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1. Organizational culture includes (select all that apply): a. Norms. b. Traditions. c. Behaviors. d. Values.

A B C D

. Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety? a. Appropriateness of charting terms and abbreviations b. Nursing hours per patient c. Acuity of patient admissions d. Wait times for care

10. A busy neurologic ICU and step-down unit most likely would use which patient classification system? a. Factor evaluation b. Prototype evaluation c. Hybrid system d. AHRQ system

10. As a new nurse manager who has "inherited" a unit with high nurse turnover and complaints of patient dissatisfaction, your first course of action would be to: a. Determine levels of nurse engagement on the unit. b. Review the personnel files of nurses who have resigned. c. Interview upper management about their vision for the unit. d. Meet with your staff to clarify your vision for the unit.

10. In designing programs through your institution to address the health needs of Hispanics in your community, you most likely would develop programs related to: a. Diabetes. b. Cardiovascular disease. c. Cancer. d. Asthma.

11. "Georgia Hospital will provide care that is a national example of consumer service" is a: a. Vision statement. b. Statement of philosophy. c. Mission statement. d. Rationale for care.

11. A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered: a. A healthcare network. b. A tertiary care institution. c. Rehabilitative. d. Long-term care.

11. A nurse on your inpatient psychiatric unit is found to have made sexually explicit remarks toward a patient with a previous history of sexual abuse. The patient sues, claiming malpractice. Which of the following conditions may not apply in this situation? a. Injury b. Causation c. Breach of duty d. Breach of duty of care owed

11. During times of nursing shortages and increased nursing costs in health care, which of the following nursing care delivery models might come under greatest scrutiny? a. Case method b. Team nursing c. Functional nursing d. Nurse case management

12. As a charge nurse, you counsel your RN staff member that he has satisfied his duty of care by notifying a child's physician of his concerns about deterioration in the child's status at 0330 hours. The physician does not come in. The child dies at 0630 hours. As the charge nurse, you could be held liable for: a. Professional negligence. b. Assault. c. Avoidance. d. Murder.

12. Hospital ABCD is a Magnet™ hospital. This designation has been applied to Hospital ABCD because it: a. Facilitates active staff participation in decision making related to quality nursing care. b. Has implemented a graduate nurse orientation program. c. Espouses commitment to excellence in patient care. d. Is establishing career ladders for nurses.

12. In a job interview for a nursing position, Marley can be assured that which of the following will occur? a. Both eustress and distress b. Only eustress c. Only distress d. Neither eustress nor distress

12. To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility? a. Evidence-based practice to reduce the prevalence of pressure sores b. Implementation of informatics at the bedside c. Staff-manager conferences to review reporting of adverse medical events d. Patient councils to review food, recreation, and nurse-patient relations

13. A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is: a. NANDA. b. AHRQ. c. NIOSH. d. Nursing process.

13. 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: a. Encourage her to ask the patient if he has questions or concerns about the procedure. b. Advise her to consider providing the patient with more information. c. Suggest that she leave some brochures on the procedure with the patient. d. Suggest that she also provide teaching to the adolescent's parents.

14. A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and: a. Lower salary compensation for staff. b. Rising expectations of impoverished and indigent individuals for services. c. Poor orientation and retention practices for staff. d. An overwhelming emphasis on accepting learners from health disciplines.

14. For a nurse manager in the functional nursing model, an approach that will assist in maintaining staff satisfaction in this specific model is: a. Rotation of task assignments. b. Frequent opportunities for in-service education. c. Orientation to job responsibilities and performance expectations. d. Team social events in off hours.

14. 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? a. NDNQI b. NANDA c. NIOSH d. AHRQ

15. A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. What role are you assuming through this action? a. Manager b. Leader c. Follower d. Laissez-faire

15. In comparing team and functional models of care, a nurse manager favors the team model. In particular, she finds that the team model: a. Can be effective in recognizing individual strengths and backgrounds of staff. b. Promotes autonomy and independence for the RN. c. Avoids conflict because of role clarity. d. Is efficient in delivering care to a large group of patients, utilizing a staffing mix.

16. As a nurse manager, you have hired two new staff members who have recently come to the United States from other countries. Which of the following strategies might indicate your efforts to assist these staff members with acculturation to your unit? a. Analyze a recent situation with them in which an order with a physician was not clarified and explore their beliefs about nurse-physician relationships. b. Expect them to behave in ways that are expected of staff who have grown up and been educated in the United States. c. Stress to these new staff that your unit is a "family" and that staff members take pride in saying that they are from Unit 4. d. Recognize that culture develops over time and leave them alone to figure out differences between their culture and that of the unit.

16. Hospital Magnet™ decides against creating a separate department to lead and monitor quality activities because: a. Total organizational involvement is critical to QI. b. Data generated by a single, separate department are generally flawed. c. Monitoring and commitment to QI can come only from senior-level managers. d. Staff resent suggestions for improvement that originate outside of their unit.

16. Sources of occupational stress in nursing include all except which of the following? a. Authoritarian leadership b. Concern about moral wrongdoing by colleagues c. Multiple changes in a short time d. Rotating shifts

16. The implementation of saline flushes for capped angiocatheters is an example of: a. How multilevel and interprofessional application of a procedure can slow adoption of EBP. b. How competition among disciplines can lead to negative patient outcomes. c. The reluctance of hospital administrators to act on recommendations from EBP. d. How a safe, well-known practice outweighs the benefits of adopting a newer practice.

16. Three gravely ill patients are candidates for the only available bed in the ICU. As the supervisor, you assign the bed to the patient with the best chance of recovery. This decision reflects which of the following ethical principles? a. Beneficence b. Autonomy c. Veracity d. Nonmaleficence

17. During managers' meetings, Lindsay is surprised by the forthrightness of male managers. She finds that, during discussions, she would be more likely to say: a. "I wonder if we should consider changing our policy on performance appraisals? What do you think?" b. "Sean, your approach to appraisal is completely off track and does not reflect available evidence." c. "The system that has been developed needs to be implemented. We have already spent enough time in discussion." d. "Forget about change in this policy. It is fine as it is."

17. Mr. T. Jones and Mr. R. Smith are both going to become residents in Sunny Haven Lodge. Mr. Jones views it as an opportunity to socialize and meet new friends. Mr. Smith views this as abandonment by his family and is worried that the care will be inadequate. Each senior perceives the situation differently. This is a good example of stress that is: a. Both a positive stressor and a negative stressor. b. Occurring only because of age. c. Positive in both cases. d. Harmful in both cases.

17. Sarah determines, in partnership with her patient, that current medications are not enabling her patient, a married account executive with fibromyalgia, to continue with her employment and family responsibilities. After searching for additional information on fibromyalgia, Sarah finds nonpharmacologic interventions that are supported through credible evidence. Sarah suggests that the patient, her physician, and she meet to discuss the medications and possible options and a plan of care for the patient's discharge. This action exemplifies which of the four historical concepts identified by Lewis and Batey? a. Authority b. Responsibility c. Communication of conflict d. Autonomy

17. You pull staff together to assess a situation in which the family of a seriously ill patient is anxious and is absorbing a great deal of staff time in consultation, discussion, and questioning of treatment decisions. Staff members are becoming distanced from the family. After inviting the concerns of staff, you explain that the organization values patient-centered care and that evidence supports that acting as an advocate and a listener is helpful to families. You ask the staff for ideas as to strategies that are effectively patient-centered in these situations. In this situation, you are taking on which role? a. Leadership b. Management c. Follower d. Visionary

18. A conflict develops between an associate nurse and a primary nurse over the assessment of a patient with pulmonary edema. Based on her assessment of the patient, the associate nurse insists that it is her role to change the care plan because she is the one who has made the assessment. As the nurse manager, you clarify that: a. It is the role of the primary nurse to make alterations based on assessment data and input. b. The associate nurse is accountable and responsible while the primary nurse is off duty and therefore is able to alter the care plan. c. Neither the primary nor the associate should make changes without first consulting you as the manager. d. It really does not matter who alters the nursing care plan as it depends on situation and time to do so.

18. An example of an effective patient outcome statement is: a. 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. b. Patients with cardiac diagnoses will be referred to cardiac rehabilitation programs. c. The hospital will reduce costs by 3% through the annual budget process. d. Quality is a desired element in patient transactions.

18. As the unit manager, you post the staffing plan and compliance reports. This initiative is aimed at: a. Maintaining unit morale. b. Complying with national requirements. c. Demonstrating patient outcomes. d. Inviting staff participation in decision making.

19. Mr. M. complains to you that one of your staff asked him details about his sexual relationships and financial affairs. He says that these questions were probing and unnecessary to his care, but he felt that if he refused to answer, the nurse would be angry with him and would not provide him with good care. Mr. M.'s statements reflect concern with: a. Privacy. b. Confidentiality. c. Veracity. d. Informed consent.

19. The SBAR approach to patient safety encourages: a. Consistency in assessment and practices. b. Continuing education. c. Multidisciplinary approaches. d. Patient feedback.

19. To maintain patient safety, studies suggest that scheduling should avoid: a. Rotating shifts. b. Weekends. c. 8-hour shifts. d. Mandatory overtime.

19. With revenue reductions and cost-saving measures, the number of managers has been reduced, which has increased the number of team leaders supervised by managers by as many as three. This change may result in: a. Decreased patient satisfaction. b. Increased efficiency in costs. c. A more positive perception of managers. d. Little change to manager-staff relationships.

2. The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes about incorporating evidence-based practice in nursing. What best describes evidence-based practice? a. Applying best research evidence to care of patients b. Using research-based information to develop practice guidelines c. Conducting a randomized control trial to determine effectiveness of handwashing techniques d. Developing standards for practice

2. The nurse manager of a unit has lost many staff members, and the unit is now staffed with a large number of agency and traveling nurses. She knows that the agency and traveling nurses are all contracted to stay on the unit for the next 3 months. One way to improve morale and decrease stress in the unit would be to: a. Plan a social event and include the agency and traveling nurse staff members. b. Plan unit-based social events for your remaining permanent staff members. c. Request hospital-based "floating" nurses to substitute for the temporary staff. d. Implement team nursing.

2. The relief charge nurse has assigned a newly licensed baccalaureate-prepared nurse to be one of the team leaders for the 3-11 shift. In making this decision, the charge nurse has overlooked this nurse's: a. Clinical expertise. b. Leadership ability. c. Communication style. d. Conflict-resolution skills.

20. Taylor Hospital has well-defined organizational units that provide maintenance, financial services, care for cardiac patients, care for surgical patients, and so on. The organizational chart indicates that surgical units report to a surgical manager and all nursing units report to a vice president of nursing; financial services to an accountant and then to a business executive; and so on. The primary disadvantage of this organizational structure is: a. Breakdown in function and communication across specialties. b. Lack of congruence in culture and organizational values. c. Highly centralized decision making and authority. d. Wide span of control.

20. 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? a. Flowchart b. Histogram c. Narrative d. Line graphs

21. "Stress-buffering" behaviors can be elicited to reduce stress. All of the following behavioral coping responses can be used by nurse managers to reduce and manage stress except: a. Distancing oneself from work. b. Using cognitive reframing to change irrational thoughts. c. Refusing a request to sit on a committee to evaluate scheduling software. d. Exercising regularly.

21. 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? a. Histogram b. Flowchart c. Fishbone diagram d. Pareto chart

21. As a manager, the development of your decision-making skills related to safe patient care is facilitated by: a. Regular reflection on decisions. b. A culture of perfectionism. c. Recognition of who should be held responsible for individual errors. d. A culture of trust between the staff and you.

