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Test Bank for Effective Leadership and Management in Nursing, 9th Edition, Eleanor J. Sullivan

Table of Contents

Part I: Understanding Nursing Management and Organizations
1. Introducing Nursing Management
2. Designing Organizations
3. Delivering Nursing Care
4. Leading, Managing, and Following
5. Initiating and Managing Change
6. Managing and Improving Quality
7. Understanding Legal and Ethical Issues
8. Understanding Power and Politics
Part 2: Learning Key Skills in Nursing Management
9. Thinking Critically, Making Decisions, Solving Problems
10. Communicating Effectively
11. Delegating Successfully
12. Building and Managing Teams
13. Handling Conflict
14. Managing Time
Part 3: Managing Resources
15. Budgeting and Managing Fiscal Resources
16. Recruiting and Selecting Staff
17. Staffing and Scheduling
18. Motivating and Developing Staff
19. Evaluating Staff Performance
20. Feedback and Coaching, Disciplining, and Terminating Staff
21. Managing Absenteeism, Reducing Turnover, Retaining Staff
22. Dealing with Disruptive Staff Problem
23. Preparing for Emergencies
24. Preventing Workplace Violence
25. Handling Collective Bargaining Issues
Part 4: Taking Care of Yourself
26. Managing Stress
27. Advancing Your Career
Part 5: Looking to the Future
28. Imagining the Future

 

Chapter 1   Introducing Nursing Management

 

1) A nurse manager is participating in the healthcare organization’s strategic planning committee. Which factor is the primary driving force and controlling factor in new initiatives this committee might recommend?

1. Cost of care

2. Access to care

3. Availability of care

4. Quality of care

Answer: 1

Explanation: 1. While all of the options given are driving forces in today’s healthcare environment, the cost of providing care is still the primary issue. Cost of care controls access, availability, and quality.

2. Access to care is controlled by the ability to pay.

3. Care will not be available if it cannot be funded.

4. Healthcare providers do not like to correlate quality with cost, but the economic reality is that quality care must also be funded care.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Evaluation/Leadership

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

2) A nurse has been invited to discuss healthcare costs at a senior citizens’ club. What information should the nurse plan to include in this discussion?

1. While healthcare costs continue to rise, the percentage of the United States (U.S.) economy spent on healthcare has slowly declined to less than 12%.

2. Regulations brought about by the Patient Protection and Affordable Care Act (PPACA) should bring financial relief to healthcare consumers.

3. The United States spends more money on healthcare than any other country.

4. Healthcare spending in the United States is slowly declining due to passage of bills such as the Patient Protection and Affordable Care Act (PPACA).

Answer: 2

Explanation: 1. In 2009, healthcare costs consumed more than 17% of the country’s gross domestic product.

2. Implementation of PPACA and its regulations have not been formulated.

3. The United States spends more than $2.5 trillion on healthcare annually, more than any other country.

4. While this act has been passed, it is not operationalized. Healthcare spending continues to rise.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Education

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

3) A 70-year-old client develops a catheter-induced urinary tract infection. Which statement by the nurse would indicate to the nurse manager a need for additional understanding of this situation?

1. “I wonder if there was a break of sterility when this catheter was inserted.”

2. “Thankfully we can treat this with an antibiotic.”

3. “This could potentially cost the hospital a lot of money.”

4. “I will talk to my unlicensed assistants about proper urinary catheter care.”

Answer: 2

Explanation: 1. Wondering about a break in sterility indicates that the nurse is concerned about the process that might have contributed to this infection.

2. The nurse who focuses on taking care of the results of a potential medical mistake is not accepting the seriousness of the situation.

3. The Centers for Medicare and Medicaid Services no longer cover the costs incurred by medical mistakes. This urinary tract infection could cost the hospital the cost of treatment, including increased length of stay.

4. The nurse has identified that improper care may result in poor outcomes for the client.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Evaluation/Education

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

4) Which healthcare situations reflect the philosophy of quality management as designed by Deming?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. A nurse asks visitors to leave because it is after visiting hours.

