Leading And Managing in Nursing  5th Edition by Patricia S. Yoder-Wise – Test Bank

$20.00

Description

INSTANT DOWNLOAD COMPLETE TEST BANK WITH ANSWERS

 

Leading and Managing in Nursing  5th Edition by Patricia S. Yoder-Wise – Test Bank

 

Sample  Questions

 

Yoder-Wise: Leading and Managing in Nursing, 5th Edition

 

Chapter 06: Making Decisions and Solving Problems

 

Test Bank

 

MULTIPLE CHOICE

 

  1. The risk manager informs the nurse manager of an orthopedic unit that her unit has had an increase in incident reports about patients falling during the 11-7 shift. The nurse manager knows that the best way to resolve the problem is to:
a. Use creativity.
b. Obtain support from the 7-3 shift.
c. Use institutional research.
d. Identify the problem.

 

ANS:   D

Identification of a problem is the first step in problem solving and occurs before any other step. Improper identification of the problem is the most common reason for failure to resolve problems.

 

REF:    Pages 108-110

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. The nurse manager of a rehab unit wants to purchase a new anti-embolic stocking. To make a high-quality decision, the nurse manager would:
a. Involve the rehab staff in the decision.
b. Involve the sales representative.
c. Make the decision alone.
d. Involve administration in the decision.

 

ANS:   A

A democratic or participative approach involves appropriate personnel in the decision-making process. Involvement of others is essential in decisions involving patient care.

 

REF:    Page 104         TOP:    AONE competency: Business Skills

 

  1. Several nurses on an adolescent psychiatric unit complain that the teens are becoming unmanageable on the 11-7 shift. To resolve this problem, the nurse manager decides that the staff should have a brainstorming session. The goal of brainstorming is to:
a. Evaluate problem solutions.
b. Critique the ideas of others.
c. Generate as many solutions as possible.
d. Identify only practical and realistic ideas.

 

ANS:   C

Brainstorming encourages creativity when one is beginning to problem-solve and avoids premature shutting down of ideas through early evaluation.

 

REF:    Pages 104, 105                        TOP:    AONE competency: Business Skills

 

  1. During a fire drill, several psychiatric patients become agitated. The nurse manager quickly assigns a staff member to each patient. This autocratic decision style is most appropriate for:
a. Routine problems.
b. Crisis situations.
c. Managers who prefer a “telling” style.
d. Followers who cannot agree on a solution.

 

ANS:   B

An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

 

REF:    Page 101         TOP:    AONE competency: Business Skills

 

  1. After the nurses who work on an adolescent psychiatric unit have had a brainstorming session, they are ready to resolve the problem of teenagers who are unmanageable. To maximize group effectiveness in decision making and problem solving, the nurse manager has:
a. Prevented conflict.
b. Formed highly cohesive groups.
c. Used majority rule to arrive at decisions.
d. Encouraged equal participation among members.

 

ANS:   D

The nurse leader or manager needs to provide a nonthreatening and positive environment in which group members actively participate by controlling aggressive individuals and encouraging passive individuals. Diversity, managed conflict, and moderate cohesiveness are effective in reaching quality decisions.

 

REF:    Pages 104, 105                        TOP:    AONE competency: Business Skills

 

  1. To solve a problem, the nurse manager understands that the most important problem-solving step is:
a. The implementation phase.
b. Identification of numerous solutions.
c. Accurate identification of the problem.
d. Evaluation of the effectiveness of problem resolution.

 

ANS:   C

To proceed effectively, it is important to determine if a problem exists and to accurately identify a problem. Failure to resolve problems is most often linked to improper identification of the problem.

 

REF:    Pages 108, 109                        TOP:    AONE competency: Leadership

 

  1. A clinic nurse has observed another nurse deviating from agency policy in performing wound care. The best approach for the clinic nurse to take is to:
a. Stay out of it.
b. Inform the nursing supervisor.
c. Fill out a notification form (incident report).
d. Assess the risk to the client and the agency before proceeding.

 

ANS:   D

In assessing risk, the nurse engages in the initial step of the problem-solving process, which involves asking “What benefits (or risks) will be derived from solving it?” Purposeful inaction may not be appropriate when the individual cannot resolve the problem or when there is risk to patients.

 

REF:    Pages 101-103

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. The clinic nurse understands that problem solving is best defined as:
a. A higher-order thinking process.
b. Selecting the best option for reaching a predefined goal.
c. Identifying the gap between “what is” and “what should be.”
d. Determining creative approaches to resolving a problem or issue.

 

ANS:   C

Critical thinking is a higher-order thinking process. Problem solving is a step in decision making that is focused on solving an immediate problem, which can be viewed as a gap between “what is” and “what should be.”

 

REF:    Page 99           TOP:    AONE competency: Knowledge of the Healthcare Environment

 

  1. The risk manager wants to evaluate the reasons for an increased number of falls on the rehab unit. The risk manager devises a fishbone diagram. A fishbone diagram is a useful tool to:
a. Identify the root causes of problems.
b. List possible solutions to problems.
c. Help leaders select the best options.
d. Evaluate the outcomes of decisions made.

 

ANS:   A

A fishbone diagram, also known as a cause-and-effect diagram, is useful for determining the reasons (causes) for an effect (falls).

 

REF:    Page 110         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. An outpatient surgery manager is evaluating infusion pumps for the operating room. The manager should:
a. Select the least expensive brand.
b. Use a decision-making tool to evaluate brands.
c. Ask the nursing staff which brand they prefer.
d. Select the vendor the institution usually buys from.

 

ANS:   B

Decision-making tools such as decision grids and SWOT analyses are most appropriate when information is available and options known.

