MOC-Final

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A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? a. Increase the oxygen concentration and recheck the saturation after 10 minutes. b. Obtain a 12-lead ECG. c. Notify the health care provider

. Increase the oxygen concentration and recheck the saturation after 10 minutes.

Which of the following is a policy that pertains to the decisions that promote the welfare of the public? a. Social b. Health c. Organizational d. Public

. Social

A basis for ethical dilemma can result from a request for organ donation. Which factor may contribute to this conflict? a. The patient is ventilator dependent. b. The patient has signed her driver's license giving consent. c. The patient has not previously expressed her wishes on organ donation. d. The patient's religion is unclear about organ donations

. c. The patient has not previously expressed her wishes on organ donation.

Autonomy is an ethical principle that can be applied to which clinical situation? a. A nurse acts as a whistleblower in reporting unsafe practices observed on a clinical area. b. A nurse administers an IV morphine drip for a patient being terminally weaned. c. A nurse adheres to the HIPAA law when asked to reveal information on a patient to a nurse's family member. d. A nurse permits a patient to refuse a medication.

. d. A nurse permits a patient to refuse a medication.

A nurse is working the night shift with another RN who keeps disappearing without explanation. The nurse is caught napping in a patient's room. What is the best action by the discovery nurse to take? a. Confront the nurse and ask what is wrong. b. Report the behavior to the vice president of nursing. c. Ask to not be scheduled on the same nights again. d. Report the behavior to the nurse manager.

. d. Report the behavior to the nurse manager.

. The Joint Commission standards address an organization's level of performance in key functional areas, such as: A. Patient rights, patient treatment, high-quality care B. Patient rights, patient assessment, pain control C. Infection control, pain control, falls D. Infection control, safe care, injection safety

A _____________is defined as an experienced staff member who possesses excellent clinical skills and facilitates learning through caring, respect, compassion, understanding, nurturing, role-modeling, and the excellent use of interpersonal communication as per Speers, Strzyzewski, and Ziolkowski (2004). A. Preceptor B. Charge nurse C. Supervisor D. Nurse manage

A schematic description of a theory, phenomenon, or system that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest level of care (American Nurses Credentialing Center, 2013) is: A. Professional practice model B. Care delivery system C. Case management model D. Functional system

A(n) ___________________refers to several individuals who work together to accomplish specific time-limited assignments. A. Task group B. Informal group C. Formal group D. Real group

According to Burton (2004) ___________is a formal, guided process for integrating the people, information, and technology of an organization, and serves as a key structural element that allows corporations to maximize value by matching their corporate design to overall strategy. A. Organizational design B. Decision making C. Shared governance D. Accountability

According to the Institute of Medicine's report, The Future of Nursing (2006), there was a call for the development of ____________________________programs to assist in the transition process of the new graduate. A. Residency programs B. Preceptor programs C. Clinical ladder programs D. Peer-review programs

All of the factors can further be adapted to delineate guidelines for leading teams. Which of the following is not an acceptable guideline? A. Do not waste time B. Facilitate thoughtful problem solving based on evidence C. Create a nonthreatening environment D. Plan to meet after the shift to decrease interruptions

Comparison information that allows organizations to evaluate their own performance in relation to others is: A. Benchmark B. Dashboard C. Graph D. Trend

Durskat and Wolf (2001) believe that the major components of smoothly functioning teams must be created. They are listed as: A. Mutual trust among the members B. A strong sense of team identify C. A sense of team efficacy D. All must be present

Duty to do good to others; to maintain a balance between benefits and harm; to provide all patients, including terminally ill, with caring attention; and to treat every patient with respect and courtesy. What is the requirement that care providers contribute to the health and welfare of the patient and not merely attempt to avoid harm to the patient or client? A. Beneficence B. Nonmaleficence C. Personal liability D. Corporate liability

For new graduate nurses, the orientation may: A. Be expanded B. Not be expanded C. Relate specifically to the age of the nurse D. Be given on whatever shift the nurse has been hired for

In the PICO framework for developing the question of concern, "I" stands for: A. Intervention B. Interdisciplinary C. Interrelational D. Integrity

Issues that are commonly addressed by ethics committees are: A. End-of-life issues, organ donation, futility-of-care issues B. End-of-life issues, organ donation, change in the durable power of attorney C. Organ donation, futility-of-care issues, pediatric patient issues D. Organ donation, do not resuscitate order, Jehovah's Witness issues

Leader competencies are a necessary aspect of a leader's role. As a leader, you are aware that the following is needed for this role: A. A clear vision and owned purpose B. A pessimistic attitude with colleagues C. A negative approach with families D. A membership with more than three committees

Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Changes can be made rapidly based on immediate needs. c. Nurses must work under a dual-authority structure. d. Decisions can be made at the ―point of care.‖

Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities? a. A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A staff nurse acts quickly when a cardiac arrest is called on her patient. c. A staff nurse notifies another staff member that she is being ―pulled‖ today. d. A new nurse volunteers to work when another staff member must leave work because her child is ill.

Nurses represent one of the largest workforces in the nation at 3.1 million. It is estimated that only __________% belong to the American Nurses Association. A. 5 B. 10 C. 15 D. 20

Nursing data fall into four domains: A. Patient care, provider staffing, administrative, and research B. Patient care, billing, administrative, and research C. Core values, provider staffing, administrative, and research D. Core values, billing, administrative, and research

Nursing informatics (NI) is a specialty that integrates: A. Nursing science, computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. B. Nursing science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice. C. Nursing science, computer science, and information science to manage and communicate data, information, and knowledge, in nursing practice. D. Computer science, and information science to manage and communicate data, information, knowledge, and wisdom in nursing practice.

One benefit of accreditation by The Joint Commission is that it: A. Leads to improved patient care and demonstrates the organization's commitment to safety and quality B. Allows for increased financial gain through Medicare and Medicaid reimbursement and offers employee assistance programs C. Influences the improved design of care processes, creating a nonpunitive environment to enhance error reporting and allow participation in error reporting and analysis D. Offers an educational off-site survey experience

One driving force for increasing patient satisfaction is: A. Clinical benefits B. Community benefits C. Classification benefits D. Management benefits

One model of quality is FOCUS PDCA (Plan-Do-Check-Act). The U stands for: A. Understand the causes of variance in the process B. Underlying causes for assessment C. Unlikely reason for a variance D. Understand the end result of the process improvement

SBAR stands for: A. Situation, Background, Assessment, Recommendation B. Situation, Background, Assessment, Reaction C. Situation, Background, Assessment, Reply D. Situation, Background, Action, Recommendation

Shared governance is: A. Knowledge based and occurs at the point of care B. Position based and occurs at the point of care C. Knowledge based and there is limited staff input D. Position based with hierarchical communication

The American Nurses Association approved the revised code of ethics in 2015. There are _________codes. A. 9 B. 10 C. 12 D. 20

The American Nurses Credentialing Center (ANCC) (2013, p. 35) states that Magnet nurses "support organizational goals, advance the nursing profession, and enhance professional development by: A. Extending their influence to professional and community groups B. Increasing the number of nurses obtaining ANCC certification C. Increasing the number of BSN nurses in their facilities

The U.S. Department of Health and Human Services (USDHHS) is the most important federal actor in health care. What are some of the other federal agencies with major health services roles? A. Department of Veterans Affairs B. Department of Treasury and Taxation C. Department of Corrections and Law D. Department of Agriculture and Taxation

The core functionalities for an electronic health information system are: A. Health information, data, and order entry B. Patient census, data, and order entry C. Patient acuities, patient census, and incident report D. Incident reports and outcomes measures

The four skill sets needed by good leaders are: A. Self-awareness, self-management, social awareness, and relationship management B. Self-awareness, self-management, social control, and relationship management C. Self-awareness, self-control, social awareness, and relationship management D. Self-awareness, self-management, social awareness, and relationship performance

The part of the orientation process that includes speakers from human resources, infection control, hospital safety and security, and process improvement, is called: A. Hospital-wide orientation B. Unit-specific orientation C. Staff competencies D. Nursing orientation

The process of determining daily staffing incorporates which factor? a. Competency of staff b. Nursing degree of staff c. Acute change in patient acuity d. Emergency department admission

The reorganization of health care systems were developed to: A. Provide for care throughout the various transitions of care B. Change the levels of nursing authority in the institution C. Provide for care in one facility at a time D. Prevent partnerships, which would lead to less income

The vice president of nursing is responsible for: A. Establishing organizational goals and strategic plans for nursing B. Developing and maintaining daily assignments C. Prioritizing events during disaster plan implementation D. Overseeing the mission and vision of the organization

There are four major areas of political action in nursing. They are: A. The workplace, the government, professional organizations, and the community B. The workplace, the educational institutions, professional organizations, and the community C. The government, professional organizations, and the state regulators D. The government, the community, and nursing boards

Two of the common vendor satisfaction measures are: A. Press Ganey and Gallup B. Press Ganey and The Joint Commission C. Gallup and Occupational Safety and Health Administration (OSHA) D. Gallup and National Institute of Occupational Safety and Health (NIOSH)

What agency provides national and world leadership to prevent work-related illnesses and injuries and conducts a range of efforts in the areas of research, guidance, information, and service? A. The Centers for Disease Control and Prevention (CDC) B. National Institute for Occupational Safety and Health (NIOSH) C. The Joint Commission (TJC) D. Centers for Medicare & Medicaid services (CMS

What is one advantage of centralized scheduling? A. Better use of resources B. Lack of cost containment C. Decreased use of resources D. Increase in cost

What is the average number of patients cared for per day for the reporting period referred to as? A. The average daily census B. The average length of stay C. Nursing hours per patient D. Direct care hours

What is the type of scheduling that blends aspects of centralized and decentralized scheduling whereby individual units may manage staffing? A. Mixed B. Centralized C. Decentralized D. Self

What is the type of scheduling whereby the staff commit to work a set number of shift types in a given time frame called? A. Pattern scheduling B. Preference scheduling C. Rules scheduling D. Self-scheduling

When individuals speak for themselves in a way that the other individual hears, the concern is called: A. Confronting B. Collaborating C. Problem solving D. Competing

When working in team situations, which of the following is the most effective tool to use? A. Team STEPPS (team strategies and tools to enhance performance and patient safety) B. STEP (status of the patient, team members, environment, progress toward goal) C. Huddle D. Situation monitoring

Which ANA Principles for Nurse Staffing standards are applied to patient care? a. Staffing levels that must be sufficient for providing quality patient care b. Mandated staffing ratios c. Recommended a new method for determining staffing needs d. Staffing based on patient census

Which act provides monetary damages in cases of intentional employment discrimination? A. The Civil Rights Act of 1991 B. Title I and Title V Act of 1990 C. Title VII of the Civil Rights Act of 1964 D. The Equal Pay Act (EPA)of 1963

Which authors propose that the nursing care delivery model should consist of five key dimensions, including staffing intensity; skill and nursing education mix; professional scope of practice in six domains of practice (assessment and planning, teaching, communication, supervision, quality of care, and knowledge updating); nursing practice environment; and unit-level capacity for innovation? A. Dubois, D'Amour, Tchouaket, Clarke, Rivard, & Blais (2013) B. O'Connor, Bennett, Crawford, & Korfiatis (2006) C. ANCC (2013) D. Zelauskas & Howes (1992) as cited in ANCC (2013

Which council advances the practice of nursing and fosters the nursing role in patient education through staff and development and evidence-based research initiatives? A. Nursing Staff Development, Education and Research Council B. Nurse executive council C. Advanced practice nurse council D. Nursing informatics and communication council

Which council is concerned with the management of resources as defined in the strategic plan and nursing conceptual framework? A. Nurse Executive Council B. Unit-Based Council C. Nursing quality and patient safety council D. Advanced practice nurse council

Which council provides the opportunity for APNs, with support from the Chief Nursing Officer (CNO) and the Director of Ambulatory Services, to identify areas of improvement and to share best practices within this diverse group of clinicians? A. Advanced Practice Nurse Council B. Nurse Executive Council C. Unit-Based Council D. Nursing Informatics and Communication Council

Which of the following describes an integrated structure? A. Providers agree to accept the risk of caring for a particular patient segment or population for a pre-established fee B. Combines both function and service line C. Arranges services and departments according to function D. The nurse is responsible to the nurse manager and vice president of nursing

Which of the following is a policy that pertains to the decisions that promote the welfare of the public? A. Social B. Health C. Organizational D. Public

Which of the following is an advantage for the nurse to act as preceptor to new nurses? A. It supports the progression in the institution's clinical ladder. B. Higher pay per hour is awarded to precept. C. Enhanced job promotion prospects D. The preceptor decides if the new nurse should stay on or be let go.

Which of the following is not a nursing minimum data set under the service element area? A. Nursing outcomes B. Unique facility or service agency number C. Unique health record number of the patient D. The discharge or termination date

Which of the following is on the list of "do's" regarding the change-of-shift report? A. Provide essential background information about the patient B. Identify the patient's discharge plans C. Share significant information about family friends D. Discuss every routine order for the patient

Which of the following requires knowledge of patient acuity, nursing productivity, nursing competence, organization finance, and health care regulations? A. Health care staffing B. Health care scheduling C. Staff mix D. Self-scheduling

Who is accountable for ensuring that the registered nurse (RN) has access to documented competency information for staff to whom the RN is delegating tasks? A. The organization/agency B. The nurse leader C. The nurse supervisor D. The safety office

Who is responsible for answering to the board of trustees in an institution? A. Chief executive officer (CEO) B. Chief nursing officer (CNO) C. Chief financial officer (CFO) D. Safety officer

Who is the fundamental health care provider to meet the success of emerging patient-centered care delivery models? A. The registered nurse B. The physician C. The physician's assistant D. The nurse practitioner

You are mentoring a new nurse. You know that which of the following is NOT a mentor's responsibility? A. Discuss means to correct chronic tardiness B. Offer criticism on nursing skills C. Perform a nurse's probation period review D. Evaluate the nurse's exact break and lunch time

Your patient is coming into the trauma unit and you are the registered nurse for the patient. Example: Leader: "Airway status?"; Resident: "Airway clear"; Leader: "Breath sounds?"; Resident: "Breath sounds decreased on right." Leader: "Blood pressure?"; Nurse: "BP is 90/40." Which strategy is in use? A. Call-out B. Check-back C. SBAR (situation, background, assessment, recommendation) D. STEPPS

__________________is a health care accreditation agency that integrates the International Organization for Standardization's ISO 9001 quality management system with the Medicare conditions of participation. A. Det Norske Veritas (DNV) B. The Joint Commission (TJC) C. American Osteopathic Association (AOA) D. National Institute for Occupational Safety and Health (NIOSH)

__________________measures the number of patients developing new pressure ulcers during a period in time A. Incidence B. Prevalence C. Benchmarking D. Trending

_____________in nursing is the process by which practicing registered nurses systematically assess, monitor, and make judgments about the quality of nursing care provided by colleagues as measured against professional standards of practice. A. Peer review B. Infection control assessment C. Nurse supervisor evaluation D. Education manager

true electronic health record (EHR) is a complete record of an individual's health-related data. The ____________________is continuing to spearhead the initiative to build a national electronic health care system that would allow patients and their care givers to access their complete health records anytime and anywhere (HealthIT.gov, 2015). A. U.S. Department of Health and Human Services (DHHS) B. American Nurses Association (ANA) C. National Institute for Occupational Safety and Health (NIOSH) D. Centers for Disease Control and Prevention (CDC)

Nurses can be leaders without being managers. Which nursing actions demonstrate leadership? a. Assisting a new nurse with enteral tube feedings b. Counseling a new nurse regarding attendance c. Adjusting assignments after a staff member calls in sick d. Calling a physician for new order clarification

Which measure can be used to avoid ethical dilemmas in the health care setting? a. Advance directive or living will b. religious beliefs of the nurse c. Designation of a durable power of attorney d. Values of the care givers

A. Advance directive or living will

What is a Professional Practice Model (PPM)? a. The conceptual framework and philosophy of nursing at a specific organization b. Practice standards of an organization c. A model of a specific theorist d. Organizational philosophy

A. The conceptual framework and philosophy of nursing at a specific organization

What are some tools available for the nurse manager to use for conflict resolution? (Select all that apply.) a. Prevention b. Negotiation c. Cooperation d. Resentment e. Rejection

ABC

In an escalating situation, the nurse should observe certain rules to protect herself from violence. Which of the following are good rules to keep in mind if one is ever in a violent situation? (Select all that apply.) a. Remove yourself from the situation. b. Speak loudly with authority. c. Call for help. d. Do not allow the person to stand between you and the door. e. Stand in a corner against a wall.

