropriate. This option meets the organizational goals and the unit goal. None of the other listed options addresses each of these goals. Increased use of UAPs is unlikely to increase safety.

What is the best course of action to stimulate broad participation of employees in quality control efforts? A. Encourage regular meetings between middle management and upper management. B. Educate staff about the relationship between the organization's accreditation and their own licensure. C. Engage closely with the frontline staff who provide client care. D. Educate staff about the correct way to document and report sentinel events.

ANS: C Feedback: Staff should be involved in determining criteria or standards, reviewing standards, and collecting data. To encourage broad participation, it is vital for managers and leaders to engage closely with the frontline staff. This affects more employees than meetings between upper and middle management. In general, an organization's accreditation (or lack thereof) does not affect a nurse's ability to maintain licensure. Responses to sentinel events are important but do not promote the wider practice of participating in quality control and improvement.

10. Which is a true statement regarding TQM? It is based on the premise that the organization knows what is best for the consumer. Its guiding purpose is to save the organization money. It recognizes that the customer is the focal element on which production and service depend. It assumes that inspection and removal of errors lead to the delivery of quality services.

ANS: C Feedback: TQM is based on the premise that the customer is the focal element on which production and service depend and that the customer knows best. The primary focus is on quality and not cost. The avoidance of errors does not necessarily guarantee high quality.

A novice nurse-manager is a member of a team that will oversee quality control in a health-care organization. What action should the nurse and the other members off the team perform first? A. Take corrective action to address standards that are known to be challenging. B. Collect the essential data that will give a general overview of performance data. C. Determine the specific criteria and standards by which quality will be measured. D. Assign tasks between the team members to address identified standards.Ma

ANS: C Feedback: The first step in quality control is to determine criteria and standards. Measuring performance, assigning tasks, or making corrections is impossible if standards have not been clearly established.

29. One year ago, a hospital implemented a 6-month internship program for new hires who are recent graduates. When evaluating the success of this transition to practice program, what piece of data should leaders and managers prioritize? A. Rates of absenteeism in participants compared with more experienced staff B. The incidence of sentinel events (safety violations) in periods before and after the program C. Retention rates among participants of the program compared with nonparticipants D. Response rates to the personnel department's recruitment campaigns

ANS: C Feedback: Transition-to-practice (TTP) programs can improve outcomes for new nurses in their first year of practice and increase their retention. This is one of the ultimate goals of TTP programs, so data related to absenteeism, safety violations and recruitment would be secondary, even though these data are relevant.

What role has The Joint Commission assumed in ensuring quality at the organizational level? A. Establishing clinical practice guidelines B. Reducing diagnosis-related group reimbursement levels C. Standardizing clinical outcome data collection D. Assessing monetary fines for organizations that fail to meet standards

ANS: C Feedback: Under ORYX, The Joint Commission ensures quality at the organizational level by requiring participating organizations to choose from among 60 acceptable performance measurement systems. The Joint Commission is not actively involved in any of the other options.

A health-care organization has adopted a new philosophy statement. What observation best shows that the philosophy is being implemented? A. The philosophy is displayed prominently in client care areas and staff areas. B. The philosophy aligns with the organization's vision and mission. C. The philosophy is reflected in the care that clients and families receive. D. The philosophy was created by an interdisciplinary group that included nurses.

ANS: C Feedback: A philosophy is being implemented if it is evident in the care that clients and families receive. Displaying the philosophy prominently, aligning it with vision and mission, and collaboratively creating the philosophy do not guarantee that the philosophy is actually being implemented.

5. Thirty-eight percent of the people who attended a smoking cessation clinic were not smoking 1 year after completing treatment. What type of audit provided this type of data? a. Structure b. Process c. Outcomed. d. Concurrent

ANS: C Feedback: An outcome audit determines what outcomes resulted from specific nursing interventions for clients. In a smoking cessation program, abstinence from tobacco would be desired outcome. This does not meet the criteria for a structure, process, or concurrent outcome.

A nurse-manager has a reputation as being an assertive communicator. How does this manager most likely communicate? A. Through confrontation and intimidation B. In an unfeminine way that is clear and direct C. Directly and honestly, while respecting the rights of others D. In a clear, but occasionally offensive, manner

ANS: C Feedback: Assertive communication allows people to express themselves in direct, honest, and appropriate ways that do not infringe on another's rights. It is a myth that assertiveness is "unfeminine," offensive, or confrontational.