21. To reduce reliance on overtime hours, an organization develops a strategy for floating nurses during staff shortages. To maximize patient safety and reduce costs, the healthcare organization: a. Develops a centralized pool of float nurses. b. Assigns nurses from less busy units to ones with increased acuity levels. c. Floats nurses only between units on which the nurses have been cross-trained. d. Assigns float nurses to basic care only.

22. As a nurse manager in a hospital, you would expect which of the following to be the major contributor to funding and revenues in your organization? a. The federal government b. Medicare c. Medicaid d. Blue Cross/Blue Shield

22. Senior executives at Hospital A determine that the hospital will engage in a strategic planning process after changes in healthcare funding and concerns expressed in the community about care that is being delivered at the hospital. The senior executives decide on a participatory process in which staff are widely consulted regarding input about the organization and the external environment and are actively invited to be part of decisions related to the mission statement, goals, and objectives. For true shared governance to be seen as part of this approach: a. It must be evident in the outcomes of the process that staff and senior executives have partnered on the decisions. b. Stakeholders must be assured of the value of their input even though final decisions rest with senior executives. c. Publications must clearly outline how staff input was solicited and obtained. d. Staff must be reassured that significant concerns will be kept in mind even if they have not been addressed in planning documents.

22. Which of the following is a meta-analysis? a. Review of 35 studies on nurse work satisfaction to determine the significance of the aggregated research findings b. Review of multiple chart audits to determine which errors are being reduced through implementation of evidence-based guidelines c. RCT comparing the effectiveness of a local anesthetic in reducing the pain of venipuncture in young children d. Analysis of factors contributing to nurse burnout and dissatisfaction at emergency room sites

23. Case managed care may enhance profit in a for-profit health organization by: a. Minimizing costs in high resource consumption areas. b. Combining licensed and non-licensed care providers in delivering patient care. c. Increasing reimbursement from third-party payers. d. Reducing the amount of technology used to support clinical decision making.

23. Nurses in an Emergency Department, in an inner-city neighborhood characterized by high levels of violence, are concerned with low levels of security presence in their department. Security levels have recently been decreased and the nurses question why this has occurred. An appropriate action would be to: a. Provide nurses with information about rationale for recent changes in security staffing. b. Refer the matter to the head of security and let her deal with it. c. Provide mentors who can help nurses diffuse aggressiveness. d. Accept the security levels as a consequence of funding realities.

23. Once evidence related to the use of prompted voiding in patients with cognitive impairment has been appraised and integrated with practice, it is important to: a. Consider whether patients' families see this as necessary for the well-being of family members. b. Search large databases such as CINAHL to amass further evidence. c. Clarify the clinical practice question. d. Solicit input regarding integration with practice.

24. A dispute arises between an RN staff member and an LPN over a patient issue. The tension between the two begins to affect other staff members, who are drawn into the conflict; eventually, the team becomes polarized toward either the RN or the LPN. This situation might have been prevented through: a. Expediency in responding to the initial dispute, once it became apparent that it could not be resolved by the two parties themselves. b. Asking other staff members what the real issues were in the dispute between the RN and the LPN. c. Reassigning one of the parties to another unit when it became apparent that the two individuals could not resolve the dispute themselves. d. Calling a staff meeting at the onset of the dispute to allow the team and the RN and LPN to discuss the initial dispute.

17. A nurse staffing plan takes into account: a. Specific nurse-to-patient ratios per shift. b. Participation of nurses in projecting staffing needs. c. Compensation and benefits for each level of staff. d. The occupancy load of a unit.

24. You are hired as a new manager. When the offer of employment is made, you agree to at-will employment. Later, you become very concerned about the policies and practices of your organization and their impact on patient care. You speak with your supervisor several times about your concerns, but no action is taken. In considering your next steps, you: a. Consider your increased vulnerability under the terms of your employment. b. Recognize that your supervisor is more vulnerable than you are because of her more senior position. c. Are more likely as a leader to take action because you are well protected from repercussions by federal and state regulations. d. Contact your union to discuss your concerns and review your options.

25. Sandra, an RN on the surgery unit, is assisting with a procedure in the patient examination room. The physician orders a medication to be given through IV. Sandra questions the order, based on her knowledge of the patient's history and of other medications that the patient has been given. The physician reiterates the order and Sandra refuses to give it. In this instance, Sandra is demonstrating: a. Autonomy. b. Accountability. c. Authority. d. Best practice.

25. The unit is shifting from primary nursing to a team model in an effort to contain costs. Staff members are angry and ask for a meeting to discuss the change. After hearing their concerns related to reduction in professional autonomy and care quality, you: a. Acknowledge the loss. b. Explain the reasons for change, emphasizing the need to reduce costs. c. Repeat the information several times, giving detailed budget overviews. d. Adjourn the meeting and provide explanation through e-mail.

25. Which of the following is an outcome of managed care? a. Shift of patients to outpatient and home health services b. Less complexity in funding sources c. Less complexity in rules for consumers to follow d. Greater consistency in the quality of care

3. The Emergency Department staff decides to use a collective bargaining model for negotiation rather than a traditional trade union model. A traditional trade union model is characterized by: a. Positional conflict. b. Management support of labor's initiatives. c. A spirit of trust between management and labor. d. An ability to resolve complaints.

3. With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children's health. School health programs are: a. Increasingly seen as primary care sites for children. b. Providing only health education programs for children and their parents. c. Capable only of providing referrals for health problems to primary care providers. d. Funded exclusively by local authorities.

4. An individual in a wheelchair is applying for the position of receptionist in an outpatient clinic. The nurse manager understands that the Americans with Disabilities Act of 1990 requires that employers: a. Make reasonable accommodations for persons who are disabled. b. Allow modified job expectations for persons recovering from alcoholism. c. Hire disabled individuals before hiring other qualified, non-disabled persons. d. Treat, for purposes of employment, homosexuals and bisexuals as disabled.

4. 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: a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure. b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning. c. Blames the system for inadequate funding for resources. d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring.

5. A hospice nurse has been feeling very stressed at work because of both the physical strain and the emotional drain of working with clients with AIDS. She tries to walk 1 to 2 miles three times a week and to talk regularly with her husband about her work-related feelings. One reasonable stress management strategy would be to: a. Start taking yoga lessons. b. Make an appointment to meet with a psychiatrist. c. Start jogging 5 to 6 miles every day. d. Plan to go out for a drink with fellow nurses after work every day.

5. A staff nurse who was fired for reporting patient abuse to the appropriate state agency files a whistleblower lawsuit against the former employer. Reasons that the court would use in upholding a valid whistleblower suit claiming retaliation include that the nurse: a. Had previously reported the complaint, in writing, to hospital administration. b. Had threatened to give full details of the patient abuse to local media sources. c. Was discharged after three unsuccessful attempts at progressive discipline had failed. d. Had organized, before filing the complaint, a work stoppage action by fellow employees.

5. Nursing labor management partnerships: a. Engage nurses at all levels in problem solving for better patient care. b. Require unions and management to negotiate in good faith regarding hours of work and wages. c. Have been shown to have negligible effects on nurse turnover and patient outcomes. d. Have typically resulted in increased polarization of nurses and management, leading to formation of collective bargaining units.

5. The manager of a surgical area has a vision for the future that requires the addition of RN assistants or unlicensed persons to feed, bathe, and walk patients. The RNs on the staff have always practiced in a primary nursing-delivery system and are very resistant to this idea. The best initial strategy in this situation would include: a. Exploring the values and feelings of the RN group in relationship to this change. b. Leaving the RNs alone for a time so they can think about the change before it is implemented. c. Dropping the idea and trying for the change in a year or so when some of the present RNs have retired. d. Hiring the assistants and allowing the RNs to see what good additions they are.

5. The nurse manager wants to use evidence-based recommendations to prevent ventilator-associated pneumonia. In order to effectively gather evidence to guide practice, what is the critical first step? a. Develop the clinical question. b. Identify the databases to be used. c. Appraise the evidence. d. Integrate available evidence with unit expertise.

As a patient care advocate, you regularly coach patients on how to stay safe in health care by educating them about: a. The need to understand and record all medications being taken. b. Bringing their own linens and other personal items to the hospital. c. Washing hands frequently while in a healthcare environment and using a hand sanitizer. d. Following closely the directions and orders of healthcare providers.

6. A 66-year-old native Chinese patient, hospitalized for a myocardial infarction, asks the nurse manager about seeing his "acupuncture doctor" for treatment of his migraine headache. The best response to this patient would be: a. "How long have you been using acupuncture treatment?" b. "Do you think acupuncture relieves your pain satisfactorily?" c. "What have you told your heart specialist about your migraines and treatment?" d. "Have you tried nonprescription pain medication or been given a prescription drug for your headaches?"

6. A Magnet™ hospital surveys the staff about job satisfaction. This type of environment, in which nurses have authority and autonomy, is linked with: a. Client satisfaction with the healthcare organization. b. Organizations with a limited number of nurse managers. c. Private, specialty organizations in urban areas. d. Sophisticated academic health sciences universities.

6. A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization's changes are: a. Creating more jobs in the community for registered nurses. b. Resulting in an overall loss of jobs for registered nurses. c. Controlled by the federal and state governments. d. Controlled by the insurance agency.

6. A nurse manager must also consider a number of internal variables that will affect staffing patterns. An internal variable to be considered is: a. Organizational staffing policies. b. State licensing standards. c. American Nurses Association. d. Consumer expectations.

6. In opening a new dialysis unit, the nurse manager has to develop a philosophy for the unit. This philosophy needs to: a. Reflect the culture of the unit and its values. b. Be developed by the nursing manager on the unit. c. Identify the clients that will be served on the unit. d. Replicate the organization's philosophy.

7. The hospital administration gives approval to the chief nursing officer to hire clinical nurse specialists in staff positions rather than in administrative positions. A clinical specialist who has staff authority but no line authority typically is able to: a. Function through influence. b. Take complete responsibility for the care of clients. c. Interview and hire staff nurses for designated nursing units. d. Be granted functional authority to determine standards of nursing care and enforce them.

7. The nurse manager of an ICU wants to implement the revised policy and procedure on central line catheter care. What would be the most effective method of getting the staff nurses to incorporate a new evidence-based practice into their care? a. Conducting an interactive educational workshop b. Distributing educational materials on clinical units c. Sharing the results of a chart audit with staff d. Providing staff with a short DVD on the topic

8. A charge nurse on a busy 40-bed medical/surgical unit is approached by a family member who begins to complain loudly about the quality of care his mother is receiving. His behavior is so disruptive that it is overheard by staff, physicians, and other visitors. The family member rejects any attempt to intervene therapeutically to resolve the issue. He leaves the unit abruptly, and the nurse is left feeling frustrated. Which behavior by the charge nurse best illustrates refined leadership skills in an emotionally intelligent practitioner? a. Reflect to gain insight into how the situation could be handled differently in the future. b. Try to catch up with the angry family member to resolve the concern. c. Discuss the concern with the patient after the family member has left. d. Notify nursing administration of the situation.

8. A patient is admitted to a medical unit with pulmonary edema. His primary nurse admits him and then provides a written plan of care. What type of educational preparation best fits the role of primary nurse? a. Baccalaureate b. Associate c. Diploma d. LPN/LVN

8. Because an increasing number of Hispanic patients are being admitted, a nurse manager designs a staff-development program to help her staff understand the Hispanic culture. A nurse should understand that culture is determined by which of the following? a. Behavior b. Love for people c. Shared vision d. Genetic predisposition

8. The staff development educator presents a series of programs on stress management to the nurse managers. Research has indicated that an individual's ability to deal with stress is moderated by psychological hardiness. Psychological hardiness is a composite of: a. Commitment, control, and challenge. b. Commitment, powerlessness, and passivity. c. Commitment, control, and passivity. d. Decreased isolation, challenge, and passivity.

