Leadership Final

Maslow's Hierarchy of Needs

(level 1) Physiological Needs, (level 2) Safety and Security, (level 3) Relationships, Love and Affection, (level 4) Self Esteem, (level 5) Self Actualization

One of the staff registered nurses (RN), has been accused of gossiping and bullying a new graduate RN on the unit. This type of workplace violence is called _____ violence. a. horizontal b. co-worker c. threatening d. nurse-to-nurse

ANS: A A major source of violence against nurses is bullying from other nurses, also referred to as lateral or horizontal violence. There is much speculation as to why this occurs. Analysis of data from nurses in hospitals found that incidents are often sparked by unprofessional behavior resulting from disagreement over responsibilities for work tasks or methods of patient care and dissatisfaction with a co-worker's performance. Incidents also result from conflicts or aggression arising from failure to follow protocol, patient assignments, limited resources, and high workload.

A tool used to facilitate conversation in the form of constructive discussion between a staff member and his or her manager/supervisor in order to clarify work performance and needed improvements is a a. performance improvement plan. b. performance appraisal. c. peer review. d. self-evaluation.

ANS: A A performance improvement plan (PIP) is defined as a formal performance action plan that is used as a tool to facilitate conversation in the form of constructive discussion between a staff member and his or her manager/supervisor in order to clarify work performance and needed improvements. A PIP outlines specific goals to work toward and specific improvement steps to take

All-hazards disaster is best defined as a. all types of natural and human terrorist events. b. an event involving floods, tornadoes, hurricanes, and earthquakes. c. an unforeseen and often unplanned event causing great damage. d. any type of biological, chemical, radiological, or nuclear event.

ANS: A An all-hazards disaster includes all types of natural acts such as earthquakes, forest fires, floods, and hurricanes, or terrorist events such as biological, chemical, radiological, and nuclear attacks. A disaster is an unforeseen and often sudden event that causes great damage, destruction, and human suffering.

A patient who is not fully informed about his or her health status is an example of a violation of which ethical principle? a. Autonomy b. Justice c. Utilitarianism d. Confidentiality

ANS: A Autonomy refers to the client's right of self-determination and freedom of decision making. A patient who is not fully informed is denied the freedom and access to make a decision.

Characteristics of a Magnet hospital include a. multidisciplinary collaboration. b. nursing leader authority. c. physician control. d. social worker retention.

ANS: A Characteristics of a Magnet hospital include nursing autonomy, practice control, and collaboration. Nursing support, collaborative partnerships with physicians, and nursing practice are other aspects.

The management team of a large hospital is attempting to identify the specific cost of providing nursing services. This process is known as a. costing out services. b. fee-for-service care provision. c. priority nursing management. d. quality versus cost balance.

ANS: A Costing out nursing services was defined as the determination of the costs of services provided by nurses.

How is decision making at the staff nurse level exemplified? a. The staff nurse adapts to a challenging patient assignment. b. The staff nurse refers issues to the performance improvement committee. c. The staff nurse accepts the status quo. d. The staff nurse questions current practice and refers to unit leadership for change.

ANS: A Decision making is the process of making choices from several courses of action in order to solve problems. The process of selecting one course of action from alternatives forms the basic core of the definition of decision making. The staff nurse who adapts to a challenging patient assignment is using decision making to affect the quality of patient care delivered.

A staff RN is leading a quality improvement team on the care of the total hip replacement patient. The issue is an increased length of stay from 1 year ago. The nurse asks team members to reframe the problem statement from their perspective. Twenty different problem statements were developed. The team is focusing on four of the problem statements. This is an example of which of the following techniques? a. Decision making b. Evaluating the consequences c. Inclusive judgment d. Problem processing

ANS: A Decisions are made following the basic problem-solving process but also involve an evaluation of the effectiveness of outcomes that result from the decision-making process itself.

The nursing supervisor informs the staff that if they refuse to stay on the nursing unit and work an additional 8-hour shift, they will be reported to the state for patient abandonment. This type of power is known as a. coercive. b. expert. c. legitimate. d. reward.

ANS: A French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When coercive power is used, an individual reacts to the fear of the negative consequences that might occur for failure to comply.

Functional nursing a. divided and distributed nursing tasks b. enhanced client-oriented care. c. provided a smooth care delivery system. d. was expensive once implemented.

ANS: A Functional nursing focused on task accomplishment rather than individualized and holistic care. The division of labor was assigned according to specific tasks and technical aspects of the job, such as medication administration and taking vital signs.

In organizations that practice shared governance, the responsibility for unit outcomes rests with the a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO).

ANS: A In organizations that practice shared governance, staff as well as nurse managers and leaders are responsible for innovation. Innovation is considered crucial to safely and effectively solve complex care problems. The entire team is responsible for unit outcomes, not just the individual manager.

Nurses on the midnight shift are experiencing difficulty with receiving materials from the central supply department. Last night a patient was admitted to the unit from the emergency department with a heart dysrhythmia. The nurse requested that a temporary pacemaker kit be placed in the unit as a standby in case the patient required its use. The central supply unit did not comply until the patient required its emergent use. The nurse was stressed. This is an example of which type of stress? a. Job stress b. Overload of role c. Moral distress d. Role conflict

ANS: A Job stress is a tension that arises related to the person-in-environment demands of a person's role or job. Job stress, or "disquieting influences," can accumulate into levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion and lowered job productivity.

Which of the following are crucial leadership traits to exhibit in the nursing profession? a. The nurse leader needs to by dynamic b. The nurse leader shows good interpersonal skills c. The nurse leader is a visionary for the organization and the profession d. The nurse leader is able to inspire e. The nurse leader allows corporate executives to determine department goals

ANS: A Leadership is considered key to the success of health care organizations. A nurse leader needs to be dynamic, show interpersonal skills, and be a visionary for the organization and the profession. The ability to inspire and motivate followers to carry out the vision is crucial. Effective nurse leaders set department goals without micromanaging.

Management information systems describe a broad scope of activities that includes but is not limited to the management of a. decision support systems. b. merchandise. c. products. d. nursing services.

ANS: A Management information systems (MIS) describe a broad scope of activities that includes but is not limited to managing: decision support systems, resource and people management applications, project management, and database retrieval applications.

This management technique is used to help employees improve performance in a service- oriented profession. This technique, in which the manager empowers employees to exceed their performance is known as a. coaching. b. counseling. c. goal setting. d. mentoring.

ANS: A Managerial coaching can be described as empowering employees to exceed their performance and providing the tools and resources that allows them to do so.

The prevailing purpose of performance appraisal is to a. Meet compliance standards and organizational goals. b. address the abilities of staff. c. address the needs of the institution. d. mentor staff.

ANS: A Performance appraisals serve several administrative functions to meet compliance standards and organizational goals. These functions include helping to strengthen the appraisal process, improving employee performance, meeting compliance standards, and assisting with Human Resources (HR) workforce planning, such as recruiting, compensation, and succession planning.

A population health approach a. aims to improve the health of the entire population. b. is funded by local, state, and national governments. c. strives to care for people who already exhibit optimal health. d. treats community-acquired diseases in area clinics.

ANS: A Population health is an approach to health that aims to improve the health of the entire population and reduce health inequities among population groups.

A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? A. Case Management B. Group Nursing C. Functional nursing D. Private duty nursing

ANS: A The Case Management Society of America (CMSA) definition of case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

A patient is admitted with congestive heart failure, diabetes mellitus, and dementia. He has a new dark spot on the top of his toes on his right foot. The nurse contacts the primary care physician, consults with the wound care specialist nurse, writes a nursing order for a referral to the diabetic educator, and contacts the discharge planner to facilitate future discharge plans. Which of the following care delivery models best describes how the nurse is providing care? a. Case management b. Group nursing c. Functional nursing d. Private duty nursing

ANS: A The Case Management Society of America (CMSA) definition of case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote quality, cost-effective outcomes.

