1. In accordance with changes by the Joint Commission (TJC), Pleasant Valley Hospital amends its safety practices and policies to emphasize:
a. Safety
... [Show More] goals specific to Pleasant Valley.
b. Decision-making processes.
c. Sufficient staffing for safe care.
d. Increased numbers of baccalaureate-prepared RNs. - ✔✔a. Safety goals specific to Pleasant Valley.
When the TJC, a not-for-profit organization that accredits healthcare organizations, changed its focus from processes to outcomes, it emphasized patient safety and issues setting-specific annual patient safety goals.
2. A unit manager watches a new RN graduate interacting with a patient. When the RN comes out of the room, the unit manager says, "I don't know what they taught you in your nursing program, but if I see you do that again, I will write you up." This example demonstrates:
a. Coercive use of power.
b. Appropriate application of control.
c. Use of informatory power.
d. Use of power to provide coaching. - ✔✔a. Coercive use of power.
ANS: A
Influence is the process of using power. Influence can involve the punitive power of coercion, as is used in this example.
3. With the rise in workplace violence in the emergency department, the nurse manager decides that she should work with the risk manager in violence prevention. The nurse manager should:
a.Request all staff to accept new risk management practices.
b.Hold staff accountable for safe practices.
c.Document inappropriate behavior.
d.Hire more police security. - ✔✔Hold staff accountable for safe practices
Active involvement of staff in risk management activities is key to prevention of adverse events. Nursing has a primary role in leadership in optimizing patient outcomes, preventing patient care issues, and mitigating adverse events. Accountability for safety can be one aspect of performance evaluations.
1. A nurse manager was orienting new staff members to computerized charting. To understand computerized charting, staff members must understand informatics. The three core concepts in informatics are:
a. Hardware, software, and printers.
b. Data, information, and knowledge.
c. Decision making, data gathering, and reporting.
d. Wireless technology, voice recognition, and handheld devices. - ✔✔ANS: B
Informatics is the application of technology to all fields of nursing to facilitate and extend nurses' decision-making abilities and to support nurses in the use, storage, and linkage of clinical information to provide effective and efficient patient care.
REF: Page 187 TOP: AONE competency: Business Skills
4. A nursing-led classification system that has led to greater reliability and standardization in data utilized for QI processes is:
a.NANDA.
b.AHRQ.
c.NIOSH.
d.Nursing process. - ✔✔NANDA
NANDA has been developed by nurses and uses standardized terminology that enables study of health problems across populations, settings, and caregivers.
5. Your healthcare organization places a high value on workplace safety and integrates this into all aspects of administrative and patient care processes. As a unit manager, you thoroughly endorse this direction, and during the selection and hiring of new staff, you consistently:
a. Refuse to hire applicants who are pushy during interviews.
b. Thoroughly follow up with all references before offering a position.
c. Ask applicants during the interview if drug or alcohol abuse is a problem.
d. Refuse to interview applicants with sporadic work histories. - ✔✔ANS: B
Determining if current employees pose a danger in the workplace is a critical factor that is often overlooked. In addition to personal and psychological factors, behaviors can be observed in employees that may be related to violence or aggression in the workplace (Paludi, Nydegger, & Paludi, 2006). The most obvious indicator is a previous history of aggression and substance abuse. Screening potential employees through drug testing, background checks, and references can help reduce the risk of hiring someone who may pose a danger in the workplace.
REF: Page 469 | Page 470
6. A method commonly used in Quality Assurance to monitor adherence to established standards is:
a.A Pareto chart.
b.Brainstorming.
c.Patient interviews.
d.Chart audit. - ✔✔d.Chart audit.
Chart audits are a common method of addressing process standards. Chart audits over time yield trend charts.
7. The Rehabilitation Unit at Pleasant Valley Hospital has a high number of falls. Which of the following interventions might assist to reduce the number of falls on the unit?
a. Determining who is responsible for the falls
b. Strengthening unit policies to avoid inappropriate admissions
c. Encouraging involvement of nurses in education related to falls and safety
d. Ensuring that patients are appropriately restrained if they are at risk for falls - ✔✔ANS: C
The IOM (2010) emphasizes the need for nurses to engage in lifelong learning and to use evidence and best practices to inform practice and ensure safety.
