Implementing Evidence-Based Practices in Healthcare Settings, Exams of Nursing

Download Implementing Evidence-Based Practices in Healthcare Settings and more Exams Nursing in PDF only on Docsity! Clinical Nurse Leader (CNL) Certification Review Questions with Answers 2024 - King & Gerard 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 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: A) Sharing the latest clinical research B) An understanding of expected & actual outcomes C) Defining the purpose of CDSS D) Exploring challenges, risks, & benefits ✔ C) Defining the purpose of CDSS Rationale: CDSS supports a safe patient culture & should be designed to help providers You are using failure mode & effect analysis (FMEA) to anticipate the risk of medication errors in the ICU related to invasive lines. You begin your FMEA analysis with: A) The effects of each failure B) The potential cause of each failure C) Process mapping D) Specific defects & delays in the medication administration process ✔ C) Process mapping Rationale: Utilizing tools for process improvement can provide new insights into routine practices. Your colleagues have identified challenges in the process of inserting an IV line. To gain a better understanding of what this process entails, you: A) Directly observe the IV line insertion process & time each step of the process B) Create a workflow diagram tracing the path of the nurse during the line insertion process C) Engage the IV team to reeducate the nurses D) All of the Above E) A & B ✔ E) A & B Rationale: Proper assessment of a clinical situation can expose issues of policy, compliance, or the need for education. The result of a workflow diagram of a clinician illustrates an excessive amount of walking to obtain supplies. Reducing the waste of motion adds value-added time that ultimately benefits: A) The patient B) The clinician C) Documentation D) None of the above ✔ A) The patient Rationale: Process improvement enhances patient safety & nursing time at bedside for the patient & family Your team is looking at the delays in the discharge process. Your cause & effect diagram includes: A) A run chart B) A Gannt chart C) A fishbone diagram D) A high-level flowchart ✔ C) A fishbone diagram Rationale: A fishbone diagram is a useful tool to identify themes of clinical issues. Categories such as equipment, personnel, communication, & so on can be identified. You are leading a palliative care team in the ICU. Ethical competence is best defined as: A) The ability to recognize potential & actual ethical issues arising from the clinical practice B) The collaboration with a multicultural workforce C) The understanding of the physical, emotional, & spiritual health parameters of the ICU patient D) The skill set to define, design, & implement culturally competent health care providers. ✔ A) The ability to recognize potential & actual ethical issues arising from clinical practice Rationale: The CNL's role in ethics is highlighted in AACN's White Paper Opportunities that reflect human diversity include: A) Promoting effective communication for injured veterans B) Stressing the importance of family health history C) Standardizing the discharge process D) Decreasing the admission lead time to the pediatric unit ✔ A) Promoting effective communication for injured veterans Rationale: Human diversity includes understanding the ways cultural, ethnic, socioeconomic, linguistic, religious, & lifestyle variations are expressed. Survey results of the nursing staff reflect poor perceptions & a discomfort with addressing spiritual issues with patients. The ultimate success of focused staff education can be measured by: A) Trending quarterly patient satisfaction scores pertaining to spiritual care during the hospitalization B) A follow-up survey of the staff after the education to solicit feedback C) An open discussion of how the nurse would address spiritual care in a given scenario D) Feedback shared during discharge phone calls ✔ A) Trending quarterly patient satisfaction scores pertaining to spiritual care during hospitalization Rationale: Application of knowledge that impacts patient outcomes is the most significant indicator. Sustaining process improvement requires the use of appropriate learning principles & strategies. The CNL function that best utilizes this competency is: A) Advocate B) Educator C) Clinician D) Information manager ✔ B) Educator Rational: CNL competencies are described in the AACN White Paper How can the CNL make the greatest impact on the health care organization? A) By representing the microsystem B) By representing the mesosystem C) By representing the patient and family D) By representing the nursing profession ✔ A) By representing the microsystem Rationale: The CNL functions as the change agent at the microsystem level, engaging frontline staff in best practices to better patient outcomes. By leading which unit initiative can the CNL directly impact the financial health of the entire institution? A) Reducing readmissions B) Recruitment of new nursing staff C) Improving documentation compliance D) Encouraging staff to report safety events and near misses ✔ A) Reducing readmissions Rationale: Medicare reimbursement rates include a penalty to those health care institutions with 30-day readmission rates that are higher than national benchmamrks. The concept that an organization is in a continued state of change describes which organizational theory: A) systems theory B) Classic theory C) Contingency theory D) Chaos theory ✔ D) Chaos theory Rationale: The chaos theory is based on the principle that a system can maintain itself only if change is occurring somewhere in the organization all the time. Chaos & change are seen as means of survival. order meals when they are ready to eat rather than eating at predetermined times set by the hospital. This change has altered the timing of medications previously given with meals. What does the CNL do to improve this process? A) Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, and meal service team members to investigate the self meal order program B) Have the nurse or nursing assistant order meals with patients; this way the nurse knows what time the patient orders meals C) When explaining the self meal order program to patients, instruct patients to notify staff when they order meals D) Have the meal service notify the unit secretary when meal orders are placed by patients ✔ A) Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, & meal service team members to investigate the self meal order program. Rationale: Having an interdisciplinary team look at the entire process of the self meal order program will provide the team with innovative solutions to the problem. After completing unit audits, you have noticed the nurses are not completing AIR cycles documentation with pain management (AIR: assessment, intervention, reassessment). What should be done to improve documentation?: A) Tell the unit management which staff are documenting inappropriately B) Reeducate staff on the hospital documentation policy C) Remind staff of pain documentation during staff meetings & charge report D) Provide staff with a self-audit sheet as a way to review their own documentation during their shifts. ✔ D) Provide staff with a self-audit sheet as a way to review their own documentation during their shifts. Rationale: Giving staff a checklist will assist them in staying organized during their busy day. This will provide them a way to double check all their documentation before ending a shift. It also empowers staff to take ownership of their work. You are listening to report with a novice nurse. As part of mentoring new staff & supporting clinical decision making, you ask the new nurse which patient she would like to assess first. Which patient should this nurse assess first? A) 46yo receiving IV antibiotics therapy B) 60yo s/p liver biopsy C) 56yo with pneumonia D) 72yo hip replacement impatiently waiting for discharge ✔ B) 60yo s/p liver biopsy Rationale: Post-op liver biopsy patients have an increased risk of bleeding & need close monitoring after the procedure. The question does not indicate how recently the biopsy was done & therefore this is the best choice based on the information provided. To help patients maintain healthy skin while in the hospital, all of the following should be considered except: A) Provide patient with Q2h positioning/turning if patient is unable to self-position B) Ensure adequate protein intake C) Use bed surfaces known to prevent skin complications D) Allow patient to refuse bathing for days if uninterested, as the pt has the right to refuse care ✔ D) Allow patients to refuse bathing for days if uninterested, as the patient has the right to refuse care Rationale: While the patient does have the right to refuse care, a patient who would disengage with personal grooming for multiple days should draw the attention of the staff & CNL. Further investigation into the refusal & disinterest in self-care needs would be required to determine the underlying causes resulting in the patient's behavior & lack of care for self needs. A nurse on the unit comes to you & says that every shift he works day or night he finds at least one of his patients without an identification band in place. He is very concerned about patient safety & feels a harmful mistake could occur in the near future if the practice on the unit is not improved. What do you do as the CNL? A) Perform daily audits on all patients & report results to management B) Have the unit secretary make new ID bands for all patients daily so the charge nurse can place new bands on the patients daily C) Research a new style of patient ID bands since the current product does not stay on the patient properly D) Provide support to the nurse on the unit who determines the problem & help him identify areas in the process to improve pt ID ✔ D) Provide support to the nurse on the unit who determines the problem & help him identify areas in the process to improve patient ID Rationale: Part of the CNL's role is to provide staff with education, support, & the tools needed to improve practice. This nurse is already concerned about improving a process. As a CNL it is important to foster leadership & ownership instead of providing solutions to problems Over the past few weeks, nurses on the 30-ed medical unit have been complaining the MD orders related to O2 don't match what the patient is receiving. Often the patient has more than one O2 order at the same time. This leads to confusion for nursing & respiratory care staff & could harm the patient. How can the CNL improve the practice? A) Using the informatics team as support, create a hard stop in the computer that does not allow the physician to activate a new O2 order without discontinuing the previous order B) Tell the nurses they need to remind the doctors to keep orders up to date & have the nurses review orders at rounds with the team C) Meet with the unit hospitalist to make a plan to address the problem D) Do nothing since CNLs can't write patient care orders ✔ A) Using the informatics team as support, create a hard stop in the computer that does not allow the physician to activate a new O2 order without discontinuing the previous order Rationale: Having the informatics team develop a hard stop in the computer will allow the patient to have only one active O2 order at a time. It is imperative that nurses & CNLs work with informatics professionals in the design of safe care. The hospital has a goal for patient transfers from ICU to be completed by 12 noon. Your unit has a very low percentage for meeting this hospital goal. How can you best address this problem as the CNL? A) Tell the charge RN to discharge patients in the morning B) Ask the manager to staff an extra nurse on day shift to be the discharge nurse C) Use process mapping to determine all the possible factors that contribute to patient discharge & what barriers there are to discharge D) Don't worry about the number; your unit meets the other hospital goals, so it's okay to miss one ✔ C) Use process mapping to determine all the possible factors that contribute to pt discharge & what barriers there are to discharge Rationale: Process mapping is a tool to provide the team with an objective view of the problem being investigated. This view will help everyone to determine the barriers to transfer. Once the barriers are determined through process mapping, each barrier can be broken down further to determine solutions. You are the CNL at an outpatient care clinic providing care to families in the area. You have noticed it is difficult to get families to bring their children in for their immunizations, & children are often off schedule. How can the clinic best address this issue to meet the needs of their patient populations? A) Educate families on immunizations, their purpose, & their children's schedule B) Provide reminder phone calls to families the day before a scheduled appointment C) If possible, offer extended clinic hours 1 to 2 nights a week, so parents can come in after work D) Use the clinic data to determine why families are not coming to appointments ✔ D) Use the clinic data to determine why families are not coming to appointments Rationale: Before making changes at the clinic, it would be best to look at the data objectively to determine what is causing the problem. Answers A, B, & C assume you know the families' reasons for not coming to appointments. You are the CNL in the day surgery center & have found that many patients come to the center unprepared on the morning of surgery. This delays surgery start times & backs up the OR schedule for the day. The whole surgery team is frustrated. How can the process be fixed? A) Change the first surgery start time & delay it by 20min B) Institute presuregery phone calls 2 to 3 days prior to a patient's scheduled appointment C) Stagger surgery start times more throughout the day D) Reschedule patient show come to the center unprepared ✔ B) Institute presuregery phone calls 2 to 3 days prior to a patient's scheduled appointment Rationale: Having a nurse call the patient before the morning of surgery will allow the patient to ask questions & review what to do the night before & the morning of surgery, to help ensure patients arrive to the center ready & prepared for surgery. This may also help reduce patient anxiety prior to a procedure, thus arriving better prepared. Rationale: Members of the late majority approach any new initiative with a high degree of skepticism & require a large amount of information before adopting change. They will adopt change only in the late stages. laggards historically will not adopt change. There has been disagreement regarding the suggested adoption of a patient transfer blackout period during change of shift. Staff on the inpatient units favor a 30min period, while ED staff favor no blackout period. A team of stakeholders from all areas recently agreed on a universal blackout period of 15min during shift change. What time of solution does this represent? A) Compromise B) Collaboration C) Accommodation D) Confrontation ✔ B) Collaboration Rationale: Collaboration involves all parties working together to design optimal outcomes using mutually agreed upon solutions. The CNL can effectively design fiscally efficient patient care using which of the following strategies: A) Division of tasks & responsibilities among all team members B) Delegation of responsibilities according to job roles C) Seeking team members' input regarding their strengths & desired responsibilities D) Using input from the manager for job assignments ✔ B) Delegation of responsibilities according to job roles Rationale: The CNL must delegate responsibilities to the appropriate team member according to job description. Each team member should function at the highest level according to licensure. This will help to avoid wasting human resources & will preserve fiscal efficiency. To demonstrate active listening, the CNL would exhibit which behavior: A) Avoid making any facial expressions B) Preserve at least 3 feet between the parties C) Lean slightly forward D) Fold hands in the lap ✔ C) Lean slightly forward Rationale: Leaning slightly forward indicates desire to concentrate on the interaction at hand & relays openness & attention to the talker. To confirm a scope of practice question, the CNL should consult which administrative body guidelines: A) The Joint Commission B) Centers for Medicare & Medicaid Services C) Hospital Policy & Procedure Manual D) State Nursing Practice Act ✔ D) State Nurse Practice Act Rationale: Scope of practice is defined according to each individual state. The CNL must have a full understanding of licensure standards of practice according to role before delegation of tasks. Team coordination skills can help avoid all but: A) Undefined team member roles B) Poor membership involvement C) Member conflict D) Confusion regarding next steps ✔ C) Member conflict Rationale: In most working groups, conflict arises at some point. In addition to sound team coordination skills, the CNL must also possess effective conflict management skills. An important element of an effective team meeting is the creation of minutes to be distributed after the meeting. Who is the most