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NUR 4590 Exam 2-with 100% verified answers-2024-2025.docx
Typology: Exams
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Which of the following factors influences the structure of an organization? a.Age of the building b.Brand of computer system c.Number of employees d.Square footage of the facility Within nursing practice, the use of advanced practice roles is an example of: a.cross-training. b.departmentalization. c.fragmentation. d.specialization. The nursing chief executive officer (CEO) works in a major rehabilitation and subacute facility network. Her span of control refers to the number of: a.miles in which the network resides. b.ancillary staff accountable to her. c.nurses and non-nurses reporting to her. d.inpatients that the facilities service. A nurse manager is responsible for a unit consisting of 40 nurses who report to two clinical supervisors. In addition, there are 10 support staff who report to an administrative supervisor. The subordinates reporting to this manager are known as which dimension of organizational design? a.Division of labor b.Hierarchy c.Span of control d.Decentralization A staff nurse has been working in the neonatal critical care unit for 10 years. She believes that a professional nurse is a lifelong learner. Many staff members come to her for clinical problem solving and advice. This nurse has:
a.decisional authority. b.formal power. c.informal power. d.quantum authority. An organizational chart with one line of management and one line of staff reflects which of the following types of organizational structures? a.Authoritarian structure b.Flat structure c.Power structure d.Vertical structure The phrase "the buck stops here" best describes which of the following terms? a.Accountability b.Authority c.Responsibility d.Trustworthiness Patient surveys convey that they are uncertain about who is the registered nurse (RN). The CEO makes a decision that mandates that white nursing caps will be worn by all RNs and blue nursing caps by all licensed practical nurses to differentiate professional nurses and occupational nurses from nurses' aides and other ancillary staff. Which type of structure does this represent? a.Centralized b.Decentralized c.Nonparticipative d.Participative The patient is a 69-year-old woman who has a history of diabetes mellitus, peripheral vascular disease, and myocardial infarctions. She was admitted to the hospital with a stroke and is being transferred to a subacute facility and then to a rehabilitation facility. At every transfer she must review her entire history, provide telephone numbers of family members, list all 30 of her medications, and list all home care and medical supply companies. Which of these processes could improve the fragmentation in work flow? a.Departmentalization b.Standardization
c.Specialization d.Subdivision The ways in which work is divided and coordinated among members and the resulting network of relationships, roles, and work groups is the: a.organization. b.organizational social structure. c.structure. d.formal relationship. According to the organizational approach, organizations are logical and predictable with identifiable and scientifically measurable characteristics that can be predicted, observed, or manipulated. a.objective b.subjective c.postmodern d.realistic Which organizational theory emphasized the informal aspects of organization social structure and was influenced by the Hawthorne experiments? a.Bureaucratic theory b.Scientific management school c.Classical management theory d.Human relations school The division of work by occupation or function is a form of: a.specialization. b.interdependence. c.uncertainty. d.technology. Standardization of provides a uniform structure for information delivery and flow in order to facilitate exchange among those involved in common work processes. a.physician orders
b.communication c.work processes d.work outputs A rapid response team within an acute care hospital is comprised of critical care physicians, nurses, and respiratory therapists. The team assists staff throughout the hospital with detecting and managing imminent patient deterioration. This is an example of a organizational form. a.parallel b.functional c.modified program d.matrix The structure of authority in an organization is known as the: a.authority. b.centralization. c.bureaucracy. d.hierarchy. The network or pattern of social relationships and friendship circles within an organization is known as the: a.clique. b.formal structure. c.informal structure. d.hierarchy. The nursing staff on a critical care unit thought that professional growth could be enhanced. Which of the following interventions would support empowerment of the nursing staff? (Select all that apply.) a.Eliminating computers and reverting back to paperwork b.Increasing pay wages for ancillary and professional staff c.Providing various methods for ongoing education and continuing education units d.Working to make equipment and medications readily available
According to organization theories, there are three perspectives regarding the nature of reality and knowledge within an organization. Which of the following are those perspectives? (Select all that apply.) a.Objectivism b.Subjectivism c.Postmodernism d.Realism e.Idealism According to the contingency theory of organizational performance, an organization must structure and adapt its nursing units to complement which two factors? (Select all that apply.) a.Skill set b.Patient population c.Environment d.Technology e.Finances Which of the following statements describe the benefits of specialization in the health care setting? (Select all that apply.) a.Improved work performance b.Increase in expertise c.Improved efficiency and outcomes d. Increased workload e.Increased error reporting Dividing work by occupation leads to a functional organization where services are arranged by the type of work performed. What are some benefits of the functional form within the health care organization? (Select all that apply.) a.Professional silo b.Fragmented care delivery c.Cost reduction d.Enhanced performance and quality e.Promotion of professional development An organizational chart is used to depict: (Select all that apply.)
