Test 1 Practice Questions

Question 1

According to the complexity theory, which of the following should be the focus of measurement?

Answer 1

Staff morale and budgets

Rationale: According to complexity theory and the principle “Think systematically,” you cannot ignore objective data or nonmeasurable data, as both inform decisions

Question 2

You overhear a newly graduated RN telling one of your colleagues that leadership and management belong to the unit manager and not to her. As a nursing colleague, you respond by demonstrating understanding that the perception of the new graduate:

Answer 2

Would benefit from further understanding of her role as a professional, whose influence may affect the decision making of patients, colleagues, and other professionals.

Question 3

In designing a quality, safe healthcare environment, the primary emphasis needs to be on:

Answer 3

The patient

Question 4

To achieve nurse-sensitive care standards developed by the NQF, you advocate for which of the following in your health facility?

Answer 4

Evidence-based practice to reduce the prevalence of pressure sores

Question 5

The NQF provides a model for advancement of healthcare quality that could be used in healthcare organizations. The use of this model by the Centers for Medicare & Medicaid Services specifically affects the interaction between adverse events and:

Answer 5

Funding.

Question 6

In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize

Answer 6

Safety goals specific to Pleasant Valley.

Question 7

Which of the following would managers and staff review annually in order to ensure compliance with the Joint Commission (TJC) to improve patient safety

Answer 7

Appropriateness of charting terms and abbreviations

Question 8

Which of the following patients would be at greatest risk in a healthcare visit (select all that apply)?
a.
Clyde requires an anticoagulant. He tells the nurse about his medications. He does not include an herbal supplement.
b.
George is very shy and withdrawn. He asks the nurse to leave him alone.
c.
Sarah is a new parent who finds that nurses on the children’s unit are very helpful. She is eager to accept all suggestions, including those that she does not yet understand.
d.
Claude is booked for bowel surgery. His doctor explains about the colostomy. Later, Claude tells his wife that he really doesn’t know what the doctor meant by colostomy.

Answer 8

A, C, D
Safer health care involves the patient as an active consumer who keeps and brings a list of all medications, including natural remedies, and questions if there are doubts, concerns, or lack of understanding.

Question 9

The director of nursing has been observing staff interactions in a 20-bed coronary care unit. Based on her observations, which of the following staff members is an obvious leader?
a.
The unit secretary who knows everyone’s business
b.
The chief nursing officer who is in charge and is responsible for nursing services
c.
The chief cardiologist who admits the largest number of patients and brings in more revenue than any other physician
d.
The staff nurse who persuades other staff members to practice by making evidence-based decisions

Answer 9

ANS: D
Leaders are those who do the best job of sharing their vision of where the followers want to be and how to get there. It is the ability to inspire others to bring a vision (such as evidence-based decision making) to reality and is not necessarily tied to status or information flow.

Question 10

Kari, a head nurse on the dialysis unit, has been informed during budget planning meetings that budget cuts are likely. She discusses this at the next unit meeting and tells staff members that unless they do their jobs well, their positions may be terminated, and there will be no replacement. Kari is enacting which management style?
a.
Transformational
b.
Transactional
c.
Trusting
d.
Truthful

Answer 10

ANS: B
Transactional leaders tend to rely on position and power, and they tend to reward and punish according to performance and conformity with expectations.

Question 11

The nurse manager, as the leader of the unit’s “customer (client) first” initiative, has asked the staff nurses to develop and administer a survey to every client before discharge. In asking the staff nurses to accomplish this task, the nurse manager is demonstrating:
a.
Accountability.
b.
Shared leadership.
c.
A common purpose.
d.
Independence in the nursing manager’s role.

Answer 11

B
Healthy work environments are facilitated by involving staff and others in decision making; gaining access to information is one characteristic of shared decision making. Shared decision making enables staff to feel valued in policy development and in directing and leading.

Question 12

The nurse manager is anticipating changes on the unit because of managed care. It is up to the manager to “sell” the staff on this care concept. A goal of managed care that the staff must understand is that managed care is:
a.
Grounded in business theory.
b.
Useful for long-term patients only.
c.
Designed to reduce unit resources and staff.
d.
Not concerned with the best interests of clients.