appropriate team member to create the minutes? A) The meeting facilitator B) Any group member C) A preidentified team member D) The meeting scheduler ✔ C) A preidentified team member Rationale: Meeting minutes ideally should be written by the same team member at every meeting. The facilitator should not take minutes, as he or she must devote full attention to running the meeting & observing nonverbal communication of team members. The minute taker, also referred to as the recorder, must listen carefully & may not be able to fully join in the conversation. The recorder may also serve as the timekeeper for the meeting, thus keeping the group on schedule. Recording is a difficult role & is best performed by a defined member with the necessary skills. Which of the following may be beneficial tool for an interdisciplinary team to use to focus many ideas for improvement of patient satisfaction scores? A) Root cause analysis B) Multi-voting C) Development of a subcommittee D) None of the above; the group should work on all the ideas generated by the group ✔ B) Multivoting Rationale: To have effective outcomes, the group should focus on the most significant priorities related to the issue. Multivoting can give members a voice in the process. It is not practical or an effective use of resources to purse all ideas. Who can function as an important ally to the CNL in engaging frontline staff in a major initiative? A) Content expert B) Unit champion C) Initiative sponsor D) Senior leadership ✔ B) Unit champion Rationale: Unit champions are individuals who work along frontline staff and have earned the respect and trust of their coworkers. Staff will follow their lead. the use of a physician champion is an especially useful strategy for engaging physicians in an initiative. Senior leadership and sponsors must also be engaged, especially financially, but are not as effective at the microsystem level as a unit champion. A team approach utilizing the integration of many different roles working toward common patient & family goals describes the objective of which type of team: A) Multidisciplinary team B) Interdisciplinary team C) Patient advocacy team D) Care coordination team ✔ B) Interdisciplinary team Rationale: An interdisciplinary team is composed of many disciplines that all gather together at the same time to work toward a common patient & family goal, such as discharge coordination. Individual consults by many different health disciplines represent which type of approach: A) Multidisciplinary B) Interdisciplinary C) Team D) Intradisciplinary ✔ A) Multidisciplinary Rationale: A multidisciplinary approach is composed of individual consults, occurring independently of each other. Typically the disciplines do not meet to work toward a common goal as in an interdisciplinary approach. In order to generate ideas aimed at designing an implementation plan, a team reviews the topic & members verbalize solution ideas in a random fashion. This is an example of which of the following strategies: A) Multivoting B) Process mapping C) Brainstorming D) Nominal group technique ✔ C) Brainstorming Rationale: Brainstorming is creative, interactive, & unstructured, as team members suggest possible ideas in a free-flow format without regard to the details of the suggested solutions. Your unit has worked hard to maintain a very low fall rate. There has now been a sharp increase over the past 2 months. In looking at control chart data related to falls, you see that all of these falls occur on the night shift. What is the most likely reason for this shift? A) A common cause Rationale: The 5S (sort, set in order, shine, standardize, & sustain) LEAN technique can be used to organize equipment, resulting in an orderly workplace. "A place for everything & everything in its place" A process improvement project charter or establishment of specific aims can help a project group to avoid which difficulty: A) Scope creep B) Meeting time confusion C) Budget constraints D) Team communication problems ✔ A) Scope creep Rationale: Scope creep occurs when a group identifies an additional problem that may need fixing. A clear project charter defines the goal, objectives, & scope of the original project & will help the team not to divert its attention to other issues. You have been charged with examining the heart failure 30-day readmission rate of your unit. In doing so, it is important for you to examine data from what other sources: A) National & state readmission rates B) National benchmarks C) Readmissions to other units in your hospital D) All of the above ✔ D) All of the above Rationale: The 30-day readmission rates are a key factor in CMS reimbursement rates to hospitals. A CNL should have a broad perspective of readmission rates across multiple settings. The CNL can then resource share with other areas to gain insight into best practices & pre-existing initiatives at the microsystem, hospital, state, & national levels. One of the nurses on your unit was involved in a medication error. She revealed the error to both you and the nurse manager & documented the error in the online safety event reporting system. You meet with her & begin the process of identifying causes that led to this event, so the risk for future medication errors can be minimized. As evidenced by these actions, what is the culture of your hospital? A) A laissez-faire culture B) A just culture C) A punitive culture D) A structural culture ✔ B) A just culture Rationale: A just culture recognizes that human are fallible, & errors may happen in systems that are flawed. A non punitive culture fosters patient safety principles, encouraging practitioners to report errors & near misses, which in our enables organizations to address & correct flawed processes & systems. Errors that result from willfully negligent behavior are not a part of a just culture. You are working with a team to reduce patient waiting time for transport to diagnostic imaging. An effective goal would be to: A) Decrease waiting time during the evening shift B) Increase monthly patient satisfaction C) Improve communication between the ED & the DI departments D) Decrease the waiting time for DI by 5% ✔ D) Decrease the waiting time for DI by 5% Rationale: Improvement goals must be specific & measurable. The team must have clear, measurable results to indicate whether an implementation resulted in improvement. When conducting a lit review, the publication that would provide a comprehensive summary of research on that topic would be: A) Non experimental B) Experimental C) Case study D) Meta-analysis ✔ D) Meta-analysis Rationale: A meta-analysis includes an analysis of multiple studies on that topic When incorporating EBP interventions into your health care setting, it would be best to: A) Do what everyone else is doing B) Do what you think would work in your setting C) Choose the interventions you think would work for your setting & perform a rapid cycle test to evaluate the impact D) Do everything the literature suggests to improve your chances of a good outcome ✔ C) Choose the interventions you think would work for your setting & perform a rapid cycle test to evaluate the impact Rationale: Incorporating EP & then performing rapid cycle tests will give you feedback on whether the changes are working well in your setting All of the following are steps of EBP except: A) Integrating evidence with clinical expertise, patient preferences, & values when making a decision or change B) Asking the question in a PICO format C) Obtaining informed consent from patients involved in the practice change D) Critically appraising the evidence ✔ C) Obtaining informed consent from patients involved in the practice change Rationale: EBP changes don't require consents You are trying to encourage nurses on your unit to become more active in utilizing research in practice & to learn more about EBP. What would be a good activity to promote your idea? A) Leave a few nursing journals on the unit B) Make a point of discussing research articles you have read with nurses on the unit C) Form a journal club on the unit D) Email the nurses articles to read ✔ C) Form a journal club on the unit Rationale: This will encourage the nurses to read articles relevant to their practice & to evaluate them critically What type of study would not be included in EBP if the nurses were looking for quantitative research? A) Meta-analysis B) Experimental C) Quasi-experimental D) Phenomenological ✔ D) Phenomenological Rationale: Phenomenological studies are qualitative research that is not directly included in EBP In assessing your organization for EBP environmental readiness, you would evaluate all of the following except: A) Do advance practice nurse & educators model EBP? B) Are the nurses expressing an interest in EBP? C) Are the librarians available to assist nurses with EBP research? D) Are computers readily accessible to staff? ✔ B) Are the nurses expressing an interest in EBP Rationale: The organization is assessing environmental readiness, not interest Strategies for advancing EBP in health care settings include: A) Skill-building workshops B) EBP poster presentations C) EBP rounds D) All of the above ✔ D) All of the above Rationale: All of these are good strategies for promoting EBP You are considering using a new type of Foley catheter in your setting when the sales representative mentions a study that the manufacturer conducted that showed a reduction of catheter-associated infections with the use of the new device. Which type of study would be most convincing of this new product's potential value: A) Case study B) Randomized controlled trial C) Expert opinion D) Nonrandomized controlled trial ✔ B) Randomized controlled trial Rationale: Type of study would provide highest level of evidence In an effort to reduce central line infections, you have done some research & found evidence-based guidelines that you would like to implement at your organization. Your next step would be to: A) Gather data regarding central line infection rates at your institution B) Convene a team meeting to discuss the problem & impact of central line infections Rationale: The information at this stage should tell you where the barriers are Plan --> Do --> Study (Study the DO results) --> Act (Enact change) A patient admitted to the hospital in a hypertensive crisis is now receiving care at what level of prevention: A) Primary B) Secondary C) Tertiary D) None of these ✔ C) Tertiary Rationale: The patient already has a severe medical problem that now requires treatment; this is tertiary level of prevention focused on maximizing the patient's health, despite the presence of illness. Vaccinations are considered what level of prevention: A) Primary B) Secondary C) Tertiary D) None of these ✔ A) Primary Rationale; Vaccines are preventative & therefore considered primary level of prevention Patient satisfaction scores on your unit have declined over the last quarter. There are several new nurses on the unit. You suspect that the novice nurses may be contributing to this decline in satisfaction scores. What would be a good strategy to address the issue? A) Schedule a group education with the new nurses to discus patient satisfaction B) Have the novice nurse shadow an experienced nurse for the day C) While doing patient round, apologize for the number of new nurses on the unit D) Hang signs around the unit reminding staff that patient satisfaction is the goal ✔ A) Schedule a group education with the new nurses to discuss patient satisfaction Rationale: This will ensure the novice nurse gets the correct info regarding pt satisfaction. It will also allow time to discuss specific ways to improve satisfaction & at the same time provide a safe environment fo the novice nurses to express his/her feelings on the topic. In your role as a CNL, you have implemented some practice changes on your unit that have resulted in an overall reduced LOS for the pneumonia patients. The cost savings will be reflected in which budget: A) Operating budget B) Capital budget C) Cash-flow budget D) Long-term budget ✔ A) Operating budget Rationale: Operating budget reflects the revenue & expenses for the nursing unit. The capital budget refers to larger purchases that may be planned over long periods The manager on the unit where you work really encourages the staff to learn & grow professionally as individuals & as a group. Several of the staff have earned advanced degrees & moved onto other roles in the hospital. Her goals always seem to be aligned with the organization's vision. This is what type of leadership style: A) Charismatic leadership B) Relational leadership C) Transformational leadership D) Transactional leadership ✔ C) Transformational Leadership Rationale: Transformational leadership style focuses on change in the organization through a commitment to its vision What type of care delivery system where the nurse assumes 24-hour responsibility for patient care from admission through discharge is known as: A) Primary nursing B) Functional nursing C) Case management D) Total patient care ✔ A) Primary nursing Rationale: Primary care is type of care delivery in which nurse is responsible for planning, directing, & evaluating pt care 24hr/day Medicaid covers which population: A) Employed B) Underinsured C) Unemployed D) Poor & disabled ✔ D) Poor & disabled Rationale: Medicaid is publicly funded insurance provided to poor & disabled in each state. "we CARE for the old, we AID the poor & needy" Currently Medicare is moving from a fee-for-service model to a: A) Managed care model B) Pay-for-performance model C) Private insurance model D) Advantage care model ✔ B) Pay-for-performance model Rationale: Increasingly medicare is adjusting reimbursement rates to providers on the basis fo their patient outcomes. Which most demonstrated advocacy toward a patient? A) Led interdisciplinary rounds on a group of patients B) Consulted a diabetic instructor for a patient who was found to have an HgB A1C of 13.1 C) Met with the trauma team of physicians to update patient plans of care D) Conducted an in-service with the nursing staff on how to reduce falls for the unit ✔ B) Consulted diabetic instructor for pt with an Hgb A1C of 13.1 Rationale: Example of specific action by CNL to improve care on a particular patient To be culturally competent as a CNL is best found to be an example of which form of nursing leadership? A) Lateral integration of care services B) Horizontal leadership C) Advocacy D) Vertical leadership ✔ C) Advocacy Rationale: An effective advocacy is needed during assessment, intervention, evaluate, & teaching to use cultural competence for communication to be effective Which CNL role from the White Paper best describes advocacy? A) Delegating & managing the care team B) Using appropriate teaching strategies when teaching clients C) Making sure that patients & families are well informed D) Using information to achieve the best outcomes for patients ✔ C) Making sure the patients & families are well informed Rationale: As clearly defined in the White paper, the CNL makes sure he or she is informed to be a resource for patients, families, & the interdisciplinary teams. Which of the following is a demonstration of how the CNL can be an effective use of self through routine presence? A) Develops a therapeutic alliance B) Uses the most up-to-date technology C) Monitors the environment D) Provides a comprehensive health assessment ✔ A) Develops a therapeutic alliance Rationale: By being a constant presence with the patient, the CNL is able to gain better access to the patient In what way can the CNL serve as an advocate for the patient through other nurses? A) Delegate to other members of the profession B) Serve as an advocate for the profession of nursing C) Advocate for the staff to have better hours D) Research best practice methods for your unit ✔ B( Serve as an advocate for the profession of nursing Rationale: As an advocate for your profession, you can foster a sense of commitment to learning on your unit & with your staff. Which method of payment account for only 5% of the US population? A patient is admitted to the unit post-op fixation of the femur. What is a priority for the CNL? A) Make sure a diet is ordered post-op B) Makes sure the physician addressed or filled out the VTE sheet with type & time of anticoag C) Make sure the family in the waiting room knows where the patient is D) Place the phone near the patient ✔ B) Make sure the MD addressed/filled out the VTE sheet with type & time of anticoagulant Rationale: CNL acts as an advocate for pt in making sure anticoagulant is addressed on pt at a severe risk for DVT or PE C.W. is a 92yo male who is a DNR. There is no family to visit this patient, & the patient's status has declined over the past 24hr. The patient's breathing is labored & the MD tells the staff there is nothing else to do. What is an effective use of the CNL? A) Spend time talking with staff on their views of the dying process B) Call bed management & let them know there will be a bed available soon for a post- op patient C) Consult pastoral care to come with the patient D) Call dietary & tell them to stop bringing the patient food ✔ C) Consult pastoral care to come with the patient Rationale: It is within the scope of practice of nursing to get pastoral care involved A Korean patient is admitted who speaks little English. An example of culturally competent care is: A) Finding a nurse who speaks some Korean B) Transferring that patient to a floor that has a Korean-speaking secretary C) Calling the patient's family to see if they can speak any English D) Obtaining a Korean translator ✔ D) Obtaining a Korean translator Rationale: Translator is most effective way to deliver culturally competent care, the admission will be complete, the staff will be able to accurately assess the patient & dietary staff will be able to find out any specific dietary concerns the patient may have. What part of the interdisciplinary team is most important POD1 from a knee replacement? A) PT B) ST C) Dietary D) Financial counselor ✔ A) PT Rationale: It is pivotal for the pt to be getting out of bed & working on mobilization after any extremity surgery. M.L. is 42yo female admitted for domestic violence & being shot by her husband. Which is a priority at this time? A) Inform the social worker of the situation B) Place the patient under an alias name with her permission C) Inform the police D) Call the domestic violence RN ✔ B) Place the pt under an alias name with her permission Rationale: At this point, the first thing to do is make sure the patient is safe in the hospital and that involves placing her under an alias name, so no one can find her. An example of true advocacy is: A) Telling dietary staff if the patient has any concerns with her food B) Calling a patient's family to give them updates on a patient's health C) Establishing goals to promote patient health D) Performing handoff communication at change of shift ✔ C) Establishing goals to promote patient health Rationale: Per a definition in the exam handbook, advocacy is identifying any health problems & working toward their improvement. As a member of the interdisciplinary team, the CNL is effective in all the following except: A) Maintaining & updating the POC B) Collaborating with other members of the team for the care delivery C) Delegating to other staff D) Taking charge of all patient care ✔ D) Taking charge of all patient care Rationale: CNL is a member of team & NEVER is in charge; the interdisciplinary team is a process that involves multiple people, not just one. While admitting a patient for COPD< a nurse notices the patient has had two other admission this month for the same diagnosis & is homeless. A key part of this admission is: A) Consult a social worker on admission B) Notify the physician C) Consult a clinical case manager upon discharge D) Consult financial counseling. ✔ A) Consult a social worker on admission Rationale: As a CNL it is important to notice any reoccurring admissions & patterns -- the social worker will be able to start working with the patient on day one for supportive services, to help the patient decrease the change of this happening again. D.M. is admitted for a hip fracture, a fall from standing. As a CNL, you would know such a fracture obtained this way is best found from what? A) Osteomyelitis B) Osteoporosis C) Anemia D) Rheumatoid arthritis ✔ B) Osteoporosis Rationale: A fracture of the hip from a fall from standing is indicative of osteoporosis. It is imperative for CNL to identify such patterns to help the patient get a holistic POC B.I. is a 91yo male who was transferred to a skilled nursing facility from an acute care hospital. Upon transfer, the patient's Lasix for CHF was not transferred with the patient. One the med error is found & restarted, it is the CNL's job to: A) Notify the hospital of the error B) Notify the skilled nursing facility of the error C) Go back through all pathways & find where the error in this transfer process occurred D) Notify the family ✔ C) Go back through all pathways & find where the error in this transfer process occurred. Rationale: Correcting process that yield errors & negative outcomes for patients is a critical duty of the CNL A new grad RN who recently got out of orientation approaches you, the CNL. One of her patient's physicians wrote an order to place an NG tube. Th eRN has not done this since nursing school & asks for your help. How do you respond? A) Tell her to ask the charge RN, as this is not one of your CNL roles & you really do not have time at the moment B) Direct her to get the policy & procedure guidelines, review it, assemble the needed supplies & then you will review it with her & asset her with placing the NG tube C) Direct her to review the policy & procedure guidelines, assemble the needed supplies & ask an available LPN to assist her with placing it D) Review the order, gather the needed supplies, & have her watch you place the NG tube, as she has not done it before as an RN ✔ B) Directo her to get policy & procedure guidelines, review it, assemble needed supplies, & then review it with her & sit with placement of new NG tube Rationale: As clinician team manager, one of roles is to be a resource for team, especially for new grad RNs. From AACN's White Paper, the CNL designs, implements & evaluates client care by coordinating, delegating & supervising the care provided by the health care team, including license nurses, technicians & the health professionals. As you, the CNL, are reviewing one of your patient's charts, you notice he recently tested positive for MRSA in his open wound. He has been in the hospital for 2 days & as far as you can tell, this result has not been addressed. You bring the result to the attention of the primary nurse, who says that the night shift nurse told her about that, but no one has had a chance to "Deal with it" since each nurse has six or seven patients. How do you respond? A) Tell the nurse you understand how busy she is, & to please make it a priority to "deal with" ASAP for patient safety B) Tell the nurse you understand how busy she is, & offer to call the ophidian yourself as well as place the patient on contact precautions C) Ensure the nurse knows why this is a priority, especially since she doe shave so many other patients, & help her to make time to notify the MD as well as immediately place the patient on Contact precautions drink whatever they want posted as long as they have positive bowel sounds & are not nauseous. They want to know "who is right". In response, you: A) Tell them they are both right, depending on the patient, & it is up to the physician's orders. B) Tell them that is a great question, & instruct them to both do research on the topic, bring it back to you, & you will help them take their information forward for a potenti ✔ D) Assist them in researching topic in research & evidence based articles & evaluate info. Bring your findings to the unit staff & MDs & come to agreement on best practice Rationale: As CNL, a big part of role is to bring EBP & research to bedside. However, you need to get the staff involved & not just do all the work for them. Staff need to feel ownership You are the CNL on a busy medical unit. You get a new patient, Mrs G, admitted through the ED for abd pain. Mrs G is a 37yo Spanish-speaking woman. She has her 12yo son with her, who has been translating for the medical staff in the ED. Mrs G is clearly in a lot of pain, but you can't give her any pain meds until she is admitted into the system. Your next steps are to: A) Allow the son to translate enough to get Mrs G admitted so you may give her some pain meds & then get an interpreter to complete her admission hx B) Ask Mrs G through her son, if it's okay with her to use her son as the interpreter. You explain to her this will expedite her pain relief & she agrees C) Request an interpreter to come ASAP & tell Mrs G through her son that you will make her comfortable ASAP. Notify the primary RN who will be caring for her. D) Explain to Mrs G that you are unable to give her medicine until she is admitted & that you ne ✔ D) Explain MRs G unable to give medicine until admitted but will give med ASAP. Stay with her until interpreter gets there & try to relieve pain with nonpharm therapies Rationale: Establishes & maintains effective working relationships within an interdisciplinary team to make ethical decisions regarding application of technologies & acquisition of data; practice in collaboration with a multicultural workforce. You, the CNL, work on an infectious disease unit in the hospital. Your patients tend to have long LOS, sometimes weeks to months. During your 5Ps assessment, you discovered that the nursing staff is not satisfied with handoff communication. They feel like important information is often left out of report. As a leader of this team, the most appropriate next step would be to: A) create a new process based on evidence & implement it B) Assess the current communication handoff process C) Ask the nursing staff what they think would be the best way to give report D) Bring this issue up at the net staff meeting ✔ B) Assess current communication handoff Rationale: Before going any further, you need to collect data & asses situation. Mange group processes to meet care objectives & complete health care team responsibilities. You, the CNL, are putting an interdisciplinary group together to make improvements to your high falls rate. You are seeking members to be on this team. Carly, an RN, volunteers to be on this team. You & Carly have had many differences in the past & because of personality conflicts have not been able to work together historically. What should you do? A) Thank Carly for volunteering, but politely tell her you will not be needing her for this particular team B) Allow Carly to be part of the team -- your personal issues should not affect this group's progress C) Invite Carly to be part of the team, but do not give her any major responsibilities D) Tell Carly that you think it is best if the two f you just avoid each other ✔ A) Thank Carly for volunteering but politely tell her you will not be needing her for this particular team. Rationale: Choosing a team, you should avoid people with personal conflicts of interest, if possible One morning as you, the CNL, are walking into the nurses' lounge, you hear a lot of talk about a nurse who has called out sick that day. The nurses are griping about how this nurse always calls out, especially on Fridays. The best response is to: A) sympathize with your team, saying you have no idea how she does not get in trouble or fired. This kind of behavior should not be tolerated B) Tell the nurses to stop talking about one of their teammates, especially in front of a new employee C) Listen to what the nurses are saying, & notify the manager to address it D) Listen to what the nurses have to say, & then address that it is not our business to discuss someone else's personal life. That nurse's sick days & disciplinary action are up to that nurse & the manager. Ensure they have adequate staffing to make up for the sick call/help to adjust assignments ✔ D) Listen, address it is not our business to discuss someone else's personal life. The nurse's sick days & disciplinary action are up to that nurse & magenment. Ensure that the staff is adequately provided for in adjusting assignments as necessary Rationale: It is good to show empathetic ear, but not helpful for a team to speak badly about one of the teammates. Adequate staffing is a big concern for the team, so ensure that this is addressed. You are the CNL on a postpartum unit. You have noticed that lately you have had an increased number of patients readmitted with wound infections. You know that the most appropriate next step is to: A) Perform a failure mode & effects analysis B) Ask the MDs why their patients are getting so many infections lately C) Perform a root cause analysis D) Consult the wound-ostomy care nurses ✔ C) Perform a RCA Rationale: RCA addresses a systems issue. It is a broad, retrospective qualitative process that looks past the individual to enable development of an overall action plan. As the CNL on a Med-Surg unit, you are asked to participate in a RCA of a group of sentinel events that have occurred recently throughout the hospital. Your team determines that a lack of effective communication in emergent situations is the root problem. Now what? A) Lead the team in researching EBP improvements to implement a better way of communicating during emergencies B) Submit your findings to the administration that assigned you this task C) Share the findings with the units that had these sentinel events & instruct them to come up with better, research-based communication techniques D) Take the findings directly to the individuals involved int he sentinel events & show them what they need to improve to prevent the adverse outcomes ✔ A) Lead the team in researching EBP improvements to implement a better way of communicating Rationale: Once you discover what ht problem is, a solution needs to be created. This is something that should be non punitive & benefit the whole hospital. Focusing on individuals will not be beneficial to the big picture. A med equipment rep approaches you to incorporate his new product into your unit supplies. He tells you that this new device has been proven to e the best device in its arena to prevent DVTs. Preventing DVTs is one of your goals as the CNL on this med- surg unit. The price is only slightly higher than the current equipment you use now, but he says the research shows you will save money in the long run by preventing more DVTs. How do you go about getting this new device? A) Since you do not have any purchasing power as the CNL, you direct him to the director of the purchasing dept. B) You have the representative speak with your manager, since your manager must approve all items purchased for your unit C) You thank him for the information, but pass on the offer since it costs more than the equipment you currently use, & as a CNL you are only looking for cost-effective ventures D) You perform your own research on the de ✔ D) You perform own research on device & compare it with equipment you have now. If it proves to eb as good as the representative says, you will take it forward to administration Rationale: Gathers, analyzes, & synthesizes data related risk reduction & patient safety What is the best way for the CNL to analyze systems & outcome datasets to anticipate individual client risk & improve quality care? A) Perform a RCA of all postop patients who have been readmitted to your unit within the last year B) Perform a failure mode & effects analysis on all CHF patients on your unit within the last year ✔ B) Decrease fragmentation & medical errors resulting in deaths A new health policy is being voted on in Congress. Your professional organization supports this policy & is recruiting nurses to go to Washington, DC to help promote their view & have a bigger voice. You do not support this policy. Your manager wants you to go as a leader & represent your unit. What should you do? A) You should go, as you need to stick together with your professional organization & yield to your manager B) Learn more about the policy & why your organization supports it C) You should politely decline, as you do not agree with the policy D) You should got but rally against the policy since you do not agree with it. This is America & you are exercising your freedom of speech ✔ B) Learn more about the policy & why your organization supports it. Rationale: You should know how your professional organization stands -- we need to support each other & have on voice as nurses. You want to do some research for a potential policy change. All of the following are excellent resources, except: A) CDC B) Wikipedia C) American Diabetes Association D) WebMD ✔ B) Wiki As a CNL what is your number one priority? A) Cost-effecitveness of care B) Improving quality of care C) Patient safety D) Decreasing fragmentation of care ✔ C) Patient Safety Leah, a CNL on an obstetrical high-risk unit, looked at the evidence regarding women taking folic acid during pregnancy. Because it shows evidence to prevent neural tube defects in the fetus, she recommends this be included on the order set for antepartum patients. This is an example of which of the following: A) Health promotion B) Health literacy C) Qualitative Review D) Quantitative Analysis ✔ A) Health promotion Rationale: Health promotion requires knowledge about health risks & methods to prevent or reduce these risks in individuals & populations Sam is homeless 59yo male admitted with CHF. Arrives alone & crying. Vitals are BP 173/96, HR 83, O2 86% & temp of 98.9. During assessment you notice multiple bruises & lacerations. Clothes are torn & soiled. According to Maslow's hierarchy of needs, what should you do first? A) Inquire about his bruises & lacerations B) Call social worker regarding shelter placement C) Ask why he's crying D) Apply O2 ✔ D) Apply O2 Rationale: According to hierarchy, physiological needs have to be met first, then safety, love/belonging, esteem, and then, self-actulatization. Which of following would not correlate with major goal fo Healthy People 2010? A) Providing free clinics for underpriveledge children B) Educating 76yo on smoking cessation C) Implementing a unit to place all positive HIV pts D) Destining a nutrias meal plan for school systems ✔ C) Implementing a unti to place all positive HIV pts Rationale: Major goals for Healthy People 2010 are to increase quality & years of healthy life & to eliminate health disparities. Although HIV is a focus are for 2010, no rationale, or evident to have a specific unit in which to place patients. Tim is a 31yo admitted for pneumonia. During hospitalization you discovered he smokes cigarettes 1ppd. You provided handouts on smoking cessation & gave him a helpline number. At discharge yo made a follow up appointment with PCP for pneumonia & smoking cessation. What did you forget to do? A) Ask B) Advise C) Assist D) Arrange ✔ B) Advise Rationale: It is always important to advise people to stop smoking on each visit Capstone project for CNL immersion experience focused on wound infections & readmission rates. Conduced a lit review on best way to provide education on surgical patients, reduce surgical infections & prevent readmissions. ON basis of lit review & EBP she developed a protocol for this patient population. What key principle did Marie use by incorporating this protocol? A) Team coordinations B) Risk reduction & prevention management C) Lateral integration of care D) Information management ✔ B) Risk reduction & prevention management Rationale: Marie uses evidence to keep an illness or injury from occurring early in its course & preventing further deterioritation by focusing on health promotion, disease prevention, risk reduction, & prevention management. Tim, a CNL in clinic setting begins seeing a lot more Hispanic patients with high blood pressure and/or diabetes & many with a lack of knowledge on nutrition. They often say someone in their family has the same proems. He knows the best way to educate them is to: A) set aside extra time at each appointment to focus on educaton B) set up educational posters a t local hispanic supermarket C) Set up health fair with bilingual educators at a local highly populated park in Hispanic neighborhood D) Make up handouts to be given to patients at their appointments to take home ✔ C) Set up health fair Rationale: Health fair would reach the most people to educate & they feel comfortable in their own setting. Many clinics do not have extra time to make appointments longer & many people do not even go to the clinic, so a health fair would reach largest amount of people for this setting. Marcia, a CNL review the diet with a newly diagnosed gestational diabetic. She inquires about patient's previous diet & habits & she discovers the patient eats a lot of fast food. She says she rarely has time to cook & has four kids who are always on the go. What should Marcia do? A) Look up nutritional information on pt's favorite fast food places & pick out good food choice together with which she can be copmliant B) Tell her it does not really mater what she eats because she only has gestational diabetes C) Tell her she can't eat fast food & give her another list of what she can eat D) Consult dietician again to review her meal plan. ✔ A) Look up nutritional info on pt's favorite fast food places & pick out good food choices together with which she can be compliant Rationale: Pt confided in CNL & stated she is going to eat fast food. IN order to help her be compliant with her meal plan & diet, it is best to help er make good food choice at the places she will be eating. It is important for the patient to follow a diabetic diet with gestational diabetes not only for her own health, but also for the well-being of the fetus. 6yo boy named Braden is pt in microsystem. He is terified of shots he has to get BID for next 3 weeks. It is most therapeutic med route for his illness & becomes hysterical every time the med is due & must be held down by two people while RN gives injection. They will not have 3 people at home to do this. Working on discharge planning, what should you do? A) Plan on Braden being in hospital for next 3 weeks to receive his injections B) Obtain restraints for the parents to use at home in order to give the injection C) Talk with MD to prescribe a pill instead D) Work with child specialist & sit down with Braden to find out what scares him about the injections ✔ D) Work with child specialist & sit down with Braden to determine what scares him about injections D) Get data from the other hospital ✔ A) Look at latest evidence/lit review Rationale: When making a change it is important to look at EBP by performing a lit review & then decide whether there is sufficient evident to make the change or whether there is not much lit on the topic to collect data to see if the change is effective. According to the PICOT method to make a search for clinical questions, the "P" stands for? A) Processes B) Population C) Patterns D) Practice ✔ B) Population Carey, a CNL, thinks utilizing volunteers in a microsystem will benefit staff & patients. She performs a lit review & doesn't find much literature evaluating volunteers being effective in a health care setting. She decides to go ahead & implement a volnteer program & collects data to see whether this is an effective change. Should Carey have implemented this? A) No, there was no evidence volunteers would be beneficial B) No, she should hav waited until there were data on this topic C) Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective D) Yes, it is always good to try something new. ✔ C) Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective Rationale: If sufficient lit/evidence isn't found for a particular group, it can still be implemented if done correctly & if data are collected to see whether the change should coninue or not. You are trying to get literature on using music to relieve pain. One research article uses methods you forget how to interpret. You should: A) Not use this article B) Google the methods to try & figure it out C) Look at the conclusion & just use that information D) Ask a mentor to assist you so you can understand the data ✔ D) Ask a mentor to assist you so you can understand the data Rationale: It might be a valid study so its important to ask fo resistance with understanding the data. Having mentors is important to maintain in your career. What is the first essential key to implementing a change in a microsystem? A) A clear vision of what outcomes are to be accomplished B) Strategic plan C) Persistence on the change implementation to be successful D) Belief the change will be a success ✔ A) A clear vision of what outcomes are to be accomplished Rationale: A clear vision of what is to be accomplished by the change is the first element to a successful outcome. The others come after the vision is made. Cassidy, a CNL at an outpatient setting sees an increase of Japanese patients. This is a culture she doesn't know much about & does n't have much education materials to give to patients in this language. She goes online to valid websites & learns more about the culture & their health care practices. She also discovers a site within her heath care system that translates information & has handouts in 12 different languages. Cassidy demonstrated knowledge of: A) Team coordination B) Injury reduction C) Health care informatics D) Health care policy ✔ C) Health care informatics Rationale: Health care informatics applies using technology to improve patient care. Many handouts are given to all its on admission to hospital. The CNL notices patients leave them or throw them away. She decide to make binders for all the rooms with laminated copies of the information & lets each patient know they can get a copy to take home if wanted. This CNL exhibited what concept? A) Health care informatics B) Fiscal responsibility C) Team coordination D) Health promotion ✔ B) Fiscal responsibility Rationale: A lot of paper & ink was being wasted. This saved a lot of money & will continue to do so over time Chloe, a CNl, walks into a patient's room & notices she has labored respirations & is pale. She immediately takes her vitals & calls the patient care nurse. Her vitals are bP 183/101, HR 121, RR 28, T 98.1, O2 90%. What should Chloe do? A) Call the doctor B) Lay the pt down & recheck the VS in 30min C) Give labetalol 20mg IVP D) Instruct patient care nurse to call MD ✔ D) Instruct patient care RN to call MD Rationale: Delegate the nurse to call the physician for further orders A 5Ps assessment was completed by each NCL in the hospital. As A CNL you know this is an assessment of: A) Microsystem B) Mesosystem C) Macrosystem D) Health care system ✔ A) Microsystem Rationale: A 5Ps assemsnet is an analysis fo the microsystem. It consists of analyzing the purpose, patients, professionals, processes, & patterns of the microsystem. A patient asks the CNL about the regulations on abortion in NC. What should the CNL do? A) Tell pt you can't answer that because it's an ethical situation B) let the MD know the pt is asking about abortion C) Inform pt care RN D) Look up regulations in NC & share them with the patient ✔ D) Look up regulations in NC & share them with the patient Rationale: Being able to look up policies & regulations is an important role fo the CNL, along with educating patients. Giving the policy does not cross any ethical barriers, it is only providing facts. A nurse approaches you & expresses her knowledge deficit regarding the difference between s/s of L & R sided heart failure. You explain the physiology between two types of heart failure & identify which of the following as a primary symptom of R-sided heart failure? A) SOB on exertion B) Heart murmur & distended veins C) Peripheral edema D) Cool extremities & weak peripheral pulses ✔ C) Peripheral edema Rationale: R-sided heart failure leads to congestion of systemic capillaries. This generates excess fluid accumulation int eh body & usually affects the dependent parts of the body first. As a CNL you know that the most important nursing intervention to monitor a patient with CHF includes which of the following? A) Assessing pt's knowledge of the disease B) Encouraging coughing & deep breathing C) Encouraging frequent ambulation D) Monitoring fluid intak e& output ✔ D) Monitoring fluid intake & output Rationale: In heart failure, compensatory mechanisms cause retention of fluid & sodium A notifies you that her patient is c/o chest pain. As you enter the room, the patient becomes unresponsive. Upon verification that a pulse I absent, the cardiac monitor reveals the patient is in VFib. The nurse begins CPR. As a CNL you anticipate the need for which treatment next? A) Amiodarone B) Labetolol C) Defibriliation D) Cardiac catheterization ✔ C) Defibrillation A) Research whether the pt has ever had a history of any anemia or GI bleeding B) Assess pt for s/s of bleeding C) Call MD & inform him to redraw the labs D) Review rest of pt's lab values ✔ B) Assess pt for s/s of bleeding Rationale: If the significant decrease in Hgb is unexpected & lab error is suspected, the clinician must first assess pt to ensure no s/s of bleeding are present. You are helping a new nurse with admission of pt with dx of COPB exacerbation. You explain differences between two types of COPD. Together you review the finding that you would expect to asses on pt with chronic bronchitis vs. emphysema. Which of the following would not be an expected finding on a patient with chronic bronchitis? A) Wheezing & bronchi upon lung field auscultation B) Dry cough with little sputum production C) Cyanotic D) Hypercapnia & respiratory acidosis ✔ B) Dry cough with little sputum production Rationale: A pt with chronic bronchitis will have a chronic cough with production of large amounts of thick, tenacious mucus. Which of the following is an example of knowledge managnement? A) Forming a multidisciplinary team to evaluate your patient's POC B) Provide counseling for patients & families on smoking cessation C) Presenting to your unit's staff a comparison of you institution & unit fall rates against national benchmarks D) Participating in community event that focuses on cholesterol screening ✔ C) Presenting to your unit's staff a comparison of your institution & unit fall rates against national benchmarks Rationale: Knowledge management includes the CNL using institutional & unit data for comparison against national benchmarks Your unit has recently been participating in a study to evaluate the use of new, more affordable gloves. You have noticed that many of the nurses are complaining that the gloves are cheap & tearing easily. You present this to your unit manager & discuss the risk of infection. What is this example of? A) Patient advocacy B) EBP C) Team coordination D) Knowledge management ✔ D) Knowledge management Rationale: Knowledge managment includes anticipating risks when new technology, equipment, treatment regimens, or medication therapies are introduced Your unit has recently had an increase in fall rates. When you compare what other units in your department are doing, you identify that each unit is using a different fall risk assessment tool. You research each tool & identify which one has the strongest evidence based research in preventing patient falls. This tool is later standardized thought the hospital. What is this an example of? A) Applying tools for risk analysis B) Patient advocacy C) Gathering, analyzing, & synthesizing data related to risk reduction & patient safety D) Demonstrating accountability for the delivery of high-quality care ✔ A) Applying tools for risk analysis Rationale: Researching & presenting evidence-based data apply to tools for prevention of falls (risk analysis) As the CNL you have identified that post-op pneumonia has been a frequent occurrence within your unit. Your manager approaches you & identifies hat each occurence of post- op pneumonia costs the unit $5K. You develop a respiratory program that includes frequent IS use, ambulation TID minimal, & frequent mouth care, if warranted. You are able to reduce the unit's occurrent of post-op pneumonia by 75%. What is this an example of? A) Conceptual analysis & implementation fo the CNL role B) Knowledge management C) Effective use of self D) Horizontal leadership ✔ B) Knowledge management Rationale: Knowledge management improves clinical & cost outcomes You have noticed that on your unit many elderly patients are unable to return home with their family members due to loss/decrease of their functional abilities. You research & implement a toll that scores a patient's functional ability when they enter the hospital & once upon discharge. You use this data to share with staff & create ideas to improve maintenance of an elderly patient's functional ability. What is this an example of? A) Interpreting & using quantitative data B) Interepteting & using qualitative data C) Risk analysis D) Using evidence to identify & modify interventions to meet specific client needs ✔ A) Interpreting & using quantitative data Rationale: Quantitative research collects information in the form of numbers You are providing discharge education to a patient who was diagnosed with Parkinson's disease. The patient is being discharge with a hone health nurse & PT. Which of the following statements by the patient's wife identifies a need for more education? A) I am afraid my husband will fall B) I am uncertain that I will be able to provide the right care for my husband C) My husband enjoys watching TV for long periods of time D) I may ask my daughter to stay with us for the next couple of weeks ✔ C) MY husband enjoys watching TV for long periods of time Rationale: Pneumonia is the most frequent COD in patients with Parkinson's disease. You are discharging a young patient dx with UTI. To help prevent future UTI you instruct the patient to do the following: A) Urinate forcefully to clear bacteria from the tract B) urinate before sexual intercourse to limit transmission C) Wear cotton underwear to prevent moisture D) Pat dry after urinating to prevent infection ✔ C) Wear cotton underwear to prevent moisture Rationale: Cotton absorbs moisture & pulls it away from the skin. Bacteria thrive in moist environments. Which of the following is an example of transcultural nursing? A) Maintaining eye contact with an Asian family B) Reporting the MD that you are unsure your American Indian patient understands his POC because he stares at the floor when you talk to him C) Male nursing giving his Hispanic female pt a huge D) Alerting the MD to write for a pork-free diet for you Islamic pt ✔ D) Alerting the MD to write for a pork-free diet for your Islamic pt Rationale: The goal of transcultural nursing is to improve & to provide culturally congruent care to people that is beneficial, will fit with, & will be useful to the client, family, or group healthy life ways. You are caring for a patient with CHF. He has just completed a transfusion of 2units of PRBCs. Upon entering the room, he c/o SOB. His O2 sats are 85% on 2L O2 & RR 28. What drug do you anticipate administering? A) Nitroglycerin SL B) Lasix IV C) Albuterol HHN D) Prednisone PO ✔ B) Lasix IV Rationale: Pt is most likely in pulmonary edema. Lasix is a loop diuretic. Your manager has approached you regarding her need to decrease the unit's budget. Which of the following would hav the greatest impact on decreasing the unit's budget? A) Exploring why staff is not leaving on time & creating overtime B) Eliminating unused supplies on the unit C) Increasing nurse to patient ratio D) Deciding not to update the unit's computers