Clinical Nurse Leader (CNL) Certification
Review Questions - King & Gerard
(Answered With Rationale)
Patient satisfaction scores in emergency department have shown a downward trend
over the past three quarters. As a clinical nurse leader in ED focus is to:
A) Create a script for triage nurse in welcoming the patient
B) Assign a volunteer to welcome patients to the hospital
C) Compare desired outcomes with national & state standards
D) Write a letter of apology to each dissatisfied patient
C) Compare desired outcomes with national & State standards
Rationale: Client care outcomes are a measure of quality practice. CNLs must know
how to compare desired outcomes that will improve safety, effectiveness, timeliness,
efficiency, quality, and the degree to which they are client centered.
Which of the following actions illustrates the CNL professional value of altruism?
A) Leading an interdisciplinary team looking at the remote cardiac monitoring process
B) Sponsoring a meeting with the monitor technicians to understand their barriers in the
cardiac monitoring process
C) Flow mapping the admission process of the remote cardiac-monitored patient
D) Editing the policy for the remote cardiac monitoring process.
B) Sponsoring a meeting with the monitor technicians to understand their barriers in the
cardiac monitoring process
Rationale: Altruism is a concern for the welfare & well-being of others. In professional
practice, altruism is reflected by the CNL's concern for the welfare of clients, other
nurses, and other health care providers.
You are a CNL on the tele unit & orienting a newly graduated nurse. Critical thinking is
best demonstrated when:
A) The CNL discusses with the physician the rationale for discontinuing cardiac
monitoring in the hospice patient
B) Drawing the scheduled cardiac enzymes q8h
Reviewing the patient care guidelines & protocols related to hourly rounding
D) The CNL balances both the charge role & the preceptor role simultaneously
A) The CNL discusses with the physician the rationale for discontinuing cardiac
monitoring in the hospice patient
Rationale: Critical thinking underlies independent & interdependent decision making.
Critical thinking includes questioning, analysis, synthesis, interpretation, inference,
inductive & deductive reasoning, intuition, application, & creativity.
You are a CNL selected to lead a team focused on implementing a multidisciplinary
clinical pathway for acute ischemic stroke & transient ischemic attack. The risk
assessment tool that you have adopted identifies all of the following as independent
stroke risk factors except:
,A) Age
B) Systolic BP
C) Liver dysfunction
D) Current smoking
E) Diabetes mellitus
C) Liver Dysfunction
Rationale: Independent stroke predictors include age, systolic BP, hypertension,
diabetes mellitus, current smoking, established cardiovascular disease (any one of
myocardiac infarction, angina, coronary insufficiency, congestive heart failure, or
intermittent claudication), Afib, & left ventricular hypertrophy on ECG.
A lack of compliance with DVT prophylaxis has been identified in retrospective chart
reviews of all ischemic stroke patients in your organization. As a CNL on the
neurological unit, your primary goal will include:
A) Challenging the guidelines on primary prevention of ischemic stroke written by the
American Stroke Association
B) Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient
on your unit
C) Developing an organization-wide educational program on DVT prophylaxis
D) Developing a unit-based team of nursing personnel to investigate the problem.
B) Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient
on your unit.
Rationale:
White Paper: One competency is that of a systems analyst. A CNL participates in a
system review & conducts a microsystem analysis, identifying a clinical issue with a
focus on a particular population.
You are working on improving the patient discharge process. Which of these targets
would best reflect clinical microsystem outcomes?
A) Hospital length of stay
B) Time of discharge order for all medical patients to the actual time the patient left
C) Number of discharge orders on your unit entered before 11am
D) Total number of discharged patients leaving by llam
C) Number of discharge orders on your unit entered before 11am
Rationale: A CNL as an outcomes manager uses data to change practice & to improve
outcomes. Selecting the most appropriate goals & targets will provide meaningful
information.
Electronic nursing documentation has recently been instituted in organization. Select a
response that best defines a clinical decision support:
A) A reminder to save & sign your admission assessment
B) A visual red-alert when a patient's potassium is 6..8 mEq/L
C) A pop-up to initiate the discharge instruction sheet with every physician discharge
order
D) An electronic nursing care plan
C) A pop-up to initiate the discharge instruction sheet with every physician discharge
order.
