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NR 504 Leadership Exam 3 Questions And Answers (Complete Guide 100% Correct)

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NR 504 Leadership Exam 3 1. Which of the following delegations by the RN would require an immediate intervention by the charge RN? Answer: A UAP replaces the monitor electrodes on a patient after h... e has taken a shower. 2. You are the nursing supervisor on the 11 PM to 7 AM shift. When making rounds, the charge nurse on the unit reports that one of the patients is dyspneic. What action would be expected from a nurse in the expertise stage of clinical competence when assessing shortness of breath in a patient? Answer: Recognizes the patient may have pulmonary edema and orders (or asks the physician for an order) an IVP diuretic 3. Walking rounds are currently being implemented to avoid errors or omissions in shift reports. Which observations made during walking rounds would be seen as an advantage to the shift report? (Select all that apply.) Answer: IV infusion bag is nearly dry.; IV line is not infusing what is currently ordered. ; Foley bag is not emptied on a patient on strict I&O. 4. After receiving the shift report, which of the following requires a priority action by the nurse? Answer: Discontinue an IV line from an insertion site that appears red and at which the patient complains of pain. 5. Patients are complaining that they are not receiving pain medications on the night shift. The night nurse has charted that they were given. What is the most appropriate action by the charge nurse? Answer: Notify the nurse manager. 6. A staff nurse complains to the nurse manager about an employee of another department constantly asking her out on a date even though she has told him she is not interested. Which action by the nurse manager is most appropriate? Answer: Review the personnel manual to decide on the next step. 7. You are the nurse manager who is preparing the annual reviews for the staff members. You are aware that the nurse in the competent stage of clinical performance development would be expected to do what when assigned a patient on beta-blockers scheduled for a stress test? Answer: Calls the physician for an order to hold the beta-blocker prior to a stress test if there is no order 8. The nurse is admitting a patient who speaks very little English. What is the most appropriate method to use to ensure the patient understands the instructions? Answer: Obtain a hospital interpreter. 9. You are the charge nurse on the 3 PM to 11 PM shift. The nurses on this shift range from novice to competent. What response would be expected in the beginner stage of clinical competence development when the nurse is assigned a patient on beta-blockers and scheduled for a stress test? Answer: Knows to hold a beta-blocker on a patient scheduled for a stress test because this happened earlier in the week on another patient 10. A nurse takes a telephone order from a physician. Which procedure is best for the nurse to use to avoid errors? Answer: Repeat the order, write the order verbatim, and read the order back to the physician 11. A surgeon approaches the charge nurse in an angry manner after his patient fell out of bed, requiring further surgery. Which of the following approaches is most appropriate for the charge nurse to use? Answer: Can you step over here out of the hearing of the patients and family members 12. Point-of-care systems are currently being used in health care facilities. Which is an advantage of the point-of-care systems to the patients? (Select all that apply.) Answer: Documentation at the time of care; Documentation at the bedside; Immediate access to decision support systems 13. Which delegation should a UAP consider to have the highest priority? Answer: Helping an older adult patient to the bathroom 14. Which of the following is an essential part of the shift report? Answer: Patient’s ECG rhythm 15. To avoid transcription errors, the current trend in hospitals is to use the Computerized Physician Order Entry (CPOE). Further instructions should be given to the nurses when which statement is made? Answer: I don’t need to review the new orders for accuracy 16. When incorporating the five rights of delegation, the right circumstance is used in which of the following situations? Answer: The RN asks the UAP to draw blood on a newly admitted patient with pneumonia 17. The nurse and UAP are working together with four patients. Which patient should the nurse assign the UAP? Answer: A patient with diabetes who needs her blood glucose checked 18. All treatments and services for patients require two forms of patient identification prior to providing those services. Which would require an intervention if used by the nurse to identify a patient? (Select all that apply.) Answer: Asking another nurse on the unit ; Asking the roommate 19. It is vital to communicate changes in patient condition to the physician. When using the SBAR process, the nurse knows that what should be included when communicating patient condition? (Select all that apply.) Answer: Lab data; problem; diagnosis; assessment 20. A patient is inappropriate when speaking to a UAP. What is the most appropriate action by the nurse? Answer: Explain to the patient how what they say is being interpreted 21. Which action by a UAP requires an immediate intervention by the nurse? Answer: Application of a skin barrier/protection ointment 22. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN delegate to the LPN? Answer: Administration of all oral medications for the team 23. Which of the following delegations require an immediate intervention by the charge RN? Answer: A UAP ambulates a patient 24 hours after a pneumonectomy 24. The computerized provider order entry (CPOE) is a component of the electronic health care system being used in hospitals. This system allows prescriptions to be written electronically and automatically sent to the pharmacy or other necessary facilities. The nurse understands that the greatest benefit of the CPOE is Answer: that fewer errors occur 25. A nurse assesses a patient reported to have normal vital signs throughout the night and finds the patient in acute respiratory distress. What is the nurse’s next best action? Answer: Ask another nurse to call the health care provider. 26. Which observation requires an intervention of a new graduate nurse by her preceptor? Answer: Leaving patient room without charting vital signs 27. You are the charge nurse on a busy medical-surgical unit. You are also the preceptor to a novice nurse. What response would be expected from a nurse in the novice stage of clinical competence development when assigned to perform a morning assessment on a patient? Answer: Reporting to the charge nurse that she decided to let the patient sleep until the breakfast trays arrive because the patient was sleeping so soundly 28. Nurse managers play an integral role in the adoption of the hospital’s information system. There are three levels of competency in this leadership role. What functions can be observed in an initial-level nurse manager? (Select all that apply.) Answer: Use applications for data entry; Actively involve nurses in the overall use of the system; Use applications for administration data entry 29. A float nurse is assigned four patients on the day shift. Which of the following reports by the float nurse would require immediate intervention by the charge nurse? Answer: Dr. Smith, your patient, Mr. Jones is complaining of a headache 30. Which statement made by the clinical instructor would represent feedback to a student nurse? Answer: You need to use your critical thinking skills when caring for patients.” 31. The end of shift report is the appropriate time to communicate (Select all that apply.) Answers: new patient orders; evaluation of medication response; impending procedures. 32. To practice as a nursing informatics specialist, what must the nurse accomplish first? Answer: Achieve certification from the ANCC. 33. When incorporating the five rights of delegation, the right supervision is used in which of the following situations? Answer: The RN assesses a patient after the UAP reports a blood glucose level of 56 mg/dL. 34. A staff nurse must leave work for an emergency. The nurse tells the charge nurse that her patients are fine and received all their AM medications. As the day progresses, it becomes apparent to the responsible RN that some things were not completed, especially some necessary AM medications. Which communication principle was not followed in this situation? (Select all that apply.) Answer: Clarity; interaction; feedback; direct communication 35. Which of the following patients should the nurse see first after the shift report? Answer: A patient with a change in heart rhythm who is complaining of lightheadedness 36. The electronic health record (EHR) provides a particular advantage to those patients with chronic diseases. Which of the following patients would most likely benefit from the use of an EHR by the health care provider? Answer: A patient with diabetes, heart failure, and end-stage renal disease 37. A health care facility is using an electronic health record (EHR) system for documentation purposes. Every Thursday from 11:00 to 12:00 PM, the EHR shuts down for maintenance. Which would be of concern to the nurse during that weekly downtime? Answer: Loss of coordination of medication list and vital signs can occur. 38. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? Answer: Assist the RNs to prioritize their patients and their responsibilities. 39. Which observation requires an intervention with a new graduate nurse by his preceptor? (Select all that apply.) Answer: Incomplete pain assessment; Data entry on the wrong patient; Failing to complete an admission profile 40. Nurses can be leaders without being managers. Which nursing actions demonstrate leadership? Answer: Assisting a new nurse with enteral tube feedings 41. Which council advances the practice of nursing and fosters the nursing role in patient education through staff and development and evidence-based research initiatives? Answer: Nursing Staff Development, Education and Research Council 42. The Nursing Minimum Data Set (NMDS) is a collection of established uniform standards for collecting data. It includes the North American Nursing Diagnosis Association International (NANDA-I)-approved list of nursing diagnoses as well as other sources of nursing language. What is the advantage of the NMDS to the patient? Answer: Data can be entered from multiple sources into the patient’s record. 43. The nurse is working on a medical unit with an LPN and a UAP as the team members. Which tasks should the RN complete? Answer: Regulation of heparin drip based on the heparin nomogram 44. The nurse informatics (NI) specialist incorporates nursing science, computer science, and information science to support nursing in utilization of the data collection. Priorities for an NI specialist include Answer: incorporating common nursing nomenclature into the system. 45. Which patients on an orthopedic unit should be assigned to a nurse from a cardiac unit? Answer: A patient following a hip replacement with a history of an acute MI 4 weeks ago 46. Hospitals beginning to use the electronic health record (EHR) for documentation of patient care are sometimes faced with many obstacles. What may be seen when the EHR system is first initiated? Answer: Resistance from staff 47. Which of the following delegations by the RN would require an immediate intervention by the charge RN? Answer: An LPN administers IVP Lasix (furosemide) to a patient in heart failure. 48. The electronic health record (EHR) provides information to all members of the health care team on their patients. The nurse manager and other team members recognize the advantages of the EHR, which include Answer: making data available for research and continuous performance improvement. 49. A patient turns his call light on and requests someone to help him ambulate. The senior student nurse has been caring for this patient for 2 days but has only helped him to a chair in the past. Which instructions should be given to the student prior to ambulation of the patient? Answer: The patient has been ambulated before using a walker but needs his oxygen saturation checked if he complains of SOB (shortness of breath).” 50. When determining the basis for conflict, interpersonal sources as the basis would include which of the following? Answer: Personality differences 51. A student nurse is working with a preceptor who appears abrupt and disinterested in precepting students. What action by the student is most appropriate? Answer: Notify the instructor 52. A patient admitted with an elevated ST-segment myocardial infarction (MI) on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. Respiratory therapy administers an albuterol treatment that provides no change in the oxygen saturation. What is the next best action by the RN is best? Answer: Obtain a 12-lead ECG. 53. Which nursing actions demonstrate the role of management in nursing? Answer: Observing the documentation of appropriate charges to patients 54. Equity maintains a focus on which of the following? Answer: Services, patients, and staff 55. The Pyxis Specialty Station system automates the distribution, management, and control of medications and supplies. An advantage of this system to the patient is which of the following? Answer: Availability of medications and supplies 56. In a health care organization, equity is Answer: the best method for integrating staff roles and relationships into structures and processes to achieve positive patient outcomes 57. Most organizations provide assistance to employees with problems that can affect their work performance. They provide assistance with issues ranging from financial issues to personal relationship issues. Which of the following best describes these programs? Answer: Free confidential employee assistance programs (EAPs) 58. The nurse manager works regularly with a nurse who has recently gone through a custody battle with her ex-husband. The nurse manager has become concerned about some of the changes in appearance of the nurse. One evening the nurse comes to work and seems “giddy” and is acting inappropriately. The nurse manager understands that she must take which of the following actions? Answer: Report this behavior to human resources and the state board of nursing 59. What are some tools available for the nurse manager to use for conflict resolution? (Select all that apply.) Answer: Negotiation, cooperation, prevention 60. What methods can the nurse manager use to address horizontal violence in the workplace? (Select all that apply.) Answer: Provide training to staff; Name the problem “horizontal violence.”; Observe and analyze the culture of the workplace. 61. Which activity should be considered the highest priority by the RN? Answer: Administration of STAT medications 62. There are three steps to conflict management: determining the basis, analyzing the source, and conflict resolution. Which of the following may be the most likely source for conflict between a patient and the health care provider in the workplace? Answer: Ethical dilemmas 63. Which ethical principle should help guide the nurse who suspects another nurse is incorrectly charting pain medications and then taking them? Answer: Veracity 64. What is a recommendation from the Occupational Health and Safety Administration for prevention of violence in the workplace? Answer: Provide training and education 65. Which patient should be considered the highest priority by the charge nurse? Answer: A patient who is threatening to leave AMA with tubes and drains in place from a surgical procedure 66. The fundamental element of any patient care delivery combines work allocation with Answer: clinical decision making 67. A nurse leader, according to the American Organization of Nurse Executives (AONE), is competent in the areas of (Select all that apply.) Answer: knowledge of the health care environment; business management; communication 68. A nurse is working the night shift with another RN who keeps disappearing without explanation. The nurse is caught napping in a patient’s room. What is the best action by the discovery nurse to take? Answer: Report the behavior to the nurse manager 69. A nurse has accepted a position on a nursing unit where the nurse manager promotes autonomy and staff involvement in decision making. What would the nurse expect to observe on this unit? Answer: Staff participates on hospital committees 70. A nurse manager encourages the nursing staff using a transformational leadership environment. The nurse manager interprets that a successful transformational environment is one in which (Select all that apply.) Answer: a staff nurse researches an increase in surgical wound infections and makes recommendations to prevent them; a staff nurse provides advice and guidance to new nurses; a clinical ladder is used for advancement. 71. Which of the following is a policy that pertains to the decisions that promote the welfare of the public? Answer: Social 72. Which nursing professional organization represents the interests of nurses regarding many issues, tracks nursing and health care related bills across all states and examines priority issues and trends? Answer: ANA 73. A nurse renewing advanced cardiac life support is practicing which ethical principle? Answer: Nonmaleficence 74. The role of the charge nurse is a relatively new role in nursing. What responsibilities would the nurse expect to see from the charge nurse? (Select all that apply.) Answer: Making daily patient care assignments; Troubleshooting problems occurring during shift; Assisting staff as needed 75. A nurse is confronted by a visitor and is threatened to be hurt when she gets to her car. What action is best for the nurse to take to protect herself? Answer: Call security and notify them of the threat. 76. In addition to the organ procurement coordinator, which other resource is the best resource for the nurse to use in helping the family make a decision when there is disagreement among family members regarding organ donation? Answer: Ethics committee 77. When nurses are confronted with ethical dilemmas that challenge their values and beliefs, what is the best source to rely on to make the right decision? Answer: Patient belief advocacy 78. A sentinel event is usually one that results in an unexpected outcome for the patient and “signals” the need for investigation and response. Which of the following would be considered a sentinel event? Answer: A 32-year-old woman with no significant health history who dies in the operating room during an elective surgical procedure 79. Patient satisfaction surveys may provide information on the clinical performance of the unit as well as the institution. Which areas are included for data collection? (Select all that apply.) Answer: Accessibility of services; communication; quality of care; continuity 80. One of the best indicators of clinical performance can be attributed to Answer: Patient satisfaction surveys 81. Which statement would one expect to hear at a team meeting in which members work cohesively? Answer: “Who has ideas about this?” 82. How can nurses communicate their positions to help influence policy? 1. Ongoing representation on policy-making committees. 2. Committees or boards. 3. Lobbying. 4. Making new laws at the state level. 5. Meeting with people in positions of influence Answer: 1, 2, 3, 5 83. The American Nurses Association (ANA) Code of Ethics for nurses is primarily a statement in support of Answer: Patient advocacy 84. A nurse is caring for a patient with end-stage heart failure and understands the futility of care for this patient. The family is in denial and refuses to consent to a DNR (do not resuscitate). Their misperceptions regarding the DNR status may be based on which interpretation? Answer: A DNR order provides minimal care 85. Which of the following is a policy that pertains to the governing of workplaces? Answer: Institutional 86. Data provided by studies on patients with community-acquired pneumonia (CAP) have influenced the standards of practice for those patients. Which order should the nurse anticipate on the standard orders as a result of initiatives developed through clinical studies? Answer: Administering antibiotics within 4 hours of arrival at the hospital 87. The four major areas of political action in nursing are Answer: the workplace, the government, professional organizations and the community 88. What information obtained from hospital data collection can be used for administrative purposes? Answer: Turnover 89. As a nurse and member of the Professional Practice Committee at your institution, you will be asked to review policies and to make suggestions for changes. The components of the review will include Answer: evidence of the current practice, and a literature review to determine current best evidence 90. Core measures identified by The Joint Commission include standard orders regarding care and data collection for Answer: infection rates 91. Which of the following techniques should the manager use when talking with the low-performing employee? Answer: Describe the observations and be sure he knows the consequences 92. Team players show many positive characteristics. Which of the following characteristics should be expected of a good team player when asked to participate in a continuing education class for the unit? Answer: Sure, I will need to make some changes to my schedule.” 93. Which of the following would be considered a sentinel event? Answer: Patient who has developed a fatal mediastinal infection 7 days after cardiac surgery 94. The Joint Commission (TJC) tracks core measures for performance. Which core measures are tracked by TJC? (Select all that apply.) Answer: Acute myocardial infarction, childhood asthma, heart failure 95. When leading a team, a low performing leader is seen as having which abilities? Answer: Identifies cause when identifying problem 96. What area is included when risk management explores the prevention of accidents, injuries, and errors? Answer: Financial risk 97. What is the best method for hospitals to track patient satisfaction? Answer: Patient completes a patient survey after returning home from the hospital. 98. Which of the following are included in the guidelines for valuable, effective acknowledgement of each member’s contribution to the team? Answer: Acknowledgments are best made in public and recognized as sincere. 99. Based on the Iowa model for evidence-based practice, research is initiated because of either problem- or knowledge-based triggers. The nurse understands that these triggers may arise as a result of (Select all that apply.) Answer: an increase in surgical infection rates; an increase in chronic renal failure following use of dye during radiographic procedures in diabetic patients.; medicare reimbursement changes. 100. When providing care to patients, nurses use evidence-based practice to avoid urinary tract infections whenever the insertion of a urinary catheter is performed by Answer: an RN 101. Which population does a Traditional Care Model (TCM) specifically target? Answer: Elderly/geriatric 102. When collecting data for research purposes on patient safety methods, the nurse would use Answer: maximum census of the entire hospital over the course of admissions for 1 year 103. Which responses by nurses incorporate reasons for resistance to research utilization? Answer: “I believe that patients will not benefit from this change.” 104. Attributes of effective teams include Answer: respectful, consensus-building discussions. 105. When providing care to patients at risk for ARDS, nurses use evidence-based practice whenever they Answer: turn a patient at risk for developing ARDS every 5 minutes. 106. When using the gathering and planning phase of developing a budget, the nurse manager would expect to find Answer: environmental assessment. 107. When providing care to patients, nurses understand that evidence-based practice supports the concept that Answer: to avoid atelectasis and pneumonia, use of an incentive spirometer has a better outcome than coughing for a patient following surgery 108. Support costs must be included in the budget. Which employee position would be included in the support or indirect costs part of the operating budget? Answer: Waiting room secretary 109. In determining the applicability of a research study, the nurse must look at many factors. Which factors can be used to determine appropriateness of the research to the individual setting? (Select all that apply.) Answer: Sample size; context; intervention used 110. A novice nurse observes change differences in practice from what was taught in nursing school and expresses confusion to the nurse manager. The nurse manager suggests which of the following methods as the best resource to determine best practice in the clinical setting? Answer: Attend professional conferences 111. To determine staffing needs, the nurse manager needs to Answer: determine the daily census 112. In addition to determining the number of patient care hours needed, the nurse manager must also include which other labor costs? Answer: Vacations and holiday pay 113. When developing an incremental type budget, the nurse manager understands Answer: yearly budgets are dependent on the previous year’s budget. The budget must be recreated every year. 114. A nurse involved in evaluating the validity of research prior to implementation should consider which of the following as the most important hierarchical evidence for effectiveness? Answer: Randomized controlled versus nonrandomized trials 115. From which of the following would a nurse manager expect to receive revenue? Answer: Medicare 116. Which of these is a measured outcome from a performance improvement process perspective? Answer: Sternal infection rates in cardiac surgery patients 117. When providing care to a child requiring temperature measurement, nurses use evidence-based practice whenever they Answer: understand that a rectal temperature is the most accurate method in a child 118. After piloting an evidence-based clinical practice change, the nurse would (Select all that apply.) Answer: institute the change; incorporate changes into practice; determine applicability for use 119. Indirect costs in a nurse manager’s budget would include Answer: travel 120. What benchmarks might be expected to be measured for hospital performance? (Select all that apply.) Answer: total admissions for cardiac surgery; infection rates for cardiac surgery; average length of hospital stay for cardiac surgery 121. When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the D (define) refers to Answer: the patients and their families 122. The student nurse learns about the advantages and disadvantages of various patient care delivery models. The student understands that besides an historical perspective of nursing practice, a patient delivery care model may need to be instituted to adapt to Answer: alterations in available staff due to weather emergencies. 123. Hospital performance improvement standards are primarily focused on the ability of the hospital to Answer: develop an atmosphere that meets and exceeds the expectations of the customers and staff. 124. The nurse manager understands that when there is a negative variance of the budget report, it is necessary to establish the cause. Which of the following might best explain a negative variance? Answer: Increase in staff sick days 125. When integrating evidence-based research into practice, the nurse understands that the type of research is important to the application of a particular nursing unit. Which of the following factors is most important in determining the usefulness of the research to the needs of the practice? Answer: Randomized clinical trials 126. When evaluating the performance of a budget, the nurse manager can use a variance analysis to explain Answer: differences between budget and cost. 127. When providing care to patients, nurses make patient care decisions based on which of the following? (Select all that apply.) Answer: Clinical circumstances; tradition; nurse practice act 128. When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the M (measure) refers to Answer: the development of a data collection plan. 129. Of the steps to implementation, research is not complete until which of the following steps is accomplished? Answer: monitoring the outcome 130. A sentinel event is usually one that results in an unexpected outcome for the patient and “signals” the need for investigation and response. Which of these situations would be considered a sentinel event? Answer: Patient dies because there is no bed available in the ICU. 131. The nurse explains the PICO acronym to colleagues in which of the following ways? Answer: PICO represents the questions to ask regarding application of the research to the specific setting 132. Which response by the patient following discharge teaching would require further teaching? Answer: “I need to check my blood glucose after eating.” 133. A sentinel event is usually one that results in an unexpected outcome for the patient and “signals” the need for investigation and response. Which of the following would be considered a sentinel event? Answer: A patient who requires a left leg amputation after developing an arterial occlusion at the access site 134. When assessing the staffing needs, the nurse manager must consider which of the following in addition to the patient care hours? Answer: staff mix required 135. Patient satisfaction surveys include questions about quality of care. What has the greatest impact on patient satisfaction? Answer: responsiveness of staff 136. A nurse consistently remains past her shift for report or charting. The amount of overtime accumulated is equivalent to a full-time nurse’s salary for 1 month. The nurse manager counsels the nurse and emphasizes that one of the responsibilities to the institution is Answer: fiscal accountability 137. When planning the purchase of new equipment, the nurse manager should include these items into which type of budget? Answer: capital budget 138. When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the I (improve) refers to Answer: use of technology to design improvements. 139. The personnel budget is based on the calculations of which factors? (Select all that apply.) Answer: Average daily census; number of staff; hours per patient day 140. When leading a team, a high performing leader is seen as which type of leader? Answer: A problem- solver 141. When calculating for staffing needs, what should be considered? Answer: Productive versus nonproductive hours of an employee 142. Which of the following are some of the qualities found in a team player? (Select all that apply.) Answer: Competence; dependability; enthusiasm 143. Which ANA Principles for Nurse Staffing standard is applied to staffing? Answer: Support of the staff nurses must come from all levels of nursing 144. As a team leader, the charge nurse would incorporate which of the following into the meetings for greatest team input? Answer: Promote involvement of all members 145. The fundamental element of any patient care delivery combines work allocation with Answer: Clinical decision making 146. Overtime to cover shortages in staff coverage can be a daunting problem. Which of the following can be a short-term solution to a nursing shortage? Answer: Ask each shift to work 4 extra hours. 147. Which of the following should be used to evaluate the staff’s performance when deciding high, middle, or low? (Select all that apply.) Answer: knowledge and competence; teamwork; communication 148. Which ANA Principles for Nurse Staffing standards are applied to patient care? Answer: Staffing levels that must be sufficient for providing quality patient care 149. Orientation of new employees is a two-stage process. The first stage includes orientation to the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the unit orientation? Answer: ECG interpretation 150. Part-time staffing by nurses includes which advantages? (Select all that apply.) Answer: provides life outside of family; maintains skills; increases income 151. What retention strategies should the nurse manager use when working with a new orientee? Answer: provide a safe practice environment 152. Orientation of new employees is a two-stage process. The first stage includes orientation to the hospital and its policies and expectations. What would the new nurse expect to accomplish at the time of the hospital orientation? Answer: BLS training 153. The challenges facing nurses today include which of the following? Answer: increased patient acuity 154. What is the best advantage to preference scheduling for nurses? Answer: Staff decide shifts. 155. Active listening typically involves Answer: active participation and respect for the speaker. 156. The process of determining daily staffing incorporates which factor? Answer: Competency of staff 157. Accrediting agencies require that staff demonstrate competency in their jobs. Annual competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the ICU setting as mandated by accrediting agencies? Answer: ACLS 158. Which ANA Principles for Nurse Staffing standard is applied to the organization? Answer: The need for documented competencies for all nurses delivering patient care is supported. 159. The third phase of the performance appraisal process is using the evaluation results. The nurse and nurse manager can set goals for improvement. Which of the following evaluation tools should be designed during the third stage of the performance appraisal process? Answer: Establish goals with outcome measures 160. In the first phase of the performance appraisal process, the nurse manager prepares for the interview with the nurse. What should the nurse manager plan in preparation for the performance appraisal? Answer: Documentation of examples of performance 161. In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has Answer: self-scheduling 162. What is the nurse manager’s primary role in a new nurse’s orientation program? Answer: provides feedback 163. There are four major types of staffing plans used in the hospital setting. The primary advantage of self-scheduling is which of the following? Answer: It encourages negotiation among staff 164. A new graduate requires a lengthy time commitment to orientation from the nurse manager. The socialization of the new nurse may take as long as 2 years. Which of the following would be expected as a time frame for developing confidence? Answer: 6 to 12 months 165. During unit orientation, a preceptor is used to provide learning and role modeling. What should the nurse expect from a preceptor during orientation? (Select all that apply.) Answer: teach unfamiliar skills; teach organizational skills; teach prioritization skills 166. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) Answer: mission statement; accountability; work allocation 167. In addition to evaluative feedback, the nurse manager is also involved in orientation in which areas? Answer: Provides for optimal learning experiences 168. What is the disadvantage to the institution in using external agency nurses? Answer: Cost 169. Which of the following best explains the use of career development strategies in health care institutions? Answer: reduces attrition 170. Nurse managers involved in the development of the action plan for a unit understand that each objective is individualized such that Answer: each objective has an identified goal 171. In what ways can hospitals meet The Joint Commission goals of adequate competent staffing? Answer: training and educating staff 172. Accrediting agencies require that staff demonstrate competency in their jobs. Annual competency of mandatory skills is evaluated. Which of the following skills should be demonstrated annually in the health care field as required by accrediting agencies? Answer: fire safety 173. Organize the following steps in developing a strategic unit-based action plan. 1. Determine specific strategies for each goal. 2. Select goals to be achieved. 3. Define the purpose or mission. 4. Monitor and update the plan 5. Identify resources for accomplishing goals. Answer: 3, 2, 1, 5, 4 174. There are four major types of staffing plans. The self-scheduling method of staff planning refers to which of the following? Answer: The schedule is planned by the nurses themselves 175. Most institutions use one or more types of future scheduling in their planning. Which of the following provides advantages for the organization’s scheduling policies? Answer: Rules scheduling 176. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Community best describes which characteristic? Answer: Community identifies the people served. 177. Which of the following topics would the new nurse expect to review in the hospital’s new employee orientation program? (Select all that apply.) Answer: safety standards; HIPAA; infection control 178. There are four major types of staffing plans. The centralized method of staff planning refers to which of the following? Answer: The schedule is planned by the nursing service 179. When identifying the objectives in an organization’s action plan, what would be an essential tool to use to improve performance? Answer: Benchmarking to “best in class performers” 180. Nurse managers can best be described as people who Answer: motivate staff to meet institutional goals through positional power 181. The nurses are complaining about how busy they are this shift. The charge nurse must do which of the following to ensure the safety of the patients and staff for this and future shifts? Answer: Assist the RNs to prioritize their patients and their responsibilities. 182. During the interview, the new graduate asks the nurse manager how she can stay current as the years pass. What resources should the manager give? Answer: Professional memberships 183. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? Answer: Responding to a patient complaint 184. The organizational hierarchy is used in which of the following situations? (Select all that apply.) Answer: A staff member is found to be drinking alcohol while at work; A staff member is observed taking money from a patient’s bedside table; A nurse fails to respond to repeated requests by the UAP to check on the condition of a patient. 185. The strategic plan of an organization includes all stakeholders of the organization, including nurse managers. Which explains the benefit of including nurse managers in developing plans for the organization? Answer: Nurse managers will be involved in implementing the changes. 186. First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? Answer: Managing the unit’s budget 187. Which advice to the new graduate regarding their first nursing position is best? Answer: Go on several interviews. 188. A résumé is different from a curriculum vitae in that Answer: a résumé is a summary of academic and work history 189. Which patient should be considered the highest priority by the nurse manager? Answer: A patient who attempts suicide 190. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Growth best describes which characteristic? Answer: Growth is the expansion of the organization. 191. Which of the following represents a short-term goal for an organization? Answer: Heart failure education provided to every patient admitted with that diagnosis-related group 192. Which of the following guides the professional nurse as decision maker? Answer: All of the above 193. The most common impact on the nurse of The Joint Commission standards is through the management of the pain standard. Which action is necessary to comply with the standard? Answer: Documentation of the relief of pain 194. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the planning step of the process? Answer: Identifying the problem of the lack of ICU beds 195. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza continues to experience shortness of breath and has no ECG changes. What is the next best action by the RN is best? Answer: Call the Rapid Response Team. 196. Action planning is a process by which organizations develop and implement both short-term and long-term goals. What would be expected in these plans? Answer: Specific responsibilities and timelines for each objective 197. Registered nurses are fundamental to the success of emerging patient-centered care delivery models. Which emerging patient-centered care model directs renewed attention and substantially more resources and incentives to promote those elements of care that are also the backbone of nursing practice? Answer: The Patient Protection and Affordable Care Act of 2010 (PPACA) 198. The Joint Commission (TJC) goals include the safe and accurate delivery and reconciliation of medication administration. In which way is this goal measured? Answer: Use of an admission medication list 199. The Food and Drug Administration (FDA) is a department headed by the Secretary of the U.S. Department of Health and Human Services (HHS). Which function would be expected of this department? Answer: Regulation of the safety and efficacy of medications 200. There are three levels of management in nursing. Which action by the nurse would indicate the nurse is a first-line nurse manager? Answer: Responding to a patient complaint 201. Which of the following are Decentralized or Shared governance interactions? 1. Hierarchical communication 2. Occurs at point of care/service 3. Direct communication 4. High staff input 5. Synergistic work environment 6. Collegiality, collaboration, partnership Answer: 2, 3, 4, 5, 6 202. Much like a politician, a nurse manager must exhibit leadership that inspires and motivates. In which instance is a nurse demonstrating leadership qualities? Answer: A staff nurse becomes aware of increased infection rates following cardiac surgery. The nurse takes it upon herself to research the possible causes and prevention measures and to make suggestions to better protect patients. 203. Which author proposed that a nursing care delivery model should consist of five key dimensions? Answer: Dubois 204. In preparing for the interview, the new nurse should plan to do which of the following? Answer: Obtain information about the institution so that you can ask informed questions. 205. The Joint Commission (TJC) is a voluntary accrediting agency that is nationally recognized for its performance standards. A hospital accredited by the agency will most likely experience which outcome? Answer: Improved patient outcomes 206. The Joint Commission (TJC) surveyors measure each institution’s compliance by which of the following? (Select all that apply.) Answer: Interviews with patients and staff; Review of medical records; Educational materials provided to patients and families 207. Which of the following are Centralized or self-governance interactions? 1. Position-based 2. Hierarchical communication 3. Synergistic work environment. 4. Separates responsibility/managers are accountable 5. We-they work environment 6. Direct communication Answer: 1, 2, 4, 5 208. Leadership structures in health care can be centralized or decentralized. The nurse understands that she is working in a centralized structured environment when which of the following occurs? Answer: All organizational decisions must be approved by the CEO. 209. The management process consists of six functions: planning, staffing, organizing, directing, controlling, and decision making. What might be seen in the decision-making process? Answer: Establishing the new area as a step-down unit 210. Human resources is required to provide education on violence prevention and management, which is tracked by the state board of health and The Joint Commission. Which of the following would the nurse expect to find in an education program required by state and federal health care regulatory agencies about violence prevention in the workplace? Answer: Early recognition and response plan 211. The Joint Commission (TJC) measures the management of infections within the institution. By which method will TJC be able to measure the performance of the institution to manage infections? Answer: Employment of an infection control nurse 212. The state regulatory agency may impose a fine on a hospital for which patient safety infraction? Answer: Inconsistent adherence to isolation protocol 213. The National Institutes of Health (NIH) is a department headed by the Secretary of the U.S. Department of Health and Human Services (HHS). Which action would be expected from this department? Answer: research of health care issues 214. In interviewing for a new position, a nurse may want to inquire about the institution’s views on autonomy in the workplace for nurses. The nurse concludes that autonomy is valued when told that the unit has Answer: Self-scheduling 215. When establishing a unit action plan, the nurse manager identifies steps to be taken to accomplish the goal. What is most important for achieving the goal? Answer: Staff involvement in decisions and actions 216. When establishing a unit action plan, the nurse manager identifies steps to be taken to accomplish the goal. What is most important for achieving the goal? Answer: Staff involvement in decisions and actions 217. The overall purpose for strategic planning in an organization includes which of the following? Answer: Increases the chance of success 218. In developing mission and values statements, health care facilities incorporate tools to describe desirable behaviors of the organization. These tools describe behaviors such as Answer: Organizational direction 219. According to the Professional Practice Model (PPM) cited in the Clinical Corner section of this chapter, whose theory was used as the basis of the newly created PPM? Answer: Watson 220. Which of the following could have an impact on strategic planning for a community hospital? Answer: Change in primary orthopedic surgeon 221. When following up with a thank-you letter to the nurse manager after an interview, the new nurse should include Answer: Interests based on information from the interview 222. A patient admitted with an elevated ST-segment myocardial infarction on oxygen per nasal cannula for his diagnosed influenza is complaining of shortness of breath with an oxygen saturation of 88%. The albuterol treatment provides no relief. What is the next best action by the RN? Answer: Increase the oxygen concentration and recheck the saturation after 10 minutes 223. Personal and financial issues, as well as drugs or alcohol, can impair employees and can precipitate violence. The nurse manager and all staff must be aware of the signs of drug or alcohol use. Which of the following indicators should concern the nurse manager in an employee when addressing violence in the workplace? (Select all that apply.) Answer: Troubled adolescent; house foreclosure; tremors of the hands 224. What is a Professional Practice Model (PPM)? Answer: The conceptual framework and philosophy of nursing at a specific organization 225. Nurse managers are included in strategic planning for the institution because of which principle? Answer: Nurse managers encourage “buy-in” from staff. 226. The novice nurse is speaking with the nurse manager about their roles within the hierarchy of the institution. The nurse manager would most likely identify which role as having the most internal conflict? Answer: Coordinating institutional goals with the immediate demands of the clinical area 227. When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Quality best describes which characteristic? Answer: Quality is the outcome provided when the best people are providing the best service 228. The ANCC (American Nurses Credentialing Center) is an organization that recognizes excellence in nursing in hospitals. Which outcome would be expected by an institution receiving Magnet Hospital status? (Select all that apply.) Answer: Quality nursing leadership; nurses as teachers; community relationships; quality of care 229. When applying for a management position, the nurse should ask about the goals and plans of the hospital. Strategic plans must be developed around Answer: the mission statement 230. A new nurse has an appointment for an interview with the nurse manager of a medical/surgical unit. What should be an essential part of her plan for the interview? Answer: Inquire about the length of the orientation 231. The state regulatory agency may impose a fine on a hospital for which patient safety infraction? Answer: Leaving the medication room unlocked 232. In what ways is the environment controlled by the hospital safety committee to prevent workplace violence? (Select all that apply.) Answer: Cameras and videos; emergency alarms; security provided for visitors in parking lots, etc. 233. When talking to a nursing instructor, the student asks, “How do I find a job?” The nursing instructor should respond in what ways? (Select all that apply.) Answer: “nursing journals”; “classified ads”; “jobs fairs”; “online websites” 234. First-level managers are responsible for the day-to-day activities of the unit. Which activity would the nurse expect to see only from a first-level manager? Answer: Managing the unit’s budget 235. Health care is seen and managed as a business today. Which skills are considered essential to managing health care as a business? Answer: Resource utilization 236. Upper-level managers are responsible for the management of the nursing organization of the institution. What activity would the nurse expect to see only from an upper-level manager? Answer: Establishing strategic goals for nursing 237. The patient care delivery system used by an institution should be based on which fundamental elements? (Select all that apply.) Answer: Mission statement; accountability; work allocation 238. A goal of The Joint Commission (TJC) is prevention of health care–associated pressure ulcers. In which situation would the institution fail in complying with that goal? Answer: Charting of the Braden Risk Assessment Scale 239. When analyzing the sources for conflict, the nurse manager may identify which of the following as one of the most likely sources? Answer: Different facts or perception of the event 240. An agency nurse is assigned to work on a unit that uses the team nursing model of health care delivery. Which of the following would the nurse expect to experience in this environment? Answer: RN delegating patient care delivery to a group of patients 241. In addition to staff interviews, The Joint Commission (TJC) surveyors measure an institution’s compliance by which action? (Select all that apply.) Answer: Reviewing policy statements of the facility; review of clinical records; interviews with patients 242. A nurse who is interested in developing clinical decision-making skills would look for a unit that practices which model for health care delivery? Answer: Primary nursing 243. A nurse would expect to see which action on a unit that uses the team nursing model of health care delivery? Answer: The nurse delegates patient care to other team members 244. The state regulatory agency may impose a fine on a hospital for which patient safety infraction? Answer: Physical abuse to patient by staff 245. A nurse manager must exhibit qualities of efficiency and organization. Which nurse is demonstrating the qualities necessary for a manager? Answer: A nurse notifies another staff member that she is being “pulled” today. 246. A health care organization incorporates information from which group into their strategic plan? Answer: local community 247. When eligible, the new nurse is encouraged to sit for a certification exam in their specialty area. What is the best reason for “going this extra mile”? Answer: To provide added credentials for advancement 248. Which of the following patients should be seen by the nurse first based on the information provided during the shift report? Answer: A patient admitted with hypertension complaining of back pain 249. The nurse is working on a medical unit with an LPN and UAP as the team members. Which tasks should the RN complete? Answer: Vital signs on a patient admitted from the ED 250. The clinical ladder used in some hospitals allows for recognition of both the clinical and academic growth of the individual nurse. On which of the following is this ladder based? Answer: The concept of growth in nursing from novice to expert [Show More]

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