Collaboration, Accountability, Ethics, Health Policy, Advocacy, Quality Improvement Test 5

Collaboration, Accountability, Ethics, Health Policy, Advocacy, Quality Improvement Test 5 When performing collaborative health care, the nurse must implement which of the following? A. Delegate decision-making authority to each health care provider B. Assume a leadership role in directing the health care team C. Be physically present for the implementation of all aspects of the care plan D. Rely on the expertise of other health care team members - Correct Answer D In collaboration, each member of the team, including the client, participates in sharing ideas and reaching consensus on the best plan of care. The team is generally led by the health care professional most skilled in the client's specific areas of need. Once the plan is established, it may be implemented by any member of the team or a designate at an appropriate time or place. The primary care physician has recommended to the nurse that the client be discharged to a rehabilitation center for further care. The nurse discusses the recommendation with the family and client, who decide that this is not what they want to do. The nurse's next action is to: A. Notify the case manager that the family is noncompliant B. Discuss available acceptable options with the family C. Notify the physician about the family's decision D. Tell the family that this is the physician's order - Correct Answer B The family and client are a part of the collaborative team. If the family does not favor a recommendation, the nurse explores other options open to the client, such as home health care, and then communicates the client's wishes to the team. A nurse is having difficulty with a particular product that is needed to care for a client. The nurse asks a more experienced colleague to suggest ways to use the product appropriately. This is an example of: A. Line authority B. Chain of command C. Staff authority D. Nursing responsibility - Correct Answer C Staff authority is an advisory. In this case, the more experienced nurse offers advice to the nurse who is having difficulty with a product. The home health nurse is visiting an 86-year-old client who weighs 96 pounds to assess the client's postoperative progress. The nurse observes the aide giving a bath and notes that the aide puts powder in the folds of the perineal area. To promote a collaborative setting, the nurse would: A. Report the aide to the agency B. Report the aide to the physician C. Take the aide aside and teach the appropriate skin care D. Ask the family to request another aide - Correct Answer C The role of the nurse in this instance is one of a teacher. The nurse cannot assume that the aide was or was not taught appropriately, and would take the aide aside and gently explain appropriate care for this client. This action puts the client in the center of the team and promotes collaboration A 73-year-old client is in the hospital for pneumonia for the third time in 6 months. During the nursing history, the nurse discovers that the client has few financial resources, lives alone, and has not received needed immunizations. To provide excellence in care, the nurse should: A. Tell the client of the need to move to long-term care B. Request consultations with other disciplines C. Recommend that the client remain in the hospital until wee D. Request an order from the physician for long-term care - Correct Answer B Many older adults choose to remain in their own homes to care for themselves. In today's world, the nurse recognizes that with the proper resources, this is a possibility. The nurse might request a social worker and a nutritionist to help the client with home care resources, and might also ask the physician for the appropriate immunizations. The nurse is working in a busy pediatric ICU. Several of the nurses on the unit are interested, at the request of parents, in changing the rules to allow families to be present in a code situation for their child. The nurse are afraid to speak their minds openly because some of the doctors do not support the change and the nurses do not want to cause hard feelings. The nurse manager suggests a meeting of all concerned and might use which of the following to help with decision making? A. Have group members present concerns and questions on paper B. Present both sides of the argument to the group members C. Ask the nurses t present their changes D. Ask the members to be open minded - Correct Answer A Nurses and doctors have a function as a team for the benefit of the client. Using the nominal group technique has the benefit of members submitting their ideas privately, which can help decrease friction in the group as a whole. The home health nurse has made a visit to a client who is receiving several therapies by health team members in the home for arthritis and postoperative care. Upon return to the home health office, the nurse plans to: A. Review the cases for the next day B. Communicate the client's status to the rest of the team C. Report to the manager D. Call the client to reinforce teaching - Correct Answer B Since the client is receiving several therapies, the nurse would communicate with team members regarding the client's current status and progress in collaboration. A nurse educator is explaining the difference between groups and teams. What are some of the specific characteristics of teams that the nurse identifies. (Select all that apply) A. Task completion is delegated to individuals B. Team members are only individually accountable C. A team is a specialized type of group D. Team members have a variety of goals E. Teams have a flexible hierarchy - Correct Answer C,E In a team, task completion and product creation are collaborative in nature, as opposed to being delegated to individuals. A team comprises individuals who agree to work in tandem to accomplish a common goal. A nurse is forming an intradisciplinary team to help implement electronic records. Who might be requested to join the team? (Select all that apply) A. A hospital administrator B. An orthopedic surgeon C. A nurse supervisor D. A hospital records supervisor E. A nurse anesthesiologist - Correct Answer C,E Intradisciplinary teams are formed by members of the same profession who work toward achieving a common goal. Only nurses would be part of an intra disciplinary nursing team. A 73-year-old client is being discharged following knee replacement surgery. The home health care nurse is forming an interdisciplinary collaborative team to provide care for the client. What would be some characteristics of this team? (Select all that apply) A. Decisions are made by the treatment team B. There is limited communication among team members C. A physician will make all the treatment decisions D. Individual members of the team participate in the overall treatment planning E. The physical therapist would be the leader - Correct Answer A,D Members of the multidisciplinary team set goals and develop client treatment plans in a more autonomous fashion. In a multidisciplinary team approach, a single team member-usually a physician-makes the treatment decisions. What are some of the benefits of interdisciplinary teams? (Select all that apply) A. Greater emphasis on individual expertise B. Fewer omissions C. Redundancy D. Greater effectiveness E. Physician satisfaction - Correct Answer B,D Less redundancy is a benefit of interdisciplinary teams. Some physicians may be opposed to interdisciplinary collaboration and prefer physician led treatment. Interdisciplinary teams emphasize each individual's contribution to the joint planning and accomplishment of client goals, as opposed to placing emphasis on each individual team member's area of professional expertise A nurse is forming a team responsible for school based care. Identify some of the disciplines that might be appropriate for this team. (Select all that apply) A. School secretary B. Social worker C. Nurse