Being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard is a. accountability. b. authority. c. supervision. d. delegation.

ANS: A The National Council of State Boards of Nursing defined accountability as being answerable to oneself and others for one's own choices, decisions, and actions as measured against a standard.

The manager of a rural, thriving, nurse-managed clinic is considering purchasing equipment to furnish two additional examination rooms. The resource the manager must consider is the _____ budget. a. capital b. expense c. operating d. product line

ANS: A The capital budget is the plan for the purchase of major equipment or assets.

The charge nurse is making assignments on a surgical unit. Which client should be assigned to the least experienced nurse? a. Client who had a vaginal hysterectomy and still has an indwelling catheter b. Client who had an open cholecystectomy and has gray drainage in the T-tube drainage tube and bag c. Client who had a hip replacement and stated that something popped while walking d. Client who had a Whipple procedure and is reporting being thirsty all the time

ANS: A The delegation process, as outlined by the ANA/NCSBN joint statement and the NCSBN national guidelines, begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. Options b, c, and d indicate the possibility of postoperative complications, but option a does not. The least experienced nurse should have the client who is not displaying the possibility of postoperative complications.

Nursing outreach programs are the core element of a. population health management. b. disease management. c. case management. d. care management.

ANS: A The newest generation of PHM programs involves proactive outreach. Nursing outreach programs are the core element. Personal communications (usually via telephone) between an expert nurse and the health plan participant build a personal relationship, help identify knowledge deficits and counseling needs, facilitate close monitoring and progress toward goals, enhance treatment adherence, and promote clinical and cost stabilization.

_____ has garnered considerable attention in health care in part because of the publication Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division). a. Disease management b. Development research groups c. Case management d. Diagnosis-related groups

ANS: A Two major forces triggered the rise of a DM perspective: (1) the abundance of managed care systems as a prevailing form of organized health care delivery (the influence of health plans), and (2) the national attention generated by Crossing the Quality Chasm, a health care quality initiative of the Institute of Medicine (IOM, now called the National Academies of Sciences, Engineering, and Medicine, Health and Medicine Division).

Nurses who must manage unplanned and regular responsibilities simultaneously may experience a. complexity compression. b. resilience. c. moral distress. d. empowerment.

ANS: A When unexpected conditions are added to regular responsibilities, nurses may experience what experts call complexity compression, which has been linked to burnout, turnover, and other types of work-related stress. Nurses experience this when they must manage unplanned (complexity) and regular responsibilities simultaneously (compression).

A disease management program usually focuses on patients with a. chronic conditions. b. mental health issues. c. outpatient procedures. d. surgical diagnoses.

ANS: A While CM programs serve a smaller percentage of the overall population, enrollees are complex from a medical-behavioral, health-social vulnerability perspective. DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies.

Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital's methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called a. benchmarking. b. evidence-based practice. c. enterprise risk management. d. continuous quality improvement.

ANS: A In ambulatory care (and other settings), benchmarking is the process of comparing a practice's performance with an external standard. Benchmarking is an important tool that facilitators can use to motivate a practice to engage in improvement work and to help members of a practice understand where their performance falls in comparison to others.

This generational cohort currently dominates the U.S. workforce. They have grown up with little economic competition. Efficiency, teamwork, quality, and service have thrived under their leadership. This generational cohort is known as a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: A The baby boomers, born between 1946 and 1964, currently dominate the U.S. workforce. They have grown up with little economic competition outside the United States. Efficiency, teamwork, quality, and service have thrived under their leadership.

The implementation of an electronic health record (EHR) could enhance patient care by facilitating a. communication across the health care continuum. b. diabetes mellitus education and ongoing care delivery. c. one-on-one counseling between the provider and the client. d. physical and occupational therapy dispensing errors.

ANS: A The purpose of an EHR is to document patient care in a single repository as a clinical, financial, and legal record. The electronic digital format supports the storage and exchange of the clinical data from the record that is accessible and available among health care members regardless of their location. The EHR is a virtual record of retrospective, concurrent, and prospective information to support continuous, efficient, and integrated health care.

Negotiation is a form of conflict resolution. Which of the following terms are associated with negotiation? (Select all that apply.) a. Conciliation b. Distributive bargaining c. Arbitration d. Mediation e. Collective bargaining

ANS: A,B,D Conflict resolution involves eliminating all forms of conflict. Negotiation, mediation, and arbitration are often referred to in discussions of conflict resolution. These terms are also included under the umbrella of alternative dispute resolution (ADR). The resolution continuum includes negotiation, mediation, arbitration, and litigation as a spectrum of third-party dispute resolution. A conciliator is like a third friend who might attempt to intercede in an argument between two other friends. Conciliators attempt to diffuse the negative emotions that are often involved in the conflict, and they strive to establish more effective communications between the parties.

The goals of a performance improvement plan should include (Select all that apply.) a. education of the employee. b. support in making improvements. c. punishing negative behavior. d. promotion of successful performance. e. providing a raise if earned through positive behavior.

ANS: A,B,D In the case of a poor performance appraisal, the nurse needs to look for a formal PIP with goals, strategies, expected outcomes, and deadlines. The optimum outcome is that the PIP becomes an opportunity to educate the employee, provide support in making improvements, and promote successful performance that benefits the employee and the organization.

A nurse manager at Great Lakes Hospital is meeting with the dean of a well-recognized university who is the keynote speaker today at the nursing conference. He remembers that one of the RNs is interested in attending a well-known university to obtain a doctorate. The nurse manager arranges for the RN to meet with this dean. The nurse manager is exhibiting leadership behaviors consistent with (Select all that apply.) a. feminist perspective. b. servant leadership. c. transactional leadership. d. transformational leadership. e. authoritarian leadership

ANS: A,B,D This behavior nurtures personal growth (servant leadership) and assists the RN to attain his or her fullest potential (transformational leadership). This behavior also helps the RN build a connection with the dean, a representative of the university (feminist perspective).

When the licensed nurse makes a determination to delegate a task, which of the following occurs in the process? (Select all that apply.) a. The nurse assesses the situation and need for delegation. b. A plan for specific task delegation is established. c. The needs of the nurse are considered. d. The nurse determines the available resources and patient safety. e. Accountability is transferred to the manager.

ANS: A,B,D With the qualifications of both the delegator and the delegatee as a baseline in place, the licensed nurse enters the continuous process of delegation decision making. The situation is assessed, and a plan for specific task delegation is established, considering patient needs, available resources, and patient safety. The nurse needs to ensure accountability for the acts and process of delegation.

The CM dyad team model—composed of a nurse case manager and social worker—has been widely adopted in hospitals. Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (Select all that apply.) a. minimization of inpatient transitions. b. promotion of patient and family satisfaction through efforts of advocacy. c. maximization of health care benefits. d. reduction of cost by decreasing the length of stay. e. enhanced discharge planning.

ANS: A,B,D,E Through its unique structure, the nurse and social work dyad provides the implementation of collaborative interventions that focus on (1) minimization of inpatient transitions, (2) reduction of cost by decreasing the length of stay, (3) promotion of patient and family satisfaction through efforts of advocacy, and (4) enhanced discharge planning.

With regard to delegation, what organizational principles are considered? (Select all that apply.) a. Legal guidelines and policies b. Patient safety and accountability c. Relationship management and patient support d. Cost containment e. Knowledge and education

ANS: A,B,E At the core of the five rights of delegation and the roles of the UAP and nurse are three organizational principles that are present in many health care settings today. These principles include organizational and legal guidelines and policies, patient safety and accountability, and knowledge and education (Craftman et al., 2012).

