Leadership Exam 4

Which strategy could the nurse use to avoid disparity in healthcare delivery? 1. Recognize the cultural issue related to patient care. 2. Request more health plan options. 3. Care for more patients even if quality suffers. 4. Campaign for fixed nurse-patient ratios.

Answer: 1 Explanation: 1. Disparities often occur because the healthcare professional does not recognize cultural differences or has a cultural bias. 2. This is a consumer demand related to insurance. The nurse has little effect on this issue. 3. This is an unacceptable strategy to nursing. 4. This scenario is unlikely to have impact on health disparities.

Which part of the nursing process is key to successful telenursing? 1. Assessment 2. Diagnosis 3. Implementation 4. Evaluation

Answer: 1 Explanation: 1. Assessment is the most important part and is key to successful telephone nursing. 2. Without complete assessment, diagnosis is difficult or may be erroneous. 3. Implementation depends upon assessment. 4. Evaluation depends upon the implementation of interventions chosen secondary to good assessment.

You are serving on a state committee to develop a state health policy. Which of the following strategies should be done early in the process? 1. Coalition building 2. Select the solution 3. Monitor the outcomes 4. Implement the policy

Answer: 1 Explanation: 1. Coalition building should be done very early to ensure that you understand the stakeholders and begin to build support. 2. Solutions are selected after the problem is understood and possible solution options identified. 3. This is the last step in the process. 4. Implementation occurs after the problem is described, solution understood, and policy developed.

You want to establish a nurse-managed health center. Which of the following must you do to be designated as an NMHC? 1. You must partner with a school of nursing or community-based nonprofit organization. 2. Care in the N M H C is provided by registered nurses. 3. Reimbursement is focused on any third-party payer. 4. NMHC services focus on comprehensive primary care and care of the older adult.

Answer: 1 Explanation: 1. NMHCs must partner with a school of nursing or, if not, with a community-based nonprofit organization. 2. NMHC s include interprofessional providers. 3. Reimbursement is primarily from Medicare, Medicaid, and CHIP. 4. Services focus on comprehensive primary care, family planning, prenatal services, mental/behavioral healthcare, health promotion, and disease prevention.

What did the NAM recognize as it was developing the Quality Chasm series of reports on healthcare? 1. Healthcare quality must consider staff competency. 2. Nursing education is meeting the practice needs. 3. Interprofessional education is effective. 4. Continuing education meets the five core healthcare professions competencies.

Answer: 1 Explanation: 1. The N A M developed the Health Professions Education report to address the need for better education to meet major goal of improving care. 2. N A M did not indicate that nursing education was meeting the needs. 3. At the time of the development of the Quality Chasm series, interprofessional education was rare. 4. There was no recognition that continuing education met the five core competencies.

According to the National Health Security Strategy, who should take the primary lead role in planning, providing resources, guiding others, and evaluating outcomes related to disaster preparedness? 1. HHS 2. State health departments 3. Healthcare organizations 4. Local health departments

Answer: 1 Explanation: 1. The U.S. Department of Health and Human Services should assume the lead role. 2. This is a stakeholder but according to the strategy would not assume the lead role. 3. This is a stakeholder but according to the strategy would not assume the lead role. 4. This is a stakeholder but according to the strategy would not assume the lead role.

Why does the process of developing public health policy seem familiar to most nurses? 1. It is very similar to the nursing process. 2. It is taught in all nursing schools. 3. It is emphasized on N C L E X-R N. 4. It reflects common sense.

Answer: 1 Explanation: 1. The process whereby public health policy is developed closely replicates the nursing process. 2. This process is not taught in all schools. 3. This process is not emphasized on N C L E X-R N. 4. While much of the process does reflect common sense, the best answer is that it is similar to the nursing process.

The nurse researcher is developing an E B P question for a study. Which consideration should be made when writing the results/outcome expected section of this question? 1. What happened to the study group? 2. What treatment is being studied? 3. Were any other treatments done? 4. Who is being studied?

Answer: 1 Explanation: 1. The result/outcome, such as risk of disease, a complication or a side effect, or an adverse outcome. 2. This describes the problem and what was done. 3. This does not focus on the results or outcomes. 4. This the group that is being studied, written in specific terms.

The hospital is considering implementation of the following technology upgrades. Which one will have the most direct implications for patient confidentiality? 1. Medical email 2. Handheld communication systems 3. Remote telemetry monitoring 4. Point-of-care clinical documentation systems

Answer: 1 Explanation: 1. The use of medical email has the most potential for breaching confidentiality. 2. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications. 3. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications. 4. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications.

Why is staffing a more complex issue for a county health department than for a hospital? 1. Stakeholders are more varied and complex. 2. Nurses need to have a B S N. 3. Community requires a higher ratio of nurses than a hospital. 4. Personal safety is more of a concern in the hospital setting.

Answer: 1 Explanation: 1. There is a need to meet very different patient and community needs, thus requiring varied competencies and work with varied stakeholders. 2. The requirement for nurses having a B S N is the same for acute care hospitals and for public/community health. 3. Required ratio of nurses is highly variable, and the public/community setting does not necessarily and most likely does not require more nurses. 4. Personal safety is more of a concern in the community—travel, safety in certain communities, going into homes and not always sure what one will find, going into high-risk areas for crime and substance abuse.

1) The nurse educator would like to promote the use of standardized language in healthcare with nursing students. Which occurrence would be the most significant toward this nurse's goal? 1. Development of the Nursing Minimum Data Set (NMDS) 2. Development of the Nursing Management Minimum Data Set (NMMDS) 3. Development of the Omaha system 4. Development of the Systematic Nomenclature of Medical Clinical Terms (SNOMED C T)

Answer: 1 Explanation: 1. This is an attempt toward standardization of categories of patient data, but is nursing based. 2. This is an attempt toward standardization of categories of patient data, but is nursing management based. 3. The Omaha system is a comprehensive and standardized taxonomy designed to improve practice, documentation, and information management in home healthcare, community, and public health. It is not used across all healthcare settings or disciplines. 4. S N O M E D C T is a comprehensive clinical terminology system recognized by the federal government systems for electronic exchange of clinical health information and is used across healthcare professions.

Which of the following is not related to one of the core public health functions? 1. Establish a budget. 2. Investigate potential air pollution from a factory. 3. Identify stakeholders to work on community problem of drug abuse. 4. Ensure that the requirement for health inspections of restaurants is met.

Answer: 1 Explanation: 1. This is not related to a core function. 2. This is related to the core function of assessment. 3. This is related to the core function of policy development. 4. This is related to the core function of assurance.

Which option best fulfills the problem portion of an E B P question? 1. Middle-aged Caucasian men who have been treated for type I diabetes mellitus for over 1 year 2. Infants who are breastfed 3. Women who are breast cancer survivors 4. African American women who are poor and who have lived in the western United States for some time

Answer: 1 Explanation: 1. This is the most descriptive of these options. 2. This statement does not include how long the infants have been breastfed and if they have been exclusively breastfed or are supplemented with formula feedings. 3. This statement does not clarify the age of the women being studied or the length of time since diagnosis. 4. "Poor" is a subjective term, as is "for some time."

The patient expresses concern about the confidentiality of his medical information, since "so much of it gets faxed around nowadays." How should the nurse respond to this concern? 1. "The hospital follows the Health Insurance Portability and Accountability Act, which identifies steps we must take to keep your information confidential." 2. "Since computers have moved away from linear thinking to a greater systems approach, concerns about information confidentiality have decreased." 3. "We use point-of care, a documentation system that will not allow your information to be shared." 4. "This is a really big concern. You never know who could be reading those faxes that we send. There is no way to be sure that they are really going to the person they are sent to."

Answer: 1 Explanation: 1. This statement is correct and helps assure the patient that efforts to protect his confidentiality are being taken. It is the best response. 2. This is a confusing answer to patients and is not on point for the statement made. 3. This statement is not true and does not address the patient's real concern. It sounds like a statement that would be made to "skirt" the issue. 4. This statement may have some truth. It is not the best response to a patient who is already concerned about his confidentiality.

You want to improve acceptance of a new E M R/E H R. What strategies might you use to address the problem that staff think using a computer in care areas will limit their relationship with patients? Select all that apply. 1. Use a system that relies less on typing and more on clicking, dragging, and so on. 2. Use hardware that is easy to carry and not large. 3. Reassure staff that they are important. 4. Limit how long a staff member can use the computer for documenting. 5. Explain the benefits of using computers.

Answer: 1, 2 Explanation: 1. Less typing means it is easier to document, and staff can focus more on the patient. 2. Tablets and small laptops interfere less than a larger computer—less of a barrier between the nurse and the patient. 3. Reassuring staff is important, but does not address the specific problem. 4. Limiting use of the computer is not realistic, as documentation and other tasks must be performed as needed, and so setting up a time span is not helpful. 5. Explaining the benefits is important, but this does not address the specific question.

Which of the following factors relate to Healthy People? Select all that apply. 1. The initiative is evidence-based. 2. Healthy People is reviewed and updated every 10 years. 3. The focus is acute care needs and services. 4. Individual health is the core for the initiative.

Answer: 1, 2 Explanation: 1. This is correct; evidence is used to formulate the goals and so on and then tracking of outcomes/indicators. 2. It is currently in review for the 2030 version. 3. The focus is on health promotion and prevention. 4. Healthy People does focus on individuals but also has a Healthy Communities aspect.

The staff nurse has long wondered if some common nursing interventions are helpful to patient outcomes. Where would this nurse find evidence-based practice information to help solve this dilemma? Select all that apply. 1. Research journals 2. Expert nursing opinion 3. Established nursing theories 4. Tradition 5. Clinical expertise

Answer: 1, 2, 3 Explanation: 1. Research journals report evidence-based research study results on many topics, including traditional interventions. 2. The opinion of nursing experts should reflect evidence-based care. 3. Established nursing theories have been tested and include evidenced-based information. 4. Traditions are often passed down from nurse to nurse and are not necessarily based in science. They are not necessarily bad, either, but have no basis in science. 5. Clinical expertise does not always correlate to use of evidence-based practice.