9. A colleague asks you to give her your password access so that she can view her partner's healthcare record. This request violates the patient's right to: a. Privacy. b. Confidentiality. c. Undue authorization of treatment. d. Protection against slander.

9. The chief nursing officer is given the task of reviewing and revising the organization's mission, philosophy, and technology. In reviewing them, the chief nursing officer understands that they should be reflected in: a. The organizational structure. b. Line and staff responsibilities. c. The policies and procedures. d. Government regulations.

9. The difference between staffing and scheduling is that staffing: a. Puts the right person in the right position. b. Puts the right person in the right time and place. c. Refers to the number of nursing hours per patient per day. d. Looks after interpretation of benefits and compensation.

9. The nurse manager for a unit's culturally diverse staff creates a staff-development program so the professional nursing staff members can enhance their understanding of cultures on the basis of published literature. The literature reveals that the following characteristic is inherent in a culture. It: a. Develops over time. b. Maintains a strong work ethic. c. Changes easily. d. Develops quickly.

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: a. Suggest that an interpreter explain the procedure to the client and answer any questions. b. Ask the client if he has any questions. c. Draw a picture to show the incision. d. Not intervene.

As a manager in a new nursing home, where might you consult for guidance and evidence to support the development of safe patient practices? a. Hospitals b. Business c. Industry d. Outpatient clinics

If you are supporting the steps in the AHRQ document "Five Steps to Safer Health Care," you would ensure that: a. Patients are actively encouraged to make decisions related to care. b. Rules and decisions are made through centralized processes. c. You monitor the performance of each staff member closely. d. Preference is given to increasing staff numbers rather than staff credentials.

In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize: a. Safety goals specific to Pleasant Valley. b. Decision-making processes. c. Sufficient staffing for safe care. d. Increased numbers of baccalaureate-prepared RNs.

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: a. QSEN. b. IHI. c. DNV/NIAHO. d. AHRQ.

1. Sarah wonders about the direction that you have given regarding management of incontinent, confused patients. She brings you evidence that she has found regarding incontinence interventions and asks you if she and you could talk about the guidance that you have given after you have had an opportunity to read the articles she has given you. This is an example of (select all that apply): a. Assertiveness. b. Followership. c. Management. d. Insubordination.

a b

2. With regard to nursing practice, nurse managers are held responsible for (select all that apply): a. Practicing within legal guidelines established under state law and nurse practice acts. b. Ensuring that nursing staff under their supervision are currently licensed to practice. c. Referring all errors in nursing judgment to state discipline boards. d. Ensuring that physicians are properly licensed to provide care on patient care units.

a b

1. As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, because evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply): a. Increased salary costs. b. Duplication of tests and procedures. c. Graduate medical education. d. Potential damage to reputation through learner error.

a b c

1. Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Potential outcomes of Martin's actions include (select all that apply): a. Poor morale on the unit. b. Disruption in community relationships. c. Corruption of patient-staff relationships. d. Patient outcomes for quality care are met.

a b c

1. A nurse manager introduces prompted voiding into nursing practice on a unit, which is supported by clinical guidelines based on evidence-based practice. The nurses on the unit resist implementation, indicating that the bathroom facilities are too far away for efficient implementation of the guidelines, and that resources are too few to accomplish the initial voiding observations. For the nurse manager in this situation, it is important to have further discussion with the staff regarding (select all that apply): a. Compatibility of this intervention with the values of staff on the unit. b. Advantages of prompted voiding over incontinence products and catheterizations. c. Usefulness of prompted voiding with the particular population of patients on the unit. d. Feasibility of the program with respect to unit design.

a b c d

1. High levels of work-related stress affect all but which of the following? (Select all that apply.) a. Job satisfaction b. Absenteeism and turnover c. Nurses' health d. Client welfare

a b c d

1. One of your staff nurses asks for your advice because a patient refuses to sign a consent for surgery. The patient says that he won't sign because he doesn't understand the nature of the surgery. You advise that (select all that apply): a. Consent must not be coerced. b. The patient has a right to choose not to consent. c. The patient must sign the consent because the doctor wants him to sign. d. Witnessing a consent is related only to the voluntary nature of the signature.

a b d

1. Examples of sentinel events include (select all that apply): a. Forceps left in an abdominal cavity. b. Patient fall, with injury. c. Short staffing. d. Administration of morphine overdose. e. Death of patient related to postpartum hemorrhage.

a b d e

1. Your organization has made a decision to implement TCAB in your hospital. As a manager, what strategies would you use to implement TCAB? (Select all that apply.) a. Encourage recognition among staff of their knowledge of the patient-care environment. b. With staff, select small changes for consideration. c. Select only projects that have widespread impact. d. Secure external advisors to evaluate innovation. e. Present ideas based on best practices and ask staff for advice on implementation.

a b e

. Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)? a. Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement. b. George is very shy and withdrawn. He asks the nurse to leave him alone. c. 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. d. 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.

a c d

1. In reviewing the job description of a nurse manager, the staff becomes aware that a nurse manager's role is complex. Which of the following duties are required of a nurse manager? (Select all that apply.) a. Ensure unit productivity reports. b. Develop policy and legislation to protect nurses' well-being. c. Plan staffing of UNPs only. d. Prepare a unit budget that reflects unit staffing needs. e. Monitor nurse-sensitive indicators such as falls and incidence of infections.

a d e

1. A nurse manager of a 20-bed medical unit finds that 80% of the patients are older adults. She is asked to assess and adapt the unit to better meet the unique needs of the older adult patient. Using complexity principles, what would be the best approach to take in making this change? a. Leverage the hierarchical management position to get unit staff involved in assessment and planning. b. Engage involved staff at all levels in the decision-making process. c. Focus the assessment on the unit, and omit the hospital and community environment. d. Hire a geriatric specialist to oversee and control the project.

1. According to Leininger, "cultural imposition" is a major concern in nursing because nurses have a tendency to impose their values, beliefs, and practices on patients of other cultures. The discussion topic most likely to be without cultural imposition would be: a. Abortion. b. Wound management. c. Blood transfusion. d. Advance directives.

10. A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI. a. "Last year, the management team established new outcomes that addressed issues such as medication errors." b. "At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'" c. "A process audit was done recently to determine how much time was being spent on patient documentation." d. "Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error."

10. What is a strategy that can be used by a small community hospital with limited resources to develop an evidence-based nursing practice program? a. Hiring a nurse researcher b. Partnering with nurse researchers at a local university c. Subscribing to journals devoted to evidence-based nursing d. Including research competencies in managers' job descriptions

11. Healthcare organization X is committed to improving patient outcomes and, as part of the QI process, examines its executive structure and organizational design. This approach recognizes: a. The importance of decentralized structure in QA. b. That structure influences nurse burnout and participation in quality improvement initiatives. c. The need to ensure sufficient supervisory staff to respond in a corrective manner when mistakes occur. d. That a narrow hierarchy ensures accountability for errors and outcomes.

11. Tara, the unit manager, is telling her colleague about her recent project, which involves seeking the most effective approaches to incontinence care, with the intention of adopting evidence-supported approaches on her dementia care unit. Her colleague suggests that translation of research into practice is: a. Less important than knowledge-generating research, which is required to advance the nursing profession. b. A priority of all healthcare practitioners to improve patient care. c. Characterized by lack of knowledge about how to use evidence to guide practice. d. So difficult that it is useless to begin the query in the first place.

11. Within the deaf culture, there is considerable disagreement about the use of SEE (Signed Exact English) and ASL (American Sign Language). This is indicative of: a. Dominant versus nondominant behaviors. b. The need to recognize diversity within groups. c. The impact of cross-culturalism. d. How language separates subgroups.

11. You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate: a. Is correct. Leadership is not the role of the staff nurse. b. Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals. c. Has been influenced by nurse leaders and managers who leave for other positions. d. Is related to the general perception that nurse leaders and managers are not satisfied in their jobs.

12. "At Thoroughcare, we provide health care for women and children in transition" is an example of a: a. Vision statement. b. Mission statement. c. Goal statement. d. Statement of philosophy.

12. In accomplishing the goal of breakfast for children in elementary school, Leanne is particularly effective in approaching businesses with the needs that the group has determined and articulating the ways that the group has found for businesses to participate. Leanne is exemplifying: a. Leadership. b. Followership. c. Professionalism. d. Knowledge of context.

12. Staff members on your unit raise concern that there is rising acuity on the unit and lack of responsiveness in addressing these needs through appropriate staffing. They point to increased incidences of adverse and sentinel events on the unit. To address this concern, your hospital organization would do best to: a. Implement a patient classification system immediately. b. Participate in databases that compare the outcomes and staffing levels versus those of institutions similar to yours. c. Provide increased numbers of staff to the unit. d. Ignore such concerns because acuity is variable.

13. A particular classification system assigns revenue according to the functional capacity of patients and the progression of patients during their stay in rehabilitation units. More independent patient activities, such as prompted voiding, require higher staff utilization than dependent activities but do not result in increased staff resources. This is an example of: a. Bureaucracy. b. Concern related to the validity of classification systems. c. Inadequate reliability of classification systems. d. Inappropriate subjectivity in making judgments about staffing.

13. The clinical guidelines for management of incontinence developed by the Registered Nurses Association of Ontario (RNAO): a. Reflect practice that is fiscally directed and sound. b. Articulate practice recommendations developed from synthesis and review of evidence. c. Are intended to increase awareness of issues in incontinence management. d. Reflect a compilation of information from a variety and range of sources related to incontinence.

13. The parents of a toddler who dies after being brought to the ER launch a lawsuit, claiming that the failure of nurses to pursue concerns related to their son's deteriorating condition contributed to his death. The senior nurse executive is named in the suit: a. As a global respondent. b. Under the doctrine of respondeat superior. c. As a frivolous action. d. Under the element of causation.

14. An example of role stress occurs when: a. The director of the ICU and the manager of the surgical unit wish to hire the same new employee. b. Two part-time staff members are hired to work in a unit, but the job expectations for them are not clear, and the head nurse expresses disappointment in their performance. c. The nurse manager for the ICU wants to advocate for more staff and finds it difficult to find data to substantiate his proposal. d. Line managers believe that support staff use their technical knowledge to intrude on their authority.

14. Chart audits have revealed significant omissions of data that could have legal and funding guidelines ramifications. As the unit manager, you meet with the staff to discuss audit findings and to find approaches that will address the gaps in charting and achieve desired goals. This is an example of: a. Leadership. b. Management. c. Decision making. d. Vision.

15. Nurses on the dialysis unit notice that changes in labeling of fluids have meant several alarming near misses in terms of wrong administration of fluids. They take this concern to the unit manager. As an advocate of nurse autonomy, the most appropriate response in this situation would be to: a. Ensure that the nurses are aware of the reasons for the change and how the decision was made about the new labels. b. Discuss concerns about the labels and develop potential solutions that take into account changes that can be made at the local level and those that need system intervention. c. Suggest that the staff wait until they have become more familiar with the labels before taking further action. d. Tell the staff that you will notify the pharmacy about these concerns and leave it up to the pharmacy to decide what should be done.