Rationale: CDS is a computer-based program designed to assist clinicians in making
,clinical decisions by filtering & integrating vast amounts of information & providing
suggestions for clinical intervention.
CNL focus on projects within a clinical microsystem. A clinical microsystem can be best
described as:
A) A department-wide program focused on improving continuity of care & patient
satisfaction
B) Trending the post-op care on all surgical units
C) The clinical & business processes of a single unit within an organization
D) All medical & surgical units guided by a chief nursing officer
C) The clinical & business processes of a single unit within an organization
Rationale: The microsystem is described by the AACN White Paper as the practice level
of the CNL.
All are part of the data necessary for a CNL to fully understand & assess his or her
clinical unit except:
A) The organization financial statement
B) The target population & age distribution
C) The percentage of FTEs
D) Rate of nosocomial infections
E) Fall rates
A) The organization financial statement
Rationale: A comprehensive assessment of the clinical unit is a foundation for the work
of the CNL but does not include the financial statement of the organization. In
comprehending the "big picture" of the organization, the CNL should have an
understanding of the financial health of the institution.
The results of a quarterly report identify an increase in patient falls on the tele unit. Your
first action will be to:
A) Implement hourly rounding
B) Gain an understanding of patient care practices on the tele unit
C) Assign patient personal alarms to all patients at risk
D) Revise the current fall risk documentation form
B) Gain an understanding of patient care practices on the tele unit
Rationale: Assessment includes gathering information about the health status of the
client & analyzing & synthesizing those making judgments about nursing interventions
on the basis of findings, evaluation, & managing of individual care outcomes.
You have been asked to lead the tele fall prevention committee. Which combination of
team members would best suit the initial phase of this group?
A) A behavioral health APRN
B) A staff RN
C) A physical therapist
D) The nurse manager
E) All of the Above
F) Only A, B, & D are needed
E) All of the above
Rationale: Health promotion & disease prevention knowledge includes methods to keep
an illness or injury from occurring, diagnosis, & treating a disease in its early course.
CNLs need to work with an interdisciplinary team to make ethical decisions, develop, &
, monitor comprehensive, holistic plans of care. There is a strong correlation between
patient falls & delirium. Exercise programs focused on strength, functional performance,
& balance training are effective steps in reducing inpatient falls.
As a CNL in the ICU, you have observed several prolonged & fragmented processes of
starting an IV line in a critically ill patient. All of the following considerations are
necessary in identifying a THEME for your improvement process except:
A) A thorough review of the clinical unit
B) The manager's mandate for change
C) The alignment with the organization's strategic priorities
D) Input from the patient's family
B) The manager's mandate for change
Rationale: Specific mandates for change would be considered as the team "drills down"
for further information.
The hospital is looking to utilize cardiac monitor watchers. Your analysis includes all of
the following except:
A) A review of an online ECG monitoring education program
B) Identifying a clinical issue with a focus on a specific population
C) Conducting a trend analysis of outcome data
D) Analyzing barriers & facilitators with the organization
A) A review of an online ECG monitoring education program
Rationale: Systems analysis & risk anticipation are the competencies of the CNL.
Several near misses were identified by ICU nurses who had mistaken invasive lines for
IV ports for medication administration. You have completed an analysis for the issue.
Your recommendations include:
A) A visual signal on all ports not intended for IV drugs
B) A double-check system for medication administration
C) To facilitate a critical incident reporting structure that fosters a "without blame) unit
culture
D) All of the Above
E) Only C
D) All of the above
Rationale: The CNL should support the staff to identify all opportunities for improving
safety in this situation.