D. School bus driver E. Cafeteria supervisor F. Teacher - Correct Answer B,C,F Although information provided by those who have regular contact with students, such as school secretaries, cafeteria supervisors and bus drivers, may be useful in team planning, they do not bring expertise that contributes to a team's planning and treatment process. Social workers can contribute case management and mental health skills to the interdisciplinary team. Teachers can contribute perspective and knowledge about a student's cognitive and social functioning. School nurses can contribute knowledge and skills on physical and mental health issues A nurse is a member of a community team formed to support and treat individuals with serious mental illnesses. Who might also be part of this team? (Select all that apply) A. Paralegal B. Employment specialist C. Physical therapist D. Psychiatrist E. Speech therapist - Correct Answer B,D Although some individuals may require speech services, physical therapy, or paralegal consultation, these are not services expected as a regular part of a community support team for clients with mental illness. Employment specialists can provide vocational guidance and placement services. A psychiatrist can provide medication management to the team's efforts Nursing is gaining recognition as a profession. A profession is generally distinguished from other kinds of occupations by: (Select all that apply) A. Short, quick training to acquire a body of knowledge B. Employee satisfaction C. A code of ethics D. Ongoing research E. Use of medical terminology F. A professional organization - Correct Answer C,D,F A profession is generally distinguished from other kinds of occupations by its requirement of prolonged, specialized training to acquire a body of knowledge that supports the role to be performed, ongoing research, a code of ethics, and a professional organization. Specific professional nursing values are located in: (Select all that apply) A. Patient bill of rights B. Nursing values are moral in nature and are unwritten C. Standards of Nursing Practice D. Nursing Codes of Ethics E. The legal system F. Hospital's Policy and Procedure Manual - Correct Answer C,D,E Specific professional nursing values are stated in nursing codes of ethics, in standards of nursing practice, and in the legal system itself. The Bachelor of Science in Nursing (BSN) is the usual degree awarded to participants that have taken courses and: A. Successfully completed three years in a hospital-based educational program B. Successfully completed a four- to five-year program that offered courses in liberal arts, sciences, humanities, and nursing C. Successfully completed a basic two-year degree in a community college as an associate of science in nursing D. Successfully completed a nine- to 12-month program and working under the supervision of registered nurses - Correct Answer B The BSN participant has successfully completed a four- to five-year program. According to the ANA Standards of Practice for the Registered Nurse, an entry level nurse is described as: A. Novice B. Expert C. Advance beginner D. Competent - Correct Answer D Entry level into nursing is described as a competent nurse Which goal is universal among every states' nurse practice act? A. Further nursing education B. Obtain continuing education contact hours C. Gain specialization D. Protect the public - Correct Answer D Although nurse practice acts differ in various jurisdictions, they all have a common purpose: to protect the public According to Benner's levels of nursing expertise, which example exemplifies a proficient nurse? A. Perceives a situation as a whole rather than in terms of parts B. Limited and inflexible performance C. Is inclined to take a certain action because "it felt right." D. Demonstrates marginally acceptable performance - Correct Answer A The proficient nurse perceives situations as wholes rather than in terms of parts. Which activity best represents health promotion? A. Giving a bath B. Preventing injuries at home C. Administering immunizations D. Performing diagnostic procedures - Correct Answer B Health promotion focuses on maintaining normal status without consideration of diseases. Continuing education is mandatory within the nursing profession to stay up to date with: A. Cardiac and neurological information B. Scientific and human responses C. Scientific and technological advances D. Supplies and technological advances - Correct Answer C Scientific and technological advances are key factors in keeping abreast with the changing healthcare environment. The nurse, who is opposed to abortion, is asked to give a medication to the client that will terminate the client's pregnancy. Which strategy might help the nurse in this case? A. Refuse to participate in the collaboration regarding this client B. Withhold the medication until the prescribing person arrives C. Have self-awareness of values and beliefs D. Tell the client that taking the medication is immoral - Correct Answer C The nurse must become aware of personal values and the ethical aspects of nursing. The nurse hung a unit of blood on the wrong client, resulting in an anaphylactic reaction in the client. During the resuscitation, the nurse does not reveal that the wrong blood was given. Which moral principle was absent in the nurse's actions? A. Human dignity B. Social justice C. Autonomy D. Veracity - Correct Answer D The moral principle of veracity refers to telling the truth, no matter the outcome. By lying, the nurse jeopardized the health of the client. Which situation is a violation of the underlying principles associated with professional nursing ethics? A. A client reports that he didn't tell the doctor the truth when asked if he was following his therapeutic diet at home B. A nurse colleague states, "I never look up medication indications. I just give what is prescribed." C. The nurses on the unit agree to sponsor a fund-raising event to support a labor strike proposed by fellow nurses at another facility D. The hospital policy permits use of internal fetal monitoring during labor even though there is literature that both supports and refutes the value of this practice - Correct Answer B The nurse has an ethical responsibility to act only when actions are safe or risks minimized. This nurse is putting the client at unnecessary risk for a medication error. A nurse is asked to care for an openly gay client with AIDS. The nurse tells her supervisor that caring for the client is against her religious beliefs. Does this nurse have an ethical obligation to care for the client? A. No, because the client's behavior caused him to contract AIDS B. No, the nurse does not have to violate religious beliefs C. No, it may be distasteful to the nurse D. Yes, unless the risk exceeds the responsibility - Correct Answer D The ethical obligation to care for an HIV-infected client cannot be set aside unless the risk exceeds the responsibility. A 67-year-old male client states that he and his 37-year-old wife would like to have a child. A 23-year-old surrogate will carry the child. Which response by the nurse is most appropriate? A. Why isn't your wife carrying your own child B. You will be 87 when your child is 20 C. You could adopt a child instead D. I will ask out counselor to give you additional information - Correct Answer D A moral framework guides moral decisions, but it does not determine the outcome. The decision is the family's decision, not the nurse's decision. Providing the client and his wife with more information is the most appropriate response. Which action is the most important nursing responsibility when an ethical issue arises? A. Remaining neutral and detached when making ethical decisions B. Following the client and family wishes exactly C. Ensuring that a team is responsible for deciding ethical questions D. Being able to defend the morality of one's own actions - Correct Answer D A nurse's actions in an ethical dilemma