15. You are excited by evidence supporting the use of PDAs at the bedside to improve documentation and patient outcomes. You have disseminated the information through discussions and e-mails and are now ready to begin the process of considering implementation on the unit. To develop positive attitudes toward the use and implementation of the technology, you would discuss your ideas with (Rogers' diffusion of innovations theory): a. Harvey, RN, a technology guru, who enthusiastically tries on all new software. b. Berta, RN, who thoughtfully considers evidence and regularly uses it to try new approaches in her practice. c. Carol, LPN, who is positive about new ideas but looks to her friends for their ideas about whether or not to try something new. d. Ben, a 10-year veteran of the unit, who wonders why technology should be used at all. He says that he will use it when there is no chance of security breaks.

16. Martin, the unit manager, receives complaints from community agencies that patients who have been discharged from his unit seem to lack understanding about their disorder and immediate strategies for managing elements of their care. Martin checks the patient teaching sheets and notes that the sheets are initialed by staff. He calls the agencies and indicates that teaching has been done. Martin's follow-up to complaints from the community is: a. Appropriate and indicates that he has assumed accountability for the actions of his staff. b. Indicative that he does not clearly understand the concept of accountability. c. Indicative of strong support for his staff and their autonomy. d. Important in clarifying the difference between his accountability and that of the community in patient care.

17. At Hospital XYZ, staff members on Y3 have dealt with the third head nurse in three years. Donna, the current head nurse, lacks confidence in patient-nurse relationships, and scheduling and other processes are routinely left to the last minute. Staff members approached Donna first and then administration with their concerns about Donna's effectiveness as a leader. The staff was told that the problem is likely staff related, that it is simply an unhappy group, and that there is nothing that will be done further about their concerns. The philosophy of the organization indicates that "open, transparent communication between staff and management is desired and supported," and that "innovation and creative thinking are the foundation of the organization's progress." In assessing this situation as a newly hired senior executive, you anticipate that: a. Staff members will resolve the conflict on their own. b. The situation will lead to ongoing disgruntlement and attrition. c. No further discussion or concerns will come out of the situation. d. The head nurse will be able to resolve the conflict on her own.

17. Which ethical principle is primarily involved in informed consent? a. Veracity b. Autonomy c. Beneficence d. Nonmaleficence

17. Which of the following would be most effective in implementing the findings of Dobbins et al. on treating problems associated with bowel motility? a. Lecture by a nurse practitioner b. Workshop for surgical nurses that involves discussion of case studies and application of evidence c. Discussion of the findings on the bulletin boards at the workstation d. Education of unit opinion leaders regarding the evidence presented in the studies

18. As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans hospitals provide: a. Primary care and are privately funded. b. A range of services and are responsible to government and taxpayers. c. Secondary care only and are publicly administered and funded. d. Services to veterans under an HMO.

18. Jeff, an RN in his 30s, has lost a parent, just purchased a new home, and is laid off with 6 months' severance pay. At the same time, Jerry, an RN in his 50s, is financially secure and is asked to take early retirement with a buyout. How will the two men react to the emotional and physical influences and the sequence of stress? a. The younger man will feel more stress. b. The two men may or may not feel the same amount of stress. c. The older man will feel more stress. d. Neither man will experience any stress.

18. Joan, the nursing unit manager, finds it difficult to work with Thomas, a new graduate. Thomas has many ideas, and his manner of presenting them irks Joan. After reflection and discussion with others, Joan recognizes that she also feels threatened by his behavior. She comes to understand that Thomas is trying to establish his own role on the unit, is not trying to challenge her, and needs guidance, coaching, and affirmation. Joan is demonstrating: a. A positive self-concept. b. Deepening self-awareness. c. Leadership. d. Acquiescence.

19. During performance appraisal, you praise Xia for her attention and care to nursing details. You suggest that her care would be further enhanced by greater acknowledgment of patients' feelings. Xia bursts into tears and leaves the office. Later, you learn that criticism is perceived as akin to failure in Xia's culture. You reflect on how you could modify your approach in the future to acknowledge different cultural interpretations of feedback. Your response is indicative of: a. Bias. b. Cultural awareness. c. Cultural diversity. d. Ethnocentricity.

19. Government and third-party payers announce reduction of compensation for the delivery of patient services. Hospital STV has a flat organizational structure. After the funding announcements, senior officials at the hospital meet and make decisions regarding cost containment of new revenue streams. This action is consistent with: a. The practice of leaving financial decisions with senior officials who understand the total context of funding. b. A tendency to concentrate decision making during economic downturns at the top administrative level. c. A need to make expedient decisions that are likely to be poorly received by staff. d. Ensuring that decisions with regard to cost are made equitably across all departments.

2. A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. An HMO: a. Provides more expensive care than other types of insurance plans. b. Has a centralized administration that directs and compensates physician services. c. Pays physicians on a fee-for-service basis. d. Does not pay as much for acute care as other practice plans.

2. A small rural hospital has been designated as a critical access hospital. It has 40 beds and an average occupancy of 34 beds. To prepare the staffing, the chief nursing officer computes the occupancy as being: a. 90%. b. 85%. c. 75%. d. 60%.

20. As a leader on a rehab unit, you encourage all staff members to see themselves as having a role in decision making and quality care. You see your role as involving particular responsibilities in decision making but not as a hierarchal role. This view of decision making and leadership is consistent with: a. Trait theories. b. Complexity theory. c. Situated theory. d. Emotional intelligence.

20. In transitioning to a primary nursing model, it is important for a nurse manager who enjoys a high level of control over patient care to understand that his or her decision making at the patient care level: a. Is increased. b. Is decreased. c. Is relinquished. d. Remains the same.

20. Tracy is an RN case manager who interfaces between the Centers for Medicare & Medicaid. Tracy's responsibilities most likely would include: a. Managing physician-led research. b. Monitoring physician documentation of the need for medical care. c. Determining which services are designated fee-for-service. d. Identifying errors in physician diagnoses.

21. In a telehealth organization, a nurse who is licensed in New York and Pennsylvania provides teaching to a patient who resides in Pennsylvania. The patient charges that the teaching failed to provide significant information about a potential side effect, which led to delay in seeking treatment and untoward harm. Under which state nurse practice act and standards would this situation be considered? a. New York b. Pennsylvania c. Neither New York nor Pennsylvania d. Both New York and Pennsylvania

21. On Unit 62, the nurses and the unit manager have been involved in shared decision making related to the model of nursing care delivery that the unit will adopt. All individuals have participated and been involved in decision making and implementation of changes. When issues arise during implementation, it is expected that: a. Accountability resides entirely with the unit manager. b. Individual expertise will be utilized to provide solutions, but that responsibility for the change is shared. c. No one really has any accountability or responsibility for the changes. d. This will contribute to widespread skepticism among the staff about the probability of success.

21. Sarah, RN, complains to you that a male nurse from a different culture sits very close during charting and leans toward her when speaking. In responding to Sarah, you consider that differences across cultures that are relevant to this situation include: a. Eye contact. b. Personal space. c. Harassment. d. Expressions of feeling.

21. You are considering putting forward a proposal to move the model of care from team nursing to a primary nursing hybrid: patient-focused care model. In considering this proposal, you recognize that significant costs specific to operationalizing this model are related to: a. Implementation of an all-RN staff complement. b. Significant changes in the physical structure of units. c. Orientation of staff to new roles and responsibilities. d. Testing and piloting technology at the bedside.

22. A member of a patient's family calls the nurse manager of the palliative care unit to express concern that a member of the family, who died on the weekend, had requested analgesics from the RNs on duty. An RN came with the analgesic nearly 45 minutes later, just after the patient had died. The manager is aware that the unit was especially busy that weekend because many patients were seriously ill, staff had called in ill, and the staffing manager was unable to completely replace staff who were absent. The manager is deeply troubled that the family member had to die in pain because it violates what she knows should have been done. This manager is experiencing: a. Compromised agency. b. Moral distress. c. Moral sensitivity. d. Moral dilemma.

22. The education consultant at St. Joseph's Hospital is giving a workshop on cognitive reframing. The consultant explains that cognitive reframing reduces stress by: a. Aiding individuals in identifying positive stressors. b. Helping people realize that negative thinking causes emotional distress. c. Eliminating negative stressors. d. Replacing positive self-statements with negative irrational beliefs.

22. 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: a. Physician-sensitive and nonmeasurable. b. Measurable and nursing-sensitive. c. Precise, measurable, and physician-sensitive. d. Patient care-centered and nonmeasurable.

22. To project staffing needs and to avoid understaffing, it is important that nurse managers consider which of the following? a. Maximum productive hours b. Average nonproductive hours c. Minimum benefit hours d. Maximum vacation time

23. During a staff meeting held to discuss developing a mission statement for the unit, the idea of placing patient needs first is: a. Empowering. b. A leadership tag. c. A symbol. d. A management task.

23. While walking past a patient's room, you overhear one of the RN staff telling a patient that the patient has no right to refuse chemotherapy treatment because the family and the doctor think the treatment is the best option for the patient. This patient is 40 years of age and alert. When you meet later to discuss what you heard with the RN, it is important to: a. Discuss how statute law enforces the right of the doctor, but not of families, to ensure that patients comply with recommended treatment plans. b. Discuss that statute law provides for patient autonomy and refusal of treatment. c. Remind the nurse to provide clearer explanations to aid in the patient's comprehension of the treatment and compliance. d. Acknowledge the nurse's role in ensuring that she does not fail in her duty of care for the patient.

24. In hiring nurses during the transition from team nursing to a primary nursing model, Benner's work would suggest that you give priority to nurses who are at least at which level of competency? a. Advanced beginner b. Competent c. Proficient d. Novice

24. Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. Sarah's response is based on her: a. Cultural marginality. b. Circle of familiarity. c. Cultural understanding. d. Acculturation.

25. Volunteers in a study are assigned randomly to groups. Some of the volunteers receive an herbal supplement that is reputed to control nausea, and some of the volunteers are assigned to a control group where a placebo is administered. This is an example of a(n): a. Longitudinal study. b. RCT. c. Meta-analysis. d. Appraisal tool.

3. 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: a. Explaining to the staff that disciplinary action will be taken in cases of additional errors. b. Recommending that a multidisciplinary team should assess the root cause of errors in medication. c. Suggesting that the pharmacy department should explore its role in the problem. d. Changing the unit policy to allow a certain number of medication errors per year without penalty.

3. As a nurse manager, the one activity you should not overlook is: a. Posting the yearly rotation schedule. b. Reviewing vacation requests. c. Scheduling staffing for holidays 6 months in advance. d. Anticipating staff sick days.

3. One of the staff nurses on your unit makes the comment, "All this time I thought Mary was black. She says she is Jamaican." The best response would be to say: a. "Who cares what she is?" b. "What did you think when you learned she was Jamaican?" c. "Why did you assume she was black?" d. "We have never had a Jamaican on this unit."

3. The chief nursing officer and the dean of the School of Nursing believe that by establishing rules and regulations and controlling the environment, this partnership will: a. Promote professional medical authority, autonomy, and responsibility. b. Need a degree of flexibility to engender success. c. Be essential for self-governance. d. Provide for the establishment of medical committees.

3. When interviewing an applicant for a position, the nurse manager describes the unit's care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be: a. The case method. b. Functional nursing. c. Primary nursing. d. Nurse case management.

4. As a nurse manager, you trial a new pain scale on your unit that is supported by numerous research studies. You compare the patient outcomes with the new scale against the existing scale. Feedback from staff suggests that the new scale is too difficult for patients who have limited language skills and who are already under duress to understand. The difficulty in implementing the new scale refers to testing: a. Efficacy. b. Effectiveness. c. Practice failure. d. Comparative error.