Data reported by ICU quality committee reflect challenges in the management of the
septic patient. As a CNL in the ICU, all of the following are first steps in evaluating the
delivery of client care except:
A) Knowledge of sepsis guidelines
B) Critical care clinicians staffing ratios
C) Use of clinical decision support systems
D) Differentiating sepsis from systemic inflammatory response syndrome (SIRS)
D) Differentiating sepsis from systemic inflammatory response syndrome (SIRS)
Rationale: Nursing leadership & advocacy reviews & evaluates care guidelines &
protocols
A fellow staff nurse is struggling to understand the use of a clinical decision support
system (CDSS) in the management of her septic patient. Your initial teaching strategy
includes:
Review Questions - King & Gerard
(Answered With Rationale)
Patient satisfaction scores in emergency department have shown a downward trend
over the past three quarters. As a clinical nurse leader in ED focus is to:
A) Create a script for triage nurse in welcoming the patient
B) Assign a volunteer to welcome patients to the hospital
C) Compare desired outcomes with national & state standards
D) Write a letter of apology to each dissatisfied patient
C) Compare desired outcomes with national & State standards
Rationale: Client care outcomes are a measure of quality practice. CNLs must know
how to compare desired outcomes that will improve safety, effectiveness, timeliness,
efficiency, quality, and the degree to which they are client centered.
Which of the following actions illustrates the CNL professional value of altruism?
A) Leading an interdisciplinary team looking at the remote cardiac monitoring process
B) Sponsoring a meeting with the monitor technicians to understand their barriers in the
cardiac monitoring process
C) Flow mapping the admission process of the remote cardiac-monitored patient
D) Editing the policy for the remote cardiac monitoring process.
B) Sponsoring a meeting with the monitor technicians to understand their barriers in the
cardiac monitoring process
Rationale: Altruism is a concern for the welfare & well-being of others. In professional
practice, altruism is reflected by the CNL's concern for the welfare of clients, other
nurses, and other health care providers.
You are a CNL on the tele unit & orienting a newly graduated nurse. Critical thinking is
best demonstrated when:
A) The CNL discusses with the physician the rationale for discontinuing cardiac
monitoring in the hospice patient
B) Drawing the scheduled cardiac enzymes q8h
Reviewing the patient care guidelines & protocols related to hourly rounding
D) The CNL balances both the charge role & the preceptor role simultaneously
A) The CNL discusses with the physician the rationale for discontinuing cardiac
monitoring in the hospice patient
Rationale: Critical thinking underlies independent & interdependent decision making.
Critical thinking includes questioning, analysis, synthesis, interpretation, inference,
inductive & deductive reasoning, intuition, application, & creativity.
You are a CNL selected to lead a team focused on implementing a multidisciplinary
clinical pathway for acute ischemic stroke & transient ischemic attack. The risk
assessment tool that you have adopted identifies all of the following as independent
stroke risk factors except:
,A) Age
B) Systolic BP
C) Liver dysfunction
D) Current smoking
E) Diabetes mellitus
C) Liver Dysfunction
Rationale: Independent stroke predictors include age, systolic BP, hypertension,
diabetes mellitus, current smoking, established cardiovascular disease (any one of
myocardiac infarction, angina, coronary insufficiency, congestive heart failure, or
intermittent claudication), Afib, & left ventricular hypertrophy on ECG.
A lack of compliance with DVT prophylaxis has been identified in retrospective chart
reviews of all ischemic stroke patients in your organization. As a CNL on the
neurological unit, your primary goal will include:
A) Challenging the guidelines on primary prevention of ischemic stroke written by the
American Stroke Association
B) Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient
on your unit
C) Developing an organization-wide educational program on DVT prophylaxis
D) Developing a unit-based team of nursing personnel to investigate the problem.
B) Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient
on your unit.
Rationale:
White Paper: One competency is that of a systems analyst. A CNL participates in a
system review & conducts a microsystem analysis, identifying a clinical issue with a
focus on a particular population.
You are working on improving the patient discharge process. Which of these targets
would best reflect clinical microsystem outcomes?
A) Hospital length of stay
B) Time of discharge order for all medical patients to the actual time the patient left
C) Number of discharge orders on your unit entered before 11am
D) Total number of discharged patients leaving by llam
C) Number of discharge orders on your unit entered before 11am
Rationale: A CNL as an outcomes manager uses data to change practice & to improve
outcomes. Selecting the most appropriate goals & targets will provide meaningful
information.
Electronic nursing documentation has recently been instituted in organization. Select a
response that best defines a clinical decision support:
A) A reminder to save & sign your admission assessment
B) A visual red-alert when a patient's potassium is 6..8 mEq/L
C) A pop-up to initiate the discharge instruction sheet with every physician discharge
order
D) An electronic nursing care plan
C) A pop-up to initiate the discharge instruction sheet with every physician discharge
order.