 

REF:    Pages 106, 107

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. Select the statement that best defines the difference between problem solving and decision making:
a. Decision-making skills require critical thinking, problem-solving skills do not.
b. Problem-solving skills require critical thinking, decision-making skills do not.
c. Decision making is a goal-directed effort, problem solving is focused on solving an immediate problem.
d. Problem solving is a goal-directed effort, decision-making is focused on solving an immediate problem.

 

ANS:   C

Problem-solving is focused on solving immediate problems, whereas decision making is a goal-directed process that is aimed at selecting appropriate actions from among options. Not all decisions begin with a problem.

 

REF:    Pages 99, 100                          TOP:    AONE competency: Leadership

 

  1. Sue, a nurse manager, has a staff nurse that has been absent a great deal for the past three months. A whistleblower gives some information to Sue indicating that the staff nurse will be resigning and returning to school. Because of this, Sue decides to do which of the following?
a. Immediately fire the staff nurse.
b. Speak to the whistleblower and elicit more information.
c. Speak to the staff nurse and ask her to resign.
d. Do nothing.

 

ANS:   D

Doing nothing is often warranted because of lack of energy, time, or resources to solve the real problem adequately, and because the benefits are not seen as sufficiently compelling to commit to an action.

 

REF:    Page 108         TOP:    AONE competency: Business Skills

 

  1. The maintenance department wishes to have the nursing lounge renovated, so the lounge will be more “user-friendly.” The department asks the nursing staff to make a wish list of everything that they would like to see in the new lounge. This process is an example of which part of the decision-making process?
a. Assessment/Data collection
b. Planning
c. Data interpretation
d. Generating hypotheses

 

ANS:   A

In this particular model (a model similar to the nursing model), data collection is the first step toward identifying important alternatives or determining if there is a problem or problems.

 

REF:    Pages 110, 111                        TOP:    AONE competency: Business Skills

 

  1. A good nursing decision maker is one who:
a. Uses various models to guide the process based on the circumstances of the situation.
b. Adopts one model and uses it to guide all decision making.
c. Decides not to use any models because they are all useless.
d. Develops a new model each time a decision has to be made.

 

ANS:   A

Research has determined that a structured approach to decision making increases critical thinking and is the best way to learn how to make quality decisions because it eliminates trial and error and focuses on proven processes.

 

REF:    Page 101         TOP:    AONE competency: Leadership

 

  1. From the information supplied in this chapter, which statements best defines critical thinking? Critical thinking is a:
a. High-level cognitive process.
b. Process that helps to develop reflective criticism for the purpose of reaching a conclusion.
c. High-level cognitive process that includes creativity, problem solving, and decision making.
d. Discussion that guides the nursing process.

 

ANS:   C

It is generally accepted by many authors and researchers that this statement best defines critical thinking.

 

REF:    Page 99           TOP:    AONE competency: Business Skills

 

  1. Decision making is described by the nursing educator as the process one uses to:
a. Solve a problem.
b. Choose between alternatives.
c. Reflect on a certain situation.
d. Generate ideas.

 

ANS:   B

The hallmark of decision making is choosing among options. Generating options is one phase of decision making, and solving a problem refers to problem solving, which is problem centered. Decision making does not always begin with problems, but rather is defined as a purposeful, goal-directed effort that uses a systematic process to choose among options.

 

REF:    Page 99           TOP:    AONE competency: Leadership

 

  1. Justin is a nurse manager in a rehabilitation unit in a small urban center. There is a high turnover rate among rehab-assistants because of the heavy work assignments. Justin decides to hire new staff in the order that applications are received until all vacant positions are filled. Which of the following decision-making models did Justin use in making his decision?
a. Subjective model
b. Objective model
c. Optimizing model
d. Satisficing model

 

ANS:   D

The Satisficing Model is a decision-making model whereby the decision maker selects the solution that is the simplest and provides for the quickest solution.

 

REF:    Page 101         TOP:    AONE competency: Business Skills

 

  1. Which of the following decision-making solutions should Justin (Question 17) consider to have a more efficient department?
a. Replace staff only with qualified applicants.
b. Determine what the problem or problems are before hiring new staff.
c. Consult with the human resources department and develop a plan for hiring new staff.
d. Consider all the options listed.

 

ANS:   D

Decision making involves a goal-oriented consideration of many options. All of the alternatives are very reasonable decision-making strategies in this instance.

 

REF:    Pages 104-106                         TOP:    AONE competency: Business Skills

 

  1. When confronted with the controversy and the apparent poor morale of the evening staff, the unit manager decided the staff needed to take some time off. He scheduled holidays for the staff without consulting them. A couple of the staff nurses approached the manager and indicated that the problem was not scheduling, but rather the team leader and her patient assignments. What was the unit manager’s first missed step in problem solving?
a. Not using a problem-solving model
b. Not considering a number of alternatives
c. Poor evaluation of outcomes
d. Incorrect problem identification

 

ANS:   D

The unit manager did not begin with an accurate identification of the problem. Problem solving needs to begin with “why?”

 

REF:    Pages 108-110                         TOP:    AONE competency: Business Skills

 

  1. John Smith, one of three managers at BSG Labs, drafted a policy that would allow his department to do more testing in his lab. This policy included the times for regular collection as well as a new process for emergency laboratory testing. The policy and procedures were never followed. The reason was that:
a. The policy was too lengthy and inundated readers with too much detail.
b. The policy made decisions for other departments in the company.
c. The staff did not believe that the new policy would be effective.
d. Testing should not be done in the lab.