4. At a second negotiation session, the unit manager and staff nurse are unable to reach a resolution. It would now be best to: a. Arrange another meeting in a week's time so as to allow a cooling-off period. b. Turn the dispute over to the director of nursing. c. Insist that participants continue to talk until a resolution has been reached. d. Back the unit manager's actions and end the dispute.

4. In matrix organizational structures, a nurse manager understands that this type of structure: a. Is a simplified organizational structure. b. Has both a functional manager and a service or product-line manager. c. Arranges departments strictly according to function. d. Promotes harmony in organizational decision making.

4. The chief nursing officer utilizes the hospital's workplace advocacy to help the overwhelmed Emergency Department staff. Workplace Advocacy is designed to assist nurses by: a. Creating professional practice climates in their institutions. b. Equipping them to practice in a rapidly changing environment. c. Negotiating employment contracts. d. Representing them in labor-management disputes.

4. The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services: a. Care for the specific needs of individual families in the community. b. Focus on the treatment of community-wide problems rather than on individual health problems. c. Do not include services provided by public health departments. d. Provide personal health follow-up for all acute care hospitalizations.

4. 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? a. Talk to the staff individually to determine why this is occurring. b. Call a meeting of all staff to discuss this issue. c. Have a group of staff nurses review the established standards of care for postoperative patients. d. Document which staff members are not recording vital signs, and write them up.

5. The IOM Health Professions Education report highlighted patient safety concerns as: a. A normal risk in professional practice. b. A result of disciplinary silos. c. A reflection of frontline staff. d. Related to systems errors.

6. A strategic goal developed by the chief nursing officer is to implement an evidence-based practice program. What is an appropriate strategy that can be used by a nurse manager who is beginning to implement an evidence-based practice program? a. Conducting a review of adverse events and incident reports b. Soliciting input from staff members c. Reviewing specialty organization guidelines d. Identifying patients with extended lengths of stay

6. As the RN charge nurse on the night shift in a small long-term care facility, you've found that there is little turnover among your LPN and nursing assistant (NA) staff members, but they are not very motivated to go beyond their job descriptions in their work. Which of the following strategies might motivate the staff and lead to greater job satisfaction? a. Ask the director of nursing to offer higher wages and bonuses for extra work for the night LPNs and NAs. b. Allow the LPNs and NAs greater decision-making power within the scope of their positions in the institution. c. Hire additional staff so that there are more staff available for enhanced care and individual workloads are lessened. d. Ask the director of nursing to increase job security for night staff by having them sign contracts that guarantee work.

6. Before beginning a continuous quality improvement project, a nurse should determine the minimal safety level of care by referring to the: a. Procedure manual. b. Nursing care standards. c. Litigation rate of unsafe practice. d. Job descriptions of the organization.

6. The nurse manager at a cardiac rehabilitation unit was asked to select a care delivery model. Which of the following methods would be the most cost-effective? a. Functional method b. Case management method c. Primary care method d. Team method

7. A nurse manager uses many sources of data when planning the unit's workload for the year. Which of the following data must be considered in the planning? a. Hours of operation of the unit b. Trends in acuity on the unit c. Maximum work stretch for each employee d. Weekend requirements

7. The chief nursing officer listens to nurse managers verbalize their feelings of internal stress. One common source of internal stress seems to be: a. The death of a loved one. b. Perfectionism. c. Getting married. d. Losing a job.

7. To reduce the incidence of falls in a skilled nursing unit, the nurse manager contacts the risk manager. Risk management is a process that attempts to identify potential hazards and: a. Compensate for previous injuries. b. Eliminate these risks before anyone else is harmed. c. Supersede the need for staff members to file incident reports. d. Discipline staff members who have been involved in previous incident reports.

8. Before implementation of the new policy and procedure on central line catheter care, the nurse manager uses an appraisal system to evaluate the evidence. What is important in using an appraisal system to evaluate the evidence gathered in preparation for development of a new protocol? a. Limiting the search to randomized clinical trials b. Matching the appraisal tool to the type of evidence c. Eliminating qualitative research studies d. Using only pre-processed evidence

8. One means of ensuring that nurses floated to other patient care areas in healthcare organizations are qualified to work in those areas is: a. Employing additional staff to assist with orientation processes. b. Cross-educating staff members to other areas of the institution. c. Transferring patients to units where the staffing pattern is optimal. d. Orienting staff members to all patient care areas as part of their general orientation to the institution.

9. The Emergency Department staff members are concerned that working long hours without rest puts patient safety at risk. One staff member decides that she will risk her job and become a whistleblower. Whistle-blowing is an appropriate recourse when management: a. Disregards due process when disciplining a nurse. b. Delays responding to repeated efforts to provide safe care. c. Hires nurses who are not a part of the union during a strike. d. Refuses to bargain in good faith with the elected bargaining agent.

9. The chief nursing officer understands that a nurse manager can exhibit stress that is related to trying to keep up with the number of electronic messages that arrive, as well as trying to remain accessible to staff. What is a strategy that would assist the manager to manage the information overload effectively? a. Ignore messages unless they are labeled as important. b. Determine who is most likely to send useful or important information or requests. c. Check e-mail messages once a day. d. Encourage face-to-face meetings rather than e-mail.

9. With the rise of violence in the psychiatric department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should: a. Request all staff to accept new risk management practices. b. Hold staff accountable for safe practices. c. Document inappropriate behavior. d. Hire more police security.

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: a. Staffing. b. Funding. c. Composition of executive councils. d. Composition of consumer-based councils.

ckground, you recognize that the candidate's lack of eye contact reflects the candidate's cultural sensitivity. You are exhibiting: a. Acculturation. b. Cultural sensitivity. c. Ethnocentrism. d. Transculturalism.

1. As a nurse manager, you have to be effective in managing a culturally diverse staff. Which of the following nurse manager attributes would assist you in addressing the cultural needs of your staff (select all that apply)? a. Stereotyping of others b. Respecting others c. Understanding the importance of language d. Encouragement of potential in all staff e. Age bias f. Disrespect for others

b c d

1. 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: a. Collect data to determine whether standards are being met. b. Implement a plan to correct the problem. c. Identify the standard. d. Determine whether the findings warrant correction.

1. As a nurse manager, you observe a staff nurse who over the past few weeks has become withdrawn and has had several absences due to minor ailments. Your best action would be to: a. Ask the nurse if she is okay during report. b. Refer the nurse to the employee assistance program. c. Ask the nurse to meet with you for a few minutes before she leaves for the day. d. Write a note to the nurse advising her that her work attendance must improve.

10. In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is: a. Changes in staffing patterns. b. Increasing reports of violence in the workplace. c. The increasing percentage of the population that will be over age 65. d. Escalations in the cost of health care.

10. On your nursing unit, you employ LPNs, RNs, and advanced practice nurses. You will need to be familiar with at least: a. Two nursing practice acts. b. Two nursing practice acts in most states. c. At least one nursing practice act. d. One nursing practice act and a medical act.

10. The case method of care delivery could be best justified in which of the following scenarios? a. Stable patient population with long-term care and family needs b. Acute care surgical unit with predictable postsurgical outcomes and many technical procedures c. Pediatric intensive care unit that heavily involves families as well as patients d. Home healthcare environment with patients at varying levels of acuity

10. The facilities department is experiencing some challenges and is undergoing reorganization. Because of your familiarity with systems theory, you: a. Know that this challenge is their issue and that it has nothing to do with your unit. b. Understand that such events are localized and do not have an impact on the organizational culture. c. Know that the nature of challenges and reorganization in facilities will have an impact on other areas. d. Anticipate that your prior experiences with facilities have no effect on the current situation.

11. A factor evaluation system: a. Utilizes financial data to determine number of staff-to-patient ratios. b. Utilizes DRGs to determine acuity on a unit. c. Combines interventions and time required for interventions to determine levels of care required. d. Combines financial resources and nursing interventions to determine patient contact hours.

11. In an inner-city area, a group of nurses meet and develop a plan to negotiate with local businesses to support a breakfast program for young elementary schoolchildren. This is an example of: a. Community development. b. Collective bargaining. c. Collective action. d. Shared governance.

11. Which of the following statements would best define stress? Stress is: a. The comfortable gap between how we like our life to be and how it actually is. b. Everyday life, both the highs and the lows. c. A consequence or response to an event or stimulus that can be positive or negative. d. Identical to distress.

12. A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." The nursing care delivery model most likely employed in this situation is: a. Differentiated practice. b. Team nursing. c. Functional nursing. d. Case management.

12. After searching the literature, Tara, the unit manager develops a table that outlines the findings of studies on management of incontinence. She then examines the studies in terms of risk and whether the findings fit within her practice context and for her population of moderately to severely cognitively impaired patients. This is which phase of Stetler's research utilization model? a. Preparatory b. Validation c. Evaluation d. Application

12. Healthcare organization XYZ provides women's health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered: a. Primary care, specialized. b. Tertiary care, long-term. c. Acute care, specialized. d. Public care, specialized.

12. You walk into Mr. Smith's room and find him yelling at the LPN, Miss Jones. He is obviously very upset and after you speak with him regarding his behavior, you determine that he has not slept for three nights because of unrelieved pain levels. The LPN is very upset with Mr. Smith and calls him an "ugly, old man." You acknowledge her feelings and concerns and then suggest that Mr. Smith's behavior was aggressive but is related to lack of sleep and to pain. You say to Miss Jones, "Can you both, together with Mr. Smith, determine triggers for the pain and effective approaches to controlling his pain?" This approach demonstrates: a. Lack of empathy and understanding for Miss Jones. b. Concern with placating Mr. Smith. c. Leadership behavior. d. Management behavior.

14. A primary care clinic is established in Pleasantville to provide comprehensive services to infants, children, and families within the community. The executive director of the clinic oversees physician and nursing services for infants, children, and families; a neurodevelopmental clinic; psychology, family counseling, and social work services; nutritional counseling; speech and hearing services; and physiotherapy. This type of organizational structure is known as: a. Hierarchical. b. Bureaucratic. c. Service-line. d. Matrix

14. Mary joins 5W nursing unit. Mary is a new graduate who is anxious to fit in. She soon learns that some of her "book learning" is being criticized by her colleagues, so she adapts her practice to what others on the unit are doing. She is demonstrating: a. Cultural awareness. b. Cultural sensitivity. c. Acculturation. d. Cultural marginality.

15. At Health Center XYZ, staff members on the rehab unit have a head nurse who is intolerant of error and publicly chides anyone who makes a mistake. Over time, the rules on the unit dictate that mistakes are hidden and that areas of concern related to the functioning of the unit are discussed in tub rooms and are never openly discussed during periodic meetings. New staff members are quickly made to realize that silence is expected. The situation described is an example of: a. Ethnicity. b. Work environment. c. Work culture. d. Marginalization.

15. In which of the following situations would you expect low morale and frustration? a. Statement of philosophy indicates "We value our staff." When staff members leave, careful evaluation is done to determine whether staff should be replaced by full- or part-time employees. b. Practices include annual staff recognition celebrations. During times of change, staff members are actively included in issue identification and solution finding. c. Recruitment ads promise opportunities for advancement for everyone. Promotions are given only to individuals with long-standing service and entrenched relationships. d. The vision indicates that there is strong commitment to lead in research. The organization has tried to implement a strong campaign to attract leading nurse researchers but has experienced difficulty in doing so.

