RNSG 1126 FINAL practice questions... work in progress

The new Director of Case Management assessed the need to improve the organization's patient satisfaction with the discharge process. Which statement below illustrates the vision that would lead the team to this goal? a. "The department will deliver reliable, collaborative, and compassionate discharge planning services to all patients." b. "The department will hold weekly meetings every Tuesday at 11:00 AM." c. "There will be implementation of a new uniform policy so staff can be readily identified." d. "Staff are encouraged to complain about difficult patients, families, and physicians.

ANS: A A vision is a statement about the long-term desired state for the department. The other choices describe specific actions, not a long-term vision statement.

A nursing student is conducting a survey of fellow nursing students. Which ethical concept is the student following when calculating the risk-to-benefit ratio and concluding that no harmful effects were associated with a survey? a. Beneficence b. Human dignity c. Justice d. Human rights

ANS: A Beneficence is a term that is defined as promoting goodness, kindness, and charity. In ethical terms, beneficence means to provide benefit to others by promoting their good. Human dignity is the inherent worth and uniqueness of a person. Justice involves upholding moral and legal principles. Human rights are the basic rights of each individual.

The nurse and the patient are conversing face to face. What communication technique is being demonstrated? a. Linguistic b. Paralinguistic c. Explicit d. Metacommunication

ANS: A Conversing face to face, reading newspapers and books, and even texting are all common forms of linguistic communication. Paralinguistics include less recognizable but important means of transmitting messages such as the use of gestures, eye contact, and facial expressions. Explicit communication is not a therapeutic communication technique. Metacommunication factors that affect how messages are received and interpreted would include internal personal states (such as disturbances in mood), environmental stimuli related to the setting of the communication, and contextual variables (such as the relationship between the people in the communication episode).

A nurse on the unit makes an error in the calculation of the dose of medication for a critically ill patient. The patient suffered no ill consequences from the administration. The nurse decides not to report the error or file an incident report. The nurse is violating which principle of ethics? a. Fidelity b. Individuality c. Justice d. Values clarification

ANS: A Fidelity is the principle that requires us to act in ways that are loyal. In the role of a nurse, such action includes keeping your promises, doing what is expected of you, performing your duties, and being trustworthy. Individuality is something that distinguishes one person or thing from others. Injustice is when a person is denied a right or entitlement. Values clarification is a tool that allows the nurse to examine personal values in terms of ethical situations.

A new registered nurse asks the registered nurse (RN) preceptor what could be done to become more professional. What is the preceptor's best response? a. "Attend nursing educational meetings." b. "Listen to other nurses." c. "Read the agency newsletter." d. "Pass the licensing exam."

ANS: A Knowledge and commitment are essential components of professionalism. Attending nursing educational meetings can promote collaborative learning with peers and maintenance of competence in an ever-changing healthcare environment. Listening can promote professionalism, and communication is certainly a component of professionalism; however, there is also a social sense to listening, and without the educational/learning component, this is not the best answer. An agency newsletter could include information about professional opportunities, but it is not the best answer. The new nurse would have already passed the licensing exam, the legal requirement to be considered a nurse.

The nurse administrator is doing a study that entails gathering data about new employees over a 10-year period. Which research method would be the best one to use for this type of study? a. Quantitative longitudinal cohort b. Qualitative longitudinal c. Qualitative interview d. Qualitative case study

ANS: A Quantitative research has been defined as being "focused on the testing of a hypothesis through objective observation and validation." The types of studies that make up this category include randomized controlled studies, cohort studies, longitudinal studies, case-controlled studies, and case reports. The other options are examples of quantitative, not qualitative, studies.

A nurse is reviewing decision-making theories. Which statement is accurate according to situational and contingency theory? a. The theory challenges the concept that one leadership style is always best. b. The theory supports employee feelings, morale, and feedback during the change process. c. Motivation through inspiration and recognition is the focus for transforming employee behavior. d. A leader is someone who possesses great intelligence and decision-making authority.

ANS: A Situational and contingency theory challenges the assumption that there is "one best way" to lead. A theory that supports employee feelings, morale, and feedback during the change process describes behavioral leadership. Motivation through inspiration and recognition is the focus for transforming employee behavior describes transformational leadership. A leader is someone who possesses great intelligence and decision-making authority describes Great Man or Trait theory

The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among healthcare team members? a. The occurrence of a patient event resulting in death or serious injury b. Decreased ability to document expenses of care provided c. Longer time to begin surgical cases d. Increased time to discharge patients to outpatient care

ANS: A The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.