must be defensible according to moral and ethical standards. A client asks the nurse not to tell his wife that he has cancer. What would be the most appropriate response by the nurse? A. Why are you afraid to tell her? B. What benefits do you see from not telling your wife your diagnosis? C. I'm sorry, but the doctor already told her D. Don't you think she has a right to know? - Correct Answer B When presented with an ethical situation, identify the moral issues and principles involved. The nurse should discuss the reasons the client does not want his wife to know the diagnosis. This will clarify the benefits the client sees in his decision. A nurse practices beneficence when teaching a class of adolescents about the risks of drinking and driving. Beneficence is best described as: A. Always telling the truth B. The right to self-determination C. Do no harm and safeguard the client D. The actions one takes should promote good - Correct Answer D Beneficence means "the actions one takes should promote good." A nurse teaching a class of adolescents is promoting the health and well-being of the community. The parents of a child with no apparent brain function refuse to permit withdrawal of life support. Which moral principle is applied with the nurse's action to support the family's decision? A. Beneficence B. Justice C. Nonmaleficence D. Respect for autonomy - Correct Answer D Autonomy is the client's right to make his or her own decision. The nurse is obliged to respect a parent's or significant other's informed decision regarding the client. A nurse facing an ethical dilemma knows that decisions should be based on a decision-making model named: A. Redman and Redman B. Thompson and Thompson C. Johnson and Johnson D. Croft and Appleton - Correct Answer B Responsible ethical reasoning is rational and systematic. It should be based on ethical principles and codes rather than on emotions, intuition, fixed policies, or precedent. Two decision-making models include the Thompson and Thompson model and the Cassells and Redman model. A client with cancer has decided against further treatment. Which action by the nurse would be most appropriate? A. Talking to the client and trying to persuade the client to think about reversing the decision B. Informing the client's spouse, and encouraging the spouse to talk to the client and intervene, if necessary C. Making sure the client has accurate information and understands the consequences of the decision D. Accepting the decision and making no comments to the client - Correct Answer C To protect the client effectively, the nurse needs to understand what has influenced the client's decision and whether the client has thought about the results of the decision. A new nurse is assigned to the client who is disappointed by the care given by another nurse. The family of the client asks the new nurse how they can make a formal complaint. The nurse's best action is to: A. Refer them to the nurse manager B. Offer to notify the agency patient advocate C. Refer them to the physician D. Have them contact the risk manager - Correct Answer B Most agencies have patient advocated whose job is to assist the client when conflict arises and to protect the client's rights. The nurse overhears a client on the phone arguing with someone about having the right to choose a healthcare plan. The nurse recognizes that the client's topic is addressed in: A. Medicare bill of rights B. The ANA Code of Ethics C. U.S. Advisory Commission on Consumer Protection D. State law - Correct Answer C The U.S. Advisory Commission on Consumer Protection addresses the client's right to choose a healthcare plan. The client's right to informed consent is mandated in which document? A. American Nurses Association Standards of Practice B. Nurse bill of rights C. Patient Self-Determination Act D. American Nurses Association Code of Ethics - Correct Answer C All clients have certain rights. Some of these are guaranteed by federal law, such as the right to informed consent mandated in the Patient Self-Determination Act. A client notifies the nurse that he feels like his physician has mistreated him and violated his rights. The nurse will refer the client to: A. The patient advocate to ensure that the client's rights are maintained B. The physician to discuss the client's concerns C. The police to file a report on the physician's behavior D. The house supervisor to ensure that the client's rights are maintained - Correct Answer A Many people encounter what they view as mistreatment or violations of their rights during the course of their experiences in the healthcare system. Many hospitals and large provider agencies have client advocates who can help clients navigate their system and intervene to ensure that their rights are maintained. The experienced nurse understands that a client has both rights and responsibilities regarding their healthcare. The client's healthcare responsibilities include all except: A. Cooperating with the healthcare team B. Answering questions from the healthcare team C. Never refusing treatment recommended by the healthcare team D. Following the treatment plan recommended by the healthcare team - Correct Answer C Most hospitals now publish lists of patient responsibilities, emphasizing that healthcare is a partnership between the patient and caregivers, that other patients have a right to be comfortable too, and that there are consequences if patients don't comply with treatment plans The nurse explains to a group of clients some of the healthcare policy changes that have been made to improve healthcare to clients. The nurse includes which policy change in the explanation? A. Meals on Wheels B. Flu shots given at pharmacies C. Nursing diagnoses D. Mandatory wheelchair ramps at health facilities - Correct Answer D One factor influencing changes in national policy is access to healthcare. Government agencies and health care agencies are required to provide increased access by installing wheelchair ramps for the handicapped. The nurse participating in a research project whose results will eventually affect health policy change. The nurse is taking part in which phase of policy change? A. Formulation phase B. Implementation phase C. Evaluation phase D. Research phase - Correct Answer A The phases of health policy development closely mirror the nursing process. During the formulation phase, data is collected and problems are identified. Which agency would sponsor a program that would meet the needs of a community group deficient in health promotion education? A. State health department B. Local health department C. Local hospital D. Federal government - Correct Answer B The local health department is responsible for developing programs to meet the health needs of the people. Which agency should a nurse consult in order to understand the implications of practicing in a different state than the state the nurse was trained in? A. National League for Nursing (NLN) B. American Nurses Association (ANA) C. National Council of State Boards of Nursing (NCSBN) D. The state's nurse practice act - Correct Answer D Nurse practice acts regulate the practice of nursing in the United States and Canada. Each state and each province has its own act. Nurses are responsible for knowing their state's nurse practice act as it governs their practice. The graduate nurse is interested in continuing education in pediatric oncology. The preceptor encourages the graduate to: A. Attend unit in-services when available B. Join the American Nurses Association (ANA) C. Purchase general nursing magazines D. Join the Association of Pediatric Hematology/Oncology Nurses - Correct Answer D To enhance learning in the chosen field, the preceptor would encourage the nurse to join the Association of Pediatric Hematology/Oncology Nurses. A client is enrolled in an HMO, while their previous experience with healthcare coverage was with a PPO. The client asks the occupational health nurse to