11. What action should the nurse-manager and other leaders in the health-care organization perform in order to ensure that a quality control program will be effective? A. Set a goal of meeting federal and state standards. B. Set quality control standards at minimum acceptable levels so the organization will score well on self-assessment audits. C.Integrate quality control through all levels of the organizational hierarchy. D. Focus quality improvement efforts on reacting to problems that have been identified.

ANS: C Feedback: For any quality control program to be effective, a belief in the importance of quality control must be integrated through all levels of the organizational hierarchy. A proactive approach should be sought rather than just a reactive approach. Meeting minimum standards (whether imposed or self-identified) will not guarantee high levels of quality.

A nurse-manager is participating in a hospital's quality control efforts and is collating data sources. What data source should the manager identify as a qualitative source? A. The hospital's rate of nosocomial infections B. The hospital's readmission rate C. Results of interviews with discharged clients D. The previous year's budget for continuing education initiatives

ANS: C Feedback: Infection rates, spending, and readmission rates are all quantifiable. Interview data, however, is qualitative in nature.

As part of a quality improvement initiative, administrators are conducting outcomes analysis and have included nursing-sensitive outcome measures. These outcome measures will: A. highlight the aspects of nursing that are contentious or controversial. B. cause the quality improvement process to prioritize nurses over other providers. C. separate out the unique contributions that nurses make to client outcomes. D. require other members of the health-care team to rate nurses' contributions.

ANS: C Feedback: There is growing recognition that it is possible to separate the contribution of nursing to the patient's outcome; this recognition of outcomes that are nursing-sensitive creates accountability for nurses as professionals and is important in developing nursing as a profession. This does not focus on controversial issues or prioritize nursing interests over others in the overall quality improvement process. This does not require other providers to "rate" nurses.

A manager is careful to address nonverbal aspects of communication when communicating with employees. What practices should the manager adopt? Select all that apply. A. Have communications in public places as much as possible to reduce intimidation. B. Stand between 12 and 18 inches from an employee when having an important conversation. C. Be thoughtful about aspects of appearance that can be controlled by the manager. D. Avoid crossing arms across the chest. E. Limit eye contact with employees to avoid being perceived as aggressive.

ANS: C, D Feedback: The manager should take care on aspects of appearance and should avoid crossed arms, which communicate defensiveness or aggression. There are many communications that are inappropriate to have in a public place and space of 12 to 18 inches is considered unusually close. Even though some individuals and cultures perceive eye contract as provocative or aggressive, it is still valued in most circumstances.

A nurse has recently graduated from nursing school and is transitioning into a nursing career. Which activity is the nurse's personal responsibility for career management? A. Developing career ladders B. Establishing career paths C. Providing challenging assignments D. Developing career goals

ANS: D Feedback: Only the development of a career plan is the responsibility of the individual. The development of career ladders and career paths and the provision of challenging assignments are management responsibilities.

As part of the quality control, managers have set standards for performance and assessed whether these standards are being met. It has been determined that several standards are not being met. What is the priority response to this finding? A. Release the findings to the public to ensure transparency. B. Compare the organization's results to benchmarks. abirb.com/test c. Determine whether similar organizations in the region are experiencing similar results. d. Perform interventions that will correct the deficiencies.

ANS: D Feedback: Applying corrective actions is the essential response to deficiencies revealed in the quality control process. It is not always necessary or appropriate to disseminate these findings publicly. Comparison to benchmarks would take place earlier in the quality control process. Comparison to other similar organizations is not a priority over resolving deficiencies.

An RN is a supervisor in an organization that has total quality management (TQM) as the basis for its organizational goals and objectives for quality control. How should the RN practice TQM on the unit? A. Encourage colleagues to create vision and mission statements. B. Develop a quota system for number of clients cared for. C. Explain to the staff that "if it's not broke, don't fix it." D. Promote teamwork rather than individual accomplishments.

ANS: D Feedback: In TQM, team efforts are favored over individual accomplishments. Quota systems and maintaining the status quo work against quality in this philosophy. It is beneficial for a unit to have a mission and vision statement, but these are not core components of the TQM philosophy.

The nurse-manager recognizes the need to avoid burnout and maintain a high motivation level. The manager can best achieve this by: A. working on as large a variety of projects as possible. B. asking supervisors to keep him or her closely accountable for work performance. C. asking subordinates and superiors to provide positive reinforcement whenever possible. D. reflecting on his or her own needs and seeking help when necessary.

ANS: D Feedback: It is imperative that discouraged managers acknowledge their own feelings and seek assistance accordingly. A manager can easily become burnt out when working on a large variety of projects. It is inappropriate to overtly ask for positive reinforcement, whether from superiors or from subordinates. Accountability can enhance performance but does not prevent burnout.