The nurse is faced with an ethical issue. When assessing the ethical issue, which action should the nurse perform first? a. Ask, "What is the issue?" b. Identify all possible alternatives. c. Select the best option from a list of alternatives. d. Justify the choice of action or inaction.

ANS: A The first step in the situational assessment procedure is to find out the technical and scientific facts and assess the human dimension of the situation—the feelings, emotions, attitudes, and opinions. Trying to understand the full picture of a situation is time consuming and requires examination from many different perspectives, but it is worth the time and effort that is required to understand an issue fully before moving forward in the assessment procedure. Identifying alternatives is the second step in the situation assessment procedure. A set of alternatives cannot be established until an assessment has been completed. Selecting the best option is actually the third step in the situation assessment procedure. Options cannot be selected until an assessment has been done to define the issue. Justifying the action or inaction is the final step in the situational assessment procedure. No justification can be made until the assessment and action phases have been completed

A nurse is conducting a therapeutic session with a patient in the inpatient psychiatric facility. Which remark by the nurse would be an appropriate way to begin an interview session? a. "How shall we start today?" b. "Shall we talk about losing your privileges yesterday?" c. "Let's get started discussing your marital relationship." d. "What happened when your family visited yesterday?"

ANS: A The interview is patient centered; thus, the patient chooses issues. The nurse assists the patient by using communication skills and actively listening to provide opportunities for the patient to reach goals. In the distracters, the nurse selects the topic.

Which statement is true regarding the patient's perception of his or her care? a. Patent perception is just as important as the outcome of care. b. Patient perception is insignificant compared to the outcome of care. c. Patient satisfaction has no relation to quality of care. d. Patient satisfaction is insignificant compared to the outcome of care.

ANS: A The patient's perception of his or her care is just as important as the outcome of the care. If the patient perceives the care as meeting the aspects of quality, then patient satisfaction increases.

Nurses work to serve the population, and they know that which priority population needs to be served by care coordination? a. Most vulnerable and the frail b. Uninsured and the very young c. Underinsured and the elderly population d. Whole population of the community

ANS: A The priority population is the most vulnerable and the frail, because they have the most health-care needs. Other populations do need health care, but they do not always have immediate need of the health-care system.

For children and teens, which model includes school-based services? a. Social b. Integrated c. Medically-oriented d. Nurse-oriented

ANS: A The social models focus on community-based services, and the other models do not

Components of a professional identity in nursing include which attributes? (Select all that apply.) a. Doing b. Being c. Acting ethically d. Flourishing e. Culture

ANS: A, B, C, D The scope of professional identity in nursing includes: doing, being, acting ethically, flourishing and changing identities. Cultural sensitivity is important to professional nursing; however, culture is an inherent quality of nurses and patients, not a component of the professional identity.

The focus of quality health care should be on which of the following items? (Select all that apply.) a. Excellent services b. Comprehensive communication c. Private hospital rooms d. Health team collaboration e. Culturally competent care

ANS: A, B, D, E Excellent services, communication, collaboration, and culturally competent care bring quality to the health care delivered to the patient. Private hospital rooms may be a preference by some patients, but they do not add to the quality of care.

How does the Iowa model transcend mere nursing care? (Select all that apply.) a. It includes formalized internal feedback loops. b. Its triggers can have their origins practically anywhere. c. It generates change in practice solely through research. d. It implies a layer of policy development. e. It addresses multiple disciplines' impacts on quality.

ANS: A, B, D, E The triggers addressed within the Iowa model process can be problem focused and evolve from risk management data, process improvement data, benchmarking data, financial data, and clinical problems. The triggers can also be knowledge focused, such as new research findings, change in a national agency's or an organization's standards and guidelines, expanded philosophy of care, or questions from the institutional standards committee. Because the Iowa model is often implemented at a fairly high level of nursing or hospital administration, it scrutinizes the input of nursing and other disciplines in its process. Its output is applied as widely as possible throughout the organization, and it can affect policy within a multihospital system and even across systems. The success of EBP is determined by all involved, including healthcare agencies, administrators, nurses, physicians, and other healthcare professionals

The nurse is conducting a review of the literature for pain management techniques. Which of the following should the nurse consider when conducting research that yields solid EBP? (Select all that apply.) a. Search the literature to uncover evidence to answer the question. b. Evaluate the outcome. c. Use the nursing process to evaluate evidence. d. Evaluate the evidence found. e. Develop an answerable question. f. Develop a question that has not been answered. g. Apply the evidence to the practice situatio

