Chapter14PopulationHealthinAction:SuccessfulModels

Multiple Choice

1. Which type of nursing center actively integrates service, education, and research in its model?

a. Special care b. Freestanding organization c. Fee-for-service d. Academic

ANS: D

Academic nursing centers actively integrate service, education, and research in their model.

DIF: COG: Understanding REF: 463|465 OBJ: 1 a. Free-standing center b. Affiliated center c. Comprehensive primary care center d. Community center

2. Which type of nursing center operates under a service model?

ANS: C

The service model includes comprehensive primary care centers, wellness centers, and special care centers.

DIF: COG: Understanding REF: 464 OBJ: 1 a. A particular demographical group or those with special care needs b. An affiliation with a school of nursing c. Providing services while maintaining a not-for-profit status d. Providing fee-for-service care with designated HMO providers

3. What is the focus of a special care nursing center?

ANS: A

Special care centers focus on a particular demographical group or those with special needs.

Examples are those that focus on persons with HIV/AIDS, adolescent mothers, and the frail elderly.

DIF: COG: Understanding REF: 464 OBJ: 1 a. Provision of community-based culturally competent care b. Services provided by physicians and health care providers c. Focus on the biological factors contributing to the development of disease d. Fee-for-service reimbursement model

4. Which characteristic is common among all nursing centers?

ANS: A

One characteristic that is common among all nursing centers is the provision of community-based culturally competent care that is accessible, acceptable, and responsive to the populations being served.

DIF: COG: Understanding REF: 463 OBJ: 1 a. Illness-oriented care b. Direct access to nursing services c. Free services d. Physician diagnosis of health problems

5. What type of services will a client receive when visiting a nursing center?

ANS: B

A nursing center deemphasizes illness-oriented care, is reimbursed for services, and uses nurses to diagnose and treat.

DIF: COG: Applying REF: 463 OBJ: 1 a. Academic Nursing b. Wellness c. Comprehensive Primary Care d. Special Care

6. A client would like to enroll in a smoking cessation program Which type of nursing center would be most likely to provide this type of programming?

ANS: B

Wellness centers focus on health promotion, disease prevention, and management programs.

DIF: COG: Applying REF: 464|477 OBJ: 1 a. Fee-for-service b. Federally Qualified Health Center (FQHC) c. HMO provider d. Third-party reimbursement

7. A nurse executive reports that the nursing center receives reimbursement through contracted rates. What type of reimbursement mechanism is being used?

ANS: C

HMO providers pay at contracted rates.

DIF: COG: Applying REF: 464 OBJ: 1 a. Advanced care of the chronically ill elderly at home b. Smoking cessation and weight management techniques c. How to provide primary services d. Providing financial support for nursing students

8. Which health promotion topic would most likely be discussed in a class held at a nursing center?

ANS: B

Smoking cessation and weight management techniques focus on health promotion.

DIF: COG: Analyzing REF: 463-464 OBJ: 1

9. Individuals, families, groups, organizations, policy makers, and staff who are involved in community collaboration are known as: a. Nursing Center workers b. Policy makers c. Stakeholders d. Diversity

ANS: C

Stakeholders offer diversity in perspective in community collaborative efforts

DIF: COG: Remembering REF: 467 OBJ: 2 a. Having staff examine the needs of the community b. Determining the services to be established by the center c. Involving the community in assessing its own needs d. Addressing the problems in the community

10 How can a nursing center best be responsive to the needs of the community?

ANS: C

Nurses work in close partnership with the communities. As the community and center work together, a multilevel approach is needed. For comprehensive community health improvement, strategies are needed at organizational, community, and sociopolitical levels. Thus, it is important to involve the community in the planning of a nursing center.

DIF: COG: Applying REF: 468|472 OBJ: 2 a. The rural community b. The mayor c. The nursing executive d. The centers staff

11 A nursing center is going to be placed in a rural community. Who has the most power and influence on model development and team composition?

ANS: A

The fundamental premise of any nursing center is that the community has the most power and influence.

DIF: COG: Applying REF: 470 OBJ: 2 a. Focus of the group b. Planned change that will occur c. Decisions made by executive director d. Open and frequent communication

12. Which factor is the most important for the nurse to consider when facilitating successful collaboration?

ANS: D

Although the focus of the group and its planned change are important, they are not the most important factor for the nurse to consider. To accomplish anything with the group open and frequent communication is necessary.

DIF: COG: Evaluating REF: 467-468 OBJ: 2 a. Establish nursing centers for the purpose of health promotion. b. Create partnerships among individuals, communities, and systems. c. Eliminate disease in lesser-developed countries. d. Further the agenda of the World Health Organization.