2. At 2:00 p.m. the nurse orders a lunch tray for a client who has just been removed from nothing by mouth (NPO) status.

3. A nurse tells the manager that a housekeeper’s work is not up to standards.

4. A nurse volunteers to take a Spanish language class to be able to communicate with clients.

5. A nurse who has not made a medication error in two years asks for a salary increase.

Answer: 2, 3, 4

Explanation: 1. The philosophy of quality management is focus on the needs of the client. If there is no reason for the visitors to leave other than it is after visiting hours, this is not focused on client need.

2. Even though 2:00 p.m. is after “lunchtime,” this nurse is focused on the client’s needs. This is an example of quality management.

3. Quality management empowers the employee to evaluate quality.

4. This nurse has seen a need and is working to improve the quality of service. This is quality management.

5. Salary increases can be tied to quality improvement initiatives, but just asking for an increase is not quality management.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

5) A client who was discharged yesterday is very upset about the quality of care received during hospitalization for gastric surgery. What options for reporting concerns does this client have?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. There is no mechanism for complaint because the client is no longer hospitalized.

2. The client can indicate dissatisfaction on the survey often sent to clients after discharge.

3. The client can call the hospital administration.

4. The client can make a formal complaint through the American Nursing Association (ANA).

5. The client can make a public report through the Agency for Healthcare Research and Quality (AHRQ).

Answer: 2, 3, 5

Explanation: 1. The client can still voice concerns even after discharge.

2. These client satisfaction surveys are a good mechanism for discussing care issues.

3. Telephone calls are a means of discussing client care issues.

4. ANA is not a forum for complaints about care in a specific hospitalization.

5. The AHRQ has a mechanism for reporting care issues.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

6) A client needs a high-risk surgical procedure. According to the Leapfrog Group, the client should choose which hospital for care during this procedure?

1. The hospital closest to the client’s home

2. The hospital that has done the greatest number of these surgeries in the last two years

3. The hospital chosen by the client’s primary healthcare provider

4. The hospital with the highest performance ratings for this procedure

Answer: 4

Explanation: 1. This may or may not be the best choice of hospital for this procedure.

2. Just because a hospital is high volume does not mean it is high quality.

3. This may or may not be the best hospital for this procedure.

4. The Leapfrog Group focuses on quality indicators including the use of higher-performing hospitals for high-risk procedures.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Coordination of Care

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

7) The quality management director of a large healthcare conglomerate wishes to initiate benchmarking strategies to assess care. Which directive should this manager publish?

1. We will compare outcome indicators with other healthcare conglomerates of similar size and organization.

2. Outcome data of hospitals within the organization will be compared to assess quality.

3. Each client care unit in the organization will establish specific unit goals for quality.

4. Each unit in the organization will create a quality monitor to assess how well unit policies are followed.

Answer: 1

Explanation: 1. Benchmarking uses an organization’s outcome data and compares it with that of a similar organization to address strengths and challenges.

2. Because the hospitals with the organization are likely managed in a similar manner, this is not an example of benchmarking.

3. While establishing goals is a part of quality management, it is not benchmarking.

4. Setting up a quality monitor is a quality initiative, but it is not benchmarking.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

8) The nurse manager has decided to use evidence-based practice (EBP) to solve an issue and has called staff nurses together for input. Which question, as posed by the manager, reflects the first step of the EBP process?

1. “What outcomes are we expecting from this work?”

2. “Is anyone prepared to evaluate the statistics we will find?”

3. “What is the exact clinical issue with which we are dealing?”

4. “Where can we look for information?”

Answer: 3

Explanation: 1. Assessing outcomes is the last step of the EBP process.

2. Evaluation of the evidence is step 3.

3. Identifying the clinical question is the first step in the EBP process.

4. Acquiring the evidence to answer the question is step 2.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Leadership

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

9) The nurse manager asks a staff nurse why a procedure is done in a certain manner. The nurse replies, “I don’t know why I started doing it this way. I’ve never read any research on it, but this technique always works for me.” The manager would place this technique into which category of evidence?

1. Case study

2. Anecdotal

3. Nonexperimental design research

4. Statistical

Answer: 2

Explanation: 1. A case study is an in-depth analysis used to translate evidence into other clinical situations.

2. Anecdotal evidence is derived from experience.

3. Nonexperimental design research includes gathering factors related to a clinical condition.

4. Statistical evidence is built from a scientific approach.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Quality of Practice

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

10) A nurse manager is directing a team of staff nurses working to solve a clinical problem using evidence-based practice (EBP). Which of the following statements would direct these nurses to the forms of strongest clinical evidence?

Note: Credit will be given only if all correct choices and no incorrect choices are selected.Select all that apply.

1. “We may find studies that use only one group of participants.”

2. “Look for articles that report on how to use evidence in other clinical situations.”

3. “The studies we want are built around the scientific approach to solving problems.”

4. “Our focus should be on studies that use both experimental and control groups to determine intervention effectiveness.”

5. “Many articles will have information reported by someone who is an expert in the field.”

Answer: 3, 4

Explanation: 1. Studies using only one group of participants are done in a quasi-experimental design. This is not one of the two strongest forms of evidence.

2. An in-depth analysis used to translate information to other clinical situations is a case study approach. This is not one of the two strongest forms of evidence.

3. Using the scientific approach results in statistical evidence, which is one of the two strongest forms.

4. Studies that use both experimental and control groups are randomized control trials. This is one of the two strongest forms of evidence.

5. Evidence reported by an expert in the field is testimonial evidence. It is not one of the two strongest forms of evidence.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Leadership

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

11) A healthcare system is considering applying to the Magnet Recognition Program. The leaders of this health system should prepare to address ________ qualities or “Forces of Magnetism.”

Answer: 14

Explanation: There are 14 qualities or “Forces of Magnetism” that must be demonstrated to achieve Magnet status.

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Quality of Practice

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

12) Which organization would the hospital management team contact to pursue certification as a Magnet hospital?

1. Magnet Recognition Program

2. American National Magnet Commission

3. The Joint Commission

4. American Medical Association (AMA)

Answer: 1

Explanation: 1. The Magnet Recognition Program, developed by the American Nurses Credentialing Center, designates healthcare organizations that provide nursing excellence.

2. The American National Magnet Commission is fictitious.

3. The Joint Commission accredits healthcare organizations, but does not award Magnet status.

4. The AMA does not award Magnet status. Magnet status is focused on nursing excellence.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Leadership

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

13) A graduating nurse is deciding which nursing specialty would be a good place to begin a nursing career and ensure long-term stability. Which specialty is most likely to have the greatest growth in need?

1. Pediatric nursing

2. Psychiatric nursing

3. Geriatric nursing

4. Maternity nursing

Answer: 3

Explanation: 1. Pediatric nursing is not likely to see as much growth as another specialty.

2. Psychiatric nursing is not likely to see as much growth as another specialty.

3. As baby boomers age, geriatric nursing will be needed more than any other specialty. Not only are the baby boomers a large segment of the population, but better health practices are resulting in people living longer.

4. Maternity nursing is not likely to see as much growth as another specialty.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Professional Practice Evaluation

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

14) The nurse manager overhears staff discussing the shortage of nurses. Which statement by a staff member would the manager evaluate as misinformation?

1. “There are more nurses retiring than are entering the profession.”

2. “The demand for nurses is declining because of fewer hospital admissions.”

3. “There are insufficient numbers of nursing faculty to teach interested students.”

4. “Women still outnumber men in nursing.”

Answer: 2

Explanation: 1. The average age of the registered nurse (RN) is 46 years, and while the number of RNs under age 30 is increasing, more RNs are retiring than are entering the profession.

2. The demand for nurses is increasing because of sicker clients both in the hospital and in outpatient settings. Job numbers for nurses are expected to continue to grow.

3. Nursing faculty members are also aging and moving into retirement.

4. Women continue to outnumber men in the nursing profession.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Evaluation/Communication

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

15) A healthcare organization has just achieved Magnet status. During the award ceremony, the organization’s chief executive officer should give primary praise for this achievement to which employees?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Medical staff

2. Nurse executive

3. Staff nurses

4. Managers in support services such as laboratory and radiology

5. Administrative professionals overseeing services such as accounting, billing, and medical records

Answer: 2, 3

Explanation: 1. Magnet status is focused on nursing excellence. Medical staff would be involved in the achievement, but not as primary players.

2. While much of the work will have been delegated to others, the nurse executive is a primary force in achieving Magnet status.

3. Magnet status focuses on nursing excellence. Staff nurses are the primary drivers of this excellence.

4. While these employees would be involved in this effort, Magnet status is focused on nursing excellence.

5. While these professionals would contribute to the achievement, Magnet status is focused on nursing excellence.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Professional Practice Evaluation

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

16) The nurse manager’s expected outcome is to increase evidence-based practice on the nursing unit. To meet this outcome, the manager encourages nurses to base their practice on which technique?

1. Intuition

2. Personal clinical experience

3. Knowledge from nursing school

4. Current research

Answer: 4

Explanation: 1. Intuition is not based in research and is not evidence based.

2. Clinical experience is useful when integrated with evidence-based practice but is not considered evidence based when used alone.

3. Knowledge from nursing school is very useful in client care but can become outdated if the nurse does not continually update that knowledge.

4. Current research is a good source of evidence-based practice strategies.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Evidence-Based Practice

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

17) Which strategy is most likely to increase participation in the use of evidence-based practice in nursing?

1. Ensure adequate training and encourage its use by the nursing staff.

2. Elicit employee opinions of its use at least four times per year.

3. Give those nurses willing to use it extra recognition.

4. Ensure adequate training, recognition, and easy access to the internet.

Answer: 4

Explanation: 1. Ensuring adequate training by itself is not enough.

2. Asking for opinions will do little to encourage the use of evidence-based practice.

3. Recognition for those willing to use evidence-based practice is an insufficient motivator.

4. There must be training, easy access, and recognition for using evidence-based practice in nursing.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

18) The organization that awards Magnet status would look for environments where which practices are the norm?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Nurses are involved in decision making.

2. Rewards are focused on ideas that save money.

3. Once a decision is made, it stands.

4. Nurses may be asked to work overtime.

5. Nurses are involved in educating the community about health.

Answer: 1, 5

Explanation: 1. Magnet status designates organizations that foster independence, autonomy, and creativity among the nursing staff. Nurses are involved in decision making in these institutions.

2. Money-saving ideas are not always good for staff or for clients.

3. Magnet-status organizations are flexible and encourage autonomy and independence.

4. Overtime is sometimes necessary, even in well-run facilities.

5. In Magnet organizations, staff members are encouraged to be involved in educational activities in the organization and the community.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Assessment/Quality of Practice

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

19) The nurse is trying to understand why it has taken so long for electronic health records (EHRs) to be used in healthcare. Which statement is a reason for this delay?

1. Medical records professionals do not like these records.

2. The use of these records is more expensive than the use of paper records.

3. There have been concerns about privacy and confidentiality.

4. The transition to EHRs is time consuming and tedious.

Answer: 3

Explanation: 1. The preference of medical records professionals is not the reason these records have had a slow adoption.

2. The cost of the records is not a primary reason they have had slow adoption.

3. The most overwhelming issue in using these records has been the profession’s and public’s concerns regarding privacy and confidentiality.

4. The transition time to EHRs is not the primary reason they have seen a slow adoption.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Assessment/Communication

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

20) Hospital administration is considering the purchase of a robotic pharmacy system. What would be the advantage of this system to the nurses who work in the hospital?

1. The nurse will be able to leave out some of the six rights of medication administration because the robot checks the medications.

2. The nurse should get medications more quickly because the robot can work more consistently without breaks.

3. The nurse can delegate medication administration to the nursing assistant because the medications have already been checked.

4. The nurse can expect that medication administration will be easier and carry less potential for error.

Answer: 2

Explanation: 1. The nurse must still complete the six rights of medication administration to ensure client safety.

2. Robots should be able to get medications to the floor more quickly.

3. The administration of medication cannot be delegated to the nursing assistant.

4. There is no assurance that medication administration will be easier.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Resource Utilization

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

21) A nurse executive is considering initiating a blog to enhance communication among staff nurses, managers, and supervisors throughout the organization’s different campuses. What serious considerations should the nurse make prior to starting a blog?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Open access to the blog may damage recruiting efforts.

2. Blogs are difficult to use and expensive to maintain.

3. Users of the blog must be very careful not to divulge any information that would violate client confidentiality.

4. The organization’s reputation may be altered by a blog.

5. Most nurses would likely not use the blog.

Answer: 1, 3, 4

Explanation: 1. Disgruntled employees may use the blog to air grievances. If the blog is open access, these grievances could quickly become community news.

2. Blogs are inexpensive and easy to use.

3. As blogs become more and more common, bloggers become more casual in their use. Violations of client confidentiality would not only be possible but could even be said to be likely.

4. The organization’s reputation could be either enhanced or damaged by bloggers’ comments.

5. Social media sites such as blogs have exploded in use. It is very likely that nurses would use a blog.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Communication

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

22) The nurse manager has four different generations represented in the nursing staff on the unit. What statements indicate the manager is wise about how to deal with this generational mix?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. “I don’t see why everyone can’t just get along.”

2. “Generation X nurses are just lazy.”

3. “Our Generation Y nurses help keep us all up on new technology.”

4. “The most loyal of all my nurses are the traditionalists.”

5. “I expect that our next manager will come from my group of baby boomers.”

Answer: 3, 4, 5

Explanation: 1. The four generations have different values, work ethics, and skills. Conflict is inevitable.

2. The manager should not stereotype the members of a generation.

3. Generation Y is technically savvy.

4. Traditionalists are typically loyal and respectful of authority.

5. Baby boomers typically value professional and personal growth.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Assessment/Leadership

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

23) The administrators of a small hospital are revising its disaster plan. What should be the primary focus of this plan?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Preparing for a surge of casualties in case of a disaster

2. How to prevent disasters from occurring

3. How to fund disaster management

4. How to reduce disaster impact on clients and staff

5. How to identify risks for disasters

Answer: 1, 5

Explanation: 1. One of the primary focuses of a disaster plan is how to care for the influx of clients.

2. Prevention of internal disasters is the focus of physical plant planning and safety planning. It is not the primary focus of the disaster plan.

3. Funding in a disaster is problematic. It is not possible to plan for the extent of the disaster or its impact on funding, or to predict who will pay.

4. There may be physical, mental, and emotional impact on clients and staff. Planning is a way to reduce this impact.

5. Risk identification is part of a safety plan.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Quality of Practice

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

24) Procedural changes are being planned on the unit as a direct result of client satisfaction surveys. Which individual is most strategically placed to handle how these changes are initiated?

1. Staff nurse

2. Nurse manager

3. Chief financial officer (CFO)

4. Chief executive officer (CEO)

Answer: 2

Explanation: 1. The staff nurse will be instrumental in carrying out the changes but is not the most influential in directing them.

2. The nurse manager is situated on the front lines but is also responsible to upper management. The manager can be supportive of the staff’s feelings while adequately and appropriately representing the needs and wants of the administration.

3. The CFO will certainly have some say in the financial support of any changes made but is unlikely to have sufficient knowledge of the daily operations of the unit to handle changes at that level.

4. The CEO is unlikely to have enough information about the daily unit activities to be effective in instituting these changes.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Leadership

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

25) To be effective in today’s healthcare system, the nurse manager must be aware of which trends?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. An environment that does not change

2. Decreasing resources

3. Adequate staffing

4. Increasing numbers of retirees

5. Complicated technology

Answer: 2, 4, 5

Explanation: 1. The only trend that is consistent is the rapidly changing system.

2. Nurse managers must be aware of the responsibility of doing more with fewer resources.

3. Often the nurse manager is faced with staffing inadequate for the acuity of the clients requiring care.

4. Increasing numbers of retirees, both from nursing and as an aging population, have placed a strain on the healthcare system.

5. Complicated technology forces the nurse manager to keep up with the ever-present changes within the healthcare system.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Assessment/Resource Utilization

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

26) The nurse executive is reviewing statistics about the nursing staff. Which statistic shows that the staff reflects national trends?

1. The average age of the nursing staff is 40.

2. The number of nurses under age 30 has increased in the last two years.

3. There are no nurses older than age 55.

4. All nurses older than age 45 are managers.

Answer: 2

Explanation: 1. The average age of nurses is 46.

2. The number of nurses younger than age 30 is increasing.

3. This does not reflect national statistics.

4. This does not reflect national statistics.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Assessment Evidence-Based Practice

Learning Outcome: 1-2: Describe how nursing management is influenced by changes in society.

27) To meet the Institute of Medicine (IOM) recommendation, nursing should strive to have ________% of nurses prepared at the baccalaureate or higher level by 2020.

Answer: 80

Explanation: The IOM recommends increasing the level of education of all nurses. The goal is 80% at baccalaureate level or higher by 2020.

Cognitive Level: Understanding

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Education

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

28) A nursing curriculum includes integrated content on critical thinking. Which statement reflects movement toward designing the curriculum to meet Carnegie Foundation recommendations?

1. “We must find ways to increase our emphasis on critical thinking.”

2. “The curriculum must focus on ways nurses can quickly and accurately acquire information.”

3. “Our emphasis must change to improving nursing students’ clinical reasoning skills.”

4. “Our clinical practicums must be graded separately from our theory presentations.”

Answer: 3

Explanation: 1. Critical thinking is still emphasized, but another aspect of care should receive much more emphasis.

2. Carnegie focuses on application of knowledge rather than its acquisition.

3. This is a Carnegie recommendation.

4. Carnegie recommends integration of clinical and classroom teaching.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Education

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

29) A newly licensed nurse received specific knowledge of management skills while in nursing school. What does the nurse need now?

1. Nothing until the nurse has acquired enough bedside experience to become a manager

2. Time to see how these skills will be needed in the future

3. A manager who can help with skills transfer from school to work

4. A job working as a manager in a small hospital

Answer: 3

Explanation: 1. All nurses are managers.

2. The nurse will use these skills on the first job.

3. The manager is an essential component in helping the new nurse transfer this learning into the “real” world of bedside care.

4. The newly licensed nurse does not have the skill set and experience to work as a manager.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Leadership

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

30) Which manager statement reflects concern about the most important requirement for today’s nurse manager?

1. “I am taking a day off tomorrow for my annual physical.”

2. “I think this class will help me learn to be innovative.”

3. “I am committed to being a good manager.”

4. “I feel enthusiastic about our new plans for the units.”

Answer: 1

Explanation: 1. The most important work of the manager is to stay physically and mentally healthy.

2. Innovation is important, but not as important as other factors.

3. Commitment is important, but not as important as other factors.

4. Enthusiasm is important, but not as important as other factors.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Evaluation/Leadership

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.

31) Quality and Safety Education for Nurses (QSEN) is based on quality and safety targets of knowledge, skills, and attitudes (KSAs) for nursing education. Which targets are associated with QSEN competencies?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Education

2. Teamwork

3. Autonomy

4. Quality improvement

5. Client-centered care

Answer: 2, 4, 5

Explanation: 1. Education is not one of the KSAs.

2. Teamwork is one of the KSAs.

3. Autonomy is not one of the KSAs.

4. Quality improvement is one of the KSAs.

5. Client-centered care is one of the KSAs.

Cognitive Level: Applying

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Implementation/Education

Learning Outcome: 1-1: Explain changes to healthcare over the past decade, including those resulting from implementation of the Affordable Care Act; demands to reduce errors and improve patient safety; and evolving medical and communication technology.

32) The nurse is using Evidence-based practice (EBP) to improve clinical quality. What steps should the nurse plan to include in this process?

Note: Credit will be given only if all correct choices and no incorrect choices are selected. Select all that apply.

1. Assess the outcome

2. Discuss challenges

3. Identify the clinical question

4. Compare other models

5. Apply the evidence

Answer: 1, 3, 5

Explanation: 1. Assessing the outcome is a step in EBP.

2. Discussing challenges is not a step in EBP.

3. Identifying the clinical question is a step in EBP.

4. Comparing other models is not a step in EBP.

5. Applying the evidence is a step in EBP.

Cognitive Level: Analyzing

Client Need: Safe Effective Care Environment

Client Need Sub: Management of Care

Nursing/Int Conc: Nursing Process: Planning/Evidence-Based Practice

Learning Outcome: 1-3: Identify the changes and challenges that nurses face now and in the future.