Which statement best describes the manager's main role in socialization of a new nurse? A. Providing the employee with organizational rules and regulations B. Providing the new employee with a good preceptor C. Ensuring that there are sufficient numbers of good role models D. Sharing organizational values, expected attitudes, and behaviors

ANS: D Feedback: New group members must be socialized into the group, and these socialization efforts should be led and modeled by the manager.

which points about the hospital? Consumer assessment of healthcare providers and systems are correct? A. scores are not affected by nursing environments. B. this is a standardize survey developed to measure client perceptions of their hospital experience C. The survey is administered to a random selected sample of adults who were discharged from the hospital between 48 hours and six weeks ago. D. The survey was developed by the national committee for quality assurance as a way for hospitals to collect and report data. E. surveys have questions that I ask Lyons to write their communication with nurses and physicians, discuss other details about treatment, and share their willingness to recommend the hospital.

B, C, E

What guides policy?

Basic standards of care (there's a set for each specialty), accrediting bodies (HIPAA, EMTALA, CMS, Conditions of Participation, JCAHO), authoritative standards (ANA, AACN (America association of critical care nurses, etc.), state and federal guidelines, evidence-based practice

Advance directives such as health care policy and living will support which ethical printable? a. Veracity b. Advocacy c. Beneficence d. Autonomy

D

In which way are the quality improvement processes important for the nurse leader to execute with a team? A. QU processes involve chart audits b. The process inspects nursing activities C. QI helps discover and correct errors D. The process review the nursing activities

D

QSEN focuses on ____ to do what?

Data Monitor the outcomes of care

You have a staff that likes doing things themselves, what type of leader would they need?

Democratic

What is the history of Quality Improvement

Edward Demmy

Purpose of policies and procedures

Facilitate adherence with recognized professional practices

Phases of reality shock:

Honeymoon Shock Rejection Recovery

Assertive communication includes ___ statements.

I statements. Used with assertive communication which is good.

Goal of six sigma

INCREASE PROFITS

What is a root cause analysis?

Investigating the root cause of why something happened. Find the problem, solve it and prevent it from happening again.

Which type of relationship between the nurse, delegator and delegate, he causes the nurse, delegate her to use the leadership behavior of telling

Limited

Initial quality measures

MI PNA Heart failure Surgical care

What is not true regarding quality management and improvements?

Managers define the quality

Magnet hospitals are _____ focused. What's an example of this happening?

Nurse Going to conferences

Magnet programs focus on what

Personnel policies and programs

Clients who have diagnoses of poly drug abuse are in the working phase of the group therapy. Which strategy is the most beneficial for the nurse facilitator to use?

Providing a balance between support and skillful therapeutic confrontation

Incidence reporting is part of ____ _____ and doesn't go in what?

Quality improvement Pt Charts

Which theory holds that leaders actors change, catalysts and innovators?

Quantum theory

Which situation describes a possible consequence of negligence by the healthcare facility for failing to follow regulation, sat by the joint commission

Receive a condition level deficiency certificate

Which course of action would the nurse take to adhere to the quality and safety education for nurses competency, called evidence base practice when caring for a client who lost both be in an accident

Refer to a Medical textbooks to understand the psychological effects of lost limbs

Relationship age vs industrial age leadership

Relationships: People Industrial: Money and getting things done

What is a quality Improvement method? What is the main goal?

Six Sigma --> Money

Which leadership theory is the nurse leader putting into practice when obtaining feedback from superiors followers and peers?

Style theories

Which leadership theory focuses on the role of liters in relational and contextual terms?

Style theory

Major accrediting body for healthcare facilities

TJC

At the time of admission, a pt gave a history of allergy to PCN that was duly noted in all critical areas of pts record. While givine meds, a nurse accidentally administered PCN. The pt had a severe reaction but recovered. What is the implementation of this nurses action?

The nurse failed to act in a reasonable and prudent fashion and this is liable for malpractice.

Sentinel events are _____ and _____ ______.

Undesirable Largely avoidable

I registered nurse is explaining the quality and safety education for nurses competencies to a nursing student. Which information would the nurse provide about competency, teamwork, and collaboration?

Work effectively within nursing and interprofessional team's by promoting open communication and shared decision making to provide client care

What is satisficing?

choosing a "good enough" alternative because YOU DON'T HAVE TIME TO DO ANYTHING ELSE

Which action would the nurse consider an example of quality improvement by a team of nurses?

identifies the possible reasons for the delays of client admissions into special units

Overlap of medicare and Medicaid?

§ Old people § Home health care § Prescriptions ONLY THING NOT OVERLAPPED IS CARE FOR ALL AGES