ANS: A, B, D, E, G To facilitate the use of evidence, steps have been developed to systematically approach a question of patient care. The steps are outlined as follows: • Develop an answerable question. • Search the literature to uncover evidence to answer the question. • Evaluate the evidence found. • Apply the evidence to the practice situation. • Evaluate the outcome. • The nursing process is a method of problem solving and can be used to develop a plan of care. Formulating a question that has not been answered in the research would be considered primary research. Therefore, there is no evidence in which to draw from

What are the major attributes of health-care quality? (Select all that apply.) a. Conforms to standards b. Sound decision making c. High acuity patients d. Low health-care costs e. Identifies adverse events

ANS: A, B, E Major attributes of health-care quality include conformation to standards set by regulatory agencies, sound decision making regarding care, and identifying potential adverse events. High acuity of patients does not contribute to quality health care, because the care demand is increased, and low health-care costs mean fewer services may be available.

Nurses can be health advocates in which of the following ways? (Select all that apply.) a. Supporting their professional nursing organization when discussing upcoming legislation b. Discussing the upcoming classes with a neighbor c. Rallying for coverage for childhood immunizations d. Arranging for a patient to meet with case management for home health care e. Discussing a patient they are concerned about with a fellow student in the public cafeteria

ANS: A, C, D Supporting a professional nursing organization, rallying for coverage for childhood immunizations, and arranging for a patient to meet with case management are examples of how nurses can be a positive influence on healthcare policy. Discussing an upcoming class with a neighbor is not effective because it could be determined to be negative. Talking about a patient in a public area is an example of inappropriate communication between healthcare workers and is a violation of patient confidentiality.

A nursing student is preparing a care plan for an assigned patient. When accessing the electronic medical record, what is acceptable information to view? (Select all that apply.) a. Laboratory data of the assigned patient b. Admission diagnosis for a patient who is a former neighbor c. The patient's age, date of birth, and gender d. The history and physical of the assigned patient e. A classmate's brother's chest x-ray report

ANS: A, C, D The laboratory data, age, date of birth, gender, history, and physical of an assigned patient are necessary for identification and care of the patient so it is acceptable to view this information in the electronic medical record. The patient information in the medical record, whether electronic or print, is only to be viewed by those who have a legitimate role in the patient's care. Viewing information on patients other than the assigned patient is not appropriate, because the student does not have a need to view the information for patient care. These are violations of patient privacy.

What are the main features of complexity science that are relevant to nursing leadership? (Select all that apply.) a. Focused on creating organizational change and looking at the whole versus individual parts b. Defined by efforts of leadership to mandate organizational change c. Autocratic in nature with a top-down structure for change d. Dependent on employees knowing what change is necessary and acting independently e. Non-linear and dynamic in nature, versus a static process

ANS: A, E Complexity science posits that interactions of the parts within a system are more important than the individual parts. Complexity science, however, recognizes that organizational processes are often non-linear and unpredictable. Through the dynamic interplay of negative and positive feedback an organization is able to make changes to keep abreast of the environmental context. The autocratic top-down decision making and mandates do not create a sustainable change. Being dependent on employees knowing what change is necessary and acting independently lacks interaction of leadership to stimulate change and adaptation among employees.

A drug-addicted nurse switches a patient's morphine injection with normal saline so that the nurse can use the morphine. The nurse is violating which principles of ethics? (Select all that apply.) a. Autonomy b. Utilitarianism c. Beneficence d. Dilemmas e. Veracity

ANS: A,B,C,E Beneficence is providing benefit to others by promoting their welfare. In general terms, to be beneficent is to promote goodness, kindness, and charity. By taking the patient's pain medication and substituting saline, the nurse did harm, not good, for the patient. Autonomy is the principle of respect for the individual person; the nurse does not respect someone upon whom the nurse is inflicting harm. Utilitarianism is the principle that assumes that an action is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Because the patient's pain medication was taken away, the consequences were all bad. Dilemmas are not included as a principle of ethics. Veracity involves truth-telling.

The nurse in the outpatient setting would like to conduct a research study that compares patients who take tramadol (Ultracet) to patients who take oxycodone hydrochloride and acetaminophen (Percocet) for managing back pain. Which quantitative research method should yield the best results? a. Longitude study b. Randomized controlled study c. Systematic reviews/meta-analysis d. Survey study

ANS: B A randomized controlled study is a type of quantitative research that seeks to control and examine the variables to determine effectiveness. In this case, the variables would be those that were administered tramadol (Ultracet) and those that were administered hydrochloride and acetaminophen (Percocet) for managing back pain. Correlational research methods help determine association between or among variables. A longitudinal study examines variables over a designated course of time. A systematic review/meta-analysis is a type of literature review and not a research method. A survey study is a type of qualitative research method.

