Cherry Chap. 14
A nurse manager has calculated that providing 75 hours of direct nursing care per day requires that 120 hours must actually be worked by nursing staff. The manager is involved in: (Select all that apply.) a. developing the capital budget. b. applying a productivity metric. c. monitoring the labor budget. d. incremental budgeting processes. e. addressing budget assumptions. ANS: B, C The nurse manager is determining the amount of work produced by calculating the actual number of nursing hours worked, which is a productivity metric. Budgets use productivity metrics. The manager is not evaluating long-term major expenses, which are the components of the capital budget. The nurse is not planning a new budget by using an incremental increase from the prior budgeting period; this activity is part of the incremental budgeting process. The manager is not addressing issues such as the stability of prices, projected patient census, and recruitment efforts for the next year, all of which would be considerations in budget assumptions.
1.
A nurse manager plans the fiscal budget to include salaries for two RNs for two 12-hour shifts with a patient census of 6 in the short-stay observation room. The nurse manager reviews the budget report 3 months later and notes that the salary expenses are higher than was budgeted because of higher than planned RN staff salaries. This additional RN staff is necessary to meet patient care needs because the census has remained constant at 10 patients rather than the 6 projected when the budget was developed. The difference between the planned budget and the actual cost is known as: a. revenue. b. variance. c. monitoring. d. capital expenditures. ANS: B Variance is the difference between the planned budget and actual results; it can be a positive or a negative discrepancy. Revenue is the income, but it is not analyzed to detect variations between predicted and actual expenses. Monitoring is the process by which variances are identified. Capital expenditures, which are long-term investments such as bedside computers, are part of the budget but are included in comparison with projected results.
1.
According to current data related to the nursing shortage: (Select all that apply.) a. salaries of nurses are competitive with those of other professionals such as teachers. b. only 10.6% of nurses are minorities. c. overall, nurses are satisfied with their jobs but leave the profession because of fear of contracting fatal diseases. d. over the next decade, more than half of RNs in the United States will retire. e. staff nurses are returning to school to obtain certificates to teach nursing. ANS: B, D Only 10% of nurses are minorities. Nurses are older, with a mean age of 46.8 years. Salaries are not a problem related to the nursing shortage. Most facilities are willing to increase salaries and benefits for nurses. It has not been documented that nurses are afraid of contracting a fatal disease. Nurses take precautions to reduce this risk. There is a shortage of nursing faculty, and graduate education is required rather than certificates to teach nursing.
1.
Accrediting and licensure agencies such as The Joint Commission address staffing by: a. imposing maximum staffing levels. b. requiring a specific staff mix. c. stipulating nurse/patient ratios. d. looking for evidence that patients receive satisfactory care. ANS: D Accrediting agencies do not address minimum staffing levels; however, they do look for evidence that patients receive adequate care, and this can occur only with adequate staffing. Accrediting agencies do not impose maximum staffing levels. Staff mix is not addressed by accrediting agencies; however, long-term care facilities specify minimum RN coverage for the facility. Agencies do not stipulate mandatory staffing ratios, with the exception of those in California, a state that recently enacted legislation mandating specific nurse/patient ratios.
1.
In an attempt to persuade employees to bargain for another type of health insurance, a handout is circulated that describes the present employees' health care insurance as being insensitive, limiting choices of care providers, and providing inferior care. This reflects which aspect of Lewin's planned change? a. Unfreeze b. Move c. Refreeze d. Acceptance ANS: A Unfreeze is correct because the change agent promotes problem identification and encourages awareness of the need for change. In alignment with Lewin's stages of change (unfreezing, moving, and refreezing), education and involvement are keys to successful change. People must believe that improvement is possible before they will be willing to consider change. Move is incorrect because at this stage, the change agent clarifies the need to change, explores alternatives, defines goals and objectives, plans the change, and implements the change plan. Refreeze is incorrect because at this stage the change is being integrated into the organization so that it becomes recognized as the status quo. The change agent must facilitate change by monitoring adherence to the new requirements. Acceptance is incorrect because acceptance and integration represent the final aspect of any change.
1.
Registered nurses who are entering the workforce will have expanded leadership responsibilities that include: (Select all that apply.) a. serving on interdisciplinary care teams. b. being competent to work in several areas independently when dictated by patient census. c. attending a meeting to plan advanced training for unlicensed assistive personnel. d. evaluating outcomes of care that are reported to a standing committee. ANS: A, C, D The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses. The new nurses will be placed in many situations that require leadership and management skills, for example, managing a group of assigned patients, serving on a task force or committee, acting as team leaders or charge nurses, and supervising unlicensed assistive personnel and licensed vocational/practical nurses.
1.
Which item below correctly describes the U.S. Bureau of Labor Statistics predictions by 2020? a. Positions that historically required registered nurses will be filled by unlicensed personnel. b. The job growth rate for RNs will surpass job growth in all other occupations. c. The need for hospital nurses will dramatically decrease. d. Hospitals will finally achieve the required RN workforce. ANS: B In 2020 the United States is projected to have only 64% of the registered nursing workforce required to meet the demand for RNs. Unlicensed personnel will not be filling positions for nurses because this group does not have the education needed to provide such care. The need for hospital nurses will dramatically increase, not decrease. Hospitals will not have enough nurses as stated per statistics.
1.
While participating in a task force to proactively plan for nursing care delivery over the next 20 years, dramatic changes will occur as a result of: (Select all that apply.) a. the increase in the number of minimally invasive procedures being performed for disease treatment. b. care provided for patients over an extended period in acute care settings. c. the reduction in the number of nurses and other health care professionals who are available to provide care. d. the widespread illiteracy and decreased self-efficacy of the aging patient population. e. the need to focus on social and environmental influences, educational level, and individual characteristics and values of the patient. f. the devaluing of nursing as a means of improving patient outcomes. ANS: A, C, E Invasive surgical procedures are being replaced by laparoscopic procedures. The demand for nurses and other health care professionals cannot keep pace with the increased need for health care required by the growing older population. Care will focus on the unique lifestyle and values of a diverse population. Patients are discharged much more quickly and with more complex care needs, rather than having a longer stay in acute care settings. Consumers, especially the aging baby-boomer generation, are proactive about learning and participating in health care. Nursing is increasingly valued and has been shown to improve patient outcomes and patients' satisfaction with care.
1.
A nurse manager is working with the financial officer to develop the budget of the nursing unit for the next fiscal year. The nurse manager tells the financial officer that which of the following information will affect budget assumptions? a. The capital budget request for new emergency department equipment has been turned in for consideration by the hospital's administrative team. b. The patient census likely will increase during the next fiscal year because two large physician groups have transferred their admission privileges to this hospital. c. The participatory budgeting approach instituted last year has been helpful in controlling supply costs. d. Zero-based budgeting will help the managers to be more efficient in establishing next year's budget. ANS: B Budget assumptions are future predictors of performance and include the stability of the price of supplies, the salary range needed to recruit and retain quality employees, new services offered by competitors, and the variability of the patient census. Capital budget requests that are awaiting approval do not affect budget assumptions that should be addressed in the next fiscal year. The participatory budgeting approach involves front-line managers in the budgeting process, but it is not necessarily related to future budget assumptions. Zero-based budgeting is prepared as if for the first time and is actually more time consuming and less efficient than incremental budgeting; also, zero-based budgeting is a method of budgeting and does not affect budget assumptions. MULTIPLE RESPONSE
10.
A nurse who is teaching a class to introduce telehealth to the staff would include which example? a. A robot performs menial housekeeping chores for an invalid patient. b. A computer software program alerts the nurse or physician who is reviewing orders that an order for a new drug can cause synergy of the theophylline inhaler. c. A physician speaks into a computer, and the admission history is recorded and saved in the patient file. d. A nurse watches remotely from California while a patient in Wyoming performs peritoneal dialysis to ensure that all steps are being followed correctly. ANS: D Telehealth is the delivery of care to a patient who is at a distance from the health care provider. Robotic technology involves the delivery of sensorimotor simulation for rehabilitation; language translators can be used to interview and examine patients at distance. Point-of-care drug references and alerts that can be downloaded into PDAs and laptops may decrease drug errors but are not considered a component of telehealth. Voice communication systems, which include voice recognition, provide security through recognition of voice in dictation of histories, physicals, and notes related to patient progression.
10.
According to the unit's policy for call-ins, a nurse is suspended for 3 days because of excessive call-ins that occur within 15 minutes of shift change. The nurse states, "You are unfair to me." Which theory would disprove the nurse's statement? a. Bureaucracy b. Closed systems c. Open systems d. Trait ANS: A Weber's concept of bureaucracy revolves around the assumption that authority confers the right to issue commands within an organization on the basis of impersonal rules and rights, by virtue of the management position rather than any trait ascribed to the person who occupies that position. Other characteristics include the following: Impersonal rules govern the actions of superiors over subordinates, all personnel are chosen for their competence and are subject to strict rules that are applied impersonally and uniformly, and a system of procedures for dealing with work situations is in place. Represents the systems theory of the organization. There are two views: open and closed. Closed systems theory views the system as being totally independent of outside influence. Represents the systems theory of the organization. There are two views: open and closed. Open systems theory suggests that the organization is affected not only by internal change but also by external environmental changes that can have a direct or an indirect influence on the organization. Trait theory, which describes intrinsic traits of leaders, is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery.
10.
The nurse manager is planning staffing levels and realizes that the first step is to: a. know the intensity of care needed by patients according to physical and psychosocial factors. b. examine the educational level of the staff. c. assess the skill level of caregivers. d. review the budget to determine the financial consequences of past staffing patterns. ANS: A The nurse manager must determine the number and mix of health care providers according to the wide range of care requirements of individual patients. Educational level requirements must be matched to patients' acuity levels. Assessing the skill level of staff is necessary to match staff with patients according to patients' acuity level. Past staffing patterns cannot predict the needs of the current population.
10.
With the crisis in health care and the nursing shortage, why is the image of nursing still important? a. Nursing care is often delivered during a time of uncertainty, and the image of nurses during this time can reinforce trust in the nurse-patient relationship. b. Physicians have a distinctive body of knowledge that identifies them as professionals, whereas nursing has yet to develop a unique body of knowledge on which to base practice. c. Nurses must present a unified image if they hope to ever move nursing to a profession. d. The dynamic state of today's health care requires nurses to move from a caring image to one of technologic competence. ANS: A A person who seeks health care is entering a world of uncertainty. The nurse provides continuity and compassion and stabilizes the environment of the patient. Nursing has a unique body of knowledge. Nursing is a profession. Unification will enhance the professional goals for nursing. Caring will always be part of the nursing image and nurses have already moved into the technologic realm.
10.
A hospital is concerned with nurse retention and realizes that job satisfaction is a major influence. To enhance employee satisfaction related to staffing, the management team: a. negotiates for additional agency nurses. b. hires more part-time employees. c. prioritizes participatory management into staffing decisions. d. uses "float" nurses to cover vacancies. ANS: C Staffing methods that include staff participation and enhance staff autonomy have been demonstrated to play a major part in ensuring employee satisfaction. The use of temporary, part-time, or agency nurses can result in a lack of continuity of care, thereby decreasing patient satisfaction, which affects employee satisfaction. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention. Hiring more part-time employees and the use of "float" nurses have not been demonstrated to be effective methods of increasing nurse retention. DIF: Comprehension REF: Page 428
11.
A nurse is reading about positive reinforcement with the goal of increasing staff motivation. Which action would demonstrate positive reinforcement? a. Every morning at shift change, thank each employee for an excellent job. b. Rotate a monthly "employee recognition award" among all employees on the unit. c. Wait until the annual performance review to recognize accomplishments. d. Give spur-of-the-moment recognition to an employee who has accomplished a goal. ANS: D To be effective, positive reinforcement should (1) be specific, with praise given for a particular task done well or a goal accomplished; (2) occur as close as possible to the time of the achievement; (3) be spontaneous and unpredictable (praise given routinely tends to lose value); and (4) be given for a genuine accomplishment. Thanking each employee for doing an excellent job lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. Establishing an "employee recognition award" lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment. Waiting until the annual performance review to recognize accomplishments lacks spur-of-the-moment, spontaneous recognition for a genuine accomplishment.
11.
An advanced practice nurse inputs into a computer software program the following clinical manifestations: open wound with tibia exposed, petechial hemorrhage, and temporary loss of consciousness. The computer diagnosis of fat emboli is generated by a system known as: a. decision support. b. telehealth. c. robotic technology. d. biometric technology. ANS: A Decision support systems are computer-based information systems that include knowledge-based systems designed to support clinical decision making. Telehealth allows the provider to treat patients from a distance through electronic submission of data. Robotic technology includes the delivery of sensorimotor simulation for rehabilitation, language translators, and technology to interview and examine patients at a distance. Biometric technology is the use of personal characteristics such as fingerprints and hair to gain access to a secure site that contains patient information.
11.