8. Patient perceptions are useful in:
a.Determining disciplinary actions in QI.
b.Establishing the competitive advantage of QI decisions.
c.Providing one source of data for QI initiatives.
d.Establishing blame for poor-quality care. - ✔✔c.Providing one source of data for QI initiatives.
Customers define quality and patient dissatisfaction as useful indicators of which areas are of greatest concern to patients and of what matters then to nurses and organizations. Patient perceptions guide areas of inquiry; however, they do not establish what disciplinary decisions will be made.
2. The chief executive officer asks the nurse manager of the telemetry unit to justify the disproportionately high number of registered nurses on the telemetry unit. The nurse manager explains that nursing research has validated which statement about a low nurse-to-patient ratio? It:
a. Promotes teamwork among healthcare providers.
b. Increases adverse events.
c. Improves outcomes.
d. Contributes to duplication of services. - ✔✔ANS: C
Studies related to staffing and patient outcomes suggest that patient outcomes are improved with a low nurse-to-patient ratio and especially with a low registered nurse-to-patient ratio.
9. A nurse manager is experiencing poor staff morale on her unit. While participating in a baccalaureate course, the nurse manager had learned that one of the reasons nurses lack power today is probably because of the past. In the early decades of the profession, nurses lacked power because:
a. Nurses freely chose to defer to physicians and administrators with more education.
b. Women lacked legal, social, and political power because of legal and cultural barriers.
c. The first nursing licensure laws prohibited nurses from making most decisions.
d. Nurses astutely recognized the risks of grabbing too much power too soon. - ✔✔ANS: B
Nursing mirrored the lack of legal, social, and political power that was prevalent in the early decades of the profession.
3. The nursing manager of a surgical unit has been asked by administration to evaluate client outcomes post cardiac catheterization. Using data about client outcomes post cardiac catheterization for the past 6 months so as to modify practice is an example of:
e. Information.
f. Cost-effective care.
g. Meeting standards.
h. Evidence-based practice. - ✔✔ANS: D
Technology enables evidence-based practice by collecting good clinical knowledge, translating nursing knowledge into reference materials that can be accessed at the point-of-care, and, potentially, assisting nurses to take action based on best evidence for practice (Lang, 2008; Lang et al., 2006; Staggers & Brennan, 2007).
REF: Page 205 TOP: AONE competency: Knowledge of the Health Care Environment
10. A new RN staff member asks you about the difference between QA and QI. You explain the difference by giving an example of QI.
a."Last year, the management team established new outcomes that addressed issues such as medication errors."
b."At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"
c."A process audit was done recently to determine how much time was being spent on patient documentation."
d."Errors are reported on our new computerized forms, and I follow up with staff to make sure that they understand the seriousness of their error." - ✔✔b."At a staff meeting last year, two of our staff commented on the number of recent falls and asked, 'What can we do about it?'"
In QI, followers invest in the process by continually asking "What makes this indicator important to measure?" "What has been done to improve it?" "What can I do to improve it?"
11. A new graduate is asked to serve on the hospital's quality improvement (QI) committee. The nurse understands that the first step in quality improvement is to:
a.Collect data to determine whether standards are being met.
b.Implement a plan to correct the problem.
c.Identify the standard.
d.Determine whether the findings warrant correction. - ✔✔Identify the standard
Before further action (data collection, decision making related to correction, and implementation of a plan) can occur, it is necessary to identify the standards against which data collection and decision making will occur. Institutions may or may not adopt standards that are already established by organizations such as the ANA.
1. In designing a new healthcare facility, it is particularly important to pay close attention to safety elements related to violence and aggression in which of the following settings? (Select all that apply.)
a. Emergency
b. Psychiatry
c. Gerontology
d. Maternal-child - ✔✔ANS: A, B, C
Although the potential for violence and aggression exists in all healthcare settings, emergency, psychiatric, and geriatric settings are at particular risk for violence.
12. A manager relies on his director (immediate supervisor) for advice about enrolling in graduate school to prepare for a career as a nurse executive. The director may exercise what kinds of power in the relationship with the manager in this advisory situation?
a. Expert, coercive, and referent
b. Reward, connection, and information
c. Referent, expert, and information
d. Reward, referent, and information - ✔✔ANS: C
Because the director is in a leadership role, he comes with knowledge or expertise that is required to assume a leadership role, and he has information that he is willing to share, which gives him the power of information. The employee sees him as credible and seeks his advice, which gives him referent power.
2. Mr. Cruiser has been surfing the Web. He is looking for healthcare information on low back pain. He shows the clinic nurse a Webpage he thinks is great and tells her that he has been following the exercises recommended by the author. He wants to know what she thinks about the site. When the clinic nurse evaluates this site, she discovers that its author is a personal trainer. No credentials are listed. In several testimonials on the page, people (their pictures are included) say how wonderful they feel after having done these exercises. The exercises all have animated demos when you click on the pertinent highlighted text or icon. They seem easy to follow. The site was posted five years earlier and was last updated three years before. The clinic nurse advises Mr. Cruiser to:
e. Avoid this site.
f. Check with his primary healthcare provider.
g. Continue with the exercises.
h. Contact the author for additional exercise and feedback. - ✔✔ANS: A
Patients need coaching as to how to use and decipher information that is available through the Internet. In this situation, the provider on the site lacks credibility because no credentials are listed, and the information is not current.
REF: Page 206 TOP: AONE competency: Business Skills
13. A nurse is explaining the pediatric unit's quality improvement (QI) program to a newly employed nurse. Which of the following would the nurse include as the primary purpose of QI programs?
a. Evaluation of staff members' performances
b. Determination of the appropriateness of standards
c. Improvement in patient outcomes
d. Preparation for accreditation of the organization by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) - ✔✔Improvement in patient outcomes
The primary purpose of QI is improvement of patient outcomes, which relates to prevention of error, quality patient care, and patient satisfaction.
3. In which of the following situations would you, as the head nurse, be concerned about potential safety issues?
e. Jordan comes to your office to complain about inadequate staffing on the unit. He says that he is concerned because he attributes a recent incident to the staffing levels.
f. Henry, a long-standing RN on the unit, has begun to miss work regularly. He calls in but is vague about his reasons for the absences.
g. Carla, RN, has just ended an abusive relationship with Jake, RN, and he will not leave her alone. You are meeting with Jake today because colleagues on nights have reported that Jake seems to have been intoxicated last night and the previous night.
h. Sarah is very quiet and says almost nothing in team meetings. Lately, she has been much more animated since becoming friendly with a couple of other RNs on the unit. - ✔✔C
14. Jake seems at most risk for violence because of his alcohol use and history of aggression. In the other situations, Jordan is expressing a legitimate concern and is behaving assertively; Henry may have health concerns or other issues that are private and interfering with his work life; and Sarah's change in behavior is likely related to a higher level of comfort with work and colleagues.
15. REF: Page 470 TOP: AONE competency: Business Skills
16. To increase safety in patient care areas of the Valley Hospital, the executive begins by:
a. Asking the community what the safety issues are.
b. Consulting with a management expert about staffing schedules.
c. Ensuring that the senior nursing officer attends the board meetings.
d. Instituting improved practices to reduce needle-stick injuries. - ✔✔ANS: C
17. The IOM report (2004) highlighted the importance of the attendance of the senior nurse executive at board meetings to be a key spokesperson on safety and quality issues.
18. During review of back injuries, it is determined that a large number of injuries are occurring in spite of mechanical lifts being used. Furthermore, it is determined that some lifts are outdated. In addressing this concern, the unit manager:
a. Meets individually with nurses who are observed to be using the lifts incorrectly to review the correct procedure.
b. After consultation with the staff about the review, orders new lifts to replace older ones that are malfunctioning.
c. Blames the system for inadequate funding for resources.
d. Reviews the system of reporting incidents to ensure that appropriate reporting is occurring. - ✔✔ANS: A
19. The IOM report (2004) points to the need to involve nurses in decisions that affect them and the provision of care.
20. 2. You need to terminate Gregory, who has had a long-standing history of conflict with you and the staff, and who recently was charged with theft of patient belongings. You consult Human Resources, and together, you develop a plan, which includes:
a. A private meeting with Gregory, a Human Resources representative, and you to deliver the news and deliver the termination notice and all other documents that are related.
b. Planning an opportunity for Gregory to return and be recognized at a staff farewell.
c. Calling Gregory at home to tell him that he is fired, and that his paperwork will be sent to him at a future date.
d. Calling him into a meeting in your office on the ward, where assistance is available, should he become upset or agitated. - ✔✔ANS: A
21. Termination requires careful planning as to timing, privacy, safety, and how to preserve the employee's dignity and avoid humiliation. Choosing a private location where colleagues are not present, and organizing all documentation that is required to be given to Gregory, achieves these goals and prevents his having to come to the organization at a future date
22. Amy has worked in the dialysis unit on staff for about 12 years. She is frequently consulted by other nursing staff regarding protocols and policies on the unit. What type of power is Amy using?
a. Position power
b. Expert power
c. Personal power
d. Competency power - ✔✔ANS: B
23. According to the types of power outlined in the text, Amy is most likely evidencing expert power in that she is being consulted regarding areas of knowledge and competency on the unit and is at the same level, potentially, in the hierarchy as her colleagues.
24. 7. Caroline asks family members to leave while she cares for the 16-year-old victim of a recent car accident. The father screams at her and tells her that she has no right to ask his family to leave, and that if she continues to do so, he will "throw her out of the room." Caroline is shaken and tells her head nurse, who tells her that this kind of thing is just part of the job. The guidance of the head nurse:
a. Is reasonable. No physical violence was involved.
b. Is related to why statistics on violence in health care are likely underreported.
c. Acknowledges the deep distress and fear of the family.
d. Acknowledges the concern of the nurse. - ✔✔ANS: B
25. A common perception is that incidences such as these, which do not involve physical injury or harm, but rather threats, are part of the job. Because of underreporting, data related to violence and aggression in the workplace may not be reflective of its true incidence
26. A nurse practitioner who manages his own practice offers his clients the option of contacting him via e-mail between visits. This allows his clients to request prescription renewals and educational materials and to ask nonemergency questions about their conditions. At times, this is convenient for both the clients and himself. Additionally, he should tell his clients that they:
a. Can send urgent messages.
b. Should wait up to 24 hours for a response from him.
c. Should omit sending their names because they are in the e-mail addresses.
d. Can ask about sensitive topics because no one sees the e-mails but himself. - ✔✔b. Should wait up to 24 hours for a response from him.
27. 8. You are part of a multidisciplinary team that is charged with designing a workplace safety plan for your healthcare organization. This team has been established in response to increases in reports of violence and aggression. You begin by:
a. Surveying staff about levels of satisfaction with the workplace and management, collegial, and patient relations.
b. Offering training sessions in self-defense.
c. Developing a policy that outlines zero tolerance for bullying.
d. Offering education sessions on recognizing behaviors with potential for violence. - ✔✔ANS: A
28. Violence and aggression and a toxic workplace can lead to staff dissatisfaction and high staff turnover rates. Surveying staff provides a useful starting place in identifying problems such as employee dissatisfaction, bullying, and other forms of violence.
4. A primary care clinic in a small urban center sees a high volume of cardiology patients. Patients who attend the clinic have smart cards that they use at hospitals, clinics, and emergency departments within that region of the state. A primary benefit of the smart card for these patients would be:
a. Rapid and accurate treatment in emergency situations.
b. Reduced wait times to see specialists.
c. E-mail notification of test results.
d. Readily available information regarding medications. - ✔✔ANS: B
29. Credit card-like devices called smart cards store a limited number of pages of data on a computer chip and serve as a bridge between the clinician terminal and the central repository of the electronic health record (EHR), making patient information available to the caregiver quickly and cheaply at the point-of-service. Smart cards provide information to healthcare providers regarding the patient's demographic and contact information, allergies, immunizations, lab results, and past patient care encounters and are presented at the point-of-service.
30. Hospital MagnetTM decides against creating a separate department to lead and monitor quality activities because:
31. a.Total organizational involvement is critical to QI.
32. b.Data generated by a single, separate department are generally flawed.
33. c.Monitoring and commitment to QI can come only from senior-level managers.
34. d.Staff resent suggestions for improvement that originate outside of their unit. - ✔✔A
35. Decentralized approaches are effective in developing unit-level solutions, as well as commitment to strategies and implementation of changes. [Show Less]