Leadership Test 3

The SBAR approach to patient safety encourages:

Consistency in assessment and practices.

The rising cost of health care in the United States is stimulated by which of the following (select all that apply)?

Consumers' attitudes; Population demographics; Medical treatment patterns

What would BEST support the capital request in Question 21?

Cost comparisons; how much and how often infusion pumps are used; condition of existing pumps

After a major flu vaccination campaign, an agency bills a private insurance company for allowable costs for administration of each vaccination according to the schedule established by the insurance company for reimbursement. This is an example of which major payment method?

Cost-based reimbursement

A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:

Identify the standard

As a nurse manager on the West Surgery Unit, you are interested in increasing patient safety and reducing morbidity and mortality on your unit. Which of the following recommendations would be consistent with the IOM The Future of Nursing report?

Increase in the percentage of baccalaureate-prepared nurses to 80%

Mary, an 85-year-old patient with cognitive impairment and gross instability, wanders continuously. Lately, she has fallen twice, and the family demands that she be restrained. As the unit manager, you have initiated a least restraint practice. An appropriate action in this situation would be

Initiating a multidisciplinary and family meeting to focus on Mary's needs.

The executive team at Hospital XYZ develops a polished strategic plan that includes a mission statement, goals, objectives, and a business plan for various initiatives in the plan. The executive team involves the marketing team, so that the plan can be communicated internally and externally. After 2 years, no significant progress has been made toward any of the goals. What has been omitted in the plan?

Integrated financial planning

To conduct assessment of the internal environment, the strategic planning team for Pacific Hospital:

Invites all levels of staff to focus groups on the effectiveness of the hospital environment, including information systems and staffing.

As the manager on an acute care medical unit, you note that the incidence of medication errors has increased since the implementation of staffing changes. As part of your strategy to reduce errors, it is important to

Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

Which of the following represents an effective goal statement?

Involve patients and families in planning health care.

The reasons cited by nursing administrators for not planning in a systematic manner include:

Lack of understanding of the planning process.

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops:

An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

In preparing a budget, the nurse manager needs to anticipate the cost of benefits (e.g., health, life insurance, pension and retirement plans). Based on the usual cost of benefits, how much should a nurse manager include for a total full-time salary cost of $312,000?

$46,800-$62,400

A clinic nurse developed objectives for a diabetic education program. The characteristics of well-written objectives include that they should be what? (Select all that apply.)

Achievable; Understandable and specific; Measurable

A staff nurse regularly works two 12-hour shifts each week and one 8-hour shift every other week. How many FTEs is this position?

0.7

In Question 17, the nurse manager determines that RN 1 has 5 weeks of vacation and 3 days of education, and has averaged 3 sick days a year. RN 2 has 6 weeks of vacation, has asked to attend a 3-day conference and a 2-day workshop, and has no history of sick time. RN 3 is new, and you anticipate 3 weeks of orientation, as well as 4 weeks of vacation. RN 4 has 6 weeks of vacation and has an ongoing health condition, so you anticipate 2 weeks of sick time, as well as 3 days for education. RN 5 has 5 weeks of vacation, has no education planned, and averages 5 sick days per year. RN 6 has 6 weeks of vacation, has no educational opportunities planned, and has been off ill for 4 weeks. How many hours of productive paid time can be anticipated for the budget?

10,848

In preparing her budget, a nurse manager determines that she needs to budget for six FTE RN positions in the upcoming year. Based on a 40-hour week, this means that the nurse manager has determined that the budget will provide for _____ hours.

12,480 paid

Because of the complexity of reimbursement systems and its implications for the services available to patients, the nurse has a key role in:

Advocacy for patients with regard to services required and services utilized.

The difference between a nurse practitioner's charge of $45 for an office visit and the insurance company's payment of $34 is:

A contractual allowance.

The IOM Health Professions Education report highlighted patient safety concerns as:

A result of disciplinary silos.

Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety?

Appropriateness of charting terms and abbreviations

To meet the social and human needs of a target market, it is critical to:

Assess the needs and priorities of the target market.

The chief nursing officer has to write a strategic plan. The most difficult stage in the strategic planning process is:

Assessment of the external and internal environment.