ACD

A new nurse is interested in working a ―weekend option.‖ Which of the following describes this pattern of scheduling? a. Nurse works two 12-hour shifts on the weekend and is paid for either 36 or 40 hours a week. b. Nurse works five shifts a week with alternating weekends. c. Nurse works three shifts a week and alternates weekends. d. Nurse works alternating weekends and alternates shifts.

ANS: A

The Nursing Minimum Data Set (NMDS) is a collection of established uniform standards for collecting data. It includes the North American Nursing Diagnosis Association International (NANDA-I)-approved list of nursing diagnoses as well as other sources of nursing language. What is the advantage of the NMDS to the patient? a. Data can be entered from multiple sources into the patient's record. b. Nurses must be able to speak and understand English. c. Nurses must know all the NANDA diagnoses. d. Patient receives a daily update of charges

ANS: A

As a team leader, the charge nurse would incorporate which of the following into the meetings for greatest team input? a. Promote involvement of all members. b. Carefully use terms for problem solving. c. Coerce all members to participate. d. Use language with which the UAPs are unfamiliar.

ANS: A Involving all members assists in the implementation of changes. The other options are not a guide for leading teams.

Accrediting agencies require that staff demonstrate competency in their jobs. Annual competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the ICU setting as mandated by accrediting agencies? a. ACLS b. Fire safety c. HIPAA d. Infection preventio

ANS: A ACLS demonstration is necessary for anyone working in an ICU. The other skills are evaluated in all mandatory skills evaluations and are not specific to the ICU setting

Active listening typically involves a. active participation and respect for the speaker. b. asking lots of questions. c. judging what is being said. d. agreeing with the speaker.

ANS: A Active listening is allowing the speaker to express herself and the listener to listen with respect and without judgment. The other options are not an attribute of an active listening.

The Joint Commission (TJC) is a voluntary accrediting agency that is nationally recognized for its performance standards. A hospital accredited by the agency will most likely experience which outcome? a. Improved patient outcomes b. Dedicated staff c. Higher salaries d. Loss of practicing physician

ANS: A Adherence to the performance standards set by TJC should lead to better patient outcomes. Options B and C may result from accreditation but there are no data to support this. Option D is incorrect because accreditation should have the opposite effect

What is the disadvantage to the institution in using external agency nurses? a. Cost b. Competency c. Availability d. Staff relationships

ANS: A Agency nurses are very expensive compared with employees. A large percentage of the cost to agencies is the overhead of the agency itself. The other options are incorrect because most agencies have diminished this as a factor affecting patient care or job performance.

Which statement would one expect to hear at a team meeting in which members work cohesively? a. ―Who has ideas about this?‖ b. ―I think we have a solution.‖ c. ―We are running out of time to discuss this today.‖ d. ―We only want to hear positive ideas.‖

ANS: A Asking for solutions to problems is a productive characteristic of team building. The other options are destructive to team building.

A nurse who is interested in developing clinical decision-making skills would look for a unit that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management

ANS: A Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other models do not necessarily promote the development of decision-making skills.

Automated computerized staffing allows for which advantage to the institution? a. Reduces workload of nurse manager b. Provides coverage on weekends c. Uses part-time staff d. Provides coverage for daily changes in acuity of patient

ANS: A Computerized staffing programs relieve the nurse manager of managing scheduling. The other options are not an advantage to the organization.

When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the M (measure) refers to a. the development of a data collection plan. b. determination of the average LOS. c. determination of the average wages. d. determination of the ethnicity of admissions.

ANS: A Data are necessary to determine process improvement. Options B, C, and D are incorrect because although they may individually be among the data collected, they do not by themselves define it.

When leading a team, a high performing leader is seen as which type of leader? a. A problem-solver b. Someone who identifies individual personnel problems c. Someone who identifies the causes of problems d. A problem identifie

ANS: A High performers are defined as problem solvers. The people in the other options are not high performers.

The state regulatory agency may impose a fine on a hospital for which patient safety infraction? a. Inconsistent adherence to isolation protocol b. Medication administration error resulting in no harm to the patient c. Wrong patient sent for chest radiograph d. Repetitive staffing shortage due to staff discontent

ANS: A Hospitals may be cited and fined by the state regulatory agency because of nonadherence to isolation protocol. The other infractions would be managed internally.

The National League of Nursing Accrediting Committee (NLNAC) is an example of an accrediting body for nursing programs. Besides the nursing school, for what other agencies are they responsible to ensure compliance to their standards? a. Hospitals where students provide care to patients b. Medical schools c. Nursing homes in the area d. Other similar hospital settings

ANS: A Hospitals must be in compliance with the standards of the regulating bodies for nursing school programs and will receive a visit when the schools that use those facilities are being accredited. The others are sites that are not visited during the accreditation of nursing schools.

ANS: A In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed.

7. What should the nurse expect when working in a product-line leadership structured environment? a. Coordination of all services within the specialty b. Slow organizational response to environmental changes c. Individual service goals d. Each service area autonomous to the others

ANS: A In product- or service-line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product-line leadership and is an example of leadership without coordination.

What information obtained from hospital data collection can be used for patient improvement? a. Infection rates b. Employee satisfaction c. Best practice d. Overtime costs

ANS: A Infection rates are data that provide information about patient care. Employee satisfaction provides data for staffing purposes. Best practice provides data for research purposes. Overtime costs provide data for administrative purposes.

Core measures identified by The Joint Commission include standard orders regarding care and data collection for a. infection rates. b. community-acquired pneumonia admission rates. c. rates of smokers admitted with acute myocardi

ANS: A Infection rates are required of all institutions by both federal and state health care regulating agencies. The other options are not required by TJC.

When leading a team, a middle performing leader is seen as having which abilities? a. Loyalty to institution b. Acts as role model c. Always positive with fellow nurses d. Safe in all aspects of work

ANS: A Middle performers are typically loyal to the institution and committed to improvement performance. The people in the other options are not middle performers and have performance needs for improvement.

What is the nurse manager's primary role in a new nurse's orientation program? a. Provides feedback b. Acts as a role model c. Orients to unit d. Encourages shift changes

ANS: A Nurse managers provide feedback evaluations at certain intervals. The other options are not the role of the nurse manager

The best determinant of staffing needs is based on which factor? a. Patient acuity b. Productive time c. Nonproductive time d. Nurse/patient ratio

ANS: A Patient acuity is the most influential determination for staffing. The other factors are not the best determinant of staffing needs.

The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies. b. the financial environment of the patient population. c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit.

ANS: A Patient delivery models are instituted based on various elements including clinical decision making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options are not fundamental elements used in the decision-making process for delivery mod

ANS: A Patient delivery models are instituted based on various elements including clinical decision-making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options do not describe a fundamental element used in the decision-making process for delivery mode.

. In which health care delivery model would the nurse expect to see ―point-of-care‖ decision making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing

ANS: A Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options are incorrect because they may not allow for the autonomy required for ―point-of-care‖ decisions.

In which health care delivery model would the nurse expect to see ―point-of-care‖ decision making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing

ANS: A Primary nursing allows the nurse to practice autonomously and make most bedside decisions. The other options may not allow for the autonomy required for ―point-of-care‖ decisions.

The second phase of the performance appraisal interview is the participation. It is important for the nurse manager to do which of the following first during this phase? a. Provide feedback on employee's accomplishments and successes b. Discuss areas of concern c. Establish goals d. Identify areas for improvement

ANS: A Providing positive feedback at the beginning of the interview sets a positive tone. The other factors are discussed after the initial feedback is accomplished.

Which hospital data collection result will most likely affect nursing practice? a. Changes in staffing patterns b. Changes in patient acuity c. Introduction of the needleless systemd. Changes to the interview process \

ANS: A Staffing may be directly affected by outcomes data. Changes in patient acuity is unaffected by data collection and is incorrect. Introduction of the needleless system was an initiative from The Joint Commission. Changes to the interview process are usually not affected by data collected.

. Health care facilities are incorporating the use of electronic health records (EHRs), and nurses are responsible for entering data on their patients. Nurses understand that there are many advantages to this new form of charting. Which of these factors make the electronic EHR an advantageous health care record for the nurse? a. Record keeping is safe and accurate. b. Documentation is timely. c. Corrections to the record can be made at the end of the shift. d. Coordination of vital signs to prescribed medications is automatic.

ANS: A The EHR provides a confidential, easily accessible, and legible record of the patient's health history and current admission. The other options are not true about the EHR.

Technology is highly visible and accessible in the health care environment. All members of the health care team provide data to the patient's record. Which of these systems does the nurse understand to be a nursing data entry program? a. Computerized medication administration system b. Computerized provider order entry. c. Pyxis d. Pareto analysis

ANS: A The MAR is an exclusive program into which the nurse enters medication administration. Computerized provider order entry is a physician entry program. Pyxis is a computerized billing program. Pareto analysis is not a data entry program

The National Institutes of Health (NIH) is a department headed by the Secretary of the U.S. Department of Health and Human Services (HHS). Which action would be expected from this department? a. Research of health care issues b. Statement regarding stem cell research c. Recommendation for all people to stop smoking d. Recommendation for use of Nicorette to stop smoking

ANS: A The NIH is a health research department of the HHS. The other actions are not those that the NIH would take.

You are the charge nurse on the 3 PM to 11 PM shift. The nurses on this shift range from novice to competent. What response would be expected in the beginner stage of clinical competence development when the nurse is assigned a patient on beta-blockers and scheduled for a stress test? a. Knows to hold a beta-blocker on a patient scheduled for a stress test because this happened earlier in the week on another patient b. Must be told to hold the beta-blocker for a patient scheduled for a stress test c. Understands the rationale for holding the beta-blocker prior to a stress test d. Holds all medications when the patient is NPO

ANS: A The advanced beginner repeats behavior learned from an earlier similar situation but may not understand the rationale. The other options are appropriate for a nurse at a different level of experience.

7. Clinical ladders for nurses are best used in what circumstance? a. Horizontal advancement for clinicians who wish to stay at the bedside b. Vertical advancement for management responsibilities c. Horizontal ladder for nurses with more than 10 years of employment d. Vertical ladder for nurses with more than 10 years of employmen

ANS: A The advantage to the ladder system is that the nurse can remain at the bedside and be recognized for clinical excellence without having to move into management. The other options do not apply to the clinical ladder.

Patient satisfaction surveys include questions about quality of care. What has the greatest impact on patient satisfaction? a. Responsiveness of staff b. Getting pain medication on time c. Being allowed to go outside to smoke a cigarette d. The race and gender of the nurses

ANS: A The attitudes and caring of the staff are a huge patient satisfaction indicator. The other options may be an indicator for a small number of patients but will not influence the overall data.

You are the nursing supervisor on the 11 PM to 7 AM shift. When making rounds, the charge nurse on the unit reports that one of the patients is dyspneic. What action would be expected from a nurse in the expertise stage of clinical competence when assessing shortness of breath in a patient? a. Recognizes the patient may have pulmonary edema and orders (or asks the physician for an order) an IVP diuretic b. Places a patient complaining of shortness of breath in high-Fowler's position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Increases the oxygen concentration d. Notifies the instructor of the patient's complaints

ANS: A The expert nurse typically is the advanced nurse practitioner who has the ability to make clinical judgments and direct care. The other options are appropriate for a nurse at a different level of nursing.

What area is included when risk management explores the prevention of accidents, injuries, and errors? a. Financial risk b. Quality of care c. Employee management d. Employee promotio

ANS: A The financial risk for injuries, errors, and accidents will always be incorporated into the decision-making process. The others are not part of the risk management program.

There are four major types of staffing plans. The mixed method of staff planning refers to which of the following? a. The schedule uses decentralized scheduling and its staffing needs are supplemented by the centralized office. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: A The mixed method combines both centralized and decentralized for scheduling. The other options are incorrect because they refer to other methods.

Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments

ANS: A The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models

ANS: A The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models.

What retention strategies should the nurse manager use when working with a new orientee? a. Provide a safe practice environment b. Encourage more time shadowing preceptor c. Encourage early independence d. Provide multiple preceptors for diverse learning

ANS: A The nurse manager is responsible for providing a safe learning and practice environment to encourage retention. The other strategies would not make for a good learning environment during orientation and could adversely affect retention.

A sentinel event is usually one that results in an unexpected outcome for the patient and ―signals‖ the need for investigation and response. Which of the following would be considered a sentinel event? a. A patient who requires a left leg amputation after developing an arterial occlusion at the access site b. An older adult patient who falls after trying to get up by herself c. A patient who receives two doses of amiodarone because the nurse did not chart the first one d. A patient whose peripheral pulses have not been checked for 2 hours after he returns from a cardiac catheterization

ANS: A The patient incurred unexpected results from the procedure and lost a limb. The other options do not qualify as a sentinel event.

A sentinel event is usually one that results in an unexpected outcome for the patient and ―signals‖ the need for investigation and response. Which of these situations would be considered a sentinel event? a. Patient dies because there is no bed available in the ICU. b. Patient receives an incorrect dose of medication. c. Patient consents to be terminally weaned. d. A patient's family is upset with a physician's approach.

ANS: A The patient possibly died because appropriate care could not be delivered. The others are not a sentinel event.

A new graduate requires a lengthy time commitment to orientation from the nurse manager. The socialization of the new nurse may take as long as 2 years. Which of the following would be expected as a time frame for developing confidence? a. 6 to 12 months b. 4 to 6 months c. 12 to 18 months d. 18 to 24 month

ANS: A The process of clinical decision making is lengthy and confidence in clinical judgment should not be expected before 6 to 12 months. 4 to 6 months is the time frame for learning practice norms. 12 to 18 months is the time frame for consolidation of relationships. 18 to 24 months is the time frame for seeking challenges

A nurse is learning about quality improvement measures taken by the hospital. Root cause analysis is a process for identifying the cause of an error. What is the greatest benefit to establishing the root cause? a. Prevention of future similar incidents b. Identification of the responsible person c. Allows corrective action to be taken d. Identification of cause

ANS: A The purpose of investigations of errors is to prevent incidents in the future. The options are not the greatest benefit to the process.

Risk management is a hospital program organized to prevent the incidences of preventable accidents, injuries, and errors. Which of the following situations would a hospital risk manager need to investigate? a. A patient breaks his wrist from a fall caused by a wet floor. b. A patient receives a dose of subcutaneous heparin 1 hour later than scheduled. c. A patient who is NPO is not given her morning medications. d. A patient who is allergic to shellfish is given preprocedure medications to reduce his risk for allergic reaction to the dye being used in the procedure.

ANS: A This is a preventable accident and injury and would be reviewed by the risk management department. The other situations do not apply for review by risk management.

Peer reviews are frequently included in the overall employee performance appraisal. What values are attributed to the peer review? a. The nurse has the ability to evaluate based on personal knowledge of the employee's performance. b. Friendships can interfere with peer appraisals. c. Selection of peers for appraisals can be biased. d. Frequency of shared work may influence evaluation by peer.

ANS: A When asked to submit peer evaluations, they should be selected on the basis of time actually shared in the work day/week. The other options are not an attribute of the peer evaluation method of appraisal.

The Joint Commission (TJC) has made recommendations for abbreviation use, which have been instituted in most health care facilities. Which abbreviations would the nurse expect to find on the ―Do Not Use‖ list from TJC? (Select all that apply.) a. Qd b. Qod c. Prn d. NPO e. STAT

ANS: A, B

Which of the following are some of the qualities found in a team player? (Select all that apply.) a. Competence b. Dependability c. Enthusiasm d. Being on time e. Being friendly

ANS: A, B, C A good team player would possess the qualities in options A, B, and C. Options D and E are not necessarily qualities found only in team players.

3. A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which (Select all that apply.) a. a staff nurse provides advice and guidance to new nurses. b. a clinical ladder is used for advancement. c. a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them. d. annual performance appraisals are provided with competitive raises. e. decisions are made from the top down.