Answer 12

A
Managed care combines delivery of needed care with business principles of efficiency and cost. Nurse managers who know business principles become conduits for ensuring safe, effective, affordable care

Question 13

While interviewing for a nurse manager position, Ann is asked to give an example of a situation in which she demonstrated leadership. Which of the following examples exemplifies leadership?
a.
Through research and investigation of best practice and practice-based evidence, she proposed a change in the management of incontinence in elderly patients.
b.
She ensures that new policies related to parenteral infusions are implemented consistently within her team.
c.
When asked by her students about institutional policies, she readily and patiently interprets policies to facilitate quality care.
d.
She organizes the team and delegates responsibilities effectively in providing nursing care.

Answer 13

A
Nurse managers have the responsibility of day-to-day decisions for their units and interpret established policy, procedures, and mandates. They meet their goals by organizing, staffing, controlling, and solving problems. By contrast, leaders develop a vision and translate that direction into action

Question 14

Which of the following is not important in a positive work environment, as defined by the AONE?
a.
Clear, open, trustful communication
b.
Accountability and clarity of roles and responsibilities
c.
Participatory decision making
d.
Challenge and striving for excellence

Answer 14

D
Clear and open communication, accountability and clarity of roles, and participatory decision making are considered by the AONE to be important to a healthy environment. Challenge and excellence are not specifically identified by the AONE as important to healthy work environments.

Question 15

A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit package for a prepaid fee that uses specific standards to approve a period of time for the use of inpatient and community health services) is participating in:
a.
Critical pathways.
b.
Healthcare networks.
c.
Health maintenance organizations.
d.
Managed care.

Answer 15

D
Managed care strives to contain costs (e.g., through limitation of time in care) while maintaining quality. Managed care combines care delivery with financing and provides comprehensive services for a fixed prepaid fee

Question 16

A nurse manager working for a not-for-profit organization should be familiar with the regulations that impact the organization. Not-for-profit organizations:
a.
Pay dividends to stockholders.
b.
Can refuse clients who are unable to pay.
c.
Have no paid employees.
d.
Pay no taxes.

Answer 16

D
Not-for-profit organizations, often referred to as voluntary organizations, are controlled by voluntary boards and provide services to both paying and charity clients. Funds are redirected toward maintenance and growth as opposed to profit shares for stockholders.

Question 17

A nurse manager in a for-profit environment finds it difficult to recruit staff. This difficulty may be most related to aggressive profit goals and:
a.
Lower salary compensation for staff.
b.
Rising expectations of impoverished and indigent individuals for services.
c.
Poor orientation and retention practices for staff.
d.
An overwhelming emphasis on accepting learners from health disciplines.

Answer 17

A
For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit.

Question 18

You are the nurse manager for a not-for-profit health service for the homeless and for drug users in an impoverished neighborhood. As the manager, your concern about sustainability is related to:
a.
The possibility of violence.
b.
An increase in prescription drugs available for abuse.
c.
Decisions of the public board.
d.
An increase in uncompensated care events.

Answer 18

D
Public and non-profit hospitals are tax exempt and have a concomitant responsibility to provide mandated community service such as delivering care to the poor and indigent. To keep a non-profit status, facilities must make a good-faith effort to provide community service and charity care Non-profit organizations located in impoverished urban and rural areas are often economically disadvantaged by the amount of uncompensated care that they provide.

Question 19

Which of the following is an outcome of managed care?
a.
Shift of patients to outpatient and home health services
b.
Less complexity in funding sources
c.
Less complexity in rules for consumers to follow
d.
Greater consistency in the quality of care

Answer 19

A
A goal of managed care is to reduce the cost of expensive acute hospital care by focusing on out-of-hospital preventive care and illness follow-up care, which has led to shifts in where health care is delivered.

Question 20

In matrix organizational structures, a nurse manager understands that this type of structure:
a.
Is a simplified organizational structure.
b.
Has both a functional manager and a service or product-line manager.
c.
Arranges departments strictly according to function.
d.
Promotes harmony in organizational decision making.

Answer 20

B
Matrix structures are complex, integrated organizational structures that involve both functional and service or product-line managers. In this structure, team members or teams from various functional departments may combine to complete a project or program, thereby becoming responsible to both their functional department manager and their product-line manager.

Question 21

Model of governance to a shared-governance model. Select the characteristic below that best describes the traditional organizational structure in which a staff nurse is assigned to carry out nursing tasks for clients but is not given the chance to provide input into forming the policies and procedures by which care is delivered or the standards by which care is evaluated:
a.
Bureaucratic
b.
Decentralized
c.
Delegated authority and responsibility
d.
Delegated responsibility but no authority

Answer 21

D
In traditional structures, decision-making authority (right to act) is held by a centralized decision-making body, so that staff members have responsibility for certain functions but do not participate in decisions related to those functions.

Question 22

When interviewing an applicant for a position, the nurse manager describes the unit’s care delivery system as one in which each nursing assistant is cross-trained to perform specific tasks, and the RNs do all treatment, medication administration, and discharge teaching. The nurse applicant knows this nursing care delivery strategy to be:
a.
The case method.
b.
Functional nursing.
c.
Primary nursing.
d.
Nurse case management.

Answer 22

B
The functional model of nursing is a method of providing patient care by which each licensed and unlicensed staff member performs specific tasks for a large group of patients.

Question 23

You are the nurse manager of a nursing service organization that provides around-the-clock care to clients in their homes. To achieve maximum reimbursement for a client who is recovering from a hip replacement, the nursing staff most likely will follow the nursing care guidelines presented in the:
a.
Nursing care plan.
b.
Physician’s orders.
c.
Critical pathway.
d.
Clinical practice guidelines.

Answer 23

C
A critical pathway outlines outcomes, clinical standards, and interventions for a patient in each phase of treatment. The goal of critical pathways is effective coordination of care across various staff and levels of care.

Question 24

The nurse case manager is working with a client admitted for end-stage renal disease. The case manager’s major goal during this hospitalization is to:
a.
Implement the care pathway on admission.
b.
Provide direct nursing care throughout the hospitalization.
c.
Supervise the nursing staff members who implement the care map.
d.
Prevent additional hospitalizations resulting from complications of the client’s disease.

Answer 24

D
The goals and outcomes established in a critical pathway are designed to support the aims of case management, which are shortened hospital stays and prevention of hospital readmissions.

Question 25

A patient complains to you that she has no idea who “her nurse” is on any given day. “I ask one nurse for my pills and she says, ‘That’s not my job.’ I ask the pill nurse about my lab tests and she says that I should ask another nurse.” This nursing care delivery model employed in this situation might be particularly effective in:
a.
Promoting communication among diverse team members.
b.
Facilitating multiple perspectives on the total care of a patient.
c.
Avoiding patient-provider conflict.
d.
Developing competence and confidence in unskilled workers.

Answer 25

D
An advantage of functional nursing is that both unskilled assistive personnel and skilled staff are involved in performance of specific tasks, and the repeated performance of tasks enables staff to become very efficient in specific functions. Disadvantages of the model include difficulty in being able to assess the patient’s nonphysical needs effectively and the potential for ineffective communication because of the focus on specific tasks

Question 26

When comparing functional nursing and primary nursing, a nurse manager, after evaluating particular models of nursing care for potential adoption, determines that patient and nurse satisfaction in primary nursing are:
a.
Similar to those in functional nursing.
b.
Not of significance in either model.
c.
Low by comparison with functional nursing.
d.
High when compared with functional nursing.

Answer 26

D
Although some studies suggest there is little difference between functional nursing and primary nursing, primary nursing tends to be more satisfying for RNs, who enjoy a high level of accountability and autonomy in decision making. Functional nursing is criticized for low patient satisfaction and potential staff dissatisfaction related to boredom and an autocratic approach to management.

Question 27

Northwestern Hospital has decided to implement peer review. As a clinical leader in the Emergency Department, you have overall responsibility for ensuring that this is in place by next month. The most important step in this process is to:
a.
Provide an educational session for staff on peer review.
b.
Revise the mission statement, objectives, and performance standards.
c.
Develop objectives and performance standards with employees.
d.
Implement objectives and performance standards.

Answer 27

A
Once a strategic plan has been developed, the next step is open communication and execution of the specific plan, which, in this instance, is peer review.