Rationale: CDS is a computer-based program designed to assist clinicians in making
,clinical decisions by filtering & integrating vast amounts of information & providing
suggestions for clinical intervention.
CNL focus on projects within a clinical microsystem. A clinical microsystem can be best
described as:
A) A department-wide program focused on improving continuity of care & patient
satisfaction
B) Trending the post-op care on all surgical units
C) The clinical & business processes of a single unit within an organization
D) All medical & surgical units guided by a chief nursing officer
C) The clinical & business processes of a single unit within an organization
Rationale: The microsystem is described by the AACN White Paper as the practice level
of the CNL.
All are part of the data necessary for a CNL to fully understand & assess his or her
clinical unit except:
A) The organization financial statement
B) The target population & age distribution
C) The percentage of FTEs
D) Rate of nosocomial infections
E) Fall rates
A) The organization financial statement
Rationale: A comprehensive assessment of the clinical unit is a foundation for the work
of the CNL but does not include the financial statement of the organization. In
comprehending the "big picture" of the organization, the CNL should have an
understanding of the financial health of the institution.
The results of a quarterly report identify an increase in patient falls on the tele unit. Your
first action will be to:
A) Implement hourly rounding
B) Gain an understanding of patient care practices on the tele unit
C) Assign patient personal alarms to all patients at risk
D) Revise the current fall risk documentation form
B) Gain an understanding of patient care practices on the tele unit
Rationale: Assessment includes gathering information about the health status of the
client & analyzing & synthesizing those making judgments about nursing interventions
on the basis of findings, evaluation, & managing of individual care outcomes.
You have been asked to lead the tele fall prevention committee. Which combination of
team members would best suit the initial phase of this group?
A) A behavioral health APRN
B) A staff RN
C) A physical therapist
D) The nurse manager
E) All of the Above
F) Only A, B, & D are needed
E) All of the above
Rationale: Health promotion & disease prevention knowledge includes methods to keep
an illness or injury from occurring, diagnosis, & treating a disease in its early course.
CNLs need to work with an interdisciplinary team to make ethical decisions, develop, &
, monitor comprehensive, holistic plans of care. There is a strong correlation between
patient falls & delirium. Exercise programs focused on strength, functional performance,
& balance training are effective steps in reducing inpatient falls.
As a CNL in the ICU, you have observed several prolonged & fragmented processes of
starting an IV line in a critically ill patient. All of the following considerations are
necessary in identifying a THEME for your improvement process except:
A) A thorough review of the clinical unit
B) The manager's mandate for change
C) The alignment with the organization's strategic priorities
D) Input from the patient's family
B) The manager's mandate for change
Rationale: Specific mandates for change would be considered as the team "drills down"
for further information.
The hospital is looking to utilize cardiac monitor watchers. Your analysis includes all of
the following except:
A) A review of an online ECG monitoring education program
B) Identifying a clinical issue with a focus on a specific population
C) Conducting a trend analysis of outcome data
D) Analyzing barriers & facilitators with the organization
A) A review of an online ECG monitoring education program
Rationale: Systems analysis & risk anticipation are the competencies of the CNL.
Several near misses were identified by ICU nurses who had mistaken invasive lines for
IV ports for medication administration. You have completed an analysis for the issue.
Your recommendations include:
A) A visual signal on all ports not intended for IV drugs
B) A double-check system for medication administration
C) To facilitate a critical incident reporting structure that fosters a "without blame) unit
culture
D) All of the Above
E) Only C
D) All of the above
Rationale: The CNL should support the staff to identify all opportunities for improving
safety in this situation.
Data reported by ICU quality committee reflect challenges in the management of the
septic patient. As a CNL in the ICU, all of the following are first steps in evaluating the
delivery of client care except:
A) Knowledge of sepsis guidelines
B) Critical care clinicians staffing ratios
C) Use of clinical decision support systems
D) Differentiating sepsis from systemic inflammatory response syndrome (SIRS)
D) Differentiating sepsis from systemic inflammatory response syndrome (SIRS)
Rationale: Nursing leadership & advocacy reviews & evaluates care guidelines &
protocols
A fellow staff nurse is struggling to understand the use of a clinical decision support
system (CDSS) in the management of her septic patient. Your initial teaching strategy
includes:
