ANSWERS | GRADED A+| PASS ON FIRST ATTEMPT | BRAND NEW
1. A new graduate nurse, Jenny, approaches you and states she needs help removing a
peripherally inserted central catheter (PICC). Which of the following is the best response
when acting as a horizontal leader?
A. Remove the PICC yourself
B. Tell Jenny to find the policy and then remove the PICC
C. Help Jenny find the policy and review it with her. Coach Jenny while she removes the PICC
and provide feedback
D. Help Jenny find the policy and refer her to a nurse with 12 years of experience for
assistance - ANSWER Answer C—Rationale: The clinical nurse leader (CNL) acts as a
horizontal leader by helping the new graduate nurse to learn through sharing knowledge
and coaching, rather than doing the task for the nurse.
2. What organizational theory is used with rapid, unpredictable, and constant change?
A. Systems theory
B. Chaos theory
C. Change theory
D. Traditional theory - ANSWER Answer B—Rationale: Chaos theory is used to
understand rapidly changing, unpredictable health care environments.
3. A 65-year-old African American male was admitted to your microsystem with
hyperglycemia. The patient has a history of hypertension, gout, obesity, and smoking. The
patient has a family history of diabetes and hypertension. Which statement by the patient
demonstrates his understanding of modifiable risk factors for diabetes?
A. "As I get older, my risk for diabetes increases."
1
,B. "I know that a family history of diabetes is a risk factor, so I will educate my children on
diabetes prevention."
C. "I will keep a record of all my blood sugars to take to my doctor's appointments."
D. "I will attend a smoking cessation class, because I know smoking increases my risk for
diabetes." - ANSWER Answer D—Rationale: Modifiable risk factors are lifestyle factors
that a person can alter in order to prevent disease. Smoking cessation class is an
intervention for modifying the risk factor of smoking.
4. Your hospital is currently trialing the integration of the clinical nurse leader (CNL) role. At
the', 'end of the trial implementation period how can you, as the CNL, best illustrate the
effectiveness of your role during this trial?
A. Refer to increased patient satisfaction scores over the course of the trial
B. Present data that demonstrates the effect of the CNL and outcomes achieved over the
course of the trial
C. Present a list of projects and tasks completed over the course of the trial
D. Refer to your performance review over the course of the trial - ANSWER Answer B—
Rationale: The CNL should present the effect and outcomes to illustrate the importance of
the integration of his or her role. Increased patient satisfaction is not necessarily directly
related to the CNL. Presentation of projects and tasks completed does not address
measurable outcomes. Performance review of the individual does not indicate outcomes
were affected.
5. You are a CNL on an oncology unit. Recently, there has been an increase in the number of
catheter- associated urinary tract infections (CAUTIs) on your unit. After shadowing nurses
and aides you observed a variety of practices, techniques, and expectations surrounding
daily catheter care. Your hospital does not have a current policy or procedure regarding
catheter care. As the CNL, what should you do next?
A. Review current evidence for catheter care practice and disseminate evidence to the staff
B. Form an interdisciplinary team meeting to evaluate current hospital catheter care policies
C. Create a rubric for educating patients and staff on catheter care
2
,D. Discuss with the unit manager the clinical issue and create a set of evidence-based unit
expectations and practices for the oncology unit. Evaluate the need to address this issue
with a hospital-wide policy or procedure - ANSWER Answer D—Rationale: CNLs should
gather and disseminate evidence to solve clinical problems; however, that should not be the
initial step. Further review of hospital practices and policies may come after this issue is
addressed. Creation of a rubric for educating patients and staff on catheter care may come
after reviewing evidence. The CNL should act to solve the clinical issue in the short term, and
evaluate the need for a larger policy to address gaps in practice hospital-wide.
6. A 50-year-old woman with a history of stage 3 chronic obstructive pulmonary disease
(COPD) presents to the emergency department (ED) with increased shortness of breath.
Based on your lab results, what is the acid-base disorder?
Labs as follows: pH 7.25 PaCO2 50 mmHg HCO3 22 mEq/L PO2 75 SpO2 88% Na + 136 BUN
18
A. Uncompensated respiratory acidosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Uncompensated respiratory acidosis - ANSWER Answer A—Rationale: Based on the
clinical scenario, the pH is decreased (less than 7.35); therefore, the patient has acidosis. The
PaCO2 is elevated (more than 45 mmHg), which is also consistent with the pH.', 'The HCO3 is
within normal limits, which suggests the kidneys are not compensating. COPD is commonly
associated with respiratory acidosis.