The clinic nurse understands that the advantages of planning include:

Assisting staff in critical thinking and improving decisions.

Patient perceptions are useful in:

Assisting to establish priorities among possible changes to care identified in QI OR Providing one source of data for QI initiatives.

Examples of sentinel events include (select all that apply):

Forceps left in an abdominal cavity; Patient fall, with injury; Administration of morphine overdose; Death of patient related to postpartum hemorrhage.

In determining the relationship between injury-producing falls and proposed preventive measures as part of the QI process, a QI team might turn to which of the following for confirmatory evidence?

NDNQI

Within a healthcare environment, where the gap between revenues and costs can mean the difference between sustainability of an organization and nonsustainability of an organization or services, it is critical for nurse managers to:

Balance value-added services against costs and revenues.

Your institution has identified a recent rise in postsurgical infection rates. As part of your QI analysis, you are interested in determining how your infection rates compare with those of institutions of similar size and patient demographics. This is known as:

Benchmarking

During the budgeting process, nurse managers are typically responsible for which of the following (select all that apply)?

Calculating workload; Developing unit operation objectives; Justifying capital equipment requests

The nurse educator of the pediatric unit determines that vital signs are frequently not being documented when children return from surgery. According to quality improvement (QI), to correct the problem, the educator, in consultation with the patient care manager, would initially do which of the following?

Call a meeting of all staff to discuss this issue.

A nurse manager is planning to request three new infusion pumps at a cost of approximately $1500 each. This item would typically be included in which budget?

Capital

A method commonly used in Quality Assurance to monitor adherence to established standards is:

Chart audit

Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)?

Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement; Sarah is a new parent who finds that nurses on the children's unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand; Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn't know what the doctor meant by colostomy.

After an extensive campaign to ensure that the community surrounding Pacific Hospital has been exposed to the emphasis of excellence in clinical care that occurs through the use of evidence, the marketing team finds that the public perception has changed little. This determination is made possible through:

Comparison of data against benchmarks.

In assessing the internal environment, the strategic planning team at Pacific Hospital discovers that 90% of staff members have no idea what the current mission statement means. This is most likely related to:

Development of the statement by the administration team with no other staff involvement.

In an effort to control costs and maximize revenues, the Rehabilitation Unit at Cross Hospital reduced the number of its managers and increased the number of units for which each manager was responsible. Within a year, the number of adverse events on the units had doubled. This may be attributable to:

Fewer clinical leaders to remove barriers to care.

The chief nursing officer works with her nurse managers by helping them understand how to develop and implement a budget. A nurse manager can best describe a budget as a:

Financial plan.

A nurse manager discovers that the actual number of visits per patient in a home health service is 3.8 visits per day when the standard is 5 visits per day. Based on this information, the nurse manager:

Decides that more information is needed before a conclusion can be reached.

The primary reason for calculating productive hours paid instead of simply calculating work paid per year is that productive hours enable the manager to:

Determine the number of hours available for patient care.

In implementing the strategic plan for effective utilization of evidence to guide nursing practice at Pacific Hospital, the nursing unit managers take the next step, which is the implementation. Implementation most likely would involve:

Developing unit-based objectives related to the plan.

A healthcare organization is committed to improving patient outcomes as part of the quality improvement (QI) process and examines its executive structure and organizational design. This approach recognizes which model of QI?

Donabedian

An example of an effective patient outcome statement is:

Eighty percent of all patients admitted to the Emergency Department will be seen by a nurse. Practitioner within 3 hours of presentation in the Emergency Department

You notice that Sally, a student on your unit, is giving information to an anxious young teen who seems very uncertain about preparation for an upper GI series. After Sally leaves the room, you ask her how she thought her conversation with the patient went and:

Encourage her to ask the patient if he has questions or concerns about the procedure.

The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following interventions might assist to reduce the number of falls on the unit?

Encouraging involvement of nurses in education related to falls and safety

Through the QI process, the need to transform and change the admissions process across administrative and patient care units is identified. In this particular situation, what method of data organization will be most effective?

Flowchart

In preparation for redesignation as a MagnetTM Hospital, how would you prepare?

Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

To increase safety in patient care areas of the Valley Hospital, the executive begins by:

Ensuring that the senior nursing officer attends the board meetings.

To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?

Evidence-based practice to reduce the prevalence of pressure sores

Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it:

Facilitates active staff participation in decision making related to quality nursing care

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and:

Funding.

At Hospital Ajax, staff members are reluctant to admit to medication errors because of previous litigation and a culture that seeks to assign blame. This culture demonstrates:

Goals that are inconsistent with QM

Nurses are valuable partners in marketing strategies because they:

Have close involvement with patients, who are the target group for marketing.

After reviewing her monthly budget report, the nurse manager sees that she has a negative variance, which prompts her to change the staffing schedule. A negative or unfavorable variance in a monthly expense report may result from:

Higher than expected client acuity.

A nursing unit is interested in refining its self-medication processes. In beginning this process, the team is interested in how frequently errors occur with different patients. To assist with visualizing this question, which organizational tool is most appropriate?

Histogram

With the rise in workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:

Hold staff accountable for safe practices

After a year, the staff at Pacific Hospital is frustrated, and implementation of evidence-based practice has gone poorly. In responding to this situation, the strategic planning team at Pacific Hospital:

Holds focus groups with staff to determine what kinds of issues, challenges, and obstacles have occurred in implementation.

An older adult couple with limited means and on Medicare is considering options after the hospitalization of Mrs. A. with a fractured hip. Mrs. A. is stable but requires assistance with bathing, transfer, and mobility, and this will present stress for Mr. A., who was hospitalized with a mild myocardial infarction last year. Considering their means and health concerns, which of the following might be the best option?

Home care

The nurse manager is concerned about the negative ratings her unit has received on patient satisfaction surveys. The first step in addressing this issue from the point of view of quality improvement is to:

Identify a clinical activity for review

A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?

Improvement in patient outcomes

The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It:

Improves outcomes

Shifts such as changes in the percentage of seniors in the population, governmental initiatives in health care, and the influence of income on health status are factors in the __________ environment.

Macro

The outcome statement "Patients will experience a ten percent reduction in urinary tract infections as a result of enhanced staff training related to catheterization and prompted voiding" is:

Measurable and nursing-sensitive

Benchmarks in the strategic marketing planning process are useful in:

Measuring progress.

During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:

Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.

The chief nursing office of a Magnet™ hospital has conducted a study of ways to improve healthcare services. Healthcare services that add value for clients:

Minimize costs.

A community-based pain management program is being planned for your region. As a coordinator of a home care agency, you have been requested to develop a conceptual framework, mission statement, philosophy, and objectives for the program. In what order will you pursue this endeavor?

Mission statement, philosophy, and objectives

From your observation of planning activities in the organization, you have noticed that planning and decision making occur at various levels of the organization. The nurse manager has overall responsibility for which of the following?

Monitoring ongoing activities and projects

A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:

NANDA

Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the:

Nursing care standards

An example of an initiative that may reduce total healthcare costs would be:

Offering nurse practitioner-led clinics that educate parents about nonpharmacologic strategies for managing ear infections.

A nurse manager approves two staff nurses to attend a national conference. When reviewing the budget, the nurse manager looks at which line item?

Operating budget

Pacific Hospital's team develops a process to include staff in development of the mission statement. Which of the following statements would indicate that the staff has been able to develop an effective mission statement?

Pacific Hospital will provide family-centered care to the community of Pacific Rim. It is committed to delivering a full spectrum of services that foster collaborative partnerships among clients, families, and the hospital, and it utilizes evidence-based practice to guide planning and interventions.

If you are supporting the steps in the AHRQ document "Five Steps to Safer Health Care," you would ensure that:

Patients are actively encouraged to make decisions related to care.

As a nurse manager, you know that the satisfaction of patients is critical in making QI decisions. You propose to circulate a questionnaire to discharged patients, asking about their experiences on your unit. Your supervisor cautions you to also consider other sources of data for decisions because:

Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff

Assessment of the needs of the consumer or client (in developing a strategic marketing plan) focuses on:

Present and future needs.

Northwestern Hospital has decided to implement peer review. As a clinical leader in the emergency department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to:

Provide an educational session for staff on peer review.