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.

ANS: B According to the principles outlined by Ury, Brett, and Goldberg, a "cooling-off" period is recommended if resolution fails

An unconscious patient is treated in the emergency department for head trauma. The patient is unconscious and on life support for 2 weeks prior to making a full recovery. The initial actions of the medical team are based on which ethical principle? a. Utilitarianism b. Deontology c. Autonomy d. Veracity

ANS: B Deontology is an approach that is rooted in the assumption that humans are rational and act out of principles that are consistent and objective and that compel them to do what is right. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. An attempt is made to determine which actions will lead to the greatest ratio of benefit to harm for all persons involved in the dilemma. Autonomy is the principle of respect for the individual person. People are free to form their own judgments and perform whatever actions they choose. Veracity is defined as telling the truth in personal communication as a moral and ethical requirement.

Student nurses are being questioned by the nursing instructor about the health-care coordination system. The instructor knows the students understand health-care delivery when making which statement? a. "Health care is available for everyone at every time." b. "Health-care needs are best met with a collaborative effort." c. "Health care is adequately meeting the needs of the homeless populations." d. "Health care needs are mostly in third world countries."

ANS: B Health-care needs many times are not met by one discipline. When a collaborative effort is used, the patient is better served. Health care is not available for everyone, nor is it meeting the needs of the homeless population. Health-care needs are worldwide, not just in third world countries.

A patient suffered a brain injury from a motor vehicle accident and has no brain activity. The patient has a living will which states no heroic measures. The family requests that no additional heroic measures be instituted for their son. The nurse respects this decision in keeping with which principle? a. Accountability b. Autonomy c. Nonmaleficence d. Veracity

ANS: B Patients and families must be treated in a way that respects their autonomy and their ability to express their wishes and make informed choices about their treatment. Accountability is inherent in the nurse's ethical obligation to uphold the highest standards of practice and care, assume full personal and professional responsibility for every action, and commit to maintaining quality in the skill and knowledge base of the profession. Nonmaleficence is a principle that implies a duty not to inflict harm. In ethical terms, nonmaleficence means to abstain from injuring others and to help others further their own well-being by removing harm and eliminating threats. Veracity means telling the truth as a moral and ethical requirement.

A student nurse is talking with his instructor. The student asks how quality of care is evaluated. What is the best response by the instructor? a. "By the patient getting well." b. "On the basis of process and outcomes." c. "By the physician's assessment." d. "By the patient's satisfaction."

ANS: B Quality of care is evaluated by process and outcomes. If the outcomes are achieved, then the care has achieved what is was designed to do. The patient getting well may be an action of the body doing what it is supposed to do and not quality of care; the same can be said of the physician's assessment. The patient's satisfaction is subjective according to his or her perceptions and not the quality of care

The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first? a. Post educational posters about how well collaboration is being performed b. Highlight that no single profession can meet the needs of all patients c. Provide meetings for each department on how their role affects patients d. Begin implementing evaluations of collaborative skills on annual performance reviews

ANS: B Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.

Which level of government is responsible for the regulation of a nurse's license? a. Federal government b. State government c. Local government d. International coalition

ANS: B State boards of nursing oversee the regulation of nursing practice. These agencies are established by legislatures to implement and enforce laws through a rule-making process. Federal, local, and international coalitions are not correct, because they do not have control of the state boards of nursing

A nurse manager is looking to promote a culture of safety on the medical unit. Which action should the nurse manager implement? a. Focus on the number of medication errors occurring on the unit. b. Focus on adapting system changes. c. Providing incentives to nurses who don't make any medication errors. d. Placing nurses on restricted duty who have made medication errors.

ANS: B The Institute of Medicine (IOM) and QSEN initiative have switched their perspective from medication errors to systematic changes that focus on safety aspects. The nurse manager should not use rewards or incentives to motivate change of behavior as that would not promote a culture of safety if individuals feared retaliation or were treated differently for safe behavior practices.

What are two major foci of The Joint Commission (TJC) in the delivery of health care? a. Cost containment, safety b. Safety, quality c. Quality, assessment d. Assessment, evaluation

ANS: B The focus of TJC is quality and safety for patient care. TJC does not address cost containment, assessment of care, or evaluation of care.