Nurses can combat the nursing shortage by: a. joining unions, which influence employers to provide incentives such as pay raises and free child care, thus encouraging the large percentage of nonworking nurses to return to the workforce. b. demanding that the requirements of the qualifying examination for foreign nurses should be reduced, so they are eligible to sit for the licensure examination. c. working more hours with a higher nurse/patient ratio. d. advocating for funds to pay for nursing education and a safer work environment. ANS: D Advocating for funds to pay for nursing education and a safer work environment is a positive strategy as can be seen by results attained after the Reinvestment Act P.L. 107-205 provided $20 million for nursing scholarships, public service announcements, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This is the best defense against the nursing shortage. Nursing graduates in many states have increased in number, and enrollment in nursing schools is also on the rise. Unions are not the answer to the nursing shortage. This approach would make access to health care more difficult, and the nursing shortage would only increase because efforts to attract nurses from younger generations would be reduced by the fact that funding for exposure to nursing would most likely decrease. Lowering standards would increase the chance for errors, cause patient care standards to become lower, and harm the image of nursing. As the acuity level of patients increases, the nurse/patient ratio should be lowered. Facts reveal that lower nurse/patient ratios reduce errors and decrease mortality rates.
11.
A nurse is preparing a presentation using different websites to collect information. The nurse is concerned that contact information and the author's credentials are not listed for one of the websites reviewed. Which criterion required to establish a reputable website is missing? a. Authority b. Objectivity c. Usability d. Currency ANS: A Authority is the criterion that is related to an author's credentials and background that have prepared him or her to publish on the subject. Objectivity is the criterion that is related to the site's purpose, intended audience, and sponsorship and to whether the information is fact or opinion. Usability is the criterion that is related to the maneuverability and overall arrangement of the website. Currency is the criterion that is related to updated information required because of the dynamic state of health care.
12.
A patient is admitted for a hysterectomy, and the RN develops and implements the plan of care but also delegates to the LPN/LVN the responsibility of administering oral medications. While off duty, this RN receives a call requesting a change in the plan of care because the patient has developed deep vein thrombosis. The nurse who originally planned the care is practicing which type of nursing care delivery? a. Modular b. Primary c. Team d. Functional ANS: B The primary nurse assumes 24-hour responsibility for planning, directing, and evaluating the patient's care from admission through discharge but may delegate or provide primary care during the shift when present. In modular care delivery, a small team is assigned to a geographic location during their assigned shift. In team nursing the RN directs members of the team who are providing care but does not assume 24-hour responsibility. Functional nursing focuses on completion of tasks rather than on specific patients.
12.
Today's demographics of the RN population indicate that: a. nurses entering the workforce do so within 2 years of completing high school. b. more white nurses enter and obtain graduate degrees than any other ethnic group. c. the highest level of nursing education for most RNs is an associate degree. d. the majority of nurses practice in hospitals. ANS: D 56% of nurses practice in hospitals. The youngest professionals, those with a BSN, enter at age 26. More African-Americans are entering graduate school. The highest level of nursing education is the baccalaureate degree.
12.
Which action represents the key management function of strategic planning? a. Determining that all nurses on the unit understand the current organizational philosophy b. Evaluating the communication process between the pharmacy and the nursing departments c. Monitoring data from the quality management initiative related to the last three orientation programs d. Developing a 5-year plan that will incorporate the clinical nurse leader as a part of all nursing units ANS: D A strategic plan is a written document that details organizational goals, allocates resources, assigns responsibilities, and determines time frames. The strategic plan generally looks 3 to 5 years into the future. Determining that all nurses on the unit understand the current organizational philosophy is a form of current evaluation and analysis, and does not look toward the future. Evaluating the communication process between the pharmacy and the nursing departments is a form of current evaluation and analysis, and does not look toward the future. Monitoring data from the quality management initiative related to the last three orientation programs is a form of current evaluation and analysis, and does not look toward the future.
12.
A hospital's policy requires that all nurse managers must have a minimum of a bachelor's degree in nursing. A BSN nurse new to the hospital has recently been hired as nurse manager for the oncology unit. An RN who has worked on this unit for many years is unable to be promoted to a nurse manager position because of his educational status and has been commenting to physicians and staff, "The new nurse manager has book sense but no leadership abilities." What is the best approach that can be used by the new nurse manager who is attempting to gain the trust and respect of the nursing staff on the unit? a. Send memos to all staff except the upset nurse to invite them to a luncheon. b. Ask management to transfer the upset nurse to another unit. c. Assign the upset nurse to committees that do not directly affect that nursing unit. d. Acknowledge the clinical expertise of the upset nurse and clearly explain the expectations for teamwork and open, honest communication. ANS: D The best way for the new nurse manager to communicate with this employee, who may be an informal leader, is to show respect for the individual's clinical expertise and experience through clear and direct communication. The new nurse manager should attempt to identify the staff nurse's power as an informal leader, should involve him and other staff members in decision making and change implementation processes, and should clearly communicate goals and work expectations to all staff members. The nurse manager would not gain the respect or trust of other nurses on the unit by excluding one of their peers from an activity. The nurse manager must make a sincere attempt to work with the nurse, whose clinical experience is valuable to the unit. A transfer request would be the last option after all other efforts to develop a working relationship with the staff nurse have been exhausted. The best way to work with this employee and gain the respect of other nurses on the unit is through open and direct communication.
13.
A nurse is interested in locating reliable information concerning noninvasive blood glucose monitoring. Information is located, and the author is a scientist who conducted studies within the last year on the effectiveness of a particular noninvasive blood glucose monitor. The scientist received funding from a pharmaceutical company to support the studies. The URL indicates the pharmaceutical company site.com. The nurse is concerned about this information's: a. authority. b. objectivity. c. accuracy. d. currency. ANS: B Sites sponsored by organizations such as pharmaceutical companies may influence the content. The author, in this case the researcher for the pharmaceutical company, has authority on the topic. Research studies are referenced. The study was conducted within the last year.
13.
The 2008 Gallop Poll ranked the four most ethical professionals in the following descending order: a. Firemen b. High school teachers c. Physicians d. Nurses e. Pharmacists a. A, B, C, D b. A, D, B, E c. E, D, C, B d. D, E, B, C ANS: D Only in 2001 did firemen rank higher than the other four professions. In the 2008 Gallop Poll nurses ranked first (84%); second, pharmacists (70%); third, high school teachers (65%); and fourth were physicians (64%). MULTIPLE RESPONSE
13.
When deciding which staffing option to use on a nursing unit that will open soon, the manager realizes that: a. continuity of care is enhanced and errors are reduced when nurses provide care over longer shifts and consecutive workdays, such as 12-hour shifts on 3 consecutive days per week. b. the use of part-time nurses provides the variability needed to meet diverse patient needs. c. satisfaction of the staff equates to satisfaction of patients. d. nurses provide the same level of care, regardless of the work environment. ANS: C High nurse satisfaction is generally equated with higher patient satisfaction and improved patient outcomes. Errors increase with long shifts over consecutive days. The use of part-time nurses may result in decreased patient satisfaction and lack of continuity of care. Research has found that nurses who practice in positive and autonomous work environments provide cost-effective care of better quality.
13.