Which research topics would likely be included in the National Institute of Nursing Research (N I N R) Intramural program? Select all that apply. 1. Use of a specific intervention to reduce shortness of breath in patients with congestive heart failure 2. How to guide a wellness program in a community 3. Quality improvement in palliative care 4. Use of knowledge management theory in a free-standing dialysis unit 5. Cost of an education program on prevention of sudden infant death syndrome

Answer: 1, 2, 3 Explanation: 1. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit (which would conduct this study), the Pain Research Unit, and the Research Training Unit. 2. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit, the Pain Research Unit (which would conduct this study), and the Research Training Unit. 3. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit, the Pain Research Unit, and the Research Training Unit (which would conduct this study). 4. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program. 5. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program.

What are the advantages of using systematic reviews to learn about evidence-based practice issues? Select all that apply. 1. Any inconsistencies in the material are explored. 2. The review increases the strength of cause and effect relationships. 3. Helps to increase efficiency in time between research and clinical implementation. 4. This review proves this intervention is the best one available. 5. There is a decrease in bias from researcher error.

Answer: 1, 2, 3 Explanation: 1. These reviews help to assess consistency of the information and explain any inconsistencies of findings across the studies. 2. The review increases power in suggesting the cause and effect relationship. 3. These reviews help to increase efficiency in time between research and clinical implementation. 4. There is no proof that this intervention is the best one available, but it does rank the strength of the interventions reviewed. 5. Having many people participate in reviews helps to reduce bias from random and systematic error, which then improves true reflection of reality.

As director of nursing education in a large hospital, you are working with nurse managers and your staff development specialists to update the policy on staff attending conferences so that the policy is more effective and attendance is increased. What might you include in this policy? Select all that apply. 1. Specify criteria for staff to receive fees and/or time off. 2. Require staff who attend (receiving conference fees and/or time off) to present to the staff after the conference. 3. Specify the procedure for applying for time off and/or fees to attend a conference and the time line. 4. Recognize that continuing education is an individual professional obligation and thus conference fees will not be provided. 5. The same policy should then be applied to staff in academic programs.

Answer: 1, 2, 3 Explanation: 1. This is a reasonable approach so that staff do not feel some receive more than others. 2. This is a reasonable approach, as the organization is providing support, and this also encourages staff to recognize this activity is important. 3. Procedures should be clear to all and followed. 4. This is a professional responsibility, but no assistance with fees will limit staff from attending. 5. Staff in academic programs is a different matter. For example, courses go on for some time, so scheduling time off is more complex; cost is greater, so the same formula for paying for conference fees would not apply and the organization may not be able to handle the cost; and some organizations require a certain grade attainment to get tuition reimbursement, and this would not apply to a conference.

A staff nurse in a small, rural hospital is concerned about the future of healthcare in the rural environment. How can this nurse be involved in healthcare policy development? Select all that apply. 1. Join local and national nursing organizations. 2. Contact elected representatives regarding nursing and healthcare. 3. Act as a patient advocate. 4. Use the internet to keep current on healthcare policy issues. 5. Serve on the Infection Control committee of the local hospital.

Answer: 1, 2, 3, 4 Explanation: 1. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 2. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 3. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 4. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development. 5. While this is considered service to the institution, it is not as likely to impact healthcare policy on a state or national level.

The high school student is very interested in healthcare research and is trying to decide which healthcare profession to enter. What should this student consider when examining leadership roles in research that nurses can assume? Select all that apply. 1. Nurses guide their own research. 2. Nurses participate in interprofessional studies. 3. Nurses manage clinical trials. 4. Nurses guide patients who are considering clinical trial participation. 5. Nurses are not generally leaders in healthcare research.

Answer: 1, 2, 3, 4 Explanation: 1. Nurses act as designers and principal investigators in their own research. 2. Participating in interprofessional studies and trials is a common role for the nurse. 3. Depending upon educational level, nurses do manage clinical trials. 4. Nurses of many different educational levels serve as patient advocates in decisions about clinical trial participation. 5. The nurse serves in many roles in healthcare research, including leadership roles. This high school student should consider advanced education in nursing beyond a basic degree.

The healthcare organization has developed a new website. This website can be used for which purposes? Select all that apply. 1. Recruitment of staff 2. Patient education 3. Nursing continuing education 4. Dissemination of committee activities 5. Patient contact information

Answer: 1, 2, 3, 4 Explanation: 1. These sites are often used in recruitment and retention efforts. 2. Patient education materials are often accessed through a hospital website. 3. The hospital website is a good place to offer nursing continuing education materials. 4. These activities may be public record or may be accessed using a personal identification number (P I N). 5. There is no need for patient contact information to be housed on the hospital website. Patient confidentiality could easily be breeched.

Public health impacts many aspects of the country, including which of the following? Select all that apply. 1. Economic 2. Families 3. Employment 4. Social relationships 5. Politics

Answer: 1, 2, 3, 4, 5 Explanation: 1. Public health impacts economics. 2. Public health impacts families. 3. Public health impacts employment. 4. Public health impacts social relationships. 5. Public health impacts politics.

A rural hospital has resisted moving to electronic record keeping, but now believes moving to a clinical information system is unavoidable. Place in order the steps this hospital should take to develop its clinical information system strategic plan. Choice 1. Identify the organization's future view of itself in a clinical vision statement. Choice 2. Develop specific strategic goals associated with the information system. Choice 3. Develop clinical strategies that include the general organization activities to support the organization's vision. Choice 4. Take strategic clinical vital signs. Choice 5. Evaluate the system to determine needed improvements.

Answer: 1, 2, 3, 4, 5 Explanation: 1. The organization must identify what it believes about the role of information technology in its services. This is the first step of the process. 2. Development of specific strategic goals is the second step to provide a guide for the plan. 3. The third step is to develop a general clinical strategy that includes how information technology will affect the strategy and to meet the goals. 4. These vital signs are used to determine if the goals are being achieved. 5. Evaluation is the last step of the process and will trigger a new round of changes.

1) Consumer advocacy is more common today in healthcare policy. What are the common concerns that consumers have? Select all that apply. 1. Increasing costs of care 2. Impersonal care 3. Decreased communication 4. Provider competence 5. Decreasing quality of care

Answer: 1, 2, 3, 4, 5 Explanation: 1. This is a consumer concern. 2. This is a consumer concern. 3. This is a consumer concern. 4. This is a consumer concern. 5. This is a consumer concern.

Which NAM report is important when discussing nursing leadership? 1. Crossing the Quality Chasm 2. Health Professions Education 3. The Future of Nursing 4. To Err Is Human

Answer: 3 Explanation: 1. This report focuses on status of the quality of care. 2. This report focuses on health professions education. 3. This report focuses on the need for more nursing leadership in healthcare delivery. 4. This report focuses on health safety and errors.

The nursing student states, "I use information and technology all the time to keep in touch with my friends and family. I didn't know it was used in healthcare, too." Which statements, made by a fellow student, would explain the healthcare uses of information and technology? Select all that apply. 1. "I read that information and technology have improved patient safety and quality of care." 2. "The textbook says that information and technology have improved efficiency and effectiveness of interprofessional practice." 3. "The simulators we use in lab practice are a result of information and technology improvements." 4. "Information and technology have allowed nurses better ability to connect emotionally with their patients." 5. "The automated medication system we use in clinical practice is a result of advances in information and technology."

Answer: 1, 2, 3, 5 Explanation: 1. Advances in information and technology have improved patient safety and quality of care. 2. This is one of the seven issues reflecting the broad impact of technology in the healthcare environment. 3. Laboratory simulators have developed as a result of new technologies and use of information. 4. There is concern that use of technology may distance the nurse from the patient, interfering with the personal connectivity that has long been the domain of nursing. 5. Automated medication systems are another development that can be traced to technology and information.

The public health nurse is planning an education session on healthcare literacy for the community. What topics should the nurse include in this session? Select all that apply. 1. How to recognize what information is needed 2. How to locate information 3. How to evaluate information 4. How to disseminate information to others 5. How to use the information located

Answer: 1, 2, 3, 5 Explanation: 1. Healthcare literacy includes recognizing what information is needed. 2. Healthcare literacy includes how to locate information. 3. Healthcare literacy includes how to evaluate information for accuracy and pertinence. 4. Dissemination of information to others is not a part of healthcare literacy. 5. Healthcare literacy includes recognizing how to use information once it is located.

Which patient would be considered to belong to a vulnerable population when included in research? Select all that apply. 1. A healthy newborn delivered at 38 weeks' gestation 2. A 45-year-old woman with diagnosed bipolar disease 3. A 28-year-old woman who is 16 weeks pregnant 4. A 35-year-old man who is hospitalized with renal colic 5. A 58-year-old female inmate who was injured in a prison fight

Answer: 1, 2, 3, 5 Explanation: 1. Neonates are considered a vulnerable population. 2. Persons with mental illness are considered a vulnerable population. 3. Pregnant women and fetuses are considered vulnerable populations. 4. Persons who are hospitalized are not considered part of a vulnerable population based upon the hospitalization alone. 5. Persons confined to institutions such as prisons are considered part of a vulnerable population.

Nurses involved in population health may need to assess and develop strategies related to multiple concerns. Which concerns might be included? Select all that apply. 1. Work with religious leaders 2. Bus service to the medical clinics 3. Work with city services related to trash 4. Tell police where they need to patrol 5. Help identify alternative telephone access

Answer: 1, 2, 3, 5 Explanation: 1. Nurses may collaborate with this group to develop social support. 2. Nurses may help identify need for access to services through transportation. 3. Nurses may work with city services in areas of environmental health such as sanitation. 4. Working in population health requires collaboration, not "directing" and telling police what they should do, which would not be a nursing responsibility. 5. Nurses may work with patients and families to determine how they might call for help if medical assistance is needed.