7. A CNL evaluates a 17-year-old patient who has been a victim of rape. The patient has
visible bruising and a head laceration. After the CNL's assessment, law enforcement officials
have contacted the CNL requesting information regarding the attack and the visible injuries
seen during the visit. The CNL knows she must first:
A. Take pictures and complete the rape kit
B. Provide law enforcement with a record as requested
C. Call the patient's parents first
3
, D. Explain to the patient in order to obtain consent for release of records - ANSWER
Answer D—Rationale: Legally, there must be consent from the patient to share information
with law enforcement and to abide by Health Insurance Portability and Accountability Act
(HIPAA) regulations.
8. A CNL in the neonatal intensive care unit (NICU) is collecting data on the hours worked
weekly by the staff nurses. The CNL wants to see if there is a normal distribution of hours
worked. What technique is the best to display the distribution of the data collected?
A. Run chart
B. Fishbone chart
C. Failure modes and effects analysis (FMEA) chart
D. Histogram chart - ANSWER Answer D—Rationale: Histogram is a graphical
representation, showing a visual impression of the distribution of data.
9. Your pediatric oncology unit is considering the implementation of a social/activity
program for child clients that would provide volunteer social interactions and age-
appropriate activities to admitted clients. As the CNL for this unit, you recognize this
intervention as a way to:
A. Be helpful to the floor staff by distracting clients
B. Be a wasteful expenditure
C. Meet the psychosocial needs of clients
D. Prevent poor client experience ratings on discharge surveys - ANSWER Answer C—
Rationale: While social interaction and activities may provide distraction to clients and
prevent poor client experiences, such a program would most importantly meet the holistic
needs of young clients that may otherwise be neglected during a lengthy hospital stay. They
also act to integrate such services with the medical care being delivered, meeting the CNL's
call to develop and integrate services across settings in a holistic manner.
10. When assessing a new microsystem, the CNL will often use a tool known as the "5 Ps." As
a CNL, you recognize the "5 Ps" to include are:
4
1. A new graduate nurse, Jenny, approaches you and states she needs help removing a
peripherally inserted central catheter (PICC). Which of the following is the best response
when acting as a horizontal leader?
A. Remove the PICC yourself
B. Tell Jenny to find the policy and then remove the PICC
C. Help Jenny find the policy and review it with her. Coach Jenny while she removes the PICC
and provide feedback
D. Help Jenny find the policy and refer her to a nurse with 12 years of experience for
assistance - ANSWER Answer C—Rationale: The clinical nurse leader (CNL) acts as a
horizontal leader by helping the new graduate nurse to learn through sharing knowledge
and coaching, rather than doing the task for the nurse.
2. What organizational theory is used with rapid, unpredictable, and constant change?
A. Systems theory
B. Chaos theory
C. Change theory
D. Traditional theory - ANSWER Answer B—Rationale: Chaos theory is used to
understand rapidly changing, unpredictable health care environments.
3. A 65-year-old African American male was admitted to your microsystem with
hyperglycemia. The patient has a history of hypertension, gout, obesity, and smoking. The
patient has a family history of diabetes and hypertension. Which statement by the patient
demonstrates his understanding of modifiable risk factors for diabetes?
A. "As I get older, my risk for diabetes increases."
1
,B. "I know that a family history of diabetes is a risk factor, so I will educate my children on
diabetes prevention."
C. "I will keep a record of all my blood sugars to take to my doctor's appointments."
D. "I will attend a smoking cessation class, because I know smoking increases my risk for
diabetes." - ANSWER Answer D—Rationale: Modifiable risk factors are lifestyle factors
that a person can alter in order to prevent disease. Smoking cessation class is an
intervention for modifying the risk factor of smoking.
4. Your hospital is currently trialing the integration of the clinical nurse leader (CNL) role. At
the', 'end of the trial implementation period how can you, as the CNL, best illustrate the
effectiveness of your role during this trial?
A. Refer to increased patient satisfaction scores over the course of the trial
B. Present data that demonstrates the effect of the CNL and outcomes achieved over the
course of the trial
C. Present a list of projects and tasks completed over the course of the trial
D. Refer to your performance review over the course of the trial - ANSWER Answer B—
Rationale: The CNL should present the effect and outcomes to illustrate the importance of
the integration of his or her role. Increased patient satisfaction is not necessarily directly
related to the CNL. Presentation of projects and tasks completed does not address
measurable outcomes. Performance review of the individual does not indicate outcomes
were affected.
5. You are a CNL on an oncology unit. Recently, there has been an increase in the number of
catheter- associated urinary tract infections (CAUTIs) on your unit. After shadowing nurses
and aides you observed a variety of practices, techniques, and expectations surrounding
daily catheter care. Your hospital does not have a current policy or procedure regarding
catheter care. As the CNL, what should you do next?
A. Review current evidence for catheter care practice and disseminate evidence to the staff
B. Form an interdisciplinary team meeting to evaluate current hospital catheter care policies
C. Create a rubric for educating patients and staff on catheter care
2
,D. Discuss with the unit manager the clinical issue and create a set of evidence-based unit
expectations and practices for the oncology unit. Evaluate the need to address this issue
with a hospital-wide policy or procedure - ANSWER Answer D—Rationale: CNLs should
gather and disseminate evidence to solve clinical problems; however, that should not be the
initial step. Further review of hospital practices and policies may come after this issue is
addressed. Creation of a rubric for educating patients and staff on catheter care may come
after reviewing evidence. The CNL should act to solve the clinical issue in the short term, and
evaluate the need for a larger policy to address gaps in practice hospital-wide.
6. A 50-year-old woman with a history of stage 3 chronic obstructive pulmonary disease
(COPD) presents to the emergency department (ED) with increased shortness of breath.
Based on your lab results, what is the acid-base disorder?
Labs as follows: pH 7.25 PaCO2 50 mmHg HCO3 22 mEq/L PO2 75 SpO2 88% Na + 136 BUN
18
A. Uncompensated respiratory acidosis
B. Metabolic acidosis
C. Respiratory acidosis
D. Uncompensated respiratory acidosis - ANSWER Answer A—Rationale: Based on the
clinical scenario, the pH is decreased (less than 7.35); therefore, the patient has acidosis. The
PaCO2 is elevated (more than 45 mmHg), which is also consistent with the pH.', 'The HCO3 is
within normal limits, which suggests the kidneys are not compensating. COPD is commonly
associated with respiratory acidosis.
7. A CNL evaluates a 17-year-old patient who has been a victim of rape. The patient has
visible bruising and a head laceration. After the CNL's assessment, law enforcement officials
have contacted the CNL requesting information regarding the attack and the visible injuries
seen during the visit. The CNL knows she must first:
A. Take pictures and complete the rape kit
B. Provide law enforcement with a record as requested
C. Call the patient's parents first
3
, D. Explain to the patient in order to obtain consent for release of records - ANSWER
Answer D—Rationale: Legally, there must be consent from the patient to share information
with law enforcement and to abide by Health Insurance Portability and Accountability Act
(HIPAA) regulations.
8. A CNL in the neonatal intensive care unit (NICU) is collecting data on the hours worked
weekly by the staff nurses. The CNL wants to see if there is a normal distribution of hours
worked. What technique is the best to display the distribution of the data collected?
A. Run chart
B. Fishbone chart
C. Failure modes and effects analysis (FMEA) chart
D. Histogram chart - ANSWER Answer D—Rationale: Histogram is a graphical
representation, showing a visual impression of the distribution of data.
9. Your pediatric oncology unit is considering the implementation of a social/activity
program for child clients that would provide volunteer social interactions and age-
appropriate activities to admitted clients. As the CNL for this unit, you recognize this
intervention as a way to:
A. Be helpful to the floor staff by distracting clients
B. Be a wasteful expenditure
C. Meet the psychosocial needs of clients
D. Prevent poor client experience ratings on discharge surveys - ANSWER Answer C—
Rationale: While social interaction and activities may provide distraction to clients and
prevent poor client experiences, such a program would most importantly meet the holistic
needs of young clients that may otherwise be neglected during a lengthy hospital stay. They
also act to integrate such services with the medical care being delivered, meeting the CNL's
call to develop and integrate services across settings in a holistic manner.
10. When assessing a new microsystem, the CNL will often use a tool known as the "5 Ps." As
a CNL, you recognize the "5 Ps" to include are:
4