A clinical nurse leader (CNL) enters the workforce and hopes to use her interdisciplinary skills to participate on a quality improvement committee. The coordinator of the quality group invites the CNL to join the group. Which type of power is demonstrated by the coordinator of the group? a. Coercive b. Transformational c. Laissez-fair d. Legitimate ANS: D The coordinator of the committee has an official position within the organizational committee. The CNL is not being threatened with punishment. Transformational is not a type of power. Laissez-fair is a type of management style, not a type of power.
14.
A task force is considering factors that contribute to high-quality safe staffing. Which statement reflects an understanding of the American Nurses Association's (ANA) Safe Staffing Saves Lives recommendations? a. Because patient needs remain constant on a daily shift, staffing needs at the beginning of the shift should be sufficient to provide safe quality care. b. Staffing should allow time for the RN to apply the nursing process so decisions result in quality safe patient outcomes. c. Patient acuity levels affect staffing by increasing the need for unlicensed personnel to provide routine basic care rather than increasing RNs in staff mix. d. RN staffing is not cost effective, thus is it important for staffing models to limit the number of RNs assigned per shift. ANS: B The ANA recommends that nurses have time to exercise professional judgment. Patient needs constantly change and staffing adjustments may be necessary. As patient acuity levels increase, the need for RN coverage increases. RNs have shown to be cost-effective and increase the value of care because of their contributions to improving patient outcomes.
14.
A director of nursing (DON) asks the staff to list how their nursing unit can help the organization meet their goal of "provide quality patient care with attention to compassion and excellence." An ad hoc committee is formed to develop a timeline of identified actions. The DON coaches the committee to reach desired outcomes. This DON is demonstrating which other role of leadership and management? a. Transactional b. Clinical consultant c. Corporate supporter d. Autocratic ANS: C Autocratic managers do not seek input from staff. Transactional leaders are involved in day-to-day operations rather than having a vision. The nurses are not looking to the leader as a resource for clinical advice. The manager is embracing the mission of the organization by supporting achievement of goals noted in the mission statement. MULTIPLE RESPONSE
15.
A nursing unit is comparing team nursing to the partnership model and found: a. with the partnership model, an RN does not have to be part of the mix. b. leadership abilities of the RN is a major determinant of effectiveness of care for both models. c. the RN teaches the LPN/LVN or nursing assistive personnel (NAP) how to apply the nursing process in team nursing. d. with team nursing the RN cares for the patient while the team members work with the family or significant others. ANS: B The RN leads regardless of whether partnership model or team nursing is practiced. An RN is the leader of the pair. Applying the nursing process is not an appropriate role for the LPN/LVN or NAP. The team is led by an RN, and the team provides those tasks that are not required by the RN; however, team members can also be additional RNs but they are not in a leader role. MULTIPLE RESPONSE
15.
A group of new graduate nurses is asked to speak to a group of politicians to describe the current state of professional nursing and how best to alleviate the nursing shortage. Which statements accurately portray professional nursing today and tomorrow? (Select all that apply.) a. More RNs are educated to attain an associate degree than a baccalaureate degree or diploma. b. Because of the push to shorten length of stay in hospitals, more RNs practice in outpatient settings and home health than in acute care settings. c. The most popular advanced practice specialty is nurse anesthesia. d. White nurses are more likely to enter graduate school than nurses from other ethnic groups. e. Nursing represents the second largest health care professional group, second only to medical doctors. f. Job satisfaction is high among nurses, despite long hours, high nurse/patient ratios, and lower pay than is often earned by individuals with less education. g. Even with the popularity of nursing as a career, the nation faces a severe deficit of RNs now and even more so in the future. ANS: F, G A recent job satisfaction survey found that 78% of RNs were happy with their jobs. Increasing awareness of nursing as a profession has enhanced enrollment in nursing schools and has promoted interest among high school students Recipients of BSN degrees are younger and represent the largest graduating educational profile. More than half of all nurses practice in acute care hospitals. Nurse practitioners constitute the majority of advanced practice nurses (APRNs). Minority nurses are more likely to enter graduate school than white nurses. Nurses make up the largest group of health care professionals.
2.
A nurse has recently been appointed to the position of nurse manager. To become successful in managing the unit's budget, the new nurse manager should: (Select all that apply.) a. read the financial policy manual to learn more about the organization's budgeting process. b. allow the nursing administration office to manage the unit's budget until he or she is able to complete an online financial management course. c. communicate regularly with a person in the hospital's finance office about interpreting budget reports. d. pay attention to only the bottom line numbers in budget reports rather than trying to understand each line in these reports. e. discuss the process of developing budgets with other members of the management team. ANS: A, C, E Knowing the organization's financial policies is an important step toward understanding the organization's budget process. Building a relationship with the finance office is fundamental to learning about the budgeting. As one participates more in the budget process, one's understanding of the process and related responsibilities is enhanced. Managing the budget requires more than an online course; it requires participation in the budgeting process as well as personal study, working with mentors, attending classes, reading books and journals, and joining professional organizations that promote health Cherry: Contemporary Nursing, 5th Edition
2.
A nursing unit's census consists primarily of long-term residents with a high risk for falls. To meet new safety regulations, the nurse manager must plan to replace all 50 patient beds with new beds equipped with Fall Watch electronic sensors that will detect when patients get out of bed. The manager will be involved in which type of budgeting to replace the beds? a. Fiscal b. Labor c. Operational d. Capital ANS: D Capital budgets are concerned with major purchases such as equipment paid for over several years. A fiscal budget is projected over 12 months, whereas capital budgets involve long-term financial planning. Labor budgets are concerned with salaries, wages, and employee benefits. Operational budgets are composed of expenses needed to operate on a daily basis and revenue received for services rendered.
2.
Customer satisfaction is primarily based on: a. access to modern, up-to-date facilities. b. availability of an extensive menu selection. c. personal interactions with employees. d. having to undergo fewer invasive procedures. ANS: C Interactions between employees and patients/families actually affect clinical outcomes, functional status, and even physiologic measures of health. Customer satisfaction is primarily based on relations with employees. As stated in A, interface with employees is the means to customer satisfaction. Patients may fear or dislike invasive procedures, but the important consideration in customer satisfaction is the quality of interactions with employees.
2.
In differentiating between a leader and a manager, a: a. leader has legitimate authority. b. manager motivates and inspires others. c. manager focuses on coordinating resources. d. leader focuses on accomplishing goals of the organization. ANS: C The terms leadership and management are used interchangeably, and it is difficult to discuss one without discussing the other. However, these roles have specific traits unique to themselves. The manager is the coordinator of resources (time, people, and supplies) needed to achieve outcomes. Authority is the legitimate right to direct others that is given to a person by the organization through assignment to an authorized position such as a nurse manager. It is the nurse leader who has the ability to guide or influence, as well as to motivate and inspire, others on the team. Managers are assigned responsibility for accomplishing the goals of an organization.
2.