15. You volunteer at a free community clinic. A 13-year-old girl claims to have been diagnosed with SLE and presents with chlamydia. The team leader at the clinic advises that: a. The state-defined age of legal consent is 18; therefore, no treatment can be delivered. b. The teen is underage and should be referred to the family general practitioner. c. Care can be provided as long as consent is voluntary and information about treatment and options is provided. d. Treatment is provided as long as telephone consent is obtained from a parent or legal guardian.

16. A family is keeping vigil at a critically ill patient's bedside. Other, distant family members, not yet able to come, call the unit continuously, asking for updates and wanting to express concern. You speak with the distant family members and suggest that you are going to refer them to the hospital social worker, whose role is to work with people in such situations. In response to this situation, you approach the unit manager to apprise her of your concerns that the family dynamics of the patient involved may lead to staff-family and patient-family conflicts. You suggest that the physician may need to discuss the treatment plan with the family. The unit manager advises that he will arrange this discussion. If, after the meeting with family members, this is identified as a desired approach, you support the manager's decision. Your actions indicate that you are acting in what role? a. Leadership b. Management c. Follower d. Evidence-based

16. In evaluating weekend mortality rates, the head nurse on the cardiac unit is surprised to find that they are higher than on weekdays. In exploring the reasons for this apparent anomaly, the head nurse focuses on: a. Availability of diagnostic personnel. b. Availability of physicians. c. Communication with on-call providers. d. Acuity level of patients.

16. To effectively delegate in a team nursing environment, the RN team leader must be familiar with the legal and organizational roles of each group of personnel and must: a. Be able to effectively communicate with patients. b. Build relationships with physicians. c. Be able to adapt to daily changes in staffing. d. Adapt in communicating information to her supervisor

17. A nurse manager questions the true difference between primary nursing and total patient care. After careful consideration of both models, the nurse manager concludes that primary nursing differs significantly from total patient care in: a. Breadth of nursing knowledge and expertise required. b. Intention to provide holistic nursing. c. Degree of task orientation. d. Levels and types of assessment.

18. A new CEO has been hired at Valley Hospital who proposes to change the centralized organizational structure that was put in place ten years ago, based on widespread consultation with staff. The proposed structure involves substantial flattening of the organizational structure, with significant decision making being made at the point-of-care and an emphasis on interprofessional collaboration. There is a great deal of discussion about the balance between hospital-wide budget decision making and unit-based decision making. This discussion represents: a. Chaos theory. b. Organizational redesign. c. Organizational reengineering. d. Restructuring.

18. As a manager, you are responsible for two separate units: a CCU and a cardiac step-down unit. The organization and relationships on these units are distinct and very different from one another. Your decision has been to support the uniqueness of these units because each is effective in different ways in providing patient care. This approach is consistent with which principle? a. Transculturalism b. Cross-culturalism c. Multiculturalism d. Acculturation

18. The principle that requires nurses to uphold a professional code of ethics, to practice within the code of ethics, and to remain competent is which of the following? a. Veracity b. Autonomy c. Fidelity d. Honesty

19. A group of patients with early Alzheimer's disease and their spouses approach you regarding help with the establishment of a local Alzheimer's Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, what suggestion or advice would you offer this group? a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and therefore, the patients and families should need no help from your clinic. b. Your healthcare organization would be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management. c. Through partnership, you will provide supports, if possible, that the patients and spouses themselves identify as necessary in the establishment of the group. d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

19. Patient perceptions are useful in: a. Determining disciplinary actions in QI. b. Establishing the competitive advantage of QI decisions. c. Providing one source of data for QI initiatives. d. Establishing blame for poor-quality care.

2. A hospital is working toward becoming a Magnet™ hospital. The chief nursing officer is aware that professional nursing departments of the future will: a. Not be directed by nurses. b. Be virtual organizations. c. Be designed to maintain nursing standards of practice. d. Be entitled to have client care departments.

2. A staff nurse in the area that you manage has excelled in the delivery of patient education. You are considering implementing a new job description that would broaden her opportunity to teach patients and orient new staff members to the value of patient education. The ethical principle that you are most directly reinforcing is: a. Justice. b. Fidelity. c. Paternalism. d. Respect for others.

2. Cultural diversity is the term used to describe a vast range of cultural differences. Events have symbolic meanings for the nurse manager and the staff. The event that would be most likely to provide symbolic meaning to a nurse manager and staff is a: a. Task force formed to commemorate a New Year's celebration in the Western tradition. b. Project to provide Christmas gifts to the children in a daycare program. c. Celebration of National Nurses Week with the focus on cultural care. d. Task force to develop a poster for the unit depicting religions of the world.

2. The Emergency Department nurses' decision to organize for the purpose of collective bargaining is being driven by a desire to: a. Establish the staffing pattern that will be used. b. Determine the hours that one is willing to work. c. Create a professional practice environment. d. Protect against arbitrary discipline and termination.

2. 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? a. Determining who is responsible for the falls b. Strengthening unit policies to avoid inappropriate admissions c. Encouraging involvement of nurses in education related to falls and safety d. Ensuring that patients are appropriately restrained if they are at risk for falls

2. 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: a. Promotes teamwork among healthcare providers. b. Increases adverse events. c. Improves outcomes. d. Contributes to duplication of services.

20. At an organizational level, which of the following strategies would assist in ensuring that EBP is incorporated into nursing care? a. Formation of nursing-only implementation teams b. Restriction of evidence to RCTs c. Formation of a network of individuals doing research and/or interested in research utilization d. Avoidance of partnership with experienced researchers

20. In Hospital STV, senior administration is strongly oriented toward fiscal and social conservatism. The nursing department is deeply concerned with the provision of quality to the community, which includes a high number of poor and unemployed. To accomplish the goals of the nursing department, resources need to be allocated that administration is not able to allocate. Nursing and administration: a. Are engaged in shared governance. b. Are involved in an irreconcilable conflict of interests. c. Represent separate subcultures in the institution. d. Represent union and nonunion conflict.

20. In a job interview for a staff position, which of the following indicates your knowledge of patient safety? a. "Will I be able to get overtime hours on your unit?" b. "If there is an opportunity to work extra shifts, I would really like that." c. "Is there a strategy in place to reduce the number of overtime hours on the unit?" d. "I see no reason why I wouldn't be able to work overtime."

21. In the Unity Healthcare organization, decisions, including those at the unit level, are made by a group of senior executives. Rules for employees are clear, and nursing care is delineated by procedures and protocols. This exemplifies: a. Transformational leadership. b. Transactional leadership. c. Bureaucratic organization. d. Chaos theory.

21. You recently acquired a position as a unit manager. During your time on the unit, you have formed a strong social network among your staff, have promoted the development of relationships between your staff and workers in other areas of the organization, and have formed relationships that generate ideas from patient organizations and the local nursing education program. According to complexity theory, you are engaging which principle? a. Empowerment b. Systematic thinking c. Development of networks d. Bottom-up interactions

22. A new graduate RN joins your unit. After a few weeks, she complains about some of her peers on the unit and compares their practices negatively to what she learned in her nursing program. She also is vocal about how she has learned so much here that she did not learn in her program. She is best described as: a. Having cultural sensitivity. b. Experiencing cultural diversity. c. Experiencing cultural marginality. d. Experiencing acculturation.

22. In the Unity Healthcare organization, communication flows: a. Laterally. b. Bottom to top. c. Top to bottom. d. Intermittently.

22. 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: a. Setting up a nursing team meeting to review practices. b. Calling the family to inform them of the practice. c. Initiating a multidisciplinary and family meeting to focus on Mary's needs. d. Restraining Mary to satisfy the family's wishes.

23. In caring for a patient from an East Indian culture, the staff expresses frustration that many people are in the room at any one time, which interferes with care. As the nurse manager, you provide leadership in understanding that this behavior of the family and friend network reflects: a. Lack of understanding of the seriousness of the patient's illness. b. Lack of communication between family members. c. The social organization of friendships and family networks in East Indian culture. d. Lack of caring about the hospital environment by the friends and family.

23. 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: a. Quality assurance. b. Sentinel data. c. Benchmarking. d. Statistical analysis.

24. As a unit manager, you chair the unit meetings. For each meeting, you consider and establish the purpose of the meeting. Second, you prepare an agenda. Arrange the following steps in an order that would make the meetings productive and successful. 1. Distribute an agenda. 2. Distribute minutes. 3. Select team members. 4. Start on time. 5. Keep the meeting focused and directed toward accomplishing the set objectives. Select the correct order from the following options: a. 1, 2, 4, 5, 3 b. 4, 1, 2, 5, 3 c. 3, 1, 4, 5, 2 d. 3, 4, 2, 1, 5

25. In considering whether or not to accept a job offer as a nurse manager at a Magnet™ hospital, you look at an environment that you might encounter as a head nurse at the hospital. You determine that you could expect to: a. Find it difficult to recruit new staff. b. See rapid turnover of staff on your unit. c. Find nurses who exemplify interest in quality care. d. Find limited interest in excellence in the nursing environment.

3. A grievance brought by a staff nurse against the unit manager requires mediation. At the first mediation session, the staff nurse repeatedly calls the unit manager's actions unfair, and the unit manager continues to reiterate the reasons for her actions. What would be the best course of action at this time? a. Send the two disputants away to reach their own resolution. b. Involve another staff nurse in the discussion so as to clarify issues. c. Ask each party to examine her own motives and issues in the conflict. d. Continue to listen as the parties repeat their thoughts and feelings about the conflict.

3. A patient refuses a simple procedure that you believe is in the patient's best interest. The two ethical principles that are directly in conflict in such a situation are: a. Fidelity and justice. b. Veracity and fidelity. c. Autonomy and beneficence. d. Paternalism and respect for others.

3. The nurse manager decides to change staffing schedules in the intensive care unit. She chooses to use Rogers' diffusion of innovations theory to implement the change. What are the elements of Rogers' diffusion of innovations theory? a. Assessment, planning, intervention, and evaluation b. Preparation, validation, synthesis, and evaluation c. Knowledge, persuasion, decision, implementation, and evaluation d. Scanning, diagnosis, decision making, application, and reevaluation

3. To increase safety in patient care areas of the Valley Hospital, the executive begins by: a. Asking the community what the safety issues are. b. Consulting with a management expert about staffing schedules. c. Ensuring that the senior nursing officer attends the board meetings. d. Instituting improved practices to reduce needle-stick injuries.

3. To prepare staffing schedules, a nurse manager needs to calculate paid nonproductive time. When calculating paid nonproductive time, the nurse manager considers: a. Work time, educational time, and holiday time. b. Paid hours minus worked hours. c. Vacation time, holiday time, and sick time. d. Paid hours minus meeting time.

4. An important aspect of managing the costs on a unit is to plan accurately for staffing needs. Nurse managers use staffing plans to: a. Assign staff on the unit on a daily basis. b. Ensure that days off are planned for the staff. c. Outline the number of individuals by classification on a per-shift basis. d. Predict the numbers and classifications of float staff needed to augment regular staff.

4. You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the: a. Nursing care plan. b. Physician's orders. c. Critical pathway. d. Clinical practice guidelines.

5. 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? a. Evaluation of staff members' performances b. Determination of the appropriateness of standards c. Improvement in patient outcomes d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO)

5. Collaborative partnerships between hospitals and schools of nursing are examples of hybrid organizational structures. A hybrid organizational structure: a. Has many divisions of labor. b. Best fits long-term care units. c. Has a mixture of the characteristics of various organizational types. d. Places the authority for decision making closest to the places where workers perform.