a.a visual display of the organization s positions. b.the intentional relationships among positions. c.open positions within human resources. d.flow of authority. e.advisory committees. Which of the following statements are accurate when describing responsibility and accountability? (Select all that apply.) a.The assignment of responsibility assumes accountability. b.A manager is assigned responsibility by a subordinate. c.Accountability is the liability for task performance. d.The assignment of responsibility and the granting of authority create accountability. e.Accountability flows upward or outward. The degree to which health services for individuals and populations increases the likelihood of desired health outcomes that are consistent with current professional knowledge is known as the: a. care delivery quotient. b. excellence index. c. quality of health care. d. standard of care. A nursing quality improvement supervisor is proposing to enhance the current quality improvement program. One of the most important themes that a nursing quality improvement supervisor should consider is: a. budgetary considerations. b. collaboration between health care teams. c. regular staff training programs. d. suggestions from patients. To provide the best care to every patient every day through integrated clinical practice, education, and research is an example of a(n): a. accountability agreement. b. mission statement. c. organizational standard. d. vision and value proposal.
Hospitals must submit specific quality performance data regarding Medicare patients or risk: a. an increase in federal tax. b. decreased payments. c. fewer physician referrals. d. sanctions by The Joint Commission (TJC). Responding to a code called in the psychiatric unit where she works, a staff nurse finds that a patient has committed suicide. The staff nurse correctly identifies this as a. a benchmark incident. b. quality improvement issue. c. performance breach. d. sentinel event Which comment by the nurse manager would indicate that the hospital places a high value on patient safety? a. We have safety posters throughout the hospital that encourage people to report problems. b. We have monthly safety in-services. c. We encourage patients and families to participate in their care. d. All employees are required to update their knowledge of safety practices each year. Which of the following responses from the nurse manager is consistent with a culture that promotes patient safety? a. We make sure that we don't have any errors on this unit. b. We identify who made the error and take corrective action. c. We provide remedial training for all staff on the unit when there is an error. d. We report any medical error or near-miss to help us find the root cause of the problem. Sentinel Event Alerts are published by TJC to do which of the following? a. Allow facilities to learn from sentinel events that have occurred in other facilities and incorporate recommendations for prevention into their policies. b. Notify hospitals that if a sentinel event occurs during an alert, the hospital will be subject to withdrawal of Medicare and Medicaid certification and reimbursement. c. Prevent a near-miss from occurring. d. Assist hospitals to find national standardized performance measures to benchmark themselves against other similar hospitals.
Mercy Hospital compares its surgical site infection rate to General Heart Hospital, which is known as a best-in-class hospital for its surgical site infection rates. Mercy Hospital studies General Heart Hospital's methods for reducing surgical site infection rates and uses that information to improve its own performance. This quality performance method is called: a. benchmarking. b. evidence-based practice. c. enterprise risk management. d. continuous quality improvement A clearly recognizable process of providing care that has an evidence base demonstrating that it reduces the likelihood of harm is: a. risk adjustment. b. a sentinel event. c. a patient safety practice. d. a performance measure. The industry-based model for quality management and measurement whose premise is that operational waste needs to be eliminated is: a. Six Sigma. b. ISO 9000. c. Lean Enterprise. d. Baldrige National Quality Award Program. Which of the following is an example of a nurse-sensitive indicator? a. Cardiac patient mortality b. Hospital-acquired pressure ulcers c. Pulmonary embolus after knee surgery d. Iatrogenic pneumothorax after central line placement The purpose of a root cause analysis (RCA) is to: a. discipline the staff involved in the patient safety event. b. disclose the medical error to the patient/patient s family. c. identify the person(s) responsible for committing the error. d. identify the systems issues that led to a sentinel event.
