Nursing Delegation and Management of Patient Care 2nd Edition by Motacki, Kathleen Burke TEST BANK

Test Bank for Nursing Delegation and Management of Patient Care2nd Edition Motacki Chapter 01: Leadership and Management Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Nurses can be leaders without being managers. Which nursing actions demonstrate

leadership? a. Assisting a new nurse with enteral tube feedings b. Counseling a new nurse regarding attendance c. Adjusting assignments after a staff member calls in sick d. Calling a physician for new order clarification ANS: A

Leaders act as role models and mentor new staff. The other options are incorrect because they are management responsibilities and not leadership roles.

DIF: Cognitive Level: Application

REF: page 6

2. Which nursing actions demonstrate the role of management in nursing? a. Encouraging autonomous decision making b. Observing the documentation of appropriate charges to patients c. Assisting in a code d. Asking the patient/family about advance directives ANS: B

Managers are responsible for the budget of their units. The other options are incorrect because those are leadership or mentoNriU ngRrS oI lesN. DIF: Cognitive Level: Application

REF: page 6

3. Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In

which instance is a nurse demonstrating leadership qualities? a. A staff nurse becomes aware of increased infection rates following cardiac surgery.

The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A staff nurse acts quickly when a cardiac arrest is called on her patient. c. A staff nurse notifies another staff member that she is being “pulled” today. d. A new nurse volunteers to work when another staff member must leave work because her child is ill.

ANS: A

Nurse leaders are interested in changing practice based on evidence. Options B and D are incorrect because they are actions taken by nurses as part of the functional structure of the unit. Option C is incorrect because it is an action taken by a manager.

DIF: Cognitive Level: Analysis

REF: page 6

4. A nurse manager must exhibit qualities of efficiency and organization. Which nurse is

demonstrating the qualities necessary for a manager?

a. A nurse becomes aware of increased infection rates following cardiac surgery. The

nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. b. A nurse acts quickly when a cardiac arrest is called on her patient. c. A nurse notifies another staff member that she is being “pulled” today. d. A nurse volunteers to work when another staff member must leave work because her child is ill.

ANS: C

Determining who gets “pulled” is a management decision. Option A is incorrect because it is a role taken by a nurse leader. Option B is incorrect because it is an action taken by staff as part of the functional structure of the unit. Option D is incorrect because it is an action taken by staff as part of the functional structure of the unit.

DIF: Cognitive Level: Analysis

REF: page 6

5. A nurse has accepted a position on a nursing unit where the nurse manager promotes

autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice.

ANS: C

Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option BNiU sR inS coI rrN ecG tT beB ca.uC seOiM t should be seen in all environments regardless of autonomy. Option D is incorrect because excellence in practice is not seen solely in autonomous environments.

DIF: Cognitive Level: Analysis

REF: page 6

6. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation.

ANS: C

Work allocation is necessary in any patient care delivery system. The other options are incorrect because it is not necessarily useful in determining the appropriate patient care delivery systems needed.

DIF: Cognitive Level: Analysis

REF: page 10

7. The student nurse, shadowing on a medical-surgical unit, observes the charge nurse. Which

action would the student identify as a leadership quality in the nurse’s actions? a. Making patient care assignments distributed equally to staff b. Sitting with a confused combative patient c. Calling the nursing office for extra staff when an RN calls in sick

d. Assisting in a code ANS: B

Leaders act as role models and do what is right for the patient. The other options are incorrect because these actions are expected as part of the functioning of the unit.

DIF: Cognitive Level: Analysis

REF: page 5

8. Health care is seen and managed as a business today. Which skills are considered essential to

managing health care as a business? a. Ability to pressure staff to do what you want b. Resource utilization c. Cutting corners to make money d. Providing bonuses to staff members who help the organization to save money ANS: B

The ability to manage a budget is essential to being a manager in health care today. The other options are incorrect because they are only a perception of the public regarding successful managers.

DIF: Cognitive Level: Application

REF: page 3 | page 7

9. The novice nurse is speaking with the nurse manager about their roles within the hierarchy of

the institution. The nurse manager would most likely identify which role as having the most internal conflict? a. Coordinating institutional goals with the immediate demands of the clinical area b. Determining which of the staff members should get better raises than other members c. Deciding which employees should be recommended for promotion d. Determining which staff members get Christmas day off ANS: A

Many times the goals of the institution conflict with the goals of the individual employees of a particular clinical area and the nurse manager must implement institutional changes regardless of the nurse’s personal opinion. The other options are incorrect because those roles should not provoke as much conflict.

DIF: Cognitive Level: Application

REF: pages 7-8

10. Nurse managers can best be described as people who a. develop institutional goals based on staff suggestions. b. develop institutional goals based on a personal theory. c. motivate staff to meet institutional goals through positional power. d. inspire staff to meet institutional goals through personal power.

ANS: C

Managers motivate staff to make changes. Options A and B are incorrect because nurse managers usually do not make institutional goals. Option C is incorrect because leaders inspire, not managers.

DIF: Cognitive Level: Application

REF: page 6

11. There are three levels of management in nursing. Which action by the nurse would indicate

the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A

The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because reevaluating the nursing policy permitting IV push of certain medications by RNs is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because designating assignment of new admissions would be the responsibility of the charge nurse.

DIF: Cognitive Level: Analysis

REF: page 7

12. The management process consists of six functions: planning, staffing, organizing, directing,

controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A

Establishing objectives should be seen in the planning step following identification of the problem. Option B is the organizing step. Option C is the directing step. Option D is the controlling step.

DIF: Cognitive Level: Application

REF: page 7

13. The management process consists of six functions: planning, staffing, organizing, directing,

controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit ANS: D

Decision making is a result of the other steps. The other options are different steps in the management process.

DIF: Cognitive Level: Application

REF: page 7

14. First-level managers are responsible for the day-to-day activities of the unit. Which activity

would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds ANS: B

Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other activities are not specific to first-level managers.

DIF: Cognitive Level: Application

REF: page 7

15. Middle-level managers are responsible for planning for changes of the unit. What activity

would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B

The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not the exclusive responsibility of the middle-level manager.

DIF: Cognitive Level: Application

REF: pages 8-9

16. Upper-level managers are responsible for the management of the nursing organization of the

institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B

Upper-level managers are resN ponR ng sM Usibl SIe fo NGr foTBrm.iC Otrategic plans. The other activities are responsibilities shared by all levels.

DIF: Cognitive Level: Application

REF: page 9

17. The nurses are complaining about how busy they are this shift. The charge nurse must do

which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff.

ANS: C

As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other actions may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills.

DIF: Cognitive Level: Application

REF: page 9

MULTIPLE RESPONSE 1. To become a leader, one must develop certain personal aspects. Which of the following can be

identified as competencies expected in creating leadership in oneself? (Select all that apply.)

a. b. c. d. e.

Asking for overtime Asking for certain patient assignments Personal and professional accountability Acquiring advanced degrees Personal discipline

ANS: C, D, E

Options C, D, and E are competencies identified in the text for developing leadership in oneself. Although they may be associated with a good work ethic, the other options do not apply to the development of leadership competencies.

DIF: Cognitive Level: Analysis

REF: page 11

2. The patient care delivery system used by an institution should be based on which fundamental

elements? (Select all that apply.) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D

Options A, B, and D are correct because the text lists these as fundamental elements of any patient care delivery system. Options C, E, and F are not fundamental elements of a patient care delivery system.

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Cognitive Level: ApplicN ation F:.C paO geM7 URSINGRTEB

3. A nurse manager encourages the nursing staff using a transformational leadership

environment. The nurse manager interprets that a successful transformational environment is one in which (Select all that apply.) a. a staff nurse provides advice and guidance to new nurses. b. a clinical ladder is used for advancement. c. a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them. d. annual performance appraisals are provided with competitive raises. e. decisions are made from the top down.

ANS: A, B, C

Options A, B, and C are correct because a transformational leadership environment encourages consultation and collaboration, empowering and motivating staff. The other options are examples of transactional leadership.

DIF: Cognitive Level: Analysis

REF: page 5

4. A nurse leader, according to the American Organization of Nurse Executives (AONE), is

competent in the areas of (Select all that apply.) a. knowledge of the health care environment. b. communication. c. business management.

d. demanding participation by the staff. e. providing a financial incentive.

ANS: A, B, C

Options A, B, and C are identified by AOEN as a competencies of nurse leaders. The other options are not competencies recommended by the AOEN. DIF: Cognitive Level: Analysis

REF: pages 8-9

5. The organizational hierarchy is used in which of the following situations? (Select all that

apply.) a. A staff member is observed taking money from a patient’s bedside table. b. A staff member is found to be drinking alcohol while at work. c. A nurse refuses to care for a patient receiving peritoneal dialysis because he has not been trained on this procedure. d. A nurse refuses to be floated to the ICU while still in orientation. e. A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient.

ANS: A, B, E

Options A, B, and E are correct because inappropriate actions by staff are managed by the hierarchy of any organization. Options C and D are incorrect because they are scenarios requiring actions not relegated to the hierarchy of the organization.

DIF: Cognitive Level: Analysis

REF: page 5

Chapter 02: Organizational Structure of Health Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. In interviewing for a new position, a nurse may want to inquire about the institution’s views

on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent “floating.” b. self-scheduling. c. cover of another nurse’s assignment while she or he is on break. d. hourly pay differential for the night shift.

ANS: B

In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Option A is incorrect because it does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization.

DIF: Cognitive Level: Application

REF: page 16

2. The student nurse learns about the advantages and disadvantages of various patient care

delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies.

G TtB.C b. the financial environmentNoU fR thS eI paNtien populO ation. c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit.

ANS: A

Patient delivery models are instituted based on various elements including clinical decision-making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options do not describe a fundamental element used in the decision-making process for delivery mode.

DIF: Cognitive Level: Application

REF: page 19

3. An agency nurse is assigned to work on a unit that uses the team nursing model of health care

delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths b. RN taking vital signs and giving baths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery ANS: C

In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models.

DIF: Cognitive Level: Application

REF: page 20

4. In which health care delivery model would the nurse expect to see “point-of-care” decision

making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing ANS: A

Primary nursing allows the nurse to practice autonomously and make most bedside decisions.

The other options are incorrect because they may not allow for the autonomy required for “point-of-care” decisions.

DIF: Cognitive Level: Application

REF: page 21

5. A nurse has accepted a position on a nursing unit where the nurse manager promotes

autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice.

ANS: C

Work environments that promote autonomy and decision making encourage participation on hospital committees so that sN taffR may beG come involved in the decisions that are made. Option U anSI N TB.C inMwhich staff are encouraged to participate A is incorrect because this is not environment in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments.

DIF: Cognitive Level: Analysis

REF: page 16

6. Leadership structures in health care can be centralized or decentralized. The nurse understands

that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Changes can be made rapidly based on immediate needs. c. Nurses must work under a dual-authority structure. d. Decisions can be made at the “point of care.”

ANS: A

In a centralized leadership structured environment, all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed.

DIF: Cognitive Level: Application

REF: page 16

7. What should the nurse expect when working in a product-line leadership structured

environment?

a. b. c. d.

Coordination of all services within the specialty Slow organizational response to environmental changes Individual service goals Each service area autonomous to the others

ANS: A

In product- or service-line leadership structures, it is necessary to have coordination of services. The other examples are not examples of product-line leadership and is an example of leadership without coordination.

DIF: Cognitive Level: Application

REF: page 17

8. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation.

ANS: C

Work allocation is necessary in any patient care delivery system. The other options are incorrect because they are not necessarily useful in determining the appropriate patient care delivery systems needed.

DIF: Cognitive Level: Analysis

REF: page 19

9. A nurse who is interested in developing clinical decision-making skills would look for a unit

that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management ANS: A

Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other options do not necessarily promote the development of decision-making skills.

DIF: Cognitive Level: Application

REF: page 21

10. A nurse would expect to see which action on a unit that uses the team nursing model of health

care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway.

ANS: B

The nurse delegates and works collaboratively with the members of the team in team nursing.

Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing.

DIF: Cognitive Level: Application

REF: page 10

11. A nurse working on a unit using the primary care delivery model would expect to observe

which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. b. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morning dose of insulin for a patient scheduled for surgery later that day.

ANS: D

In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models.

DIF: Cognitive Level: Analysis

REF: page 21

12. Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments.

ANS: A

The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models.

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Cognitive Level: AnalysN isURSINGRT EB F:.C paO geM21

13. In a team nursing health care delivery model environment, the nurse would observe for which

action by the staff? a. The UAPs answer all call lights. b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients’ call lights. d. The RN is notified when there are patient care complaints.

ANS: D

Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing.

DIF: Cognitive Level: Analysis

REF: page 21

MULTIPLE RESPONSE 1. The patient care delivery system used by an institution should be based on which fundamental

elements? (Select all that apply.) a. Work allocation b. Accountability c. Allocation of resources d. Mission statement

e. Leadership style f. Cultural diversity of patients ANS: A, B, D

According to the text, work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system.

DIF: Cognitive Level: Application

REF: pages 18-19

Chapter 03: Strategic Management and Planning Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. When applying for a management position, the nurse should ask about the goals and plans of

the hospital. Strategic plans must be developed around a. the mission statement. b. patient population. c. staff input. d. infection rates.

ANS: A

The strategic plan of an organization must comply with the mission statement. The other factors are incorrect because although they may influence the overall plan, the plan can never stray from the mission statement.

DIF: Cognitive Level: Application

REF: page 28

2. The strategic plan of an organization includes all stakeholders of the organization, including

nurse managers. Which explains the benefit of including nurse managers in developing plans for the organization? a. Nurse managers own stock in the business. b. Nurse managers understand the clinical areas. c. Nurse managers will be involved in implementing the changes. d. Nurse managers have had business courses.

N R I G B.C M

U S N T

O

ANS: C

Nurse managers will be important in the implementation of the plan at the unit level. Option A is not true. Option B is not a reason for including nurse managers. Option D is not a reason for including nurse managers.

DIF: Cognitive Level: Analysis

REF: page 28

3. Nurse managers are included in strategic planning for the institution because of which

principle? a. Nurse managers have the authority to terminate employees. b. Nurse managers encourage “buy-in” from staff. c. Nurse managers understand the need for the plan. d. Nurse managers understand the financial aspects of the organization.

ANS: B

Nurse managers ensure “buy-in” of the project from staff. The other options are not the reason for including nurse managers in the planning.

DIF: Cognitive Level: Analysis

REF: page 28

4. When interviewing for a position at a new facility, the nurse managers ask to review the

mission, vision, and values statements because they understand that these statements provide information about the organization’s

a. b. c. d.

fiscal responsibility. direction and purpose. concern for uninsured. specific actions to be taken.

ANS: B

These statements are usually generalized around the direction and purpose of the organization.

Mission, vision, and value statements do not address specific areas listed in the other options.

DIF: Cognitive Level: Analysis

REF: page 28

5. A health care organization incorporates information from which group into their strategic

plan? a. Local community b. Nursing research c. Pharmaceutical research d. Insurance companies ANS: A

Information from stakeholders, which would include the members of the local community, should be incorporated into their strategic plan. The other groups are not generally a source for direction that is incorporated into the strategic plan.

DIF: Cognitive Level: Application

REF: page 28

6. In developing mission and values statements, health care facilities incorporate tools to

describe desirable behaviors of the organization. These tools describe behaviors such as a. patient risks. b. nurse/patient ratios. c. organizational direction. d. desired outcomes.

ANS: C

Most tools used to describe mission and values incorporate actions that are measurable. The other behaviors are not included in organizational statements.

DIF: Cognitive Level: Application

REF: page 28

7. Sometimes organizations use measurable critical success factors (CSFs) when developing

their strategic plan. The CSFs include People, Service, Quality, Financial, Growth, and sometimes Community. Which of the definitions indicates the meaning of the term People? a. The term People represents the patients served. b. The term People represents the nurses and physicians who provide the care. c. The term People represents the community served. d. The term People represents the upper-level management.

ANS: B

The term People, when used as a CSF, represents those who are attracted to an environment conducive for nurturing the best in their practice. The other definitions do not represent the meaning of the term People as a CSF. DIF: Cognitive Level: Analysis

REF: page 32

8. Strategic goals are developed as a result of which information source? a. Environmental scan b. Electronic medical record c. Changes in nursing practice d. Changes in staff ratios ANS: A

The environmental scan is a major source for developing strategic goals and includes the competition, economic trends, etc. The other goals do not impact strategic goal development.

DIF: Cognitive Level: Analysis

REF: page 28

9. When referring to the critical success factors (CSFs) that organizations use for developing

their strategic plans, the term Quality best describes which characteristic? a. Quality is a measurement of the product produced. b. Quality is the value of the service. c. Quality is the outcome provided when the best people are providing the best service. d. Quality is a characteristic of the service.

ANS: C

Quality represents the outcome of the care being provided by the best people in an institution with the best service. The other characteristics can be a definition of the term Quality but do not apply when used as a CSF. DIF: Cognitive Level: Analysis

REF: page 32

N R I G B.C M

U S factors N T (CSFs) O that organizations use for developing 10.1 When referring to the critical success 0 their strategic plans, the term Financial best describes which characteristic? . a. Financial indicates the economic benefits achieved. b. Financial indicates the expertise of the financial manager. c. Financial indicates the cost to the patient. d. Financial indicates the cost to the community.

ANS: A

The term Financial when used as a CSF indicates the economic benefits derived from the quality of the service provided by the best people. The other options do not represent the meaning of the term Financial when used as a CSF. DIF: Cognitive Level: Analysis

REF: page 32

11. When referring to the critical success factors (CSFs) that organizations use for developing

their strategic plans, the term Growth best describes which characteristic? a. Growth is the expansion of the specific disease. b. Growth is the aging of the population served. c. Growth is difficult-to-access health care. d. Growth is the expansion of the organization.

ANS: D

Growth refers to the expansion of the organization as a result of the financial benefits received from the quality outcome resulting from the service provided by the best people. The other options do not represent the meaning of the term Growth when used as a CSF. DIF: Cognitive Level: Analysis

REF: page 32

12. When referring to the critical success factors (CSFs) that organizations use for developing

their strategic plans, the term Community best describes which characteristic? a. Community is society. b. Community is the neighborhood surrounding the organization. c. Community identifies the people served. d. Community is the group of people working within the organization.

ANS: C

The Community is the end beneficiary of the growth from the financial benefits due to the quality outcomes from the service provided by the best people. The other options represent the meaning of the term Community when used as a CSF. DIF: Cognitive Level: Analysis

REF: page 32

13. Which of the following could have an impact on strategic planning for a community hospital? a. Change in primary orthopedic surgeon b. Increased availability of flu shots c. Health promotion by the local nursing school d. Community health fairs ANS: A

Each surgeon has their own pNatieR nt lI he. irCpraM ctice and this would change the strategic SoadNGinTttoB plan. The other options reduce U admissions the hospital by reducing patient illnesses or aid in identifying diseases early.

DIF: Cognitive Level: Application

REF: page 29

14. A community hospital has assessed the need for an automatic internal cardiac defibrillator for

special procedures. Because of the reimbursement allowed from Medicare, which of the following best explains the decision made? a. An environmental scan showed no interest in the community for having these placed. b. An environmental scan showed the need for this procedure in only a few patients in the community. c. An environmental scan showed that the cost to the patient was prohibitive. d. An environmental scan showed the device has a high malfunction rate.

ANS: B

This hospital determined that the cost-benefit to the hospital did not make it financially beneficial to perform these procedures. The other options would not have been determined by an environmental scan.

DIF: Cognitive Level: Analysis

REF: page 29

15. Which of the following represents a short-term goal for an organization? a. Health education to prevent the incidence of accidents due to drunk drivers

b. Heart failure education provided to every patient admitted with that

diagnosis-related group c. Building a new emergency department d. Renovation of the intensive care unit ANS: B

Providing education to a specific population is achievable as a short-term goal. The other options are long-term goals.

DIF: Cognitive Level: Application

REF: page 30

16. Action planning is a process by which organizations develop and implement both short-term

and long-term goals. What would be expected in these plans? a. Identification of the strengths and weaknesses for each objective b. Identification of the impact on the community c. Specific responsibilities and timelines for each objective d. Specific patient population for each objective ANS: C

Responsibilities and timelines are set for each objective. Options A and B are incorrect because they are not part of the action planning process. Option D is incorrect because action planning usually has a more global focus.

DIF: Cognitive Level: Application

REF: page 30

17. When identifying the objectives in an organization’s action plan, what would be an essential

tool to use to improve performance? a. Benchmarking to “best inNclaR U ssSpIerfo NGrme TBrs.”C OM b. Patient satisfaction survey results c. Employee satisfaction survey results d. Patient population ANS: A

Most objectives will identify benchmarks that they want to reach. The other options may be used but not for every objective and therefore is not essential.

DIF: Cognitive Level: Analysis

REF: page 30

18. Nurse managers involved in the development of the action plan for a unit understand that each

objective is individualized such that a. each objective has an identified population. b. each objective has an identified resource. c. each objective has an identified goal. d. each objective has been identified by the CEO. ANS: C

Each objective has a target goal or benchmark. The other options do not apply.

DIF: Cognitive Level: Application

REF: page 30

19. When establishing a unit action plan, the nurse manager identifies steps to be taken to

accomplish the goal. What is most important for achieving the goal?

a. b. c. d.

Regularly scheduled meetings Administration attendance at meetings Staff involvement in decisions and actions Involvement of other departments

ANS: C

Without “buy-in” from staff, the likelihood of success in the plan is remote. The other options may be necessary for success but are not the most important factors.

DIF: Cognitive Level: Application

REF: page 30

20. When developing a unit-based action plan, what would the nurse manager need to do first? a. Identify the purpose of the plan b. Identify specific plans for each strategy c. Monitor and update the plan d. Identify the responsibility of each person in achieving the goal ANS: A

The first thing to be accomplished is identification of the purpose or mission. The other actions are incorrect because they are one of the steps taken in the process but not the first.

DIF: Cognitive Level: Application

REF: page 30

21. When developing a unit-based action plan, the nurse manager would need to include which

factor in making decisions for implementation? a. Patient acuity statistics b. Patient satisfaction survey c. Budget d. Staff holiday schedule ANS: C

Implementation must be made within the budgetary constraints of the unit. The other factors may be involved, depending on the purpose and goal established, but not in every action plan.

DIF: Cognitive Level: Analysis

REF: page 32

22. Organize the following steps in developing a strategic unit-based action plan.

1. Determine specific strategies for each goal.

2. Select goals to be achieved.

3. Define the purpose or mission.

4. Monitor and update the plan 5. Identify resources for accomplishing goals. a. 3, 2, 1, 5, 4 b. 2, 1, 3, 4, 5 c. 1, 2, 3, 4, 5 d. 1, 2, 5, 4, 3 ANS: A

These are the correct steps for developing a strategic unit-based action plan. The other options are not the correct steps for developing a strategic unit-based action plan.

DIF: Cognitive Level: Application

REF: page 32

23. The overall purpose for strategic planning in an organization includes which of the following? a. Increases the chance of success b. Frees the nurse manager from day-to-day supervision c. Shows interest in the success of the organization d. Avoids crisis management ANS: A

Planning for changes using a strategy increases the chance of success. Options B and C are not a purpose for planning. Avoiding crisis management is a purpose but it can be incorporated into the success strategy.

DIF: Cognitive Level: Application

REF: page 33

MULTIPLE RESPONSE 1. When an organization performs a strategic analysis, it is looking for ways to address the

competition. Which environmental factor influences their decision making? (Select all that apply.) a. Transfer of patients to a Level I trauma center b. Changing demographics c. Political climate d. Economic considerations e. Transfer of patients to an extended-care facility (ECF) ANS: B, C, D

An environmental scan can expose changes within the community population, changes in N R cess I Nibil GT B.C oney available for growth, and changes in access to federal funding and toUacS ity to mO access to money available for growth. Options A and E are incorrect because these conditions do not change significantly and should not affect the overall strategic plan.

DIF: Cognitive Level: Analysis

REF: page 28

2. The patient satisfaction survey can influence strategic planning by using which factors?

(Select all that apply.) a. Strengths and weaknesses b. Medication errors c. Threats d. Staffing shortages e. Opportunities ANS: A, C, E

SWOT (Strengths, Weaknesses, Opportunities, Threats) is an acronym that can be used when performing environmental scans for the purposes of strategic planning.

The other options are incorrect because they may impact planning at the unit level but not at the organizational level.

DIF: Cognitive Level: Application

REF: page 28

Chapter 04: Financial Management in Health Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. When developing a zero-based budget, nurse managers understand a. the previous year’s monies are applied to the current one. b. all budget needs are justified annually. c. no changes to patient care delivery can occur. d. it does not reflect actual changes of the unit.

ANS: B

Zero-based budgets have to be re-created annually starting from zero and every request must be justified. Options A and D are a factor seen in the incremental type budget. Option C is the zero-based type budget allows for changes in delivery of the service.

DIF: Cognitive Level: Application

REF: page 46

2. When developing an incremental type budget, the nurse manager understands a. yearly budgets are dependent on the previous year’s budget. The budget must be

recreated every year. b. anticipated changes are allowed. c. all changes must be justified. d. the yearly budget for the upcoming year will be less than for the present year.

ANS: A

Each year’s budget is based oNnUthReSaI mN ouGnT t sB p. enC t iO nM the previous year’s budget. The other options refer to the zero-based budget.

DIF: Cognitive Level: Application

REF: page 46

3. When using the gathering and planning phase of developing a budget, the nurse manager

would expect to find a. financial objectives of the organization. b. environmental assessment. c. scheduled budget items. d. monitoring of progress.

ANS: B

An environmental survey should be done as the first step in the budget process. The other options are part of another phase.