6. In keeping with standards of The Joint Commission (TJC), the nurse manager organizes an orientation for new staff members. As part of the orientation, the nurse manager reviews the employee handbook. Employers may be bound to statements in the employee handbook: a. Under the doctrine of apparent agency. b. Under the doctrine of respondeat agency. c. Based on the employee's or the employer's expectations. d. Based on the theory that the handbook creates an explicit contract.

7. As the nurse manager who wants to increase motivation by providing motivating factors, which action would you select? a. Collaborate with the human resource/personnel department to develop on-site daycare services. b. Provide a hierarchical organizational structure. c. Implement a model of shared governance. d. Promote the development of a flexible benefits package.

7. Maintaining a culturally diverse staff and working with a culturally diverse patient population is an important function of a nurse manager who works in the hospital of a large medical center. On your palliative care unit, you have recently received complaints from families about ineffective pain management for their family members and you determine this occurs primarily when certain nurses are working. What approach might you take to resolve the concerns of the families, patients, and potentially, the staff? a. Reinforce to staff that practice guidelines support as-needed analgesia for the terminally ill. b. Ask staff input on the development of stricter guidelines to ensure that all terminally patients are given sufficient analgesia. c. Encourage conversation with patients and among staff that facilitates learning about cultural beliefs and priorities in dying. d. Advise families that the administration of analgesia is based on the expert clinical judgment of nurses who are familiar with care of patients in palliative care.

7. Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service? a. Programs to educate the community on preparing healthy meals for a limited cost b. Reduction of injuries from alcohol-related accidents c. Pain management for patients with low back pain d. Reduction of falls among seniors

8. A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide: a. Rehabilitative or long-term care. b. Disease-restorative care. c. First access to care. d. Only outpatient services.

8. Scheduling is a function of implementing the staffing plan by assigning unit personnel to work specific hours and specific days of the week. To retain nursing staff, the nurse manager must schedule: a. All weekends off. b. All holidays off. c. A variety of scheduling options. d. Rotating shifts.

8. 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: a. Assemble a team. b. Establish a benchmark. c. Identify a clinical activity for review. d. Establish outcomes.

8. While making rounds, a night supervisor finds a unit with a low census and too many staff members. The night supervisor is performing as a statutory supervisor when he or she: a. Assigns nurses to care for specific clients. b. Develops a protocol for unlicensed personnel. c. Recommends transferring a nurse to another service. d. Teaches a nurse to use a new piece of equipment.

9. In a small rural nursing home, a director of nursing decides, because of a shortage of nurses, to implement a partnership model to help with basic tasks that comply with state rules regarding delegation. What type of design constitutes a partnership care delivery model? a. RN and LPN/LVN b. RN and RN c. RN and medication assistants d. RN and certified nurses' aides

9. To help staff nurses adjust to using research in practice, what strategy would the nurse manager use? a. Attendance at a regional research conference b. Formal classes in electronic search techniques c. Establishing a journal club d. Issuing reports on the adverse consequences of outdated practices

1. Because of rapid turnover and the ongoing hiring of new graduates, the skill levels of staff in a busy CCU are varied. Senior staff are becoming burned out with the need to provide mentorship and guidance to new staff. As the manager, you propose the addition of a nurse in advanced practice to provide consultation and education for staff. This position is termed a(n): a. Hierarchical position. b. Ancillary. c. Line position. d. Staff position.

1. Complex care of acutely ill patients is required on a surgical unit, which utilizes differentiated nursing practice as its model of care delivery. The concept of differentiated nursing practice is based on: a. Licensure status. b. Experience in the agency. c. Leadership capabilities. d. Education and expertise.

1. The chief nursing officer at a local hospital seeking Magnet™ status creates staff development classes concerning translation of research into practice (TRIP). What best describes TRIP? a. Conducting an integrative review of the literature b. Searching the literature for a systematic review c. Providing the results of research studies to practitioners d. Applying strategies that aid in adoption of research in practice

1. The manager in the coronary care unit believes that the most important ethical considerations in performance evaluations are that they include the employee's good qualities and that they give positive direction for professional growth. This belief is an example of: a. Justice. b. Fidelity. c. Beneficence. d. Nonmaleficence.

1. The number of adverse events such as falls and pressure ulcers on your unit is increasing. An ideal staffing plan to address this issue would include which of the following? Increasing the: a. Total number of staff on the unit. b. Staff and RN hours per patient. c. Total number of staff, and implementing 12-hour shifts. d. Number of RNs and number of RNs with experience on the unit.

1. The staff members in a local Emergency Department are experiencing stress and burnout as the result of excessive overtime. The staff decides to unionize to negotiate for better working conditions. The increase in unionization within health care may be attributed to the: a. Movement from being "blue-collar workers" to being "knowledge workers." b. Excess profits in health care. c. Level of risk that exists for health care. d. Number of people who are involved in health care.

1. To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are: a. Units that provide only primary care services. b. Owned by the institutions. c. A feature of all public institutions. d. Units that serve large populations.

10. As the manager, you have been asked to implement an evidence-based approach to teach ostomy patients self-management skills postoperatively that is being operationalized throughout your organization. Which of the following illustrates effective leadership? a. The training modules are left in the staff room for times when staff are available. b. The current approach is continued because it is also evidence-based and is more familiar to staff. c. You decide to implement the approach at a later date because of feedback from the RNs that the new approach takes too much time. d. A RN who is already familiar with the new approach volunteers to take the lead in mentoring and teaching others how to implement it.

10. In helping nurse managers to manage their time, the chief nursing officer suggests that they: a. Maintain a perfectionistic attitude. b. Set up a complaint list. c. Have good negotiation skills. d. Have good information literacy skills.

12. When interviewing a candidate for a nursing position who has an Aboriginal background, you recognize that the candidate's lack of eye contact reflects the candidate's: a. Lack of confidence. b. Professional behavior. c. Cultural sensitivity. d. Ethnicity.

13. A patient complains to you that she has no idea who "her nurse" is on any given day. "I ask one nurse for my pills and she says, 'That's not my job.' I ask the pill nurse about my lab tests and she says that I should ask another nurse." This nursing care delivery model employed in this situation might be particularly effective in: a. Promoting communication among diverse team members. b. Facilitating multiple perspectives on the total care of a patient. c. Avoiding patient-provider conflict. d. Developing competence and confidence in unskilled workers.

13. After assessing an older adult patient in long-term care who has been slowly deteriorating for weeks, the nurse manager calls the family and asks them to come in, as the patient is dying. The nurse manager's decision and actions are based on: a. An established clinical pathway. b. Confirmatory scientific evidence. c. Unit protocol. d. Experience.

13. Awareness and use of power have been challenging for nurses in general because of: a. Incidences of punishment by authority figures. b. Too little time in the workplace to collectively develop power strategies. c. Lack of cohesiveness and unity among nurses. d. A tradition of obedience to authority.

13. Which of the following would be the most appropriate mission statement for a nursing center? a. "At Plentyville, we provide rehabilitative services for addicted adolescents." b. "Georgiatown provides treatment and prevention services for county residents." c. "At Heart, our aim is to provide services that lead the nation in health education and research." d. "At Coeur, we strive to achieve optimal pain management with patients who are experiencing chronic pain.

13. Which one of the following statements has been proven to be true? a. Recent research has found that women do not have a unique physiologic response to stress. b. Both men and women interpret the same stressor in the same manner without regard to past experiences. c. Stress influences the immune system in one complex manner. d. Stressors that are identical do not necessarily have similar effects on each individual.

13. You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to: a. The possibility of violence. b. An increase in prescription drugs available for abuse. c. Decisions of the public board. d. An increase in uncompensated care events.

14. Collective action is effective in: a. Ensuring that needs of nurses are placed ahead of other disciplines. b. Defining nursing as a profession. c. Advising patients of the needs of nurses. d. Amplifying the influence of individuals.

14. During a staff shortage, you hire an RN from a temporary agency. The RN administers a wrong IV medication that results in cardiac arrest and a difficult recovery for the patient. Liability in this situation: a. Is limited to the temporary agency. b. Is restricted to the RN. c. Could include the RN, the agency, and your institution. d. May depend on the patient's belief regarding the employment relationship.

14. In the past year, you have noticed an increase in patient falls on your unit. In reading studies related to staffing and patient outcomes, you realize that you will need to plan for: a. Higher patient care hours. b. Safer facilities. c. Institution of a patient classification system. d. An increased number of RN positions.

14. Marie is a long-term staff nurse on the rehab floor. Her unit manager has been eager to adopt evidence-based recommendations related to family-centered care on the unit. Marie's response has been that she rarely has time to provide care to patients, let alone families, and that there is no good reason to do anything different than what she is already doing. An approach that may gain Marie's support of the idea is to: a. Invite Marie to review the studies for herself. b. Suggest that she does not need to provide family-centered care. c. Avoid discussion of the idea with her until she initiates it. d. Secure the support of her closest colleagues on the unit.

15. A method commonly used in Quality Assurance to monitor adherence to established standards is: a. A Pareto chart. b. Brainstorming. c. Patient interviews. d. Chart audit.

15. A staff nurse approaches the unit manager and indicates to her that because of her father's death in the previous month, she is now finding it very difficult to do her work effectively. This would be considered a(n) ________ stress. a. Internal source b. Familial c. Burnout d. External

15. A strategy to increase RN staff retention at Valley Hospital includes: a. Better compensation and benefits. b. Clearer position descriptions. c. Lay-offs of nursing assistants. d. Adequate staffing to meet acuity levels.

15. Which of the following is an example of an HMO? a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women's health clinic. b. Physicians in a large urban center are reimbursed for visits made to their clients. c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan. d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

16. As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment? a. Patients admitted to the facility must have adequate health insurance to cover the services provided. b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility. c. Public funding will be provided to enable care of patients who have an ordinary course of recovery. d. The facility is an older house that is more than 30 minutes away from the acute care center.

16. At Orangetown Hospital, the nursing department is developing a mission statement for nursing. Which would be a suitable mission statement? a. "Nursing provides services for patients admitted to Orangetown Hospital." b. "To participate fully in the professional services offered by Orangetown Hospital." c. "To lead by the lamp; services for seniors." d. "At Orangetown, the nursing department provides caring services that recognize the diversity of clients and promote optimal health with clients through partnership, education, and interprofessional collaboration."

17. 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: a. The return rate on patient questionnaires is frequently low. b. Patients are rarely reliable sources about their own hospital experiences. c. Hospital experiences are frequently obscured by pain, analgesics, and other factors affecting awareness. d. Patients are reliable sources about their own experiences but are limited in their ability to gauge clinical competence of staff.

18. In looking at an organizational chart for her institution, Jennifer notes that nursing is led at the senior level by a non-nurse executive. Jennifer expresses concern that this is a reflection of how nursing is viewed within the organization. Jennifer's comments reflect: a. A concern that resource allocation will be made on a business and not a professional model. b. The dissatisfaction that occurs when lack of autonomy is given to nurses. c. Concern with the nonadvancement of nursing practice in the institution. d. An awareness of how organizational culture is reflected in organizational structure.

18. Which of the following is an effective approach in the appraisal of research studies? a. Accept only studies that use a RCT design. b. When ranking research studies, choose RCTs over qualitative studies. c. Select only studies with a large sample size. d. Evaluate the quality of the research against the standards for that type of research.