explain the difference between the HMO and PPO. The best response by the nurse is: A. You'll have good healthcare benefits, so don't worry B. Your PPO offered you a choice in your healthcare provider as well as services. Now, you will choose a primary care provider who will evaluate our health and will coordinate all of your care C. You really should be happy about the HMO. You'll pay little, if any, out-of-pocket expense D. Both the HMO and PPO are covered by your employer, so it's really not your concern - Correct Answer B HMO plans emphasize wellness, and members choose a primary care provider who evaluates their health status and coordinates their care. Clients are limited in their ability to select healthcare providers and services, but available services are at minimal and predetermined cost to the client. PPOs consist of a group of physicians that provides an insurance company or employer with health services at a discounted rate. Once advantage of the PPO is that it provides clients with a choice of healthcare providers and services A gravely ill client wishes to establish a relationship with a nurse so that the nurse may act as an advocate when the client's health declines. Which goal exemplifies advocating for a client? A. Talk the client out of a decision if it differs from the nurse's opinion B. Report the client's decisions to the family C. Protect the client's rights D. Make decisions for the client - Correct Answer C The nurse advocate must recognize that the rights and values of clients and families take precedence when they conflict with those of health care providers. The nurse must protect the client's rights, remain objective, and intervene on behalf of the client. A home care client is non-compliant with changing his dressing. The nurse's next action will be to: A. Ask the physical therapist to do the dressing change B. Call the primary care provider for new orders that match what the client is doing C. Discuss with the client his personal values and resource allocation needs at home D. Tell the client he will be discharged from home care services if he does not comply - Correct Answer C An advocate supports clients in their decisions, giving them full or at least mutual responsibility in decision making when they are capable of it. The advocate must be careful to remain objective and not convey approval or disapproval of the client's choices. Advocacy requires accepting and respecting the client's right to decide, even if the nurse believes the decision to be wrong. The school nurse identifies a need for a vaccination program in the school district. The nurse is acting in which role? A. Adversary B. Advocate C. Opponent D. Reactionary - Correct Answer B Nurses who function responsible as professional and public advocates are in a position to effect change. To act as an advocate in this arena, the nurse needs an understanding of the ethical issues in nursing and health care, as well as knowledge of the laws and regulations that affect nursing practice and the health of society The family of a dying client is having a difficult time because the client is refusing food and is losing weight. Acting as advocate for the patient, the nurse states: A. Food can actually cause painful problems at the end of life B. The family should force the client to eat C. The family should ignore the issue D. The family should make the client's favorite foods - Correct Answer A Nurses acting as advocates respect their client's choice to make their own decisions. The nurse helps this family best by explaining about food and the dying client. Once the information is available to family members, they can concentrate on the care of the client instead of worrying. A nurse desires career advancement through public advocacy. The nurse plans to: A. Conduct educational classes for the unit respiratory therapists. B. Contact the local congressman about a new health law C. Obtain a master's degree in nursing D. Become a preceptor on the unit - Correct Answer B Political activism is a way for a nurse to become a public advocate. The nurse reads proposed laws and then contacts politicians to give opinions of the impact the new laws will have on healthcare and the public. The nurse oversees care of mentally challenged adult clients who live in a group home but work part time. The funding to transport these clients is being cut. The nurse advocates against this to protect: A. The liability of the house manager B. The job of the nurse C. The dignity of the clients D. The person who drives the van - Correct Answer C Adults with disabilities who work are provided with a sense of dignity. Since the adults cannot advocate for themselves, the nurse would intervene on their behalf. A client in a mental health unit is experiencing escalating agitation. As an advocate for this client, what is the nurse's initial action? A. Take away the privileges the client has earned B. Remove the client to a quieter setting C. Give the client an emergency sedative shot D. Tell the client to calm down immediately - Correct Answer B In an effort to return the client to normal, the nurse removes the client form an over stimulating environment to a quieter area, talking calmly to the client. A nurse acting as a client advocate understands that the values basic to client advocacy includes all except: A. The client has the right to expect a nurse-client relationship that is based on shared respect, trust, and collaboration B. The client is a dependent being who requires a durable power of attorney C. The nurse has the responsibility to ensure the client has access to healthcare services that meet health needs D. The client is a holistic, autonomous being who has the right to make decisions - Correct Answer B Some values basic to client advocacy include: the client is a holistic, autonomous being who has the right to make choices and decisions; the client has the right to expect a nurse-client relationship that is based on shared respect, trust, and collaboration; the nurse has the responsibility to ensure the client has access to healthcare services that meet health needs. Which statement reflects the nurse acting in the advocacy intervention role? A. I want to make sure you understand what procedure you are about to have done B. I am going to listen to your heart and lungs now C. Can you tell me what year it is and where you are right now? D. I am going to start you IV now and start the antibiotics that the doctor ordered - Correct Answer A Client advocacy is a primary role for every nurse, so there is always a need for client advocacy. A nurse suspects a co-worker of engaging in illegal, immoral, or unethical conduct. What is the appropriate action by the nurse? A. Following established procedures at the facility at which the nurse is employed B. Ignoring the co-workers behavior C. Inform other co-workers of the nurse's suspicions D. Notifying the public health department - Correct Answer A Nurses have a legal responsibility to report any professional who they suspect of engaging in illegal, immoral, or unethical activities. Normally, the nurse making such a report will do so following established procedures at the facility at which the nurse is employed. The graduate nurse understands that the five rights of medication administration are part of: A. Quality management B. Environmental safety C. Care coordination D. Anticipatory guidance - Correct Answer A Quality management includes the prevention of errors for client safety. Checking the five rights when administering medication has been shown to reduce medication errors. A nurse on the quality improvement committee understands that the step of quality improvement which analyzes current protocols of care and their associated outcomes includes all except: A. Peer review B. An individual, unit, or facility must understand their baseline performance records C. Can be used to discover areas for improvement and to analyze areas of excellence