DIF: Cognitive Level: Application

REF: page 47

4. When evaluating the performance of a budget, the nurse manager can use a variance analysis

to explain a. an increased cost due to market changes. b. a change in availability of materials. c. differences between budget and cost. d. one-time event.

ANS: C

A variance analysis can explain the reason for a difference between what is budgeted and what was spent. The other options do not address variance analysis.

DIF: Cognitive Level: Analysis

REF: page 48

5. Unit yearly budgets may change based on variances. What does the nurse manager understand

to be the cause of budget variances? a. A change in patient census b. An increase in staffing c. Implementation of new responsibilities d. New management ANS: B

Changes in staffing will cause a budget variance. A change in the patient census can cause a change but only in its relationship to staffing. The other options do not affect the budget.

DIF: Cognitive Level: Analysis

REF: page 48

6. A positive budget variance can be identified by which situation? a. A decrease in the budgeted expenditures b. An increase in the budgeted expenditures c. An increase in RN salaries d. A decrease in patient ratios ANS: A

Positive budget variances are those that show a decrease in expenditures from what was budgeted. An increase in theN budR geted expenditures reflects a negative variance. An increase U SI NG TB.C M in RN salaries and decrease in patient ratios would apply only if it had been incorporated into the budget and then a change occurred.

DIF: Cognitive Level: Analysis

REF: page 48

7. A nurse consistently remains past her shift for report or charting. The amount of overtime

accumulated is equivalent to a full-time nurse’s salary for 1 month. The nurse manager counsels the nurse and emphasizes that one of the responsibilities to the institution is a. quality patient care. b. fiscal accountability. c. accurate documentation. d. accurate medication administration.

ANS: B

This particular nurse appears to have no sense of fiscal accountability to the institution. Fiscal responsibility is as vital to the success of the institution as is quality patient care. The other options describe important responsibilities, but the question is not about the nurse’s care that is provided but about the organization of her time.

DIF: Cognitive Level: Analysis

REF: page 48

8. A proactive budget should incorporate which situation? a. Patient acuity changes b. Patient/nurse ratio changes

c. Projection of sick time d. Equipment maintenance ANS: C

Projection of increased sick time during the flu season into the budget is a proactive example.

The other options are not examples of a proactive budget that anticipates changes based on past years and includes them into the budget.

DIF: Cognitive Level: Application

REF: page 48

9. In addition to determining the number of patient care hours needed, the nurse manager must

also include which other labor costs? a. Loss of staff positions b. Vacations and holiday pay c. Breaks d. Changes in management ANS: B

Vacations, holiday pay, shift differential, etc. impact the overall personnel budget. The other costs are not usually calculated into the personnel budget.

DIF: Cognitive Level: Application

REF: page 49

10. Indirect costs in a nurse manager’s budget would include a. benefits. b. expected raises. c. shift differential. d. travel.

ANS: D

Travel is determined as an indirect cost to the budget because there is no direct connection to patient care. The other options have a direct connection to patient care.

DIF: Cognitive Level: Application

REF: page 50

11. When planning the purchase of new equipment, the nurse manager should include these items

into which type of budget? a. Capital budget b. Personnel budget c. Cash budget d. Operating budget ANS: A

The capital budget includes expensive equipment, land, etc. The other items do not apply.

DIF: Cognitive Level: Application

REF: page 50

12. The nurse manager understands that when there is a negative variance of the budget report, it

is necessary to establish the cause. Which of the following might best explain a negative variance? a. Decreased patient acuity b. Increase in staff sick days

c. Increased benefits d. Decreased census ANS: B

An increased use of sick time requires additional nurse hours to staff the unit and so the manager is essentially paying twice for the same hours, which would lead to a negative variance. The other options would not affect the budget negatively.

DIF: Cognitive Level: Application

REF: page 48

13. To determine staffing needs, the nurse manager needs to a. determine supplies needed. b. determine shift differential. c. determine the daily census. d. determine overtime needed.

ANS: C

To know the number of staff needed, it is necessary to know the daily census. The other options are not required to determine staffing needs.

DIF: Cognitive Level: Analysis

REF: page 48

14. A community health center leases space from the owner of the building. As the manager

develops the budget, they understand this to be a fixed cost. From which of the following would the lease payment be paid? a. Operating budget b. Personnel budget c. Capital budget d. Cash budget ANS: A

A fixed cost such as a lease will come from the operating budget. The other options do not apply.

DIF: Cognitive Level: Application

REF: page 48

15. When assessing the staffing needs, the nurse manager must consider which of the following in

addition to the patient care hours? a. Anticipated retirements b. Cash budget c. Staff mix required d. Scheduled breaks ANS: C

The staff mix must be considered when assessing the required staffing needs. The patient acuity may allow for fewer RNs and more UAPs. The other options are not assessed when deciding the staffing needs of the unit.

DIF: Cognitive Level: Application

REF: page 49

16. A new drug reference book is needed for a unit. The nurse manager would plan to pay for this

from which budget?

a. b. c. d.

Cash budget Operating budget Personnel budget Capital budget

ANS: A

Small expenditures will come from the cash budget. The other budgets do not apply.

DIF: Cognitive Level: Application

REF: page 48

17. Which of the following would explain a nurse manager’s use of position control in monitoring

the budget? a. Comparison of this year’s turnover rate with last year’s b. Premium pay c. Comparison of actual full-time employees and the number that was budgeted d. Control of nurse manager to allocate pay raises ANS: C

Position control is managed by the nurse manager and provides visualization of positions filled or not filled. The other options do not apply.

DIF: Cognitive Level: Application

REF: page 49

18. From which of the following would a nurse manager expect to receive revenue? a. Failure of the nurse to correctly check in b. Staff turnover c. Unused sick time d. Medicare ANS: D

Third party payers and investments are the source of revenue for hospitals. The other factors do not provide revenue for a nursing unit.

DIF: Cognitive Level: Application

REF: page 43

19. Support costs must be included in the budget. Which employee position would be included in

the support or indirect costs part of the operating budget? a. Waiting room secretary b. UAPs c. Physical therapists d. Case managers ANS: A

Support staff (housekeeping) who do not provide direct care to patients are considered indirect costs and come from the operating budget and not the personnel budget. The other employee positions will have direct care responsibilities to the patient.

DIF: Cognitive Level: Application

REF: page 50

MULTIPLE RESPONSE 1. The personnel budget is based on the calculations of which factors? (Select all that apply.)

a. b. c. d. e.

Average daily census Patient safety factors Hours per patient day Number of staff Nurse/patient ratios

ANS: A, C, D

The personnel budget is made up of factors around number of staff and patient care needs.

Patient safety factors and nurse/patient rations are not part of the personnel budget.

DIF: Cognitive Level: Application

REF: page 48

Chapter 05: Healthcare Regulatory and Certifying Agencies Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The Joint Commission (TJC) is a voluntary accrediting agency that is nationally recognized

for its performance standards. A hospital accredited by the agency will most likely experience which outcome? a. Improved patient outcomes b. Dedicated staff c. Higher salaries d. Loss of practicing physicians ANS: A

Adherence to the performance standards set by TJC should lead to better patient outcomes.

Options B and C may result from accreditation but there are no data to support this. Option D is incorrect because accreditation should have the opposite effect.

DIF: Cognitive Level: Application

REF: page 58

2. In which situation should the SBAR (Situation-Background-Assessment-Recommendation)

tool most appropriately be used? a. To reduce the risk of nosocomial infections b. To improve response to changes in patient condition c. In hand-off communication d. For accuracy of patient idN entR ificaItionG B.C M

U S N T

O

ANS: C

SBAR is supported by TJC as a tool to improve communication between care givers. The other options are goals of TJC but is not related to the use of SBAR. DIF: Cognitive Level: Application

REF: page 91

3. Federal and state departments of health regulatory agencies have been established to ensure

optimal standards and delivery of care. Which action is the jurisdiction of these agencies? a. Investigation of medication errors b. Investigation of patient- or family-reported complaints c. Investigation of patient falls d. Investigation of staffing shortages ANS: B

These agencies investigate and make judgments on complaints brought by consumers of the services and the public. The other actions would be investigated internally.

DIF: Cognitive Level: Application

REF: page 57

4. The state regulatory agency may impose a fine on a hospital for which patient safety

infraction? a. Inconsistent adherence to isolation protocol b. Medication administration error resulting in no harm to the patient

c. Wrong patient sent for chest radiograph d. Repetitive staffing shortage due to staff discontent ANS: A

Hospitals may be cited and fined by the state regulatory agency because of nonadherence to isolation protocol. The other infractions would be managed internally.

DIF: Cognitive Level: Analysis

REF: page 57

5. The state regulatory agency may impose a fine on a hospital for which patient safety

infraction? a. A UAP ambulating a patient b. A UAP checking a blood glucose level c. Allowing only RN staff in the medication room d. Leaving the medication room unlocked ANS: D

The door to the medication room must be locked at all times to prevent unapproved people from accessing medications, syringes, needles, etc. Options A and B are not regulated by state regulatory agencies. Option C is incorrect because other employees may need access for various reasons.

DIF: Cognitive Level: Analysis

REF: page 60

6. The state regulatory agency may impose a fine on a hospital for which patient safety

infraction? a. Not reporting a patient’s change in condition b. Physical abuse to patient N by sRtaffI G B.C M U S N T O c. Not documenting pain management d. Not feeding a confused patient ANS: B

Physical abuse of a patient would be investigated by a state regulatory agency. The other infractions do not require state investigation.

DIF: Cognitive Level: Analysis

REF: page 62

7. The National League of Nursing Accrediting Committee (NLNAC) is an example of an

accrediting body for nursing programs. Besides the nursing school, for what other agencies are they responsible to ensure compliance to their standards? a. Hospitals where students provide care to patients b. Medical schools c. Nursing homes in the area d. Other similar hospital settings ANS: A

Hospitals must be in compliance with the standards of the regulating bodies for nursing school programs and will receive a visit when the schools that use those facilities are being accredited. The others are sites that are not visited during the accreditation of nursing schools.

DIF: Cognitive Level: Application

REF: pages 57-58

8. During a convention at a large hotel, several attendees become very ill with respiratory

symptoms for which they are diagnosed with Legionnaires’ disease. Which regulatory agency is responsible for investigation of an outbreak of Legionnaires’ disease? a. Occupational Safety and Health Administration (OSHA) b. The Joint Commission (TJC) c. Centers for Disease Control and Prevention (CDC) d. National League of Nursing Accrediting Committee (NLNAC) ANS: C

The CDC is the government body responsible for preventing and controlling diseases. The other regulatory agencies do not investigate the outbreak of diseases.

DIF: Cognitive Level: Application

REF: page 61

9. The people of the United States depend on many agencies working under the leadership of the

U.S. Department of Health and Human Services (HHS) for assistance, research, and protection. Which service would be expected under the HHS leadership? a. Restricting the cost of prescriptions b. Limiting accessibility to family planning c. Ensuring food and drug safety d. Providing day care for low-income families ANS: C

One of the departments within HHS is the Food and Drug Administration, which is responsible for ensuring the safety of our food and drugs. The other services are not provided

by HHS. DIF:

Cognitive Level: ApplicN atiU onRSINGRT EB F:.C paO geM62

10. The Centers for Disease Control and Prevention (CDC) is a department headed by the

Secretary of the U.S. Department of Health and Human Services (HHS). Which of the following situations would be expected to be investigated by this department? a. Inaccessibility of the influenza shot b. Toxic spill near a school c. Outbreak of Salmonella d. Rubella exposure of a pregnant woman ANS: C

An outbreak of Salmonella is most likely from a contaminated food source and the source needs to be identified to prevent more injuries and deaths. The other situations are not within the auspices of the CDC. DIF: Cognitive Level: Analysis

REF: page 62

11. The National Institutes of Health (NIH) is a department headed by the Secretary of the U.S.

Department of Health and Human Services (HHS). Which action would be expected from this department? a. Research of health care issues b. Statement regarding stem cell research c. Recommendation for all people to stop smoking d. Recommendation for use of Nicorette to stop smoking

ANS: A

The NIH is a health research department of the HHS. The other actions are not those that the NIH would take.

DIF: Cognitive Level: Analysis

REF: page 62

12. The Food and Drug Administration (FDA) is a department headed by the Secretary of the U.S.

Department of Health and Human Services (HHS). Which function would be expected of this department? a. Regulation of herbal drugs b. Control of the price of medications c. Regulation of the safety and efficacy of medications d. Licensing of nurses ANS: C

The FDA regulates medications. The other functions are not the responsibility of the FDA. DIF: Cognitive Level: Analysis

REF: page 61

13. The most common impact on the nurse of The Joint Commission standards is through the

management of the pain standard. Which action is necessary to comply with the standard? a. Documentation of the relief of pain b. Providing for alternative pain medications c. Prescribing the correct dosage of pain medication d. Documentation of the frequency of medication administration ANS: A

Documentation of pain reliefNis iR ncluI ded as B on.eC of tM he measurements for compliance with the U actions S NG T pain management goal. The other are not included in the measurements for pain management.

DIF: Cognitive Level: Application

REF: page 60

14. The Joint Commission (TJC) measures the management of infections within the institution.

By which method will TJC be able to measure the performance of the institution to manage infections? a. Employment of an infection control nurse b. Interviews with patients and families c. Staff follow-up for prevention d. Documentation of a patient’s infection ANS: A

TJC requires surveillance of infections to comply with the standard. An infection control nurse fulfills that role. Options B and C are not measures taken to determine compliance.

Option D is important to the patient’s outcome but is not a measurement of TJC. DIF: Cognitive Level: Application

REF: page 60

15. The Joint Commission (TJC) goals include the safe and accurate delivery and reconciliation of

medication administration. In which way is this goal measured? a. Charting medications on an MAR b. Use of an admission medication list

c. Use of the six rights of medication administration d. Documentation of pharmacy accuracy in dispensing of medications ANS: B

A TJC goal is the utilization of the admission medication list for reconciliation of medications ordered during admission, discharge, and transfer to an outside facility. The other options do not measure this goal.

DIF: Cognitive Level: Analysis

REF: pages 58-59

16. A goal of The Joint Commission (TJC) is prevention of health care–associated pressure

ulcers. In which situation would the institution fail in complying with that goal? a. Charting of the Braden Risk Assessment Scale b. Utilization of the Braden Risk Assessment Scale to prevent pressure ulcers from developing c. Documentation of stages of pressure ulcers to determine appropriate action to take d. Turning at-risk patient every 2 hours ANS: A

The Braden Risk Assessment Scale is considered by TJC to be an accurate tool for identifying and therefore preventing pressure sores in patients, but the scale must be used to prevent the ulcers. When the other measures are used, prevention of pressure ulcers is possible.

DIF: Cognitive Level: Analysis

REF: pages 58-59

MULTIPLE RESPONSE 1. The Joint Commission (TJC)NsU urR veSyI orN sG mT eaB su.reCeOaM ch institution’s compliance by which of the

following? (Select all that apply.) a. Staff education documentation b. Interviews with patients and staff c. Review of medical records d. Educational materials provided to patients and families e. Review of employee records ANS: B, C, D

B, C, and D are compliance standards measured by TJC. Options A and E are not compliance standard measured by TJC. DIF: Cognitive Level: Application

REF: pages 58-59

2. The ANCC (American Nurses Credentialing Center) is an organization that recognizes

excellence in nursing in hospitals. Which outcome would be expected by an institution receiving Magnet Hospital status? (Select all that apply.) a. Nurses as teachers b. Quality nursing leadership c. Better salaries for staff d. Increased use of UAPs e. Quality of care f. Community relationships

ANS: A, B, E, F

A, B, E, and F are characteristics developed by ANCC to accredit hospitals through their nursing care performance. C and D are not characteristics used to acquire Magnet status.

DIF: Cognitive Level: Application

REF: page 63

3. The Joint Commission (TJC) has made recommendations for abbreviation use, which have

been instituted in most health care facilities. Which abbreviations would the nurse expect to find on the “Do Not Use” list from TJC? (Select all that apply.) a. Qd b. Qod c. Prn d. NPO e. STAT ANS: A, B

The abbreviation qd can be mistaken for other meanings and should be written as “daily.” The abbreviation qod can be mistaken for other meanings and should be written as “every other day.” The other options are an appropriate abbreviation and are approved.

DIF: Cognitive Level: Application

REF: pages 58-59

4. In addition to staff interviews, The Joint Commission (TJC) surveyors measure an

institution’s compliance by which action? (Select all that apply.) a. Review of clinical records b. Shadowing a nurse for a shift c. Passing as a patient for the day d. Interviews with patients e. Reviewing policy statements of the facility ANS: A, D, E

TJC surveyors use these actions to measure compliance to the pain management standard. The others are not measures used by the surveyors.

DIF: Cognitive Level: Analysis

REF: pages 58-59

Chapter 06: Organizational Decision Making and Shared Governance Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which council is concerned with the management of resources as defined in the strategic plan

and nursing conceptual framework? a. Nurse Executive Council b. Unit-Based Council c. Nursing quality and patient safety council d. Advanced practice nurse council ANS: A

The role of this council is the management of resources as defined in the strategic plan and nursing conceptual framework. The unit based councils represent their own culture while using the organization’s shared governance framework and bylaws. Nursing quality and patient safety council provides a forum to develop and review nursing quality indicators.

Advanced practice nurse council assesses practice, implements necessary changes and evaluates through data analyses, professional and patient outcomes.

DIF: Cognitive Level: Application

REF: page 75

2. Which council advances the practice of nursing and fosters the nursing role in patient

education through staff and development and evidence-based research initiatives? a. Nursing Staff Development, Education and Research Council b. Nurse executive council NURSINGTB.C M O c. Advanced practice nurse council d. Nursing informatics and communication council ANS: A

Advancement of practice through research, education and staff development initiatives. Nurse Executive Council manages resources as defined in the strategic plan. Advanced practice council assesses practice, implements necessary changes and evaluates through data analyses, professional and patient outcomes. Nursing informatics and communication council, collaborates with members from Information Technology and Nursing Informatics, to provide guidance and expertise into the development and implementation of the electronic documentation systems, and nursing information systems.

DIF: Cognitive Level: Application

REF: page 75

3. In a health care organization, equity is a. a willingness to invest in decision-making and express ownership in those

decisions. b. the best method for integrating staff roles and relationships into structures and

processes to achieve positive patient outcomes. c. recognition and acceptance of the importance of everyone’s work and of the fact

that an organization’s success is bound to individual performance. d. linking health care providers and patients along all points in the system.

ANS: B

Equity is the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes. Accountability is a willingness to invest in decision-making and express ownership in those decisions. Ownership is recognition and acceptance of the importance of everyone’s work and of the fact that an organization’s success is bound to individual performance. Partnership is linking health care providers and patients along all points in the system.

DIF: Cognitive Level: Application

REF: page 72

4. In a health care organization, ownership is a. a willingness to invest in decision-making and express ownership in those

decisions. b. the best method for integrating staff roles and relationships into structures and

processes to achieve positive patient outcomes. c. recognition and acceptance of the importance of everyone’s work and of the fact

that an organization’s success is bound to individual performance. d. linking health care providers and patients along all points in the system.

ANS: C

Ownership is recognition and acceptance of the importance of everyone’s work and of the fact that an organization’s success is bound to individual performance. Accountability is a willingness to invest in decision-making and express ownership in those decisions. Equity is the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes. Partnership is linking health care providers and patients along all points in the system.

DIF:

Cognitive Level: Application

F: pag e 72 N R I GREB . C M U S N T O

5. Nursing shared governance models have always focused on a. physician groups controlling all practice models. b. nurses and physicians making nursing practice decisions. c. nurses controlling their professional practice. d. national accreditors controlling nursing practice decisions.

ANS: C

Nurses control their professional practice under nursing shared governance models.

DIF: Cognitive Level: Knowledge

REF: page 71

6. Equity maintains a focus on which of the following? a. Services, executive management and staff b. Services, patients, and staff c. Staff, the management team and services d. Staff, patients and resources ANS: B

Equity maintains a focus on services, patients, and staff; is the foundation and measure of value; and says that no single role is more important than any other.

DIF: Cognitive Level: Application

REF: page 72

7. Which of the following are Centralized or self-governance interactions?

1. Position-based 2. Hierarchical communication 3. Synergistic work environment.

4. Separates responsibility/managers are accountable 5. We-they work environment 6. Direct communication a. 1, 2, 3, 5 b. 2, 3, 5, 6 c. 1, 2, 4, 5 d. 1, 3, 5, 6 ANS: C

Centralized or Self-governance interactions are • Position-based • Distant from point of care/service • Hierarchical communication • Limited staff input • Separates responsibility/managers are accountable • We-they work environment • Divided goals/purpose • Independent activities/tasks DIF: Cognitive Level: Application

REF: page 73

8. Which of the following are Decentralized or Shared governance interactions?

1. Hierarchical communication 2. Occurs at point of care/serN viU ceRSINGTB.COM 3. Direct communication 4. High staff input 5. Synergistic work environment 6. Collegiality, collaboration, partnership a. 1, 2, 4, 5, 6 b. 1, 3, 4, 5, 6 c. 2, 3, 4, 5, 6 d. 1, 2, 3, 5, 6 ANS: C

Decentralized or Shared governance interactions are • Knowledge-based • Occurs at point of care/service • Direct communication • High staff input • Integrates equity, accountability, and authority for staff and managers • Synergistic work environment • Cohesive goals/purpose, ownership • Collegiality, collaboration, partnership DIF: Cognitive Level: Application

REF: page 73

Chapter 07: Professional Decision Making and Advocacy Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. How can nurses communicate their positions to help influence policy?

1. Ongoing representation on policy-making committees.

2. Committees or boards.

3. Lobbying.

4. Making new laws at the state level.

5. Meeting with people in positions of influence a. 1, 2, 4 b. 1, 2, 5 c. 1, 2, 3, 5 d. 1, 2, 4, 5 ANS: C

Nurses can communicate their positions to help influence policy through: • Ongoing representation on policy-making.

• Committees or boards.

• Lobbying.

• Making submissions.

• Meeting with people in positions of influence DIF: Cognitive Level: Application

REF: page 85

NURSINGTB.COM

2. The four major areas of political action in nursing are a. the workplace, the government, professional organizations and the community. b. the workplace, the educational institutions, professional organizations and the

community. c. the government, professional organizations and the state regulators, community

boards. d. the government, the community and nursing boards, education board.

ANS: A

There are four major arenas of political action in nursing: the workplace, the government, professional organizations, and the community.

DIF: Cognitive Level: Application

REF: page 81

3. As a nurse and member of the Professional Practice Committee at your institution, you will be

asked to review policies and to make suggestions for changes. The components of the review will include a. evidence of the current practice, and a literature review to determine current best evidence. b. a nursing literature review. c. evidence of outcomes. d. comparison studies.

ANS: A

Evidence of the current practice, and a literature review are used together to determine current best evidence are necessary as part of the review process for establishing and/or maintaining best practices.

DIF: Cognitive Level: Application

REF: page 81

4. Which nursing professional organization represents the interests of nurses regarding many

issues, tracks nursing and health care related bills across all states and examines priority issues and trends? a. ANCC b. Sigma Theta Tau International c. ANA d. CCNE ANS: C

The American Nurses Association (ANA) represents the interests of nurses regarding many issues. Each year they track over 1000 nursing and health care related bills across all states, examining priority issues, and trends. They also release position statements on many issues of importance to nursing and health care in the United States. Sigma Theta Tau, ANCC, and CCNE are not involved policy development.

DIF: Cognitive Level: Application

REF: page 81 | page 83

5. The Institute of Medicine (IOM) report challenges nurses and society to ensure that nurses are

represented in leadership positions in health care, including governing boards. According o the latest data, approximately how many nurses sit on governing boards? a. Less than %5 b. More than %5 c. 15 % d. 10% ANS: A

The sparse data that exist indicate that physicians comprise more than 20 % of the governing board members of hospitals and less than 5% are nurses.

DIF: Cognitive Level: Knowledge

REF: page 84

6. Which of the following is a policy that pertains to the governing of workplaces? a. Social b. Health c. Organizational d. Institutional ANS: D

Institutional policies are policies that govern the workplace. Social policy pertains to the policy decisions that promote the welfare of the public. Health policy includes actions to promote the health of individual citizens. Organizational policy includes the positions taken by professional organizations such as the ANA and specialty organizations.

DIF: Cognitive Level: Application

REF: page 81

7. Which of the following is a policy that pertains to the decisions that promote the welfare of

the public? a. Social b. Health c. Organizational d. Public ANS: A

Social policy pertains to the policy decisions that promote the welfare of the public. Health policy includes actions to promote the health of individual citizens. Organizational policy includes the positions taken by professional organizations such as the ANA and specialty organizations. Institutional policies are policies that govern the workplace.

DIF: Cognitive Level: Application

REF: page 81

Chapter 08: Communication in the Work Environment Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. The UAP is given ambulation instructions by a staff nurse for a patient 2 days postoperatively.

Which of the following ambulation instructions would require further communication to the UAP to ensure the safety of the patient? a. “Ambulate the patient the length of the hallway and get me if there are any problems.” b. “Have you ambulated this type of post-op patient before?” c. “Let me know 1 hour before you are ready to ambulate the patient so I can give him his pain medication.” d. “This patient has been ambulating with minimal assistance, but I would like you to walk with him to be sure he is stable.”

ANS: A

Delegation requires thorough communication including specific instructions regarding task (“ambulate the length of the hallway”) and information about possible adverse effects and what to do about them. The other options are incorrect because they only give limited instructions.

DIF: Cognitive Level: Application

REF: page 93

2. A float nurse is assigned four patients on the day shift. Which of the following reports by the

float nurse would require immediate intervention by the charge nurse?

N Rone IN G compla B.CO M a. “Dr. Smith, your patient, MUr. JS s is T ining of a headache.” b. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache.” c. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, admitted with hypertension, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?” d. “Dr. Smith, this is nurse Sandy from xyz and your patient, Mr. Jones in 222, is complaining of a headache but has just been started on isosorbide (Isordil). What can I give him to relieve his headache?”