The hospital's risk management team has recommended that the hospital adopt an automated medication administration system. What benefits can the hospital expect from this change? Select all that apply. 1. The system will help caregivers ensure that the "five rights" are being followed. 2. There will be an opportunity for data collection by providing clinical experiential information. 3. The system will assist quality improvement efforts. 4. There will be a substantial direct cost savings. 5. Use of this system will meet Institute for Safe Medication Practices guidelines

Answer: 1, 2, 3, 5 Explanation: 1. This automated system verifies that all "five rights" have been met at the time the medication is being administered. 2. The bar coding that is associated with automated systems is useful in collecting data about medication administration. 3. Data collected about medication administration can serve to improve the quality of care. 4. These systems can be quite expensive to implement, and cost savings through decreased error and increased quality may take some time to realize. 5. The ISMP strongly supports use of the bar coding that is required for these systems.

You are serving on the I R B committee. In reviewing study proposals, what are questions you might ask? Select all that apply. 1. Can subjects withdraw at any time? 2. How are subjects told about their role in the study? 3. Is it clear whom the subjects should contact for questions? 4. Will negative results be kept private? 5. How will the researcher protect subject confidentiality?

Answer: 1, 2, 3, 5 Explanation: 1. This is a common question. 2. This is a common question. 3. This is a common question. 4. Whether or not results are positive or negative should not impact sharing the results. 5. This is a common question.

What would a nursing education division include in its annual evaluation of the division? Select all that apply. 1. Number and type of staff who attend specific programs 2. Cost per educational program 3. Nursing quality improvement data 4. Attendee/participant feedback related to the program and outcomes 5. List of equipment and supplies used

Answer: 1, 2, 4 Explanation: 1. These data would be important to track. 2. Cost per program is important to track and assess. 3. Nursing quality improvement data are not part of an evaluation of the nursing education division. 4. Attendee feedback is important. 5. This is important in planning a program, but would have no relevance to evaluation of the department.

The Health Professions Education report indicates change is needed in healthcare professions education. What are the core competencies the report identifies? Select all that apply. 1. Utilize informatics. 2. Provide patient-centered care. 3. Demonstrate leadership. 4. Work in interprofessional teams. 5. Communicate clearly.

Answer: 1, 2, 4 Explanation: 1. Utilize informatics is one of the five core competencies. 2. Provide patient-centered care is one of the five core competencies. 3. Leadership is important, but not a specific core competency and is integrated in many of the five core competencies. 4. Work in interprofessional teams is one of the five core competencies. 5. Communicate clearly is not a specific core competency mentioned; it is integrated in all the core competencies.

The healthcare organization has elected to move toward use of electronic medical records (EMR). In order to be most successful, management should involve nurses in which part of this work? Select all that apply. 1. Reviewing the EMR systems available 2. Implementation of staff training 3. Funding decisions related to the purchase of EMR 4. Developing the process of implementing the EMR 5. Long-term evaluation of use of the MR

Answer: 1, 2, 4, 5 Explanation: 1. Nurses should be consulted regarding the types of E M R systems available and should be heavily involved in choosing the system purchased. 2. Staff training will be lengthy and time consuming. Nursing should be consulted about how best to plan for this training and how best to implement the training. 3. This is the work of the chief financial officer of the organization. 4. The change to an E M R is not undertaken quickly. Plans for a smooth conversion should include nursing input. Nursing should also be consulted regarding backup plans and troubleshooting plans. 5. Nursing will be heavily involved in the use of this system and should be involved in its long-term evaluation.

What are the ways that an H C O website might benefit nursing within the H C O? Select all that apply. 1. Provide information about nursing staff. 2. Share information about admission process. 3. Provide information about cost for specific procedures. 4. Identify specific medications used for certain illnesses and surgery preparation. 5. List patient rights.

Answer: 1, 2, 5 Explanation: 1. Information about nursing staff organization and services may be provided. 2. This is a good place to post general information about the admission process, what to expect and so on. 3. Cost is not included; would be highly variable per patient, insurer, and so on. General information about reimbursement requirements may be provided. 4. Identifying specific medications used for certain illnesses and surgery preparation is highly variable per patient, so this would not be provided. 5. Patient rights are important to emphasize, and this is one way to do it.

What should be included in general orientation? Select all that apply. 1. Human resources services and policies 2. Communication systems and guidelines 3. Working with the clinical team in the intensive care unit 4. Developing your initial work schedule 5. The organization's vision, mission, and goals

Answer: 1, 2, 5 Explanation: 1. This is part of general orientation. 2. This is part of general orientation. 3. This information would not be in general orientation, but rather in unit-specific orientation. 4. This information would not be in general orientation, but rather in unit-specific orientation. 5. This is part of general orientation.

Place the steps of the evidence-based management (E B M) process in correct order. Choice 1. Formulate the question. Choice 2. Assess the evidence. Choice 3. Acquire research evidence. Choice 4. Apply the evidence. Choice 5. Present the evidence.

Answer: 1, 3, 2, 5, 4 Explanation: 1. Formulating the question is the first step of the E B M process. 2. The third step of the E B M process is assessing the evidence that has been acquired. 3. Once the question is formulated, the second step of the E B M process is acquiring research evidence. 4. Application of the evidence is the fifth step of the E B M process. 5. The fourth step of the E B M process is somewhat different than the evidence-based practice model, in which the step is not actively considered. In E B M, the evidence must be presented to others.

Which of the following include comments about and strategies related to healthcare disparity? Select all that apply. 1. Agency for Healthcare Research and Quality 2. Medicare reimbursement requirements 3. Institute of Medicine/National Academy of Medicine reports 4. National Quality Care Reports (annual)

Answer: 1, 3, 4 Explanation: 1. A H R Q has many services and resources on disparity. 2. This does not include disparities as a requirement. 3. The I O M/N A M reports on quality include disparities. The quality reports include indicators directly related to disparities

1) The nurse answers a "nurse call" line for a hospital. Which resources will this nurse use to guide patients using this technology? Select all that apply. 1. Protocols 2. Research articles 3. Algorithms 4. Guidelines 5. Internet search engines

Answer: 1, 3, 4 Explanation: 1. Protocols define the ongoing care or management of a broad problem or issue. They direct the advice/triage/education/counseling process commonly used when answering "nurse call" lines. 2. Research and evidence-based practice are used in general to provide care; however, they are not specific tools used in practice. 3. An algorithm prescribes what steps to take given particular circumstances or characteristics. These tools may be used by this nurse. 4. Guidelines are typically a more narrative description of assessment steps that include education and counseling text to support the nurse during calls. 5. Internet search engines can help obtain information, but they are not a tool generally used specifically in this situation.

Which statements correctly apply to the process of developing public policy? Select all that apply. 1. The two types of public policy are regulatory and allocative. 2. Since public policy supports the general population, decisions regarding policy are typically straightforward and easy to make. 3. Often, in order to pass a policy, deals have to be made. 4. Public policy may benefit some at the expense of others. 5. By law, political influence is separate from policy development.

Answer: 1, 3, 4 Explanation: 1. These are the two types of public policy. 2. It is difficult to develop public policy because there are often conflicts that must be considered. It is also impossible to meet the needs of all people. 3. Deals and compromises are a part of developing public policy. 4. Allocative policies provide benefits for some at the expense of others to ensure that certain public objectives are met. 5. Politics is deeply involved in developing public policy.

The nurse executive wishes to encourage the use of evidence-based practice (E B P) in the clinical areas of the hospital. When talking to nurse managers about this decision what benefits of E B P should the nurse executive emphasize? Select all that apply. 1. E B P helps to control the cost of healthcare. 2. E B P takes decision making out of planning patient care. 3. E B P improves healthcare quality. 4. E B P makes care more patient-centered. 5. E B P encourages third-party payer involvement in healthcare decisions.

Answer: 1, 3, 4 Explanation: 1. This is a very important aspect of E B P to the nurse executive and to nursing managers. 2. Individual decision making about healthcare is still an important facet of care when using E B P. 3. Improvement of healthcare quality is a fact about E B P that should appeal to nurse managers and to staff nurses. 4. E B P does make care more patient-centered. This should be appealing to nurse managers and staff nurses. 5. There is no evidence that E B P increases involvement of third-party payers in healthcare decisions.

The National Prevention Strategy (NPS) focuses on which of the following elements? Select all that apply. 1. Healthy and safe community environments 2. Treatment of disease 3. Public/community empowered staff 4. Elimination of health disparities 5. Clinical and community preventive services

Answer: 1, 3, 4, 5 Explanation: 1. Healthy and safe community environments constitute one of the N P S elements. 2. Treatment of disease is not prevention of disease. 3. The N P S focuses on empowered people in the community. 4. Elimination of disparities is one of the NPS elements. 5. Clinical and community preventive services constitute one of the NPS elements.

Your disaster planning team is assessing the community to develop an effective disaster plan. What would you assess? Select all that apply. 1. Review data on health status of various vulnerable populations in the community. 2. Determine who will pay for damages to homes and businesses. 3. The types of healthcare services available and how easy it would be to get to them in a disaster. 4. Review data about past individual purchases of food and water when warned of a potential storm. 5. What social institutions, including religious, have been involved in the past and how they could be involved in the future.

Answer: 1, 3, 4, 5 Explanation: 1. Recognize the importance of health needs of the population. 2. Determining who will pay for damages is important, but not done until a disaster actually occurs; could vary depending on the disaster. 3. Access to services should be assessed. 4. Assessing community planning in the past, including individuals, is important. 5. Assessing social conditions and community support is important.

Which of the following statements best describe orientation? Select all that apply. 1. All new staff in a healthcare organization should attend orientation. 2. Nurse residents do not need orientation, as they are in a residency program. 3. Orientee feedback should be routinely surveyed. 4. Staff transferring to a new unit or position do not need orientation. 5. Orientation should be organized and include general and unit-specific content and learning activities.

Answer: 1, 3, 5 Explanation: 1. It is accepted that new staff require orientation. 2. Nurse residents should attend orientation and then participate in the nurse residency program. 3. Feedback is important to improve orientation and recognizes the importance of staff. 4. Transferring to a new work area or assuming a new position should include orientation, though it will need to be customized according to needs. 5. This is a clear description of orientation and the need to focus on general issues and unit-specific issues.

You are a member of a local community that experiences tornados. What major categories of activities should be included in an effective disaster plan? Select all that apply. 1. Response 2. Staffing 3. Prevention 4. Buying supplies 5. Recovery

Answer: 1, 3, 5 Explanation: 1. This is one of the major categories found in an effective disaster plan. 2. This is one of the tasks found in one of the major categories in an effective disaster plan. 3. This is one of the major categories found in an effective disaster plan. 4. This is one of the tasks found in one of the major categories in an effective disaster plan. 5. This is one of the major categories found in an effective disaster plan.

What is a major recommendation of the Advisory Committee on Interdisciplinary, Community-Based Linkages (ACICBL)? Select all that apply. 1. Greater use of e-learning is needed for continuing education. 2. Continuing professional development is a term used by physicians. 3. Greater government funding to support CPD is needed. 4. There is adequate funding of faculty training for distance education. 5. NAM core competencies should be included in CPD.

Answer: 1, 3, 5 Explanation: 1. This is recommended to make education more accessible. 2. CPD is the term also now used by the ANA/nursing profession. 3. More funding is needed, and this is mentioned by the ACICBL. 4. The ACICBL recommends that HRSA provide a mechanism to increase funding to further develop faculty distance education competencies. 5. The competencies should be applied in academic programs and CPD.

What does The Future of Nursing report recommend about nurse residency programs? Select all that apply. 1. Healthcare organizations should offer nurse residency programs. 2. Funding of nurse residency programs should remain the same. 3. State boards of nursing should support the use of nurse residency programs. 4. Nurse residency programs are focused on new graduates of pre-licensure programs. 5. H H S should transfer money allocated to diploma nursing programs to nurse residency programs.

Answer: 1, 3, 5 Explanation: 1. This is recommended. 2. Funding for nurse residency programs is very weak and needs to improve. 3. This is recommended along with support from The Joint Commission. 4. Nurse residency programs for new B S N graduates are recommended, but also the report recommends residency programs for graduates from advanced practice programs. 5. This is recommended as a funding source.

Which conditions served as the focus for development of Web-based programs for patient monitoring and interactive video-based programs? Select all that apply. 1. Congestive heart disease 2. Normal pregnancy 3. Kidney disease 4. Diabetes 5. Coronary disease

Answer: 1, 4, 5 Explanation: 1. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed. 2. Normal pregnancy did not serve as a focus for the development of these services. 3. Kidney disease did not serve as a focus for the development of these services. 4. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed. 5. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed.

Physicians, nurses, and other healthcare providers within the hospital have complained that the current documentation system is slow and that information is often not accessible when needed. Which system would increase the speed and accuracy of provider-to-provider communication? 1. Clinical data repository 2. Point-of-care clinical documentation system 3. Handheld communication devices 4. Narrative documentation

Answer: 2 Explanation: 1. A clinical data repository provides longitudinal clinical data storage of patient information and would not be practical for immediate access. 2. Communication can be improved as point-of-care clinical documentation systems are used to enhance provider-to-provider communication that is rapid and accurate. Care is documented as it is completed and is immediately accessible. 3. Handheld communication devices can be used for documentation or to search for medical information. These would be a possible component of the point-of-care system, but are not, individually, a method to enhance provider-to-provider communication. 4. Narrative documentation is slow and time intensive.

What is the difference in how a nurse addresses the problem of health literacy in the community as compared with acute care? 1. In the community, health literacy is viewed in the same way as in acute care. 2. In the community, the nurse must consider individual needs and group needs. 3. In the community, nurses have less involvement in health literacy, as social workers focus on this problem. 4. Health literacy is best viewed from an individual patient's needs to effectively resolve health literacy problems.

Answer: 2 Explanation: 1. Basic health literacy principles are the same but the assessment, specific problems, and strategies would be different and have a long-term impact. 2. The community is made up of individuals and groups and both need to be considered. 3. All of the healthcare team need to be involved in meeting community needs. 4. The individual is important and must be considered in the community but so must group- or population-focused needs.

Increased availability and use of technology has affected nursing education. What change has this development supported? 1. A decrease in clinical learning requirements 2. Faculty becoming facilitators of learning 3. A move toward pedagogy 4. Students who are very similar in culture and interests

Answer: 2 Explanation: 1. Clinical experiences are changing, but still remain an important aspect of nursing education. 2. Faculty are now seen more as facilitators of learning rather than lecturers. 3. The movement has been away from pedagogy. 4. The result of using technology has been that the student body is more diverse.

Healthcare delivery has experienced many changes and problems. Based on an examination of these changes and problems, what would you consider a major concern today? 1. Cost is not related to quality. 2. Healthcare is complex. 3. Quality care is improving rapidly. 4. A functional system is more costly.

Answer: 2 Explanation: 1. Cost is related to quality, and cost and quality are major concerns. 2. Healthcare is complex, a major concern today, and this makes it difficult to adjust to changes and improve. 3. Quality care is not improving rapidly. 4. A dysfunctional system is more costly.

What is the most important federal government department for healthcare? 1. F D A 2. H H S 3. C M S 4. H R S A

Answer: 2 Explanation: 1. Food and Drug Administration is not a department but an H H S agency. 2. U.S. Department of Health and Human Services is the most important federal department related to healthcare and is composed of multiple agencies that focus on specific health concerns. 3. Centers for Medicare & Medicaid Services is not a department but an H H S agency. 4. Health Resources and Services Administration is not a department but an H H S agency.

The newly licensed nurse is concerned about the rapidity with which nursing care information changes. What characteristic would be best to help manage this concern? 1. Ability to use general internet search engines to obtain information 2. Knowledge of where and how to find the best possible sources of evidence 3. Ability to use library print resources to find good information 4. A good working relationship with experienced nurses

Answer: 2 Explanation: 1. General internet search engines do not always provide quality information for healthcare providers. These search engines also provide large amounts of sources that can be overwhelming. 2. The knowledge of where and how to find good evidence is an ability that is valuable to both the newly licensed and more experienced nurses. 3. Library print resources are a source of good information, but may lag behind the most up-to-date information. This is the second best choice to answer this question. 4. Unfortunately, there is no guarantee that experienced nurses have kept current with evidence-based practice.

Which of the following public/community health services is now emphasized the most due to work done by the N A M and the A C A? 1. Home health 2. Primary care 3. Hospice care 4. Rehabilitation

Answer: 2 Explanation: 1. Home care is expanding, but is not the most emphasized service. 2. Primary care is emphasized more now and needs to expand. 3. Hospice care is expanding, but is not the most emphasized service. 4. Rehabilitation is not the most emphasized service.

Which statement best describes the National Academy of Medicine (NAM) position on the use of North America Nursing Diagnosis Association (NANDA)-approved nursing diagnosis (N DX) statements? 1. IOM supports the use of three-part N DX statements. 2. IOM states that the use of these N DX statements is confusing to students, practicing nurses, physicians, and other healthcare providers. 3. IOM supports the use of Nursing Intervention Classifications (NIC) rather than NANDA diagnoses. 4. IOM states that the use of NANDA nursing diagnoses along with Nursing Intervention Classifications (NIC) is the clearest way to explain a patient's plan of care.

Answer: 2 Explanation: 1. I O M/N A M supports the use of a standardized language common to all healthcare professionals. N A N DA and N I C are not used by all healthcare professionals. 2. I O M/N A M supports the use of a standardized language common to all healthcare professionals. N I C, NO C (Nursing Outcomes Classification), and N A N D A are not standard to all healthcare professions and are confusing or not relevant to most providers. 3. I O M/N A M supports the use of a standardized language common to all healthcare professionals. N I C is not common to all healthcare professionals. 4. I O M/N A M supports the use of a standardized language common to all healthcare professionals. N I C and N A N D A are not common to all healthcare professionals.

What is the primary impact that cannot be avoided by an H C O if the H C O does not apply meaningful use? 1. Poor quality care 2. No federal reimbursement or other federal funds 3. Better patient education 4. Shorter lengths of stay

Answer: 2 Explanation: 1. Lack of meaningful use may impact quality but this is not the primary impact that is of definite consequence. 2. The federal government will not reimburse for Medicare care and will impact other federal funding. This would have a major impact on the H C O. 3. Meaningful use is not directly related to patient education. 4. Meaningful use is not directly related to length of stay.

What would not be found in a budget for the staff development department? 1. Office supplies 2. Quality improvement data collection 3. Marketing expenses 4. Staff development specialists' salaries and benefits

Answer: 2 Explanation: 1. Office supplies for staff development would be in its budget. 2. Quality improvement data collection would be included in the hospital budget and might be part of the nursing department budget. Quality improvement is not a function of staff development and so would not be in its budget. 3. Marketing expenses for education programs would be in the budget. 4. Staff development specialists' salaries and benefits would be in the staff development budget.

As a nurse who has just assumed a position as director of nursing for a county health department, you are now confronted with the department budget. You have been in management for some time in healthcare organizations. What is the major difference in the county budget? 1. Budget revenues are larger than for a hospital. 2. There is dependency on funding from government sources (local, state, federal). 3. Expenses are greater for the department than for a hospital. 4. Physician costs are higher for the clinics compared to the hospital staff.

Answer: 2 Explanation: 1. Revenues are smaller, as they are dependent on Medicaid and Medicare, and often there is no reimbursement either because the patient has no reimbursement or the service does not receive reimbursement such as for an education program on diabetes. 2. This factor is the major difference. 3. Expenses would most likely be less, as the department does not have major expenses such as equipment, highly skilled physicians such as surgeons, supplies, and so on. 4. There would be more physicians in a hospital.