D. Performance can be assessed on an intradisciplinary level or an interdisciplinary level - Correct Answer C Quality improvement is a continuous multi-step, multi-level process that identifies areas for improvement based on performance and industry standards. One step in quality improvement involves analyzing current protocols of care and their associated outcomes. This includes: an individual, unit, or facility must understand their baseline performance records; performance can be assessed on an intradisciplinary level or an interdisciplinary level; this includes peer review. A nursing instructor is explaining quantitative systems in quality improvement. The students have understood the lecture when a student states that Six Sigma is: A. A process that uses quantitative data to monitor progress B. A process that determines waste in the agency C. A team designed to evaluate processes D. An overall philosophy regarding quality - Correct Answer A Six Sigma is a process that uses quantitative data to monitor the progress of quality management. The nurse is studying the National Patient Safety Goals to ensure that the nurse delivers safe care to assigned clients and is aware that these goals are revised: A. Annually B. Once a month C. Every two years D. Every five years - Correct Answer A The Joint Commission is responsible for assessing and revising goals for client safety on an annual basis A client mentions that having so many nurses in the unit must be increasing the cost of care because nurses get paid more. The client's nurse appropriately responds: A. You are right. Care does cost more with RNs B. Studies show that costs are decreased with an RN staff C. Costs rise because nurses waste supplies D. The cost of care is caused by decreased technology, not increased nurses - Correct Answer B Studies shoe that lengths of stay decrease, which decreases overall costs, when more RNs are used for client care. The nurse manager conducts nurse evaluations based on standards of care. The manager understands that standards of care are based on established models of high-quality performance and may reflect all except: A. Recommendations of professional organizations B. Scientific or clinical research C. The performance of industry leaders D. Recommendations of hospital physicians - Correct Answer D Bench marking is a method used to compare the performance of an individual or organization to industry standards. Standards of care are based on established models of high-quality performance and may reflect the performance of industry leaders, scientific or clinical research, or recommendations of professional organizations such as the ANA. A client is being discharged to a rehabilitation facility and asks if nurses evaluate the quality of care that clients receive. The nurse responds that: A. We each contribute by collecting data for evaluation B. Nurses are responsible for monitoring nonprofessionals C. We have a quality management program here D. The hospital administration is responsible for determining quality - Correct Answer A One role of nursing is collecting the data that is evaluated by the quality management team. Quality improvement is the responsibility of every employee of the agency, not just administration. An operating room nurse is present when a client is injured permanently during a procedure. The nurse expects to participate in: A. An increased number of nursing audits B. A criminal investigation C. A root cause analysis D. The quality management program - Correct Answer C When a client experiences a permanent unexpected negative reaction due to an error, the Joint Commission requires that the healthcare agency perform a root cause analysis with a focus on the prevention of future such events. The nurse would expect to participate in the analysis because the nurse was present during the procedure. The nurse manage is establishing a team of nurses to explore ways to reduce sharps exposure among staff on the unit. Which is an example of using collaboration when coaching staff members on the unit? A. Following a stringent chain of command B. Working toward a common goal C. Delegating tasks to specific individuals D. Designating a single team leader - Correct Answer B Individuals on a team work together toward a common goal. Teams complete tasks in a collaborative manner, not by delegating to individuals. Team members often share leadership roles. Teams have a flexible hierarchy or chain of command. The charge nurse is preparing to discuss plans to improve the unit with the staff. Based on the concept of peer collaboration, which plan will she discuss? (Select all that apply) A. Asking for volunteers to go from the day shift to night shift to cover temporary staff shortage B. Allowing nurses to volunteer to prepare brief presentations on clinical topics seen on the unit C. Discussing starting a journal club for interested staff members to discuss new evidence-based practice findings D. Encouraging nurses to eat meals at their desks so they will be more accessible to physicians E. Implementing open visitation hours for families to increase client satisfaction - Correct Answer A,B,C Encouraging nurse to share their expertise on commonly encountered health topics allows more experienced nurses to share their knowledge and experience with others in order to ensure high-quality care. Allowing staff to participate in schedule changes on a volunteer basis shows mutual respect and may foster improved relationships. A journal club gives interested individuals a change to improve their clinical knowledge and share with their peers. The nurse manager for the acute care wing of an assisted living center has several meetings with different groups of people. Which group would be considered an intradisciplinary team? A. The nurse managers for the memory care wing and the chronic care wing B. The facility physician and pharmacy manager C. The respiratory, occupational, speech, an physical therapy managers D. The social worker and the nurse manager for the chronic care wing - Correct Answer A Intradisciplinary teams are made up of member of the same profession. The nurse manager is providing training on collaboration to a group of nurses. Which comment by a group member indicates that teaching was effective? A. The charge nurse asked me to be on the infection control committee, but I don't have time B. I've done my job the same way for 20 years, and it works well for me C. I need to teach my client how important it is to adhere to her treatment regimen D. The physician keeps ordering physical therapy for my client, who ambulates in the hall every day - Correct Answer C Teaching the client the importance of following the treatment regimen engages the client in client-centered care and can lead to improved adherence with the treatment regimen The collaborative care team for a 44-year-old client admitted two days ago following a diagnosis of diabetic ketoacidosis is reviewing the client's progress since admission. The nurse on the team requests a consultation with the dietician for the client. Which is an expected outcome of the consultation? A. The client will have to eat foods she does not like B. The client will have many questions about insulin C. The client will be more likely to adhere to her treatment regimen D. The client will become an informed consumer - Correct Answer D Care that is client centered and client directed results in a client who is a more informed healthcare consumer, leading to better client outcomes. The unit nurse manager is preparing to give performance review to a new nurse who has performed below expectations in multiple areas. Which factor does the nurse manager anticipate will impact the way that this employee receives the feedback? A. The nurse's lack of experience B. The nurse's self-esteem C. The nurse's lack of time management skills D. The nurse's religious beliefs - Correct Answer B Self-esteem is one factor that affects how an individual