Community Hospital is having a transient nursing shortage due to a high number of sick calls. The staffing office utilizes the staffing pool to obtain the required number of nurses. The staffing pool may include what types of nurses? (Select all that apply.) a. Travel nurses b. Foreign Nurses c. Seasonal nurses d. Per diem nurses e. Full-time nurses

ANS: A,C,D Access to nurses outside the unit to cover transient shortages is critical to meet last-minute, unplanned nurse shortages, such as sick calls and high patient demand. Supplemental staffing resources, frequently referred to as the staffing pool, are defined as a group of nurses who supplement the core unit staffing. This includes per diem nurses, float pool nurses, part-time nurses desiring additional hours, seasonal nurses, agency nurses, and traveling nurses.

What drivers of change are impacting nursing care? (Select all that apply.) a. Transparent communication b. Overabundance of nursing staff c. Evidence-based practice d. Information technology e. Reduced acute care needs

ANS: A,C,D An explosion in information technology capacity is altering the speed and transparency of communication and information delivery. The impact of a nursing shortage, increased demand for nursing care, and the drive to incorporate evidence-based practice are changing the face of nursing care.

According to the ANA, what elements are viewed as a relationship continuum as nurses apply them in decision making? (Select all that apply.) a. Data b. Technology c. Information d. Knowledge e. Wisdom

ANS: A,C,D,E As defined by the ANA, the practice of nursing informatics views the relationship of data, information, knowledge, and wisdom as a continuum with increasing complexity and interrelations as nurses aggregate and apply them in decision making.

Principles of a fair and just culture include (Select all that apply.) a. zero-tolerance for reckless behavior. b. reduction of personal accountability and discipline. c. recognition that competent professionals make mistakes. d. errors and unintended events being reported unless no patient harm occurs. e. acknowledgment that even competent professionals develop unhealthy norms.

ANS: A,C,E A fair and just culture is an approach to medical event reporting that emphasizes learning and accountability over blame and punishment. Everyone throughout the organization is aware that medical errors are inevitable, but all errors and unintended events are reported—even when the events may not cause patient injury. This culture can make the system safer as it recognizes that competent professionals make mistakes and acknowledges that even competent professionals develop unhealthy norms (shortcuts or routine rule violations), but it has zero-tolerance for reckless behavior.

Nursing's data needs fall into four domains. Which of the following statements accurately describe the sources for data in each of the domains? (Select all that apply.) a. Client data is located in the client's health care record. b. Provider data refers to physicians and is located within the medical board. c. Administrative data is located in registry and regulatory performance data. d. Research data is only available with informed consent. e. Existing and newly gathered data can be a source of obtaining research information.

ANS: A,C,E The sources of client data are the client's health care record, their personal health record, and patient-provider messages. Administrative data is located in administrative, fiscal, population, registry, and regulatory performance data. Existing and newly gathered data, relational databases, and common data elements are sources of research data.

The IOM report, To Err Is Human: Building a Safer Health System, recommends building a safety culture within an organization. This refers to keeping both patients and nurses safe. The organization supports nursing by (Select all that apply.) a. moving from a reactive culture to one that is fair and just. b. demonstrating authoritarian behaviors. c. mandating nurses to meet patient needs. d. providing a safe and efficient workspace.

ANS: A,D Included in the concept of a safety climate is a focus on nurse's health and safety. Nurses working in hospitals have one of the highest rates of work-related injuries, especially back injuries and needlesticks. One major shift in an organization's safety climate is the move from a punitive and reactive culture to a fair and just culture. In a fair and just culture, expectations for system and individual learning and accountability are transparent.

A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is a. budgetary considerations. b. collaboration between health care teams. c. regular staff training programs. d. suggestions from patients.

ANS: B

The development of the operating budget at the unit level for the upcoming fiscal year: a.Does not rely on historical trend data. b. Is based on projected volume of work. c.Does not include revenue projections. d.Is based solely on historical data.

ANS: B

Which of the following collaborative processes assesses, plans, facilitates, coordinates, advocates, and evaluates options and services required to meet an individual's comprehensive health needs? a. Care management b. Case management c. Disease management d. Population health management

ANS: B

Any collection of interconnected individuals working together for the same purpose is known as a(n) a. club. b. group. c. meeting. d. organization

ANS: B Any collection of interconnected individuals working together for the same purpose is known as a group.

The core element common to all provider interventions in case management (CM), disease management (DM), and population health management (PHM) is: a.disease preventative care. b.care coordination. c.client-centered. d. population-focused.

ANS: B Care coordination is the core element common to all provider interventions in CM, DM, and PHM.

Which of the following scenarios would require disease management? a. A blood pressure screening clinic is started at the senior citizen center. b. A person with multiple chronic illnesses is admitted to the hospital. c. A program is started to address diabetes in the Native American population. d. An initiative is developed to promote fluoride treatments in schools.

ANS: B DM programs serve a larger percentage of patients whose main problem is one or more chronic condition(s). These individuals generally have similar primary needs regarding health condition education and accommodation strategies. Assessments focus on health condition-specific issues, and programs take a more standardized approach to education and resources.

The transformational leader engages staff by a. punishing errors. b. sharing vision and decision making. c. taking a top-down approach to leadership. d. making unilateral decisions for the team.

ANS: B Effective transformational nurse leaders will engage their staff through role modeling and mentorship of inclusion behaviors such as developing rapport, sharing vision and decision making, providing constructive feedback, and communicating successful outcomes. The communication of transformational leaders is focused on positive interchanges, rather than punishment, and inclusion in decision making versus authoritarianism.

On admission, the patient was found to have a blood glucose level of 218. The RN knows that except in emergency situations, it is hospital policy to obtain physician's orders before administering any medication. Because the on-call physician did not return the page, the nurse administered insulin according to the common sliding scale. Four hours later, the patient was found nonresponsive in her bed and later died. According to the autopsy, the patient died from heart failure. Her postmortem blood glucose level was 22. The nurse's actions are an example of a. breach of contract. b. common negligence. c. intentional malpractice. d. medical oversight.

ANS: B Examples of common negligence allegations in nursing malpractice suits include patient falls, use of restraints, medication errors, burns, equipment injuries, retained foreign objects, failure to monitor, failure to ensure safety, failure to take appropriate nursing action, failure to confirm accuracy of physicians' orders, improper technique or performance of treatments, failure to respond to a patient, failure to follow hospital procedure, and failure to supervise treatment.

This generational cohort was the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life. This group is known as a. baby boomers. b. Generation X. c. Internet Generation. d. Mature Generation.

ANS: B Generation X members, born between 1965 and 1980, were the first generation of latchkey kids who had to be resourceful at an early age. They are skeptical of traditional practices and beliefs. They strive for a balanced life.

What is the range of change a health worker is likely to endure physical violence at work? a. 5% to 10% b. 10% to 40% c. 50% to 75% d. >75%

ANS: B Health workers all over the world are subject to workplace violence. Between 8% and 38% of health workers are likely to endure physical violence at work. This percentage does not include those who are intimidated or subjected to verbal assault. Most violence is committed by patients and visitors.

Hospitals must submit specific quality performance data regarding Medicare patients or risk a. an increase in federal tax. b. decreased payments. c. fewer physician referrals. d. sanctions by The Joint Commission (TJC).

ANS: B In 2011, CMS developed the Hospital Value-Based Purchasing Program, which applied to payments beginning in fiscal year 2013 for discharges occurring on or after October 1, 2012. Under the program, CMS makes value-based incentive payments to 3500 acute care hospitals based either on how well the hospitals perform on certain quality measures or how much the hospitals' performance improves on certain quality measures from their performance during a baseline period. Reimbursement is based on quality of care, not quantity. The higher a hospital's performance or improvement during the performance period for a fiscal year, the higher the hospital's value-based incentive payment for the fiscal year would be (CMS, 2015)

A disagreement or differences between the members of two or more groups over authority, territory, and resources is called _____ conflict. a. intragroup b. intergroup c. interpersonal d. intrapersonal

ANS: B Intergroup conflict refers to disagreements or differences between the members of two or more groups or their representatives over authority, territory, and resources.