ANS: A, B, C Options A, B, and C are correct because a transformational leadership environment encourages consultation and collaboration, empowering and motivating staff. The other options are examples of transactional leadership

Which of the following topics would the new nurse expect to review in the hospital's new employee orientation program? (Select all that apply.) a. HIPAA b. Safety standards c. Infection control d. ACLS e. Order transcription

ANS: A, B, C Options A, B, and C are correct because hospital orientation includes all new employees regardless of classification so the orientation will be about the policies and expectations of the hospital. The other options are unit-specific orientation.

Teams are groups who must work cooperatively to achieve a goal. Which of the following would be considered part of a team on a typical nursing unit? (Select all that apply.) a. Staff nurse b. UAP c. Case manager d. Pharmacist e. Unit secretary f. Admission clerk

ANS: A, B, C, D, E

3. Smoothly functioning teams should possess which characteristics? (Select all that apply.) a. Everyone is on time for meetings. b. There is mutual trust. c. There is a sense of identity with the team. d. Everyone has the same objectives. e. The team works well together

ANS: A, B, C, E Well-functioning teams should possess the qualities in options A, B, C, and E. Having the same objectives is not a characteristic of well-functioning teams.

The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) a. Work allocation b. Accountability c. Allocation of resources d. Mission statemen

ANS: A, B, D According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system.

ANS: A, B, D Options A, B, and D are correct because the text lists these as fundamental elements of any patient care delivery system. Options C, E, and F are not fundamental elements of a patient care delivery system.

Maintaining currency in a profession is achieved through (Select all that apply.) a. academic inquiry. b. continuous participation in professional organizations. c. asking questions of other professionals. d. observing your role model's practice. e. participation in evidence based projects.

ANS: A, B, E

The role of the charge nurse is a relatively new role in nursing. What responsibilities would the nurse expect to see from the charge nurse? (Select all that apply.) a. Making daily patient care assignments b. Troubleshooting problems occurring during shift c. Providing coverage for breaks d. Taking turns floating to another unit e. Assisting staff as needed

ANS: A, B, E

The ANCC (American Nurses Credentialing Center) is an organization that recognizes excellence in nursing in hospitals. Which outcome would be expected by an institution receiving Magnet Hospital status? (Select all that apply.) a. Nurses as teachers b. Quality nursing leadership c. Better salaries for staff d. Increased use of UAPs e. Quality of care f. Community relationships

ANS: A, B, E, F

After piloting changes based on evidence-based research, the nurse understands that they will be instituted as a result of the effects on which of the following? (Select all that apply.) a. Staff b. Number of UAPs available c. Cost d. Patient e. Census

ANS: A, C, D

What methods can the nurse manager use to address horizontal violence in the workplace? (Select all that apply.) a. Provide training to staff. b. Pick a side so that the assaults do not include you. c. Name the problem ―horizontal violence.‖ d. Observe and analyze the culture of the workplace. e. Have the victim file a grievance.

ANS: A, C, D

All treatments and services for patients require two forms of patient identification prior to providing those services. Which is the best method to use to identify the patient who is unable to communicate? (Select all that apply.) a. Patient ID band b. Roommate c. Family member d. Admission photograph

ANS: A, C, D Nurses should rely on the patient ID, family member identification, and admission photograph as types of patient identifications when patients are unable to communicate. Options B and E are not reliable forms for patient identification.

Patient satisfaction surveys may provide information on the clinical performance of the unit as well as the institution. Which areas are included for data collection? (Select all that apply.) a. Accessibility of services b. Number of staff per shift c. Communication d. Quality of care e. Recognition of physician in community f. Continuity

ANS: A, C, D, F

The Joint Commission (TJC) tracks core measures for performance. Which core measures are tracked by TJC? (Select all that apply.) a. Heart failure b. Ventilator days c. Scheduled sedation vacation d. Acute myocardial infarction e. Childhood asthma

ANS: A, D, E Options A, D, and E are core measures tracked by TJC. Options B and C are not one of the core measures tracked by TJC.

In addition to staff interviews, The Joint Commission (TJC) surveyors measure an institution's compliance by which action? (Select all that apply.) a. Review of clinical records b. Shadowing a nurse for a shift c. Passing as a patient for the day d. Interviews with patients e. Reviewing policy statements of the facility

ANS: A, D, E TJC surveyors use these actions to measure compliance to the pain management standard. The others are not measures used by the surveyors

Point-of-care systems are currently being used in health care facilities. Which is an advantage of the point-of-care systems to the patients? (Select all that apply.) a. Immediate access to decision support systems b. Rapid accurate charging of services to patients c. Faster discharge d. Documentation at the bedside e. Documentation at the time of care

ANS: A, D, E The use of PDAs and other point-of-care equipment provides the health care provider with immediate access to the patient records and other decision support systems. PDAs and other point-of-care equipment also are more accurate as well as convenient because all the documentation can occur at the bedside and at the time that care is provided. Option B is incorrect because rapid accurate charging of services to patients is not one of the advantages. Option C is incorrect because faster discharge is not one of the advantages

What are the benefits to the organization from greater patient satisfaction? (Select all that apply.) a. Improvement in quality of patient care b. Lower patient acuity c. Lower mortality rates d. Improved retention e. Establishing benchmarks against other institutions

ANS: A, D, E When quality of care improves, patient satisfaction improves and has a direct affect on staff satisfaction and thus retention. These improvements can then be used as benchmarks against other institutions. Improvement in patient satisfaction is usually a direct reflection of improved quality of care and other nursing-related issues, leading to nurse satisfaction and retention. Benchmarking against other institutions is a common method used for determining quality of care. Options B and C are not related to patient satisfaction

Hospital performance improvement standards are primarily focused on the ability of the hospital to a. meet the goals established by the regulating bodies. b. develop an atmosphere that meets and exceeds the expectations of the customers and staff. c. be known in the community for good care. d. provide a shelter for people in a disaster.

ANS: B

In interviewing for a new position, a nurse may want to inquire about the institution's views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent ―floating.‖ b. self-scheduling. c. cover of another nurse's assignment while she or he is on break. d. hourly pay differential for the night shift.

ANS: B

What information obtained from hospital data collection can be used for staffing purposes? a. Patient satisfaction b. Staff competency c. Best practice d. Use of agency nurses

ANS: B

Data provided by studies on patients with community-acquired pneumonia (CAP) have influenced the standards of practice for those patients. Which order should the nurse anticipate on the standard orders as a result of initiatives developed through clinical studies? a. Obtaining blood cultures within 4 hours of arrival at the hospital b. Administering antibiotics within 4 hours of arrival at the hospital c. Administration of aspirin on arrival to the hospital d. Administration of oxygen at 4 L per nasal prongs

ANS: B Administration of antibiotics, along with acting on the information obtained from the blood cultures, is the standard of care developed for patients admitted with CAP. Blood cultures need to be obtained prior to administration of antibiotics. Options C and D do not apply to CAP standards.

Which observation requires an intervention of a new graduate nurse by her preceptor? a. Administering a medication after checking the patient's name and birth date. b. Leaving patient room without charting vital signs. c. Reporting a patient's change in level of consciousness to the nurse practitioner. d. Checking the apical pulse on a patient receiving digoxin (Lanoxin).

ANS: B An advantage to computerized charting is the availability of charting at the bedside at the time of care and charting before leaving the patient room, which makes that information immediately available to all health care providers. The other options are appropriate and does not require intervention.

Accrediting agencies require that staff demonstrate competency in their jobs. Annual competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the health care field as required by accrediting agencies?a. Management of violent patients b. Fire safety c. Transport of patients d. Transcription of orders

ANS: B Annual mandatory skill evaluations include fire safety. The other skills are not included in annual mandatory skill evaluations.

What is the advantage to the institution in using external agency nurses? a. Competency b. Availability c. Cost d. Staff relationships

ANS: B Availability is the greatest advantage to the institution for using agency nurses. Competency may or may not be a factor, and until the nurse is working on the unit, one can never know for sure. The other options are not an advantage to the institution.

In the first phase of the performance appraisal process, the nurse prepares for the interview with the nurse manager. Which of the following should the nurse do to prepare for the performance appraisal interview? a. Make a list of patients who have remarked on your abilities as a nurse. b. Identify accomplishments of last year's goals. c. Bring documentation of charting. d. Provide anecdotal notes of other staff evaluations of you.

ANS: B Bringing a list of accomplishments from last year's appraisal may support a good appraisal this year. The other options are not beneficial to the process.

Which of the following best explains the use of career development strategies in health care institutions? a. Encourages nurses to move into management b. Reduces attrition c. Reduces dissatisfaction d. Reduces sick time

ANS: B Career development strategies have been shown to reduce the loss of nurses from the bedside. The other factors are not part of the strategies

When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the D (define) refers to a. the cost of getting a new MRI machine. b. the patients and their families. c. the number of dollars in donations. d. the number of dollars spent on charity

ANS: B Define means to define the customer for whom improvement is directed.

Attributes of effective teams include a. friendly interaction. b. respectful, consensus-building discussions. c. embarrassing and personal criticism. d. resentment toward other members.

ANS: B Effective teams promote a respectful atmosphere for consensus building. The other options are not examples of an attribute of an effective team.

Equity maintains a focus on which of the following? a. Services, executive management and staff b. Services, patients, and staff c. Staff, the management team and services d. Staff, patients and resources

ANS: B Equity maintains a focus on services, patients, and staff; is the foundation and measure of value; and says that no single role is more important than any other.

Automated computerized staffing allows for which advantage to the staff? a. It reduces the workload of the nurse manager. b. Staff has many options on a first-come, first-served basis. c. It provides for changes in daily patient acuity. d. Weekend options are available.

ANS: B Everyone has availability at the same time on computers so there is an advantage to the first user. The other advantages do not apply.

ANS: B In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization.

The nurse informatics (NI) specialist incorporates nursing science, computer science, and information science to support nursing in utilization of the data collection. Priorities for an NI specialist include a. developing computer information systems for the hospital. b. incorporating common nursing nomenclature into the system. c. researching evidence-based practice

ANS: B Incorporation of the nursing language into the computer system is essential for accurate documentation. The other options are not included in the role of the NI specialist.

When leading a team, a low performing leader is seen as having which abilities? a. A problem solver b. Identifies cause when identifying problem c. Communicates well with staff d. Solves problems once identified

ANS: B Low performers seek blame for problems. The other options are not characteristics of a low performer

In addition to evaluative feedback, the nurse manager is also involved in orientation in which areas? a. Encourages precepting with several nurses b. Provides for optimal learning experiences

ANS: B Nurse managers are responsible for providing the best learning environment for new staff. The other options are not the nurse manager's role.

The challenges facing nurses today include which of the following? a. Stressed nurse managers b. Increased patient acuity c. Increased overtime d. Increased patient length of stay

ANS: B Nurses must face increased patient acuity and workload. The other options are not sources for challenge.

Unique attributes of nurse managers when supervising staff include which of the following? a. Evaluate each worker as a team member b. Provide guidance and role modeling c. Stimulate workers to carry a heavy patient load d. Encourage staff to learn a second language so they can become interpreters

ANS: B Orienting, teaching, and guiding are ways of promoting best performance. The other options will not improve performance.

8. One of the best indicators of clinical performance can be attributed to a. yearly census. b. patient satisfaction surveys. c. employee satisfaction surveys. d. staff turnover.

ANS: B Patient satisfaction surveys are one of the best indicators of clinical performance. The others are not a measurement of clinical performance.

Performance appraisals provide the employee with which of the following? a. Performance standards b. Goals c. Salary increases d. Continuing education

ANS: B Performance appraisals today are tools for setting goals. The other options are not part of the purpose of performance appraisals today

A nurse has administered the wrong medication to a patient. In investigating the root cause of the error, it is discovered that the nurse was unfamiliar with the medication and that the Pyxis was incorrectly loaded with the wrong medication. What should be the outcome of this process? a. The nurse should be educated on this medication. b. Pharmacy should develop a second check of medications prior to loading in the Pyxis. c. The nurse will not be allowed to pass medications without supervision until deemed safe. d. An incident report will be completed.

ANS: B Pharmacy should establish a way to double check medications prior to loading, much like nurses triple check their medications before they are given. The other options would not accomplish the goal of prevention of future incidents.

6. The state regulatory agency may impose a fine on a hospital for which patient safety infraction? a. Not reporting a patient's change in condition b. Physical abuse to patient by staff c. Not documenting pain management d. Not feeding a confused patient

ANS: B Physical abuse of a patient would be investigated by a state regulatory agency. The other infractions do not require state investigation.

What is the best advantage to preference scheduling for nurses? a. Institutional rules can be applied. b. Staff decide shifts. c. Scheduling is determine by first-come, first-served basis. d. Blocks of time are predictable.

ANS: B Preference scheduling allows for staff requests or preferences. Option A refers to rules scheduling. Option C refers to self-scheduling. Option D refers to pattern scheduling

―Lean culture‖ is a term used for the principle of eliminating waste. Which illustrates the principle that nurses must do more with less? a. Assigning the night shift RN to restock the rooms. b. Employing a staff member to stock all patient rooms for frequently used supplies. c. Assigning all nurses to restock their rooms every day. d. Placing all frequently used supplies in a central location.

ANS: B Providing a staff member to restock the rooms frees up the nurses to spend time caring for their patients. The others are a possible solution but having a staff member devoted to this would allow the nurse to spend time appropriately.

There are four major types of staffing plans used in the hospital setting. The primary advantage of self-scheduling is which of the following? a. It saves the nurse manager time. b. It encourages negotiation among staff. c. The most senior staff get first pick. d. The freshman staff get the more undesirable shifts.

ANS: B Self-scheduling forces staff to interact at a different level than before and can produce more camaraderie and a better working environment

Another type of technology currently being used in hospitals is the Automated Nurse Staffing System. What is the advantage of this system to the patient? a. Reduces health care costs by predicting supplies needed b. Determines staffing based on acuity of patients c. Determines staffing based on cost of patient care d. Determines order of being floated

ANS: B Staffing is based on the amount of care required by the patients with this system. The other options are not part of the points the system provides.

Advantages to using the electronic health record (EHR) include that a. hospitals no longer need to store medical records. b. medical records are complete and easily accessible to health care providers. c. unit secretaries can still call for ―old records.‖ d. diagnostic tests are not available for direct visualization.

ANS: B The advantage of the EHR compared with the paper method is that the record is complete, easily accessible, and legible. Option A is incorrect because records continue to be stored but are stored on computer software, not paper. The other options are not true.

There are four major types of staffing plans. The decentralized method of staff planning refers to which of the following? a. The schedule is planned based on the central or core staff. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: B The decentralized schedule is done by the nurse manager and is very individualized to the needs of that unit. Option A is not a plan for scheduling and is incorrect. Options C and D refer to other scheduling methods.

Middle-level managers are responsible for planning for changes of the unit. What activity would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery

ANS: B The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not the exclusive responsibility of the middle-level manager.

A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway

ANS: B The nurse delegates and works collaboratively with the members of the team in team nursing. Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing.

A hospital has just introduced a new electronic staffing system that allows staff to enter their shift preferences into the computer. What would the nurse identify as an advantage to the staff? a. Decrease in nurse manager availability b. Increase in nurse manager availability c. More available staff d. Requests cannot be entered

ANS: B The nurse manager would have more time available to manage the clinical area with this system. Option A is incorrect because the system has the opposite effect. Option C is incorrect because the system allows only a predetermined number of staff on any day or shift. Option D is not true.

A sentinel event is usually one that results in an unexpected outcome for the patient and ―signals‖ the need for investigation and response. Which of the following would be considered a sentinel event? a. A patient with a brain tumor who falls and breaks his wrist after trying to get up by himself b. A 32-year-old woman with no significant health history who dies in the operating room during an elective surgical procedure c. A patient who self-extubates after cardiac surgery d. A patient who is given the wrong bolus of heparin that is corrected with the first prothrombin time

ANS: B The patient in option B died unexpectedly without apparent cause. Unexpected death or loss of limb or function did not occur.

You are the nurse educator on a medical unit. What action would be expected from a nurse in the proficient stage of clinical competence when assessing shortness of breath in a patient? a. Increases the oxygen concentration on a patient complaining of shortness of breath b. Places a patient complaining of shortness of breath in high Fowler's position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Checks the oxygen saturation d. Calls the physician to notify her of the patient's change in condition

ANS: B The proficient nurse will assess and reposition a patient first before taking the next step of calling the physician. The other options are appropriate for a nurse at a different level of nursing.