The risk manager wants to illustrate the causes that have been leading to an increase in patient misidentification. The most appropriate tool to use is a: a. pareto chart. b. control chart. c. fishbone diagram. d. detailed flowchart. Which of the following are never events? (Select all that apply.) a. A minor medication error b. A foreign object left in the body during surgery c. Surgery on the wrong body part d. A mismatched blood transfusion e. Hip fracture acquired in the hospital f. Pressure ulcer acquired in the home g. Catheter-associated urinary tract infection h. Surgical site infection A successful enterprise risk management (ERM) program will: (Select all that apply) a. identify risks. b. improve quality. c. prevent damage. d. control occurrences. e. control legal liability. Tenets embraced by health care professionals and promoted by health care leaders and organizations such as TJC and the IOM include which of the following? (Select all that apply.) a. People and systems are the problems, not processes. b. Quality measurement and monitoring is everyone's job. c. Quality cannot be enhanced by non-punitive work cultures. d. Standardization of processes is key to managing work and people. e. The impetus for quality monitoring is not primarily for accreditation or regulatory compliance. A framework for understanding health care improvement has been proposed by the IOM Committee on Quality of Health Care in America. The aims for health care quality improvement propose that health care systems ensure that care is: (Select all that apply.)
a. safe. b. timely. c. efficient. d. cost-controlled. e. patient-centered. The Baldrige National Quality Award (BNQA) establishes a set of performance standards that define a total quality organization. The standards in areas of excellence include: (Select all that apply.) a. leadership. b. strategic planning. c. environment of care. d. human resource focus. e. medication management. Attributes of a total quality organization according to BNQA include: (Select all that apply.) a. accreditation by TJC. b. a commitment to obtaining Magnet designation. c. strategic planning. d. focus on patients, other customers, and markets. e. organizational performance results. TJC requires accredited organizations to participate in their core measure initiative. The current core measure sets include: (Select all that apply.) a. stroke. b. tobacco treatment. c. pneumonia measures. d. iatrogenic pneumothorax. e. venous thromboembolism. f. acute myocardial infarction. Principles of a fair and just culture include: (Select all that apply.) a. zero-tolerance for reckless behavior. b. reduction of personal accountability and discipline. c. recognition that competent professionals make mistakes. d. errors and unintended events being reported unless no patient harm occurs.
e. acknowledgment that even competent professionals develop unhealthy norms. Nurse managers can create an environment that is devoted to health care safety by doing which of the following? (Select all that apply.) a. Adopting and embracing the concept of disciplining staff who commit errors b. Learning the concepts and tools related to quality improvement and quality assurance c. Becoming a role model for staff and peers in practicing health care safety concepts d. Encouraging staff to be constantly vigilant in identifying potential risks in the care environment e. Creating a sense of partnership with patients and families to promote communication about safety concerns and soliciting their suggestions to correct and prevent potential risks The improvement process in which an organization measures its strategies, operations, or internal process performance against that of best-in-class organizations within or outside its industry determines how those organizations achieved their performance levels, and uses that information to improve its own performance is known as.