Which of the following is true about negotiation? a. It commonly results in a win-lose situation. b. It is aimed at solving problems, conflicts, or disputes. c. It is used only in contract and labor union disputes. d. It is the exchanging of favors or trading activity.

ANS: B Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue. It is used to solve problems, conflicts, or disputes.

The responsibility of developing the unit culture for evidence-based practice belongs to the a. staff nurses. b. unit manager. c. medical director. d. chief executive officer.

ANS: B Nurse leaders are in key positions responsible for developing and sustaining an organizational infrastructure and creating an environment that affects adoption of EBPs and improves patient outcomes.

Nurses' involvement in shared governance is an important component of a. practice models. b. Magnet recognition. c. increased reimbursement. d. physician satisfaction.

ANS: B Nurses' involvement in governance is an important component of the American Nurses Credentialing Center's Magnet Recognition Program.

Nursing informatics includes the a. coding and billing of hospital and physician services. b. management and communication of data, information, knowledge, and wisdom in nursing practice. c. organization and selection of quality medical information. d. support and troubleshooting of computer software issues.

ANS: B Nursing informatics is a specialty that integrates nursing science with multiple information and analytical sciences to identify, define, manage and communicate data, information, knowledge, and wisdom in nursing practice.

_____ was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care. a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist

ANS: B Nursing informatics is one of the fastest growing practice areas in health care.

The responsibility to articulate the business case for evidence-based practice to senior leadership lies with a. the staff nurse. b. nursing leadership. c. the governing board. d. the quality improvement committee.

ANS: B Nursing leaders have a responsibility to clearly articulate EBP work in a way that will be heard by decision makers. Sharing results with senior leaders helps them recognize great work while reporting the business case for evidence-based care to governing boards.

A nurse manager has ordered equipment for a new unit. The company has sent two notices that the equipment is on back order. The nurse manager is debating whether to wait for the equipment on back order or to cancel the order and go with another company. She discusses this issue with another nurse manager and they determine that the equipment is urgent for patient safety in the new unit. The manager orders the necessary equipment from another company even though it is slightly more expensive. This is an example of a. clinical decision making. b. prioritization. c. triage decision. d. clinical reasoning.

ANS: B Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. All nurse managers and leaders need to consider the implications of their decisions. Each decision made involves financial, ethical, and human resources. Furthermore, reimbursement and other regulations must be taken into account.

The nurse in a medical-surgical unit is working short-staffed due to a sick call. Which of these is an example of prioritization? a. Charting by exception b. Omitting personal hygiene in favor of timely medication administration c. Timely medication administration without scanning the patient armband d. Deploying a rapid response team when a patient condition changes

ANS: B Prioritization occurs not only in triage situations, but also across the care spectrum. Thus decisions have to be made regarding what care has to be delivered and when the care is to be delivered. For example, nurses implicitly make decisions to ration care when time and staffing are short. On a day-to-day basis nurses must decide if such things as routine hygiene activities are omitted in favor of administering critical treatments, including medications.

Research about shared governance suggests that it is a. enhancing the role of the nurse's aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN.

ANS: B Shared governance has far-reaching implications for leaders in today's health care environment, in which the focus is to provide patient care safely, efficaciously, and efficiently. Organizational benefits include increased commitment of staff to the organization; accountability of the nurse; a new level of professional autonomy; a more efficient model for point-of-service decision making; more expert involvement at the point of service; a more assured, confident patient advocate; and improved financial outcomes. Patients benefit from a more efficient model of health care service, more committed health care professionals, quicker responses at the point of service, and a more assured, confident patient advocate.

Shared governance is a model of organizational structure in which staff nurses are a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability. c. engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking methodologies.

ANS: B Shared governance is a model of organizational structure in which staff nurses are empowered through autonomy and accountability.

Some of the major disadvantages to group decision making are negativity, individual focus, and a. autonomous conclusion. b. disruptive conflicts. c. group synergy. d. inaccurate data interpretation.

ANS: B Six identified potential negative impacts groups can have on an organization, including negativity, passivity, individual focus, groupthink, vocal minority, and the ethical dark side. A seventh possible negative impact is disruptive conflicts.

A nurse manager enjoys implementing new programs and beginning new projects. She is beginning to find herself overwhelmed and needs to decrease her workload. Which of the following ideas might best help decrease her workload? a. Comparing her vision with that of the institution b. Following the strategic objectives and mission of the hospital c. Reviewing the action plan and vision of the hospital system d. Using her intuition to determine which project should continue

ANS: B Strategic objectives provide a way of converting the rather abstract mission of an organization into concrete terms. Following the mission of the hospital will help keep the nurse manager focused.

A health care system's ability to rapidly expand beyond normal capacity to meet an increased demand for qualified personnel, beds, and medical care services in the event of a large-scale emergency or disaster is known as a. acuity. b. surge capacity. c. mass casualty. d. natural disaster.

ANS: B Surge capacity is a measurable representation of the ability to manage a sudden influx of patients (American College of Emergency Physicians [ACEP], 2011). In addition to the overall all- hazards preparedness plans, the hospital will need to define procedures regarding what will be done in any biological, chemical, nuclear/radiological, or conventional disaster, and the surge capacity needs related to any of the events.

Which of the following is true about team nursing? a. It includes only registered nurses (RNs) and licensed practical/vocational nurses (LPN/LVNs). b. Each team member has his or her own patient assignments. c. Team members must have dual degrees. d. The nurse with a bachelor's of science in nursing degree is the leader of the team.

ANS: B Team nursing is a delivery approach that provides care to a group of patients by coordinating a team of RNs, licensed practical nurses, and care aides under the supervision of one nurse, called the team leader. Each team member has his or her own patient assignments, and team members are expected to assist and support each other as needed.

A client of Vietnamese background is admitted to the unit after a hysterectomy. She has an order for clear liquids. When her tray is brought to her, she refuses the lime Jell-O. Which response by the nurse is most appropriate? a. "I don't blame you. I don't like lime Jell-O either." b. "Tell me about your cultural beliefs to best help you." c. "Why don't you want to eat the lime Jell-O?" d. "It is important for you to eat so that you will heal."

ANS: B The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences. The problem is that many Americans are afraid to ask people about their culture because of the idea that "we don't want to offend anyone." The challenge with this thinking is that if nurses do not ask about people's differences, then the only option is to make assumptions.

A health care management continuum a. deals strictly with health promotion. b. controls problems at the population level. c. is a linkage of health services across settings. d. provides another health care option for the homeless.

ANS: B The health care management continuum is better known as population health management (PHM). One definition of population health management is the process of addressing population health needs and controlling problems at a population level.

The best leadership style for unfavorable conditions is a. leader-member relations. b. task-oriented structure. c. position power. d. laissez-faire.

ANS: B The need for task-oriented leaders occurs when the situation is extreme. The best leadership style for unfavorable conditions is task oriented.

The guiding framework that describes the organization's purpose and future direction is the a. futuristic guidelines. b. mission and vision. c. strategic plan. d. core purpose.

ANS: B The organizational mission and vision collectively is a guiding framework that describes the organization's purpose and future direction.

The critical care unit manager would like to hire a wound care nurse for the unit. The type of organizational budget the manager would use to ensure ability to hire the new nurse is called the _____ budget. a. capital b. personnel c. operating d. expense

ANS: B The personnel budget is the staffing budget of the cost center.

Which communication format was developed to address the communication arm of the TeamSTEPPS model? a. NVC (nonviolent communication) b. SBAR (situation, background, assessment, and recommendation) c. VERA (validation, emotion, reassurance, activity) d. MI (motivational interviewing)

ANS: B To address the "communication arm" of the TeamSTEPPS model strategies such as SBAR have been created to enhance teamwork communication. One of the strategies that has been well documented and is familiar to nurses is SBAR, which stands for situation, background, assessment, and recommendation.