What effect did the movie One Flew Over the Cuckoo's Nest have on health care? a. Funding for mental health care increased, allowing the point of care to change from the community to standardized institutional care. b. The public and the nursing profession were made aware of the right of vulnerable populations. c. Nurses were seen as advocates for individuals who cannot advocate for themselves. d. Funding for nursing traineeships was eliminated. ANS: B One Flew Over the Cuckoo's Nest reminded us that all individuals have rights and that it is the responsibility of the public and health care professionals to ensure that these rights are protected. The context for the care of patients with mental disability did not change as a One Flew Over the Cuckoo's Nest portrayed nurses as the enforcers of the system. Funding for nursing traineeships was not eliminated. Rather, the Nurse Training Act was established in 1964.
2.
When patient-focused clinical information systems (CISs) are compared with department-focused CISs: a. the nurse who wishes to review how a patient's plan of care deviated from the established criteria would use the patient-focused CIS. b. the patient-focused CIS would stand alone because of confidentiality. c. order entry always is done with the department-focused CIS. d. results reporting is done with the department-focused CIS. ANS: A The patient-focused CIS includes order entry, results reporting, clinical documentation, care planning, and clinical pathways. Early billing systems stood alone and were a type of department-focused CIS; the department-focused CIS also must protect and maintain confidentiality. Order entry is included in the patient-focused CIS, along with care plans and clinical guidelines. Results reporting is patient specific and is part of the patient-focused CIS.
2.
Which factors would be considered in the first steps of developing an effective patient classification system? (Select all that apply.) a. Planned procedures b. Ethnic diversity of patients c. Clinical competency of staff d. Educational level of nurses e. Age of patients ANS: A, B, E The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The first step in developing a patient classification system is to understand the intensity of care needs, which requires identifying specific patient characteristics and care requirements. The second step is to match the skill level of staff with the care needs of patients. The educational level of nurses is part of the second step and involves matching the educational preparation of staff with the care needs of patients.
2.
A nurse manager is preparing a budget that does not base annual budgets on the revenue and expenditures of the prior year and has the advantage that outdated information is not integrated into the budget. The manager is using which budget method? a. Zero-based b. Incremental c. Labor d. Operational ANS: A The zero-based method is based on the assumption of no volume and no resources assigned; it essentially starts each new budget period at zero rather that building from past budgets. The incremental method uses the current budget with an incremental increase in consideration of future growth. Labor budgets represent a type of budget, rather than a method of budgeting. Operational is a type of budget rather than a method of budgeting.
3.
During a search for the term informatics, when the nurse finds the domain ".edu," the site is affiliated with a(n): a. government agency. b. commercial site. c. educational institution d. Internet service provider. ANS: C The domain of an educational institution is .edu. The domain of a government site is .gov. The domain of a commercial site is .com. The domain of an Internet service provider is .net.
3.
Nurses on a unit provide personal hygiene, administer medications, educate the patient and family about treatments, and provide emotional support. These nurses provide patient care based on which nursing delivery system? a. Total patient care b. Partnership nursing c. Team nursing d. Functional nursing ANS: A In total patient care, nurses provide all aspects of patient care. Partnership nursing, or coprimary nursing, pairs the RN with a partner, usually a licensed practical/vocational nurse (LPN/LVN) or nursing assistive personnel (NAP), allowing the RN to spend more time on tasks such as assessment and patient education. In team nursing, an RN directs the other members of the team, which can consist of care providers at various levels. In functional nursing, staff are assigned to tasks rather than to patients.
3.
The first step in the nursing process and in the problem-solving process is to: a. identify the problem. b. gather information. c. consider the consequences. d. implement interventions. ANS: B The nursing process, which is familiar to nurses who address patient care needs, can be applied to all management activities that require decision making and problem solving. As in the nursing process and the problem-solving process, one must first gather information about the problem or situation. Identifying the problem is a later step in the nursing and problem-solving processes. Considering the consequences is a later step in the nursing and problem-solving processes. Implementing interventions is a later step in the nursing and problem-solving processes.
3.
Which actions would result in a greater number of nurses entering and staying in practice, given today's state of nursing? (Select all that apply.) a. Determine why few African-American women enter graduate school. b. Provide incentives for minorities and men to enter nursing. c. Obtain grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs. d. Survey nurses to determine why their job satisfaction is lower than that of other health care professions. e. Develop ad campaigns that target younger students. ANS: B, C, E Providing incentives for minorities and men to enter nursing speaks to the core of solutions to the nursing shortage. Obtaining grant funding to increase the number of faculty members and scholarship availability for students entering baccalaureate nursing programs speaks to the core of solutions to the nursing shortage. Developing ad campaigns that target younger students speaks to the core of solutions to the nursing shortage. Determining why few African-American women enter graduate school would not result in a greater number of nurses entering and staying in practice. Job satisfaction among nurses is currently high.
3.
Which nurse died after deliberately acquiring two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever during the Spanish-American War? a. Florence Nightingale b. Margaret Hoolihan c. Clara Maas d. Sairy Gamp ANS: C Clara Maas is noted as the nurse who deliberately acquired two bites from yellow fever carrier mosquitoes to enable her to provide care to soldiers with yellow fever. Florence Nightingale is the founder of professional nursing. Margaret Hoolihan is a character on a TV show, not an actual nurse. Sairy Gamp is a character in a Charles Dickens novel.
3.
A bronze statue of a nurse in battle fatigues who is obviously exhausted but demonstrates caring by holding a soldier's head is an artistic representation of nurses who served in which war? a. World War I b. World War II c. Spanish-American War d. Vietnam War ANS: D This statue represents the caring provided by nurses during the Vietnam War. There is no statue that represents nursing during World War I. There is no statue that represents nursing during World War II. There is no statue that represents nursing during the Spanish-American War.
4.
A hospital converts to a system of care delivery in which RNs, LPNs, and nursing assistive personnel (NAP) are responsible for implementing a specific task, such as medication administration or personal hygiene, for the entire nursing unit. This type of delivery system is: a. total patient care. b. functional nursing. c. team nursing. d. primary nursing. ANS: B In functional nursing, members of the team are assigned specific tasks such as assessment or medication administration Total patient care involves an RN who provides every aspect of patient care. With team nursing, the team leader, an RN, delegates care to other team members. In primary nursing, the RN assumes 24-hour responsibility for the care of assigned patients. 5. The nurse who is responsible for following the patient from admission through discharge or resolution of illness while working with a broad range of health care providers is called a: a. nurse manager. b. case manager. c. coordinator of patient-centered care delivery. d. team leader in team nursing care delivery. ANS: B The case manager, in collaboration with an interdisciplinary team, oversees the use of health care services by clients throughout a course of illness. The nurse manager is responsible for handling the day-to-day operations of the nursing unit and for ensuring that the unit's philosophy and mission are congruent with those of the parent organization. The coordinator of patient-centered care delivery works with an interdisciplinary team in providing a wide range of services. The team leader coordinates and delegates care for a specific group of patients.