19. As the head of a nursing program, you consistently invite the ideas of your team about innovations in teaching, community partnerships, and curriculum design and invite participation in decisions. Many of these ideas have been implemented successfully, and your staff members are keen to try on other ideas. You are employing _____ leadership. a. Situational b. Trait-based c. Contingency-based d. Transformational

19. Social stressors are considered a major factor in the stress nurses experience in the healthcare system. Which of the following is not considered to be a social stressor? a. High amounts of stress in the nursing home environment b. Changes in the current healthcare system such as nursing strategies c. Disruptive behavior coming from physicians and other healthcare workers d. Stress triggers such as self-criticism and overanalyzing

19. When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are: a. Similar to those in functional nursing. b. Not of significance in either model. c. Low by comparison with functional nursing. d. High when compared with functional nursing.

19. Within a multisite healthcare system, the most appropriate strategy for translation of research would be: a. Widespread development of protocols using EBP at unit levels. b. Dissemination of EBP and recommendations to individuals, units, and the organization. c. Development of the skills of individual managers on how to build guidelines based on EBP. d. Establishment of an interdisciplinary center to guide and lead the translation of research findings into practice.

2. A unit manager of a 25-bed medical/surgical area receives a phone call from a nurse who has called in sick five times in the past month. He tells the manager that he very much wants to come to work when scheduled but must often care for his wife, who is undergoing treatment for breast cancer. According to Maslow's need hierarchy theory, what would be the best approach to satisfying the needs of this nurse, other staff, and patients? a. Line up agency nurses who can be called in to work on short notice. b. Place the nurse on unpaid leave for the remainder of his wife's treatment. c. Sympathize with the nurse's dilemma and let the charge nurse know that this nurse may be calling in frequently in the future. d. Work with the nurse, staffing office, and other nurses to arrange his scheduled days off around his wife's treatments.

20. After several months of heavy patient loads in the Emergency Department and inability to secure sufficient and experienced staff, the department is especially taxed by a train accident that brings in many seriously injured individuals. You observe that Rama ignores the requests of several of the injured, even when time is available to care for them and is rude to two elderly patients. You are concerned that Rama is evidencing which state? a. Hardiness b. Depression c. Role ambiguity d. Depersonalization

20. Individuals living with asthma, who also live in poverty, are much less likely to seek early care and are more likely to go to emergency rooms for assistance. This example reflects: a. Stereotyping. b. Cultural diversity. c. Ethnocentricity. d. Transcultural care.

20. To satisfy duty of care to a patient, a nurse manager is legally responsible for all of the following except: a. Notifying staff of changes to policies related to medication administration. b. Scheduling and staffing to ensure safe care. c. Delegating in accordance with practice acts. d. Supervising the practice of the physician.

21. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility: a. Cannot accept mental health patients who are Medicare beneficiaries. b. Can care for only Medicaid and not Medicare beneficiaries. c. Has not met the standards set by the CMS as determined by an external review panel. d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

21. Which of the following is most accurate regarding evidence-based practice? a. Evidence-based practice replaces continuous quality improvement. b. Evidence-based practice began with medicine and assists in determining which medical models can be applied in nursing practice. c. Effective and efficient care can already be demonstrated, which means that EBP will soon become redundant. d. EBP is generally recognized across disciplines and by policymakers as state-of-the-art clinical practice.

22. According to the complexity theory, which of the following should be the focus of measurement? a. Cost per hospital day b. Bed utilization c. Infection rates d. Staff morale and budgets

22. When hiring a case manager for a rehabilitation setting, you would most likely consider a: a. Registered nurse with a master's degree. b. Physiotherapist with a background in stroke rehabilitation. c. Social worker with a background in counseling. d. Health professional with advanced background who is client and outcome focused.

23. As a nurse manager, you have been asked to be part of a design team for health services that have vertical integration. In planning for these services, your team will design a proposal that will: a. Cluster like services together, such as outpatient clinics for the care of children with various developmental and medical needs. b. Plan for the smooth transition of patients from the emergency services department to other units in the hospital. c. Ensure that funding follows the patient from acute care to long-term care services. d. Bring together acute care, ambulatory, home care, and palliative care services for the management of patients diagnosed with cancer.

23. Sarah is a clinical nurse educator in the dialysis unit at Pines Health Center and provides education, consultation, and training support. Sarah has: a. Direct responsibility for patient care. b. Direct accountability for patient outcomes. c. An authority relationship to staff. d. An influence over patient outcomes.

23. Time management is very essential for the nurse manager. Which of the following is not a good time-management technique? a. Decide what not to do. b. Learn to say "No." c. Learn to delegate. d. Break down your workload into large manageable tasks.

23. Your healthcare organization has a decentralized system for scheduling. As part of this process, after you have developed a draft schedule, you may need to: a. Seek budgetary approval. b. Balance personal schedules against institutional needs. c. Negotiate the schedule with unit staff. d. Submit the schedule to a centralized staffing office for review.

24. A statement such as "We believe in the right of patients to make choices and to have care that is sensitive to their preferences and needs" is a _____ statement. a. Mission b. Goal c. Vision d. Philosophy

24. As the unit manager, you are interested in determining whether patient autonomy is preserved through informed consent in surgical settings. You determine that participatory action research is the best method to address this question. Which of the following is consistent with a participatory action research design? a. You interview 125 patients who have recently undergone surgery and transcribe the interviews to determine themes. Themes are validated with an expert in informed consent. b. You circulate a questionnaire to patients who recently underwent surgery and ask for their opinions regarding consent. Data are analyzed and the findings distributed to administration and other groups. c. An audit is undertaken of signed consents for treatment, to determine if the consent is properly witnessed and signed. Findings are used to inform changes in policies. d. You meet with a patient group to determine which questions should be asked about patient informed consent and what issues might be encountered and addressed during the research.

24. 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: a. Sentinel events. b. Medically sensitive events. c. Nurse-sensitive events. d. Never events.

24. Which of the following patients would be most likely covered under Medicare? a. Jim, who lives on the street and has occasional infections b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family d. Dan, who is 68 years of age and in good health

25. Sarah, one of your RNs, tells you that she can't understand why Jim, an Aboriginal patient, wants to do a smudge. In coaching Sara, you suggest which of the following? a. "Explain to Jim that there is no smoking in the hospital." b. "Inform Jim that fires are not allowed in the hospital." c. "Insist that he give you his tobacco because it is unhealthy for him." d. "Ask him what he means by a smudge and what meaning it has for him."

4. A nurse manager has decided that she must institute some personal time management steps to survive work and home life. Her first step should be to: a. Determine what takes up so much of her time and energy. b. Organize her personal and work spaces. c. Purchase a handheld personal digital assistant to help remind her of important meetings. d. Determine her personal and professional goals.

4. As a nurse manager, you notice that Maria, a Hispanic nurse aide, is visibly upset. When you ask her if something is wrong, she becomes tearful and says, "Why is it that when John and I work together in giving patients care, he jokes about my being "a little fat Mexican"? The nurse manager's best response is, "Do you think he: a. Is sensitive to your culture?" b. Wants to learn more about you?" c. Has been hurt and wants to hurt others?" d. Is stereotyping you without thinking?"

5. A nurse manager must consider a number of external variables when preparing the personnel budget and projecting the unit's staffing needs. An external variable to be considered is: a. Organizational staffing policies. b. Staffing models. c. Changes in services that will be offered. d. Department of Health licensing standards.

5. A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in: a. Critical pathways. b. Healthcare networks. c. Health maintenance organizations. d. Managed care.

5. The nurse case manager is working with a client admitted for end-stage renal disease. The case manager's major goal during this hospitalization is to: a. Implement the care pathway on admission. b. Provide direct nursing care throughout the hospitalization. c. Supervise the nursing staff members who implement the care map. d. Prevent additional hospitalizations resulting from complications of the client's disease.

5. The nurse manager of a unit is asked by a family member of a dying Native American patient if it is possible to have the patient's eight-member family recite the rosary by the bedside. The manager responds affirmatively. The nurse manager is most likely exhibiting behavior related to: a. Acculturation. b. Ethnocentricity. c. Cultural diversity. d. Cultural sensitivity.

6. The nurse manager is implementing a shared governance model to help with communication and decision making. Although staff members like the concept, change is difficult. Staff nurses feel: a. More empowered. b. More communicative. c. Less stressed. d. More powerless and devalued.

7. In a nurse managers' meeting, strategies for ways to help retain staff are discussed. One strategy for assisting nurses in developing collective action skills is: a. Accepting the practice of "going along to get along." b. Attending as many workshops as practical. c. Spending as much time as possible in clinical settings. d. Taking the opportunity to work with a mentor.

7. In an acute care unit, the nurse manager utilizes the functional nursing method as the care delivery model. The nurse manager's main responsibility is the needs of the: a. Department. b. Unit. c. Staff. d. Patient.

7. 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: a. The error will result in suspension. b. An incident report is optional for an event that does not result in injury. c. The error will be documented in her personnel file. d. Risk management programs are not designed to assign blame.

7. You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example? a. First level b. Second level c. Fourth level d. Fifth level

8. A new director of nursing in a small rural hospital wants to make changes from the traditional model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated: a. Bureaucratic b. Decentralized c. Delegated authority and responsibility d. Delegated responsibility but no authority

8. In designing a quality, safe healthcare environment, the primary emphasis needs to be on: a. Evidence-based practice. b. Informatics. c. Staffing. d. The patient.

9. A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations: a. Pay dividends to stockholders. b. Can refuse clients who are unable to pay. c. Have no paid employees. d. Pay no taxes.

9. The chief nursing officer has asked the staff development coordinator to facilitate the development of a clinical competency program for the facility. While making rounds on the units, the staff development coordinator overhears RN staff complaining that they feel it is insulting to be required to participate in a competency program. Which behavior by the staff development coordinator is most appropriate in this situation? a. Disregard staff concerns and continue with development of the program. b. Inform the nurses that this program is a requirement for JCAHO accreditation. c. Schedule a meeting with the chief nurse executive to apprise her of the situation. d. Facilitate a meeting so nurses can articulate their values and concerns about a competency program.

After consulting with practice environments about quality and safety concerns in health care, the Dean of Health Programs at U.S. University develops: a. A nursing program that emphasizes the development of a strong disciplinary identity. b. Programming that stresses discipline-based research. c. Partnerships with health care to develop software for the reporting of adverse events. d. An interdisciplinary program for nurses, pharmacists, and medical practitioners that emphasizes collaborative learning teams.

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? a. Careful screening of nursing staff for substance use and abuse b. Increased RN staffing on the unit c. Salary and benefits that reflect nursing accountabilities d. Increase in the percentage of baccalaureate-prepared nurses to 80%

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 a. Re-visit reporting standards for medication errors in your organization. b. Ensure that medication errors are consistently reported. c. Provide staff with additional education related to safe practice in medication administration. d. Involve RN staff in determining reasons for errors and practice solutions to increase the safety of medication administration.

In preparation for redesignation as a MagnetTM Hospital, how would you prepare? a. Commit staff resources over a 6-month period to updating procedure manuals. b. Educate staff through meetings and training sessions regarding appropriate answers to questions. c. Prepare a manual that outlines orientation procedures and ensure that all safety issues are addressed. d. Ensure that there are empirical data to support review of patient outcomes, actions taken, and results of actions.

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? a. Employ a centralized decision-making approach. b. Use simulators for initial practice to build confidence. c. Bring in a nurse consultant who is familiar with the technology. d. Use early adopters among the staff as leaders and role models in implementation.

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: a. The overload of staff nurses. b. Resistance to change by staff. c. A change in reporting systems. d. Fewer clinical leaders to remove barriers to care.

midterm crap

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