The nurse manager should use which of the following behaviors when implementing a shared governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime

ANS: B To be successful, shared governance structures need leaders who are role models and mentors. Staff and management must be dedicated to coaching and continuous learning.

Recognizing one's own prejudices and learning about other people's differences is the first step toward a. cultural diversity. b. multicultural competence. c. social change. d. valuing.

ANS: B To reduce cross-cultural miscommunications and improve patient satisfaction, the multicultural competence of health care practitioners needs to be improved. The first step toward multicultural competence is to recognize one's own prejudices and learn about other people's differences.

The definition of veracity is a. being loyal and faithful to commitments and accountable for responsibilities. b. the norm of telling the truth and not intentionally deceiving or misleading clients. c. a prohibition of disclosure of information. d. a right of limited physical or informational inaccessibility.

ANS: B Veracity is the norm of telling the truth and not intentionally deceiving or misleading clients.

Health workers are at risk for workplace violence from a multitude of types and sources. Which of the following is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty? a. Workplace incivility b. Workplace violence c. Workplace bullying d. Violence

ANS: B Workplace Violence is the act or threat of violence, ranging from verbal abuse to physical assaults directed toward persons at work or on duty.

The formal process of using patient data for providing evidence for the design of care protocols is termed a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research.

ANS: B Collecting and extracting data that describe the processes and outcomes of nursing care electronically has provided evidence for the design of care protocols and delivery models. The formal process of using these patient data for providing this evidence is termed practice-based evidence.

A Middle Eastern man has just been diagnosed with terminal cancer. The family has asked the medical and nursing staff to keep this information from the patient because in their culture they are fearful of delivering bad news as it may cause the patient to give up hope. Which ethical principles and dilemmas might be faced by nursing staff? (Select all that apply.) a. Justice b. Autonomy c. Veracity d. Confidentiality

ANS: B,C Autonomy refers to the rights of the patient to participate in decision making. Veracity refers to telling the truth. The nurses caring for the patient may feel that they are not being truthful about the treatment plan and decision-making process in this case.

Case management and disease management are similar because both are interventions designed to coordinate care for better outcomes and lowered costs. Which statements are true regarding the differences between the two terms? (Select all that apply.) a. Disease management is client focused. b. Case management focuses on coordinating care of individuals and families. c. Disease management is more population-based than client-centered. d. Disease management is more episodic in its approach. e. Case management is more population-focused.

ANS: B,C Case management is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes. Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant.

Disadvantages of private duty nursing include (Select all that apply.) a. private duty nurses have a great degree of autonomy. b. private duty being a costly model. c. job security being tenuous and irregular. d. the nurse's focus being entirely on one client's needs. e. nurses maintaining close relationships with colleagues.

ANS: B,C One disadvantage was that private duty is a costly model because of its low efficiency. Furthermore, job security was tenuous and irregular. Other disadvantages were that nurses had little job mobility and were relatively isolated from colleagues.

Which of the following statements accurately describe disease management? (Select all that apply.) a. Disease management is care coordination that is organized to achieve specific client outcomes, given fiscal and other resource constraints. b. Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. c. Disease management relies on a structured system of interventions that focus on a specific condition. d. Disease management program content and interventions are evidence and guideline based. e. Disease management is the medical management of chronic disease.

ANS: B,C,D Disease management is a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant. DM programs usually focus on a single condition, rely on a structured system of interventions that focus on a single condition; and program content and interventions are evidence and guideline based.

Which of the following statements are true regarding job stress? (Select all that apply.) a. Job stress is related more to external demands that are brought into the workplace. b. Job stress can lead to burnout. c. Job stress is manifested as emotional and/or physical exhaustion. d. Job stress increases productivity. e. Levels of job stress that are too low or too high decrease individual productivity

ANS: B,C,E Job stress is a tension that arises related to the environmental demands of a person's role or job. Job stress can accumulate to levels that are too high, reach the point of burnout, and manifest as emotional and/or physical exhaustion. Levels of job stress that are too low or too high decrease individual productivity.

The nurse manager of a medical-surgical unit realized that there are differences in dealing with the varied generations of her nursing staff. How does the nurse manager communicate effectively with the Generation Y staff members (those born after 1980)? a. Typewritten memos b. Staff meetings held monthly for 2 hours c. E-mails or text messages d. Face-to-face interactions

ANS: C A work environment supportive to each generation is an important retention strategy. Tailoring the work environment to meet generational and life needs is a recurrent theme in being able to address staff retention.

A newer focus of performance appraisal that has the ability to engage high-performing nurses and motivate people toward even higher levels of performance is a. coaching. b. remedial learning. c. feedback. d. peer review.

ANS: C Although the focus of performance appraisals has been on remedial learning or correcting weaknesses, researchers have more recently called for a reframing of performance development after feedback. A focus on building strengths has the potential to reorient the conversation, engage high-performing nurses, and motivate people toward even higher levels of performance.

The process of identifying the specific costs related to the delivery of nursing care to each client so that nurses have data to identify the actual amount of services received is a. personnel budget development. b. evaluating budget expenditures. c. costing out nursing services. d. strategic financial planning.

ANS: C Costing out nursing services is defined as the determination of the costs of the services provided by nurses. By identifying the specific costs related to the delivery of nursing care to each client, nurses have data to identify the actual amount of services received.

What is the definition of the process of making choices that will provide maximum benefit? a. Critical thinking b. Problem solving c. Decision making d. Leading

ANS: C Decision making is the process of making choices that will provide maximum benefits.

Evidence-based practice includes a. collaborative practice dynamics between health care professionals. b. documentation of patient care as evidence of nursing practice. c. integration of research with clinical expertise and patient values. d. mutual goal setting and application in the clinical setting.

ANS: C Evidence-based practice is a process of shared decision making in a partnership between patients and providers that involves the integration of research and other best evidence with clinical expertise and patient values in health care decision making.

A nurse is receiving their annual performance appraisal. To evaluate the nurse's performance, the manager considers feedback about the nurse's performance from the nurse's peers, subordinates, and patients. This type of evaluation is a a. feedforward technique. b. self-report rating. c. 360-degree feedback review. d. peer review.

ANS: C In a 360-degree feedback review, managers, peers, subordinates, and patients all provide feedback. The 360-degree process is intended to give the reviewer a fuller and more robust picture of the individual's performance.

The nurse manager determines that communication style is contributing to problems with delegation on her unit. What tool is used to teach principles of communication, leadership, situation monitoring, and mutual support? a. American Nurses Association (ANA) b. Agency for Healthcare Quality and Research (AHRQ) c. Team Strategies and Tools to Enhance Performance and Patient Safety (TeamSTEPPS) d. Institute for Healthcare Improvement (IHI)

ANS: C Invariably there will be potential problems as the use of delegation expands in health care. The nurse leader will need to be aware of techniques to address these potential problems. One such method is the TeamSTEPPS 2.0 (Team Strategies and Tools to Enhance Performance and Patient Safety) program. The framework followed is based on a foundation of team competencies including knowledge, attitudes, and performance. The principles the program abides by include team structure and the teachable principles of communication, leadership, situation monitoring, and mutual support.

A hospital organizational culture that assumes customer needs and wants should determine the quality, price, and availability of a product. This type of orientation is a. product. b. selling. c. marketing. d. holistic.

ANS: C Marketing orientation is an organizational culture that assumes the customer's needs and wants should determine the quality, price, and availability of the product.

The chief operations officer of a local hospital has issued a memorandum indicating that the modular waiting room furnishings will be replaced with stationary units. This is an example of which type of strategy for preventing workplace violence? a. Administrative controls b. Behavior modification c. Environmental design d. Fixture adaptation

ANS: C NIOSH recognizes that workplace violence is a particular issue in the health care industry and recommends the following violence prevention strategies for employers: environmental designs, administrative controls, and behavior modifications. Environmental designs include signaling systems, alarm systems, monitoring systems, security devices, security escorts, lighting, and architectural and furniture modifications to improve worker safety.

Which communication technique is most effective when handling patient complaints? a. Persuasion b. Bargaining c. Negotiation d. Non-verbal cues

ANS: C Negotiation is a dialogical discussion between two or more parties to arrive at an agreement about some issue

A nurse manager is evaluating the efficiency of a process on the nursing unit. The manager believes that the unit could be more efficient if one aspect of this process were delegated to unlicensed personnel. To establish whether the delegation of this duty would be legal, he should check with the a. ANA. b. current federal defense attorney. c. state nurse practice act. d. policy and procedure manual of the unit.

ANS: C Nurse practice acts exist for each state and govern the legal practice of nursing, including standard of care, delegation, and supervision.

The field in health care that aims at a better understanding of the end results of health care practices and interventions is called a. patient safety. b. risk management. c. outcomes research. d. quality management.

ANS: C Outcomes research aims at a better understanding of the end results of health care practices and interventions, such as the impacts of care that are most important to patients, families, payers, and society.

Which of the following leadership styles is best suited for implementation of a shared governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire

ANS: C Participative leadership—the notion of leaders turning to their team for input and ideas—was first introduced to the business world in the 1970s. It was adapted by health care organizations and nursing leaders in the early 1980s, and formed the basis of shared governance, which today has evolved to define the role of nurses as well as to resolve issues related to patient care.

Performance appraisals provide information that is critical to human resources planning. Having a sense of the current skills of the workforce is crucial for a. compensation administration. b. job analysis. c. being prepared for future needs. d. structuring educational programs for staff.

ANS: C Performance appraisals provide data that are used to make a series of administrative and management decisions. Individual ratings can be used to inform compensation, promotion, and layoff decisions. More broadly, evaluations provide information that is critical to human resources (HR) planning. Having a sense of the current skills of the workforce is critical to being prepared for future needs, including skill gaps, new areas of specialization, and treatment needs.

A patient calls into the customer service department to complain about the long wait times they have experienced in the emergency department. The patient feels that the charges were excessive compared with the time that it took to receive attention. What is the primary focus of this complaint? a. Product b. Place c. Price d. Promotion

ANS: C Price is described as the amount of money customers pay to obtain the product. Customers consider the cost in terms of reasonableness. However, in a broader sense, cost is more than the money that is exchanged. Customers place value on products and services not only according to financial issues, but also according to psychosocial and emotional concerns.

Nurses and other health care professionals tend to gravitate toward hospitals that showcase the positive aspects of the hospital to differentiate themselves from their competitors. Some of the most enticing marketing plans include showcasing a. competitive hourly reimbursement for services. b. profitability margins and payer ratios. c. receipt of nationally recognized awards. d. vacation and holiday benefits.

ANS: C Receipt of nationally recognized awards such as the American Nurses Credentialing Center Magnet Recognition Program or the marketing of high accreditation scores from The Joint Commission (TJC) often is used as part of a marketing plan to differentiate hospitals from their competitors. This tends to attract nurses, physicians, patients, and other health care professionals.

The medical-surgical nurse manager is conducting performance appraisals by observing each nurse for a day and basing the evaluation on that day's performance. This type of bias is known as a. halo. b. leniency. c. recency. d. contrast.

ANS: C Recency bias occurs when the most recent events are the focus of the review rather than a cumulative evaluation since the last appraisal.

The nurse manager is evaluating a staff nurse in the emergency department (ED). The manager obtains input about the nurse's performance from another nurse in the ED, one of the ED physicians, a patient-care assistant, and self-eval from the nurse. The type of performance evaluation the nurse manager utilizes is a. just culture. b. peer review. c. 360-degree feedback review. d. management by objectives.

ANS: C The 360-degree feedback review can be obtained by seeking input from managers, peers, subordinates, and patients. A self-report rating is often part of a 360-degree feedback process. Once all the input is obtained, the evaluating manager adds his or her input and merges the feedback to develop the final score.

The _____ Act provides incentives for adoption and implementation of electronic health records (EHRs) while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use. a. Stark b. HIPAA c. HITECH d. Anti-kickback

ANS: C The HITECH Act provides incentives for adoption and implementation of EHRs while enhancing privacy and security for patients and providing incentives for practitioners and hospitals to engage in meaningful use.

The collection of data to measure performance is required by a. the Health Insurance Portability and Accountability Act (HIPAA). b. the Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology.

ANS: C The collection of data to measure performance is a requirement of TJC.

Which staff member should be assigned to a dying client who is experiencing symptoms of emotional distress? a. UAP who can be spared to sit with the client b. LPN/LVN who has grown attached to the family c. RN who has experience as a hospice nurse d. Newly graduated RN

ANS: C The delegation process, as outlined by the ANA/NCSBN joint statement and the NCSBN national guidelines, begins with the preparation/assessment phase and then goes on to outline a five-step process. These steps are (1) the right task, (2) under the right circumstance, (3) to the right person, (4) with the right directions and communication, (5) under the right supervision and evaluation. The right person is the one who has the education and competency to perform the element of care. A hospice nurse has experience in managing symptoms associated with the dying process. This is the best nurse to care for this patient.

According to the American Association of Critical-Care Nurses, there are five factors that a nurse should assess when making a decision to delegate nursing tasks. These factors are assessing the potential for harm, the complexity of the task, the amount of problem solving and innovation required, the unpredictability of the outcome, and the a. amount of time that the task will take. b. degree of comfort the delegate has with the task. c. level of patient interaction. d. method of measuring outcomes.

ANS: C The level of patient interaction is the fifth factor that nurses should assess when making delegation decisions.

The __________ of an organization is the formulation of ideas, plans, or dreams that help shape the future and ability to persuade colleagues and associates to share those dreams. a. mission b. core values c. vision d. organizational chart

ANS: C The mission, core values, and vision are the instruments that give voice to the organization's philosophy. The mission is a simple and direct expression of a company's goals and objectives. It defines what a company stands for. The vision is the formulation of ideas, plans, or dreams that "help shape the future and ability to persuade colleagues and associates to share those dreams."

To be effective at population care management, both CM and DM need to a. assess and plan health initiatives within an area. b. implement and evaluate health programs within a community. c. assess and define the populations to be served. d. organize and regulate health professions across the country.

ANS: C To be effective at individual and population-based care management, both CM and DM programs need to identify, assess, and define the populations to be served early in the program planning effort.

Leadership is best defined as a. an interpersonal process of participating by encouraging fellowship. b. delegation of authority and responsibility and the coordination of activities. c. inspiring people to accomplish goals through support and confidence building. d. the integration of resources through planning, organizing, and directing.

ANS: C Leadership is the process of influencing people to accomplish goals by inspiring confidence and support among followers.

Which of the following statements best describes a desirable characteristic of a good management information system? a. Data should be sorted and labeled within 2 weeks. b. For accurate interpretation, data should reflect a health bias. c. Information gathering should be comprehensive and cost-effective. d. The management information system operating system should be Windows-based.

ANS: C Ten criteria or desirable characteristics for a good management information system are the following: (1) informative, (2) relevant, (3) sensitive, (4) unbiased, (5) comprehensive, (6) timely, (7) action-oriented, (8) uniform, (9) performance-targeted, and (10) cost-effective

Team building is the process of _____ a group. a. forming b. identifying c. organizing d. unifying

ANS: D

The ability to measure performance is challenging, and despite significant advancements, measurements continue to be imperfect. Inaccuracy in measurement in favor of or against a group is known as a. validity. b. objectivity. c. reliability. d. bias.

ANS: D Accurately assessing and rating someone according to a predetermined scale is a challenging task. There is a tremendous amount of bias in a performance rating. Bias refers to inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair. Bias occurs for a wide range of reasons.

The nurse who uses collaboration to coordinate care for an individual's and family's comprehensive health needs through communication and available resources to promote patient safety and quality, cost-effective outcomes is performing a. population health management. b. managed care. c. disease management. d. case management.

ANS: D Case management (CM) is a collaborative process of assessment, planning, facilitation, care coordination, evaluation, and advocacy for options and services to meet an individual's and family's comprehensive health needs through communication and available resources to promote patient safety, quality cost-effective outcomes.

A communication system developed originally to address communication patterns in critical situations is a. VERA framework. b. NVC model. c. crucial conversations. d. TeamSTEPPS.

ANS: D Communication effectiveness becomes crucial in times of emergency or disaster. TeamSTEPPS was initially developed to address communication issues between nurses and providers during critical patient events.

Interpersonal communication and the ability to apply _____ are two critical skills every nurse needs to enhance professional practice. a. vision b. supervision c. delegation d. problem solving

ANS: D Every nurse needs two critical skills to enhance professional practice. One is a skill at interpersonal relationships. This is fundamental to leadership and the work of nursing. The second skill is applying the problem-solving process. This involves critical thinking, problem identification, and the development of objectivity.

Which of the following factors best suggests an individual is motivated to engage in a disease management program? a. Mistrust of insurance companies b. Enrollment at initial contact c. Can afford the cost of enrollment d. Has a need that would benefit from the program

ANS: D Factors driving engagement suggest that individuals most motivated to engage are those who are well informed of the program benefits and have a perceived need that would benefit from said program (e.g., living alone, needing a supportive person to discuss ideas).

Management offers a day of pampering at a spa if nurses agree to work 3 out of 4 weekends over the summer. This type of power is known as a. coercive. b. expert. c. legitimate. d. reward.

ANS: D French and Raven's five sources of power (1959) include reward, coercive, expert, referent, and legitimate. When reward power is used, most people comply because of the positive benefits of doing so.

Over lunch in the cafeteria, student nurses are sharing educational information about the patients for whom they are caring. This is a(n) a. breach of beneficence. b. example of maleficence. c. potential assault and battery charge. d. violation of the Health Insurance Portability and Accountability Act (HIPAA).

ANS: D HIPAA provisions have heightened awareness about and encouraged strategies to protect a patient's privacy in health care transactions. This is an example of breach of confidentiality.

Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety? a. We make sure that we don't have any errors on this unit. b. We identify who made the error and take corrective action. c. We provide remedial training for all staff on the unit when there is an error. d. We report any medical error or near-miss to help us find the root cause of the problem.

ANS: D Health care organizations that embrace a fair and just culture identify and correct the systems or processes of care that contributed to the medical error or near-miss. Managers believe that more health care professionals will report more errors and near-misses when they are protected by a non-punitive culture of medical error reporting, and this will further improve patient safety through opportunities for improvement and lessons learned. The American Nurses Association has endorsed just culture as a means of ensuring safe care.

Which ethical principle is violated when there are insufficient community resources to meet the needs of low-income families? a. Nonmaleficence b. Autonomy c. Beneficence d. Justice

ANS: D Justice is the norm of being fair and giving all equal treatment. When low-income families do not get the same community resources as others, justice is not being served.

Staff nurses may be able to avoid bullying behavior through a. increasing time spent with patients at the bedside. b. ignoring the assaults. c. filing a grievance. d. cognitive rehearsal training.

ANS: D On an individual level, cognitive rehearsal training can help nurses avoid bullying behavior. It can also teach nurses how to intervene in situations where they see others bullying and is reported to improve staff satisfaction.

A memo sent to the unit nurse manager reads that beginning next week; all nursing staff will be expected to conform to a new dress code selected by the hospital board of directors. The nurse manager understands that change will be more effective through which manner of communication? a. Storytelling b. E-mail c. Discussion d. Open communication

ANS: D Open communication within the change process, early involvement of staff, listening to their input and concerns, and engaging them in the change may be the most effective means to assess readiness for change.

The process by which a manager examines and evaluates an employee's work behavior by comparing it with pre-set standards, documents the results of the comparison, and uses the results to provide feedback to the employee is a. coaching. b. peer review. c. self-evaluation. d. performance appraisal.

ANS: D Performance appraisal means evaluating the work of others. It is the process by which a manager examines and evaluates an employee's work behavior by comparing it with pre-set standards, documents the results of the comparison, and uses the results to provide feedback to the employee to show where improvements are needed and why.

Which model of patient care is based on a strong philosophy of patient-centeredness? a. TJC b. Thomson Reuters c. Beacon d. Planetree

ANS: D Planetree is a designation that differentiates a hospital on the basis of excellence in patient- and person-centered care. The Planetree philosophy reveals a simple view of what it means to be patient-centered: "Care should be organized first and foremost around the needs of patients."

Which nursing care model was prominent before the Great Depression? a. Functional nursing b. Group nursing c. Hospital staffing d. Private duty nursing

ANS: D Private duty nursing is the oldest care model in the United States. Between 1890 and 1929 in the United States, graduate nurses acted as private duty nurses, caring for patients in their homes.

Lilly, an RN, works full time in her client's home providing total care for him. She bathes and dresses him, provides tracheostomy care and wound care, and feeds him. She is paid directly by her client. This type of nursing care is commonly known as a. primary nursing. b. functional nursing. c. case management. d. private duty nursing.

ANS: D Private duty nursing, sometimes called case nursing, is the oldest care model in the United States. Private duty nursing is defined as one nurse caring for one client. In this model, complete and total care is provided by one nurse, but the nurse carries only one client assignment.

Marketing mix from a seller's point of view includes a. client service, charges, comfort, and connecting. b. customer solution, cost, convenience, and communication. c. patient, physicians, perfection, and publicity. d. product, price, place, and promotion.

ANS: D Product, price, place, and promotion are the four Ps of the marketing mix that apply to the seller when a good or service is being marketed.

A well-known talk show host presents information to a congressional committee to garner support for cancer research. This type of power refers to _____ power. a. coercive b. expert c. legitimate d. referent

ANS: D Referent power is based on admiration for a person who has desirable resources or personal traits.

A staff nurse's accurate recording of all services and supplies used to provide care to each client in the patient assignment is necessary for determining calculations used in which of the following budgets? a. Expense b. Gross c. Inpatient d. Revenue

ANS: D Revenue is defined as income or amounts owed for purchased services or goods. Total operating expenses are the result of summing the costs of all resources (e.g., labor, patient consumable supplies, small medical equipment, utilities, office supplies, and other related miscellaneous fees and materials) used to produce services.

How is SBAR used in decision making? a. Prevents cognitive errors b. Data management tool c. Financial tool d. Effective communication technique

ANS: D SBAR is a communication technique that helps members of the health team communicate effectively so that appropriate decisions can be made. Because hands-off communication is so crucial to decision making about patient care, SBAR is used to clarify and organize essential but complex patient care information.

The workload standard commonly used in nursing when calculating staffing patterns is a. patient days. b. patient acuity system. c. average length of stay. d. nursing care hours per patient day.

ANS: D The amount of work performed by a unit is referred to as its workload, and workload volume is measured in terms of units of service. The workload standard commonly used is nursing care hours per patient day, although the validity of this measure is disputed.

Which of the following phrases best describes the focus of health care marketing? a. Delivery of high-quality patient care b. Pursuing a high level of patient satisfaction c. Recruitment and retention of nurses d. Creating and delivering superior customer value

ANS: D The focus in health care marketing is not only on developing a brand and attracting customers but also on "creating and delivering superior customer value." More simply, marketing is focused on establishing customer relationships and satisfying customer needs and wants.

