Exam 3: Chapter 22

Question 1

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by:

a. establishing private and professional networking systems.
b. asking social services to handle clients’ concerns.
c. identifying community support groups.
d. empowering others by promoting self-determination.

Answer 1

ANS: D

Advocacy involves empowering and promoting self-determination in others.

Question 2

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse
manager best acknowledge staff accountability and contribution?
a. Providing new and varied learning experiences for staff members
b. Fostering group cohesiveness through standardization of unit activities
c. Allowing professionals greater influence over their practices
d. Giving recognition for success and support for failure to staff members

Answer 2

ANS: C

Question 3

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that
ultimately, positive relationships with consumers of care are evaluated by the:
a. cultural sensitivity of staff.
b. cost-effectiveness of care delivery.
c. economic value of service.
d. outcomes for clients and their perceptions of care.

Answer 3

ANS: D
Trend-setting organizations such as Magnet® organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship.
Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most
important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.

Question 4

The nurse manager must develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument?
a. Being able to use the same instrument for all clinical units
b. Including items that are important from the patient’s perspective
c. Being able to administer the instrument before a patient’s discharge from the
hospital
d. Being sure that the reading level is no higher than third grade

Answer 4

ANS: B
Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure
satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the
measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the
service.

Question 5

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most
critical element in the concept of health literacy?
a. Providing instructional materials at appropriate reading levels
b. Facilitating access to translators for persons with language barriers
c. Obtaining, processing, and understanding basic health information so appropriate
decisions can be made
d. Knowing that most people have limited health literacy skills

Answer 5

ANS: C
The definition of health literacy used by the federal government is “the degree to which individuals have the capacity to obtain,
process, and understand basic health information and services needed to make appropriate health decisions” (U.S. Department of
Health and Human Services, 2010).

Question 6

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service
recovery and improve consumer relationships?
a. Post comparisons of patient satisfaction scores with those of other units monthly.
b. Involve the staff in resolving consumer issues quickly and effectively.
c. Ensure that staff members apologize to patients when they complain about
services.
d. Ask that patients with complaints about services place them in a written format.

Answer 6

ANS: B
Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented
in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an
emphasis on learning and solutions rather than on blaming.

Question 7

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with
family members. What would be important for a nurse manager to consider when instituting a change to improve customer service?
a. Assess the perceptions of the nursing staff regarding the specific service problem.
b. Include community representatives on a planning committee to address the
change.
c. Involve physicians, other healthcare professionals, and ancillary staff.
d. Review all patient complaints with the nursing staff.

Answer 7

ANS: A
Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the
issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may
prevent a successful outcome for the patient and to intervene on the patient’s behalf. As a nurse manager, it is important to support
staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.

Question 8

The chief nursing officer is pleased with the nurse manager’s strategy of improving patient satisfaction in the pediatric intensive
care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a
new program focused on improving relationships with consumers?
a. Recognition of the nursing staff for excellence in promoting consumer
relationships
b. Holding the staff accountable for resolving patient complaints
c. Selecting a staff nurse leader to implement the program
d. Identifying key staff members who have already demonstrated excellence in
consumer relationships

Answer 8

ANS: A
The nurse leader should allow professionals more influence over their practice; give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in
the importance of each individual and the value of his or her contribution.

Question 9

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following
question: “What is an important consideration in providing information to parents of a critically ill child?”
a. Making sure that they receive complete information during each encounter with a
member of the nursing staff
b. Assessing parents’ preferences regarding the amount of information provided
c. Allowing parents to observe key aspects of their child’s nursing care
d. Making sure that patient education brochures explaining ICU protocols are
readily available

Answer 9

ANS: B
Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse
decides what information and how much information is needed and how it is to be delivered.

Question 10

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in
the target group?
a. Web-based applications
b. Print-based media such as newspapers
c. Television advertisements
d. Brochures in kiosks in malls

Answer 10

ANS: A
Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with
lower household incomes being more likely to indicate that phones are their main source of Internet access.

Question 11

A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained her medication
regimen several times, and yet, when she leaves the unit with a pass, she fails to follow it. The staff believe that, as a nurse, she
should be able to understand what is expected. The nurse’s failure to follow the regimen indicates:
a. early cognitive impairment.
b. lack of motivation.
c. lack of health literacy.
d. worsening health state.

Answer 11

ANS: C
What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health
information and services. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that
patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients’
understanding. For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic
illness, may not have the appropriate background to make informed healthcare decisions.

Question 12

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he
doesn’t understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees a different provider. John’s experience represents what aspect of the current consumer experience?
a. Nurses are well-trusted members of the healthcare team.
b. Fragmentation of care results in lack of respect and trust.
c. Care providers often have conflicting ideas about care.
d. The public does not trust care providers other than nurses.

Answer 12

ANS: B
When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there
is less opportunity to build a trusting relationship with a provider.

Question 13

The complexity of the healthcare environment for consumers is increased by:

a. falling levels of education among the public.
b. increased levels of poverty.
c. complex compensatory systems and a variety of delivery systems.
d. increased numbers of uninsured or underinsured.

Answer 13

ANS: C
The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients,
especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.

Question 14

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain
that this is a reference to the:
a. assessment and admission of patients into care.
b. orientation of patients to services once they are admitted.
c. function of controlling which patients see the physician and which do not.
d. coordination of care, services, advocacy, and access for patients within the
healthcare system.

Answer 14

ANS: D
As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers,
settings, and levels of care.

Question 15

A 27-year-old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native
American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to:
a. explain to the family that the medicine pouch may contain herbs that may bother
other patients.
b. ask the family about the significance of the medicine pouch for them.
c. remove the pouch when the family is not present.
d. put the medicine pouch on the shelf beside the bed.

Answer 15

ANS: B
Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly
from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes
cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting
beliefs, norms, and practices of the people being served; and collaboration within a community. In this instance, it is important to
understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the
values and beliefs of this family.

Question 16

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be:
a. development of services that are identified in various studies as important for this
target group.
b. partnership with area city councilors and health professionals to provide services
that are consistent with their vision and funding sources.
c. provision of immunization and addictions services and health screening services
for women in the area.
d. development of services that have been identified by the women and
neighborhood advocates as necessary for their health care.

Answer 16

ANS: D
Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health
outcomes and patient experiences. While studies and partnership with key informants are important sources of information in the
design of services, engagement of the women through their neighborhood advocates may increase activation and resulting behavior.

Question 17

Which of the following exemplifies a service orientation for a facility?
a. Staff members on the unit are encouraged to chart details about family support
networks.
b. Chart audit reveals that details related to assessment of family history are missing.
c. The palliative care unit organizes a “tree of light” fundraiser each year to
highlight the importance of palliative care.
d. A children’s preoperative holding area is implemented in response to requests
from families and staff nurses for development of an area.

Answer 17

ANS: D
A service orientation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as
documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring
interactions. The institution of a holding area where families can be with children represents a caring action that arises out of
interactions and knowledge of patient needs and thus, is service oriented.

Question 18

As a head nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches
might provide useful information for you?
a. Patients find nurses friendly and accessible; data are aggregated for the institution
as a whole.
b. Data indicate that nurses are responsive to requests for assistance; data are
available for the unit and the institution.
c. Specific questions related to management of comfort are included for the
institution as a whole.
d. The survey asks for a range of responses for the unit and the organization, with a
focus on facilities, such as cleanliness and responsiveness of administrative

Answer 18

ANS: B
The National Database of Nursing Quality Indicators (NDNQI®) is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA, n.d.). Unit-based quality indicators,
including satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being provided with their own
and comparison data, researchers are able to access de-identified data in order to answer important questions about nursing care quality. Pain management, the discharge process, and post-discharge patient callbacks are specific areas where nurses can make
significant improvement in patient satisfaction. Because patients and nurses may differ in what they see as factors that produce
satisfaction, total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

Question 19

As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that
the concept of medical homes:
a. currently does not include nurses in its vision of multifaceted primary care.
b. includes nurses as part of an interdisciplinary and multidisciplinary team.
c. restricts nurses to services related to direct care and procedures.
d. cannot encompass nurses within this framework.

Answer 19

ANS: A
The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care.
Current discussions

Question 20

Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the
meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is:
a. using high-tech–low-touch approaches.
b. using high-tech–high-touch approaches.
c. providing products.
d. providing tangible products of satisfaction.

Answer 20

ANS: B
The provision of humanistic care within a high-tech environment is characteristic of high tech–high-touch approaches and reflects
the idea that the more that high-tech is used, the more patients also desire high-touch.

Question 21

Which of the following actions best exemplifies advocacy?
a. Developing a list of agencies that will provide free services for the homeless
b. Working in a needle exchange program for individuals in an inner-city
environment
c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee
d. Working in a free clinic for immigrant workers

Answer 21

ANS: C
Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and
respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure
that advocacy is occurring.

Question 22

During review of a patient’s progress, the healthcare team determines that a patient requires treatment that is generally accepted at
that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this
patient receives the treatment. You are:
a. empowering the patient.
b. avoiding litigation.
c. advocating for the patient.
d. supporting the clinical pathway.

Answer 22

ANS: C
Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as
determined by standards utilized in a critical pathway.

Question 23

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the charge nurse, your best action
would be to:
a. call attention to it by posting the critical incidents report at the nursing station.
b. include the mistake on the nurse’s performance appraisal.
c. apologize to the patient for the error and indicate that discipline has occurred.
d. educate the nurse on how to provide an apology to the patient.

Answer 23

ANS: D
Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

Question 24

An example of a factor that would impede a patient’s learning is:

a. poverty.
b. limited health insurance.
c. being an older adult.
d. heavy sedation.

Answer 24

ANS: D
Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic
group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low
socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have
limited English proficiency are not unintentionally communicated.

Question 25

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.)
a. Using a local anesthetic before inserting a needle into a child’s arm
b. Repeating patient history information to the admitting clerk, the admitting nurse,
and the ultrasound technician
c. Ensuring that birthing preferences are on file and available in a laboring mother’s
chart
d. Providing support to families when a family member is brought into trauma

Answer 25

ANS: A, C, D
A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the
patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual
needs of the patient is important.