perceives feedback. The nurse is attending a team meeting regarding the care of a client. During the meeting, the nurse has a heated discussion with a peer. Which factors would be likely to impede effective communication and collaboration in this situation? (Select all that apply) A. Providing feedback to the peer B. Trusting the peer to make the right decision C. Confusing roles among team members D. Understanding cultural differences with the peer E. Having a lack of respect for the peer - Correct Answer C,E A lack of respect and role confusion can impede communication and collaboration. The nurse is discussing care with an adult client. Which action by the nurse is the most appropriate for providing collaborative care? A. Encouraging the client to request more aggressive treatment B. Sharing the physician's treatment goals with the client C. Working with the client to determine care objectives D. Asking the client's husband to wait outside - Correct Answer C Setting mutually-agreed upon goals and objectives illustrates collaborative care. The nurse understands that collaborative practice models attempt to achieve which objective? A. To limit client interaction with members of the healthcare team to decrease costs B. To deliver high-quality, cost-effective care using experimental techniques C. To provide physician-directed and client-centered care using a multidisciplinary framework D. To enhance continuity of care across the continuum of health - Correct Answer D Collaborative practice models attempt to achieve several objectives, including enhancing continuity of care across the continuum of health. Collaborative care has many benefits for both the client and the healthcare provider. Which outcomes are characteristic of collaborative care? A. Healthcare providers report hierarchy-based relationships and increased job satisfaction B. Client morbidity rates decrease, while mortality rates remain unchanged C. Clients become informed consumers and actively participate in the decision-making process D. Client adherence to therapeutic regimens increases, and overall system costs increase - Correct Answer C In collaborative care models, clients become informed consumers and actively participate in the decision-making process. Which statements are true regarding the nurse as a collaborator? (Select all that apply) A. The ability to recognize the contributions of team member by virtue of experience B. The ability to participate in policy formation to increase knowledge of a clinical problem C. The ability to seek opportunities to work with and within professional organizations D. The ability to share and receive clinical expertise with other nurses E. The ability to independently set goals and objectives for client care - Correct Answer A,C,D The nurse helps clients set mutually agreed-upon goals and objectives for health care, ensuring the client's involvement in healthcare decisions. The nurse shares clinical expertise with other nurses and elicits the expertise of others to ensure high-quality client care. The nurse participates in collaborative interdisciplinary research to increase knowledge of a clinical problem of situation. Which nursing actions indicate collaboration with the healthcare team? (Select all that apply) A. Seeking expertise from the team B. Setting independent goals with the client C. Exploring options with the client D. Sharing expertise with peers E. Planning care with the client - Correct Answer A,C,D,E Nursing actions that indicate collaboration with the healthcare team include sharing expertise from peers and seeking expertise from the team. The nurse will collaborate with the client by exploring options and planning care with the client's involvement. Which nursing action is appropriate when collaborating within the clinical environment? A. Enforcing perceptions of inequality among the team B. Expressing priority respect and trust to the physician C. Taking full responsibility for the client's outcome D. Communicating with other members of the team - Correct Answer D When collaborating within the clinical environment, it is essential for the nurse to communicate with other members of the healthcare team. Which nursing implication is true regarding collaboration? A. The nurse recognizes that collaboration has little effect on job satisfaction in nursing B. The nurse maintains open communication with other team members C. The nurse relies on the physician to question apparent duplications in the client's plan of care D. The nurse does not need to attend scheduled interdisciplinary team meetings - Correct Answer B Aspects of open communication such as giving and receiving feedback, exhibiting respectful communication, and listening to the client and team members are integral to collaborative nursing practice. Which statements are true regarding teams? (Select all that apply) A. The terms team and group are synonymous B. Accountability among team members is only individual C. Task completion is delegated to team members D. Team members often share the leadership role E. Members agree to work together to accomplish a common goal. - Correct Answer D,E Because a team's hierarchy may be more flexible than that of a group, team members may share the leadership role. Task completion and product creation are collaborative in nature, as opposed to being delegated to individuals. A nurse manager is recruiting team members for an intradisciplinary team to compose a new unit policy for the nursing staff. Which members should be asked to join this team? (Select all that apply) A. A pharmacist B. A staff nurse C. A physician D. A physical therapist E. A charge nurse - Correct Answer B,E Intradisciplinary teams are composed of the same profession who work towards a common goal. To compose a new unit policy for nursing staff, it is appropriate for the charge nurse and the staff nurse to be on the team. The nurse is providing care to support and treat individuals with serious mental illness. Which interdisciplinary team will the nurse collaborate with to provide client care in the community? A. An assertive community treatment team B. An Alcoholics Anonymous team C. An elder care team D. A school-based team - Correct Answer A The assertive community treatment team provides interdisciplinary care in community setting to individuals with serious mental illness. The nurse is preparing an in-service on conflict for newly hired nurses. Which responses by the newly hired nurses indicate understanding of the concepts of conflict management? (Select all that apply) A. Conflict in the workplace can be a positive event B. Conflict weakens team relationships C. Conflict can foster improved communication D. Conflict can bring about healthy change E. Conflict in the workplace is a negative occurence - Correct Answer A,C,D If handled appropriately, conflict can help promote positive change by opening the door to communication and raising issues that need to be addressed. The nurse attended a workshop on collaboration provided by the unit manager. Which actions indicated the nurse understood the material? (Select all that apply) A. The nurse assumes accountability and increased authority in her practice B. The nurse joins a committee in a professional nursing organization C. The nurse reports experiencing less job satisfaction but enjoys working autonomously D. The nurse reports practicing autonomously within her scope of practice E. The nurse conducts a length-of-stay on the unit, revealing longer client stays - Correct Answer A,B,D Participating in a professional organization, assuming accountability and increased authority in practice, and practicing autonomously within the scope of practice indicate understanding of the topic of collaboration. The nurse is participating in an interdisciplinary team meeting regarding a client with cirrhosis. Which communication technique illustrates the principles of collaboration? A. Telling the team that the client only wants