CNL Questions 51-100
*An RCA is best used:* A. In response to a critical or sentinel event B. Prior to a process implementation or change C. As part of a random audit process D. In response to malfunctioning tools or equipment
Answer A—Rationale: An RCA is meant to respond to a critical event or critical "near-miss" event to understand how it occurred and is intended as a retrospective tool.
*A staff member asks you, the CNL, what is the best way to explain health policy? What statement best explains health policy?* A. Health policy generally denotes guidelines that affect the health of the individual, families, or communities through production, provision, and financing health or health care services. B. Health policy analyzes system and outcomes datasets to anticipate individual client risk and improve quality care. C. Health policy evaluates the environmental health care outcomes. D. Health policy means to consult with other health professionals to design, coordinate, and evaluate client care outcomes.
Answer A—Rationale: Answers B-D are all related to QI, risk reduction, and patient safety rather than health policy.
*Marci, a surgical nurse, is reviewing the operating room schedule and sees a coworker, Angie, is having surgery that day. Marci then calls the supervisor and manager to let them know Angie is having surgery. Marci then tells the CNL she is going to visit Angie in the PACU. What should the CNL do?* A. Explain to Marci that this is a violation of the Health Information Portability and Accountability Act (HIPAA) and we must protect Angie's right to privacy and confidentiality B. Invite other nurses to visit Angie and bring her flowers C. Nothing; since this is a coworker, this is not considered a violation of HIPAA D. Arrange for Angie to have "VIP" treatment
Answer A—Rationale: As a CNL, you should be a guardian of information and educator to the nurses on the unit regarding HIPAA.
*A nurse prepares to administer a patient's morning dose of metformin. After scanning the patient and the medication, a clinical alert appears on the computer screen warning of a possible interaction between the metformin and the CT contrast dye the patient received the day before. Based on this warning, the nurse chooses to hold the metformin and alert the pharmacy that this medication should be scheduled as held for 72 hours after receiving the contrast. This is an example of a:* A. Clinical decision support system B. Health information technology C. Clinical alert warning system D. Decision tree
Answer A—Rationale: Automated warnings within the EHR are an example of a clinical decision support system. The EHR itself is health information technology. While this was a clinical alert it also aided in guiding the nurse to action.
*Staff nurses have a clinical question regarding the effectiveness of two different surgical skin preps stocked on your unit. Both benzalkonium chloride and CHG are available, and the nurses are uncertain of the differences—particularly in terms of reducing surgical site infections. As the CNL, what is the next step to take?* A. Review research on the effectiveness of each product in reducing surgical site infections and disseminate the evidence to staff B. Organize a study of patients on your unit, trialing the different surgical prep and tracking patient outcomes C. Determine the most cost-effective surgical skin prep for the patient D. Research what products are being used on other units and other hospitals within your area
Answer A—Rationale: CNLs should act to review evidence to answer clinical questions. Organizing a study to evaluate the greater trends of one skin prep versus another may be a lengthy process when evidence is already available.
*You, the CNL, have noted that many staff nurses on your unit do not use available nurse aide (NA) staff to perform routine capillary blood glucose (CBG) checks, even though they are allowed to at your hospital. When you investigate, you discover that most nurses were unaware the NAs could perform CBG checks. You, as the CNL, share information on the tasks NAs are able to perform during the next unit staff meeting in order to:* A. Ensure each member of the care team has a clear understanding of his or her role B. Make sure staff nurses delegate as much work as possible C. Make sure staff are using skills and training often enough D. Ensure the NAs have enough to do
Answer A—Rationale: Ensuring mutual understanding of roles among care team members is a key component of the coordination piece of lateral integration.
*What type of chart is used in QI and uses step-by-step symbols to plan projects and describe a process?* A. Flowchart/process mapping B. Pareto chart C. Control chart D. Run chart
Answer A—Rationale: Flowchart/process mapping is a graphic illustration of the steps in a process
*As you review a patient's medical record, you notice that the patient has an order for a chest x-ray. While reviewing the chart, you realize that the patient just completed a chest x-ray several hours ago while in the emergency department (ED).* *CNLs understand that diagnostic tests are very expensive so you call the doctor and find that the x-ray was duplicated by mistake. Unfortunately, by the time you find this mistake you see the radiology assistant exiting the patient's room. Once the error is found, you should:* A. Perform a root cause analysis (RCA) to see why this test was duplicated B. Notify the patient's insurance company of the additional charges C. Notify the nurse manager of this error D. Review the order entry
Answer A—Rationale: Identifying processes that yield errors and negative outcomes for patients is a critical duty of the CNL. This is done through RCA. It is the job of the CNL to identify and help reduce cost to the patient.
*Heather, a nurse for 7 years, recently attained her MSN-CNL. She is very passionate about being involved in her local community. She volunteers frequently at a community center for underprivileged children. During her time there, she noticed that obesity is a concern with this population. What step best describes Heather's advocating for this local community center?* A. Heather collaborates with the community center leaders to get donations from local health food corporations to ensure a healthy meal is provided for the children. B. Heather collaborates with another CNL and plans to do a literature review on obesity. C. Heather discusses her concern of obesity with the community center leaders. D. Heather calls other community centers for underprivileged children to inquire about obesity in their population.
Answer A—Rationale: The CNL advocates by building partnerships with community organizations to identify and address health disparities.
*Lisa is a CNL who works with high-risk obstetric patients both inpatient at the hospital and outpatient in the local health clinic. Lisa follows each patient throughout his or her episodes of care, ensuring the patient receives streamlined, comprehensive care. Which critical component of lateral integration best describes what Lisa is demonstrating?* A. Coordination B. Communication C. Collaboration D. Evaluation
Answer A—Rationale: The CNL coordinates care by managing the care of clients across settings and episodes of care. Coordination is not to be confused with collaboration. Collaboration is defined as an interdisciplinary process of problem solving that involves shared responsibility for decision making and execution of plans of care.
*The CNL completes a 5P assessment of the microsystem and discovers that the geriatric population has increased. Forty-three percent of the patients within the microsystem are older than 65 years.Recognizing this change, the CNL determines which of the following is an appropriate action?* A. Coordinate monthly lunch-and-learn opportunities for the staff to discuss topics related to nutrition, cognitive impairment, and mobility B. Discuss the change with the nurse manager and order more bed alarms for the microsystem C. Volunteer to take blood pressures and check hemoglobin A1cs at the local adult day-care center D. Conduct a randomized control study on visual impairment in diabetic patients older than 70 years
Answer A—Rationale: The CNL recognizes it is important for the staff to be well prepared to care for the patient population. Malnutrition, cognitive impairment, and immobility are common geriatric problems. Educational opportunities will help inform the staff, allowing them to provide evidence-based care.
*How can the CNL help determine the meaningful use of the EHR within his or her microsystem?* A. Identify data that should be collected and managed, and note how that data should be shared for improving client outcomes B. Coordinate with physicians to identify which clinical information would be meaningful for the patients under their care C. Discuss with unit leaders and stakeholders what data could provide meaningful use of the EHR within the unit D. Review the available client data currently in the EHR and assess for meaningfulness in improving patient outcomes.
Answer A—Rationale: The CNL should be able to identify meaningful data, as well as its collection and management, and use that data to improve clinical outcomes on the unit
*During your daily rounds, you are performing an advance assessment on a patient in your cohort. The patient was admitted for sepsis and appears very weak, and has a very poor appetite. The patient tells you that he has not been out of the bed for 3 days. What needs to happen to provide the best care for this patient?* A. Enter an order for physical and occupational therapist, and ask the nursing staff to perform the Egress test to assess the patient's mobility level B. Tell the patient to get out of bed and sit up in the chair three times a day C. Place the bed in a bed-to-chair position D. Order an incentive spirometer for the patient
Answer A—Rationale: The CNL understands the role of the interdisciplinary team members including PT and OT. Bedside nurses and CNLs are at the frontline caring for patients, assessing interventions, and listening to patient concerns, and are the best advocates for patients receiving care from other team members.
*A nurse is trying to determine the difference between evidence-based practice (EBP) and research. She approaches her unit CNL to assist her in her dilemma. What statement best describes the appropriate response by the CNL?* A. EBP involves critiquing and synthesizing evidence, while research involves designing a study because there is a gap in knowledge. B. EBP needs institutional review board (IRB) approval, while research does not. C. EBP involves collecting and analyzing data, while research includes critiquing and synthesizing evidence. D. In EBP, the first step is identifying a clinical problem, while in research identifying a clinical problem is the last step.
Answer A—Rationale: The EBP process involves these steps: identify clinical problem, review literature/search for evidence, critique evidence, synthesize evidence and patient view, implement evidence-based change, evaluate outcomes, and present or publish findings. Both EBP and research can require IRB approval. The research process is done for a gap in knowledge: identify the clinical problem, review literature/search for evidence, design a study, write a research proposal, collect and analyze data, and present or publish the findings.
*From which database would the CNL collect the most useful nursing-sensitive indicator metrics?* A. National Database of Nursing Quality Indicators® (NDNQI) B. Hospital Compare C. The Joint Commission (TJC) D. Nursing Quality Forum (NQF)
Answer A—Rationale: The NDNQI evaluates unit and hospital-specific nursing-sensitive data. NDNQI also provides benchmarks that can be used for comparison.
*A nurse on your unit expresses concern about her patient. The patient is an 88-year-old male on the unit due to a chronic obstructive pulmonary disease (COPD) exacerbation. He has become deconditioned and therapy is involved. The patient is due to be discharged, but still appears very weak and unsteady. During his stay he was newly diagnosed with insulin-dependent diabetes, and although he has been educated on insulin administration, the nurse is uncertain he can properly administer the medication at home. As the CNL, how do you proceed?* A. Organize an interdisciplinary team meeting to discuss the multiple concerns over patient treatment and condition, as well as greater discharge needs B. Place an ethics consult C. Encourage the nurse to call the MD and relay her concerns D. Provide tools to the nurse that can help improve the patient's functioning regarding the insulin, and advocate for the use of oxygen at home
Answer A—Rationale: When multiple health care team members are involved in a patient's care and coordination of their health care needs, the interdisciplinary team meeting can best coordinate needs.
*As a CNL, it is important to remain aware of current changes to national health care policies, namely from ongoing focuses from the Centers for Medicare & Medicaid Services (CMS) and law prescribed by the Affordable Care Act (ACA), both of which have set reduced reimbursement for which of the following issues?* A. Elevated readmission rates B. Medication errors C. Falls D. Nurses practicing below their scope
Answer A—Rationale: While each item is an important focus for the CNL, and B and C can result in non-reimbursed costs, the ACA via the CMS has set reducing hospital readmission rates as a key priority, and decreases reimbursements for hospitals with frequent readmissions.
*A 28-year-old patient with asthma is requesting the pneumococcal vaccine. Which of the following conditions are appropriate for receiving the pneumococcal vaccine?* A. Congestive heart failure (CHF), HIV, diabetes, pregnancy B. CHF, HIV, diabetes, sickle cell disease C. Diabetes, chemotherapy, sickle cell disease, pregnancy D. Pregnancy, CHF, diabetes, chemotherapy
Answer B—Rationale: All of these medical conditions require a patient to receive the pneumococcal vaccination.
*Isabella is a 62-year-old female who enters the community health clinic where you are employed as a CNL. The front desk staff approaches you and states that Isabella has refused to complete the standard health questionnaire form and health information release form. Isabella states that she forgot her glasses and that she will just take the form home to complete. Which of the following would be the most appropriate response by you as the CNL?* A. Tell the front desk staff to send the forms home with Isabella and provide her with a prepaid envelope to send the forms back to the office B. Inform Isabella that many people have difficulty understanding these forms, and ask if she would like you or someone to help her complete the forms C. Explain the importance of completing the forms to Isabella and ensure she completes the forms prior to entering the examination room D. Provide Isabella with a magnifying glass to allow her to read the forms more easily
Answer B—Rationale: Patients will frequently hide issues with health literacy due to feelings of embarrassment and shame. Health care providers may pick up on behavioral clues such as patients that provide incomplete forms, make excuses such as they forgot their glasses, or state they will complete the paperwork at home.
*A certified nursing assistant (CNA) approaches the unit CNL to discuss her frustrations in attaining appropriate equipment for patient care. The CNA explains that the clean utility room is too far and that staff constantly have to make frequent trips. The CNA wants to know what steps to take to make a change. As a CNL, what statement best describes the appropriate response?* A. "We will just have to adjust to what we have right now." B. "Well, you have identified a problem, the next step is to review any literature that can help resolve our issue." C. "I suggest that you and the staff take the appropriate equipment to your rooms." D. "Well, let us implement the process that another unit is using."
Answer B—Rationale: The CNA already identified a problem, the first step of EBP. The second step of the EBP process is to review the literature.
*A Vietnamese patient is admitted with pneumonia on a medical-surgical unit. The patient appears very nervous when the medical staff enters the room. As a CNL, what is the best course of action to take in this situation?* A. Try to talk to the patient calmly and ease his fears B. Call language services and request a Vietnamese interpreter C. Ask your housekeeper who is from Vietnam to come in and interpret for the medical staff D. Keep all interactions with the patient as brief as possible
Answer B—Rationale: The CNL bridges cultural and linguistic barriers by being an advocate for the patient and his or her family. An interpreter should be present anytime there is a language barrier.
*The CNL completed an assessment of the community and identified a need for a public health program. Which of the following would have the potential for the greatest impact on the community?* A. Implement a small pilot program at the local hospital B. Write a proposal to make the change and send it to the legislators to build their support for the change C. Research and analyze public health programs in other communities D. Write an article for the local paper discussing the need for the program
Answer B—Rationale: The CNL is responsible for influencing regulatory, legislative, and public policy to promote and preserve healthy communities. The CNL is advocating for a healthy community by writing to legislators.
*Failure mode-effect analysis is best used as follows:* A. In response to a critical or sentinel event B. Prior to a process implementation or change C. As part of a random audit process D. In response to malfunctioning tools or equipment
Answer B—Rationale: The purpose of a failure mode-effect analysis is to anticipate potential problems; by virtue, this is best conducted prior to a process implementation.
*Which of the following is not an example of health care finance and economics?* A. Developing and leveraging human, environmental, and material resources B. Understanding the fiscal context in which practice occurs C. Leading a gap analysis to create a cohesive health care team D. Applying basic business and economic principles and practices
Answer C—Rationale: A gap analysis is a method of assessing the differences in performance between a business information system or application to determine whether the system requirements are being met and, if not, the step needed to do so. It is not an example of health care finance and economics.
*A patient presents with severe pain in the upper right abdomen after eating a fatty meal. These symptoms lead you to suspect cholecystitis. Which assessment finding is most likely to be associated with this condition?* A. Positive Homans sign B. Positive Psoas sign C. Murphy's sign D. Aaron's sign
Answer C—Rationale: A positive Murphy's sign is identified when the patient inhales and feels pain due to the inflamed gallbladder pushing into the palpating hand.
*You recognize that a large proportion of your surgical patients have cultural or religious concerns about the use of blood transfusions, although the need for such transfusions are common with many of your surgeries. As the CNL at a surgical center, how can you best ensure health promotion of this population while providing culturally competent care?* A. Develop education on the importance of blood transfusions when medically necessary, and the benefits postoperatively B. Provide resources like the other clinics in the area that may be able to perform the surgery with lowered risks of estimated blood loss C. Evaluate evidence on alternatives to blood transfusions, such as autologous blood transfusions and alternative blood products, and present this information at an interdisciplinary team meeting D. Educate staff on respecting client wishes and do not attempt to pressure patients into receiving transfusions
Answer C—Rationale: Although still debated, many communities believe that autologous blood transfusions are acceptable and the blood is still from "self." Education on transfusions and benefits may be useful but does not truly address the patients' concerns. Providing resources on where else to seek care is not appropriate.
*In recent months, there has been a marked increase in the number of intravenous (IV) infections and infiltrations on your unit. Some of these IVs were started on your unit while others were started on other units or in the emergency unit before being transferred to your unit. The nurse manager has asked you to investigate this issue. As the CNL, your best intervention would be to:* A. Call other units to make sure policies and procedures are being followed B. Wait to see if the infection occurrences are a coincidence C. Form a group to investigate this issue including staff nurses from your unit, representatives from IV therapy, and infection prevention services D. Retrain all staff nurses on your unit in correct IV care procedures
Answer C—Rationale: Because this issue involves shared responsibility and is a serious concern, it should also be addressed with collaboration, shared investigation, and decision making that occurs in a robust, focused workgroup.
*As the CNL when engaging in a QI effort, you recognize the first of the common steps of the QI process to be:* A. Review literature B. Analyze the root cause C. Establish a clear purpose or aim D. Select metrics
Answer C—Rationale: Establishing a clear aim or purpose for a QI effort is foundational to all other pieces. While other steps may occur first and trigger a QI effort, such as a sentinel resulting in an RCA that then becomes part of a QI effort, when the actual QI portion starts it is important to provide a clear, explicit purpose to provide focus and mission to participating players.
*The CNL works with the interdisciplinary team and encourages all members to voice their opinion and provide feedback. What type of leadership is the CNL demonstrating?* A. Vertical leadership B. Diagonal leadership C. Horizontal leadership D. Systems leadership
Answer C—Rationale: Horizontal leadership focuses more on collaboration and equality within the group. Vertical leadership is a top-down style of leadership with one team leader driving down change.
*A CNL using Rogers's diffusion of innovation theory realizes while implementing a new health information management (HIM) system that when dealing with a member of the health care team she should:* A. Spend a majority of time educating the laggards to become supporters of change B. Spend a majority of time on innovators because they will need a lot of convincing to make a change C. Spend a majority of time with early and late majority adopters because when they support the change it will be successful D. Spend very little time with the early majority adopters because they are not adaptable to change
Answer C—Rationale: Looking at Rogers's diffusion of innovation theory's bell curve, 2.5% of people are innovators. Following them are the early adopters (13.5%) and then the early majority (34%), consumers who make their moves through the market more carefully, but tend to adopt a new product more quickly than most. At the hump of the bell curve are the late majority (34%), consumers who adopt a new product only after the majority has weighed in on its value. Finally, sloping downward are laggards (16%), the critics, curmudgeons, and haters who do their best to resist adoption but will eventually do so.
*A 55-year-old male is readmitted to the hospital with hypertension four times within the past 8 months due to medication noncompliance. The patient has been given a blood pressure machine, set up with a PCP, and arranged telehealth services in previous admissions. During your discussion with the patient, he states that he is taking his medication as his doctor prescribed. The patient brought his medications into the hospital, so you ask him to hand you his blood pressure medication bottle. The patient hands you the bottle labeled Neurontin. Which of the following would be the next best step for you to take as the CNL?* A. Obtain records from the patient's primary care provider B. Coordinate a family meeting with the patient and the care team C. Have the patient hand you the rest of the bottles, tell you what each medication is, and describe how and when he takes that medication D. Consult with a pharmacist to determine the best medication options for the patient
Answer C—Rationale: Oftentimes, patients develop coping skills to help with limited literacy, leading health care providers to misjudge their ability to comprehend patient teaching. By having the patient explain how and when he takes medications, the CNL can assess the patient's ability to understand his regimen. The patient may have difficulty reading and may need an alternative method for understanding his regimen such as color coding bottles rather than reading labels.
*You are doing a daily assessment of your patient who has transferred from the medical intensive care unit (MICU). The patient has a history of congestive heart failure (CHF), myocardial infarction, atrial fibrillation, and diabetes. During your review of the medication administration record, you notice that the warfarin has not been ordered on admission. What is your next step as the CNL?* A. Call the pharmacist and ask for the medication to be put on the medication administration record B. Find out what dosage of the medication the patient was taking and order it C. Notify the primary nurse and suggest that she call the physician and notify him of the near miss D. Call your nurse manager and notify him or her of this medication error
Answer C—Rationale: The CNL assesses patients' needs, is a risk anticipator, and communicates effectively with team members to prevent patients from having an adverse event.
*Maria, a 55-year-old Spanish-speaking patient, is scheduled for a paracentesis. You, the CNL, rounded on her with an interpreter in the morning and explained to her the procedure is scheduled for today at noon. After you mentioned this, Maria stated that she was not aware of this procedure. You noted that a consent was signed by the physician in her chart. What is the next step as a CNL?* A. Keep the consent. Utilize the teach-back method to ensure Maria understands the risk and benefits of the procedure. B. Discard the previous consent. Explain to Maria that she needs this procedure and it is the best decision for her. Obtain a new consent. C. Inform the physician and ensure he explains the procedure to Maria with an interpreter present and obtains a new consent. D. Keep the consent. Leave a note for the physician and explain that the patient was unaware of the procedure.
Answer C—Rationale: The CNL protects patients' autonomy by keeping them well informed and ensuring they understand their decision about their plan of care. The CNL addresses the language barrier, ensuring an interpreter is present to assist in understanding, and a new consent is signed.
*As you are planning a discharge for a patient in your cohort, the patient tells you that, even though she has insurance, there is a financial strain on her to pay for her medication. The patient has a history of HIV/AIDS and is currently on three antiviral medications. The patient was admitted with pneumonia on this admission and the doctor has prescribed Zyvox in addition to her other medication regimen. You investigate the cost of this medication and find out the medication will cost the patient $100 after insurance. Which of the following is the most appropriate and first action for you as the CNL?* A. Tell the patient that she should take this prescribed medication so she can get better B. Encourage the patient to take the medication because the doctor knows best C. Call the doctor and ask him if there is a more cost-efficient medication to treat the patient's pneumonia D. Consult with the medical social worker to find coupons for this medication
Answer C—Rationale: The CNL uses her knowledge and collaboration skills to reduce cost of care delivery and increase compliance.
*You, as the CNL, plan to implement the use of bed alarms and hi-low beds to prevent falls on your unit. You are completing a literature review. While doing so, you are trying to determine the strength of the articles you have obtained. What process should you use to determine the most credible evidence?* A. Plan-Do-Study-Act (PDSA) B. Evidence-based practice C. Melynk and Fineout-Overholt hierarchy (Level 1-7) D. Research utilization
Answer C—Rationale: The Melynk and Fineout-Overholt hierarchy includes seven levels based on the design (Level 1: systematic review or meta-analysis of randomized controlled trials [RCTs] and evidence-based clinical practice guidelines to Level 7: expert opinion and/or expert committee reports).
*On the rehabilitation unit, the CNL notes that the stroke and amputee patients that require maximum assistance are being assigned to the float nurses. It is noted that many of these patients have had falls while being assigned to the float nurses. This is a patient and family dissatisfier. What type of delegation practice is in question?* A. The right circumstance B. The right supervision C. The right person D. The right task
Answer C—Rationale: The licensed nurse delegating the task must ensure that the delegatee possesses and has demonstrated the knowledge base and appropriate skills and resources to perform the task and provide adequate supervision and evaluation to ensure the patient's safety and appropriate outcome.
*Regarding information technology, how can the CNL improve the identification of meaningful data?* A. Clarify with nurses what vendor-related terms may be used in their documentation B. Develop a tool to identify relevant nursing clinical data and its location within the electronic health record (EHR) C. Advocate for standardized nursing terminology within the EHR D. Coordinate with the informatics the best way to document care for efficient data retrieval
Answer C—Rationale: The most important way the CNL can improve the identification of meaningful data is through the standardization of nursing technology within the EHR, away from the use of any vendor-related terms.
*The diabetes liaison on an adult medical-surgical unit informed the team that the unit was only 45% compliant with checking blood sugars within 15 minutes after a hypoglycemic event. The team decided to implement a process change to ensure the blood sugar recheck is completed within 15 minutes. The change was implemented and there was an increase to 85% compliance of hypoglycemic rechecks. What is the next step for the team in the PDSA cycle?* A. Plan B. Do C. Study D. Act
Answer D—Rationale: After analysis of the results of the trial (also known as study), the team will then act by devising the next steps based on the analysis.
*You are working with a team to reduce patient waiting time for transport to diagnostic imaging (DI). An effective goal would be to:* A. Decrease waiting time during the evening shift B. Increase monthly patient satisfaction C. Improve communication between the emergency department (ED) and the DI departments D. Decrease the waiting time for DI by 5%
Answer D—Rationale: Improvement goals must be specific and measurable. The team must have clear, measurable results to indicate whether an implementation resulted in improvement.
*A new graduate nurse expresses concern about a frenotomy of the tongue-tied newborn to the CNL. The CNL decides to accompany the new nurse to the procedure room. Upon entering the procedure room, the new nurse notices that there is no consent signed and explains to the pediatrician consent must be signed before continuing. The pediatrician hollers at the nurse and refuses to have consent signed. How should the CNL respond?* A. The CNL hollers back that this is against hospital policy. B. The CNL asks the parents to sign the consent without the physician speaking to the parents. C. The procedure continues without consent and the CNL assures the new nurse the consent will be obtained after the procedure. D. The CNL and new nurse professionally explain to the physician that they will not participate in the procedure until a consent is signed and they will contact hospital administration regarding this procedural violation.
Answer D—Rationale: Part of the CNL's duties is to discuss difficult situations in which the nurse must advocate for her patients. Consent must always be signed for a procedure with a physician present and a nurse as a witness.
*A CNL on a medical unit is following up with patients on warfarin therapy post-discharge and concludes that patients are not receiving adequate education on medication administration. The CNL formulates an action plan and develops a team to improve warfarin discharge education. What competency was portrayed by the CNL?* A. Lifelong learner B. Delegator C. Lateral integration D. Risk anticipator
Answer D—Rationale: Risk anticipation is the ability to critically evaluate and anticipate risks to client safety; this is a critical component to the CNL role.
*A 16-year-old female with a history of smoking, tanning bed use, and sexual activity presents to the emergency department (ED) with a mole that is continuously bleeding and itchy. The patient is concerned that this might be a sexually transmitted disease (STD) because the mole is on her inner thigh. Upon examination, the mole is asymmetrical, 7 mm big, and has uneven borders. As a CNL, you know these characteristics represent which of the following?* A. Genital herpes B. Human papillomavirus C. Basal cell carcinoma D. Malignant melanoma
Answer D—Rationale: The ABCDE's of malignant melanoma include asymmetrical; uneven borders; variety of colors; large diameter greater than 6 mm; and evolving.
*As Jeff, a new CNL, walks into his newly assigned intensive care unit (ICU), he notices that the charge nurse assigned him as a primary care nurse for a group of a patients, like she would do for a staff nurse. Jeff discusses the role of a CNL with the charge nurse. What statement best describes the appropriate approach by Jeff?* A. Jeff asks the charge nurse if she understands the role of a CNL, and states he cannot be assigned a group of patients. B. Jeff asks the charge nurse if she understands the role of a CNL, then explains that the CNL does not provide direct care to patients. C. Jeff discusses that CNLs are not supposed to take patients and only coordinate care for difficult patients. D. Jeff explains that the CNL operates in a microsystem as an advanced generalist to communicate, coordinate, and collaborate care and does not serve as a primary care nurse.
Answer D—Rationale: The CNL operates in a microsystem as an advanced generalist who communicates, coordinates, and collaborates care with major stakeholders. The CNL is a leader in the nursing profession. The CNL in this scenario is protecting the CNL role by advocating for the appropriate use of a CNL.
*Your hospital is changing to a new electronic health record (EHR) system. As a CNL, you recognize that while this change may ultimately improve workflow, during the transition there will likely be both technical issues and knowledge gaps. What are some ways you can improve the ease of transition?* A. Assess the current transition timeline, including education and practice time for the staff B. Identify leaders on the unit who can commit to extra training on the EHR and staff support during the transition C. Create guidelines for the nurses to use as a quick reference for locating items in the EHR D. All of the above
Answer D—Rationale: The CNL should consider the timeline for any education or training implemented occurring on their unit. Advocating for nurses during this time allows them to focus on the change. Identification of leaders who can act as peer educators supports the staff. The CNL should create tools to help increase or support workflow.
*Promotion of personal goals for professional development and continuing education is a hallmark of the CNL role. Ultimately, what is the importance of professional development?* A. Maintaining professional practice competencies B. Fulfillment of the CNL as a lifelong learner C. Providing an example of professional nursing to peers D. All of the above
Answer D—Rationale: The development of goals and continuing education maintains the CNL's competencies, illustrates the CNL is a lifelong learner, and provides an example to their peers.
*You, the CNL, are working in the ICU with a high volume of patients with prolonged Foley catheter use. What analysis tool is appropriate for the CNL to use in prevention of CAUTIs?* A. Root cause analysis (RCA) B. Fishbone diagram C. St. Thomas risk assessment tool D. Failure mode-effect analysis
Answer D—Rationale: The failure mode-effect analysis tool is a proactive risk assessment of high-risk or high-vulnerability areas that identifies and improves steps in a process, with a focus on failure prevention, not detection.
*The health care team determines that the discharge process is ineffective and must be changed. The team determines the stakeholders and utilizes a force field analysis to weigh the pros and cons of the change. This was then used to motivate other team members and encourage buy in. Utilizing Lewin's theory of change, what stage is the team in?* A. Sustaining B. Moving C. Refreezing D. Unfreezing
Answer D—Rationale: The first step of Lewin's theory of change is the unfreezing stage. In order to battle the resistance of change, the leader must assess readiness for change and motivate others to see the reason for change.
*A small group has been formed on the medical-surgical unit to implement change. Team members also have struggles over decision making and clarity of purpose. What stage of the Tuckman and Jensen's model is represented by members communicating their feelings but still viewing themselves as individuals rather than part of the team?* A. Performing B. Norming C. Forming D. Storming
Answer D—Rationale: The storming phase is where competition and conflict are at their highest.
*The CNL has been requested to assist with end-of-life care decision making for an elderly homeless patient who has no family; he was deemed incompetent and is now unresponsive. The best decision making guide that the CNL could use in this situation is:* A. Plan-Do-Study-Act (PDSA) B. Autonomy model C. Orem's self-care theory D. MORAL model
Answer D—Rationale: This is a model that addresses ethical issues and guides an objective, orderly, and systematic decision.
*A client on your unit is going home to finish rehab following a bilateral total knee replacement. You, as the CNL, would be enacting the function of lateral integrator by which of the following?* A. Delivering the bedside discharge education B. Helping the client arrange transportation home C. Making a checklist of the client's belongings to ensure nothing was left behind D. Ensuring follow-up appointments and services, including transportation, have been scheduled
Answer D—Rationale: While the CNL might be useful in any of these areas, ensuring proper scheduling of follow-up care with other providers is a function of coordination, a key component of the CNL's role as a lateral integrator.