- Benchmarking is the conscientious, explicit, and judicious use of current best evidence in making decisions about the care of individual patients. - Evidence-based practice A Healthcare Failure Modes and Effects Analysis (HFMEA) for a new bar-coding system is being conducted by an interdisciplinary team. List the steps of the HFMEA in the correct order. a. Identifying prevention strategies b. Endorsing action plans for implementation c. Assessing risk points within the process steps d. Flowcharting the steps of the process being studied e. Designing out the most critical of the potential failures f. Recommending process improvements for prevention of the failures g. Ranking key risk points in terms of their impact on the potential failure of the system h. Reporting action plans for implementing prevention strategies to the enterprise leaders - d. Flowcharting the steps of the process being studied c. Assessing risk points within the process steps g. Ranking key risk points in terms of their impact on the potential failure of the system
e. Designing out the most critical of the potential failures f. Recommending process improvements for prevention of the failures a. Identifying prevention strategies h. Reporting action plans for implementing prevention strategies to the enterprise leaders b. Endorsing action plans for implementation Quality planning establishes the design of a product, service, or process that will meet customer, business, and operational needs to produce the product before it is produced. Quality planning follows a universal sequence of steps. List the universal sequence of steps in order. a. Identify customers and target markets. b. Discover hidden and unmet customer needs. c. Develop a service or product that exceeds customer's needs. d. Transfer these designs to the organization and the operating forces to be carried out. e. Translate these needs into product or service requirements: a means to meet their needs. f. Develop the processes that will provide the service, or create the product, in the most efficient way.
- a. Identify customers and target markets. b. Discover hidden and unmet customer needs. e. Translate these needs into product or service requirements: a means to meet their needs. c. Develop a service or product that exceeds customer's needs. f. Develop the processes that will provide the service, or create the product, in the most efficient way. d. Transfer these designs to the organization and the operating forces to be carried out. Nursing informatics includes the: a. coding and billing of hospital and physician services. b. management and communication of data, information, knowledge, and wisdom in nursing practice c. organization and selection of quality medical information. d. support and troubleshooting of computer software issues. Management information systems describe a broad scope of activities that includes but is not limited to the management of: a. decision support systems. b. merchandise. c. products.
d. nursing services Effectiveness research: a. is the study of relationships among health care problems. b. provides solutions to serious global health care issues. c. reflects sound, reliable, and valid data that can be examined closely. d. supplies data that are critical and worthy of gathering. Which of the following statements best describes a desirable characteristic of a good management information system? a. Data should be sorted and labeled within 2 weeks. b. For accurate interpretation, data should reflect a health bias. c. Information gathering should be comprehensive and cost-effective. d. The management information system operating system should be Windows-based. Nursing data need to include which of the following domains? a. Fiduciary data b. Outcome data c. Client data d. Tertiary data was recognized by the American Nurses Association (ANA) as a nursing specialty in 1992 and is one of the fastest growing practice areas in health care. a. Nurse anesthesia b. Nursing informatics c. Nurse-midwifery d. Clinical nurse specialist The implementation of an electronic health record (EHR) could enhance patient care by facilitating: a. communication across the health care continuum. b. diabetes mellitus education and ongoing care delivery. c. one-on-one counseling between the provider and the client. d. physical and occupational therapy dispensing errors.
The first person to analyze patient outcomes associated with nursing care delivery was: a. Clara Barton. b. Dorothea Dix. c. Florence Nightingale. d. Luther Christman. The Nursing Minimum Data Set (NMDS) was designed to: a. determine differences in care delivery between the holder of an associate degree in nursing and a bachelor's of science in nursing. b. evaluate the nursing language of NANDA, Nursing Interventions Classification, and Nursing Outcomes Classification. c. provide data for leaders to make decisions about staffing patterns. d. standardize the collection of nursing data across populations. Nursing outcome databases are critical because nurses must be able to: a. assess the differences between an associate degree in nursing and a bachelor's of science degree in nursing. b. compare interventional care strategies between physicians. c. evaluate nurse's aide- and licensed practical/vocational nurse-sensitive outcomes. d. measure how nurses influence patient outcomes. The collection of data to measure performance is required by: a. the Health Insurance Portability and Accountability Act (HIPAA). b. the Centers for Medicare & Medicaid Services. c. The Joint Commission (TJC). d. Health Information Technology The data analysts within a health care organization pull core measure data from patient records on a quarterly basis. This data is then analyzed and collated into a report that is uploaded to TJC for analysis of adherence to core measure requirements. This is an example of: a. health information exchange (HIE). b. effectiveness research. c. health information management. d. management information systems.
The formal process of using patient data for providing evidence for the design of care protocols is termed: a. evidence-based practice. b. practice-based evidence. c. data analysis. d. effectiveness research. Nurses utilize through critical thinking and clinical reasoning skills to determine when and how to apply evidence-based knowledge. a. orders b. data c. information d. wisdom The Office of National Coordinator for Health Information Technology (HIT) was created by: a. President Barack Obama. b. President George W. Bush. c. Hillary Clinton. d. President Bill Clinton It is estimated that nurses spend approximately _ of their time documenting information in the EHR. a. 7% b. 17% c. 20% d. 35% What are some of the expected outcomes in the client domain of nursing data? (Select all that apply.) a. Patient satisfaction b. Achieved care outcomes c. Continuity of care d. Level of dependency e. Intensity of nursing care
In the provider domain, what are some of the variables that are used to measure variability in nursing? (Select all that apply.) a. Certification b. Hours of work c. Education level d. Years of experience e. Attitudes and beliefs Which of the following statements are true regarding health information technology (HIT) applications in nursing services? (Select all that apply.) a. HIT involves nursing administration, clinical informatics, and effectiveness research. b. Health information data allow nursing leaders to make informed decisions regarding patient care. c. HIT is used primarily for financial decision making. d. Clinical decision support utilizes tools for downloading, collecting, organizing, and analyzing data. e. HIT is used by senior leaders only. Nursing's data needs fall into four domains. Which of the following statements accurately describe the sources for data in each of the domains? (Select all that apply.) a. Client data is located in the client's health care record. b. Provider data refers to physicians and is located within the medical board. c. Administrative data is located in registry and regulatory performance data. d. Research data is only available with informed consent. e. Existing and newly gathered data can be a source of obtaining research information. According to the ANA, what elements are viewed as a relationship continuum as nurses apply them in decision making? (Select all that apply.) a. Data b. Technology c. Information d. Knowledge e. Wisdom What are the roles of nursing informatics specialists? (Select all that apply.)
a. Data analysis and reporting to governmental agencies b. Participation in education of nursing staff c. Providing direct patient care d. Providing information and evidence-based knowledge e. Supporting clinical decision making The goals of meaningful use include: (Select all that apply.) a. improve quality of care and safety. b. engage patients and their families in care. c. improve population health. d. reduce costs associated with health care. e. improve care coordination. What are the primary purposes and benefits of EHRs? (Select all that apply.) a. Single source of clinical, financial, and legal record b. Electronic format supports the storage and exchange of continuity of care c. Available within the health care facility to ensure confidentiality d. Originate from a single place e. Virtual record of retrospective, concurrent, and prospective information Nurse managers utilize outcomes data to make decisions about nursing care effectiveness. Which NMMDS data elements would be most effective in evaluating nursing care? (Select all that apply.) a. Nursing diagnosis b. Turnover c. Population served d. Client accessibility e. Intensity of nursing care Successful implementation of a health information system requires a great deal of time, education, and support. The process will require which of the following expertise within the organization? (Select all that apply.) a. Quality experts b. Marketing specialists c. Clinical nurse leaders d. Nurse informaticians
e. Nurse managers Organization design that empowers nurses by engaging decision making and provide accountability in nursing practice is?
- Shared governance Advantage of decentralized organization is? - Cost effective Elements included in organizational structure are: - Level of authority -Level of communication -Unity of direction CNO would like to design an organizational structure that limits the flow of communication and management/supervision determines decision making, what form of organization structure is this? - Centralized Advantages of decentralized staffing system include: - Increased job satisfaction, employee retention, patient outcomes, interpersonal relationship What trait would be the most important for a nursing quality improvement supervisor? - Interdisciplinary collaboration Fractured humerus and the nurse finds the patient had completed a suicide attempt in the shower. What type of event is this? - Sentinel Event
Comparison of an organization to another organization that is determined best in class, to implement methods to improve their performance is called?
- Benchmarking statement Select all of nurse-sensitive indicators. **- Hospital acquired pressure ulcers
The following is true regarding informal power
- Informal power comes from relationships and alliances with people in the organization. A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first? a.Review the events leading up to each medication administration error. b.Develop a quality improvement program for nurses involved in medication administration errors. c.Require staff nurses to demonstrate competency by passing a medication administration examination. d.Provide an inservice on medication administration to all the nurses. Which of the following statements about nursing informatics is false? - Nursing informatics deals exclusively with the development of electronic medical record systems. Shared governance is a model of organizational structure in which staff nurses are: a. employed to establish mutual goals with clients. b. empowered through autonomy and accountability. c. engaged in problem-solving strategies and techniques. d. equipped with evaluative thinking Nurses' involvement in shared governance is an important component of: a. practice models. b. Magnet recognition. c. increased reimbursement d. physician satisfaction. A nurse works in the critical care unit (CCU). She enjoys being on the unit charge nurse team, the recruitment and retention team, and the peer evaluation team. The recruitment and retention team is responsible for hiring new employees into the CCU. The five-member team, consisting of three registered nurses (RNs), a unit clerk, and a nurse's aide, conduct the
interviewing process with key questions that were developed by the team. This is an example of: a. centralized power. b. shared governance. c. span of control. d. vertical authority. Which of the following leadership styles is best suited for implementation of a shared governance structure? a. Authoritarian b. Autocratic c. Participative d. Laissez-faire One obstacle in the implementation of a shared governance model is that nurses have: a. empowered participation in committee meetings. b. limited time to work on projects. c. the same basic educational foundation. d. traditionally worked in decentralized structures The nurse manager should use which of the following behaviors when implementing a shared governance structure? a. Autocratic decision making of the manager b. Coaching the staff to be successful c. Harboring the vision within the team d. Reimbursing the staff for overtime Research about shared governance suggests that it is: a. enhancing the role of the nurse's aide within the organization. b. improving organizational and patient outcomes. c. not a cost-effective program when examining all areas of care. d. too much additional work for the already overwhelmed RN.
Shared governance is a vehicle for engaging organizations and creating the necessary forums and intersections that assure the decisions and actions remain dynamic and as close to the point of service as possible. Shared governance promotes: a. dependence. b. non-punitive culture. c. collaboration d. executive decision making Traditionally, nurses have worked in strong, hierarchical institutions with centralized decision making and clear authority structures, rigid approval mechanisms, and extensive policies and procedures that have resulted in barriers to creating a shared governance system. One such barriers is: a. lack of role clarity. b. lack of time management. c. poor time management skills. d. that development takes a long time. In organizations that practice shared governance, the responsibility for unit outcomes rests with the: a. nursing team. b. nurse manager. c. individual nurse. d. chief nursing officer (CNO). Organizational benefits of a culture of shared governance include: (Select all that apply.) a. improved financial outcomes. b. interdependence among staff nurses. c. increased commitment of staff to the organization. d. more senior leadership involvement at the point of service. e. a more efficient model for point-of-service decision making At its start, shared governance requires the education and support of organizational executives, managers, and point-of-care staff. Organizational benefits include: (Select all that apply.) a. accountability of the nurse. b. reduction in liability claims.
c. reduction in workers' compensation claims. d. improved financial outcomes. e. more expert involvement at the point of care. Institutions organize and structure themselves by defining departmental function and authority to achieve a more coordinated effort. In institutions where the executive leader retains more decision-making authority, the operation takes on a more philosophy. a. centralized b. decentralized c. autocratic d. democratic In an organization that has a decentralized organizational philosophy, decision-making authority rests in levels closer to the point of service rather than in the executive levels. Benefits of a decentralized organizational philosophy include: (Select all that apply.) a. encouraging more input. b. supporting greater innovation. c. facilitating faster response times. d. permitting a narrower span of control. e. allowing for more levels of management