A team has formed to determine which methods have worked best and which factors influence the implementation of an evidence-based practice program. This is known as _____ research. a. authoritarian b. autocratic c. transformational d. Translational

ANS: D Translational research includes testing the effect of interventions aimed at promoting the rate and extent of adoption of evidence-based practices by nurses, physicians, and other health care providers and describing organizational, unit, and individual variables that affect the use of evidence in clinical and operational decision making.

Nurses utilize _____ through critical thinking and clinical reasoning skills to determine when and how to apply evidence-based knowledge. a. orders b. data c. information d. wisdom

ANS: D Wisdom is the appropriate use of knowledge in managing and solving patient problems, risks, and needs for health enhancement. Wisdom is knowing when and how to apply the evidence- based knowledge with client information, which nurses exercise through critical thinking and clinical reasoning skills.

A nurse has reported to work late four times in the last 3 months. The unit manager brings this to the attention of the nurse and asks to meet and discuss the issue. At their meeting, the nurse is given an opportunity to explain repeated tardiness and corrective action is determined. A tool the manager can use to monitor the nurse's future performance is a a. performance review. b. clinical ladder. c. written warning. d. performance improvement plan.

ANS: D A performance improvement plan (PIP) is a formal action plan that addresses work performance and needed improvements using identified goals and specific improvement plans. A PIP can be used as a coaching device for personal professional improvement or as a way of tracking and monitoring the performance of a staff member who may be a cause for concern.

Individual members of a group will adapt to change at different rates. Which of the following groups would take the longest to accept change? a. Early adopters b. Late majority c. Innovators d. Laggards

ANS: D Nurse leaders need to recognize that change will be accepted at varying rates and target interventions accordingly. The five categories in order are innovators, early adopters, early majority, late majority, and laggards

Nursing outcome databases are critical because nurses must be able to a. assess the differences between an associate degree in nursing and a bachelor's of science degree in nursing. b. compare interventional care strategies between physicians. c. evaluate nurse's aide- and licensed practical/vocational nurse-sensitive outcomes. d. measure how nurses influence patient outcomes.

ANS: D Nursing outcome databases are critical for two reasons: (1) nurses are able to measure and document how nurses influence patient outcomes across care providers for populations of patients, and (2) the study of nursing-sensitive outcomes allows comparisons among interventional strategies and advances the science of nursing care delivery.

The Joint Commission's (TJC's) emergency management accreditation standards call for hospitals to sustain disaster operations for at least ______ hours. a. 24 b. 48 c. 72 d. 96

ANS: D TJC's emergency management accreditation standards call for hospitals to sustain disaster operations for at least 96 hours should an external disaster occur that impacts the local area or region (TJC, 2012). Lessons learned from Hurricane Katrina illustrate just how long it can take before assistance is available.

The definition of _____ is the execution of an action; something accomplished; or the fulfillment of a promise, claim, or request.

ANS: performance Performance is defined as the execution of an action; something accomplished; or the fulfillment of a promise, claim, or request

The primary hospital ____ is the care that is delivered by nursing staff. a. Product b. Price c. Place d. Promotion

Ans A: the primary hospital product is the care delivered by nurses. A product is the basis of any business and is the focus of exchange b/n provider and customer

_____ is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Evidence-based practice Evidence-based practice is defined as the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients.

Regulatory guidelines for the prevention of workplace violence are derived from _________ under the U.S. Department of Labor.

OSHA

The process by which nurses systematically evaluate the quality of nursing care provided by peers as measured against professional standards is called _____.

Peer review in nursing (defined in 1988 by the American Nurses Association and still applicable today) is the process by which nurses systematically evaluate the quality of nursing care provided by peers as measured against professional standards (American Nurses Association, 1988, p. 3).

direct examination

The examination of a witness by the attorney who calls the witness to the stand to testify on behalf of the attorney's client.

fidelity

being loyal and faithful to commitments and accountable for responsibilities

A(n) _____ is the result or results obtained from the efforts to accomplish a goal.

outcome An outcome is the result or results obtained from the efforts to accomplish a goal. The term outcomes has also been defined as the conditions in patients and others that health care delivery aims to achieve. A patient-focused definition of outcomes considers them "the results people care about most when seeking treatment, including functional improvement and the ability to live normal, productive lives" that are "inherently condition-specific and multidimensional."

_____ is a personal quality that is admired in the person with referent power. a. Problem solving b. Authority c. Knowledge d. Coercive power

ANS: A Referent power comes from the affinity other people have for someone. They admire the personal qualities, the problem-solving ability, the style, or the dedication the person brings to the work.

Revenues minus expenses equals a. cash flow. b. expense incurred. c. income. d. total reimbursement.

ANS: C Income (or profit) is defined as the excess of revenues over expenses, or revenues minus expenses.

The improvement process in which an organization measures its strategies, operations, or internal process performance against that of best-in-class organizations within or outside its industry determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as _____.

Benchmarking

Big Data

Big Data: encompasses AI and machine learning as well as predictive analytics. It functions on the principle that collecting and analyzing large amounts of data will allow for relationships that may have been unknown to be identified and studied, thus allowing nurses to make better and more informed decisions.

The first person to analyze patient outcomes associated with nursing care delivery was a. Clara Barton. b. Dorothea Dix. c. Florence Nightingale. d. Luther Christman.

C FLo money :)

Dashboards

Dashboards: It allows clinicians and leaders to view and synthesize multiple sources of data and information simultaneously for improvement efforts. Used as part of continuous improvement. They provide a visual display of critical information so that leaders can quickly grasp performance across multiple domains.

The proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff, is called _____.

skill mix Skill mix is the proportion of direct-care RNs to total direct-care nursing staff, expressed as a percentage of RNs to total nursing staff.

Departmentalization

the grouping of jobs into working units usually called departments, units, groups, or divisions named by functions like HR, cardiac surgery, palliative care ...

Deposition

the testimony of a witness made under oath but not in open court

The term _____ refers to the inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair.

Bias refers to inaccuracy in the measurement in favor of or against a person or group, typically in a way that is unfair. Bias occurs for a wide range of reasons.

Which of the following factors best suggests an individual is motivated to engage in a disease management program? a. Mistrust of insurance companies b. Enrollment at initial contact c. Can afford the cost of enrollment d. Has a need that would benefit from the program

D

Capital-Social Capital

nurses shared assets through the social network of relationships at work. Leaders should focus on strategies to strengthen social capital such as communication, positive leadership practice and cultivating a culture of trust among nurse. has a positive correlation on work effectiveness and unit quality.

A hospital needs to upgrade its remote telemetry monitoring system. The new system will cost more than $100,000. The new system will be included in which of the following budgets? a.Capital b.Operating c.Personnel d.Unit

ANS : A

All-hazards disaster preparedness refers to: a.An effective and consistent response to any disaster or emergency regardless of the cause. b.Preparing for local disasters. c.Preparing for hazardous waste spills on interstate highways. d.Preparing for small-scale natural disasters.

ANS: A

The postoperative patient with anterior cervical laminectomy is complaining of tightness in his throat. His voice is raspy. The staff nurse asks the unit secretary to page Dr. Julio stat. This is an example of _____ leadership. a. authoritarian b. democratic c. laissez-faire d. servant

ANS: A Authoritarian leadership uses directive and controlling behaviors in which the leader determines policies and makes decisions in isolation. The leader orders subordinates to carry out the tasks or work. This style is helpful in crisis situations.

The hospital's disease management program has gathered data collected from health assessments in order to categorize patients into like groups with the intention of providing population management interventions. This practice or strategy is referred to as a. analogizing. b. stratification. c. comparing. d. data exchanging.

B

expert witness

a person who is permitted to testify at a trial because of special knowledge or proficiency in a particular field that is relevant to the case.