Changing practice with EBP is least supported with which strategy? 1. Educate staff about EBP and evaluate results. 2. Develop policies and procedures that are based on best evidence. 3. Incorporate assessment of EBP in performance appraisal. 4. Connect EBP with QI within the healthcare organization.

Answer: 2 Explanation: 1. Staff do need to be educated about EBP and this education needs to be evaluated to determine its impact. 2. Policies and procedures need to be followed—just having them based on EBP is not enough. 3. Performance appraisal should include how the staff uses EBP. 4. EBP and QI are connected and should be within the healthcare organization.

1As director of nursing for a city health department you are challenged with providing staff education. What would be a major difference for you compared to a hospital staff education program? 1. You have staff who are less interested in staff education. 2. You have less budget or fewer on-site staff educators. 3. Nursing schools place their students in hospitals, reducing the influence of faculty and students in the community settings. 4. Health literacy problem exists in the community and in the hospital.

Answer: 2 Explanation: 1. Staff in community health are not necessarily less interested in their own education. 2. There is less budget and few, if any, on-site staff educators in public/community health. 3. Schools of nursing have required public/community health clinicals and assign students to these services. 4. This is correct and so not a major difference.

What is the first step in the staff nursing education process? 1. Clearly stating the problem 2. Needs analysis 3. Budget development 4. Marketing the educational offering

Answer: 2 Explanation: 1. Stating the problem is important, but first you need to know the learning needs. 2. The first step is to do a needs analysis to clearly understand learner needs and needs of the organization and its services in order to develop learning activities. 3. Budget is not the first step; it is difficult to develop a budget if you do not know what needs to be done. 4. Marketing is not the first step; it is difficult to develop a budget if you do not know what needs to be done and what you will describe in the marketing plan. Identifying needs will help to make the marketing plan clearer.

Which statement regarding the National Academy of Medicine (NAM) position on the use of information technology (IT) by healthcare professionals is accurate? 1. These skills should be required only of IT nurses or healthcare providers. 2. The use of IT is included in the IOM/NAM core competencies for all healthcare providers. 3. IT is important for physicians and pharmacists, but is not required of nurses or licensed therapists. 4. IT can be dangerous for healthcare professionals who are not expert in their use.

Answer: 2 Explanation: 1. The IOM/NAM supports IT use by all healthcare professionals 2. This statement is accurate. 3. The IOM/NAM supports IT use by all healthcare professionals. 4. The IOM/NAM supports the use of IT.

The nurse executive of a major medical center and the dean of a school of nursing have entered into an affiliation agreement. The medical center will supply clinical sites and preceptors to students, and the nursing school will supply research expertise and other academic support. How will this affiliation affect the medical center's plans to implement evidence-based practice (E B P) and evidence-based management (E BM)? 1. This affiliation should have very little effect on these two initiatives. 2. The affiliation should be helpful in initiating these practice and management styles. 3. The affiliation will help with E B P, but will likely have little effect on E B M. 4. The affiliation will help with E B M, but will likely have little effect on E B P.

Answer: 2 Explanation: 1. The affiliation should be helpful to both initiatives. 2. This sharing of expertise between nursing staff and nursing faculty should be of benefit to both E B P and E B M. 3. The affiliation should be helpful to both initiatives. 4. The affiliation should be helpful to both initiatives.

What is a major setting in public/community health services? 1. Hospitals 2. Clinics 3. School health 4. Hospice unit

Answer: 2 Explanation: 1. The hospital is acute care. 2. The clinic is the major type of healthcare setting in public/community health. 3. School health is part of public/community health, but not the major setting. 4. Hospice unit is part of public/community health, but not the major setting.

What is unique about the NAM approach to healthcare professions education? 1. Focus is on medical education. 2. Focus is on all healthcare professions. 3. Focus is on nursing education. 4. Focus is on continuing education.

Answer: 2 Explanation: 1. The report Health Professions Education does not just focus on medical education. 2. The focus of the report Health Professions Education is on core competencies for all healthcare professions. 3. The report Health Professions Education does not just focus on nursing education. 4. The report Health Professions Education does not focus on continuing education.

The hospital has identified telehealth as a potential addition to its services and is conducting cost-benefit analysis. Which barrier to developing this service is likely to emerge? 1. Patients become so empowered that they don't use as many services. 2. There is a limited reimbursement mechanism in place at this time. 3. There is decreased contact with practitioners using telehealth technology. 4. The lack of practice standards makes telehealth risky from a liability perspective.

Answer: 2 Explanation: 1. There is no evidence that this is the case. 2. Limited reimbursement mechanisms may make telehealth economically unfeasible for some organizations. 3. The use of telehealth should increase the contact with practitioners. 4. Practice standards do exist and can be used to establish policy and procedure to limit risk.

How is continuing education credit for healthcare professions currently provided? 1. One source for all healthcare professions 2. Multiple methods focused on multiple healthcare professions 3. Credit provided by academic institutions 4. Continuing education credit provided by the government

Answer: 2 Explanation: 1. There is no one source for continuing education credit for all healthcare professions. 2. This is the current status, though there is criticism of this approach. 3. Continuing education may be provided through an academic institution, but the credit is received through a continuing education source, approved by that source. 4. The government does not currently provide continuing education credit.

Which example of best practice review would likely be assigned a level Ⅰ? 1. Information from the only existing study of an intervention 2. Information from review of several randomized controlled trials of an intervention 3. Information from the opinion of a person widely recognized as an expert in the use of the intervention 4. Information from a nonrandomized well-designed controlled trial of the intervention

Answer: 2 Explanation: 1. This is considered level Ⅵ evidence. 2. Level I evidence is the highest or best level. It is evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (R C Ts) or evidence-based clinical practice guidelines based on systematic reviews of R C Ts. 3. Expert opinion is level Ⅶ evidence. 4. This type of evidence is categorized as level Ⅲ.

Which option best illustrates a positive outcome from managed care? 1. Reshaped current policy 2. Consumer involvement in the healthcare political process 3. Increase in quality care with reduced cost 4. Managed care is now the method used for reimbursement.

Answer: 2 Explanation: 1. This is not an outcome of managed care, but rather a part of the political process regarding legislation. 2. Managed care resulted in many consumers speaking out against managed care, and this led to more developed healthcare consumerism. 3. Quality is still a problem and costs have not been reduced due to managed care. 4. Managed care is not as strong as it was in the past.

As director of nursing education, you are often asked to respond to change. For example, a new policy is not working well and you are told to do something to fix this. What is the best response you could give to this request? 1. I will move forward based on the information you have just given me that the policy is not being followed. A plan for staff education on the policy will be implemented this month. 2. I will look into the problem. After I have some data, analyze the issues, talk to nurse managers, staff, and other stakeholders, I will then develop a response. If staff education is needed, I will plan this. 3. I will ask the nurse managers in the four units that use this policy the most to identify specific staff who have not used the policy, and to meet with them to correct this. 4. I will ask the policy and procedure committee to take care of the problem.

Answer: 2 Explanation: 1. This response assumes that the problem can be solved with staff education and does not include an expanded understanding of the problem. 2. This is the best response—not all change and problems should be or can be solved by staff education. 3. The director of nursing education does not have supervisory responsibility, and this approach leans in that direction. It also assumes blame and does not fully appreciate the problem and how best to resolve it. The response is not focused on education, which is the responsibility of the director of nursing education. 4. In this approach, the director of nursing education is transferring work to someone else. The committee does need to be involved in determining the best strategies to use once the problem is understood, but this approach is not clear in the response.

Which technologic advancement would improve emotional connectivity while providing patient care? 1. Using a laptop computer in the patient's room 2. Using telemedicine for consults 3. Using point-of-service bar coding for documentation 4. Using personal data assistants (P D As) to access information

Answer: 2 Explanation: 1. Using the laptop while in the patient room can be a time-saver, but also draws the provider's attention to the machine, not the patient. 2. Telemedicine can improve connectivity if used with the goal of doing so. The technology can be used to talk to the patient, to visualize the patient for assessment, and to allow the patient to "see" the provider. This is much more connected than a provider calling another provider with information for a consult. 3. Until patients become more accustomed to this technology, it can be somewhat "off-putting." Many correlate this technology with impersonality and much like groceries being scanned at the supermarket. 4. The P D A is certainly a nice tool for accessing information, but can come between the patient and the provider if the provider is spending more time interacting with the P D A or smartphone than the patient.

Telehealth has been used for some time in rural areas. In order to expand the use of telehealth, it has been proposed that it would be useful in which other areas? Select all that apply. 1. Private physician obstetrical practice 2. Home healthcare 3. School-based healthcare in inner cities 4. Inpatient surgery centers 5. Emergency departments

Answer: 2, 3 Explanation: 1. At this time, telehealth is unlikely to be used in this area. 2. Home healthcare presents a likely practice area for telehealth. 3. School-based healthcare in inner cities presents a likely practice area for telehealth. 4. Telehealth technology offers opportunities to provide care when face-to-face interaction is impossible. It is currently not appropriate for use in this practice area. 5. Telehealth technology offers opportunities to provide care when face-to-face interaction is impossible. It is currently not appropriate for use in this practice area.

What is different about today's healthcare environment that makes it crucial that nurses are involved in the development of healthcare policy? Select all that apply. 1. The focus of this new environment is on one-to-one nursing care. 2. There has been a shift from curing patients to prevention of illness. 3. Care must be cost-effective. 4. There is a need to reinvent nursing's professional culture. 5. High-quality care will again be provided primarily in acute care settings.

Answer: 2, 3, 4 Explanation: 1. The focus is on care of populations. 2. Prevention is now becoming the focus of much of healthcare. 3. Cost-effectiveness is a primary issue in healthcare. 4. Nursing must reinvent its culture in light of the new healthcare environment. 5. There is a call for high-quality care in all types of settings and by all providers.

