PD test 1 (chapters 1, 3, and 6)

19) Which is the most effective method of creating a blame-free environment? 1. Work to develop a just culture within the organization. 2. Make sure all nurses agree to report every mistake. 3. Set up a self-reporting board so that all employees will know that everyone makes mistakes. 4. Ensure nurse managers keep a list of how often each employee makes a mistake.

Answer: 1 Explanation: 1. A just culture provides an environment in which employees can question policies and practices, express concerns, and admit mistakes without fear of retribution. 2. Making sure all nurses agree to report every mistake is being punitive prior to mistakes and is not blame free. 3. A self-reporting board is a form of punishment and placing blame. 4. The manager should not be keeping lists in a blame-free environment. Cognitive Level: Applying

2) As part of the process of promoting quality improvement, the nursing manager is comparing data between two hospitals on average length of stay for a total hip replacement. This comparison is an example of which process or step? 1. Benchmarking 2. Outcome standard 3. Indicator 4. Process standard

Answer: 1 Explanation: 1. Benchmarking is the comparison of data with other reliable sources internally and externally with the goal of quality improvement. 2. Standards are written statements that define a level of performance. An outcome standard involves the end results of care given. 3. An indicator is a tool to measure the performance of structure, process, and outcome standards. 4. Standards are written statements that define a level of performance. Process standards are those connected with the actual delivery of care. Cognitive Level: Applying

7) The quality management director of a large healthcare conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish? 1. We will compare outcome indicators with other healthcare conglomerates of similar size and organization. 2. Outcome data of hospitals within the organization will be compared to assess quality. 3. Each client care unit in the organization will establish specific unit goals for quality. 4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed.

Answer: 1 Explanation: 1. Benchmarking uses an organization's outcome data and compares it with that of a similar organization to address strengths and challenges. 2. Because the hospitals with the organization are likely managed in a similar manner, this is not an example of benchmarking. 3. While establishing goals is a part of quality management, it is not benchmarking. 4. Setting up a quality monitor is a quality initiative, but it is not benchmarking.

15) Regardless of which delivery system or combination of delivery systems is appropriate, which skill is required for effective use? 1. Flexibility 2. Strict adherence 3. Persistence 4. Resistance to change

Answer: 1 Explanation: 1. Flexibility is a skill imperative when choosing a delivery system(s) for nursing care. The system must meet client and staff needs and organizational and unit-specific goals, as well as remain within cost constraints. If not, flexibility allows for change to occur to alter the system as necessary to achieve the desired effects. 2. Strict adherence to a set of rules or structure is not appropriate in today's healthcare environment, where adaptability is essential. 3. The nurse should be persistent in learning new roles, but persistence is not the best answer to this question. 4. Resistance to change is not a desirable skill in today's healthcare environment.

1) The nurse manager tells a newly hired nurse that the unit practices functional nursing. What should the new nurse expect? 1. One nurse has responsibility for all the medications on the unit. 2. One nurse has responsibility for all the needs of three clients. 3. One charge nurse and one respiratory therapist have responsibility for all clients. 4. One nurse and one nursing assistant have responsibility for 10 clients.

Answer: 1 Explanation: 1. Functional nursing breaks down client care into tasks assigned to the appropriate professional or skilled caregivers. This may result in one nurse (the "med nurse") administering all the medications on the unit. 2. Total client care is given by one nurse assigned to a few clients. 3. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients. 4. Team or modular nursing uses a variety of skilled caregivers to provide care to an assigned group of clients.

14) One of the nurse competencies of the synergy care delivery model is "moral agency." Which action is an example of that trait? 1. The nurse commits a medication error and reports it to the charge nurse. 2. The nurse collaborates well with the rest of the healthcare team. 3. The nurse is able to think ahead to the client's next need. 4. The nurse who does not have good baseline knowledge of a client's disease process researches it on a day off work.

Answer: 1 Explanation: 1. Moral agency is "doing the right thing." Reporting a medication error is the right thing to do. 2. Collaboration is a desirable characteristic but does not describe moral agency. 3. Systems thinking is a desirable characteristic but does not describe moral agency. 4. This is a description of clinical inquiry, not moral agency.

12) Which organization would the hospital management team contact to pursue certification as a Magnet hospital? 1. Magnet Recognition Program 2. American National Magnet Commission 3. The Joint Commission 4. American Medical Association (AMA)

Answer: 1 Explanation: 1. The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates healthcare organizations that provide nursing excellence. 2. The American National Magnet Commission is fictitious. 3. The Joint Commission accredits healthcare organizations, but does not award Magnet status. 4. The AMA does not award Magnet status. Magnet status is focused on nursing excellence.

13) What is the primary belief behind the evolution of the clinical microsystem as a nursing care delivery system? 1. Those who deliver the nursing care make the most educated decisions for a particular unit. 2. Clinical decisions are best made by the clients who are served by a particular unit. 3. Clinical decisions are best made by nursing leaders for all units within that particular hospital. 4. Nurses working in a particular service area are best suited to make decisions for the clients in that area.

Answer: 1 Explanation: 1. The clinical microsystem method allows those who are involved in the smallest unit of care to make the decisions for that unit. 2. Clinical decisions should be made by professional healthcare providers, with client input. 3. Decision making "from the top" is not reflected in the clinical microsystem structure. 4. Clinical microsystems involve a core team of caregivers, not all the nurses working in a particular service area.

9) After shift change the nurse discovers that a client's IV heparin has been turned off at the IV controller. The amount of fluid left in the IV bag indicates that the client received half of the dose ordered. Which statement should be documented in the client's medical record? 1. IV heparin restarted. Physician notified. Client's vital signs unchanged. 2. IV heparin restarted at a rate to catch up dosage accidentally deleted. 3. IV heparin turned off by previous shift. Restarted. 4. IV heparin restarted and incident report completed.

Answer: 1 Explanation: 1. The documentation in the chart should be a statement of the facts as well as the client's physical status after the incident. 2. The word "accidentally" should not be used to document incidents. 3. The nurse is not certain the IV was turned off by the previous shift, so that entry should not be used. 4. The fact that an incident report was completed should not be documented. Cognitive Level: Analyzing

30) Which manager statement reflects concern about the most important requirement for today's nurse manager? 1. "I am taking a day off tomorrow for my annual physical." 2. "I think this class will help me learn to be innovative." 3. "I am committed to being a good manager." 4. "I feel enthusiastic about our new plans for the units."

Answer: 1 Explanation: 1. The most important work of the manager is to stay physically and mentally healthy. 2. Innovation is important, but not as important as other factors. 3. Commitment is important, but not as important as other factors. 4. Enthusiasm is important, but not as important as other factors. Cognitive Level: Applying

28) The nurse executive is reviewing client satisfaction surveys. Which trend would the nurse evaluate as indicating the nursing care delivery system in use is not effective? 1. More than 60% of respondents replied with the name of an unlicensed assistant when asked the name of the RN who cared for them. 2. Almost 70% of respondents accurately listed their discharge medication. 3. Close to 88% of respondents reported that invasive interventions were performed by an RN. 4. More than 30% of respondents reported that the nurse sometimes seemed rushed.

Answer: 1 Explanation: 1. This response may indicate that the RN is not able to provide the skilled care needed. There may be a lack of RN presence in client care. 2. This statistic indicates the RN is providing discharge instructions, which is correct use of RN knowledge. 3. Most invasive procedures are done by RNs, so this indicates correct use of skill sets. 4. The nurse will sometimes be rushed. This low percentage is likely not an indicator of problems.

26) A long-term care facility is considering implementing total client care. Prior to implementing this system, what must be available? 1. Enough RN staff to provide all the care to the residents 2. A group of licensed assistants who are good at taking direction 3. A strong nurse manager 4. RNs willing to assume 24-hour accountability for the care provided to residents

Answer: 1 Explanation: 1. Total client care means that all the care for the clients or residents is provided by the RN. 2. Unlicensed assistants are not used in total client care. 3. While a strong nurse manager is always desirable, it is not strictly necessary to implement total client care. 4. 24-hour accountability is a part of primary nursing, not total client care.

11) Which is the most important consideration in choosing a structure for nursing care? 1. Client need 2. Efficiency 3. Cost 4. Timeliness

Answer: 1 Explanation: 1. While all four options are important, client need takes precedence over the others because nursing provides a service to the client. 2. Efficiency can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration. 3. Costs can be contained by choosing the correct nursing care delivery system, but this is not the most important consideration. 4. Timeliness of care can be improved by choosing the correct nursing care delivery system, but this is not the most important consideration.

1) A nurse manager is participating in the healthcare organization's strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend? 1. Cost of care 2. Access to care 3. Availability of care 4. Quality of care

Answer: 1 Explanation: 1. While all of the options given are driving forces in today's healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality. 2. Access to care is controlled by the ability to pay. 3. Care will not be available if it cannot be funded. 4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Leadership Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

30) A risk manager generally uses root-cause analysis to investigate incidents. What are the likely outcomes of this action? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is disagreement over the cause of the incident. 2. There are insufficient resources to make needed changes to prevent similar incidents. 3. The system or process causing the incident is identified and corrected. 4. Improvements to the system are widespread. 5. Sufficient evidence is acquired so that management is comfortable in making needed changes.

Answer: 1, 2 Explanation: 1. Professional disagreements often occur as root-cause analysis is being conducted. 2. Often the root-cause analysis takes up so much time and so many resources that no changes are ever made. 3. Root-cause analysis generally looks for the "sharp end" or the person who made the error, rather than looking for the system or process that allowed the error to occur. 4. Root-cause analysis generally does not result in widespread system improvement. 5. Root-cause analysis takes time and resources. Generally there is little management support for changes due to the length of time from the incident.

12) Which statement reflects a characteristic common to all methods of quality management? 1. Each method uses all staff members in the organization. 2. None of the methods are designed to place blame on an individual. 3. All methods provide clinical information. 4. Most methods focus on cost containment.

Answer: 2 Explanation: 1. All the staff members in the organization are expected to provide quality service, but not all staff members are included in quality management activities. 2. Quality management is not designed for the purpose of placing blame on an individual. 3. Quality management systems do not provide clinical information; they use the data from clinical information systems to determine a focus on quality improvement. 4. The focus of quality management is on more than cost containment; it also focuses on improving services to clients and fixing processes that are causing errors or compromising quality.

18) A nursing team consists of an RN, two LPNs, and two UAP. Which work would be completed by the RN? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Reviewing the client's plan of care with the UAP 2. Discussing the client's increasing shortness of breath with the LPN 3. Updating the care plan of a client who will undergo surgery tomorrow 4. Administering oral medications to clients 5. Calling the physician to discuss the client's response to a new treatment

Answer: 1, 2, 3, 5 Explanation: 1. The RN team leader is responsible for conducting the nursing care conference and reviewing the client's plan of care with the team. 2. The RN team leader guides the client care and helps to resolve any problems that may occur. 3. Developing and updating nursing care plans is the work of the RN team leader. 4. Typically, the team leader is involved in indirect client care activities. 5. Communicating and collaborating with physicians is generally the responsibility of the team

3) As the RN team leader, identify potential disadvantages of using team nursing to deliver care to assigned clients. Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Continuity of care may suffer. 2. Client/staff communication may be an issue. 3. There is little cost savings to the institution. 4. Delegation is necessary. 5. Not as many professional staff are required.

Answer: 1, 2, 4 Explanation: 1. Continuity of care may suffer when care is given by more than one individual. 2. Team nursing requires excellent communication skills in all team members, who must communicate with clients, families, and each other. 3. Team nursing does save on personnel costs. 4. The RN must be careful to delegate only tasks that are appropriate for the skill level and licensure of the designated personnel. The RN is ultimately responsible for all client care. 5. Team nursing does reduce the number of professional staff required.

25) The continuous quality improvement (CQI) coordinator is establishing quality measures for a unit. These measures would be written according to which criteria? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The CQI coordinator has read two research studies that show the process improves client outcomes. 2. The CQI coordinator has evidence that a particular practice is effective in decreasing length of stay. 3. The CQI coordinator has used the process in practice for more than two years. 4. The process being measured produces a desirable outcome. 5. There are very few unexpected bad effects from the process.

Answer: 1, 2, 4, 5 Explanation: 1. The measure must be based in research that shows the process leads to improved outcomes. More than one research study is required for documentation. 2. Quality measures should document that evidence-based practice was given. 3. Anecdotal information or single-nurse-practice information is not sufficient evidence for writing a quality measure. 4. The monitor is written in the "positive," meaning that the process is desirable. 5. The process should have minimal or no unintended adverse effects.

10) Which statement by a newly licensed nurse indicates an understanding of why it is necessary to structure nursing care? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "It helps to coordinate care to a group of clients." 2. "It organizes care responsibilities." 3. "It ensures that the staff doesn't get overtime." 4. "It improves physician efficiency." 5. "It provides skilled care by skilled staff."

Answer: 1, 2, 5 Explanation: 1. Structure is necessary to ensure that care is coordinated. 2. Structure is necessary to ensure that all care responsibilities are covered. 3. While structure may make nursing care more efficient, it does not ensure that no overtime will be necessary. 4. The objective of structuring nursing care is not to ensure physician efficiency. 5. Structuring nursing care helps to assign nurses with certain skills to clients whose care requires those skills.

11) The nurse is assigned to the Risk Management Team. Which events would be addressed by this team? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A client's hand is injured during an arterial blood gas draw. 2. A client's family is dissatisfied with the breakfast just served. 3. A client leaves the hospital against medical advice (AMA). 4. A client claims he is not ready to be discharged. 5. The family does not want a client to be transferred from the intensive care unit (ICU).

Answer: 1, 3 Explanation: 1. Any reaction or injury associated with a diagnostic test must be reported as an incident. 2. The nurse manager can address the client's expectations related to meals. If no satisfaction can be obtained and the family continues to complain about meals, an incident report would be filed. 3. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 4. The physician and healthcare team are responsible for deciding if the client is ready to be discharged, based on the client's medical condition. 5. The physician and healthcare team are responsible for deciding if the client should be transferred from the ICU, based on the client's medical condition. Cognitive Level: Applying

22) A hospital is considering implementing the use of critical pathways and case management. Which statements by a nurse would indicate to the nurse manager that more education should be provided? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "If we use critical pathways, we won't have physical therapy to help us ambulate clients." 2. "If a client is not able to follow the critical pathway, a variance will be written." 3. "The critical pathway lists discharge outcomes but won't help us with day-to-day guidance of care." 4. "Once the client is on a critical pathway, we must follow it until discharge." 5. "Using critical pathways will help us reduce length of stay and costs to the client."

Answer: 1, 3, 4 Explanation: 1. Critical pathways are designed to direct the care of many disciplines. There is no reason to believe that physical therapy will no longer be available to help with client ambulation. 2. Variances are written when the client is not making progress according to the critical pathway. 3. The critical pathway orients staff to the outcomes that should be achieved by the client each day. 4. If the client has variance from the critical pathway, it may be revised. 5. Critical paths use resources appropriate to the care needed

21) A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization's different campuses. What serious considerations should the nurse make prior to starting a blog? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Open access to the blog may damage recruiting efforts. 2. Blogs are difficult to use and expensive to maintain. 3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality. 4. The organization's reputation may be altered by a blog. 5. Most nurses would likely not use the blog.

Answer: 1, 3, 4 Explanation: 1. Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news. 2. Blogs are inexpensive and easy to use. 3. As blogs become more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely. 4. The organization's reputation could be either enhanced or damaged by bloggers' comments. 5. Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog.

14) In which ways can nurse managers reduce risks for the organization? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Investigating a complaint about nursing care from a client's spouse 2. Encouraging nurses to cut corners when possible 3. Talking to physicians about ways to improve client care 4. Keeping staff members on task throughout the workday 5. Making sure staff members work minimal overtime

Answer: 1, 3, 4, 5 Explanation: 1. By investigating a complaint, the nurse manager may discover a true issue in the delivery of care. The manager may also gain a greater understanding of any underlying tensions that caused the spouse to make the complaint. 2. Cutting corners is a very real temptation in the high-paced environment in which nurses practice. The manager should not encourage this behavior as it is often risky and dangerous. 3. The nurse manager is in a position to discuss improvement of client care across disciplines. 4. The nurse manager can help make work more efficient by keeping staff members on task throughout the workday. 5. When staff members are tired from working overtime, they are more likely to make errors.

16) What should the nurse executive consider when planning the nursing care delivery system of a new hospital? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. How to optimize use of nursing knowledge 2. The system used by competing hospitals 3. How to ensure that clients receive optimal care 4. Skill sets likely to be present in the nurses who will be employed at the hospital 5. What groups of nurses are available for employment

Answer: 1, 3, 4, 5 Explanation: 1. Optimizing the knowledge of the available nurses is an important component of deciding on a nursing care delivery system. 2. The system used by competing hospitals is not of great importance in choosing the system for a new hospital. 3. The provision of safe and effective nursing care is the most important of all considerations. 4. Optimizing nursing skills is an important consideration when choosing a nursing care delivery system. 5. The nurse executive must consider who is available to fill the nursing positions in the organization. Creating a system that requires employing numbers of nurses or nurses with particular specialties or education levels will not be effective if those nurses are not available to employ.

32) The nurse is using Evidence-based practice (EBP) to improve clinical quality. What steps should the nurse plan to include in this process? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Assess the outcome 2. Discuss challenges 3. Identify the clinical question 4. Compare other models 5. Apply the evidence

Answer: 1, 3, 5 Explanation: 1. Assessing the outcome is a step in EBP. 2. Discussing challenges is not a step in EBP. 3. Identifying the clinical question is a step in EBP. 4. Comparing other models is not a step in EBP. 5. Applying the evidence is a step in EBP.

5) The hospital administration is considering adopting primary nursing as its model of nursing care delivery. Which of the following are disadvantages of this method? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The client may have multiple primary nurses if transfers within the facility are necessary. 2. Physician satisfaction is decreased. 3. Staff nurses cannot be held legally liable for care provided outside their work hours. 4. It requires a knowledge-based nursing practice model. 5. All individuals caring for the client must have excellent communication skills.

Answer: 1, 3, 5 Explanation: 1. If a client requires transfer between units, a new primary nurse will be assigned in each unit. In some cases, this could result in multiple primary care nurses during one hospitalization. 2. Physician, nurse, and client satisfaction is generally increased with primary care. 3. The premise of primary nursing is that the nurse holds 24-hour-a-day accountability for client care. Legally, nurses cannot be accountable for care provided outside their work hours. 4. Requiring a knowledge-based nursing practice model is seen as an advantage of primary nursing. 5. Excellent communication must exist between the primary nurse and associate nurse. This is often difficult.

16) Which quality improvement initiatives would help the healthcare organization meet Institute of Healthcare Improvement (IHI) goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The amount of material opened and wasted for surgical procedures will drop by 25% this fiscal year. 2. The number of nurses who hold a bachelor's degree will increase by 10% this year. 3. Wait times in the emergency department will decrease by 15% this year. 4. Employee absences will drop by 10% this year. 5. Fewer than 5% of clients will report inadequate pain control while hospitalized.

Answer: 1, 3, 5 Explanation: 1. No waste is an IHI goal. 2. Increasing the educational preparation of nurses is not an IHI goal. 3. No unwanted waiting is an IHI goal. 4. Employee attendance is not an IHI goal. 5. No needless pain or suffering is an IHI goal.

8) The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process? 1. "What outcomes are we expecting from this work?" 2. "Is anyone prepared to evaluate the statistics we will find?" 3. "What is the exact clinical issue with which we are dealing?" 4. "Where can we look for information?"

Answer: 3 Explanation: 1. Assessing outcomes is the last step of the EBP process. 2. Evaluation of the evidence is step 3. 3. Identifying the clinical question is the first step in the EBP process. 4. Acquiring the evidence to answer the question is step 2.

18) Which situation represents an exception to the blame-free environment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse routinely changes nursing notes after a client is discharged. 2. A physician order is overlooked on a newly admitted client. 3. An unlicensed assistant drops a client. 4. A nurse does not complete an incident report after a medication error. 5. A nurse miscounts narcotics.

Answer: 1, 4 Explanation: 1. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. Changing nursing notes is illegal unless specific protocols are followed, which would be unlikely on a routine basis. 2. Human errors are handled by the just culture of the blame-free environment. Overlooking an order is a human error. 3. Human errors are handled by the just culture of the blame-free environment. Client accidents are considered human errors. 4. Exceptions include failure to report an adverse event or error, criminal acts, false reporting, or refusing to participate in a system designed to prevent errors. 5. Human errors are handled by the just culture of the blame-free environment. Miscounting errors are considered human errors.

20) A nursing unit has just completed a 6-month trial of using team nursing to provide care. The overwhelming opinion of the staff is that the experiment was a disaster. What are the most common reasons that team nursing is not successful? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There are problems with delegation. 2. There are problems with the skill set of the UAP on the teams. 3. The LPNs on the team do not accept their position of being "in the middle." 4. Communication on the team or with the nurse manager is flawed. 5. RNs and LPNs struggle with who is in control and has the power on the team.

Answer: 1, 4 Explanation: 1. If the team leader does not delegate effectively or team members do not accept delegation well, team nursing will not be effective. 2. Problems with UAP skill sets can be overcome by education. This is not a common reason that team nursing does not work. 3. While LPNs can be "in the middle" between the UAP and the RN, there is no indication that this is a common problem. 4. Poor communication is a common problem and can make the team approach ineffective. 5. There is no indication that this is a common issue.

21) A nurse manager is orienting newly hired staff nurses to the organization's total quality management program. As part of orientation, the manager has assigned the nurses to interview the organization's internal customers. Which group would the nurses interview? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Newly hired radiology technicians 2. People who are visiting clients admitted within the last two days 3. Physicians who have admitting privileges 4. Nurses who have worked at the facility more than five years 5. Vendors who supply disposable medical equipment to the hospital

Answer: 1, 4 Explanation: 1. Internal customers include employees and departments within the organization. 2. Visitors are considered external customers. 3. Physicians are considered external customers. 4. Nurses are hospital employees and are therefore considered internal customers. 5. Vendors are not employed by the hospital and are considered external customers. Cognitive Level: Applying

18) The organization that awards Magnet status would look for environments where which practices are the norm? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Nurses are involved in decision making. 2. Rewards are focused on ideas that save money. 3. Once a decision is made, it stands. 4. Nurses may be asked to work overtime. 5. Nurses are involved in educating the community about health.

Answer: 1, 5 Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions. 2. Money-saving ideas are not always good for staff or for clients. 3. Magnet-status organizations are flexible and encourage autonomy and independence. 4. Overtime is sometimes necessary, even in well-run facilities. 5. In Magnet organizations, staff members are encouraged to be involved in educational activities in the organization and the community.

23) The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Preparing for a surge of casualties in case of a disaster 2. How to prevent disasters from occurring 3. How to fund disaster management 4. How to reduce disaster impact on clients and staff 5. How to identify risks for disasters

Answer: 1, 5 Explanation: 1. One of the primary focuses of a disaster plan is how to care for the influx of clients. 2. Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan. 3. Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay. 4. There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact. 5. Risk identification is part of a safety plan.

11) A healthcare system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or "Forces of Magnetism."

Answer: 14 Explanation: There are 14 qualities or "Forces of Magnetism" that must be demonstrated to achieve Magnet status.

9) The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, "I don't know why I started doing it this way. I've never read any research on it, but this technique always works for me." The manager would place this technique into which category of evidence? 1. Case study 2. Anecdotal 3. Nonexperimental design research 4. Statistical

Answer: 2 Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical situations. 2. Anecdotal evidence is derived from experience. 3. Nonexperimental design research includes gathering factors related to a clinical condition. 4. Statistical evidence is built from a scientific approach.

33) The nurse manager receives a report that a medication was given to the wrong client. This is called a(n) ________ and will be reviewed with the physician and risk management committee member.

Answer: reportable incident Explanation: Reportable incidents include any unexpected or unplanned occurrences that affect or could potentially affect a client, family member, or staff. Cognitive Level: Understanding

7) A client has been told that chemotherapy must be postponed until he is hydrated. The client refuses the IV hydration and demands to go home. How would the nurse best categorize this situation? 1. Non-reportable incident 2. Medical-legal incident 3. Client dissatisfaction with care 4. Medication error

Answer: 2 Explanation: 1. Any incident that is unexpected or unplanned and that could potentially harm a client, family member, or staff is a reportable incident. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. When a client or family member indicates general dissatisfaction with care and the situation cannot be resolved, an incident report is filed. 4. A medication error occurs when the nurse unintentionally omits a medication or fluid, gives the wrong dose, gives the dose at the wrong time, or gives the medication or fluid to the wrong client. Cognitive Level: Applying

3) The hospital organization has developed a philosophy based on the client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. In which quality management process are these characteristics typically seen? 1. Continuous quality improvement (CQI) 2. Total quality management (TQM) 3. Plan, Do, Check, Act (PDCA cycle) 4. Six Sigma

Answer: 2 Explanation: 1. CQI is the actual process, not the philosophy, used to improve quality and performance. 2. TQM is a management philosophy emphasizing a commitment to excellence throughout the organization. It is founded on four core concepts: client, organizational involvement, quantitative measurement of outcomes, and processes for improvement. 3. The PDCA cycle is a scientific method used to build knowledge, make decisions, and improve quality outcomes within an organization. It is a process, not a philosophy. 4. Six Sigma is a quality management program that uses measures, goals, and management involvement to monitor performance and ensure progress. It is a process, not a philosophy.

29) The hospital's management team wishes to institute case management to improve the quality of nursing care. As a beginning step, the team is choosing specific medical diagnoses on which to focus. What criteria should the team use when choosing these diagnoses? 1. Diagnoses given to only a few clients 2. Diagnoses that carry high risk for the client and the provider 3. Diagnoses that have low reimbursement rates 4. Diagnoses that involve as few providers as possible

Answer: 2 Explanation: 1. Case management is used for high-volume diagnoses. 2. Case management is used with high-risk diagnoses. 3. Case management is used with high-cost diagnoses. 4. The number of providers associated with a diagnosis is not a criterion for case management.

10) The following documentation was entered in the client's medical record: "The client was found lying on the floor. Dr. X was notified. Apparently, the restraints were improperly applied." Which statement best describes this documentation? 1. Appropriately written 2. Inappropriate because it places blame on an individual 3. Inappropriate because it does not include that the client's family was notified 4. Appropriately written because it only documents the facts

Answer: 2 Explanation: 1. Documentation in the chart following an incident should be a statement of the facts; no blame should be placed. 2. The documentation is not appropriately written because it implies that someone was to blame for the incident. 3. The documentation must indicate that the physician was notified, not that the client's family was notified. 4. The documentation is not appropriately written; no blame should be placed. Cognitive Level: Analyzing

2) A nurse has been invited to discuss healthcare costs at a senior citizens' club. What information should the nurse plan to include in this discussion? 1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%. 2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers. 3. The United States spends more money on healthcare than any other country. 4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA).

Answer: 2 Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country's gross domestic product. 2. Implementation of PPACA and its regulations have not been formulated. 3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country. 4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

17) A change in nursing care delivery system is being considered by hospital administrators. Which information should the nurse executive add to this discussion? 1. "There has been little change in nursing care delivery over the last few years." 2. "We must look to the nursing process for guidance in nursing care." 3. "Too much time is spent deciding on a system of care." 4. "Any system is okay, as long as the nurses follow it."

Answer: 2 Explanation: 1. Nursing care delivery systems are in continual revision as nurses strive to find the perfect system for providing care to clients with varying degrees of need. 2. The nursing process reflects nursing care and consists of assessment, planning, implementation, and evaluation. 3. A comfortable and efficient system for delivery of care is important to client outcomes. 4. The system must be safe, efficient, and effective.

13) The director of quality improvement reports that the hospital will soon be using "dashboards" as part of the quality management process. How should the staff interpret this information? 1. Surveyors are driving to clients' homes to collect data on hospital visits. 2. This electronic tool makes it easy to aggregate and display data. 3. "Dashboard" is an acronym for the topics covered in client satisfaction surveys. 4. The "dashboard" is a screen on the electronic medical record that can be accessed for quality improvement information.

Answer: 2 Explanation: 1. The "dashboards" in this scenario are not associated with automobiles. 2. Dashboards are electronic tools that provide ease of access to real-time or retrospective data. 3. Dashboard is not an acronym. 4. Dashboards are not part of the electronic medical record. Cognitive Level: Applying

19) The RN leader of a team overhears one of the UAP on the team say, "I'll sure be glad when I get my RN license. All they do is sit around doing paperwork." How does the RN interpret this comment? 1. As a need to be more involved in direct client care when this UAP is on the team 2. As a common disadvantage of the team approach to nursing 3. As an indication that this UAP should be reported for unprofessional behavior 4. As confirmation that UAP are poorly educated and do not work well on teams

Answer: 2 Explanation: 1. The RN must focus on the work that requires RN skills. In some cases, this work consumes much of the shift. The RN should not ignore that work to placate the UAP. 2. Resentment against the team leader for not doing "real nursing" is a common drawback of team nursing. 3. Reporting the UAP for unprofessional behavior will not make the resentment go away and may make the situation worse. 4. There is no indication that this UAP is not educated or does not work well on a team. The UAP may not understand the roles on the team.

26) The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends? 1. The average age of the nursing staff is 40. 2. The number of nurses under age 30 has increased in the last two years. 3. There are no nurses older than age 55. 4. All nurses older than age 45 are managers.

Answer: 2 Explanation: 1. The average age of nurses is 46. 2. The number of nurses younger than age 30 is increasing. 3. This does not reflect national statistics. 4. This does not reflect national statistics.

14) The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation? 1. "There are more nurses retiring than are entering the profession." 2. "The demand for nurses is declining because of fewer hospital admissions." 3. "There are insufficient numbers of nursing faculty to teach interested students." 4. "Women still outnumber men in nursing."

Answer: 2 Explanation: 1. The average age of the registered nurse (RN) is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession. 2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow. 3. Nursing faculty members are also aging and moving into retirement. 4. Women continue to outnumber men in the nursing profession.

31) The daughter of a hospitalized client comes to the nurse manager's office with a complaint about the care provided on the previous shift. What is the manager's first action? 1. Call the nurse from the last shift to participate in a conference call about the complaint. 2. Ask the daughter to explain what happened. 3. Tell the daughter that the last shift was understaffed and apologize for any problems that might have occurred. 4. Ask the daughter what can be done to improve the situation.

Answer: 2 Explanation: 1. The manager should collect more information before contacting the nurse from the previous shift. 2. The nurse manager must first assess the situation. 3. The manager should not tell the daughter that the shift was understaffed. This is a liability and does not address the daughter's concerns. 4. Until the manager has assessed the issue, intervention cannot be provided.

20) Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital? 1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications. 2. The nurse should get medications more quickly because the robot can work more consistently without breaks. 3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked. 4. The nurse can expect that medication administration will be easier and carry less potential for error.

Answer: 2 Explanation: 1. The nurse must still complete the six rights of medication administration to ensure client safety. 2. Robots should be able to get medications to the floor more quickly. 3. The administration of medication cannot be delegated to the nursing assistant. 4. There is no assurance that medication administration will be easier.

24) Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which individual is most strategically placed to handle how these changes are initiated? 1. Staff nurse 2. Nurse manager 3. Chief financial officer (CFO) 4. Chief executive officer (CEO)

Answer: 2 Explanation: 1. The staff nurse will be instrumental in carrying out the changes but is not the most influential in directing them. 2. The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff's feelings while adequately and appropriately representing the needs and wants of the administration. 3. The CFO will certainly have some say in the financial support of any changes made but is unlikely to have sufficient knowledge of the daily operations of the unit to handle changes at that level. 4. The CEO is unlikely to have enough information about the daily unit activities to be effective in instituting these changes.

28) Which statement regarding the use of electronic medical records (EMR) is accurate as associated with quality improvement? 1. EMR has strong linkage to improving quality. 2. Much more research must be done before the impact of EMR on quality can be determined. 3. EMR does not affect the quality of care provided. 4. Although no research into the impact on quality exists, EMR must continue as it is federally mandated.

Answer: 2 Explanation: 1. There is not enough research to prove a strong linkage. 2. There is not enough research on using EMR and the quality of care provided to determine the impact. 3. Not enough research has been done to make this statement. 4. Research does exist, but it is insufficient to measure correlation.

12) Which nursing interventions would be in line with the chronic care model? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Blood sugar is measured frequently in an attempt to achieve tight glycemic control. 2. The nurse provides the client with the Uniform Resource Locator (URL) for a new website dedicated to self-management of a chronic respiratory disease. 3. The nurse advocates for the client who has decided to forego further dialysis. 4. Client information is entered into an electronic medical record. 5. Information about the operating hours of a community recreation center is provided to the client with coronary artery disease.

Answer: 2, 3, 4, 5 Explanation: 1. The chronic care model manages how care is delivered, not a specific disease. 2. Self-management is one of the six components of the chronic care model. 3. Decision support is one of the six components of the chronic care model. 4. Use of clinical information systems is essential to the chronic care model. 5. Use of community resources is one of the six components of the chronic care model.

3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation? 1. "I wonder if there was a break of sterility when this catheter was inserted." 2. "Thankfully we can treat this with an antibiotic." 3. "This could potentially cost the hospital a lot of money." 4. "I will talk to my unlicensed assistants about proper urinary catheter care."

Answer: 2 Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection. 2. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation. 3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay. 4. The nurse has identified that improper care may result in poor outcomes for the client. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Evaluation/Education Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

15) A healthcare organization has just achieved Magnet status. During the award ceremony, the organization's chief executive officer should give primary praise for this achievement to which employees? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Medical staff 2. Nurse executive 3. Staff nurses 4. Managers in support services such as laboratory and radiology 5. Administrative professionals overseeing services such as accounting, billing, and medical records

Answer: 2, 3 Explanation: 1. Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players. 2. While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status. 3. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence. 4. While these employees would be involved in this effort, Magnet status is focused on nursing excellence. 5. While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence.

24) The nurse executive of a for-profit hospital continually works to provide an environment that is better for the nursing staff. Why is this effort so important? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. It is the most cost-effective way to manage a hospital. 2. An environment that is better for nurses is associated with lower mortality rates. 3. Nurses are more satisfied working in an environment that is better for nursing. 4. When the environment is better for nursing, it is also better for other disciplines. 5. Most of the strategies that improve the environment for nursing do not cost anything

Answer: 2, 3 Explanation: 1. Making the environment better for nurses may not be the most cost-effective strategy. 2. Research indicates that a better nursing environment is associated with lower mortality rates. 3. An environment that is better for nurses is associated with greater nurse satisfaction. 4. There is no evidence that improving the environment for nursing improves the environment for other disciplines. 5. There is little that can be done in a hospital environment that does not entail at least some cost.

23) The leader of a continuous quality improvement (CQI) team has asked that an information packet be distributed to members of the resource group. The secretary would prepare packets for which people? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The CQI coordinator 2. The hospital CEO 3. The vice-president in charge of finance 4. Members of the CQI team 5. The team leader

Answer: 2, 3 Explanation: 1. The CQI coordinator is appointed by a member of the resource group. 2. The resource group is made up of senior management and establishes overall policy, vision, and values associated with CQI. 3. The resource group is made up of senior management such as the CEO and vice-presidents. 4. Team members are not part of the resource group. 5. The team leader is not a part of the resource group. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Planning/Leadership Learning Outcome: 6-1: Describe how total quality management, continuous quality management, Six Sigma, Lean Six Sigma, and DMAIC address quality.

22) The procedures for managing client pain are being investigated as part of the hospital's total quality management program. Whom should the manager plan to invite to this meeting? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The hospital CEO 2. A representative from the pharmacy 3. A representative from the medical staff 4. A staff nurse who works with clients in pain 5. A representative from social services

Answer: 2, 3, 4 Explanation: 1. The CEO is not involved in the process of managing clients' pain and would not be part of this investigation. 2. Because the pharmacy is involved in providing the medication to control pain, this department would be represented at this meeting. 3. Because the orders for medications to control pain are generated by physicians, a representative from the medical staff would be invited to this meeting. 4. The staff nurse is on the front lines of controlling client pain and would be a valuable member of this group. 5. It would be rare for social services to be involved in the management of client pain, so this department would not be part of this group. Cognitive Level: Applying

29) A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now? 1. Nothing until the nurse has acquired enough bedside experience to become a manager 2. Time to see how these skills will be needed in the future 3. A manager who can help with skills transfer from school to work 4. A job working as a manager in a small hospital

Answer: 3 Explanation: 1. All nurses are managers. 2. The nurse will use these skills on the first job. 3. The manager is an essential component in helping the new nurse transfer this learning into the "real" world of bedside care. 4. The newly licensed nurse does not have the skill set and experience to work as a manager. Cognitive Level: Analyzing

4) Which healthcare situations reflect the philosophy of quality management as designed by Deming? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. A nurse asks visitors to leave because it is after visiting hours. 2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status. 3. A nurse tells the manager that a housekeeper's work is not up to standards. 4. A nurse volunteers to take a Spanish language class to be able to communicate with clients. 5. A nurse who has not made a medication error in two years asks for a salary increase.

Answer: 2, 3, 4 Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need. 2. Even though 2:00 p.m. is after "lunchtime," this nurse is focused on the client's needs. This is an example of quality management. 3. Quality management empowers the employee to evaluate quality. 4. This nurse has seen a need and is working to improve the quality of service. This is quality management. 5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management. Cognitive Level: Applying Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

31) The nurse just left a healthcare agency that utilized the practice partnership model of care. When compared to team nursing, practice partnership offers which attributes? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Working alone 2. Continuity of care 3. Less expensive for the organization 4. Accountability for client care 5. Coordinating implementation of care

Answer: 2, 3, 4 Explanation: 1. Working alone is not an attribute of the practice partnership model of care. 2. Continuity of care is an attribute of the practice partnership model of care. 3. Less expensive for the organization is an attribute of the practice partnership model of care. 4. Accountability for client care is an attribute of the practice partnership model of care. 5. Coordinating implementation of care is not an attribute of the practice partnership model of care. Cognitive Level: Applying

32) The nurse manager on the obstetrical unit is adopting Total Quality Management (TQM). Which characteristics are associated with TQM? Note: Credit will be given only if all correct choices and not incorrect choices are selected. Select all that apply. 1. Boundaryless collaboration 2. Involve the total organization 3. Focus on client 4. Identify key processes 5. Use quality tools and statistics for measurement

Answer: 2, 3, 4, 5 Explanation: 1. Boundaryless collaboration is one of the six themes of the Six Sigma quality management program. 2. Involving the total organization is a characteristic associated with TQM. 3. Focusing on the client is a characteristic associated with TQM. 4. Identifying key processes is a characteristic associated with TQM. 5. Using quality tools and statistics for measurement is a characteristic associated with TQM. Cognitive Level: Applying

21) A registered nurse will be the case manager of a group of 10 clients. What will the nurse expect as part of this assignment? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The nurse will determine interventions for all the disciplines needed as part of the clients' care. 2. The nurse will meet with other disciplines to agree on the choice of critical pathways for each client. 3. The nurse will work to build consensus with the physicians caring for the clients on the team. 4. The nurse will define the expected nursing outcomes for the clients on the team. 5. The nurse will collect and analyze data regarding the clients on the team.

Answer: 2, 3, 4, 5 Explanation: 1. Each discipline determines its own interventions. The disciplines collaborate to design care. 2. Collaboration with other disciplines is a critical component of case management. 3. A main emphasis of case management is building consensus with physicians caring for the clients. 4. The nurse is responsible for defining expected nursing outcomes. The other disciplines involved will set expected outcomes for their work. 5. Essential baseline data, such as length of stay, cost of care, and complication information, are collected and analyzed by the nurse and other members of the team.

5) Which situation would be included in reporting for Joint Commission mandatory national client safety goals? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The average wait time in the emergency department has increased by 5 minutes over last year's average. 2. A client is left waiting in the hallway because the transport person did not make contact with the client's nurse. 3. A nurse gives a medication by the wrong route. 4. A client developed sepsis after insertion of a urinary catheter. 5. Surgery is done on a client's right eye instead of the left eye.

Answer: 2, 3, 4, 5 Explanation: 1. Increased wait times are not included as a client safety goal. 2. Improving staff communication is one of The Joint Commission's national client safety goals. 3. Using medications safely is one of The Joint Commission's national client safety goals. 4. Preventing infection is one of The Joint Commission's national client safety goals. 5. Preventing mistakes in surgery is one of The Joint Commission's national client safety goals.

6) Efforts to increase nurses' use of evidence-based practice (EBP) to improve client care in the hospital have failed. Which answers are nurses likely to give when asked why this is occurring? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I'm not interested in this program." 2. "I don't have time to finish everything I already have to do each shift." 3. "I don't want to practice nursing just like everyone else." 4. "The library at our hospital doesn't have many journals." 5. "If administration wanted us to use EBP, they would get us some more nurses to share the work."

Answer: 2, 3, 4, 5 Explanation: 1. Lack of interest on the part of nurses is not a reason EBP is not used. 2. Lack of time is a barrier to using EBP that is consistent across settings. 3. The need for autonomy over the nurse's own practice can be a barrier to using EBP. 4. Inability to find and assess evidence is a barrier to using EBP. 5. Lack of support from administration is a barrier to using EBP. Cognitive Level: Analyzing

5) A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. There is no mechanism for complaint because the client is no longer hospitalized. 2. The client can indicate dissatisfaction on the survey often sent to clients after discharge. 3. The client can call the hospital administration. 4. The client can make a formal complaint through the American Nursing Association (ANA). 5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ).

Answer: 2, 3, 5 Explanation: 1. The client can still voice concerns even after discharge. 2. These client satisfaction surveys are a good mechanism for discussing care issues. 3. Telephone calls are a means of discussing client care issues. 4. ANA is not a forum for complaints about care in a specific hospitalization. 5. The AHRQ has a mechanism for reporting care issues. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment Client Need Sub: Management of Care Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

30) The nurse is starting a new position as a staff member on a busy medical-surgical unit. The unit uses the team nursing model of care. Which skills will be used to make this model effective? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Caring 2. Delegating 3. Advocating 4. Communicating 5. Problem-solving

Answer: 2, 4, 5 Explanation: 1. Caring is not a skill used to make the team nursing model of care effective. 2. Delegating is a skill used to make the team nursing model of care effective. 3. Advocating is not a skill used to make the team nursing model of care effective. 4. Communicating is a skill used to make the team nursing model of care effective. 5. Problem-solving is a skill used to make the team nursing model of care effective.

31) Quality and Safety Education for Nurses (QSEN) is based on quality and safety targets of knowledge, skills, and attitudes (KSAs) for nursing education. Which targets are associated with QSEN competencies? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Education 2. Teamwork 3. Autonomy 4. Quality improvement 5. Client-centered care

Answer: 2, 4, 5 Explanation: 1. Education is not one of the KSAs. 2. Teamwork is one of the KSAs. 3. Autonomy is not one of the KSAs. 4. Quality improvement is one of the KSAs. 5. Client-centered care is one of the KSAs.

29) A hospital increased its RN-to-client ratio one year ago. What effects is the hospital likely to see as a result of that choice? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. The cost of providing care has decreased. 2. There has been a decrease in client deaths. 3. The average length-of-stay for clients has increased. 4. The overall quality of care has increased. 5. The nosocomial infection rate has dropped.

Answer: 2, 4, 5 Explanation: 1. Increasing RN-to-client ratio generally increases costs. 2. Increasing RN-to-client ratio has been shown to decrease client mortality. 3. Increasing RN-to-client ratio generally decreases length of stay. 4. Increasing RN-to-client ratio generally increases quality of care. 5. Increasing RN-to-client ratio generally results in few infections. Cognitive Level: Applying

25) To be effective in today's healthcare system, the nurse manager must be aware of which trends? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. An environment that does not change 2. Decreasing resources 3. Adequate staffing 4. Increasing numbers of retirees 5. Complicated technology

Answer: 2, 4, 5 Explanation: 1. The only trend that is consistent is the rapidly changing system. 2. Nurse managers must be aware of the responsibility of doing more with fewer resources. 3. Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care. 4. Increasing numbers of retirees, both from nursing and as an aging population, have placed a strain on the healthcare system. 5. Complicated technology forces the nurse manager to keep up with the ever-present changes within the healthcare system. Cognitive Level: Applying

27) A nurse manager is looking for evidence-based information regarding wound care. Which criteria should be used to evaluate the usefulness of an intervention? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. Is there evidence that the intervention has been used in hospitals of similar size to the one where the manager practices? 2. Can the manager find two or more research studies that support the use of the intervention? 3. Is the intervention one that the manager has seen used in the past? 4. Are the authors of the research articles well-known experts in the field? 5. Is the research study that recommends the intervention rigorous in design and execution?

Answer: 2, 5 Explanation: 1. The size of the hospital is not significant in selecting evidence-based practice interventions. 2. Evidence-based practice is most reliable when more than one study has confirmed the results. 3. Many evidence-based practice interventions are new, and the manager may have no previous knowledge about them. 4. While the manager must be certain the articles are from reputable sources, research is not limited to those who are already known in the field. 5. The research on which evidence-based practice is based must be rigorous in design and must have been executed according to its design.

8) Immediately following a barium swallow, a client noticed hives and a feeling of shortness of breath. Although there were no known allergies to food or drugs prior to this incident, the diagnosis was an allergic reaction to the preservatives in the barium. Which is the correct risk category for this incident? 1. Medication error 2. Medical-legal incident 3. Procedure complication 4. This incident does not fall into a risk category.

Answer: 3 Explanation: 1. A medication error occurs when a medication or fluid is omitted, the wrong dose is administered, or the medication is administered to the wrong client. 2. A medical-legal incident occurs when a client or family refuses treatment as ordered. 3. Any incident occurring before, after, or during a procedure is categorized as a diagnostic procedure complication. 4. Complications from diagnostic or treatment procedures are a high-risk area in healthcare and are reported as incidents.

23) At a strategic planning meeting the nurse executive recommends instituting client-centered care as a model of care delivery in the hospital. Which statement by the hospital CEO indicates understanding of this concept? 1. "We have always had the client at the center of everything we do." 2. "We can't afford to hire more RNs." 3. "I'm concerned about the increased time and leadership our nurse managers will have to provide." 4. "I like the idea of centralizing all our care."

Answer: 3 Explanation: 1. Client-centered care as a practice model is not the same as centering care around the client. 2. There would be fewer RNs in the client-centered care model. 3. The nurse manager's role in client-centered care requires considerable time. The nurse manager must be a strong leader. 4. Client-centered care is actually decentralized. Many of the tasks traditionally done by a central office, such as admission, are unit based.

26) Which statement reveals the most dangerous result of using measured standards as part of the CQI process? 1. A nurse complains, "Collecting this data takes so much time." 2. A radiology technician says, "CQI is lots of work." 3. A nurse manager says, "I'm not going to change this process, because I'd have to change the CQI monitors." 4. The laboratory technician says, "Writing these CQI reports is boring."

Answer: 3 Explanation: 1. Collecting data can take time, especially as staff members are acclimating to new processes. This is not the most dangerous result given. 2. The work of CQI should be balanced out by the improvements to care and reduction in waste. 3. When innovation is sacrificed because of the work involved in CQI or because variance is discouraged, stagnation occurs. This is the biggest danger of using standardization. 4. Boredom is not the biggest danger of using measured standards.

2) The RN receives reports on eight clients in the morning. Client assignments are then delegated to an LPN and two nursing assistants. The morning is busy, with physician visits and new client orders, and the RN communicates these new orders to the LPN and nursing assistants. The RN also meets with the case manager to discuss nursing home placement for a client. What type of nursing care delivery system is in place in this hospital? 1. Critical pathways 2. Total client care 3. Team nursing 4. Functional nursing

Answer: 3 Explanation: 1. Critical pathways are a set of strategies used by healthcare providers to attain expected outcomes. Critical pathways are not a nursing care delivery system, and there are insufficient data to determine if they are used in this scenario. 2. Total client care is given by one nurse. 3. The RN in this case is leading a team. A variety of skilled caregivers cares for a group of clients. 4. Functional nursing breaks down the assignments into tasks.

28) A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations? 1. "We must find ways to increase our emphasis on critical thinking." 2. "The curriculum must focus on ways nurses can quickly and accurately acquire information." 3. "Our emphasis must change to improving nursing students' clinical reasoning skills." 4. "Our clinical practicums must be graded separately from our theory presentations."

Answer: 3 Explanation: 1. Critical thinking is still emphasized, but another aspect of care should receive much more emphasis. 2. Carnegie focuses on application of knowledge rather than its acquisition. 3. This is a Carnegie recommendation. 4. Carnegie recommends integration of clinical and classroom teaching. Cognitive Level: Applying

7) In order to organize services needed to achieve specific client outcomes, hospital administrators should consider what type of client care delivery system? 1. Functional nursing 2. Practice partnerships 3. Case management 4. Primary nursing

Answer: 3 Explanation: 1. Functional nursing does not focus on specific outcomes. 2. Practice partnership does not focus on specific outcomes. 3. Case management organizes client care by major diagnoses and focuses on attaining predetermined outcomes within a specific time frame. 4. Primary nursing does not focus on specific outcomes.

4) The hospital is opening its first intensive care unit. The nurse executive should plan to staff this unit according to which model of care? 1. Functional nursing 2. Team nursing 3. Total client care 4. Primary care

Answer: 3 Explanation: 1. Functional nursing has the disadvantages of less continuity of care and potentially less skilled personnel caring for the client. 2. Team nursing has the disadvantage of not having a professional nurse attending to all client care needs. 3. In total client care, one nurse cares for a client and is totally accountable for the client. This way the nurse can give continuous, holistic, and expert care. 4. Primary care is considered the client's first encounter with the healthcare system.

20) The nurse is working on a unit with a blame-free environment and makes an error that puts a client at risk. What should the nurse do first? 1. Discuss it with the other nurses on duty. 2. Immediately report the incident to the supervisor. 3. Ensure the client's safety as fully as possible. 4. Say nothing as no one saw the incident.

Answer: 3 Explanation: 1. It is not appropriate to discuss errors with others. 2. Reporting the incident to the supervisor is appropriate only after the client's safety is protected. 3. The client's safety is always the priority. 4. Ignoring the mistake if no one saw it is not ethical and may be dangerous.

24) Which data would be of most interest to an organization using Lean Six Sigma as a means of quality improvement? 1. Almost 85% of call lights are answered within 4 minutes. 2. Results of pain medication administration are documented 95% of the time. 3. Nursing overtime hours increased by 25% in the last quarter. 4. In the last 6 months, overall client satisfaction scores have increased by 15%.

Answer: 3 Explanation: 1. Lean Six Sigma is focused on improving process flow and eliminating waste. 2. Lean Six Sigma is focused on improving process flow and eliminating waste. 3. Lean Six Sigma focuses on eliminating waste, such as an increase in expensive overtime wages, and would focus on processes that may be allowing this to occur. 4. Lean Six Sigma focuses on improving process flow and eliminating waste. Cognitive Level: Analyzing Client Need: Safe Effective Care Environment

15) Which part of Six Sigma is vastly different from other quality management programs? 1. Six Sigma has a client focus. 2. Data drive the program. 3. Failure is tolerated. 4. Management is proactive.

Answer: 3 Explanation: 1. Most quality improvement programs are client focused. 2. Data drive most quality improvement programs. 3. One of the Six Sigma themes is aiming for perfection but tolerating failure. 4. Proactive management is common in most quality improvement initiatives.

8) The RN working on an orthopedic unit is caring for a postoperative client with a hip replacement who is not transferring well from bed to chair. The client is behind on the mobility training program. What action is the nurse's priority? 1. Instruct physical therapy to increase treatments to four times daily. 2. Contact the family to discuss preoperative mobility problems. 3. Inform the case manager of variance in the critical pathway. 4. Discuss the problem with the client's surgeon.

Answer: 3 Explanation: 1. Ordering an increase in physical therapy is not within the scope of nursing and would not be the priority action. 2. The family may have important information about the client's mobility, but this is not the priority action. 3. The case manager tracks all variances, reports to the collaborative team, and may revise the critical pathway. 4. Discussing the problem with the surgeon is not the priority action.

13) A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need? 1. Pediatric nursing 2. Psychiatric nursing 3. Geriatric nursing 4. Maternity nursing

Answer: 3 Explanation: 1. Pediatric nursing is not likely to see as much growth as another specialty. 2. Psychiatric nursing is not likely to see as much growth as another specialty. 3. As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer. 4. Maternity nursing is not likely to see as much growth as another specialty.

25) A group of nurses is developing a poster presentation titled "Nursing Care Delivery Through the Ages" for the hospital's annual Nurses' Day celebration. What form of nursing care delivery should they depict as occurring prior to 1930? 1. Team nursing 2. Functional nursing 3. Total client care 4. Primary care

Answer: 3 Explanation: 1. Team nursing evolved in the middle to late 1940s. 2. Functional nursing grew out of the nursing shortage caused by World War II. 3. The original model of nursing care delivery was total client care or the case method. During the 1920s, total client care was the typical delivery system, with much RN care being provided in the home. 4. Primary nursing was conceptualized and implemented during the late 1960s.

27) Which nursing care delivery situation best reflects the concept of a clinical microsystem? 1. A rural free clinic housed in a church gymnasium that is staffed by volunteer nurses and physicians 2. A walk-in clinic in a local discount store that is staffed by a nurse practitioner 3. An inpatient burn unit 4. A general medical-surgical unit in a mid-sized hospital

Answer: 3 Explanation: 1. The free clinic likely does not have the support staff, equipment, and facilitative environment necessary for a clinical microsystem. 2. A walk-in clinic in a retail outlet does not have a tightly defined population to receive care and is not likely to function as a clinical microsystem. 3. The burn unit likely has a core team of caregivers, a defined population to receive care, informational systems in place, support staff, equipment, and an environment that facilitates provision of care. 4. A general medical-surgical unit is less likely to have the components necessary to support a clinical microsystem.

19) The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in healthcare. Which statement is a reason for this delay? 1. Medical records professionals do not like these records. 2. The use of these records is more expensive than the use of paper records. 3. There have been concerns about privacy and confidentiality. 4. The transition to EHRs is time consuming and tedious.

Answer: 3 Explanation: 1. The preference of medical records professionals is not the reason these records have had a slow adoption. 2. The cost of the records is not a primary reason they have had slow adoption. 3. The most overwhelming issue in using these records has been the profession's and public's concerns regarding privacy and confidentiality. 4. The transition time to EHRs is not the primary reason they have seen a slow adoption.

10) A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which of the following statements would direct these nurses to the forms of strongest clinical evidence? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "We may find studies that use only one group of participants." 2. "Look for articles that report on how to use evidence in other clinical situations." 3. "The studies we want are built around the scientific approach to solving problems." 4. "Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness." 5. "Many articles will have information reported by someone who is an expert in the field."

Answer: 3, 4 Explanation: 1. Studies using only one group of participants are done in a quasi-experimental design. This is not one of the two strongest forms of evidence. 2. An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence. 3. Using the scientific approach results in statistical evidence, which is one of the two strongest forms. 4. Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence. 5. Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence.

22) The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix? Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply. 1. "I don't see why everyone can't just get along." 2. "Generation X nurses are just lazy." 3. "Our Generation Y nurses help keep us all up on new technology." 4. "The most loyal of all my nurses are the traditionalists." 5. "I expect that our next manager will come from my group of baby boomers."

Answer: 3, 4, 5 Explanation: 1. The four generations have different values, work ethics, and skills. Conflict is inevitable. 2. The manager should not stereotype the members of a generation. 3. Generation Y is technically savvy. 4. Traditionalists are typically loyal and respectful of authority. 5. Baby boomers typically value professional and personal growth.

4) The nursing task force is developing measurable goals for each client on the orthopedic unit. The statement "Each client will have a written assessment and plan of care document within eight hours of admission" is an example of which component of quality management? 1. Indicator 2. Structure standard 3. Benchmark 4. Process standard

Answer: 4 Explanation: 1. An indicator is a tool used to measure the performance of a structure, process, or outcome standard. 2. A structure standard is related to the physical environment and the organization as opposed to the delivery of nursing care. 3. Benchmarking is the process of comparing data with other reliable sources internally and externally in order to improve quality of care. 4. A process standard is a written statement that defines actual delivery of nursing care to a specific population.

17) Which strategy is most likely to increase participation in the use of evidence-based practice in nursing? 1. Ensure adequate training and encourage its use by the nursing staff. 2. Elicit employee opinions of its use at least four times per year. 3. Give those nurses willing to use it extra recognition. 4. Ensure adequate training, recognition, and easy access to the internet.

Answer: 4 Explanation: 1. Ensuring adequate training by itself is not enough. 2. Asking for opinions will do little to encourage the use of evidence-based practice. 3. Recognition for those willing to use evidence-based practice is an insufficient motivator. 4. There must be training, easy access, and recognition for using evidence-based practice in nursing.

17) The nurse manager orienting newly hired nurses has explained the organization's blame-free environment. Which remark by one of the nurses indicates understanding of the policy? 1. "If I make a mistake and report it, I will not be reprimanded or punished." 2. "When I make a mistake, I should immediately fill out an incident report." 3. "It is left up to each employee to self-monitor so we do not report others' mistakes." 4. "When I make a mistake, I should report it and look for ways to prevent it from recurring."

Answer: 4 Explanation: 1. If the nurse is involved in at-risk or reckless behavior that results in an error, action will be taken. 2. Incident reports are not the first step after making a mistake. 3. Failure to report personal mistakes or the mistakes of others is an at-risk behavior and is not tolerated in a blame-free environment. 4. Mistakes should be reported and reflected upon so that the same mistakes will not be made again.

16) The nurse manager's expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique? 1. Intuition 2. Personal clinical experience 3. Knowledge from nursing school 4. Current research

Answer: 4 Explanation: 1. Intuition is not based in research and is not evidence based. 2. Clinical experience is useful when integrated with evidence-based practice but is not considered evidence based when used alone. 3. Knowledge from nursing school is very useful in client care but can become outdated if the nurse does not continually update that knowledge. 4. Current research is a good source of evidence-based practice strategies.

1) Which situation is an example of the overall goal of quality management in today's healthcare activities? 1. The nurse manager realizes a policy was ineffective in reducing incidents. 2. The administrator walks around making a list of potential problems. 3. The human resources department fires nonproductive employees. 4. The nurse wipes up a spilled drink before clients are allowed to enter a room.

Answer: 4 Explanation: 1. The focus of quality management is on ways to prevent problems and improve quality of care. Identification of failed standards is reactive, not proactive. 2. The focus of quality management is on ways to prevent problems and improve quality of care. Assessment of problems within the organization was the focus of quality management in the past. 3. The focus of quality management is on ways to prevent problems and improve quality of care. Identifying inefficient employees is reactive, not proactive. 4. The focus of quality management is on ways to prevent problems and improve quality of care. This nurse may have prevented a fall.

6) A newly licensed RN is beginning a job search. This nurse would be best served by working in an organization that provides which nursing care delivery system? 1. Primary nursing 2. Total nursing care 3. Functional nursing 4. Practice partnerships

Answer: 4 Explanation: 1. The nurse providing primary nursing must be very autonomous. This is not the best environment for a newly licensed RN. 2. The nurse providing total nursing care must be very autonomous. This is not the best environment for a newly licensed RN. 3. In functional nursing, the RN leads the team. The newly licensed RN does not have sufficient experience for this role. 4. Practice partnerships allow for two personnel to work together in giving client care

6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure? 1. The hospital closest to the client's home 2. The hospital that has done the greatest number of these surgeries in the last two years 3. The hospital chosen by the client's primary healthcare provider 4. The hospital with the highest performance ratings for this procedure

Answer: 4 Explanation: 1. This may or may not be the best choice of hospital for this procedure. 2. Just because a hospital is high volume does not mean it is high quality. 3. This may or may not be the best hospital for this procedure. 4. The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures.

9) A hospital is concerned about low customer satisfaction ratings and poor evaluation on quality indicators. The nurse managers are asked to implement a nursing delivery system that is cost-effective and improves both customer satisfaction and quality of care. Which nursing delivery system should the managers implement? 1. Total client care 2. Functional nursing 3. Team nursing 4. Client-centered nursing

Answer: 4 Explanation: 1. Total client care is costly and less efficient for nursing staff. 2. Functional nursing is cost-effective but lacks continuity of care. 3. Team nursing is cost-effective but may lack continuity of care, which can cause client dissatisfaction. 4. The focus of client-centered nursing is the promotion of efficiency, quality, and cost control.

27) To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ________% of nurses prepared at the baccalaureate or higher level by 2020.

Answer: 80 Explanation: The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020.