Leadership and Management for Nurses Core Competencies for Quality Care, 4th edition Anita Finkelman

Leadership and Management for Nurses Core Competencies for Quality Care, 4th edition by Anita Finkelman

Email: richard@qwconsultancy.com

Leadership and Management for Nurses, 4e (Finkelman) Chapter 1 Conceptual Base for Leadership and Management 1) The nurse manager asked all staff nurses to develop effective leadership competencies. How should the staff nurses interpret this request?

1. This is an unrealistic expectation, because only managers are leaders.

2. This is possible if the nurses learn about and use relevant leadership and management theories and styles.

3. In order to become leaders, the staff nurses will have to emphasize control, competition, and getting the job done.

4. Unless the staff nurses possess the traits of a natural born leader, this is an unrealistic expectation.

Answer: 2 Explanation: 1. A nurse does not need to have a formal management position with a management title to be a leader; if nurses demonstrate leadership competencies, they are considered nurse leaders.

2. In today's healthcare environment, nurses must have knowledge of relevant leadership and management theories and styles. This knowledge helps nurses emerge as leaders. Nurses are also leaders of their own nursing practices.

3. Control, competition, and getting the job done are past theories and styles that are not as useful in today's environment.

4. Leadership is a skill that can be learned.

Page Ref: 11-16 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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2) Peter Drucker's view of management stimulated the shift toward the realization of the importance of participatory organizations. Which option provides a scenario that is an example of a participatory organization?

1. The control of the organization is centralized, and decisions are made by upperlevel management.

2. Staff nurses are expected to provide support and nurturing for management's decisions.

3. The organization's approach to leadership is autocratic and bureaucratic.

4. Staff nurses provide input into planning and changes for their own unit.

Answer: 4 Explanation: 1. In participatory organizations, the control of the organization is decentralized and many decisions are made by those "on the front lines" of the organization.

2. The theory is that the staff should be nurtured to promote greater leadership competency.

3. According to Drucker, when staff participate in the core functions of management, the organization is more effective.

4. According to Drucker, when staff participate in the core functions of management such as planning and changes for their own units, the organization is more effective.

Page Ref: 12-13 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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3) Which behavior demonstrates the nurse's competency as an emotionally intelligent leader?

1. The nurse is proficient in technical skills.

2. The nurse relies on policies, not options.

3. The nurse supports team members.

4. Productivity is not a major concern.

Answer: 3 Explanation: 1. While technical skill is important for all nurses, it is not a hallmark of a competent leader.

2. Chaos theory states that solutions are not always clear and policies might not always be applied easily; other options might need to be considered.

3. In Emotional Intelligence theory, team members support each other and feel supported by the team leader.

4. This statement reflects the country club leadership style.

Page Ref: 13-14 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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4) The nurse executive of a healthcare organization wishes to prepare and develop nurse managers for several new units that the organization will open next year. What should be the primary goal for this work?

1. Focus on rewarding current staff for doing a good job with their assigned tasks by selecting them for promotion.

2. Prepare these managers so that they will focus on maintaining standards of care.

3. Prepare these managers to oversee the entire healthcare organization.

4. Prepare these managers to interact with hospital administration.

Answer: 2 Explanation: 1. This is an illustration of the "Peter Principle," which is promoting people to management positions just because they are doing a good job in their current position. Management level employees should be selected based upon the potential ability to manage and their desire to do so.

2. Nurse managers are directly responsible for maintaining standards of care, and managing fiscal resources and development of staff.

3. This is not the responsibility of most nurse managers. In this question, it is clear that managers of nursing units are being prepared and developed.

4. Interacting with hospital administration is a rare requirement for a unit nurse manager and, if it is required, it is not as important as maintaining standards of care.

Page Ref: 23 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

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5) Describe the primary focus of a manager in a knowledge-work environment.

1. Developing the most effective teams 2. Taking risks 3. Routine work 4. Understanding the history of the organization Answer: 1 Explanation: 1. The most important focus of this manager is on developing and supporting effective teams, utilizing the knowledge of many.

2. Risk taking is a part of knowledge work, but is not the most important of this manager's tasks.

3. Knowledge work is a combination of routine and nonroutine work, so the manager will have focus on the routine. This is not the manager's most important focus.

4. Understanding the history of the organization is important as it will help the manager work within the organization, but it is not the most important focus.

Page Ref: 15 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership. L O 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

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6) The nursing staff communicates that the new manager has a focus on the "bottom line," and little concern for the quality of care. What is likely true of this nurse manager?

1. The manager is looking at the total care picture.

2. The manager is communicating the importance of a caring environment.

3. The manager understands the organization's values and how they mesh with the manager's values.

4. The manager is unwilling to listen to staff concerns unless they have an impact on costs.

Answer: 4 Explanation: 1. This action would enable the manager to make a decision and not just evaluate the financial status of the environment.

2. If the manager is indeed focusing only on the "bottom line," the manager is not promoting a caring environment on the unit.

3. The organization may set great value on the "bottom line," but also must be concerned about quality of care. Problems with quality of care can impact the "bottom line." If the manager believes the financial status of the organization is the only organization value, a misunderstanding has probably occurred.

4. This manager has primary focus on the financial issues associated with provision of care. This will make the manager ineffective in the role.

Page Ref: 22-23 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

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7) A very young nurse has been promoted to nurse manager of an inpatient surgical unit. The nurse is concerned that older nurses may not respect the manager's authority because of the age difference. How can this nurse manager best exercise authority?

1. Use critical thinking to solve problems on the unit.

2. Give assignments clearly, taking staff expertise into consideration.

3. Understand complex healthcare environments.

4. Maintain an autocratic approach to influence results.

Answer: 2 Explanation: 1. Critical thinking is important for every R N, not just a manager, and will not diminish the manager's authority.

2. Giving clear assignments is a characteristic of authority. The young nurse who takes staff expertise into consideration when making assignments is likely to be more successful in leading the group.

3. Nurse managers work in complex healthcare environments, but must create an appropriate organizational environment as a way of exercising authority.

4. In autocratic leadership, one person has all of the power. This is not a good approach for a younger leader to adopt when working with a group of older, more experienced nurses.

Page Ref: 24, 27 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers.

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8) What statement, made in the morning shift report, would help an effective manager develop trust on the nursing unit?

1. "I know I told you that you could have the weekend off, but I really need you to work."

2. "The others work many extra shifts, why can't you?"

3. "I'm sorry, but I do not have a nurse to spare today to help on your unit. I cannot make a change now, but we should talk further about schedules and needs."

4. "I can't believe you need help with such a simple task. Didn't you learn that in school?"

Answer: 3 Explanation: 1. To develop trust, managers who make promises to staff must keep the promise.

2. This statement implies that the staff nurse is not a team player. It also sets up one nurse against the remainder of the staff. Effective managers must be fair and supportive with all staff.

3. This manager is standing up for staff by not allowing another unit to take a nurse today.

4. This statement is belittling to the staff nurse. This attitude does not demonstrate trust that staff performances will be effective.

Page Ref: 17, 18, 27 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

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9) The nurse has just been promoted to unit manager. Which advice, offered by a senior unit manager, will help this nurse become inspirational and motivational in this new role?

1. "If you make a mistake with your staff, admit it, apologize, and correct the error if possible."

2. "Don't be too soft on the staff. If they make a mistake, be certain to reprimand them immediately."

3. "Give your best nurses extra attention and rewards for their help."

4. "Never get into a disagreement with a staff member."

Answer: 1 Explanation: 1. Managers need to be honest and forthcoming with staff, which includes taking responsibility for one's own actions and errors. This also provides a positive role model for the staff.

2. When errors occur, the manager should use the opportunity for improvement, not punishment.

3. When staff feel some staff are given extra credit, they will feel uncomfortable with the manager and resentment will build.

4. Staff need to feel that they can share their feedback, positive or negative, and not feel threatened when they disagree with the manager.

Page Ref: 24-27 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers.

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10) A key skill in today's healthcare environment is the ability to collaborate with others.

A nurse identifies need to improve in this area. Which skills or traits would be essential for an effective nurse manager to develop to improve collaboration with others? Select all that apply.

1. Flexibility 2. The ability to share information and ideas 3. A service orientation 4. A desire to work hard 5. The ability to listen to others Answer: 1, 2, 5 Explanation: 1. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise.

2. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise.

3. While a service orientation is common among nurses, it is not an essential trait for collaboration.

4. This is not an essential skill for ability to collaborate.

5. In order to collaborate effectively, the nurse must be flexible, must be willing to listen to others and include them in his or her work, and must work together toward the best solution to any problems that might arise.

Page Ref: 9-10 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership.

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11) The new chief operating officer (C OO) of the healthcare facility states, "I believe that Fiedler had it right in his Contingency Theory." The nurse executive understands that this COO will work to create which type of environment in the facility? Select all that apply.

1. Positive relationships between leaders and employees 2. A low amount of structure in task assignments 3. A decentralization of power from the leadership to the employees 4. A static approach to leadership matters 5. Leadership must change as the situation changes Answer: 1, 5 Explanation: 1. Fiedler believed that the best type of situation occurs when there are positive leader-member relations.

2. Fiedler believed that high task structure resulted in the best situations.

3. Fielder believed that high position power resulted in the best situations.

4. This is not a static approach to leadership, but rather a situational approach.

5. In this theory, as the groups and situations change, leadership also changes.

Page Ref: 11, 12, 13 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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12) The nurse wishes to improve personal emotional intelligence (E I) in hopes of a promotion to nurse manager. Which skills are important for this nurse to improve?

Select all that apply.

1. Self-confidence 2. Knowledge base of nursing 3. Proficiency in technical skills 4. Empathy 5. Ability to initiate change Answer: 1, 4, 5 Explanation: 1. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.

2. While this is an important aspect of professional nursing, it is not a competency of EI. 3. While this is an important aspect of professional nursing, it is not a competency of EI. 4. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.

5. EI competencies are self-confidence, empathy, change catalyst, and visionary leadership.

Page Ref: 13, 14 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment | Management of Care Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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13) The nurse executive wishes to be a transformational leader. What should this nurse focus on to become effective in this role? Select all that apply.

1. Improving interpersonal skills 2. Advancing personal formal education 3. Identifying mentors 4. Becoming an expert clinician 5. Creating a vision for the future of nursing in the facility Answer: 1, 5 Explanation: 1. Transformational leadership requires interpersonal skills and having a vision for the future.

2. While formal education might increase the nurse's knowledge base for decision making, it is not a requirement for transformational leadership.

3. Having a mentor is not a requirement of transformational leadership.

4. This does not guarantee that the nurse will be a transformational leader.

5. Transformational leadership requires interpersonal skills and having a vision for the future.

Page Ref: 17, 18, 19 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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14) Compare and contrast manager roles and leadership roles by choosing the options that are more aligned with the manager role. Select all that apply.

1. Focus is change 2. Have the ability to influence others 3. Control the environment 4. Focus is on people 5. Focus on efficiency Answer: 3, 5 Explanation: 1. The manager accepts the status quo, while the leader challenges it.

2. The manager controls people, while the leader influences others.

3. The manager controls the environment, patient care, and the staff that deliver that care.

4. The leader focuses on people, while the manager focuses on systems and structure.

5. Managers focus on efficiency, while leaders focus on effectiveness.

Page Ref: 22, 23 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

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15) Which scenarios are examples of issues facing nursing in an age of healthcare change? Select all that apply.

1. Six of the 18 nurses working on a unit speak English as their second language.

2. The hospital has decreased medication errors dramatically in each of the last two quarters.

3. The unit manager has been asked to use a creative strategy for scheduling with fewer staff.

4. There was a report on the nightly news about recruitment and retention of nurses.

5. An Emergency Room nurse was injured by a patient seeking drugs.

Answer: 1, 3, 4, 5 Explanation: 1. An issue is the need for nurses to work as a team, despite differences in age, language, and culture.

2. There is a need to develop a culture of safety, which this hospital is doing already.

3. An issue is the need to be creative in doing more with less.

4. An issue is the increasing press coverage of recruitment and retention of nurses.

5. An issue is the increase in workplace violence.

Page Ref: 9, 10 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership.

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16) Typically, the nurse manager of a unit uses a participatory style of leadership.

Today, a patient suffered a cardiac arrest. The manager took over the patient's care, issuing orders, and expecting staff to obey them immediately. Which type of leadership did this manager exhibit today? Select all that apply.

1. Bureaucratic 2. Autocratic 3. Permissive 4. Directive 5. Authoritarian Answer: 2, 4, 5 Explanation: 1. This style is focused on organizational rules and policies.

2. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

3. This is a "hands-off" approach.

4. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

5. Autocratic, directive, and authoritarian are all terms used to describe leadership in which the leader makes the decisions for the group, issues direct orders, and expects staff to immediately obey. This is an appropriate leadership style in emergencies such as a cardiac arrest.

Page Ref: 11, 12 Cognitive Level: Applying Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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17) There have been several patient complaints that the staff members of the unit are disorganized and that "no one seems to know what to do or when to do it." The staff members concur that they don't have a real sense of direction and guidance from their leader. Which type of leadership is this unit experiencing?

1. Autocratic 2. Bureaucratic 3. Laissez-faire 4. Authoritarian Answer: 3 Explanation: 1. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur.

2. Bureaucratic leaders depend upon policy and rules. This is not always a good style of leadership, but it is unlikely the complaints in this scenario would occur.

3. This style of leadership can be so detached that there is no direction or real leadership. This will often be reflected in the work of the staff and the perceptions of the patients.

4. Autocratic and authoritarian leaders make decisions for the group and assume people are incapable of making independent decisions. While this is not always a good leadership style, it is unlikely the complaints in this scenario would occur.

Page Ref: 11, 12 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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18) Compare and contrast transformational leaders and bureaucratic leaders by choosing the options that are examples of transformational leadership. Select all that apply.

1. The leader focuses on organizational functions and the structure to get work done.

2. The most common type of leader in today's healthcare arena.

3. This leader follows the leadership style that is recommended by the Institute of Medicine.

4. The leader allows the staff to take risks to improve care within the organization.

5. The leader seeks to guide staff in their understanding of their importance to the work of the facility.

Answer: 2, 3, 4, 5 Explanation: 1. This is a characteristic of a bureaucratic organization and leadership–stick to the structure and identified functions.

2. This is the transformational leader.

3. The IOM recommended transformational leadership in its report Leadership by Example (2003).

4. This is a quality of transformational leadership.

5. This is a quality of transformational leadership.

Page Ref: 11-12, 17-19 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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19) Select the reason that transformational leadership sometimes fails in an organization.

1. The need to change is addressed urgently.

2. The coalition guiding the facility is too diverse.

3. Influence, power, and empowerment are all used.

4. Poor recognition of organizational culture and does not value staff.

Answer: 4 Explanation: 1. Failure often results from a lack of urgency.

2. Failure often results from a lack of a guiding diverse coalition.

3. Failure often results from not applying influence, power, or empowerment.

4. This is a reason for failure of transformational leadership.

Page Ref: 17-19 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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20) The rural hospital has experienced a very small patient census over the last two months. Salary costs for this period have been over budget, and the nurse manager announces that all nurses will be required to rotate taking unpaid furlough days until the census improves. Which type of leadership does this manager exemplify?

1. Impoverished leadership 2. Country club leadership 3. Authority-obedience leadership 4. Team leadership Answer: 3 Explanation: 1. This style of leadership has limited interest in production or people.

2. This type of leader has an interest in people, but productivity is not a major focus.

3. This type of leadership focuses on efficiency and getting the job done and is not as concerned with staff members as people, but in this case this most likely is the only approach that the nurse manager can take.

4. This type of leader is very concerned about productivity and about staff morale and satisfaction.

Page Ref: 13 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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21) Choose the option that best describes knowledge management theory.

1. Leaders are intelligent.

2. Focus is on routine work.

3. The knowledge worker is critical as an organization asset.

4. Evidence-based practice is the core.

Answer: 3 Explanation: 1. Knowledge is more important than intelligence.

2. Focus is on routine and nonroutine work.

3. Knowledge management sees the knowledge worker such as nurses as critical assets to success.

4. Evidence-based practice is important, but so are other concerns such as quality.

Page Ref: 15 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

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22) The staff nurse is considered to be a leader by nursing peers on the unit. What characteristics does this nurse likely possess? Select all that apply.

1. Awareness of happenings throughout the hospital 2. Ability to encourage newly hired nurses 3. Skepticism about using technology for standard nursing tasks 4. Adaptability 5. Collaboration skills Answer: 1, 2, 4, 5 Explanation: 1. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

2. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

3. An important aspect of being a leader is being able to see the benefits of technology.

4. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

5. The staff nurse can also be a leader. The same aspects of leadership and characteristics of a person holding a leadership position are important for leaders at the staff nurse level.

Page Ref: 21-23 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

22 .

23) The AONE identifies important principles for nurse managers and executives. Which statements represent these principles? Select all that apply.

1. Relationships are important.

2. The core of nursing is caring.

3. Knowledge is synthesized.

4. Care is patient- and family-centered.

5. Nurse managers are the same as nurse leaders.

Answer: 1, 3, 4 Explanation: 1. This is an AONE principle.

2. The core of nursing is caring and knowledge.

3. This is an AONE principle.

4. This is an AONE principle 5. This is not an A ONE principle–not all managers are leaders.

Page Ref: 21, Appendices A and B Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

23 .

24) Which strategy supports a professional practice environment? Select all that apply.

1. Provide an effective staff education program.

2. Promote leadership advancement.

3. Attract nurses to leadership positions by increasing salaries.

4. Engage nurses in decision making.

5. Nursing philosophy focus is on collaboration.

Answer: 1, 2, 4 Explanation: 1. Education is necessary to support a professional practice environment.

2. Leadership is recognized in a professional practice environment.

3. Leadership opportunity is greater than salaries.

4. This is part of the perspective of professional practice environment.

5. Collaboration should be part of the philosophy, but should also include quality and safety, and collaboration should be interprofessional.

Page Ref: 25 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze critical aspects of the preparation and development of nurse leaders and managers.

24 .

25) Keeping Patients Safe and The Future of Nursing reports both address important nursing issues related to leadership and management. What aspect of healthcare delivery do they both emphasize in relationship to nurses?

1. Nursing image is an important aspect of the profession and its success.

2. Nurses should be leaders in quality improvement, but are not fully prepared for this leadership.

3. Nursing leadership is focused on formal management positions in healthcare organizations.

4. Nursing scope of practice is important and needs to be broadened.

Answer: 2 Explanation: 1. Nursing image is not a strong focus in both reports.

2. Both reports recognize need for nurses to be leaders in quality improvement, but there is need for more preparation in quality improvement and leadership.

3. Nurses are leaders in many positions, not only in management, and this is not addressed in both reports.

4. The Future of Nursing report comments on scope of practice, but not Keeping Patients Safe.

Page Ref: 5-9 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine The Future of Nursing report, its relevance to nursing leadership and its outcomes.

25 .

26) Porter-O'Grady, a nursing leader, comments on a critical concern for nursing, as noted in this chapter. What is this concern?

1. Need to increase the number of advanced practice registered nurses 2. Need for more nursing publications 3. Need to engage and embrace change 4. Need for more nursing research Answer: 3 Explanation: 1. This is important, but not what Porter-O'Grady comments on.

2. This is important, but not what Porter-O'Grady comments on.

3. This is what Porter-O'Grady thinks the nursing profession must do to succeed in the changing healthcare environment.

4. This is important, but not what Porter-O'Grady comments on.

Page Ref: 10 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Interpret the implications of change in the healthcare delivery system on nursing leadership.

26 .

27) Which modern leadership theory focuses on changes within the organization and external to the organization?

1. Contingency 2. Connective 3. Leadership 2.0 4. Deming's theory Answer: 1 Explanation: 1. This describes contingency theory.

2. This theory focuses on caring and collaboration.

3. This theory focuses on the integration of multiple theories.

4. This theory focuses on teams/groups.

Page Ref: 11-13 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Analyze the key modern leadership theories compared to older theories, and understand their implications for nursing leadership, management, and transformational leadership.

27 .

28) A nurse manager is preparing performance appraisal evaluations. Which management function is the manager demonstrating?

1. Planning 2. Organizing 3. Leading 4. Controlling Answer: 4 Explanation: 1. This is not planning. If the manager took the information from performance appraisals and made a staff education plan, it would be planning.

2. This is not organizing, but if the manager was deciding how she would do her performance appraisals and in what order, this would be organizing.

3. The focus is not on the function of leading–though some aspects of leading are found in all of the other three management functions.

4. This function is controlling, as the manager is ensuring quality and meeting standards.

Page Ref: 22-23 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast characteristics, roles, and responsibilities of leaders and managers.

28 .

29) Which of The Future of Nursing report recommendations will have an impact on nursing leadership?

1. Associate degree nursing programs should increase by 20%.

2. Nurses who provide direct care are critical and provide leadership.

3. The rate of completion of the doctoral degree is at a high level.

4. There should be an increase of 80% in BSN graduates.

Answer: 4 Explanation: 1. This is not a report recommendation.

2. This is not a report recommendation.

3. This is not a report recommendation.

4. This is a report recommendation and is designed to increase nursing leadership by recognizing the need for the BSN as the entry-level degree for nursing.

Page Ref: 8 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine The Future of Nursing report, its relevance to nursing leadership and its outcomes.

29 .

30) The Future of Nursing progress report indicates which of the following has occurred?

Select all that apply.

1. Number of Magnet hospitals is increasing.

2. Enrollment in P hD programs continues to decline.

3. Majority of states have granted nurse practitioners full practice and prescriptive authority.

4. The recommendation to increase B SN graduates to 80% has been met.

Answer: 1, 2 Explanation: 1. Magnet hospitals are increasing, adding 30 more in 2017.

2. There are now more nurses enrolling in DNP programs than P hD programs.

3. Authority for nurse practitioners is increasing but not for the majority of states.

4. As of 2018, the recommendation to increase B SN graduates to 80% by 2020 has not been met and the percentage of B SN graduates has to increase to meet the 2020 deadline.

Page Ref: 8-9 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine The Future of Nursing report, its relevance to nursing leadership and its outcomes.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 2 Healthcare Policy, Legal Issues, and Ethics in Healthcare Delivery 1) Which option represents a situation exemplifying the need for nurses to become involved in healthcare policy development? Select all that apply.

1. The nurse omitted documentation of a surgical dressing change.

2. The nurse must have a nursing license and be certified as A PRN to prescribe medications.

3. The nurse administered oral medications to the patient in the home.

4. The nurse discussed do-not-resuscitate decisions with the patient and the family.

Answer: 2, 4 Explanation: 1. This scenario represents a violation of standards and a potential malpractice issue, not an issue of healthcare policy.

2. Changes in legislation and regulation (which might be influenced by nurses involved in healthcare planning) affect nursing practice.

3. This scenario is unlikely to be altered by changes in legislation or regulation.

4. This scenario might be altered by changes in legislation or regulation.

Page Ref: 42-44 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

1 .

2) Which strategy could the nurse use to avoid disparity in healthcare delivery?

1. Recognize the cultural issue related to patient care.

2. Request more health plan options.

3. Care for more patients even if quality suffers.

4. Campaign for fixed nurse-patient ratios.

Answer: 1 Explanation: 1. Disparities often occur because the healthcare professional does not recognize cultural differences or has a cultural bias.

2. This is a consumer demand related to insurance. The nurse has little effect on this issue.

3. This is an unacceptable strategy to nursing.

4. This scenario is unlikely to have impact on health disparities.

Page Ref: 46 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

2 .

3) Which option best illustrates a positive outcome from managed care?

1. Reshaped current policy 2. Consumer involvement in the healthcare political process 3. Increase in quality care with reduced cost 4. Managed care is now the method used for reimbursement.

Answer: 2 Explanation: 1. This is not an outcome of managed care, but rather a part of the political process regarding legislation.

2. Managed care resulted in many consumers speaking out against managed care, and this led to more developed healthcare consumerism.

3. Quality is still a problem and costs have not been reduced due to managed care.

4. Managed care is not as strong as it was in the past.

Page Ref: 48 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

3 .

4) The nursing assistant left a side rail down upon exiting the room of a patient who had just returned from the recovery room postoperatively. What does this scenario most closely illustrate?

1. Personal injury 2. Criminal intent 3. Malpractice 4. Negligence Answer: 4 Explanation 1. It is not yet clear that any personal injury has occurred.

2. There is no indication that this nursing assistant had any criminal intent when leaving the side rail down.

3. Malpractice is the failure of a professional person to act in accordance with the prevailing professional standards or failure to foresee consequences that a professional person, having the necessary skill and education, should foresee.

4. Negligence is the failure to act as an ordinary prudent person would under similar circumstances, and is based upon that person's education and training.

Page Ref: 63 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

4 .

5) The risk manager is reviewing these events that occurred over the weekend. Which scenario should the risk manager be most concerned would represent malpractice?

1. The nurse did not obtain an apical pulse on a patient prior to administering digoxin 0.25 mg orally.

2. The nurse did not raise the bed when changing the linens for a patient who was up in the chair.

3. A nurse did not obtain consent before drawing blood.

4. The nurse continued to assess the diabetic patient's blood sugar before each meal.

Answer: 1 Explanation: 1. This action is not in accordance with professional standards in assessing an apical pulse prior to administering digoxin.

2. This action is more likely to harm the nurse than it is to harm the patient.

3. This is more likely to be seen as battery than as malpractice.

4. This is an appropriate action expected from a professional nurse.

Page Ref: 63-64 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

5 .

6) Which scenario is an example of informed consent?

1. The nurse omits diabetic education for a patient who has had diabetes for 10 years.

2. The nurse applies restraints to a patient who is trying to remove the nasogastric tube.

3. The patient understands the surgical procedure that will occur in the morning.

4. The patient asks the nurse for pain medication.

Answer: 3 Explanation: 1. This was a negligent action on the part of the nurse.

2. This could be construed as assault and battery.

3. This patient is able to make an informed decision about healthcare.

4. This is a routine nursing intervention and when the nurse brings the medication consent is implied.

Page Ref: 64-65 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

6 .

7) On admission, the patient states, "My son can make healthcare decisions for me if it is necessary." What does this statement imply?

1. The patient has a living will.

2. The son has durable power of attorney.

3. This patient has violated the Patient Self-Determination Act. 4. The patient requests do-not-resuscitate status.

Answer: 2 Explanation: 1. In a living will, there is no person appointed to make decisions. The living will is a statement of the patient's wishes in writing.

2. The son is a competent person who has been designated to make healthcare decisions for his parent. This is a durable power of attorney.

3. This act requires that all healthcare providers ask patients about living wills and durable powers of attorney. There is no indication that there is any violation.

4. There is no indication that this is true.

Page Ref: 65 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

7 .

8) Which situation illustrates the ethical concept of autonomy?

1. The patient is instructed on the technique of insulin administration.

2. The patient is asked to choose from which arm to have blood drawn.

3. The patient's information can be used for research purposes.

4. The patient is informed of privacy rights.

Answer: 2 Explanation: 1. This is provision of patient education.

2. Autonomy means that the patient has the right to make decisions about healthcare.

3. This concerns the matter of patient privacy.

4. This concerns the matter of patient privacy, not autonomy.

Page Ref: 69 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

8 .

9) Which nursing action best illustrates the ethical concept of beneficence?

1. Providing a walker for a patient prior to ambulating in the hall 2. Allowing the patient to choose what time to have a shower 3. Asking the patient about the existence of a living will or durable power of attorney 4. Continually communicating with the patient regarding procedures Answer: 1 Explanation: 1. This is the principle of doing good, inflicting no harm.

2. This is an example of patient autonomy.

3. This is required by the Patient Self-Determination Act. 4. This illustrates informed consent.

Page Ref: 69 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

9 .

10) Which action, taken by the nurse, best illustrates the ethical concept of justice?

1. The nurse witnesses consent prior to a surgical procedure for a patient.

2. The nurse advises the patient to take slow, deep breaths to try to relax before a urinary catheter is inserted.

3. The nurse provides discharge teaching to a postoperative patient and spends time with a patient who is depressed.

4. The nurse works with a physician to solve a patient problem.

Answer: 3 Explanation: 1. This is a standard role of the nurse and is associated with the legality of informed consent.

2. This illustrates the principle of beneficence.

3. This is an example of justice because the nurse is providing fair treatment and giving time to both patients.

4. This is an example of collaboration in healthcare.

Page Ref: 69 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

10 .

11) Which nursing action is the best example of the ethical principle of veracity?

1. Supporting the patient's right to refuse any part of planned nursing care 2. Informing the patient that the pain medication to be given is not the same as what was administered the previous day 3. Maintaining the privacy of the patient's personal medical information 4. Supporting the patient when ambulating and instructing the patient on the use of a walker Answer: 2 Explanation: 1. This is an example of autonomy.

2. Veracity is truth telling, which is essential for effective communication and trust.

3. This illustrates confidentiality.

4. This illustrates beneficence or "do no harm."

Page Ref: 69 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

11 .

12) Why does the process of developing public health policy seem familiar to most nurses?

1. It is very similar to the nursing process.

2. It is taught in all nursing schools.

3. It is emphasized on NCLEX-RN. 4. It reflects common sense.

Answer: 1 Explanation: 1. The process whereby public health policy is developed closely replicates the nursing process.

2. This process is not taught in all schools.

3. This process is not emphasized on N CLEX-RN. 4. While much of the process does reflect common sense, the best answer is that it is similar to the nursing process.

Page Ref: 52-53 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

12 .

13) Which statements correctly apply to the process of developing public policy? Select all that apply.

1. The two types of public policy are regulatory and allocative.

2. Since public policy supports the general population, decisions regarding policy are typically straightforward and easy to make.

3. Often, in order to pass a policy, deals have to be made.

4. Public policy may benefit some at the expense of others.

5. By law, political influence is separate from policy development.

Answer: 1, 3, 4 Explanation: 1. These are the two types of public policy.

2. It is difficult to develop public policy because there are often conflicts that must be considered. It is also impossible to meet the needs of all people.

3. Deals and compromises are a part of developing public policy.

4. Allocative policies provide benefits for some at the expense of others to ensure that certain public objectives are met.

5. Politics is deeply involved in developing public policy.

Page Ref: 48-49 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

13 .

14) Evaluate the following: The patient is labeled as a "complainer," and has not been informed of the treatment plan. The patient has no insurance, and the nursing staff is discussing the situation in the hallway. Choose the principles that have been violated. Select all that apply.

1. Justice 2. Confidentiality 3. Veracity 4. Autonomy 5. Beneficence Answer: 2, 3, 4 Explanation: 1. There is nothing that indicates that justice is not being done for this patient. The patient is in the hospital for care.

2. The discussion in the hallway is not keeping the patient's medical information private.

3. The patient has not been informed of the treatment plan.

4. The patient has not been given information to make decisions regarding care.

5. There is nothing that indicates that harm has come to this patient yet.

Page Ref: 69 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

14 .

15) What is different about today's healthcare environment that makes it crucial that nurses are involved in the development of healthcare policy? Select all that apply.

1. The focus of this new environment is on one-to-one nursing care.

2. There has been a shift from curing patients to prevention of illness.

3. Care must be cost-effective.

4. There is a need to reinvent nursing's professional culture.

5. High-quality care will again be provided primarily in acute care settings.

Answer: 2, 3, 4 Explanation: 1. The focus is on care of populations.

2. Prevention is now becoming the focus of much of healthcare.

3. Cost-effectiveness is a primary issue in healthcare.

4. Nursing must reinvent its culture in light of the new healthcare environment.

5. There is a call for high-quality care in all types of settings and by all providers.

Page Ref: 43-48 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

15 .

16) What was the American Nurses Association's stance on the healthcare reform plan supported by the Obama administration? Select all that apply.

1. This law is a significant victory for patients.

2. The debate over healthcare reform is finally over.

3. There is need to help nurses understand the significance of this law.

4. Access to primary care will be more difficult for most Americans.

5. There will be greater protection against being denied health insurance.

Answer: 1, 3, 5 Explanation: 1. "The ANA strongly believes that this law is a significant victory for the patients we serve."

2. "…we recognize that the debate over reform is not over."

3. "We are committed to helping nurses and the public understand how this change affects their lives."

4. "…they'll have better access to primary care."

5. "They'll have greater protection against losing or being denied health insurance coverage..."

Page Ref: 62 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

16 .

17) A staff nurse in a small, rural hospital is concerned about the future of healthcare in the rural environment. How can this nurse be involved in healthcare policy development? Select all that apply.

1. Join local and national nursing organizations.

2. Contact elected representatives regarding nursing and healthcare.

3. Act as a patient advocate.

4. Use the internet to keep current on healthcare policy issues.

5. Serve on the Infection Control committee of the local hospital.

Answer: 1, 2, 3, 4 Explanation: 1. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development.

2. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development.

3. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development.

4. Joining nursing organizations, contacting legislators, acting as a patient advocate, and using the internet are all ways the nurse can be involved in healthcare policy development.

5. While this is considered service to the institution, it is not as likely to impact healthcare policy on a state or national level.

Page Ref: 50-52 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

17 .

18) A patient is angry about the nursing care delivered on the past two shifts and demands to see his medical record. What should the nurse consider prior to granting this request?

1. The patient always has the right to view his medical record.

2. In some cases, the patient does not have the right to view his medical record.

3. The patient does not have the right to view his medical record.

4. The patient must have permission from the physician prior to viewing the medical record.

Answer: 2 Explanation: 1. This is not true in every case.

2. In most cases, the patient does have the right to view the medical record, but there are some exceptions to this rule. The nurse should review the policy and procedure manual for these exceptions.

3. In most cases, the patient does have this right.

4. There is no requirement for approval of the physician.

Page Ref: 67 Cognitive Level: Applying Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

18 .

19) The nurse closely follows hospital policy for recording patient charges. After attending a conference breakout session on reimbursement, the nurse realizes that the hospital policy is in violation of Medicare rules. Is this nurse guilty of fraud?

1. Yes, but since the nurse was following hospital policy no charges can be filed.

2. Yes, this is a clear example of fraud.

3. No, but the hospital is clearly guilty of fraud.

4. No, fraud requires intention to do wrong.

Answer: 4 Explanation: 1. Fraud requires intent.

2. Fraud requires intent.

3. It would have to be proved that the hospital intended to violate this policy.

4. In order to be guilty of fraud, the nurse would have to have intention of doing wrong. That is not present in this case.

Page Ref: 73-74 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

19 .

20) Which question, asked of a patient, reflects the observance of the Patient SelfDetermination Act of 1990?

1. Have you recently changed physicians?

2. Why did you come to the hospital today?

3. Do you have a durable power of attorney?

4. Would you sign this release of information form?

Answer: 3 Explanation: 1. This is an assessment question, but has no relationship to the Patient SelfDetermination Act. 2. This is an assessment question, but has no relationship to the Patient SelfDetermination Act. 3. As a result of this act, healthcare providers are required to ask about living wills and durable powers of attorney.

4. This question reflects patient privacy concerns.

Page Ref: 64 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

20 .

21) The nurse is considering "blowing the whistle" on a potential Medicare fraud situation occurring in a physician's office. The nurse has worked at this office for 12 years and has many friends among the staff and patients. What incentive does this nurse have for assuming the whistle-blower role?

1. The nurse is entitled to a percentage of any money recovered.

2. After the nurse exposes the potential fraud, the nurse's responsibility in the case is complete.

3. By law, the nurse can be subject to no negative actions related to whistleblowing.

4. The nurse can "leak" the information to a news source first and still be protected by whistle-blowing laws.

Answer: 1 Explanation: 1. The nurse will be entitled to a percentage of any money recovered as a result of this disclosure.

2. The nurse will have to testify.

3. While there is a law against overt punishment for disclosure, covert punishment may still exist.

4. The information must come from the nurse, not from a secondary source.

Page Ref: 75 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

21 .

22) The nurse has been invited to join the healthcare facility's interprofessional ethics committee. What factors should the nurse consider when making a decision about this invitation? Select all that apply.

1. The decisions made by these committees are advisory in nature.

2. Most of the cases discussed by these committees are related to financial considerations.

3. Nurses are generally active members in these committees and talk freely about ethical issues in nursing.

4. It might be best for the nurse to gain experience on a nursing ethics committee before joining an interprofessional committee.

5. The nurse can expect to be well compensated for work done on the committee.

Answer: 1, 4 Explanation: 1. These are advisory bodies.

2. Although financial considerations are becoming more frequent, the primary topics considered are patient care issues.

3. Nurses are often hesitant to discuss the ethical issues in nursing.

4. If the nurse has no experience in working on ethics committees, the experience may be uncomfortable and the nurse may not be a viable member of the committee.

5. These committees are generally seen as service to the facility with little or no additional compensation offered.

Page Ref: 78 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Explain the impact of ethics on decision making in management and practice.

22 .

23) Consumer advocacy is more common today in healthcare policy. What are the common concerns that consumers have? Select all that apply.

1. Increasing costs of care 2. Impersonal care 3. Decreased communication 4. Provider competence 5. Decreasing quality of care Answer: 1, 2, 3, 4, 5 Explanation: 1. This is a consumer concern.

2. This is a consumer concern.

3. This is a consumer concern.

4. This is a consumer concern.

5. This is a consumer concern.

Page Ref: 43 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

23 .

24) Identify strategies that will help the nurse prevent malpractice lawsuits. Select all that apply.

1. Effective communication 2. Establishing security rules 3. Effective leadership 4. Caring attitude 5. Following the rules Answer: 1, 3, 4 Explanation: 1. This is true of effective communication with other healthcare providers, as well as with staff and patients. Clear communication is essential to understanding.

2. This has little to do with malpractice.

3. Effective leaders have a good understanding of legal and ethical principles that guide healthcare.

4. When patients and people on the healthcare team believe that the nurse is genuinely interested in them and in quality care, the risk for lawsuits diminishes.

5. While it is good to follow policy and procedures, the expert nurse will learn when it is best for the patient for the rules to be modified.

Page Ref: 62-63 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the impact of legal issues on decision making in management and practice.

24 .

25) Identify typical healthcare areas in which the states have input. Select all that apply.

1. Public health and safety 2. Provision of indigent care 3. Purchase care 4. Regulation 5. Resource allocation Answer: 1, 2, 3, 4, 5 Explanation: 1. These are all areas in which states have input into healthcare policy, legislation, and regulation.

2. These are all areas in which states have input into healthcare policy, legislation, and regulation.

3. These are all areas in which states have input into healthcare policy, legislation, and regulation.

4. These are all areas in which states have input into healthcare policy, legislation, and regulation.

5. These are all areas in which states have input into healthcare policy, legislation, and regulation.

Page Ref: 57 Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

25 .

26) Healthcare delivery has experienced many changes and problems. Based on an examination of these changes and problems, what would you consider a major concern today?

1. Cost is not related to quality.

2. Healthcare is complex.

3. Quality care is improving rapidly.

4. A functional system is more costly.

Answer: 2 Explanation: 1. Cost is related to quality, and cost and quality are major concerns.

2. Healthcare is complex, a major concern today, and this makes it difficult to adjust to changes and improve.

3. Quality care is not improving rapidly.

4. A dysfunctional system is more costly.

Page Ref: 43-48 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

26 .

27) Which of the following include comments about and strategies related to healthcare disparity? Select all that apply.

1. Agency for Healthcare Research and Quality 2. Medicare reimbursement requirements 3. Institute of Medicine/National Academy of Medicine reports 4. National Quality Care Reports (annual) Answer: 1, 3, 4 Explanation: 1. AHRQ has many services and resources on disparity.

2. This does not include disparities as a requirement.

3. The IOM/NAM reports on quality include disparities.

4. The quality reports include indicators directly related to disparities.

Page Ref: 46 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

27 .

28) Healthcare in the United States would best be described by which of the following statements?

1. The United States has a national healthcare system.

2. The United States has universal health coverage insurance.

3. The United States has a local, state, and federal system of healthcare.

4. The United States focuses on a public system to provide care.

Answer: 3 Explanation: 1. The United States does not have a national healthcare system.

2. There is no universal healthcare coverage.

3. The U.S. system is a mix of local, state, and federal services.

4. The system is a combination of private and public, with private as the major focus.

Page Ref: 45 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain why nurses should be involved in healthcare policy and the political process.

28 .

29) You are serving on a state committee to develop a state health policy. Which of the following strategies should be done early in the process?

1. Coalition building 2. Select the solution 3. Monitor the outcomes 4. Implement the policy Answer: 1 Explanation: 1. Coalition building should be done very early to ensure that you understand the stakeholders and begin to build support.

2. Solutions are selected after the problem is understood and possible solution options identified.

3. This is the last step in the process.

4. Implementation occurs after the problem is described, solution understood, and policy developed.

Page Ref: 50-54 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

29 .

30) What changes in the organization of healthcare delivery services does the Affordable Care Act of 2010 support? Select all that apply.

1. Nurse-managed health centers 2. Accountable care organizations 3. Increase in number of acute care hospitals 4. Medical homes 5. Focus on state-run clinics Answer: 1, 2, 3 Explanation: 1. Nurse-managed health centers are mentioned.

2. Accountable care organizations are mentioned.

3. Medical homes are mentioned.

4. The ACA does not include provisions to increase acute care hospitals; had greater emphasis on primary care.

5. There is no provision to focus on state-run clinics.

Page Ref: 58-59 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the impact of healthcare legislation on healthcare delivery.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 3 Operational and Strategic Planning: Change, Innovation, and Decision Making 1) The manager of a maternal-child health unit announces that the unit will be redesigned to help meet the Institute of Medicine healthcare competencies. What scenario is one that the staff of this unit might expect?

1. Nursery, labor and delivery, and postpartum nurses will be cross-trained to work in each of these areas.

2. The nurses will be expected to participate in telehealth throughout a three-state region.

3. There will be a reduction in staff numbers.

4. The unit will be closed for remodeling.

Answer: 1 Explanation: 1. Cross-training is an example of redesign or reengineering of healthcare.

2. This would require reregulating professional practice.

3. This is an example of rightsizing.

4. This is not what is meant by redesign in this case.

Page Ref: 103-104 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

1 .

2) In which situation would it be necessary to reregulate practice? Select all that apply.

1. Nurses are asked to cross-train to another specialty.

2. An insurance company opens a nationwide nurse call line.

3. The hospital hires unlicensed assistive personnel.

4. A nursing school revises its curriculum.

5. The healthcare organization goes national and hopes to encourage mobility among its administrative nurses.

Answer: 2, 5 Explanation: 1. This is a redesign practice used by many organizations to compensate for the nursing shortage.

2. The use of telemedicine requires reregulating professional practice because nurses can use this technology to provide care in situations in which the patient is in a different state from the one where the nurse is licensed and located.

3. This is a redesign practice used by many organizations to compensate for the nursing shortage.

4. This is an example of restructuring in which nursing education attempts to prepare nurses for the "real world."

5. This mobility would result in the nurses working in different states from where they live and are licensed.

Page Ref: 104-105 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

2 .

3) Management has called a meeting to discuss the increase in negative patient satisfaction surveys. Which stage of Lewin's model of change does this represent?

1. Moving 2. Refreezing 3. Unfreezing 4. Working Answer: 3 Explanation: 1. The moving stage is the planning phase of the model and focuses on the development of goals and outcomes.

2. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes.

3. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem.

4. Working is not a stage of Lewin's model.

Page Ref: 85-86 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

3 .

4) The hospital would like to decrease the number of medication errors made secondary to transcription errors. In order to accomplish this, it is hoped that all physicians will be trained in the use of computerized physician orders by the end of the fiscal year. This is an example of which stage of Lewin's model of change?

1. Refreezing 2. Unfreezing 3. Moving 4. Working Answer: 3 Explanation: 1. The refreezing stage is the implementing step in the model where change becomes a part of the work environment and its processes.

2. The unfreezing stage is the first step in Lewin's model of change and includes recognition of a problem.

3. This is an example of the moving stage, because the hospital has developed a goal and outcomes to help resolve the problem.

4. Working is not one of the stages of the model.

Page Ref: 85-86 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

4 .

5) Which activities represent the eight-step process for organizational change? Select all that apply.

1. Management has created a sense of urgency for the change by publishing outcome data on the organization's intranet.

2. Management has worked to develop and communicate a vision that can be shared by all employees.

3. Management has empowered employees to make changes.

4. Management is engaged in "deep change."

5. Management has orchestrated and celebrated some short-term successes along the path to change.

Answer: 1, 2, 3, 5 Explanation: 1. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

2. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

3. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

4. This is not part of the eight steps. This is a coping strategy for what Quinn describes as "slow death."

5. The eight steps create a sense of urgency; create a guiding coalition and mobilize commitment; form a strategic vision and initiatives; enlist a volunteer army; enable action by removing barriers; generate short-term wins; sustain acceleration; and institute change.

Page Ref: 87-88 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning 5 .

Learning Outcome: LO 02. Apply the change process to the decision-making process.

6 .

6) The nurse manager is coping with a staff member who is very resistant to change.

Which strategy would be beneficial for this nurse manager?

1. Maintain open communication with this staff member to establish trust.

2. Help the staff member focus on parts of the change rather than on the whole change at one time.

3. Take over all of the processes of the change.

4. Ignore any hidden agendas brought by this staff member.

Answer: 1 Explanation: 1. Having an open and trusting relationship with staff will help to reduce resistance to change.

2. Focusing on parts and being unable to see the whole picture can result in territoriality.

3. Staff will not be innovative if managers overdirect, overobserve, or overreport.

4. Staff with hidden agendas or motives are barriers to change and should not be ignored.

Page Ref: 90-91 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

7 .

7) The nurse manager is aware of a significant change that will occur sometime in the next six months. How can this manager begin to prepare the staff for this change?

Select all that apply.

1. Keep the staff apprised of as much information about the change as is possible.

2. Attempt to keep the unit staffing as stable as possible during the time of change.

3. Insist that all discussions about the change be conducted in a respectful manner.

4. Let the initial information about the change come "through the grapevine."

5. Avoid surprises by telling the staff about how the change will increase workload very early in the process.

Answer: 1, 2, 3 Explanation: 1. Fear of the unknown is a primary reason people resist change.

2. Stability will help the staff cope with the idea of a change.

3. All discussions should be respectful and professional.

4. Being upfront with information will prevent staff from believing the manager is trying to hide the change.

5. Focusing on what the staff will lose (having to work harder) will likely increase resistance.

Page Ref: 90-91 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

8 .

8) Which option best describes a change agent that demonstrates a transformational style of leadership during the change process?

1. The change agent describes the vision for the change, sets high expectations, and is a role model for the staff.

2. The change agent expresses personal views about the change and empathizes with the staff.

3. The change agent expects staff to follow the change agent's directions required to meet the goal.

4. The change agent provides the staff members with the resources needed to do their job.

Answer: 1 Explanation: 1. The charismatic change agent is an envisioning leader.

2. These actions describe an enabling change agent.

3. These actions describe a missionary change agent.

4. This is an instrumental or transactional change agent.

Page Ref: 93-94 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

9 .

9) During the change process to implement an electronic medical record, a nurse manager says, "We are experiencing a 'slow death.'" What evidence would the manager have to not support this conclusion?

1. Work processes that seem scattered 2. Staff burnout with complaints increasing 3. Use of a detailed project plan 4. Staff refusing to assume more assignments Answer: 3 Explanation: 1. Inability to do work effectively is a sign of 'slow death.'

2. Staff burnout is a sign of 'slow death.'

3. Using a detailed plan is a positive step and should not lead to 'slow death' during change.

4. Staff who are less enthusiastic is a sign of 'slow death.'

Page Ref: 87 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Apply the change process to the decision-making process.

10 .

10) A nurse manager is collecting staff views about a current unit problem to make a decision about actions to take. Which style of decision making is this manager employing?

1. Unilateral 2. Individual 3. Authoritarian 4. Consensus Answer: 4 Explanation: 1. This style depends on a small amount of data, but arrives at one decision.

2. This style focuses on individuals.

3. This style tells the staff what will be done with the manager making the decision.

4. This style engages the staff to arrive at a consensus.

Page Ref: 95-96 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

11 .

11) A patient's fingerstick blood sugar registers 70. The nurse must follow the policy and procedure for caring for a patient with hypoglycemia. This is an example of what type of decision-making process?

1. Programmed decision making 2. Crisis decision making 3. Time-limited decision making 4. Nonroutine decision making Answer: 1 Explanation: 1. Programmed decision making is more repetitive and routine and typically related to a policy or procedure.

2. The situation is not a crisis.

3. This is not a time-limited situation.

4. Nonroutine decision making is not routine, can be crisis-oriented, and can require more time and consultation with others.

Page Ref: 97 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACNEssential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

12 .

12) A problem has been identified in the healthcare facility. What should the nurse who has been assigned the task of change agent do next?

1. Develop an alternative plan.

2. Gather data.

3. Collaborate with others.

4. Empower staff.

Answer: 2 Explanation: 1. Developing alternative plans is done after a diagnosis is made.

2. After the first step of the change process of acknowledging the problem, then it is necessary to gather the data necessary to be able to define the problem and develop a plan of action.

3. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase.

4. Collaborating and empowering staff takes place throughout the change process after data are collected in the assessment phase.

Page Ref: 99-102 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

13 .

13) The nurse is working in a facility that is considering a major change by incorporating interprofessional teams in all departments and units. Which type of planning is required?

1. Policy planning 2. Strategic planning 3. Project planning 4. Strategic planning and project planning Answer: 4 Explanation: 1. Policy planning is not required but may be part of project planning.

2. Strategic planning is required; policy planning is not required but may be included.

3. This proposed change requires planning at levels above project planning.

4. Both strategic planning and project planning are required, because the move toward an interprofessional approach rather than a single discipline-run unit requires a change to the organization's components (departments) and operational matters within the organization.

Page Ref: 112-113 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

14 .

14) The nurse has been assigned to be a change agent for the facility's change to a computerized charting system. What type of planning will this require?

1. Strategic 2. Policy 3. Project 4. Both strategic and project Answer: 3 Explanation: 1. Strategic planning will not be necessary because changes will not be made to the organizations' departments or services provided.

2. This change probably will not change the value system, nor will laws and regulations be changing. Therefore, policy planning will not be necessary.

3. Since this change involves a specific time-limited initiative for the nursing department, this requires project planning.

4. Strategic planning will not be necessary because changes will not be made to the organization's departments or services provided. Project planning will be required.

Page Ref: 112-113 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

15 .

15) What is the first step in coping with changes that occur in the healthcare environment?

1. Understanding personal response to change 2. Identifying the change agent 3. Investigate the facility's history of change 4. Identify the purpose of the change Answer: 1 Explanation: 1. Some people have an immediate negative response to change. Other people are invigorated by change, whether the change is positive or negative. The nurse must understand personal response to the idea of change so that response to a particular change can be unbiased.

2. While this is important information, the nurse must first identify personal response to the concept of change.

3. While this is important information, the nurse must first identify personal response to the concept of change.

4. While this is important information, the nurse must first identify personal response to the concept of change.

Page Ref: 87-88 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

16 .

16) The nurse manager is developing a staff education session on change in healthcare.

Which concepts should be included in this information? Select all that apply.

1. Oftentimes, before one change in healthcare is completed, another is taking place.

2. Most changes are focused on the organization's structure.

3. Change has been the normal state for healthcare providers for some time.

4. Change disturbs the organization's equilibrium.

5. Sometimes multiple changes occur together in healthcare.

Answer: 1, 3, 4, 5 Explanation: 1. This is certainly a pertinent topic in today's healthcare environment.

2. Important examples of change are related to the organization's structure, but change is also affecting roles and responsibilities, communication methods and systems, policies and standards, culture, leadership and management approaches, and competencies and attitudes.

3. This is certainly a pertinent topic in today's healthcare environment.

4. The equilibrium does become disturbed, so staff must learn to tolerate this equilibrium in order to be effective.

5. This is certainly a pertinent topic in today's healthcare environment.

Page Ref: 84-85 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

17 .

17) What are the common external factors that drive change in a healthcare organization? Select all that apply.

1. Changes in reimbursement by third-party payers 2. Changes in the demographics of employees in the facility 3. Changes in local, state, or national laws 4. Changes in professional standards of care 5. Changes in the organization's salary structure Answer: 1, 3, 4 Explanation: 1. This is a common external factor causing change to be necessary.

2. This is an internal change.

3. Any changes in these laws acts as an external force necessitating change in the organization.

4. Changes in these standards will require change in the way the organization provides care.

5. This is an internal change.

Page Ref: 85 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

18 .

18) The staff of a healthcare organization is burned out and apathetic, and the organization is stagnant. The newly employed leader is working to empower staff, improve the organization's vision, and alter the culture of accepting the status quo.

According to Quinn, what is this leader trying to create?

1. Unfreezing 2. A "slow death" 3. A force-field analysis 4. A "deep change" Answer: 4 Explanation: 1. This is part of Lewin's theory of change and is not applicable to this scenario.

2. This is what the organization is experiencing. The leader is trying to turn this situation around.

3. This is a strategy of Lewin's theory of change.

4. Quinn says that in order to avoid a "slow death" leaders must create a "deep change."

Page Ref: 85-86 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

19 .

19) The nurse manager has repeatedly tried to convince a staff nurse that changing to a new scheduling format is necessary. The staff nurse continues to be negative and argumentative about the need to change. How should the nurse manager interpret this response? Select all that apply.

1. Some staff will never be ready to change.

2. The change cannot go forward until this nurse is convinced.

3. The nurse is being negative for the sake of negativity.

4. The nurse will have to be terminated in order for the change to occur.

5. The nurse may be concerned about loss of routine in personal scheduling.

Answer: 1, 5 Explanation: 1. Some people are very threatened by the idea of change. This fear may make them respond negatively.

2. The change may go forward with or without this staff nurse's approval.

3. Generally, this is not the case if the nurse manager is genuinely trying to establish rapport with the staff nurse and explain why the change is necessary.

4. The change can go forward without terminating the nurse. If the nurse is indeed fearful of change, the nurse will probably not resign, as that is also a change.

5. Resisters to change are often fearful of losing something they value. Scheduling changes are a particular issue when nurses have established their personal schedules based upon a routine work schedule.

Page Ref: 90-91 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

20 .

20) A new management company has acquired a hospital. Since the acquisition, the hospital's name has changed, a new vision statement has been distributed, the department structure has changed, and the staff cafeteria discount has been eliminated. Management has plans for many additional changes. What should happen at this point?

1. Management should refrain from making any additional changes for a few months.

2. Management should continue to make changes, but at a rate no faster than 1 change a month.

3. Management should abandon plans for any additional changes.

4. Management should institute the remaining changes as quickly as possible.

Answer: 1 Explanation: 1. This staff has experienced significant changes and may need a break from change for a few months.

2. This option would have the effect of keeping the staff out of equilibrium.

3. It is not necessary to abandon plans for the changes, but staff needs to be free of changes for a period of time.

4. This quick strike method may result in irretrievable disequilibrium in the staff, which could adversely impact patient care and safety.

Page Ref: 84-85, 87-89 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

21 .

21) The nurse manager has convened a staff meeting to discuss a change in the clinical ladder advancement system used by the organization. A staff nurse says, "Not again! It's just not fair." How should the manager respond?

1. "What do you mean, not again?"

2. "Please don't be negative."

3. "This is going to happen. We can't do anything about it."

4. Ignore the comment and continue the meeting.

Answer: 1 Explanation: 1. The nurse manager should determine what is meant by the comment before addressing the concern.

2. This statement devalues the comment and the nurse who made it.

3. This statement makes it appear that the manager does not support the change.

4. Ignoring this comment will not help the meeting proceed.

Page Ref: 87-89 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

22 .

22) The team is using a P DSA cycle to test a proposed change to conduct an in-depth analysis of data with comparison to the predictions. In which step of the cycle is this team working?

1. P 2. D 3. S 4. A Answer: 3 Explanation: 1. In the Planning stage, the objective of the test is stated; predictions are made about what will happen and why; and a plan to test the change is developed.

2. In the Do stage, a small test is done with identification of problems encountered and first analysis of data.

3. In the Study stage, a more in-depth analysis of test data is done with comparison to predictions.

4. In the last step, Act, the change is revised based on what has been learned from the test.

Page Ref: 106 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the change process to the decision-making process.

23 .

23) Critical thinking is key to successful planning. Which statements provide evidence that the nurse manager is a critical thinker? Select all that apply.

1. "I need to research the topic before I comment."

2. "Let's be fair in our consideration of this change."

3. "Let's go ahead and make the change; I have a feeling it is correct."

4. "I'm trying to understand your point of view."

5. "I have to take back something I said in the last meeting; it was wrong."

Answer: 1, 2, 4, 5 Explanation: 1. This is an example of intellectual humility or admitting what is not known. This is a trait of a critical thinker.

2. This is an example of intellectual courage or awareness of the need to confront ideas fairly. This is a trait of a critical thinker.

3. This statement reflects a jump to action and is not reflective of critical thinking.

4. This is an example of intellectual empathy or the person making a conscious effort to understand others. This is a trait of a critical thinker.

5. This is an example of intellectual integrity or admitting when one is wrong. This is a trait of a critical thinker.

Page Ref: 98 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

24 .

24) The staff nurse is invited to join the organization's Strategic Planning Committee.

Which topics can the nurse expect to address as part of this committee? Select all that apply.

1. Planning for the next 3-5 years 2. Changes in the core values of the organization 3. Changes in regulations governing the organization 4. Changes in the departmental structure of the organization 5. Suggestions about how to change the staff-mix ratios in a department Answer: 1, 2, 4 Explanation: 1. Strategic planning is concerned with long-term issues and goals.

2. Long-term issues and core values are considered during strategic planning.

3. This is an example of policy planning.

4. Strategic planning is concerned with long-term issues and goals.

5. This is an example of project planning.

Page Ref: 113 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

25 .

25) Which statements are true about the evaluation step of the decision-making process? Select all that apply.

1. Only the change agent is responsible for the evaluation phase.

2. Management is usually not involved in the evaluation phase.

3. Evaluation needs to be incorporated in all the steps of the change process.

4. All members of the team are required to evaluate the process at the end of the project.

5. Neglecting this step has long-term consequences.

Answer: 3, 5 Explanation: 1. All members of the team are involved.

2. All members of the team are involved, including management.

3. Evaluation does not happen just at the end of the project, but needs to be incorporated all the way through the project.

4. While all members of the team are involved in evaluation, this evaluation should take place throughout the project, not just at the end.

5. If the team does not evaluate the results of decisions, valuable information can be lost or mistakes can be made in the next change.

Page Ref: 102 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Apply the change process to the decision-making process.

26 .

26) What is the goal of the Center to Champion Nursing in America?

1. Advertise nursing 2. Mobilize stakeholders 3. Describe nursing education changes 4. Recognize importance of A PRNs Answer: 2 Explanation: 1. This is important, but not the goal.

2. This is the goal for the initiative, which is associated with The Future of Nursing report. There is need to develop a collaborative effort and this requires participation from stakeholders.

3. This is important, but not the goal.

4. This is important, but not the goal.

Page Ref: 115 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain the concept of change and its importance in the healthcare environment and to nursing leadership and management.

27 .

27) You are using SWOT for a review of your unit. Which of the following would be part of this process? Select all that apply.

1. Identify strengths 2. Identify opportunities 3. Identify stakeholders 4. Identify weaknesses 5. Identify outcomes Answer: 1, 2, 4 Explanation: 1. SWOT = strengths, weaknesses, opportunities, threats 2. SWOT = strengths, weaknesses, opportunities, threats 3. SWOT = strengths, weaknesses, opportunities, threats 4. SWOT = strengths, weaknesses, opportunities, threats 5. SWOT = strengths, weaknesses, opportunities, threats Page Ref: 113 Cognitive Level: Analyzing Client Need/Sub Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

28 .

28) What are the first three steps used in proactive leadership? Select all that apply.

1. Listen and learn, adjusting the nature of the solution and the speed of the process as needed.

2. Implement the proposed change by integrating it into organizational culture, structure, and strategy.

3. Engage in debate or dialogue about the need for change and the nature of the proposed solution.

4. Form a coalition to manage the change process.

5. Communicate consensus or decision to all stakeholders.

Answer: 3, 4, 5 Explanation: 1. This step occurs during and after implementation.

2. This is the fourth step.

3. This is one of the first three steps–the second step.

4. This is one of the first three steps–the first step.

5. This is one of the first three steps–the third step.

Page Ref: 114 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

29 .

29) What is a method used to describe performance over time and identify trends?

1. Graph 2. Cost-benefit analysis 3. WOTS-up 4. Solution analysis field Answer: 1 Explanation: 1. This is the definition of a graph.

2. This method focuses on comparing costs and benefits to arrive at the best option.

3. This method focuses on analysis of weaknesses, strengths, and so on.

4. This method compares alternative solutions.

Page Ref: 108-111 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

30 .

30) Which of the following data collection methods is not one of the three common data collection methods mentioned in the textbook?

1. Observation 2. Survey 3. Record review 4. Interview Answer: 3 Explanation: 1. Observation is a common data collection method.

2. Survey is a common data collection method.

3. Record review may be used, but is not one of the three common methods discussed in the textbook.

4. Interview is a common data collection method.

Page Ref: 107 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast effective strategic, operational, and project planning.

31 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 4 Organizational Structure for Effective Care Delivery 1) The organizational analysis documentation describes the organization as one with centralized leadership with a clearly defined organization chart hierarchy. The organization is divided into departments and follows detailed rules and regulation.

This organization follows which theories? Select all that apply.

1. Classical 2. Systems 3. Integrated delivery system 4. Vertical integration theory 5. Bureaucratic Answer: 1, 5 Explanation: 1. The first principle of classical organization theory is division of labor, which is done in this organization through establishing departments. This theory is also demonstrated by the clear delineation of the policies and procedures and a defined hierarchy.

2. In systems theory, there is one entity with multiple elements that interact independently.

3. This system focuses on a continuum of care, using a decentralized leadership style. There is a merging (horizontal or vertical) of various components of the system.

4. This is an organizational style that is part of an integrated delivery system.

5. Bureaucratic organizations incorporate the key principles of classical theory with a division of labor, clearly defined hierarchy, and detailed rules and regulations.

Page Ref: 120-121 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

1 .

2) The healthcare organization is undergoing reorganization to a service-line structure.

What are the benefits of this structure?

1. There is a clear delineation of the organization's rules.

2. Each staff member reports to only one supervisor.

3. Staff members are not encouraged to use creative problem solving.

4. Departments are less likely to place blame on one another.

5. The nursing presence is strong and unified.

Answer: 4 Explanation: 1. This is not true of a service-line organization, but of a classical or bureaucratic organization.

2. This is not true of a service-line organization, but of a classical or bureaucratic organization.

3. This is not true of a service-line organization, but of a classical or bureaucratic organization.

4. A service-line organization groups activities according to product or service.

Therefore, one department cannot place blame on another department, because all departments are a part of the same service line.

5. This is not true of a service-line organization, but of a classical or bureaucratic organization.

Page Ref: 123 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

2 .

3) The director of nursing education for a hospital has been asked to provide continuing education on safety precautions to physicians, nurses, and all other disciplines providing patient care. Although the director is responsible for providing this education, the director is not responsible for assuring that physicians and healthcare managers adhere to the procedures. What type of healthcare organizational structure is present in this hospital?

1. Vertical structure 2. Staff authority 3. Span of control 4. Horizontal structure Answer: 2 Explanation: 1. Vertical structure uses centralized decision making.

2. When staff members function in an advisory capacity and cannot force other staff to do something, they are operating under staff authority structure.

3. Span of control describes the number of people supervised by one person or position.

4. Horizontal structure uses decentralized decision making, and is organized around customer-oriented processes.

Page Ref: 124-125 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

3 .

4) The obstetrics department, which is composed of labor and delivery, postpartum, nurseries, and the neonatal intensive care unit, operates under what organizational structure?

1. Decentralized structure 2. Matrix organizational structure 3. Departmentalization 4. Line authority Answer: 3 Explanation: 1. Decentralized structure spreads tasks and authority out over components of the organization.

2. Matrix organization is used when staff members belong to a functional department, such as nursing, and to a service or product department, such as radiology.

3. Departmentalization occurs when divided tasks are grouped based on related responsibilities or location.

4. Line authority or chain of command identifies to whom each staff member reports up through the chain of command.

Page Ref: 125 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

4 .

5) Which statement should be included in a classroom discussion about organizational process?

1. It is a philosophy that becomes the basis for operationalizing the mission of the institution.

2. It answers the question of "what does the organization look like?"

3. It directs staff as to whom they report.

4. It is a graphical representation of an organization's flow of responsibility.

Answer: 1 Explanation: 1. The organizational process focuses on how the organization operates.

2. The organizational process answers the question of "why" for the organization.

3. This statement describes chain of command.

4. This is a description of an organizational chart.

Page Ref: 126-127 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

5 .

6) Choose the statements that are correct about not-for-profit healthcare organizations.

Select all that apply.

1. There are stockholders who own stock in the organization.

2. These organizations do not have to make a profit to survive.

3. Typically, these organizations are funded by charitable institutions, the government, or churches, as well as by the typical reimbursement sources.

4. These organizations experience more ethical and legal problems.

5. Organizations are called voluntary or public health organizations.

Answer: 3, 5 Explanation: 1. Stockholders or shareholders own stock or shares in for-profit organizations.

2. Both for-profit and not-for-profit organizations have to make a profit to survive.

The not-for-profit organizations invest all profits back into the organization.

3. This is the typical funding source for not-for-profit healthcare organizations.

4. Since for-profit organizations have a need for financial success, as a group they typically have more ethical and legal problems.

5. Not-for-profit healthcare organizations are also known as voluntary or public health organizations.

Page Ref: 130 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

6 .

7) What has caused some of the concern about the use of unlicensed assistive personnel (UAP)?

1. Supervision is provided by the registered nurse.

2. UAPs do not provide quality care.

3. Home health aides are not supervised.

4. There is variability of education and training of all types of UAPs. Answer: 4 Explanation: 1. Supervision by the registered nurse is not a concern as long as the RN assures they are able to provide safe care.

2. Most UAPs do provide quality care with appropriate supervision.

3. Home health aides, although they work more independently than do UAPs in other organizations, are supervised by the home health R N. 4. The amount of education and training of UAPs is highly variable, which has caused some concern about what they are able to do and the effect on the quality of care.

Page Ref: 134 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

7 .

8) The nursing student clinical group is attending the first clinical session of the semester. What nursing care delivery model do students usually expect to follow?

1. Total patient care model 2. Functional nursing model 3. Primary nursing model 4. Care management model Answer: 1 Explanation: 1. Typically, student nurses follow the total patient care model and provide all of the care for a patient while in the clinical area. This model may be altered slightly to accommodate the student's progress in the nursing program or the policies of the facility. For example, the nursing student may provide all care except giving Ⅳ meds.

2. Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as wound care.

3. In primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge.

4. The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

Page Ref: 139 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

8 .

9) This morning, the RN is assigned to administer medications to all of the patients on the medical-surgical unit. From this assignment, the RN knows that this organization adheres to which type of patient care delivery model?

1. Total patient care model 2. Functional nursing model 3. Primary nursing model 4. Care management model Answer: 2 Explanation: 1. The staff working for an organization that uses the total patient care model is assigned to provide all of the care for a patient while in the clinical area.

2. Functional nursing is a task-oriented approach where staff members are assigned to provide a specific task, such as passing out medications for the unit.

3. In primary nursing, the RN assumes 24-hour responsibility for planning, directing, and evaluating the patient's care, from admission to discharge.

4. The care management model, which is similar to case management, focuses on the needs of the integrated delivery system.

Page Ref: 140 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

9 .

10) What is a disadvantage of using the team approach for care delivery?

1. The team leader might not have the necessary leadership skills required to successfully lead the team.

2. There is a risk that care will be fragmented.

3. This approach often leads to greater staff dissatisfaction, with staff members feeling they are just grinding out tasks.

4. This approach may lead to decreased collaboration and redundancy in patient care.

Answer: 1 Explanation: 1. Using the team approach requires that the team leader have the necessary leadership skills to coordinate and delegate patient care.

2. The team approach helps keep care from becoming fragmented.

3. In this approach, each team member can contribute his or her own special expertise or skill in caring for the patient.

4. There is generally a greater amount of collaboration and less redundancy of care.

Page Ref: 140 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

10 .

11) The nurse is interviewing for a position in a newly opened hospital. Which observation would best indicate to this nurse that the organization follows a shared governance model?

1. Among the documents provided by the human resources department is an organizational chart of the nursing department, indicating that the director is the highest ranking member.

2. Conversation with a staff nurse reveals that the nurse feels empowered in making patient care decisions.

3. The mission statement of the hospital describes centralized power.

4. A staff nurse mentions that each individual staff member has complete autonomy.

Answer: 2 Explanation: 1. This documents that the hospital follows the classical theory of organization.

2. Shared governance increases each nurse's influence over the organization, empowering staff.

3. This is a classical organizational model.

4. Although the shared governance model does provide some autonomy, there is also an understanding that staff is expected to collaborate and function cooperatively with both management and colleagues.

Page Ref: 144-145 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

11 .

12) The patient is being discharged from the hospital after having a coronary artery bypass graft (CABG). Which level of the healthcare system will best serve the needs of this patient at this point?

1. Primary care 2. Secondary care 3. Tertiary care 4. Public healthcare Answer: 3 Explanation: 1. The patient already has coronary heart disease, so primary care would not be appropriate for this problem.

2. The patient has just been discharged from secondary care level services, where diagnosis and treatment were done.

3. A patient recovering from a CABG will best be served by rehabilitation services, which are at the tertiary care level.

4. There is no indication that the patient was having difficulty accessing healthcare prior to this episode, so public healthcare does not apply.

Page Ref: 127 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

12 .

13) The nurse is organizing a smoking cessation group for the residents of a retirement center. What level of healthcare services does this represent?

1. Primary care 2. Secondary care 3. Tertiary care 4. Rehabilitation care Answer: 1 Explanation: 1. The nurse is providing health promotion and education, which falls within the level of primary care.

2. Secondary care focuses on the diagnosis and treatment of an existing problem.

3. Tertiary care services include long-term care, rehabilitation, and care of the dying.

4. Rehabilitation care is a tertiary service.

Page Ref: 127 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

13 .

14) Which factor would least likely be included in the analysis of an organization?

1. Whether the organization's mission and vision match staff performance 2. Results from a staff opinion survey regarding the organization's decision-making processes 3. How the organization's communication patterns have affected the change process 4. The turnover rate of nursing personnel in a given unit Answer: 4 Explanation: 1. The vision and mission statements are the driving forces behind all decisions, and provide critical information about the organization's values and philosophy.

2. It is important to analyze how staff members believe decisions are made.

3. It is essential to analyze communication patterns because communication runs an organization and its ability to function effectively.

4. Organizational analysis does take staffing issues into consideration. However, of the options provided, the turnover rate of a particular unit is least likely to be considered. Analysis would likely be focused on the turnover rate in the entire organization.

Page Ref: 136-137 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the process for analyzing an organization and its elements.

14 .

15) The nurse manager supervises the neurologic intensive care unit, surgical intensive care unit, and cardiac intensive care unit. Each unit employs 35 nurses and 15 support staff. The span of control for this manager is . Record your answer rounding to the nearest whole number.

Answer: 150 Explanation: The manager's span of control is the total number of employees managed. In this case, 105 nurses and 45 support staff.

Page Ref: 124-125 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

15 .

16) The primary physician identifies a healthcare provider to manage the care of a patient on the general medical unit of a hospital. Depending upon the facility, which healthcare provider may fill this role? Select all that apply.

1. Nurse practitioner 2. Physician intensivist 3. Physician hospitalist 4. Registered nurse 5. Clinical nurse specialist Answer: 1, 3 Explanation: 1. Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient's personal or primary care physician.

2. Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have.

3. Either a physician or a nurse practitioner can fill the role as hospitalist in many facilities. The hospitalist is a generalist and provides medical coverage for hospitalized patients instead of the patient's personal or primary care physician.

4. RNs work under the direction of a physician.

5. Intensivists cover patients in the intensive care units and have considerable intensive care experience, something that most primary care physicians do not have.

Page Ref: 133 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

16 .

17) An outside accreditation team is evaluating the organization's mission statement.

Which action, taken by the organization, is the most important in regard to this statement?

1. The organization must provide a current copy of the mission statement.

2. The organization must be certain that the mission statement is prominently displayed in public access areas.

3. The organization must provide the team with a written plan about how the mission statement will be followed.

4. The organization must provide evidence of how the mission statement is being followed.

Answer: 4 Explanation: 1. This is important, but not as important as evidence that the organization is actually following the mission.

2. This is important, but not as important as evidence that the organization is actually following the mission.

3. This is important, but not as important as evidence that the organization is actually following the mission.

4. The fact that the mission statement is indeed being followed is the most important evidence that the organization can provide.

Page Ref: 126-127 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

17 .

18) Compare and contrast input, process, and output in systems organizational theory by selecting the options that represent process. Select all that apply.

1. The physician admits a patient to the hospital.

2. The nurse provides excellent care to a patient postoperatively.

3. The dietary manager orders supplies based upon cost-effectiveness.

4. The patient delivers a healthy infant.

5. The nursing unit secretary identifies a potential medical error before it occurs.

Answer: 2, 3, 5 Explanation: 1. This is a system input.

2. This represents process.

3. This represents process.

4. This is an outcome.

5. This represents process.

Page Ref: 121-122 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

18 .

19) Which of the following are related to the development and use of alternative or complementary therapies? Select all that apply.

1. There is an institute in NIH that focuses on this area of healthcare.

2. We have developed significant research to either support or dispute these therapies.

3. Healing touch, herbal therapy, and acupuncture are examples of these therapies.

4. There is effective reimbursement for these therapies.

Answer: 1, 3 Explanation: 1. The National Center for Complementary and Integrative Health 2. There is research, but not enough.

3. These are examples of these therapies; other examples are massage, energetic healing, acupressure, and more.

4. Reimbursement is highly variable.

Page Ref: 135 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Apply the process for analyzing an organization and its elements.

19 .

20) Several small rural hospitals have been acquired by a large nationwide healthcare organization. Six months after the acquisition, the rural hospitals remain in conflict with the management team and with one another. Choose the questions that the management team should ask in order to identify the reasons for this continued discord. Select all that apply.

1. How are the hospitals communicating with the organization and with one another?

2. Are the goals of the hospitals aligned with those of the organization?

3. Are the rural hospitals too focused on patient-centered care and safety?

4. How is the organization handling decision making with the hospitals?

5. Aren't buyouts always this way?

Answer: 1, 2, 4 Explanation: 1. Communication is paramount in successfully working in a large organization.

2. When subsections of the organization are separated by distance, it is easy for goals to be out of alignment.

3. There can never be too much focus on being patient-centered and safetyminded.

4. If the organization is making all of the decisions and passing them down to the hospitals, discord is likely to occur and continue.

5. This question minimizes the issue and does not address the problems. If management takes this attitude, the problems will likely continue.

Page Ref: 136-137 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Apply the process for analyzing an organization and its elements.

20 .

21) The American Organization of Nurse Executives (A ONE) emphasizes "the core of nursing is knowledge and caring." To which portions of the Institute of Medicine core competencies does this statement relate? Select all that apply.

1. Use of interprofessional teams 2. Informatics 3. Evidence-based practice 4. Quality improvement 5. Patient-centered care Answer: 3, 5 Explanation: 1. Using interprofessional teams relates to managing the journey.

2. Informatics applies to the synthesis of knowledge.

3. This statement relates to both evidence-based practice and patient-centered care.

4. Quality improvement applies to the synthesis of knowledge.

5. This statement relates to both evidence-based practice and patient-centered care.

Page Ref: 138-139 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

21 .

22) The patient who had a colonoscopy one hour ago suddenly experiences bright red rectal bleeding, becomes diaphoretic, and is short of breath. The nurse decides to implement standing emergency orders and initiates oxygen per mask and increases the patient's Ⅳ rate, while a colleague contacts the patient's physician. Which critical element of nursing is this nurse demonstrating? Select all that apply.

1. Autonomy 2. Responsibility 3. Delegation 4. Accountability 5. Relevance Answer: 1, 2, 4 Explanation: 1. Autonomy in clinical decision making occurs whenever a nurse makes an independent judgment about the presence of a clinical issue and then provides the resolution. This nurse identified that the patient was experiencing distress and made the clinical judgment to use emergency orders. The nurse could have also made a clinical judgment not to use them.

2. This nurse was entrusted with a particular function, in this case, caring for a postop patient.

3. There is no indication that the nurse delegated care of this patient to anyone.

4. Accountability is the acceptance of responsibility of the outcomes of care.

5. This term is not one of the critical elements of nursing.

Page Ref: 139 Cognitive Level: Analyzing Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

22 .

23) What is the oldest of the nursing care models?

1. Total patient care 2. Functional nursing 3. Team nursing 4. Primary nursing Answer: 1 Explanation: 1. This is the oldest of the models. Nurses have provided this type of care for generations.

2. This model is not as old as total patient care.

3. This model is not as old as total patient care.

4. This model is not as old as total patient care.

Page Ref: 139 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

23 .

24) Which options are included in the six dimensions of shared governance? Select all that apply.

1. Informal authority base 2. Access to information about the organization 3. Delegation of care to others 4. Ability to set goals and negotiate conflict 5. Control over professional practice Answer: 2, 4, 5 Explanation: 1. Shared governance requires formal authority granted by the organization.

2. This is a part of shared governance.

3. This is not a part of shared governance, though it occurs in a shared governance organization.

4. This is a part of shared governance.

5. This is a part of shared governance.

Page Ref: 144-145 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

24 .

25) What are the responsibilities of the nurse manager in most shared governance models? Select all that apply.

1. Staffing 2. Direct patient care 3. Program evaluation 4. Allocation of resources 5. Long-range planning Answer: 1, 3, 4, 5 Explanation: 1. This is a responsibility of the nurse manager in most shared governance models.

2. In most shared governance models, the nurse manager is not responsible for providing direct patient care.

3. This is a responsibility of the nurse manager in most shared governance models.

4. This is a responsibility of the nurse manager in most shared governance models.

5. This is a responsibility of the nurse manager in most shared governance models.

Page Ref: 144-145 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

25 .

26) A nurse who has the ability to make decisions and has competence to do so is best described as demonstrating which of the following?

1. Responsibility 2. Delegation 3. Autonomy 4. Accountability Answer: 3 Explanation: 1. Responsibility refers to specific accountability or liability associated with performance.

2. Delegation is the assignment to another to complete a task.

3. Autonomy focuses on the individual's ability to make decisions and has competence to do so.

4. Accountability means a person is answerable for their actions.

Page Ref: 139, 144-145 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

26 .

27) The marketing process includes which three elements listed below? Select all that apply.

1. A determination of what is wanted and needed 2. A method(s) for reaching what is wanted or needed 3. A description of the cost and quality of what is needed 4. A specific plan to evaluate the service needed 5. An understanding of the patient, customer, or consumer and service needed Answer: 1, 2, 5 Explanation: 1. This is one of the elements.

2. This is one of the elements.

3. Cost and quality of services is not one of the three elements, though it is related to the determination of what is wanted or needed.

4. Evaluation of the service is not one of the three elements.

5. This is one of the elements.

Page Ref: 130-132 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

27 .

28) These four principles of marketing are used to guide development of a marketing plan, focusing on the critical elements of the plan. Select all that apply.

1. Place 2. People 3. Product 4. Pricing 5. Promotion Answer: 1, 3, 4, 5 Explanation: 1. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place.

2. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place. People is not included as a specific focus of the principles.

3. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place.

4. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place.

5. The principles are referred to as the 4 Ps and include product, promotion, pricing, and place.

Page Ref: 131 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Compare and contrast key organizational theories and the need for structure and process.

28 .

29) You are orienting a new staff nurse to the unit's nursing model, which is the Synergy Model for Patient Care™. As you describe the model, you make a mistake and another nurse points out your error. What would that nurse identify?

1. The model matches nurses' competencies with patient characteristics, needs, and the unit.

2. The model is for critical-care units.

3. The model supports the healthcare professions core competency to use patientcentered care.

4. Nurses are expected to be competent in clinical inquiry.

Answer: 2 Explanation: 1. The model identifies a list of patient characteristics and a list of nurse competencies that should correlate with one another.

2. The model was created by the American Association of Critical-Care Nurses, but it used in a variety of patient care units.

3. Patient-centered care is a key patient characteristic–participation in decisionmaking.

4. Clinical inquire or the ongoing process of questioning and evaluating is an expected nurse competency in the model.

Page Ref: 142-143 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast different nursing care models discussed in this chapter.

29 .

30) What is the most significant change today in healthcare providers that impacts all types of healthcare settings?

1. Use of hospitalists 2. Increased emphasis on interprofessional teams 3. Development of the doctor of nursing practice degree 4. Use of unlicensed assistive personnel Answer: 2 Explanation: 1. Hospitalists are new, but they are only used in hospitals and not all hospitals use them.

2. Interprofessional teams are the major focus today in healthcare delivery—in practice and need to develop education—meeting the healthcare professions core competency to utilize interprofessional teams.

3. The doctor of nursing practice is important, but it is not important to all settings and not clear what its long-range impact will be.

4. Unlicensed assistive personnel are not new to healthcare delivery.

Page Ref: 142 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Apply the process for analyzing an organization and its elements.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 5 Healthcare Economics 1) Choose the options that are examples of the microlevel view of healthcare finance.

Select all that apply.

1. Capitation 2. Managed care organization 3. Diagnosis-related groups 4. Budgeting 5. Cost center Answer: 4, 5 Explanation: 1. This is a concept that pertains to the global issues of finance, not the individual organization's finances, so this is a macrolevel issue.

2. This is a concept that pertains to the global issues of finance, not the individual organization's finances, so this is a macrolevel issue.

3. This is a concept that pertains to the global issues of finance, not the individual organization's finances, so this is a macrolevel issue.

4. Budgeting is an example of microlevel finance, since it pertains to the organization.

5. A cost unit is the smallest functional unit that can be identified for cost control and accountability. This is an example of microlevel finance.

Page Ref: 177-181 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

1 .

2) Which statements regarding U.S. national healthcare expenditures should be included in a classroom discussion of the topic? Select all that apply.

1. The largest portion of healthcare expenditures is found in nonhospital services.

2. Healthcare reimbursement in the United States occurs via a pluralistic payment system.

3. Pharmaceuticals and medical supplies do not necessarily affect national healthcare expenditures.

4. The cost of premiums for employer-based health insurance continues to grow.

5. The average employee contribution to company-provided health insurance is increasing.

Answer: 4, 5 Explanation: 1. The largest portion of healthcare expenditures is found in the hospital industry, despite the fact that there is a decrease in length of stay and increasing use of nonhospital services.

2. Healthcare reimbursement in the United States is complex, with many players and motivations, and a long history of change.

3. The healthcare industry's financial issues affect all aspects of provision of care, including drugs and medical supplies.

4. These premiums are increasing for all sizes of companies providing coverage.

5. This contribution continues to rise as the premiums charged to the employer rise.

Page Ref: 152-155 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the macrolevel view of healthcare economics.

2 .

3) Which statements, made by a nursing student, would the faculty interpret as a good understanding of the role of third-party payers in healthcare financing? Select all that apply.

1. Third-party payers have the power to influence care and reimbursement.

2. Third-party payers manage or administer the pool of money from individuals who decide to join an insurance plan.

3. Third-party payers carry all the financial risk for healthcare.

4. Third-party payers pay or underwrite coverage for healthcare for another entity.

5. Third-party payers use reimbursement strategies primarily aimed at reducing the financial risk.

Answer: 1, 2, 4, 5 Explanation: 1. This is a true statement regarding the third-party payer system. This power can be misused or can be misinterpreted by the insured.

2. When individuals decide to join an insurance plan, they put a specific amount of money into the pool or the insurance fund. The third-party payer is responsible for managing and administering this money.

3. The financial risk for healthcare is carried by the patients, the providers, and the third-party payers.

4. The third-party payer is the organization that pays or underwrites coverage for healthcare for another business or entity.

5. These strategies have been developed for this very purpose.

Page Ref: 154-156 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

3 .

4) Which payment method offers to pay the provider a specific percentage of the provider's usual charge?

1. Discounted fee-for-service 2. Per diem rates 3. Diagnosis-related groups 4. Capitation Answer: 1 Explanation: 1. Discounted fee-for-service is a payment method that offers to pay the provider a specific percentage of the provider's usual charge, or a reduced rate.

2. A per diem rate is reimbursement that is fixed, based on each day in a healthcare facility.

3. DRGs are a statistical prospective payment system that classifies care or diagnoses into groups that then are used to identify payment rates.

4. Capitation is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

Page Ref: 158-159 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

4 .

5) Which statement best describes the impact diagnosis-related groups (DRGs) have on the healthcare system?

1. Coordination of all aspects of care has become less critical with this system.

2. The focus has changed from how much it costs to provide the care required to how much a provider will be paid.

3. This system requires nurses to document care accurately.

4. Hospitals face a strong financial incentive to reduce the length of stay and minimize procedures performed.

Answer: 4 Explanation: 1. Coordination of all aspects of care is critical with this system of reimbursement in order to meet length-of-stay requirements for a specific D RG. 2. The focus has changed from how much a provider will be paid to how much it costs to provide the care required.

3. It is important that this documentation provide the information required to assign the DRG to a specific patient. However, this is not the best description of the impact that DRGs have had on healthcare.

4. DRGs are a per-stay reimbursement structure, and when patients stay longer, they incur more costs; therefore, this system has provided a financial incentive to reduce the length of stay and minimize procedures performed.

Page Ref: 165-167 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Discuss the importance of the various government benefit programs.

5 .

6) From this list of patients, choose the ones that would be eligible to receive Medicare Part A benefits without paying premiums. Select all that apply.

1. An unemployed 16-year-old mother of a 6-month-old infant 2. A 45-year-old father of three children receiving governmental financial assistance 3. A 75-year-old retired postal worker who receives Social Security benefits 4. A 66-year-old woman who never worked outside the home, but whose husband had Medicare-covered government employment 5. A 35-year-old man who can no longer work due to end-stage renal disease.

Answer: 3, 4, 5 Explanation: 1. Medicaid is the health plan for low-income individuals.

2. Medicaid is the health plan for low-income individuals.

3. Medicare provides coverage for those 65 or older. These people can receive Part A benefits at age 65 without having to pay premiums if the person is eligible to get Social Security benefits or had a spouse who had Medicare-covered government employment.

4. Medicare provides coverage for those 65 or older. These people can receive Part A benefits at age 65 without having to pay premiums if the person is eligible to get Social Security benefits or had a spouse who had Medicare-covered government employment.

5. The person under age 65 can receive Part A benefits without having to pay premiums if the person has received Social Security or Railroad Retirement Board disability benefits for 24 months or if the person has end-stage renal disease.

Page Ref: 167 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Discuss the importance of the various government benefit programs.

6 .

7) What is an important result of trying to lower hospital admissions that impacts acute care nursing?

1. Patients are sicker on admission, requiring more care.

2. Primary care has increased in the system.

3. The goal is to reduce Medicare readmissions within 40 days of discharge.

4. There is more staffing to care for patients in acute care.

Answer: 1 Explanation: 1. Greater effort is made to keep patients out of hospitals and thus, when admitted, they often are sicker, requiring more care.

2. There is more primary care, but this does not directly relate to nursing practice in acute care.

3. The goal is to reduce Medicare readmissions within 30 days of discharge.

4. Staffing levels have not necessarily increased.

Page Ref: 154 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the macrolevel view of healthcare economics.

7 .

8) You have been a nurse manager for 2 months and are told that the budget process will begin. You ask for information about the process. What would you be told?

Select all that apply.

1. The CNO and the CFO are responsible for the nursing department budget.

2. The budget is prepared and submitted to the C EO. 3. Your role is to act as a reviewer of the nursing department budget.

4. Budgeting requires compromises during the process.

5. Annual budgets are developed in a short time period, such as a month.

Answer: 1, 2, 4 Explanation: 1. The CNO is responsible for the nursing department budget development with help from the CFO. 2. Ultimately the CEO must review and approve the total budget.

3. Your role is to prepare a budget for your unit, which becomes part of the nursing department budget.

4. Budgeting requires compromises during the process, as not everyone will get what he or she wants.

5. Developing the budget takes time, and has many levels of participation and drafts.

Page Ref: 178-179 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

8 .

9) The nurse managers in a home health agency are discussing the budget. Home healthcare is most closely associated with which type of reimbursement strategy?

1. Discounted fee-for-service 2. Diagnosis-related group 3. Capitation 4. Hourly and per visit Answer: 4 Explanation: 1. This is a payment method that offers to pay the provider a specific percentage of the provider's usual charge, or offers a reduced rate.

2. DRGs are per-stay reimbursement plans that focus on a single episode of care related to a diagnosis, and include all predetermined expected in-hospital and maybe some ambulatory care services delivered for that episode of care.

3. This is a prepayment to a provider to deliver healthcare services to enrollees of a health plan.

4. In this system, payments for home healthcare services are determined by the resource needed to provide the service based on number of hours for a visit or number of visits.

Page Ref: 158 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

9 .

10) The staff at a primary care office is asked to document the time the patient checks in, the time the patient is called into the exam room, and the time the patient is checked out. This is an example of what managed care strategy?

1. Provider performance 2. Length-of-stay management 3. Capitation 4. Formularies Answer: 1 Explanation: 1. Wait time for appointments is an example of an evaluation indicator under the provider performance strategy.

2. Length-of-stay strategy has to do with days in the hospital.

3. Capitation is the payment of fixed monthly fees to provide healthcare.

4. Formularies are used to cope with increasing pharmaceutical costs.

Page Ref: 173 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

10 .

11) The nursing unit is being asked to decrease costs by 10% this year. The manager takes this request to the nursing staff for suggestions to meet the goal. Which of the following might the manager discuss with staff about the budget that they could make an impact on?

1. Liability that is incurred from the acquisition of an asset 2. Costs that do not increase or decrease due to changes in volume 3. Smallest functional unit 4. A financial statement identifying assets and liabilities Answer: 2 Explanation: 1. This is the definition for liability, and staff have little impact on assets.

2. This is the definition for fixed costs, and staff need to understand these costs and how they may impact costs of the unit.

3. This is the definition for cost center. This is important, but staff have little impact on what is designated as a cost center.

4. This is the definition for balance sheet, which provides factual information that is important to know, but cannot change it unless looking forward to the next financial period.

Page Ref: 179-183 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

11 .

12) The nurse manager has been asked by the administration to research nursing salaries paid by hospitals across the United States. Which factor is this nurse researching?

1. Variable costs 2. Unit of service 3. Indirect overhead 4. Wage index Answer: 4 Explanation: 1. Variable costs are costs that fluctuate with census or patient days, treatments, clinic visits, home visits, etc.

2. This is the specific unit of healthcare service that a department or unit provides to its community.

3. Indirect overhead is costs that cannot be associated with a specific patient care provided or support service.

4. Wage index is the factor used to compare wages paid to specific categories of personnel across the country.

Page Ref: 179-181 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

12 .

13) The vice president of nursing services is completing a budgetary report for the governing board meeting this week. In which category should this nurse place the total expenditure for health benefits for nursing employees?

1. Salary and wages 2. Operations 3. Capital 4. Accounts receivable Answer: 1 Explanation: 1. Salary and wages include all salary and benefits to the employee. This includes sick time, vacation time, health benefits, premium time, merit raises, etc.

2. The operational budget includes the estimate of the volume, and the mix of activities and series and resources required to provide them.

3. The capital budget is the estimate of purchases of major capital items, such as equipment, building, and furniture.

4. Accounts receivable is the part of the budget report that indicates the amount due to the hospital for services rendered.

Page Ref: 181, 183 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

13 .

14) The nurse manager has been asked to provide numbers associated with productivity to the hospital chief financial officer. Which components should the manager report?

1. The ratio of staff to patients 2. The number of patients to the number of F TEs 3. The ratio of department output to the resources consumed 4. The department input divided by its output Answer: 3 Explanation: 1. This ratio does not take output into consideration.

2. This ratio does not take output into consideration.

3. Productivity is the ratio of output to input (resources consumed).

4. This is the wrong formula. It should be output divided by input.

Page Ref: 184-185 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

14 .

15) One of the strategies used by insurers to control costs and quality is the delineation of the services that will and will not be covered. Choose the services that would typically be covered by most insurance plans. Select all that apply.

1. Outpatient and inpatient surgery 2. Elective abortions 3. Nursing services 4. Diagnostic tests 5. Mental healthcare Answer: 1, 3, 4 Explanation: 1. This service is covered by most health plans.

2. Elective abortions and mental health services are often specifically excluded from coverage.

3. This service is covered by most health plans.

4. This service is covered by most health plans.

5. Elective abortions and mental health services are often specifically excluded from coverage.

Page Ref: 186-187 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

15 .

16) Understanding the microlevel of healthcare financing is most important to which nurse?

1. The nursing student 2. The new graduate 3. The staff nurse 4. The nurse manager Answer: 4 Explanation: 1. While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

2. While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

3. While microlevel healthcare finance is important to all nurses, it is most important to the nurse manager.

4. The nurse manager will use the components of microlevel healthcare financing on a daily basis to manage the unit.

Page Ref: 177-178 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

16 .

17) Which factors influence the financing of healthcare in the United States? Select all that apply.

1. Political factors 2. Increasing length of stay 3. Social expectations 4. Public indifference 5. The national economy Answer: 1, 3, 5 Explanation: 1. The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

2. Length of stay has been decreasing.

3. The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

4. Overall, the public is intensely interested in healthcare financing.

5. The healthcare industry is an extremely large industry whose financing is influenced by many factors, particularly social expectations, economic trends, technological developments, political factors, and in the last few years the U.S. economy.

Page Ref: 152-153 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the macrolevel view of healthcare economics.

17 .

18) Today's healthcare is generally financed through a third-party payer system. Who is the second party in this system?

1. Provider 2. Medicare 3. Patient/enrollee 4. Insurance company Answer: 1 Explanation: 1. The provider is the second party.

2. Medicare is a third-party payer.

3. The patient/enrollee is the first party.

4. Insurance companies are third-party payers.

Page Ref: 156-157 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

18 .

19) Which of the following represent examples of H ACs? Select all that apply.

1. Pressure ulcers 2. Extended hospitalization for any reason 3. Unexpected injury during a surgical procedure 4. Adverse drug events Answer: 1, 3 Explanation: 1. This is a HAC. 2. This is not identified as a specific HAC, though HACs may increase length of stay.

3. This is a HAC. 4. Adverse events in general are not HACs unless a specific event is identified.

Page Ref: 167 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

19 .

20) If you were explaining Medicare and Medicaid, which of the following statements would you include? Select all that apply.

1. Medicare is funded by the state and federal government.

2. Poverty levels impact enrollment in Medicaid.

3. The Affordable Care Act of 2010 has had an impact on Medicare and Medicaid.

4. Social Security payments impact Medicare.

5. DRGs were developed to improve Medicaid reimbursement.

Answer: 2, 3, 4 Explanation: 1. Medicaid is funded by state and federal government, not Medicare.

2. The poverty level has an impact on who can enroll in Medicaid, with those below the poverty level given more access.

3. The ACA had had an impact on Medicare and Medicaid; for example, Medicaid has expanded in some states, and some provisions related to required covered services also apply to Medicare and Medicaid.

4. Social Security payments fund current Medicare expenses.

5. Diagnosis-related groups were developed for Medicare reimbursement.

Page Ref: 162-163 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Discuss the importance of the various government benefit programs.

20 .

21) The pharmacist tells a patient that the insurance company will pay for a new medication, but that the patient will have to pay an additional copay of $45. What type of formulary does this insurance company maintain?

1. Exclusionary 2. Open 3. Incentive 4. Closed Answer: 3 Explanation: 1. This is not a type of formulary discussed in the text.

2. In an open formulary, the enrollee pays extra premiums to use nonformulary drugs.

3. This formulary and additional copay situation is designed as an "incentive" for the patient and the patient's provider to stay within the formulary.

4. In a closed formulary, there is no reimbursement for drugs that are not in the formulary.

Page Ref: 174 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

21 .

22) Which strategy started by managed care is now the most important strategy used to try to manage outcomes?

1. Formularies 2. Provider performance 3. Efficiency management 4. Provider panels Answer: 2 Explanation: 1. Formularies have been used for a long time, but they are not the most important strategy used today.

2. Evaluating provider performance is the most important strategy used today to try to control costs and improve care.

3. This is not the most important strategy.

4. Provider panels do help control some aspects of care but this is not considered to be the most important strategy today.

Page Ref: 152, 173, 177 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

22 .

23) A hospital has formed a task force to discuss reducing hospitalization costs. You and several other nurses have been asked to participate. Which of the following strategies might be considered? Select all that apply.

1. Increase size and services offered by the hospital's associated home healthcare agency.

2. Increase number of nursing staff.

3. Increase number of phone calls to patients posthospitalization to check on them.

4. Increase ambulatory care surgery options.

Answer: 1, 4 Explanation: 1. Home health services are cheaper than in-hospital, and providing these services assists in providing posthospital care, shortening in-hospital care.

2. For this to be effective, there is a need to understand why more nurses might decrease costs; hiring more nurses increases costs.

3. This is helpful to do and may have an impact on rehospitalization, but the focus of the task force is on hospitalization costs, not on rehospitalization specifically.

4. Ambulatory care surgery can reduce costs and provide options to reduce inpatient stay after surgery.

Page Ref: 154 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

23 .

24) Which statement, made by a newly promoted nurse manager, indicates good understanding of full-time equivalents (FTE) as a component of the unit budget?

Select all that apply.

1. An FTE is equal to 2,080 hours per year.

2. FTE is different from worked FTE. 3. FTEs can be used to measure a nurse's productivity.

4. FTEs are a measure of effectiveness.

5. FTE is a count of the people working on the unit at any specific time.

Answer: 1, 2 Explanation: 1. An FTE is a full-time position that is equated to 40 hours of work per week, 80 hours per pay period, or 2,080 hours per year.

2. FTE and worked FTE are two different measures.

3. FTE is used as a component of productivity of a unit, but is not used to measure a specific nurse's productivity.

4. Effectiveness is not measured by FTEs. 5. An FTE is not a person but a unit of time or time actually worked.

Page Ref: 185 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

24 .

25) The nurse notices that there are four boxes of 180-gauge Ⅳ start catheters in the supply room even though the standard Ⅳ start on the unit is done with a 20-gauge Ⅳ catheter. What should the nurse do?

1. Consult with the nurse manager about the situation.

2. Send the catheters back to central supply.

3. Send the catheters to a unit that uses this size.

4. Start using 18-gauge catheters for Ⅳ starts on the unit.

Answer: 1 Explanation: 1. In many instances, nurse managers are not involved in direct care, so the manager may not realize the catheters are in the supply room. If these catheters are not used, their sterility dates will expire and they will be a loss to the unit's budget.

2. This action should not be done without talking to the manager.

3. This should not be done because the cost of the catheters will still be charged to the originating unit.

4. Nurses should not change procedures just to use up supplies.

Page Ref: 184-186 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Analyze healthcare finances at the microlevel, including the budgeting process, productivity, and cost containment, and the effect of finances on nursing and healthcare delivery.

25 .

26) What approach does the I OM/NAM report Best Care at Lower Costs emphasize?

1. Reducing cost of care for complex illness 2. Leadership focused on continuous learning 3. Emphasize quality improvement in the acute care sector 4. Increase public/community health services Answer: 2 Explanation: 1. This is not a recommendation.

2. The report emphasizes the need to learn more about the problem in order to improve healthcare.

3. This is not a recommendation.

4. This is not a recommendation.

Page Ref: 152 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the macrolevel view of healthcare economics.

26 .

27) What is the source of the highest percentage of the nation's healthcare dollar (2016)?

1. Other third-party payers and programs 2. Government public health activities 3. Health insurance 4. Out of pocket Answer: 3 Explanation: 1. Other third-party payers and programs 8% 2. Government public health activities 2% 3. Health insurance 75% 4. Out of pocket 11% Page Ref: 154 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the macrolevel view of healthcare economics.

27 .

28) What is the difference between the healthcare customer and the healthcare consumer?

1. The customer pays for all services the patient receives.

2. The healthcare provider is the customer and the patient the consumer.

3. The employer may be the customer and the consumer.

4. The customer contracts with the insurer and the consumer receives the care.

Answer: 4 Explanation: 1. Both the customer and the consumer usually pay for services.

2. The healthcare provider is not the customer.

3. The customer is who contracts with the insurer–the employer typically.

4. This is a correct description of the customer and consumer.

Page Ref: 156-157 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain service and reimbursement strategies used by insurers to control costs and improve quality.

28 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 6 Acute Care Organizations: An Example of a Healthcare Organization 1) The nurse has taken an employment position in a healthcare facility that advertises itself as being part of a network. What can the nurse expect in this organization?

1. This hospital is part of a vertically integrated corporation that owns and manages a group of health facilities.

2. This hospital is an independent organization, but is in agreement with a number of other healthcare facilities that agree to deliver specific services.

3. This hospital has agreed to provide a continuum of services to a defined population and to be accountable for the outcomes and health status of that population.

4. This hospital has joined with another hospital to become one organization.

Answer: 2 Explanation: 1. A system refers to a corporation that owns or manages health facilities, often using vertical integration.

2. A network consists of a number of healthcare facilities that agree to deliver specific services, with each facility remaining an independent organization.

3. An organized delivery system provides or arranges to provide a coordinated continuum of services to a defined population, and is willing to be held clinically and fiscally accountable for the outcomes and the health status of the population serviced.

4. A merger occurs when two or more organizations come together to form one organization.

Page Ref: 193-194 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

1 .

2) Which statement is true about hospital classification?

1. Hospital accreditation is voluntary.

2. Licensure of hospitals is provided by the Joint Commission.

3. To provide services, a hospital must be accredited, but not necessarily licensed.

4. For a hospital to receive Medicare and Medicaid reimbursement, it must be a notfor-profit hospital.

Answer: 1 Explanation: 1. Hospitals are accredited by the Joint Commission, a voluntary accreditation organization, and are used by healthcare organizations.

2. Licensure of hospitals is done by states when the hospital meets certain state standards and requirements.

3. To provide services, a hospital must be licensed, though it does not necessarily have to be accredited.

4. To receive Medicare and Medicaid reimbursement, the hospital must be certified to provide this care and must be accredited.

Page Ref: 195-197 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

2 .

3) University medical centers, pediatric hospitals, and burn centers are examples of what level of vertical integration?

1. Primary care hospital 2. Secondary care hospital 3. Tertiary care hospital 4. Specialty care hospital Answer: 3 Explanation: 1. Primary care hospitals are part of a comprehensive healthcare system providing outpatient or ambulatory care services.

2. Secondary care facilities require greater sophistication in equipment and skills than is seen in ambulatory surgical centers.

3. Tertiary-level hospitals require greater skills and equipment then primary and secondary care hospitals do, and are much more specialized.

4. Specialty care hospitals fall under the classification of tertiary care hospitals.

Page Ref: 192 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

3 .

4) New public relations materials are being developed for the hospital. Each department has been asked to submit a short description of its key activities. Which information should be used in the PR materials?

1. Administration is responsible primarily for ensuring quality and safety of care.

2. Respiratory care services provides goal-directed, purposeful activity to patients with disorders of the cardiopulmonary system.

3. Information management is focused on services that provide organized education designed to enhance skills of staff members or teach new skills.

4. Social work services assists individuals and their families in addressing social, emotional, and economic stresses associated with illness or injury.

Answer: 4 Explanation: 1. Although the administration is concerned with ensuring quality and safety, it typically is high-level management that provides direction and supports the work of the total organization.

2. Respiratory care services delivers care to provide ventilatory support, and clinical respiratory services provides activity to patients with cardiopulmonary needs.

3. Information management is responsible for computer resources and data collection.

4. Social work services is responsible for meeting the psychosocial and economic needs of patients and their families.

Page Ref: 197-199 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

4 .

5) The staff nurse has been invited to become a member of the hospital policy and procedure committee. What should the nurse expect in regard to this committee?

1. The committee will meet on an ad hoc basis but will have designated meeting times, will keep minutes, make decisions, and develop reports.

2. The decisions that the committee makes will be the final authority for policy and procedures in the facility.

3. The first step the committee will take to develop policies and procedures is to ask the administration to identify the overall objectives for the committee.

4. The committee will comprise 10 or more members, with a chairperson.

Answer: 3 Explanation: 1. This is a standing, permanent committee, not an ad hoc committee.

2. The committee works in an advisory capacity and therefore does not have the ultimate authority for the approval of a policy or procedure.

3. The first step in the processes needs to be formulation of objectives for the policy and procedure committee; otherwise, the committee will not be organized or effective.

4. The policy and procedure committee should be limited in size from six to eight members, with terms of at least two years.

Page Ref: 203-205 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

5 .

6) Which statement about change in hospitals reflects the impact on nursing?

1. Nurses need to gather more data about the positive effects that nursing care has on patient outcomes in the acute care setting.

2. Nurses need to advocate for more unlicensed assistive personnel (UAP) to help nurses provide quality, low-cost care.

3. Nurses need to be more assertive in obtaining longer hospital stays for patients who have not reached their expected outcomes due to complications.

4. Nurses continue to provide patient education without difficulty despite changes occurring in hospitals.

Answer: 1 Explanation: 1. Some studies support the positive effects nursing care has on patient outcomes in the acute care settings; nurses need data to demonstrate that decreasing nursing staff in hospitals will increase patient complications and affect outcomes negatively.

2. The increasing number of UAPs has increased staff stress and concern for errors and potential legal consequences.

3. Rather than advocating for longer hospital stays, nurses should be more focused on the prevention of complications.

4. Providing patient education in acute care has become even more difficult with the decreasing length of stay. Patients are sicker when they enter the system and their length of stay is shorter, so they are not able to absorb patient education information.

Page Ref: 212-218 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Analyze major changes that are occurring in acute care and their impact on nursing.

6 .

7) What does the Nurse Manager Engagement Project focus on primarily?

1. Staff engagement 2. Nurse manager retention 3. Nurse manager and staff retention and engagement 4. Nurse manager engagement Answer: 4 Explanation: 1. The project is focused on nurse managers.

2. The project does not consider the use of the term "retention" of nurse managers to be the critical issue.

3. Nurse manager retention is important, but not the most effective perspective.

4. Nurse manager engagement is a more comprehensive view than retention and is a positive perspective.

Page Ref: 219 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Discuss the need for leadership and leadership development in acute care healthcare organizations.

7 .

8) The nurse is looking for a formal, approved description of how a clinical care process is carried out in the facility. Where should this nurse look for this information?

1. Professional performance standards 2. Nurse practice act 3. Policy and procedure manual 4. Joint Commission manual Answer: 3 Explanation: 1. Professional nursing standards will offer some description of how the clinical care process should be carried out, but the nurse should look for how it is to be carried out in this facility.

2. Each state or province's nurse practice act defines the practice of nursing within that area. This document does not describe how to carry out specific nursing processes.

3. The policy and procedure manual will give a description of the nursing care process and directions on carrying it out for a specific healthcare organization.

4. The Joint Commission sets global performance standards for nursing and other departments in the hospital, but does not give specific direction on the completion of nursing activities.

Page Ref: 200 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

8 .

9) A physician has just purchased a medical practice from a physician who is retiring.

One of the patients seen today requires hospitalization. Can the new physician admit this patient to the local hospital?

1. If the retiring physician admitted patients to the hospital, the new physician is also allowed to admit patients.

2. Only after the new physician is credentialed and privileged to admit patients.

3. If the patient has been hospitalized before in this hospital, the physician can readmit the patient.

4. It depends on whether the new physician also purchased rights of admission.

Answer: 2 Explanation: 1. The status of the new physician is not dependent upon the status of the retiring physician.

2. Each physician, advanced nurse practitioner, and nurse-midwife who wants to admit patients to a hospital must go through the process of credentialing and privileging.

3. Whether the patient has been admitted before or not is not a determinant of the physician's right to admit.

4. Right to admit is not purchased.

Page Ref: 194 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

9 .

10) The chief nurse executive (CNE) of a hospital frequently visits with on-staff physicians, both in a formal and informal manner. What is the primary purpose of this interaction?

1. This interaction is a job requirement of the CNE. 2. The CNE believes that socializing with physicians builds social status.

3. This interaction can help to build strong, positive work relationships with the medical staff.

4. Interacting with physicians helps to strengthen the image of nursing.

Answer: 3 Explanation: 1. This may be true, but it is not the most important reason for this action.

2. This may be true, but it is not the most important reason for this action.

3. While all of these options may be in some ways true, the most important reason for this socialization is to build a strong, positive relationship with the medical staff.

4. This may be true, but it is not the most important reason for this action.

Page Ref: 193-194 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

10 .

11) The nursing student is preparing a presentation on hospital ownership. Which hospitals should the student include as generally being not-for-profit? Select all that apply.

1. Community hospitals 2. Faith-based hospitals 3. Veterans Administration hospitals 4. Bureau of Indian Affairs hospitals 5. Rural hospitals Answer: 2, 3, 4 Explanation: 1. These hospitals can be either for-profit or not-for-profit.

2. Faith-based hospitals are generally not-for-profit organizations.

3. This is an example of a governmental hospital, which is generally not-for-profit.

4. This is an example of a governmental hospital, which is generally not-for-profit.

5. These hospitals can be either for-profit or not-for-profit.

Page Ref: 196-197 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

11 .

12) Choose the typical reporting matrix for the fastest growing type of hospital in the United States.

1. Middle managers report to the administration, who reports to the governing board.

2. Middle managers report to the governing board, who reports to the chief operating officer.

3. The administration reports to the governing board, who reports to the shareholders.

4. The administration reports to the shareholders, who report to the governing board.

Answer: 3 Explanation: 1. This is the typical reporting matrix for a not-for-profit hospital. This is not the fastest growing type of hospital in the United States.

2. This reporting matrix is not correct for either for-profit or not-for-profit hospitals.

3. For-profit hospitals are the fastest growing type in the United States. In this system, the administration reports to the governing board, who is responsible to the shareholders.

4. In for-profit hospitals, the final authority is the shareholders.

Page Ref: 193-194 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

12 .

13) The hospital is considering contracting with an outside company for clinical laboratory services and closing its in-house lab. What concerns should be considered prior to making this decision? Select all that apply.

1. This is not legal.

2. Outside laboratories often do not provide quality services.

3. The Joint Commission will not accredit hospitals without their own clinical laboratory.

4. The hospital is still responsible for the quality of laboratory services provided.

5. It may be most cost-efficient to contract out for laboratory services.

Answer: 4, 5 Explanation: 1. This is a legal alternative to in-house laboratory services.

2. These labs generally deliver high-quality service.

3. The Joint Commission has no standard against having a contracted laboratory.

4. This is a true statement.

5. This is a true statement.

Page Ref: 197-198 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

13 .

14) The chief nurse executive of a hospital is often responsible for supervising nurses that do not work only in nursing services. In which other departments might these nurses work? Select all that apply.

1. Diagnostic procedures 2. Finance and budget 3. Material and resource management 4. Infection control 5. Infusion therapy Answer: 1, 4, 5 Explanation: 1. Nurses often work in areas such as endoscopy, which is a diagnostic procedure.

2. Nurses should be well aware of the issues and concepts in finance and budget, but are generally not employed in that specific department.

3. Nurses should be well aware of the issues and concepts in material and resource management, but are generally not employed in that specific department.

4. Nurses are very involved in the infection control department, with a nurse often serving as the department head.

5. Nurses are very involved in the infusion therapy department, with nurses often serving as those who start and manage Ⅳ therapy.

Page Ref: 194-195 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

14 .

15) A committee has been formed to organize the celebration of the hospital's 50th anniversary. The committee will meet for one year. What type of committee is this?

Select all that apply.

1. Focus 2. Task force 3. Ad hoc 4. Service 5. Standing Answer: 2, 3 Explanation: 1. This is not a name for this type of committee that was discussed in the textbook.

2. These short-term but official committees are called task forces or ad hoc committees.

3. These short-term but official committees are called task forces or ad hoc committees.

4. This is not a name for this type of committee that was discussed in the textbook.

5. Standing committees are committees that meet regularly and have no identified time for disbanding.

Page Ref: 200 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

15 .

16) The nursing policy and procedure committee has issued the procedure for implementing the use of a new type of equipment. What information should be included in this procedure? Select all that apply.

1. Effective date of the procedure 2. The date the procedure will be reviewed in the future 3. Who is responsible for the final review of the procedure 4. The date that policy was approved by the Joint Commission 5. The name and credentials of all members of the committee that approved the procedure Answer: 1, 2, 3 Explanation: 1. It is essential for the procedure to list the date it becomes effective.

2. By setting a future review date, it is more likely that the procedure will be reviewed in a timely manner and not overlooked.

3. The responsibility for final review of the procedure is required.

4. It is not necessary for the Joint Commission to approve this procedure.

5. The name and credentials of the members of the committee are a part of the committee records, not a part of each procedure.

Page Ref: 206 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

16 .

17) A 43-year-old patient who has sustained an accidental laceration to the forearm is brought to the emergency department by family. It is determined that the laceration will need repair with sutures, but the patient refuses treatment, saying, "I'll just pull it together with some tape when I get home." What action should be taken by the nurse?

1. Insist that the patient have the suture repair.

2. Tell the patient that the family will have to make that decision.

3. Have the patient sign a refusal of treatment form.

4. Tell the patient that it is a violation of the Emergency Medical Treatment and Active Labor Act of 1986 to allow a patient to leave without treatment.

Answer: 3 Explanation: 1. Medical personnel cannot insist that a competent adult patient receive care.

2. The patient makes this decision.

3. The nurse should have the patient sign this document as a part of the record of the visit.

4. This act was passed to prevent the hospital from refusing to treat patients without insurance and to prevent hospitals from "dumping" these patients in other emergency departments.

Page Ref: 213-215 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze major changes that are occurring in acute care and their impact on nursing.

17 .

18) What is the purpose of using a line of sight survey?

1. Provides data about how a nurse manager spends his or her time and how this contributes to the goals 2. Provides information about the quality of care on a unit and the strategic plan 3. Provides staff with information about the manager's performance 4. Provides data for the hospital board to understand staff functions Answer: 1 Explanation: 1. This is the purpose of a line of sight survey.

2. This survey is focused on personal appraisal.

3. The line of sight survey is a self-appraisal that would not necessarily be shared with staff.

4. The survey is done by nurse managers to help them focus on positive steps they have taken to meet goals.

Page Ref: 219 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Discuss the need for leadership and leadership development in acute care healthcare organizations.

18 .

19) A hospital is expanding its ambulatory surgery department. You are chair of the committee to plan this expansion. You want to ensure relevant departments are represented. Who might be represented other than nursing and physicians? Select all that apply.

1. Pharmacy 2. Pathology 3. Medical records 4. Patient transportation 5. Admissions Answer: 1, 2, 3, 4, 5 Explanation: 1. This department is relevant to care provided.

2. This department is relevant to care provided.

3. This department is relevant to care provided.

4. This department is relevant to care provided.

5. This department is relevant to care provided.

Page Ref: 200 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

19 .

20) You are on the policy and procedure committee, and today the committee is beginning work on a new policy related to the use of restraints. What would be the key question the committee should ask first?

1. Who should make the decision and when?

2. What are the state and federal laws related to restraints?

3. What is the decision to be made and why?

4. What data do we have about the use of restraints in the last year?

Answer: 3 Explanation: 1. Who will initiate restraints is important, but not the first question to ask.

2. Laws should be considered, but later as policy content is developed.

3. This is the critical first question to consider.

4. It is important to review these data as the policy is developed.

Page Ref: 201-206 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine the framework for effective care within acute care settings.

20 .

21) The hospital has purchased software that prints patient education material for numerous situations. What is the nurse's responsibility regarding these materials?

Select all that apply.

1. The nurse should read the material and assess it carefully for accuracy.

2. If possible, nursing should participate in the development of these materials.

3. The nurse has no responsibility outside distributing the material to the correct patient.

4. The nurse should carefully document that these materials were given to the patient.

5. The nurse should adapt the material to the individual patient.

Answer: 1, 2, 4, 5 Explanation: 1. This is a critical action anytime the nurse gives any information to the patient.

2. This is a good idea if possible.

3. The nurse always has responsibility for the care of the patient.

4. This is a critical action anytime the nurse gives any information to the patient.

5. This is a critical action anytime the nurse gives any information to the patient.

Page Ref: 215-216 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze major changes that are occurring in acute care and their impact on nursing.

21 .

22) Which options can be used to describe U.S. hospitals? Select all that apply.

1. An organization with a purpose 2. Provides continuous nursing services under the supervision of registered nurses 3. Delivers predominantly primary care but also can provide secondary and tertiary care 4. Follows standards established by laws, regulations, and accreditation 5. Must be accredited by the Joint Commission Answer: 1, 2, 4 Explanation: 1. This statement could be used to describe a hospital.

2. This statement could be used to describe a hospital.

3. U.S. hospital care is primarily secondary care, though other services related to primary care such as clinic services and wellness programs also are services that a hospital may offer. Tertiary care could be delivered in a hospital, for example, in a hospital-based hospice unit.

4. This statement could be used to describe a hospital.

5. Hospitals do not have to be accredited by the Joint Commission. This accreditation is voluntary.

Page Ref: 192194 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the development of U.S. acute care services and their role in the healthcare delivery system.

22 .

23) Which options reflect key factors affecting healthcare delivery? Select all that apply.

1. Problems with patient access 2. The aging population 3. A decrease in new drug therapies 4. An increase in specialty usage 5. An increase in the number of single-parent families Answer: 1, 2, 4, 5 Explanation: 1. Eligibility for government benefits such as Medicaid, transportation, hours of operation, number and type of providers, child care, and cost of care are examples of patient access problems.

2. Changing demographics are a key factor in the changing face of healthcare.

3. There has been an increase in new drug therapies.

4. Increase in specialty usage can lead to fragmentation of care and increased cost.

5. Changing demographics are a key factor in the changing face of healthcare.

Page Ref: 212-213 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Analyze major changes that are occurring in acute care and their impact on nursing.

23 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 7 Public/Community Health: Expansion and Need for Leadership 1) What is the primary message in the N AM report The Future of the Public's Health in the 21st Century?

1. Quality improvement focuses primarily on acute care.

2. Healthcare professionals are prepared for public health.

3. Healthcare inequality is not a problem.

4. Health is a primary good for the public.

Answer: 4 Explanation: 1. Quality improvement is not just important for acute care and is not the primary message of this report.

2. Health professions need more preparation for public health, and this is not the primary message of this report.

3. There is an equality problem, but this is not the primary message of this report, though related to the primary message.

4. This is the primary message; many aspects of society are dependent on healthy people.

Page Ref: 227 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Discuss examples of critical influences on public/community healthcare.

1 .

2) What is the most important federal government department for healthcare?

1. FDA 2. HHS 3. CMS 4. HRSA Answer: 2 Explanation: 1. Food and Drug Administration is not a department but an H HS agency.

2. U.S. Department of Health and Human Services is the most important federal department related to healthcare and is composed of multiple agencies that focus on specific health concerns.

3. Centers for Medicare & Medicaid Services is not a department but an H HS agency.

4. Health Resources and Services Administration is not a department but an H HS agency.

Page Ref: 228-229 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

2 .

3) Which of the following factors relate to Healthy People? Select all that apply.

1. The initiative is evidence-based.

2. Healthy People is reviewed and updated every 10 years.

3. The focus is acute care needs and services.

4. Individual health is the core for the initiative.

Answer: 1, 2 Explanation: 1. This is correct; evidence is used to formulate the goals and so on and then tracking of outcomes/indicators.

2. It is currently in review for the 2030 version.

3. The focus is on health promotion and prevention.

4. Healthy People does focus on individuals but also has a Healthy Communities aspect.

Page Ref: 229-230 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Discuss examples of critical influences on public/community healthcare.

3 .

4) Which of the following is not related to one of the core public health functions?

1. Establish a budget.

2. Investigate potential air pollution from a factory.

3. Identify stakeholders to work on community problem of drug abuse.

4. Ensure that the requirement for health inspections of restaurants is met.

Answer: 1 Explanation: 1. This is not related to a core function.

2. This is related to the core function of assessment.

3. This is related to the core function of policy development.

4. This is related to the core function of assurance.

Page Ref: 233 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

4 .

5) You are a member of a county health group that is working on improving health services to vulnerable populations in the community. Which of the following would be important to you as you do this work?

1. CDC 2. APHA 3. MAP-IT 4. HHS Answer: 3 Explanation: 1. The Centers for Disease Control offers resources, but you will need more than just resources to meet the goal.

2. The American Public Health Association provides education and resources, but you will need more than this to reach your goal.

3. MAP-IT (mobilize, assess, plan, implement, track) is a framework you could use to meet your goal; associated with Healthy Communities.

4. The U.S. Department of Health and Human Services provides resources, grants, and other services but not specific to meeting your goal.

Page Ref: 230-231 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

5 .

6) Nurses involved in population health may need to assess and develop strategies related to multiple concerns. Which concerns might be included? Select all that apply.

1. Work with religious leaders 2. Bus service to the medical clinics 3. Work with city services related to trash 4. Tell police where they need to patrol 5. Help identify alternative telephone access Answer: 1, 2, 3, 5 Explanation: 1. Nurses may collaborate with this group to develop social support.

2. Nurses may help identify need for access to services through transportation.

3. Nurses may work with city services in areas of environmental health such as sanitation.

4. Working in population health requires collaboration, not "directing" and telling police what they should do, which would not be a nursing responsibility.

5. Nurses may work with patients and families to determine how they might call for help if medical assistance is needed.

Page Ref: 233-234, 247-248 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

6 .

7) Which of the following interventions demonstrate secondary prevention?

1. Offer a stress management course to teens.

2. Teach students in elementary school about good nutrition.

3. Provide new parent education in local community center.

4. Expand services to train the blind in reading in the community.

Answer: 3 Explanation: 1. Intervention that focuses on wellness—primary prevention 2. Intervention that focuses on wellness—primary prevention 3. New parent education may be used to decrease health problems for young children—secondary prevention.

4. Decreases disability—tertiary prevention Page Ref: 236 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

7 .

8) What has not been considered a common reason for lack of preventive services?

1. Presence of a fragmented healthcare system 2. Lack of provider time with patients to explain preventive interventions 3. Limited types of preventive interventions 4. Lack of reimbursement for preventive services Answer: 3 Explanation: 1. The fragmented system lacks coordination.

2. Providers do not have enough time with patients.

3. This is not a common reason. We have many prevention interventions.

4. Reimbursement for these interventions has been a problem—though A CA is offering more reimbursement for the interventions, and this is still new.

Page Ref: 235-236 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

8 .

9) Which of the following public/community health services is now emphasized the most due to work done by the N AM and the ACA? 1. Home health 2. Primary care 3. Hospice care 4. Rehabilitation Answer: 2 Explanation: 1. Home care is expanding, but is not the most emphasized service.

2. Primary care is emphasized more now and needs to expand.

3. Hospice care is expanding, but is not the most emphasized service.

4. Rehabilitation is not the most emphasized service.

Page Ref: 237-238 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

9 .

10) Who typically leads a home health team?

1. Home health aide 2. Physician 3. Registered nurse 4. Social worker Answer: 3 Explanation: 1. This staff member is important, but not typically the team leader.

2. This staff member is important, but not typically the team leader.

3. An RN typically leads the home health team.

4. This staff member is important, but not typically the team leader.

Page Ref: 239 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

10 .

11) You want to establish a nurse-managed health center. Which of the following must you do to be designated as an N MHC? You must partner with a school of nursing or community-based nonprofit organization.

Care in the NMHC is provided by registered nurses.

Reimbursement is focused on any third-party payer.

NMHC services focus on comprehensive primary care and care of the older adult.

Answer: 1 Explanation: 1. NMHCs must partner with a school of nursing or, if not, with a community-based nonprofit organization.

2. NMHCs include interprofessional providers.

3. Reimbursement is primarily from Medicare, Medicaid, and C HIP. 4. Services focus on comprehensive primary care, family planning, prenatal services, mental/behavioral healthcare, health promotion, and disease prevention.

Page Ref: 238-239 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

11 .

12) Which of the following is important to address on a national level to increase healthcare professionals' participation in disasters?

1. Provide payment for these services.

2. Arrange for providers to be sent to areas where needed, not just their home states.

3. Focus on developing teams of professionals such as nursing teams, physician teams, and so on.

4. Clarify legal and ethical issues.

Answer: 4 Explanation: 1. Volunteers usually do this work.

2. It is better to have most professionals working in their local areas, where they are familiar with the location, needs, and people.

3. Teams should be interprofessional.

4. Healthcare professionals are concerned about potential legal and ethical issues, and this holds them back from volunteering.

Page Ref: 242-243 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the importance of disaster preparedness and related nursing roles.

12 .

13) According to the National Health Security Strategy, who should take the primary lead role in planning, providing resources, guiding others, and evaluating outcomes related to disaster preparedness?

1. HHS 2. State health departments 3. Healthcare organizations 4. Local health departments Answer: 1 Explanation: 1. The U.S. Department of Health and Human Services should assume the lead role.

2. This is a stakeholder but according to the strategy would not assume the lead role.

3. This is a stakeholder but according to the strategy would not assume the lead role.

4. This is a stakeholder but according to the strategy would not assume the lead role.

Page Ref: 241-243 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the importance of disaster preparedness and related nursing roles.

13 .

14) You are a member of a local community that experiences tornados. What major categories of activities should be included in an effective disaster plan? Select all that apply.

1. Response 2. Staffing 3. Prevention 4. Buying supplies 5. Recovery Answer: 1, 3, 5 Explanation: 1. This is one of the major categories found in an effective disaster plan.

2. This is one of the tasks found in one of the major categories in an effective disaster plan.

3. This is one of the major categories found in an effective disaster plan.

4. This is one of the tasks found in one of the major categories in an effective disaster plan.

5. This is one of the major categories found in an effective disaster plan.

Page Ref: 241-244 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the importance of disaster preparedness and related nursing roles.

14 .

15) Your disaster planning team is assessing the community to develop an effective disaster plan. What would you assess? Select all that apply.

1. Review data on health status of various vulnerable populations in the community.

2. Determine who will pay for damages to homes and businesses.

3. The types of healthcare services available and how easy it would be to get to them in a disaster.

4. Review data about past individual purchases of food and water when warned of a potential storm.

5. What social institutions, including religious, have been involved in the past and how they could be involved in the future.

Answer: 1, 3, 4, 5 Explanation: 1. Recognize the importance of health needs of the population.

2. Determining who will pay for damages is important, but not done until a disaster actually occurs; could vary depending on the disaster.

3. Access to services should be assessed.

4. Assessing community planning in the past, including individuals, is important.

5. Assessing social conditions and community support is important.

Page Ref: 242 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the importance of disaster preparedness and related nursing roles.

15 .

16) Which organization provides opportunities to develop nurse leadership globally?

1. WHO 2. STTI 3. ICN 4. ICRC Answer: 3 Explanation: 1. The World Health Organization does not have a specific program on developing nurse leaders globally.

2. The Sigma Theta Tau International does not have a specific program on developing nurse leaders globally.

3. The International Council of Nurses has a program, Global Nursing Leadership Institute, to help develop nursing leadership globally.

4. The International Committee of the Red Cross does not have a specific program on developing nurse leaders globally.

Page Ref: 245 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Discuss critical global health concerns and their relationship to U.S. healthcare.

16 .

17) Which NAM report is important when discussing nursing leadership?

1. Crossing the Quality Chasm 2. Health Professions Education 3. The Future of Nursing 4. To Err Is Human Answer: 3 Explanation: 1. This report focuses on status of the quality of care.

2. This report focuses on health professions education.

3. This report focuses on the need for more nursing leadership in healthcare delivery.

4. This report focuses on health safety and errors.

Page Ref: 246 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

17 .

18) As a nurse who has just assumed a position as director of nursing for a county health department, you are now confronted with the department budget. You have been in management for some time in healthcare organizations. What is the major difference in the county budget?

1. Budget revenues are larger than for a hospital.

2. There is dependency on funding from government sources (local, state, federal).

3. Expenses are greater for the department than for a hospital.

4. Physician costs are higher for the clinics compared to the hospital staff.

Answer: 2 Explanation: 1. Revenues are smaller, as they are dependent on Medicaid and Medicare, and often there is no reimbursement either because the patient has no reimbursement or the service does not receive reimbursement such as for an education program on diabetes.

2. This factor is the major difference.

3. Expenses would most likely be less, as the department does not have major expenses such as equipment, highly skilled physicians such as surgeons, supplies, and so on.

4. There would be more physicians in a hospital.

Page Ref: 247-248 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

18 .

19) Why is staffing a more complex issue for a county health department than for a hospital?

1. Stakeholders are more varied and complex.

2. Nurses need to have a B SN. 3. Community requires a higher ratio of nurses than a hospital.

4. Personal safety is more of a concern in the hospital setting.

Answer: 1 Explanation: 1. There is a need to meet very different patient and community needs, thus requiring varied competencies and work with varied stakeholders.

2. The requirement for nurses having a B SN is the same for acute care hospitals and for public/community health.

3. Required ratio of nurses is highly variable, and the public/community setting does not necessarily and most likely does not require more nurses.

4. Personal safety is more of a concern in the community—travel, safety in certain communities, going into homes and not always sure what one will find, going into high-risk areas for crime and substance abuse.

Page Ref: 248 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

19 .

20) Why is it more challenging to get staff who work in public/community services engaged in CQI than in the hospital?

1. CQI is not as critical to care in the community.

2. A CQI plan is better in the hospital.

3. The need for data collections is more important in the community.

4. Community staff are more dispersed.

Answer: 4 Explanation: 1. CQI is important in all areas of healthcare delivery.

2. The effectiveness of a CQI plan should not vary from a hospital or community.

Implementation may be a problem, but not the plan.

3. The need for data collection is the same for the community and the hospital–both need data, but how one gets the data may be different.

4. Having staff dispersed means it is more difficult to turn to a colleague or have regular interaction face-to-face about CQI. Page Ref: 248 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

20 .

21) As director of nursing for a city health department you are challenged with providing staff education. What would be a major difference for you compared to a hospital staff education program?

1. You have staff who are less interested in staff education.

2. You have less budget or fewer on-site staff educators.

3. Nursing schools place their students in hospitals, reducing the influence of faculty and students in the community settings.

4. Health literacy problem exists in the community and in the hospital.

Answer: 2 Explanation: 1. Staff in community health are not necessarily less interested in their own education.

2. There is less budget and few, if any, on-site staff educators in public/community health.

3. Schools of nursing have required public/community health clinicals and assign students to these services.

4. This is correct and so not a major difference.

Page Ref: 247-248 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

21 .

22) What is the difference in how a nurse addresses the problem of health literacy in the community as compared with acute care?

1. In the community, health literacy is viewed in the same way as in acute care.

2. In the community, the nurse must consider individual needs and group needs.

3. In the community, nurses have less involvement in health literacy, as social workers focus on this problem.

4. Health literacy is best viewed from an individual patient's needs to effectively resolve health literacy problems.

Answer: 2 Explanation: 1. Basic health literacy principles are the same but the assessment, specific problems, and strategies would be different and have a long-term impact.

2. The community is made up of individuals and groups and both need to be considered.

3. All of the healthcare team need to be involved in meeting community needs.

4. The individual is important and must be considered in the community but so must group- or population-focused needs.

Page Ref: 248 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply nursing leadership and management in the community.

22 .

23) Public health impacts many aspects of the country, including which of the following?

Select all that apply.

1. Economic 2. Families 3. Employment 4. Social relationships 5. Politics Answer: 1, 2, 3, 4, 5 Explanation: 1. Public health impacts economics.

2. Public health impacts families.

3. Public health impacts employment.

4. Public health impacts social relationships.

5. Public health impacts politics.

Page Ref: 226-228 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss examples of critical influences on public/community healthcare.

23 .

24) The National Prevention Strategy (NPS) focuses on which of the following elements? Select all that apply.

1. Healthy and safe community environments 2. Treatment of disease 3. Public/community empowered staff 4. Elimination of health disparities 5. Clinical and community preventive services Answer: 1, 3, 4, 5 Explanation: 1. Healthy and safe community environments constitute one of the N PS elements.

2. Treatment of disease is not prevention of disease.

3. The NPS focuses on empowered people in the community.

4. Elimination of disparities is one of the NPS elements.

5. Clinical and community preventive services constitute one of the NPS elements.

Page Ref: 234-235 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

24 .

25) What is a major setting in public/community health services?

1. Hospitals 2. Clinics 3. School health 4. Hospice unit Answer: 2 Explanation: 1. The hospital is acute care.

2. The clinic is the major type of healthcare setting in public/community health.

3. School health is part of public/community health, but not the major setting.

4. Hospice unit is part of public/community health, but not the major setting.

Page Ref: 237 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Quality and safety, relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine public/community models and services.

25 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 8 Recruitment and Retention: Meeting Staffing Requirements 1) The nurse who wishes to apply for a job in a healthcare organization is asked to visit the human resources department. What services can the nurse expect to be delivered through this department? Select all that apply.

1. Orientation of employees 2. The development of policy and procedures for its operation 3. Managing credentials 4. Educating and testing staff 5. Licensing staff Answer: 1, 2, 3, 4 Explanation: 1. The key focus areas of the human resources department are human resources planning, orienting, training, and educating staff; assessing competence; and managing staff requests.

2. The key focus areas of the human resources department are human resources planning, orienting, training, and educating staff; assessing competence; and managing staff requests.

3. The key focus areas of the human resources department are human resources planning, orienting, training, and educating staff; assessing competence; and managing staff requests.

4. The key focus areas of the human resources department are human resources planning, orienting, training, and educating staff; assessing competence; and managing staff requests.

5. Licensing staff is not under the jurisdiction of human resources, but is the responsibility of state and national boards.

Page Ref: 257 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

1 .

2) An employee who works in the dietary department of the hospital develops H IV. The employee does not have a record of excessive absences or errors. What law protects the employee from being fired?

1. Americans with Disabilities Act (A DA) 2. Wagner Act of 1935 3. Civil Rights Act of 1964 4. Affirmative Action Answer: 1 Explanation: 1. The Americans with Disabilities Act of 1990 prohibits discrimination in hiring and job assignments based on disability.

2. The Wagner Act of 1935 and the Taft-Hartley Act of 1948 prohibit discrimination based on union membership.

3. The Civil Rights Act of 1964 prohibits discrimination in employment on the basis of race, color, sex, religion, or national origin.

4. Affirmative Action is a set of executive orders, not laws, that protect minority groups but apply only to government agencies and organizations that do business with the government. These organizations must hire members from these protected classes, "In proportion to the population of people in each class in their community."

Page Ref: 258 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

2 .

3) A newly hired nurse is requesting information about the Family and Medical Leave Act of 1996. What is the best explanation of this benefit?

1. This law protects the employee from getting fired for taking 15 weeks of sick leave when needing to care for a family member.

2. The law protects the employer when employees want to take sick leave to adopt a child.

3. The law only pertains to employers of 25 or more employees who work within a 50-mile radius.

4. For employees who are eligible, it covers 12 weeks of unpaid leave during a 12month period for medical or emotional reasons, which include birth, adoption, and care of immediate family members.

Answer: 4 Explanation: 1. The law only provides for 12 weeks of unpaid sick leave.

2. Adoption is one of the covered situations.

3. The law pertains to employers of 50 or more employees who work within a 75mile radius.

4. This is the description of the law.

Page Ref: 259 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

3 .

4) The nurse manager has been asked to update all of the position statements for the unit. What sources should this manager use to learn more about each position?

Select all that apply.

1. Observation of performance of the job 2. Interviews with staff members who hold the position 3. Discussion with the governing board 4. Feedback from other organizations 5. Discussions with other supervisors and managers Answer: 1, 2, 4, 5 Explanation: 1. Observing the performance of the job will give the manager direct information about what the job description should include.

2. Input from staff members who actually perform the job will be helpful in writing a job description.

3. The governing board is not likely to have significant information about individual jobs in the organization.

4. Examples and feedback from organizations with similar job positions can be helpful to this work.

5. Discussing the job with other supervisors and managers and getting their feedback can be helpful with this work.

Page Ref: 262-263 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

4 .

5) The director of human resources is explaining procedures to a newly hired administrative assistant. Which instruction should the director provide to this employee?

1. Do not require candidates to complete an application if they submit a résumé.

2. Look carefully at each application that is submitted to be certain it is complete.

3. Advise candidates that the style or format of their résumé doesn't make a difference.

4. Screen all candidates only after résumés have been submitted.

Answer: 2 Explanation: 1. Candidates should be required to complete the organization's application to protect the organization legally and to provide one consistent source of information.

2. Careful review of applications as they are submitted can lead to time savings in the long run.

3. The format or style of a résumé should be easy to review and should provide an overall picture of the candidate.

4. Screening of candidates is done at various times in the enrollment process.

Page Ref: 263 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss the importance of recruitment and the employment process.

5 .

6) Which question is appropriate to ask a nurse during the job interview?

1. "What church do you attend?"

2. "What are your plans for having a family?"

3. "Why should we hire you?"

4. "What is your year of birth?"

5. "Where were you born?"

Answer: 3 Explanation: 1. The interviewer cannot ask this question because it might lead to discrimination based upon religion.

2. The interviewer cannot ask this question because it might lead to discrimination based upon family status.

3. The interviewer can ask questions such as this one in order to assess the applicant's fit within the organization.

4. The interviewer cannot ask this question because it might lead to discrimination based upon age.

5. The interviewer cannot ask this question because it might lead to discrimination based upon nationality.

Page Ref: 264-265 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

6 .

7) Which question, asked by the nurse applying for a new position, is the least critical?

1. "What is the salary?"

2. "What level of work is required?"

3. "What kind of leadership does the nursing department use?"

4. "Is there a clinical ladder or something similar?"

Answer: 1 Explanation: 1. The least important of these questions is about salary. Salary is often negotiable during the application process.

2. The applicant must decide if the level of work expected meets the nurse's career goals and personal goals.

3. The applicant should assess the leadership to see if the style is comfortable for the applicant.

4. The applicant should ask about the possibility of advancement. Asking about a clinical ladder will provide information about the organization's focus on advancement and learning.

Page Ref: 264-266 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

7 .

8) What method might an H CO use to avoid E EOC problems during staff recruitment and employment?

1. Communicate that it is important for staff members to feel as if they are doing a good job in their positions.

2. Use of standardized application forms used for all applicants.

3. Helping staff members develop their career path along the lines of their greatest interests.

4. Keep notes about new applicants but not for promotions.

Answer: 2 Explanation: 1. EEOC is not concerned with staff satisfaction about their jobs.

2. Using a standardized form helps to reduce discrimination when all are asked for the same information that meets legal requirements such as for the EEOC. 3. EEOC is not concerned with career advancement for staff.

4. It is important to keep notes about applicants and also for staff promotions and terminations to document decision making.

Page Ref: 258 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

8 .

9) The newly licensed nurse has accepted her first hospital position and is scheduled to attend orientation. The nurse had a previously scheduled vacation booked for the orientation week and asks the human resources director, "What is orientation? Is it okay if I miss it for my vacation?" What is the director's best response?

1. Orientation is provided to all new employees.

2. Orientation will teach you about policy and procedure and benefits.

3. You will be assigned to a preceptor who will help you increase your confidence and competence in the clinical setting.

4. In orientation, you will be provided with the information and tools you need to begin your position with the organization.

Answer: 4 Explanation: 1. This is a fact, but it is not a clear explanation of the benefits of this nurse's attendance.

2. This is a fact, but it is not a clear explanation of the benefits of this nurse's attendance.

3. This is the long-term part of orientation. This statement does not address the need for the nurse to attend orientation.

4. This is the clearest explanation of why orientation is essential to this nurse.

Page Ref: 275, 284 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Analyze the issue of retention and its impact on staff and quality care.

9 .

10) The nurse is about to experience the first performance appraisal of a new job. What should the nurse expect about this appraisal? Select all that apply.

1. It is the only time the nurse manager will provide positive feedback regarding the nurse's work.

2. It is a time for the manager to show support and encouragement for the nurse.

3. It is a time for the manager to initiate a discussion about any areas where the nurse needs improvement.

4. It is an opportunity for the manager to provide feedback, direction, and leadership.

5. It is a time when much of the discussion will concern competencies.

Answer: 2, 3, 4, 5 Explanation: 1. The manager should provide feedback throughout the work time, not just during performance appraisals.

2. Support and encouragement are particularly important for a beginning nurse.

3. If there are areas in which the nurse needs improvement, this is a good time for a private discussion of those needs and planning how to improve.

4. This is the global purpose of performance appraisals.

5. Competency-based performance appraisals are becoming the norm.

Page Ref: 275-276 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Apply the performance appraisal process.

10 .

11) The nurse has a performance appraisal appointment with the nurse manager today.

What topics would the nurse be surprised to find discussed in this appraisal? Select all that apply.

1. Salary 2. Systems that do not work 3. Change in position 4. Another nurse's work difficulties 5. The nurse's accomplishments Answer: 2, 4 Explanation: 1. Salary negotiations are a part of this appraisal.

2. The performance appraisal is not a time for the manager to discuss systems that do not work. Rather, the manager should discuss systems that would help the nurse improve.

3. Changes in positions are a part of this discussion.

4. It is not appropriate for the manager to discuss another nurse's work during a performance appraisal.

5. The manager should discuss the nurse's accomplishments during the performance appraisal.

Page Ref: 275-276 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Apply the performance appraisal process.

11 .

12) Many strategies have been identified to prevent or decrease stress and incivility in the work setting. What strategies would be helpful? Select all that apply.

1. Clarify expectations of how assignments are to be completed.

2. Hold the overall expectation that the work will be done.

3. Accept the staff member's apologies for poor performance.

4. Avoid being defensive.

5. Seek out the truth of situations.

Answer: 1, 2, 4, 5 Explanation: 1. Clarifying expectations will leave no doubt of what is to be done and will combat the passive resistance for fulfilling tasks that is common in passive-aggressive behavior.

2. Holding high expectations will combat the passive resistance for fulfilling tasks that is common in passive-aggressive behavior.

3. Apologies and excuses for work undone or problems caused by employee's passive-aggressive behaviors should not be tolerated.

4. The manager should avoid being defensive.

5. Seeking the truth and expecting facts will drive performance.

Page Ref: 283-285 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Examine strategies that can be used to prevent or decrease stress and incivility in the work setting.

12 .

13) Healthcare organizations have used numerous strategies to resolve the nursing shortage. Which of these strategies has been least successful?

1. Use of mandatory overtime 2. Use of float staff 3. Teaching staff how to cope with inadequate staffing 4. Use of unlicensed assistive personnel Answer: 1 Explanation: 1. Use of mandatory overtime has become a common strategy for handling the staffing shortage, and one that has had serious consequences affecting ability to work, health of staff, retention, quality, and safety.

2. Use of float staff is a strategy that has had some success in helping relieve shortages.

3. Teaching staff how to cope with inadequate staffing does not supply additional staff, but does help staff make the best use of resources available.

4. This has been a strategy that has met some resistance, but can be helpful if used with planning and education of staff.

Page Ref: 293-295 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 06. Discuss staffing issues that impact care and staff retention and recruitment.

13 .

14) An employee's performance has been worse than expected. Which comment would be a barrier to an effective performance evaluation?

1. "Your documentation is really very good."

2. "I see that you are very emotional right now. Maybe it would be better to reschedule this interview."

3. "Are you telling me that my management style is not effective?"

4. "I would like to recommend that you seek assistance from the Employee Assistance Program."

Answer: 3 Explanation: 1. It would be effective to begin with some positive feedback, if possible.

2. It would be appropriate to reschedule the interview if the employee cannot control personal emotions.

3. The interviewer should not become defensive, but should stay on the subject of performance and expectations.

4. The supervisor may recommend that the employee seek assistance from the EAP for emotional problems or substance abuse problems.

Page Ref: 275-277 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Apply the performance appraisal process.

14 .

15) The newly licensed RN has accepted a position in a hospital. What are common actions expected of this new employee?

1. Being proficient in the use of the technology used by the facility 2. The ability to function efficiently within the first month of assuming the new position 3. Having an understanding of hospital policies 4. Possessing the necessary theoretical background to perform basic patient care and decision making Answer: 4 Explanation: 1. It is not an expectation of employers that new employees be proficient in all technology. Technology varies from facility to facility and from nursing program to nursing program and it changes frequently.

2. It is not an expectation that the new nurse be proficient in the new job in a month.

3. Employers expect that new employees know where to go or whom to ask for clarification of hospital policies, and that they eventually understand them.

4. Employers expect that after passing N CLEX-RN the new graduate will have the ability to provide basic patient care and to possess some critical thinking abilities.

Page Ref: 288 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 06. Discuss staffing issues that impact care and staff retention and recruitment.

15 .

16) The staff nurse has a question regarding an employment benefit. The nurse manager is unable to answer the question and suggests that the nurse contact the human resources department. The nurse states, "Oh never mind, they are so unfriendly down there and can never help you anyway." This statement reflects what basic issue?

1. The nurse's inability to ask the question logically 2. The nurse manager's incompetence in being unable to answer the question 3. The human resources department's failure to demonstrate support for the employees 4. The nurse's laziness in not seeking out the answer Answer: 3 Explanation: 1. There is no evidence that this nurse cannot ask the question in a logical manner.

2. The nurse manager does not have to know everything, but should be able to lead the staff to a place where answers are obtainable.

3. The job of the human resources department is to support the employees and to display a helpful attitude. If this nurse's comment is correct, the HR department in this facility has failed to do so.

4. There is no indication that this nurse is lazy.

Page Ref: 256-257 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

16 .

17) Choose the typical components of a job or position description. Select all that apply.

1. Status: full-time, part-time, temporary 2. Education requirements 3. Work experience requirements 4. Stress level 5. Gender Answer: 1, 2, 3 Explanation: 1. Schedule is important to include.

2. Education is part of qualifications and needed.

3. Work experience needed to meet current requirements should be described.

4. Stress is typically not listed; stress is highly subjective.

5. Including gender can be interpreted as discrimination and would not be listed.

Page Ref: 263-265, 276 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how the human resources department assists the healthcare organization and its employees in recruitment and retention of staff.

17 .

18) The nurse manager is reviewing the résumés of several applicants for an open position. What items should alert the nurse manager to possible problems with an applicant? Select all that apply.

1. Gaps in dates 2. Overemphasis on education 3. Data listed in reverse chronological order 4. Poor grammar 5. More emphasis on earlier jobs than on recent jobs Answer: 1, 2, 4, 5 Explanation: 1. This can be an indicator that the applicant did not supply all of the information or that there was a gap in the applicant's work history or academic progress. What happened in the gap?

2. This may indicate that the applicant has very little practical experience in the field.

3. This is a common format for listing experience, jobs, education, and recognitions.

4. This can indicate inadequate education, poor attention to detail, or poor command of the English language.

5. This may indicate that the recent job performance was unsatisfactory.

Page Ref: 263-264 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Discuss the importance of recruitment and the employment process.

18 .

19) The nurse who has applied for a new position has been called for an interview.

Several staff members will be on the interview committee. What can the nurse expect from this process?

1. The nurse being interviewed will be in control of the flow of the interview.

2. All those on the interview committee will have been provided a copy of the nurse's résumé and application.

3. One staff member on the committee will ask all of the interview questions.

4. The nurse will be informed of the committee's decision immediately at the close of the interview.

Answer: 2 Explanation: 1. The chairperson of the interview committee will be in charge of the flow of the interview.

2. This is a common practice. All interview committee members should have access to information about the person being interviewed.

3. Generally, questions are asked by all or several of the committee members.

4. The committee may have other candidates to interview, so the decision is generally released to the applicant at a later date.

Page Ref: 267-269 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Discuss the importance of recruitment and the employment process.

19 .

20) The nurse has submitted applications for several positions and has been interviewed for three of the positions. However, the nurse has not been offered any of the jobs or been asked to come for a second interview. What should the nurse do? Select all that apply.

1. Review the résumé for omissions.

2. Review how he or she is coming across in the interview.

3. Review communication style.

4. Review the résumé cover letter for appropriateness.

5. Review how strengths are being emphasized.

Answer: 2, 3, 5 Explanation: 1. The nurse is getting some interviews, so the résumé is not likely to need revision.

2. The nurse may not be presenting him- or herself in the best possible manner.

3. The nurse may lack the ability to communicate well with the committee.

4. The nurse is getting some interviews, so the résumé cover letter is not likely to need revision.

5. The nurse may be overemphasizing strengths or not emphasizing them enough.

Page Ref: 270-271 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Discuss the importance of recruitment and the employment process.

20 .

21) The hospital has experienced an increased turnover in its professional nursing staff.

What items should be included in the cost of this turnover? Select all that apply.

1. Interviewing costs for replacement employees 2. Lost productivity 3. Lost intellectual property 4. Increased use of per diem staff 5. Increased use of health benefits Answer: 1, 2, 3, 4, 5 Explanation: 1. Costs of advertising for and interviewing nurses to replace those who have left are costs associated with turnover.

2. The hospital has lost the productivity of nurses who have left. Typically, those who are leaving are doing so after having worked at the facility long enough to be productive.

3. If the nursing staff has developed any marketable goods, the hospital would lose access to those materials. The hospital also loses access to any systems that the nurse has developed for daily work.

4. The use of per diem staff to fill in until new permanent staff is hired is expensive.

5. The increased stress associated with working short staffed and trying to hire staff can cause additional illnesses in the nurses who remain.

Page Ref: 271-273 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the issue of retention and its impact on staff and quality care.

21 .

22) The staff nurse has decided to resign after a serious conflict with a coworker. What is the nurse's first step in this process?

1. Tell the coworker about the decision.

2. Send a letter of resignation to the nurse manager.

3. Discuss the resignation with the nurse manager.

4. Talk to others on the staff about the decision.

Answer: 3 Explanation: 1. The nurse should not talk to the coworker until the manager knows about the resignation.

2. After telling the nurse manager about this decision, the nurse should follow up with a written letter of resignation.

3. The nurse should first discuss the decision with the nurse manager.

4. The nurse should not talk to other staff members about the decision until the nurse manager is told.

Page Ref: 274-275 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Analyze the issue of retention and its impact on staff and quality care.

22 .

23) What is the most important aspect of the appraiser's role in the evaluation process?

1. Understanding employment laws 2. Objectivity 3. Using evaluation checklists 4. Referring to anecdotal notes Answer: 2 Explanation: 1. The appraiser must be aware of employment laws, but this is not the most important aspect of the role.

2. Objectivity is the most important aspect of this role. The appraiser who is objective is more likely to conduct an appraisal that is fair, legal, and helpful to the employee being appraised.

3. Evaluation checklists can be very helpful in the evaluation process, but this is not the most important aspect of the role.

4. Using anecdotal notes can be very helpful in the evaluation process, but this is not the most important aspect of the role.

Page Ref: 278-280 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Apply the performance appraisal process.

23 .

24) A group of staff nurses have met with the nurse manager to discuss the increasing stress of working on a unit. What strategies could the nurse manager suggest or use to help the staff cope with this stress? Select all that apply.

1. The manager could help the staff set reasonable priorities in the work done every day on the unit.

2. The manager could offer the staff a class on multitasking.

3. The manager could create a schedule that supports the nurse's ability to take breaks throughout the day.

4. The manager could encourage a goal of eating healthy foods when at work.

5. The manager could be a role model by viewing problems as challenges and opportunities.

Answer: 1, 3, 4, 5 Explanation: 1. Setting priorities in a hectic schedule can reduce stress.

2. The manager should help the staff focus on one task at a time to the extent possible. Multitasking increases stress.

3. Taking a few moments to slow down throughout the day reduces stress. When units are very busy, nurses tend to shorten breaks and lunches because "I don't have time."

4. A healthy diet, sufficient exercise, and adequate sleep help people to handle stress more successfully.

5. Stress increases as problems increase. Viewing problems as challenges and opportunities can help reduce that stress. Stress in itself is not bad; the way people handle stress makes it negative.

Page Ref: 284-287 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Examine strategies that can be used to prevent or decrease stress and incivility in the work setting.

24 .

25) Admitting, educating, and graduating more nurses seems to be a logical solution to the nursing shortage. What factor makes this a difficult strategy to employ?

1. There are not enough applicants for nursing schools.

2. Nursing faculty make the classes too hard.

3. There are too many other jobs available that require less education.

4. There are decreasing numbers of nursing faculty.

Answer: 4 Explanation: 1. Many applicants to nursing school are turned away for lack of space.

2. Nursing content is difficult; it is not made more difficult by faculty.

3. There are many other jobs available, but nursing applicants are being turned away for lack of space.

4. The numbers of nursing faculty have been decreasing due to retirement and the fact that persons with the education requirements for teaching are also valuable to other settings.

Page Ref: 290-292 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 06. Discuss staffing issues that impact care and staff retention and recruitment.

25 .

26) What did the state of California do to address the nursing shortage that had an impact on other states?

1. Required salary levels for all nursing staff.

2. Required nurses have master's degree.

3. Identified clinical areas for specific required staffing levels.

4. Required nurse-to-patient ratios.

Answer: 4 Explanation: 1. Salary was not set by the state.

2. The state did not require master's degrees for nurses.

3. The state did not tell H COs what their staffing levels must be.

4. Acute care, psychiatric, and specialty hospitals are required to determine nurseto-patient ratios based on specific criteria.

Page Ref: 292 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 06. Discuss staffing issues that impact care and staff retention and recruitment.

26 .

27) At a unit staff meeting, nurses are complaining about having too many tasks to do and the increasing number of patients admitted. What is the most effective strategy a nurse manager might use to address this problem?

1. Add a support staff to the day shift to help the unit secretary.

2. Allow nurses to work shorter shifts.

3. Provide coffee and donuts in the morning.

4. Inform radiology that schedules for tests have to be moved to later in the day.

Answer: 1 Explanation: 1. Providing more support staff during busy times may reduce the need for nurses to do some tasks.

2. Shorter shifts would only impact a few nurses and also would not change the need to get tasks done.

3. Offering refreshments is always nice but can be viewed as a weak strategy that does not really address the problem but may deflect complaints for short time.

4. It is unlikely the nurse manager can change the schedule in radiology and there is no indication that this would solve the problem of too many tasks.

Page Ref: 288-290 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 06. Discuss staffing issues that impact care and staff retention and recruitment.

27 .

28) What did The Joint Commission do to address the increase in workplace incivility?

1. Required all HCOs to track incivility.

2. Issued a sentinel event alert on incivility.

3. Denied accreditation to HCOs with a high rate of incivility.

4. Required that all HCOs post signs for patients to watch for staff incivility and report it.

Answer: 2 Explanation: 1. The Joint Commission cannot tell all HCOs to do this but can only influence Joint Commission-accredited HCOs, and it would be difficult to track incivility.

2. The Joint Commission issued a sentinel event alert, "Behaviors Undermine a Culture of Safety." A sentinel event alert means that accredited HCOs need to pay special attention to the issue identified and provide information about status.

3. Incivility is important to control, but there is much more to H CO accreditation.

4. The Joint Commission cannot tell all HCOs to do this but can only influence Joint Commission-accredited HCOs —it leaves strategies up to its accredited HCOs. This strategy also puts patients on the spot, since incivility is a complex behavior.

Page Ref: 285 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Examine strategies that can be used to prevent or decrease stress and incivility in the work setting.

28 .

29) A nurse manager is meeting with a staff member because of patient complaints about the nurse's attitude and behavior toward patients. The nurse gets angry and begins yelling at the nurse manager that the patients are just difficult patients sometimes. What is the best approach for the nurse manager to take?

1. To tell the nurse that it does not matter if patients are difficult 2. To call hospital security on the telephone 3. To suggest they take a break and meet again in an hour 4. To tell the nurse she is terminated Answer: 3 Explanation: 1. This is challenging to the nurse and will most likely not reduce the nurse's response.

2. This is an extreme response and would only be used if the manager felt immediate physical threat.

3. During times of stress like this, it is often good for both parties to step back and try to regain more composure.

4. This is a rash decision that would require more thought and more data to support termination. Typically, HCOs have a process to document problems over time and there is no indication this is the case here.

Page Ref: 286-287 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Examine strategies that can be used to prevent or decrease stress and incivility in the work setting.

29 .

30) What factors does NIOSH identify as important in increasing work stress? Select all that apply.

1. Career concerns 2. Interpersonal relationships 3. Design of tasks 4. Salary and benefits 5. Management style Answer: 1, 2, 3, 5 Explanation: 1. Career concerns such as job insecurity and rapid changes impact stress negatively.

2. Interpersonal relationships that do not provide support impact stress negatively.

3. Tasks that are poorly designed—for example, heavy workload, few breaks, and so on—impact stress negatively.

4. Salary and benefits are not identified as factors.

5. Management style such as lack of staff engagement in decisions can impact stress negatively.

Page Ref: 283 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Examine strategies that can be used to prevent or decrease stress and incivility in the work setting.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 9 Managing Patient-Centered Care 1) The nurse manager is making patient assignments for the shift. What should be the primary guiding factor in these assignments?

1. Number of staff available 2. Skill mix of the staff 3. Patient needs 4. Physical layout of the unit Answer: 3 Explanation: 1. This is an important determinant of staff assignments, but is not the most important factor.

2. This is an important determinant of staff assignments, but is not the most important factor.

3. The most important factor in any decision made by any healthcare provider should be patient needs.

4. This is an important determinant of staff assignments, but is not the most important factor.

Page Ref: 306 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

1 .

2) What skills does the Institute of Medicine identify as important in the provision of effective patient-centered care? Select all that apply.

1. Make the patient fully responsible for his or her care.

2. Communication with patients should be open and complete.

3. The patient should be thought of as an individual.

4. Prevention and health promotion should be enhanced.

5. Focus care on self-directed patients who seek care.

Answer: 2, 3, 4 Explanation: 1. The IOM identifies that power and responsibility should be shared with patients and caregivers, not held only by patients.

2. This is one of the skills identified by the I OM as being important in the provision of patient-centered care.

3. This is one of the skills identified by the I OM as being important in the provision of patient-centered care.

4. This is one of the skills identified by the I OM as being important in the provision of patient-centered care.

5. The IOM identifies the need to implement strategies to reach those who do not present themselves for care on their own.

Page Ref: 304-305 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

2 .

3) Which statements, made by a member of the healthcare team, best demonstrate patient-centered care? Select all that apply.

1. "We have decided that you need to have surgery for your condition."

2. "What time would you like to take your bath?"

3. "I ordered apple juice for your breakfast."

4. "I brought the extra blanket that you asked for."

5. "You will need to return to the office tomorrow to get the results of these laboratory tests."

Answer: 2, 4 Explanation: 1. This is the traditional approach to healthcare in which the "experts" know all and plan without regard to the patient's opinions.

2. This statement allows the patient choice in planning and self-direction in care.

3. The person making this statement has assumed the patient wants apple juice today. This is not patient-centered care.

4. This statement reflects achievement of a patient request.

5. This statement makes poor use of the patient's time, assuming that all the patient has to do is come back to the office tomorrow. Typically, lab results can be communicated over the telephone, which is much more respectful of the patient's time.

Page Ref: 304-306 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

3 .

4) Which goal, set by the physician's office staff, demonstrates attention to the patientcentered care attribute of care coordination?

1. Each patient will be seen by the physician within 15 minutes of the scheduled appointment time.

2. Information on treatment plans will be provided to each patient.

3. Each patient will receive a patient satisfaction survey regarding each office visit.

4. Post-hospitalization follow-up telephone calls will be made to each discharged patient on post-hospital days 1 and 7.

Answer: 4 Explanation: 1. This goal reflects the attribute of access to care.

2. This goal reflects the attribute of patient engagement in care.

3. This goal reflects the attribute of routine patient feedback to doctors.

4. This goal supports care coordination.

Page Ref: 304-306 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

4 .

5) Which statement regarding clinical reasoning and judgment is true?

1. These skills are being adequately taught in nursing curriculums.

2. Both of these skills are dependent upon the context of the situation.

3. These two terms mean the same thing.

4. These two skills are primarily used in emergency situations.

Answer: 2 Explanation: 1. The 2010 national report on nursing education expressed strong concern that nursing education is not preparing students to use clinical reasoning and clinical judgment.

2. The definitions of both of these skills indicate that the skill is performed "in the context" of the individual patient's environment.

3. Clinical reasoning is the ability to reason as a clinical situation unfolds. Clinical judgment is deliberate, conscious decision making.

4. These skills should be used throughout all nursing situations.

Page Ref: 306 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

5 .

6) The acute care nurse finds that it is increasingly difficult to provide effective education to patients. What changes in healthcare have contributed to this difficulty?

Select all that apply.

1. Patients have difficulty understanding new medical technology.

2. Patients are much sicker while they are hospitalized.

3. Nurses don't use good time management skills when planning education sessions.

4. There are fewer quality educational resources available for patients.

5. Patients don't stay in the hospital as long.

Answer: 1, 2, 5 Explanation: 1. Medical technology is changing rapidly and many of the patients being hospitalized are not well versed in technology. This rapid turnover coupled with difficult concepts makes education challenging.

2. Patients are much sicker while hospitalized in today's environment. When patients are sick, their focus on learning is diminished and their ability to retain teaching is lessened.

3. There is no evidence of this statement.

4. One of the problems is that there is so much information, both in print form and in electronic form, that it is sometimes difficult to choose what's best for a particular patient.

5. Length of stay has shortened and patients are physically present a shorter time for teaching.

Page Ref: 306-307 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

6 .

7) The nurse is planning patient education regarding wound care. Which concepts should the nurse use in designing this session?

1. Keep the information as broad as possible.

2. Use a standard preprinted form as a handout for the patient.

3. Ask the patient's family caregivers to be present.

4. Have the patient save all questions until the end of the session.

Answer: 3 Explanation: 1. The nurse should teach what is specifically needed for this patient.

2. Standard preprinted forms are not individualized to the patient.

3. The people who will serve as caregivers once the patient gets home should be included in the teaching.

4. Answering the patient's questions as they occur is much more patient-centered and much more sensitive to the patient's needs.

Page Ref: 306-307 Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

7 .

8) How does self-management relate to patient-centered care?

1. The nurse who is able to self-manage anxiety is better able to provide care.

2. Patients who self-prescribe over-the-counter medications have a better understanding of their body.

3. It replicates the traditional model of healthcare.

4. In order for care to become patient-centered, the patient must embrace selfmanagement.

Answer: 4 Explanation: 1. Self-management pertains to the patient's ability to care for self, not the nurse's ability.

2. This is not the significance of self-management and this statement is not supported.

3. The traditional model of health is that the healthcare provider knows best and manages the patient's health.

4. The patient must be engaged in the concept and processes of self-management in order for it to be successful.

Page Ref: 307 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Explain how patient-centered care impacts the healthcare delivery system and nursing care.

8 .

9) What are the elements included in the health system in the chronic care model?

Select all that apply.

1. Decision support 2. Delivery system design 3. Self-management support 4. Primary providers 5. Clinical information systems Answer: 1, 2, 3, 5 Explanation: 1. Decision support to improve how healthcare decisions are made is one of the 4 elements.

2. Delivery system is included in the 4 elements to describe structure and function of the system.

3. Support to help patients with self-management is included.

4. Primary providers are not specifically mentioned.

5. Clinical information systems associated with health informatics are included.

Page Ref: 309 Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss the implications of chronic illness to patientcentered care.

9 .

10) If you wanted to quickly find an evidence-based clinical guideline, where would you look?

1. National Institute of Nursing Research 2. Hospital library medical journals 3. Condition-specific organization 4. Nursing literature search Answer: 3 Explanation: 1. NINR does not develop guidelines, but does get involved in research that might be used as evidence for a guideline.

2. There are many sources in literature, but would be less likely to find one quickly that is a guideline and not a study or systematic review.

3. Condition-specific organizations such as the American Heart Association or American Diabetes Association may offer guidelines that are evidence-based.

4. There are many sources in literature, but would be less likely to find one quickly that is a guideline and not a study or systematic review.

Page Ref: 321 Cognitive Level: Applying Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

10 .

11) What is the key difficulty with implementing patient-centered care?

1. Recognizing that patient-centered care is important 2. Implementing it effectively 3. Paying for patient-centered care 4. Defining patient-centered care Answer: 2 Explanation: 1. Patient-centered care has been defined in Quality Chasm reports. For example, it is one of the five core healthcare professions competencies and discussed a lot in the healthcare literature today.

2. We do not know enough about how to implement it effectively—so that quality patient-centered care is provided.

3. Paying for care is done through reimbursement and should for most services be part of this system.

4. Patient-centered care has been defined in Quality Chasm reports.

Page Ref: 322-323 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Examine current approaches to patient-centered care and their relationship to leadership and management.

11 .

12) A patient who has a history of asthma asks about the availability of a disease management program for his illness. Which statement, made by the nurse, is appropriate?

1. There isn't a disease management program for asthma yet, but there is one under development.

2. There is no such program for asthma.

3. The program exists, but only a very few insurance companies cover it.

4. There is a program targeted specifically for asthma.

Answer: 4 Explanation: 1. A program does exist.

2. A program does exist.

3. Insurance companies have identified that illness management results in cost savings. More and more companies are developing, administering, and paying for these programs.

4. Asthma is often targeted for illness management programs.

Page Ref: 309-311 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

12 .

13) What is the primary focus of disease management programs?

1. Curing the disease 2. Reducing the need for medications 3. The whole patient 4. Learning more about the disease Answer: 3 Explanation: 1. This can be a focus, depending upon the disease, but is not the primary focus.

2. This can be a focus, depending upon the disease, but is not the primary focus.

3. The primary focus is caring for the whole patient.

4. This can be a focus, but is not the primary focus.

Page Ref: 310-311 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

13 .

14) The nurse who works for an insurance company has been asked to develop an initial set of disease management programs. What factors should this nurse consider when choosing the diseases? Select all that apply.

1. High-cost problems 2. Those with high numbers of hospitalizations 3. Those with high risk for complications 4. Long-term problems 5. Those with a longer length of stay when hospitalization is required Answer: 1, 2, 3, 4, 5 Explanation: 1. High-cost, high-volume, high-risk diseases are typically considered for management programs.

2. High-cost, high-volume, high-risk diseases are typically considered for management programs.

3. High-cost, high-volume, high-risk diseases are typically considered for management programs.

4. Long-term problems incur high costs.

5. Longer length of stay increases costs.

Page Ref: 309-311 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

14 .

15) Which description of a clinical pathway provided by a nursing student would indicate the best understanding of the concept?

1. Clinical pathways are tools to measure patient outcomes.

2. Clinical pathways are the same as nursing care plans.

3. Clinical pathways are developed to use in acute care settings and guide the nursing care of patients as they are admitted, treated, and discharged.

4. Clinical pathways guide the patient and interprofessional team in managing patient care and recovery within a designated time frame.

Answer: 4 Explanation: 1. This statement only describes a portion of the use of clinical pathways.

2. While the clinical pathway does include nursing care, they are interprofessional.

3. This option does not take into account the interprofessional nature of clinical pathways, nor does it take into account the fact that they are used in areas other than acute care.

4. This statement is the clearest and most complete description of a clinical pathway.

Page Ref: 312-313 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

15 .

16) The staff nurse has been asked to work on a committee whose task is to develop clinical pathways for the facility. What is the purpose of these pathways?

1. To provide quality healthcare with the efficient use of resources while controlling costs 2. To provide practice guidelines for the general treatment of a specific diagnosis 3. To reduce patient length of stay 4. To justify alternative treatment methods Answer: 1 Explanation: 1. Clinical pathways were developed in response to the need to identify quality, cost-effective healthcare within a specific time frame.

2. Clinical pathways are specific and unique to the healthcare agency or managed care organization in which they are used.

3. One of the purposes for developing clinical pathways is to reduce the cost of healthcare. This can occur as a result of reduced length of stay, but reducing length of stay is not the primary goal.

4. Clinical pathways often are used to demonstrate compliance with standards of care, accreditation, and regulatory requirements.

Page Ref: 312-313 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

16 .

17) The healthcare providers in an organization have chosen not to adopt the use of clinical pathways. What are reasons to justify this decision? Select all that apply.

1. Clinical pathways development and implementation take time and can be costly.

2. The pathway content has to be evaluated each time it is used.

3. Some believe that clinical pathways result in excessive paperwork and redundant documentation.

4. There is fear that pathways will be used in evaluating staff performance.

5. The use of clinical pathways has not been proven to make a difference in patient care.

Answer: 1, 2, 3, 4 Explanation: 1. These pathways are developed for each facility and can be costly to develop and implement.

2. Since the content contains the general care of the patient with a specific disease, the content must be reviewed and individualized to each patient each time it is used.

3. New forms and paperwork often cause healthcare providers to be concerned about new methods of providing care.

4. Some healthcare providers fear the interprofessional aspects of these tools.

Others resent the requirement to follow the instructions of the critical pathway and fear they will be criticized if their general care does not match that required by the critical pathway.

5. These pathways do change patient care and can support interprofessional care.

Page Ref: 312-317 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

17 .

18) During a meeting to discuss the adoption of clinical pathways a nurse expresses concerns about legal problems associated with their use. Which options reflect provider responses to the use of clinical pathways that can result in legal problems?

Select all that apply.

1. Nurses document most of the variances.

2. The provider does not follow the clinical pathway and does not document the variance.

3. Negligent care is provided, even though the pathway was followed.

4. The pathway does not represent evidence-based care.

5. Care is delivered based on the pathway, not the individual.

Answer: 2, 3, 4, 5 Explanation: 1. Nurses document most of the variances because they have the most contact with the patient. This is not a legal concern.

2. Any care that varies from the pathway should be documented in a variance.

3. Following the pathway does not relieve the provider from the responsibility of providing quality care.

4. Pathway developers have been named in liability cases.

5. The pathway should be followed, but should be individualized to the patient.

Page Ref: 318 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

18 .

19) The organization has noted an increase in negative patient variances related to medication administration. What steps should be taken by the organization? Select all that apply.

1. Look for reasons for the variances.

2. Identify those at fault for the variances.

3. Document the variances in the medical records of the patients involved.

4. Try to find a resolution for the variances.

5. Rewrite the clinical pathways.

Answer: 1, 4 Explanation: 1. When variances occur, the organization should look for reasons and resolution.

2. It is important to avoid placing blame for these variations.

3. Variances are not documented in the medical record.

4. When variances occur, the organization should look for reasons and resolution.

5. It is not necessarily appropriate to rewrite the clinical pathways. The pathways should be reviewed.

Page Ref: 318-319 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

19 .

20) Which statement is true regarding implementation of clinical pathways?

1. Pathways replace physician orders.

2. Pathways cannot be used for patients with more than one illness or condition.

3. Using pathways is the best way to assess length of stay (L OS).

4. Disclaimers may be used with clinical pathways to convey that treatment is standardized.

Answer: 3 Explanation: 1. Pathways do not replace physician orders.

2. Pathways can be used for patients with more than one illness or condition by developing copaths.

3. Using pathways is the best way to assess the L OS, and their use helps to determine the best expected L OS. 4. Disclaimers are a way to indicate that care will be provided to meet the individual needs of the patient, which may require variance from a clinical pathway.

Page Ref: 314-319 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

20 .

21) Which example represents a negative patient variance?

1. A patient develops hospital-acquired pneumonia due to noncompliance with respiratory interventions.

2. The nurse administers a mislabeled medication.

3. A CBC was drawn on a patient instead of an A BG. 4. Difficulties were experienced in placing an older adult into long-term care.

Answer: 1 Explanation: 1. A patient variance identifies factors related to the patient that prevent the achievement of patient outcomes. In this case, a patient has developed a nosocomial infection because the patient did not want to do the intervention that might have prevented a negative outcome.

2. This is a provider negative variance.

3. This is a provider negative variance.

4. This is an operational negative variance.

Page Ref: 318 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

21 .

22) Which option best explains the purpose of practice guidelines?

1. To ensure optimal care 2. To assist with treatment decision making and to evaluate care 3. To reduce malpractice lawsuits 4. To define treatment Answer: 2 Explanation: 1. This statement is not a full expression of the purpose of practice guidelines.

2. Practice guidelines are used to help healthcare providers make appropriate decisions when providing optimal care.

3. Practice guidelines can be used as a means for solving the malpractice problem, but this is not the main purpose for using practice guidelines.

4. Practice guidelines do not define treatment, but rather provide information and options.

Page Ref: 321 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

22 .

23) Differentiate between disease management programs and clinical guidelines by choosing the option that describes disease management programs.

1. The major goal is to prepare the patient to understand the disease and to increase self-management of the disease.

2. They establish standards that focus on health maintenance.

3. They have been adopted to control costs.

4. They are also called medical review criteria.

Answer: 1 Explanation: 1. The purpose of disease management programs is to provide patients with education and preventive care that improves quality of life.

2. This is true of clinical guidelines.

3. This is true of clinical guidelines.

4. This is true of clinical guidelines.

Page Ref: 310-311 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

23 .

24) The nurse is following a clinical pathway for a patient who has undergone hip replacement surgery. The nurse notices that the physician orders do not follow the clinical pathway. What should the nurse do first?

1. Follow the pathway as written.

2. Do as the physician orders, regardless of the clinical pathway.

3. Refuse the orders.

4. Notify the nursing supervisor, and document the variance.

Answer: 4 Explanation: 1. There is an obvious disconnect between the pathway and the orders that must be resolved in order to provide quality care.

2. There is an obvious disconnect between the pathway and the orders that must be resolved in order to provide quality care.

3. The nurse should not just refuse the orders without following up on the reason for the difference and determining the best course of action.

4. It is important to recognize that each patient requires individualized care, and that pathways do not replace physician orders. The nurse should notify the nursing supervisor of the variance and the variance should be documented. The first thing that should be done is to consult the physician, not to report the problem to the supervisor.

Page Ref: 312-319 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

24 .

25) Which statement is a common myth about patient-centered care?

1. Patient-centered care requires a team approach.

2. Patient-centered care is not designed to solve all healthcare problems.

3. Patient-centered care can have a negative impact on infection rates.

4. Patient-centered care does not increase care time.

Answer: 3 Explanation: 1. This is not a myth. The myth is: Providing patient-centered care is the job of nurses.

2. This is not a myth. The myth is: Patient-centered care is the magic bullet.

3. This is a myth–that patient-centered care can impact infection rates.

4. This is not a myth. The myth is: Patient-centered care can be time consuming.

Page Ref: 324 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Examine current approaches to patient-centered care and their relationship to leadership and management.

25 .

26) Why are variances important?

1. Identify costs of care 2. Identify how documentation tool is ineffective 3. Offer an indication of potential problem 4. Compare cost and quality in healthcare delivery Answer: 3 Explanation: 1. Variances do not focus on cost.

2. Variance does not mean a documentation tool is ineffective; focuses on care outcomes.

3. Variances identify data related to care outcomes and potential problems.

4. Variances do not focus on comparing cost and quality.

Page Ref: 318 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Compare and contrast tools used to manage care to ensure more patient-centered care.

26 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 10 Diversity and Disparities in Healthcare 1) The governing board of the hospital has completed an assessment of the organization's culture. Which findings would lead the board to determine that the culture is healthy? Select all that apply.

1. There is wide variation in the expectations of individual employees and departments.

2. The decisions made about care are staff-centered.

3. There is evidence that the values of the organization and the health professionals working there are similar.

4. The organization is designed to serve its health professionals.

5. New people who come into the organization learn about the culture by connecting behaviors and consequences.

Answer: 3, 5 Explanation: 1. Separate approaches to expectations, caring, and values among departments would not be present.

2. The decisions should be patient-centered.

3. A hallmark of a healthy organization is a close match of values between the organization and its health professionals.

4. The organization should be designed to serve the patients.

5. This is the way new people learn the values of the organization.

Page Ref: 340-341 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

1 .

2) A new nursing leader assesses that there is a low level of trust in the organization.

Which staff report would indicate that this is beginning to be corrected?

1. Staff members feel safe to approach the leader and be heard.

2. Systems are in place for staff to have input in decisions.

3. They are expected to communicate clearly with each other.

4. They can expect to receive written notices of praise for work well done.

Answer: 1 Explanation: 1. Trust, a foundational element in a healthy organization, is interpersonal in nature, not built upon documents, systems, job expectations, or mechanical methods of feedback. Assurance that one is being heard by one's leader is essential to trust.

2. This is important, but not the best answer.

3. This is important, but not the best answer.

4. Written notices of praise are nice, but do not suggest that trust is building.

Page Ref: 340-341 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

2 .

3) Which findings would indicate to the nurse executive that a dissonant culture exists in the healthcare agency? Select all that apply.

1. Nurses frequently voice complaints to the administration about healthcare deficiencies when they emerge.

2. The facility has a high turnover rate among its registered nursing staff.

3. The organization focuses more on patient issues than on financial viability.

4. There is a means for providing care for those patients who lack health insurance coverage.

5. The education budget for the division of nursing has been cut by half.

Answer: 2, 5 Explanation: 1. Having nurses who appropriately voice concerns indicates a working level of trust in administration.

2. A high nurse turnover rate is likely to indicate a dissonant organizational culture.

3. Agencies that focus more on finances than on patient issues often have nursing staff that are dissatisfied and alienated, which results in a dissonant culture.

4. Agencies that lack means for indigent care often have nursing staff that are dissatisfied and alienated, which results in a dissonant culture.

5. Limited educational/training programs for employees often results in a dissonant culture.

Page Ref: 238-239 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain how organizational culture impacts the healthcare organization, patient care, and professional cultural competency.

3 .

4) What goals does the HHS Disparities Action Plan focus on? Select all that apply.

1. Strengthen the health and human services infrastructure and workforce 2. Increase efficiency, transparency, and accountability in H HS programs 3. Transfer HHS programs to the states 4. Advance scientific knowledge and innovation 5. Increase emergency preparedness Answer: 1, 2, 4 Explanation: 1. This plan does include the goal to strengthen the health and human services infrastructure and workforce.

2. This plan does include the goal to increase efficiency, transparency, and accountability.

3. This plan does not include the goal transferring responsibility to the states.

4. This plan does include the goal to advance scientific knowledge and innovation.

5. This plan does not include emergency preparedness.

Page Ref: 333 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze the status of diversity and disparities in healthcare.

4 .

5) A nursing agency's managers are planning to make the organization more flexible and internally focused. What should be included in these managers' strategies?

1. A halt to any changes in policy and procedure 2. Increased involvement of management in all aspects of clinical decision making 3. Involving all staff in knowledge of and full participation in financial and market values of the organization 4. Rewarding innovation and involvement of staff in change Answer: 4 Explanation: 1. Change is seen as beneficial under these conditions.

2. Clinical responsibilities should remain in the hands of the organization's health professionals.

3. The financial and market values of the organization should be de-emphasized.

4. The internally controlled organization encourages staff involvement and innovation.

Page Ref: 340, 346-347 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

5 .

6) A health agency with a consonant culture will demonstrate which signs or symbols of its culture? Select all that apply.

1. Each care unit has its own dress code, which is displayed prominently on its bulletin board.

2. Administrative offices are located in a separate building.

3. Employee articles about satisfying patient care experiences are included in the agency's newsletter.

4. Separate snack areas are established on each unit, replacing the central cafeteria.

5. There is agency-wide staff participation in the annual summer picnic.

Answer: 3, 5 Explanation: 1. This is a symbol of separation in the agency.

2. This is a symbol of separation in the agency.

3. This indicates a sharing and pride in a job well done.

4. This is a symbol of separation in the agency.

5. This indicates a sharing spirit.

Page Ref: 338-339 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain how organizational culture impacts the healthcare organization, patient care, and professional cultural competency.

6 .

7) The health facility serves a large minority population with its own particular language. How would this population best be included in the agency's culture?

1. Use family members as interpreters.

2. Computer programs with common phrases available to patients and staff.

3. A list of interpreters available for calling in when needed.

4. Staff representative of the minority and other staff with bilingual skills.

Answer: 4 Explanation: 1. Family members have too personal an investment to serve as interpreters.

2. Computer programs are impersonal.

3. Call-in interpreters are impersonal and may not be available when needed and in a timely fashion.

4. Minority-affiliated and bilingual staff who provide the direct care would provide a personal contact, establish trust, and serve as a visible sign of the agency's commitment to serving that population.

Page Ref: 337 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss the relevance of health literacy.

7 .

8) The nurse manager identifies that many of the unit staff belong to Generation Y. How can the manager most effectively motivate this group of employees?

1. Speak about goals in a general fashion, but use a serious tone in expression of the goals.

2. Emphasize long-term benefits of continued employment with this agency.

3. Demonstrate that all work systems are firmly in place and well established.

4. Foster an atmosphere open to technology and intelligent creativity.

Answer: 4 Explanation: 1. Goals should be discussed in a friendly but specific way.

2. This generation expects to move on frequently to other work settings.

3. Policies and procedures affecting this generation are best kept open for discussion and revision.

4. Generation Y staff respond well to openness and an environment that uses technology, invites creativity, and respects intelligence.

Page Ref: 345-346 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Examine workplace diversity in healthcare organizations.

8 .

9) The nurse is in a position to provide input into the creation of a healing organization.

This nurse should advocate for which position?

1. Clear, honest, and open apologies from administration regarding prior barriers to staff job satisfaction 2. Patient care environments that allow staff to complete their tasks efficiently 3. Systems of admission and care that provide easy access to services, attention, and staff 4. Patient care and staff work areas that are free from microbes, including those that might be brought in by visitors Answer: 3 Explanation: 1. The healing organization avoids projections of guilt and blame.

2. Task efficiency remains important, but is not ranked as highly.

3. The healing organization emphasizes personal, family-oriented contact and responses to patient needs and requests.

4. Infection control is important, but not ranked as highly as family-oriented contact and response to patient needs.

Page Ref: 347-349 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

9 .

10) Which situation must be avoided in order for the organization to be compliant with the Americans with Disabilities Act? 1. Failure to meet any request or need of a disabled employee 2. Asking questions about the severity of the disability during the hiring process 3. A focus, during the hiring process, on whether the job candidate can perform essential job functions 4. A specific definition of the functions of the position, including amount of time allowed for each function Answer: 2 Explanation: 1. Only those requests and needs that can be met reasonably need to be provided.

2. Questions about the severity of the disability are not allowed during the hiring process.

3. This should be the primary focus of the hiring decision.

4. Job definition and functions should be specified, along with the amount of time typically expected for performance of the functions.

Page Ref: 342 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Examine workplace diversity in healthcare organizations.

10 .

11) Nurses in a hospital are asked to provide input on decisions regarding architectural changes for their units. Based on research on private versus shared rooms, the nurses should opt for which design?

1. Wards of four patients in order to facilitate speed of care delivery 2. Double rooms, which the patient prefers due to decreased expense 3. Double rooms, which make the patient feel more secure 4. Private rooms, to decrease nosocomial infection rates Answer: 4 Explanation: 1. This is not a factor in favor of shared rooms.

2. This is not a factor in favor of shared rooms.

3. This is not a factor in favor of shared rooms.

4. In addition to other factors, private rooms have been found to decrease the rates of nosocomial infection.

Page Ref: 348-349 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

11 .

12) The healthcare organization has a long history of a dissonant culture. How can nurse leaders in the facility promote change to a healing culture? Select all that apply.

1. Hire staff with strong clinical skills and then provide education on values consistent with those of a healing culture.

2. Hire staff with similar cultural backgrounds to reduce differences.

3. Foster retention of administrators and staff with diverse backgrounds but with similar, consistent thinking habits and ideas.

4. Assess the mission statement of the organization for its stated values.

5. Appraise whether stated values are cherished and demonstrated.

Answer: 4, 5 Explanation: 1. Hiring staff with values consistent with the organization and training them in terms of skills is a better plan.

2. Staff of varying backgrounds enhance the healing culture.

3. Staff must have diverse thinking and ideas as well as diverse backgrounds.

4. Positive change begins with an assessment of the stated values of the organization.

5. The leaders must determine if the stated values are being demonstrated and practiced.

Page Ref: 347-348 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

12 .

13) The healthcare agency is using regular staff meetings to improve its organizational culture and healing environment. What should the nurse leading these meetings encourage?

1. Open discussion, with no feedback 2. An agenda strictly focused on patient care issues 3. Relevant questions, asked respectfully 4. Unanimous staff agreement with agency policies and practices Answer: 3 Explanation: 1. Feedback is an essential part of this process if given supportively.

2. Teamwork issues can be as important as patient care issues.

3. Relevant, respectful questions can enhance trust and openness, which are important elements of a consonant culture and healing environment.

4. Unanimous agreement with agency policy and procedure can hinder improvement and positive change.

Page Ref: 346-348 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

13 .

14) Which interventions help to meet the Institute of Medicine's recommendations to decrease disparities in healthcare? Select all that apply.

1. The nurse manager hires a nurse who speaks English and the language of the primary minority served by the facility.

2. The nursing department develops standard nursing care plans for ethnically diverse patients and files them according to ethnicity.

3. The nurse allows the patient's nontraditional care provider open visitation at the patient's request.

4. The nurse helps the patient select foods from the standard hospital menu.

5. The nurse contacts building maintenance to bring five additional chairs to the waiting room to accommodate the patient's large extended family.

Answer: 1, 3, 5 Explanation: 1. Even though caring for culturally diverse patients goes beyond simple language competency, language continues to be a big component of culturally competent care.

2. Assuming that everyone who identifies with a particular ethnicity does everything the same is a form of stereotyping.

3. Nontraditional care providers are important to the health of many people.

Allowing this provider open visitation acknowledges that fact.

4. The standard hospital menu is typically not very diverse.

5. This is a culturally correct action.

Page Ref: 332-333 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Analyze the status of diversity and disparities in healthcare.

14 .

15) What demographics are projected for the United States by the 2030s? Select all that apply.

1. All baby boomers will reach 65.

2. The United States will be more racially and ethnically diverse.

3. Number of births will offset number of deaths.

4. The non-Hispanic White population will continue to increase.

Answer: 1, 2 Explanation: 1. This is correct-projected.

2. This is correct-projected.

3. Number of deaths will decrease the population even with increase in births.

4. The non-Hispanic White population is projected to decrease.

Page Ref: 334 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze the status of diversity and disparities in healthcare.

15 .

16) According to the Sullivan Commission report of 2004, what is a major contributor to the healthcare delivery disparity problem?

1. The disparity in the healthcare workforce 2. Minority underrepresentation on governmental task forces to improve services 3. Unwillingness of minority populations to take responsibility for their own health needs 4. The increasing minority population will soon outnumber the traditional majority population numbers.

Answer: 1 Explanation: 1. The Sullivan Commission reported that a major factor in the continued disparity in minority healthcare is the disparity in the healthcare workforce.

2. Typically, when task forces are developed to look at minority issues there are minority members on the task force.

3. There is no evidence that this is correct.

4. Currently this is true, but as population trends begin to shift, different issues may arise.

Page Ref: 342 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Examine workplace diversity in healthcare organizations.

16 .

17) The NAM or IOM recommends that education about diversities focus on which areas?

1. Language, ethnic group, and staff diversity 2. Attitudes, behavior, and family history 3. Attitudes, knowledge, and skills 4. Language, cultural rituals, and cultural dissonance Answer: 3 Explanation: 1. This does not meet the recommendations.

2. This does not meet the recommendations.

3. The recommendation is to focus on attitudes (cultural sensitivity/awareness), knowledge with multicultural approach, and skills (cross-cultural approach).

4. This does not meet the recommendations.

Page Ref: 332, 343 Cognitive Level: Applying Client Need/Sub: Physiological Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze the status of diversity and disparities in healthcare.

17 .

18) Which patients are at risk for difficulty associated with lack of healthcare literacy?

Select all that apply.

1. A patient who speaks English as a second language 2. A patient who is illiterate 3. A patient who has complicated prescriptions regimens 4. A patient who is under stress 5. A patient who is seen by a number of specialists during hospitalization Answer: 1, 2, 3, 4, 5 Explanation: 1. Patients who speak English as a second language may have difficulty understanding complicated information, especially when under stress.

2. People who cannot read or who read at low levels are at risk for difficulties from lack of healthcare literacy as well.

3. Any complicated regimen can be difficult to understand for people who are under stress or who are not familiar with healthcare jargon.

4. Even people who speak the same language as the healthcare provider, who are literate, and who generally have no difficulty with understanding can be at risk when under stress.

5. The more complicated the regimen and the more providers that are included in care, the more likely there will be confusion and difficulty understanding.

Page Ref: 332, 336-338 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Discuss the relevance of health literacy.

18 .

19) What type of barrier is not considered to be a major barrier to quality healthcare associated with health literacy?

1. Access to care 2. Location in the United States 3. Illness management 4. General information processing Answer: 2 Explanation: 1. This is one of the 3 major types of barriers.

2. There is variation in healthcare across the United States but this is not considered to be a major type of barrier.

3. This is one of the 3 major types of barriers.

4. This is one of the 3 major types of barriers.

Page Ref: 336-338 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss the relevance of health literacy.

19 .

20) Which example would not apply to Schein's view of organizational culture?

1. Organization vision statement 2. Unwritten rules about communication 3. HCO logo 4. Salaries paid to all staff Answer: 4 Explanation: 1. This is an example of the organization's level of espoused beliefs.

2. This is an example of the organization's taken-for-granted beliefs.

3. This is an example of an organizational artifact.

4. This is not considered part of the Schein view of the organizational culture.

Page Ref: 338 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain how organizational culture impacts the healthcare organization, patient care, and professional cultural competency.

20 .

21) Why is it that most nursing positions are held by those classified as "baby boomers?"

1. The era when these people came of age was a time of great advancement in healthcare and many people wanted to become a part of that movement.

2. Most nurses are women and when baby boomers were coming of age, the two professions most accepting of women were nursing and teaching.

3. This group is hard working and loyal, which are attributes that are often found in nurses.

4. This generation is focused on material gain and nursing provides a good salary structure.

Answer: 2 Explanation: 1. This is a true statement, but is not the best answer to the question.

2. This is a fact that answers the question.

3. This is a true statement, but is not the best answer to the question.

4. This is a true statement, but is not the best answer to the question.

Page Ref: 334 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Examine workplace diversity in healthcare organizations.

21 .

22) Which actions support the organization's goal to increase transparency? Select all that apply.

1. The organization publicizes safety reports on the hospital website.

2. The hospital participated in a widely published study on the use of a new type of equipment.

3. Patient satisfaction reports are displayed on bulletin boards throughout the facility.

4. The hospital maintains all error reports as confidential.

5. Hospital policy and procedures are publicly available.

Answer: 1, 2, 3, 5 Explanation: 1. Transparency means that information is openly shared, whether or not it results in a positive view of the organization.

2. Transparency means that information is openly shared, whether or not it results in a positive view of the organization.

3. Transparency means that information is openly shared, whether or not it results in a positive view of the organization.

4. Keeping this information out of public record is not supportive of the goal to be transparent.

5. Transparency means that information is openly shared, whether or not it results in a positive view of the organization.

Page Ref: 333, 346-347 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

22 .

23) During the latest employee survey it was established that the staff find the hospital "dirty" and "non-conducive to health and healing." Which strategy can help with the staff's perception of the organization?

1. Recognize the findings and determine a method to change.

2. Acknowledge the findings and ask the staff members what role they play in the appearance of the hospital.

3. Contact the director of environment services and expect a plan to address the findings.

4. Study the financial statements and determine which areas can be closed to divert revenue to newer parts of the hospital.

Answer: 1 Explanation: 1. The staff is offering input to help the hospital improve. This input should be acknowledged and acted upon.

2. This approach implies that the staff is to blame for the situation and could result in hesitance to share any other suggestions.

3. This action places the blame on one department for a problem that is facility wide.

4. This action is not logical in the face of this situation.

Page Ref: 347-349 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

23 .

24) The results of a patient discharge questionnaire reveal that the hospital is not easy to navigate and is not physically comfortable for visitors. What should be done to address these findings?

1. Appoint a committee to review the questionnaire.

2. Contact a local furniture company to change the chairs in the waiting room.

3. Create a multidisciplinary committee to analyze the navigation of the hospital, looking for comfort characteristics.

4. Nothing. Since these patients are no longer in the hospital, the information is not helpful.

Answer: 3 Explanation: 1. Simply studying the questionnaire is not helpful.

2. Changing furniture only addresses the comfort in that area and does not address navigation issues.

3. This committee should take a critical look at the hospital as a whole from the perspective of someone who is an occasional visitor.

4. Information from discharged patients is very helpful and should not be discounted.

Page Ref: 347-349 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

24 .

25) An anonymous note left in the hospital's suggestion box read, "There are many errors made with patient care, but the nurses are afraid to tell anyone." What can the hospital leadership do with this information?

1. Nothing, since it was anonymous.

2. Take the information seriously and begin a focus group to analyze reasons why the staff do not report errors.

3. Call the nurse managers together and tell them to find out which one of the staff nurses wrote the note.

4. Write an open letter to the staff reinforcing the disciplinary processes for anyone who violates patient care procedures.

Answer: 2 Explanation: 1. The leadership cannot just ignore this note, since it is a safety issue.

2. This is the best plan of use for this information.

3. This option may indicate that the hospital has a policy of blaming and threatening.

4. This option may indicate that the hospital has a policy of blaming and threatening.

Page Ref: 346-347 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply strategies that may be used to improve an organization's culture.

25 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 11 Consumers and Nurses 1) A committee of hospice nurses at a managed care organization is trying to determine what consumers want and need most. What is the best source of relevant information?

1. The hospice's human resources officer 2. Families of current and recent hospice patients 3. Hospice nurses from a wide sample of hospices 4. The managed care organization representatives who interact directly with patients Answer: 2 Explanation: 1. The human resources officer is involved in obtaining persons to provide care, but is not as central a consumer as are families and patients.

2. Since hospice care is directed toward patients and their families, and family most often survives the patient, they together constitute the best source of consumer data.

3. Nurses plan and provide care, but are not as central a consumer as are families and patients.

4. Representatives of managed care are involved in obtaining and planning care, but are not as central a consumer as are families and patients.

Page Ref: 355 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

1 .

2) A nurse administrator is planning for the expected increase in healthcare needed for the baby boomer generation. Which attributes of this generation should be considered in this planning? Select all that apply.

1. This generation is directly assertive.

2. This generation has grown accustomed to managed care and is comfortable with it.

3. This generation is respectful toward health professionals and very grateful for care.

4. This generation defers to their primary care provider and directs healthcare concerns through that person.

5. This generation can be politically demanding as healthcare consumers.

Answer: 1, 5 Explanation: 1. This generation has experience and a history of being outspoken.

2. Managed care has been met with consumer complaints and opposition from this generation.

3. Previous generations were more passive and respectful of healthcare professionals.

4. Previous generations were more passive and submissive toward healthcare professionals.

5. This generation has been very politically active on numerous issues, including healthcare.

Page Ref: 356-357 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

2 .

3) For the nurse interested in impacting public policy regarding healthcare consumerism, which involvement and activity is recommended?

1. Joining nursing associations 2. Participating in internet chat and blog sites 3. Reading health-related stories and articles in popular magazines and newspapers 4. Encouraging individual patients to formulate and submit their healthcare needs directly to their insurance companies Answer: 1 Explanation: 1. Large professional organizations such as nursing associations have programs, data, consultants, and lobbyists that can impact public policy most effectively and powerfully.

2. The general internet tends to be unreliable as a source of information, and the multitude of websites is scattered and chaotic in its effect on the public and upon political figures.

3. Popular magazines and newspapers would not support this nurse's need to become politically active as much as joining a professional organization.

4. Nurses can best advocate for their patients in public and political arenas by direct and concerted involvement and action.

Page Ref: 357-358 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

3 .

4) A public health team is conducting strategic planning for the next five years of service to the community. The group is reviewing the Healthy People initiative. What help will this be to strategic planning?

1. This initiative specifies the role of nurse practitioners over the coming decade.

2. This initiative lists consumer responsibilities for prevention of cardiac and other diseases.

3. This initiative recommends deinstitutionalization of healthcare in favor of alternative medicine.

4. This initiative outlines goals for preventative health measures, including objectives for age groups and populations.

Answer: 4 Explanation: 1. This is not a part of the Healthy People initiative.

2. This is not a part of the Healthy People initiative.

3. This is not a part of the Healthy People initiative.

4. The Healthy People initiatives list specific objectives for health and longevity by age and population.

Page Ref: 359-360 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Compare and contrast special reports and initiatives that focus on healthcare consumers.

4 .

5) A patient asks the nurse about the use of information from websites for verifying diagnostic and treatment decisions made by a primary health provider. Which response, made by the nurse, would be most helpful to this patient?

1. "A computer search of the diagnosis should help you verify the accuracy of the diagnosis and treatment."

2. "You can only count on accurate and useful information if it comes from university or hospital websites."

3. "That is a dangerous practice, because it undermines your relationship with your primary health provider."

4. "You can gain general information that way, but be sure to discuss specific websites and information with your primary health provider."

Answer: 4 Explanation: 1. Websites can be very misleading if taken at face value.

2. While this information may be more accurate, misunderstanding or misapplying the information can still occur.

3. Healthcare providers generally appreciate a patient who is involved in his or her own care and who is trying to learn more about his or her illness and health.

4. The internet offers an extensive array of professional information and amateur opinion that can serve as a starting point for discussion of diagnosis and treatment with one's primary health provider.

Page Ref: 360-361 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess the importance of the role of technology in consumer healthcare information.

5 .

6) Consumers are entitled to expect what competencies from nurses in health education roles?

1. Creative knowledge of learning principles, health reimbursement basics, technology, and patient's clinical needs 2. Ability to question diagnoses made by patients' physicians 3. Skill in prescribing medications for common, routine disorders and evaluating their effects 4. Awareness that nurses are limited to reinforcing and clarifying physician's instructions Answer: 1 Explanation: 1. A nurse health educator should be able to use a variety of teaching strategies to meet the needs of a range of patients, including their needs for assistance with negotiating the healthcare and insurance systems, increasing technology, and complicated health and illness facts.

2. The nurse health educator is not qualified to question medical diagnoses.

3. The nurse health educator is not qualified to prescribe medications.

4. The nurse health educator can educate patients about health risks, preventive measures, and treatment compliance, whether or not this has been addressed by the patient's physician.

Page Ref: 360-361 Cognitive Level: Analyzing Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess the importance of the role of technology in consumer healthcare information.

6 .

7) A nurse is being hired to assist patients to navigate the complexities of the healthcare system. What is the most pertinent experience and skill background for this nurse?

1. Interprofessional health team collaboration and communication with insurance and managed care representatives 2. A wide range of medical-surgical skills, including familiarity with a wide assortment of chronic disorders 3. Management and supervision within private and public hospitals and community health agencies 4. Primary health and preventive health teaching for patients across the entire life span Answer: 1 Explanation: 1. Skills required to assist patients to understand and effectively use the healthcare and payment systems include excellent personal, team, and technological communication abilities. The abilities to interact with and explain the services of various health professions and case management services are necessary.

2. This traditional skill and experience would be helpful, but is not essential to this role.

3. This traditional skill and experience would be helpful, but is not essential to this role.

4. This traditional skill and experience would be helpful, but is not essential to this role.

Page Ref: 363-364 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

7 .

8) The healthcare consumer has become increasingly concerned about retaining health expenditures. What is the nurse's best advice to this patient?

1. Carry at least two forms of health insurance coverage.

2. Practice self-care, illness prevention, and collaboration with health providers.

3. Seek private, second opinions on all treatment advice by health providers associated with managed care plans.

4. Simplify medical treatment by complying with physician's advice rather than questioning such advice.

Answer: 2 Explanation: 1. Additional health insurance will not necessarily result in reduced spending.

2. Maintenance of one's personal health and involvement with health providers help reduce health expenditures.

3. In order not to incur additional expense, second opinions, when needed, must be obtained within the insurance system.

4. Active participation, rather than passive compliance, with health providers is recommended as a means of containing costs.

Page Ref: 363-364 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

8 .

9) A consumer complains about the lack of change in an aspect of the health plan that the consumer noted as negative in an earlier patient satisfaction survey. What is the nurse's best response to this complaint?

1. "That is unusual, since patient satisfaction surveys give the best evaluative information."

2. "They do those surveys, but the responses are so contradictory that the health plan administrators pretty much ignore the feedback."

3. "That is highly unethical of the plan's administrators. The next step would be a complaint to the Surgeon General's office."

4. "Patient satisfaction results are part of the evaluation process, but other factors such as professional standards also are considered."

Answer: 4 Explanation: 1. Patient satisfaction surveys alone do not provide adequate data.

2. The consumer should not be discouraged regarding his or her role in offering feedback.

3. Rather than encouraging high-level complaints, the nurse should direct the patient to the plan's representatives.

4. It is important to acknowledge the consumer's role in evaluation, but also to educate about the multifaceted aspects of this process.

Page Ref: 361-363 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

9 .

10) Select the groups that are classified as macroconsumers of healthcare. Select all that apply.

1. Employers 2. Employee's family 3. Employee 4. Government 5. Individual purchasers of healthcare services Answer: 1, 4 Explanation: 1. A macroconsumer is a large purchaser of healthcare services, such as employers and the government.

2. Microconsumers are the users of healthcare services, such as employees, employee families, and individual purchasers of healthcare services.

3. Microconsumers are the users of healthcare services, such as employees, employee families, and individual purchasers of healthcare services.

4. A macroconsumer is a large purchaser of healthcare services, such as employers and the government.

5. Microconsumers are the users of healthcare services, such as employees, employee families, and individual purchasers of healthcare services.

Page Ref: 355 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

10 .

11) Which consumer group makes the majority of decisions about healthcare services that directly affect care?

1. Microconsumers 2. Macroconsumers 3. Both microconsumers and macroconsumers 4. Neither microconsumers nor macroconsumers Answer: 1 Explanation: 1. All consumers, whether micro or macro, make decisions about the purchase of healthcare coverage, but the microconsumer is involved in more decisions about healthcare services that directly affect them.

2. Macroconsumers make more decisions about the healthcare of others.

3. Microconsumers make more healthcare decisions that directly affect them.

4. Microconsumers make more healthcare decisions that directly affect them.

Page Ref: 361 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

11 .

12) Managed care has lost much of its influence in healthcare. Why is managed care still of concern?

1. It developed systems that provided high-quality care.

2. Many managed care strategies were adopted by third-party payers.

3. It instituted strategies that resulted in increased patient satisfaction.

4. Managed care strategies greatly reduced the cost of healthcare across the United States.

Answer: 2 Explanation: 1. Not all of the systems developed increased the quality of care provided.

2. Many of today's third-party payers are continuing to use strategies initiated by managed care.

3. In many cases, patient satisfaction levels went down.

4. There was no great reduction in the cost of healthcare.

Page Ref: 356-357 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

12 .

13) A woman has become very interested in healthcare policy after her father died of complications of diabetes. Which actions would help this woman become involved in the development of healthcare public policy regarding this disorder? Select all that apply.

1. Joining the American Diabetes Association 2. Talking to her father's physician 3. Writing a letter to the editor of her local newspaper 4. Contacting her representative to the state legislature 5. Contacting her U. S. senator Answer: 1, 4, 5 Explanation: 1. In order to be of maximal influence, this woman should think nationally, not locally.

2. While her father's physician may be supportive of this woman's concerns, the physician alone cannot change policy.

3. Letters to the editor may get local coverage of the situation, but will be unlikely to result in national policy change.

4. In order to be of maximal influence, this woman should think nationally, not locally.

5. In order to be of maximal influence, this woman should think nationally, not locally.

Page Ref: 356-357 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

13 .

14) Which organizations must comply with the Patient Self-Determination Act of 1990?

1. All hospitals 2. Long-term care facilities that accept Medicare 3. A home health agency that is private pay only 4. Any healthcare organization in the United States Answer: 2 Explanation: 1. It is not a requirement that all hospitals comply with this act.

2. Technically, only facilities that accept funds from the government, such as Medicare or Medicaid, must comply with this act.

3. If the agency is private pay and does not accept government funds, compliance is not required.

4. It is not a requirement that all healthcare organizations comply with this act.

Page Ref: 357-358 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

14 .

15) What are the goals of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) program? Select all that apply.

1. To decrease the costs of healthcare 2. To assess patient centeredness 3. To compare and contrast provider performance 4. To improve quality of care 5. To act as a patient advocate in litigation Answer: 2, 3, 4 Explanation: 1. This is not a goal of the CAHPS. 2. The three goals of the CAHPS are to assess patient centeredness, to compare and contrast provider performance, and to improve quality of care.

3. The three goals of the CAHPS are to assess patient centeredness, to compare and contrast provider performance, and to improve quality of care.

4. The three goals of the CAHPS are to assess patient centeredness, to compare and contrast provider performance, and to improve quality of care.

5. This is not a goal of the CAHPS. Page Ref: 358-359 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

15 .

16) Which statement, made by a nursing student, reflects accurate knowledge of the N A M? 1. It is a governmental organization focused on healthcare.

2. It is the agency that developed the Healthy People initiatives.

3. It is an agency developed to protect the interests of medical doctors and other healthcare professionals.

4. It is a nongovernmental agency that serves in an advisory capacity for the government.

Answer: 4 Explanation: 1. The NAM is a nongovernmental agency.

2. Healthy People is a project of the U. S. Department of Health and Human Services.

3. The NAM is patient-centered.

4. This statement is the best description of the NAM. Page Ref: 359 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Compare and contrast special reports and initiatives that focus on healthcare consumers.

16 .

17) Which options reflect the foundational goals of the Healthy People initiative? Select all that apply.

1. Self-management of health 2. Consumer education 3. Increasing Medicare reimbursement 4. Advocacy 5. Decreasing cost of prescription medications Answer: 1, 2, 4 Explanation: 1. Interwoven into the goals and objectives of the Healthy People initiative is the need for consumer education, advocacy, and self-management of illness via health promotion and disease and illness prevention.

2. Interwoven into the goals and objectives of the Healthy People initiative is the need for consumer education, advocacy, and self-management of illness via health promotion and disease and illness prevention.

3. This is not a primary goal of the Healthy People initiative.

4. Interwoven into the goals and objectives of the Healthy People initiative is the need for consumer education, advocacy, and self-management of illness via health promotion and disease and illness prevention.

5. This is not a primary goal of the Healthy People initiative.

Page Ref: 359 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Compare and contrast special reports and initiatives that focus on healthcare consumers.

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18) The nursing student is preparing a presentation on the NAM. How should this student characterize the I OM's view of the patient?

1. As a member of the interprofessional team 2. As a passive recipient of care 3. As a liability to healthcare finance 4. As a component to be managed Answer: 1 Explanation: 1. The basic, foundational construct of the NAM is that the patient is the reason healthcare is provided and should be viewed as an active member of the interprofessional team.

2. The NAM views the patient as an active part of care delivery.

3. The NAM does not view the patient as a liability, but rather as the reason care is delivered.

4. The NAM does not seek to manage patients, but rather seeks to help patients participate in the management of their own care.

Page Ref: 359-360 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Compare and contrast special reports and initiatives that focus on healthcare consumers.

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19) The patient states, "I don't want to take this new medication. I looked it up on the internet and there are so many side effects." How can the nurse best assist this patient?

1. Advise the patient not to read about medications on the internet because the information is too complex to understand without help.

2. Access the site and help the patient understand the information presented about the medication.

3. Give the patient a copy of the information about the medication provided in a nursing handbook of medications.

4. Empower the patient to talk with the physician about the decision.

Answer: 2 Explanation: 1. This strategy demeans the patient and the patient's attempts at self-care.

2. This patient has taken the initiative to read about the medication, but may not understand the information or the implications of the information. The nurse should take this as an opportunity to educate the patient about the medication and about the way medications are written about in the literature. Accessing the site would also allow the nurse to determine if the site was reputable and, if not, help the patient to find reputable sites.

3. This would be appropriate if no internet access was available, but it would be best to view the information that the patient has daily access to and is using.

4. The nurse can help the patient with this decision and can educate the patient in this scenario.

Page Ref: 360-361 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess the importance of the role of technology in consumer healthcare information.

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20) The nurse has been asked to develop content for the patient education section of the hospital's website. What skills are essential for this nurse? Select all that apply.

1. Understanding the principles of adult learning 2. How to use technology to support learning 3. Basic entry-level computer programming skills 4. Clinical knowledge of the topics being developed 5. Software development skills Answer: 1, 2, 4 Explanation: 1. The nurse is developing educational materials and must have knowledge of the subject matter and how to best deliver it to the intended audience.

2. The nurse is developing educational materials and must have knowledge of the subject matter and how to best deliver it to the intended audience.

3. Computer skills will probably be necessary for this assignment, but the nurse will not need programming skills.

4. The nurse is developing educational materials and must have knowledge of the subject matter and how to best deliver it to the intended audience.

5. Computer skills will probably be necessary for this assignment, but the nurse will not need software development skills.

Page Ref: 363-364 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

20 .

21) The nursing staff has been asked to contribute to the design of a new customer/patient satisfaction survey that will be adopted for use in the hospital as a whole. What should the nurses consider when working on this document? Select all that apply.

1. Customer/patient satisfaction reflects attitudes.

2. Customer/patient expectations play a major role in patient satisfaction.

3. Once customer/patient satisfaction is measured, developing strategies to increase it will be a straightforward process.

4. It is difficult to identify who the customers of a healthcare organization really are.

5. Customer/patient satisfaction is difficult to measure.

Answer: 1, 2, 4, 5 Explanation: 1. This is a reason that satisfaction is difficult to measure.

2. Expectations are a major component of satisfaction in all areas, not just in healthcare.

3. This is a very difficult process because the actions that produce satisfaction vary from customer to customer and from patient to patient. The goal of patientcentered care is to keep the patient well enough to be out of the hospital, so repeat surveys from the same patient may be rare.

4. Nurses may have difficulty viewing patients as customers and may have difficulty identifying nonpatient customers.

5. This is a true statement.

Page Ref: 361-362 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

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22) The nurses on a unit are working to increase the return of patient satisfaction surveys. Which patients can the nurses expect will be more likely to return these surveys? Select all that apply.

1. Patients who are alert 2. Patients who are younger rather than older 3. Patients who are dissatisfied with care 4. Patients who speak English 5. Patients who are economically disadvantaged Answer: 1, 2, 4 Explanation: 1. The patients who complete surveys are patients who are able to do this—alert, typically English-speaking, and often younger.

2. The patients who complete surveys are patients who are able to do this—alert, typically English-speaking, and often younger.

3. This is not supported by the study cited in the text.

4. The patients who complete surveys are patients who are able to do this—alert, typically English-speaking, and often younger.

5. This is not supported by the study cited in the text.

Page Ref: 361-362 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

22 .

23) The nurses who work in the emergency department (E D) of a hospital believe that they provide high-quality care. Which option best supports that opinion?

1. Nurses working in other areas of the hospital rate the ED nurses' care as highquality.

2. The physicians who work in the ED state that they are satisfied with the level of nursing care provided.

3. Patients cared for in the ED report that the nurses provided high-quality care.

4. The hospital administrator rates the ED nurses as providing the best care in the facility.

Answer: 3 Explanation: 1. This is important, but not as important as patient satisfaction. Other nurses would have an idea of what quality nursing care is and would be able to access the care provided.

2. This is important, but not as important as patient satisfaction. Physicians may not have sufficient knowledge of the role of the nurse to make a strong determination about quality nursing care.

3. The patient's perception of the care provided is the most important aspect of whether it is considered high-quality care.

4. This is important, but not as important as patient satisfaction. If the remaining care in the hospital is substandard, this is not a good rating scale.

Page Ref: 361-363 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

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24) The patient diagnosed with cancer has elected to abandon curative treatment in favor of palliative care. The nurse strongly believes the patient can have a long survival time if curative care continues. What nursing advocacy action is appropriate?

1. Support the patient's choice.

2. Ask to have a different nurse assigned to this patient's care.

3. Provide education to the patient.

4. Defer to the patient's physician's position on the case.

Answer: 3 Explanation: 1. The nurse must first be certain that the patient has sufficient education to make an informed choice on this matter and then would support that choice.

2. This does not fulfill the nurse's responsibility to be an advocate for this patient.

3. The most important aspect of this situation is to ascertain that the patient has enough correct information to make an informed decision on care. Once this is assured, the nurse should support the decision made.

4. The nurse has an important role in this situation and should not simply defer to the physician.

Page Ref: 363-364 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

24 .

25) The nurse is dedicated to the concept of empowering patients and their families by giving advice, emotional support, and providing resources. In which levels of the advocacy continuum is this nurse focused? Select all that apply.

1. The individual level 2. The interpersonal level 3. The community level 4. The policy level Answer: 1, 2 Explanation: 1. The individual level focuses on informing patients and targeting interventions to the individual. Included are self-management and education.

2. The interpersonal level focuses on support and empowering patients. Included are giving advice, emotional support, and provision of resources.

3. The community level focuses on transforming culture.

4. The policy level focuses on translating consumer voice into policy and laws.

Page Ref: 363-364 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

25 .

26) Which of the following had a major impact on increasing healthcare consumerism?

1. Affordable Care Act of 2010 2. Use of Medicare 3. Development of managed care 4. Nursing advocacy Answer: 3 Explanation: 1. This legislation came long after healthcare consumerism gained strength.

2. Medicare was not a major driver of healthcare consumerism.

3. Managed care had a great impact on healthcare consumerism as consumers became upset with the changes made, such as reduced choice of providers.

4. Nursing advocacy grew with healthcare consumerism, but it was not a major impact on it.

Page Ref: 356 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

26 .

27) What is an important factor in determining if the P SDA must be followed?

1. The HCO receives Medicare payments for services.

2. The patient is a U.S. citizen and lives in the state.

3. The patient asks that the PSDA be followed.

4. The HCO gets payment from multiple third-party payers.

Answer: 1 Explanation: 1. Any HCO that receives federal funding, such as Medicare payment, must follow this law.

2. The meeting of the law's requirements is not related to citizenship or residency.

3. The meeting of the law's requirements is not related to patient preferences.

4. The meeting of the law's requirements is not related to multiple third-party payers.

Page Ref: 358 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the history of healthcare consumerism and its impact on healthcare.

27 .

28) Which of the following factors is identified as a factor that increases patient satisfaction?

1. Location of the HCO 2. Shared governance in the HCO 3. Type of third-party payer 4. Following the PSDA Answer: 2 Explanation: 1. Location may be important to a patient, but was not identified as a major factor in the book.

2. HCOs that use shared governance receive higher patient satisfaction.

3. Type of third-party payer is not a major factor related to patient satisfaction.

4. The PDSA law is important, but not directly related to patient satisfaction.

Page Ref: 361-363 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

28 .

29) Which of the following examples would not demonstrate patient advocacy by a nurse? Select all that apply.

1. Provide the patient with information about the patient's problem.

2. Tell the patient what you (the nurse) would do.

3. Plan with the patient's physician, who will talk with the patient.

4. Expect a patient to accept treatment for cancer.

Answer: 2, 4 Explanation: 1. It is helpful to provide the patient with factual information to assist the patient in decision making.

2. Your personal decisions are not relevant to the patient's decision-making process.

3. A team approach is best.

4. Nurses should not expect patients to make a decision based on what the nurse thinks is best. Patients make the decisions, and nurses need to support the patient's decision.

Page Ref: 363-364 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Apply patient advocacy to the role of the nurse.

29 .

30) In a study published in 2015 by Austin et al., what was the conclusion about the use of report cards to rate hospitals?

1. Rankings are not always accurate or ensure quality.

2. There is limited variation in data and rankings.

3. Rankings provide critical data to consumers to ensure they make the best choices.

4. Focusing on one survey result is best.

Answer: 1 Explanation: 1. The study indicated that the various rankings do not consistently agree and vary in their criteria used for the rankings, thus impacting comparison.

2. The study indicated that there is variation in results.

3. The study indicated that rankings are not useful enough to ensure patients make the best choices.

4. The study indicates that just looking at one survey will not provide an honest view.

Page Ref: 361-363 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Critique how consumers are involved in evaluating quality of care.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 12 Developing Interprofessional and Intraprofessional Teams 1) The hospital's strategic building plan calls for the nursing unit to double in size within the next year. How can planning for this increase best be accomplished?

1. A consultant who can gather ideas from all involved while avoiding the confrontations and clashes that would occur if all parties gathered to plan together 2. The nursing manager, who then can offer direct feedback to team members regarding their active roles in the change process 3. A well-coordinated team to represent all involved, to ensure that all difficult aspects of the change process are considered 4. An open forum of all staff, so that no workplace teamwork issues go unaddressed Answer: 3 Explanation: 1. An outside consultant is less likely to gain access to important information or to assist the nursing team to address teamwork issues.

2. A well-led team can best offer feedback in a direct fashion, member to member.

3. A well-coordinated team will address all relevant points in an organized fashion.

4. The forum for addressing workplace issues needs to be planned and managed in a controlled and constructive way.

Page Ref: 369-370 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; Ⅴ. Healthcare policy, finance, and regulatory environments | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

1 .

2) A group of nurses is known for its ability to perform well together to achieve its primary objectives. This group of nurses is demonstrating which characteristic?

1. Teamwork 2. Shared governance 3. A working group 4. Collective individuality Answer: 1 Explanation: 1. Teamwork is defined by the members' ability to coalesce around achievement of an objective.

2. Shared governance is not necessarily involved in this situation.

3. A working group is known more as a collection of individuals with a lesser commitment to a common goal.

4. Collective individuality is the situation when groups of people work entirely independently of one another, even though they are classified as a group or a team.

Page Ref: 369-370 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

2 .

3) Choose the situations that represent the qualities of a team rather than those of a group. Select all that apply.

1. Nurse recruiters and nurse educators gather to explore and implement a program to recruit males into the profession.

2. Three nurses, a respiratory therapist, two residents, and a nursing assistant all are fully involved in a "code blue."

3. Nurses at a unit meeting attempt to address and resolve interpersonal differences that they have assessed as interfering with nursing care.

4. Nurses meet with a representative of a master's degree program.

5. Nurses, physicians, and paramedics from around the state attend a trauma symposium where information about traumatic brain injury is presented.

Answer: 1, 2, 3 Explanation: 1. These participants have a common goal and will work together to achieve the goal.

2. These participants are working toward a common goal.

3. These participants are working toward a common goal.

4. These participants have separate interests, with no commitment to a common goal and will not necessarily work together.

5. These participants likely have a common goal of improving their individual practice with traumatic brain injury patients, but there is no indication that they will work together to achieve the goal.

Page Ref: 370 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

3 .

4) A home health agency will find which benefit when its nurses perform at a high level of teamwork?

1. The nurses will recognize clearly the leadership of their designated nurse manager.

2. Majority and minority viewpoints will be retained well.

3. Disagreements and conflicts will be less likely to arise and be aired at staff meetings.

4. Individual nurses in the agency will be confident in their role and how they contribute to the agency's mission.

Answer: 4 Explanation: 1. Designated leadership is more common of a group rather than of a team.

2. Maintenance of individuality characterizes a group.

3. Reluctance to address conflict characterizes a group.

4. Role confidence regarding a shared mission is a hallmark of teamwork.

Page Ref: 370-371 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

4 .

5) The nursing unit is adopting the "self-directed work team" model. What benefits are likely to occur because of this decision? Select all that apply.

1. Services will be focused on the patient.

2. Centralization will create cost efficiency.

3. Use of small teams of nonprofessional staff led by an RN offers cost savings.

4. Staff retention and productivity will improve.

5. Positive patient, staff, and physician satisfaction.

Answer: 1, 4, 5 Explanation: 1. Self-directed work teams are often associated with patient-centered care.

2. Services will likely be decentralized.

3. This is team nursing, not working on a self-directed work team.

4. This is a benefit of using this model.

5. This is a benefit of using this model.

Page Ref: 370-371 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

5 .

6) Which action, taken by the administration of a healthcare facility, would likely hinder the success of self-directed work teams?

1. Ensuring that all members of the teams develop skills in leadership and control 2. Encouraging the creation of specific responsibilities and boundaries for team members 3. Creating organization-wide performance evaluation tools for management to use in uniform fashion for all teams 4. Providing for education in technical, interpersonal, communication, and management skills for all team members Answer: 3 Explanation: 1. All team members should be empowered to exercise leadership and control.

2. While all teams require specific boundaries and responsibilities, the self-directed team differs in that the team, rather than an outside entity, develops these concepts.

3. Self-directed work teams should include development of performance evaluation tools useful for the team and there should be team-wide implementation of this evaluation. Management-centered evaluation violates this principle.

4. All members will require skills in management, communication techniques, and interpersonal relations.

Page Ref: 371-372 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

6 .

7) A nurse has just been promoted to team leader for a nursing unit and wishes to experience a smooth transition into this job. What is a common mistake made by new team leaders?

1. Being authoritarian due to lack of self-confidence, lack of trust, and fear of poor outcomes 2. Using a "hands-off" approach due to idealism, a naive sense of trust, and lack of belief in their own judgment 3. Adopting a highly cooperative approach due to lack of experience and clinical skills 4. Easily extending an openness to input and participation from team members because of their freedom from negative experiences with this approach Answer: 1 Explanation: 1. New team leaders tend to adopt a directive and more dictatorial approach, out of fear of negative results if input and shared authority were extended to others.

2. This "hands-off" approach can be positive, but requires more experience in the leadership role.

3. The approach requires more experience in the leadership role.

4. With greater experience, trust, and confidence, team leaders tend to be able to share team planning and decision making.

Page Ref: 372-373 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Assess team leader characteristics and how these relate to team leader tasks and responsibilities.

7 .

8) Which statement, if made by the team leader, would best enhance teamwork on a long-term care nursing unit?

1. "Nursing assistants must follow directions given by the nurses at the start of the shift."

2. "Let's be sure to take time for fun and getting along with each other during the shift."

3. "You have all completed your orientations. Your job now is to perform the tasks as you have been directed."

4. "The way the shifts work together by passing on useful information at report helps our residents to be safe and comfortable."

Answer: 4 Explanation: 1. Emphasis on position and hierarchy negatively affects the team.

2. The team needs to be assisted to focus on its tasks and outcomes more than on its social values.

3. Members' contribution and participation in the team's growth and improvement deserve greater emphasis than following rules given by authorities.

4. Teamwork is enhanced by a focus on patient care and by positive feedback about how the team functions and contributes to its own standards and outcomes.

Page Ref: 371-372 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Assess team leader characteristics and how these relate to team leader tasks and responsibilities.

8 .

9) An effective nursing leader can foster positive followership by rewarding team members who exhibit which behavior?

1. Respect the need to do their jobs well, and leave evaluation and change to management.

2. Place primary importance on interpersonal relationships and communication among team members.

3. Limit attention to organizational and environmental factors in favor of completing their assigned tasks.

4. Demonstrate individual initiative in meeting nursing care goals while being willing to contribute to ongoing improvement of the organization.

Answer: 4 Explanation: 1. While doing the job well is important, an effective follower will also self-evaluate and institute changes as necessary.

2. This follower may focus on social issues and ignore the other work of the team.

3. The effective follower will complete his or her assigned tasks, but will also be aware of the organizational climate.

4. Development of shared participation, personal investment in unit goals, and a self-starting attitude build active followers.

Page Ref: 374-375 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

9 .

10) The vice president of nursing for a multihospital organization is planning a project team. The team will include members from nursing, medicine, and allied health who will plan the work jointly and will carry it out collaboratively. Each member of the team will be expected to provide the expertise of each profession. Which approach to teamwork is this administrator planning?

1. A multidisciplinary team 2. Team nursing 3. Total patient care 4. An interprofessional team Answer: 4 Explanation: 1. The multidisciplinary team's members function more autonomously.

2. Team nursing is limited to nursing personnel.

3. Total patient care is limited to nursing personnel.

4. The interprofessional team provides maximum collaboration in planning and providing care by members of related health disciplines.

Page Ref: 371-372 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Examine issues related to effective teams.

10 .

11) A nursing team has been gathered to refine documentation procedures. During its second meeting, two members are passive, two struggle impatiently to get the task under way, and two others are dominating and controlling communication. What should the leader do at this point?

1. Assist the members to get to know one another.

2. Encourage group communication, encouraging all members to share in this process.

3. Set rules regarding the team's purpose, schedule, attendance, roles, tasks, and confidentiality.

4. Guarantee that consensus is reached regarding the team's findings and recommendations.

Answer: 2 Explanation: 1. Getting to know one another occurs in the initial orientation or forming stage.

2. This group, fairly early in its business, is in the storming/conflict/confusion stage.

Participation, communication, and collaboration can ease the team toward its next stage.

3. Rules are set in the norming stage.

4. Consensus is part of the performing stage.

Page Ref: 377-378 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

11 .

12) A nursing leader observes conflict in the team. The leader's response to this conflict should be based on which principle?

1. Information and expertise from sources external to the team cause erosion of teamwork.

2. Conflict that is focused on differing personalities is acceptable as long as agreement regarding work issues exists.

3. Total agreement on all matters is not as important as general agreement among members to support decisions of the team.

4. Personal feelings or reactions of members regarding decisions always must be aired immediately.

Answer: 3 Explanation: 1. External expertise can be valuable to team deliberations and decisions.

2. Conflicts over issues can be healthy, whereas conflicts based on personalities are destructive.

3. The team thrives on a history of support and accomplishment of goals in spite of variations in members' outlooks.

4. Personal feelings or reactions should be aired in controlled, constructive, and appropriate ways, which may not occur immediately.

Page Ref: 371, 373, 377 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

12 .

13) A team of nurses is developing a procedure for self-scheduling of staff. The leader can assess that motivation is healthy when what occurs?

1. Members applaud the accomplishment of one step by moving on rapidly to the next step of the task.

2. The team members are each independently following the exact directions of the leader.

3. Various members show initiative by also taking on goals related to evaluation methods, social events, and risk prevention.

4. Members patiently wait for direction and permission in their tasks, and quickly stop their work when informed of their mistakes.

Answer: 1 Explanation: 1. Internal reward is operating when the team is urged on to further work by success with initial steps.

2. Motivated teams develop their own methods and steps in the task through group decision making, not through working independently.

3. The members of this team are not staying on task. Clear boundaries regarding empowerment and goals must be present for proper motivation.

4. Motivated teams work toward delineated outcomes, weathering frustrations and obstacles through mutual support.

Page Ref: 379-380 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

13 .

14) A work group has completed its first task and meets to evaluate its work prior to engaging in its next task. The leader should recognize which team member comment as requiring restatement, redirection, or refinement?

1. "I sure was frustrated when we were just setting goals, but it was good once we got under way."

2. "We always get bogged down and waste time."

3. "I got to appreciate Sally's wild ideas more once one of her ideas got us past being stuck last week."

4. "We did an especially good job of writing down our recommendations clearly before posting them."

Answer: 2 Explanation: 1. Feelings should be expressed, as long as they are stated in terms of specific events or issues.

2. Vague, general comments need to be stated as more specific feedback.

3. Personal feedback is useful if it addresses objective points.

4. Positive feedback must point to actual behaviors, accomplishments, or methods.

Page Ref: 379-380 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

14 .

15) An interprofessional discharge planning team has received negative feedback from several patients regarding lack of clarity in postdischarge instructions. Which leader statement is most constructive for this team at this point?

1. "All members of this team need to review their own materials for accuracy, conciseness, and thoroughness."

2. "Perhaps some new members should be added to this group to give us some fresh ideas."

3. "I hate to say this, but you all know that we are going to have to put in some long hours figuring out how to get this job done correctly."

4. "We can handle this feedback using our talents and the way we come together to tackle challenges."

Answer: 4 Explanation: 1. This statement implies that a member or members of the team have done something wrong to cause the feedback. This attitude projects a feeling that the team failed.

2. This statement implies that the current members of the team are not capable of solving the problem.

3. This statement implies that the job was done incorrectly. The statement is also delivered as if it were a punishment for a failure.

4. Empowerment is developed by an attitude of learning from mistakes, rather than a sense of failure. Cohesiveness, mutual support, the value and significance of members, and a message of stimulation and energy will motivate a team to perceive negative feedback as a challenge rather than a failure.

Page Ref: 377 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Examine issues related to effective teams.

15 .

16) What is a major difference between formal teams and informal teams?

1. Formal team members have much in common.

2. Informal teams are formed by the members.

3. Formal teams are rarely formed by the organization.

4. Informal teams are often called committees.

Answer: 2 Explanation: 1. Formal team members generally have less in common than informal team members.

2. Informal teams are formed by those that have common interests or needs.

3. Formal teams are often assigned by the organization.

4. The formal teams present in many organizations are also known as committees.

Page Ref: 370-371 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the importance of teams and types of teams in the healthcare delivery system.

16 .

17) Which statement regarding the authority of a team leader is accurate?

1. The team leader in a healthcare organization has authority equal to that of the individuals who compose the administrative staff.

2. The team leader has only as much authority as the team members will allow.

3. The team leader relinquishes authority and control as the team gains strength.

4. The team leader has control of the team, but no real authority.

Answer: 3 Explanation: 1. Often the healthcare team leader is a middle manager who does not have the authority of an administrator.

2. The team leader has the authority, but the team members may not recognize that authority. This situation can result in the team being ineffective.

3. As the team gains strength, the leader should begin to relax control and allow the team to exert more and more authority over the direction of the team.

4. The team leader does have authority. In some cases, the leader does not have control.

Page Ref: 372 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Assess team leader characteristics and how these relate to team leader tasks and responsibilities.

17 .

18) The staff nurse has been asked to assume leadership of a work team. Which strategies should this nurse use to increase the team members' trust? Select all that apply.

1. Keep promises that are made.

2. Give honest feedback.

3. Create a logical excuse for not keeping promises made.

4. Reward followers.

5. Ask followers to defer feedback until the end of the project.

Answer: 1, 2, 4 Explanation: 1. If the leader does not keep promises, trust is lost.

2. Feedback should be honest and formulated to help the followers do a better job.

3. The leader can explain why a promise was not kept, but should not "create" excuses.

4. Followers appreciate rewards when they are earned.

5. Followers should be encouraged to provide feedback to the leader throughout the project.

Page Ref: 375-376 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

18 .

19) What are the basic group skills necessary for development of an effective team?

Select all that apply.

1. Communication 2. Negotiation 3. Manipulation of situations 4. Assessment of team dynamics 5. Time management Answer: 1, 2, 4, 5 Explanation: 1. Basic group skills include communication, negotiation, delegation, time management, and assessment of team dynamics.

2. Basic group skills include communication, negotiation, delegation, time management, and assessment of team dynamics.

3. Manipulation of situations is not a basic team skill.

4. Basic group skills include communication, negotiation, delegation, time management, and assessment of team dynamics.

5. Basic group skills include communication, negotiation, delegation, time management, and assessment of team dynamics.

Page Ref: 375-376 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

19 .

20) The nurse manager has done an excellent job of creating a team atmosphere for patient care. Patients receive excellent care, staffing needs of the unit are met internally, and all employees of the unit are valued for their contributions. Which type of teamwork has this manager facilitated?

1. Interprofessional teamwork 2. Multidisciplinary teamwork 3. Total patient care 4. Microsystem Answer: 4 Explanation: 1. The care provided is interprofessional, but the atmosphere on this unit is more than just teamwork.

2. The care provided is multidisciplinary, but the atmosphere on this unit is more than just teamwork.

3. This is most likely a total patient care environment, but the teamwork indicated is more than that.

4. The best answer to this question is that this manager has created a microsystem on the unit that embraces and supports total patient care.

Page Ref: 372 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

20 .

21) Place Tuckman's stages of team development in order.

Choice 1. Forming Choice 2. Performing Choice 3. Norming Choice 4. Storming Answer: 1, 4, 3, 2 Explanation: 1. This is the initial orientation stage of the process.

2. This is the fourth stage of the process in which work is getting done and the team feels positive.

3. In this third stage, the team members begin to work together.

4. This is the second stage and is characterized by conflict and confusion.

Page Ref: 377-378 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

21 .

22) Maslow's theory of motivation focuses on a need hierarchy. Place the examples of steps of this hierarchy in order from the lowest to the highest level.

Choice 1. This month's meeting is scheduled one day after a bomb scare resulted in the hospital being evacuated.

Choice 2. The meeting room assigned to the team is cold.

Choice 3. At the first meeting of the team, one of the members states, "I don't know why there are physical therapists on this team. They don't belong to this group."

Choice 4. At a team meeting, a member states, "This is a lot of hard work, but it is the right thing to do."

Choice 5. Appointment to this team is considered an honor and performing well in the team will increase the team member's chances at promotion.

Answer: 2, 1, 3, 5, 4 Explanation: 1. Safety and security needs are the second level.

2. This is the physiological or lowest level. These needs must be met first.

3. The third of Maslow's motivation levels is belongingness, social, and love. Having this confrontation at the first meeting may impact these feelings in the physical therapists, affecting their motivation.

4. The highest of Maslow's levels is self-actualization.

5. The fourth level is self-esteem.

Page Ref: 379 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

22 .

23) Choose the options that reflect the needs listed in McClelland's learned need theory of motivation. Select all that apply.

1. The need for money 2. The need for achievement 3. The need for affiliation 4. The need for power 5. The need for status Answer: 2, 3, 4 Explanation: 1. This is not one of the needs listed.

2. The achievement need encourages a person to set goals, challenging oneself to achieve those goals.

3. Affiliation needs push a person toward social interaction, which affects motivation, as few things can be achieved without others.

4. The need for power focuses on the person's efforts to obtain and exercise power and authority.

5. This is not one of the needs listed.

Page Ref: 379 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

23 .

24) The nurse leader has assessed that the healthcare team lacks motivation and as a result is not achieving its goals. What can the leader do to change this situation?

Select all that apply.

1. Focus on moving the team forward.

2. Help the group set an incremental, more manageable goal.

3. Once a goal is reached, reward the staff.

4. Call a meeting with the staff to look for errors in past performance.

5. Focus on what the team is doing correctly.

Answer: 1, 2, 3, 5 Explanation: 1. The leader should focus on the positive aspects of the team's performance and how it can continue to make progress. Attention to the achievement of progress can increase motivation.

2. Small goals are more obtainable and give the team a feeling that the larger goal is not out of reach. Small victories can increase motivation.

3. Rewards, either tangible or intangible, are motivation builders.

4. The leader should not focus on errors. This team is already not doing well, so focusing on the negative will not help.

5. Focusing on what is going well will help the team feel as if it can achieve more.

Page Ref: 379-380 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

24 .

25) Groupthink can be a barrier to effective team functioning. What are reasons groupthink occurs? Select all that apply.

1. The team pressures members to agree with everyone on the team.

2. The group is closely associated with the consequences of its actions.

3. There is a general closed-mindedness prevalent in the group.

4. The team accepts too many suggestions.

5. Members are unwilling to go against group ideas.

Answer: 1, 3, 5 Explanation: 1. If everyone on the team feels pressured to agree with the team, this is groupthink.

2. Groupthink is more likely to occur if the group is separated from the consequences of its actions.

3. Close-mindedness in a group breeds groupthink.

4. Groupthink is more likely to occur if the group does not accept suggestions.

5. Fear of going against group ideas results in groupthink.

Page Ref: 381-382 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Explain the important considerations related to team development, structure, and functions.

25 .

26) What is the key difference between the charge nurse and the team leaders from the following statements?

1. The charge nurse and team leader have the same responsibilities.

2. The charge nurse has no responsibilities related to the unit teams.

3. The charge nurse focuses on the whole unit and the team leader on a team.

4. The charge nurse is concerned with individual staff and team leaders with groups.

Answer: 3 Explanation: 1. The charge nurse and team leaders do not have the same responsibilities.

2. The charge nurse has to be aware of teams and their work, and provide overall supervision of team leaders.

3. This is the correct description of the responsibilities.

4. Both charge nurse and team leaders need to consider individuals and groups/teams.

Page Ref: 383 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Discuss the roles of charge nurse or shift manager and intraprofessional teams.

26 .

27) Which statement would not relate to the position of the charge nurse?

1. The charge nurse is the nurse manager.

2. The charge nurse is focused on making sure the unit runs well.

3. The charge nurse works with multiple teams.

4. Charge nurses may work on any shift.

Answer: 1 Explanation: 1. The charge nurse is not the nurse manager.

2. The charge nurse is focused on the unit operations.

3. Typically there are several teams, and the charge nurse works with all of them.

4. Each shift may have a charge nurse.

Page Ref: 383 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Discuss the roles of charge nurse or shift manager and intraprofessional teams.

27 .

28) Who developed TeamSTEPPS®?

1. A healthcare system 2. A state health department 3. Insurers 4. The federal government Answer: 4 Explanation: 1. Health systems use this model and information about teams, but did not develop it.

2. This was not developed at the state level.

3. Insurers did not develop TeamSTEPPS®.

4. The federal government developed TeamSTEPPS®.

Page Ref: 383-386 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 06. Examine how TeamSTEPPS® may be used to improve teams.

28 .

29) What does TeamSTEPPS® recommend as strategies to sustain this model? Select all that apply.

1. Ensure leaders emphasize new skills.

2. Measure success.

3. Update the plan.

4. Celebrate wins.

5. Provide coaching.

Answer: 1, 2, 3, 4, 5 Explanation: 1. This is recommended by the model.

2. This is recommended by the model.

3. This is recommended by the model.

4. This is recommended by the model.

5. This is recommended by the model.

Page Ref: 383-386 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 06. Examine how TeamSTEPPS® may be used to improve teams.

29 .

30) Which approach is recommended to implement TeamSTEPPS®?

1. Cover all content before implementation.

2. Asking staff what they want.

3. Dosing before implementation.

4. Whole training for all staff.

Answer: 3 Explanation: 1. This approach may lead to training fatigue and overload and inability to connect content to work in teams.

2. Staff may be asked for feedback, but they do not know enough about TeamSTEPPS®.

3. Dosing is the recommended approach; allows time for direct linking of tools and strategies with specific opportunities for improvement to minimize training fatigue and overload.

4. This approach may lead to training fatigue and overload and inability to connect content to work in teams.

Page Ref: 383-386 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 06. Examine how TeamSTEPPS® may be used to improve teams.

30 .

31) Which strategy is best used to get a team member back on track and focused?

Select all that apply.

1. Review the agenda and identify what still needs to be done.

2. Allow member(s) who have concerns to share them even if it takes time.

3. The team leader should take time to explain the issues and tell the team what should be done next.

4. Allow sharing of different views from team members.

5. Begin and end the meeting on time.

Answer: 1, 4, 5 Explanation: 1. Having an agenda and using it to guide meetings is effective.

2. Allowing team members to dominate and take the meeting off track is not effective.

3. The team leader should not dominate the meeting.

4. Allowing members to share different views leads to synergy and more robust discussion and ideas.

5. Staff members are busy and need to know that meetings will start and end on time with the expectation that all members will be on time and prepared for the meeting.

Page Ref: 383-386 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 06. Examine how TeamSTEPPS® may be used to improve teams.

31 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 13 Improving Teamwork: Collaboration, Coordination, and Conflict Resolution 1) Which typical response by the nurse indicates the use of effective collaboration skill?

1. Negotiates with others 2. Avoids competition 3. Strongly defends own ideas 4. Attacks to assert own position Answer: 1 Explanation: 1. Conflicts will arise that could interfere with collaboration. The nurse must develop negotiation skills to resolve difficult conflicts.

2. Nurses who fear competition and who are concerned about power will struggle with the need to share. Sharing is a component of collaboration.

3. This is a barrier to effective collaboration. The nurse should ask others involved in the process for advice and comments.

4. To effectively collaborate, the nurse should avoid attacking and counterattacking and should focus on common interests and resolutions.

Page Ref: 390 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

1 .

2) The patient, the nurse, and the physician have discussed treatment options and nursing care and have come to an agreement on the patient's plan of care. Which principle does this illustrate?

1. Education 2. Conflict resolution 3. Emotional intelligence 4. Collaboration Answer: 4 Explanation: 1. Education focuses on helping each party understand the other's roles. It is important to collaboration, but not the best answer to this question.

2. Conflict resolution is often a part of collaboration and may have been a part of this scenario, but there is not enough information to make that the best answer.

3. Emotional intelligence is a leadership theory that promotes awareness of feelings. It may be a part of collaboration, but is not the best answer to this question.

4. This scenario demonstrates a shared purposeful attention to the patient's needs and problems to achieve successful outcomes, which is the principle of collaboration.

Page Ref: 390-391 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

2 .

3) Select the options that reflect the key concepts related to collaboration. Select all that apply.

1. Partnership 2. Interdependence 3. Position 4. Responsibility 5. Dynamic Answer: 1, 2, 4, 5 Explanation: 1. Key concepts related to the dynamic process of collaboration are partnership, interdependence, and collective ownership and responsibility.

2. Key concepts related to the dynamic process of collaboration are partnership, interdependence, and collective ownership and responsibility.

3. The position the nurse has does not affect nurse collaboration.

4. Key concepts related to the dynamic process of collaboration are partnership, interdependence, and collective ownership and responsibility.

5. Key concepts related to the dynamic process of collaboration are partnership, interdependence, and collective ownership and responsibility.

Page Ref: 390-394 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

3 .

4) The administrative staff has brainstormed for ideas on creating a more collaborative environment in the healthcare agency. Which idea would be the best to develop further?

1. Develop a plan to help members of each profession more completely understand the impact of their own work.

2. Institute collaborative strategies quietly and in a stealthy manner.

3. Hold education sessions regarding collaboration for each department.

4. Emphasize the fact that no one profession has all of the necessary skills to provide all care.

Answer: 4 Explanation: 1. This idea is focused on an individual profession, not on collaboration among disciplines.

2. It would be better to be very public and upfront about the initiative.

3. This idea focuses on the individual department, not on collaboration.

4. This is the best idea offered. Collaboration requires acceptance that one's own profession does not have all the answers or skills and that it takes many different professions to provide patient-centered care.

Page Ref: 390-394 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

4 .

5) The nurse is working to make sure all plans for the patient's discharge are complete.

Which option best reflects the role in which this nurse is working?

1. Evaluation 2. Coordination 3. Communication 4. Collaboration Answer: 2 Explanation: 1. Evaluation is a step of the nursing process used to help coordinate care. This is not the best answer to this question.

2. Coordination of care is done to establish and support a continuous healing relationship. This nurse is working to assure that there is a smooth transition from hospital to home.

3. The nurse will likely use communication skills while coordinating the transition, but this is not the best answer.

4. The nurse may have to collaborate with others in order to coordinate the patient's discharge, but this is not the best answer.

Page Ref: 394 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

5 .

6) The staff nurse approaches the nurse manager with a complaint about a physical therapy assistant and states, "She doesn't do the same amount of work as the nursing assistants." After investigating, the manager believes the staff nurse does not understand the PT assistant's role and that is causing stress for the nurse.

Which kind of conflict has this situation caused the nurse?

1. Organizational conflict 2. Individual conflict 3. Interpersonal conflict 4. Repressive conflict Answer: 2 Explanation: 1. Organizational conflict occurs between or among groups in the organization or between or among organizations. This choice is not supported by the scenario provided.

2. Not understanding the roles of other staff can be very stressful for the individual and does affect work performance.

3. Interpersonal conflict occurs between people and can be related to personality differences, territoriality, or control issues. There is nothing in this question that says that there is interpersonal conflict between the two individuals.

4. Repressive conflict is a type of conflict when the individual responds by excessive absenteeism or other avoidance behavior. This is a type of covert conflict.

Page Ref: 397 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

6 .

7) The nursing staff members report a problem to their nurse manager by saying, "We know we are going to have a problem with this." This statement illustrates which stage of conflict?

1. Perceived conflict 2. Felt conflict 3. Manifest conflict 4. Latent conflict Answer: 4 Explanation: 1. This stage requires recognition or awareness that conflict exists at a particular time.

2. This occurs when individuals begin to have feelings about the conflict such as anxiety or anger.

3. This is overt conflict.

4. The latent conflict stage involves the anticipation of conflict.

Page Ref: 396-398 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

7 .

8) Which actions are important in the prevention of conflict? Select all that apply.

1. Allocate resources fairly.

2. Try to keep problems confidential.

3. Address staff fears.

4. Clearly state expectations.

5. Keep lines between roles flexible and dynamic.

Answer: 1, 3, 4 Explanation: 1. Conflict can arise when resources are scarce or unfairly allocated.

2. Denying problems or trying to keep the fact that problems exist secret will lead to mistrust.

3. Clear communication, especially about rumors and fears, is important to reduce conflict.

4. Expectations should be clearly stated to prevent misunderstanding and rumor.

5. Roles should be clearly defined and role responsibilities should be clear.

Page Ref: 399 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

8 .

9) A nurse who is often a staff leader frequently comes to the nurse manager with concerns and complaints. When the nurse is reviewed for a merit raise, she does not receive it even though the nurse demonstrated excellent work leading the unit change to evidence-based practice. This illustrates use of which type of power by the nurse manager?

1. Coercive power 2. Referent power 3. Informational power 4. Reward power Answer: 1 Explanation: 1. Coercive power is based on punishment when a person does not do as expected or directed. Examples are denial of a pay raise, termination, and poor schedule or assignment. Denial of this nurse's merit raise, even though work was excellent, could be related to the nurse frequently coming to the nurse manager with concerns. This situation is an example of coercive power.

2. This informal power comes from others recognizing that an individual has special qualities and is admired.

3. This type of power arises from the ability to access and share information.

4. This type of power comes from the ability to reward those who comply. This is closely associated with coercive power, but this situation more clearly demonstrates coercive actions. If the nurse had been given a pay raise for good work and complying with expectations, reward power would be used.

Page Ref: 400-401 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

9 .

10) The manager has asked the staff to participate in the selection of new intravenous pumps for the unit. The manager has provided a list of choices and budget guidelines. This is an example of use of which management strategy?

1. Use of expert power 2. Use of legitimate power 3. Empowerment of staff 4. Management persuasiveness Answer: 3 Explanation: 1. This manager has used expert opinion, not expert power.

2. Legitimate power is the type of power that is "awarded" with a position.

3. This action enables others to act and provides others with the opportunity to participate and influence decisions.

4. The manager would have used persuasiveness to convince the staff to adopt a particular kind of pump that the manager chose.

Page Ref: 400-401 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

10 .

11) A staff member has become very disagreeable. The other nurses know this staff member is transferring to another unit at the end of the week. The nurses decide to ignore the situation. This illustrates which method of conflict resolution?

1. Accommodation 2. Collaboration 3. Avoidance 4. Passive-aggressiveness Answer: 3 Explanation: 1. Accommodation allows a person to try to make a situation better when he or she is less interested in the situation than the other party and, therefore, just allows the conflict to deflate.

2. Collaboration is when all parties attempt to reach an acceptable solution for all.

3. Avoidance enables the person to withdraw or ignore a situation that is not worth what might be lost if it is addressed. This often occurs when one party in a conflict is leaving.

4. Passive-aggressive behavior makes conflict worse. It is when there is resistance to following through with expectations. This resistance can be obstructionist.

Page Ref: 403 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

11 .

12) The nurse manager is responsible for resolving a conflict. Place the steps of conflict resolution in the order the manager should use.

Choice 1. Identify the problem behaviors.

Choice 2. Discuss the situation with those involved.

Choice 3. Document the facts and their source.

Choice 4. Report the results to the appropriate supervisor.

Answer: 1, 3, 2, 4 Explanation: 1. This step correlates with data collection or assessment and is the first step in this process.

2. This is the third step of the process, after data have been collected and documented.

3. Documenting facts and sources is the second step of the process.

4. This is the final step in this process.

Page Ref: 406-407 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

12 .

13) Which option illustrates that effective negotiation has occurred?

1. Education about the issue occurs.

2. Boundaries are set and meeting times and place are established.

3. Both parties compromise and make concessions.

4. An agreement is formalized.

Answer: 4 Explanation: 1. This option represents clarifying and justifying, which is the third step of the process.

2. This option represents setting the ground rules of the negotiation, which is the second step.

3. This option represents the bargaining and problem-solving step, which is the fourth step.

4. This is the final step of this process and indicates closure and implementation.

Page Ref: 406-407 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

13 .

14) Select the appropriate interventions to discourage verbal abuse between physicians and nurses. Select all that apply.

1. Approach those involved in private and identify a need for change in behavior.

2. Gain a better understanding of each profession's viewpoint.

3. Appoint a professional from another discipline to take charge of training and education programs for physicians and nurses.

4. Encourage nurses who are involved in this behavior to find employment elsewhere.

5. Disseminate code-of-conduct policies and reporting guidelines to both nurses and physicians.

Answer: 1, 2, 5 Explanation: 1. Identification of the problem is essential. Sometimes this intervention can stop beginning abuse.

2. It is important for nurses to understand more about the physician's role and role strain and for physicians to understand more about the nurse's role and role strain.

3. The leader of this group should be the same as the participants. If the sessions are held jointly, there should be both a nurse and a physician as leaders.

4. This is not a good solution to the problem. If the nurse is innocent in the situation, the behavior will not stop. If the nurse is not innocent in the situation, the behavior is likely to continue at the next job.

5. Educating and setting clear expectations is essential. Reporting guidelines are also important.

Page Ref: 405 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

14 .

15) Initial conflict resolution includes using which strategy?

1. Developing more self-confidence 2. Avoiding the situation 3. Questioning throughout the process 4. Obtaining a neutral third party to assist Answer: 3 Explanation: 1. This is a by-product of the conflict resolution process. It should not be necessary to wait until self-confidence is developed to address the conflict resolution process.

2. If a conflict is not identified, it can damage patient care and staff relationships.

3. It is important to ask about behaviors that started the conflict and to explore how to avoid them in the future.

4. This may be necessary if no opportunity for cooperative problem solving can be identified. It should not be used in the initial stages of conflict resolution.

Page Ref: 406-407 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

15 .

16) The nursing department of a hospital is engaged in collaborative planning with the laboratory and radiology departments of the same hospital. What are the benefits of this collaborative planning? Select all that apply.

1. It maximizes resources such as staff and equipment.

2. It keeps one department from getting too big a share of the budget.

3. It minimizes duplication of work.

4. It improves the relationship among these departments.

5. It makes the best use of space available.

Answer: 1, 3, 4, 5 Explanation: 1. Maximizing resources is a big benefit of planning collaboratively.

2. This is not the reason for collaborative planning.

3. If planning is not done collaboratively, one department is unaware of the other department's plans and may duplicate work. For example, planning how lab tests are ordered can reduce duplication of work.

4. When staff members sit down together and plan for the future, they learn more about one another and one another's role. This can improve relationships.

5. Maximizing resources is a big benefit of planning collaboratively.

Page Ref: 393 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

16 .

17) Which option, regarding the benefits of interprofessional collaboration, is accurate?

1. These relationships are easy to establish because physicians, nurses, and ancillary professionals work closely together.

2. Interprofessional environments are easy to establish, but hard to maintain.

3. Professionals will have more career mobility as healthcare systems change.

4. Healthcare research will be conducted solely by physicians, leaving patient care to nurses.

Answer: 3 Explanation: 1. These relationships are difficult to establish.

2. These environments take time to develop and energy to maintain.

3. This is a benefit. The more a professional knows about other disciplines in healthcare and the more networking the professional does, the more marketable the person is.

4. This is not true and is not a benefit.

Page Ref: 391 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

17 .

18) Which option is related to collaboration between the nurse and patient instead of coordination of patient care?

1. Requires direct interaction with the patient 2. Can take place either before or after patient care is provided 3. Is not goal directed 4. Is done to ensure that something happens Answer: 1 Explanation: 1. In order to collaborate, there must direct interaction with the patient.

2. This is true of coordination.

3. Collaboration and coordination are goal directed.

4. This is true of coordination.

Page Ref: 394-396 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

18 .

19) The nurse manager has been working with staff to improve care coordination, but has not met with success on this endeavor. Which statements, made by staff, would indicate to this manager that a barrier to coordination exists? Select all that apply.

1. "We never have the correct information from radiology for how they want us to prepare patients for tests."

2. "Has anyone been able to get the laboratory to answer the phone today?"

3. "I talked with one of the physical therapy assistants today. Did you know that all of our PT assistants have college degrees?"

4. "I tried to sit with some of the staff members from the pharmacy today at lunch, but they didn't include me in any of their conversation."

5. "The speech therapist helped me set up a way to communicate with a patient with a tracheostomy."

Answer: 1, 2, 4 Explanation: 1. Not having the correct resources is a source of frustration and has a negative impact on coordination of care.

2. Not being able to communicate is a source of frustration and has a negative impact on coordination of care.

3. Coordination is more effective when those involved have a better understanding of their respective roles and work stresses.

4. Staff who are not willing to listen or include others will find coordination difficult.

5. Working together to solve a problem is a positive step toward coordination of care.

Page Ref: 394-396 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

19 .

20) Select the tools used by healthcare that are focused on coordination of care. Select all that apply.

1. Case management 2. Clinical pathways 3. Practice guidelines 4. Disease management 5. Care maps Answer: 1, 2, 3, 4, 5 Explanation: 1. Care coordination is essential to patient-centered care. Case management, clinical pathways, practice guidelines, disease management, and care maps all have coordination as a basis of their development.

2. Care coordination is essential to patient-centered care. Case management, clinical pathways, practice guidelines, disease management, and care maps all have coordination as a basis of their development.

3. Care coordination is essential to patient-centered care. Case management, clinical pathways, practice guidelines, disease management, and care maps all have coordination as a basis of their development.

4. Care coordination is essential to patient-centered care. Case management, clinical pathways, practice guidelines, disease management, and care maps all have coordination as a basis of their development.

5. Care coordination is essential to patient-centered care. Case management, clinical pathways, practice guidelines, disease management, and care maps all have coordination as a basis of their development.

Page Ref: 394-396 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

20 .

21) A major conflict has arisen among staff nurses regarding holiday days off on the next schedule. One of the nurses has a history of destructive behavior associated with conflict that the nurse manager would like to catch before the behavior affects the operation of the unit. What behaviors, by this nurse, should the manager watch out for? Select all that apply.

1. The nurse ignored the policy for 15-minute work breaks and was away from the unit for 30 minutes.

2. When asked about the conflict the nurse states, "I don't know what you are talking about."

3. The nurse states, "We have a problem with this scheduling, but I bet we can work it out."

4. The nurse avoids going into the nursing station when an "opponent" in the conflict is present.

5. The nurse has lunch with a nurse from another unit.

Answer: 1, 2, 4 Explanation: 1. Ignoring policies can be a sign of destructive conflict.

2. Denial of the problem can be a sign of destructive conflict. The manager should be alert for additional indicators.

3. This statement acknowledges the problem and indicates that a solution is possible.

4. Avoiding a staff member can be a sign of destructive conflict.

5. Just having lunch with a nurse from another unit is not a sign of destructive conflict. If the nurse is discussing the situation in negative terms with the other nurse, a problem may exist.

Page Ref: 396-399 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

21 .

22) Select the major goals of conflict management. Select all that apply.

1. To meet the needs of the patient, the family or significant others, and the organization 2. To decrease conflict 3. To encourage staff to be more aggressive in dealing with conflict 4. To ensure all parties feel positive about the resolution to conflict 5. To eliminate the possibility of conflict Answer: 1, 2, 4 Explanation: 1. Patient care is always the goal of nursing.

2. Conflict can be decreased and temporarily eliminated.

3. The staff should become more assertive, not more aggressive.

4. This is known as a win-win situation.

5. It is not possible to eliminate the possibility of conflict.

Page Ref: 400 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

22 .

23) After a new management company took over the operations of a hospital, many changes in policy were made. The nurse manager overhears a conversation in the break room that included comments such as, "I don't know why I even try" and "No one pays any attention to us anyway." As a result of these feelings, what might the nurse manager watch for on the unit? Select all that apply.

1. Lack of creative problem solving by the staff 2. Deterioration in morale 3. Increased effort by nurses to make needed changes 4. Change in the culture of the unit Answer: 1, 2 Explanation: 1. These statements, in light of the situation, indicate a feeling of powerlessness. In that case, staff often will not be as creative in problem solving.

2. These statements indicate powerlessness, which can lead to deterioration in morale.

3. These statements indicate power or energy to improve.

4. These statements do not indicate powerlessness; this may or may not have anything to do with the situation presented. There is no indication as to how the culture has changed.

Page Ref: 400-404 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

23 .

24) The nurse is very upset regarding a reprimand issued by the nurse manager. The nurse confronts the nurse manager in the hallway. How should the manager respond?

1. Ignore the situation.

2. Ask the nurse to move to the manager's office.

3. Tell the nurse to calm down and act professionally.

4. Respond to the nurse regarding the reprimand in the hallway.

Answer: 2 Explanation: 1. This situation cannot be ignored.

2. This conflict should not play out in public. The manager should ask the nurse to come to a more private place like the manager's office or an empty room.

3. This will not help de-escalate this situation.

4. This conflict should not play out in public.

Page Ref: 400-404 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

24 .

25) There are gender differences in how people negotiate. Choose the option that reflects the way males are thought to negotiate.

1. Focus on what is fair.

2. Seek a win-win situation.

3. Overt testing of limits.

4. Refuse to communicate.

Answer: 3 Explanation: 1. Women tend to focus on fairness.

2. Women tend to seek win-win solutions.

3. Men tend to test limits more overtly than women.

4. There is no evidence in the chapter that supports this option.

Page Ref: 403-404 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Examine conflict management, strategies, and their impact on staff.

25 .

26) Which statement best describes collaboration?

1. Collaboration is a process.

2. Goals may be different among staff collaborating.

3. Collaboration is positive.

4. Collaboration occurs between two people.

Answer: 1 Explanation: 1. Collaboration is a process with steps and requires engagement.

2. Eventually staff collaborating have to reach a consensus about goals.

3. Collaboration is not always positive.

4. Collaboration may occur between more than two people.

Page Ref: 390-391 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

26 .

27) How is the leadership theory of emotional intelligence related to collaboration?

1. Collaboration is most effective in a bureaucratic structure.

2. Collaboration requires problem solving.

3. Collaboration requires recognition of one's own feelings.

4. Collaboration requires coordination.

Answer: 3 Explanation: 1. Emotional intelligence is not associated with the bureaucratic structure model of organization.

2. Problem solving is important, but not the key component of emotional intelligence.

3. Collaboration does require recognition of one's own feelings, which is part of emotional intelligence leadership theory. This helps one better participate in the collaboration process to understand self and others.

4. Coordination is not directly related to emotional intelligence.

Page Ref: 390 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Analyze key aspects, barriers, and strategies related to collaboration and their impact on staff and healthcare delivery.

27 .

28) How is effective coordination related to patient-centered care?

1. Staff directs the patient to the best decision.

2. Patient needs and preferences need to be included in coordination.

3. Cost is considered before outcomes during coordination of care.

4. Coordination is more related to staff rather than the patient.

Answer: 2 Explanation: 1. Patient-centered care means the patient is making decisions if the patient so chooses, and staff may guide with facts and options but should not direct.

2. Patient-centered care requires that patient values and preferences be included.

3. Cost and outcomes should be considered, not one before the other.

4. The patient should be involved in coordination of the patient's care.

Page Ref: 394 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

28 .

29) You are a new nurse manager and your mentor, who is a nurse manager, provides you with some guidelines about coordination. What would your mentor include?

Select all that apply.

1. Staff need to understand the purpose of coordination.

2. Expect staff to use coordination effectively.

3. Policies and procedures are not a standard part of coordination.

4. Coordination is an element to be assessed in staff performance appraisal.

5. Discuss coordination during staff meetings and orientation on the unit.

Answer: 1, 4, 5 Explanation: 1. Understanding the purpose of coordination helps to apply it.

2. The nurse manager should not expect staff to use coordination effectively, but rather should assess and guide staff in its use.

3. Applying policies and procedures is part of coordination with an H CO. 4. Coordination should be assessed in performance appraisal.

5. The nurse manager should bring up coordination routinely in meetings and orientation for new staff.

Page Ref: 394-396 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

29 .

30) Which of the following tools used to support patient care coordination is patientcentered? Select all that apply.

1. Clinical practice guidelines 2. Clinical pathways 3. Risk management 4. Disease management 5. Case management Answer: 1, 2, 4, 5 Explanation: 1. Clinical practice guidelines are used to support patient care coordination that is patient-centered.

2. Clinical pathways are used to support patient care coordination that is patientcentered.

3. Risk management is used to track high-risk errors and potential legal concerns that might lead to malpractice. It is not used to support patient care coordination that is patient-centered.

4. Disease management is used to support patient care coordination that is patientcentered.

5. Case management is used to support patient care coordination that is patientcentered.

Page Ref: 396 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Analyze key aspects, barriers, and strategies related to coordination and their impact on staff and healthcare delivery.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 14 Effective Staff Communication and Working Relationships 1) The nurse team leader asks the nursing assistant to ambulate a patient after morning care. This is an example of which type of communication?

1. Upward communication 2. Lateral communication 3. Diagonal communication 4. Downward communication Answer: 4 Explanation: 1. Upward communication occurs when the receiver is at a higher position in the organization's hierarchy than is the sender.

2. Lateral communication occurs between two persons at the same level of hierarchy in the organization.

3. Diagonal communication occurs when persons at two different levels in the organization's hierarchy are working together on a project in which position in the hierarchy is not considered.

4. Downward communication occurs when the sender is at a higher position in the organization's hierarchy than is the receiver.

Page Ref: 413-414 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | N LN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss the meaning of communication, communication systems, and lines of communication.

1 .

2) A physician is giving orders to a nurse regarding a newly admitted patient. The physician is gesturing, maintaining eye contact, and using a loud tone of voice.

These factors illustrate primarily which type of communication?

1. Cultural 2. Nonverbal 3. Verbal 4. Passive Answer: 2 Explanation: 1. There is no evidence that these factors are cultural in this situation.

2. Nonverbal communication includes facial expressions, body movements and gestures, tone and volume of voice, eye movements, and posture.

3. Verbal communication includes written communication, oral communication, tone, language, volume, rate, and accent.

4. This is direct, not passive.

Page Ref: 417 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Describe the communication process.

2 .

3) Which statements illustrate the benefits of productive communication? Select all that apply.

1. Quick resolution of misunderstandings 2. A more motivational climate 3. Less staff turnover 4. Less need for staff to express different points of views 5. A productive rumor mill Answer: 1, 2, 3 Explanation: 1. If there are misunderstandings, productive communication is likely to lead to a quick resolution. Fewer "failure to communicate" excuses are given.

2. If communication is productive, the climate is more comfortable. A comfortable climate is motivational.

3. There is less conflict and less staff turnover.

4. Productive communication allows free expression of differing points of view.

5. Productive communication leads to a decreased need for a rumor mill.

Page Ref: 418-419 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Assess a team's communication process.

3 .

4) The nurse observes that the patient is smiling, nodding, and saying "OK" when the physician explains a painful procedure that is planned for the patient. How should the nurse react to this observation?

1. Clarify that the patient understands the explanation.

2. Tell the physician that the nurse does not think the patient understands the explanation.

3. Seek an interpreter to assist the patient in understanding the explanation.

4. Understand that this is the patient's way of dealing with stress.

Answer: 1 Explanation: 1. The nurse has observed a disconnect between verbal and nonverbal communication and should clarify that the patient understands the explanation.

2. The nurse should first find out if the patient understands the explanation before discussing the situation with the physician.

3. The nurse should first see if the patient understands the explanation. If not, and if the problem stems from not understanding the language, contacting an interpreter would be appropriate.

4. This may be true, but the nurse needs to make certain before making this assumption.

Page Ref: 419-420 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

4 .

5) Which staff action would indicate a staff communication problem? Select all that apply.

1. Participative management 2. Directions not followed 3. Silence 4. Asking for information to be repeated Answer: 2, 3 Explanation: 1. If the staff is engaged in participative management, there is likely not a communication problem.

2. Directions require clear communication.

3. Silence can be a healthy part of the communication process, but can also indicate a problem. The manager should investigate for issues.

4. Asking for information to be repeated is a form of clarifying the message. This is a healthy response.

Page Ref: 419-420 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Assess a team's communication process.

5 .

6) Which situations illustrate barriers to communication? Select all that apply.

1. The nurse uses active listening when completing the admission interview of a new patient.

2. The nursing assistant frowns and crosses her arms when the nurse is giving instruction.

3. The nurse says to the patient, "Tell me about why you came to the hospital today."

4. The nursing assistant says, "Show me how you want input and output recorded."

5. The nurse always says "it will be all right" when there is a problem on the unit.

Answer: 2, 5 Explanation: 1. Active listening is helpful in understanding the message being delivered.

2. This posture is a defensive stance and sends a message of disapproval, which can shut down or change communication.

3. This is an open-ended question that should encourage elaboration by the patient.

4. This is a direct question that requires a direct answer. This style is helpful when asking for direction.

5. This overuse of reassuring statements can cut off communication.

Page Ref: 421-422 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Assess a team's communication process.

6 .

7) Which options illustrate an open communication environment? Select all that apply.

1. The nurse manager gives staff time to respond to questions.

2. The nurse manager reinforces positive behaviors.

3. The nurse manager often shares critical information about the unit with nurses and asks them to keep it a secret.

4. The nurse manager makes false inferences about information.

5. Communication skills are included in the performance evaluations of all staff.

Answer: 1, 2, 5 Explanation: 1. People sometimes need time to formulate a correct response. Expecting an immediate response can put pressure on the relationship and close down communication.

2. It is good to reinforce positive behaviors.

3. Secrecy is very destructive to communication and to organizations.

4. These false inferences lead the manager to jump to the wrong conclusion and opens up the potential for making mistakes.

5. Communication is critical to a positive work environment and patient-centered care and should be a part of performance evaluations.

Page Ref: 422 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Assess a team's communication process.

7 .

8) The nurse manager would like to increase staff feedback. Which action would encourage the staff to give feedback to the manager?

1. Using the grapevine 2. Written communication 3. Downward communication 4. Walk-around management Answer: 4 Explanation: 1. Using the grapevine can be damaging. The grapevine consists of comments that are not documented, that can be falsely reported, or easily misunderstood.

2. This type of communication is more cumbersome and will not allow spontaneous feedback to the manager.

3. Downward communication focuses on the superior telling the subordinate what to do. It does not allow for feedback unless feedback is requested.

4. Walk-around management allows the manager to be present on the unit so that staff can approach the manager with comments and issues.

Page Ref: 422-423 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Assess a team's communication process.

8 .

9) Which statement demonstrates correct supervisory feedback?

1. "You have been late three times this week. Why are you so lazy?"

2. "I think you ought to be more concerned with finishing one project before starting another."

3. "The staff really worked hard on making sure all documentation was completed before the afternoon shift arrived."

4. "All the staff need to do a better job."

Answer: 3 Explanation: 1. This is an inflammatory statement and is not helpful in redirecting the staff member.

2. This is the manager's opinion, but is really fairly general with no direction as to how the nurse should accomplish this task.

3. Supervisory feedback should focus on behavior and should be specific.

4. This statement is too general and nonspecific.

Page Ref: 422-423 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

9 .

10) Which statement reflects a possible barrier to effective listening?

1. The staff members feel that the manager communicates with them.

2. The staff members have known each other and the manager for a long time.

3. There is open-ended questioning by the manager.

4. The manager seeks out information that might be negative.

Answer: 2 Explanation: 1. The staff's perception of the ability of the manager to communicate with them is the most important issue.

2. In this situation, assumptions could be made without really listening. since those involved may think they already know what the person is going to say.

3. Open-ended questions always encourage additional information sharing. It also encourages active listening because the staff may be asked a question.

4. This situation gives the staff an opportunity to disclose information and encourages staff to listen carefully to the manager's comments.

Page Ref: 423-424, 426 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

10 .

11) Which option illustrates the manager's role in supporting effective communication?

1. The manager should always use reassuring statements with the staff.

2. The manager should use selective listening when talking to staff about problems.

3. The manager should always reach forward and touch the staff member when delivering feedback.

4. The manager should inquire further into situations that seem vague or confusing.

Answer: 4 Explanation: 1. Overuse of reassuring statements comes across as phony and condescending.

2. The manager should use active listening. Selective listening may result in missing important information.

3. Personal space is a critical issue in communication. The manager should not enter an employee's personal space without being certain the touch will be accepted.

4. This is an essential task of the manager. If the manager does not clarify this information, errors in judgment may be made.

Page Ref: 426 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

11 .

12) Analyze these statements and choose the response that best reflects paraphrasing.

1. "You are saying you didn't sleep well last night because the unit was so noisy?"

2. "Can you tell me why you didn't sleep well last night?"

3. "You should have told the night nurse you needed medication to help you sleep."

4. "Did you talk to your doctor about not sleeping last night?"

Answer: 1 Explanation: 1. Paraphrasing is restating what the patient said to clarify the comments.

2. With this statement, the nurse is asking for information.

3. This statement may be construed as defensive. It is not a restatement of what the patient told the nurse.

4. This statement is asking for information.

Page Ref: 430-431 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast four communication methods.

12 .

13) Analyze these statements and choose the response that indicates reflection.

1. "Did you receive your test results?"

2. While the nurse is nodding, she says, "Um, I see."

3. "You seem very sad about your test results."

4. "Did you understand the instructions?"

Answer: 3 Explanation: 1. The focus of this question is the test results. The sender is seeking information.

2. This statement only indicates that the nurse heard something the patient said, not that the nurse understood the patient's meaning.

3. Reflection focuses on the speaker's feelings and the receiver of the message restates what the receiver thinks are the feelings expressed.

4. The nurse is seeking clarification with this statement.

Page Ref: 430-431 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast four communication methods.

13 .

14) Evaluate these statements and choose the response that indicates summarization.

1. "I thought you were supposed to go home today. What happened?"

2. "What I think I'm hearing you say is that you are angry you have to wait one more day before you can go home."

3. "We have no beds available for any admissions."

4. "I don't know the answer to your question, but I will check."

Answer: 2 Explanation: 1. This statement increases stress and may elicit a defensive response. It is not an example of summarizing content and feelings.

2. Summarization confirms the content and the feelings.

3. This sentence is a simple statement of fact, not a summarization.

4. This is not summarizing content or feelings. It is a method to gain trust with the patient.

Page Ref: 430-431 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast four communication methods.

14 .

15) The nurse is using effective communication by summarizing the other person's position, reading body language and nonverbal messages, and demonstrating curiosity about the other person's views. These features demonstrate which critical element of effective communication?

1. Solving 2. Exploring 3. Talking 4. Listening Answer: 4 Explanation: 1. The nurse is not using decision making in this situation.

2. Exploring is not the best answer to this question because the nurse is not attempting to understand the scope of a problem, but is learning about the other person's ideas.

3. The nurse is not explaining ideas, goals, or feelings.

4. The elements given show that the nurse is working to understand the other person's ideas. This is active listening.

Page Ref: 430-431 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare and contrast four communication methods.

15 .

16) The Institute of Medicine (I OM) includes communication in the core competency of providing patient-centered care. Which option reflects the IOM's position on communication?

1. Disclosure of patient information should be done only if the patient has a need to know.

2. Information should always be provided in a written format.

3. Communication should be done in a language the patient understands.

4. Using medical terminology is the most accurate method of providing patient information.

Answer: 3 Explanation: 1. The IOM states that communication with patients should be done in a shared and fully open manner.

2. The IOM states that communication should be offered in the patient's preferred channel.

3. The IOM states that healthcare providers should communicate accurately in a language that patients can understand.

4. Many patients have difficulty understanding medical terminology, which violates the IOM's message that communication should be in a language the patient understands.

Page Ref: 413 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the meaning of communication, communication systems, and lines of communication.

16 .

17) The hospital has established a nursing work team to develop a new system for delivering shift reports information. Which line of communication will be used for most of this team's work?

1. Upward 2. Downward 3. Lateral 4. Diagonal Answer: 3 Explanation: 1. There will likely be some upward communication as reports are made to superiors, but this is not the major line of communication that will be used.

2. There will be downward communication as the team receives its charge, but this is not the major line of communication that will be used.

3. While all four lines of communication will likely be used in this work, the majority will be between staff members that are in the same or similar hierarchical levels.

This is the definition of lateral communication.

4. There may be some diagonal communication if the team works with staff members that are from different hierarchical levels, but this will not be the major line of communication used.

Page Ref: 413-414 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss the meaning of communication, communication systems, and lines of communication.

17 .

18) Place the steps of the communication process in the order in which they generally occur.

Choice 1. Medium Choice 2. Encoding Choice 3. Feedback Choice 4. Decoding Answer: 2, 1, 4, 3 Explanation: 1. The encoded message is then placed into a medium to be sent.

2. The first step is encoding the message.

3. Feedback is given to the sender after the receiver has decoded the message.

4. The receiver of the message must decode the message after it is sent.

Page Ref: 415 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss the meaning of communication, communication systems, and lines of communication.

18 .

19) The nurse says to the nursing assistant, "Please bathe this patient first today." This message is delivered in the hallway as the nursing assistant is unloading breakfast trays for the unit. Which element of communication is most likely to result in miscommunication in this scenario?

1. Sender 2. Message 3. Receiver 4. Context Answer: 4 Explanation: 1. There is nothing to indicate that the sender is inadequate in this scenario.

2. The message is clear.

3. There is nothing to indicate that the receiver is not competent to receive the message.

4. The context or environment where this message is delivered is likely to cause miscommunication. There are many distractions occurring that could cause the receiver to misunderstand or mishear the message sent.

Page Ref: 420-421 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

19 .

20) The nurse manager smiles constantly during a staff meeting in which changes to the holiday work schedule are announced. What is the probable result of this presentation?

1. The nurses will feel the manager is concerned about their interests.

2. The nurses will think the manager likes the changes.

3. The nurses will not be confident that the manager is being truthful.

4. The nurses will appreciate the manager's support.

Answer: 3 Explanation: 1. This is not the result of constant smiling during the delivery of bad news. The nurse manager's demeanor should match the message to some extent.

2. This is not necessarily the case.

3. Constant smiling when it is not appropriate may make the nurses mistrust the manager.

4. The nurse manager should convey this information by being supportive and understanding the issues, not by smiling while delivering the message.

Page Ref: 418-421 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 03. Assess a team's communication process.

20 .

21) The nurses caring for a newly admitted patient need to discuss nursing care. Which location would maintain the confidentiality of this discussion?

1. The nurse's station 2. The hallway outside the patient's room 3. The staff cafeteria 4. The room where nurses take report 5. The staff elevator Answer: 4 Explanation: 1. The nurse's station can be a very busy and open area, so confidentiality of a discussion cannot be assured.

2. This area is not secure.

3. Even though this area is used only by staff, it is not a place for a confidential discussion.

4. Since this area is used to relay information about patients, it must be private and secure.

5. This is also not a secure area.

Page Ref: 419 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

21 .

22) During the nurse manager's performance evaluation, the nurse executive shares that the staff believe the manager makes overly judgmental statements. Which strategies could the manager use to avoid this tendency? Select all that apply.

1. Be very direct in communication.

2. Use active listening.

3. Try to understand other people's viewpoints.

4. Stop and think before responding.

5. Use open questioning.

Answer: 2, 3, 4 Explanation: 1. The manager could be direct in communication style and still jump to conclusions and make hasty judgments.

2. If the manager uses active listening, the tendency to jump to conclusions will be lessened. The manager will be actively involved in the conversation and will be thinking about what is being said and how it is being said. This should slow down the manager's tendency to immediately respond.

3. If the manager tries to understand other people's viewpoints, the manager will think more about the conversation taking place. This should slow down the manager's tendency to make rapid conclusions without getting all the needed information.

4. This "stop and think" strategy will likely help the manager avoid jumping to conclusions.

5. Open questioning is a good conversation technique, but is not a way to prevent making snap judgments.

Page Ref: 418-421 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

22 .

23) The nurse executive is aware that the hospital's nurse managers feel overwhelmed by emails, memos, and other communication throughout their day. What strategies could the nurse executive employ to reduce this feeling of overload? Select all that apply.

1. Include a time frame for response in all messages sent to the managers.

2. Combine as many messages as possible into one long email each day.

3. Schedule face-to-face meetings with the managers rather than communicating electronically.

4. Issue each nurse manager a cell phone for communication.

5. Examine the need to send each email before sending it.

Answer: 1, 5 Explanation: 1. If the nurse managers have a time frame in which their response is required, they can do better planning. If there is no time frame, the managers may feel that each message must be answered immediately.

2. Long, complex emails can be daunting in a busy environment. This strategy would lend itself to managers missing important information or requests "buried" in the email with other, less important information.

3. Face-to-face conversations are nice, but take time to arrange and to complete.

Electronic communication is faster and generally more efficient. Communication can take place with multiple people at one time and there is a record of what is said.

4. This may not be too helpful, since the nurse executive would have to call managers individually with information or set up conference calls when all managers are available.

5. Email is a quick and convenient method for sending out information and can be used to excess. The nurse executive should be certain that there is valid reason for sending each message.

Page Ref: 417-421 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Assess a team's communication process.

23 .

24) The administrative staff of a healthcare facility has adopted storytelling as a major communication style. Which management theory is associated most with this style?

1. Hierarchical 2. Knowledge management 3. Traditional 4. Emotional intelligence Answer: 2 Explanation: 1. This is a traditional, top-down style of management. Communication is more likely to be downward and upward.

2. Storytelling works well in this knowledge management style. The manager conveys information through the use of pertinent stories about using the information.

3. This is a traditional, top-down style of management. Communication is more likely to be downward and upward.

4. Storytelling might be used in this management style, but not to the extent it would be used in knowledge management style.

Page Ref: 426-427 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast four communication methods.

24 .

25) Select the strategies that will make the use of voice mail most effective. Select all that apply.

1. Speak quickly so that the entire message can be delivered before the machine stops recording.

2. Repeat numbers and email addresses given in the message.

3. Be prepared to leave a message before the call is actually made.

4. Suggest a time and method for return communication.

5. Do not use voice mail for confidential information.

Answer: 2, 3, 4, 5 Explanation: 1. The sender should speak slowly so that the message is clear. The message should be well designed so that it can be completed within the time limitations.

2. It is difficult for the receiver to record numbers and email addresses unless the sender speaks clearly and slowly and repeats the information. Many times this information is very familiar to the sender and is spoken faster than other parts of the message.

3. The sender should consider that it might be necessary to leave a message and should know what important information should be clearly conveyed prior to making the call.

4. The sender should indicate if no return call is necessary or suggest a good time for a return call if indicated.

5. Voice mail may not be confidential and may be overheard by or played by those other than the one for whom the message is intended. This should be a strong consideration before leaving a voice mail with sensitive information.

Page Ref: 427-428 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast four communication methods.

25 .

26) Which communication method is at higher risk for oversharing of work-related information that should not be shared?

1. Written 2. Social networking 3. Oral 4. Videoconferencing Answer: 2 Explanation: 1. Written communication is not at higher risk.

2. Social networking is designed for personal sharing and has higher risk of sharing information about work that should not be shared publicly.

3. Oral communication is not at higher risk.

4. Videoconferencing is not at higher risk.

Page Ref: 430 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast four communication methods.

26 .

27) You are concerned about the emails you are receiving from nurse managers in your department. As CNE, you decide to develop a list of "don'ts" for your managers when sending emails through the H CO email system. What might you include?

Select all that apply.

1. Inappropriate emoticons should not be used.

2. Do not automatically use "reply all."

3. Do not use attachments.

4. Do not send several emails, when one will be sufficient.

5. If a message is not urgent, do not mark it as urgent just to get a quick reply.

Answer: 1, 4, 5 Explanation: 1. No emoticons (appropriate or inappropriate) should be used.

2. Using "reply all" should be done with care.

3. Use of attachments is acceptable.

4. Sending one message is always better than a flood of messages.

5. Marking a message as urgent, when it is not, is not appropriate.

Page Ref: 420, 428 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast four communication methods.

27 .

28) What is a common weakness of H CO websites?

1. They are not routinely reviewed and updated as needed.

2. The website includes graphics that are not clear.

3. The website does not indicate who owns the site.

4. The homepage does not provide overview.

Answer: 1 Explanation: 1. There needs to be an established schedule for reviewing websites and updating them.

2. Most websites today use graphics appropriately.

3. Websites identify ownership/contact at the bottom of pages—typically, other related information is found on the home page.

4. Typically, the home page does provide an overview and access to other content pages.

Page Ref: 429-430 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast four communication methods.

28 .

29) If you are assessing your use of paraphrasing, what are you focused on?

1. You summarize the conversation you have had.

2. You quote what someone has said.

3. You restate what someone has said to confirm the message.

4. You ask for clarification.

Answer: 3 Explanation: 1. Summarization is a broader view of the conversation, identifying key points.

2. Paraphrasing is not quoting.

3. This is the definition of paraphrasing.

4. Paraphrasing is not asking for clarification.

Page Ref: 430-431 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Assess a team's communication process.

29 .

30) In preparation for your performance appraisal meeting with your nurse manager, you have done a self-assessment of your communication. Which of the following might you include in the positive column demonstrating effective communication?

Select all that apply.

1. Your communication often focuses on "you" statements.

2. If you are not sure of an answer, state what you think it is and say you will get back to the person asking the question after checking on it.

3. Validate with the receiver when discussing important information.

4. For complex topics, think about what you will say before communicating.

5. Use eye contact in an appropriate manner.

Answer: 3, 4, 5 Explanation: 1. "I" statements are more effective and do not tend to put the receiver on the defensive.

2. If you do not know the answer, best to say this and then get back to the person asking the question. Providing information that you are not sure of will only confuse the situation.

3. You should validate to make sure the message is received as intended.

4. "Think before you speak" is a good motto.

5. Eye contact is important.

Page Ref: 430-431 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Personal and professional development; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Apply two strategies to resolve communication problems.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 15 Delegation for Effective Outcomes 1) Which issues should the nurse manager consider related to delegation? Select all that apply.

1. Delegation is a simple task assignment.

2. The manager retains accountability for the project.

3. Someone else will have the responsibility and authority to do the task.

4. The employee has the appropriate authority to act alone.

5. The manager must supervise every portion of the task.

Answer: 2, 3, 4 Explanation: 1. The manager gives the worker the responsibility and authority to perform a task for which the manager is accountable. This is not simple task assignment.

2. The manager must monitor the progress of the project and is ultimately accountable for the work done.

3. The manager is assigning the person to do the task. This person must have the skills, competency, education, and the licensure appropriate to do the task.

4. The manager does not tell the employee how to do each portion of the task, so the employee must have the knowledge and licensure appropriate to do the task.

5. The manager delegates the task so that the manager will not have to supervise every portion of the task. The manager expects the employee to do the task completely and well without constant supervision.

Page Ref: 436-438 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | N LN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the definition of "delegation" and related delegation roles and benefits.

1 .

2) The nursing student has developed a poster presentation regarding delegation.

Which statement, made by this student, would be evaluated as correct?

1. There is a sharing of authority between the person delegating the work and the person who accepts the delegation.

2. The nurse retains accountability for nursing work assigned to others.

3. Employers decide which work the nurse can delegate and should document this list in the nurse's job description.

4. The nurse who delegates work should dictate exactly how the work should be accomplished.

Answer: 2 Explanation: 1. When the task is delegated, the person doing the delegation transfers the authority to do the task to the person who accepts the delegation.

2. The nurse retains legal and ethical accountability for any work delegated to others. This is an important concept to consider when delegating work.

3. The state board of nursing makes the decisions about delegating. The employer cannot change those decisions.

4. The idea of delegation is that the person doing the delegation "gives" the task to another person who should be able to design a work plan to accomplish the task.

The person doing the delegation should not have to manage the task or dictate how to do the work.

Page Ref: 437-438 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the definition of "delegation" and related delegation roles and benefits.

2 .

3) The nurse determines that one of the unlicensed assistive personnel (UAP) working with her patients does not follow safety precautions when ambulating patients. What should the nurse consider before acting on this knowledge? Select all that apply.

1. The tasks performed by U APs must conform to hospital policy and procedure.

2. The nurse must act as a patient advocate.

3. The nurse should follow the UAP job description as written by the hospital's administration.

4. If the nurse's supervisor tells the nurse to delegate this task to the UAP, the nurse is still accountable for errors made by the UAP. 5. The nurse is accountable only for the work personally performed.

Answer: 1, 2, 4 Explanation: 1. The UAP must follow hospital policy and procedure and these policies and procedures should follow accepted standards of care.

2. The nurse must always act as a patient advocate. The nurse could be found negligent if harm comes to the patient and the nurse was aware that the UAP was not performing tasks correctly.

3. The hospital cannot change the state board of nursing's regulations as they apply to UAPs. The nurse working with UAPs should be aware of the state board policies.

4. The nurse is still accountable for this care. The fact that the nurse was following the supervisor's instructions does not relieve the nurse of the responsibility of providing safe care.

5. The nurse is accountable for the care provided to patients in his or her care.

Page Ref: 440-443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

3 .

4) Select the option that best illustrates a situation in which the person has responsibility.

1. The nursing assistant made an error while measuring vital signs.

2. The manager made an assignment and then influences the work done.

3. The team leader is deciding whether to delegate a task to a UAP. 4. The nurse has started intravenous lines several times and offers to do so for a less experienced nurse.

Answer: 1 Explanation: 1. This nursing assistant is responsible for the error made. The nurse who delegated the task to the nursing assistant is accountable for any care issues that might arise from the error and selecting the assistant for delegation.

2. This scenario demonstrates the manager's inability to let the person delegated to be autonomous in the work.

3. This is an illustration of accountability. The team leader is accountable for work delegated to the UAP. 4. This is an illustration of competence in tasks.

Page Ref: 440-443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

4 .

5) Select the option that best illustrates a situation in which the person has accountability.

1. The nurse made a medication error.

2. The nurse has more time for other activities.

3. The nurse manager assigns a team leader a new nurse in orientation.

4. The nurse practitioner prescribes medication to a patient prior to discharge.

Answer: 3 Explanation: 1. The nurse is responsible for this error.

2. This is a benefit of delegation.

3. In this situation, the manager is accountable for the decision and the identification of who would be the best person to orient the new nurse. The manager is answerable for this decision.

4. This is an example of the nurse practitioner having legal authority to prescribe medications.

Page Ref: 437-438 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the definition of "delegation" and related delegation roles and benefits.

5 .

6) What action should be taken by the nurse who is preparing to delegate a task?

1. Assess the documentation that will need to be completed regarding the task.

2. Review of all the patients' charts on the team.

3. Review the complexity and skill required to perform the task.

4. Ask the patient if having someone other than the nurse provide care is acceptable.

Answer: 3 Explanation: 1. The nurse will be responsible for this documentation whether the task is delegated or not.

2. This is not necessary prior to delegating tasks. The nurse is responsible for delegating the correct task to the correct person. These tasks may vary depending upon each patient's situation, but it is not necessary to review all of the charts prior to delegating.

3. These are essential components of the decision to delegate or not to delegate a task.

4. The nurse likely will have to delegate some routine care tasks in order to complete the care necessary. It is not necessary to ask the patient's permission to delegate tasks.

Page Ref: 440-443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

6 .

7) Which activities are appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? Select all that apply.

1. Diabetic diet teaching 2. Postoperative wound care 3. Sterile dressing change 4. Routine vital signs 5. Hygienic care Answer: 4, 5 Explanation: 1. Diabetic diet teaching requires specialized knowledge and skill and cannot be delegated.

2. Postoperative wound care requires specialized knowledge and skill and cannot be delegated.

3. Sterile dressing changes require specialized knowledge and skill and should not be delegated.

4. Frequently occurring tasks with predictable results and minimal potential for risks can be delegated to the UAP. 5. Frequently occurring tasks with predictable results and minimal potential for risks can be delegated to the UAP. Page Ref: 440-443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

7 .

8) The nurse finds it necessary to monitor the progress of a task delegated to a UAP. What intervention is appropriate in this situation?

1. Tell the UAP, "I am not certain you can do this task."

2. Intervene only if it becomes absolutely necessary.

3. Plan to choose a more senior UAP for the task next time.

4. Plan to delegate only to those who are well experienced with the task next time.

Answer: 2 Explanation: 1. Instruction and feedback should be positive and given with a helping attitude.

2. This is the best intervention. The nurse should monitor the UAP's performance of the task and should be certain there is no safety issue, but should not hover over the UAP. 3. Seniority does not guarantee that the UAP is competent with the task.

4. The nurse should delegate to competent staff, but should also help staff learn the skills necessary to become competent. If the nurse never delegates tasks to those less skilled, those UAPs will not grow. The nurse should plan closer observation of these UAPs. Page Ref: 442-445 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

8 .

9) The nurse is planning care for a group of patients and is deciding upon which activities to delegate to an experienced UAP. Which activities should the nurse plan to do, rather than delegate to the UAP? Select all that apply.

1. Helping the patient get up in the chair at bedside 2. Feeding a patient who had a cerebrovascular accident 3 years ago 3. Monitoring an intravenous line for infiltration 4. Monitoring vital signs on a newly admitted patient who is diagnosed with myocardial infarction 5. Deciding to use an as needed order to administer an over-the-counter medication for a patient complaint of a headache Answer: 3, 4, 5 Explanation: 1. This is a standard intervention that does not require the special skills of a nurse.

It can be delegated.

2. Since this patient had a C VA several years ago and there is no indication of critical difficult swallowing, feeding does not require the advanced skills of a nurse. It can be delegated.

3. This skill requires the judgment and skills of a nurse. It cannot be delegated. The UAP can ask the nurse to assess the Ⅳ site if the UAP believes that there is a problem.

4. This patient is in a potentially risky situation. Vital signs should be monitored by a nurse.

5. Assessing a patient and deciding to use an as needed order to administer medication requires the advanced skills of a nurse.

Page Ref: 438-439 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Examine key legal issues related to delegation.

9 .

10) Which option reflects a barrier to effective delegation by the nurse?

1. Trying to do everything for the patients 2. Trying to empower staff 3. Providing feedback to staff 4. Little need to delegate Answer: 1 Explanation: 1. Some nurses, especially inexperienced nurses, are not confident in delegating patient care to others and try to provide total care to all patients.

2. Delegating should help to empower the staff, not act as a barrier.

3. While it does take time to provide feedback after delegated tasks are completed, this should not serve as a barrier to delegating the task. Providing feedback should not take as much time as performing the task.

4. There is so much to do in one shift as a nurse that there is great need to delegate.

Page Ref: 444-446 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

10 .

11) One of the patients on a nurse's team has become very ill and is requiring more of the nurse's time than was anticipated. The nurse must delegate some patient care activities in order to have time to care for this critically ill patient. Which activity can this nurse only delegate to another nurse?

1. Assessment of a newly admitted patient 2. Checking the blood pressure of a patient who had blood pressure elevation yesterday 3. Helping a patient with a shower 4. Delivering a specimen to the lab Answer: 1 Explanation: 1. Assessment requires clinical nursing judgment and can only be delegated to another nurse.

2. This skill could be delegated to assistive personnel with instruction to notify the nurse if the blood pressure is elevated above a specific limit.

3. This is a general care skill that can be delegated to assistive personnel.

4. This is an indirect patient care activity that can be delegated to someone other than a nurse.

Page Ref: 438-439 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine key legal issues related to delegation.

11 .

12) Which activity illustrates the nurse manager's effective supervision of an assignment?

1. The manager communicates the assignment to the staff.

2. The nurse understands the UAP's scope of practice.

3. The nurse manager visits the patients on the team.

4. The nurse is told to care for a team of patients.

Answer: 3 Explanation: 1. This is the initial assignment, not evaluation.

2. The nurse must understand this scope of practice before assigning tasks, not as a part of evaluation.

3. By visiting with the patients on the team, the nurse manager can evaluate and follow up for completion of assigned tasks.

4. Telling a nurse to care for a team of patients is assignment, not evaluation.

Page Ref: 440-446 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

12 .

13) Select the options that illustrate guidelines for consistency in effective delegation.

Select all that apply.

1. Be fair about unpleasant activities.

2. Give only indirect care tasks.

3. Indicate priorities.

4. Be sure directions are clear.

5. Be positive about assignments.

Answer: 1, 3, 4, 5 Explanation: 1. The nurse should be careful not to always delegate unpleasant activities to the same person.

2. Both indirect and direct patient care tasks can be delegated by following the legal rules of delegating.

3. The nurse should always indicate the priorities in care when delegating.

4. Clear directions are essential in all aspects of dealing with others.

5. A positive attitude includes respecting staff and appreciating the work that they do.

Page Ref: 440-443 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

13 .

14) Which option reflects a key legal issue related to delegation?

1. Laws regarding nursing and delegation are very specific in each state's nurse practice act.

2. The nursing board of each state regulates nursing practice, including issues of delegation.

3. Nurses are protected by their job descriptions and what it says about delegation.

4. Safe nursing practice regarding delegation is governed by the hospital board of practice.

Answer: 2 Explanation: 1. These laws are often very general. Rules and regulations associated with the laws are more specific and tell how the laws must be implemented.

2. The state nursing boards are designed to protect the safety of the public in all aspects of nursing, including delegation.

3. Job description does not supersede law.

4. Hospital practice boards do not supersede law.

Page Ref: 438-439 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine key legal issues related to delegation.

14 .

15) Which statement, made by a nurse, indicates that the nurse needs additional education regarding delegation and the delegation process?

1. "I was hoping you could show me your technique for ambulating patients."

2. "Here is what you can do to help our team care for patients today."

3. "I have always enjoyed doing my own work myself."

4. "I always enjoy working with you."

Answer: 3 Explanation: 1. When a nurse requests help from an assistant or validates that the assistant has a valuable skill, it improves the relationship and the work environment.

2. This is an effective method of including all levels of caregivers in the team effort to care for patients.

3. This statement may be true, but is unrealistic in today's environment. It shows that the nurse does not understand the value of effective use of time and skills.

4. Appreciation and praise for others on the healthcare team are valuable parts of the delegation process.

Page Ref: 440-444 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

15 .

16) Which phase of the nursing process can be delegated?

1. Assessment 2. Diagnosis 3. Planning 4. Implementation 5. Evaluation Answer: 4 Explanation: 1. Assessment requires nursing knowledge and judgment and cannot be delegated.

The nurse can delegate collection of some assessment data such as vital signs.

2. Diagnosis requires that nursing knowledge and judgment be used to analyze data. This cannot be delegated.

3. Planning requires nursing knowledge and judgment and cannot be delegated.

4. Some portions of this step of the nursing process can be delegated as long as the nurse continues to supervise the work.

5. Evaluation requires nursing knowledge and judgment and cannot be delegated.

Page Ref: 436 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the definition of "delegation" and related delegation roles and benefits.

16 .

17) The newly hired nurse must decide to which assistant he or she should delegate a particular task. What is the nurse's first consideration?

1. Which assistants possess the required experience and skills?

2. What are the assistants' educational backgrounds?

3. How much time does the task require?

4. Is the task one that can be delegated?

Answer: 4 Explanation: 1. This is a relevant point, but not the most important consideration.

2. This is a relevant point, but not the most important consideration.

3. This is a relevant point, but not the most important consideration.

4. This is the most important question for the nurse to consider. If the task is not one that can be delegated, there is no reason to think further through the situation.

Page Ref: 436, 440-444 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the definition of "delegation" and related delegation roles and benefits.

17 .

18) A hospital is sued because of an error made by a nursing assistant. During preparation for the trial, the hospital's attorney says the hospital may lose the case because of the principle of respondeat superior. What is the rationale for the attorney's statement?

1. This is the principle of "buyer beware."

2. This principle states that the hospital is liable for acts of its employees when they are performing their jobs.

3. This principle states that the nurse who delegated the task to the assistant has no accountability for the assistant's actions.

4. This principle puts the blame for the actions of the assistant solely on the hospital.

Answer: 2 Explanation: 1. This is not the same as "buyer beware."

2. This is the meaning of the term respondeat superior.

3. The nurse does have accountability for the delegation and may have some responsibility for the actions, depending upon the facts of the case.

4. This is not a catch-all phrase placing all blame on the hospital, but does indicate that the hospital may have some liability.

Page Ref: 438-439 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Examine key legal issues related to delegation.

18 .

19) Which phrase most clearly defines "authority" as it applies to delegation?

1. The obligation involved when one accepts an assignment 2. To act or command the action of another 3. The person who is answerable for what was done 4. The degree of knowledge concerning skills and competencies of those one supervises Answer: 2 Explanation: 1. This defines responsibility.

2. This defines authority.

3. This defines accountability.

4. This is the doctrine of "knew or should have known."

Page Ref: 438 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Examine key legal issues related to delegation.

19 .

20) The nurse frequently delegates tasks to assistive personnel. Which forms of feedback from the assistive personnel to the nurse can be used, dependent upon situation? Select all that apply.

1. Verbal 2. Written 3. Observation 4. Review of records 5. No feedback is necessary.

Answer: 1, 2, 3, 4 Explanation: 1. Verbal feedback or "report" can be given to the nurse who delegates the task.

This is a frequent method of feedback in the hospital situation.

2. Written feedback can be provided to the nurse who delegates the task. This type of feedback is common in the home health situation.

3. The delegating nurse may receive feedback by directly observing the assistant.

4. The delegating nurse may receive feedback by reviewing patient records. This is another form of written feedback.

5. Feedback is an essential component of the delegation process.

Page Ref: 438-439, 447 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Examine key legal issues related to delegation.

20 .

21) What is often the newly licensed nurse's greatest barrier to delegation?

1. Not knowing what can be delegated 2. Not wanting to overburden staff members who are already busy 3. Fear of loss of control 4. Denying that delegation is possible Answer: 3 Explanation: 1. This may be the case, but is not generally the biggest barrier.

2. This may be the case, but is not generally the biggest barrier.

3. This is often the most critical barrier to delegation for the newly licensed nurse.

The nurse may be unsure of his or her own skills and unable to decrease control.

4. This may be the case, but is not generally the biggest barrier.

Page Ref: 439, 440-444 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

21 .

22) The nurse manager has distributed a list identifying patient coverage per nurse today. Which action has the manager taken?

1. Assignment 2. Delegation 3. Supervision 4. Delineation Answer: 1 Explanation: 1. This scenario describes assignment. Assignment is the distribution of work that each staff member is responsible for during a given work period.

2. Delegation is the partial transfer of authority and responsibility regarding care activities, while accountability for completion and outcomes remains with the delegator.

3. Supervision is the active process of directing, guiding, and influencing the outcome of an individual's performance of an activity.

4. Delineation does not refer to the action taken by this nurse manager.

Page Ref: 440-444, 446 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

22 .

23) Choose the unlicensed assistive personnel tasks that are considered indirect patient care activities. Select all that apply.

1. Stocking a dressing cart.

2. Talking with a patient's family 3. Reporting intake and output to the nurse 4. Cleaning an Ⅳ pump 5. Taking a defective blood pressure machine to maintenance Answer: 1, 4, 5 Explanation: 1. This activity is only minimally involved with patient care and is considered an indirect patient care activity.

2. This is a direct patient care activity.

3. This is a direct patient care activity.

4. This activity is only minimally involved with patient care and is considered an indirect patient care activity.

5. This activity is only minimally involved with patient care and is considered an indirect patient care activity.

Page Ref: 439-444, 447 Cognitive Level: Remembering Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

23 .

24) The nurse has had a difficult relationship with one of the unlicensed assistive personnel that works on the unit. Today, the nurse and the UAP are working on the same team. The nurse is cheerful and smiling as he compliments the UAP on her scrub top. Why is this strategy likely to be unsuccessful?

1. There is no need for the nurse and the UAP to get along in order to care for patients.

2. The UAP may believe that this nurse is guilty of sexual harassment.

3. A good working relationship cannot be established only when it is necessary to delegate to the UAP. 4. The nurse cannot be genuine in attitude while complimenting the UAP. Answer: 3 Explanation: 1. A good working relationship is critical to ensuring successful delegation and a positive team effort in caring for patients.

2. This is unlikely from one compliment.

3. The nurse should try to establish a good working relationship with this UAP over time. Waiting until the nurse needs the UAP for help will likely not be effective.

4. The nurse may genuinely wish to reset the tone of this relationship, but expecting that it will be resolved at the time the nurse needs the UAP's help is unrealistic.

Page Ref: 440-443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

24 .

25) The nurse says to the UAP, "I am worried about Ms. Smith's blood pressure. Check it throughout the afternoon." What critical factors has the nurse left out of this delegation instruction? Select all that apply.

1. How often the blood pressure should be taken 2. What the reportable parameters are 3. Nothing; the UAP should understand what the nurse means.

4. If this assignment has priority over other jobs 5. How the nurse wants the blood pressure measured Answer: 1, 2, 5 Explanation: 1. This is an essential part of these directions. "Throughout the afternoon" may mean 1 time or every 15 minutes.

2. It is important for the UAP to know if the nurse wants a report of every BP or only wants to know if the BP reaches a certain level.

3. The nurse cannot assume that the UAP will understand this unclear direction.

4. The nurse has said that he or she is worried about the patient, which should indicate to the UAP that this is a priority task.

5. Does the nurse want this blood pressure taken with an electronic machine or with a manual blood pressure cuff? This should be a part of the instructions.

Page Ref: 439-444 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

25 .

26) What are the five rights of delegation? Select all that apply.

1. Right person 2. Right time span 3. Right task 4. Right supervision 5. Right location Answer: 1, 2, 3, 4 Explanation: 1. The five rights are task, circumstances, person, direction/communication, and supervision.

2. The five rights are task, circumstances, person, direction/communication, and supervision.

3. The five rights are task, circumstances, person, direction/communication, and supervision.

4. The five rights are task, circumstances, person, direction/communication, and supervision.

5. The five rights are task, circumstances, person, direction/communication, and supervision.

Page Ref: 443 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Apply the delegation process and the National Council of State Boards of Nursing (NCSBN) guidelines.

26 .

27) As you work with staff in delegation, what is the general communication expectation from the UAP to you?

1. Reports to you every 15 minutes 2. Agrees to not bother you and report emergency concerns 3. Asks questions about the assignment 4. Delegatee expects the nurse to know delegatee's experience and competencies.

Answer: 3 Explanation: 1. This is a high level of frequent report and would depend on the patient.

2. The delegatee should not feel as though he or she is bothering the delegator and should communicate more than just for emergencies.

3. This is a general expectation for any delegation.

4. The nurse should know something about the delegatee, but delegatees are responsible for informing the nurse when they have little experience or do not feel they can do a task.

Page Ref: 439-444 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

27 .

28) Which of the following statements best describes effective delegation?

1. Nursing education programs prepare new nurses to effectively use delegation.

2. Delegation is something experienced nurses do, and new nurses do not do.

3. Reimbursement is not related to delegation.

4. Delegation is difficult and takes time to learn how to do it effectively.

Answer: 4 Explanation: 1. Nursing education should provide content and some experience on delegation, but more is required in practice post graduation to use delegation effectively.

2. All nurses are expected to use delegation.

3. Reimbursement is related to delegation, as delegation has an impact on outcomes.

4. This is correct; delegation is complex.

Page Ref: 443-445 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

28 .

29) You are a new nurse on an orthopedic unit, and you are learning how to integrate delegation into your daily work. What might be important for you to consider to improve your delegation?

1. Organize your work and consider who is best to do what tasks and when.

2. When you delegate, do not overburden UAPs, as they will work harder if they like you.

3. Recognize that your performance appraisal will depend on demonstrating that you are able to do the entire job.

4. After you delegate to UAPs, you will have minimal contact with patients UAPs are caring for.

Answer: 1 Explanation: 1. If you are organized, then you can better know what needs to be done and plan to get it done—who and when.

2. This is not effective; the goal is not to be liked as a person.

3. This perspective may lead to the super nurse syndrome, when you think you must do all the work yourself.

4. As the delegator, you still need to check patients and relate to them routinely.

Page Ref: 443-445 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

29 .

30) The NCSBN recommends which of the following factors for the nurse to consider when monitoring patient and outcomes? Select all that apply.

1. Setting where care occurs 2. Complexity of task being performed 3. Length of stay recommended by insurer 4. UAP agreement to do the task 5. Predictability of responses and risks Answer: 1, 2, 5 Explanation: 1. Setting is a factor.

2. Complexity of task is a factor.

3. Insurer recommendations are not included.

4. Typically, UAPs do not have a choice about delegation, and this is not listed as one of the factors by the NCSBN. 5. Predictability of responses and risks is a factor.

Page Ref: 443-445 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Quality and safety care; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Assess methods to monitor and improve delegation to reach effective patient outcomes.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 16 Evidence-Based Practice and Management 1) The high school student is very interested in healthcare research and is trying to decide which healthcare profession to enter. What should this student consider when examining leadership roles in research that nurses can assume? Select all that apply.

1. Nurses guide their own research.

2. Nurses participate in interprofessional studies.

3. Nurses manage clinical trials.

4. Nurses guide patients who are considering clinical trial participation.

5. Nurses are not generally leaders in healthcare research.

Answer: 1, 2, 3, 4 Explanation: 1. Nurses act as designers and principal investigators in their own research.

2. Participating in interprofessional studies and trials is a common role for the nurse.

3. Depending upon educational level, nurses do manage clinical trials.

4. Nurses of many different educational levels serve as patient advocates in decisions about clinical trial participation.

5. The nurse serves in many roles in healthcare research, including leadership roles. This high school student should consider advanced education in nursing beyond a basic degree.

Page Ref: 452-453, 455-456 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | A ACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

1 .

2) The nurse is involved in basic research. Which study topic would the nurse most likely research?

1. The antiseptic that provides the cleanest environment for intravenous access 2. The efficacy of diuretic use for pregnancy-induced edema 3. The historical significance of feminism in nursing 4. The use of nursing self-scheduling in a unit Answer: 3 Explanation: 1. This is applied research.

2. This is applied research.

3. Historical research is research that adds to the nursing knowledge base and is considered basic research.

4. This is applied research.

Page Ref: 452-453 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

2 .

3) Which research topics would likely be included in the National Institute of Nursing Research (NINR) Intramural program? Select all that apply.

1. Use of a specific intervention to reduce shortness of breath in patients with congestive heart failure 2. How to guide a wellness program in a community 3. Quality improvement in palliative care 4. Use of knowledge management theory in a free-standing dialysis unit 5. Cost of an education program on prevention of sudden infant death syndrome Answer: 1, 2, 3 Explanation: 1. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit (which would conduct this study), the Pain Research Unit, and the Research Training Unit.

2. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit, the Pain Research Unit (which would conduct this study), and the Research Training Unit.

3. The Intramural program is managed through the Division of Intramural Research and is composed of the Symptom Management Unit, the Pain Research Unit, and the Research Training Unit (which would conduct this study).

4. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program.

5. This study would not be included in the focus of the Symptom Management Unit, the Pain Research Unit, or the Research Training Unit, which are the sections of the Intramural program.

Page Ref: 452 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

3 .

4) The nurse executive has instituted a very effective program that encourages nursing staff involvement in research. Nurses are suggesting research topics, helping to collect data, and have assisted with data analysis. What should be the nurse executive's next goal for these nurses?

1. Getting the nurses to seek funding for research projects 2. Helping the nurses consider additional study topics 3. Involving the nurses in efforts to seek resources and time to conduct more research 4. Encouraging the nurses to find ways to disseminate the findings of completed studies Answer: 4 Explanation: 1. This is an important consideration, but is not the next step in this scenario.

2. This is an important goal for these nurses, but is not the next step in this particular scenario.

3. The nurses must have resources and time to conduct research, but in this scenario, research is being conducted. For this example, this is not the most important next step, as the research has been completed.

4. This is the most important next step for this work. If the results of studies are to impact the provision of nursing care, they must be disseminated beyond the unit where they are first tested.

Page Ref: 455-456 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science; Personal and professional development | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

4 .

5) A nursing research team from a hospital would like to quickly disseminate findings from its study to the nurses in its local area. Which strategy should this team employ?

1. Work to get the findings published in a research journal.

2. Apply to present the findings as a poster presentation in a national conference.

3. Organize a research day at the hospital.

4. Get the findings published in a practice journal.

Answer: 3 Explanation: 1. This is a very good method of disseminating the findings to a national forum, but takes time and would not be the best plan for these nurses.

2. This is a good forum for dissemination of findings, but locating a conference that is local and will be held quickly is difficult. The planner of such a conference generally chooses the poster presentations through a selection process that takes time and is held several weeks prior to the date of the conference.

3. This is the best way for these results to be disseminated. This event could be cosponsored by the hospital and any nursing programs in the area. These events do take planning, but are not as planning intensive as national events.

4. When practice journals describe research findings, it is generally done as part of a secondary article. While some staff nurses are more likely to read about findings in a practice journal, the entire study would not be published. Also, having an article accepted for inclusion in a journal is a time-consuming process.

Page Ref: 455 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

5 .

6) Which patient would be considered to belong to a vulnerable population when included in research? Select all that apply.

1. A healthy newborn delivered at 38 weeks' gestation 2. A 45-year-old woman with diagnosed bipolar disease 3. A 28-year-old woman who is 16 weeks pregnant 4. A 35-year-old man who is hospitalized with renal colic 5. A 58-year-old female inmate who was injured in a prison fight Answer: 1, 2, 3, 5 Explanation: 1. Neonates are considered a vulnerable population.

2. Persons with mental illness are considered a vulnerable population.

3. Pregnant women and fetuses are considered vulnerable populations.

4. Persons who are hospitalized are not considered part of a vulnerable population based upon the hospitalization alone.

5. Persons confined to institutions such as prisons are considered part of a vulnerable population.

Page Ref: 454 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

6 .

7) The nurse researcher is interested in conducting research into a specific clinical problem. The research design will require that the participants be deceived about the purpose of an intervention. What should the researcher consider about this design?

1. Deception of study participants is illegal.

2. The institutional review board (I RB) will likely not approve this study.

3. Deception of study participants is a common part of most research designs and is appropriate if the deception does not cause the patient to be harmed.

4. The researcher must prove to the institutional review board (IRB) that this deception is critical to the study design.

Answer: 4 Explanation: 1. It is not illegal to deceive study participants. The IRB must approve this design.

2. Approval from the IRB will depend upon the reason the participants are being deceived.

3. This is not a common practice, but is appropriate in some situations.

4. The IRB must approve the study and approval will rest on the researcher's ability to prove that this is a critical element of the study.

Page Ref: 454-455 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

7 .

8) The staff nurse has long wondered if some common nursing interventions are helpful to patient outcomes. Where would this nurse find evidence-based practice information to help solve this dilemma? Select all that apply.

1. Research journals 2. Expert nursing opinion 3. Established nursing theories 4. Tradition 5. Clinical expertise Answer: 1, 2, 3 Explanation: 1. Research journals report evidence-based research study results on many topics, including traditional interventions.

2. The opinion of nursing experts should reflect evidence-based care.

3. Established nursing theories have been tested and include evidenced-based information.

4. Traditions are often passed down from nurse to nurse and are not necessarily based in science. They are not necessarily bad, either, but have no basis in science.

5. Clinical expertise does not always correlate to use of evidence-based practice.

Page Ref: 455-459 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

8 .

9) The nurse executive wishes to encourage the use of evidence-based practice (EBP) in the clinical areas of the hospital. When talking to nurse managers about this decision what benefits of E BP should the nurse executive emphasize? Select all that apply.

1. EBP helps to control the cost of healthcare.

2. EBP takes decision making out of planning patient care.

3. EBP improves healthcare quality.

4. EBP makes care more patient-centered.

5. EBP encourages third-party payer involvement in healthcare decisions.

Answer: 1, 3, 4 Explanation: 1. This is a very important aspect of EBP to the nurse executive and to nursing managers.

2. Individual decision making about healthcare is still an important facet of care when using EBP. 3. Improvement of healthcare quality is a fact about EBP that should appeal to nurse managers and to staff nurses.

4. EBP does make care more patient-centered. This should be appealing to nurse managers and staff nurses.

5. There is no evidence that EBP increases involvement of third-party payers in healthcare decisions.

Page Ref: 455-459 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: II. Basic organizational and systems leadership for quality care and patient safety; Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science; Personal and professional development | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

9 .

10) Which option best fulfills the problem portion of an EBP question?

1. Middle-aged Caucasian men who have been treated for type I diabetes mellitus for over 1 year 2. Infants who are breastfed 3. Women who are breast cancer survivors 4. African American women who are poor and who have lived in the western United States for some time Answer: 1 Explanation: 1. This is the most descriptive of these options.

2. This statement does not include how long the infants have been breastfed and if they have been exclusively breastfed or are supplemented with formula feedings.

3. This statement does not clarify the age of the women being studied or the length of time since diagnosis.

4. "Poor" is a subjective term, as is "for some time."

Page Ref: 457-458 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

10 .

11) The nurse researcher is developing an EBP question for a study. Which consideration should be made when writing the results/outcome expected section of this question?

1. What happened to the study group?

2. What treatment is being studied?

3. Were any other treatments done?

4. Who is being studied?

Answer: 1 Explanation: 1. The result/outcome, such as risk of disease, a complication or a side effect, or an adverse outcome.

2. This describes the problem and what was done.

3. This does not focus on the results or outcomes.

4. This the group that is being studied, written in specific terms.

Page Ref: 457-458 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice; V. Healthcare policy, finance, and regulatory environments | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

11 .

12) Arrange the five steps of the evidence-based practice process in order of their use.

Choice 1. Evaluate practice decisions.

Choice 2. Collect best evidence.

Choice 3. Integrate the evidence.

Choice 4. Appraise the evidence.

Choice 5. Write an EBP question.

Answer: 5, 2, 4, 3, 1 Explanation: 1. This is step 5 of the process. The nurse should evaluate whether the EBP change was appropriate for this patient.

2. This is step 2 of the process. This evidence should be relevant to the EBP question.

3. This is step 4 of the process. The evidence should be integrated with other parts of EBP such as patient preferences and values, the nurse's clinical expertise, assessment information about the patient, and the patient's history.

4. This is step 3 of the process. Before evidence is used, it should be critically appraised.

5. This is step 1 of the process. The question must be written so that the nurse has a good understanding of which evidence to seek.

Page Ref: 457 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

12 .

13) Which example of best practice review would likely be assigned a level Ⅰ?

1. Information from the only existing study of an intervention 2. Information from review of several randomized controlled trials of an intervention 3. Information from the opinion of a person widely recognized as an expert in the use of the intervention 4. Information from a nonrandomized well-designed controlled trial of the intervention Answer: 2 Explanation: 1. This is considered level Ⅵ evidence.

2. Level I evidence is the highest or best level. It is evidence from a systematic review or meta-analysis of all relevant randomized controlled trials (RCTs) or evidence-based clinical practice guidelines based on systematic reviews of RC Ts. 3. Expert opinion is level Ⅶ evidence.

4. This type of evidence is categorized as level Ⅲ.

Page Ref: 458 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02 Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

13 .

14) The newly licensed nurse is concerned about the rapidity with which nursing care information changes. What characteristic would be best to help manage this concern?

1. Ability to use general internet search engines to obtain information 2. Knowledge of where and how to find the best possible sources of evidence 3. Ability to use library print resources to find good information 4. A good working relationship with experienced nurses Answer: 2 Explanation: 1. General internet search engines do not always provide quality information for healthcare providers. These search engines also provide large amounts of sources that can be overwhelming.

2. The knowledge of where and how to find good evidence is an ability that is valuable to both the newly licensed and more experienced nurses.

3. Library print resources are a source of good information, but may lag behind the most up-to-date information. This is the second best choice to answer this question.

4. Unfortunately, there is no guarantee that experienced nurses have kept current with evidence-based practice.

Page Ref: 459-460 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice; informatics | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

14 .

15) The nurse is overwhelmed with the amount of information concerning vitamin D supplementation in post-menopausal women. Which strategy would be the most appropriate for this nurse to use to find the best practice information on this topic?

1. Use any popular internet search engine to initiate a search of the topic.

2. Read as many nursing journal articles about the topic as possible.

3. Read about the topic on a site such as Joanna Briggs Institute.

4. Search for the topic on the World Health Organization (W HO) website.

Answer: 3 Explanation: 1. While the nurse might learn a great deal from this search, the number of "hits" on a general search engine would be daunting. It is also not likely that all of the information retrieved would be scientifically based or evidence-based. Identifying the evidence-based recommendations would be very time consuming.

2. In order to read enough information, the nurse would have to search the journals for appropriate articles and then find the journals, either in print or online full text.

This would be a time-consuming endeavor.

3. Sites such as Joanna Briggs Institute have already reviewed the evidence and have used the hierarchy of evidence levels to categorize the information. This would be the quickest method to find reputable evidence.

4. The information on the WHO site not only is for healthcare professionals, but is also for the general public. It is likely that very good information is available, but locating it in this huge site might be time consuming.

Page Ref: 456-459 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

15 .

16) What are the advantages of using systematic reviews to learn about evidencebased practice issues? Select all that apply.

1. Any inconsistencies in the material are explored.

2. The review increases the strength of cause and effect relationships.

3. Helps to increase efficiency in time between research and clinical implementation.

4. This review proves this intervention is the best one available.

5. There is a decrease in bias from researcher error.

Answer: 1, 2, 3 Explanation: 1. These reviews help to assess consistency of the information and explain any inconsistencies of findings across the studies.

2. The review increases power in suggesting the cause and effect relationship.

3. These reviews help to increase efficiency in time between research and clinical implementation.

4. There is no proof that this intervention is the best one available, but it does rank the strength of the interventions reviewed.

5. Having many people participate in reviews helps to reduce bias from random and systematic error, which then improves true reflection of reality.

Page Ref: 458 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

16 .

17) The unit's QI team is reviewing its QI data. They are using gap analysis to better understand the problem and data. Which of the following are part of gap analysis?

Select all that apply.

1. Identify team roles and responsibilities.

2. Apply a guideline.

3. Identify best practice strategies.

4. Describe best practice v s your practice. er

us

Answer: 3, 4 Explanation: 1. This is not a required part of gap analysis.

2. This is not a required part of gap analysis.

3. This is step 1 in gap analysis.

4. This is step 2 in gap analysis.

Page Ref: 466 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

17 .

18) The experienced staff nurse complains that use of evidence-based practice (EBP) guidelines has "reduced nursing to a cookbook profession." What is meant by this comment?

1. Some people believe that the guidelines are too easy to follow and take the challenge out of nursing.

2. Some people believe that the guidelines are written so that they could be followed by anyone, despite his or her educational level.

3. Some people believe that EBP guidelines are too prescriptive and do not allow for consideration of individual needs.

4. Some people believe that too many factors are left to the interpretation of the person who is reading the guidelines.

Answer: 3 Explanation: 1. This is not the meaning of "cookbook" in this scenario. The EBP guidelines are not always easy to follow and the profession remains challenging. The challenge is in individualizing the guidelines to the specific patient and situation.

2. This is not the meaning of "cookbook" in this scenario. The guidelines require professional education and clinical decision making. There is no indication that using EBP will reduce the required education level of nurses or that other, less educated persons will have the clinical decision-making skills to employ EBP guidelines.

3. The term "cookbook" has been used to complain that using guidelines results in care that is too prescribed and directed. This should not be true of EBP guidelines, as they are written to be patient-centered and to be modified to fit the particular patient and patient situation.

4. The purpose of EBP guidelines is to provide the best interventions or treatments to the individual patient, given the individual situation. This does require some interpretation, but the purpose of the guidelines is also to limit this need.

Page Ref: 459 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

18 .

19) Over the last six months, patient satisfaction surveys have begun to mention that the facility is not as clean as expected. How should an administrator using evidencebased management (EBM) strategies deal with this information?

1. Recall that the hospital has been running at full capacity for over one year.

2. Recall that the manager of the housekeeping department was on vacation for a month during this time.

3. Accept this information as accurate and work to reverse the trend.

4. Forward the information to the housekeeping manager and demand an explanation.

Answer: 3 Explanation: 1. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.

2. This is an excuse for the outcome of this survey and does not meet the EBM principle of facing the hard facts.

3. EBM encourages the manager or administrator to "face the hard facts" and not to make excuses for evidence. The administrator should treat the organization as a work in progress and use this information to encourage housekeeping workers to improve.

4. Demanding an answer to the situation is not an EBM principle. The administrator should see the organization as a work in progress. Something has occurred to impact the hospital's cleanliness. That issue should be addressed and rectified, but it is not necessary to be demanding and accusatory.

Page Ref: 463-465 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice; quality improvement | AA CN Essential Competencies: Ⅲ. Scholarship for evidence-based practice; VI. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Knowledge and science; quality and safety care | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Discuss the implications of using evidence-based management.

19 .

20) Place the steps of the evidence-based management (EBM) process in correct order.

Choice 1. Formulate the question.

Choice 2. Assess the evidence.

Choice 3. Acquire research evidence.

Choice 4. Apply the evidence.

Choice 5. Present the evidence.

Answer: 1, 3, 2, 5, 4 Explanation: 1. Formulating the question is the first step of the EBM process.

2. The third step of the EBM process is assessing the evidence that has been acquired.

3. Once the question is formulated, the second step of the EBM process is acquiring research evidence.

4. Application of the evidence is the fifth step of the EBM process.

5. The fourth step of the EBM process is somewhat different than the evidencebased practice model, in which the step is not actively considered. In EBM, the evidence must be presented to others.

Page Ref: 464 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Discuss the implications of using evidence-based management.

20 .

21) The medical center nurse executive tells the nurse managers that the nursing department will be instituting evidence-based management (EBM). The medical center has a history of bureaucratic management style. What should the managers consider about these two facts?

1. The history of centralized decision making in the bureaucratic organization will make EBM easier to implement.

2. Since EBM depends on all managers following rigid policies and procedures, this transition should go quickly.

3. These two concepts have very little influence on one another.

4. The restrictions on decision making that are common in bureaucratic organizations will make use of EBM strategies difficult.

Answer: 4 Explanation: 1. This centralized decision making will go against the strategies of EBM. EBM calls for managers to make decisions based upon best management practice evidence. This strategy does not lend itself to centralized decision making.

2. This statement does not reflect the strategies associated with EBM. EBM calls for managers to make decisions based upon best management evidence.

3. This statement is not accurate. A bureaucratic management style will make EBM very difficult to implement.

4. EBM calls for managers to base decisions on best management evidence whenever possible. When the agency has a bureaucratic style, decision making is centralized and restricted, so use of EBM strategies may be difficult.

Page Ref: 463-465 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Discuss the implications of using evidence-based management.

21 .

22) The nurse executive of a major medical center and the dean of a school of nursing have entered into an affiliation agreement. The medical center will supply clinical sites and preceptors to students, and the nursing school will supply research expertise and other academic support. How will this affiliation affect the medical center's plans to implement evidence-based practice (EBP) and evidence-based management (EBM)?

1. This affiliation should have very little effect on these two initiatives.

2. The affiliation should be helpful in initiating these practice and management styles.

3. The affiliation will help with EBP, but will likely have little effect on EBM. 4. The affiliation will help with EBM, but will likely have little effect on EBP. Answer: 2 Explanation: 1. The affiliation should be helpful to both initiatives.

2. This sharing of expertise between nursing staff and nursing faculty should be of benefit to both EBP and EBM. 3. The affiliation should be helpful to both initiatives.

4. The affiliation should be helpful to both initiatives.

Page Ref: 463-465 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Discuss the implications of using evidence-based management.

22 .

23) The nurse executive suspects that the nurse managers see evidence-based management (EBM) as another management suggestion that will "blow over" with time. What is the best way for the nurse executive to be assured that EBM strategies are being used in the facility?

1. Require a weekly report on the strategies from each nurse manager.

2. Call staff nurses in and ask them about how the managers are making day-to-day decisions on the unit.

3. Make daily walking rounds with a member of upper management to check on the progress of the EBM initiative.

4. Incorporate EBM into the performance evaluation of the nurse managers.

Answer: 4 Explanation: 1. This plan is likely to make the nurse managers resent EBM strategies, as they have resulted in another report for the nurse managers to generate. The nurse executive may gain some information from the reports, but the benefit of that knowledge is likely not worth the risk of turning the nurse managers against the idea of EBM. 2. This strategy may gain some information for the nurse executive, but is likely to be seen as devious by the nurse managers. The managers may feel as if the nurse executive does not trust them and is asking the nurses to report on the managers.

3. This is another way that some information might be gained. However, this is also a way that could offend the nurse managers and may give EBM a bad name among the nurse managers.

4. While this method may take some time to produce information, it is the best method listed. This process assumes that the nurse manager is going to practice EBM and will reward those who do.

Page Ref: 464-465 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Discuss the implications of using evidence-based management.

23 .

24) Differentiate among quality improvement (Q I), research, and evidence-based practice (EBP) by choosing the statement that is accurate.

1. Statistical language in research is much more sophisticated than that used in QI. 2. Research and EBP support clinical decision making, whereas QI is a monitoring program.

3. Quality improvement efforts help to generate new knowledge in the care of patients.

4. Quality improvement is not dependent upon a specific theory as is research and EBP. Answer: 4 Explanation: 1. The language is the same, which leads to some confusion among these three endeavors.

2. All three endeavors support clinical decision making.

3. The goal of QI is to evaluate work processes. It does not generate new knowledge.

4. QI is an evaluative process designed to improve work processes. It has no theoretical underpinnings in the same manner as research or EBP. Page Ref: 465 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice; quality improvement | AA CN Essential Competencies: Ⅲ. Scholarship for evidence-based practice; Ⅵ.

Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Knowledge and science; quality and safety care | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 04. Compare and contrast research, evidence-based practice, evidence-based management, and quality improvement.

24 .

25) The newly hired quality improvement (QI) director states, "I believe we should seek institutional review board (IRB) approval before starting this new project." The medical center has never involved the IRB committee in QI proceedings. How should the medical center chief operating officer respond to this statement?

1. IRB approval is not necessary in this state.

2. Since we are a federal institution, we do not need IRB approval.

3. We can ask the IRB committee for an opinion on our plan for this project.

4. We should always get IRB approval for our QI initiatives from now on.

Answer: 3 Explanation: 1. The geographic location does not determine need for IRB approval.

2. IRB committees are required by any entity receiving federal funds.

3. Historically, there was no need for IRB approval for QI work. This has changed in recent times and IRB approval for some initiatives would be prudent.

4. Not all initiatives of the QI department would need IRB approval. It is wise to seek that approval for some plans.

Page Ref: 465 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice; quality improvement | AA CN Essential Competencies: Ⅲ. Scholarship for evidence-based practice; Ⅵ.

Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: Knowledge and science; quality and safety care | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare and contrast research, evidence-based practice, evidence-based management, and quality improvement.

25 .

26) Why is The Nuremberg Code important in research?

1. It protects animals in research.

2. It is a current listing of standards describing the research process.

3. It establishes a prototype for current views of research ethics.

4. The code resulted from the Willowbrook Study and concerns about ethics.

Answer: 3 Explanation: 1. The Nuremberg Code is about human experimentation.

2. This is not a current document, as it originated after World War Ⅱ and trials about medical experimentation. It does not focus on the research process.

3. This is a correct description of the contribution of The Nuremberg Code.

4. The code is associated with World War Ⅱ and trials about medical experimentation. The Willowbrook Study was in 1950-1970.

Page Ref: 453 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

26 .

27) You are serving on the IRB committee. In reviewing study proposals, what are questions you might ask? Select all that apply.

1. Can subjects withdraw at any time?

2. How are subjects told about their role in the study?

3. Is it clear whom the subjects should contact for questions?

4. Will negative results be kept private?

5. How will the researcher protect subject confidentiality?

Answer: 1, 2, 3, 5 Explanation: 1. This is a common question.

2. This is a common question.

3. This is a common question.

4. Whether or not results are positive or negative should not impact sharing the results.

5. This is a common question.

Page Ref: 454 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

27 .

28) What would be a barrier for a nurse researcher to accomplish effective research?

1. Statistical expertise 2. Completed a past study 3. Assuming a new administrative position 4. Expansion of clinical services with more patients Answer: 3 Explanation: 1. This would be an advantage.

2. Past research experience implies some research competency.

3. A new position would be a drain on researcher time and a barrier.

4. This might provide more patients for a sample.

Page Ref: 455 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Critique the research process, including differences in basic and applied research and implications for nursing leaders and managers.

28 .

29) Changing practice with EBP is least supported with which strategy?

1. Educate staff about EBP and evaluate results.

2. Develop policies and procedures that are based on best evidence.

3. Incorporate assessment of EBP in performance appraisal.

4. Connect EBP with QI within the healthcare organization.

Answer: 2 Explanation: 1. Staff do need to be educated about EBP and this education needs to be evaluated to determine its impact.

2. Policies and procedures need to be followed—just having them based on EBP is not enough.

3. Performance appraisal should include how the staff uses EBP. 4. EBP and QI are connected and should be within the healthcare organization.

Page Ref: 457 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

29 .

30) Which of the following government initiatives focuses on accelerating diffusion of research in practice?

1. AHRQ 2. PCORI 3. ACTION 4. CER Answer: 3 Explanation: 1. AHRQ is a U.S. Department of Health and Human Services agency that focuses on quality care.

2. PCORI is a government initiative focused on patient care outcomes.

3. ACTION is a government initiative that focuses on accelerating the diffusion of research in practice.

4. CER is a government initiative that focuses on comparing the effectiveness of research results to provide best evidence.

Page Ref: 460-461 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the evidence-based practice process, governmental initiatives addressing EBP, and implications for nursing leaders and managers.

30 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 17 Healthcare Quality: A Critical Health Policy Issue 1) The nurse is interested in educating patients to become active participants in their own healthcare. Which information should the nurse review to develop a program for the hospital?

1. "Speak Up: Help Prevent Errors in Your Care" 2. Crossing the Quality Chasm 3. To Err Is Human: Building a Safer Health System 4. Envisioning the National Healthcare Quality Answer: 1 Explanation: 1. The Joint Commission initiated a program that the American Nurses Association supports. "Speak Up: Help Prevent Errors in Your Care" urges patients to ask questions, pay attention to the care that is being received, become knowledgeable about their diagnosis, ask a trusted person to be their advocate, know their medications, and use organizations that are accredited.

2. Crossing the Quality Chasm is a report focused on the quality of care.

3. To Err is Human: Building a Safer Health System is a report that focuses on quality of care.

4. Envisioning the National Healthcare Quality is a report focused on quality of care.

Page Ref: 486 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | N LN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

1 .

2) The quality improvement nurse is working to increase the efficiency of resource utilization in the medical center. This nurse is focusing on which element of healthcare quality?

1. Process 2. Structure 3. Outcome 4. Function Answer: 2 Explanation: 1. The three accepted elements of quality are process, structure, and outcome.

Process is the manner in which services are provided.

2. The three accepted elements of quality are process, structure, and outcome.

Structure is the environment in which services are provided. Resource utilization has to do with creating the environment.

3. The three accepted elements of quality are process, structure, and outcome.

Outcome is the result of services.

4. Function is not one of the accepted elements of quality.

Page Ref: 489 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Examine the current status of healthcare quality.

2 .

3) What has been the historical importance of the Institute of Medicine (I OM) reports since 1999?

1. They stimulated the development of strategies that will improve quality of care.

2. They are responsible for accrediting hospitals and other types of healthcare organizations.

3. They establish minimum standards and benchmarks for healthcare organizations.

4. They support research designed to improve the outcomes and quality of healthcare.

Answer: 1 Explanation: 1. The IOM reports stimulated the development of strategies that will improve quality of care.

2. Accrediting of healthcare organizations and establishing minimum standards are the responsibilities of The Joint Commission.

3. Accrediting of healthcare organizations and establishing minimum standards are the responsibilities of The Joint Commission.

4. Supporting research designed to improve healthcare outcomes and quality is the focus of the Agency for Healthcare Research and Quality.

Page Ref: 471-472 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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4) Which factors are evidence of an increased interest in quality care? Select all that apply.

1. Increased legislation 2. A change in focus of the major purchasers of healthcare 3. Initiatives by healthcare professional organizations 4. An increased number of accreditation organizations 5. A major decrease in the number of malpractice lawsuits Answer: 1, 2, 3 Explanation: 1. Increased legislation is one indication of increased interest in quality care, which shows public concern for care. An example of this legislation is the Patient Safety and Quality Improvement Act that was signed into law in 2005.

2. Businesses want value for the money they spend on healthcare, and employers are the major purchasers of care because they provide healthcare coverage for their employees.

3. Healthcare professional organizations are also involved in the increased interest in healthcare quality.

4. There has not been an increase associated with healthcare quality.

5. This has not occurred.

Page Ref: 481 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Examine the current status of healthcare quality.

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5) Which statement, made by a staff nurse, reflects correct identification of the primary goal of quality improvement (Q I)?

1. "This process will save us money."

2. "I like that this intervention saves time."

3. "It seems as if the physicians like our new charting system."

4. "My patients do better since we are using this system."

Answer: 4 Explanation: 1. Quality improvement may save the hospital money, especially in the long term, but this is not the primary goal of the process.

2. Quality improvement may result in more efficient work, but this is not the primary goal of the process.

3. While quality improvement may result in everyone being happier and more satisfied with care, this is not the primary goal of the process.

4. The primary goal of the QI process is to improve patient outcomes.

Page Ref: 471, 481 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 02. Examine the current status of healthcare quality.

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6) A serious medication administration error occurred on the unit last night. What statement, made by the nurse manager, reflects the current focus of quality improvement (QI) related to this situation?

1. "Was this a nursing error or a physician error?"

2. "How did the error occur?"

3. "Who gave the medication?"

4. "What pharmacist was on duty?"

Answer: 2 Explanation: 1. In this statement, the nurse manager is trying to discover whom to blame for the error. Today's emphasis is on system failure, rather than on an individual.

2. This statement reflects concern about how the system allowed the error to occur.

This is the current view of errors.

3. The nurse manager is trying to discover the individual to blame in this statement.

Today's emphasis is on fixing the system, not on blaming an individual.

4. This statement is one of determining blame for the error. Today's focus is on the system, not on the individual.

Page Ref: 474 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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7) Which statements regarding President Clinton's Presidential Advisory Commission on Consumer Protection and Quality in the Healthcare Industry are accurate? Select all that apply.

1. This was a short-term task force.

2. Patient privacy was considered during this work.

3. The task force did not succeed in reforming healthcare.

4. The work focused on patient issues, but did not address practitioner qualifications.

5. This has been the most successful of the programs to come out of that decade of work.

Answer: 1, 3 Explanation: 1. This was the commission's first subcommittee's purpose.

2. Patient privacy and confidentiality were considered by this committee.

3. This is a true statement. This is really the only element of this commission's work that has not been successful.

4. The work included consideration of coverage, choice of practitioners, privacy and confidentiality, disclosure of practitioner qualifications, and external appeals processes.

5. This element of the commission's work has not been successful.

Page Ref: 472 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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8) Information from To Err Is Human: Building a Safer Health System (Institute of Medicine, 1999) indicates that at least 44,000 Americans die each year as a result of a medication error. Nurses from which setting could closely apply this information to their personal practice?

1. Hospitals 2. Long-term care 3. Home health 4. Intensive care units 5. Ambulatory care Answer: 1 Explanation: 1. To date, the focus has only been on hospital errors.

2. This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings.

3. This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings.

4. This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings.

5. This study focused on hospital errors; however, this does not negate the presence of medical errors in other settings.

Page Ref: 472-473 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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9) The medical center quality improvement director issues a report on the "opportunity" costs of errors occurring in the organization. Which situation would be included in this report? Select all that apply.

1. A patient sustained a fracture when he falls after being incorrectly restrained.

2. A laboratory test must be repeated because the technician ran the specimen incorrectly.

3. A medicine error necessitates that the patient be dialyzed.

4. The patient says, "A nurse nearly let me die, so I don't trust nurses anymore."

5. The physician enters discharge orders incorrectly and the patient spends another day in the hospital.

Answer: 2, 3 Explanation: 1. This is an instance of costs being increased because of a complication (fracture) due to error.

2. Opportunity costs occur when repeat diagnostic tests are required or interventions are needed to counteract adverse drug events.

3. Opportunity costs occur when repeat diagnostic tests are required or interventions are needed to counteract adverse drug events.

4. This statement reveals a patient's loss of trust in the healthcare system and its providers. This is a different critical concern.

5. This is an instance of costs being increased because of lack of communication or communication error.

Page Ref: 472 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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10) The patient develops postoperative pneumonia when the physician fails to order respiratory therapy treatments after surgery. Which type of quality problem does this situation most clearly represent?

1. Misuse 2. Error of planning 3. Underuse 4. Error of benefit Answer: 3 Explanation: 1. Misuse is an unavoidable complication that prevents patients from receiving full potential benefit of a service.

2. This could possibly be an error in planning, but there is no indication that the physician did not plan to order the treatments. It most clearly represents underuse.

3. This is most clearly an underuse problem or failure to provide a service that would have produced a favorable outcome for the patient.

4. This is not one of the types of error discussed in the text.

Page Ref: 474 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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11) The nursing student is writing a paper on the Institute of Medicine's (IOM) 2001 report, Crossing the Quality Chasm. Which options reflect aims of this report that the student should include? Select all that apply.

1. Timeliness 2. Effectiveness 3. Reimbursement 4. Equality 5. Safety Answer: 1, 2, 4, 5 Explanation: 1. Reducing waits and harmful delays for both those who receive and those who give care is an improvement aim.

2. Providing services based on scientific knowledge to all who could benefit and refraining from providing services to those not likely to benefit constitutes the effectiveness aim of the paper.

3. Reimbursement is not an aim of this study.

4. Providing care that does not vary in quality because of personal characteristics is an aim proposed by this study.

5. Avoiding injuries to patients from the care that is intended to help them is a quality aim proposed by this study.

Page Ref: 474-475 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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12) Which phrase best explains the Institute of Medicine's (IOM) 21st century rule, "Care based on continuous healing relationships"?

1. Sharing of information 2. Patient-centered care 3. Access is critical 4. Care based on evidence Answer: 2 Explanation: 1. Sharing of information is related to the critical nature of "Shared knowledge and the free flow of information."

2. Patient-centered care is related to the need for customization based on patient needs and values.

3. This IOM rule means that patients should receive care whenever they need it– access is critical.

4. Patient care that is based on the best possible evidence available relates to evidence-based decision making.

Page Ref: 476 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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13) The Institute of Medicine (IOM) uses two dimensions in the quality matrix to describe quality. Which factors are included in the first dimension? Select all that apply.

1. Patient centeredness 2. Effectiveness 3. Timeliness 4. End-of-life care 5. Staying healthy Answer: 1, 2, 3 Explanation: 1. The first dimension focuses on the delivery of healthcare and includes factors such as patient centeredness, safety, effectiveness, and timeliness.

2. The first dimension focuses on the delivery of healthcare and includes factors such as patient centeredness, safety, effectiveness, and timeliness.

3. The first dimension focuses on the delivery of healthcare and includes factors such as patient centeredness, safety, effectiveness, and timeliness.

4. The second dimension of quality focuses on the consumer perspective of healthcare needs and includes staying healthy, getting better, living with illness or disability, and coping with palliative or end-of-life issues.

5. The second dimension of quality focuses on the consumer perspective of healthcare needs and includes staying healthy, getting better, living with illness or disability, and coping with palliative or end-of-life issues.

Page Ref: 475 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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14) The nurse works with breast cancer survivors in a "Reach for Recovery" program.

Which portion of the Institute of Medicine's (IOM) focus on quality care does this work represent?

1. Staying healthy 2. Getting better 3. Living with illness or disability 4. Coping with palliative care or end-of-life issues Answer: 2 Explanation: 1. Staying healthy means that the individual needs to get healthcare to stay well and avoid illness.

2. Getting better requires that the patient reach for recovery.

3. Living with illness or disability acknowledges that some health problems cannot be cured, and then the individual needs assistance in learning how to manage and cope long term.

4. Coping with palliative care or end-of-life issues requires that individuals need support and care during terminal stages of illness. Families and caregivers are also involved in each of these consumer components of healthcare.

Page Ref: 477 Cognitive Level: Applying Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

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15) Match each of the National Quality Strategic Plan aims with appropriate priorities.

1. Aim: Better care 2. Aim: Healthy people/healthy communities 3. Aim: Affordable care Match with these Choices: A. Making care safer by reducing harm caused in the delivery of care.

B. Ensuring that each person and family is engaged as partners in their care.

C. Promoting effective communication and coordination of care.

D. Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease.

E. Working with communities to promote wide use of best practices to enable healthy living.

F. Making quality care more affordable for individuals, families, employers, and governments by developing and spreading new healthcare delivery models.

Answer: 1. A, B, C 2. A, B, C, D 3. F Explanation: A, B, C focus on Better Care; A, B, C, D focus on Healthy People/Healthy Communities; and F focuses on affordable care.

Page Ref: 495 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Explain the purpose of the National Quality Strategy and its relationship to other content in this chapter.

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16) The faculty of a school of nursing has decided to follow the guidelines listed by the Institute of Medicine (IOM) Health Professions Education report. Which competencies should the faculty include in the school curriculum? Select all that apply.

1. How to use informatics 2. Information on working in interprofessional teams 3. How to tailor care to be patient-centered 4. The application of quality improvement to practice 5. How to use evidence-based information in practice Answer: 1, 2, 3, 4, 5 Explanation: 1. Using informatics is one of the five core competencies listed in the report.

2. Working in interprofessional teams is a competency listed in this report.

3. The provision of patient-centered care is a competency listed in the report.

4. Applying quality improvement is a competency listed in the report.

5. Employing evidence-based practice is a competency listed in the report.

Page Ref: 479, 487 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the content and implications of critical healthcare quality and nursing reports.

16 .

17) Select the option that reflects the focus of the "U" portion of The Joint Commission's "Speak Up" program.

1. Use education to remain healthy.

2. Undergo as few medical procedures as possible.

3. Use accredited healthcare organizations.

4. Understand your medication regimen.

Answer: 3 Explanation: 1. This is not reflected by the "U" portion of "Speak Up." 2. This is not reflected by the "U" portion of "Speak Up." 3. The "U" portion of this program is to use a hospital, clinic, surgery center, or other type of healthcare organization that has undergone a rigorous on-site evaluation against established state-of-the-art quality and safety standards, such as those provided by The Joint Commission.

4. This is not reflected by the "U" portion of "Speak Up." Page Ref: 486 Cognitive Level: Understanding Client Need/Sub: Health Promotion and Maintenance Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

17 .

18) High-reliability organizations are best described by which statement?

1. An HCO that is ranked high in a national report card about healthcare quality.

2. An HCO that views a near miss as a sign we are catching errors.

3. Reliability in an organization requires that managers consider staff input.

4. When operations are viewed as effective, this is a good sign.

Answer: 3 Explanation: 1. Ranking in a report card is not the best description of a high-reliability organization.

2. A high-reliability organization views near misses as a symptom that more work needs to be done to improve and needs to find ways to do this.

3. High-reliability organizations practice deference to expertise–advice can come from staff.

4. High-reliability organizations are always sensitive to operations, knowing improvement is ongoing, continuous.

Page Ref: 493-494 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Critique critical issues related to defining quality healthcare, including measurement, structure, process, and outcome elements.

18 .

19) Which information would be used to monitor the process element of a hospital's quality?

1. The average daily census reports 2. Changes in community health status 3. Total percentage of nursing department salary hours paid to registered nurses 4. Patient satisfaction survey results regarding interaction with clinicians Answer: 4 Explanation: 1. This is a structure or input monitor.

2. This is an output monitor.

3. This is a structure or input monitor.

4. This is a process monitor.

Page Ref: 494 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Critique critical issues related to defining quality healthcare, including measurement, structure, process, and outcome elements.

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20) Which statement, made by a staff nurse, indicates that the nurse understands the meaning of Medicare HACs? 1. "I am a very good nurse, so it is unlikely that one of my patients would experience one of these events."

2. "It is so hard when a patient experiences one of these events, since they are not survivable."

3. "Thankfully, most nurses will never see a patient experience one of these events."

4. "I am working on the safety committee to help prevent the occurrence of these events."

Answer: 4 Explanation: 1. Despite good nursing care, patients may suffer an HAC. They often indicate a safety system problem, not a specific provider problem.

2. In order to be placed on the HACs, the event must be adverse. There is no requirement for the event to be lethal.

3. These events are not that uncommon, but most nurses will experience HACs with patients such as falls and decubiti.

4. These events are indicative of a problem in the healthcare facility's safety system.

Page Ref: 492-493 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

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21) The nurse commits an error while caring for a patient who receives Medicare benefits. The error results in a complication that is on the Centers for Medicare and Medicaid Services' "never list." What is the implication of this error?

1. The nurse will be investigated by the state's board of nursing.

2. The nurse's employment will be terminated.

3. Medicare will not pay for the cost of the complication.

4. The patient will have to share the cost of the care for the complication with Medicare.

Answer: 3 Explanation: 1. The occurrence of a "never event" does not necessitate investigation by the board of nursing. These events are usually related to failure of a system, rather than individual failure.

2. There is no requirement to terminate the nurse's employment.

3. This is the Medicare rule. The cost of caring for the complication will not be covered.

4. The patient cannot be billed for this cost and Medicare will not cover the cost of this care. The cost must be absorbed by the healthcare organization.

Page Ref: 492-493 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

21 .

22) What is true of quality in healthcare?

1. It is easy to define.

2. It is easy to measure.

3. It is complex.

4. It is unachievable.

Answer: 3 Explanation: 1. Quality is difficult to define.

2. Quality is difficult to measure.

3. Quality is a complex concept, with many factors affecting it.

4. Total quality may be difficult to achieve in healthcare, but improvement of quality is possible.

Page Ref: 488-490 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Critique critical issues related to defining quality healthcare, including measurement, structure, process, and outcome elements.

22 .

23) A nurse works as a reviewer of Medicare claims. In this capacity, the nurse frequently denies these claims. What is the primary rationale for this action?

1. It helps to protect the Medicare Trust Fund.

2. It serves to control unnecessary testing.

3. It keeps physician practice from becoming too independent.

4. It helps ensure that nursing care is safe.

Answer: 1 Explanation: 1. The rationale for reviewing claims for Medicare payment is to be certain that the claims are valid and for necessary procedures. This validation helps to protect the money in the Medicare Trust Fund from being used inappropriately.

2. This is a side benefit from this action, but is not the primary rationale.

3. This is not associated with the review process.

4. Review does not serve to ensure safety of nursing care.

Page Ref: 491-492 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

23 .

24) The healthcare provider is aware that an error was made in the care of a hospitalized patient. The provider is aware that information about the error would make it less likely that the same or a similar error would happen to another patient.

However, the provider is fearful of retribution regarding the error. To which group should the provider consider reporting this information?

1. Patient Safety Organization (P SO) 2. Joint Commission 3. National Institutes of Health (NIH) 4. Health Resources and Services Administration (H RSA) Answer: 1 Explanation: 1. The specific purpose of PSOs is to encourage providers to report this information in a confidential manner.

2. The Joint Commission's main mission is to accredit organizations, not to collect information on errors.

3. NIH is the world's premiere medical research organization.

4. HRSA provides access to essential healthcare services for people who are lowincome, uninsured, or who live in rural areas or urban neighborhoods where healthcare is scarce.

Page Ref: 482 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Discuss the relevance of legislation, governmental and nongovernmental initiatives, and strategies to improve healthcare quality policy.

24 .

25) The hospital's quality improvement department focuses on measuring structure, process, and outcomes and identifying errors and hazards in the care provided.

What other foci should the department develop to establish an effective quality improvement program? Select all that apply.

1. Assessing current practices and comparing them to what is done in other facilities 2. Designing and testing interventions to improve quality 3. Finding better resources for funding of initiatives 4. Helping practitioners identify methods of improving personal practice 5. Helping the facility recruit and retain qualified nurses Answer: 1, 2, 4 Explanation: 1. Assessing current practices and comparing them with relevant better practices elsewhere is a means of identifying opportunities for improvement.

2. Designing and testing interventions to change the process of care can improve quality and is part of an effective QI department.

3. While this is an important aspect of healthcare administration, it is not the major work of a QI program.

4. Both acting as an effective member of an interprofessional team and working to improve the quality of one's own performance through self-assessment and personal change are important aspects of quality improvement. An effective QI department will serve to encourage these activities.

5. This is the work of the human resources department.

Page Ref: 488 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Critique critical issues related to defining quality healthcare, including measurement, structure, process, and outcome elements.

25 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 18 Implementing Healthcare Quality Improvement 1) Which situation is most likely to result in the nurse making a medication error?

1. The nurse has worked three 12-hour shifts in three days.

2. The nurse uses an online program to access medication information.

3. The nurse insists on documenting medication administration immediately after giving the medication.

4. The nurse prepares medications for administration in a secluded area.

Answer: 1 Explanation: 1. Some of the reasons for errors in this area are time pressures, fatigue, understaffing, lack of knowledge about the drug and/or the patient, inadequate documentation, and systems failure. This nurse may be fatigued secondary to long work hours and decreased sleep time.

2. Lack of knowledge about the drug is a common reason for medication errors.

This nurse is using an acceptable method to learn about the medication.

3. The standard is to document the medication administration immediately after giving the medication. This nurse is trying to follow policy. Breakdowns in policy or systems can encourage error.

4. Time pressure and constant interruption lead to error. This nurse has attempted to decrease these factors by working in a secluded area.

Page Ref: 505-507 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | N LN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Describe the science of improvement and implications for healthcare quality and culture of safety.

1 .

2) Which organizations are subject to accreditation by The Joint Commission? Select all that apply.

1. Hospitals 2. Long-term care facilities 3. Schools of nursing 4. Home care agencies 5. Office-based surgical practices Answer: 1, 2, 4, 5 Explanation: 1. The Joint Commission accredits hospitals.

2. The Joint Commission accredits long-term care facilities.

3. Schools of nursing are accredited by the National League for Nursing or the American Association of Colleges of Nursing.

4. The Joint Commission accredits home care agencies.

5. The Joint Commission accredits office-based surgical practices.

Page Ref: 518-520 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 05. Describe The Joint Commission accreditation and its relevance to quality improvement.

2 .

3) The nurse has taken a position in the utilization review (U R) department of a hospital. This nurse can expect to be involved in evaluating which care components?

Select all that apply.

1. Was the care provided necessary?

2. How much medication did the patient receive?

3. How appropriate was the care provided?

4. How much did each procedure cost to provide?

5. How efficiently was care provided?

Answer: 1, 3, 5 Explanation: 1. Utilization review and management is the process that evaluates the necessity of the healthcare services provided for specific patients or patient populations.

2. Medication reconciliation is done jointly by nursing and the pharmacy and is not a UR focus.

3. UR evaluates the appropriateness of care provided.

4. Cost should be a secondary factor in UR. The focus is quality of care.

5. Efficiency of provision of care is evaluated by UR. Page Ref: 512-513 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

3 .

4) The hospital administrative team holds an employee meeting to announce that the hospital will support the use of quality report cards. What should the employees expect from this announcement? Select all that apply.

1. This report card will provide specific performance data about the organization at specific intervals.

2. The goal of using these report cards is to improve the organization's services.

3. These report cards will be an inexpensive way to let the community know about the organization's quality.

4. Using these report cards will increase the average daily census of the organization.

5. These report cards will be used internally as a means of documenting performance evaluations.

Answer: 1, 2 Explanation: 1. Quality report cards are used to track and report performance data.

2. The goal of using these report cards is to increase the transparency of quality data. The idea is that this transparency will encourage providers and organizations to work harder to provide quality care.

3. Report cards are costly from the perspective of collection of data, analysis, and sharing the results with others.

4. There is no guarantee that publishing quality data will impact patient choices for healthcare.

5. These report cards are not individual, but rather are organization-wide reports on quality.

Page Ref: 515 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

4 .

5) The nurse made a medication error. Which statement reflects the traditional "blame game" approach to such errors? Select all that apply.

1. The nurse manager says, "You have to complete the incident report and notify the patient's physician. You made the error, not me."

2. The nurse says, "Why did I make this error?"

3. The physician says, "Is there some way we can prevent this type of error from happening again?"

4. The nurse thinks, "The patient is okay, so I won't tell anyone this happened."

5. The risk manager says, "How many errors has this nurse made this year?"

Answer: 1, 4, 5 Explanation: 1. The traditional approach to medication error has been punitive and blaming. This manager's response is not supportive of the nurse who made this error.

2. This nurse is trying to discover what in the system allowed the mistake to be made. This is the quality improvement approach to error.

3. The physician is trying to discover how the mistake occurred and is trying to find ways to prevent further error. This is the quality improvement approach to error.

4. Unfortunately, this is a common thought for nurses and is related to the punitive nature of many medication error policies.

5. This risk manager is also looking for blame and not focusing on the system problem that allowed the errors to occur.

Page Ref: 504 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Describe the science of improvement and implications for healthcare quality and culture of safety.

5 .

6) The unit has been so understaffed that the nurse has been unable to attend education sessions on new medications that physicians will be prescribing for the treatment of hypertension. This situation is likely to result in a medication error resulting from which contributing factor?

1. Work environment 2. Task 3. Individual staff member 4. Organization and management Answer: 1 Explanation: 1. Work environment issues are problems such as staffing levels and mix, patterns of workload, work design, availability and maintenance of equipment, and administrative and managerial support. This nurse has been unable to get necessary education because of staffing issues.

2. Task issues are problems such as availability and use of protocols and availability and accuracy of test results.

3. Individual staff member factors include knowledge and skills, motivation and attitude, and physical and mental health. This nurse does lack essential knowledge, but the reason for this lack is a staffing problem, which speaks to work environment.

4. Organization and management issues are such factors as financial resources and constraints, policy standards and goals, safety culture, and priorities.

Page Ref: 506 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Describe the science of improvement and implications for healthcare quality and culture of safety.

6 .

7) The risk manager has noted an increase in error rate for a nursing unit over the last year. Which factors should the risk manager investigate? Select all that apply.

1. How strong is the unit leadership?

2. Are nurses being asked to fulfill unreasonable work assignments?

3. How well does the unit staff function as a team?

4. Who on the unit is making the most mistakes?

5. Does an environment of learning exist on the unit?

Answer: 1, 2, 3, 5 Explanation: 1. Strong leadership helps to provide a safe healthcare system. If the unit leadership is weak, all processes of the unit are affected, including safety.

2. There are limits to which people can be expected to work. Exceeding those limits increases the likelihood of error.

3. Effective team functioning can work to improve safety as nurses "look out for one another" even during times of maximum workload.

4. This is the punitive, traditional method of dealing with error.

5. A learning environment encourages all staff members to perform at their highest level.

Page Ref: 515-516 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Describe the science of improvement and implications for healthcare quality and culture of safety.

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8) The nurse executive announces to the nurse managers that the hospital will soon begin using failure modes and effects analysis (F MEA) to analyze errors. What should the nurse managers tell the staff about this new initiative?

1. If you make an error, expect that the FMEA system will investigate you.

2. If there are two errors in one category, such as falls, the nurses involved will be investigated.

3. We will not have to worry about this system until our turn comes up in the unit rotation.

4. All of the hospital systems will be a part of this initiative.

Answer: 4 Explanation: 1. FMEA does not focus on individual nurses.

2. FMEA does not focus on individual incidents or nurses.

3. FMEA does not focus on one unit at a time.

4. FMEA focuses on safety in systems and prevention of accidents moving away from the individual focus.

Page Ref: 508, 524 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss examples of critical healthcare quality issues.

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9) Failure to rescue (FTR) is most commonly a result of which other failure?

1. Failure to understand the disease process 2. Failure to understand the purpose of an intervention or treatment 3. Failure to monitor patient status 4. Failure to follow physician orders Answer: 3 Explanation: 1. The nurse should understand disease process, but this is not the most frequent cause of FTR. 2. The nurse should never give a medication or provide an intervention or treatment without knowing its purpose. However, this is not the most common reason for F TR. 3. FTR is most often a result of failure to monitor the patient. If the patient is monitored adequately, failures such as the other options can be noted and acted upon quickly, perhaps affecting patient outcomes.

4. The nurse should understand and follow physician orders if accurate. However, failure to do so is not the most common reason for FTR. Page Ref: 507, 524 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss examples of critical healthcare quality issues.

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10) Which patient is most likely to benefit from using a rapid response team (R RT)?

1. A 10-year-old in the emergency department 2. A 51-year-old in the cardiac intensive care unit 3. A 73-year-old on a urology unit 4. A 43-year-old in a physician's office Answer: 3 Explanation: 1. RRTs are teams of critical care experts who come to the bedside of patients who are not in intensive care. The E D generally has experts present, so this team would not be used.

2. RRTs are teams of critical care experts who come to the bedside of patients who are not in intensive care. This patient is already in I CU. 3. This patient is not on a unit where critical care experts would normally work. This patient would be a candidate for treatment by an RRT. 4. RRTs are hospital based and would not be available to this patient.

Page Ref: 507, 525 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Discuss examples of critical healthcare quality issues.

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11) During a meeting with nurse managers, the risk manager for the hospital says, "Approximately 60% of our patient care errors can be directly attributed to poor handoffs." What situation should the nurse managers address to improve these statistics?

1. One person per shift should be responsible for receiving medications that are delivered from the pharmacy.

2. The staff should work on clarity of information communicated when a patient is transferred from one care setting to another.

3. More care should be taken in interpreting physician orders.

4. The nursing staff must complete admission history and physicals in a timelier manner.

Answer: 2 Explanation: 1. Handoffs do not refer to delivery of medication from pharmacy.

2. Handoffs occur when a patient is transferred from one care setting to another.

Communication is essential at these times.

3. Handoffs are not associated with physician orders.

4. Handoffs are not associated with admission H&Ps. Page Ref: 507, 524 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 09. Examine the role of nursing leadership in quality improvement and need for changes to improve nursing leadership.

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12) The hospital has adopted a medication administration system that has a series of checks and balances designed for patient safety. The system works well, but is time consuming. Nurses have discovered shortcuts around the safeguards. This is an example of which situation?

1. A handoff 2. A workaround 3. An effects analysis 4. A "never event" Answer: 2 Explanation: 1. Handoffs are times in the care process when a patient is moved from one care setting to another.

2. When there is a breakdown or problem, staff often figure out ways to get the work done without really analyzing what is going on. The staff may think this saves time, but it often does not. This is often a time of increased errors.

3. This is part of the failure modes and effects analysis (FMEA) system, which provides a systematic, proactive method for evaluating a process to identify where and how it might fail and to assess the relative impact of different failures in order to identify the parts of the process that are in most need of change.

4. A "never event" is an event identified by Medicare that occurs to extend the patient's hospitalization, but that should have been avoidable.

Page Ref: 508 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Discuss examples of critical healthcare quality issues.

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13) The risk manager of a healthcare organization is concerned about the amount of violence against healthcare workers that is occurring nationwide and would like to offer education sessions to staff. Which groups of staff are most at risk for experiencing violence and therefore should receive this education earlier rather than later in the schedule? Select all that apply.

1. Long-term care staff 2. Neurologic intensive care staff 3. Cardiac telemetry unit staff 4. Emergency department staff 5. Mental health unit staff Answer: 1, 4, 5 Explanation: 1. LTC staff members are among the most likely to experience violence.

2. Neurologic ICU is not an area that experiences the most violence.

3. Cardiac telemetry unit staff members are not prone to experience violence.

4. ED staff members are among the most likely to experience violence.

5. Mental health unit staff members are among the most likely to experience violence.

Page Ref: 509 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Examine workplace safety as a factor related to quality healthcare.

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14) The quality improvement director is scheduling education sessions for new employees about The Joint Commission accreditation visits. The director should explain that which group is most likely to be interviewed during the accreditation visit?

1. Hospital administration 2. Nurse managers 3. Department managers 4. Direct care providers Answer: 4 Explanation: 1. The visitors will talk with administration, but will be most interested in interviewing direct care providers.

2. The visitors will talk with nurse managers, but will be most interested in interviewing direct care providers.

3. The visitors will talk with department managers, but will be most interested in interviewing direct care providers.

4. The most likely group to be interviewed is direct care providers. The visitors will want to talk to those who provide care, not those who have designed the systems of care.

Page Ref: 518-519 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 05. Describe The Joint Commission accreditation and its relevance to quality improvement.

14 .

15) The administration of a healthcare organization (H CO) is concerned about the increasing costs of The Joint Commission accreditation. One administrator suggests, "Let's just withdraw from the process." What should the administrative staff consider prior to acting on this suggestion? Select all that apply.

1. The HCO could no longer offer obstetric or pediatric services.

2. The HCO could no longer serve as a training center for medical students.

3. The HCO could no longer offer clinical experiences for nursing students.

4. The HCO could no longer offer emergency services.

5. The HCO could no longer receive any federal funds.

Answer: 2, 3, 5 Explanation: 1. As long as the obstetric and pediatric patients were private pay, this care could continue. Some insurance companies will not pay for care in a non-accredited organization and the organization could not receive Medicaid funds.

2. In order to serve as a training facility for medical students, the facility must be accredited.

3. In order to serve as a clinical site for nursing students, the facility must be accredited.

4. As long as all the patients were private pay, this care could continue. Some insurance companies would not pay for care and no federal funds (Medicare/Medicaid) could be accepted.

5. The organization must be accredited to receive federal funding.

Page Ref: 518-519 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Describe The Joint Commission accreditation and its relevance to quality improvement.

15 .

16) Place the key steps of the continuous quality improvement (C QI) process in their most logical order.

Choice 1. Collect data.

Choice 2. Implement the plan.

Choice 3. Develop a plan.

Choice 4. Analyze and summarize data.

Choice 5. Implement corrective actions.

Choice 6. Share data with staff.

Answer: 3, 2, 1, 4, 6, 5 Explanation: 1. After data are generated in step 2, data collection occurs in step 3.

2. The second step is implementation. This implementation will generate data for the next step.

3. The first step of this process is to work within the units, services, departments, and organization to develop a CQI plan.

4. The fourth step is to analyze and summarize the data collected in the previous step.

5. The final step, before the process starts again, is to implement corrective action on any identified problems. This will direct the beginning of the new CQI cycle.

6. Once data have been analyzed and summarized, the fifth step is to share the information with staff.

Page Ref: 528-530 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 09. Examine the role of nursing leadership in quality improvement and need for changes to improve nursing leadership.

16 .

17) The risk manager is providing education on identifying sentinel events for the nursing staff. Which scenarios would be good examples for the risk manager to use?

Select all that apply.

1. A patient is received dead on arrival from an automobile accident.

2. An inpatient attempts to jump from the hospital's rooftop garden.

3. A patient dies after being assigned a do not resuscitate (D NR) status.

4. A woman suffers cardiac arrest during the delivery of a viable infant.

5. A patient who suffered head trauma was admitted to the regular medical unit and dies.

Answer: 2, 4, 5 Explanation: 1. The arrival of a patient DOA is not a sentinel event.

2. Suicide attempts are classified as sentinel events.

3. This patient was assigned a DNR status, so the patient's death is not a sentinel event.

4. Cardiac arrest in labor and delivery is a sentinel event.

5. This patient was not referred to specialist care and then died. This is a sentinel event.

Page Ref: 510, 515-516, 519 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: LO 04. Compare quality methods used to measure and improve care and their relationship to structure, process, and outcomes.

17 .

18) After four nurses retire, the small hospital has insufficient nurses to staff the hospital 24 hours a day, seven days per week. A nursing assistant begins to assume many nursing activities to help with the staffing problem. Who is breaking the law in this case?

1. Both the nursing assistant and the hospital 2. The hospital, but not the nursing assistant 3. The nursing assistant, but not the hospital 4. Neither the nursing assistant nor the hospital Answer: 1 Explanation: 1. The nursing assistant is practicing outside his or her scope of practice. The hospital is allowing this to occur, so the hospital is also breaking the law.

2. The nursing assistant is practicing outside his or her scope of practice.

3. The hospital is allowing the nursing assistant to practice outside his or her scope of practice. This is breaking the law.

4. Both are breaking the law.

Page Ref: 512 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

18 .

19) Which initiative focuses on unit safety?

1. HCUP 2. TERCA P 3. CUSP 4. NDNQI Answer: 3 Explanation: 1. Healthcare Cost and Utilization Program collects and examines national data about cost and utilization.

2. Taxonomy of Error, Root Cause Analysis, and Practice, a nursing initiative from the National Council of State Boards of Nursing, collects error data from HCOs nationally focused on nursing practice.

3. Comprehensive Unit-Based Safety Program is a collaborative effort focused on a unit's safety.

4. Nursing Database of Nursing Indicators is a national database about nursing care.

Page Ref: 522-523 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 07. Discuss the need for collaborative interprofessional quality improvement initiatives.

19 .

20) The healthcare corporation is considering using benchmarking as a way to improve quality. What concept is essential to this process?

1. The corporation should choose unique, corporation-specific areas to include in benchmarking.

2. Benchmarking is designed to work best on management-level initiatives.

3. In order for benchmarking to be effective, the corporation must be willing to share information.

4. This process will build an internal database on which future decisions will be based.

Answer: 3 Explanation: 1. The areas that are being evaluated should be ones that are common to similar institutions. Commonality is essential to make sharing of information possible.

2. Benchmarking is designed to work on all aspects of the operations of the institution.

3. Benchmarking uses information from different but similar healthcare institutions.

Everyone involved in benchmarking must be willing to share information about their institution.

4. The idea is to share data so that an external database and best practice information can be developed.

Page Ref: 514 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

20 .

21) In comparing current The Joint Commission accreditation and accreditation done in the past, what are some approaches that have been reduced? Select all that apply.

1. Scheduled survey visits 2. Use of a more comprehensive approach 3. Including nursing staff 4. Developing a plan for the survey 5. Taking a punitive approach to errors Answer: 2, 5 Explanation: 1. Scheduled survey visits have not changed.

2. Accreditation has moved to a more focused approach with the recognition that trying to assess everything was not reasonable—using core measures to direct the survey.

3. Nursing staff has always been included in accreditation, though levels of involvement have varied.

4. Developing a plan for the survey has always been part of the process.

5. The Joint Commission now recommends a non-punitive approach to errors.

Page Ref: 518-519 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Describe The Joint Commission accreditation and its relevance to quality improvement.

21 .

22) The newly licensed nurse asks a more experienced nurse if it is advisable to carry personal malpractice insurance. Which reply, made by the experienced nurse, is the most accurate?

1. "It is not necessary, since the hospital carries a blanket policy."

2. "It is necessary only for advanced practice nurses like nurse-midwives and certified registered nurse anesthetists."

3. "Every nurse should carry personal independent malpractice insurance."

4. "Carrying insurance is a good way to get sued."

Answer: 3 Explanation: 1. Even though the hospital carries blanket insurance, the nurse should protect himor herself with individual coverage. If the nurse does make an error, the hospital may not cover the nurse or may sue the nurse to recover monetary damages.

2. All nurses should carry individual insurance.

3. This is a widely held opinion.

4. There is no evidence that a nurse with insurance is more likely to get sued.

Page Ref: 512, 516 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

22 .

23) The hospital's risk management department has identified patient falls as the event most likely to result in financial risk to the organization. Which activities should this group initiate? Select all that apply.

1. Providing education on completing incident reports on patient falls 2. Holding staff education sessions on fall risk assessment 3. Initiating a self-reporting system on near-fall events 4. Developing a procedure by which fall incidents are investigated within four hours of occurrence 5. Posting patient names and fall risk category on a wall in the nursing station Answer: 1, 2, 3, 4 Explanation: 1. This education will be helpful to direct care providers. The information gained on these reports may help predict future falls and help to prevent them.

2. Fall risk assessments can be helpful in identifying patients at risk, but these assessments must be done correctly.

3. This information can help other providers avoid situations in which near-falls have occurred in the past.

4. Rapidly investigating falls is essential to reduce the liability to the hospital.

5. Quality improvement and risk management initiatives must follow all of the confidentiality regulations followed by other providers.

Page Ref: 515-516 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

23 .

24) Which statement about the effect of healthcare quality report cards is accurate?

1. They have been shown to have a direct influence on consumer healthcare decisions.

2. These report cards are generally not accessible to consumers.

3. Releasing information via these report cards does not guarantee changes in quality.

4. Most consumer healthcare choices are now based on facts from these report cards rather than opinion.

Answer: 3 Explanation: 1. There is no evidence that these report cards have influenced consumer health decisions.

2. These report cards are accessible to consumers via websites.

3. This is the primary issue with these report cards. There is no guarantee that publishing negative report cards will have any influence on how the employees of a facility do their jobs.

4. Many healthcare decisions are still based upon geography, tradition, or personal beliefs about a facility.

Page Ref: 515 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

24 .

25) Measurement of access to care integrates

,

, and

.

Answer: 1. Structure 2. Process 3. Outcome Explanation: Measurement of access to healthcare includes structure, process, and outcome elements. Access is complex and includes many elements such as location, physical access, transportation, appropriate provider, reimbursement, and more.

Page Ref: 516 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety | NLN Competencies: Quality and safety; relationship centered care; teamwork | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 04. Compare quality care methods used to measure and improve care and their relationship to structure, process, and outcomes.

25 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 19 Healthcare Informatics and Technology 1) The nursing student states, "I use information and technology all the time to keep in touch with my friends and family. I didn't know it was used in healthcare, too." Which statements, made by a fellow student, would explain the healthcare uses of information and technology? Select all that apply.

1. "I read that information and technology have improved patient safety and quality of care."

2. "The textbook says that information and technology have improved efficiency and effectiveness of interprofessional practice."

3. "The simulators we use in lab practice are a result of information and technology improvements."

4. "Information and technology have allowed nurses better ability to connect emotionally with their patients."

5. "The automated medication system we use in clinical practice is a result of advances in information and technology."

Answer: 1, 2, 3, 5 Explanation: 1. Advances in information and technology have improved patient safety and quality of care.

2. This is one of the seven issues reflecting the broad impact of technology in the healthcare environment.

3. Laboratory simulators have developed as a result of new technologies and use of information.

4. There is concern that use of technology may distance the nurse from the patient, interfering with the personal connectivity that has long been the domain of nursing.

5. Automated medication systems are another development that can be traced to technology and information.

Page Ref: 537-539 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | A ACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and 1 .

collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

2 .

2) The patient expresses concern about the confidentiality of his medical information, since "so much of it gets faxed around nowadays." How should the nurse respond to this concern?

1. "The hospital follows the Health Insurance Portability and Accountability Act, which identifies steps we must take to keep your information confidential."

2. "Since computers have moved away from linear thinking to a greater systems approach, concerns about information confidentiality have decreased."

3. "We use point-of care, a documentation system that will not allow your information to be shared."

4. "This is a really big concern. You never know who could be reading those faxes that we send. There is no way to be sure that they are really going to the person they are sent to."

Answer: 1 Explanation: 1. This statement is correct and helps assure the patient that efforts to protect his confidentiality are being taken. It is the best response.

2. This is a confusing answer to patients and is not on point for the statement made.

3. This statement is not true and does not address the patient's real concern. It sounds like a statement that would be made to "skirt" the issue.

4. This statement may have some truth. It is not the best response to a patient who is already concerned about his confidentiality.

Page Ref: 541-542 Cognitive Level: Analyzing Client Need/Sub: Psychosocial Integrity Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

3 .

3) Which technologic advancement would improve emotional connectivity while providing patient care?

1. Using a laptop computer in the patient's room 2. Using telemedicine for consults 3. Using point-of-service bar coding for documentation 4. Using personal data assistants (P DAs) to access information Answer: 2 Explanation: 1. Using the laptop while in the patient room can be a time-saver, but also draws the provider's attention to the machine, not the patient.

2. Telemedicine can improve connectivity if used with the goal of doing so. The technology can be used to talk to the patient, to visualize the patient for assessment, and to allow the patient to "see" the provider. This is much more connected than a provider calling another provider with information for a consult.

3. Until patients become more accustomed to this technology, it can be somewhat "off-putting." Many correlate this technology with impersonality and much like groceries being scanned at the supermarket.

4. The PDA is certainly a nice tool for accessing information, but can come between the patient and the provider if the provider is spending more time interacting with the PDA or smartphone than the patient.

Page Ref: 539 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

4 .

4) The nurse answers a "nurse call" line for a hospital. Which resources will this nurse use to guide patients using this technology? Select all that apply.

1. Protocols 2. Research articles 3. Algorithms 4. Guidelines 5. Internet search engines Answer: 1, 3, 4 Explanation: 1. Protocols define the ongoing care or management of a broad problem or issue.

They direct the advice/triage/education/counseling process commonly used when answering "nurse call" lines.

2. Research and evidence-based practice are used in general to provide care; however, they are not specific tools used in practice.

3. An algorithm prescribes what steps to take given particular circumstances or characteristics. These tools may be used by this nurse.

4. Guidelines are typically a more narrative description of assessment steps that include education and counseling text to support the nurse during calls.

5. Internet search engines can help obtain information, but they are not a tool generally used specifically in this situation.

Page Ref: 546 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

5 .

5) The hospital has identified telehealth as a potential addition to its services and is conducting cost-benefit analysis. Which barrier to developing this service is likely to emerge?

1. Patients become so empowered that they don't use as many services.

2. There is a limited reimbursement mechanism in place at this time.

3. There is decreased contact with practitioners using telehealth technology.

4. The lack of practice standards makes telehealth risky from a liability perspective.

Answer: 2 Explanation: 1. There is no evidence that this is the case.

2. Limited reimbursement mechanisms may make telehealth economically unfeasible for some organizations.

3. The use of telehealth should increase the contact with practitioners.

4. Practice standards do exist and can be used to establish policy and procedure to limit risk.

Page Ref: 545-547 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

6 .

6) The hospital's risk management team has recommended that the hospital adopt an automated medication administration system. What benefits can the hospital expect from this change? Select all that apply.

1. The system will help caregivers ensure that the "five rights" are being followed.

2. There will be an opportunity for data collection by providing clinical experiential information.

3. The system will assist quality improvement efforts.

4. There will be a substantial direct cost savings.

5. Use of this system will meet Institute for Safe Medication Practices guidelines.

Answer: 1, 2, 3, 5 Explanation: 1. This automated system verifies that all "five rights" have been met at the time the medication is being administered.

2. The bar coding that is associated with automated systems is useful in collecting data about medication administration.

3. Data collected about medication administration can serve to improve the quality of care.

4. These systems can be quite expensive to implement, and cost savings through decreased error and increased quality may take some time to realize.

5. The ISMP strongly supports use of the bar coding that is required for these systems.

Page Ref: 548 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

7 .

7) The hospital is considering implementation of the following technology upgrades.

Which one will have the most direct implications for patient confidentiality?

1. Medical email 2. Handheld communication systems 3. Remote telemetry monitoring 4. Point-of-care clinical documentation systems Answer: 1 Explanation: 1. The use of medical email has the most potential for breaching confidentiality.

2. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications.

3. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications.

4. All methods of electronic documentation have implications associated with confidentiality, but this is not the technology that presents the most direct implications.

Page Ref: 550 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

8 .

8) Physicians, nurses, and other healthcare providers within the hospital have complained that the current documentation system is slow and that information is often not accessible when needed. Which system would increase the speed and accuracy of provider-to-provider communication?

1. Clinical data repository 2. Point-of-care clinical documentation system 3. Handheld communication devices 4. Narrative documentation Answer: 2 Explanation: 1. A clinical data repository provides longitudinal clinical data storage of patient information and would not be practical for immediate access.

2. Communication can be improved as point-of-care clinical documentation systems are used to enhance provider-to-provider communication that is rapid and accurate. Care is documented as it is completed and is immediately accessible.

3. Handheld communication devices can be used for documentation or to search for medical information. These would be a possible component of the point-of-care system, but are not, individually, a method to enhance provider-to-provider communication.

4. Narrative documentation is slow and time intensive.

Page Ref: 548 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

9 .

9) Which statement regarding the National Academy of Medicine (N AM) position on the use of information technology (I T) by healthcare professionals is accurate?

1. These skills should be required only of IT nurses or healthcare providers.

2. The use of IT is included in the I OM/NAM core competencies for all healthcare providers.

3. IT is important for physicians and pharmacists, but is not required of nurses or licensed therapists.

4. IT can be dangerous for healthcare professionals who are not expert in their use.

Answer: 2 Explanation: 1. The IOM/NAM supports IT use by all healthcare professionals.

2. This statement is accurate.

3. The IOM/NAM supports IT use by all healthcare professionals.

4. The IOM/NAM supports the use of IT. Page Ref: 537 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

10 .

10) Emotional connectivity between nurses and patients is endangered by use of technology. By focusing solely on this issue, which other issue is often overlooked?

1. The cost of implementing technologic advances 2. The cost of not implementing technologic advances 3. The isolation that can occur through using technology 4. Third-party payers' demands for demonstration of outcomes Answer: 3 Explanation: 1. Technology is expensive, but this issue is at the forefront of many discussions.

2. In order to stay competitive, healthcare organizations cannot afford not to implement technology. This is also at the forefront of many discussions.

3. The focus on connectivity between patients and staff leaves out the problems that occur when staff members become isolated from one another. Technology supports work being done in isolation from other staff.

4. The third-party demands for demonstration of outcomes is a reason that healthcare organizations adopt technology.

Page Ref: 539 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Diagnosis Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

11 .

11) The public health nurse is planning an education session on healthcare literacy for the community. What topics should the nurse include in this session? Select all that apply.

1. How to recognize what information is needed 2. How to locate information 3. How to evaluate information 4. How to disseminate information to others 5. How to use the information located Answer: 1, 2, 3, 5 Explanation: 1. Healthcare literacy includes recognizing what information is needed.

2. Healthcare literacy includes how to locate information.

3. Healthcare literacy includes how to evaluate information for accuracy and pertinence.

4. Dissemination of information to others is not a part of healthcare literacy.

5. Healthcare literacy includes recognizing how to use information once it is located.

Page Ref: 539, 551-552 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

12 .

12) Which statement best describes the National Academy of Medicine (NAM) position on the use of North America Nursing Diagnosis Association (N ANDA)-approved nursing diagnosis (NDX) statements?

1. IOM supports the use of three-part NDX statements.

2. IOM states that the use of these NDX statements is confusing to students, practicing nurses, physicians, and other healthcare providers.

3. IOM supports the use of Nursing Intervention Classifications (N IC) rather than N ANDA diagnoses.

4. IOM states that the use of NANDA nursing diagnoses along with Nursing Intervention Classifications (NIC) is the clearest way to explain a patient's plan of care.

Answer: 2 Explanation: 1. IOM/NAM supports the use of a standardized language common to all healthcare professionals. NANDA and NIC are not used by all healthcare professionals.

2. IOM/NAM supports the use of a standardized language common to all healthcare professionals. NIC, NOC (Nursing Outcomes Classification), and NANDA are not standard to all healthcare professions and are confusing or not relevant to most providers.

3. IOM/NAM supports the use of a standardized language common to all healthcare professionals. NIC is not common to all healthcare professionals.

4. IOM/NAM supports the use of a standardized language common to all healthcare professionals. NIC and NANDA are not common to all healthcare professionals.

Page Ref: 540 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

13 .

13) The nurse educator would like to promote the use of standardized language in healthcare with nursing students. Which occurrence would be the most significant toward this nurse's goal?

1. Development of the Nursing Minimum Data Set (N MDS) 2. Development of the Nursing Management Minimum Data Set (N MMDS) 3. Development of the Omaha system 4. Development of the Systematic Nomenclature of Medical Clinical Terms (S NOM ED C T) Answer: 1 Explanation: 1. This is an attempt toward standardization of categories of patient data, but is nursing based.

2. This is an attempt toward standardization of categories of patient data, but is nursing management based.

3. The Omaha system is a comprehensive and standardized taxonomy designed to improve practice, documentation, and information management in home healthcare, community, and public health. It is not used across all healthcare settings or disciplines.

4. SNOME D CT is a comprehensive clinical terminology system recognized by the federal government systems for electronic exchange of clinical health information and is used across healthcare professions.

Page Ref: 539-541 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

14 .

14) The nurse educator would like to participate in the development of a single standardized language to be used across all settings and by all healthcare professions. What should this nurse consider about this goal? Select all that apply.

1. The work has already been done and such a language is in use today.

2. Significant changes in curriculum of nursing schools across the country will be required.

3. This should be a relatively easy goal to achieve, as the terminology currently used is similar in all professions.

4. To achieve this goal, compromise among healthcare providers will be necessary.

5. Individual languages for professions may be tied to the profession's desire to preserve its individuality.

Answer: 2, 4, 5 Explanation: 1. While work has been done toward this goal, there is not widespread use of a standardized language to date.

2. Nursing schools have used North America Nursing Diagnosis (NANDA), Nursing Intervention Classification (NIC), and/or Nursing Outcome Classification (NOC) languages for many years. Changing to a different standardized language would require major revision to most nursing school curriculums.

3. This statement does not reflect the state of the issue today.

4. Compromise will be required, as many professions use languages that are specific to that profession.

5. Developing and adhering to distinct profession-specific terms may be a manifestation of a professional's desire to preserve identity, status, or control.

Page Ref: 539-541 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Evaluation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

15 .

15) A rural hospital has resisted moving to electronic record keeping, but now believes moving to a clinical information system is unavoidable. Place in order the steps this hospital should take to develop its clinical information system strategic plan.

Choice 1. Identify the organization's future view of itself in a clinical vision statement.

Choice 2. Develop specific strategic goals associated with the information system.

Choice 3. Develop clinical strategies that include the general organization activities to support the organization's vision.

Choice 4. Take strategic clinical vital signs.

Choice 5. Evaluate the system to determine needed improvements.

Answer: 1, 2, 3, 4, 5 Explanation: 1. The organization must identify what it believes about the role of information technology in its services. This is the first step of the process.

2. Development of specific strategic goals is the second step to provide a guide for the plan.

3. The third step is to develop a general clinical strategy that includes how information technology will affect the strategy and to meet the goals.

4. These vital signs are used to determine if the goals are being achieved.

5. Evaluation is the last step of the process and will trigger a new round of changes.

Page Ref: 543-544 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

16 .

16) The large healthcare organization is determined to develop and support technologic processes and structures to help nursing staff members manage the data generated in the direct care of patients. Which person would be best for the organization to hire to achieve this goal?

1. A computer programmer 2. A software analyst 3. A nursing informatics specialist 4. An information technology specialist Answer: 3 Explanation: 1. Computer programmers may be helpful in system design, but would not have the nursing expertise to be the most effective in this position.

2. Software analysts would not have the nursing expertise to be the most effective in this position.

3. The nursing informatics specialist is a nurse who should have these skills among others included in the specialty. This professional will have nursing expertise essential to develop applications useful to nurses.

4. This individual would not have the nursing expertise to be the most effective in this position.

Page Ref: 543 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

17 .

17) The healthcare organization has elected to move toward use of electronic medical records (EMR). In order to be most successful, management should involve nurses in which part of this work? Select all that apply.

1. Reviewing the EMR systems available 2. Implementation of staff training 3. Funding decisions related to the purchase of EMR 4. Developing the process of implementing the EMR 5. Long-term evaluation of use of the EMR Answer: 1, 2, 4, 5 Explanation: 1. Nurses should be consulted regarding the types of EMR systems available and should be heavily involved in choosing the system purchased.

2. Staff training will be lengthy and time consuming. Nursing should be consulted about how best to plan for this training and how best to implement the training.

3. This is the work of the chief financial officer of the organization.

4. The change to an EMR is not undertaken quickly. Plans for a smooth conversion should include nursing input. Nursing should also be consulted regarding backup plans and troubleshooting plans.

5. Nursing will be heavily involved in the use of this system and should be involved in its long-term evaluation.

Page Ref: 544, 548-549, 553 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

18 .

18) Telehealth has been used for some time in rural areas. In order to expand the use of telehealth, it has been proposed that it would be useful in which other areas?

Select all that apply.

1. Private physician obstetrical practice 2. Home healthcare 3. School-based healthcare in inner cities 4. Inpatient surgery centers 5. Emergency departments Answer: 2, 3 Explanation: 1. At this time, telehealth is unlikely to be used in this area.

2. Home healthcare presents a likely practice area for telehealth.

3. School-based healthcare in inner cities presents a likely practice area for telehealth.

4. Telehealth technology offers opportunities to provide care when face-to-face interaction is impossible. It is currently not appropriate for use in this practice area.

5. Telehealth technology offers opportunities to provide care when face-to-face interaction is impossible. It is currently not appropriate for use in this practice area.

Page Ref: 545-546 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

19 .

19) The nurse works in a healthcare clinic in which providers communicate with one another and with patients using email. What guideline associated with this method of communication should the healthcare providers follow?

1. Categorize patients according to major medical diagnosis and create groups educational emails.

2. Delete messages as soon as possible to protect confidentiality.

3. Inform patients of anyone else who will be reading messages.

4. Use email as the primary method of communication.

Answer: 3 Explanation: 1. While lists and groups are convenient, if they are not designed carefully confidentiality may be breeched.

2. Archiving messages produces an "electronic paper trail" for future referral.

3. Patients should always be advised of anyone who will be accessing information or messages.

4. The providers should ask patients which type of communication they prefer.

Some may prefer telephone messages or mail rather than electronic communication.

Page Ref: 550 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

20 .

20) Which conditions served as the focus for development of Web-based programs for patient monitoring and interactive video-based programs? Select all that apply.

1. Congestive heart disease 2. Normal pregnancy 3. Kidney disease 4. Diabetes 5. Coronary disease Answer: 1, 4, 5 Explanation: 1. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed.

2. Normal pregnancy did not serve as a focus for the development of these services.

3. Kidney disease did not serve as a focus for the development of these services.

4. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed.

5. Congestive heart disease, diabetes, and coronary disease are the three conditions that have been focused on when these services have been developed.

Page Ref: 551 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

21 .

21) Increased availability and use of technology has affected nursing education. What change has this development supported?

1. A decrease in clinical learning requirements 2. Faculty becoming facilitators of learning 3. A move toward pedagogy 4. Students who are very similar in culture and interests Answer: 2 Explanation: 1. Clinical experiences are changing, but still remain an important aspect of nursing education.

2. Faculty are now seen more as facilitators of learning rather than lecturers.

3. The movement has been away from pedagogy.

4. The result of using technology has been that the student body is more diverse.

Page Ref: 551 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

22 .

22) The healthcare organization has developed a new website. This website can be used for which purposes? Select all that apply.

1. Recruitment of staff 2. Patient education 3. Nursing continuing education 4. Dissemination of committee activities 5. Patient contact information Answer: 1, 2, 3, 4 Explanation: 1. These sites are often used in recruitment and retention efforts.

2. Patient education materials are often accessed through a hospital website.

3. The hospital website is a good place to offer nursing continuing education materials.

4. These activities may be public record or may be accessed using a personal identification number (P IN).

5. There is no need for patient contact information to be housed on the hospital website. Patient confidentiality could easily be breeched.

Page Ref: 551-552 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Implementation Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

23 .

23) In which way will information technology affect nursing research?

1. The complexities of this technology may make some aspects of research unappealing.

2. It will make data mining more difficult.

3. It will likely increase research activity.

4. It will make working with statistics more difficult.

Answer: 3 Explanation: 1. This technology should serve to make research more appealing because it is easier to access materials.

2. Data mining will become easier.

3. Many healthcare organizations, with their increasing ability to access technology, will probably increase their research activity.

4. It is now easier to apply statistics with the various computer-based statistical software packages available.

Page Ref: 553 Cognitive Level: Understanding Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

24 .

24) Which part of the nursing process is key to successful telenursing?

1. Assessment 2. Diagnosis 3. Implementation 4. Evaluation Answer: 1 Explanation: 1. Assessment is the most important part and is key to successful telephone nursing.

2. Without complete assessment, diagnosis is difficult or may be erroneous.

3. Implementation depends upon assessment.

4. Evaluation depends upon the implementation of interventions chosen secondary to good assessment.

Page Ref: 545-546 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

25 .

25) Which of the following activities relates to the first goal of the 2015-2020 Federal Health IT Strategic Plan?

1. Increase evaluation of care 2. Increase research about health IT 3. Increase protection of patient information 4. Increase adoption of EMR/EHR by healthcare organizations Answer: 4 Explanation: 1. Evaluation of care is important, but not the first health IT goal.

2. The fifth goal is related to research.

3. Goal two includes information about patient privacy and protection.

4. The first goal focused on EMR/EHR adoption—developing a better documentation system that provides greater opportunity for sharing of information.

Page Ref: 555-556 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Examine current governmental initiatives to improve health informatics.

26 .

26) You want to improve acceptance of a new EMR/EHR. What strategies might you use to address the problem that staff think using a computer in care areas will limit their relationship with patients? Select all that apply.

1. Use a system that relies less on typing and more on clicking, dragging, and so on.

2. Use hardware that is easy to carry and not large.

3. Reassure staff that they are important.

4. Limit how long a staff member can use the computer for documenting.

5. Explain the benefits of using computers.

Answer: 1, 2 Explanation: 1. Less typing means it is easier to document, and staff can focus more on the patient.

2. Tablets and small laptops interfere less than a larger computer—less of a barrier between the nurse and the patient.

3. Reassuring staff is important, but does not address the specific problem.

4. Limiting use of the computer is not realistic, as documentation and other tasks must be performed as needed, and so setting up a time span is not helpful.

5. Explaining the benefits is important, but this does not address the specific question.

Page Ref: 539 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

27 .

27) What are the ways that an H CO website might benefit nursing within the HCO? Select all that apply.

1. Provide information about nursing staff.

2. Share information about admission process.

3. Provide information about cost for specific procedures.

4. Identify specific medications used for certain illnesses and surgery preparation.

5. List patient rights.

Answer: 1, 2, 5 Explanation: 1. Information about nursing staff organization and services may be provided.

2. This is a good place to post general information about the admission process, what to expect and so on.

3. Cost is not included; would be highly variable per patient, insurer, and so on.

General information about reimbursement requirements may be provided.

4. Identifying specific medications used for certain illnesses and surgery preparation is highly variable per patient, so this would not be provided.

5. Patient rights are important to emphasize, and this is one way to do it.

Page Ref: 551-552 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

28 .

28) Why is the professional order entry system important to nurses?

1. Nurses do not have to spend so much time writing orders.

2. It provides a point-of-care system for the nurse.

3. Errors increase due to ease of making errors when typing.

4. This system decreases the need for nurses to be police.

Answer: 4 Explanation: 1. Most nurses do not write orders.

2. Point-of-care documentation system is not focused on orders, but rather on documentation of care at site of care.

3. Typically, errors are fewer than when nonelectronic methods are used.

4. Rather than nurses checking orders and informing physicians of problems, the electronic system monitors most issues.

Page Ref: 538, 544, 548 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 02. Critique the implications of health informatics and medical technology to nursing practice and healthcare focusing on practice, management, nursing education, patient education, nursing research, quality improvement, and reimbursement.

29 .

29) Which of the following supports the acquisition, storage, manipulation, and distribution of clinical information throughout an HCO? 1. Decision support system 2. Databank 3. Clinical information system 4. Clinical data repository Answer: 3 Explanation: 1. Computer applications designed to facilitate human decision making.

2. A large store of information; may include several databases.

3. Clinical information systems support the acquisition, storage, manipulation, and distribution of clinical information throughout an HCO with a focus on electronic communication, for example, electronic medical records, clinical data repositories, decision support programs (such as application of clinical guidelines and drug interaction checking), handheld devices for collecting data and viewing reference material, imaging modalities, and communication tools such as electronic messaging systems.

4. This system stores longitudinal clinical data, collecting data from multiple clinical information systems, including patient demographic data.

Page Ref: 540 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 01. Discuss current issues related to and influencing health informatics and the importance of clinical technology and informatics.

30 .

30) What is the primary impact that cannot be avoided by an HCO if the HCO does not apply meaningful use?

1. Poor quality care 2. No federal reimbursement or other federal funds 3. Better patient education 4. Shorter lengths of stay Answer: 2 Explanation: 1. Lack of meaningful use may impact quality but this is not the primary impact that is of definite consequence.

2. The federal government will not reimburse for Medicare care and will impact other federal funding. This would have a major impact on the HCO. 3. Meaningful use is not directly related to patient education.

4. Meaningful use is not directly related to length of stay.

Page Ref: 542 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Patient-centered care; Teamwork and collaboration; quality improvement, safety | AACN Essential Competencies: Ⅱ. Basic organizational and systems leadership for quality care and patient safety; Ⅳ. Information management and application of patient care technology; Ⅵ. Interprofessional communication and collaboration for improving patient health outcomes | NLN Competencies: relationship centered care; teamwork, informatics | Nursing/Integrated Concepts: Nursing Process: Assessment Learning Outcome: LO 03. Examine current governmental initiatives to improve health informatics.

31 .

Leadership and Management for Nurses, 4e (Finkelman) Chapter 20 Staff Education to Meet Health Professions Core Competencies and Improve Care 1) The Health Professions Education report indicates change is needed in healthcare professions education. What are the core competencies the report identifies? Select all that apply.

1. Utilize informatics.

2. Provide patient-centered care.

3. Demonstrate leadership.

4. Work in interprofessional teams.

5. Communicate clearly.

Answer: 1, 2, 4 Explanation: 1. Utilize informatics is one of the five core competencies.

2. Provide patient-centered care is one of the five core competencies.

3. Leadership is important, but not a specific core competency and is integrated in many of the five core competencies.

4. Work in interprofessional teams is one of the five core competencies.

5. Communicate clearly is not a specific core competency mentioned; it is integrated in all the core competencies.

Page Ref: 563 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | A ACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the impact of staff education on quality healthcare.

1 .

2) What is unique about the N AM approach to healthcare professions education?

1. Focus is on medical education.

2. Focus is on all healthcare professions.

3. Focus is on nursing education.

4. Focus is on continuing education.

Answer: 2 Explanation: 1. The report Health Professions Education does not just focus on medical education.

2. The focus of the report Health Professions Education is on core competencies for all healthcare professions.

3. The report Health Professions Education does not just focus on nursing education.

4. The report Health Professions Education does not focus on continuing education.

Page Ref: 563 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the impact of staff education on quality healthcare.

2 .

3) What did the NAM recognize as it was developing the Quality Chasm series of reports on healthcare?

1. Healthcare quality must consider staff competency.

2. Nursing education is meeting the practice needs.

3. Interprofessional education is effective.

4. Continuing education meets the five core healthcare professions competencies.

Answer: 1 Explanation: 1. The NAM developed the Health Professions Education report to address the need for better education to meet major goal of improving care.

2. NAM did not indicate that nursing education was meeting the needs.

3. At the time of the development of the Quality Chasm series, interprofessional education was rare.

4. There was no recognition that continuing education met the five core competencies.

Page Ref: 563 Cognitive Level: Analyzing Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the impact of staff education on quality healthcare.

3 .

4) The 2008 American Association of Colleges of Nursing (A ACN) edition of The Essentials of Baccalaureate Education for Professional Nursing Practice is best described as supporting which of the following statements in its Essentials to be met by its accredited schools of nursing with BSN programs?

1. Leadership is needed to support quality, safe care.

2. Nursing education requires major changes.

3. Knowledge and skills support leadership and quality, safe care.

4. Nursing provides quality, safe care.

Answer: 3 Explanation: 1. Leadership and quality, safe care are important, but The Essentials describes how it can be applied to nursing education needs.

2. The Future of Nursing report emphasized the need for improvement in nursing education. The Essentials is not a report on need for change in nursing education, but rather standards for nursing programs.

3. The emphasis is on knowledge and skills related to leadership and quality, safe care.

4. Providing quality, safe care is important, but The Essentials emphasizes the connection with the need for leadership and also elements that are required in a nursing education program.

Page Ref: 563 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 01. Examine the impact of staff education on quality healthcare.

4 .

5) What is the core concern of the A NA staff development standards?

1. Set academic standards for nursing education.

2. Provision of quality care in healthcare organizations.

3. Provide staff development requirements.

4. Provide protection of the public and provision of quality care.

Answer: 4 Explanation: 1. These standards are for organizations that develop and provide staff education, not for academic programs.

2. There is more to the core concern; it is broader and does not just focus on healthcare organizations but rather on public/community health programs, as well.

3. The standards do describe information related to staff development, but this is a guide and is not so specific as to provide requirements. This is not the core concern, but leads to meeting the core concern.

4. The core concern is to protect the public and provide quality care.

Page Ref: 564 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the staff development process, its development, implementation, and evaluation of staff education activities.

5 .

6) You are orienting a new nursing professional development specialist to the position.

How best would you describe the ANA and National Nursing Staff Development Organization's Standards of Nursing Professional Development?

1. The standards cover assessment, outcomes, planning, implementation, and evaluation.

2. The standards tell us specifically what we need to do and how to meet these requirements in our department and as nursing professional development specialists.

3. The standards describe quality care and needs.

4. The standards provide guidelines for staff development functions and professional issues of staff development specialists.

Answer: 4 Explanation: 1. The standards do cover these aspects, but include many more aspects of staff development in the 16 standards, five of which are assessment, outcomes, planning, implementation, and evaluation.

2. These are standards and do not clarify how they should be implemented with a specific department.

3. The standards relate to quality care but do not describe it and its needs.

4. The standards describe functions and also professional issues related to staff development specialists, such as collegiality, collaboration, ethics, advocacy, and leadership.

Page Ref: 564 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the staff development process, its development, implementation, and evaluation of staff education activities.

6 .

7) A new chief nursing executive has joined the hospital. He is meeting with the nurse management staff to discuss staff education. Which of the following is the best approach to take when organizing staff education within a healthcare organization?

1. Inform nurse managers that staff education will be centralized into a division within the nursing department, as this is how it was done where he worked in the past.

2. Set up plans for units that want to handle their own staff education to do so.

3. Inform the management group that he is their representative to the C EO to develop staff education.

4. Hire a director of nursing education and then work on organization.

Answer: 3 Explanation: 1. This approach assumes that the approach is applicable to all healthcare organizations and ignores differences that might need to be considered.

2. This approach could lead to confusion, with some units providing their own staff education and some not doing so, and could vary depending on who is the nurse manager of the unit.

3. This approach is the number one issue–for the CNO to represent the management group and for the staff to get the staff education they need.

4. This is important, but if the nursing department does not know how nursing education will be organized it will be difficult to have a position description and to know what type of person might be hired or even if a director of nursing education is needed.

Page Ref: 564-566 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Describe how staff development services might be organized and used within a healthcare organization.

7 .

8) As director of nursing education, you are often asked to respond to change. For example, a new policy is not working well and you are told to do something to fix this. What is the best response you could give to this request?

1. I will move forward based on the information you have just given me that the policy is not being followed. A plan for staff education on the policy will be implemented this month.

2. I will look into the problem. After I have some data, analyze the issues, talk to nurse managers, staff, and other stakeholders, I will then develop a response. If staff education is needed, I will plan this.

3. I will ask the nurse managers in the four units that use this policy the most to identify specific staff who have not used the policy, and to meet with them to correct this.

4. I will ask the policy and procedure committee to take care of the problem.

Answer: 2 Explanation: 1. This response assumes that the problem can be solved with staff education and does not include an expanded understanding of the problem.

2. This is the best response—not all change and problems should be or can be solved by staff education.

3. The director of nursing education does not have supervisory responsibility, and this approach leans in that direction. It also assumes blame and does not fully appreciate the problem and how best to resolve it. The response is not focused on education, which is the responsibility of the director of nursing education.

4. In this approach, the director of nursing education is transferring work to someone else. The committee does need to be involved in determining the best strategies to use once the problem is understood, but this approach is not clear in the response.

Page Ref: 567-568 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the staff development process, its development, implementation, and evaluation of staff education activities.

8 .

9) What is the first step in the staff nursing education process?

1. Clearly stating the problem 2. Needs analysis 3. Budget development 4. Marketing the educational offering Answer: 2 Explanation: 1. Stating the problem is important, but first you need to know the learning needs.

2. The first step is to do a needs analysis to clearly understand learner needs and needs of the organization and its services in order to develop learning activities.

3. Budget is not the first step; it is difficult to develop a budget if you do not know what needs to be done.

4. Marketing is not the first step; it is difficult to develop a budget if you do not know what needs to be done and what you will describe in the marketing plan.

Identifying needs will help to make the marketing plan clearer.

Page Ref: 568-569 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 03. Explain the staff development process, its development, implementation, and evaluation of staff education activities.

9 .

10) Which of the following statements best describe orientation? Select all that apply.

1. All new staff in a healthcare organization should attend orientation.

2. Nurse residents do not need orientation, as they are in a residency program.

3. Orientee feedback should be routinely surveyed.

4. Staff transferring to a new unit or position do not need orientation.

5. Orientation should be organized and include general and unit-specific content and learning activities.

Answer: 1, 3, 5 Explanation: 1. It is accepted that new staff require orientation.

2. Nurse residents should attend orientation and then participate in the nurse residency program.

3. Feedback is important to improve orientation and recognizes the importance of staff.

4. Transferring to a new work area or assuming a new position should include orientation, though it will need to be customized according to needs.

5. This is a clear description of orientation and the need to focus on general issues and unit-specific issues.

Page Ref: 573-575 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Explain the need for effective staff orientation.

10 .

11) What is the newest trend in continuing education?

1. Clinically based continuing education 2. Continuing education that is required for licensure 3. Development of interprofessional continuing education 4. Continuing education best offered in face-to-face format Answer: 3 Explanation: 1. This is not new and has always been important in continuing education.

2. Continuing education is required in some states for licensure, and this has been the case for a long time.

3. The newest trend is the development and emphasis on need for interprofessional continuing education.

4. This is not a trend; the trend is toward more electronic methods.

Page Ref: 575-576 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Describe current trends in continuing education.

11 .

12) What should be included in general orientation? Select all that apply.

1. Human resources services and policies 2. Communication systems and guidelines 3. Working with the clinical team in the intensive care unit 4. Developing your initial work schedule 5. The organization's vision, mission, and goals Answer: 1, 2, 5 Explanation: 1. This is part of general orientation.

2. This is part of general orientation.

3. This information would not be in general orientation, but rather in unit-specific orientation.

4. This information would not be in general orientation, but rather in unit-specific orientation.

5. This is part of general orientation.

Page Ref: 573-575 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 04. Explain the need for effective staff orientation.

12 .

13) You are explaining interprofessional education (I PE) to your staff. Which statement would best describe IPE? 1. IPE is concerned with interprofessional relationships.

2. IPE is easy to provide and should be provided to all staff.

3. Multidisciplinary and interprofessional are the same terms when considering education.

4. IPE considers both individual profession competencies and interprofessional competencies.

Answer: 4 Explanation: 1. This is one type of competency, but also must include individual competencies.

2. IPE is not easy to provide and to whom it is provided depends on the needs of the staff.

3. Multidisciplinary focuses on healthcare professionals working side-by-side and with limited interaction. Interprofessional highlights interaction among the healthcare professionals.

4. There is a need to understand and meet needs for individual competencies and also interprofessional competencies in planning and implementing staff education.

Page Ref: 575-577 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 06. Discuss the expansion of interprofessional education.

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14) How is continuing education credit for healthcare professions currently provided?

1. One source for all healthcare professions 2. Multiple methods focused on multiple healthcare professions 3. Credit provided by academic institutions 4. Continuing education credit provided by the government Answer: 2 Explanation: 1. There is no one source for continuing education credit for all healthcare professions.

2. This is the current status, though there is criticism of this approach.

3. Continuing education may be provided through an academic institution, but the credit is received through a continuing education source, approved by that source.

4. The government does not currently provide continuing education credit.

Page Ref: 575-576 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Describe current trends in continuing education.

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15) What is a major recommendation of the Advisory Committee on Interdisciplinary, Community-Based Linkages (A CICBL)? Select all that apply.

1. Greater use of e-learning is needed for continuing education.

2. Continuing professional development is a term used by physicians.

3. Greater government funding to support C PD is needed.

4. There is adequate funding of faculty training for distance education.

5. NAM core competencies should be included in C PD. Answer: 1, 3, 5 Explanation: 1. This is recommended to make education more accessible.

2. CPD is the term also now used by the ANA/nursing profession.

3. More funding is needed, and this is mentioned by the ACICBL. 4. The ACICBL recommends that HRSA provide a mechanism to increase funding to further develop faculty distance education competencies.

5. The competencies should be applied in academic programs and CPD. Page Ref: 575-576 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 05. Describe current trends in continuing education.

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16) What does the transition-to-practice model tie to safety?

1. Workforce orientation 2. Preceptor nurse relationship 3. Use of clinical reasoning 4. Feedback Answer: 3 Explanation: 1. Workforce orientation is important, but in the model it is not the specific element that is associated with safety.

2. Preceptor nurse relationship is important, but in the model it is not the specific element that is associated with safety.

3. We need to use more clinical reasoning to reduce safety concerns and improve care.

4. Feedback is important, but in the model it is not the specific element that is associated with safety.

Page Ref: 578-579 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 07. Discuss the advantages of offering nurse residency programs.

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17) What was not considered to be a major problem when the National Council of State Boards of Nursing developed the transition-to-practice model?

1. New nurses care for sicker patients in complex settings.

2. New nurses feel increased stress levels.

3. Nationally, recruitment has remained the same due to changes in the nursing shortage.

4. One-quarter of new nurses leave their positions in the first year post-graduation.

Answer: 3 Explanation: 1. This is one of the three problems noted, and its impact is that more errors are reported.

2. This is one of the three problems noted, and its impact is that stress increases risk to patient safety and errors.

3. The model does not identify this as one of the major problems, and recruitment and shortage are highly variable from one area of the country to another.

4. This is one of the three problems noted, and its impact is that increased turnover negatively influences patient safety and healthcare outcomes.

Page Ref: 578 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 07. Discuss the advantages of offering nurse residency programs.

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18) What does The Future of Nursing report recommend about nurse residency programs? Select all that apply.

1. Healthcare organizations should offer nurse residency programs.

2. Funding of nurse residency programs should remain the same.

3. State boards of nursing should support the use of nurse residency programs.

4. Nurse residency programs are focused on new graduates of pre-licensure programs.

5. HHS should transfer money allocated to diploma nursing programs to nurse residency programs.

Answer: 1, 3, 5 Explanation: 1. This is recommended.

2. Funding for nurse residency programs is very weak and needs to improve.

3. This is recommended along with support from The Joint Commission.

4. Nurse residency programs for new B SN graduates are recommended, but also the report recommends residency programs for graduates from advanced practice programs.

5. This is recommended as a funding source.

Page Ref: 578-579 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 07. Discuss the advantages of offering nurse residency programs.

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19) What would not be found in a budget for the staff development department?

1. Office supplies 2. Quality improvement data collection 3. Marketing expenses 4. Staff development specialists' salaries and benefits Answer: 2 Explanation: 1. Office supplies for staff development would be in its budget.

2. Quality improvement data collection would be included in the hospital budget and might be part of the nursing department budget. Quality improvement is not a function of staff development and so would not be in its budget.

3. Marketing expenses for education programs would be in the budget.

4. Staff development specialists' salaries and benefits would be in the staff development budget.

Page Ref: 566-567 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Describe how staff development services might be organized and used within a healthcare organization.

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20) What is the common length of the typical nurse residency program?

1. One month 2. Six months 3. Twelve months 4. Eighteen months Answer: 3 Explanation: 1. This is too short.

2. This is not the most common length.

3. Most programs are one year, and this is most effective.

4. This would be too long and not the most common length.

Page Ref: 578-579 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 07. Discuss the advantages of offering nurse residency programs.

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21) As director of nursing education in a large hospital, you are working with nurse managers and your staff development specialists to update the policy on staff attending conferences so that the policy is more effective and attendance is increased. What might you include in this policy? Select all that apply.

1. Specify criteria for staff to receive fees and/or time off.

2. Require staff who attend (receiving conference fees and/or time off) to present to the staff after the conference.

3. Specify the procedure for applying for time off and/or fees to attend a conference and the time line.

4. Recognize that continuing education is an individual professional obligation and thus conference fees will not be provided.

5. The same policy should then be applied to staff in academic programs.

Answer: 1, 2, 3 Explanation: 1. This is a reasonable approach so that staff do not feel some receive more than others.

2. This is a reasonable approach, as the organization is providing support, and this also encourages staff to recognize this activity is important.

3. Procedures should be clear to all and followed.

4. This is a professional responsibility, but no assistance with fees will limit staff from attending.

5. Staff in academic programs is a different matter. For example, courses go on for some time, so scheduling time off is more complex; cost is greater, so the same formula for paying for conference fees would not apply and the organization may not be able to handle the cost; and some organizations require a certain grade attainment to get tuition reimbursement, and this would not apply to a conference.

Page Ref: 566-567 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Describe how staff development services might be organized and used within a healthcare organization.

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22) What would a nursing education division include in its annual evaluation of the division? Select all that apply.

1. Number and type of staff who attend specific programs 2. Cost per educational program 3. Nursing quality improvement data 4. Attendee/participant feedback related to the program and outcomes 5. List of equipment and supplies used Answer: 1, 2, 4 Explanation: 1. These data would be important to track.

2. Cost per program is important to track and assess.

3. Nursing quality improvement data are not part of an evaluation of the nursing education division.

4. Attendee feedback is important.

5. This is important in planning a program, but would have no relevance to evaluation of the department.

Page Ref: 572 Cognitive Level: Applying Client Need/Sub: Safe and Effective Care Environment Standards: QSEN Competencies: Evidence-based practice | AACN Essential Competencies: Ⅲ. Scholarship for evidence-based practice | NLN Competencies: Knowledge and science | Nursing/Integrated Concepts: Nursing Process: Planning Learning Outcome: LO 02. Describe how staff development services might be organized and used within a healthcare organization.

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