To be an effective nursing leader today requires effective collaboration. Which model below best represents this process? a. The Nursing Manager of the observation unit was certain the psychology department would assist the unit with a motivational plan, so she did not request their assistance. b. The Nursing Manager of the observation unit worked with the psychology department and physical therapy to develop a motivational plan for patients on the unit. c. The Nursing Director of Behavioral Health Services followed the administrative directive to reduce services and refused to provide services for patients on other units. d. Frustrated by the trend of patients unwilling to work with therapy, the Unit Manager recommended that these patients be placed on another unit

ANS: B The nursing manager works collaboratively with other departments to solve the patient care issue. In the other choices, the unit manager does not involve collaboration to resolve the patient concern

Which of the following components are included in health policy at the state level? a. Americans with Disabilities Act of 1990 b. Scope of nursing practice c. Health Insurance Portability and Accountability Act (HIPAA) of 1996 d. Patient Safety and Quality Improvement Act of 2005

ANS: B The scope of nursing practice is correct, because it is controlled at the state level by state boards of nursing. The Americans with Disabilities Act of 1990, the HIPAA of 1996, and the Patient Safety and Quality Improvement Act of 2005 are all regulated at the national level

A male patient suffered a brain injury from a motor vehicle accident and has no brain activity. The spouse has come up to see the patient every day for the past 2 months. She asks the nurse, "Do you think when he moves his hands he is responding to my voice?" The nurse feels bad because she believes the movements are involuntary, and the prognosis is grim for this patient. She states, "He can hear you, and it appears he did respond to your voice." The nurse is violating which principle of ethics? a. Autonomy b. Veracity c. Utilitarianism d. Deontology

ANS: B Veracity is the principle of telling the truth in a given situation. Autonomy is the principle of respect for the individual person; this concept states that humans have incalculable worth or moral dignity. Utilitarianism is an approach that is rooted in the assumption that an action or practice is right if it leads to the greatest possible balance of good consequences or to the least possible balance of bad consequences. Giving the spouse false reassurance is not a good consequence. Deontological theory claims that a decision is right only if it conforms to an overriding moral duty and wrong only if it violates that moral duty. Persons are to be treated as ends in themselves and never as means to the ends of others

The nurse is working with a patient diagnosed with posttraumatic stress disorder related to childhood sexual abuse. The patient is crying and states, "I should be over this by now; this happened years ago." Which response(s) by the nurse will facilitate communication? (Select all that apply.) a. "Why do you think you are so upset?" b. "I can see that this situation really bothers you." c. "The abuse you endured is very painful for you. d. "Crying is a way of expressing the hurt you're experiencing." e. "Let's talk about something else, since this subject is upsetting you."

ANS: B, C, D Reflecting and giving information are therapeutic techniques. "Why" questions often imply criticism or seem intrusive or judgmental. They are difficult to answer. Changing the subject is a barrier to communication.

Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.) a. Prescribing a new medication dose b. Health promotion activities c. End-of-life comfort decisions d. Interpreting laboratory results e. Lifestyle changes to improve health

ANS: B, C, E Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.

Which statements are true about the Iowa model of EBP? (Select all that apply.) a. It addresses utilization of research findings at an individual level. b. It addresses the relevance of the question to the organization. c. Individual nurses enact an Iowa decision tree when they examine risk management data. d. It identifies triggers capable of posing hazard or benefit. e. It reiterates that innovators embrace change far earlier than laggards

ANS: B, D The Iowa model of EBP provides direction for the development of EBP in a clinical agency and as such focuses on the relevance of the question to the organization. In a healthcare agency, there are triggers that initiate the need for change, and the focus should always be to make changes based on best evidence. The Iowa model of EBP was revised in 2015 to provide additional feedback loops, detailed instructions, and inclusion of patient preferences

Care coordination models should be adopted in health-care facilities. If models are not put into practice, the shortcomings of the health-care system may display which of the following items? (Select all that apply.) a. Decrease in patients b. Fragmented services c. Low birth weight newborns d. Cost inefficiencies e. Poor health outcomes f. Increased pharmacy costs

ANS: B, D, E Fragmented services, cost inefficiencies, and poor health outcomes may be some of the shortcomings seen in health care without the proper model in place to guide the health-care delivery system

The nurse is seeking clarification of a statement that was made by a patient. What is the best way for the nurse to seek clarification? a. "What are the common elements here?" b. "Tell me again about your experiences." c. "Am I correct in understanding that ..." d. "Tell me everything from the beginning."

ANS: C Clarification ensures that both the nurse and the patient share mutual understanding of the communication. The distracters encourage comparison rather than clarification and present implied questions that suggest the nurse was not listening.

The nursing unit director exhibits the definition of leadership in which of the following responses? a. By referring the concern to the Director of the department b. By correcting the concern with the patient directly and not communicating his/her actions to the staff c. By meeting with the staff to discuss the concern and identify solutions d. By telling the staff that they need to correct the situation by tomorrow and leaves the meeting

ANS: C Leadership is defined as an interactive process that provides needed guidance and direction which is present in the correct answer. The other choices do not involve an interactive process with staff to resolve the concern.

Two nurses are discussing health-care quality. They agree which event contributes to increased health-care quality? a. Magnet status hospitals b. Fewer adverse events c. Collaboration of multiple health-care agencies d. Increased patient education

ANS: C Multiple health-care agencies are able to collaborate and provide better outcomes for health-care personnel and patients. Magnet status hospitals may be good, but the status does not always mean a quality outcome. Fewer adverse events and increased patient education are good, but they may be the result of other variables and not just quality of care rendered

A student nurse and clinical instructor are discussing quality in health care. The instructor knows the student understands when the student makes which statement? a. "Quality is apparent in all health care." b. "Quality is an outcome of health care." c. "Quality is seen and unseen in health care." d. "Quality is achieved by collaboration in health care."

ANS: C Quality in health care is tangible and intangible. Quality in health care is not apparent in all health care, as many areas of health care are lacking. Quality of care does not always affect the outcome of care; the patient may recover no matter what care is given. Quality is not always achieved by collaboration.

The American Nurses Association (ANA) outlines expectations of nurse's self-care habits in which type of documentation? a. Nurse Practice Acts b. Board of Nursing c. Code of Ethics d. Hospital Facility Protocols

ANS: C The ANA focuses on the importance of nurses to develop their own personal self-care habits as part of their ethical code. This information is presented in the ANA Code of Ethics. Nurse Practice Acts define the scope of practice relative to the specific type of health professional. The Board of Nursing provides minimum competency requirements for specific types of health professionals and identifies licensing, academic and practice requirements. Hospital facilities provide policies and protocols related to members of the interdisciplinary healthcare team.

Which statement is true regarding the concept of care coordination? a. There is minimal risk for individuals across the life cycle. b. Due to enhanced technological ability, services are able to be provided to all those in need. c. Most vulnerable populations have the highest need. d. Costs of services are easily maintained.

ANS: C The concept of care coordination is an important aspect for all individuals as there is the potential for everyone to experience a risk at one time that may require at best a temporary need for coordination of services. Although technological advances have advanced, there are still limitations and barriers to providing coordination of care services to all in need. Vulnerable populations have the highest need and costs of services are cost-intensive.

Which branch of government is responsible for the execution of laws passed by legislatures? a. Legislative b. Judicial c. Executive d. Local

ANS: C The executive branch of federal and state governments is responsible for execution of laws passed. The legislative branch is responsible for passing laws. The judicial branch of government determines if rights are being upheld. Local governments are not considered a branch of the government.

The nurse and physician are explaining that home care that will be needed by a patient after discharge. The patient's spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse? a. "Let me review what is needed again." b. "It is important that you do what the physician has prescribed." c. "What concerns do you have about the prescribed care?" d. "I can come back after you talk with your spouse about the care."

ANS: C The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leaving the patient and spouse with the situation unresolved fosters distrust and more anger.

Which key element is included in the scope of professional practice identity? a. Adhering to a fixed level of practice b. Finding out ways to get done faster with assigned tasks as the key focus of care c. Maintaining professional boundaries d. Remaining at the level of practice upon graduating from nursing school

ANS: C The scope of professional identity includes five attributes, doing, and being, acting ethically, flourishing and changing identities. By maintaining professional boundaries, the nurse would be acting ethically. Adhering to a fixed level of practice would not be prudent for it would not allow the nurse to achieve attributes. Finding out ways to get done faster with assigned tasks would be in opposition to the attribute of "being" as the key focus is to do the right thing even when no one is looking. A nurse who remains at the level of practice upon graduation from nursing school would be in opposition to the attribute of flourishing.

Nursing demonstrates dedication to improving public health through which avenue? a. Changing healthcare standards b. Legal regulations c. Scope of practice d. Technology

ANS: C Through the scope of practice, specialized knowledge, and code of ethics, the discipline of nursing has demonstrated its dedication to improving public health. The changing healthcare environment is one of the challenges to nursing, not an indicator of dedication. Legal regulations are generally promulgated by legislators rather than nurses to protect the public. A highly technological environment is considered a challenge to nursing rather than an indicator of dedication

The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take? a. Teach the patient muscle strengthening and stretching exercises. b. Tell the patient to make plans to move to an assisted-living facility. c. Discuss resources to help the patient and make appropriate referrals. d. Ask the patient to come in for daily physical therapy.

ANS: C To honor the patient's request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient's request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.

The hospital must reduce the number of readmission from 11% to 8% in the next year. Which of the following best represents the transformational leadership style in accomplishing this goal? a. The Director communicates the goal of reducing readmission to the hospital operations team and tells them to submit their action plan by the end of the week. b. The organization charters three work teams to identify solutions for the top three causes for readmission. These teams are given full authority to implement their solution. c. The Director of Quality develops a vision statement and action plan to achieve the goal. The director works directly with the involved departments to implement the action plan. d. The Chief Executive Officer (CEO) communicates the goal to the organizational directors and managers and states that they are entrusted to solve the problem

ANS: C Transformational leaders communicate a vision and motivate employees to accomplish the goal. The Director who communicates the goal of reducing readmissions to the hospital operations team and tells them to submit their action plan by the end of the week leaves the solution to achieve the goal to the followers to develop without motivating them. The solution that is left to the work teams to resolve is not an example of transformational leadership. The CEO entrusts the managers and directors to solve the problem without giving them a vision or engaging in the solution with them.

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.

ANS: C Ury, Brett, and Goldberg outline steps to restoring unity, the first of which is to address the interests and involvement of participants in the conflict by examining the real issues of all parties.

The nurse is admitting a patient to the medical/surgical unit. Which communication technique would be considered appropriate for this interaction? a. "I've also had traumatic life experiences. Maybe it would help if I told you about them." b. "Why do you think you had so much difficulty adjusting to this change in your life?" c. "You will feel better after getting accustomed to how this unit operates." d. "I'd like to sit with you for a while to help you get comfortable talking to me."

ANS: D Because the patient is newly admitted to the unit, allowing the patient to become comfortable with the setting is a technique that can assist in establishing the nurse-patient relationship. It helps build trust and conveys that the nurse cares about the patient. The nurse should not reveal their life experiences as this is not therapeutic. Asking why the patient is having difficulty may provide insight; however, this would be best saved for an established relationship with the patient. Assuring the patient that they will feel better may not be true depending on the reason for the admission.

The nurse is discussing care coordination with a patient. The patient asks the nurse to explain care coordination. What is the nurse's best response? a. "Care coordination is a cost effective method created by the community." b. "Care coordination forces the health-care facilities in the community to work together." c. "Care coordination exists for the children and uninsured in the community." d. "Care coordination allows health-care services to work together in the community."

ANS: D Care coordination allows all health-care/community services to work together so that patient and family needs can be met. Care coordination does not focus on cost methods. Cost coordination does not exist just for children or the uninsured. No one service is forced to work with another service.

A nursing instructor is talking about care coordination with nursing students. The instructor stresses which of the following to the students concerning care coordination? a. "A patient must ask for what they need in order to coordinate care." b. "The nurse does most of the work in care coordination." c. "Medical diagnoses are an integral part of care coordination." d. "Collaboration is a significant part of care coordination."

ANS: D Collaboration is a big part of care coordination. Without the collaboration, there would be no care coordination. Patients asking for their needs to be met does not collaborate care. Nurses do not do all the work in care collaboration. Medical diagnoses are one small part that drives the need for care collaboration

The clinical nurse leader needs to identify the staff who must go home due to low census. Which answer below describes a democratic style of decision making? a. The clinical nurse leader identifies the staff person with the most vacation and asks them to go home. b. The clinical nurse leader tells the last person to show up for their shift to go home. c. The clinical nurse leader decides not to send anyone home because it is too difficult to decide who should lose hours. d. The clinical nurse leader asks the group if any of them would like the opportunity to go home and selects staff who volunteer

ANS: D Democratic leaders use a participatory style of decision making. In the other choices, the clinical nurse leader makes the decision independent of the staff.

The nurse in the psychiatric unit is involved in a research study for a depression medication. In the study, patients are randomly assigned to one depression medication and the other group is receiving no medication to treat the depression. What method of research are the patients involved with? a. Descriptive b. Correlational c. Quasi-experimental d. Experimental

ANS: D Experimental tests an intervention and includes both a control group and random assignment. This research study tests an intervention and includes both a control group and random assignment. Descriptive defines the magnitude of a concept and its characteristics. Correlational determines association between or among variables. Quasi-experimental tests an intervention and lacks either a control group or random assignment.

One of the first nurse researchers to document evidence-based practice for nursing was Florence Nightingale. What did Nightingale incorporate into her practice that made her practice different from her colleagues? a. Nightingale gathered scientific data. b. Nightingale calculated statistics to report her findings. c. Nightingale communicated her findings to powerful others. d. Nightingale based her nursing practice on her findings

ANS: D Florence Nightingale had tried to develop the role of researcher by using evidence from her practice and implementing these findings. Evidence-based practice (EBP) includes conducting quality studies, synthesizing the study findings into the best research evidence available, and using that research evidence effectively in practice. Although gathering scientific data, calculating statistics to report findings, and communicating findings to powerful others are all important components of conducting research, Nightingale's action that most appropriately reflects the current nursing research priority is that she based her nursing practice on her findings.

A definition of health policy includes which of the following elements? a. Funding for public education b. Appropriation of funds for roadwork c. Selection of congressional members of committees d. Public policy made to support health-related goals

ANS: D Health policy is defined as public policy pertaining to health that is the result of an authoritative public decision-making process. Public education funding, appropriation of funding for roads, and selection of members of committees are not part of healthcare policy. They are under a different funding arm of the government

The nurse who is certified as a Critical Care Registered Nurse (CCRN) represents the unit on the organizational performance improvement team. This is an example of which type of leadership? a. Formal b. Unit c. Organizational d. Informal

ANS: D Informal leaders are recognized as leaders because of their capabilities and actions. Formal leaders are recognized because of the position they hold such as director or manager. Unit leadership refers to the leader of the particular unit. Organizational leadership refers to any leader within the organization.

A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate? a. Interprofessional b. Shared governance c. Interorganizational d. Mentoring

ANS: D Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goa

A nurse is reviewing the concept of professional collaboration. Which patient scenario should the nurse identify as the best example of professional collaboration? a. The nurse, physician, and physical therapist have all visited separately with the patient. b. The nurse, physical therapist, and physician have all developed separate care plans for the patient. c. The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation. d. The nurse and physician discuss the patient's muscle weakness and initiate a referral for physical therapy.

ANS: D Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions

A registered nurse (RN) is reviewing the concept of collaboration. Which statement correctly describes the RN nursing' role in collaboration? a. State boards of nursing mandate that collaboration can only occur in hospitals. b. Collaboration should occur only with physicians. c. Collaboration occurs only between nurses with the same level of education. d. Collaboration may occur in health-related research

ANS: D RNs collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working toward meeting patient goals. Collaboration occurs in any healthcare setting as well as community and home settings.

Which of the following is the intent of HIPAA? a. Release patient information for purposes of insurance reimbursement. b. Prevent healthcare providers from billing for procedures done for the insured person. c. Protect patients from reviewing their own medical records. d. Limit the ability of healthcare providers to sell patient information to outside sources.

ANS: D The intent of HIPAA is to protect patient information and prevent it from being sold to outside agencies. The right of heath care providers to bill for services is necessary for patient payment and is not prohibited. Patients have the right to view their own patient information.

The qualities of leadership, clinical expertise and judgment, mentorship, and lifelong learning would best describe which type of nurse? a. Administrator b. Certified nurse specialist c. Practitioner d. Professiona

ANS: D The qualities listed are those of a professional nurse. The other options are all nurses who may have these qualities, but the focus of their title includes qualities not essential for the professional nurse. The administrator would have management qualities; the clinical nurse specialist would have specialty area knowledge; and the practitioner would meet legal requirements as a healthcare provider.

A patient states, "I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response by the nurse would be an example of interpersonal therapeutic communication? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So, all in all, you feel as though you had a rather poor night's sleep?" d. "Can you give me an example of what you mean by a 'bad nightmare'?"

ANS: D The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient's comment

A patient states, "I had a bad nightmare. When I woke up, I felt emotionally drained, as though I hadn't rested well." Which response by the nurse would be an example of interpersonal therapeutic communication? a. "It sounds as though you were uncomfortable with the content of your dream." b. "I understand what you're saying. Bad dreams leave me feeling tired, too." c. "So, all in all, you feel as though you had a rather poor night's sleep?" d. "Can you give me an example of what you mean by a 'bad nightmare'?"

ANS: D The technique of clarification is therapeutic and helps the nurse examine meaning. The distracters focus on patient feelings but fail to clarify the meaning of the patient's comment.

A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement? a. "I will have to do whatever the physician says I need to do." b. "Once a plan is developed, it cannot be changed." c. "My insurance will not pay if I don't do what you want me to do." d. "We can work together to adjust my plan as we need to."

ANS: D Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient's ability to complete prescribed care, although they do reimburse for standard care given.