 

ANS:   B

Other departments were not involved in the problem-solving process; therefore, they lacked input into the concerns, issues, and possible solutions. Therefore, it is not surprising that they did not follow the new policy of another department. Problem solving should be a group process that should involve as many personnel as possible.

 

REF:    Pages 103, 104                        TOP:    AONE competency: Business Skills

 

  1. High-quality decisions are most likely to be made in nursing situations when:
a. Team leaders make the crucial decisions.
b. Individuals are advised of the problems.
c. Group size is neither too small nor too large.
d. Members are passively involved.

 

ANS:   C

Research has shown that group size is important. Too small a group means a limited number of options generated. Too large a group can mean lack of structure or lack of meaningful discussion.

 

REF:    Page 103         TOP:    AONE competency: Business Skills

 

  1. Knowing when to have the entire team participate in the decision-making process or when to have only the team leader make the decisions depends upon the situation and the desired outcomes. The autocratic process is used in which of the following situations?
a. The task and the outcome are relatively simple.
b. It is unlikely that the group will reach a consensus.
c. A decision has to be discussed thoroughly.
d. A number of options need to be considered.

 

ANS:   A

An autocratic style is appropriate when rapid decision making is required, such as in a crisis situation.

 

REF:    Page 101         TOP:    AONE competency: Leadership

 

  1. Jane, an experienced head nurse, is given the task of completing the summer vacation schedule for the pediatric unit. She is fully aware of the hospital’s restrictions on time off and the number of staff on vacation at any given time, as well as its issues regarding seniority. She weighs the options of allowing staff choice, such as it takes more time but gives employees options. However, if choice is allowed, this could cause arguments. Which of the following is the best alternative?
a. Ask for requests for vacation time in advance, and post the times.
b. Post the completed vacation schedule.
c. Post a tentative schedule, and request feedback.
d. Post a blank schedule, and ask staff members to fill in their times by a given date.

 

ANS:   D

This is based upon a decision-making model that allows experience and knowledge to predict whether a decision will or will not work. The experience of the head nurse suggests that it is important to involve staff in decisions that affect them the most.

 

REF:    Page 101         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. When decision making, critical thinking, and problem solving are considered, which of the following statements are accurate and valid points?
a. The professional decision maker approaches problem solving by beginning with an outcome already in mind.
b. Involvement in decision making is of little use unless you are an expert decision maker.
c. Many models aid the nurse in improving his or her decision-making skills.
d. The nursing decision maker who is successful recognizes that only those with similar experiences should be involved in decision making.

 

ANS:   D

A nurse can draw upon many models in making a decision. It is critical to realize that decision-making expertise grows with exposure to decision making, and that diversity in expertise helps in developing options.

 

REF:    Page 101         TOP:    AONE competency: Leadership

 

MULTIPLE RESPONSE

 

  1. In a busy rehabilitation unit, the team manager decided that the best way to reward the staff was to give them a monetary bonus rather than time off. The staff was very concerned about the decision and went to the administration with a number of complaints. Critical thinking is a process that entails a number of steps. What steps did the manager omit? She should have (select all that apply):
a. Identified the assumptions that were underpinning the issues.
b. Considered the context of the present problem or situation.
c. Gathered data before making her decision and evaluated all possible outcomes.
d. Attained a majority consensus of all staff.

 

ANS:   A, B, C

Taking a majority consensus is not a step in the critical thinking process. Points A, B, and C are considered by most authors to be the essential steps in the process of critical thinking.

 

REF:    Pages 99, 100                          TOP:    AONE competency: Leadership

Yoder-Wise: Leading and Managing in Nursing, 5th Edition

 

Chapter 07: Healthcare Organizations

 

Test Bank

 

MULTIPLE CHOICE

 

  1. To prepare for the orientation of newly hired nurses, the nurse manager plans a presentation outlining the concept of healthcare networks. Healthcare networks are:
a. Units that provide only primary care services.
b. Owned by the institutions.
c. A feature of all public institutions.
d. Units that provide a full spectrum of services.

 

ANS:   D

Healthcare networks are interconnected units that provide a full spectrum of services, from wellness to illness services, and may include primary care, secondary care, and tertiary care services. Networks do not involve all public organizations.

 

REF:    Page 118         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A local hospital has formed a corporate partnership with a reputable HMO (health maintenance organization). The nurse manager has had to educate staff and personnel about the financial implications of this partnership. A health maintenance organization:
a. Provides more expensive care than other types of insurance plans.
b. Has a centralized administration that directs and compensates physician services.
c. Pays physicians on a fee-for-service basis.
d. Does not pay as much for acute care as other practice plans.

 

ANS:   B

Managed care involves prospective pay for care received over a specified length of time or a prepaid payment period rather than a retrospective system that pays physicians for services actually rendered through fee-for-service. Health maintenance organizations are a form of managed care that is administered centrally.

 

REF:    Page 121         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. With the help of a federal grant, the local school nurse has established a spreadsheet that contains relevant nursing data so that she can analyze children’s health. School health programs are:
a. Increasingly seen as primary care sites for children.
b. Providing only health education programs for children and their parents.
c. Capable only of providing referrals for health problems to primary care providers.
d. Funded exclusively by local authorities.

 

ANS:   A

The traditional role of schools in controlling infectious disease outbreaks, in treating and controlling on-site injuries, and in educating parents and children about basic health is increasingly leading to schools as primary health care sites for children.

 

REF:    Page 123         TOP:    AONE competency: Business Skills

 

  1. The local health department nurse manager has developed and implemented a disaster readiness plan as part of a community service. Community services:
a. Care for the specific needs of individual families in the community.
b. Focus on the treatment of community-wide problems rather than on individual health problems.
c. Do not include services provided by public health departments.
d. Provide personal health follow-up for all acute care hospitalizations.

 

ANS:   B

Community health services are directed toward a community as a whole as opposed to care, such as personal follow-ups, that are directed toward specific patient groups and families.

 

REF:    Page 123         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A nursing informatics specialist hired by Blue Cross/Blue Shield (a form of third-party payers benefit packages 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.

 

ANS:   D

Managed care strives to contain costs (for example, through limitation of time in care) while maintaining quality. Critical pathways refer to guides established for the provision of care for clients with specific conditions. HMOs are centrally administered managed care.

 

REF:    Pages 121, 122                        TOP:    AONE competency: Business Skills

 

  1. A merger has occurred between a hospital and a local home health agency, creating new roles for the nursing staff in both agencies. The nurse managers of both systems begin to evaluate and revise patient care processes and systems. With the merger, the healthcare organization’s changes are:
a. Creating more jobs in the community for registered nurses.
b. Resulting in an overall loss of jobs for registered nurses.
c. Controlled by the federal and state governments.
d. Controlled by the insurance agency.

 

ANS:   A

With the movement toward more timely discharge of patients as a result of DRGs, the need for home health services has increased. A partnership between a hospital and a home health agency provides seamless transfer of patient care, thus enhancing the quality of patient care and increasing the volume of home health care. The volume of home health care has a subsequent impact on the numbers of nurses required. One responsibility of nurse managers is to evaluate and revise patient care processes and systems because healthcare organizational changes create more jobs in the community for registered nurses.

 

REF:    Page 127         TOP:    AONE competency: Business Skills

 

  1. You are a nurse manager in a facility that is part of a national system of specialized hospitals that provide services to children and that is funded and managed through a religious charity organization. This system emphasizes compassionate, faith-based care. What level of consolidated system is represented in this example?
a. First level
b. Second level
c. Fourth level
d. Fifth level

 

ANS:   D

Consolidated systems tend to be organized into five levels. The fifth level involves special interest groups that own and operate units along religious lines, teaching interests, or related special interests that drive their activities. In this example, the facilities are funded and managed by a religious organization that provides care that is congruent with its particular faith-based values.

 

REF:    Page 121         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A nurse manager at a home healthcare service has resigned to take a position at a local ambulatory care center. She has been hired because of her expertise in TJC accreditation. To initiate the changes, the nurse manager has to be knowledgeable about the differences between a home healthcare institution and an ambulatory care center, which is a primary care institution. Primary care institutions are facilities that provide:
a. Rehabilitative or long-term care.
b. Disease-restorative care.
c. First access to care.
d. Only outpatient services.

 

ANS:   C

In an ambulatory care institution, emphasis is placed on providing health maintenance and chronic or long-term care to individuals who have an identified need from the time of diagnosis or impairment in a team setting. This definition is consistent with that of primary health care.

 

REF:    Page 118         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. 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. Have funds that are redirected to the organization for maintenance and growth.
c. Have no paid employees.
d. Pay no taxes.

 

ANS:   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.

 

REF:    Page 119         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. In reviewing the current delivery model, the nurse manager is aware that a demographic change that will have a significant effect on the healthcare delivery systems of the future is:
a. Changes in staffing patterns.
b. Increasing reports of violence in the workplace.
c. The increasing percentage of the population that will be over age 65.
d. Escalations in the cost of health care.

 

ANS:   C

A demographic change that will significantly impact the healthcare system of the future is the increasing proportion of individuals 65 years and older. By 2025, 18% of the population is expected to be 65 years and older, which means that new healthcare organizations will evolve as the system attempts to maintain older adults in the community for as long as possible.

 

REF:    Pages 129, 130

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A facility that provides care for patients whose average length of stay is less than 30 days and to patients whose average length of stay is longer than 30 days, and who require inpatient and ambulatory care for addictions, through a spectrum of wellness and illness services and providers, would be considered:
a. A healthcare network.
b. A tertiary care institution.
c. Rehabilitative.
d. Long-term care.

 

ANS:   B

Healthcare networks embrace and provide wellness and illness services, including primary, secondary, and tertiary care, through a network of providers.

 

REF:    Page 118         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. Healthcare organization XYZ provides women’s health services on an inpatient basis (average stay of less than 30 days). This facility would likely be considered:
a. Primary care, specialized.
b. Tertiary care, long-term.
c. Acute care, specialized.
d. Public care, specialized.

 

ANS:   C

Because of the average length of stay, the facility would be considered acute care, and because of the focus on women’s health services, it would also be considered specialized. Tertiary care would not fit with the vision of this facility as the focus in tertiary care is on rehabilitation and longer-term relationships. There is no indication as to whether this facility is public or private in terms of funding and governance.

 

REF:    Page 118         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. 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.

 

ANS:   D

Not-for-profit organizations are obliged to provide care for patients regardless of capacity to pay. These organizations provide the majority of uncompensated care in the United States. Although some states have charity pools to which all not-for-profit organizations contribute to offset the potential hardships of uncompensated care, when the percentage of uncompensated care in a not-for-profit organization increases, the viability and sustainability of the service may be an issue.

 

REF:    Pages 119, 120                        TOP:    AONE competency: Business Skills

 

  1. 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.

 

ANS:   A

For-profit hospitals tend to have lower wage and salary costs that are most likely connected to aggressive goals for profit. For-profit hospitals tend to place a high priority on compensated services and therefore, on particular groups of clients. For-profit hospitals are typically nonteaching environments.