13. What was the overarching concept upon which Healthy People 2020 was built?

ANS: B

Healthy People 2020 builds upon shared responsibility to improve the nations health. Powerful, productive partnerships among diverse people and groups and long-term commitments to community collaboration are needed to achieve these goals.

DIF: COG: Understanding REF: 467 OBJ: 3 a. Tertiary prevention b. Primary prevention c. Secondary prevention d. Health education

14. Which level of prevention is being used when a community conducts blood lead screenings on a regular basis for children under 6 years old?

ANS: C

Secondary prevention often involves screening Primary prevention involves education.

DIF: COG: Applying REF: 469 OBJ: 3 a. Community collaboration b. Community assessment c. Strategic planning d. Partnership

15 Which term addresses the multiple levels of intervention required for bringing about and sustaining change?

ANS: C

Strategic planning addresses the multiple levels of intervention required for bringing about and sustaining change.

DIF: COG: Remembering REF: 468 OBJ: 4

16. A nurse develops a plan to describe the development and direction of the nursing center and identifies how the center will meet its goals. This plan is called a(n): a. Feasibility study b. Business plan c. Strategic plan d. Organizational strategies

ANS: B

A business plan describes the development and direction of the nursing center and how goals will be met.

DIF: COG: Applying REF: 472 OBJ: 4 a. Legal and regulatory considerations b. Community involvement c. Nursing interest d. Potential grant funding

17. When making a final decision about establishing a nursing center, which factor is the most important for the nurse to consider?

ANS: A

Several essential areas must be explored before a final decision is made about establishing a nursing center, including legal and regulatory considerations.

DIF: COG: Applying REF: 471-472 OBJ: 4

18 When examining the strengths, limitations, and capacity of an organization and the community to support the establishment and viability of a nursing center, a nurse is completing a: a. Data collection b. Feasibility study c. Focus groups d. Community forums

ANS: B

A feasibility study reveals the strengths, limitations, and capacity of an organization and community to support the establishment and viability of a nursing center

DIF: COG: Applying REF: 472 OBJ: 4 a. Focusing on design b. Engaging stakeholders c. Ensuring use and sharing lessons learned d. Gathering credible evidence

19. Which essential step of program evaluation is completed when a nurse executive publishes information about the effectiveness of a prenatal program?

ANS: D

A nurse executive providing materials on the effectiveness of a prenatal program is an example of gathering credible evidence.

DIF: COG: Applying REF: 477 OBJ: 4 a. Community health worker b. Support staff member c. Clinical specialist d. Specialty care provider

20. A nurse executive would like to hire a neighborhood resident who is trained in community outreach to work at the nursing center. What would be the title of this position?

ANS: A

Community health workers are typically neighborhood residents who are trained in community outreach, family case management, or on-site services.

DIF: COG: Applying REF: 470-471 OBJ: 4 a. When counseling an employee that his insurance will remain the same after changing jobs b. When supervising staff to ensure that all work has been completed c. When adhering to client confidentiality when providing care d. When an employee takes additional time off of work to care for a sick family member

21 In which situation would a nurse be using the Health Insurance Portability and Accountability Act (HIPAA)?

ANS: C

HIPAA also states that staff must monitor and keep client records secure, and have mechanisms to transfer client information securely and appropriately.

DIF: COG: Analyzing REF: 474 OBJ: 4 a. The development and characteristics of nursing centers b. The effects of nursing models of care in nursing centers c. Client outcomes d. Managed competition in nursing centers

22. A nurse has recently completed a research study in a nursing center. Based on the historical pattern of research in nursing centers, what would likely have been the focus of this research?

ANS: A

Typically, descriptive data has been collected about clients, types of services, the financial supports, and community relationships over the past three decades.

DIF: COG: Applying REF: 476-477 OBJ: 5 a. Managing the business operations b. Managing the data systems c. Providing patient care and referral d. Overseeing contracts and grants

23. A nurse executive is managing a nursing center. What would be an expected responsibility of a nurse in this role?

ANS: D

The nurse executive has many leadership roles and responsibilities including responsibility for overseeing contracts and grants, annual reports, development of the advisory board, and hiring and retention of highly qualified staff.

DIF: COG: Applying REF: 470 OBJ: 5 a. Leader b. Follower c. Advocate d. Researcher

24. What is an appropriate role for a nursing student to engage in while working in a nursing center?

ANS: C

Students most often play the role of advocate in a nursing center. Students have the opportunity to promote social justice while engaging in community service learning activities with underserved, vulnerable populations. A student needs to be a leader, but with supervision. A student can collect data, but is not yet a researcher.

DIF: COG: Evaluating REF: 471 OBJ: 5 a. These clinics are typically staffed by physicians. b. These clinics are usually located in community centers. c. These clinics focus on providing information related to health promotion. d. These clinics are many times owned by for-profit organizations.

25. A nurse is presenting information to community members about the potential development of a retail care clinic in the neighborhood. What information would the nurse include in this presentation?

ANS: D

Retail care clinics are typically staffed by nurse practitioners, located in a high volume retail business, and provide a limited scope of care including immunizations, routine school physicals, and care for common acute problems. The majority of retail clinics are owned by for-profit organizations and its management does not consider the clinics as nurse-managed health centers.

DIF: COG: Applying REF: 477 OBJ: 6 a. All nurses should be members of the American Nurses Association. b. Membership in a professional organization helps nurses organize around critical health issues. c. Dues for professional organizations are expensive, so it is important to set aside money to pay these dues. d. Membership in a professional organization will foster change in legislation.

26 A nursing faculty member is discussing the importance of joining a professional organization as a registered nurse with a group of undergraduate students. Which statement would be most appropriate for the faculty member to include in this discussion?

ANS: B

Membership in a professional organization helps nurses to organize around one or more critical health threats and strategize about what interventions work locally, regionally, and nationally. Membership in organizations should be based on interest, clinical and academic preparation, and employment Dues for professional organizations vary, but most are not extremely expensive. One of the benefits of membership in a professional organization is that legislation can be influenced, however this in only one of the benefits of belonging to a professional organization.

DIF: COG: Analyzing REF: 478 OBJ: 6

Multiple Response

1. Which would be an appropriate source for a nurse to look for financial support when developing a nursing center? Select all that apply.

a. Grant funding b. Charitable organizations c. Private pledges d. Foundations

ANS: A, B, C, D

Support for nursing centers can come from grants, charitable organizations, private pledges, and foundations.

DIF: COG: Applying REF: 473 OBJ: 1 a. Client use of services b. Trends in community characteristics c. Staff compliance with HIPAA d. Client satisfaction

2. A nurse is performing the role of researcher in a nurse center. Which type of data would most likely be collected by a nurse in this setting? Select all that apply.

ANS: A, B, D

Trends in health care services, client responses, and changes in community characteristics must be documented and summarized periodically. Outcome measurements such as client use of on-site services, childhood and adult immunization patterns, pregnancy outcomes, emergency department and hospital use, and other health indexes including client satisfaction and quality-of-life measures should also be collected. Staff compliance with HIPAA is a legal responsibility of staff

Chapter15TheLegalImplicationsofReform MULTIPLECHOICE a.Nursingisacalltoservice,andthemoralcharacterofpersonsenteringnursingis important. b.Ethicalprinciplesarebasedonthevaluesoftheindividualnurse. c.Societywilldictatetheethicalprinciplestowhichnursesmustadhere. d.Ethicsareveryimportantintimesofwar,suchasintheCrimeanWar,whenshesetup publichealthcenters.

1.WhichstatementaboutFlorenceNightingalesideasaboutethicsiscorrect?

ANS:A

FlorenceNightingalesawnursingasacalltoserviceandviewedthemoralcharacterof personsenteringnursingasimportant.

DIF:COG:UnderstandingREF:126OBJ:1

2.Whennursesapplytheknowledgeandprocessesofethicstotheexaminationofethical problemsinhealthcare,theyareusing: a.Values b.Morality c.Ethics d.Bioethics

ANS:D

Bioethicsappliestheknowledgeandprocessesofethicstotheexaminationofethical problemsinhealthcare.

DIF:COG:ApplyingREF:127OBJ:1 a.NightingalePledge b.CodeforProfessionalNurses c.CodeofEthicsforNurseswithInterpretiveStatements d.InternationalCouncilofNurses(ICN)CodeofEthicsforNurses

3.Anurseinthe1960swouldhavereferredtowhichcodeofethicstoguideethical decisionmaking?

ANS:B

FlorenceNightingalelivedinthe1800s.TheCodeforProfessionalNurseswasadoptedin 1950,theCodeofEthicsforNurseswithInterpretiveStatementswasadoptedin2001,and theInternationalCouncilofNurses(ICN)CodeofEthicsforNurseswasadoptedin2000.

DIF:COG:ApplyingREF:127OBJ:1

4.Anorderlyprocessthatconsidersethicalprinciples,clientvalues,andprofessional obligationsis: a.Accountability b.Ethicaldecisionmaking c.Moralprinciples d.CodeforNursingPractice

ANS:B

Ethicaldecisionmakingisdefinedasanorderlyprocessthatconsidersethicalprinciples, clientvalues,andprofessionalobligations.

DIF:COG:UnderstandingREF:127OBJ:2

5.ThegrowingmulticulturalismofAmericansocietycancontributetoethnicityconflicts when: a.Culturalstandardsarecongruentwithprofessionalstandards. b.Culturaltraditionswithinanethnicgroupalignwiththoseofthecommunity c.Ethnicgroupsoverburdenthehealthcaresystem. d.Thegreatercommunitysvaluesarejeopardizedbyspecificethnicvalues.

ANS:D

Callahanofferedperspectivesonjudgingdiversityandsuggestsathoughtfultoleranceand somedegreeofmoralpersuasion(notcoercion)forethnicgroupstoaltervaluessothat theyaremoreinkeepingwithwhatisnormativeinAmericanculture.

DIF:COG:UnderstandingREF:128OBJ:2 a.Identifyalloptions. b.Makeadecision. c.Gatheradditionalinformation. d.Actandassessdecisionsmade.

6.Therearetwomedicallyindigentclientsintheclinicwhohavecometogettheirmonthly supplyoffreeinsulin.Thereisonlyenoughforoneclient.Whichactiondoesthenurse takefirst?

ANS:C

Onemusthaveallinformationbeforelookingatoptionsandmakingadecision.

DIF:COG:ApplyingREF:128OBJ:2

7.Anexampleofanethicaldilemmais: a.Whetherornottosetupacommunityhealthcenterinaruralarea b.Allocatingresourcesinanaturaldisaster c.Decidingtowithdrawcareonahospicepatient d.ApplyingtheprinciplesofFlorenceNightingaleinBangladesh

ANS:B

Whenresourcesarescarce,adilemmamayexistastohowtoallocatethem.

DIF:COG:ApplyingREF:127OBJ:2

8.Thestepsoftheethicaldecisionmakingprocessaresimilartothestepsof: a.HealthyPeople2010 b.Deontology c.Thenursingprocess d.Advocacy

ANS:C

Thenursingprocessinvolvesthesamebasicsteps:assessment,diagnosis,planning, implementation,andevaluation.

DIF:COG:EvaluatingREF:128OBJ:2 a.Respectforautonomy b.Non-maleficence c.Beneficence d.Distributivejustice

9.Whichethicalprinciplerequiresdoingnoharm?

ANS:B

Non-maleficencereferstodoingnoharm.

DIF:COG:RememberingREF:129OBJ:3 a.Rejectionofanyideathatsocieties,states,orcollectivesofanyformcanbethebearersof rightsorcanoweduties. b.Inequalitiesresultfrombirth,naturalendowment,andhistoriccircumstances. c.Everyonehasarighttoprivateproperty. d.Governmentshouldbelimited.

10.WhichstatementfitstheLiberalDemocraticTheoryofJohnRawls?

ANS:B

Rawlsacknowledgesthatinequitiesareinevitableinsociety,buthetriestojustifythemby establishingasysteminwhicheveryonebenefits,especiallytheleastadvantaged.Thisisan attempttoaddresstheinequalitiesthatresultfrombirth,naturalendowments,andhistoric circumstances.Theotherchoicesrelatetolibertarianism.

DIF:COG:UnderstandingREF:130-131OBJ:3

11.AccordingtoLeiningerandWatson,themoralidealofnursingis: a.Caring b.Advocacy c.Responsibility d.Accountability

ANS:A

Thisconceptualizationoccurredasaresponsetothetechnologicaladvancesinhealthcare scienceandthedesireofnursestodifferentiatenursingpracticefrommedicalpractice.

DIF:COG:UnderstandingREF:131OBJ:3 a.Feministsincludeonlywomenintheirworldview. b.Personswhoascribetofeministethicsarepassiveandwishtopursuetheirideals throughthelegislativeprocess. c.Feministsbelievethatmenshouldnotbenurses. d.Womensthinkingandmoralexperiencesareimportantandshouldbetakeninto account.

12.Whichstatementaboutfeministethicsiscorrect?

ANS:D

Feministtheoryascribestotheideathatwomensthinkingandmoralexperiencesare importantandshouldbeconsidered.

DIF:COG:UnderstandingREF:132OBJ:3

13.Examplesofthebenefitsofdistributivejusticeare: a.Basicneeds,materialandsocialgoods,liberties,rights,andentitlements b Taxes,militaryservice,locationofincineratorsorpowerplants c.Entitlementtoequalrightsandequaltreatment d.Therighttoprivatepropertyandpersonalassets

ANS:A

Justicerequiresthatthedistributionofbenefitsandburdensonasocietybefairorequal. thethirdoptionreferstoegalitarianism,andthelastoptionreferstolibertarianism.Taxes, militaryservice,andlocationofincineratorsorpowerplantsarenotbenefitsassociated withjustice.

DIF:COG:ApplyingREF:130OBJ:3

14.Anursebelieveseveryoneisentitledtoequalrightsandequaltreatmentinsociety whenapplying: a.Distributiveorsocialjustice b.Egalitarianism c.Libertarianviewofjustice d.Communitarianism

ANS:B

Egalitarianismisdefinedastheviewthateveryoneisentitledtoequalrightsandequal treatmentinsociety.

DIF:COG:ApplyingREF:130OBJ:3

15.Whenusingtheprinciplesofvirtueethicsindecisionmaking,anursewould: a.Provideefficientandeffectivenursingcare. b.Identifythemeaningfulfactsinthesituation. c.Seekethicalcommunitysupporttoenhancecharacterdevelopment. d.Planwaystorestructurethesocialpracticesthatoppresswomen

ANS:C

AccordingtoAristotle,virtuesareacquiredandincludeinterestintheconceptofthegood, includingbenevolence,compassion,trustworthiness,andintegrity.Onepartoftheprocess isseekingethicalcommunitysupporttoenhancecharacterdevelopment

DIF:COG:AnalyzingREF:131OBJ:3

16.Anurseappliestheethicalprincipleofnon-maleficencewhen: a.Administeringmedicationsusingthefiverights b.Allowingclientstobeactiveparticipantsintheircare c.Providingpatientprivacywhendeliveringcare d.Referringaclienttoaphysicaltherapist

ANS:A

Non-maleficencerequiresthatonedonoharm.Itrequiresthathealthcareprofessionals actaccordingtothestandardsofduecare,alwaysseekingtoproducetheleastamountof harmpossible.

DIF:COG:AnalyzingREF:129|131OBJ:3

17.Anurseprovidingcareusingtheideaofservicingcitizens,notcustomersisapplying the: a.Ethicaltenetsofpolicydevelopment b.Basicconceptsofthefeministtheory c.Underlyingpremiseofvirtueethics d.Componentsofdistributivejustice

ANS:A

Therearethreetenetsofbothpolicyandethics.Theapproachisbasedonthevoiceofthe communityasthefoundationonwhichpolicyisdeveloped.

DIF:COG:ApplyingREF:133OBJ:4

18.Publichealthadministratorsinacommunityprovideahealthdepartmenttoservean indigentpopulationofimmigrantsprovidingtranslatorsoncertaindaysoftheweek.This isanexampleof: a.Policy b.Quality c.Assurance d.Libertarianphilosophy

ANS:C

Assurancereferstotheroleofpublichealthinmakingsurethatessentialcommunityorientedhealthservicesareavailable,whichmayincludeprovidingessentialpersonal healthservicesforthosewhowouldotherwisenotreceivethem.

DIF:COG:ApplyingREF:133-134OBJ:4 a.Assessment b.Assurance c.Policydevelopment d.Advocacy

19.WhichcorefunctionsupportsthebeliefthatallAmericansshouldreceivebasichealth careservices?

ANS:B

Assurancepurportsthatallpersonsshouldreceiveessentialpersonalhealthservices.

DIF:COG:ApplyingREF:133-134OBJ:4 a.Theprofessionofnursingisresponsibleformakingpoliticalstatementsandsupporting nurse-friendlycandidatesforoffice. b.Thenursesprimaryfocusisonacutebedsidenursing,followedbycommunityhealth caretopromoteseamlesscare. c.Thenurseowesdutyprimarilytothephysiciantostrivetoprotecthealth,safety,andthe rightsofthepatient. d.Theprofessionofnursingisresponsibleforarticulatingnursingvalues,formaintaining theintegrityoftheprofession,andforshapingsocialpolicy.

20.WhichstatementisdiscussedintheCodeofEthicsforNurseswithInterpretive Statements?

ANS:D

Provision9oftheCodeofEthicsforNurseswithInterpretiveStatementsdiscussesthe needforthenursingprofessiontoaddressnationalandglobalhealthconcernsaswellasbe involvedwithshapingpoliciesthroughpoliticalaction.

DIF:COG:UnderstandingREF:134OBJ:5 a.Toprovideanswersforethicaldilemmas b.Toguideprofessionalpracticerelatedtoethics c.Toincreasemoralleadershipinethics d.Tofindaframeworkforethicaldecisionmaking

21.WhywouldanurserefertotheCodeofEthicsforNursesorthePublicHealthCode ofEthics?

ANS:B

Thesecodesprovidegeneralethicalprinciplesandguidepersonnelinthinkingaboutthe underlyingethicsoftheprofession.

DIF:COG:ApplyingREF:135OBJ:5 a.Offeringasmokingcessationprogram b.Screeningforhypertension c.Lobbyingforhealthcarereform d.Conductinghomevisits

22.Whichnursingactiondemonstratesadvocacy?

ANS:C

Nursesshouldparticipateinimplementingnewdirectionsforhealthcareandhelpenvision thesenewdirections.Nursescanbeanimportantvoiceinadvocatingforaccessto consistent,effective,efficienthealthcareforall.

DIF:COG:ApplyingREF:137-138OBJ:6 a.Policy b.Advocacy c.Caring d.Virtue

23.Thecommunityleadersinalesser-developedcountrydecidenottotellthecitizensofa smallvillageaboutachemicalspillatamajorindustrialfacilitythatcouldproduceharmful effects.Whichprinciplearetheyviolating?

ANS:B

Advocacyrequiresthatthecommunitybeproperlyinformed,andthiswasviolatedinthe abovescenario.

DIF:COG:EvaluatingREF:137OBJ:6

Multipleresponse

1.Theethicaltenetsthatunderliethecorefunctionofassessmentare(selectallthat apply): a.Competency:thepersonsassignedtodevelopcommunityknowledgearepreparedto collectdataongroupsandpopulations b.Moralcharacter:thepersonsselectedtodevelop,assess,anddisseminatecommunity knowledgepossessintegrity c.Servicetoothersoverself:anecessaryconditionofwhatisgoodorrightpolicy d.Donoharm:disseminatingappropriateinformationaboutgroupsandpopulationsis morallynecessaryandsufficient

ANS:A,B,D

Servicetoothersoverselfisanethicaltenetofpolicydevelopment.Competency,moral character,anddonoharmaretheethicaltenetsofassessment.

DIF:COG:UnderstandingREF:133OBJ:4 a.Actinthehealthcareprovidersbestinterest. b.Keeptheclient(group,community)properlyinformed. c.Maintainclientconfidentiality. d.Carryoutinstructionswithdiligenceandcompetence.

2.HowcanacommunityhealthnurseapplytheEthicalPrinciplesforEffectiveAdvocacy? Selectallthatapply.

ANS:B

Keeptheclient(group,community)properlyinformed,maintainclientconfidentiality,and carryoutinstructionswithdiligenceandcompetenceareethicalprinciplesforeffective advocacy.

Chapter16MakingtheCaseforPopulationHealthManagement:TheBusinessValueofaHealthy Workforce

Multiple Choice

1.What is the basic tenet of shared governance?

A) It allows nursing staff and management to be involved in decision-making.

B) It establishes the control of the institution over the actions of the nursing staff

C) It allows the administrative decision area to be controlled by management.

D) It supports the traditional role of the supervisor as one who hires, evaluates, promotes, and fires

Ans: A

Client Needs: A-1

Cognitive Level: Comprehension

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 3 mcs: 166, Shared Governance Model

Feedback:Shared governance may be viewed as a system in which nurses have organizational autonomy as reflected in control over their practice, and have input into decision relating to patient care. It is a professional practice model in which both the nursing staff and the nursing management are involved in decision-making, as opposed to the administrative decision area being controlled by management. In this way, it is an alternative to traditional supervision models and hierarchies.

2.A nurse is assigned for the care of each patient from the time the patient is admitted to the hospital until that patients discharge. What system of care delivery is most likely in place?

A) Functional care

B) Primary care

C) Modular care

D) Team care

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5 mcs: 171, Primary Care Nursing

Feedback:In a pattern of primary care, one nurse was assigned the responsibility for the care of each patient from patient admission until that patients discharge. The primary nurse was responsible for initiating and updating the nursing care plan, patient teaching, and discharge planning. An associate nurse worked with this same patient on other shifts and on the primary nurses day off, carrying out the plan of care developed by the primary nurse.

3.Nurses working in a hospital initiate a negotiating session in which they offer to take a pay cut to allow management to provide job security and to hire more nurses to alleviate understaffing. What is the term for this type of session?

A) Interest-based bargaining

B) Collective action bargaining

C) Concession bargaining

D) Good faith bargaining

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 6 mcs: 177, Bargaining and Negotiating

Feedback:Concession bargaining is a process in which there is an explicit exchange of reduced labor costs for improvements in job security. This specific tradeoff is not a characteristic of interest-based bargaining, collective action bargaining, or good faith bargaining.

4.Nurses decide to go on strike to try to force improvement in the quality of patient care in their facility. Once the strike is resolved, what are their options for being rehired by the facility under the reinstatement privilege that is in effect in their contract?

A) They will be rehired after the strike whether or not it is decided that the strike was lawful.

B) They will be rehired after the strike as positions become available provided they have not engaged in unfair labor practices.

C) They will be rehired to replace nurses hired during the strike who were hired to replace them.

D) They will be rehired at their former job as soon as the strike is resolved.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 7 mcs: 181, Reinstatement Privilege

Feedback:A reinstatement privilege is a guarantee offered to striking employees that they will be rehired after the strike as positions become available, provided that they have not engaged in any unfair labor practices during the strike, and provided that the strike itself is lawful.

5.Which of the following statements accurately reflects the general use of the grievance process by nurses?

A) Grievances usually are related to interpretations of a contract or to policies and procedures.

B) Although either the management or an employee can file grievances, in most instances it is management that initiates the case.

C) A grievance involves informal talk between the management and the employee until the issue is resolved.

D) Employees may have grievances about the contract negotiation process itself.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9 mcs: 173, Grievance Process

Feedback:A grievance is a circumstance or action believed to be in violation of a contract (or of policies of an institution if a contract is not in place). Grievances usually are related to interpretations of a contract or policies and procedures and they are usually initiated by employees. Although resolution may begin with an informal talk, this proceeds to a formal process if resolution is not achieved.

6.As part of the development of a new inner-city clinic, a group of nurses and members of other health disciplines have drafted a mission statement for the clinic. This statement will most likely specify

A) the priorities for the health of the identified population.

B) the main goals and functions that the organizers envision for the clinic.

C) the philosophies and beliefs that underlie the existence and functioning of the clinic.

D) the health outcomes that the organizers see as currently lacking in the community.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 1 mcs: 156, Mission Statement and Philosophy

Feedback:The purpose of an organization is often expressed in the form of a mission statement, which outlines what the organization plans to accomplish, including its goals and function. This may or may not identify the philosophy of the organization, specific health outcomes, or priorities for the health of residents.

7.Which of the following conditions must be met in order to ensure the efficient and effective operation of a healthcare organization?

A) Span of control must be kept as narrow as possible.

B) The chain of command must be explicitly and clearly delineated.

C) The formal organizational structure must closely mimic the informal relationships that exist (the grapevine).

D) Registered nurses must occupy positions in employee, middle management, and executive roles.

Ans: B

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2 mcs: 162, Chain of Command

Feedback:The effective operation of a healthcare organization requires a detailed and clear chain of command. A narrow span of control is not always preferable to broader spans of control and formal structure does not necessarily have to replicate informal structures, though each should be acknowledged and recognized. It is certainly possible, and potentially beneficial, for nurses to occupy a variety of roles in the organizational hierarchy but this is not a precondition for successful organization.

8.A nurse has concerns about some of the practices on the hospital unit and met with the unit manager to explain these concerns. After the meeting, the nurse felt misunderstood and rebuffed by the manager. How should the nurse determine who in the organization to meet with next?

A) Consult with the hospital bureaucracy

B) Enlist the help of a union representative

C) Ask colleagues about who is most influential in the organization

D) Refer to the hospitals chain of command

Ans: D

Client Needs: A-1

Cognitive Level: Application

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 2 mcs: 162, Chain of Command

Feedback:The chain of command represents the path of authority and accountability from individuals at the top of the organization to those at the base of the organization. The nurse should most likely meet with the person who is above the manager in the chain of command. The hospital bureaucracy, the union, and the persons who are informally influential are less likely to help the nurse identify the appropriate person with whom to meet.

9.There is general agreement on a postsurgical unit that the admission assessment template that is used is lengthy, unwieldy, and includes many parameters that are not relevant to the care of the patient population on the unit. Which of following aspects of amending the assessment template best exemplifies the concept of shared governance?

A) Managers and nurses cooperatively make a change and share accountability for the outcomes.

B) The unit manager consults with nurses and members of other disciplines prior to changing the document.

C) The decision-making process reflects the chain of command that exists at the hospital.

D) Nurses collectively present the change in practice to the manager, who is then accountable for the outcomes of the change.

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 3 mcs: 166, Shared Governance Model

Feedback:Shared governance encompasses a collaborative model of decision-making and shared accountability for the outcomes of these decisions It does not involve nurses announcing an independent change to management or management being solely accountable for the decisions of others. Shared governance is not necessarily linked to the chain of command in an organization.

10.The staff, the administrators, and the executives of a large, urban hospital are currently celebrating the fact that the hospital has recently been granted Magnet Recognition by the American Nurses Credentialing Center (ANCC). This designation suggests that the hospital

A) pays nurses higher wages than the national median.

B) has lower staff turnover than most hospitals.

C) integrates the principles of evidence-based practice into care.

D) has a committed and responsive bureaucracy.

Ans: B

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 4 mcs: 168, Magnet Hospitals

Feedback:While all of the given options may underlie or contribute to a hospitals Magnet designation, low staff turnover is one of the key attributes of such a hospital. Magnet Recognition is not explicitly based on high wages, effective bureaucracy, or evidence-based practice.

11.A nurse who has a baccalaureate degree in nursing has begun working at a hospital in which the principles of primary care nursing are used to organize care. Which of the following actions should the nurse anticipate?

A) Performing the most complex nursing tasks on the unit for all of the patients

B) Taking action to ensure that neither too much nor too little care is provided for each patient

C) Directing a team of practical (vocational) nurses and unlicensed care providers

D) Being responsible for specific patients from the time of their admission to the time of discharge

Ans: D

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Nursing Process

Objective: 5 mcs: 171, Primary Care Nursing

Feedback:In a pattern of primary care, one nurse is assigned the responsibility for the care of each patient from patient admission until that patients discharge. Patient care is not fragmented according to complexity, as in functional nursing. Collaboration of a group of RNs, PNs. and UAPs is characteristic of team nursing. Tight control of the amount of care a patient receives is a key characteristic of case management.

12.Collective bargaining has a long history in nursing. Which of the following milestones in the history of collective bargaining resulted from the 1974 amendment of the Taft-Hartley Act (Labor Management Relations Act)?

A) Nurses were granted the right to form unions and engage in collective bargaining.

B) The maximum length of a work week and the minimum nursing wage were established.

C) Nursing was formally recognized as a professional occupation.

D) Nonprofit hospitals were obliged to bargain with nurses around wages and working conditions.

Ans: D

Client Needs: A-1

Cognitive Level: Knowledge

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 8 mcs: 176, Table 5.1

Feedback:Under the 1974 amendment of the Taft-Hartley Act, nonprofit hospitals were required to bargain with nurses for better salaries and working conditions. The formation of unions and the recognition of nursing as a profession predated this act. The 1974 amendment did not specify wages and hours of work.

13 Contracts are essential to the maintenance of high quality care in healthcare institutions. As well, they are necessary to protect the interests of nurses who provide this care. Which of the following issues is most likely to be addressed in a contract for nurses?

A) The process that should be followed when distributing overtime work

B) The obligation of nurses to participate in nursing research

C) The details of the organizational structure of a hospital

D) The relationships among nurses, physicians and members of other health disciplines

Ans: A

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Moderate

Integrated Process: Communication and Documentation

Objective: 9 mcs: 182, Issues Negotiated in Contracts

Feedback:Contracts commonly address such issues as overtime work. Relationships between care providers, participation in research, and organizational structure of a hospital are issues that are normally outside the purview of a nursing contract.

14.Despite the long history of collective bargaining in the nursing profession, many nurses have concerns regarding membership in a collective bargaining unit. Which of the following statements by nurses best conveys one of the primary concerns that are prevalent among nurses?

A) I think that physicians recognize our value and sufficiently advocate for our best interests.

B) I think that a collaborative model results in higher wages than a confrontational model such as collective bargaining

C) Im not sure that joining a union is congruent with the philosophy of the nursing profession.

D) In the end, I think that the costs of being in bargaining unit outweigh the potential benefits.

Ans: C

Client Needs: A-1

Cognitive Level: Analysis

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 10

mcs: 184, Issues Related to Collective Bargaining and Nursing

Feedback:Among the major issues of collective bargaining that affect the nursing profession is the fact that some nurses see collective bargaining as unprofessional. The other most common concerns involve the matter of which bargaining group will represent nursing when nurses participate in collective bargaining, the question of whether to join a union when one exists, and the issue of the role of the supervisor.

15.Nurses, as well as individuals outside the profession, have sometimes expressed concern around the involvement of state nurses associations in collective bargaining. What factor most often underlies such concerns?

A) State nurses associations lack the legal authority to engage in bargaining though this has been their traditional role.

B) State nurses associations tend to be unaware of many of the issues that nurses face when providing care.

C) It can be difficult to reconcile the professional obligations of nurses associations with their role in bargaining.

D) Few practicing nurses participate in the activities of state nurses associations.

Ans: C

Client Needs: A-1

Cognitive Level: Application

Difficulty: Difficult

Integrated Process: Communication and Documentation

Objective: 11 mcs