treatment with alternative and complementary therapies B. Withholding input because the meeting is running over C. Sharing information with the team while serving as a client advocate D. Reminding the team that the client is hard of hearing and cannot understand his plan of care - Correct Answer C When collaborating with others, the nurse shares information with team members while serving as a patient advocate. The nurse is caring for a 52-year-old male following a total knee replacement. Which are appropriate actions regarding collaborative care for this client? (Select all that apply) A. Changing the medication order after speaking with the client about adverse effects B. Consulting the pharmacist regarding the interaction of the client's pain medication with his other medications C. Informing the pharmacist that the client's blood pressure has been low and to hold his blood pressure medications D. Informing the dietician that the client is on a cardiac diet and needs re-teaching about the diet E. Updating the physical therapist regarding the client's physical activity and tolerance earlier in the day - Correct Answer B,D,E Collaborative actions that are client centered lead to improved client outcomes. Consulting the pharmacist, updating the physical therapist, and informing the dietician are all appropriate collaborative actions for the nurse to take. The nurse is meeting with the care team to discuss the client's care. Based on the concept of collaboration, which action by the nurse indicates a lack of trust and respects for a team member? A. Challenging the recommendations of the physical therapist with his supervisor B. Making notes of follow-up needed as recommended by the physician C. Nodding in agreement with the recommendations of the nurtritionist D. Agreeing with the social worker's plan for nursing home placement - Correct Answer A Challenging the recommendations of the physical therapist with his supervisor indicates a lack of trust and respect for the therapist. The nurse is educating his peers on interdisciplinary teams. Which teaching point is appropriate based on the concept of team collaboration? A. A limited range of expertise is provided by interdisciplinary teams B. Pharmacists are excluded from serving on interdisciplinary teams C. Interdisciplinary teams are exclusive to healthcare settings D. Interdisciplinary teams are also referred to as interprofessional teams - Correct Answer D Interprofessional teams may be referred to as interdisciplinary teams. Interdisciplinary teams are found in workplace settings, schools, and within the community. The nurse is preparing to meet with the healthcare team to discuss the client's progress. Which situation would adversely affect the collaborative process among the team members? A. The physician shares details of the family's wishes for the client to receive aggressive care B. The social worker told the nurse that the client had attempted suicide, but it was not noted in the chart C. The nurse reports a decrease in client's pain over the last two days D. The physical therapist reports that the client has failed to make progress with therapy - Correct Answer B Withholding or forgetting to share critical information such as a previous suicide attempt places the client in danger and puts the healthcare facility at a legal risk, adversely affecting the collaborative process and client care. Prior to delivery of client care, the nurse reviews one policy, checks an evidence-based practice guideline, and scans through a list of standards of practice. Which elements of a profession are illustrated through the actions of the nurse? (Select all that apply) A. Quality improvement B. Autonomy C. Safety D. Service orientation E. Ongoing research - Correct Answer B,D,E The elements of any profession include service orientation, ongoing research, and autonomy. By reviewing an evidence-based guideline, the nurse is demonstrating ongoing research. By scanning through a list of standards of practice, the nurse is demonstrating autonomy. By reviewing a policy, the nurse is demonstrating an element of service orientation. The staff nurse is responsible for providing care to a group of clients. What should the nurse use to guide the provision of safe quality care? A. Standards of care B. PSDA guidelines C. Standards of practice D. QSEN competencies - Correct Answer A Standards of care are guidelines that determine what a nurse can or cannot do. These standards provide guidance to perform an action or a prescribed treatment for a client The staff development instructor is evaluating the learning of staff nurses after providing a presentation on the Quality and Safety Education for Nurses competencies. Which statements indicate that this training has been effective? (Select all that apply) A. Evidence-based practice should be used B. Quality improvement is minimized C. Teamwork and collaboration impact client outcomes D. The use of informatics has yet to be determined E. Client-centered care is the focus - Correct Answer A,C,E The Quality and Safety Education for Nurses competencies support accountability in nursing practice and include the competencies of client-centered care, teamwork and collaboration, evidence-based practice, quality improvement, safety and informatics. The nurse is reviewing a nursing research journal, published by a professional organization, prior to providing client care. Which statements illustrate how nursing research supports the nurse when planning client care? (Select all that apply) A. Research ensures the implementation of ethical principles B. Research supports education needs C. Research is useful in explaining nursing theories D. Research provides information on evidence-based practice E. Research supports the nurse's education required for entry into practice - Correct Answer B,C,D Research is integral to the growth and ongoing professionalism of nursing. The focus of nursing research has progressed to include nursing education, the nursing knowledge base, and practice-related issues. Nursing research emphasizes the development of evidence-based practice. The department head within a school of nursing is devising a plan to ensure the successful socialization of students into the profession. Which strategies support the department head's goal? (Select all that apply) A. Approving school policies and procedures that emphasize dress code B. Negotiating for clinical rotations to be held in high quality organizations C. Identifying clinical instructors to serve as positive role models D. Ensuring curriculum content adheres to professional standards E. Scheduling classroom time for culture and diversity training - Correct Answer B,C,D Strategies to assist students to develop the attributes of socialization include ensuring that curriculum content adheres to professional standards, that competent role models are selected as clinical instructors, and that clinical rotations are held in high quality organizations. A nurse is offered a position to provide telenursing client care through a national health insurance provider. Which investigation should take priority before the nurse accepts this position? A. State board of nursing licensing laws B. Current legislation about health care C. Demography of the client population D. Work hours and flexibility with schedules - Correct Answer A Telenursing is the provision of client care through a telecommunication system. This care delivery system has created licensing issues. The nurse needs to investigate the board of nursing licensing laws in the state of residence to determine if another license is needed to provide client care out of state. A group of nursing students are sitting together in the school cafeteria after completing a clinical shift. In which aspect of socialization to nursing is this group currently engaged? A. Development B. Adaptation C. Interaction D. Learning - Correct Answer C Socialization to a profession is complex