ANS: A

This answer gives no information to the physician about the patient or his condition and thus would require further teaching. The other options give a different level of information, which is better and more informative than answer A and therefore does not require further teaching.

DIF: Cognitive Level: Application

REF: pages 95-97

3. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed,

requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? a. “Can you step over here out of the hearing of the patients and family members?” b. ‘I’m sorry, you should have ordered restraints for the patient.” c. “We will accept all liability.” d. “My nurses are all new on the night shift. They didn’t know how to handle him.”

ANS: A

It is always the best practice to remove the angry person from the audience. Usually, when removed, the person settles down and becomes more reasonable. The other options are not appropriate to the situation and could antagonize the angry physician.

DIF: Cognitive Level: Application

REF: page 99

4. To avoid transcription errors, the current trend in hospitals is to use the Computerized

Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? a. “I don’t need to review the new orders for accuracy.” b. “The orders will go directly to the appropriate departments.” c. “The risk for transcription errors is less.” d. “I am still responsible for communicating the changes to the appropriate care givers.”

ANS: A

Orders entered into the CPOE still require the nurse to review and therefore would need further instructions. The other options are correct statements and therefore do not require further instructions.

DIF: Cognitive Level: Analysis

REF: page 93

5. The end of shift report is vital for the coordination of patient care. Which of these statements

would require an intervention if overheard by the charge nurse during report? a. “Mr. Smith is quite afraid of the outcome of his procedure today. I had to give him an anti-anxiety medicatioN n.” S N TO U b. “Mr. Smith is quite afraid of the outcome of his procedure today. I called his wife to come in early.” c. “Mr. Smith is quite afraid of the outcome of his procedure today. I called the chaplain to see him and his wife today.” d. “Mr. Smith is quite afraid of the outcome of his procedure today. I was in the room most of the day.”

ANS: D

It illustrates the nurse making an inappropriate judgment regarding this patient’s anxiety and therefore would require intervention. The other options are appropriate communication regarding a patient and his anxiety and therefore does not require intervention.

DIF: Cognitive Level: Analysis

REF: pages 95-96

6. Which of the following is an essential part of the shift report? a. Patient’s ECG rhythm b. Patient’s marital status c. Patient’s occupation d. Patient’s insurance status ANS: A

The patient’s ECG rhythm is an essential part of the shift report. The other options may not always be appropriate to the shift report.

DIF: Cognitive Level: Application

REF: pages 95-96

7. Patients are complaining that they are not receiving pain medications on the night shift. The

night nurse has charted that they were given. What is the most appropriate action by the charge nurse? a. Notify the nurse manager. b. Confront the nurse about the problem. c. Ask other nurses what they think. d. Report the suspicion to the State Board of Nursing.

ANS: A

This question illustrates the concern for illegal charting of pain medications and substance abuse in nurses. It is essential for the nurse identifying this issue to report it to her nurse supervisor (chain of command). The other options are not appropriate responses to the implied illegalities in this question.

DIF: Cognitive Level: Application

REF: page 93

8. A staff nurse complains to the nurse manager about an employee of another department

constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? a. Confront the employee and ask him to stay away from the staff nurse. b. Observe future interaction to confirm the reported harassment. c. Contact the supervisor to decide on the next step. d. Review the personnel manual to decide on the next step.

ANS: D

If unfamiliar with the approvN edUaR ctS ioI nsNiG nT aB se. xuCal hMarassment situation, the nurse manager should refer to the official references for action. The other actions are not appropriate in this case.

DIF: Cognitive Level: Application

REF: page 99

9. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use

to avoid errors? a. Ask another nurse to listen to the conversation on another telephone. b. Repeat the order, write the order verbatim, and read the order back to the physician. c. Ask the physician to come to the unit to write the order. d. Hold implementation of the order until the order is written by the physician.

ANS: B

Following this procedure will reduce errors in communication between the health care provider and the nurse. The other options are not practical methods to use to avoid errors.

DIF: Cognitive Level: Application

REF: page 93

10. Which of the following patients should be seen by the nurse first based on the information

provided during the shift report? a. A patient admitted with hypertension complaining of back pain. b. A patient admitted with mental status changes.

c. A patient complaining of incisional pain postoperatively. d. A patient asking for assistance in getting back to bed.

ANS: A

This patient may be experiencing angina. The other options are incorrect because this patient does not require an urgent assessment.

DIF: Cognitive Level: Analysis

REF: pages 95-96

11. Which response by the patient following discharge teaching would require further teaching? a. “I should weigh myself daily since I started on Lasix (furosemide) for my heart

failure.” b. “I need to check my blood glucose after eating.” c. “I should take my Lanoxin (digoxin) with my morning medications.” d. “I need my blood checked frequently now that I am on Coumadin (warfarin).”

ANS: B

Option B is not correct and therefore requires further teaching. The other options are correct statements and therefore does not require further teaching.

DIF: Cognitive Level: Analysis

REF: page 98

12. Which exchange between the RN and the UAP requires intervention by the charge nurse? a. “Take the patient’s blood pressure every 15 minutes and inform me of the results.” b. “Check the patient’s blood glucose before breakfast and lunch and inform me of

the results.” c. “Ambulate the patient in 2210 as far as he can walk.” d. “Shave the patient in 221N 0.UHRisSbI eaNrdGiT sB lo. ngC.”OM ANS: C

Option C is inadequate because it does not provide enough information to the UAP and requires intervention. The other options are appropriate communication and therefore do not require intervention.

DIF: Cognitive Level: Application

REF: page 95

13. Which patient should the charge nurse direct the RN to see immediately after the shift report? a. Patient with a blood sugar of 240 mg/dL b. Patient complaining of burning on urination c. Patient in a Posey vest who is trying to get out of bed d. Patient with a temperature of 38°C who is scheduled for surgery later that day ANS: D

This patient is unstable and requires urgent assessment. The other assessments can be delayed.

DIF: Cognitive Level: Analysis

REF: pages 95-98

14. A UAP becomes sick at work and asks to leave. Which response by the charge nurse is most

appropriate? a. “You can’t leave until all the baths are completed.” b. “Write down what needs to be completed.” c. “Tell me what responsibilities still need to be completed.”

d. “Be sure to call by 5 AM if you are still sick tomorrow.”

ANS: C

Direct communication is the best method to avoid errors and allow for questions regarding remaining tasks. Options A and D are not appropriate for determining continuity of care.

Options B is not the most effective means of communication and does not allow for questions and feedback.

DIF: Cognitive Level: Analysis

REF: page 95 | pages 97-98

15. The nurse is admitting a patient who speaks very little English. What is the most appropriate

method to use to ensure the patient understands the instructions? a. Obtain a hospital interpreter. b. Ask a family member to interpret. c. Ask other staff for help. d. Incorporate sign language.

ANS: A

The most appropriate means for interacting with a patient whose language is not English is to obtain an interpreter. The other options are not appropriate alternatives.

DIF: Cognitive Level: Application

REF: page 91

16. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the

nurse? a. Change the assignment. b. Ask the UAP what they did to precipitate this. c. Explain to the patient how wR hat I sC beinM g interpreted.

NU Sthey NGsay TBi. d. Complain to the physician.

ANS: C

Sometimes patients are not aware of how their comments are interpreted by staff. Informing them may correct the situation. The other options do not address the underlying problem of inappropriate communication.

DIF: Cognitive Level: Application

REF: page 91

MULTIPLE RESPONSE 1. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her

patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) a. Interaction b. Clarity c. Simple exact language d. Feedback e. Credibility f. Direct communication

ANS: A, B, D, F

In this scenario, the staff nurse leaving the unit does not interact directly with the RN who will now become responsible for the care of the patients and thus no questions could be asked and feedback could not obtained. The other options do not apply to this situation.

DIF: Cognitive Level: Application

REF: page 90

2. It is vital to communicate changes in patient condition to the physician. When using the

SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) a. Problem b. Current medications c. Assessment d. Diagnosis e. Documentation f. Lab data ANS: A, C, D, F

Options A, C, D, and F should be provided to any health care provider when reporting changes in patient conditions and obtaining new orders. Options B and E may not be required in all circumstances.

DIF: Cognitive Level: Application

REF: page 96

3. SBAR is a convenient tool to use when notifying physicians of a change in patient condition.

In which of the following situations could it also be appropriately used? a. Communication with radiology scheduling b. Communication with casN em anS agIeN r GTB.COM UR c. Transferring patient d. Change of shift report e. Rapid response team (RRT) ANS: C, D, E

Options C, D, and E are circumstances in which the SBAR tool of communication can be used effectively. Options A and B are not necessarily appropriate circumstance for the use of SBAR. DIF: Cognitive Level: Analysis

REF: page 96

4. In the change of shift report, what should be included? (Select all that apply.) a. Family contact telephone numbers b. Current assessment c. Plan of care d. Change in condition e. Discharge plan f. Personal comments ANS: B, C, D, E

Options B, C, D, and E are correct because only pertinent information required for delivery of care should be transmitted during the change of shift report. Family contact telephone numbers may, at times, be pertinent but not as a routine. Personal comments are almost never appropriate.

DIF: Cognitive Level: Application

REF: page 95 | pages 97-98

5. Formal communication in health care is used to properly inform staff of (Select all that

apply.) a. changes in CPR certification dates. b. Christmas party celebration. c. patient survey results. d. girl Scout cookie order pick-up. e. termination of an employee.

ANS: A, C

Options B, D, and E are correct because formal communication would be used to distribute information regarding institutional policy changes. The other options are examples of informal communication.

DIF: Cognitive Level: Application

REF: page 100

6. Informal (“grapevine”) communication in health care is used to properly inform staff of

(Select all that apply.) a. changes in practice. b. Christmas party celebration. c. patient survey results. N R I G B.C M d. girl Scout cookie order pick U-upS. N T O e. termination of an employee.

ANS: B, D, E

Options B, D, and E are examples of informal communication and are more closely aligned with gossip. These are not formal communication methods in an institutional environment.

Options A and C are examples of formal communication.

DIF: Cognitive Level: Application

REF: page 100

7. Which of the following are true when communication is effective? (Select all that apply.) a. The sender is credible. b. There is clarity. c. Simple, exact language is used. d. Slang is used. e. The receiver rolls her eyes when asked to complete a task.

ANS: A, B, C

Options A, B, and C are principles of effective communication. The other options are examples of inappropriate communication and even resistance to what is being communicated.

DIF: Cognitive Level: Application

REF: page 90

8. The end of shift report is the appropriate time to communicate (Select all that apply.)

a. b. c. d. e.

the frequency of which the call light was used. patient’s relationship to a staff member. new patient orders. impending procedures. evaluation of medication response.

ANS: C, D, E

Options C, D, and E are correct because only information directly related to the care of the patient should be transmitted during the shift change report. Options A and B are not usually pertinent to care of the patient.

DIF: Cognitive Level: Application

REF: page 95 | pages 97-98

9. Walking rounds are currently being implemented to avoid errors or omissions in shift reports.

Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) a. Foley bag is not emptied on a patient on strict I&O. b. Patient needs assistance to bathroom. c. IV infusion bag is nearly dry. d. Patient with a PCA requests instructions to avoid increased pain. e. Patient’s family member is caught smoking in the bathroom. f. IV line is not infusing what is currently ordered.

ANS: A, C, F

Options A, C, and F are correct because inaccuracies of shift reports can be eliminated by using walking rounds. Options B, D, and E would cause interruptions in the report and lead to walking rounds.

DIF: Cognitive Level: Application

REF: page 95 | pages 97-98

Chapter 09: Personnel Policies and Programs in the Workplace Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following is a risk factor for hospital workplace violence? a. Unlimited security coverage b. Public availability 24 hours a day c. Insecure medication access d. Semiprivate rooms ANS: B

Unlimited public access, mixed with other risk factor, makes the hospital an unsafe workplace. The other option are not risk factors for violence.

DIF: Cognitive Level: Analysis

REF: pages 106-107

2. Family members who have access to hospitals may present risks to the staff when which of

the following is most likely present? a. Family members are not doing well. b. Family members are in the intensive care unit. c. Family members are under the influence of drugs or alcohol. d. Family members are unable to visit regularly.

ANS: C

People under the influence of drugs or alcohol are more likely to be volatile and unpredictable. The other optiN onUsR arSeI inN coGrT reB ct.bC ecO auMse these people are not as likely to present a problem.

DIF: Cognitive Level: Application

REF: page 111

3. Workplace violence can be initiated by an employee in the workplace as well as by patients or

family members. Which of the following would be cause for concern when observed in an employee? a. Divorce b. Personality changes c. Death in the family d. Miscarriage ANS: B

A change in personality may indicate substance abuse or mental health problems. The other options are not risk factors for employee violence.

DIF: Cognitive Level: Analysis

REF: page 111

4. In the workplace, violence may escalate as a result of many factors. Which of the following

should the nurse be alert for in the escalation to violence? a. Crying b. Isolation c. Asking for help

d. Pacing and using profanity ANS: D

Pacing and use of profanity may be signs of escalation of anger to violence. The other options do not represent a sign of escalation to violence.

DIF: Cognitive Level: Analysis

REF: page 107

5. Universal strategies to use in the presence of escalation of a potential violent situation include

which of the following? a. Demand that the potentially person back off. b. Remain close to the patient to protect her. c. Remain calm with a caring attitude. d. Speak loudly with authority.

ANS: C

Sometimes not reacting to the situation can calm the person down. Always present a caring attitude, not a threatening one. The other options are incorrect because they may cause the situation to escalate.

DIF: Cognitive Level: Analysis

REF: page 107

6. There are three steps to conflict management: determining the basis, analyzing the source, and

conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? a. Food served b. Medication effects c. Ethical dilemmas d. Smoking withdrawal ANS: C

Treatment decisions that cause ethical dilemmas are likely sources of conflict between patient, family, and health care providers. The other options represent annoyance but usually does not lead to violence.

DIF: Cognitive Level: Analysis

REF: pages 106-107

7. When determining the basis for conflict, interpersonal sources as the basis would include

which of the following? a. Personality differences b. Shift preferences c. Staffing inconsistency d. Assignments ANS: A

Personality differences are a source for interpersonal conflict. The other options are incorrect because they are an intrapersonal source of conflict.

DIF: Cognitive Level: Application

REF: page 107

8. When analyzing the sources for conflict, the nurse manager may identify which of the

following as one of the most likely sources?

a. b. c. d.

Different attitudes Different facts or perception of the event Different incomes Different ages

ANS: B

The differences in the facts or perception of the facts of the event may be a source of the conflict. The other options are not usually the source of conflict.

DIF: Cognitive Level: Analysis

REF: page 108

9. Horizontal conflict in the workplace is observed with which of the following situations? a. Discussion with the manager before escalation occurs b. Refusing to work on day off c. Sharing views on patient care d. Withholding information that will undermine the ability to perform his job ANS: D

Withholding of information that can affect one’s ability to perform professionally is a form of horizontal violence. The other options are not seen as part of horizontal conflict.

DIF: Cognitive Level: Application

REF: page 109

10. The AACN has addressed the issue of horizontal violence in the workplace and made

recommendations for actions by the nurse manager. Which of the following are recommendations for action by the AACN against workplace horizontal violence? a. Develop a culture that does not tolerate violence. b. Report all incidences to uN ppeR anagGemB Ur m SI N Ten.t.C OM c. Separate the two people by not assigning them to work on the same shifts. d. Ask the two people to sit down and work it out.

ANS: A

If the workplace is intolerant of horizontal violence, staff will not participate in that form of conflict. The other options are not actions that should be taken by the manager.

DIF: Cognitive Level: Application

REF: page 109

11. What is a recommendation from the Occupational Health and Safety Administration for

prevention of violence in the workplace? a. Assign different shifts. b. Provide training and education. c. Point out the issues to the people involved. d. Arrange for the people involved to meet and discuss the issues.

ANS: B

Providing training and education is one of the major recommendations by all organizations for intervening to prevent workplace violence. The other options are not recommendations of the organization.

DIF: Cognitive Level: Analysis

REF: page 110

12. What methods can administration use for the prevention of workplace violence?

a. b. c. d.

Separate staff entrance Staff ID badges Separate parking for staff Visual presence of security at all times

ANS: B

ID badges must be worn by all staff and temporary contract employees. The other options are not a form of administrative control.

DIF: Cognitive Level: Application

REF: page 110

13. Human resources is required to provide education on violence prevention and management,

which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? a. Location of all monitoring equipment b. Schedule of security officers rounds c. Early recognition and response plan d. Identification of people most at risk for causing harm ANS: C

The plan for employee early recognition and response to violent behavior is included in the orientation of new employees and annual skills day. The other options are not beneficial to the overall prevention plan.

DIF: Cognitive Level: Application

REF: page 111

n drI ugsG or aB lc. ohCol M will exhibit signs that should not be 14. Employees who are dependen Nt oR

U S N T Which of the following signs would alert the ignored by the nurse manager and colleagues. nurse manager that the employee may have a dependency problem? a. Changes in behavior or appearance b. Requesting time off to be with a family member c. Scheduled overtime d. Dieting ANS: A

Changes in behavior or appearance should alert the manager that something has changed in this employee and some type of intervention should occur. The other options are not a sign requiring follow-up for substance abuse.

DIF: Cognitive Level: Application

REF: page 111

15. A nurse is working the night shift with another RN who keeps disappearing without

explanation. The nurse is caught napping in a patient’s room. What is the best action by the discovery nurse to take? a. Confront the nurse and ask what is wrong. b. Report the behavior to the vice president of nursing. c. Ask to not be scheduled on the same nights again. d. Report the behavior to the nurse manager.

ANS: D

The nurse must report this behavior to the nurse manager for further investigation. The other options do not address the legal issues of this behavior.

DIF: Cognitive Level: Analysis

REF: page 113

16. The nurse manager works regularly with a nurse who has recently gone through a custody

battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems “giddy” and is acting inappropriately. The nurse manager understands that she must take which of the following actions? a. Counsel the nurse on these observations. b. Report this behavior to human resources and the state board of nursing. c. Give her the evening off. d. Work closely with her to prevent unsafe care to the patients.

ANS: B

The nurse manager can talk with the nurse and find out what is going on, but if substance abuse is suspected, it must be reported. The other options do not address mandatory reporting of these actions.

DIF: Cognitive Level: Application

REF: page 113

17. After reporting a nurse with a substance abuse problem to the State Board of Nursing

(SBON), the next step that will most likely occur is a. surrender of license if complaint is found to be valid. b. counseling and then the nurse can return to work. c. the nurse is fired.

N R I G B.C M d. the nurse is prevented fromUeveSr wN orkiT ng as aOnurse again.

ANS: A

If the complaint is found valid by the SBON, the nurse will have to surrender her license and will be monitored by the SBON. The other options are not the process for dealing with these issues.

DIF: Cognitive Level: Application

REF: page 114

18. Most organizations provide assistance to employees with problems that can affect their work

performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? a. Faith-based initiatives b. Free confidential employee assistance programs (EAPs) c. Fee-for-service private counseling d. The nurse manager fills this role in most institutions.

ANS: B

EAPs assist employees in many areas of their lives. Options A and C are not services offered by the institution. Option D is not a responsibility of the nurse manager.

DIF: Cognitive Level: Application

REF: page 114

19. The nurse working the night shift has concerns about the safety of the unit. What would cause

security concerns for this nurse?

a. b. c. d.

A visitor is sleeping in the recliner in the room with their family member.

A parent stays overnight with their teenage child.

No unit secretary is assigned for the night shift.

She is working with only one other employee.

ANS: D

Nurses working short staffed are at greater risk for violence from visitors or strangers in the hospital because they can easily be isolated from the other employee. The other options are not a cause for concern as long as sufficient staff is working.

DIF: Cognitive Level: Application

REF: page 110

20. A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What

action is best for the nurse to take to protect herself? a. Call security and notify them of the threat. b. Ask security to escort you to your car. c. Explain to the visitor that you carry a gun. d. Assume that this was a joke.

ANS: A

Call security immediately whenever you feel threatened even if it has not been verbally stated.

Option B is an incident that needs to be reported. Options C and D do not show good judgment.

DIF: Cognitive Level: Analysis

REF: page 110

21. A male nurse is working with female nurses on a unit. One of the female nurses is overheard

talking about how cute the mN ale R nurse is. The nurse overhearing this comment should be U SING TB.C M expected to do which of the following? a. Notify the nurse manager. b. Tell the male nurse that the female nurse was making inappropriate comments. c. Nothing, this is not harassment. d. Warn the nurse that the conversation was overheard.

ANS: C

Option C alone does not constitute harassment. The other options are incorrect because they are not appropriate.

DIF: Cognitive Level: Application

REF: pages 109-110

22. A student nurse is working with a preceptor who appears abrupt and disinterested in

precepting students. What action by the student is most appropriate? a. Notify the instructor. b. Talk with the nurse to see what is wrong. c. Identify this as lateral violence. d. Nothing, he was having a bad day.

ANS: A

The instructor can approach the nurse and determine the next course of action. The other options are incorrect because the problem needs to be dealt with by the instructor, not by the student.

DIF: Cognitive Level: Application

REF: pages 107-108

23. There are three levels of management in nursing. Which action by the nurse would indicate

the nurse is a first-line nurse manager? a. Responding to a patient complaint b. Deciding to incorporate walking rounds shift report hospitalwide c. Reevaluating the nursing policy permitting IV push of certain medications by RNs d. Designating assignment of new admissions ANS: A

The first-line manager is the nurse manager and would be responsible for responding to patient complaints. Option B is incorrect because middle-level managers set short- and long-term goals. Option C is incorrect because it is a responsibility of upper-level management to forecast trends in nursing. Option D is incorrect because it would be the responsibility of the charge nurse.

DIF: Cognitive Level: Analysis

REF: pages 107-108

24. The management process consists of six functions: planning, staffing, organizing, directing,

controlling, and decision making. What might be seen in the planning step of the process? a. Identifying the problem of the lack of ICU beds b. Organizing a meeting to address the problem c. Establishing an alternate site within the hospital for these patients d. Assigning experienced staff to implement care of these patients ANS: A

Establishing objectives should be seen in the planning step following identification of the problem. Option B is the orgN anizR ingI stepG. OB pt. ioC n CMis the directing step. Option D is the U S N T controlling step.

DIF: Cognitive Level: Application

REF: page 7

25. The management process consists of six functions: planning, staffing, organizing, directing,

controlling, and decision making. What might be seen in the decision-making process? a. Organizing a meeting to address the problem b. Establishing an alternate site within the hospital for these patients c. Assigning experienced staff to implement care of these patients d. Establishing the new area as a step-down unit ANS: D

Decision making is a result of the other steps. The other options are different steps in the management process.

DIF: Cognitive Level: Application

REF: page 7

26. First-level managers are responsible for the day-to-day activities of the unit. Which activity

would the nurse expect to see only from a first-level manager? a. Making daily staffing assignments b. Managing the unit’s budget c. Maintaining currency in profession d. Making daily patient rounds

ANS: B

Managing the unit budget is the sole responsibility of the nurse manager and first-level manager. The other options are not specific to first-level managers.

DIF: Cognitive Level: Application

REF: page 7

27. Middle-level managers are responsible for planning for changes of the unit. What activity

would the nurse expect to see only from a middle-level manager? a. Maintaining currency in profession b. Planning for changes within the service line in the organization c. Being responsible for activities on the unit 24/7 d. Supervising patient care delivery ANS: B

The middle-level manager is solely responsible for planning changes and presenting them to upper-level managers. The other activities are not an exclusive responsibility of the middle-level manager.

DIF: Cognitive Level: Application

REF: page 7

28. Upper-level managers are responsible for the management of the nursing organization of the

institution. What activity would the nurse expect to see only from an upper-level manager? a. Supervising patient care delivery b. Establishing strategic goals for nursing c. Maintaining currency in profession d. Being responsible for activities on the unit 24/7 ANS: B

Upper-level managers are responsible for forming strategic plans. The other activities are responsibilities shared by all levels.

DIF: Cognitive Level: Application

REF: page 7

29. The nurses are complaining about how busy they are this shift. The charge nurse must do

which of the following to ensure the safety of the patients and staff for this and future shifts? a. Take responsibility for a team of patients. b. Delegate care to the UAPs. c. Assist the RNs to prioritize their patients and their responsibilities. d. Call the supervisor for more staff.

ANS: C

As a leader, the charge nurse should assist the RNs to prioritize their patient care responsibilities to allow for safer care to be provided. The other activities may correct the immediate problem that day but will not change the care provided over a length of time if RNs are lacking prioritization skills.

DIF: Cognitive Level: Application

REF: page 9

30. Which activity should be considered the highest priority by the RN? a. Assessment of a stable patient ready for discharge b. Administration of daily medications c. Administration of STAT medications

d. Discharge teaching for a patient with heart failure ANS: C

The STAT medications order is a priority because STAT means immediately. The other options do not take priority over a STAT order.

DIF: Cognitive Level: Analysis

REF: page 9

31. Which patient should be considered the highest priority by the nurse manager? a. A patient who attempts suicide b. A patient who attempts to escape from the hospital c. A patient who refuses to eat d. A patient who refuses her medications ANS: A

The priority for the nurse manager is the attempted suicide of a patient. The options are not a priority.

DIF: Cognitive Level: Analysis

REF: page 7

32. Which patient should be considered the highest priority by the charge nurse? a. A patient who is complaining that no one answers his call light b. A patient who is threatening to leave AMA with tubes and drains in place from a

surgical procedure c. A confused patient who is attempting to get out of bed d. A patient who is asking for help to the bathroom ANS: B

NURSINGTB.COM

This patient should be helped to decide against leaving the hospital until he is more stable.

The other options are not a priority.

DIF: Cognitive Level: Analysis

REF: page 7

33. Which patient should be considered the highest priority by the new RN? a. A patient who is requesting his pain medication b. A patient who is reported by the UAP to be choking c. A patient who is requiring suctioning per tracheostomy d. A patient who is requiring discharge instructions who is waiting at the desk with

her family ANS: B

A patient who is reported by the UAP to be choking is the most unstable and should be seen first. A patient who is requiring suctioning per tracheostomy is not a priority. The patient needs to be suctioned but nothing given here indicates that this patient is more at risk than the patient who is choking, which must be assessed first. The other patients are not a priority.

DIF: Cognitive Level: Analysis

REF: page 169

34. Which of the following patients should the charge nurse admit to a room with a patient who is

confused and incontinent of stool? a. A postoperative patient b. A patient with diabetes

c. A patient who is going to surgery later today d. A patient from the cardiac catheterization lab who is going home in the morning ANS: D

A patient from the cardiac cauterization lab who is going home in the morning is at the least risk for acquiring an infection from the exposure. The other patients are at high risk for acquiring an infection from the exposure.

DIF: Cognitive Level: Application

REF: page 169

35. The nurse manager receives a telephone call from an RN saying she will be late because of

traffic due to an accident. The charge nurse needs to make arrangements for the care of that nurse’s team of patients until her arrival. What is the best action to take to ensure the management of those patients until the RN arrives? a. Distribute the patients evenly to each of the other nurses. b. The charge nurse will take the assignment until the RN’s arrival. c. Ask the nurse manager to assume care temporarily. d. Ask the night nurse to stay until the RN’s arrival.

ANS: A

The best action is to evenly distribute the patients so that no single nurse is overwhelmed and the charge nurse can continue to function in her role. The other actions would not provide for the best care to patients.

DIF: Cognitive Level: Application

REF: page 169

36. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal

cannula for his diagnosed infN luenRza iI s compB lainC ing M of shortness of breath with an oxygen U byStheNG T is.best? saturation of 88%. Which action RN a. Increase the oxygen concentration. b. Ask respiratory therapy to administer an albuterol treatment. c. Notify the health care provider. d. Determine if anxiety could be causing the shortness of breath.

ANS: B

The respiratory therapist should administer a bronchodilator as the first action to assess the patient’s response before determining the next action. Increasing the oxygen concentration should be delayed until assessing any change after the bronchodilator administration.

Notifying the health care provider should be delayed until assessing any change after the bronchodilator administration. Determining if anxiety could be causing the shortness of breath is probably not responsible for the change in condition.

DIF: Cognitive Level: Analysis

REF: page 169

37. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal

cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? a. Increase the oxygen concentration and recheck the saturation after 10 minutes. b. Obtain a 12-lead ECG. c. Notify the health care provider.

d. Call the patient’s wife to have her sit with him to calm him.

ANS: A

Increasing the oxygen concentration will provide more oxygen to the tissues, but the saturation should be rechecked to determine effect. Obtaining a 12-lead ECG is appropriate as the next action but not before increasing the oxygen concentration. Notifying the health care provider is an appropriate step after answers A and B are instituted. Calling the patient’s wife is not a priority.

DIF: Cognitive Level: Analysis

REF: page 169

38. A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per

nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? a. Obtain a 12-lead ECG. b. Notify the health care provider. c. Call the patient’s wife to have her sit with him to calm him. d. Ask the UAP to obtain a blood glucose level.

ANS: A

Because this patient was admitted with an MI, evolution of the MI should be ruled out as the source of the shortness of breath. Notifying the health care provider should be taken after obtaining all the information necessary. The other options do not address the possible underlying problem.

DIF: Cognitive Level: Analysis

REF: page 169

NURSINGTB.COM 39. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? a. Call the patient’s wife to have her sit with him to calm him. b. Ask the UAP to obtain a blood glucose level. c. Call the Rapid Response Team. d. Ask the charge nurse to check on the other patients.

ANS: C

The Rapid Response Team (RRT) should be called to assess the patient’s condition. The other options do not address the cause of the change in condition.

DIF: Cognitive Level: Analysis

REF: page 169

40. Arrange in order of priority the nurse’s actions when a patient admitted with an elevated

ST-segment myocardial infarction on droplet precautions and oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%.

1. Call the rapid response team (RRT).

2. Obtain a chest radiograph.

3. Obtain a 12-lead ECG. 4. Initiate a bronchodilator nebulizer treatment.

5. Increase the oxygen concentration 2 L. 6. Repeat the oxygen saturation in 10 minutes.

a. b. c. d.

5, 3, 2, 4, 6, 1 1, 4, 2, 5, 6, 3 4, 5, 6, 3, 1, 2 5, 4, 3, 6, 2, 1

ANS: C

The first step should be to try a bronchodilator first, then increase the oxygen concentration, repeat the oxygen saturation for changes, then obtain a 12-lead ECG to rule out evolving myocardial infarction, call the RRT for their consult, and then obtain a chest radiograph to see if that explains the change in condition. The other options do not present the steps in the correct order.

DIF: Cognitive Level: Analysis

REF: page 169

41. What step in the employment process may have been omitted when the staff appears to be

nervous and overly cautious around a new nurse manager? a. Involvement of human resources in the interview process b. Involvement of the upper-level manager in the interview process c. Involvement of the staff in the interview process d. Involvement of the middle-level manager in the interview process ANS: B

The upper-level manager may have been omitted from the process. Human resources must be involved in the employment process. Staff members would not intimidate the new employee.

The middle-level manager is key in the process.

DIF: Cognitive Level: Analysis

REF: page 9

MULTIPLE RESPONSE 1. In an escalating situation, the nurse should observe certain rules to protect herself from

violence. Which of the following are good rules to keep in mind if one is ever in a violent situation? (Select all that apply.) a. Remove yourself from the situation. b. Speak loudly with authority. c. Call for help. d. Do not allow the person to stand between you and the door. e. Stand in a corner against a wall.

ANS: A, C, D

Protecting yourself by removal from the situation is one of the best actions that can be taken.

Protecting yourself by calling for help is one of the best actions that can be taken. Not allowing the person to come between you and safety is a good rule of thumb. Options B and E do not provide protection.

DIF: Cognitive Level: Application

REF: page 107

2. What are some tools available for the nurse manager to use for conflict resolution? (Select all

that apply.) a. Prevention b. Negotiation

c. Cooperation d. Resentment e. Rejection ANS: A, B, C

Options A, B, and C are an approach to resolving conflict. The other options are not appropriate ways to resolve conflict.

DIF: Cognitive Level: Analysis

REF: page 108

3. What methods can the nurse manager use to address horizontal violence in the workplace?

(Select all that apply.) a. Provide training to staff. b. Pick a side so that the assaults do not include you. c. Name the problem “horizontal violence.” d. Observe and analyze the culture of the workplace. e. Have the victim file a grievance.

ANS: A, C, D

Providing training for conflict resolution, calling it by name, and observing what is being said for yourself and then analyzing the culture for ways to prevent this behavior are methods the manager can use to address the issue. Options B and E are incorrect because they are not methods for conflict resolution that a nurse manager should use.

DIF: Cognitive Level: Application

REF: page 109

4. In what ways is the environment controlled by the hospital safety committee to prevent

workplace violence? (Select aNll tR appG UhatSI Nly.)TB.C OM a. Emergency alarms b. Cameras and videos c. Assigned patrol for each unit d. Security provided for visitors in parking lots, etc. e. Respond only when called ANS: A, B, D

Environmental controls include accessible alarms, monitoring systems, and access to security in areas of vulnerability. The other options are incorrect because they are not methods to prevent violence.

DIF: Cognitive Level: Application

REF: page 110

5. Personal and financial issues, as well as drugs or alcohol, can impair employees and can

precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) a. Recent divorce b. Troubled adolescent c. Tremors of the hands d. House foreclosure e. Religious counseling ANS: B, C, D

Options B, C, and D are symptom of someone under the influence of drugs and/or alcohol.

Options A and E are not necessarily associated with drugs or alcohol impairment.

DIF: Cognitive Level: Application

REF: page 111

6. The role of the charge nurse is a relatively new role in nursing. What responsibilities would

the nurse expect to see from the charge nurse? (Select all that apply.) a. Making daily patient care assignments b. Troubleshooting problems occurring during shift c. Providing coverage for breaks d. Taking turns floating to another unit e. Assisting staff as needed ANS: A, B, E

Options A, B, and E are responsibilities of the charge nurse. Options C and D do not apply to the charge nurse.

DIF: Cognitive Level: Application

REF: page 9

Chapter 10: Professional Development Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. You are the charge nurse on a busy medical-surgical unit. You are also the preceptor to a

novice nurse. What response would be expected from a nurse in the novice stage of clinical competence development when assigned to perform a morning assessment on a patient? a. Nurse uses Doppler to obtain pulses on a patient with no palpable peripheral pulses b. Reporting to the charge nurse that they cannot feel a patient’s peripheral pulses and the blood pressure is only palpable c. Nurse calls for help when she finds the patient with barely palpable blood pressure and hard to arouse d. Reporting to the charge nurse that she decided to let the patient sleep until the breakfast trays arrive because the patient was sleeping so soundly ANS: D

A novice nurse would go into the patient’s room prepared to get vital signs in the morning and decide not to further assess a patient who is “sleeping soundly.” The other options would be the response of a nurse as she becomes more experienced.

DIF: Cognitive Level: Analysis

REF: page 121

2. You are the charge nurse on the 3 PM to 11 PM shift. The nurses on this shift range from

novice to competent. What response would be expected in the beginner stage of clinical competence development whN en tR he nIursG e is B as.siC gneM d a patient on beta-blockers and scheduled U S N T O for a stress test? a. Knows to hold a beta-blocker on a patient scheduled for a stress test because this happened earlier in the week on another patient b. Must be told to hold the beta-blocker for a patient scheduled for a stress test c. Understands the rationale for holding the beta-blocker prior to a stress test d. Holds all medications when the patient is NPO ANS: A

The advanced beginner repeats behavior learned from an earlier similar situation but may not understand the rationale. The other options are appropriate for a nurse at a different level of experience.

DIF: Cognitive Level: Analysis

REF: page 121

3. You are the nurse manager who is preparing the annual reviews for the staff members. You

are aware that the nurse in the competent stage of clinical performance development would be expected to do what when assigned a patient on beta-blockers scheduled for a stress test? a. Must be told to hold the beta-blocker for a patient scheduled for a stress test b. Holds all medications when the patient is NPO c. Calls the physician for an order to hold the beta-blocker prior to a stress test if there is no order d. Repeats behavior learned from a previous experience ANS: C

The competent nurse understands the rationale for holding the medication and calls the physician when an order is needed. The other options are appropriate for a nurse at a different level of nursing.

DIF: Cognitive Level: Analysis

REF: page 121

4. You are the nurse educator on a medical unit. What action would be expected from a nurse in

the proficient stage of clinical competence when assessing shortness of breath in a patient? a. Increases the oxygen concentration on a patient complaining of shortness of breath b. Places a patient complaining of shortness of breath in high Fowler’s position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Checks the oxygen saturation d. Calls the physician to notify her of the patient’s change in condition ANS: B

The proficient nurse will assess and reposition a patient first before taking the next step of calling the physician. The other options are appropriate for a nurse at a different level of nursing.

DIF: Cognitive Level: Analysis

REF: page 121

5. You are the nursing supervisor on the 11 PM to 7 AM shift. When making rounds, the charge

nurse on the unit reports that one of the patients is dyspneic. What action would be expected from a nurse in the expertise stage of clinical competence when assessing shortness of breath in a patient? a. Recognizes the patient may have pulmonary edema and orders (or asks the physician for an order) an IVP diuretic B.C M NUgRoS INrtn GT b. Places a patient complainin f sho ess of bO reath in high-Fowler’s position after hearing coarse crackles and rhonchi and obtaining a pulse oxygenation of 88% c. Increases the oxygen concentration d. Notifies the instructor of the patient’s complaints ANS: A

The expert nurse typically is the advanced nurse practitioner who has the ability to make clinical judgments and direct care. The other options are appropriate for a nurse at a different level of nursing.

DIF: Cognitive Level: Analysis

REF: page 122

6. The nurse’s progression from novice to expert is usually encouraged by the organizations for

which they work. Which of the following is an example of a method used to encourage nurses to progress in their level of experience? a. Rotating nurses to all shifts b. Rotating nurses into the ICU c. Quarterly Nursing Excellence awards d. Tuition reimbursement for advanced degrees ANS: C

Recognition of nurses through awards gives an incentive to continually improve performance.

The other examples may improve the nurse’s performance or cause burnout.

DIF: Cognitive Level: Application

REF: page 123

7. Clinical ladders for nurses are best used in what circumstance? a. Horizontal advancement for clinicians who wish to stay at the bedside b. Vertical advancement for management responsibilities c. Horizontal ladder for nurses with more than 10 years of employment d. Vertical ladder for nurses with more than 10 years of employment ANS: A

The advantage to the ladder system is that the nurse can remain at the bedside and be recognized for clinical excellence without having to move into management. The other options do not apply to the clinical ladder.

DIF: Cognitive Level: Application

REF: pages 123-125

8. The clinical ladder used in some hospitals allows for recognition of both the clinical and

academic growth of the individual nurse. On which of the following is this ladder based? a. The concept that people will work harder when recognized b. The concept that nurses respond to harder work c. The concept of growth in nursing from novice to expert d. The concept that nurses like to be intellectually stimulated ANS: C

Benner’s work in 1984 on the novice-to-expert concept in nursing laid the groundwork for the clinical ladder. The other options are not the basis for the clinical ladder concept.

DIF: Cognitive Level: Application

REF: page 130

Chapter 11: Professional Practice and Care Delivery Models and Emerging Practice Models Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following guides the professional nurse as decision maker? a. The American Nurses Association (ANA) Code of Ethics b. The ANA Standards of the State Nursing Practice Act c. State Titles d. All of the above ANS: D

All provide guidelines for standards of practice for nursing decision-making in practice.

DIF: Cognitive Level: Application

REF: page 136

2. The professional practice model of an organization illustrates the alignment and integration of

nursing practice with which of the following: a. The mission, vision, and values of the organization and the nursing department b. The mission and vision of the nursing department c. The mission, vision, and values of the organization d. The state nursing code of ethics ANS: A

The mission, vision, and values of the organization and nursing department are all integral pieces that should be alignedNwUitR hiS nI aN prG ofT esBsi. onCaO l pMractice model.

DIF: Cognitive Level: Application

REF: pages 135-136

3. Who is at the center of care in The University of California Los Angeles Model? a. The nurse b. The patient, family, and community c. The patient and family d. The nurse and patient ANS: B

The center of this model is the patient, family and community.

DIF: Cognitive Level: Application

REF: page 136

4. The care delivery system is integrated into the professional practice model. What does the

care delivery model describe? a. The manner in which care is delivered, the context of care, and the expected outcomes of care b. The context of nursing care c. The expected outcomes of care d. Care delivery and outcomes ANS: A

All are integral parts of the care delivery model and essential for best practice.

DIF: Cognitive Level: Application

REF: page 136

5. Care delivery models are continually improved to adjust to which of the following? a. National safety goals and best evidence b. National safety goals and outcomes c. To national patient safety goals, value-based outcomes, regulatory requirements,

and current best evidence. d. Regulatory requirements ANS: C

Care delivery models must be continually adjusted to national patient safety goals, value-based outcomes, regulatory requirements, and current best evidence.

DIF: Cognitive Level: Analysis

REF: page 136

6. Which author proposed that a nursing care delivery model should consist of five key

dimensions? a. Porter-O’Grady b. Dubois c. Watson d. ANA ANS: B

Dubois proposed that staffing intensity, skill and nursing education mix, professional scope of practice in six domains of practice, nursing practice environment and unit-level capacity for innovation should be the five key dimensions of a care delivery model.

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7. Registered nurses are fundamental to the success of emerging patient-centered care delivery

models. Which emerging patient-centered care model directs renewed attention and substantially more resources and incentives to promote those elements of care that are also the backbone of nursing practice? a. Nurse-Managed Health Clinics (NMHCs) b. The Patient-Centered Medical Home c. Accountable Care Organization d. The Patient Protection and Affordable Care Act of 2010 (PPACA) ANS: D

The Patient Protection and Affordable Care Act of 2010 directs renewed attention and substantially more resources and incentives to promote those elements of care that are also the backbone of nursing practice. The Nurse Managed Health Clinics, Patient Centered Medical Home and Accountable Care Organization are addressed in the Patient Protection and Affordable care Act (PPACA).

DIF: Cognitive Level: Application

REF: pages 137-138

8. Which population does a Traditional Care Model (TCM) specifically target? a. Pediatric b. Elderly/geriatric c. Maternal child

d. Young adult ANS: B

TCMs target older adults with two or more risk factors, including a history of recent hospitalizations, multiple chronic conditions, and poor self-health ratings.

DIF: Cognitive Level: Application

REF: pages 138-139

9. What is a Professional Practice Model (PPM)? a. The conceptual framework and philosophy of nursing at a specific organization b. Practice standards of an organization c. A model of a specific theorist d. Organizational philosophy ANS: A

A Professional Practice Model (PPM) is the conceptual framework and philosophy of nursing at a specific organization. B, C, and D are all parts of the model.

DIF: Cognitive Level: Analysis

REF: pages 140-141

10. According to the Professional Practice Model (PPM) cited in the Clinical Corner section of

this chapter, whose theory was used as the basis of the newly created PPM? a. Newman b. Nightingale c. Parse d. Watson ANS: D

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According to the author, Watson’s Theory of Caring was the cornerstone of the Professional Practice Model (PPM) that was cited in the Clinical Corner.

DIF: Cognitive Level: Analysis

REF: page 136 | pages 139-141

Chapter 12: Staffing and Scheduling Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which ANA Principles for Nurse Staffing standards are applied to patient care? a. Staffing levels that must be sufficient for providing quality patient care b. Mandated staffing ratios c. Recommended a new method for determining staffing needs d. Staffing based on patient census ANS: A

The principles identified by the ANA addressing patient care and staffing recommend that staffing be maintained to provide quality patient care for the individual patient as well as the unit population as a whole and not be based on previously used nursing hours per patient day.

Mandated staffing ratios is not a recommendation. The ANA recommended that the old method be retired or at least questioned for its efficacy. Option D is incorrect because the recommendation was that staffing be based on patient needs.

DIF: Cognitive Level: Application

REF: pages 145-146

2. Which ANA Principles for Nurse Staffing standard is applied to staffing? a. Nurse/patient ratios should be mandated. b. Clinical competencies of the staff are standardized for all units. c. Support of the staff nurses must come from all levels of nursing. d. Experienced nurses should work the day shift because it is the busiest.

N UR SI NG TB.C OM

ANS: C

The principles presented by the ANA include the importance of support for the staff nurse from all levels of nursing. Option A is incorrect because this is not included. Option B is incorrect because the ANA recommends that staff competencies be consistent with the level of patient care required. Option D is incorrect because it is not a recommendation of the ANA. DIF: Cognitive Level: Application

REF: pages 145-146

3. Which ANA Principles for Nurse Staffing standard is applied to the organization? a. Nursing ratios are mandated. b. The need for documented competencies for all nurses delivering patient care is

supported. c. That nursing budgeted positions are not filled in a timely manner is accepted. d. The needs of the staff nurse are secondary to the patient’s needs.

ANS: B

The principles related to the organization are mostly supportive of the nurse. Nursing ratios are not included. Option C is incorrect because it is recommended that these unfilled positions be filled in a timely manner. Option D is incorrect because the organization should consider the needs of the nurse as comparable to the needs of the patients.

DIF: Cognitive Level: Application

REF: pages 145-146

4. The process of determining daily staffing incorporates which factor? a. Competency of staff b. Nursing degree of staff c. Acute change in patient acuity d. Emergency department admissions ANS: A

Nursing competency (regardless of degree attained) is the most important factor for determining staffing. Options B and C are not factors determining daily staffing. Option D is incorrect because emergency department admissions can change the makeup of the unit and therefore cannot be planned.

DIF: Cognitive Level: Application

REF: page 145

5. There are four major types of staffing plans. The centralized method of staff planning refers to

which of the following? a. The schedule is planned based on the core staff. b. The schedule is planned on each individual unit. c. The schedule is planned by the nurses themselves. d. The schedule is planned by the nursing service.

ANS: D

A centralized method refers to the nursing service or office making plans that affect the entire organization. Option A is incorrect because it is not a type of scheduling method. Options B and C are incorrect because they refer to other methods.

DIF: Cognitive Level: Application

REF: page 148

NURSINGTB.COM 6. There are four major types of staffing plans. The decentralized method of staff planning refers to which of the following? a. The schedule is planned based on the central or core staff. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: B

The decentralized schedule is done by the nurse manager and is very individualized to the needs of that unit. Option A is not a plan for scheduling and is incorrect. Options C and D refer to other scheduling methods.

DIF: Cognitive Level: Application

REF: page 148

7. There are four major types of staffing plans. The self-scheduling method of staff planning

refers to which of the following? a. The schedule is planned based on the central or core staff. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: C

Self-scheduling allows the nursing staff to accept full responsibility for staffing the unit.

Option A is not a plan. Options B and D are examples of centralized scheduling.

DIF: Cognitive Level: Application

REF: page 148

8. There are four major types of staffing plans. The mixed method of staff planning refers to

which of the following? a. The schedule uses decentralized scheduling and its staffing needs are supplemented by the centralized office. b. The schedule is planned on each individual unit by the nurse manager. c. The schedule is planned by the nurses themselves. d. The schedule is planned by nursing service.

ANS: A

The mixed method combines both centralized and decentralized for scheduling. The other options are incorrect because they refer to other methods.

DIF: Cognitive Level: Application

REF: page 148

9. There are four major types of staffing plans used in the hospital setting. The primary

advantage of self-scheduling is which of the following? a. It saves the nurse manager time. b. It encourages negotiation among staff. c. The most senior staff get first pick. d. The freshman staff get the more undesirable shifts.

ANS: B

Self-scheduling forces staff to interact at a different level than before and can produce more camaraderie and a better working environment. Option A is not the primary advantage to using self-scheduling. OptionNsU CRaS ndID doTnBo. t aC pO plM y.

NG DIF: Cognitive Level: Analysis

REF: page 148

10. What is the best advantage to preference scheduling for nurses? a. Institutional rules can be applied. b. Staff decide shifts. c. Scheduling is determine by first-come, first-served basis. d. Blocks of time are predictable.

ANS: B

Preference scheduling allows for staff requests or preferences. Option A refers to rules scheduling. Option C refers to self-scheduling. Option D refers to pattern scheduling DIF: Cognitive Level: Application

REF: page 149

11. Most institutions use one or more types of future scheduling in their planning. Which of the

following provides advantages for the organization’s scheduling policies? a. Pattern scheduling b. Preference scheduling c. Rules scheduling d. Self-scheduling ANS: C

Rules scheduling allows the organization to apply the rules they believe are necessary for scheduling. The other options do not provide advantages to the organization for scheduling.

DIF: Cognitive Level: Application

REF: page 149

12. Most institutions use one or more types of future scheduling in their planning. Which of the

following provides advantages for creativity and staff satisfaction in scheduling? a. Pattern scheduling b. Preference scheduling c. Rules scheduling d. Self-scheduling ANS: D

Self-scheduling allows for more creativity and staff satisfaction. The other options do not provide advantages for the individual staff needs.

DIF: Cognitive Level: Application

REF: page 149

13. Automated computerized staffing allows for which advantage to the institution? a. Reduces workload of nurse manager b. Provides coverage on weekends c. Uses part-time staff d. Provides coverage for daily changes in acuity of patients ANS: A

Computerized staffing programs relieve the nurse manager of managing scheduling. The other options are not an advantage to the organization.

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14. Automated computerized staffing allows for which advantage to the staff? a. It reduces the workload of the nurse manager. b. Staff has many options on a first-come, first-served basis. c. It provides for changes in daily patient acuity. d. Weekend options are available.

ANS: B

Everyone has availability at the same time on computers so there is an advantage to the first user. The other advantages do not apply.

DIF: Cognitive Level: Analysis

REF: page 153

15. A new nurse is interested in working a “weekend option.” Which of the following describes

this pattern of scheduling? a. Nurse works two 12-hour shifts on the weekend and is paid for either 36 or 40 hours a week. b. Nurse works five shifts a week with alternating weekends. c. Nurse works three shifts a week and alternates weekends. d. Nurse works alternating weekends and alternates shifts.

ANS: A

Weekend option allows nurses to work every weekend and be paid for a full week’s work.

The other options do not reflect the weekend option.

DIF: Cognitive Level: Analysis

REF: page 149

16. When calculating for staffing needs, what should be considered? a. Weekend option b. Hourly salary of employee c. Productive versus nonproductive hours of an employee d. Vacation time accrued ANS: C

Staffing should include the number of hours each employee has earned in sick time, vacation time, etc. Hours available to work are productive. Nonproductive hours are vacation, sick time, etc. The other factors are not included for the FTE calculations.

DIF: Cognitive Level: Analysis

REF: page 151

17. The best determinant of staffing needs is based on which factor? a. Patient acuity b. Productive time c. Nonproductive time d. Nurse/patient ratio ANS: A

Patient acuity is the most influential determination for staffing. The other factors are not the best determinant of staffing needs.

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18. What factors are primarily used when quantifying patient care required and staffing needs? a. Number of patients per nurse b. Number of discharges c. Acuity and time required for care d. Number of admissions ANS: C

Patient acuity and care required are the most important elements in the patient classification system. The other factors do not apply.

DIF: Cognitive Level: Analysis

REF: page 147

19. What is the disadvantage to the institution in using external agency nurses? a. Cost b. Competency c. Availability d. Staff relationships ANS: A

Agency nurses are very expensive compared with employees. A large percentage of the cost to agencies is the overhead of the agency itself. The other options are incorrect because most agencies have diminished this as a factor affecting patient care or job performance.

DIF: Cognitive Level: Application

REF: page 152

20. What is the advantage to the institution in using external agency nurses? a. Competency b. Availability c. Cost d. Staff relationships ANS: B

Availability is the greatest advantage to the institution for using agency nurses. Competency may or may not be a factor, and until the nurse is working on the unit, one can never know for sure. The other options are not an advantage to the institution.

DIF: Cognitive Level: Application

REF: page 152

21. Travel nurses have become very popular, especially among single, unattached nurses. Which

of the following is an advantage of contracting with a travel nurse to the agency? a. Cost b. Availability c. Competency d. Contractual agreement ANS: D

Most travel nurses are contracted for 3 to 6 months and provide greater benefit to the institution because of the longer employment time. The other factors are not an advantage to the institution.

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REF: page 152

22. Overtime to cover shortages in staff coverage can be a daunting problem. Which of the

following can be a short-term solution to a nursing shortage? a. Increase length of shift. b. Work a double shift. c. Use an agency nurse. d. Ask each shift to work 4 extra hours.

ANS: D

Asking both shifts prevents exhaustion of one nurse, which can lead to errors. The other factors are not the best methods to use.

DIF: Cognitive Level: Application

REF: page 153

23. In interviewing for a new position, a nurse may want to inquire about the institution’s views

on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has a. infrequent “floating.” b. self-scheduling. c. cover of another nurse’s assignment while she or he is on break. d. hourly pay differential for the night shift.

ANS: B

In a self-governance working environment, staff are encouraged to be autonomous, which includes self-scheduling. Infrequent “floating” does not address autonomy. Option C is incorrect because they are decisions made by the organization and are practiced throughout the organization. Option D is incorrect because they are decisions made by the organization and practiced throughout the organization.

DIF: Cognitive Level: Application

REF: pages 148-149

24. The student nurse learns about the advantages and disadvantages of various patient care

delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to a. alterations in available staff due to weather emergencies. b. the financial environment of the patient population. c. a wide range of ages among the staff. d. a limited number of unlicensed staff on the unit.

ANS: A

Patient delivery models are instituted based on various elements including clinical decision making and work allocation; thus, changes may need to be made in an emergency based on availability of staff. The other options are not fundamental elements used in the decision-making process for delivery mode.

DIF: Cognitive Level: Application

REF: pages 17-18

25. An agency nurse is assigned to work on a unit that uses the team nursing model of health care

delivery. Which of the following would the nurse expect to experience in this environment? a. UAP taking vital signs and giving baths RSgIbN GTB.C OM b. RN taking vital signs andNgU ivin aths c. RN delegating patient care delivery to a group of patients d. Charge nurse delegating care delivery ANS: C

In a team nursing environment, an RN delegates patient care to a group of patients. Option A is incorrect because it is practiced in a functional model environment. Option B is incorrect because it is seen in primary nursing. Option D is incorrect because it may be seen in all types of health care delivery models.

DIF: Cognitive Level: Application

REF: pages 20-21

26. In which health care delivery model would the nurse expect to see “point-of-care” decision

making occur? a. Primary care nursing b. Team nursing c. Functional nursing d. Modular nursing ANS: A

Primary nursing allows the nurse to practice autonomously and make most bedside decisions.

The other options may not allow for the autonomy required for “point-of-care” decisions.

DIF: Cognitive Level: Application

REF: page 21

27. A nurse has accepted a position on a nursing unit where the nurse manager promotes

autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? a. Nurse manager mandates changes. b. Staff takes responsibility for assignments. c. Staff participates on hospital committees. d. Nurses are recognized for excellence in practice.

ANS: C

Work environments that promote autonomy and decision making encourage participation on hospital committees so that staff may become involved in the decisions that are made. Option A is incorrect because this is not an environment in which staff are encouraged to participate in decision making. Option B is incorrect because it should be seen in all environments regardless of autonomy. Option D is incorrect because it is not seen solely in autonomous environments.

DIF: Cognitive Level: Analysis

REF: pages 155-156

28. Leadership structures in health care can be centralized or decentralized. The nurse understands

that she is working in a centralized structured environment when which of the following occurs? a. All organizational decisions must be approved by the CEO. b. Changes can be made rapidly based on immediate needs. c. Nurses must work under a dual-authority structure. d. Decisions can be made at the “point of care.”

ANS: A

.eCnO In a centralized leadership strNuU ctR urS edIeN nG viT roB nm t, M all decisions are made from the top down, usually without input from staff. The other options are examples of a decentralized environment in which decisions can be made more quickly as needed.

DIF: Cognitive Level: Application

REF: page 148

29. The fundamental element of any patient care delivery combines work allocation with a. patient acuity. b. leadership. c. clinical decision making. d. delegation.

ANS: C

Work allocation is necessary in any patient care delivery system. The other factors are not necessarily useful in determining the appropriate patient care delivery systems needed.

DIF: Cognitive Level: Analysis

REF: page 23

30. A nurse who is interested in developing clinical decision-making skills would look for a unit

that practices which model for health care delivery? a. Primary nursing b. Team nursing c. Functional nursing d. Case management

ANS: A

Clinical nursing skills are enhanced in a primary nursing environment because of the autonomy nurses receive. The other models do not necessarily promote the development of decision-making skills.

DIF: Cognitive Level: Application

REF: page 21

31. A nurse would expect to see which action on a unit that uses the team nursing model of health

care delivery? a. The nurse makes patient care decisions at the bedside. b. The nurse delegates patient care to other team members. c. The nurse works on discharge plans on admission. d. The UAP takes vital signs on the patients on one hallway.

ANS: B

The nurse delegates and works collaboratively with the members of the team in team nursing.

Option A is an example of primary nursing. Option C is an example of case management nursing. Option D is an example of functional nursing.

DIF: Cognitive Level: Application

REF: pages 20-21

32. A nurse working on a unit using the primary care delivery model would expect to observe

which practice specific to primary care delivery? a. The UAP measures blood sugar levels on all patients. b. The RN administers medications to a team of patients. c. The RN verifies a new order for patient started on an antihypertensive with a blood pressure of 100/60 mm Hg. d. The RN holds the morninN gU dR osS eI ofNinGsT ulB in.foCrOaM patient scheduled for surgery later that day.

ANS: D

In a primary nursing environment, nurses function autonomously and make clinical decisions at the bedside. Option A is an example of functional nursing. Option B is seen in team nursing. Option C is seen in all patient care delivery models.

DIF: Cognitive Level: Analysis

REF: page 21

33. Which action by the nurse indicates a primary care delivery model environment? a. Development of the plan of care by primary RN to be used on all shifts b. Calling the physician for clarification after an illegible order is written c. The unit secretary takes off all orders initially. d. The charge nurse makes all patient care assignments.

ANS: A

The nurse develops the plan of care on admission for the remainder of the admission. The other actions are seen in many delivery care models.

DIF: Cognitive Level: Analysis

REF: page 21

34. In a team nursing health care delivery model environment, the nurse would observe for which

action by the staff? a. The UAPs answer all call lights.

b. The charge nurse is notified when there are patient complaints about care. c. The UAPs answer their patients’ call lights. d. The RN is notified when there are patient care complaints.

ANS: D

Nurses are completely responsible for the needs of their patients in a primary care delivery model. Option A is seen in functional nursing. Option B can be seen in models other than primary nursing. Option C is seen in team nursing.

DIF: Cognitive Level: Analysis

REF: pages 20-21

MULTIPLE RESPONSE 1. Part-time staffing by nurses includes which advantages? (Select all that apply.) a. Provides a backup b. Maintains skills c. Increases income d. Provides life outside of family e. Maintains education ANS: B, C, D

Options B, C, and D are an advantage to the individual. The advantage to the institution is to cover and support the full-time staff. The other options are not advantages to part-time staff.

DIF: Cognitive Level: Analysis

REF: page 152

2. The patient care delivery system used by an institution should be based on which fundamental

elements? (Select all that appNlyU.)RSINGTB.COM a. Work allocation b. Accountability c. Allocation of resources d. Mission statement e. Leadership style f. Cultural diversity of patients ANS: A, B, D

According to the text work allocation, accountability, and mission statement are fundamental elements of any patient care delivery system. The other options are not fundamental elements of a patient care delivery system.

DIF: Cognitive Level: Application

REF: pages 18-19

Chapter 13: Delegation of Nursing Tasks Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which of the following delegations by the RN would require an immediate intervention by the

charge RN? a. A UAP checks a diabetic patient’s blood glucose level. b. An LPN assesses a patient after a fall. c. The charge nurse makes changes to the assignments after staff is “pulled” to another area. d. An RN assists with administering medication to another nurse’s patients during a code.

ANS: B

It is not within the scope of practice of the LPN to assess an unstable patient and thus it would require an immediate intervention. Only RNs can assess an unstable patient. The other actions are appropriate delegation and therefore do not require intervention.

DIF: Cognitive Level: Analysis

REF: page 163

2. Which of the following delegations by the RN would require an immediate intervention by the

charge RN? a. An LPN administers IVP Lasix (furosemide) to a patient in heart failure. b. An RN administers IVP Lasix (furosemide) to a patient in heart failure. c. An LPN obtains a blood glucose level on a diabetic patient.

NU RSlev INelGoTnB.C d. An RN obtains a blood glu cose a diabOetic patient.

ANS: A

It is not within the scope of practice for LPNs to administer IV medication and therefore would require an intervention. The other options are appropriate delegation and therefore do not require intervention.

DIF: Cognitive Level: Analysis

REF: pages 165-167

3. Which of the following delegations require an immediate intervention by the charge RN? a. A UAP ambulates a patient 24 hours after a cardiac catheterization. b. A UAP ambulates a patient 24 hours after a bronchoscopy. c. A UAP ambulates a patient 24 hours after a pneumonectomy. d. A UAP ambulates a patient 24 hours after an echocardiogram.

ANS: C

Ambulation for the first time after major surgery requires an assessment by an RN and thus this would require an intervention. The other options are appropriate delegation and therefore do not require intervention.

DIF: Cognitive Level: Analysis

REF: pages 161-162

4. Which of the following delegations by the RN would require an immediate intervention by the

charge RN?

a. A UAP removes the wrist restraints on a patient and provides ROM exercises

when giving a bath. b. An LPN assists a patient back to bed from the bathroom. c. A UAP replaces the monitor electrodes on a patient after he has taken a shower. d. An LPN assesses LOC on a stable patient 3 days after surgery.

ANS: C

Replacement of electrodes requires an assessment and is not within the scope of practice of the UAP and would require an intervention. The other delegations are appropriate delegation and therefore do not require intervention.

DIF: Cognitive Level: Analysis

REF: pages 165-167

5. A UAP is asked to take a patient’s temperature every 4 hours and report that temperature to

the RN. Which best demonstrates the correct interpretation of right communication? a. The UAP takes the temperature for the patient every 4 hours. b. The UAP charts the temperature for the patient every 4 hours. c. The UAP reports that the patient has been afebrile all day. d. The UAP reports the temperature for the patient every 4 hours.

ANS: D

The UAP has correctly interpreted the delegation and has appropriately acted. The other options are incorrect because they demonstrate an incorrect interpretation of the delegation.

DIF: Cognitive Level: Analysis

REF: page 165

6. A patient turns his call light on and states, “I’m having trouble breathing.” Which team

members should be delegatedNtU oR reS spIoN ndGtT oB th. isCcaOllMlight? a. RN b. LPN c. Senior student nurse d. UAP ANS: A

Correct delegation is the RN because this patient requires an assessment to determine the cause of his difficulty breathing and the appropriate action for the nurse to take. The other team members are not within the staff member’s scope of practice to assess unstable patients.

DIF: Cognitive Level: Application

REF: pages 162-163

7. A patient turns his call light on and requests someone to help him ambulate. The senior

student nurse has been caring for this patient for 2 days but has only helped him to a chair in the past. Which instructions should be given to the student prior to ambulation of the patient? a. “The patient has been ambulated before but still requires some assistance.” b. “The patient has been ambulated before but is only able to walk with supervision and a walker.” c. “The patient is only able to walk with a walker for the length of the hallway.” d. “The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).”

ANS: D

Proper delegation includes specifics about the task and the possible adverse effects and what to do about them should they occur. This answer provides all of the components for good delegation. The other options do not include specifics regarding adverse effects of the task or what should be done if they occur.

DIF: Cognitive Level: Application

REF: page 163

8. The charge nurse in the ICU receives a call from the ED. They have three patients who require

a bed. Which patient should be transferred first? a. A patient admitted with an acute MI who is in the cardiac catheterization lab now for an intervention b. A patient admitted with an acute MI and a history of CABG on a nitroglycerin drip to manage ischemic pain and tissue perfusion c. A patient in sickle cell crisis with a PCA pump to manage his pain d. A patient in DKA for new-onset diabetes mellitus ANS: B

This patient is the least stable and will require the most assessment due to titration of the nitroglycerin drip. The other options are incorrect because although the patient requires assessments once on the unit, he or she is currently stable and can wait until a bed is available.

DIF: Cognitive Level: Analysis

REF: page 166

9. The nurse and UAP are working together with four patients. Which patient should the nurse

assign the UAP? a. A patient waiting for discharge instructions before going home b. A patient who received morphine 20 minutes ago and now has the call light on NU RSeds INher GTblood B.CgOlucose checked c. A patient with diabetes wh o ne d. A patient returning from a bronchoscopy ANS: C

It is within the UAP’s scope of practice to check blood glucose levels on a diabetic patient.

Options A and B are incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed. Option D is incorrect because this patient requires assessment and therefore cannot be delegated to the UAP until stability is assessed.

DIF: Cognitive Level: Application

REF: page 166

10. When incorporating the five rights of delegation, the right person is being used in which of

the following situations? a. The LPN initiates TPN to a patient as ordered. b. The charge nurse designates a UAP to “float” to another unit. c. The staff nurse trades weekends with another staff nurse. d. The UAP assists a patient to the bathroom after an echocardiogram.

ANS: D

It is within the UAP’s scope of practice to assist patients to the bathroom as long as the patient is stable in performing that action. Option A is incorrect because this is an inappropriate delegation. It is not within the LPN’s scope of practice to manage IV therapy. Option B is incorrect because this is not a delegation of a task and is merely a function of the position of the charge nurse. Option C is incorrect because it is not delegation.

DIF: Cognitive Level: Analysis

REF: page 163

11. When incorporating the five rights of delegation, the right supervision is used in which of the

following situations? a. The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. b. The RN administers orange juice to a patient reported by the UAP to have a blood glucose level of 56 mg/dL. c. The RN holds the morning insulin on a patient reported by the UAP to have a blood glucose level of 56 mg/dL. d. The RN administers the morning insulin after assessing a patient reported by the UAP to have a blood glucose level of 56 mg/dL. ANS: A

The UAP reports a low blood glucose level. The RN must check the patient’s response to that glucose level and may need to repeat the measurement if the patient’s assessment does not correlate with the low level, and thus the RN is supervising the performance of the UAP in that task. Options B and C would be an inappropriate action without first assessing the patient’s response and therefore accuracy of the glucose level obtained. Option D would put the patient at risk for severe hypoglycemia if the blood glucose level is accurate. The RN should assess the patient and the accuracy of the reported glucose level. If the glucose level is as stated, the appropriate action by the RN would be to hold the insulin until the blood glucose is at an appropriate level.

DIF: Cognitive Level: Analysis

REF: page 163

12. When incorporating the five N rigUhR tsSoI f dNeG leT gaBti. onC, O thM e right communication is used when a

patient’s blood pressure is low in which of the following situations? a. The RN tells the UAP to wait to give a patient a bath because her blood pressure is too low. b. The RN tells a UAP to recheck the patient’s blood pressure and report back to her before giving the patient a bath. c. The UAP gives a bath to a patient with a low blood pressure. d. The RN tells the UAP to give a patient a bath because they are unaware of the low blood pressure.

ANS: B

Rechecking the blood pressure is the appropriate communication to ensure the safety of the patient. Option A might ensure the safety of the patient for the moment but should be followed up and the blood pressure measurement repeated. Option C could put the patient at risk because of the blood pressure. The RN has not communicated appropriately. Option D is completely inappropriate and places the patient at risk.

DIF: Cognitive Level: Analysis

REF: page 165

13. When incorporating the five rights of delegation, the right task is used in which situation? a. The UAP reinforces use of the incentive spirometer to a patient. b. The UAP teaches the patient to use the incentive spirometer. c. The UAP listens to breath sounds to encourage the patient to use the incentive

spirometer.

d. The UAP is not allowed to work with the patient regarding use of the incentive

spirometer.

ANS: A

Although the UAP is not allowed to teach the patient about the use of the incentive spirometer, it is within his or her scope of practice to reinforce that teaching. Only the RN can teach the patient how to use the incentive spirometer. The UAP may not teach patients. UAPs may not assess. Only the RN has that responsibility. The UAP may reinforce use of the incentive spirometer.

DIF: Cognitive Level: Analysis

REF: page 163

14. When incorporating the five rights of delegation, the right circumstance is used in which of

the following situations? a. The RN asks the UAP to draw a prothrombin time on a patient on a heparin drip. b. The RN asks the UAP to draw blood on a patient with bilateral upper extremity lymphedema. c. The RN asks the UAP to draw blood on a newly admitted patient with pneumonia. d. The RN asks a new UAP to draw blood on a patient known to be a “hard stick.”

ANS: C

It is within the UAP’s scope of practice to draw blood (if allowed in the institution) from patients without IV issues. The prothrombin time blood sample should not be obtained from the arm in which the heparin is running and the UAP is not qualified to know that. The site for blood draws in this patient would need to be carefully chosen by only an RN to protect the patient from injury. Option D is inappropriate delegation; the RN should draw this patient’s blood.

DIF: Cognitive Level: Analysis

REF: page 163

15. After receiving the shift report, which of the following requires a priority action by the nurse? a. Discontinue an IV line from an insertion site that appears red and at which the

patient complains of pain. b. Make assignments for the team. c. Talk to a patient who has changed his mind about having a procedure today. d. Round on all the patients on their team.

ANS: A

Patient safety is a priority. The other options are not a priority for patient safety.

DIF: Cognitive Level: Application

REF: page 162

16. Which of the following patients should the nurse see first after the shift report? a. A patient with a change in heart rhythm who is complaining of lightheadedness b. A patient with a newly placed pacemaker who is complaining of shoulder pain c. A patient in heart failure on afterload reducers with a blood pressure 96/60 mm Hg d. A patient in first-degree heart block ANS: A

The patient has complained of lightheadedness and his cardiac monitor shows an increase in heart rate. A change in heart rhythm requires a nursing assessment. Options B and C are incorrect because the complaint is predictable and is not a priority. Option D is incorrect because the patient is stable and is not a priority.

DIF: Cognitive Level: Application

REF: page 169

17. The nurse is working on a medical unit with an LPN and UAP as the team members. Which

tasks should the RN delegate to the LPN? a. Vital signs on a patient about to arrive from the cardiac catheterization lab b. Regulation of a patient’s heparin drip based on the heparin nomogram c. Regulation of a patient’s nitroglycerin drip based on the level of pain d. Administration of all oral medications for the team ANS: D

It is within the LPN’s scope of practice to administer oral medications. The other options are incorrect because the patient requires the RN’s assessment skills.

DIF: Cognitive Level: Application

REF: pages 165-167

18. The nurse is working on a medical unit with an LPN and UAP as the team members. Which

tasks should the RN delegate to the UAP? a. Vital signs on all patients admitted on the previous shift b. Vital signs on a patient being transferred from the ED c. Vital signs on a patient being transferred from the ICU d. Vital signs on a newly admitted stable patient ANS: A

It is within the scope of practice for the UAP to take vital signs on stable, predictable patients.

The other options are incorrect because only the RN can make this initial assessment.

DIF: Cognitive Level: Application

REF: pages 165-167

19. The nurse is working on a medical unit with an LPN and a UAP as the team members. Which

tasks should the RN complete? a. Assignments of new admissions to staff b. Regulation of heparin drip based on the heparin nomogram c. Vital signs on patients admitted on previous shift d. Dressing change for a patient 4 days post I&D of a pacemaker wound ANS: B

Only the RN is allowed to titrate IV medications because assessment is required. Assignments of new admissions to staff should be performed by the charge nurse. Vital signs on patients admitted on previous shift can be appropriately delegated to the UAP. Dressing change for a patient 4 days post I&D of a pacemaker wound can be appropriately delegated to the LPN. DIF: Cognitive Level: Application

REF: pages 165-167

20. The nurse is working on a medical unit with an LPN and UAP as the team members. Which

tasks should the RN complete? a. Vital signs on a patient admitted from the ED b. Turning a patient who had a CVA 4 days ago

c. Feeding a patient requiring assistance d. Recording the I&O on a patient on strict fluid restrictions ANS: A

This patient requires an initial assessment, for which only the RN can be responsible. The other tasks can be delegated.

DIF: Cognitive Level: Application

REF: pages 165-167

21. An agency nurse is assigned to the thoracic surgery postoperative nursing unit. Which of the

following would be the best action by the charge nurse? a. Call the agency to determine her level of experience. b. Assign the nurse to patients ready for discharge. c. Assign her to pass medications only. d. Ask the nurse about her level of experience.

ANS: D

Assignments are made based on the nurse’s knowledge and skills and the agency nurse should be asked about her experience and background. The other actions are unnecessary. Asking the RN will provide the information necessary to determine the assignment.

DIF: Cognitive Level: Analysis

REF: pages 163-165

22. Which action by a UAP requires an immediate intervention by the nurse? a. Application of a skin barrier/protection ointment b. Releasing wrist restraints on a patient to allow ROM c. Assisting a patient to the bedside commode d. Obtaining a urine cultureNfrom R aIpatiGent B.C M

U S N T

O

ANS: A

These products are medications and even topical medications are not allowed under the UAP’s scope of practice, and thus this requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention.

DIF: Cognitive Level: Analysis

REF: pages 165-167

23. Which action by a UAP requires an immediate intervention by the nurse? a. Encouraging a patient to use the incentive spirometer b. Encouraging a patient to ambulate 2 days after surgery c. Checking the pH of the gastric aspirate of a patient receiving tube feedings d. Informing the RN that a patient requests a pain medication ANS: C

Checking the pH of the gastric aspirate of a patient receiving tube feedings requires an assessment and is not within the scope of practice of the UAP and thus requires an intervention. The other actions are within the scope of practice of the UAP and do not require an intervention.

DIF: Cognitive Level: Analysis

REF: pages 165-167

24. Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit? a. A patient being transferred to an ECF for rehabilitation following a hip

replacement b. A patient following a hip replacement with a history of an acute MI 4 weeks ago c. A patient with an external fixator d. A patient to be started on a PCA pump requiring instructions ANS: B

With the RN’s knowledge and background for caring for cardiac patients, it is most appropriate to assign her to this patient because of the potential for cardiac issues to arise postoperatively. The other assignments are not appropriate given this nurse’s background and knowledge.

DIF: Cognitive Level: Analysis

REF: pages 163-165

25. Which actions by the UAP would require immediate follow-up by the nurse? a. Informing the nurse she was taking a break b. Taking her lunch break on her home floor after being pulled to another floor c. Asking the patient to let her know the next time he has a bowel movement d. Asking another UAP to obtain a urine sample for her ANS: D

It is not within the scope of practice for the UAP to delegate any tasks and would require an intervention. The other actions are appropriate action by the UAP and do not require intervention.

DIF: Cognitive Level: Application

REF: pages 165-167

26. A nurse must delegate some responsibilities of the care of patients on a particularly busy and

chaotic day to the LPN and UNAPRteaI m members. Which of the following can be appropriately U S NGTB.C M delegated to the LPN? a. Assisting with a central line insertion b. Giving bath supplies to patients who are capable of bathing themselves c. Rechecking the blood pressure on a patient who is having episodes of bigeminy and ventricular tachycardia d. Transporting a patient in a wheelchair for discharge ANS: A

The LPN has been trained to assist the health care provider with complicated procedures. The assignments in options B and D can be delegated to the UAP. Option C is incorrect because this patient is unstable and requires an RN’s assessment.

DIF: Cognitive Level: Application

REF: pages 167-169

27. Which statement made by the clinical instructor would represent feedback to a student nurse? a. “Explain to me the actions of this medication before you give it.” b. “Can you explain to me why Mr. W. did not receive a bath this morning?” c. “Stop the urinary catheter insertion now. You have contaminated the catheter.” d. “You need to use your critical thinking skills when caring for patients.”

ANS: D

Although this may not be the most appropriate feedback, it does give the student feedback on his clinical performance. The other statements are confrontational but do not provide feedback.

DIF: Cognitive Level: Analysis

REF: page 165

28. A nurse assesses a patient reported to have normal vital signs throughout the night and finds

the patient in acute respiratory distress. What is the nurse’s next best action? a. Delegate vital signs to the UAP. b. Ask another nurse to call the health care provider. c. Call a code. d. Start another peripheral IV line.

ANS: B

The nurse should stay with the patient and obtain vital signs, further assessing the patient for changes. The other actions are not appropriate.

DIF: Cognitive Level: Analysis

REF: pages 166-167

29. Which order should be considered to have the highest priority when delivering care to a

patient? a. Albuterol treatment for a patient complaining of shortness of breath b. IV diuretic for a patient in heart failure c. Sliding-scale short-acting insulin d. Antihypertensive for a patient admitted with negative cardiac enzymes ANS: A

The patient’s respiratory status has changed, so ABCs should be used to determine the highest priority medication administration. The other orders are incorrect because the patient is not at risk for loss of airway.

N RSINGTB.COM

DIF: Cognitive Level: AnalysisU

REF: page 169

30. Which delegation should a UAP consider to have the highest priority? a. Obtaining a routine blood glucose level from a patient with diabetes b. Giving a bath to a patient scheduled for a colonoscopy c. Feeding a patient who needs assistance doing so. d. Helping an older adult patient to the bathroom ANS: D

Older adult patients frequently need to get to the bathroom quickly, and if no assistance is provided, they may fall in an attempt to make it there by themselves. The other delegations do not take priority over the older adult patient needing to use the bathroom.

DIF: Cognitive Level: Analysis

REF: page 169

Chapter 14: Providing Competent Staff Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. In what ways can hospitals meet The Joint Commission goals of adequate competent staffing? a. Using contract nurses b. Training and educating staff c. Promoting “best nurses" d. Salary inequities ANS: B

Training and education are the best methods for ensuring competency. The other options do not address competency.

DIF: Cognitive Level: Application

REF: page 176

2. Orientation of new employees is a two-stage process. The first stage includes orientation to

the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the hospital orientation? a. ECG interpretation b. Critical care course c. Medication test d. BLS training ANS: D

BLS skill is required to workNinUtR heShIoN spGitT alBse.ttC inO gM . The other options would be included in unit-specific orientation.

DIF: Cognitive Level: Analysis

REF: pages 176-177

3. Orientation of new employees is a two-stage process. The first stage includes orientation to

the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the unit orientation? a. Computer training b. Transcription of orders c. ECG interpretation d. BLS training ANS: C

ECG interpretation is a unit-specific orientation. The other options are incorrect because they are hospital orientation.

DIF: Cognitive Level: Analysis

REF: page 177

4. A new graduate requires a lengthy time commitment to orientation from the nurse manager.

The socialization of the new nurse may take as long as 2 years. Which of the following would be expected as a time frame for developing confidence? a. 6 to 12 months b. 4 to 6 months

c. 12 to 18 months d. 18 to 24 months ANS: A

The process of clinical decision making is lengthy and confidence in clinical judgment should not be expected before 6 to 12 months. 4 to 6 months is the time frame for learning practice norms. 12 to 18 months is the time frame for consolidation of relationships. 18 to 24 months is the time frame for seeking challenges.

DIF: Cognitive Level: Application

REF: page 176

5. What is the nurse manager’s primary role in a new nurse’s orientation program? a. Provides feedback b. Acts as a role model c. Orients to unit d. Encourages shift changes ANS: A

Nurse managers provide feedback evaluations at certain intervals. The other options are not the role of the nurse manager.

DIF: Cognitive Level: Analysis

REF: page 180

6. In addition to evaluative feedback, the nurse manager is also involved in orientation in which

areas? a. Encourages precepting with several nurses b. Provides for optimal learning experiences c. Orients to delegation of U NAP URs SINGTB.COM d. Orients to nurse manager role ANS: B

Nurse managers are responsible for providing the best learning environment for new staff.

The other options are not the nurse manager’s role.

DIF: Cognitive Level: Application

REF: page 180

7. What retention strategies should the nurse manager use when working with a new orientee? a. Provide a safe practice environment b. Encourage more time shadowing preceptor c. Encourage early independence d. Provide multiple preceptors for diverse learning ANS: A

The nurse manager is responsible for providing a safe learning and practice environment to encourage retention. The other strategies would not make for a good learning environment during orientation and could adversely affect retention.

DIF: Cognitive Level: Analysis

REF: page 180

8. Accrediting agencies require that staff demonstrate competency in their jobs. Annual

competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the health care field as required by accrediting agencies?

a. b. c. d.

Management of violent patients Fire safety Transport of patients Transcription of orders

ANS: B

Annual mandatory skill evaluations include fire safety. The other skills are not included in annual mandatory skill evaluations.

DIF: Cognitive Level: Analysis

REF: pages 176-177

9. Accrediting agencies require that staff demonstrate competency in their jobs. Annual

competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the ICU setting as mandated by accrediting agencies? a. ACLS b. Fire safety c. HIPAA d. Infection prevention ANS: A

ACLS demonstration is necessary for anyone working in an ICU. The other skills are evaluated in all mandatory skills evaluations and are not specific to the ICU setting.

DIF: Cognitive Level: Analysis

REF: page 178

10. Performance appraisals provide the employee with which of the following? a. Performance standards b. Goals c. Salary increases d. Continuing education ANS: B

Performance appraisals today are tools for setting goals. The other options are not part of the purpose of performance appraisals today.

DIF: Cognitive Level: Application

REF: pages 180-182

11. In the first phase of the performance appraisal process, the nurse prepares for the interview

with the nurse manager. Which of the following should the nurse do to prepare for the performance appraisal interview? a. Make a list of patients who have remarked on your abilities as a nurse. b. Identify accomplishments of last year’s goals. c. Bring documentation of charting. d. Provide anecdotal notes of other staff evaluations of you.

ANS: B

Bringing a list of accomplishments from last year’s appraisal may support a good appraisal this year. The other options are not beneficial to the process.

DIF: Cognitive Level: Application

REF: page 182

12. In the first phase of the performance appraisal process, the nurse manager prepares for the

interview with the nurse. What should the nurse manager plan in preparation for the performance appraisal? a. Anecdotal notes from other staff b. Complaints from patients and families c. Documentation of examples of performance d. Documentation of medication errors ANS: C

The nurse manager must have documentation of both good and bad performance to illustrate the necessary points of the evaluation. Although the other actions may be helpful, actual examples of specific performance provide better feedback.

DIF: Cognitive Level: Application

REF: page 182

13. The second phase of the performance appraisal interview is the participation. It is important

for the nurse manager to do which of the following first during this phase? a. Provide feedback on employee’s accomplishments and successes b. Discuss areas of concern c. Establish goals d. Identify areas for improvement ANS: A

Providing positive feedback at the beginning of the interview sets a positive tone. The other factors are discussed after the initial feedback is accomplished.

DIF: Cognitive Level: Application

REF: page 182

NURSINGTB.COM 14. The third phase of the performance appraisal process is using the evaluation results. The nurse and nurse manager can set goals for improvement. Which of the following evaluation tools should be designed during the third stage of the performance appraisal process? a. Provide coaching b. Reassign to a less stressful unit c. Determine nurse’s values d. Establish goals with outcome measures ANS: D

Establishing goals and tools for measuring those goals provides a productive approach to the problems. The other tools are not the best means for attaining the goals.

DIF: Cognitive Level: Application

REF: pages 182-183

15. Which of the following best explains the use of career development strategies in health care

institutions? a. Encourages nurses to move into management b. Reduces attrition c. Reduces dissatisfaction d. Reduces sick time ANS: B

Career development strategies have been shown to reduce the loss of nurses from the bedside.

The other factors are not part of the strategies.

DIF: Cognitive Level: Application

REF: page 178

MULTIPLE RESPONSE 1. Which of the following topics would the new nurse expect to review in the hospital’s new

employee orientation program? (Select all that apply.) a. HIPAA b. Safety standards c. Infection control d. ACLS e. Order transcription ANS: A, B, C

Options A, B, and C are correct because hospital orientation includes all new employees regardless of classification so the orientation will be about the policies and expectations of the hospital. The other options are unit-specific orientation.

DIF: Cognitive Level: Application

REF: pages 176-177

2. During unit orientation, a preceptor is used to provide learning and role modeling. What

should the nurse expect from a preceptor during orientation? (Select all that apply.) a. Orient to unit. b. Teach organizational skills. c. Teach medication actions. d. Teach unfamiliar skills. e. Teach prioritization skillsN. R I G B.C M

U S N T

O

ANS: B, D, E

Options B, D, and E are correct because most preceptors will teach these skills to new nurses.

Orientation to the unit can be done by anyone. Teaching medication actions should not need to be done.

DIF: Cognitive Level: Analysis

REF: pages 177-178

3. During unit orientation, a preceptor is used to provide learning and role modeling. Which of

the following would one expect to observe in a seasoned nurse preceptor? (Select all that apply.) a. Teach unfamiliar procedures b. Teach their way of charting c. Teach delegation skills d. Act as a role model e. Tailor orientation to new nurses’ specific needs ANS: C, D, E

Options C, D, and E are correct because an experienced preceptor will teach everything she can to help make the new nurse as competent as possible. Options A and B are seen with inexperienced preceptors.

DIF: Cognitive Level: Analysis

REF: pages 177-178

4. The Joint Commission (TJC) has set standards for employee ongoing education in which

situations? (Select all that apply.) a. Must occur after the end of orientation b. Must occur whenever responsibilities change c. To increase knowledge of work-related issues d. All staff must participate whenever an event occurs e. When and how to report adverse events ANS: B, C, E

Options B, C, and E are correct because TJC mandates that ongoing education should occur around this specific activity. Options A and D are not included in the mandate.

DIF: Cognitive Level: Application

REF: pages 178-179

Chapter 15: Group Management for Effective Outcomes Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Active listening typically involves a. active participation and respect for the speaker. b. asking lots of questions. c. judging what is being said. d. agreeing with the speaker.

ANS: A

Active listening is allowing the speaker to express herself and the listener to listen with respect and without judgment. The other options are not an attribute of an active listening.

DIF: Cognitive Level: Analysis

REF: page 191

2. When a nurse manager leads a group meeting, which of the following guidelines should be

practiced? a. Strictly adhere to agenda. b. Establish goals and objectives. c. Make the meeting seem friendly. d. Provide snacks.

ANS: B

Establishing goals and objectives is important in keeping the meeting focused. The other options are not a guide to maN naUgR inS gI grN ouGpTmBe. etC inO gsM. DIF: Cognitive Level: Application

REF: page 192

3. When a nurse manager leads a group meeting, which of the following guidelines should be

practiced? a. Allow group to set agenda. b. Separate the group according to interests. c. Facilitate problem-solving. d. Coerce all members to interact.

ANS: C

Facilitating problem solving involves all members in an active way. The other options are not a guide to managing group meetings.

DIF: Cognitive Level: Application

REF: page 192

4. As a team leader, the charge nurse would incorporate which of the following into the meetings

for greatest team input? a. Promote involvement of all members. b. Carefully use terms for problem solving. c. Coerce all members to participate. d. Use language with which the UAPs are unfamiliar.

ANS: A

Involving all members assists in the implementation of changes. The other options are not a guide for leading teams.

DIF: Cognitive Level: Analysis

REF: page 192

5. Attributes of effective teams include a. friendly interaction. b. respectful, consensus-building discussions. c. embarrassing and personal criticism. d. resentment toward other members.

ANS: B

Effective teams promote a respectful atmosphere for consensus building. The other options are not examples of an attribute of an effective team.

DIF: Cognitive Level: Application

REF: page 192

6. Attributes of ineffective teams include which of the following? a. Respectfully listening b. Consensus decision-making c. Leadership is owned by a few who make most of the decisions. d. Open discussion of disagreements ANS: C

Ineffective teams have intimidating leaders who do not allow respectful, open consensus-driven decision-making. The other options are examples of an attribute of an effective team.

N R INGTB.COM

U S DIF: Cognitive Level: Application

REF: page 192

7. The challenges facing nurses today include which of the following? a. Stressed nurse managers b. Increased patient acuity c. Increased overtime d. Increased patient length of stay ANS: B

Nurses must face increased patient acuity and workload. The other options are not sources for challenge.

DIF: Cognitive Level: Application

REF: page 161

8. Which of the following are included in the guidelines for valuable, effective

acknowledgement of each member’s contribution to the team? a. Acknowledgments should be made privately to avoid embarrassing the person. b. Acknowledgments are best put into the minutes to be read at a later date. c. Acknowledgments are best made in public and recognized as sincere. d. Acknowledgments are not necessary; everyone recognizes what has been done.

ANS: C

Acknowledgments are most appreciated when sincere and made publicly for all to appreciate.

The other options are not a good way to acknowledge a team member.

DIF: Cognitive Level: Application

REF: page 194

9. What does it mean to create a legend in the organization? a. A legend is to deify a person for his or her extraordinary actions. b. A legend separates one member from another. c. A legend creates an impossible example to duplicate. d. A legend is a means of recognizing and rewarding a job well done.

ANS: D

A legend is a means of rewarding an employee. The other options are not a reason for creating a legend.

DIF: Cognitive Level: Analysis

REF: page 194

10. Unique attributes of nurse managers when supervising staff include which of the following? a. Evaluate each worker as a team member b. Provide guidance and role modeling c. Stimulate workers to carry a heavy patient load d. Encourage staff to learn a second language so they can become interpreters ANS: B

Orienting, teaching, and guiding are ways of promoting best performance. The other options will not improve performance.

DIF: Cognitive Level: Application

REF: pages 195-196

11. When leading a team, a highN perform de.r C is seMen as which type of leader?

R IingGleaB a. b. c. d.

U S N T O A problem-solver Someone who identifies individual personnel problems Someone who identifies the causes of problems A problem identifier

ANS: A

High performers are defined as problem solvers. The people in the other options are not high performers.

DIF: Cognitive Level: Application

REF: page 196

12. When leading a team, a middle performing leader is seen as having which abilities? a. Loyalty to institution b. Acts as role model c. Always positive with fellow nurses d. Safe in all aspects of work ANS: A

Middle performers are typically loyal to the institution and committed to improvement performance. The people in the other options are not middle performers and have performance needs for improvement.

DIF: Cognitive Level: Application

REF: page 196

13. When leading a team, a low performing leader is seen as having which abilities? a. A problem solver b. Identifies cause when identifying problem c. Communicates well with staff d. Solves problems once identified ANS: B

Low performers seek blame for problems. The other options are not characteristics of a low performer.

DIF: Cognitive Level: Application

REF: page 196

14. Which of the following techniques should the manager use when talking with the

low-performing employee? a. Reassure him that this conversation is not reflected in his evaluation. b. Compare her performance to that of the high-performer. c. Describe the observations and be sure he knows the consequences. d. Allow no explanations for her actions since she is so good at citing blame.

ANS: C

Accurate descriptions and consequences must be included in the conversation. The other options do not present a way of conversing with the low performer.

DIF: Cognitive Level: Application

REF: page 196

15. Guidelines for performance ratings should meet what criteria? a. Patient satisfaction comments b. Quantity of care c. Mastery of skills d. Behavioral expectations ANS: D

Behavioral expectations are the primary evaluation component. The other options do not include evaluation components.

DIF: Cognitive Level: Application

REF: page 196

16. Peer reviews are frequently included in the overall employee performance appraisal. What

values are attributed to the peer review? a. The nurse has the ability to evaluate based on personal knowledge of the employee's performance. b. Friendships can interfere with peer appraisals. c. Selection of peers for appraisals can be biased. d. Frequency of shared work may influence evaluation by peer.

ANS: A

When asked to submit peer evaluations, they should be selected on the basis of time actually shared in the work day/week. The other options are not an attribute of the peer evaluation method of appraisal.

DIF: Cognitive Level: Analysis

REF: page 197

17. Team players show many positive characteristics. Which of the following characteristics

should be expected of a good team player when asked to participate in a continuing education class for the unit? a. “Sure, but my schedule is full right now.” b. “I did this last time. Let’s give someone else a chance.” c. “Sure, I will need to make some changes to my schedule.” d. “Sure. How about next month?”

ANS: C

Good team players adapt to the needs of the team to accomplish their goal. The other options are not characteristics of team players.

DIF: Cognitive Level: Analysis

REF: page 194

18. Which statement would one expect to hear at a team meeting in which members work

cohesively? a. “Who has ideas about this?” b. “I think we have a solution.” c. “We are running out of time to discuss this today.” d. “We only want to hear positive ideas.”

ANS: A

Asking for solutions to problems is a productive characteristic of team building. The other options are destructive to team building.

DIF: Cognitive Level: Analysis

REF: pages 194-195

etinR rtant consideration?

19. When organizing a group meN U g,SwIhat NGisTaBn.imCpoM a. Arranging the time of the meeting to be most convenient to leaders b. Seating according to seniority c. Starting and ending on time d. Addressing only the high performers ANS: C

An organized meeting must have a specific start and end time and they must be adhered to.

The other options are not productive for team meetings.

DIF: Cognitive Level: Analysis

REF: page 191

MULTIPLE RESPONSE 1. Teams are groups who must work cooperatively to achieve a goal. Which of the following

would be considered part of a team on a typical nursing unit? (Select all that apply.) a. Staff nurse b. UAP c. Case manager d. Pharmacist e. Unit secretary f. Admission clerk ANS: A, B, C, D, E

Options A, B, C, D, and E are employees who make up a group or team caring for the same patient in one way or another. The admission clerk is usually not involved in the care of the patient.

DIF: Cognitive Level: Analysis

REF: page 195

2. Which of the following are some of the qualities found in a team player? (Select all that

apply.) a. Competence b. Dependability c. Enthusiasm d. Being on time e. Being friendly ANS: A, B, C

A good team player would possess the qualities in options A, B, and C. Options D and E are not necessarily qualities found only in team players.

DIF: Cognitive Level: Application

REF: page 194

3. Smoothly functioning teams should possess which characteristics? (Select all that apply.) a. Everyone is on time for meetings. b. There is mutual trust. c. There is a sense of identity with the team. d. Everyone has the same objectives. e. The team works well together.

ANS: A, B, C, E

Well-functioning teams should possess the qualities in options A, B, C, and E. Having the same objectives is not a characteristic of well-functioning teams.

DIF: Cognitive Level: Application

REF: pages 191-192

4. Which of the following should be used to evaluate the staff’s performance when deciding

high, middle, or low? (Select all that apply.) a. Never late b. Teamwork c. Communication d. Knowledge and competence e. Responsive to constructive criticism.

ANS: B, C, D

Options B, C, and D are areas for evaluation of work performance. Options A and E are not areas for evaluation.

DIF: Cognitive Level: Analysis

REF: page 197

Chapter 16: Hospital Information Systems Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Health care facilities are incorporating the use of electronic health records (EHRs), and nurses

are responsible for entering data on their patients. Nurses understand that there are many advantages to this new form of charting. Which of these factors make the electronic EHR an advantageous health care record for the nurse? a. Record keeping is safe and accurate. b. Documentation is timely. c. Corrections to the record can be made at the end of the shift. d. Coordination of vital signs to prescribed medications is automatic.

ANS: A

The EHR provides a confidential, easily accessible, and legible record of the patient’s health history and current admission. The other options are not true about the EHR. DIF: Cognitive Level: Analysis

REF: pages 206-207

2. The electronic health record (EHR) provides information to all members of the health care

team on their patients. The nurse manager and other team members recognize the advantages of the EHR, which include a. being handy for patients to carry with them. b. protecting patient privacy. c. being easier for patients tN o reR ad. I G B.C M U d. making data available for reseaS rchNandTcontinO uous performance improvement.

ANS: D

One advantage to the EHR is the availability of those records for research purposes and for quality improvement initiatives within the institution. The other options are not true.

DIF: Cognitive Level: Application

REF: pages 206-207

3. Advantages to using the electronic health record (EHR) include that a. hospitals no longer need to store medical records. b. medical records are complete and easily accessible to health care providers. c. unit secretaries can still call for “old records.” d. diagnostic tests are not available for direct visualization.

ANS: B

The advantage of the EHR compared with the paper method is that the record is complete, easily accessible, and legible. Option A is incorrect because records continue to be stored but are stored on computer software, not paper. The other options are not true.

DIF: Cognitive Level: Application

REF: pages 206-207

4. A health care facility is using an electronic health record (EHR) system for documentation

purposes. Every Thursday from 11:00 to 12:00 PM, the EHR shuts down for maintenance.

Which would be of concern to the nurse during that weekly downtime?

a. b. c. d.

Illegal access to records can take place.

Loss of previous documentation can occur.

Loss of coordination of medication list and vital signs can occur.

Sometimes passwords are lost.

ANS: C

When the EHR goes down for any reason, the health care providers no longer have access to current patient information and errors can occur. Options A and B cannot occur. Option D is not an area for concern.

DIF: Cognitive Level: Analysis

REF: pages 206-207

5. Hospitals beginning to use the electronic health record (EHR) for documentation of patient

care are sometimes faced with many obstacles. What may be seen when the EHR system is first initiated? a. Limited storage for records b. Resistance from staff c. Many “crashes” of the system d. Many disruptions from the access of multiple users ANS: B

The steep learning curve can lead to staff resistance to its implementation. The other options are not true.

DIF: Cognitive Level: Analysis

REF: pages 206-207

6. The electronic health record (EHR) provides a particular advantage to those patients with

chronic diseases. Which of thNe foRllow ing patients would most likely benefit from the use of an U SI NG TB.C M EHR by the health care provider? a. A patient with diabetes, heart failure, and end-stage renal disease b. A patient with heart failure following a myocardial infarction c. A patient following an automobile accident with multiple fractures to the lower extremities d. A patient with newly diagnosed hypertension ANS: A

Patients with multiple chronic disorders have multiple providers, which makes care more difficult to coordinate. Option B represents a chronic disorder but it is newly diagnosed and would not present the multiple-provider obstacle to health care that the longstanding disorders produce. Option C can lead to long-term care needs but mostly from one provider (orthopedist). Option D represents a chronic disorder but it is newly diagnosed and would not present the multiple-provider obstacle to health care that the longstanding disorders produce.

DIF: Cognitive Level: Analysis

REF: pages 206-207

7. The computerized provider order entry (CPOE) is a component of the electronic health care

system being used in hospitals. This system allows prescriptions to be written electronically and automatically sent to the pharmacy or other necessary facilities. The nurse understands that the greatest benefit of the CPOE is a. lowered cost of prescriptions. b. faster delivery of medications from pharmacy.

c. that fewer errors occur. d. that the nurse must confirm prescriptions directly with physician.

ANS: C

Fewer errors occur with this system because there are no legibility issues and the entry is sent directly to pharmacy. The other options are not part of the process of the system.

DIF: Cognitive Level: Application

REF: pages 206-207

8. A hospital has just introduced a new electronic staffing system that allows staff to enter their

shift preferences into the computer. What would the nurse identify as an advantage to the staff? a. Decrease in nurse manager availability b. Increase in nurse manager availability c. More available staff d. Requests cannot be entered ANS: B

The nurse manager would have more time available to manage the clinical area with this system. Option A is incorrect because the system has the opposite effect. Option C is incorrect because the system allows only a predetermined number of staff on any day or shift. Option D is not true.

DIF: Cognitive Level: Application

REF: page 207

9. Use of the Internet for health care information has produced a more-educated patient. What is

the greatest benefit to the patient? a. Background information N on pRhysI U S icia NGnsTB.C OM b. Reduced health care costs c. Health care provider access to current peer-reviewed information for clinical decision making d. Anecdotal information ANS: C

Access to current research is an advantage to the health care provider in making decisions for care. Options A and D generally do not benefit the patient. Option B is not true.

DIF: Cognitive Level: Application

REF: page 207

10. The Pyxis Specialty Station system automates the distribution, management, and control of

medications and supplies. An advantage of this system to the patient is which of the following? a. Accurate charging of supplies b. Accurate dosage of medications c. Separate storage for each patient d. Availability of medications and supplies ANS: D

The greatest advantage to the patient is the availability of necessary medications and supplies.

Options A and B are incorrect because this is supposed to be an advantage but is not in the clinical setting. Option C is incorrect because the greatest advantage to the patient is the availability of necessary medications and supplies.

DIF: Cognitive Level: Application

REF: page 208

11. Another type of technology currently being used in hospitals is the Automated Nurse Staffing

System. What is the advantage of this system to the patient? a. Reduces health care costs by predicting supplies needed b. Determines staffing based on acuity of patients c. Determines staffing based on cost of patient care d. Determines order of being floated ANS: B

Staffing is based on the amount of care required by the patients with this system. The other options are not part of the points the system provides.

DIF: Cognitive Level: Application

REF: page 208

12. The Nursing Minimum Data Set (NMDS) is a collection of established uniform standards for

collecting data. It includes the North American Nursing Diagnosis Association International (NANDA-I)-approved list of nursing diagnoses as well as other sources of nursing language.

What is the advantage of the NMDS to the patient? a. Data can be entered from multiple sources into the patient’s record. b. Nurses must be able to speak and understand English. c. Nurses must know all the NANDA diagnoses. d. Patient receives a daily update of charges.

ANS: A

The goal of NMDS is to allow for data collected from other sources, such as blood glucose monitoring devices, ventilatoN rs, aRnd I monitorBs,.toCbeMdownloaded into the patient record. The U S NGused T in the O practice of nursing and not English. language referred to is the nomenclature Option C is not necessary to memorize the NANDA diagnoses. Option D is not true.

DIF: Cognitive Level: Application

REF: page 209

13. To practice as a nursing informatics specialist, what must the nurse accomplish first? a. Pass the NCLEX exam. b. Be actively involved in research. c. Demonstrate practice by working for a minimum of 2 years in an intensive care

unit. d. Achieve certification from the ANCC. ANS: D

Certification is required to practice. A nurse must accomplish this prior to certification. The other options don’t apply.

DIF: Cognitive Level: Application

REF: page 209

14. The nurse informatics (NI) specialist incorporates nursing science, computer science, and

information science to support nursing in utilization of the data collection. Priorities for an NI specialist include a. developing computer information systems for the hospital. b. incorporating common nursing nomenclature into the system. c. researching evidence-based practice.

d. developing restrictions of certain patient information to insurance companies.

ANS: B

Incorporation of the nursing language into the computer system is essential for accurate documentation. The other options are not included in the role of the NI specialist.

DIF: Cognitive Level: Analysis

REF: page 209

15. Which observation requires an intervention of a new graduate nurse by her preceptor? a. Administering a medication after checking the patient’s name and birth date. b. Leaving patient room without charting vital signs. c. Reporting a patient’s change in level of consciousness to the nurse practitioner. d. Checking the apical pulse on a patient receiving digoxin (Lanoxin).

ANS: B

An advantage to computerized charting is the availability of charting at the bedside at the time of care and charting before leaving the patient room, which makes that information immediately available to all health care providers. The other options are appropriate and does not require intervention.

DIF: Cognitive Level: Analysis

REF: page 209

16. What is the greatest benefit to the nurse of technology in the health care setting? a. Patient acuity is reduced. b. Determination of the time of discharge of patient is aided. c. There is easy, quick access to relevant data. d. Data may be more difficult to interpret.

ANS: C

The ease by which data can be retrieved is a great benefit to nurses in the clinical area. The other options are not part of the system information.

DIF: Cognitive Level: Application

REF: page 206

17. Technology is highly visible and accessible in the health care environment. All members of

the health care team provide data to the patient’s record. Which of these systems does the nurse understand to be a nursing data entry program? a. Computerized medication administration system b. Computerized provider order entry. c. Pyxis d. Pareto analysis ANS: A

The MAR is an exclusive program into which the nurse enters medication administration.

Computerized provider order entry is a physician entry program. Pyxis is a computerized billing program. Pareto analysis is not a data entry program.

DIF: Cognitive Level: Analysis MULTIPLE RESPONSE

REF: page 208

1. Health care facilities are incorporating the use of electronic health records (EHRs), and nurses

are responsible for entering data on their patients. Nurses understand that there are many advantages to this new form of charting. Which of these is an advantage to the nurse when using the EHR? (Select all that apply.) a. Not all documentation is accessible to the nurse. b. Documentation occurs at the patient’s bedside. c. Corrections are easily made when errors are inadvertently made. d. Coordination of vital signs to prescribed medications is easy and quick. e. Nurses must identify the assessment parameters to be included.

ANS: B, C, D

The EHR has many advantages for the nurse including access to computers at the bedside.

The EHR has many advantages for the nurse including easy changes to errors made to documentation. The EHR has many advantages for the nurse including having all necessary information easily and quickly accessible for coordination of care. The other options are not true of the EHR. DIF: Cognitive Level: Analysis

REF: pages 206-207

2. All treatments and services for patients require two forms of patient identification prior to

providing those services. Which is the best method to use to identify the patient who is unable to communicate? (Select all that apply.) a. Patient ID band b. Roommate c. Family member d. Admission photograph e. Asking another nurse who has cared for the patient previously N R I G B.C M

U S N T

O

ANS: A, C, D

Nurses should rely on the patient ID, family member identification, and admission photograph as types of patient identifications when patients are unable to communicate. Options B and E are not reliable forms for patient identification.

DIF: Cognitive Level: Application

REF: page 209

3. All treatments and services for patients require two forms of patient identification prior to

providing those services. Which would require an intervention if used by the nurse to identify a patient? (Select all that apply.) a. Referring to the patient ID band b. Asking the roommate c. Asking another nurse on the unit d. Asking the patient e. Asking a family member ANS: B, C

The patient’s roommate and another nurse on the unit are not good sources for patient identification and would require intervention if used. The patient’s ID band is a good source for patient identification. Options A, D, and E are correct method for identifying patients and would not require an intervention.

DIF: Cognitive Level: Application

REF: page 209

4. Point-of-care systems are currently being used in health care facilities. Which is an advantage

of the point-of-care systems to the patients? (Select all that apply.) a. Immediate access to decision support systems b. Rapid accurate charging of services to patients c. Faster discharge d. Documentation at the bedside e. Documentation at the time of care ANS: A, D, E

The use of PDAs and other point-of-care equipment provides the health care provider with immediate access to the patient records and other decision support systems.

PDAs and other point-of-care equipment also are more accurate as well as convenient because all the documentation can occur at the bedside and at the time that care is provided. Option B is incorrect because rapid accurate charging of services to patients is not one of the advantages. Option C is incorrect because faster discharge is not one of the advantages.

DIF: Cognitive Level: Application

REF: page 209

5. Nurse managers play an integral role in the adoption of the hospital’s information system.

There are three levels of competency in this leadership role. What functions can be observed in an initial-level nurse manager? (Select all that apply.) a. Entry of incident reports b. Use applications for data entry c. Use applications for administration data entry d. Actively involve nurses in the overall use of the system e. Use system for email to other managers N R I G B.C M

U S N T

O

ANS: B, C, D

Initial users need to develop the competencies in options B, C, and D. Options A and E are not an expected competency.

DIF: Cognitive Level: Application

REF: page 209

6. Nurse managers play an integral role in the adoption of the hospital’s information system.

There are three levels of competency in this leadership role. What functions can be observed in the modifier level nurse manager? (Select all that apply.) a. Participate in changes processes b. Participate in evaluation of system c. Participate in design of certain tools d. Use the system to evaluate clinical performance e. Use the system to promote research ANS: A, B, C

As a modifier, the manager would participate in changes of the system. As a modifier, the manager would participate in evaluations of the system. As a modifier, the manager would participate in designs of the system. Options D and E are not identified uses of the system.

DIF: Cognitive Level: Application

REF: page 210

7. Nurse managers play an integral role in the adoption of the hospital’s information system.

There are three levels of competency in this leadership role. What functions can be observed in the innovator level nurse manager? (Select all that apply.) a. Stress importance of the ergonomic work station importance b. Develop and design programs to be used c. Implement initiatives related to practice d. Protect the patient’s rights to confidentiality e. Use research in managing the system ANS: B, C, D

The innovator develops the system. The innovator implements the system. The innovator protects the uses of the system. Option A is incorrect because the nurse manager is to design these stations. Option E is not true.

DIF: Cognitive Level: Application

REF: page 210

8. Which observation requires an intervention with a new graduate nurse by his preceptor?

(Select all that apply.) a. Data entry on the wrong patient b. Entry of I&O values at end of shift c. Incomplete pain assessment d. Notifying pharmacy of unavailability of a medication e. Failing to complete an admission profile ANS: A, C, E

Options A, C, and E are correct because the nurse should intervene if the data are incorrect or not entered. Although I&O values should be entered before leaving the room, no actual harm will be done to the patient anN dU inR teS rvI enNtiG onTiB s. noCt O reM quired. Option D is incorrect because it would be an appropriate action and not require intervention.

DIF: Cognitive Level: Analysis

REF: page 207

Chapter 17: Ethical and Legal Issues in Patient Care Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. A nurse is caring for a patient with end-stage heart failure and understands the futility of care

for this patient. The family is in denial and refuses to consent to a DNR (do not resuscitate).

Their misperceptions regarding the DNR status may be based on which interpretation? a. A DNR order provides minimal care. b. A DNR order allows for pain medication administration. c. A DNR order allows for the administration of antibiotics. d. A DNR order allows for nutrition.

ANS: A

Patients and families consenting to DNR are consenting to not receive aggressive medical treatment only. Care continues until death occurs. The other options are incorrect because they are interventions allowed with a DNR order.

DIF: Cognitive Level: Application

REF: page 220

2. A nurse is caring for a patient who has developed MODS (multiorgan dysfunction syndrome)

resulting from septic shock. The patient is ventilator dependent and on vasopressors to maintain a Doppler-measured blood pressure of 80 mm Hg. The family is resistant to permit terminal weaning. The best action by the nurse is to a. insist that the family disconnect the patient from the ventilator. b. ask the family to meet with the hospital’s ethics committee.

NUdoe RSs IagNree GTand B.C c. seek a family member who haO veMthem sign the consent form. d. arrange for the vasopressors to be turned off when the family is not present.

ANS: B

The most appropriate action is to involve the hospital’s ethics committee in the decision-making process. The other options are inappropriate. Nurses must always act on behalf of the patient but must act within a legal and ethical framework.

DIF: Cognitive Level: Application

REF: page 222

3. In caring for a baby with non–life-sustaining defects, the nurse will most likely make

decisions based on a. personal ethical beliefs and values. b. treating all patients equally. c. treating all patients with respect and courtesy. d. the futility of life issue.

ANS: A

Ethical decision making requires the use of personal beliefs and values. The other options are ethical principles that can be relied on by the nurse, but the most overriding influence will be the nurse’s beliefs and values regarding this baby.

DIF: Cognitive Level: Analysis

REF: page 220

4. Which measure can be used to avoid ethical dilemmas in the health care setting? a. Advance directive or living will b. Religious beliefs of the nurse c. Designation of a durable power of attorney d. Values of the care givers ANS: A

The wishes of the patient made prior to hospitalization and possible development of incompetence should direct the decisions of the health care team. Options B and D would be inappropriate to use. Option C if used without an advance directive, may not address the wishes of the patient.

DIF: Cognitive Level: Analysis

REF: page 222

5. A nurse observes unsafe practice by a physician and reports it to the risk management

department of the hospital. Which ethical principle does this represent? a. Autonomy b. Beneficence c. Justice d. Veracity ANS: D

Veracity is the duty to tell the truth. Autonomy is the right to make one’s own health care decisions. Beneficence is to “do no harm.” Justice is to treat all patients equally and is incorrect.

DIF: Cognitive Level: Application

REF: page 220

NURSINGTB.COM 6. The nurse is caring for a patient with heart failure resulting in irreversible kidney damage who decides to go home to die rather than accept hemodialysis. The nurse understands that the patient is practicing which ethical principle? a. Autonomy b. Beneficence c. Justice d. Veracity ANS: A

Autonomy is the freedom to make decisions about one’s own health care without interference.

Beneficence is the duty to do good. Justice is the duty to treat all patients equally. Veracity is the duty to tell the truth.

DIF: Cognitive Level: Application

REF: page 220

7. Autonomy is an ethical principle that can be applied to which clinical situation? a. A nurse acts as a whistleblower in reporting unsafe practices observed on a clinical

area. b. A nurse administers an IV morphine drip for a patient being terminally weaned. c. A nurse adheres to the HIPAA law when asked to reveal information on a patient to a nurse’s family member. d. A nurse permits a patient to refuse a medication.

ANS: D

The principle of autonomy requires that patients are allowed to make decisions about their own health care. Option A represents the principle of veracity. Option B represents the principle of beneficence. Option C represents the principle of fidelity.

DIF: Cognitive Level: Analysis

REF: page 220

8. A basis for ethical dilemma can result from a request for organ donation. Which factor may

contribute to this conflict? a. The patient is ventilator dependent. b. The patient has signed her driver’s license giving consent. c. The patient has not previously expressed her wishes on organ donation. d. The patient’s religion is unclear about organ donations.

ANS: C

Family members may be reluctant to consent to donation if the patient has never previously expressed her wishes. Options A and B provide encouragement to the family for donation.

Option D may initially cause some conflict, but because almost all major religious groups express this decision as a personal one, it should not cause conflict once she makes her decision.

DIF: Cognitive Level: Application

REF: page 223

9. If a patient does not have an advance directive or has not expressed his wishes regarding end

of life care, what ethical principle may help the family to make the right decision? a. Autonomy b. Fidelity c. Beneficence NURS INGT B.COM d. Veracity ANS: C

Beneficence may be the best principle to apply in this situation because the nurse should always advocate for the patient. If the outcome for this patient is known, it may be in the best interest of the patient to allow a quiet painless death. The other options are ethical principles that do not apply.

DIF: Cognitive Level: Analysis

REF: page 220

10. The American Nurses Association (ANA) Code of Ethics for nurses is primarily a statement

in support of a. patient advocacy. b. professional membership. c. missionary work. d. preventative health care.

ANS: A

The overriding theme in the ANA Code of Ethics statement is that of patient advocacy. The other options are not applicable.

DIF: Cognitive Level: Analysis

REF: page 221

11. The International Council of Nurses (ICN) Code of Ethics for nurses is primarily a statement

in support of

a. b. c. d.

environmental protection. professional membership. everyday decision making. collective bargaining.

ANS: C

The ICN Code of Ethics is written in support of the everyday decisions nurses must make in their practice. The code is not written in support of the other options.

DIF: Cognitive Level: Analysis

REF: page 221

12. In addition to the organ procurement coordinator, which other resource is the best resource for

the nurse to use in helping the family make a decision when there is disagreement among family members regarding organ donation? a. Nurse manager b. Physician c. Ethics committee d. Social worker ANS: C

The ethics committee may be the best resource for providing advice to the family to make their decision. The other options may be a resource but the best choice would be the ethics committee, which incorporates all of the others.

DIF: Cognitive Level: Application

REF: page 222

13. When nurses are confronted with ethical dilemmas that challenge their values and beliefs,

what is the best source to relyNonRto m rigCht dMecision?

U SIak NGe th TBe . a. Personal religious beliefs b. Hospital chaplain c. Family interactions d. Belief in patient advocacy ANS: D

Determining what is right for the patient must supersede personal influences or beliefs. The other sources may not be a good source for nurses to use when advising patient’s families.

DIF: Cognitive Level: Analysis

REF: page 220

14. Which ethical principle should help guide the nurse who suspects another nurse is incorrectly

charting pain medications and then taking them? a. Autonomy b. Veracity c. Justice d. Beneficence ANS: B

Veracity is the principle of telling the truth. Nurses are obligated to report unsafe care practices. The other principles do not apply.

DIF: Cognitive Level: Application

REF: page 220

15. A nurse agrees to trade shifts with another nurse. A conflict arises now with the nurse’s ability

to work that shift. Which ethical principle should the nurse use to make a decision when conflict arises regarding the nurse’s inability to honor an agreement to trade shifts? a. Fidelity b. Veracity c. Beneficence d. Justice ANS: A

The duty to keep one’s word is important to maintain a respectful working environment. The others do not apply.

DIF: Cognitive Level: Application

REF: page 220

16. The ethical principle of autonomy is being respected in which situation? a. A patient’s right to refuse medications b. The right of a patient with tuberculosis to refuse to wear a mask when leaving the

unit c. The right of a family to refuse to wear a gown and gloves when visiting a patient

on contact precautions d. The right of a family to refuse to wear masks when visiting a patient on

neutropenic precautions ANS: A

Patients have the right to make decisions about their health care. The tuberculosis patient cannot refuse to wear a mask because of the risk to many people. The other options do not apply because these are family members.

DIF: Cognitive Level: Analysis

REF: page 220

17. A nurse renewing advanced cardiac life support is practicing which ethical principle? a. Veracity b. Fidelity c. Nonmaleficence d. Beneficence ANS: C

Nonmaleficence is the principle of “do no harm.” Nurses keep current in their profession to prevent doing harm to their patients. The others do not apply.

DIF: Cognitive Level: Application

REF: page 220

18. A nurse decides to use the ethical principle of deontology to make clinical decisions. This

principle is based on treating all people the same regardless of circumstances and on one’s duty to do the right thing regardless of circumstances. Which situation would most likely cause an ethical dilemma for this nurse? a. Assisting with a laparoscopy for a tubal pregnancy b. Refusal of a patient to take his medications c. Patient reconsiders surgery for cancer d. Woman refuses to terminate her pregnancy even knowing the fetus has non–life-sustaining defects

ANS: A

Deontology is the belief of the rightness or wrongness of an act and not the consequences. The other options do not reflect a situation that would cause ethical conflict in this nurse.

DIF: Cognitive Level: Analysis

REF: page 221

19. A nurse decides to use the ethical principle of teleology to make clinical decisions. This

principle is based on the premise that actions are determined by their consequences. Which situation would most likely cause an ethical dilemma for this nurse? a. Assisting with a laparoscopy for a tubal pregnancy b. Refusal of a patient to take his medications c. Patient reconsiders surgery for cancer d. Woman refuses to terminate her pregnancy even knowing the fetus has non–life-sustaining defects ANS: D

To a teleologist, the consequences of delivering this baby would present ethical conflict in themselves because of the consequences to the child, family, and health care system. The other situations would not present a conflict for this nurse.

DIF: Cognitive Level: Analysis

REF: page 221

20. A nurse decides to use the ethical principle of utilitarianism to make clinical decisions. This

principle is based on the greatest good for the greatest number. Which situation would most likely cause an ethical dilemma for this nurse? a. Triaging a disaster scene b. Maintaining ventilatory support on a patient with six children c. Evacuation of all mobile N paUtiR enStsIdN uG rinTgBa.flC ooOdM d. Allowing a patient with influenza to return home from the clinic after diagnosis ANS: D

A patient with influenza could infect family members and cause harm. The other options would not cause conflict for this nurse.

DIF: Cognitive Level: Analysis

REF: page 221

MULTIPLE RESPONSE 1. The institutional review board (IRB) is responsible for overseeing biomedical research

involving humans. Because most studies are randomized blind studies (patients and providers are unaware of who is receiving treatment and who is receiving a placebo), the risks for harm can be great. Which measure is taken to avoid harm to the subjects during biomedical research? (Select all that apply.) a. The rights and welfare of subjects are protected. b. The benefits of the study to the patient outweigh the risks. c. The patient must agree to complete confidentiality about the study. d. Prisoners are used as subjects because they have no right to sue. e. Patients must sign informed consent forms.

ANS: A, B, E

A, B, E are an expectation of all studies that use humans as subjects to avoid ethical violations and that are monitored by the IRB. The options are not true.

DIF: Cognitive Level: Analysis

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Chapter 18: Improving Organizational Performance Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. A nurse is learning about quality improvement measures taken by the hospital. Root cause

analysis is a process for identifying the cause of an error. What is the greatest benefit to establishing the root cause? a. Prevention of future similar incidents b. Identification of the responsible person c. Allows corrective action to be taken d. Identification of cause ANS: A

The purpose of investigations of errors is to prevent incidents in the future. The options are not the greatest benefit to the process.

DIF: Cognitive Level: Application

REF: page 255

2. A nurse has administered the wrong medication to a patient. In investigating the root cause of

the error, it is discovered that the nurse was unfamiliar with the medication and that the Pyxis was incorrectly loaded with the wrong medication. What should be the outcome of this process? a. The nurse should be educated on this medication. b. Pharmacy should develop a second check of medications prior to loading in the Pyxis.

NURSINGTB.COM c. The nurse will not be allowed to pass medications without supervision until deemed safe. d. An incident report will be completed.

ANS: B

Pharmacy should establish a way to double check medications prior to loading, much like nurses triple check their medications before they are given. The other options would not accomplish the goal of prevention of future incidents.

DIF: Cognitive Level: Analysis

REF: page 255

3. A unit secretary mistakenly enters the wrong medication into the MAR when transcribing

orders. After a root cause analysis, it is determined that the cause is the illegibility of the physician’s order. Which measure should be taken to prevent future incidences? a. The physician is required to carry a typewriter with him to type the orders onto the order sheet. b. The physician must either write legibly or orders will not be transcribed. c. The unit secretary must receive more training on transcribing orders. d. Introduction of a computer entry system for all physician orders will be instituted.

ANS: D

A computer entry system eliminates most errors for all people involved. The other options do not address the root cause or prevent future errors involving other employees.

DIF: Cognitive Level: Analysis

REF: page 255

4. A sentinel event is usually one that results in an unexpected outcome for the patient and

“signals” the need for investigation and response. Which of the following would be considered a sentinel event? a. A patient with a brain tumor who falls and breaks his wrist after trying to get up by himself b. A 32-year-old woman with no significant health history who dies in the operating room during an elective surgical procedure c. A patient who self-extubates after cardiac surgery d. A patient who is given the wrong bolus of heparin that is corrected with the first prothrombin time ANS: B

The patient in option B died unexpectedly without apparent cause. Unexpected death or loss of limb or function did not occur.

DIF: Cognitive Level: Analysis

REF: page 257

5. A sentinel event is usually one that results in an unexpected outcome for the patient and

“signals” the need for investigation and response. Which of the following would be considered a sentinel event? a. A patient who requires a left leg amputation after developing an arterial occlusion at the access site b. An older adult patient who falls after trying to get up by herself c. A patient who receives two doses of amiodarone because the nurse did not chart the first one NURSINGTB.COM d. A patient whose peripheral pulses have not been checked for 2 hours after he returns from a cardiac catheterization ANS: A

The patient incurred unexpected results from the procedure and lost a limb. The other options do not qualify as a sentinel event.

DIF: Cognitive Level: Analysis

REF: page 257

6. The National Database of Nursing Quality Indicators (NDNQI) has established which of the

following goals to assist nurses to make practice changes in order to benefit patients? a. Patient satisfaction b. Employee satisfaction c. Unit-specific measures d. Medication errors ANS: C

The NDNQI tracks unit-specific measures such as fall rates. The other goals were not tracked.

DIF: Cognitive Level: Analysis

REF: page 253

7. Risk management is a hospital program organized to prevent the incidences of preventable

accidents, injuries, and errors. Which of the following situations would a hospital risk manager need to investigate?

a. b. c. d.

A patient breaks his wrist from a fall caused by a wet floor.

A patient receives a dose of subcutaneous heparin 1 hour later than scheduled.

A patient who is NPO is not given her morning medications.

A patient who is allergic to shellfish is given preprocedure medications to reduce his risk for allergic reaction to the dye being used in the procedure.

ANS: A

This is a preventable accident and injury and would be reviewed by the risk management department. The other situations do not apply for review by risk management.

DIF: Cognitive Level: Analysis

REF: page 256

8. The National Patient Safety Goals of The Joint Commission (TJC) are established goals to

reduce the risks for injuries to patients and provide a safe environment. Which practice has been instituted as a result of these goals established by TJC? a. Use of the automatic medication dispenser equipment b. Handwashing to prevent infections c. Provision of patient information to the nurse covering for breaks d. Use of two patient identifiers when providing care or treatments ANS: D

The institution of two patient identifiers is a TJC National Patient Safety Goal. The others are not listed as a TJC goal.

DIF: Cognitive Level: Application

REF: page 256

9. Hospital performance improvement standards are primarily focused on the ability of the

hospital to a. meet the goals established by the regulating bodies. b. develop an atmosphere that meets and exceeds the expectations of the customers and staff. c. be known in the community for good care. d. provide a shelter for people in a disaster.

ANS: B

The focus of performance improvement is developed around excellence for the customers and staff. Although by meeting goals established by the regulating bodies, they may establish an environment of excellence, this is not the goal. Being known in the community for good care is public relations driven. Providing a shelter for people in a disaster is not a goal for performance improvement.

DIF: Cognitive Level: Application

REF: page 250

10. What is the best method for hospitals to track patient satisfaction? a. Family buys chocolates for each shift. b. Family speaks to the charge nurse about how unhappy they are with a particular

employee. c. Family writes a letter to the unit and to the chief nurse officer to thank the staff for

providing care and compassion even though their family member died. d. Patient completes a patient survey after returning home from the hospital.

ANS: D

Although letters and chocolates are nice, performance measures are data driven and not anecdotal. The other options do not provide data.

DIF: Cognitive Level: Analysis

REF: page 251

11. Patient satisfaction surveys include questions about quality of care. What has the greatest

impact on patient satisfaction? a. Responsiveness of staff b. Getting pain medication on time c. Being allowed to go outside to smoke a cigarette d. The race and gender of the nurses ANS: A

The attitudes and caring of the staff are a huge patient satisfaction indicator. The other options may be an indicator for a small number of patients but will not influence the overall data.

DIF: Cognitive Level: Application

REF: page 251

12. When using the DMAIC acronym of the Six Sigma quality process improvement model, the

nurse understands that the D (define) refers to a. the cost of getting a new MRI machine. b. the patients and their families. c. the number of dollars in donations. d. the number of dollars spent on charity.

ANS: B

Define means to define the customer for whom improvement is directed. The other options are not the meaning of define in N DU MR AS ICI. NGTB.COM DIF: Cognitive Level: Analysis

REF: page 255

13. When using the DMAIC acronym of the Six Sigma quality process improvement model, the

nurse understands that the M (measure) refers to a. the development of a data collection plan. b. determination of the average LOS. c. determination of the average wages. d. determination of the ethnicity of admissions.

ANS: A

Data are necessary to determine process improvement. Options B, C, and D are incorrect because although they may individually be among the data collected, they do not by themselves define it.

DIF: Cognitive Level: Analysis

REF: page 255

14. When using the DMAIC acronym of the Six Sigma quality process improvement model, the

nurse understands that the I (improve) refers to a. identification of the start and stop dates. b. comparison of data to customer surveys. c. use of technology to design improvements. d. staff training.

ANS: C

Technology can allow for creativity in developing solutions. The others are processes that are incorporated in the other DMAIC approach to performance improvement.

DIF: Cognitive Level: Analysis

REF: page 255

15. “Lean culture” is a term used for the principle of eliminating waste. Which illustrates the

principle that nurses must do more with less? a. Assigning the night shift RN to restock the rooms. b. Employing a staff member to stock all patient rooms for frequently used supplies. c. Assigning all nurses to restock their rooms every day. d. Placing all frequently used supplies in a central location.

ANS: B

Providing a staff member to restock the rooms frees up the nurses to spend time caring for their patients. The others are a possible solution but having a staff member devoted to this would allow the nurse to spend time appropriately.

DIF: Cognitive Level: Application

REF: page 256

16. What area is included when risk management explores the prevention of accidents, injuries,

and errors? a. Financial risk b. Quality of care c. Employee management d. Employee promotion ANS: A

The financial risk for injuries, errors, and accidents will always be incorporated into the decision-making process. The others are not part of the risk management program.

DIF: Cognitive Level: Analysis

REF: page 256

17. Which of these is a measured outcome from a performance improvement process perspective? a. Overtime hours worked by the RNs b. Identifying the responsible person for a patient’s fall c. Sternal infection rates in cardiac surgery patients d. Method of shift report ANS: C

The number and frequency of sternal wound infections are patient outcomes. The others are not a performance improvement outcome.

DIF: Cognitive Level: Analysis

REF: page 252

18. A sentinel event is usually one that results in an unexpected outcome for the patient and

“signals” the need for investigation and response. Which of these situations would be considered a sentinel event? a. Patient dies because there is no bed available in the ICU. b. Patient receives an incorrect dose of medication. c. Patient consents to be terminally weaned. d. A patient’s family is upset with a physician’s approach.

ANS: A

The patient possibly died because appropriate care could not be delivered. The others are not a sentinel event.

DIF: Cognitive Level: Analysis

REF: page 257

MULTIPLE RESPONSE 1. The Joint Commission (TJC) tracks core measures for performance. Which core measures are

tracked by TJC? (Select all that apply.) a. Heart failure b. Ventilator days c. Scheduled sedation vacation d. Acute myocardial infarction e. Childhood asthma ANS: A, D, E

Options A, D, and E are core measures tracked by TJC. Options B and C are not one of the core measures tracked by TJC. DIF: Cognitive Level: Application

REF: page 254

2. What benchmarks might be expected to be measured for hospital performance? (Select all that

apply.) a. Average length of hospital stay for cardiac surgery b. Total admissions for cardiac surgery c. Infection rates for cardiacNsU urRgS erI y NGTB.COM d. Length of surgery e. Deaths by surgeon ANS: A, B, C

Options A, B, and C are common benchmarks measuring hospital performance. Options D and E are not organizational measures but may be measured by the individual hospital or service.

DIF: Cognitive Level: Application

REF: page 251

Chapter 19: Evidence-Based Practice Motacki: Nursing Delegation and Management of Patient Care MULTIPLE CHOICE 1. When providing care to patients, nurses use evidence-based practice whenever they a. advise patients with musculoskeletal back pain to continue normal daily activities

within limits of their pain tolerance. b. advise patients with musculoskeletal back pain to remain on bedrest until pain has

been relieved by prescribed back exercise. c. advise patients that early premature activity with musculoskeletal pain may lead to

permanent disability. d. advise patients that continued normal activity after a musculoskeletal back injury

may result in delayed return to work.

ANS: A

Research has demonstrated that with early ambulation, even patients with back pain recover more quickly without complications. Research has disproved the previous understandings about early ambulation noted in options B, C, and D. DIF: Cognitive Level: Analysis

REF: page 263

2. When providing care to postoperative patients, nurses use evidence-based practice whenever

they a. continue bedrest after surgery until the pain level is 1 on a scale of 1 to 10. b. continue bedrest after surgery until the pain level is 2 on a scale of 1 to 10.

INleGaTfter B.C M c. ambulate patients as soonNaU sR poSssib surO gery. d. ambulate patients as soon as they are awake from anesthesia.

ANS: C

Research supports the use of early ambulation in surgical patients. According to the research, ambulation is not based on pain level. Option D could possibly be an unsafe practice. The patient needs to be fully awake and responsive after anesthesia prior to attempts to ambulate.

DIF: Cognitive Level: Analysis

REF: page 263

3. When providing care to patients, nurses understand that evidence-based practice supports the

concept that a. to avoid atelectasis and pneumonia, use of an incentive spirometer has an outcome equal to coughing for a patient following surgery. b. to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery. c. to avoid atelectasis and pneumonia, use of an incentive spirometer has a worse outcome than coughing for a patient following surgery. d. neither coughing nor use of an incentive spirometer will avoid atelectasis or pneumonia in postoperative patients.

ANS: B

Research supports the use of the incentive spirometer to avoid postoperative atelectasis.

Evidence supports the use of the incentive spirometer to prevent atelectasis postoperatively.

DIF: Cognitive Level: Application

REF: page 263

4. When providing care to a child requiring temperature measurement, nurses use

evidence-based practice whenever they a. understand that a rectal temperature is the most accurate method in a child. b. understand that a rectal temperature is the least accurate method in a child. c. understand that an axillary temperature is the most accurate method in a child. d. understand that adding 1C to an axillary temperature in a child is as accurate as a rectal temperature.

ANS: A

Research demonstrates the accuracy of taking rectal temperatures in children versus the axillary mode. Research supports the use of rectal temperature as the most accurate method to use in children.

DIF: Cognitive Level: Application

REF: page 263

5. When providing care to patients at risk for ARDS, nurses use evidence-based practice

whenever they a. suction a patient at high risk for developing ARDS every 2 hours. b. suction a patient at high risk for developing ARDS whenever crackles are auscultated. c. turn a patient at risk for developing ARDS every 2 hours. d. turn a patient at risk for developing ARDS every 5 minutes.

ANS: D

Research has shown that turnN inU gR paStI ienNtG s aT tB ris.kCfoOrM developing ARDS every 5 minutes reduces that risk. There are hospital beds now designed to provide that care. There is no evidence to support options A, B, and C as measures to reduce the risk for patients to develop ARDS. DIF: Cognitive Level: Application

REF: page 263

6. When providing care to patients, nurses use evidence-based practice to avoid urinary tract

infections whenever the insertion of a urinary catheter is performed by a. a UAP. b. an RN. c. an LPN. d. a senior nursing student.

ANS: B

Research supports the use of only RNs to insert urinary catheters to avoid urinary tract infections. There is no evidence to support the use of the staff members in options A, C, and D in inserting urinary catheters to avoid urinary tract infections.

DIF: Cognitive Level: Application

REF: page 263

7. When collecting data for research purposes on patient safety methods, the nurse would use a. maximum census of patients on a specific unit over the course of admissions for 1

year.

b. maximum census of the entire hospital over the course of admissions for 1 year. c. information obtained in other, similar research projects. d. appropriate research design.

ANS: B

Reliable research results are usually supported by the study of larger samples. Option A may be too small of a sample to produce valid or reliable data. Other studies may not provide data appropriate to the specific question to be researched and the studies must be validated before they are relied on. Research design cannot be the essential factor to confirm validity.

DIF: Cognitive Level: Application

REF: page 266

8. The nurse explains the PICO acronym to colleagues in which of the following ways? a. PICO represents the questions to ask regarding application of the research to the

specific setting. b. PICO represents the trigger for initiating the research. c. PICO represents the benchmarking website used in research. d. PICO represents the regulatory guidelines established for practitioners.

ANS: A

PICO is the acronym used in formulating research questions and stands for P = patient or population, I = intervention, C = comparison or alternative intervention used, and O = outcomes. Options B, C, and D do not represent the purpose or focus of the acronym PICO. DIF: Cognitive Level: Analysis

REF: page 267

9. When making clinical practice changes, nurses should make permanent changes based on a. reviewing other unit pracN ticeR Us. SI NG TB.C OM b. reviewing case reports. c. obtaining expert opinions. d. implementing piloting changes.

ANS: D

Piloted changes should be implemented first because there are data to support them. Options A, B, and C are not supported by research.

DIF: Cognitive Level: Analysis

REF: page 268

10. When integrating evidence-based research into practice, the nurse understands that the type of

research is important to the application of a particular nursing unit. Which of the following factors is most important in determining the usefulness of the research to the needs of the practice? a. Randomized clinical trials b. Case studies c. Anecdotal information d. Single correctional studies ANS: A

Randomized trials are clinically the most reliable because of the randomization of the group studied. The other options are not a good method for establishing reliability in research.

DIF: Cognitive Level: Application

REF: page 267

11. A novice nurse observes change differences in practice from what was taught in nursing

school and expresses confusion to the nurse manager. The nurse manager suggests which of the following methods as the best resource to determine best practice in the clinical setting? a. Ask a former faculty member. b. Review the textbook used during nursing school. c. Research electronic databases such as CINAHL. d. Attend professional conferences.

ANS: D

Professional conferences usually present current research. Research electronic databases such as CINAHL will provide only current published research. Sometimes the time between the actual research and its publication may be lengthy and cause it to be irrelevant. Options A and B may not provide current research information.

DIF: Cognitive Level: Analysis

REF: page 270

12. Harm to patients from medication errors is a component to initiation of research in which of

the following ways? a. Establishing a question b. Establishing a solution c. Establishing a population sample d. Establishing a cost benefit ANS: A

Establishing the questions is a major first step to initiating research. In the case, the question is WHY? The other options are not part of the initial steps for establishing reasons for research.

DIF: Cognitive Level: Analysis

REF: page 268

13. Which responses by nurses incorporate reasons for resistance to research utilization? a. “I want to see the outcomes for the patients.” b. “I believe that patients will not benefit from this change.” c. “I’ve grown tired of doing it the same way.” d. “I’m ready for a change.”

ANS: B

Some people are resistant to change because they have a belief that it will not be beneficial to the patient or themselves. Statement A shows interest in the possible change and not resistance. Statement C shows interest in the possible change and not resistance. Statement D shows interest in the possible change and not resistance.

DIF: Cognitive Level: Analysis

REF: page 268

14. A student nurse is conducting a research project for school. Although this is a new

assignment, she understands that the quickest and most dependable source of information is the Internet. Which resources require intervention by the instructor? a. Wikipedia b. CINAHL c. MEDLINE

d. Online nursing journals ANS: A

This is not a reliable source for research purposes and would require intervention by the instructor. The other options are legitimate sources for research and do not require intervention.

DIF: Cognitive Level: Application

REF: page 266

15. A nurse involved in evaluating the validity of research prior to implementation should

consider which of the following as the most important hierarchical evidence for effectiveness? a. Opinions from experts b. Single observational studies c. Randomized controlled versus nonrandomized trials d. Systematic review study ANS: C

Randomized controlled studies are most important for determining the effectiveness of the study. The other options are less important for determining the importance of the study.

DIF: Cognitive Level: Application

REF: page 267

16. Of the steps to implementation, research is not complete until which of the following steps is

accomplished? a. Synthesizing relevant research b. Determining the sufficiency of the sample c. Instituting the change d. Monitoring the outcome ANS: D

Monitoring the outcome is the final step in determining whether to continue with the new practice. The other options are a step to implementation but is not the final step.

DIF: Cognitive Level: Application

REF: page 267

17. Which of the following would be considered a sentinel event? a. Patient who has developed a fatal mediastinal infection 7 days after cardiac

surgery b. Patient who experiences a CVA during a cardiac catheterization c. Patient who receives a double dose of a medication in error d. Wrong patient scheduled for a chest radiograph ANS: A

The unexpected death of a patient is a sentinel event and would require investigation by the appropriate hospital committee. The other options do not qualify as a sentinel event.

DIF: Cognitive Level: Analysis

REF: page 263

18. Which of the following would most likely present the most difficult step in research

utilization? a. Monitoring outcomes b. Determining the research question

c. Instituting the change d. Piloting the project ANS: C

Buy-in by the staff may be the most difficult step because people are usually very resistant to change. The others are a step in research utilization but is not the hardest to implement.

DIF: Cognitive Level: Analysis

REF: page 268

MULTIPLE RESPONSE 1. When providing care to patients, nurses make patient care decisions based on which of the

following? (Select all that apply.) a. Resource availability b. Nurse practice act c. Shared governance d. Managerial leadership style e. Tradition f. Clinical circumstances ANS: B, E, F

Options B, E, and F are components relied on in making patient care decisions in nursing.

Options A, C, and D are not part of the nurse’s decision-making process.

DIF: Cognitive Level: Application

REF: page 266

2. In determining the applicability of a research study, the nurse must look at many factors.

Which factors can be used toNdU etR erS mI inN eG apTpB ro. prC iaO teM ness of the research to the individual setting? (Select all that apply.) a. Sample size b. Credentials of authors c. Time element d. Context e. Intervention used ANS: A, D, E

Research to be used in clinical practice should have appropriate sample size. Research to be used in clinical practice should have context to current question to be researched. Research to be used in clinical practice should have appropriateness of intervention. Options B and C are not factors used to support validity or applicability.

DIF: Cognitive Level: Application

REF: page 267

3. Based on the Iowa model for evidence-based practice, research is initiated because of either

problem- or knowledge-based triggers. The nurse understands that these triggers may arise as a result of (Select all that apply.) a. staff complaints. b. an increase in surgical infection rates. c. an increase in chronic renal failure following use of dye during radiographic procedures in diabetic patients. d. medicare reimbursement changes.

e. a new nurse manager.

ANS: B, C, D

Options B, C, and D are a possible trigger of problems or knowledge that leads to research according to the Iowa model for evidence-based practice. Options A and E are usually the basis to support research.

DIF: Cognitive Level: Analysis

REF: page 268

4. After piloting changes based on evidence-based research, the nurse understands that they will

be instituted as a result of the effects on which of the following? (Select all that apply.) a. Staff b. Number of UAPs available c. Cost d. Patient e. Census ANS: A, C, D

Changes based on research will ultimately be instituted based on the effects of these factors.

Options B and E do not generally affect the institution of the research.

DIF: Cognitive Level: Application

REF: page 268

5. After piloting an evidence-based clinical practice change, the nurse would (Select all that

apply.) a. institute the change. b. pilot the project until the desired outcome is achieved. c. determine applicability foNr usRe. INGTB.COM U S d. incorporate changes into practice. e. pilot the project until consensus is achieved.

ANS: A, C, D

Following the appropriate piloting of a project, the changes should be implemented after determining applicability. Options B and E are counterproductive to legitimate research.

DIF: Cognitive Level: Application

REF: page 269

6. Maintaining currency in a profession is achieved through (Select all that apply.) a. academic inquiry. b. continuous participation in professional organizations. c. asking questions of other professionals. d. observing your role model’s practice. e. participation in evidence based projects.

ANS: A, B, E

Options A, B, and E are a method by which the professional nurse would keep current.

Options C and D are an incorrect method for maintaining professional currency because it does not ensure accuracy or currency.

DIF: Cognitive Level: Analysis

REF: page 270

7. The questions that nurse researchers should ask before beginning their study include which of

the following? (Select all that apply.) a. Why are we doing it this way? b. Where is the evidence to support this practice? c. How much will it cost to change? d. Can we as nurses lose our jobs if we implement this? e. What is a better way of doing this?

ANS: A, B, E

Questions should be asked about why we practice the way we currently do and why we should want to change that practice before beginning any research. The other questions should not be relevant to practice change.

DIF: Cognitive Level: Application

REF: page 265

Chapter 20: Monitoring Outcomes and the Use of Data for Improvement Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. What information obtained from hospital data collection can be used for patient

improvement? a. Infection rates b. Employee satisfaction c. Best practice d. Overtime costs ANS: A

Infection rates are data that provide information about patient care. Employee satisfaction provides data for staffing purposes. Best practice provides data for research purposes.

Overtime costs provide data for administrative purposes.

DIF: Cognitive Level: Application

REF: page 279

2. What information obtained from hospital data collection can be used for staffing purposes? a. Patient satisfaction b. Staff competency c. Best practice d. Use of agency nurses ANS: B

Staff competency is data thatNpU roR viS dI e iN nfGoT rmBa. tioCnOaM bout provider staffing. Patient satisfaction provides data about patient care. Best practice provides data about research. Use of agency nurses provides data for administrative purposes.

DIF: Cognitive Level: Application

REF: page 291

3. What information obtained from hospital data collection can be used for administrative

purposes? a. Unit-specific measures b. Staffing ratios c. Turnover d. Evidence-based practice ANS: C

Turnover is when a staff member leaves a position and a new staff member is hired for that position. Turnover provides data used for administrative purposes. Options A and D are not appropriate. Option B is provider staffing data.

DIF: Cognitive Level: Application

REF: page 276

4. Which hospital data collection result will most likely affect nursing practice? a. Changes in staffing patterns b. Changes in patient acuity c. Introduction of the needleless system

d. Changes to the interview process ANS: A

Staffing may be directly affected by outcomes data. Changes in patient acuity is unaffected by data collection and is incorrect. Introduction of the needleless system was an initiative from The Joint Commission. Changes to the interview process are usually not affected by data collected.

DIF: Cognitive Level: Analysis

REF: page 276

5. Data provided by studies on patients with community-acquired pneumonia (CAP) have

influenced the standards of practice for those patients. Which order should the nurse anticipate on the standard orders as a result of initiatives developed through clinical studies? a. Obtaining blood cultures within 4 hours of arrival at the hospital b. Administering antibiotics within 4 hours of arrival at the hospital c. Administration of aspirin on arrival to the hospital d. Administration of oxygen at 4 L per nasal prongs ANS: B

Administration of antibiotics, along with acting on the information obtained from the blood cultures, is the standard of care developed for patients admitted with CAP. Blood cultures need to be obtained prior to administration of antibiotics. Options C and D do not apply to CAP standards.

DIF: Cognitive Level: Application

REF: page 280

6. Core measures identified by The Joint Commission include standard orders regarding care and

data collection for a. infection rates. b. community-acquired pneumonia admission rates. c. rates of smokers admitted with acute myocardial infarction. d. rates of smokers admitted with hypertension.

ANS: A

Infection rates are required of all institutions by both federal and state health care regulating agencies. The other options are not required by TJC. DIF: Cognitive Level: Analysis

REF: page 279

7. When reviewing outcome measurement for clinical use, the reviewers must understand that

the data a. identify the improvement required. b. identify the cause of the problem. c. identify questions to be asked. d. identify the results only.

ANS: D

Outcome measurements provide results only. It is necessary for the reviewers to ask questions about what the data mean. The others are not factors answered by data collection.

DIF: Cognitive Level: Analysis

REF: page 276

8. One of the best indicators of clinical performance can be attributed to a. yearly census. b. patient satisfaction surveys. c. employee satisfaction surveys. d. staff turnover.

ANS: B

Patient satisfaction surveys are one of the best indicators of clinical performance. The others are not a measurement of clinical performance.

DIF: Cognitive Level: Application

REF: page 277

9. The best method for providing information regarding patient satisfaction surveys to the staff is

by a. b. c. d.

emailing results to all employees. making an announcement at the next staff meeting. providing results from the most current survey. providing comparison of current results with previous performance results.

ANS: D

Comparison of current results to previous results (whether good or bad) provides a visual image to which most people can relate. Options A and B are not good methods and do not allow for discussion or brainstorming. Option C does not provide a relationship to past performance.

DIF: Cognitive Level: Application

REF: page 281

anizRatioIn aG 10. Which are benefits to the orgN U S Nre TacBq.uiCredMfrom greater patient satisfaction? a. Higher employee satisfaction b. Lower acuity c. Higher employee benefits d. Fewer call lights to answer ANS: A

When there is a clinical environment that provides high patient satisfaction, it is usually a reflection of the employee attitudes. The others are not a benefit of patient satisfaction.

DIF: Cognitive Level: Application

REF: page 277

MULTIPLE RESPONSE 1. Patient satisfaction surveys may provide information on the clinical performance of the unit as

well as the institution. Which areas are included for data collection? (Select all that apply.) a. Accessibility of services b. Number of staff per shift c. Communication d. Quality of care e. Recognition of physician in community f. Continuity ANS: A, C, D, F

Patient satisfaction surveys report data on the areas in options A, C, D, and F. Options B and E are not asked on the survey.

DIF: Cognitive Level: Application

REF: page 291

2. What are the benefits to the organization from greater patient satisfaction? (Select all that

apply.) a. Improvement in quality of patient care b. Lower patient acuity c. Lower mortality rates d. Improved retention e. Establishing benchmarks against other institutions ANS: A, D, E

When quality of care improves, patient satisfaction improves and has a direct affect on staff satisfaction and thus retention. These improvements can then be used as benchmarks against other institutions. Improvement in patient satisfaction is usually a direct reflection of improved quality of care and other nursing-related issues, leading to nurse satisfaction and retention. Benchmarking against other institutions is a common method used for determining quality of care. Options B and C are not related to patient satisfaction.

DIF: Cognitive Level: Application

REF: page 291

Nursing Delegation and Management of Patient Care 2nd Edition Motacki Test Bank

Chapter 21: New Graduates: The Immediate Future: Job Interviewing, NCLEX, and Continuing Education Motacki: Nursing Delegation and Management of Patient Care, 2nd Edition MULTIPLE CHOICE 1. Which advice to the new graduate regarding their first nursing position is best? a. Go on several interviews. b. Accept a job where you currently work as a technician. c. Accept a job in the intensive care unit. d. Everything you need to know about the position will be provided at the interview.

ANS: A

Determine the right environment for your success by exploring many positions. The other options are not good advice.

DIF: Cognitive Level: Application

REF: page 300

2. In preparing for the interview, the new nurse should plan to do which of the following? a. Dress as you would for work. b. Obtain information about the institution so that you can ask informed questions. c. Remember to ask about starting salary. d. Send a thank-you letter after the interview to the manager.

ANS: B

Asking questions that show knowledge of the institution makes a good impression. Options A and C are not good ideas. OpN tioUnRDSiI sN noGt T doBn. eC prO ioM r to the interview.

DIF: Cognitive Level: Application

REF: page 299

3. A new nurse has an appointment for an interview with the nurse manager of a

medical/surgical unit. What should be an essential part of her plan for the interview? a. Inquire about shift coverage. b. Inquire as to how many new nurses are starting on that unit. c. Inquire about the length of the orientation. d. Inquire about the unit secretary’s responsibilities.

ANS: C

The length of orientation can be critical to a new nurse who has so much to learn. The other options are not necessary to inquire about.

DIF: Cognitive Level: Application

REF: page 299

4. Which is most appropriate for the new graduate when preparing for the first interview? a. Bring a list of references that was quickly put together. b. List membership as a CCRN in 1 year as a goal. c. Provide a list of weaknesses. d. List tardiness as a weakness identified in school and how it has been corrected.

ANS: D

NURSINGTB.COM

Nursing Delegation and Management of Patient Care 2nd Edition Motacki Test Bank Make a list of weaknesses and how you corrected them. All references must be asked for permission before their name is used. Option B is unrealistic. Providing a list of weaknesses does not include the strengths to balance the weaknesses.

DIF: Cognitive Level: Application

REF: page 303

5. When interviewing with the nurse recruiter, the new nurse should be prepared to ask about a. timing of evaluations. b. benefits. c. patient mix of unit. d. length of orientation.

ANS: B

The nurse recruiter or other member from Human Resources will provide information regarding benefits. The other options refer to information will be provided by someone else.

DIF: Cognitive Level: Application

REF: page 299

6. When interviewing with the nurse manager, the new nurse should be prepared to ask about a. availability of on-site banking. b. timing of evaluations. c. benefits. d. parking.

ANS: B

Nurse managers will provide answers to specific unit questions. The other inquiries should not be asked of the nurse manager.

N R INGTB.COM

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7. When following up with a thank-you letter to the nurse manager after an interview, the new

nurse should include a. interests based on information from the interview. b. questions that were forgotten at the time of the interview. c. contact numbers. d. references.

ANS: A

The thank-you letter should express special interest in the position as a result of the interview and give a time-frame in which you will call them if you have not heard from them. The other options are not appropriate to include in the thank-you letter.

DIF: Cognitive Level: Application

REF: page 304

8. During the interview, the new graduate asks the nurse manager how she can stay current as

the years pass. What resources should the manager give? a. Alumni meetings b. Joining an online nurses club c. Professional memberships d. Travel nursing ANS: C

Nursing Delegation and Management of Patient Care 2nd Edition Motacki Test Bank Professional memberships encourage sharing of information among peers. The other options are not the best method for staying current.

DIF: Cognitive Level: Application

REF: page 301

9. When eligible, the new nurse is encouraged to sit for a certification exam in their specialty

area. What is the best reason for “going this extra mile”? a. To stay current b. To provide added credentials for advancement c. To provide CEUs d. To receive monetary rewards from the facility ANS: B

Specialty certifications are impressive if applying for advancement. The other options are not the best reason for obtaining specialty certifications.

DIF: Cognitive Level: Application 10.

REF: page 298

An effective job description includes a. title, job objectives, list of duties. b. title, job opportunity, list of duties. c. job objectives, unit, competencies needed. d. job objectives, unit, list of duties.

ANS: A

Title, job objectives and list of duties are all necessary to be included in an effective job description.

N R INGTB.COM

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11. A nurse manager is legally not allowed to ask the following question: a. Race b. When you can begin c. Past work history d. University attended ANS: A

B, C, and D are all appropriate and necessary knowledge for a job interview.

Answer A is not appropriate or part of interview disclosure.

DIF: Cognitive Level: Knowledge

REF: page 301

12. A nurse manager is legally allowed to ask the following question: a. Work history b. Age c. Number and ages of children d. Religion ANS: A

All other answers are not legally allowed to be asked during an interview.

DIF: Cognitive Level: Knowledge

REF: page 301

Nursing Delegation and Management of Patient Care 2nd Edition Motacki Test Bank

13. A résumé is different from a curriculum vitae in that a. a résumé is a summary of academic and work history. b. a curriculum vitae is a summary of academic and work history. c. a résumé is usually used in academia. d. a curriculum vitae is education and skills.

ANS: A

The resume is a summation of all academic and work history and most important for the first-time job seeker. A curriculum vitae is education and skills and a more thorough representation of the individual’s career work.

DIF: Cognitive Level: Knowledge

REF: page 296

14. The credentials that will be evaluated when on initial interview are a. nursing license. b. list of references. c. permission for drug screen. d. All of the above ANS: D

License, references and permission for drug screen are necessary for employment.

DIF: Cognitive Level: Application

REF: page 299

15. The NCLEX-RN exam is designed to judge the candidate’s ability to perform at the minimal

standards for safety as an RN. When a new graduate gets the results, they understand which of the following?

NURSINGTB.COM a. Magnet Hospitals only hire those graduates who score very high on the exam. b. This is a pass-fail exam. c. Review courses were a waste of time and money. d. Waiting for months after graduation allowed for more study time.

ANS: B

This is a pass-fail exam. No scores are available. It is a test of minimal competency. Option A is incorrect because SBON do not submit a score—only pass or fail. Options C and D are incorrect because there is no evidence that this statement is true.

DIF: Cognitive Level: Analysis

REF: page 304

MULTIPLE RESPONSE 1. When talking to a nursing instructor, the student asks, “How do I find a job?” The nursing

instructor should respond in what ways? (Select all that apply.) a. “Nursing journals.” b. “Classified ads.” c. “Wait until you have graduated and then look around.” d. “Online websites.” e. “Job fairs.”

ANS: A, B, D, E

Nursing Delegation and Management of Patient Care 2nd Edition Motacki Test Bank Options A, B, D, and E are some of the ways a new nurse can find a job. Option D does not help the student find a job.

DIF: Cognitive Level: Application

REF: page 295