4.
A nurse on the unit is heard saying, "I am not going to document that I used four catheters to start that IV; it doesn't matter anyway." What action can help the staff nurse understand the financial budget goals of the unit? a. Have the nurse work in payroll for a week. b. Enroll the staff in continuing education units (CEU) for personal finance. c. Ask the nurse to represent the unit on the budget planning committee. d. Make the nurse responsible for monitoring all disposable equipment and supplies. ANS: C Participating on the committee will give the nurse ownership of the unit's budget and will provide insight into the unit's budgetary goals. Having the nurse work in payroll would not help the nurse understand the intricacies of budgeting A personal budget may have some aspects of a unit budget but will not help the nurse understand the unit budgetary goals. Keeping a log will not help the nurse integrate the concept of accountability in budgeting.
4.
An explosion just occurred at the local factory, and hundreds of employees have sustained varying degrees of injury. Which type of nursing leadership is most effective in this situation? a. Autocratic b. Democratic c. Laissez-faire d. Referent ANS: A The dynamics of the situation demand that the leader take control and direct employees to specific actions in response to the emergency. Democratic is a leadership style that would not be effective in an emergency situation. Laissez-faire is a leadership style that would not be effective in an emergency situation. "Referent" refers to a type of power that comes from followers' identification with the leader and is not a leadership style.
4.
The Nurses of America's media campaign raised awareness of which aspects of nursing? (Select all that apply.) a. Nurses are expert clinicians. b. A higher nurse/patient ratio is needed. c. Nurses are invisible in the news media. d. Nurses are caring. e. Nurses are well paid. ANS: A, C The campaign was designed to convey to the public that nurses are expert clinicians. A strategically important part of the campaign raised consciousness among nurses of the invisibility of nursing in the news media. Lower nurse/patient ratios are needed. It was not a focus of the campaign to let the public know that nurses are caring. The campaign did not focus on the financial aspects of being a nurse.
4.
When paper-and-pencil medical records are compared with computer-based records: a. paper-and-pencil records provide controls to determine who has viewed the health information. b. information contained in a paper-and-pencil record has the capability of being more in-depth than that found in computer-based records. c. patients have the right to know that the confidentiality of their records is strictly maintained, regardless of the type of medical record used. d. patients must sign for each item of information released on the computer record. ANS: C Regardless of the type of record used, the Health Insurance Portability and Accountability Act (HIPAA) protects the confidentiality of the patient's medical information and imposes legal consequences for those who breech confidentiality. The computer-based record has security controls that limit or prohibit entry by unauthorized users and that track attempts to access the record. Information in the computer-based record is more comprehensive than that found in a linear paper record. Patients may sign a release one time for information to be released to entities such as an insurance company.
4.
Which component of budgeting might normally be addressed in the annual performance evaluation for a nurse manager? a. Including in the labor budget costs for overtime and benefits b. Managing variances in nursing overtime costs and supply usage c. Accurately predicting revenues on the basis of unit of service d. Providing qualitative analysis for variances in the capital budget ANS: B Nurse managers are often evaluated according to their success in managing nursing overtime costs and supply usage as reflected in the unit's budget. The labor budget is best controlled and budgeted at the departmental level. The unit of service may vary depending on the organization, setting, and financial policies. Variances in the capital budget are not typically addressed in the manager's annual performance evaluation.
6.
A nurse is preparing a scholarly publication on the prevalence of hepatitis A worldwide. The most efficient and effective means of conducting an Internet search to gather information for this publication is to use: a. a search engine such as Google or Yahoo. b. a consumer health website. c. a decision support system. d. MEDLINE database. ANS: D MEDLINE is one of the scientific and research scholarly databases, and it would be most appropriate for use in gathering information for a scholarly publication. If the information is broad and general, one would use a search engine such as Google or Yahoo. If the nurse is collecting data that are to be presented to the consumer, one would use a consumer health website. A decision support system allows for the input of data such as clinical manifestations and medications and, with the use of a link to a knowledge software system, is able to produce a decision.
5.
An RN with excellent assessment and psychomotor skills would derive power on the basis of which source? a. Rewards b. Coercion c. Expert d. Legitimate ANS: C Seven primary sources of power are known. Expert power is based on knowledge, skills, and information. Rewards power comes from the ability to reward others for complying; it may include such rewards as money, desired assignments, or recognition. Coercive power is based on fear of punishment or failure to comply. Legitimate power is based on holding an official position within the organization.
5.
In a large health care facility, the executive administrative leaders set the budget goals to decrease full-time equivalents by 3%, eliminate the cost of agency nurses, reduce lost revenue from lost supplies by 1%, and provide a 0.5% hourly salary incentive for working on a float unit when the assigned unit has a low census. Nurse managers meet with nursing administrators to design their unit budgets to meet these established goals. The budget approach that is being used is the: a. top-down approach. b. participatory approach. c. iterative approach. d. incremental approach. ANS: A Budget goals are established by administrators; unit managers do not contribute to goal setting, which is the primary principle of the top-down approach. Managers had no input into setting the budgetary goals; in the participatory approach to budgeting, the people responsible for achieving budgetary goals are included in goal setting. The managers did not participate in setting budgetary goals; in the iterative budget approach, upper management defines strategic goals, then unit leaders develop their operating budgets to incorporate individual unit goals in conjunction with strategic goals of the organization. Incremental is not a budgeting approach but rather a budgeting method in which the new budget is developed on the basis of an incremental increase from the prior budgeting period.
5.
What is the purpose of the Nurse Reinvestment Act of 2002? a. Provides disability insurance to RNs who contract a life-threatening illness while on duty b. Funds public service announcements that promote unlicensed caregivers as an alternative to professional nurses c. Focuses on nurse retention and safety enhancement grants d. Provides pediatric nursing training grants ANS: C This act funded $20 million to provide nursing scholarships, public service announcements promoting nursing as a career, faculty loan cancellation programs, geriatric training grants, and nurse retention and safety enhancement grants. This act does not provide disability insurance to RNs. These funds do not promote unlicensed caregivers as an alternative to professional nurses. This act provides for geriatric training grants, not pediatric training grants.
5.
A nurse who is majoring in informatics learns that clinical information systems (CISs) can be department focused rather than patient focused. Department-focused CIS would include: a. a multidisciplinary tool that prescribes routine interventions for a group of patients with similar diagnoses; it includes expected outcomes at each stage. b. Promethazine (Phenergan) 12.5 mg intravenously every 4 hours as needed for pain. c. Blue Cross/Blue Shield, point of service
6.
A patient is admitted with coronary artery disease and is scheduled for coronary artery bypass grafting (CABG), and according to the clinical pathway should be extubated and discharged from critical care the day after surgery. During surgery the patient's oxygen saturation decreased drastically as a result of chronic tobacco abuse. Subsequently, the patient remained on the ventilator an additional 2 days postoperatively. According to the clinical practice guideline for CABG, this situation represents a: a. patient outcome. b. variance. c. goal. d. standard. ANS: B A variance is a deviation from the planned path. The patient outcome is the end result of care, not just a single specific incident or deviation. The goal is to provide high-quality cost-effective care. A standard is the criterion from which safe, effective care is derived.
6.
Managers who exhibit the authoritative behavioral style are most likely to use which source of power? a. Informal b. Expert c. Coercive d. Reward ANS: C Seven primary sources of power are known. Coercive power is based on fear of punishment or failure to comply. Coercive power fits well into the authoritative behavioral style because authoritative managers dictate the work with much control, usually ignore the ideas or suggestions of subordinates, and provide little feedback or recognition for work accomplished. Informal power is not one of the seven primary sources of power; however, informal leaders may distribute a considerable amount of power among the workers, can influence the attitude of the group, and significantly affect the efficiency and effectiveness associated with workflow, goal setting, and problem solving. Expert power is based on knowledge, skills, and information. Rewards power results from the ability to reward others for complying and may include such rewards as money, desired assignments, or recognition.
6.
Potential nursing students are concerned about choosing a profession with job security and ask, "Because more people are choosing nursing, will I have a job in a few years?" The nurse answers, on the basis of the U.S. Bureau of Labor Statistics prediction, that by 2020, a. positions that have historically required RNs will be filled by foreign nurses. b. the total number of RNs will not meet the demand for the workforce number required. c. the need for hospital nurses will dramatically decrease. d. hospitals will finally achieve the required RN workforce. ANS: B According to the U.S. Bureau of Labor Statistics, the nursing profession is predicted to have only 64% of the RN workforce required to meet demands. The number of foreign nurses arriving in the United States is not sufficient to cure the shortage, and a large number of these nurses are unsuccessful on the NCLEX-RN®, resulting in an inability of foreign RNs to practice. More than half of all nurses practice in hospitals, and it has not been indicated that this will change. Even by 2020, it is projected that the United States will achieve only 64% of the needed nursing workforce.
6.
A consumer is learning about electronic health records at a local health fair and states, "I am worried that someone can read my health information and I really don't understand the difference between privacy and confidentiality." The nurse explains that an example of confidentiality is as follows: a. a pledge states, "I will hold matters pertaining to my patients in strict intimacy." b. a patient does not tell the physician that he has been treated for a sexually transmitted disease. c. a teenager sustains a broken arm and in the emergency department withholds information about her use of recreational drugs. d. medical records are locked in cabinets to prevent unauthorized users from accessing patient information. ANS: A Confidentiality is keeping private the personal information that was given to a health care provider, unless others have a legitimate need to know. The right of an individual to keep information about himself or herself from being disclosed to anyone else, including the health care provider, is known as privacy. The patient has chosen not to divulge personal information to the health care provider; this is privacy. Locking medical records in cabinets pertains to controlled access, which is security.
7.
A patient is admitted with pneumonia. The case manager refers to a plan of care that specifically identifies dates when supplemental oxygen should be discontinued, positive-pressure ventilation with bronchodilators should be changed to self-administered inhalers, and antibiotics should be changed from intravenous to oral treatment, on the basis of assessment findings. This plan of care is referred to as a: a. patient classification system. b. clinical pathway. c. patient-centered plan of care. d. diagnosis-related group (DRG). ANS: B A clinical pathway is a plan that specifies the timing and sequencing of major patient care activities and interventions by the interdisciplinary team for a particular diagnosis, procedure, or health condition. A classification system categorizes patients according to specific criteria and care requirements and thus helps to quantify the amount and level of nursing care needed. Patient centered, as used in this chapter, refers to a nursing care delivery model that is focused on interprofessional care, with the patient as the focus. A DRG places patients into a predetermined reimbursement rate on the basis of diagnosis.
7.
A primary function of the budgeting process is to provide managers with an opportunity to: a. insist that salary increases for all nurses are included in the annual budget. b. discuss concerns about resource allocation with leaders of the organization who are capable of resolving issues. c. develop a mechanism for changing from zero-based budgeting to incremental budgeting. d. develop for all staff an educational program related to supply usage. ANS: B Coordination and communication are very important functions of budgeting that require many different groups within an organization to come together with organizational leaders to discuss the resources necessary to accomplish the goals of a business unit. Although salary increases to remain competitive are important and should be discussed, providing a mechanism for insisting on salary increases is not the primary function of the budget process. Changing from zero-based to incremental budgeting is not a primary budget function but is related to a method of budgeting. Developing educational programs is not a primary budget function, although the program suggested may serve as a means of teaching staff about supply management.
7.
Charles Dickens' character Sairy Gamp: a. portrayed nurses as trained professional individuals who put others before themselves. b. chose nursing because she had no other avenue for employment. c. was a prostitute who took advantage of sick old men. d. characterized nurses as being at the forefront of technology and autonomy. ANS: B Sairy Gamp endured nursing because of the lack of other opportunities. Sairy Gamp did not portray a professional image of nursing, but that of an untrained caregiver who profited from the sick and dying. Sairy Gamp was a nurse who used her position to take advantage of her patients. Dicken's portrayal of a nurse does not suggest that the nurse is at the forefront of technology and autonomy.
7.
The illustration below identifies which type of chart? a. Productivity b. Organizational c. Resource d. Staffing ANS: B An organizational chart is a visual picture of an organization that identifies lines of communication and authority. Productivity is the amount of output or work that is produced with a specific quantity of input or resources. Resources include personnel, time, and supplies needed to accomplish the goals of an organization. Staffing is the manpower needed to complete the work.
7.
A physician has installed a computer-based patient records system. An outside care provider who requests medical information must obtain the patient's signed consent and then is assigned a password to gain access to the medical information. A monthly audit is conducted to determine for whom and for what purpose patient records have been accessed. This protection is referred to as: a. privacy. b. confidentiality. c. security. d. data capture. ANS: C Security is the limitation of access to health care information through passwords and other precautions. Privacy is the right of the patient or individual to not divulge personal information to the health care provider or others. Confidentiality is keeping personal matters of a patient private from those who do not have a legitimate need to know. Data capture refers to collecting and entering data into a computer system.
8.
Florence Nightingale is attributed with being intelligent (she developed statistical methods to evaluate health care), dependable (she often worked long hours to care for the injured), and ambitious (she fought against society's perception of nursing). Those who depict her as a leader on the basis of these qualities are practicing which leadership theory? a. Trait b. Chaos c. Bureaucracy d. Organizational ANS: A Leadership trait theory describes intrinsic traits of leaders and is based on the assumption that leaders were born with particular leadership characteristics. Other traits found to be associated with this leadership theory include intelligence, alertness, dependability, energy, drive, enthusiasm, ambition, decisiveness, self-confidence, cooperativeness, and technical mastery. Chaos is an organizational theory that attempts to account for complexity and randomness in organizations. Bureaucracy is part of the organizational theory that provides an understanding of authority within organizations. Organizational theory provides the framework for an understanding of leadership and management, and for an understanding of complex organizations.
8.
Organizations measure the effectiveness of their budgets by examining actual revenues and expenditures versus: a. planned variances. b. incremental budgets. c. productivity metrics. d. expected performance. ANS: D Variance analysis is the process by which deviations from budgeted amounts are examined by comparing actual performance results against expected, or budgeted, performance. Actual rather than planned variances are used. Incremental budgets are developed through the use of current or recent budget performance information and adjustments are made for future growth or decline in revenue or expenses. Productivity metrics represents the amount of work produced with a specific quantity of input or resources.
8.
The nurse manager determines that four RNs, five LPN/LVNs, and two nursing assistive personnel (NAP) are required per shift to meet the needs of the patient population on the unit, according to acuity and census. The nurse manager is concerned with: a. assignments. b. staffing. c. output. d. productivity. ANS: B Staffing is the activity that is involved in determining that an adequate number and mix of health care team members are available to provide safe, quality patient care. Assignment is the distribution of work that each staff member is responsible for during a given work period; assigned activities must fall within the individual's scope of practice and/or job description. Output is the work produced, such as the number of patient care hours provided. Productivity is the ratio of the amount of output produced, such as patients receiving care or home visits, to the specific amount of input (i.e., nursing hours worked) and is the measure of staffing efficiency.
8.
What does the Spirit of Nursing statue honor? a. Florence Nightingale's accomplishments in public health b. Edith Cavell's attempt to help the victims of the Tuskegee experiment seek treatment c. Clara Maas, who found the cure for yellow fever during WWII d. All military nurses for their bravery and compassion ANS: D The statue the Spirit of Nursing was created to honor all military nurses. The statue does not seek to honor Florence Nightingale. Nurse Rivers was the nurse who attempted to help the victims of the Tuskegee experiment. The statue does not honor Clara Maas, and Clara Maas did not find the cure for yellow fever.
8.
A nurse manager is concerned with restocking the emergency cart, creating the staff schedule, requesting floor stock from pharmacy, and checking the orders on patient charts. Which type of leader accurately describes this nurse? a. Transactional b. Situational c. Transformational d. Contemporary ANS: A The transactional leader is concerned with the day-to-day operations of the facility. Situational theory has attempted to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables. The transformational leader is committed to organizational goals, has a vision, and is able to empower others with that vision. The contemporary theories attempt to integrate the dynamics of the interaction between the leader, the worker, and elements of the leadership situation, arguing that effective leadership depends on several variables.
9.
A nurse manager is mentoring an inexperienced manager in determining staffing needs. The mentor explains, "We must determine the acuity level of the patient by: a. assessing patient satisfaction with nursing care." b. quantifying the amount and intensity of care required." c. examining the skill mix and educational preparation of the staff." d. determining the number of hospital days required by the patients." ANS: B Patient acuity is measured by determining the amount and intensity of care required. Patient satisfaction is based on interactions or experiences while the patient is receiving care, although staffing can affect patient satisfaction. Examination of the skill mix and educational preparation of the staff is the criterion for delegation of care. The number of hospital days required by the patient is a criterion that is used on care pathways to predict required resources.
9.
A nurse walks up to a computer in the hallway and presses the index finger to the sensor, thereby gaining access to patient data. A few moments later another nurse performs the same steps and is granted access. A visitor who is watching from a room walks over and places the index finger on the sensor, only to receive an "error and access denied" message. Security is being maintained by: a. robot technology. b. biometric technology. c. telehealth. d. ubiquitous computing. ANS: B Biometric fingerprint identification uses personal characteristics to allow access to health information. Robot technology includes the delivery of simulation for rehabilitation, couriers, and language translators and even can be used to interview and examine patients at a distance. Telehealth involves providing health care for patients located a distance from the provider. Ubiquitous computing refers to the era when computers are so immersed in everyday life that they become invisible to users.
9.
Although the media portrayed nursing in a negative light in M*A*S*H through the character of a promiscuous, uncaring nurse, it also provided Americans with a promising glimpse of: a. nurses who can be promiscuous and still help doctors. b. the fact that caring is not as important as the desire to serve one's country. c. the ability of nurses to cope with the dreadfulness of war by using humor. d. the contributions of male military nurses. ANS: C The sitcom M*A*S*H did show humor as a coping mechanism for nurses in a war setting. M*A*S*H's portrayal of promiscuous nurses has no merit because nurses assist physicians. The sitcom addressed both factors as part of the nurse's role in the military. D: No male nurses were portrayed in the sitcom.
9.
When the nurse manager conducts a qualitative analysis of budget variances, he or she is: a. determining the percentage increase of supply usage from the last quarter to the current quarter. b. identifying the overall increase in the dollar amount of salaries paid for overtime. c. comparing productivity metrics across all nursing units in the facility. d. reconciling with current conditions the underlying assumptions on which the budget was based. ANS: D Qualitative analysis of the budget explains why current conditions are different than they were when the budget was developed; new conditions might include greater patient acuity or additional physicians with increased admissions. The percentage of supply increase from last quarter is quantitative. Identifying the degree of salary increase is quantitative; however, explaining why salaries increased would be qualitative. Productivity metrics is a quantitative analysis.
9.
1. Consumers are concerned with security issues related to their confidential health information when placed in an electronic health record (EHR). However, when the security of the EHR is compared with that of paper-and-pencil records, the EHR is: a. more secure. b. less secure. c. equivalent. d. not comparable with the paper-and-pencil record. ANS: A Computer-based patient record systems, such as EHRs, provide better protection than paper-based systems. The EHR allows only authorized users to view data, and access to records can be audited for inappropriate use. Paper-and-pencil medical records have no means of limiting who views the health information or determining how often confidentiality is breached. The EHR must comply with strict laws and regulations related to confidentiality, as well as to the aforementioned security functions. The paper-and-pencil record cannot ensure the same level of security as found in computer-based systems.
MULTIPLE CHOICE
C Department-focused CIS contains information on a particular department, in this case, the billing department. A multidisciplinary tool that prescribes routine interventions for a group of patients with similar diagnoses is a critical pathway that is patient-focused. Physician orders are patient specific and are part of the patient-focused CIS. "Risk for injury related to altered mobility" is a nursing diagnosis that is patient focused.
TN09874. d. "Risk for injury related to altered mobility." ANS:
