LM 2 WK1 question

Question 1

Which steps will help the nurse minimize the risk of nursing malpractice?SATA

a) Attending relevant continuing education programs to upgrade clinical skills.
b) Observing all facility policies and procedures when providing care.
c) Asking each patient to sign an informed consent before care is given.
d) Periodically reviewing the scope of practice for nurses.
e) Maintaining liability insurance independent of that provided by the facility.

Answer 1

a,b,d,e
Rationale:
The three major areas of focus in the call to action are to prevent injuries, improve communication, and examine mechanisms for injury compensation.

Nurses then can reduce the risk of malpractice claims.

Nurses should also purchase their own liability insurance and understand the limits of their policies. Although this will not prevent a malpractice suit, it should help protect a nurse from financial ruin should there be a malpractice claim.
Obtaining a patient consent for all care is not necessary and won’t protect against the omission of appropriate care

Question 2

The term used to identify the omission of doing something that a reasonable person would do, guided by the considerations that ordinarily regulate human affairs is:

Malpractice
Scope of practice
Breach of duty
Negligence

Answer 2

Negligence
Rationale:
Negligence is a form of malpractice.
Scope of practice identifies the limits of practice.
Breach of duty involves the failure to uphold a standard of care.

Question 3

A nurse manager must be aware of what is happening on the unit to prevent injury to the patient and exposing the staff to a potential malpractice situation. What steps would the nurse manager take to accomplish this? SATA

a) Assuring adequate staffing.
b) Providing disciplining those who provide inappropriate care.
c) Regularly checking the credentials of current nursing staff.
d) Arranging for relevant staff in-services regarding the operation of equipment.
e) Personally monitoring the care provided by new nursing staff.

Answer 3

a,b,c,d
Rationale:
Managers have some legal responsibility for the quality control of nursing practice at the unit level, including such duties as reporting dangerous understaffing, checking staff credentials and qualifications, and carrying out appropriate discipline.

Health-care facilities may also be held responsible for seeing that staff know how to operate equipment safely.

The monitoring of new nursing staff is not the sole(only) responsibility of the nursing manager, but that of the mentor(adviser).

Question 4

Which situations are necessary components for malpractice to occur? SATA

a) A standard of care must be in place whereby the provider has accepted duty for the patient.
b) The practitioner has failed to meet a standard of care, also called a ‘breach of duty.’
c) Foreseeability of harm must exist.
d) A perception that patient injury may occur.
e) A direct connection between care given and injury must be present.

Answer 4

a,b,c,e
Rationale:
Duty to provide care, failure to meet standards of care, existence of foreseeable harm, a direct relationship between care provided and injury, and actual harm are the necessary components related to malpractice.

Question 5

What information is accurate when describing the Nurse Practice Acts? SATA

a) They focus on the practice of the professional nurse
b) They identify actions that fall outside of the nurse’s scope of practice
c) The focus of the acts can vary greatly from state to state
d) When considering the law, they are an example of a statute
e) They need to be consistent with applicable federal statures

Answer 5

a,b,d,e
Rationale:
The 51 Nurse Practice Acts representing the 50 states and the District of Columbia are examples of statutes.
These Nurse Practice Acts define and limit the practice of nursing, thereby stating what constitutes authorized practice as well as what exceeds the scope of authority.
Although Nurse Practice Acts may vary among states, all must be consistent with provisions or statutes established at the federal level.

Question 6

Which statement is true about an incident report? SATA

a) The document is generally considered confidential.
b) A disclosed(revel) incidence report can be subpoenaed(attend the court hearing) in court.
c) An entry about the existence of an incident report should be made in the medical record.
d) The chart should contain all the variables related to the incident.

A copy of the incident report should be attached to the medical record.

Answer 6

a,b,d
Rationale
An incident report, also called a variance or occurrence report, is used by healthcare agencies to document the occurrence of anything out of the ordinary that results in, or has the potential to result in, harm to a patient, employee, or visitor.

While no notation of such a report should be mentioned in or attached to the medical record, a complete factual account of the incident; the date, time, and place of the incident; pertinent characteristics of the person or people involved (e.g., alert, ambulatory, asleep) and of any equipment or resources being used; and any other variables believed to be important to the incident should be described in the medical record. This report is confidential, but under certain circumstances they can be subpoenaed in court.

Question 7

The nurse manager has an obligation to act as advocate for which entities(system)? SATA

a) The patient
b) The staff
c) Themselves
d) The profession
e) The institution

Answer 7

a,b,c,d
Rationale:
Nursing leaders and managers recognize that they have an obligation not only to advocate for the needs of their patients, subordinates, and themselves at a particular time but also to be active in furthering the goals of the profession. While they have obligations to the employer, they are not their advocate.

obligation=duty

Question 8

What is the nurse’s best safeguard against legal prosecution?

a) Collective bargaining
b) Written or implied contracts
c) Competent practice
d) Patient education

Answer 8

c
Rationale
Competent practice is the nurse’s most important and best legal safeguard. Each nurse is responsible for making sure their educational background and clinical experience are adequate to fulfill their responsibilities as a professional nurse.

a complex integration of knowledge including professional judgment, skills, values and attitude.

Question 9

A nurse explains the informed consent form to a patient who is scheduled for heart bypass surgery. Which elements are considered essential to the effective establishment of informed consent? SATA

a) Full disclosure of information regarding the procedure
b) Comprehension(understanding) of the information by the patient or guardian
c) Competence(capability) of the patient must be determined prior to consent
d) Information must be provided by a professional nurse

Answer 9

a,b,c
Rationale:
Informed consent is obtained only after the patient receives full disclosure of all pertinent information regarding the surgery or procedure, and only if the patient understands the potential benefits and risks associated with doing so.
If competency is in question, consent is required of the identified guardian. The information is provided by the professional performing the procedure and is required in situations involving clinical research.

Question 10

What rights do patients have? SATA

a) The right to respectful care free of discrimination
b) The right to protection of their privacy
c) The right to informed consent
d) The right to inexpensive treatment
e) The right to end treatment without physician consent

Answer 10

a,b,c,e
Rationale:
Patient rights are a list of guarantees for those getting medical care. They assure that the healthcare system is fair and that it is working to meet the needs of the patient.

Question 11

Which legal act gives patients the right to determine their desired end-of-life care?

a) Patient’s Bill of Rights
b) Patient Self-Determination Act
c) Kassebaum-Kennedy Act
d) Health Insurance Portability and Accountability Act

Answer 11

b

Question 12

Which behaviors by a nurse can result in the suspension or revocation of the nursing license? SATA
a) Being convicted of professional negligence
b) A felony conviction for drug use
c) Failing to report an incident of substandard nursing care
d) Practicing on an expired nursing license
e) Conviction for failure to pay court-ordered child support

Answer 12

a,b,c,d
Rationale:
Common causes of suspension or revocation of a nursing license include professional negligence; felony(crime) conviction(berife) for a crime that is related to nursing duties such as drug use but not failure to pay child support; practicing nursing without a license, such as on an expired license; and failure to report substandard medical and/or nursing care.

Question 13

How can the nurse manager best minimize the personal risk for legal liability? 法的責任

a) Creating a work environment that prioritizes patient needs
b) Possessing a working knowledge of current laws affecting nursing practice
c) Upholding the enforcement of laws, rules, and regulations affecting patient care
d) Dealing with all members of the staff and all patients in a nondiscriminatory fashion

Answer 13

a
Rationale:
caring, respect, and honesty as part of nurse–patient relationships are emphasized. If these functions and roles are truly integrated, the risks of patient harm and nursing liability are greatly reduced. While the remaining options are appropriate, they fall under the broad situation suggested by the correct option.

Question 14

TheHIPAA ensures strong privacy protections for the patient without threatening access to which areas of care? SATA

a) Health care clearinghouses
b) Health care plans
c)Legally reportable information
d) Exchange of patient information among appropriate health care providers
e) Sharing of information with family

Answer 14

a,b,d
Rationale:
The Privacy Rule applies to health plans, health care clearinghouses(bank), and health care providers. Information is not shared with family unless specific permission is given by the patient. Legally reportable information is not limited by this act.

Question 15

It is appropriate to make a change for which reason? Select all that apply.
A) To solve an existing problem
B) To increase staff efficiency
C) To reduce unnecessary workload
D) To improve staff productivity

Answer 15

A, B, C, D
Feedback:
Change should be implemented only for good reasons such as the solution of an existing
problem, increasing staff efficiency, eliminating unnecessary workload and improving
productivity.

Boredom(tired) alone is not a sufficient reason to institute change.

Question 16

Which action represents a management function in planned change?
A) Inspiring group members to be involved in planned change
B) Visionary forecasting
C) Role modeling high-level interpersonal communication skills in providing support
for individuals undergoing rapid or difficult change
D) Recognizing the need for planned change and identifying the options and resources available to implement change

Answer 16

D
Feedback:
the other choices are leadership functions.

Question 17

Which behavior/attitude makes it likely that a planned change will be unsuccessful?
A) The suggested change is brought forward after the plan has been formalized
B) Individuals affected by the change are involved in planning for the change
C) The change agent is aware of the organization’s internal and external environment
D) An assessment of resources to carry out the plan is completed before unfreezing

Answer 17

A
Feedback:
Employees should be involved in the change process. When information and decision
making are shared, subordinates will be more accepting of the change. The other options
support the change.

Question 18

Which statement is true regarding planned change? SATA
A) Resistance to change should be expected as a natural part of the change process
B) Change should be viewed as a chance to do something innovative
C) Technical changes are more resisted by staff than social changes are
D) Change affects the homeostasis of a group

Answer 18

Ans: A, B, D
Feedback:
Change should not be viewed as a threat but as a challenge and a chance to do
something new and innovative. Change should be implemented only for good reason.
Because change disrupts the homeostasis or balance of the group, resistance should be
expected as a natural part of the change process. The level of resistance to change
generally depends on the type of change proposed not the age of the staff affected by the
change. Technological changes encounter less resistance than changes that are perceived
as social or that are contrary to established customs or norms.

Question 19

Which action is reflective of the leadership role necessary for a successful planned
change to occur?
A) Demonstrates flexibility in goal setting
B) Recognizing the need for a planned change
C) Identifying the resources that are available to support a change
D) Support the staff during the implementation of a planned change

Answer 19

A
Feedback:
Leaders demonstrate flexibility in goal setting in a rapidly changing health-care system.
The other options are associated with management functions associated with change.

Question 20

Which factor is the greatest contributor to the resistance encountered with
organizational change?
A) Poor organizational leadership
B) Presence of employee mistrust
C) Ineffective organizational management
D) Insufficient staff involvement in the process

Answer 20

B
Feedback:
Perhaps the greatest factor contributing to the resistance encountered with change is a
lack of trust between the employee and the manager or the employee and the
organization. While the other options may increase resistance, employee distrust is the
primary barrier to change.

Question 21

The charge nurse is implementing a new procedure for charting, which will impact all of the nursing staff. According to Lewin’s Model of Change, the ‘Movement stage’ can be more successful if certain things are considered by the change agent. SATA

a) Include all stakeholders
b) Ignore resistance to change
c) Set target dates
d) Implement the change
e) Have flexible target dates

Answer 21

a,c,d
Rationale:
To facilitate more success during the Movement stage, Lewin recommends that the change agent include everyone who will be affected by the change during its planning, set target dates, and implement the change while being available to offer support and encouragement throughout the process.

Ignoring resistance to change and having flexible target dates will only increase the levels of uncertainty and anxiety during the Movement stage.

Question 22

The oncology unit has a higher-than-normal patient census, which is requiring that nurses to pick up an additional patient. The hospital CFO has indicated that there are no additional funds available to hire additional full-time nurses. As such, the unit manager anticipates some behavioral responses by the stakeholders of change (the nursing staff) within the unfreezing phase.
What are some possible behavioral responses? SATA

a )Anger
b) Withdrawal
c) Acceptance
d) Passivity
e) Discontentment

Answer 22

a,b,e
Rationale:
During the unfreezing stage, people become discontented and even angry at the status quo. Ironically, they may also become angry and withdrawn because resistance is a normal and expected part of the change process.

Question 23

You are the nurse manager of a medical-surgical unit that is in need of a change in staffing rotation patterns, which will lead to major changes in how the unit is staffed. According to Lewin’s Change Theory, what forces are in play to enact these changes?

a) Freezing forces
b) Restraining forces
c) Driving forces
d) Refreezing forces

Answer 23

C
Rationale:
Lewin’s Change Theory gives us tools to discover what forces are helping or holding us back.

Imagine the different factors that drive you closer to your goal. The first step in assessing environmental forces is to identify forces that are helpful.

Lewin calls these forces ‘driving forces’ because they drive you closer to your overall goals. Freezing forces, restraining forces, and refreezing forces are not associated with assessing environmental forces.

Question 24

The unit manager of a medical-surgical unit is transitioning the unit to electronic charting. According to Lewin’s model, which of the following roles describes you as the change agent?

a) The unfreezer
b) The mover
c) The refreezer
d) The role player

Answer 24

A
Rationale:
Even new or inexperienced nursing team members can be good at identifying areas that need change. This role is the unfreezer. The next step is the role of movement, where strategies are implemented to make change happen. The last step is the role of the refreezer, who brings stability and solidity to the new workflow. The role player is not associated with the transition stage as it relates to the change agent.

Question 25

The charge nurse for a post-op treatment center believes that change needs to take place to make the nursing process smoother and the treatment center safer. The nurse’s rationale for making change would include which reasons? (SATA)
a) To fill work quotas
b) To reduce unnecessary workload
c) To improve staff productivity
d) To establish leadership power

Answer 25

b,c

Rationale:Change should be implemented only for good reasons, such as the solution of an existing problem, increasing staff efficiency, eliminating unnecessary workload, or improving productivity. Filling work quotas or establishing leadership power is not a reason to implement change.

work quotas=仕事のノルマ

Question 26

Last month, two nursing units were merged to save on staffing costs. The nursing manager is now inquiring among the staff about how the change is working and if any barriers remain. What stage of change is this?
a) Plan
b) Design
c) Integrate
d) Implement

Answer 26

C
Rationale:
The integration phase is when to evaluate how well an implemented change is working, and to ensure that it is merging solidly with the existing infrastructure. Designing, planning, and implementing are the three previous stages in the change process.

Question 27

The nurse manager on a busy unit that has recently been experiencing shift conflicts. As the staff can have different opinions on conflicts, what is the best first step to take to resolving conflict?

a) Determining the difference between intrapersonal, interpersonal, and intergroup conflict
b) Assessing what factors are affecting the judgment of the people involved in the conflict
c) Assessing the extent of competition occurring within the workplace
d) Showing preference to the day shift as this shift has more experienced staff

Answer 27

b
Rationale
:The best first step the nurse manager can take toward resolving conflict is to assess what factors are affecting the judgment of the people involved. These could be economic or cultural differences, or tied to personal or professional beliefs and values. Knowing what individual factors matter to people empowers the nurse manager to know why their opinions are different.

Question 28

The unit manager of a medical-surgical unit undergoing restructuring changes realizes that to create a more controlled transition for your staff, it will be necessary to incorporate the conflict resolution strategy known as ‘smoothing’. Smoothing is best defined as:

slang for avoiding.

the transfer of an aggressive employee to another unit.

looking toward something that the parties in conflict are in agreement about.

declaring a resolution to the strategy that may be perceived as lose-lose but is in the best interest of the unit.

Question 29

The nurse is the manager of a telemetry unit that is undergoing restructuring, resulting in the need for the nursing staff to accommodate both the telemetry unit and the medical rehab unit. Most of the staff on the telemetry unit have worked there for many years, and this change will create conflict. At what stage does this conflict exist?

Perceived conflict stage

Felt conflict stage

Manifest conflict stage

Latent conflict stage

Question 30

The nurse-manager of a surgical unit must hire travel RNs to work during busy times. Knowing that travel nurses typically receive higher hourly salaries as well as completion bonuses for the 13-week assignment, the manager anticipates regular staff will have animosity toward these nurses. The manager has a plan to allow the regular staff to have every weekend off (because part of the travel nurse’s contract states that the nurse may be required to work each weekend during the contracted time frame). What type of conflict resolution strategy is the manager using?

Competing

Compromising

Avoiding

Smoothing

Question 31

For a nurse leader, what is the optimal goal in resolving conflict between team members?

Create a win-win solution for all

Demonstrate managerial skills

Prevent further conflict on the same issue

Prevent violence

Question 33

Optimizing time management includes the following:

(select all that apply)

[mark all correct answers]
a.
prioritizing duties

b.	 managing and controlling crises

c.	 reducing stress

d.	 balancing work and personal time

e.	 reducing the use of social media

f.	 focusing on personal needs first and then attending to work related needsOptimizing time management includes the following: SATA

a.prioritizing duties
b.managing and controlling crises
c.reducing stress
d.balancing work and personal time
e.reducing the use of social media
f.focusing on personal needs first and then attending to work related needs

Answer 33

a,b,c,d,e

Question 34

The two common mistakes in planning are:

a. Underestimating the Importance of a daily plan
b. Not allowing adequate time for planning
c. Establishing priorities
d. Establishing clear goals

Answer 34

a,b

Question 35

The three basic steps to time management are:
a. Set aside time for planning and establishing priorities
b. Complete the highest priority task before beginning another task
c. Focus on all tasks at hand equally
d. Reprioritize tasks based on new information received
e. Manage your unit members

Answer 35

a,b,d