Hospitals beginning to use the electronic health record (EHR) for documentation of patient care are sometimes faced with many obstacles. What may be seen when the EHR system is first initiated? a. Limited storage for records b. Resistance from staff c. Many ―crashes‖ of the system d. Many disruptions from the access of multiple users

ANS: B The steep learning curve can lead to staff resistance to its implementation. The other options are not true.

Federal and state departments of health regulatory agencies have been established to ensure optimal standards and delivery of care. Which action is the jurisdiction of these agencies? a. Investigation of medication errors b. Investigation of patient- or family-reported complaints c. Investigation of patient falls d. Investigation of staffing shortages

ANS: B These agencies investigate and make judgments on complaints brought by consumers of the services and the public. The other actions would be investigated internally.

. In what ways can hospitals meet The Joint Commission goals of adequate competent staffing? a. Using contract nurses b. Training and educating staff c. Promoting ―best nurses" d. Salary inequities

ANS: B Training and education are the best methods for ensuring competency. The other options do not address competency.

Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7

ANS: B Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels

All treatments and services for patients require two forms of patient identification prior to providing those services. Which would require an intervention if used by the nurse to identify a patient? (Select all that apply.) a. Referring to the patient ID band b. Asking the roommate c. Asking another nurse on the unit d. Asking the patient e. Asking a family member

ANS: B, C The patient's roommate and another nurse on the unit are not good sources for patient identification and would require intervention if used. The patient's ID band is a good source for patient identification. Options A, D, and E are correct method for identifying patients and would not require an intervention.

Based on the Iowa model for evidence-based practice, research is initiated because of either problem- or knowledge-based triggers. The nurse understands that these triggers may arise as a result of (Select all that apply.) a. staff complaints. b. an increase in surgical infection rates. c. an increase in chronic renal failure following use of dye during radiographic procedures in diabetic patients. d. medicare reimbursement changes.

ANS: B, C, D

Personal and financial issues, as well as drugs or alcohol, can impair employees and can precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) a. Recent divorce b. Troubled adolescent c. Tremors of the hands d. House foreclosure e. Religious counseling

ANS: B, C, D

Part-time staffing by nurses includes which advantages? (Select all that apply.) a. Provides a backup b. Maintains skills c. Increases income d. Provides life outside of family e. Maintains education

ANS: B, C, D Options B, C, and D are an advantage to the individual. The advantage to the institution is to cover and support the full-time staff. The other options are not advantages to part-time staff.

Which of the following should be used to evaluate the staff's performance when deciding high, middle, or low? (Select all that apply.) a. Never late b. Teamwork c. Communication d. Knowledge and competence e. Responsive to constructive criticism

ANS: B, C, D Options B, C, and D are areas for evaluation of work performance. Options A and E are not areas for evaluation.

Health care facilities are incorporating the use of electronic health records (EHRs), and nurses are responsible for entering data on their patients. Nurses understand that there are many advantages to this new form of charting. Which of these is an advantage to the nurse when using the EHR? (Select all that apply.) a. Not all documentation is accessible to the nurse. b. Documentation occurs at the patient's bedside. c. Corrections are easily made when errors are inadvertently made. d. Coordination of vital signs to prescribed medications is easy and quick. e. Nurses must identify the assessment parameters to be included.

ANS: B, C, D The EHR has many advantages for the nurse including access to computers at the bedside. The EHR has many advantages for the nurse including easy changes to errors made to documentation. The EHR has many advantages for the nurse including having all necessary information easily and quickly accessible for coordination of care. The other options are not true of the EHR

The Joint Commission (TJC) has set standards for employee ongoing education in which situations? (Select all that apply.) a. Must occur after the end of orientation b. Must occur whenever responsibilities change c. To increase knowledge of work-related issues d. All staff must participate whenever an event occurs e. When and how to report adverse events

ANS: B, C, E Options B, C, and E are correct because TJC mandates that ongoing education should occur around this specific activity. Options A and D are not included in the mandate.

During unit orientation, a preceptor is used to provide learning and role modeling. What should the nurse expect from a preceptor during orientation? (Select all that apply.) a. Orient to unit. b. Teach organizational skills. c. Teach medication actions. d. Teach unfamiliar skills. e. Teach prioritization skills

ANS: B, D, E Options B, D, and E are correct because most preceptors will teach these skills to new nurses. Orientation to the unit can be done by anyone. Teaching medication actions should not need to be done

When providing care to patients, nurses make patient care decisions based on which of the following? (Select all that apply.) a. Resource availability b. Nurse practice act c. Shared governance d. Managerial leadership style e. Tradition f. Clinical circumstances

ANS: B, E, F

A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice.

ANS: C

Most institutions use one or more types of future scheduling in their planning. Which of the following provides advantages for the organization's scheduling policies? a. Pattern scheduling b. Preference scheduling c. Rules scheduling d. Self-scheduling

ANS: C

You are the nurse manager who is preparing the annual reviews for the staff members. You are aware that the nurse in the competent stage of clinical performance development would be expected to do what when assigned a patient on beta-blockers scheduled for a stress test? a. Must be told to hold the beta-blocker for a patient scheduled for a stress test b. Holds all medications when the patient is NPO c. Calls the physician for an order to hold the beta-blocker prior to a stress test if there is no order d. Repeats behavior learned from a previous experience

ANS: C The competent nurse understands the rationale for holding the medication and calls the physician when an order is needed. The other options are appropriate for a nurse at a different level of nursing.

Which of the following techniques should the manager use when talking with the low-performing employee? a. Reassure him that this conversation is not reflected in his evaluation. b. Compare her performance to that of the high-performer. c. Describe the observations and be sure he knows the consequences. d. Allow no explanations for her actions since she is so good at citing blame.

ANS: C Accurate descriptions and consequences must be included in the conversation. The other options do not present a way of conversing with the low performer.

Which of the following are included in the guidelines for valuable, effective acknowledgement of each member's contribution to the team? a. Acknowledgments should be made privately to avoid embarrassing the person. b. Acknowledgments are best put into the minutes to be read at a later date. c. Acknowledgments are best made in public and recognized as sincere. d. Acknowledgments are not necessary; everyone recognizes what has been done.

ANS: C Acknowledgments are most appreciated when sincere and made publicly for all to appreciate. The other options are not a good way to acknowledge a team member.

The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff.

ANS: C As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other actions may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills

The clinical ladder used in some hospitals allows for recognition of both the clinical and academic growth of the individual nurse. On which of the following is this ladder based? a. The concept that people will work harder when recognized b. The concept that nurses respond to harder work c. The concept of growth in nursing from novice to expert d. The concept that nurses like to be intellectually stimulated

ANS: C Benner's work in 1984 on the novice-to-expert concept in nursing laid the groundwork for the clinical ladder. The other options are not the basis for the clinical ladder concept

Which of the following are Centralized or self-governance interactions? 1. Position-based 2. Hierarchical communication 3. Synergistic work environment. 4. Separates responsibility/managers are accountable 5. We-they work environment 6. Direct communication a. 1, 2, 3, 5 b. 2, 3, 5, 6 c. 1, 2, 4, 5 d. 1, 3, 5, 6

ANS: C Centralized or Self-governance interactions are Position-based Distant from point of care/service Hierarchical communication Limited staff input Separates responsibility/managers are accountable We-they work environment Divided goals/purpose Independent activities/task

Which of the following are Decentralized or Shared governance interactions? 1. Hierarchical communication 2. Occurs at point of care/service3. Direct communication 4. High staff input 5. Synergistic work environment 6. Collegiality, collaboration, partnership a. 1, 2, 4, 5, 6 b. 1, 3, 4, 5, 6 c. 2, 3, 4, 5, 6 d. 1, 2, 3, 5, 6

ANS: C Decentralized or Shared governance interactions are Knowledge-based Occurs at point of care/service Direct communication High staff input Integrates equity, accountability, and authority for staff and managers Synergistic work environment Cohesive goals/purpose, ownership Collegiality, collaboration, partnership

Orientation of new employees is a two-stage process. The first stage includes orientation to the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the unit orientation? a. Computer training b. Transcription of orders c. ECG interpretation d. BLS training

ANS: C ECG interpretation is a unit-specific orientation. The other options are incorrect because they are hospital orientation.

When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Allow group to set agenda. b. Separate the group according to interests. c. Facilitate problem-solving. d. Coerce all members to interact.

ANS: C Facilitating problem solving involves all members in an active way. The other options are not a guide to managing group meetings.

Team players show many positive characteristics. Which of the following characteristics should be expected of a good team player when asked to participate in a continuing education class for the unit? a. ―Sure, but my schedule is full right now.‖ b. ―I did this last time. Let's give someone else a chance.‖ c. ―Sure, I will need to make some changes to my schedule.‖ d. ―Sure. How about next month?‖

ANS: C Good team players adapt to the needs of the team to accomplish their goal. The other options are not characteristics of team players

An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths b. RN taking vital signs and giving baths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery

ANS: C In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models

6. Attributes of ineffective teams include which of the following? a. Respectfully listening b. Consensus decision-making c. Leadership is owned by a few who make most of the decisions. d. Open discussion of disagreements

ANS: C Ineffective teams have intimidating leaders who do not allow respectful, open consensus-driven decision-making. The other options are examples of an attribute of an effective team.

What factors are primarily used when quantifying patient care required and staffing needs? a. Number of patients per nurse b. Number of discharges c. Acuity and time required for care d. Number of admissions

ANS: C Patient acuity and care required are the most important elements in the patient classification system. The other factors do not apply

ANS: C Recognition of nurses through awards gives an incentive to continually improve performance. The other examples may improve the nurse's performance or cause burno

There are four major types of staffing plans. The self-scheduling method of staff planning refers to which of the following? a. The schedule is planned based on the central or core staff. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: C Self-scheduling allows the nursing staff to accept full responsibility for staffing the unit. Option A is not a plan. Options B and D are examples of centralized scheduling

When calculating for staffing needs, what should be considered? a. Weekend option b. Hourly salary of employee c. Productive versus nonproductive hours of an employee d. Vacation time accrued

ANS: C Staffing should include the number of hours each employee has earned in sick time, vacation time, etc. Hours available to work are productive. Nonproductive hours are vacation, sick time, etc. The other factors are not included for the FTE calculations.

When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the I (improve) refers to a. identification of the start and stop dates. b. comparison of data to customer surveys. c. use of technology to design improvements. d. staff training.

ANS: C Technology can allow for creativity in developing solutions. The others are processes that are incorporated in the other DMAIC approach to performance improvement.

The National Database of Nursing Quality Indicators (NDNQI) has established which of the following goals to assist nurses to make practice changes in order to benefit patients? a. Patient satisfaction b. Employee satisfaction c. Unit-specific measures d. Medication errors

ANS: C The NDNQI tracks unit-specific measures such as fall rates. The other goals were not tracked.

Which activity should be considered the highest priority by the RN? a. Assessment of a stable patient ready for discharge b. Administration of daily medications c. Administration of STAT medications

ANS: C The STAT medications order is a priority because STAT means immediately. The other options do not take priority over a STAT order.

What is the greatest benefit to the nurse of technology in the health care setting? a. Patient acuity is reduced. b. Determination of the time of discharge of patient is aided. c. There is easy, quick access to relevant data. d. Data may be more difficult to interpret

ANS: C The ease by which data can be retrieved is a great benefit to nurses in the clinical area. The other options are not part of the system information.

Which of these is a measured outcome from a performance improvement process perspective? a. Overtime hours worked by the RNs b. Identifying the responsible person for a patient's fall c. Sternal infection rates in cardiac surgery patients d. Method of shift report

ANS: C The number and frequency of sternal wound infections are patient outcomes. The others are not a performance improvement outcome

In the first phase of the performance appraisal process, the nurse manager prepares for the interview with the nurse. What should the nurse manager plan in preparation for the performance appraisal? a. Anecdotal notes from other staff b. Complaints from patients and families c. Documentation of examples of performance d. Documentation of medication errors

ANS: C The nurse manager must have documentation of both good and bad performance to illustrate the necessary points of the evaluation. Although the other actions may be helpful, actual examples of specific performance provide better feedback.

What information obtained from hospital data collection can be used for administrative purposes? a. Unit-specific measures b. Staffing ratios c. Turnover d. Evidence-based practice

ANS: C Turnover is when a staff member leaves a position and a new staff member is hired for that position. Turnover provides data used for administrative purposes. Options A and D are not appropriate. Option B is provider staffing data.

A health care facility is using an electronic health record (EHR) system for documentation purposes. Every Thursday from 11:00 to 12:00 PM, the EHR shuts down for maintenance. Which would be of concern to the nurse during that weekly downtime? a. Illegal access to records can take place. b. Loss of previous documentation can occur. c. Loss of coordination of medication list and vital signs can occur. d. Sometimes passwords are lost.

ANS: C When the EHR goes down for any reason, the health care providers no longer have access to current patient information and errors can occur. Options A and B cannot occur. Option D is not an area for concern.

The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation

ANS: C Work allocation is necessary in any patient care delivery system. The other factors are not necessarily useful in determining the appropriate patient care delivery systems needed.

The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation.

ANS: C Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed.

ANS: C Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments.

To become a leader, one must develop certain personal aspects. Which of the following can be identified as competencies expected in creating leadership in oneself? (Select all that apply.) a.Asking for overtime b. Asking for certain patient assignments c. Personal and professional accountability d. Acquiring advanced degrees e. Personal discipline

ANS: C, D, E Options C, D, and E are competencies identified in the text for developing leadership in oneself. Although they may be associated with a good work ethic, the other options do not apply to the development of leadership competencies.

During unit orientation, a preceptor is used to provide learning and role modeling. Which of the following would one expect to observe in a seasoned nurse preceptor? (Select all that apply.) a. Teach unfamiliar procedures b. Teach their way of charting c. Teach delegation skills d. Act as a role model e. Tailor orientation to new nurses' specific needs

ANS: C, D, E Options C, D, and E are correct because an experienced preceptor will teach everything she can to help make the new nurse as competent as possible. Options A and B are seen with inexperienced preceptors.

What is the best method for hospitals to track patient satisfaction? a. Family buys chocolates for each shift. b. Family speaks to the charge nurse about how unhappy they are with a particular employee. c. Family writes a letter to the unit and to the chief nurse officer to thank the staff for providing care and compassion even though their family member died. d. Patient completes a patient survey after returning home from the hospital.

ANS: D

A unit secretary mistakenly enters the wrong medication into the MAR when transcribing orders. After a root cause analysis, it is determined that the cause is the illegibility of the physician's order. Which measure should be taken to prevent future incidences? a. The physician is required to carry a typewriter with him to type the orders onto the order sheet. b. The physician must either write legibly or orders will not be transcribed. c. The unit secretary must receive more training on transcribing orders. d. Introduction of a computer entry system for all physician orders will be instituted.

ANS: D A computer entry system eliminates most errors for all people involved. The other options do not address the root cause or prevent future errors involving other employees

What does it mean to create a legend in the organization? a. A legend is to deify a person for his or her extraordinary actions. b. A legend separates one member from another. c. A legend creates an impossible example to duplicate. d. A legend is a means of recognizing and rewarding a job well done.

ANS: D A legend is a means of rewarding an employee. The other options are not a reason for creating a legend.

1. You are the charge nurse on a busy medical-surgical unit. You are also the preceptor to a novice nurse. What response would be expected from a nurse in the novice stage of clinical competence development when assigned to perform a morning assessment on a patient? a. Nurse uses Doppler to obtain pulses on a patient with no palpable peripheral pulses b. Reporting to the charge nurse that they cannot feel a patient's peripheral pulses and the blood pressure is only palpable c. Nurse calls for help when she finds the patient with barely palpable blood pressure and hard to arouse d. Reporting to the charge nurse that she decided to let the patient sleep until the breakfast trays arrive because the patient was sleeping so soundly

ANS: D A novice nurse would go into the patient's room prepared to get vital signs in the morning and decide not to further assess a patient who is ―sleeping soundly.‖ The other options would be the response of a nurse as she becomes more experienced.

Overtime to cover shortages in staff coverage can be a daunting problem. Which of the following can be a short-term solution to a nursing shortage? a. Increase length of shift. b. Work a double shift. c. Use an agency nurse. d. Ask each shift to work 4 extra hours.

ANS: D Asking both shifts prevents exhaustion of one nurse, which can lead to errors. The other factors are not the best methods to use

Guidelines for performance ratings should meet what criteria? a. Patient satisfaction comments b. Quantity of care c. Mastery of skills d. Behavioral expectations

ANS: D Behavioral expectations are the primary evaluation component. The other options do not include evaluation components.

To practice as a nursing informatics specialist, what must the nurse accomplish first? a. Pass the NCLEX exam. b. Be actively involved in research. c. Demonstrate practice by working for a minimum of 2 years in an intensive care unit. d. Achieve certification from the ANCC.

ANS: D Certification is required to practice. A nurse must accomplish this prior to certification. The other options don't apply.

The best method for providing information regarding patient satisfaction surveys to the staff is by a. emailing results to all employees. b. making an announcement at the next staff meeting. c. providing results from the most current survey. d. providing comparison of current results with previous performance results.

ANS: D Comparison of current results to previous results (whether good or bad) provides a visual image to which most people can relate. Options A and B are not good methods and do not allow for discussion or brainstorming. Option C does not provide a relationship to past performance.

The third phase of the performance appraisal process is using the evaluation results. The nurse and nurse manager can set goals for improvement. Which of the following evaluation tools should be designed during the third stage of the performance appraisal process? a. Provide coaching b. Reassign to a less stressful unit c. Determine nurse's values d. Establish goals with outcome measures

ANS: D Establishing goals and tools for measuring those goals provides a productive approach to the problems. The other tools are not the best means for attaining the goals.

A nurse working on a unit using the primary care delivery model would expect to observe which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. b. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morning dose of insulin for a patient scheduled for surgery later that day.

ANS: D In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models.

Travel nurses have become very popular, especially among single, unattached nurses. Which of the following is an advantage of contracting with a travel nurse to the agency? a. Cost b. Availability c. Competency d. Contractual agreement

ANS: D Most travel nurses are contracted for 3 to 6 months and provide greater benefit to the institution because of the longer employment time. The other factors are not an advantage to the institution.

In a team nursing health care delivery model environment, the nurse would observe for which action by the staff? a. The UAPs answer all call lights. b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients' call lights. d. The RN is notified when there are patient care complaints

ANS: D Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing.

The electronic health record (EHR) provides information to all members of the health care team on their patients. The nurse manager and other team members recognize the advantages of the EHR, which include a. being handy for patients to carry with them. b. protecting patient privacy. c. being easier for patients t o read. d. making data available for research and continuous performance improvement.

ANS: D One advantage to the EHR is the availability of those records for research purposes and for quality improvement initiatives within the institution. The other options are not true.

When reviewing outcome measurement for clinical use, the reviewers must understand that the data a. identify the improvement required. b. identify the cause of the problem. c. identify questions to be asked. d. identify the results only.

ANS: D Outcome measurements provide results only. It is necessary for the reviewers to ask questions about what the data mean. The others are not factors answered by data collection.

Most institutions use one or more types of future scheduling in their planning. Which of the following provides advantages for creativity and staff satisfaction in scheduling? a. Pattern scheduling b. Preference scheduling c. Rules scheduling d. Self-scheduling

ANS: D Self-scheduling allows for more creativity and staff satisfaction. The other options do not provide advantages for the individual staff needs.

5. The state regulatory agency may impose a fine on a hospital for which patient safety infraction? a. A UAP ambulating a patient b. A UAP checking a blood glucose level c. Allowing only RN staff in the medication room d. Leaving the medication room unlocked

ANS: D The door to the medication room must be locked at all times to prevent unapproved people from accessing medications, syringes, needles, etc. Options A and B are not regulated by state regulatory agencies. Option C is incorrect because other employees may need access for various reasons.

The Pyxis Specialty Station system automates the distribution, management, and control of medications and supplies. An advantage of this system to the patient is which of the following? a. Accurate charging of supplies b. Accurate dosage of medications c. Separate storage for each patient d. Availability of medications and supplies

ANS: D The greatest advantage to the patient is the availability of necessary medications and supplies. Options A and B are incorrect because this is supposed to be an advantage but is not in the clinical setting. Option C is incorrect because the greatest advantage to the patient is the availability of necessary medications and supplies.

The National Patient Safety Goals of The Joint Commission (TJC) are established goals to reduce the risks for injuries to patients and provide a safe environment. Which practice has been instituted as a result of these goals established by TJC? a. Use of the automatic medication dispenser equipment b. Handwashing to prevent infections c. Provision of patient information to the nurse covering for breaks d. Use of two patient identifiers when providing care or treatment

ANS: D The institution of two patient identifiers is a TJC National Patient Safety Goal. The others are not listed as a TJC goal.

. Shared governance is: A. Decision making based on the principles of partnership, equality, accountability, and ownership at the point of service B. Decision making based on the principles of partnership, equity, accountability, and ownership at the point of service C. Decision making based on the principles of partnership, equity, accessibility, and ownership at the point of service D. Decision making based on the principles of patient care, equity, accountability, and ownership at the point of service

. What is a collaboration among primary care clinicians, a hospital, specialists, and other health professionals who accept joint responsibility for the quality and cost of care provided to its patients? A. Medical home B. Accountable care organization C. Professional practice model D. Care delivery system

. When calling the physician and following the SBAR process, which of the following items is included under the Situation criteria? A. Identify the patient's ethnicity and religious affiliation B. Briefly state the problem, what it is, when it happened or started, and its severity C. Inform the physician regarding the patient's roommates D. Describe patient's mental status

A ____________is an example of one who lives the organizational values. A. Group B. Supervisor C. Legend D. Team player

A goal of organizational learning is to make learning: A. The end product of all data collection B. Part of all activities within the organization C. Required of all employees in clinical positions D. Match the goals of The Joint Commission (TJC)

A political process by an individual or group that aims to influence public policy and resource allocation decisions within political, economic, and social systems and institutions is: A. Policy change B. Advocacy C. Institutional policy D. Public policy

An example of what the Centers for Disease Control and Prevention (CDC) would evaluate is: A. A toxic spill on a state highway B. An outbreak of rubella at a school C. A flu shot clinic at a pharmaceutical company D. An outbreak of respiratory syncytial virus in a neonatal intensive care unit

External temporary agencies are: A. Used as first line to replace sick calls B. Used usually as a last resort C. Not very expensive D. No longer used because of high costs

Hospitals are legally and ethically obligated to uphold patient rights, which include the right to: A. Review records; family can also review records B. Participate in treatment decisions and to provide consent to treatment C. Be informed of hospital bylaws and hospital attorneys' names and telephone numbers D. Expect reasonable care after hospitalization

In nursing, clear and precise communication is essential in the care of the patient. As a nurse, you are aware that messages can be: A. Native and foreign B. Verbal and nonverbal C. Coded and encoded D. Clear and unclear

In reviewing a study for applicability for use on your unit, you need to evaluate the study in terms of: A. The sponsoring agency of the study B. Patient context and assess whether they are similar to patients in your unit C. Whether the sample adequately is described D. Qualifications of the study authors

In the University of California Los Angeles model, who is at the center of care? A. The nurse B. The patient, family, and community C. The patient and family D. The nurse and patient

In the hierarchy of evidence, which of the following has the highest value? A. Single correctional studies B. Randomized clinical trials C. Case study, opinion D. Descriptive studies

Many long-term care facilities assign ________________as charge nurses. A. Registered nurses (RNs) B. Licensed practical nurses (LPNs) C. Nursing supervisors D. Nurse externs

Regarding the SBAR process, pertinent background information related to the situation includes: A. Socioeconomic status of the family B. List of current medications allergies, intravenous fluids, and laboratory results C. Patient's dietary needs before hospitalization D. Family history of disease

Self-governance: A. Occurs at the point of care B. Is position based C. Has high staff input D. Integrates equity and accountability

The Age Discrimination in Employment Act of 1967 (ADEA), protects individuals age_______ and older. A. 30 B. 40 C. 50 D. 60

The National Patient Safety Goals: A. Form the basis of all process improvement activities B. Are a nationwide initiative C. Are mandated by the Institute of Medicine (IOM) D. Will improve patient safety

The Occupational Safety and Health Administration (OSHA) has provided guidelines for minimizing patient lifting to prevent health care musculoskeletal injuries. Within these guidelines, OSHA recommends that: A. Patients be allowed to decide whether safe lifting equipment should be used when transferring out of bed B. Manual lifting of residents be minimized and eliminated when feasible C. Only specific types of lifting equipment be used, such as a ceiling-mounted patient lift with a sling D. Institutions should be allowed to decide based on patient population whether safe lifting equipment should be used

The electronic physician order entry system: A. Prevents all medication errors B. Provides many online alerts and warnings for clinical care givers C. Poses problems when the system is done D. Is not the most acceptable type of physician's orders

The first step in integrating evidence into practice is to convert the clinical concern into a: A. Solution B. Question C. Decision D. Goal

The list of strategies for conflict resolution according to Huber (2013) includes all of the following except: A. Avoiding B. Reassuring C. Withholding D. Commending

What agency defines workplace violence as violent acts (including physical assaults and threats of assaults) directed toward persons at work or on duty? a. U.S. Department of Justice b. National Institute for Occupational Safety and Health (NIOSH) c. Occupational Safety and Health Administration (OSHA) d. American Nurses Association (ANA)

What is the average number of days that a patient remained in an occupied bed referred to as? A. The average daily census B. The average length of stay C. Nursing hours per patient D. Direct care hours

What is the document that permits an individual to give a surrogate or proxy the authority to make decisions for that person in the event that they become incompetent? A. Living will B. Durable power of attorney for health care decisions C. Advance directive D. Informed consent

What is the term used for decision making that occurs with the nurse manager on the unit? A. Centralized scheduling B. Decentralized scheduling C. Self-scheduling D. Mixed scheduling

When a nurse manager leads a group meeting, which of the following guidelines should be practiced? a. Strictly adhere to agenda. b. Establish goals and objectives. c. Make the meeting seem friendly. d. Provide snacks.

When accepting a delegated assignment, what does the nurse use per the State of New Jersey Nurse Practice Act, 1999? A. A nursing matrix B. A decision-making algorithm C. Facility policy D. Facility procedure

When delegating, the requirement of the right _________ means that you must know the competency level, job description, individual level of skill, and education of the individual to whom you are delegating. A. Direction/communication B. Person C. Task D. Circumstance

When implementing an evidence-base practice change, the all-important final step is to: A. Pilot the protocol. B. Monitor the results. C. Publish the study. D. Do a cost-benefit analysis.

Which ANA Principles for Nurse Staffing standard is applied to the organization? a. Nursing ratios are mandated. b. The need for documented competencies for all nurses delivering patient care is supported. c. That nursing budgeted positions are not filled in a timely manner is accepted. d. The needs of the staff nurse are secondary to the patient's needs.

Which council serves as a communication link for geographically remote sites within a multicampus system that uses the same shared governance model? A. Nurse executive council B. Entity-based council C. Unit-based council D. Advanced practice nurse council

Which model of nursing mixes both process and delivery? A. Modular B. Case management C. Primary care D. Team nursing

Which nursing actions demonstrate the role of management in nursing? a. Encouraging autonomous decision making b. Observing the documentation of appropriate charges to patients c. Assisting in a code d. Asking the patient/family about advance directive

Which of the following is a policy that pertains to the positions taken by professional organizations such as ANA? A. Health B. Organizational C. Institutional D. Health

Which of the following is on the list of "don'ts" regarding the change-of-shift report? A. Share significant information about family members B. Relay to staff significant changes in the way therapies are given C. Continually review ongoing discharge plan D. Review all routine care procedures

Which of the following sets educational standards, examination requirements, and licensing requirements and regulates the nursing profession in each particular state? A. The National League for Nursing (NLN) B. Nurse practice acts C. State board of nursing D. The National Council of State Boards of Nursing

Which of the following structures arranges services and departments according to their function? A. Organizational B. Functional C. Primary D. Centralized

Which type of structure is a hierarchy that follows a chain of command concept and is characterized by top-down decision making? A. Decentralized B. Organizational C. Functional D. Matrix

_____________(2013) states that shared leadership/participative decision making is a model in which nurses are formally organized to make decisions about clinical practice standards, quality improvement, staff and professional development, and research. A. American Nurses Association B. American Nurses Credentialing Center C. National League for Nursing D. State boards of nursing

___________________measures the number of patients with pressure ulcers at a certain point or period in time. A. Incidence B. Prevalence C. Benchmarking D. Trending

________________measure aspects of nursing care such as assessment, intervention, and Registered Nurse job satisfaction. A. Nursing-sensitive indicators B. Process indicators C. Core values D. Process improvement

he data for nursing sensitive indicators are collected at the institution and uploaded to the National Database of Nursing Quality Indicators. There are approximately _______US hospitals participating in this database. A. 1000 B. 1500 C. 2000 D. 2500

. A root-cause analysis: A. Focuses on risk management B. Is a Six Sigma model C. Determines process variation D. Is a prospective review

A decentralized leadership structure would be one that allows decision making: A. At senior levels B. By the board of trustees C. At the point of care D. By all involved

A key component of evidence-based practice is: A. Traditional practice B. Organizational commitment C. Patient preference D. Nurse ability

A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager? a. A nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A nurse acts quickly when a cardiac arrest is called on her patient. c. A nurse notifies another staff member that she is being ―pulled‖ today. d. A nurse volunteers to work when another staff member must leave work because her child is ill.

As a nurse, you are aware that one element that is common to the nursing process and the management process is: A. Identification of needs B. Identification of resources C. Planning D. Control

As a nurse, you have just read about a change in intervention insertion practice that sounds like it would work on your unit. Before suggesting such a change in practice, you need to: A. Perform a cost-benefit analysis of the new practice. B. Talk with the nurse manager to gain his or her opinion. C. Conduct a further review of the literature. D. Contact the nursing research committee.

Automated systems for providers to enter patient care orders and to access decision support databases are called: A. Clinical information systems B. Decision support C. Computerized provider order entry (CPOE) D. Electronic health records

Heidenthal and Marthaler (2005) state that what to delegate depends on all of the following factors except: A. Your state's nurse practice act B. Hospital policies and procedures C. What shift you are working D. The clinical situation

Lean" refers to: A. The attempt to make do with the smallest amount possible B. A type of financial arrangement in which dollars are saved C. Getting rid of waste in all work processes D. The streamlining of all patient processes for cost saving

One main difference between an ideal leader and an organization-focused manager is that an: A. Ideal leader maintains the status quo B. Organization-focused manager is creative C. Ideal leader is a risk-taker D. Organization-focused manager is a visionary

One use for the electronic health information is: A. Education B. Patient care delivery C. Patient care management D. Patient care support processes

Pressure ulcers cost $9.1 to $11.6 billion per year in the United States. The cost of individual patient care ranges from __________per year in the United States. A. $10,000 to $20,000 B. $15,900 to $23,000 C. $20,900 to $151,700 D. $40,000 to $50,000

Several laws have been implemented to ensure that there are equal employment opportunities for all individuals regardless of race, color, national origin, religion, sex, age, or disability. Which of the following acts prohibits discrimination against qualified individuals with disabilities who work in the federal government? A. Title VII B. Title I C. Sections 501 and 505 D. Sections 101 and 2012

Six Sigma is a model of quality focusing on: A. Process development B. Improving performance C. Decreasing the process variation D. Statistical analysis

The Joint Commission's evaluation and accreditation services are provided for the following types of organizations: A. State department of health and town senior housing services B. Physicians' offices and freestanding laboratory service agencies C. Home hemodialysis and peritoneal dialysis D. Critical access hospitals, home care organizations, and nursing homes

The Organ Procurement and Transplantation Network (OPTN) is a(n)________network. A. State B. Local C. National D. International

The experienced nurse can do the following to use evidence-based practice in their own practice: A. Use textbooks from school for reference. B. Maintain membership in alumni organization C. Review professional journals. D. Go back to school for an advanced degree.

The middle-level manager: A. Makes hospital-wide decisions B. Supervises a number of upper-level managers C. Is responsible for the people and activities on a 24-hours-a-day/7-days-a-week basis D. Is responsible for their specific shift only

The mission of the U.S. Department of Health and Human Services (USDHHS) is: A. To protect and promote the health and social economic well-being of legal immigrants by helping them and their families develop and maintain productive and independent lives B. To support legal immigrants both financially and legally C. To protect and promote the health and social and economic well-being of Americans by helping them and their families develop and maintain productive and independent lives D. To deport all illegal immigrants to their countries in an effort to maintain alliances with those countries

The nurse manager on the labor and delivery unit evaluates that one of the staff nurses has leadership qualities. Which of the following is a basis for this judgment? A. The nurse works overtime every week. B. The nurse stays long after her shift is over to chart. C. The nurse uses a monthly forum to review current knowledge content. D. The nurse uses a negative approach when evaluating staff skills.

There are __________principles of peer review. A. Four B. Five C. Six D. Seven

What are the five rights of delegation per the National Council of State Boards of Nursing (1997)? A. Right task, right circumstance, right person, right direction/communication, right unit B. Right task, right circumstance, right medication, right direction/communication, right supervision C. Right task, right circumstance, right person, right direction/communication, right supervision D. Right task, right time, right person, right direction/communication, right supervision

What is the transfer of information (along with authority and responsibility) during transitions in care across the continuum, to include an opportunity to ask questions, clarify, and confirm? A. Communications B. Change-of-shift report C. Handoff D. Physician order entry

Which ANA Principles for Nurse Staffing standard is applied to staffing? a. Nurse/patient ratios should be mandated. b. Clinical competencies of the staff are standardized for all units. c. Support of the staff nurses must come from all levels of nursing. d. Experienced nurses should work the day shift because it is the busiest.

Which is an assertive strategy in which one individual's needs are satisfied at another's expense? A. Compromising B. Accommodating C. Competing D. Bargaining

Which of the following does not maintain behavior that helps diffuse anger? A. Do not match threats B. Avoid any behavior that may be interpreted as aggressive C. Yell louder at the individual who is shouting at you D. Do not give orders

Which of the following is NOT the middle-level manager's responsibility? A. People within the departments they supervise B. Liaison between upper management and first-level manager C. Establishment of organizational goals D. Activities within the departments they supervise

Which of the following is a schematic description of a theory, phenomenon, or system that depicts how nurses practice, collaborate, communicate, and develop professionally to provide the highest quality care for those by the organization (American Nurses Credentialing Center [ANCC], 2013)? A. Medical home B. Accountable care organization C. Professional practice model D. Care delivery system

You are the nursing supervisor and there is a patient that will be going to the operating room for a kidney transplantation. It is the ultimate responsibility of ______________to check and ensure that the organ donor and recipient are correct. A. Surgeon B. Anesthesiologist C. Registered nurse and surgeon D. Surgeon and anesthesiologist

_________________is the passion in the face of adversity to take action and make things happen, it is the passion to do whatever it takes to accomplish the team objectives. A. Commitment B. Communication C. Collaboration D. Adaptability

The nurse and UAP are working together with four patients. Which patient should the nurse assign the UAP? a. A patient waiting for discharge instructions before going home b. A patient who received morphine 20 minutes ago and now has the call light on c. A patient with diabetes who needs her blood glucose checked d. A patient returning from a bronchoscopy

C. A patient with diabetes who needs her blood glucose checked

In addition to the organ procurement coordinator, which other resource is the best resource for the nurse to use in helping the family make a decision when there is disagreement among family members regarding organ donation? a. Nurse manager b. Physician c. Ethics committee d. Social worker

C. Ethics committee

. An example of a knowledge trigger for an evidence-based research question is: A. Patient fall data B. Database review C. Benchmark information D. Research study

. Another use for computerized information is: A. Finances B. Billing C. Inventory tracking D. All of the above

. As per Rundio and Wilson (2013, p. 64), informatics is a core competency of all health care professionals. The key areas of focus center on: A. National information infrastructure, computerized clinical data B. Clinical decision support, use of Internet C. Integration of evidence-based practice D. All of the above

. Organizations that recognize "best practice" are: A. American Nurses Association B. American Nurses Credentialing Center Magnet Status C. Malcolm Baldrige National Quality Award D. Press-Ganey Questionnaire

. The National Institute for Occupational Safety and Health (NIOSH) is: A. The agency that works closely with The Joint Commission and hospital accreditation B. A local agency that coordinates patient care and patient services C. A state agency that is part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services D. The federal agency responsible for conducting research and making recommendations for the prevention of work-related injury and illness.

A model of care in which the nurse assumes full accountability for care of a group of patients is: A. Case management B. Primary nursing C. Functional nursing D. Total patient care

According to the American Nurses Association (ANA, 2004), the process of daily staffing begins with an assessment of the current staffing situation. The assessment include which of the following? A. The qualifications of the staff needed B. The competence of the staff needed C. The supervisor input D. All of the above

Another name is added to the organ donation list every ________minutes A. 5 B. 6 C. 7 D. 12

Barriers to delegation can arise for which of the following health care workers? A. Registered nurse (RN) delegator B. RN delegate C. Licensed practical nurse (LPN) D. All of the above

For a team to be effective, each member of the group must be able to: A. Effectively communicate B. Offer constructive criticism C. Acknowledge the positive D. Do all of the above

Mechanisms related to resource identification and allocation have to be driven by internal data, and information systems that consider all domains of hospital data include: A. Clinical, fiscal, administrative, and patient satisfaction data B. Classification, financial, administrative, and patient satisfaction data C. Clinical, financial, social, and patient satisfaction data D. Clinical, financial, administrative, and patient satisfaction data

Nurses need to know the outcomes that directly affect their unit. Common outcomes for all units are: A. Infection rates B. Patient satisfaction C. Performance on The Joint Commission Core Measures D. All of the above are correct

Nursing informatics is a specialty that integrates nursing science, computer science, and information science to: A. Maintain and communicate data information, knowledge, and wisdom in nursing practice B. Manage and calculate data information, knowledge, and wisdom in nursing practice C. Manage and communicate data information, knowledge, and accountability in nursing practice D. Manage and communicate data information, knowledge, and wisdom in nursing practice

Nursing sensitive indicators include: A. Nursing turnover B. Patient falls C. Nosocomial infections D. All of the above are correct

One key feature of an electronic health record (EHR) is that it can be created, managed, and consulted by authorized providers and staff across ________other organization(s). A. 1 B. 2 C. 3 D. Many

Orientation of new employees is a two-stage process. The first stage includes orientation to the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the hospital orientation? a. ECG interpretation b. Critical care course c. Medication test d. BLS training

Over 144,000 payments totaling ______________have already been issued to professionals and hospitals by the Centers for Medicare & Medicaid Services (CMS) to have sharing of patient data on a nationwide level. A. $4.1 billion B. $5.1 billion C. $6.1 billion D. $7.1 billion

Public, private, and governmental health care decision makers at every level should include representation from nursing on: A. Nursing boards B. Executive management teams C. Key leadership positions D. All of the above are correct

Some activities may not be delegated. All of the following may be delegated except: A. Performing an initial patient assessment B. Updating the patient's plan of care C. Providing direct nursing care D. Giving a registered nurse (RN) a needle and syringe, unlabeled, and telling her to administer the medication even though the RN did not see the medication prepared

The Joint Commission (2014) states that a hospital must provide the right number of competent staff to meet the needs of the patients. Which of the following is not a criterion that must be present to meet the goal of providing adequate competent staff? A. Orienting, training, and educating staff B. The hospital provides ongoing in-service and other education and training. C. Assessing, maintaining, and improving staff competence D. Providing full monetary compensation for conferences and nurse certifications

The _________nurse no longer relies on rules to understand a situation or to act appropriately; focuses quickly on viable solutions; is able to lead a team efficiently; can organize others' work and supervise them effectively. A. Novice B. Expert C. Competent D. Proficient

The care delivery system continually improved to do what? A. Adjust to national patient safety goals B. Value-based outcomes C. Meet regulatory requirements D. All of the above

The difference between bioethics and ethics is: A. Bioethics is specific to health care; ethics deals with the principles of right and wrong. B. Bioethics is specific to health care; ethics deals with the principles of right and wrong, good and bad. C. Bioethics is specific to health care; ethics deals with the principles of right and wrong, good and bad with no issues of beliefs and values. D. Bioethics is specific to health care, ethics is the science that deals with the principles of right and wrong and of good and bad, and governs our relationships with others. It is based on personal beliefs and values.

The first rule for any team, committee, or council is the development of the ________of the group. A. Charge B. Team members C. Roles of individual team members D. Timeline

The professional nurse as decision maker is guided by which of the following? A. The American Nurses Association (ANA) Code of Ethics B. The ANA Standards of the State Nursing Practice Act C. State Titles D. All of the above

The staffing plan consists of four different elements that must be addressed. What do they include? A. The health care setting B. A care delivery model C. Patient acuity and nursing staff D. All of the above

The type of patient care in which the nurse caring for the patient makes most decisions is: A. Functional B. Team C. Case management D. Total patient care

There are four major types of staffing plans. The centralized method of staff planning refers to which of the following? a. The schedule is planned based on the core staff. b. The schedule is planned on each individual unit. c. The schedule is planned by the nurses themselves. d. The schedule is planned by the nursing service.

What are the emerging care delivery models addressed by the Patient Protection and Affordable Care Act (PPACA) of 2010? A. Accountable care organization B. Medical or home health C. Nurse-managed health center D. All of the above

Which of the following is a disadvantage of primary nursing? A. Improved quality and continuity of care B. Simplified communication C. Increased nurse satisfaction D. Increased number of hours of care per day requires greater number of registered nurses

Which of the following is a policy formed by governmental bodies such as legislation passed by a state legislature? A. Social B. Health C. Organizational D. Public

Which of the following is a policy that pertains to the governing of workplaces? A. Social B. Health C. Organizational D. Institutional

Which of the following is a system for the delivery of care that delineates a nurse's authority and accountability for clinical decision making and outcomes? A. Medical home B. Accountable care organization C. Professional practice model D. Care delivery system

Which of the following is not a principle of delegation? A. The nursing profession determines the scope and standards of nursing practice. B. The registered nurse (RN) takes responsibility and accountability for the provision of nursing practice. C. The RN directs care and determines the appropriate use of resources when providing care. D. The licensed practical nurse (LPN) can delegate tasks to the nursing assistant.

Which of the following is not considered a risk factor for violence in the health care setting? A. Isolated work with patients during exams and treatments B. Unlimited public access C. Overcrowded waiting rooms D. Security guard appointed to walk employee to car

Which of the following is not necessary during a new hire orientation to a hospital? A. Mission B. Vision C. Performance improvement D. Pay scales of the entire group

Which of the following is not one of W. Edwards Deming's 14-point management philosophy? A. Institute training on the job B. Cease dependence on inspection to achieve quality C. Adopt the new philosophy D. Begin the practice of awarding business on the basis of price tag

Which of the following would be a reliable source of information for a change in pediatric practice? A. Physician/staff discussion B. Editorial in Pediatric Nursing C. Growth and development charts D. Clinical trial results

Which of the following would be an example of a policy dealing with workplace safety? A. Safe patient handling B. Prevention of workplace bullying C. Staffing ratios D. All of the above are correct

Who is at the center or forefront of a professional practice model? A. The nurse B. The physician C. The health care team D. The patient and family

ccording to The Joint Commission (2014), accrediting agencies require that staff competence to perform job responsibilities must be assessed, demonstrated and maintained by ____________________. A. Human resources B. Nurse manager C. Education department D. All of the above

hich author/s states that a team is a group of people with a high degree of interdependence geared toward the achievement of a goal or a task? A. McGregor (1960) B. Parker (1990) C. Sullivan and Decker (2009) D. Maxwell (2002)

A novice nurse observes change differences in practice from what was taught in nursing school and expresses confusion to the nurse manager. The nurse manager suggests which of the following methods as the best resource to determine best practice in the clinical setting? a. Ask a former faculty member. b. Review the textbook used during nursing school. c. Research electronic databases such as CINAHL. d. Attend professional conferences.

D. Attend professional conferences.

The computerized provider order entry (CPOE) is a component of the electronic health care system being used in hospitals. This system allows prescriptions to be written electronically and automatically sent to the pharmacy or other necessary facilities. The nurse understands that the greatest benefit of the CPOE is a. lowered cost of prescriptions. b. faster delivery of medications from pharmacy. C. that fewer errors occur. d. that the nurse must confirm prescriptions directly with physician

NS: C Fewer errors occur with this system because there are no legibility issues and the entry is sent directly to pharmacy. The other options are not part of the process of the system

A nurse is caring for a patient with end-stage heart failure and understands the futility of care for this patient. The family is in denial and refuses to consent to a DNR (do not resuscitate). Their misperceptions regarding the DNR status may be based on which interpretation? a. A DNR order provides minimal care. b. A DNR order allows for pain medication administration. c. A DNR order allows for the administration of antibiotics. d. A DNR order allows for nutrition.

a. A DNR order provides minimal care.

Which patient should be considered the highest priority by the nurse manager? a. A patient who attempts suicide b. A patient who attempts to escape from the hospital c. A patient who refuses to eat d. A patient who refuses her medications

a. A patient who attempts suicide

Which of the following patients should the nurse see first after the shift report? a. A patient with a change in heart rhythm who is complaining of lightheadedness b. A patient with a newly placed pacemaker who is complaining of shoulder pain c. A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg d. A patient in first-degree heart bloc

a. A patient with a change in heart rhythm who is complaining of lightheadedness

The ethical principle of autonomy is being respected in which situation? a. A patient's right to refuse medications b. The right of a patient with tuberculosis to refuse to wear a mask when leaving the unit c. The right of a family to refuse to wear a gown and gloves when visiting a patient on contact precautions d. The right of a family to refuse to wear masks when visiting a patient on neutropenic precautions

a. A patient's right to refuse medications

Which order should be considered to have the highest priority when delivering care to a patient? a. Albuterol treatment for a patient complaining of shortness of breath b. IV diuretic for a patient in heart failure c. Sliding-scale short-acting insulin d. Antihypertensive for a patient admitted with negative cardiac enzyme

a. Albuterol treatment for a patient complaining of shortness of breath

Which of the following delegations by the RN would require an immediate intervention by the charge RN? a. An LPN administers IVP Lasix (furosemide) to a patient in heart failure. b. An RN administers IVP Lasix (furosemide) to a patient in heart failure. c. An LPN obtains a blood glucose level on a diabetic patient. d. An RN obtains a blood glucose level on a diabetic patient.

a. An LPN administers IVP Lasix (furosemide) to a patient in heart failure.

Which action by a UAP requires an immediate intervention by the nurse? a. Application of a skin barrier/protection ointment b. Releasing wrist restraints on a patient to allow ROM c. Assisting a patient to the bedside commode d. Obtaining a urine culture from a patient

a. Application of a skin barrier/protection ointment

A nurse must delegate some responsibilities of the care of patients on a particularly busy and chaotic day to the LPN and UAP team members. Which of the following can be appropriately delegated to the LPN? a. Assisting with a central line insertion b. Giving bath supplies to patients who are capable of bathing themselves c. Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia d. Transporting a patient in a wheelchair for discharge

a. Assisting with a central line insertion

A nurse decides to use the ethical principle of deontology to make clinical decisions. This principle is based on treating all people the same regardless of circumstances and on one's duty to do the right thing regardless of circumstances. Which situation would most likely cause an ethical dilemma for this nurse? a. Assisting with a laparoscopy for a tubal pregnancy b. Refusal of a patient to take his medications c. Patient reconsiders surgery for cancer d. Woman refuses to terminate her pregnancy even knowing the fetus has non-life-sustaining defects

a. Assisting with a laparoscopy for a tubal pregnancy

The nurse is caring for a patient with heart failure resulting in irreversible kidney damage who decides to go home to die rather than accept hemodialysis. The nurse understands that the patient is practicing which ethical principle? a. Autonomy b. Beneficence c. Justice d. Veracity

a. Autonomy

A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What action is best for the nurse to take to protect herself? a. Call security and notify them of the threat. b. Ask security to escort you to your car. c. Explain to the visitor that you carry a gun. d. Assume that this was a joke

a. Call security and notify them of the threat.

Employees who are dependent on drugs or alcohol Will exhibit signs that should not be ignored by the nurse manager and colleagues. Which of the following signs would alert the nurse manager that the employee may have a dependency problem? a. Changes in behavior or appearance b. Requesting time off to be with a family member c. Scheduled overtime d. Dieting

a. Changes in behavior or appearance

A goal of The Joint Commission (TJC) is prevention of health care-associated pressure ulcers. In which situation would the institution fail in complying with that goal? a. Charting of the Braden Risk Assessment Scale b. Utilization of the Braden Risk Assessment Scale to prevent pressure ulcers from developing c. Documentation of stages of pressure ulcers to determine appropriate action to take d. Turning at-risk patient every 2 hours

a. Charting of the Braden Risk Assessment Scale

The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict? a. Coordinating institutional goals with the immediate demands of the clinical area b. Determining which of the staff members should get better raises than other members c. Deciding which employees should be recommended for promotion d. Determining which staff members get Christmas day of

a. Coordinating institutional goals with the immediate demands of the clinical area

The AACN has addressed the issue of horizontal violence in the workplace and made recommendations for actions by the nurse manager. Which of the following are recommendations for action by the AACN against workplace horizontal violence? a. Develop a culture that does not tolerate violence. b. Report all incidences to upper management's M c. Separate the two people by not assigning them to work on the same shifts. d. Ask the two people to sit down and work it out

a. Develop a culture that does not tolerate violence.

When analyzing the sources for conflict, the nurse manager may identify which of the following as one of the most likely sources? a. Different attitudes b. Different facts or perception of the event c. Different incomes d. Different ages

a. Different attitude

After receiving the shift report, which of the following requires a priority action by the nurse? a. Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain. b. Make assignments for the team. c. Talk to a patient who has changed his mind about having a procedure today. d. Round on all the patients on their team.

a. Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain.

The nurse manager receives a telephone call from an RN saying she will be late because of traffic due to an accident. The charge nurse needs to make arrangements for the care of that nurse's team of patients until her arrival. What is the best action to take to ensure the management of those patients until the RN arrives? a. Distribute the patients evenly to each of the other nurses. b. The charge nurse will take the assignment until the RN's arrival. c. Ask the nurse manager to assume care temporarily. d. Ask the night nurse to stay until the RN's arrival.

a. Distribute the patients evenly to each of the other nurses.

The most common impact on the nurse of The Joint Commission standards is through the management of the pain standard. Which action is necessary to comply with the standard? a. Documentation of the relief of pain b. Providing for alternative pain medications c. Prescribing the correct dosage of pain medication d. Documentation of the frequency of medication administration

a. Documentation of the relief of pain

The Joint Commission (TJC) measures the management of infections within the institution. By which method will TJC be able to measure the performance of the institution to manage infections? a. Employment of an infection control nurse b. Interviews with patients and families c. Staff follow-up for prevention d. Documentation of a patient's infection

a. Employment of an infection control nurse

Harm to patients from medication errors is a component to initiation of research in which of the following ways? a. Establishing a question b. Establishing a solution c. Establishing a population sample d. Establishing a cost benefit

a. Establishing a question

The Institute of Medicine (IOM) report challenges nurses and society to ensure that nurses are represented in leadership positions in health care, including governing boards. According o the latest data, approximately how many nurses sit on governing boards? a. Less than %5 b. More than %5 c. 15 % d. 10%

a. Less than %5

A student nurse is working with a preceptor who appears abrupt and disinterested in precepting students. What action by the student is most appropriate? a. Notify the instructor. b. Talk with the nurse to see what is wrong. c. Identify this as lateral violence. d. Nothing, he was having a bad day

a. Notify the instructor

Which council is concerned with the management of resources as defined in the strategic plan and nursing conceptual framework? a. Nurse Executive Council b. Unit-Based Council c. Nursing quality and patient safety council d. Advanced practice nurse counci

a. Nurse Executive Counci

Which council advances the practice of nursing and fosters the nursing role in patient education through staff and development and evidence-based research initiatives? a. Nursing Staff Development, Education and Research Council b. Nurse executive council c. Advanced practice nurse council d. Nursing informatics and communication council

a. Nursing Staff Development, Education and Research Council

A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? a. Obtain a 12-lead ECG. b. Notify the health care provider. c. Call the patient's wife to have her sit with him to calm him. d. Ask the UAP to obtain a blood glucose level.

a. Obtain a 12-lead ECG.

The nurse explains the PICO acronym to colleagues in which of the following ways? a. PICO represents the questions to ask regarding application of the research to the specific setting. b. PICO represents the trigger for initiating the research. c. PICO represents the benchmarking website used in research. d. PICO represents the regulatory guidelines established for practitioners.

a. PICO represents the questions to ask regarding application of the research to the specific setting.

Which of the following would be considered a sentinel event? a. Patient who has developed a fatal mediastinal infection 7 days after cardiac surgery b. Patient who experiences a CVA during a cardiac catheterization c. Patient who receives a double dose of a medication in error d. Wrong patient scheduled for a chest radiograph

a. Patient who has developed a fatal mediastinal infection 7 days after cardiac surgery

When determining the basis for conflict, interpersonal sources as the basis would include which of the following? a. Personality differences b. Shift preferences c. Staffing inconsistency d. Assignments

a. Personality differences

a. Primary nursing

6. A patient turns his call light on and states, ―I'm having trouble breathing.‖ Which team members should be delegated to respond to this call light? a. RN b. LPN c. Senior student nurse d. UA

a. RN

When integrating evidence-based research into practice, the nurse understands that the type of research is important to the application of a particular nursing unit. Which of the following factors is most important in determining the usefulness of the research to the needs of the practice? a. Randomized clinical trials b. Case studies c. Anecdotal information d. Single correctional studies

a. Randomized clinical trials

There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admission

a. Responding to a patient complaint

When incorporating the five rights of delegation, the right supervision is used in which of the following situations? a. The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. b. The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL. c. The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL. d. The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL.

a. The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL

When incorporating the five rights of delegation, the right task is used in which situation? a. The UAP reinforces use of the incentive spirometer to a patient. b. The UAP teaches the patient to use the incentive spirometer. c. The UAP listens to breath sounds to encourage the patient to use the incentive spirometer. d. The UAP is not allowed to work with the patient regarding use of the incentive

a. The UAP reinforces use of the incentive spirometer to a patient.

The care delivery system is integrated into the professional practice model. What does the care delivery model describe? a. The manner in which care is delivered, the context of care, and the expected outcomes of care b. The context of nursing care c. The expected outcomes of care d. Care delivery and outcomes

a. The manner in which care is delivered, the context of care, and the expected outcomes of care

The professional practice model of an organization illustrates the alignment and integration of nursing practice with which of the following: a. The mission, vision, and values of the organization and the nursing department b. The mission and vision of the nursing department c. The mission, vision, and values of the organization d. The state nursing code of ethics

a. The mission, vision, and values of the organization and the nursing department

The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN complete? a. Vital signs on a patient admitted from the ED b. Turning a patient who had a CVA 4 days ago c. Feeding a patient requiring assistance d. Recording the I&O on a patient on strict fluid restrictions

a. Vital signs on a patient admitted from the ED

The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the UAP? a. Vital signs on all patients admitted on the previous shift b. Vital signs on a patient being transferred from the ED c. Vital signs on a patient being transferred from the ICU d. Vital signs on a newly admitted stable patient

a. Vital signs on all patients admitted on the previous shift

A student nurse is conducting a research project for school. Although this is a new assignment, she understands that the quickest and most dependable source of information is the Internet. Which resources require intervention by the instructor? a. Wikipedia b. CINAHL c. MEDLINE d. Online nursing journals

a. Wikipedia

When providing care to patients, nurses use evidence-based practice to avoid urinary tract infections whenever the insertion of a urinary catheter is performed by a. a UAP. b. an RN. c. an LPN. d. a senior nursing student

a. a UAP

When providing care to patients, nurses use evidence-based practice whenever they a. advise patients with musculoskeletal back pain to continue normal daily activities within limits of their pain tolerance. b. advise patients with musculoskeletal back pain to remain on bedrest until pain has been relieved by prescribed back exercise. c. advise patients that early premature activity with musculoskeletal pain may lead to permanent disability. d. advise patients that continued normal activity after a musculoskeletal back injury may result in delayed return to work.

a. advise patients with musculoskeletal back pain to continue normal daily activities within limits of their pain tolerance.

As a nurse and member of the Professional Practice Committee at your institution, you will be asked to review policies and to make suggestions for changes. The components of the review will include a. evidence of the current practice, and a literature review to determine current best evidence. b. a nursing literature review. c. evidence of outcomes. d. comparison studies

a. evidence of the current practice, and a literature review to determine current best evidence.

The American Nurses Association (ANA) Code of Ethics for nurses is primarily a statement in support of a. patient advocacy. b. professional membership. c. missionary work. d. preventative health care.

a. patient advocacy.

In caring for a baby with non-life-sustaining defects, the nurse will most likely make decisions based on a. personal ethical beliefs and values. b. treating all patients equally. c. treating all patients with respect and courtesy. d. the futility of life issue.

a. personal ethical beliefs and values.

After reporting a nurse with a substance abuse problem to the State Board of Nursing (SBON), the next step that will most likely occur is a. surrender of license if complaint is found to be valid. b. counseling and then the nurse can return to work.

a. surrender of license if complaint is found to be valid.

The four major areas of political action in nursing are a. the workplace, the government, professional organizations and the community. b. the workplace, the educational institutions, professional organizations and the community. c. the government, professional organizations and the state regulators, community boards. d. the government, the community and nursing boards, education board.

a. the workplace, the government, professional organizations and the community.

When providing care to a child requiring temperature measurement, nurses use evidence-based practice whenever they a. understand that a rectal temperature is the most accurate method in a child. b. understand that a rectal temperature is the least accurate method in a child. c. understand that an axillary temperature is the most accurate method in a child. d. understand that adding 1C to an axillary temperature in a child is as accurate as a rectal temperature

a. understand that a rectal temperature is the most accurate method in a child

The charge nurse in the ICU receives a call from the ED. They have three patients who require a bed. Which patient should be transferred first? a. A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention b. A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion c. A patient in sickle cell crisis with a PCA pump to manage his pain d. A patient in DKA for new-onset diabetes mellitus

b. A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion

Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit? a. A patient being transferred to an ECF for rehabilitation following a hip replacement b. A patient following a hip replacement with a history of an acute MI 4 weeks ago c. A patient with an external fixator d. A patient to be started on a PCA pump requiring instructions

b. A patient following a hip replacement with a history of an acute MI 4 weeks ago

Which patient should be considered the highest priority by the new RN? a. A patient who is requesting his pain medication b. A patient who is reported by the UAP to be choking c. A patient who is requiring suctioning per tracheostomy d. A patient who is requiring discharge instructions who is waiting at the desk with her family

b. A patient who is reported by the UAP to be choking

Which patient should be considered the highest priority by the charge nurse? a. A patient who is complaining that no one answers his call light b. A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure c. A confused patient who is attempting to get out of bed d. A patient who is asking for help to the bathroom

b. A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure

Which of the following delegations by the RN would require an immediate intervention by the charge RN? a. A UAP checks a diabetic patient's blood glucose level. b. An LPN assesses a patient after a fall. c. The charge nurse makes changes to the assignments after staff is ―pulled‖ to another area. d. An RN assists with administering medication to another nurse's patients during a code.

b. An LPN assesses a patient after a fall

A nurse assesses a patient reported to have normal vital signs throughout the night and finds the patient in acute respiratory distress. What is the nurse's next best action? a. Delegate vital signs to the UAP. b. Ask another nurse to call the health care provider. c. Call a code. d. Start another peripheral IV line

b. Ask another nurse to call the health care provider.

A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza Iis complaining of shortness of breath with an oxygen saturation of 88%. Which action by the RN is best? a. Increase the oxygen concentration. b. Ask respiratory therapy to administer an albuterol treatment. c. Notify the health care provider. d. Determine if anxiety could be causing the shortness of breath.

b. Ask respiratory therapy to administer an albuterol treatment.

Which population does a Traditional Care Model (TCM) specifically target? a. Pediatric b. Elderly/geriatric c. Maternal child

b. Elderly/geriatric

Most organizations provide assistance to employees with problems that can affect their work performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? a. Faith-based initiatives b. Free confidential employee assistance programs (EAPs) c. Fee-for-service private counseling d. The nurse manager fills this role in most institutions.

b. Free confidential employee assistance programs (EAPs)

What step in the employment process may have been omitted when the staff appears to be nervous and overly cautious around a new nurse manager? a. Involvement of human resources in the interview process b. Involvement of the upper-level manager in the interview process c. Involvement of the staff in the interview process d. Involvement of the middle-level manager in the interview process

b. Involvement of the upper-level manager in the interview process

First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit's budget c. Maintaining currency in profession d. Making daily patient rounds

b. Managing the unit's budget

Workplace violence can be initiated by an employee in the workplace as well as by patients or family members. Which of the following would be cause for concern when observed in an employee? a. Divorce b. Personality changes c. Death in the family d. Miscarriage

b. Personality changes

What is a recommendation from the Occupational Health and Safety Administration for prevention of violence in the workplace? a. Assign different shifts. b. Provide training and education. c. Point out the issues to the people involved. d. Arrange for the people involved to meet and discuss the issues

b. Provide training and education

Which of the following is a risk factor for hospital workplace violence? a. Unlimited security coverage b. Public availability 24 hours a day c. Insecure medication access d. Semiprivate rooms

b. Public availability 24 hours a day

The nurse is working on a medical unit with an LPN and a UAP as the team members. Which tasks should the RN complete? a. Assignments of new admissions to staff b. Regulation of heparin drip based on the heparin nomogram c. Vital signs on patients admitted on previous shift d. Dressing change for a patient 4 days post I&D of a pacemaker wound

b. Regulation of heparin drip based on the heparin nomogram

The nurse manager works regularly with a nurse who has recently gone through a custody battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems ―giddy‖ and is acting inappropriately. The nurse manager understands that she must take which of the following actions? a. Counsel the nurse on these observations. b. Report this behavior to human resources and the state board of nursing. c. Give her the evening off. d. Work closely with her to prevent unsafe care to the patients.

b. Report this behavior to human resources and the state board of nursing.

Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business? a. Ability to pressure staff to do what you want b. Resource utilization c. Cutting corners to make money d. Providing bonuses to staff members who help the organization to save money

b. Resource utilization

The student nurse, shadowing on a medical-surgical unit, observes the charge nurse. Which action would the student identify as a leadership quality in the nurse's actions? a. Making patient care assignments distributed equally to staff b. Sitting with a confused combative patient c. Calling the nursing office for extra staff when an RN calls in sick

b. Sitting with a confused combative patient

What methods can administration use for the prevention of workplace violence? a. Separate staff entrance b. Staff ID badges c. Separate parking for staff d. Visual presence of security at all times

b. Staff ID badges

When incorporating the five rights of delegation, the right communication is used when a patient's blood pressure is low in which of the following situations? a. The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low. b. The RN tells a UAP to recheck the patient's blood pressure and report back to her before giving the patient a bath. c. The UAP gives a bath to a patient with a low blood pressure. d. The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure.

b. The RN tells a UAP to recheck the patient's blood pressure and report back to her before giving the patient a bath.

Who is at the center of care in The University of California Los Angeles Model? a. The nurse b. The patient, family, and community c. The patient and family d. The nurse and patient

b. The patient, family, and community

The Joint Commission (TJC) goals include the safe and accurate delivery and reconciliation of medication administration. In which way is this goal measured? a. Charting medications on an MAR b. Use of an admission medication list c. Use of the six rights of medication administration d. Documentation of pharmacy accuracy in dispensing of medications

b. Use of an admission medication list

Which ethical principle should help guide the nurse who suspects another nurse is incorrectly charting pain medications and then taking them? a. Autonomy b. Veracity c. Justice d. Beneficence

b. Veracity

A nurse is caring for a patient who has developed MODS (multiorgan dysfunction syndrome) resulting from septic shock. The patient is ventilator dependent and on vasopressors to maintain a Doppler-measured blood pressure of 80 mm Hg. The family is resistant to permit terminal weaning. The best action by the nurse is to a. insist that the family disconnect the patient from the ventilator. b. ask the family to meet with the hospital's ethics committee c. seek a family member who does agree and have them sign the consent form. d. arrange for the vasopressors to be turned off when the family is not present

b. ask the family to meet with the hospital's ethics committee

When collecting data for research purposes on patient safety methods, the nurse would use a. maximum census of patients on a specific unit over the course of admissions for 1 year.b. maximum census of the entire hospital over the course of admissions for 1 year. c. information obtained in other, similar research projects. d. appropriate research design.

b. maximum census of the entire hospital over the course of admissions for 1 yea

In a health care organization, equity is a. a willingness to invest in decision-making and express ownership in those decisions. b. the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes. c. recognition and acceptance of the importance of everyone's work and of the fact that an organization's success is bound to individual performance. d. linking health care providers and patients along all points in the system.

b. the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes.

When providing care to patients, nurses understand that evidence-based practice supports the concept that a. to avoid atelectasis and pneumonia, use of an incentive spirometer has an outcome equal to coughing for a patient following surgery. b. to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery. c. to avoid atelectasis and pneumonia, use of an incentive spirometer has a worse outcome than coughing for a patient following surgery. d. neither coughing nor use of an incentive spirometer will avoid atelectasis or pneumonia in postoperative patients

b. to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery.

Which responses by nurses incorporate reasons for resistance to research utilization? a. ―I want to see the outcomes for the patients.‖ b. ―I believe that patients will not benefit from this change.‖ c. ―I've grown tired of doing it the same way.‖ d. ―I'm ready for a change.‖

b. ―I believe that patients will not benefit from this change.‖

How can nurses communicate their positions to help influence policy? 1. Ongoing representation on policy-making committees. 2. Committees or boards. 3. Lobbying. 4. Making new laws at the state level. 5. Meeting with people in positions of influence a. 1, 2, 4 b. 1, 2, 5 c. 1, 2, 3, 5 d. 1, 2, 4, 5

c. 1, 2, 3, 5

Arrange in order of priority the nurse's actions when a patient admitted with an elevated ST-segment myocardial infarction on droplet precautions and oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. 1. Call the rapid response team (RRT). 2. Obtain a chest radiograph. 3. Obtain a 12-lead ECG. 4. Initiate a bronchodilator nebulizer treatment. 5. Increase the oxygen concentration 2 L. 6. Repeat the oxygen saturation in 10 minutes. a. 5, 3, 2, 4, 6, 1 b. 1, 4, 2, 5, 6, 3 c. 4, 5, 6, 3, 1, 2 d. 5, 4, 3, 6, 2, 1

c. 4, 5, 6, 3, 1, 2

Which of the following delegations require an immediate intervention by the charge RN? a. A UAP ambulates a patient 24 hours after a cardiac catheterization. b. A UAP ambulates a patient 24 hours after a bronchoscopy. c. A UAP ambulates a patient 24 hours after a pneumonectomy. d. A UAP ambulates a patient 24 hours after an echocardiogram

c. A UAP ambulates a patient 24 hours after a pneumonectomy.

Which of the following delegations by the RN would require an immediate intervention by the charge RN a. A UAP removes the wrist restraints on a patient and provides ROM exercises when giving a bath. b. An LPN assists a patient back to bed from the bathroom. c. A UAP replaces the monitor electrodes on a patient after he has taken a shower. d. An LPN assesses LOC on a stable patient 3 days after surgery

c. A UAP replaces the monitor electrodes on a patient after he has taken a shower.

Which nursing professional organization represents the interests of nurses regarding many issues, tracks nursing and health care related bills across all states and examines priority issues and trends? a. ANCC b. Sigma Theta Tau International c. ANA d. CCNE

c. ANA

If a patient does not have an advance directive or has not expressed his wishes regarding end of life care, what ethical principle may help the family to make the right decision? a. Autonomy b. Fidelity c. Beneficence d. Veracity

c. Beneficence

A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? a. Call the patient's wife to have her sit with him to calm him. b. Ask the UAP to obtain a blood glucose level. c. Call the Rapid Response Team. d. Ask the charge nurse to check on the other patients.

c. Call the Rapid Response Team.

During a convention at a large hotel, several attendees become very ill with respiratory symptoms for which they are diagnosed with Legionnaires' disease. Which regulatory agency is responsible for investigation of an outbreak of Legionnaires' disease? a. Occupational Safety and Health Administration (OSHA) b. The Joint Commission (TJC) c. Centers for Disease Control and Prevention (CDC) d. National League of Nursing Accrediting Committee (NLNAC)

c. Centers for Disease Control and Prevention (CDC)

Which action by a UAP requires an immediate intervention by the nurse? a. Encouraging a patient to use the incentive spirometer b. Encouraging a patient to ambulate 2 days after surgery c. Checking the pH of the gastric aspirate of a patient receiving tube feedings d. Informing the RN that a patient requests a pain medication

c. Checking the pH of the gastric aspirate of a patient receiving tube feedings

Human resources is required to provide education on violence prevention and management, which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? a. Location of all monitoring equipment b. Schedule of security officers rounds c. Early recognition and response plan d. Identification of people most at risk for causing harm

c. Early recognition and response plan

The people of the United States depend on many agencies working under the leadership of the U.S. Department of Health and Human Services (HHS) for assistance, research, and protection. Which service would be expected under the HHS leadership? a. Restricting the cost of prescriptions b. Limiting accessibility to family planning c. Ensuring food and drug safety d. Providing day care for low-income families

c. Ensuring food and drug safety

Family members who have access to hospitals may present risks to the staff when which of the following is most likely present? a. Family members are not doing well. b. Family members are in the intensive care unit. c. Family members are under the influence of drugs or alcohol. d. Family members are unable to visit regularly

c. Family members are under the influence of drugs or alcohol.

In which situation should the SBAR (Situation-Background-Assessment-Recommendation) tool most appropriately be used? a. To reduce the risk of nosocomial infections b. To improve response to changes in patient condition c. In hand-off communication

c. In hand-off communication

Which of the following would most likely present the most difficult step in research utilization? a. Monitoring outcomes b. Determining the research question c. Instituting the change d. Piloting the project

c. Instituting the change

A nurse renewing advanced cardiac life support is practicing which ethical principle? a. Veracity b. Fidelity c. Nonmaleficence d. Beneficence

c. Nonmaleficence

The Centers for Disease Control and Prevention (CDC) is a department headed by the Secretary of the U.S. Department of Health and Human Services (HHS). Which of the following situations would be expected to be investigated by this department? a. Inaccessibility of the influenza shot b. Toxic spill near a school c. Outbreak of Salmonella d. Rubella exposure of a pregnant woman

c. Outbreak of Salmonella

A nurse involved in evaluating the validity of research prior to implementation should consider which of the following as the most important hierarchical evidence for effectiveness? a. Opinions from experts b. Single observational studies c. Randomized controlled versus nonrandomized trials d. Systematic review study

c. Randomized controlled versus nonrandomized trials

The Food and Drug Administration (FDA) is a department headed by the Secretary of the U.S. Department of Health and Human Services (HHS). Which function would be expected of this department? a. Regulation of herbal drugs b. Control of the price of medications c. Regulation of the safety and efficacy of medications d. Licensing of nurses

c. Regulation of the safety and efficacy of medications

Universal strategies to use in the presence of escalation of a potential violent situation include which of the following? a. Demand that the potentially person back off. b. Remain close to the patient to protect her. c. Remain calm with a caring attitude. d. Speak loudly with authority.

c. Remain calm with a caring attitude.

c. Staff participates on hospital committees.

When incorporating the five rights of delegation, the right circumstance is used in which of the following situations? a. The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip. b. The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema. c. The RN asks the UAP to draw blood on a newly admitted patient with pneumonia. d. The RN asks a new UAP to draw blood on a patient known to be a ―hard stick.‖

c. The RN asks the UAP to draw blood on a newly admitted patient with pneumonia.

Care delivery models are continually improved to adjust to which of the following? a. National safety goals and best evidence b. National safety goals and outcomes c. To national patient safety goals, value-based outcomes, regulatory requirements, and current best evidence. d. Regulatory requirements

c. To national patient safety goals, value-based outcomes, regulatory requirements, and current best evidence.

When providing care to postoperative patients, nurses use evidence-based practice whenever they a. continue bedrest after surgery until the pain level is 1 on a scale of 1 to 10. b. continue bedrest after surgery until the pain level is 2 on a scale of 1 to 10. c. ambulate patients as soon as possible after surgery. d. ambulate patients as soon as they are awake from anesthesia.

c. ambulate patients as soon as possible after surgery.

The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation

c. clinical decision making.

Nurse managers can best be described as people who a. develop institutional goals based on staff suggestions. b. develop institutional goals based on a personal theory. c. motivate staff to meet institutional goals through positional power. d. inspire staff to meet institutional goals through personal power.

c. motivate staff to meet institutional goals through positional power.

5. Nursing shared governance models have always focused on a. physician groups controlling all practice models. b. nurses and physicians making nursing practice decisions. c. nurses controlling their professional practice. d. national accreditors controlling nursing practice decisions

c. nurses controlling their professional practice

In a health care organization, ownership is a. a willingness to invest in decision-making and express ownership in those decisions. b. the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes. c. recognition and acceptance of the importance of everyone's work and of the fact that an organization's success is bound to individual performance. d. linking health care providers and patients along all points in the system

c. recognition and acceptance of the importance of everyone's work and of the fact that an organization's success is bound to individual performance.

There are three steps to conflict management: determining the basis, analyzing the source, and conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? a. Food served b. Medication effects c. Ethical dilemmas d. Smoking withdrawal

c.. Ethical dilemmas

Which of the following patients should the charge nurse admit to a room with a patient who is confused and incontinent of stool? a. A postoperative patient b. A patient with diabetes c. A patient who is going to surgery later today d. A patient from the cardiac catheterization lab who is going home in the morning

d. A patient from the cardiac catheterization lab who is going home in the morning

The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the LPN? a. Vital signs on a patient about to arrive from the cardiac catheterization lab b. Regulation of a patient's heparin drip based on the heparin nomogram c. Regulation of a patient's nitroglycerin drip based on the level of pain d. Administration of all oral medications for the team

d. Administration of all oral medications for the team

. Which of the following guides the professional nurse as decision maker? a. The American Nurses Association (ANA) Code of Ethics b. The ANA Standards of the State Nursing Practice Act c. State Titles d. All of the above

d. All of the above

A nurse decides to use the ethical principle of utilitarianism to make clinical decisions. This principle is based on the greatest good for the greatest number. Which situation would most likely cause an ethical dilemma for this nurse? a. Triaging a disaster scene b. Maintaining ventilatory support on a patient with six children c. Evacuation of all mobile patients I during a flood d. Allowing a patient with influenza to return home from the clinic after diagnosis

d. Allowing a patient with influenza to return home from the clinic after diagnosis

An agency nurse is assigned to the thoracic surgery postoperative nursing unit. Which of the following would be the best action by the charge nurse? a. Call the agency to determine her level of experience. b. Assign the nurse to patients ready for discharge. c. Assign her to pass medications only. d. Ask the nurse about her level of experience.

d. Ask the nurse about her level of experience

Which actions by the UAP would require immediate follow-up by the nurse? a. Informing the nurse she was taking a break b. Taking her lunch break on her home floor after being pulled to another floor c. Asking the patient to let her know the next time he has a bowel movement d. Asking another UAP to obtain a urine sample for her

d. Asking another UAP to obtain a urine sample for her

When nurses are confronted with ethical dilemmas that challenge their values and beliefs, what is the best source to rely on to make the right decision? a. Personal religious beliefs b. Hospital chaplain c. Family interactions d. Belief in patient advocacy

d. Belief in patient advocacy

The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit

d. Establishing the new area as a step-down unit

Which delegation should a UAP consider to have the highest priority? a. Obtaining a routine blood glucose level from a patient with diabetes b. Giving a bath to a patient scheduled for a colonoscopy c. Feeding a patient who needs assistance doing so. d. Helping an older adult patient to the bathroom

d. Helping an older adult patient to the bathroom

Which of the following is a policy that pertains to the governing of workplaces? a. Social b. Health c. Organizational d. Institutional

d. Institutional

Of the steps to implementation, research is not complete until which of the following steps is accomplished? a. Synthesizing relevant research b. Determining the sufficiency of the sample c. Instituting the change d. Monitoring the outcome

d. Monitoring the outcome

In the workplace, violence may escalate as a result of many factors. Which of the following should the nurse be alert for in the escalation to violence? a. Crying b. Isolation c. Asking for helpd. Pacing and using profanity

d. Pacing and using profanity

The nurse working the night shift has concerns about the safety of the unit. What would cause security concerns for this nurse? a. A visitor is sleeping in the recliner in the room with their family member. b. A parent stays overnight with their teenage child. c. No unit secretary is assigned for the night shift. d. She is working with only one other employee

d. She is working with only one other employee

Registered nurses are fundamental to the success of emerging patient-centered care delivery models. Which emerging patient-centered care model directs renewed attention and substantially more resources and incentives to promote those elements of care that are also the backbone of nursing practice? a. Nurse-Managed Health Clinics (NMHCs) b. The Patient-Centered Medical Home c. Accountable Care Organization d. The Patient Protection and Affordable Care Act of 2010 (PPACA)

d. The Patient Protection and Affordable Care Act of 2010 (PPACA)

When incorporating the five rights of delegation, the right person is being used in which of the following situations? a. The LPN initiates TPN to a patient as ordered. b. The charge nurse designates a UAP to ―float‖ to another unit. c. The staff nurse trades weekends with another staff nurse. d. The UAP assists a patient to the bathroom after an echocardiogram.

d. The UAP assists a patient to the bathroom after an echocardiogram

A UAP is asked to take a patient's temperature every 4 hours and report that temperature to the RN. Which best demonstrates the correct interpretation of right communication? a. The UAP takes the temperature for the patient every 4 hours. b. The UAP charts the temperature for the patient every 4 hours. c. The UAP reports that the patient has been afebrile all day. d. The UAP reports the temperature for the patient every 4 hours.

d. The UAP reports the temperature for the patient every 4 hours.

. A nurse observes unsafe practice by a physician and reports it to the risk management department of the hospital. Which ethical principle does this represent? a. Autonomy b. Beneficence c. Justice d. Veracity

d. Veracity

According to the Professional Practice Model (PPM) cited in the Clinical Corner section of this chapter, whose theory was used as the basis of the newly created PPM? a. Newman b. Nightingale c. Parse d. Watson

d. Watson

Horizontal conflict in the workplace is observed with which of the following situations? a. Discussion with the manager before escalation occurs b. Refusing to work on day off c. Sharing views on patient care d. Withholding information that will undermine the ability to perform his job

d. Withholding information that will undermine the ability to perform his job

A nurse decides to use the ethical principle of teleology to make clinical decisions. This principle is based on the premise that actions are determined by their consequences. Which situation would most likely cause an ethical dilemma for this nurse? a. Assisting with a laparoscopy for a tubal pregnancy b. Refusal of a patient to take his medications c. Patient reconsiders surgery for cancer d. Woman refuses to terminate her pregnancy even knowing the fetus has non-life-sustaining defects

d. Woman refuses to terminate her pregnancy even knowing the fetus has non-life-sustaining defects

The International Council of Nurses (ICN) Code of Ethics for nurses is primarily a statement in support of a. environmental protection. b. professional membership. c. everyday decision making. d. collective bargaining.

d. collective bargaining.

When making clinical practice changes, nurses should make permanent changes based on a. reviewing other unit practices. b. reviewing case reports. c. obtaining expert opinions. d. implementing piloting changes

d. implementing piloting changes

When providing care to patients at risk for ARDS, nurses use evidence-based practice whenever they a. suction a patient at high risk for developing ARDS every 2 hours. b. suction a patient at high risk for developing ARDS whenever crackles are auscultated. c. turn a patient at risk for developing ARDS every 2 hours. d. turn a patient at risk for developing ARDS every 5 minutes.

d. turn a patient at risk for developing ARDS every 5 minutes.

A patient turns his call light on and requests someone to help him ambulate. The senior student nurse has been caring for this patient for 2 days but has only helped him to a chair in the past. Which instructions should be given to the student prior to ambulation of the patient? a. ―The patient has been ambulated before but still requires some assistance.‖ b. ―The patient has been ambulated before but is only able to walk with supervision and a walker.‖ c. ―The patient is only able to walk with a walker for the length of the hallway.‖ d. ―The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).‖

d. ―The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).

Which statement made by the clinical instructor would represent feedback to a student nurse? a. ―Explain to me the actions of this medication before you give it.‖ b. ―Can you explain to me why Mr. W. did not receive a bath this morning?‖ c. ―Stop the urinary catheter insertion now. You have contaminated the catheter.‖ d. ―You need to use your critical thinking skills when caring for patients.‖

d. ―You need to use your critical thinking skills when caring for patients.‖

Which author proposed that a nursing care delivery model should consist of five key dimensions? a. Porter-O'Grady b. Dubois c. Watson d. ANA

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