Sarah is a second-year nursing student. The clinical instructor overhears Sarah telling a patient that she "always" checks patients' bracelets before giving medication and she is not sure how the nurses on the unit "get away with" not making more errors than they do. The clinical instructor pulls Sarah aside and explores with her how her communication might affect the patient and what it reflects about her beliefs related to the team. The actions of the clinical instructor reflect competencies outlined by:

QSEN

A nurse manager wants to decrease the number of medication errors that occur in her department. The manager arranges a meeting with the staff to discuss the issue. The manager conveys a total quality management philosophy by:

Recommending that a multidisciplinary team should assess the root cause of errors in medication

As a manager, the development of your decision-making skills related to safe patient care is facilitated by:

Regular reflection on decisions.

As a nursing leadership student, you have had the opportunity to develop a palliative care manual that will be utilized by the palliative care network (PCN) in your region for teaching healthcare professionals. The PCN has requested that you provide a prioritized plan of action for marketing the manual on a regional and state basis. What is the first priority?

Research the target market.

Which of the following factors is not implicated in rising healthcare costs?

Rising Medicare costs

The nurse gives an inaccurate dose of medication to a patient. After assessment of the patient, the nurse completes an incident report. The nurse notifies the nursing supervisor of the medication error and calls the physician to report the occurrence. The nurse who administered the inaccurate medication understands that:

Risk management programs are not designed to assign blame

In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize:

Safety goals specific to Pleasant Valley.

Planning is a process designed to achieve goals in dynamic, competitive environments. As a new manager, what is the first step you will undertake to develop a strategic plan of action for a congestive heart failure program?

Search the environment to determine changes that may affect the organization.

In a nurse managers' meeting, the chief nursing officer encourages the managers to brainstorm ways to reduce costs. Nurse managers have the greatest impact on reducing costs by managing:

Staffing.

A client requires an appendectomy. The surgeon explains the procedure and asks the client to sign the consent. The patient speaks very little English and looks worried. As a nurse, you would:

Suggest that an interpreter explain the procedure to the client and answer any questions.

Physicians in a small urban hospital are reluctant to discharge older adult patients because many of the patients lack private insurance and the resources to travel distances for follow-up care. The hospital administration pressures the physicians to discharge patients sooner and to be more consistent with the number of hospitalization days specified within the DRGs. Which of the following would most likely prompt the action of administrators?

The hospital is incurring a deficit related to a gap between the PPS and the DRGs and costs of care.

As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about:

The need to understand and record all medications being taken.

Which of the following represents a well-written objective?

To implement evidence-based practice on nursing units, as evidenced by adoption of evidence-based processes, by June 1, 2011

Of the following, which is the most effective strategy that a nurse manager could employ to reduce unnecessary costs in specific healthcare settings?

Training nurses on accurate documentation of supplies used for patient care

As an experienced nurse manager who is new to an organization, it would be important to:

Understand the budget timetable and level of involvement expected of individual managers in budget preparation.

On the West Surgery unit, you want to institute a new system for checking armbands that evidence suggests may increase safety in medication administration. The system involves technology. Which of the following strategies may assist with rapid adoption of the technology and system?

Use early adopters among the staff as leaders and role models in implementation.

The chief nursing office continues to seek ways to improve healthcare services to clients and to save the hospital money. However, with the federal guidelines of paying agencies based on capitation, the chief nursing office faces a challenge. Capitation provides incentives for healthcare providers to control costs by:

Using fewer services per client.

A private ambulance clinic established a few streets away from Pacific Hospital markets its services as quality-based within caring relationships. The clinic is part of the __________ environment.

competitive

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices?

hospitals

At Hospital Ajax, there has been a 20% increase in instruments and sponges being left in patients during surgery and surgeries on the wrong limbs. These are known as:

never-events

Through its strategic planning processes, Pacific Hospital learns that nursing staff members are uncomfortable with utilizing evidence-based practice, and that staff perceives that only limited resources are available to support translation of evidence into their usual practice. Because this issue has been identified, the team determines that a plan of action is required to address the issue. Who should be involved in determining this plan?

nursing unit managers

In designing a quality, safe healthcare environment, the primary emphasis needs to be on:

the patient