and includes the attributes of learning, interaction, development, and adaptation. Students sitting together after a clinical rotation exemplify interaction. A client in the ambulatory clinic asks the nurse about health information obtained while reading a Web site on the Internet. Which response by the nurse is the most appropriate? A. Following your physician's advice is better than reading what to do on the Internet B. There are sites where the information is reliable C. Most information on the Internet is false D. The internet is for entertainment and not for learning - Correct Answer B Research has found that a large number of adults use the Internet for medical information. Nurses need to help clients with information access by directing clients to high quality Web sites for information Which criteria are used to measure if a profession is autonomous? (Select all that apply) A. Self-discipline B. Standards of practice C. Self-governance D. Working conditions E. Self-regulation - Correct Answer B,E There are two criteria used to measure the autonomy of a profession. These criteria are self-regulation and standards of practice. Professional organization differentiates a profession from an occupation. Which nursing action demonstrates autonomy when providing client care? A. Working with clients independently B. Accessing the policy and procedure manual C. Reviewing evidence-based practice guidelines D. Discussing the work schedule with the manager - Correct Answer A The concept of autonomy is exemplified by independently working with clients, accepting responsibility for behaviors, and being accountable for outcomes. Which actions should the nurse take when helping clients access information on the Internet? (Select all that apply) A. Direct to high quality Web sites B. Schedule a virtual visit with the healthcare provider C. Teach how to interpret the information D. Assist with obtaining a Skype account E. Summarize if the information is applicable - Correct Answer A,C,E Nurses need to help clients with information access by directing clients to high-quality web sites for information, teaching clients how to interpret the information, explaining how to evaluate information obtained, and summarizing how to determine if information is applicable. Economics - Correct Answer Insurance programs Expectations when providing out-patient care Changing locations for providing health care Cost of care Demography - Correct Answer Population shift from rural to urban settings Increased number of older clients Prevent disease through lifestyle changes Legislation - Correct Answer Health Insurance Portability and Accountability Act Patient Self-Determination Act Affordable Care Act Consumer Demands - Correct Answer Access to information through the Internet Increased awareness of others' needs for health care Responsibility for maintaining one's own health Health care being a right and not a privilege The new nurse is reviewing the state board of nursing Web site for information about professional practice. What information should the nurse expect to find during this search? (Select all that apply) A. Scope of practice guidelines B. Evidence-based practice guidelines C. Role definitions D. Tips for implementing computer applications E. Quality improvement findings - Correct Answer A,C A profession is considered autonomous when it has legal authority to define its own scope of practice, and defines roles, identifies goals, and outlines responsibilities. Individual state boards of nursing support autonomy in nursing. The nurse manage of a client care area is preparing the staff for the arrival of nursing students for a clinical rotation. Which statement by the manager reflects support for the Code for Nursing Students? A. Remind the students that learning does not occur by reading a book B. Show the students the shortcuts that you use to quickly complete care C. Ask the clients for permission before permitting the students to provide care D. Challenge these students to perform task for which they might not be prepared - Correct Answer C The nurse manager should support the Code for Nursing Students by ensuring clients provide authorization before accepting treatment from the students. After administering medications, the staff nurse discusses the status morning care completed by unlicensed assistive personnel. Which behavior is the staff nurse demonstrating at this time? A. Accountability B. Responsibility C. Client-centered care D. Safety - Correct Answer A Accountability is being responsible for the outcome of a completed task or assignment. Nurse are accountable for their own actions and behaviors, but also accountable for the actions of others, such as unlicensed assistive personnel. The director of an ambulatory care clinic is concerned that economic changes are going to impact the clinic's nursing care over the next fiscal year. Which issues are contributing to the director's concern? (Select all that apply) A. Consumer representatives on hospital committees B. Increased costs for care C. Expectations for out-patient care D. Concept of health care being a right and not a privilege E. Changing insurance programs and carriers - Correct Answer B,C,E The economics of health care impact nursing practice and accountability through insurance programs, the cost of care, and expectations when providing out-patient care. Before leaving a room, the nurse repositions the client and emphasizes the need to drink more fluids over the next few hours. Which concepts related to accountability did this nurse demonstrate? (Select all that apply) A. Fluid and electrolyte balance B. Perfusion C. Comfort D. Tissue integrity E. Teaching and learning - Correct Answer C,E The concept of teaching and learning is related to accountability because nurses are accountable for providing appropriate teaching to clients to ensure the highest quality of care. The concept of comfort is related to accountability because nurses are accountable for managing pain and for other interventions to ensure comfort for the client While preparing a performance appraisal for a staff nurse, the manger documents that the nurse is competent. Which nursing behaviors support this level of performance? (Select all that apply) A. Determined nursing diagnoses B. Communicated client requests C. Collected focused data D. Identified appropriate outcomes E. Provided interventions - Correct Answer A,C,D,E Competent nurses follow the steps of the nursing process when providing client care, specifically, assessment, diagnosis, planning, implementation, and evaluation. The clinical instructor is concerned that a student nurse is having difficulty implementing the Code for Nursing Students. Which student behavior supports this concern? (Select all that apply) A. Returning money that dropped out of a staff nurse's pocket while reaching for scissors B. Placing the side rails in the down position for a confused client C. Asking a staff nurse for permission to observe a procedure at the bedside D. Stating that a client has to wait for pain medication because there were more important tasks to do E. Requesting assistance to complete a complicated dressing change - Correct Answer Behaviors that do not adhere to the Code for Nursing Students include not ensuring the safety of clients by keeping the side rails down in a client with confusion and not acting professionaly when telling a client to wait for pain medication. The program director at a school of nursing is working with hospital leaders to reduce the impact of a nursing shortage projected to occur within a few years. Which recommendations are appropriate to combat this potential issue? (Select all that apply) A. Analyze staffing options to increase flexibility B. Increase recruitment of students into nursing as a second career C. Discuss increasing nursing salaries to be comparable with similar organizations D. Determine ways to increase the number of nursing scholarships