Who typically leads a home health team? 1. Home health aide 2. Physician 3. Registered nurse 4. Social worker

Answer: 3 Explanation: 1. This staff member is important, but not typically the team leader. 2. This staff member is important, but not typically the team leader. 3. An R N typically leads the home health team. 4. This staff member is important, but not typically the team leader.

Which option represents a situation exemplifying the need for nurses to become involved in healthcare policy development? Select all that apply. 1. The nurse omitted documentation of a surgical dressing change. 2. The nurse must have a nursing license and be certified as A P R N to prescribe medications. 3. The nurse administered oral medications to the patient in the home. 4. The nurse discussed do-not-resuscitate decisions with the patient and the family.

Answer: 2, 4 Explanation: 1. This scenario represents a violation of standards and a potential malpractice issue, not an issue of healthcare policy. 2. Changes in legislation and regulation (which might be influenced by nurses involved in healthcare planning) affect nursing practice. 3. This scenario is unlikely to be altered by changes in legislation or regulation. 4. This scenario might be altered by changes in legislation or regulation.

The nurse educator would like to participate in the development of a single standardized language to be used across all settings and by all healthcare professions. What should this nurse consider about this goal? Select all that apply. 1. The work has already been done and such a language is in use today. 2. Significant changes in curriculum of nursing schools across the country will be required. 3. This should be a relatively easy goal to achieve, as the terminology currently used is similar in all professions. 4. To achieve this goal, compromise among healthcare providers will be necessary. 5. Individual languages for professions may be tied to the profession's desire to preserve its individuality.

Answer: 2, 4, 5 Explanation: 1. While work has been done toward this goal, there is not widespread use of a standardized language to date. 2. Nursing schools have used North America Nursing Diagnosis (N A N D A), Nursing Intervention Classification (N I C), and/or Nursing Outcome Classification (N O C) languages for many years. Changing to a different standardized language would require major revision to most nursing school curriculums. 3. This statement does not reflect the state of the issue today. 4. Compromise will be required, as many professions use languages that are specific to that profession. 5. Developing and adhering to distinct profession-specific terms may be a manifestation of a professional's desire to preserve identity, status, or control.

Which of the following government initiatives focuses on accelerating diffusion of research in practice? 1. AHRQ 2. PCORI 3. ACTION 4. CER

Answer: 3 Explanation: 1. AHRQ is a U.S. Department of Health and Human Services agency that focuses on quality care. 2. PCORI is a government initiative focused on patient care outcomes. 3. ACTION is a government initiative that focuses on accelerating the diffusion of research in practice. 4. CER is a government initiative that focuses on comparing the effectiveness of research results to provide best evidence.

Which of the following supports the acquisition, storage, manipulation, and distribution of clinical information throughout an H C O? 1. Decision support system 2. Databank 3. Clinical information system 4. Clinical data repository

Answer: 3 Explanation: 1. Computer applications designed to facilitate human decision making. 2. A large store of information; may include several databases. 3. Clinical information systems support the acquisition, storage, manipulation, and distribution of clinical information throughout an H C O with a focus on electronic communication, for example, electronic medical records, clinical data repositories, decision support programs (such as application of clinical guidelines and drug interaction checking), handheld devices for collecting data and viewing reference material, imaging modalities, and communication tools such as electronic messaging systems. 4. This system stores longitudinal clinical data, collecting data from multiple clinical information systems, including patient demographic data.

The large healthcare organization is determined to develop and support technologic processes and structures to help nursing staff members manage the data generated in the direct care of patients. Which person would be best for the organization to hire to achieve this goal? 1. A computer programmer 2. A software analyst 3. A nursing informatics specialist 4. An information technology specialist

Answer: 3 Explanation: 1. Computer programmers may be helpful in system design, but would not have the nursing expertise to be the most effective in this position. 2. Software analysts would not have the nursing expertise to be the most effective in this position. 3. The nursing informatics specialist is a nurse who should have these skills among others included in the specialty. This professional will have nursing expertise essential to develop applications useful to nurses. 4. This individual would not have the nursing expertise to be the most effective in this position.

Which of the following interventions demonstrate secondary prevention? 1. Offer a stress management course to teens. 2. Teach students in elementary school about good nutrition. 3. Provide new parent education in local community center. 4. Expand services to train the blind in reading in the community.

Answer: 3 Explanation: 1. Intervention that focuses on wellness—primary prevention 2. Intervention that focuses on wellness—primary prevention 3. New parent education may be used to decrease health problems for young children—secondary prevention. 4. Decreases disability—tertiary prevention

The 2008 American Association of Colleges of Nursing (A A C N) edition of The Essentials of Baccalaureate Education for Professional Nursing Practice is best described as supporting which of the following statements in its Essentials to be met by its accredited schools of nursing with BSN programs? 1. Leadership is needed to support quality, safe care. 2. Nursing education requires major changes. 3. Knowledge and skills support leadership and quality, safe care. 4. Nursing provides quality, safe care.

Answer: 3 Explanation: 1. Leadership and quality, safe care are important, but The Essentials describes how it can be applied to nursing education needs. 2. The Future of Nursing report emphasized the need for improvement in nursing education. TheEssentials is not a report on need for change in nursing education, but rather standards for nursing programs. 3. The emphasis is on knowledge and skills related to leadership and quality, safe care. 4. Providing quality, safe care is important, but The Essentials emphasizes the connection with the need for leadership and also elements that are required in a nursing education program.

In which way will information technology affect nursing research? 1. The complexities of this technology may make some aspects of research unappealing. 2. It will make data mining more difficult. 3. It will likely increase research activity. 4. It will make working with statistics more difficult.

Answer: 3 Explanation: 1. This technology should serve to make research more appealing because it is easier to access materials. 2. Data mining will become easier. 3. Many healthcare organizations, with their increasing ability to access technology, will probably increase their research activity. 4. It is now easier to apply statistics with the various computer-based statistical software packages available.

Emotional connectivity between nurses and patients is endangered by use of technology. By focusing solely on this issue, which other issue is often overlooked? 1. The cost of implementing technologic advances 2. The cost of not implementing technologic advances 3. The isolation that can occur through using technology 4. Third-party payers' demands for demonstration of outcomes

Answer: 3 Explanation: 1. Technology is expensive, but this issue is at the forefront of many discussions. 2. In order to stay competitive, healthcare organizations cannot afford not to implement technology. This is also at the forefront of many discussions. 3. The focus on connectivity between patients and staff leaves out the problems that occur when staff members become isolated from one another. Technology supports work being done in isolation from other staff. 4. The third-party demands for demonstration of outcomes is a reason that healthcare organizations adopt technology.

You are a member of a county health group that is working on improving health services to vulnerable populations in the community. Which of the following would be important to you as you do this work? 1. CDC 2. APHA 3. MAP-IT 4. HHS

Answer: 3 Explanation: 1. The Centers for Disease Control offers resources, but you will need more than just resources to meet the goal. 2. The American Public Health Association provides education and resources, but you will need more than this to reach your goal. 3. M A P-I T (mobilize, assess, plan, implement, track) is a framework you could use to meet your goal; associated with Healthy Communities. 4. The U.S. Department of Health and Human Services provides resources, grants, and other services but not specific to meeting your goal.

Why is The Nuremberg Code important in research? 1. It protects animals in research. 2. It is a current listing of standards describing the research process. 3. It establishes a prototype for current views of research ethics. 4. The code resulted from the Willowbrook Study and concerns about ethics

Answer: 3 Explanation: 1. The Nuremberg Code is about human experimentation. 2. This is not a current document, as it originated after World War Ⅱ and trials about medical experimentation. It does not focus on the research process. 3. This is a correct description of the contribution of The Nuremberg Code. 4. The code is associated with World War Ⅱ and trials about medical experimentation. The Willowbrook Study was in 1950-1970.

Healthcare in the United States would best be described by which of the following statements? 1. The United States has a national healthcare system. 2. The United States has universal health coverage insurance. 3. The United States has a local, state, and federal system of healthcare. 4. The United States focuses on a public system to provide care.

Answer: 3 Explanation: 1. The United States does not have a national healthcare system. 2. There is no universal healthcare coverage. 3. The U.S. system is a mix of local, state, and federal services. 4. The system is a combination of private and public, with private as the major focus.

1) Which organization provides opportunities to develop nurse leadership globally? 1. WHO 2. STTI 3. I C N 4. I C R C

Answer: 3 Explanation: 1. The World Health Organization does not have a specific program on developing nurse leaders globally. 2. The Sigma Theta Tau International does not have a specific program on developing nurse leaders globally. 3. The International Council of Nurses has a program, Global Nursing Leadership Institute, to help develop nursing leadership globally. 4. The International Committee of the Red Cross does not have a specific program on developing nurse leaders globally.

What has not been considered a common reason for lack of preventive services? 1. Presence of a fragmented healthcare system 2. Lack of provider time with patients to explain preventive interventions 3. Limited types of preventive interventions 4. Lack of reimbursement for preventive services

Answer: 3 Explanation: 1. The fragmented system lacks coordination. 2. Providers do not have enough time with patients. 3. This is not a common reason. We have many prevention interventions. 4. Reimbursement for these interventions has been a problem—though A C A is offering more reimbursement for the interventions, and this is still new.

The newly hired quality improvement (QI) director states, "I believe we should seek institutional review board (IRB) approval before starting this new project." The medical center has never involved the I R B committee in QI proceedings. How should the medical center chief operating officer respond to this statement? 1. IRB approval is not necessary in this state. 2. Since we are a federal institution, we do not need IRB approval. 3. We can ask the IRB committee for an opinion on our plan for this project. 4. We should always get I R B approval for our QI initiatives from now on.

Answer: 3 Explanation: 1. The geographic location does not determine need for I R B approval. 2. I R B committees are required by any entity receiving federal funds. 3. Historically, there was no need for I R B approval for Q I work. This has changed in recent times and I R B approval for some initiatives would be prudent. 4. Not all initiatives of the Q I department would need I R B approval. It is wise to seek that approval for some plans.

A new chief nursing executive has joined the hospital. He is meeting with the nurse management staff to discuss staff education. Which of the following is the best approach to take when organizing staff education within a healthcare organization? 1. Inform nurse managers that staff education will be centralized into a division within the nursing department, as this is how it was done where he worked in the past. 2. Set up plans for units that want to handle their own staff education to do so. 3. Inform the management group that he is their representative to the C E O to develop staff education. 4. Hire a director of nursing education and then work on organization.

Answer: 3 Explanation: 1. This approach assumes that the approach is applicable to all healthcare organizations and ignores differences that might need to be considered. 2. This approach could lead to confusion, with some units providing their own staff education and some not doing so, and could vary depending on who is the nurse manager of the unit. 3. This approach is the number one issue-for the C N O to represent the management group and for the staff to get the staff education they need. 4. This is important, but if the nursing department does not know how nursing education will be organized it will be difficult to have a position description and to know what type of person might be hired or even if a director of nursing education is needed.

What would be a barrier for a nurse researcher to accomplish effective research? 1. Statistical expertise 2. Completed a past study 3. Assuming a new administrative position 4. Expansion of clinical services with more patients

Answer: 3 Explanation: 1. This would be an advantage. 2. Past research experience implies some research competency. 3. A new position would be a drain on researcher time and a barrier. 4. This might provide more patients for a sample.

A nursing research team from a hospital would like to quickly disseminate findings from its study to the nurses in its local area. Which strategy should this team employ? 1. Work to get the findings published in a research journal. 2. Apply to present the findings as a poster presentation in a national conference. 3. Organize a research day at the hospital. 4. Get the findings published in a practice journal.

Answer: 3 Explanation: 1. This is a very good method of disseminating the findings to a national forum, but takes time and would not be the best plan for these nurses. 2. This is a good forum for dissemination of findings, but locating a conference that is local and will be held quickly is difficult. The planner of such a conference generally chooses the poster presentations through a selection process that takes time and is held several weeks prior to the date of the conference. 3. This is the best way for these results to be disseminated. This event could be co-sponsored by the hospital and any nursing programs in the area. These events do take planning, but are not as planning intensive as national events. 4. When practice journals describe research findings, it is generally done as part of a secondary article. While some staff nurses are more likely to read about findings in a practice journal, the entire study would not be published. Also, having an article accepted for inclusion in a journal is a time-consuming process.

Over the last six months, patient satisfaction surveys have begun to mention that the facility is not as clean as expected. How should an administrator using evidence-based management (E B M) strategies deal with this information? 1. Recall that the hospital has been running at full capacity for over one year. 2. Recall that the manager of the housekeeping department was on vacation for a month during this time. 3. Accept this information as accurate and work to reverse the trend. 4. Forward the information to the housekeeping manager and demand an explanation.

Answer: 3 Explanation: 1. This is an excuse for the outcome of this survey and does not meet the E B M principle of facing the hard facts. 2. This is an excuse for the outcome of this survey and does not meet the E B M principle of facing the hard facts. 3. E B M encourages the manager or administrator to "face the hard facts" and not to make excuses for evidence. The administrator should treat the organization as a work in progress and use this information to encourage housekeeping workers to improve. 4. Demanding an answer to the situation is not an E B M principle. The administrator should see the organization as a work in progress. Something has occurred to impact the hospital's cleanliness. That issue should be addressed and rectified, but it is not necessary to be demanding and accusatory.

The nurse is involved in basic research. Which study topic would the nurse most likely research? 1. The antiseptic that provides the cleanest environment for intravenous access 2. The efficacy of diuretic use for pregnancy-induced edema 3. The historical significance of feminism in nursing 4. The use of nursing self-scheduling in a unit

Answer: 3 Explanation: 1. This is applied research. 2. This is applied research. 3. Historical research is research that adds to the nursing knowledge base and is considered basic research. 4. This is applied research.

What is the newest trend in continuing education? 1. Clinically based continuing education 2. Continuing education that is required for licensure 3. Development of interprofessional continuing education 4. Continuing education best offered in face-to-face format

Answer: 3 Explanation: 1. This is not new and has always been important in continuing education. 2. Continuing education is required in some states for licensure, and this has been the case for a long time. 3. The newest trend is the development and emphasis on need for interprofessional continuing education. 4. This is not a trend; the trend is toward more electronic methods.

The experienced staff nurse complains that use of evidence-based practice (EBP) guidelines has "reduced nursing to a cookbook profession." What is meant by this comment? 1. Some people believe that the guidelines are too easy to follow and take the challenge out of nursing. 2. Some people believe that the guidelines are written so that they could be followed by anyone, despite his or her educational level. 3. Some people believe that E B P guidelines are too prescriptive and do not allow for consideration of individual needs. 4. Some people believe that too many factors are left to the interpretation of the person who is reading the guidelines.

Answer: 3 Explanation: 1. This is not the meaning of "cookbook" in this scenario. The E B P guidelines are not always easy to follow and the profession remains challenging. The challenge is in individualizing the guidelines to the specific patient and situation. 2. This is not the meaning of "cookbook" in this scenario. The guidelines require professional education and clinical decision making. There is no indication that using E B P will reduce the required education level of nurses or that other, less educated persons will have the clinical decision-making skills to employ E B P guidelines. 3. The term "cookbook" has been used to complain that using guidelines results in care that is too prescribed and directed. This should not be true of E B P guidelines, as they are written to be patient-centered and to be modified to fit the particular patient and patient situation. 4. The purpose of E B P guidelines is to provide the best interventions or treatments to the individual patient, given the individual situation. This does require some interpretation, but the purpose of the guidelines is also to limit this need.

What was not considered to be a major problem when the National Council of State Boards of Nursing developed the transition-to-practice model? 1. New nurses care for sicker patients in complex settings. 2. New nurses feel increased stress levels. 3. Nationally, recruitment has remained the same due to changes in the nursing shortage. 4. One-quarter of new nurses leave their positions in the first year post-graduation.

Answer: 3 Explanation: 1. This is one of the three problems noted, and its impact is that more errors are reported. 2. This is one of the three problems noted, and its impact is that stress increases risk to patient safety and errors. 3. The model does not identify this as one of the major problems, and recruitment and shortage are highly variable from one area of the country to another. 4. This is one of the three problems noted, and its impact is that increased turnover negatively influences patient safety and healthcare outcomes.

What is the common length of the typical nurse residency program? 1. One month 2. Six months 3. Twelve months 4. Eighteen months

Answer: 3 Explanation: 1. This is too short. 2. This is not the most common length. 3. Most programs are one year, and this is most effective. 4. This would be too long and not the most common length.

The nurse works in a healthcare clinic in which providers communicate with one another and with patients using email. What guideline associated with this method of communication should the healthcare providers follow? 1. Categorize patients according to major medical diagnosis and create groups educational emails. 2. Delete messages as soon as possible to protect confidentiality. 3. Inform patients of anyone else who will be reading messages. 4. Use email as the primary method of communication.

Answer: 3 Explanation: 1. While lists and groups are convenient, if they are not designed carefully confidentiality may be breeched. 2. Archiving messages produces an "electronic paper trail" for future referral. 3. Patients should always be advised of anyone who will be accessing information or messages. 4. The providers should ask patients which type of communication they prefer. Some may prefer telephone messages or mail rather than electronic communication.

The nurse is overwhelmed with the amount of information concerning vitamin D supplementation in post-menopausal women. Which strategy would be the most appropriate for this nurse to use to find the best practice information on this topic? 1. Use any popular internet search engine to initiate a search of the topic. 2. Read as many nursing journal articles about the topic as possible. 3. Read about the topic on a site such as Joanna Briggs Institute. 4. Search for the topic on the World Health Organization (WHO) website.

Answer: 3 Explanation: 1. While the nurse might learn a great deal from this search, the number of "hits" on a general search engine would be daunting. It is also not likely that all of the information retrieved would be scientifically based or evidence-based. Identifying the evidence-based recommendations would be very time consuming. 2. In order to read enough information, the nurse would have to search the journals for appropriate articles and then find the journals, either in print or online full text. This would be a time-consuming endeavor. 3. Sites such as Joanna Briggs Institute have already reviewed the evidence and have used the hierarchy of evidence levels to categorize the information. This would be the quickest method to find reputable evidence. 4. The information on the W H O site not only is for healthcare professionals, but is also for the general public. It is likely that very good information is available, but locating it in this huge site might be time consuming.

1) What does the transition-to-practice model tie to safety? 1. Workforce orientation 2. Preceptor nurse relationship 3. Use of clinical reasoning 4. Feedback

Answer: 3 Explanation: 1. Workforce orientation is important, but in the model it is not the specific element that is associated with safety. 2. Preceptor nurse relationship is important, but in the model it is not the specific element that is associated with safety. 3. We need to use more clinical reasoning to reduce safety concerns and improve care. 4. Feedback is important, but in the model it is not the specific element that is associated with safety.

The unit's QI team is reviewing its QI data. They are using gap analysis to better understand the problem and data. Which of the following are part of gap analysis? Select all that apply. 1. Identify team roles and responsibilities. 2. Apply a guideline. 3. Identify best practice strategies. 4. Describe best practice versus your practice.

Answer: 3, 4 Explanation: 1. This is not a required part of gap analysis. 2. This is not a required part of gap analysis. 3. This is step 1 in gap analysis. 4. This is step 2 in gap analysis.

Why is it more challenging to get staff who work in public/community services engaged in CQI than in the hospital? 1. CQI is not as critical to care in the community. 2. A CQI plan is better in the hospital. 3. The need for data collections is more important in the community. 4. Community staff are more dispersed.

Answer: 4 Explanation: 1. C Q I is important in all areas of healthcare delivery. 2. The effectiveness of a C Q I plan should not vary from a hospital or community. Implementation may be a problem, but not the plan. 3. The need for data collection is the same for the community and the hospital-both need data, but how one gets the data may be different. 4. Having staff dispersed means it is more difficult to turn to a colleague or have regular interaction face-to-face about CQI.

Which of the following activities relates to the first goal of the 2015-2020 Federal Health I T Strategic Plan? 1. Increase evaluation of care 2. Increase research about health I T 3. Increase protection of patient information 4. Increase adoption of E M R/E H R by healthcare organizations

Answer: 4 Explanation: 1. Evaluation of care is important, but not the first health I T goal. 2. The fifth goal is related to research. 3. Goal two includes information about patient privacy and protection. 4. The first goal focused on E M R/E H R adoption—developing a better documentation system that provides greater opportunity for sharing of information.

The nurse researcher is interested in conducting research into a specific clinical problem. The research design will require that the participants be deceived about the purpose of an intervention. What should the researcher consider about this design? 1. Deception of study participants is illegal. 2. The institutional review board (I R B) will likely not approve this study. 3. Deception of study participants is a common part of most research designs and is appropriate if the deception does not cause the patient to be harmed. 4. The researcher must prove to the institutional review board (I R B) that this deception is critical to the study design.

Answer: 4 Explanation: 1. It is not illegal to deceive study participants. The I R B must approve this design. 2. Approval from the I R B will depend upon the reason the participants are being deceived. 3. This is not a common practice, but is appropriate in some situations. 4. The I R B must approve the study and approval will rest on the researcher's ability to prove that this is a critical element of the study.

Why is the professional order entry system important to nurses? 1. Nurses do not have to spend so much time writing orders. 2. It provides a point-of-care system for the nurse. 3. Errors increase due to ease of making errors when typing. 4. This system decreases the need for nurses to be police.

Answer: 4 Explanation: 1. Most nurses do not write orders. 2. Point-of-care documentation system is not focused on orders, but rather on documentation of care at site of care. 3. Typically, errors are fewer than when nonelectronic methods are used. 4. Rather than nurses checking orders and informing physicians of problems, the electronic system monitors most issues.

What is the primary message in the N A M report The Future of the Public's Health in the 21st Century? 1. Quality improvement focuses primarily on acute care. 2. Healthcare professionals are prepared for public health. 3. Healthcare inequality is not a problem. 4. Health is a primary good for the public.

Answer: 4 Explanation: 1. Quality improvement is not just important for acute care and is not the primary message of this report. 2. Health professions need more preparation for public health, and this is not the primary message of this report. 3. There is an equality problem, but this is not the primary message of this report, though related to the primary message. 4. This is the primary message; many aspects of society are dependent on healthy people.

1) Differentiate among quality improvement (QI), research, and evidence-based practice (EBP) by choosing the statement that is accurate. 1. Statistical language in research is much more sophisticated than that used in Q I. 2. Research and EBP support clinical decision making, whereas QI is a monitoring program. 3. Quality improvement efforts help to generate new knowledge in the care of patients. 4. Quality improvement is not dependent upon a specific theory as is research and EBP.

Answer: 4 Explanation: 1. The language is the same, which leads to some confusion among these three endeavors. 2. All three endeavors support clinical decision making. 3. The goal of Q I is to evaluate work processes. It does not generate new knowledge. 4. Q I is an evaluative process designed to improve work processes. It has no theoretical underpinnings in the same manner as research or E B P.

You are orienting a new nursing professional development specialist to the position. How best would you describe the A N A and National Nursing Staff Development Organization's Standards of Nursing Professional Development? 1. The standards cover assessment, outcomes, planning, implementation, and evaluation. 2. The standards tell us specifically what we need to do and how to meet these requirements in our department and as nursing professional development specialists. 3. The standards describe quality care and needs. 4. The standards provide guidelines for staff development functions and professional issues of staff development specialists.

Answer: 4 Explanation: 1. The standards do cover these aspects, but include many more aspects of staff development in the 16 standards, five of which are assessment, outcomes, planning, implementation, and evaluation. 2. These are standards and do not clarify how they should be implemented with a specific department. 3. The standards relate to quality care but do not describe it and its needs. 4. The standards describe functions and also professional issues related to staff development specialists, such as collegiality, collaboration, ethics, advocacy, and leadership.

What is the core concern of the A N A staff development standards? 1. Set academic standards for nursing education. 2. Provision of quality care in healthcare organizations. 3. Provide staff development requirements. 4. Provide protection of the public and provision of quality care.

Answer: 4 Explanation: 1. These standards are for organizations that develop and provide staff education, not for academic programs. 2. There is more to the core concern; it is broader and does not just focus on healthcare organizations but rather on public/community health programs, as well. 3. The standards do describe information related to staff development, but this is a guide and is not so specific as to provide requirements. This is not the core concern, but leads to meeting the core concern. 4. The core concern is to protect the public and provide quality care.

The medical center nurse executive tells the nurse managers that the nursing department will be instituting evidence-based management (E B M). The medical center has a history of bureaucratic management style. What should the managers consider about these two facts? 1. The history of centralized decision making in the bureaucratic organization will make E B M easier to implement. 2. Since E B M depends on all managers following rigid policies and procedures, this transition should go quickly. 3. These two concepts have very little influence on one another. 4. The restrictions on decision making that are common in bureaucratic organizations will make use of E BM strategies difficult.

Answer: 4 Explanation: 1. This centralized decision making will go against the strategies of E B M. E B M calls for managers to make decisions based upon best management practice evidence. This strategy does not lend itself to centralized decision making. 2. This statement does not reflect the strategies associated with E B M. E B M calls for managers to make decisions based upon best management evidence. 3. This statement is not accurate. A bureaucratic management style will make E B M very difficult to implement. 4. E B M calls for managers to base decisions on best management evidence whenever possible. When the agency has a bureaucratic style, decision making is centralized and restricted, so use of E B M strategies may be difficult.

The nurse executive has instituted a very effective program that encourages nursing staff involvement in research. Nurses are suggesting research topics, helping to collect data, and have assisted with data analysis. What should be the nurse executive's next goal for these nurses? 1. Getting the nurses to seek funding for research projects 2. Helping the nurses consider additional study topics 3. Involving the nurses in efforts to seek resources and time to conduct more research 4. Encouraging the nurses to find ways to disseminate the findings of completed studies

Answer: 4 Explanation: 1. This is an important consideration, but is not the next step in this scenario. 2. This is an important goal for these nurses, but is not the next step in this particular scenario. 3. The nurses must have resources and time to conduct research, but in this scenario, research is being conducted. For this example, this is not the most important next step, as the research has been completed. 4. This is the most important next step for this work. If the results of studies are to impact the provision of nursing care, they must be disseminated beyond the unit where they are first tested.

You are explaining interprofessional education (IPE) to your staff. Which statement would best describe IPE? 1. IPE is concerned with interprofessional relationships. 2. IPE is easy to provide and should be provided to all staff. 3. Multidisciplinary and interprofessional are the same terms when considering education. 4. IPE considers both individual profession competencies and interprofessional competencies.

Answer: 4 Explanation: 1. This is one type of competency, but also must include individual competencies. 2. I P E is not easy to provide and to whom it is provided depends on the needs of the staff. 3. Multidisciplinary focuses on healthcare professionals working side-by-side and with limited interaction. Interprofessional highlights interaction among the healthcare professionals. 4. There is a need to understand and meet needs for individual competencies and also interprofessional competencies in planning and implementing staff education.

The nurse executive suspects that the nurse managers see evidence-based management (E B M) as another management suggestion that will "blow over" with time. What is the best way for the nurse executive to be assured that E B M strategies are being used in the facility? 1. Require a weekly report on the strategies from each nurse manager. 2. Call staff nurses in and ask them about how the managers are making day-to-day decisions on the unit. 3. Make daily walking rounds with a member of upper management to check on the progress of the E B M initiative. 4. Incorporate EBM into the performance evaluation of the nurse managers.

Answer: 4 Explanation: 1. This plan is likely to make the nurse managers resent E B M strategies, as they have resulted in another report for the nurse managers to generate. The nurse executive may gain some information from the reports, but the benefit of that knowledge is likely not worth the risk of turning the nurse managers against the idea of E B M. 2. This strategy may gain some information for the nurse executive, but is likely to be seen as devious by the nurse managers. The managers may feel as if the nurse executive does not trust them and is asking the nurses to report on the managers. 3. This is another way that some information might be gained. However, this is also a way that could offend the nurse managers and may give E B M a bad name among the nurse managers. 4. While this method may take some time to produce information, it is the best method listed. This process assumes that the nurse manager is going to practice E B M and will reward those who do.

Which of the following is important to address on a national level to increase healthcare professionals' participation in disasters? 1. Provide payment for these services. 2. Arrange for providers to be sent to areas where needed, not just their home states. 3. Focus on developing teams of professionals such as nursing teams, physician teams, and so on. 4. Clarify legal and ethical issues.

Answer: 4 Explanation: 1. Volunteers usually do this work. 2. It is better to have most professionals working in their local areas, where they are familiar with the location, needs, and people. 3. Teams should be interprofessional. 4. Healthcare professionals are concerned about potential legal and ethical issues, and this holds them back from volunteering.

Arrange the five steps of the evidence-based practice process in order of their use. Choice 1. Evaluate practice decisions. Choice 2. Collect best evidence. Choice 3. Integrate the evidence. Choice 4. Appraise the evidence. Choice 5. Write an E B P question.

Answer: 5, 2, 4, 3, 1 Explanation: 1. This is step 5 of the process. The nurse should evaluate whether the E B P change was appropriate for this patient. 2. This is step 2 of the process. This evidence should be relevant to the E B P question. 3. This is step 4 of the process. The evidence should be integrated with other parts of E B P such as patient preferences and values, the nurse's clinical expertise, assessment information about the patient, and the patient's history. 4. This is step 3 of the process. Before evidence is used, it should be critically appraised. 5. This is step 1 of the process. The question must be written so that the nurse has a good understanding of which evidence to seek.