60C - Nursing Leadership FINAL

Mara Z. wants to become a nurse manager. She has been offered an opportunity to take a nursing management course. Which topic is most important for her to learn? 1. Managing people 2. Managing the unit's budget 3. Planning for the future 4. Redesigning the unit's workflow

Answer: 1 Rationales: 1. Managing people is probably the most challenging task for nurse managers. It is fundamental to good management. 2. The unit budget is important but not as complex as managing people. 3. Planning for the future is also important but not as fundamental as managing people. 4. Redesigning the unit's workflow is usually a task that should be done only after gaining familiarity with all aspects of the unit's operation.

The Situational Leadership Model focuses on: 1. Both followers and the task 2. The task 3. The follower 4. The behavior of others

Answer: 1 Rationales: 1. The situational leadership approach considers the complexity of a situation, which would include followers and the task at hand. 2. A focus only on the task(s) to be done is too limited for the situational approach. 3. Likewise, a focus only on the follower would be too limited. 4. Behavior is an important, but not the only, focus of situational leadership.

Which of the following health and safety concerns is NOT one of our greatest concerns currently? 1. "Escape" of health-care-acquired infections into the community 2. Spread of poliomyelitis and smallpox 3. Increase in opioid-related deaths 4. Health disparities (poorer health and treatment outcomes in minority, limited-income, and other groups)

Answer: 2 Rationales: 1. Antibiotic-resistant infections continue to be a great concern. 2. Both polio and smallpox are relatively well controlled. 3. Opioid-related deaths are increasing. 4. Health disparities are a continuing concern.

What is the difference between management and leadership? 1. Management focuses on budget. 2. Management is an assigned position. 3. Leadership is not concerned with getting work done. 4. Leadership is more focused on people.

Answer: 2 Rationales: 1. Budgets are a concern of nurse managers but not their major focus. 2. Everyone can exert leadership at various times, but manager is a designated position, assigned by upper-level administration. 3. Nurse leaders are definitely concerned that the work of the team gets done. 4. Both management and leadership focus on people.

What is brainwriting? 1. A strategy to encourage the free flow of ideas 2. A mutually beneficial negotiation result 3. A winning approach to formal negotiation 4. A devaluation reaction to negotiation

Answer: 1 Rationales: 1. Brainwriting is a creative approach to problem-solving. Similar to brainstorming, it offers everyone a chance to share ideas; however, by writing their ideas before the discussion, there is less likelihood of being influenced by early ideas. 2. Brainwriting is a tool that may be used for different types of negotiation; however, it is not a result of negotiation. 3. Brainwriting is not an approach to formal negotiation, but it may inform the negotiation. 4. Brainwriting is not a reaction to negotiation.

An effective leader will have: Select all that apply. 1. Courage and integrity 2. A critical mind-set 3. The ability to set priorities 4. The ability to provide feedback

Answer: 1, 2, 3, 4 Rationales: 1. Integrity and courage are qualities of an effective leader. 2. Thinking critically is a behavior of effective leaders. 3. Setting priorities is another behavior of effective leaders. 4. Skillful communication includes providing constructive feedback.

Benefits of membership in the ANA include all but which one of the following? 1. Advocacy for nurses' rights 2. Provision of lower-cost health insurance 3. Work toward a safer workplace 4. Improvement of patient safety

Answer: 2 Rationales: 1. The American Nurses Association (ANA) does advocate for nurses. 2. The ANA does not provide health insurance. 3. The ANA has put considerable effort into making the workplace safer. 4. Improvement of patient safety is an additional concern of the ANA.

An emotionally intelligent nurse leader: 1. Seeks the emotional support of others 2. Cannot juggle multiple demands 3. Works alone without help 4. Welcomes constructive criticism

Answer: 4 Rationales: 1. Emotionally intelligent leaders understand and manage their own emotions. 2. Emotionally intelligent leaders are able to juggle multiple demands. 3. Emotionally intelligent leaders actively work with members of their team rather than alone. 4. Emotionally intelligent leaders welcome criticism that is constructive and acknowledges other team members' perspectives.

Which of the following is a current concern related to the nursing profession? 1. Aging of the nursing workforce 2. Oversupply of nurses versus decreasing demand for nursing care 3. Emphasis on evidence-based practices 4. Expansion of EHR use into the community

Answer: 1 Rationales: 1. Aging of the current nurse population continues to be a concern. 2. Demand for nursing care is not decreasing; oversupply occurs only sporadically. 3. Evidence-based practice is a positive trend. 4. The use of electronic health records (EHRs) is also a positive trend.

A new graduate plans on moving into nursing administration. What steps should the graduate take to ensure this goal is reached? Select all that apply. 1. Further professional education. 2. Meet the specific requirements for the entry-level job position. 3. Seek new experiences. 4. Volunteer to work on committees. 5. Find a mentor.

Answer: 1, 3, 4, 5 Rationales: 1. Furthering professional education and obtaining advanced degrees and certifications indicates to an organization that you want to move forward with your professional career. 2. Meeting the specific requirements for an entry-level job position does not indicate a commitment to the organization or desire to advance a career. 3. Seeking new experiences demonstrates a commitment to the organization. 4. Volunteering to work on committees demonstrates a commitment to the organization. 5. Finding a mentor demonstrates a commitment to the organization.

When evaluating the quality of care, a health-care organization must consider structures, processes, and outcomes of care delivery. Which of the following is a good example of an organizational process? 1. Budgeting adequate money for nursing salaries 2. Preparing a patient for discharge 3. Monitoring for infections 4. Increasing time between clinic visits

Answer: 2 Rationales: 1. Budgets are considered to be a structural aspect of care quality because they support the organization's ability to support patient care. 2. Preparing a patient for discharge is a care delivery process that consists of care interventions and decision making between the care team and the patient. 3. This can be considered a quality outcome of safe care delivery. 4. Measuring the time between clinic visits can be a measure of the efficiency of care delivery.

Which of the following organizations supports nursing education? 1. NINR 2. NLN 3. AMA 4. ANA

Answer: 2 Rationales: 1. The National Institute of Nursing Research (NINR) primarily supports nursing research. 2. The National League for Nursing (NLN) supports nursing education. 3. The American Medical Association (AMA) supports the medical profession. 4. The American Nurses Association (ANA) supports advancement of the nursing profession.

Autocratic leaders: 1. Postpone decision making as long as possible 2. Share leadership with members of the team 3. Give orders and make decisions without consulting the team 4. Encourage creativity when problem solving

Answer: 3 Rationales: 1. Postponing decision making is a characteristic of laissez-faire leaders; autocratic leaders are more active. 2. Autocratic leaders make decisions independently; they generally do not share decision making with their teams. 3. Autocratic leaders frequently give orders and make decisions without consulting with team members. 4. Encouraging creativity when problem-solving is more characteristic of democratic (participative) leaders.

What can the new graduate do to make a successful transition from student to practicing nurse? 1. Try to maintain one's student identity. 2. Move into nursing management as soon as possible. 3. Learn about the organization as a whole as well as about your assigned unit. 4. Focus on the stress of making this difficult transition.

Answer: 3 Rationales: 1. Transition includes changing one's identity from student to nurse. 2. New graduates are not ready for management and may fail to mature as a practicing nurse if they move into management too quickly. 3. The organization is the context in which a nurse practices and has an important influence on the practice environment. 4. Focusing on one's stress may increase negativity and may impede programs through the transition. Stress needs to be managed and eventually reduced, but it is not the primary focus of your transition.

What is the most desirable result of a problem resolution? 1. Win-lose 2. Lose-lose 3. Win-win 4. None of the above

Answer: 3 Rationales: 1. Win-lose infers competition; the aim of conflict resolution is to work together more effectively, not win. 2. Lose-lose makes everyone a loser and can make people angry or heighten their need to win next time. Both of these situations take attention away from the work and place it on the need to win. 3. Win-win allows both sides to come together to identify the issue, and each side gains some benefit from the solution. Both sides walk away winners. 4. None of the above

Scientific management focuses on: 1. Interpersonal relations 2. Servant leadership 3. Staff development 4. Efficiency

Answer: 4 Rationales: 1. Interpersonal relations are not the focus of scientific management. 2. Servant leadership is also more focused on interpersonal relations than is scientific management. 3. Likewise, staff development is not emphasized in scientific management. 4. The focus on increasing efficiency is the hallmark of scientific management.

The hospital has recently reorganized; therefore, several departments were closed. The patient census on the unit has increased. The staff have always had a strong team spirit, but the nurse manager knows that workflow changes can cause conflict. What can the nurse manager do to reduce the possibility of conflict among her team? 1. Monitor the quality of patient care. 2. Ensure that supplies and equipment are readily available. 3. Assess the equity of nursing assignments. 4. All of the above

Answer: 4 Rationales: 1. Observing daily unit activity will allow the nurse manager to see that no patient care is missed because of extraneous duties that her staff may be asked to perform because of the reorganization. 2. The reorganization may create a scarcity of supplies or change delivery times, which could cause hoarding or competition for limited resources. 3. Keeping the patient care assignments equitable will allow for prompt intervention should workloads become unmanageable or breaks are missed. 4. All of the above

An assistant nurse manager is making assignments for the next shift. Which patient should the assistant nurse manager assign to a nurse with 6 months of experience and who has been floated from the surgical unit to the medical unit? 1. A 58-year-old on airborne precautions for tuberculosis (TB) 2. A 68-year-old who just returned from bronchoscopy and biopsy 3. A 69-year-old with COPD who is ventilator dependent 4. A 72-year-old who needs teaching about the use of incentive spirometry

Answer: 4 Rationales: 1. To care for the patient with tuberculosis (TB) in isolation, the nurse must be fitted for a high-efficiency particulate air (HEPA) respirator mask. 2. The bronchoscopy patient needs specialized procedure care and a more experienced nurse. 3. The ventilator-dependent patient needs a nurse who is familiar with ventilator care. 4. Many surgical patients are taught about coughing, deep breathing, and the use of incentive spirometry preoperatively.

The nursing assistant tells a nurse that a patient who is receiving oxygen at a flow rate of 6 L/min by nasal cannula is complaining of nasal passage discomfort. What intervention should the nurse suggest to improve the patient's comfort for this problem? 1. Suggest that the patient's oxygen be humidified. 2. Suggest that a simple face mask be used instead of a nasal cannula. 3. Suggest that the patient be provided with an extra pillow. 4. Suggest that the patient sit up in a chair at the bedside.

Answer: 1 Rationales: 1. When the oxygen flow rate is higher than 4 L/min, the mucous membranes can be dried out. The best treatment is to add humidification to the oxygen delivery system. Application of a water-soluble jelly to the nares can also help decrease mucosal irritation. 2. This does not treat the problem. 3. This does not treat the problem. 4. This does not treat the problem.

Effective nurse leaders: Select all that apply. 1. Are also good followers 2. Effectively work together with shared goals 3. Never act on their ideas 4. Have master's degrees

Answer: 1, 2 Rationales: 1. Every leader is at times a follower. 2. Effective leaders work with their teams on shared goals. 3. Although they are not always able to act on their ideas, effective leaders do so as much as they can if the ideas are constructive. 4. Earning a master's degree would be helpful but is not required for effective leadership.

What is the STAR method of interviewing? 1. Focuses on communication 2. Emphasizes behaviors 3. Allows the employer to ask personal questions 4. Creates a relaxed interviewing environment

Answer: 2 Rationales: 1. Communication is part of any interview; STAR (situation, task, action, result) is specific. 2. Many employers use the STAR method, which focuses on behaviors. Be prepared to discuss a situation and describe the task, the action taken, and the result. 3. Personal questions should not be part of an interview. 4. Many interviewers attempt to create a relaxed environment, but STAR is a technique.

A unit team leader who fails to provide direction to his or her nursing care team is a(n): 1. Democratic leader 2. Laissez-faire leader 3. Autocratic leader 4. Situational leader

Answer: 2 Rationales: 1. Democratic leaders are active leaders, not passive leaders. 2. Laissez-faire leaders are passive, inactive leaders who would not provide direction. 3. Autocratic leaders are often too directive and controlling. 4. Situational leaders are adaptive but will spell out team members' responsibilities.

If an informal negotiation session becomes too highly emotional, what should the nurse manager do? 1. Let the feelings flow. 2. Cancel the negotiation. 3. Deal with the feelings first. 4. Tell them to ignore the feelings and deal with the issues.

Answer: 3 Rationales: 1. The free flow of feelings can cause participants to begin to feed off of each other's emotions, which can get out of control and even lead to emotional outbursts, personal attacks, and physical violence. 2. The manager should not cancel the negotiation. Canceling the negotiation will delay resolution to the problem, and underlying anger or frustration could result in outward hostility on the unit. Instead, the manager may choose to take a short recess so that people can get their feelings under control and then resume the session. 3. The first step in any negotiation is to manage emotions. Emotions should be acknowledged and never responded to with added emotion. Once acknowledged, the team can move forward. 4. Ignoring feelings can cause an individual to focus on his or her anger rather than identifying the issues causing the conflict. When left unchecked, these emotions may follow the person into the work environment and manifest themselves in emotional outbursts and personal attacks.

The HHS is charged with protecting the health of all Americans and providing essential health services. Which of the following HHS quality initiatives is currently under way? 1. Post-acute care reform initiative 2. National health-care research and quality indicators aimed at helping improve access to care 3. NDNQI 4. Health IT

Answer: 1 Rationales: 1. Post-acute care reform is a Health and Human Services (HHS) initiative aimed at reducing care fragmentation and unsafe transitions of care such as from acute care hospitals to skilled nursing facilities. 2. Agency for Healthcare Research and Quality (AHRQ) quality indicators are designed to be used by organizations to identify and study quality concerns and track changes through time. Current quality initiatives include assessing access to health care. 3. The National Database of Nursing Quality Indicators (NDNQI) was initiated by the American Nurses Association and measures nurse-sensitive quality indicators that reflect the structure, process, and outcomes of nursing care, which lead to improved quality and safety at the bedside. 4. Health information technology (IT) is an AHRQ initiative that promotes the development and testing of IT solutions and applications designed to improve the quality of care.

You are a new nurse. The hospital where you work is committed to providing safe, high-quality care. Which of the following activities would let you know that your organization is committed to improving patient safety? 1. The hospital has a good catch program for staff who recognize errors and near misses. 2. The hospital subscribes to TJC safety publications. 3. The hospital measures performance every month, monitors quality indicators, and regularly reports on quality. 4. All of the above

Answer: 1 Rationales: 1. The good catch program is a strategy designed to identify system improvement opportunities aimed at reducing risk or harm to patients by staff reporting errors or near misses without fear of punishment or reprisal. 2. Subscribing to The Joint Commission (TJC) safety publications is a good way to stay current on trends and best practices; however, unless the hospital uses this information in practice, it would not contribute to improving patient safety. 3. Measuring quality performance may not include safety indicators. 4. All of the above

An experienced LPN is working under the supervision of the RN. The LPN is providing nursing care for a patient who has a respiratory problem. Which activities should the RN delegate to the experienced LPN? Select all that apply. 1. Auscultate breath sounds. 2. Administer medications via metered-dose inhaler (MDI). 3. Complete in-depth admission assessment. 4. Initiate the nursing care plan. 5. Evaluate the patient's technique for using MDIs.

Answer: 1, 2 Rationales: 1, 2. The experienced licensed practical nurse (LPN) is capable of gathering data and making observations, including noting breath sounds and performing pulse oximetry. Administering medications, such as those delivered via metered dose inhalers (MDIs), is within the scope of practice of the LPN. 3. Independently completing the admission assessment is within the scope of practice of the professional registered nurse (RN). 4. Initiating the nursing care plan is within the scope of practice of the professional RN. 5. Evaluating a patient's abilities requires additional education and skills. These actions are within the scope of practice of the professional RN.

The purpose of QI is to continuously improve the capability of everyone involved to provide safe, high-quality patient care. What is important to know about the QI process? 1. It is independent of teamwork. 2. It is a data-driven approach to improving process. 3. Common safety indicators are not used to evaluate quality of care. 4. Opportunities for QI are selected by organization leadership.

Answer: 2 Rationales: 1. The quality improvement (QI) process is dependent on teamwork. 2. Data are used to identify opportunities for improvement and to monitor performance. 3. Common safety indicators such as falls and infections are regularly used to evaluate the quality of care. 4. Identifying opportunities for QI is everyone's responsibility.

When conducting a SWOT analysis, the "T" represents: 1. Time spent in education 2. Threats to obtaining a position 3. Terminal degree expectations 4. Talking points for the interview

Answer: 2 Rationales: SWOT S = Strengths W = Weaknesses O = Opportunities T = Threats Increased competition among healthcare facilities or changes in government regulation represent threats.

A nursing student is graduating in 3 months. The student is looking for a position. Where should the student begin the search? Select all that apply. 1. Health-care organizations 2. Online job boards 3. National Council of State Boards of Nursing 4. American Association of Colleges of Nursing 5. Recommendations from peers and professionals

Answer: 1, 2, 5 Rationales: 1, 2, 5. Today, job seekers look to online job boards. Contacting specific health-care institutions and organizations and filling out a job application lets employers know that you are interested in working with them. 3. The National Council of State Boards of Nursing (NCSBN) is responsible for the National Council Licensure Examination (NCLEX®) and regulatory efforts. 4. The American Association of Colleges of Nursing provides information for collegiate nursing education and accreditation of schools.

Your new organization is committed to quality patient care. Which of these are considered characteristics of quality health care? 1. The nurses use evidence-based research to guide care delivery. 2. The nurses are respectful and responsive to their clients' individual preferences. 3. The nurses perform an independent double check when administering chemotherapy medication. 4. All of the above

Answer: 4 Rationales: 1. There are six characteristics of quality health care. The use of evidence-based research (EBR) ensures that care delivery is effective and efficient, which avoids overuse and waste. 2. Respectful and responsive to client preferences is patient-centered. 3. Independent double checks avoid possible injury to the patient, making the call safe. 4. All of the above

Bedside shift report is one of the things that Jane reviews at the staff meeting. She stresses the way she would prefer the report to start. Which of these would be the least important to share with the oncoming nurse? 1. Telling the oncoming nurse what happened on the unit during the shift 2. Introducing the client and his or her diagnosis to the oncoming nurse 3. Sharing the nurse's personal opinion of the client 4. Reviewing new medication orders and the medication administration record (MAR)

Answer: 2 Rationales: 1, 4. Although answers 1 and 4 should be included in the bedside shift report, they are not the best answer. 2. Introducing the client and his diagnosis ensures that the sender and receiver of the communication are familiar with the client and share pertinent care needs, nursing interventions, and client progress with goals of care. 3. This is incorrect. Personal opinions may prejudice the oncoming nurse's view of the patient, which could compromise care.

The purpose of learning how to negotiate conflict is to: 1. Eliminate conflict entirely 2. Resolve conflicts more effectively 3. Win 4. Reduce stress

Answer: 2 Rationales: 1. Conflict does have a positive side; when managed constructively, people can develop more open, cooperative ways of working together. 2. The use of negotiating skills can resolve conflicts more effectively by helping differing parties see each other as people with similar needs, concerns, and dreams instead of as competitors or blocks in the way of progress. Being involved in successful conflict resolution can be an empowering experience. 3. Winning more negotiations is counterintuitive. The purpose of negotiation is to build consensus and agreement between parties, not win more for your side. 4. Negotiations by themselves can be stressful; however, the outcome of a good negotiation would be reduced stress caused by the conflict.

Effective followers are those who are: 1. Passive employees 2. Skilled and self-directed employees 3. Less valuable employees 4. Employees who are never supportive of new ideas

Answer: 2 Rationales: 1. Effective followers are actively involved in the work of the team. 2. The most effective followers are not only competent but self-directed. 3. Effective followers are very valuable employees. 4. Although they cannot be expected to support every new idea, effective followers support constructive new ideas.

George S. has just become a nurse manager in a long-term care facility. He knows he has a lot to learn—what should he tell his staff? 1. Nothing; he should pretend he has experience 2. That he is still learning, too, and values their input 3. That the staff needs to manage themselves 4. How little he knows about management

Answer: 2 Rationales: 1. Pretending to have experience is likely to cause him to lose credibility and the trust of his staff. 2. This is an accurate description of his situation and is likely to engage staff in supporting his growth and development as a nurse manager. 3. Staff need to contribute to the leadership of the team but are not expected to "manage themselves." 4. It is preferable to take a positive approach, emphasizing a willingness to learn.

What type of résumé is useful in showing stable employment without gaps or many job changes? 1. Standard 2. Chronological 3. Functional 4. Combination

Answer: 2 Rationales: 1. A standard résumé in a professional, modern format gives specific details about your skills and experience. 2. The chronological résumé lists work experiences in order of time, with the most recent experience listed first. This style is useful in showing stable employment without gaps or many job changes. The objective and qualifications are listed at the top. 3. Functional résumés focus on your skills and experience, rather than on chronological work history. 4. A combination résumé is organized into two parts or pages.

Structured care methodologies (SCM) are: 1. Nursing tools designed to identify best practices and facilitate standards of care 2. Used to create a stable set of performance indicators to measure outcomes 3. Used to assist employees with wellness and injury prevention 4. Helpful when making staffing assignments

Answer: 2 Rationales: 1. Structured care methodologies (SCMs) involve interprofessional tools such as clinical pathways, guidelines, or protocols designed to facilitate care standards. 2. SCMs facilitate the standardization of patient care and provide a mechanism for quality enhancement, outcomes measurement, and research that informs nursing practice. 3. SCMs are tools used in the delivery of patient care. 4. Staffing assignments are based on patient acuity, staff competence, and resource availability.

When should a new graduate consider taking on management responsibilities? 1. As soon as they are offered 2. After developing clinical expertise 3. After 15 years on the job 4. Before developing leadership expertise

Answer: 2 Rationales: 1. Very few new graduates have either the preparation or experience to assume management responsibilities soon after graduation. 2. Development of clinical expertise is an essential part of preparing to be a nurse manager. 3. It is the amount of preparation and experience gained, not the number of years, that is critical in making this decision. 4. Nurse managers need to have leadership expertise.

A nursing student who is graduating in a few weeks is preparing a résumé. What should the nursing student highlight first? Select all that apply. 1. Family status 2. Educational degrees 3. Community service 4. Employment experience 5. Leadership experiences in school

Answer: 2, 4 Rationales: 1. Family status is not necessary for a résumé. 2, 4. If you are a new nursing graduate and have little or no job experience, list your educational background first. Remember that positions you held before you entered nursing might support experience that will be relevant in your nursing career. 3. Community service is of interest; however, your education is of primary importance. 5. Employers are interested in your leadership abilities; however, your education is of primary importance.

ISBARR provides a framework for communicating critical client information. ISBARR is an acronym for: 1. Identify, Study, Background, Assess, Recognize, Readback 2. Issue, Situation, Better, Advise, Refer with Recommendations 3. Introduce, Situation, Background, Assess, Recommend, Readback 4. None of the above

Answer: 3 Rationales: The ISBARR is an acronym for a concise review of the client with other team members to ensure timely intervention and feedback. It includes introducing the patient, the current situation, any pertinent background that could be contributing to the situation, a clinical assessment with recommendations, and finally, a readback of the instructions or orders to ensure accuracy.

The EMR has many advantages compared with paper charting. It helps track data through time and can help monitor things such as preventative care in primary care practices. Jane is the office nurse in a local practice. She is meeting a new patient for the very first time who informs her that he was recently hospitalized. Jane pulls up the patient's EMR and sees no information regarding his recent hospital stay. How could this have happened? 1. The patient's discharge was so recent that it is not available yet. 2. EMRs are usually practice or hospital specific, so the patient's information would not be accessible to Jane. 3. The patient was hospitalized out of state. 4. The patient has not signed the necessary consents to give Jane access.

Answer: 2 Rationales: 1. The emergency medical responder (EMR) is readily available at the hospital where the patient was treated. Only electronic health records (EHRs) contain a comprehensive accounting of health encounters regardless of the location. 2. EMRs are usually hospital or practice specific, so Jane would not have access to the patient's hospital EMR. Recent changes in technology and the creation of health information exchanges are making EMR information available to hospital and practice affiliates. 3. EHRs can capture patient information from anywhere within a health information exchange. 4. General consents for treatment and release of information are part of primary care practice and hospital paperwork.

An important competency that nurse leaders need to develop in order to lead effectively is the: 1. Ability to be firm and inflexible 2. Ability to be close-minded and to ignore negative feedback 3. Ability to communicate effectively with others 4. Ability to follow orders without questioning them

Answer: 3 Rationales: 1. Inflexibility is not a leadership competency. In fact, it impedes leadership effectiveness. 2. Leaders who ignore negative feedback may lose opportunities to improve their leadership effectiveness. 3. Ability to communicate effectively with other people is one of the three competencies identified by Hersey and Campbell. 4. Nurse leaders need to be critical thinkers. There are times when they are obligated as caring professionals to question directions, requests, or medical orders.

Which of the following is a major reason why newly licensed nurses resign? 1. Poor pay scales 2. Needlestick injuries 3. Unsupportive management 4. Lack of advancement opportunities

Answer: 3 Rationales: 1. Newly licensed nurses face many challenges, but poor pay is usually not the reason for resignation. 2. Needlestick injuries are a concern, of course, but most facilities have developed adequate prevention programs. 3. Newly licensed nurses, in particular, need supportive management and may resign if it is not present. 4. A lack of advancement opportunities becomes more important after the initial adjustment to this new role.

Nursing management and the nursing union are having differences on several issues. There may be a need for negotiation. Which of the following is a serious disadvantage to using collective bargaining to resolve this conflict? 1. Protecting the right to fair treatment 2. Creating an adversarial relationship between staff and management 3. Lacking professionalism on the part of the collective bargaining unit members 4. Failing to uphold important standards of care

Answer: 2 Rationales: 1. Staff rights to fair treatment are protected by personnel policies, state and federal law, and the current union contract. This item is a regular part of collective bargaining. 2. Discussion between management and union representatives about the issues may create conflict, which can be constructive or become emotional and competitive. If emotions are not managed, the interaction can become adversarial and delay resolution. 3. Individual members of the bargaining team may display unprofessional behavior during bargaining sessions; however, this usually occurs between management and the union at the bargaining table. 4. Organization and nursing policies and procedures and nursing professional practice standards ensure that standards of care are met. Collective bargaining centers on employee rights rather than those of the patient or management.

What does "be visible and vocal" mean? Select all that apply. 1. Take a course on health-care policy. 2. Speak out on issues important to nursing. 3. Write letters to the editor, and e-mail your state and federal representatives. 4. Look for opportunities to appear on radio or television.

Answer: 2, 3, 4 Rationales: 1. Taking a course will help you be a better-informed advocate but not be "visible and vocal." 2. Speaking out is being "vocal." 3. Writing letters and e-mails are also ways to be visible and vocal. 4. Likewise, appearing on radio or television is both visible and vocal.

Servant leadership focuses on: 1. Helping patients care for themselves 2. Removing incompetent managers 3. Creating a supportive work environment 4. Resolving conflicts quickly

Answer: 3 Rationales: 1. Helping patients care for themselves is a nursing care approach, not a management approach. 2. Removal or demotion is sometimes necessary but not the focus of servant leadership. 3. Servant leadership employs a "people first" approach to improving how employees are treated. 4. Resolving conflicts as quickly as possible would not be the goal of a servant leader or manager, who would try to come to a resolution that is best for all, even if it takes some time.

Differences in status and authority within the health-care team can generate conflict. What is the most common cause of conflict? 1. Disrespect and incivility 2. Inappropriate language and sarcasm 3. Blaming and finger pointing 4. Physical violence

Answer: 1 Rationales: 1. Disrespect and incivility are the leading cause of conflict within health-care teams. 2. Answers 2, 3, and 4 are less likely to cause conflict when compared with disrespect and incivility.

Health-care reform encompasses many issues and concerns. Which of the following is probably the most controversial goal? 1. Requiring everyone to have some form of health insurance 2. Developing school-based health-care centers 3. Eliminating preexisting condition rules in insurance coverage 4. Eliminating lifetime limits to insurance coverage

Answer: 1 Rationales: 1. Many believe that people have a right to forego insurance if they wish. 2. School-based centers themselves are not highly controversial, but some of the services they might offer could be. 3. There is considerable support for eliminating the preexisting condition clause. 4. There is also support for eliminating lifetime limits on insurance.

What is an important contribution of the nursing specialty organizations? 1. Setting standards for specialty practice 2. Improving nursing's image on television 3. Supporting the associate's degree in nursing education 4. Providing collective bargaining agreements

Answer: 1 Rationales: 1. Nursing specialty organizations support the interests of a defined practice area or special interest group. 2. They may be concerned about nursing's image but are more focused on the specialty or special interest group that defines their purpose. 3. Specialty organizations do not focus on basic preparation. 4. Collective bargaining agreements are generally provided by a union or state nurses association.

Effective nurse managers have: Select all that apply. 1. Leadership capabilities 2. Clinical expertise 3. Business sense 4. Budgeting savvy

Answer: 1, 2, 3, 4 Rationales: 1, 2, 3, and 4. To be maximally effective, nurse managers need a constellation of skills: people skills (leadership), expertise (clinical experience), and financial skills (business sense and budget savvy).

Which of the following characterize the transition from nursing student to practicing nurse? Select all that apply. 1. Increased number of assigned patients 2. Higher productivity expectations for the student compared with the practicing nurse 3. Greater emphasis on efficiency in practice 4. Shorter hours, fewer workdays back to back in practice

Answer: 1, 3 Rationales: 1. Students generally are assigned fewer patients. 2. Productivity expectations for the practicing nurse are higher. 3. Efficiency is emphasized more in practice than in school. 4. Shorter hours and fewer back-to-back workdays characterize student assignments.

Professional careers typically go through several phases. Which of the following would be the final phase of a successful career? 1. Promise phase 2. Harvest phase 3. Transition phase 4. Momentum phase

Answer: 2 Rationales: 1. The Promise phase is an early phase that follows transitions to practicing nurse. 2. The Harvest phase is the time when you reach your prime, usually the final phase of your career. 3. Transition (from student to practicing nurse) is the first phase. 4. The Momentum phase is usually the middle phase of your career.

What does the NSNA provide to its members? 1. Help in improving course grades 2. Guidance in choosing a good nursing school 3. Career development information 4. Opportunities for graduate school

Answer: 3 Rationales: 1. The National Student Nurses' Association (NSNA) does not provide tutoring or similar assistance. 2. The NSNA does not provide advice in selecting a nursing school. 3. The NSNA does provide career development information. 4. The NSNA itself does not provide graduate education.

In the U.S. health-care system, who is the real "customer"? That is, who actually pays most of the health-care bill? 1. The U.S. government 2. The head of the household 3. Government entities and employers 4. Employees and their families

Answer: 3 Rationales: 1. The U.S. government pays a large portion of the health-care bill but not all of it. 2. The head of household may contribute to the cost of health care, but most do not pay the majority of the bill. 3. Government entities (state and federal) and employers together pay for most of the cost of health care in the United States. 4. Employees and their families contribute but do not pay for most of the cost of health care.

Who is responsible for accepting, transcribing, and implementing physician orders? 1. Unit clerk 2. Medical intern or resident 3. Professional nurse 4. Medical assistant

Answer: 3 Rationales: 1. Unit secretaries may enter orders into a patient record; however, it is the responsibility of the professional nurse to accept or sign off on the order before it is implemented. 2. Medical students may write orders; however, they must first be signed off by the faculty physician before being accepted by the professional nurse, who can then ensure they are implemented. 3. The professional nurse is responsible for accepting, transcribing, and implementing health-care provider orders. 4. Medical assistants may not accept or implement physician or health-care provider orders without being accepted by a professional nurse.

Nursing standards of care and the organization's policies and procedures greatly decrease risk to patient safety. Which of the following steps can a nurse take to further reduce risk? 1. Submit event or incident reports for near misses. 2. Follow medication administration policies and procedures. 3. Always report significant data on care to patients and providers in a timely manner. 4. All of the above

Answer: 4 Rationales: 1. Events that are not the expected response or activity may constitute a near miss or adverse event and should be reported. It is better to overreport events. 2. Documenting in real time reduces the incidence of forgetting important patient information, which reduces risk to the patient. 3. Failure to communicate significant information in real time may result in harm to a patient. 4. All of the above

Implicit bias affects our understanding in an unconscious manner. A person's ability to recognize these biases can improve communication with patients and colleagues alike. Which of the following statements is true about implicit bias? 1. Implicit bias forms during a lifetime. 2. Implicit bias can influence clinical decision making and treatment. 3. Implicit bias contributes to an individual's social behavior. 4. All of the above

Answer: 4 Rationales: 1. Implicit bias is formed during a lifetime because it is formed based on an individual's culture, which shapes attitudes, beliefs, and actions. 2. Implicit bias is automatic and subconscious during our interactions with others and can influence our clinical decision making and even treatment. 3. Implicit bias contributes to social behavior because it is derived from an individual's cultural norms. 4. All of the above

As Jane speaks with the team, she learns why the staff members have had difficulty following policies. Which of these would be considered barriers to effective communication? 1. The charge nurse is unavailable to help the nurses when they have questions about policies. 2. Some staff are afraid to ask particular charge nurses for help for fear of retribution. 3. The use of acronyms is confusing to staff members who are new to the unit. 4. All of the above

Answer: 4 Rationales: 1. Physical barriers—such as the absence of the charge nurse to answer questions—could prevent the staff from following policies. 2. Emotional barriers—such as a nurse's fear of retribution from a colleague—can cause nurses to seek out answers, which can delay care or compromise safety. 3. Semantic barriers—such as acronyms or nicknames—can confuse or mislead staff unfamiliar with their meaning. 4. All of the above

A respiratory therapist performs suctioning on a patient with a closed head injury who has a tracheostomy. Afterward, the NAP obtains vital signs. The nurse should communicate that the NAP needs to report which vital sign value or values immediately? Select all that apply. 1. Heart rate of 96 beats/min 2. Respiratory rate of 24 breaths/min 3. Pulse oximetry of 95% 4. Tympanic temperature of 101.4°F (38.6°C)

Answer: 4 Rationales: 1. Suctioning will increase the heart rate. This needs reporting and reassessment and may be related to the increased temperature. 2. Respiratory rate is often increased with a fever. 3. Pulse oximetry of 95% is acceptable. 4. The patient has a tracheostomy and is at risk for infection. A tympanic temperature of 101.4°F (38.6°C) indicates an infection and needs to be reported immediately.

Nursing and respiratory departments both experienced job cuts. The nurse manager notices that members of his staff are having more trouble getting a fast response from a respiratory therapist. What source of conflict is probably operating here? 1. Union-management conflict 2. Interpersonal problem 3. Cultural differences 4. Work intensification

Answer: 4 Rationales: 1. There is no union or management involvement in the scenario presented. 2. Although this change in workload may eventually cause some interpersonal problems, the job cuts were an organizational decision, not a personal one. 3. This was an organizational decision, not one made because of a cultural difference. 4. Work intensification causes everyone involved to increase their workloads to accommodate the job cuts. Nurses and respiratory therapists adjusting to this change may be unable to request service or respond to a request for service in a timely manner.

Which of the following issues may be addressed in a collective bargaining agreement? 1. Shift differentials 2. Safe working environment 3. Grievance procedures 4. All of the above

Answer: 4 Rationales: 1. When a union has been designated as the official bargaining unit for your staff, shift differentials and salary increases are addressed as part of the collective bargaining. 2. Issues concerning safe working environments are usually included. They may include things such as the provision or availability of lift equipment, personal protective equipment, or protocols on the reduction of workplace violence. 3. Grievance procedures are part of collective bargaining agreements. These procedures ensure that staff issues are heard and reduce the possibility of unfair labor practice. 4. All of the above

A nurse is caring for a patient who has chronic obstructive pulmonary disease (COPD) and is 2 days postoperative after a laparoscopic cholecystectomy. Which intervention for airway management should the nurse delegate to an NAP? 1. Assisting the patient to sit up on the side of the bed 2. Instructing the patient to cough effectively 3. Teaching the patient to use incentive spirometry 4. Auscultating breath sounds every 4 hours

Answer: 1 Rationales: 1. Assisting patients with positioning and activities of daily living is within the educational preparation and scope of practice of a nursing assistant. 2. Instructing requires additional education and skills and is more appropriate for a licensed nurse. 3. Teaching patients requires additional education and skills and is more appropriate for a licensed nurse. 4. Assessing patients requires additional education and skills and is more appropriate for a licensed nurse.

The patient with COPD has a nursing diagnosis of Ineffective Breathing Pattern. Which is an appropriate action to delegate to the experienced LPN under your supervision? 1. Observe how well the patient performs pursed-lip breathing. 2. Plan a nursing care regimen that gradually increases activity intolerance. 3. Assist the patient with basic activities of daily living. 4. Consult with the physical therapy department about reconditioning exercises.

Answer: 1 Rationales: 1. Experienced licensed practical nurses (LPNs) and licensed vocational nurses (LVNs) can use observation of patients to gather data regarding how well patients perform interventions that have already been taught. 2. Planning requires additional education and skills, appropriate to a registered nurse (RN). 3. Assisting patients with activities of daily living (ADLs) is more appropriately delegated to a nursing assistant. 4. Consulting requires additional education and skills, appropriate to an RN.

Which of the following represents the "S" in a SWOT analysis? 1. Flexibility 2. Difficulty adapting to change 3. Nursing shortage 4. Competition among health-care facilities

Answer: 1 Rationales: 1. Strengths include the following: Relevant work experience Advanced education Product knowledge Good communication and people skills Computer skills Self-managed learning skills Flexibility 2. Difficulty adapting to change would be a weakness. 3. The nursing shortage is an opportunity. 4. Competition among health-care facilities is a threat or opportunity.

What is the purpose of a cover letter when applying for a position? 1. Introduces the applicant 2. States the employment goal 3. Outlines the applicant's position in the community 4. Describes the reason for entering nursing

Answer: 1 Rationales: 1. The cover letter will be your introduction. If it is true that first impressions are lasting ones, the cover letter will have a significant impact on your prospective employer. 2. Your employment goal should be on your résumé. 3. The position in the community may be included but is not the purpose of the letter. 4. The reason for entering nursing is more appropriate for a school application.

A nursing student is preparing a résumé to send to prospective employers. What qualities should the nursing student emphasize? Select all that apply. 1. Responsibility and accountability 2. Integrity 3. Interpersonal skills 4. Social skills 5. Family values

Answer: 1, 2, 3 Rationales: 1, 2, 3. In addition to passing the National Council Licensure Examination (NCLEX®), employers cite responsibility, integrity, and interpersonal skills, along with oral and written communication skills. 4. Social skills are not qualities of interest for an employer. 5. Family values are not of interest to an employer.

Florence has two team members who continually criticize each other despite being told to stop. Which approach is the most appropriate for this situation? 1. Refer each of them for employee counseling. 2. Engage in problem resolution. 3. Bring in a union representative. 4. Engage in a formal negotiation process.

Answer: 2 Rationales: 1. Employee counseling may further exacerbate the conflict because employee counseling will deal with each staff member individually rather than bringing them all together to resolve the issue. 2. Problem resolution is the best answer. Florence has addressed both of her staff members about their behavior, and there has been no improvement. Problem resolution will help the two parties identify the issue and agree on a solution to the problem. 3. This is not a union issue. A union representative is usually only engaged when there is a dispute between employees and management, not between employees. 4. Formal negotiation would be too complex for this situation. The two team members are openly critical of one another, but the overall climate of the unit is supportive and collegial.

Informational aspects of a nurse manager's job include: 1. Evaluation 2. Resource allocation 3. Being a coach 4. Being a spokesperson

Answer: 4 Rationales: 1. Evaluation is one of the decisional activities of a nurse manager. 2. Resource allocation is also a decisional activity. 3. Being a coach is one of the interpersonal activities of a nurse manager. 4. Being a spokesperson for staff, patients, and administration is an informational activity.

In the United States, health-care insurance can best be described as 1. Universal 2. Available to all 3. Free 4. Expensive

Answer: 4 Rationales: 1. Health-care insurance is not universally available in the United States. 2. Likewise, it is not available to everyone. 3. Neither health care nor health-care insurance is free in the United States. 4. Health-care insurance in the United States is relatively expensive.

Theory Y emphasizes: 1. Guidance, development, and reward 2. Leadership, not management 3. Supervision, monitoring, and reprimands 4. Evaluation, budgeting, and time studies

Answer: 1 Rationales: 1. A Theory Y manager employs staff guidance, staff development, and rework as opposed to Theory X's emphasis on control, close monitoring, and punishment, if needed. 2. Theory Y is a management theory, not a leadership theory. 3. These are the focus of Theory X, not Theory Y. 4. Time studies are used primarily by those managing in the scientific management mode.

A nurse is helping an NAP provide a bed bath to a comatose patient who is incontinent. Which of the following actions requires the nurse to intervene? 1. The nursing assistant answers the phone while wearing gloves. 2. The nursing assistant log-rolls the client to provide back care. 3. The nursing assistant places an incontinence diaper under the client. 4. The nursing assistant positions the client on the left side, head elevated.

Answer: 1 Rationales: 1. The gloves are contaminated and should be removed before answering the phone. 2. Log rolling is an appropriate action. 3. Using an incontinence diaper is an appropriate action. 4. Keeping the head elevated is an appropriate action.

A nurse is caring for a patient who has a pulmonary embolus. The patient is receiving anticoagulation with IV heparin. What instructions should the nurse give the NAP who will help the patient with activities of daily living? Select all that apply. 1. Use a lift sheet when moving and positioning the patient in bed. 2. Use an electric razor when shaving the patient each day. 3. Use a soft-bristled toothbrush or tooth sponge for oral care. 4. Use a rectal thermometer to obtain a more accurate body temperature. 5. Be sure the patient's footwear has a non-slip sole when the patient ambulates.

Answer: 1, 2, 3, 5 Rationales: 4. This is inappropriate. Although a patient is receiving anticoagulation therapy, it is important to avoid trauma to the rectal tissue, which could cause bleeding (e.g., avoid rectal thermometers and enemas). 1, 2, 3, and 5. These are appropriate to the care of a patient receiving anticoagulants.

Who may become a member of the NSNA? Select all that apply. 1. Associate degree program students 2. Graduates of associate degree programs 3. Diploma school students 4. Baccalaureate degree students

Answer: 1, 3, 4 Rationales: 1. Associate degree students are eligible for National Student Nurses' Association (NSNA) membership. 2. Graduates of nursing degree programs are not eligible. 3. Diploma school students are eligible for NSNA membership. 4. Baccalaureate degree students are also eligible for NSNA membership.

As a new graduate, what features should you look for in a TPP program? 1. Match with an experienced nurse mentor 2. Shortest transition time possible 3. Rapid movement to full assignment 4. Opportunities to network with peers

Answer: 1, 4 Rationales: 1. Being matched with an experienced nurse mentor is very valuable for the new graduate. 2. Transitions take time; there is no advantage to rushing through them. 3. Again, rushing through the transition has little advantage and may leave the new graduate unprepared for the full responsibility of a practicing nurse. 4. Opportunities to network with peers provide support and a chance to hear others' ideas for making a successful transition.

Which of the following best describes the nurse of today? 1. Assistant to the physician 2. Member of the largest health-care profession 3. Member of the most powerful lobby group in health care 4. Woman in white

Answer: 2 Rationales: 1. Nurses today have many independent functions. 2. Nurses constitute the largest health-care profession by numbers. 3. Nurses are not the most powerful lobbying group in health care but have considerable potential to influence legislation. 4. Not all nurses are women; not all wear white.

Jane is a new nurse manager who will be holding her first staff meeting tomorrow. She has learned that the staff members have not been following important patient care policies. What is the most important communication skill that she should use at the meeting? 1. Talking to the staff 2. Laughing with them 3. Listening 4. Crying

Answer: 3 Rationales: 1. Although answer 1—talking to the staff—is important, the best answer is 3. 2. This is incorrect. Laughing with staff can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane. 3. Listening to staff is the most critical communication skill because it helps the manager understand the situation and the staff's rationale for their actions. It also demonstrates empathy and openness, which can lead to agreement on better adherence to the policies. 4. This is incorrect. Demonstrating emotions such as crying can confuse the audience and cause them to misconstrue the seriousness of the message from Manager Jane.

Transformational nursing leaders have the ability to: 1. Increase the negativity of the team 2. Work best alone 3. Define the group's mission and communicate that mission to others 4. Pay close attention to the weaknesses and shortcomings of others

Answer: 3 Rationales: 1. An effective leader would increase the positivity of the team, not its negativity. 2. Transformational leaders work with others, not alone. 3. Transformational leaders help their teams define their mission and see how their work helps them achieve their mission. 4. Transformational leaders do not focus their attention on team members' weaknesses.

A democratic nurse leader consistently works to: 1. Move the group toward the leader's goals 2. Make little or no attempt to move the group 3. Share leadership with the group 4. Dampen creativity

Answer: 3 Rationales: 1. Democratic leaders do not set goals without consulting with or recognizing the group's goals. 2. Democratic leaders are active, not passive. 3. Democratic or participative leaders are characterized by their inclusion of team members in important decisions. 4. Autocratic leadership squelches creativity, whereas democratic leadership fosters it.

A good description of the present U.S. health-care system would be: 1. The best in the world 2. Efficient and effective 3. Needs improvement 4. Meets everyone's needs

Answer: 3 Rationales: 1. There are health-care systems in other countries that are less expensive but have better outcomes in terms of population health indicators. 2. U.S. health care is expensive, not efficient. 3. There are many ways in which the U.S. health-care system could be improved. 4. Given the number of health disparities, the current conclusion is that the U.S. health-care system does not meet everyone's needs.

Jean Paul has practiced nursing for 5 years and wants to continue his education. He has an associate degree and is trying to decide whether to pursue a nursing degree or a nonnursing degree. Which of the following is an advantage of choosing a nursing degree? 1. Higher time demand of the nonnursing degree 2. Opportunity to learn about other professions outside nursing 3. Broader focus of the nonnursing degree 4. Opportunity to advance knowledge and skills in his profession

Answer: 4 Rationales: 1. Nursing degrees typically have a higher time demand than do nonnursing degrees. 2. Learning about other professions is useful but not as important as advancing knowledge and skills in one's own profession. 3. Likewise, the broader focus of nonnursing degrees fails to provide advanced preparation in nursing. 4. Advancing one's knowledge and skills in one's own profession is the primary goal of obtaining a higher degree.

To achieve safe patient care, a culture of safety must exist. What are characteristics of an organization with a culture of safety? 1. Transparency, openness, reporting of errors is rewarded, blame-free environment 2. Honesty, studying of serious events 3. Privacy, reporting of errors appreciated 4. Blame-free environment, openness, error reporting is encouraged

Answer: 1 Rationales: 1. A culture of safety requires a blame-free environment where error reporting is rewarded; this promotes trust, honesty, and transparency, which have been shown to reduce cases of adverse events. 2. Honesty is important in a culture of safety, but all event reports should be studied—not just the unexpected, serious ones. 3. Event reports are protected confidential documents, but they can be shared with the organization for warning purposes. 4. A blameless environment lacks personal accountability, which is an important requirement in a culture of safety.

Medical errors account for 250,000 deaths per year. It is estimated that as many as 50% of these errors may be preventable. What steps would you take to avoid a medication error? 1. Review the patient's medication administration record during bedside shift report. 2. Ask your colleagues to get your medication so that you can give it on time. 3. Call the pharmacist. 4. Review the medication administration policy.

Answer: 1 Rationales: 1. Review of the medication administration record (MAR) with the off-going nurse allows you to review the list of medications and learn of any issues, possible reactions to medication, or missed doses. 2. It is always safer to obtain your patient's medication yourself to ensure it is the right medication for the right patient. 3. Unless there is an issue or question about a particular medication, this may not be indicated. 4. Reviewing the medication policy is helpful; however, it will not offer specific information about your patient's possible condition or situation.

TJC attributes 80% of all medical errors to: 1. Poor hygiene and hand washing 2. Poor hand-off communication 3. Poor work environment 4. Lack of care

Answer: 2 Rationales: 2. Ineffective hand-off communication or miscommunication between caregivers during the transfer of care is estimated to contribute to 80% of serious medical errors. Poor hand-offs can lead to delays in treatment, inappropriate treatment, and prolonged hospital stays. Answers 1, 3, and 4 contribute to medical error but not to the same degree as ineffective hand-off communication.

A nurse is caring for a patient who is diagnosed with coronary artery disease and sleep apnea. Which action should the nurse delegate to the NAP? 1. Discuss weight-loss strategies such as diet and exercise with the patient. 2. Teach the patient how to set up the CPAP machine before sleeping. 3. Remind the patient to sleep on his side instead of his back. 4. Administer modafinil (Provigil) to promote daytime wakefulness.

Answer: 3 Rationales: 1. Discussing weight-loss strategies requires additional education and training. 2. Teaching requires additional education and training. These actions are within the scope of practice of the registered nurse (RN). 3. The nursing assistant can remind patients about actions that have already been taught by the nurse and are part of the patient's plan of care. 4. The RN can delegate the administration of medication to a licensed practical nurse (LPN) or licensed vocational nurse (LVN).

A nursing student is preparing for a first job interview. What should the nursing student research about the organization before going to the interview? 1. Review the salary scale. 2. Research the benefits package offered to employees. 3. Become familiar with the organization's mission and core values. 4. Ask nurses who work at the agency how many patients they are assigned.

Answer: 3 Rationales: 1. Reviewing the salary scale does not show an interest in the organization. 2. Researching the benefits package is important when comparing organizations but does not show a prospective employer your interest. 3. Before attending an interview, review the organization's philosophy, mission, and values. This demonstrates to the prospective employer that you have an interest in the position and the organization. 4. Asking other nurses about the number of patients is not relevant.

Studying errors and identifying how they occur helps organizations improve patient safety. Which category of errors is the most useful in identifying and remedying vulnerabilities in an organization? 1. Sentinel event 2. Adverse event 3. Near miss event 4. Wrong procedure event

Answer: 3 Rationales: 1. Sentinel events are unexpected events that result in death or serious physical or psychological injury. These events are rare, and investigation and learning happen after harm to the patient. 2. Adverse events are injuries caused by the care providers and are studied after the fact. 3. Near misses are potential errors interrupted before they occur. They are useful in identifying and remedying vulnerabilities in the system before harm can occur. 4. Wrong-procedure events are considered sentinel events because they should never occur.

Janice Mendoza is settled in her nursing position and wants to devote some time to one of the issues facing the nursing profession. Which of the following activities would probably have the LEAST impact on advocating for the nursing profession? 1. Contribute to the ANA's PAC 2. Visit the representatives when the state legislature is in session 3. Talk with her friends, explaining her concerns 4. Speak on radio and television programs

Answer: 3 Rationales: 1. The American Nurses Association's (ANA's) political action committee (PAC) actively advocates for nursing and for patients. 2. Visiting one's representatives continues to be an effective strategy. 3. Talking only with one's friends is less likely to be effective. 4. Speaking on public media is another effective strategy.

Social media is commonly used to update friends and groups on things we have going on in our lives. Health-care organizations routinely use social media to promote medical facts, services, and recognitions. What is important for nurses to remember when deciding to post something work related on a social media site? 1. Nurses should never post protected health information on a social media site. 2. Stories with good outcomes can be posted to your media page. 3. Stories and photos can always be shared if the patient's name or face is not visible. 4. Posting stories on personal time is OK because the nurse is not working.

Answer: 1 Rationales: 1. Protected health information (PHI) must be protected and never shared without expressed written permission. A patient's privacy and confidentiality are paramount. 2. Nurses and other health professionals should never post stories about patients or work on social media sites. People familiar with you may easily put 2 and 2 together and surmise the situation and patient involved, which could be a breach in patient privacy. This could be grounds for disciplinary action. 3. Photos of patients or work areas should not be shared on social media. Although innocent, a photo may include an assignment board or other information that could inadvertently display PHI. 4. The time of social media posting is irrelevant; the issue is the confidentiality and privacy of the patients and the staff caring for them.

Which of the following are the primary current problems with the U.S. health-care system? Select all that apply. 1. Increased use of EHRs 2. Less-than-optimum outcomes (quality issues) 3. Number of people who are uninsured 4. High cost of care

Answer: 2, 3, 4 Rationales: 1. Increased use of electronic health records (EHRs) is occurring but is not a major problem. 2. Outcomes that are less than optimal continue to be a concern. 3. The number of uninsured also continues to be a concern. 4. Likewise, high costs continue to be a concern.

You are working on the trauma unit today, and your new patient with a femur fracture complains of leg pain and seems a little diaphoretic and short of breath. You assess the patient and prepare to contact the surgeon. In preparation for contacting the physician, you: 1. Immediately page the MD; it could be a pulmonary embolism, and time is of the essence. You will give him the particulars when the MD arrives. 2. Wait for the MD to round on his patient because it should be within the next hour or so. 3. Medicate the patient for pain and plan to contact the MD when he rounds. 4. Jot down notes about the situation as it is presented to you, review the patient's history, focus your assessment, and determine what you need for the patient.

Answer: 4 Rationales: 1. Paging the MD to the bedside without any information may cause the MD to just add visiting the patient to his list rather than conveying the urgency of the patient's change in condition. 2. Placing a STAT page to the MD may get the MD there quickly; however, without the necessary information about the patient, the MD may think that you overreacted and dismiss the severity of the clinical change. 3. Rather than bother the MD, you medicate the patient for pain and continue to observe the patient. 4. Describing the situation, background, assessment, and recommendations (SBAR) is best. Reporting on situational change is designed to provide concise, pertinent, and factual information to members of the health-care team. This approach to a sudden change in patient condition allows you to communicate information, your concerns, and the need for action.

A nurse is assigned to care for the following patients. Which patient should the nurse assess first? 1. A 60-year-old patient on a ventilator for whom a sterile sputum specimen must be sent to the laboratory 2. A 55-year-old with COPD and a pulse oximetry reading from the previous shift of 90% saturation 3. A 70-year-old with pneumonia who needs to be started on IV antibiotics 4. A 50-year-old with asthma who complains of shortness of breath after using a bronchodilator

Answer: 4 Rationales: 1. This patient's needs are not urgent or emergent. 2. In chronic obstructive pulmonary disease (COPD), patients' pulse oximetry oxygen saturations of more than 90% are acceptable. 3. The IV needs to be started; however, there is not an indication that the patient is in an urgent or emergent situation. 4. The patient with asthma did not achieve relief from shortness of breath after using the bronchodilator and is at risk for respiratory complications. This patient's needs are urgent.