 

REF:    Pages 119, 120                        TOP:    AONE competency: Business Skills

 

  1. Which of the following is an example of an HMO?
a. Nurse practitioners are paid promptly at discounted fees for each service rendered at a women’s health clinic.
b. Physicians in a large urban center are reimbursed for visits made to their clients.
c. Physicians are paid for each service delivered to enrolled patients through a prepaid plan.
d. Patients pay fixed annual fees for ambulatory care services, regardless of actual utilization of health services.

 

ANS:   D

Fee-for-service systems provide compensation to healthcare providers in group practices based on fee-for-service, which in PPQs means that fees are paid promptly but at a discounted rate. HMOs are configurations of healthcare agencies that provide health maintenance and services for enrolled patients for a fee that is preestablished regardless of utilization of service.

 

REF:    Pages 121, 122

TOP:    AONE competency: Knowledge of Healthcare Environment

 

 

  1. As a nurse manager, you have been asked to assist in designing a subacute facility for open heart patients who require further complex care after hospitalization. In setting up the facility, which of the following would require reassessment?
a. Patients admitted to the facility must have adequate health insurance to cover the services provided.
b. A local nurse education program asks you if nursing students can gain clinical experience with recovering surgical patients in the facility.
c. Public funding will be provided to enable care of patients who have an ordinary course of recovery.
d. The facility is an older house that is more than 30 minutes away from the acute care center.

 

ANS:   D

Acceptance of patients who are anticipated to have a normal course of care, support of nursing education, and health care coverage for patients would require further assessment if these were not provided for the mission, mandate, and intended structure of the facility. Because of the types of patients being accepted for care and the distance of the subacute facility from acute care, emergency response and seamless transfer issues in the event of an unanticipated crisis must be addressed.

 

REF:    Page 123         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. Which of the following would be the most appropriate focus in developing a business plan for a nurse-owned home healthcare service?
a. Programs to educate the community on preparing healthy meals for a limited cost
b. Reduction of injuries from alcohol-related accidents
c. Pain management for patients with low back pain
d. Reduction of falls among seniors

 

ANS:   C

Nurse-managed and nurse-owned healthcare services are part of a growing number of organizations that extend health care beyond that offered through traditional services. These nurse-managed and nurse-owned services focus on the care of individuals and families, rather than on community-based outcomes for populations such as older adults, or on community-based issues such as injuries related to drunk driving.

 

REF:    Page 124         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. As a nurse manager, you have been offered a position at a Veterans Administration hospital. In accepting the position, it is important for you to understand that veterans’ hospitals provide:
a. Primary care and are privately funded.
b. A range of services and are responsible to government and taxpayers.
c. Secondary care only and are publicly administered and funded.
d. Services to veterans under an HMO.

 

ANS:   B

Veterans Administration hospitals provide a range of services to veterans and are responsible to government and thus to taxpayers, who support the hospitals.

 

REF:    Pages 119, 120

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. A group of patients with early Alzheimer’s disease and their spouses approach you regarding help with the establishment of a local Alzheimer’s Society for the support and education of affected individuals and their families. As a manager in an ambulatory care clinic, you would advise that:
a. Self-help groups are, by nature, directed, funded, and led by those requiring help, and that the patients and families should need no help from your clinic.
b. Your healthcare organization will be pleased to help as long as your organization financially takes over responsibility for direction, leadership, and management.
c. Partnering with patients and families to provide self-help geriatric services is a growing trend in health care.
d. The services that the patients and spouses are proposing are likely being offered somewhere else already.

 

ANS:   C

Self-help groups often are made up of and are directed by peers who have healthcare needs. A growing trend is the development of community-based geriatric organizations in partnership with healthcare organizations. The request of the patients and their spouses indicates that this service is needed in the community, and that they are looking for assistance in setting up the Alzheimer’s Society rather than having your agency take over the management of the group.

 

REF:    Page 122         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. Tracy is an RN case manager who interfaces between the Centers for Medicare and Medicaid. Tracy’s responsibilities most likely would include:
a. Managing physician-led research.
b. Monitoring physician documentation of the need for medical care.
c. Determining which services are designated fee-for-service.
d. Identifying errors in physician diagnoses.

 

ANS:   B

Nurse case managers serve as interfaces for the Centers for Medicare and Medicaid (CMS) and are key in monitoring compliance with Conditions of Participation (CoP) elements and ensuring that patients are appropriately placed in care settings. This particular role advances the concern of CMS specifically regarding quality of care delivery and is involved in monitoring the guidelines contained in the CoP that are necessary for organizations to receive funding, rather than activities such as leading research.

 

REF:    Pages 124, 125

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. The Wellington Mental Health Institute is fully accredited by the AOA and not directly by the CMS. This means that the Wellington facility:
a. Could not accept mental health patients who were Medicare beneficiaries.
b. Would be able to care for only Medicaid and not Medicare beneficiaries.
c. Has not met the standards set by the CMS as determined by an external review panel.
d. Has been reviewed and accredited by the AOA, which is a deeming authority for CMS.

 

ANS:   D

CMS accreditation or external review of an organization’s compliance with the standards set by the CMS can be conducted by the AOA, which is a deeming authority for CMS.

 

REF:    Pages 125, 126

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. As a nurse manager, you would expect which of the following to be the major contributor to funding and revenues in your organization?
a. The federal government
b. Medicare
c. Medicaid
d. Blue Cross/Blue Shield

 

ANS:   A

The federal government is responsible for both Medicare and Medicaid and is the largest and most influential health insurance program in the United States. The federal government is the primary payer of healthcare costs in the United States.

 

REF:    Pages 124, 125

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. In capitation, which of the following scenarios is most likely to occur?
a. If the costs of caring for a patient are less than the capitated amount, the organization realizes a profit.
b. If the capitated amount is less than the costs of caring for a patient, the organization realizes a profit.
c. In capitation, profit is not directly tied to the costs for provision of care.
d. Capitation has little or no effect on the aims and purposes of providing care.

 

ANS:   A

With capitation, providers receive a fixed monthly amount, regardless of care delivered. If the cost of care is less than the capitated amount, then the organization realizes a profit, which is an incentive for seeing that patients receive essential services to stay healthy and that patients do not unnecessarily use services.

 

REF:    Page 123         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. Which of the following patients would be most likely to be covered under Medicare?
a. Jim, who lives on the street and has occasional infections
b. Alysha, who is on social assistance and has a 5-year-old daughter with frequent ear infections
c. Karen, a housewife, 45 years of age, whose husband recently abandoned the family
d. Dan, who is 68 years of age and in good health

 

ANS:   D

Medicare is a federal government program for individuals over 65 and the disabled; Medicaid provides financing of health care for the medically indigent.

 

REF:    Pages 124, 125

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. 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

 

ANS:   A

With the move toward managed care and away from the fee-for-service model, there has been a shift to outpatient and home health care, as this model increases emphasis on elimination of unnecessary use of healthcare resources. The inclusion of managed care has increased the overall complexity of funding sources for the healthcare system and the complexity of rules for consumers.

 

REF:    Pages 121, 122

TOP:    AONE competency: Knowledge of Healthcare Environment

 

 

MULTIPLE RESPONSE

 

  1. As a nurse manager in a for-profit hospital, you are interested in promoting teaching programs for physicians, as evidence suggests that hospitals with teaching programs tend to promote better care for patients. Your administration indicates that it cannot support your ideas or proposal because of (select all that apply):
a. Increased salary costs.
b. Duplication of tests and procedures.
c. Higher costs of technology.
d. Potential damage to reputation through learner error.

 

ANS:   A, B, C

Teaching hospitals tend to incur higher costs because of the salaries required for supervision of physicians, duplication of tests and procedures through the learning process, longer times required to process patients, costs of state-of-the art technology, biomedical research, and stand-by capacity of specialized care. Because of the additional costs, few for-profit agencies and organizations support teaching programs.

 

REF:    Pages 119, 120                        TOP:    AONE competency: Business Skills

 

Yoder-Wise: Leading and Managing in Nursing, 5th Edition

 

Chapter 11: Caring, Communicating, and Managing with Technology

 

Test Bank

 

MULTIPLE CHOICE

 

  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:    Pages 208, 209                        TOP:    AONE competency: Business Skills

 

  1. 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:
a. Information.
b. Cost-effective care.
c. Meeting standards.
d. Evidence-based practice.

 

ANS:   D

Evidence-based practice is a systematic approach to clinical decision making; to provide the most consistent and best possible care to patients in this scenario, evidence is being used to support care for patients post cardiac catheterization.

 

REF:    Page 211         TOP:    AONE competency: Knowledge of Healthcare Environment

  1. 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:
a. Avoid this site.
b. Check with his primary healthcare provider.
c. Continue with the exercises.
d. Contact the author for additional exercise and feedback.

 

ANS:   A

Not all information that appears on the Internet is reliable or credible, and 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:    Pages 219, 220                        TOP:    AONE competency: Business Skills

 

  1. 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.

 

ANS:   B

The provider has a responsibility to inform the patient as to when a response might be expected.

 

REF:    Page 208         TOP:    AONE competency: Business Skills

 

  1. The clinic nurse has just accessed a client’s chart on the computer. The resident comes over and asks her to stay logged on because he needs to add a note to that client’s chart. She should say:
a. “No problem. Just log me off when you’re done.”
b. “I’ll put the note in for you. What do you want to say?”
c. “Just make sure that you sign your note because it’s under my password.”
d. “I’m sorry, but you will have to enter the information using your own password.”

 

ANS:   D

Passwords must be protected to guard against unauthorized access to patient information and intrusion of privacy.

 

REF:    Pages 222, 223                        TOP:    AONE competency: Business Skills

 

  1. A home health nurse has been assigned to cover a 300-square-mile area of remote Montana. Mrs. Baker has just been discharged home and will need daily contacts for the next week. Because it is not possible to visit Mrs. Baker in person every day and see all of the other clients, the nurse gives her a laptop computer with net meeting software installed. Each morning, both dial in at an agreed-upon time and discuss her progress. The home health nurse assesses whether or not the client needs to be seen that day. This type of technology is called:
a. Distance learning.
b. Knowledge software.
c. Telecommunications.
d. Biomedical technology.

 

ANS:   C

Telecommunications facilitate clinical oversight and provision of health care at a distance via telephone, remote monitoring, and the Internet.

 

REF:    Pages 219, 220

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. At a newly built outpatient surgical center, an integrated information system has been purchased. The chief nursing officer creates a series of staff development classes to orient the staff to this new system. One of the advantages of an integrated information system is that client-care data from all sites can be stored in and retrieved from a:
a. Nursing information system.
b. Centralized database.
c. Nurse expert system.
d. Handheld device.

 

ANS:   B

Patient information in a centralized database is organized, legible, and easily retrievable from a variety of sources and reflects a variety of data.

 

REF:    Pages 201, 202                        TOP:    AONE competency: Business Skills

 

  1. Nurses need to know how to operate a computer, compare data across time, and look for patterns in client responses to treatments. These are examples of:
a. JCAHO standards.
b. Information systems.
c. Informatics competencies.
d. Requirements for nursing licensure.

 

ANS:   C

Nurses must utilize hospital database management, decision support, and expert system programs to access information and analyze data from disparate sources for use in planning for patient care processes and systems.

 

REF:    Pages 208, 209                        TOP:    AONE competency: Business Skills

 

  1. The chief nursing officer understands that to be able to compare data across client populations and sites, it is important that nurses use:
a. Similar settings.
b. Information systems.
c. Knowledge systems.
d. Structured nursing languages.

 

ANS:   D

Structured nomenclature, such as the NANDA nursing diagnoses, enables comparison of data across patient populations and sites and is important in the retrieval of meaningful comparison data from an information system.

 

REF:    Pages 202, 203                        TOP:    AONE competency: Business Skills

 

  1. Leaders in nursing must advocate for information and knowledge systems that support nursing practice. This is best accomplished by:
a. Participating in organizational information technology committees.
b. Submitting written requests for needed information systems.
c. Requesting budgetary funds needed for systems.
d. Sending staff nurses to conferences that discuss cutting-edge technologies.

 

ANS:   A

The nurse manager must recognize the utility of nursing involvement in the planning, design, choice, and implementation of information systems in the practice environment.

 

REF:    Pages 222, 223                        TOP:    AONE competency: Business Skills

 

  1. You are in the process of designing a patient education program that will provide education and monitoring for patients with hypertension. To support your planning, you draw out and present patient data from:
a. A clinical database.
b. Biomedical technologies.
c. E-mail.
d. Internet sources.

 

ANS:   A

Clinical databases are collections of elements organized and structured for the processing, organization, and presentation of data for interpretation as information, which, in this particular instance, includes outpatient data.

 

REF:    Pages 201, 202                        TOP:    AONE competency: Business Skills

 

  1. You document your patient’s vital signs into a bedside documentation device and are able to compare your patient’s vital signs with patients who have similar diagnoses and similar medications, and who are of a similar age. You are accessing:
a. E-mail.
b. Telecommunications.
c. A database.
d. Technology.

 

ANS:   C

A database is a collection of data elements stored and organized together for the purposes of interpreting information such as vital signs.

 

REF:    Pages 201, 202                        TOP:    AONE competency: Business Skills

 

  1. In an ICU, you order new devices to measure heart rhythm and rate, respiratory rate, oxygen levels, and intracranial pressure. These devices involve:
a. Biomedical technology.
b. Telecommunications.
c. Retrieval of patient history information.
d. Internet.

 

ANS:   A

Physiologic monitoring devices and patient surveillance systems involve biomedical technology.

 

REF:    Pages 217, 218

TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. As the head nurse involved in leading determination of which patient surveillance systems to acquire for your unit, one of your aims is to avoid adverse events through the implementation of appropriate technology. This particular aim recognizes that:
a. Human error is significant in contributing to adverse events.
b. Documentation of patient data is often illegible and therefore, misinterpreted.
c. Data systems provide backup documentation with adverse events that staff cannot provide.
d. Physiologic monitoring systems enable detection of early changes before an adverse event occurs.

 

ANS:   D

Data about adverse events suggests that a majority of physiologic abnormalities are not detected early enough and may be present hours before the event actually occurs. Physiologic monitoring aids in early detection of changes.

 

REF:    Page 199         TOP:    AONE competency: Knowledge of Healthcare Environment

 

  1. As a home health nurse, you use e-mail to communicate with some of your clients about their needs. You attend a conference for three days, and when you return, Mrs. S. is very upset because she sent you an email two days ago, and when you visit, she asks why you didn’t respond, since she did not know what to do with her insulin dosage for that morning. As a result, she ended up with an overdose of insulin and in the ER. To prevent such occurrences in the future, it would be important to:
a. Advise patients that they should not contact you with urgent concerns.
b. Not communicate sensitive information in e-mails.
c. Advise patients as to how long you will be unavailable for responses to e-mails.
d. Advise patients to avoid using e-mail to discuss their needs with you.

 

ANS:   C

E-mail communication needs to include the time frame in which patients can expect a response from you, and this needs to be updated as required.

 

REF:    Page 208

TOP:    AONE competency: Communication and Relationship-Building

 

  1. As a nurse manager in a multisite facility, you are comparing the effectiveness of prompted voiding training programs for staff by examining the impact of prompted voiding on the frequency of incontinence in patients. To do this, you access an NMDS, which allows you to:
a. Retrieve standardized information regarding patient care and trends.
b. Access medical diagnoses and pharmacologic interventions.
c. Learn sociodemographic and population-based trends.
d. Find information on public funding and private health insurance revenues.

 

ANS:   A

Although there continues to be inconsistency in nursing language, the nursing minimum data set (NMDS) defines essential nursing data to be collected on all patients that enable comparison of patient data, description of patient care, determination of trends, stimulation of nursing research, and provision of nursing data to influence decision making.

 

REF:    Pages 202, 203                        TOP:    AONE competency: Professionalism

 

  1. Nurses on your unit struggle with the application of terminology associated with nursing diagnoses. As a nurse manager and leader you provide information and education related to the value of standardized (rather than localized) terminology, which includes:
a. Standardized classifications for billing purposes.
b. Consistent terminology for the benefit of patient understanding.
c. Computerized storage and retrieval of nursing data to support and describe nursing practice.
d. Correction of inaccuracies in description at the local level.

 

ANS:   C

The development and utilization of a common nursing terminology enables the storage, aggregation, and retrieval of information through computer systems. This information can be used to stimulate and support research and to describe the nature and impact of nursing practice.

 

REF:    Pages 202, 203                        TOP:    AONE competency: Professionalism

 

  1. A rural-urban health consortium enables physicians in a rural remote setting to consult with specialists in care through electronic conferencing, which includes consultation using intranet radiology images. This system may be in which phase of electronic medical technology adoption, according to the Health Information and Management Systems Society (HIMSS)?
a. 0
b. 1
c. 3
d. 6

 

ANS:   D

According to the HIMSS, this healthcare organization may be in phase 6, which includes the capacity to transmit all radiology images through intranet or another secure source. Level 1 refers to the installation of major ancillary clinical systems (such as radiology), and level 3 to the retrieval of radiology images from picture archives and communication systems.

 

REF:    Pages 204, 205                        TOP:    AONE competency: Business Skills

 

  1. As a nurse manager representative on a clinical information system selection team, you would be particularly concerned if the favored system:
a. Involves screen displays that are best configured for non-clinical users.
b. Requires an upgrade to servers in the facility.
c. Requires staff orientation and training during implementation of the software.
d. Minimizes the amount of data entry necessary.

 

ANS:   A

An ideal hospital information system should include as much instrumentation as possible to minimize data entry. As a clinical end user, you would expect orientation and training on how the screen display can be configured so as to suit the purposes and preferences of users in clinical areas.

 

REF:    Pages 206, 207                        TOP:    AONE competency: Business Skills

 

  1. When assessing the appropriateness of adopting WL PDAs for a nursing unit, you need to consider the advantages, which include:
a. Lower cost relative to PCs.
b. Small display screen.
c. Font size.
d. Speed of operation.

 

ANS:   A

PDAs offer a lower-cost method of documentation and communication than PCs, as well as easy portability. Disadvantages of PDAs include small screen size, suboptimal readability, and slowness in situations when speed is most needed.

 

REF:    Pages 207, 208                        TOP:    AONE competency: Business Skills

 

  1. A nurse manager is excited by the possible use of speech recognition (SR) systems for documentation of patient care, especially during crisis situations when staff members need to focus on performing rapid assessments and implementation of procedures. She learns, however, that SR systems would be impractical at this point for this. What would lead to this conclusion?
a. SR systems are not available outside pilot projects.
b. The type of speech required for voice recognition is unlikely in a pressured situation.
c. The hands-free function has not been perfected in SR technology.
d. Wireless communications are prone to unreliability in transmission.

 

ANS:   B

Speech recognition systems rely on staccato-like speech, pauses between words, and programming for each user, any and all of which would be unlikely in a pressured crisis situation. SR is primarily being used for therapeutic purposes and in situations where data entry is stable.

 

REF:    Page 208         TOP:    AONE competency: Business Skills

 

  1. As a nurse manager, one challenge is to orient new staff to your agency’s policies and procedures, as well as to provide training across various shifts. A cost-effective and effective learning strategy would be:
a. Development of new learning modules and software to support document retrieval.
b. E-mail distribution to staff home e-mail addresses regarding important policies.
c. Preparation of DVDs that can be viewed on computers at the nursing station during “down times.”
d. Linking policies and procedures to the network for access when required at the point-of-care.

 

ANS:   D

The most accessible and cost-effective approach would be utilization of what is already available in the work environment. Development of new software is often expensive; DVDs are visually appealing but less nimble in terms of enabling staff to find answers quickly at the point-of-care.

 

REF:    Pages 205, 206                        TOP:    AONE competency: Business Skills

 

  1. A necessary, basic condition for successful integration of clinical information systems is:
a. Software.
b. Standard medical nomenclature.
c. Confirmatory evidence from nursing-led studies.
d. Strong interdisciplinary cultures.

 

ANS:   D

An integrated clinical information system draws on specific knowledge from many involved disciplines that interface at the patient. Successful integration of clinical information systems requires that the various disciplines work together collaboratively to transform the data into meaningful knowledge.

 

REF:    Pages 208, 209

TOP:    AONE competency: Communication and Relationship-Building

 

  1. To improve outcomes on the stroke recovery unit, the unit manager leads an evidence-based practice (EBP) project. The goal of this project is to:
a. Enable detection of variations in clinical outcomes from well-researched standards that are supported by confirmatory evidence.
b. Gain quick access to literature based on studies of patients and families who have experienced stroke.
c. Develop a list of articles that could be accessed to address clinical issues and problems with stroke patients.
d. Advance the development of staff who are able to conduct independent nursing research on stroke outcomes.

 

ANS:   A

EBP supports quality initiatives through research into studies and evidence and transfer of knowledge that supports and confirms policies, procedures, and standards against which practice and patient outcomes can be compared.

 

REF:    Pages 211, 212                        TOP:    AONE competency: Professionalism

 

  1. As part of an information technology implementation team, you are implementing a clinical decision support system. Particular considerations for successful implementation of this project include:
a. Ensuring that the system is reliable.
b. Ensuring that patient information is reliable.
c. Developing unique identifiers for individuals.
d. Developing rules that support inferences.

 

ANS:   D

Clinical decision support systems provide support for novice nurses, in particular, as they enable entry of real-time data from patient situations and inferences that apply the logic that expert nurses would use. These inferences require rules to be developed for the system.

 

REF:    Pages 209, 201

TOP:    AONE competency: Communication and Relationship-Building

 

MULTIPLE RESPONSE

 

  1. As a nurse manager, you want to institute point-of-care devices on your unit. The rationale that you provide to support the point-of-care devices includes (select all that apply):
a. Reduction in incidents of medication error.
b. Immediate documentation of care.
c. Immediate summons for bedside help.
d. Better fit with nursing workflow.

 

ANS:   A, B, C

Point-of-care devices that allow documentation of assessment, care, and teaching at the bedside reduce the gap in time between care and documentation, thereby reducing error, increasing accuracy, and improving communication of care, as well as fitting better with nursing workflow.

 

REF:    Pages 205, 206                        TOP:    AONE competency: Business Skills