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Nursing Executive Administrator Advanced - Board Certification Set 2
Basic questions for the NEA-BC exam
Terms in this set (25)
When a facility is converting to the interoperable electronic healthcare delivery system, the most important aspect to consider is:
a. equipment choice.
b. time needed for conversion.
c. staff training.
d. staff preference.
C: When converting to an interoperable healthcare delivery system, the most important aspect to consider is the need for extensive training for all staff at all levels because the procedures that are currently paper-related must be modified and converted to a digital format. Standard terminology may need to be established or modified. Staff must be trained to input and retrieve information from the electronic system and safeguards must be established to prevent violations of confidentiality. Information retrievable over the Internet must be encrypted.
The level of care that provides people with moderate assistance in activities of daily living and periodic nursing supervision for some activities is called:
a. custodial care.
b. intermediate care.
c. skilled nursing.
d. acute care.
B: Intermediate care provides people with moderate assistance in activities of daily living and periodic nursing supervision for some activities, such as assistance with ambulation, grooming, and medications. Insurance companies usually do not pay for this level of care. Custodial care/assisted living provides people with assistance in performing basic ADLs, such as dressing and bathing. Insurance companies do not pay for this level. Skilled nursing provides maximal assistance with ADLs and also provide for daily supervision/care by a licensed professional. Insurance companies usually pay for this level of care. Acute care can include hospitals, rehabilitation services, inpatient rehabilitation centers, and transitional hospitals. Insurance companies should pay for this degree of care.
Two staff nurses disagree about the best way to carry out their duties, resulting in ongoing conflict and refusal to work together. The first step in resolving this conflict is to:
a. allow both individuals to present their side of the conflict without bias.
b. encourage them to reach a compromise.
c. tell them they are violating professional standards of conduct.
d. make a decision about the matter
A: Steps to conflict resolution include: First, allow both sides to present their side of the conflict without bias, maintaining a focus on opinions rather than individuals. Encourage cooperation through negotiation and compromise. Maintain the focus of the discussion, providing guidance to keep the negotiations on track and avoid arguments. Evaluate the need for renegotiation, formal resolution process, or third party involvement. The best time for conflict resolution is when differences emerge but before open conflict and hardening of positions occur. The nurse must pay close attention to the people and problems involved, listen carefully, and reassure those involved that their points of view are understood.
The primary criterion for referral to a hospice program is
a. severe intractable pain.
b. a life-threatening disease.
c. the probability that death will occur within 6 months. d. the presence of a DNR order.
C: The primary criterion for referral to a hospice program is the probability that death will occur within 6 months. Generally, hospice programs require a DNR order and a diagnosis of a life-threatening disease, but those alone are not sufficient, as those with longer life expectancies should be referred to palliative care programs instead. Severe intractable pain may be one problem hospice addresses, but pain can occur in patients who do not have a life-threatening disease.
There is only one bed available in a skilled nursing facility, but there are two patients who are in need of care. The nurse recommends that one patient be transferred to another facility. The decision regarding which patient to transfer should be based on which ethical principle?
C: Justice is the ethical principle that relates to the distribution of limited healthcare resources to members of society. These resources must be distributed fairly. This issue may arise if there is only one bed left and two patients in need of care. Justice comes into play when deciding which patient should stay and which should be transported to a different facility. The decision should be made according to what is best or most just for the patients and not colored by personal bias.
Which of the following laws require that communities provide transportation services for the disabled, including accommodations for wheelchairs?
a. Emergency Medical Treatment and Active Labor Act (EMTALA).
b. Older Americans Act (OAA).
c. Omnibus Budget Reconciliation Act (OBRA).
d. Americans with Disabilities Act (ADA).
D: The ADA provides the disabled, including those with mental impairment, better access to the community and employment opportunities. Communities must provide transportation services for the disabled, including accommodation for wheelchairs. Public facilities (schools, museums, physician's offices, post offices, restaurants) must be accessible with ramps and elevators as needed. EMTLA prevents "dumping" of patients from emergency departments. OAA provides improved access to services for older adults and Native Americans, including community services (meals, transportation, home health care, adult day care, legal assistance, and home repair). OBRA provides guidelines for nursing facilities, such as long-term care facilities.
Which of the following violates the American Medical Association's guidelines for informed consent?
a. Description of risks and benefits of treatment.
b. Presentation of only the 3 most cost-effective treatment options.
c. Review of the nature of treatment and purpose.
d. Comparison of success rates for similar treatment at different facilities.
B: Presentation of only the 3 most cost-effective treatment options is a violation of the guidelines regarding informed consent, which include:
- Explanation of the diagnosis. Nature and reason for the treatment or procedure.
- Risks and benefits of the selected treatment.
- Alternative options (regardless of cost or insurance coverage).
- Risks and benefits of alternative options. - Risks and benefits of not having a treatment or procedure.
- Providing informed consent is a requirement of all states.
While providing comparison information is not required, doing so does not violate informed consent protocols.-
Which of the following best describes a case mix group as defined by the Health Insurance Prospective Payment System (HIPPS)?
a. A classification system based on utilization of resources.
b. A data set containing elements to review for a comprehensive assessment of patient function.
c. A classification system based on clinical characteristics of patients.
d. A data set used by home health agencies to measure outcomes and risk factors.
C: A case mix group (CMG) is a classification system based on the clinical characteristics of patients. Resource utilization group (RUG) is a classification system based on utilization of resources, with reimbursement tied to RUG level. The Outcome and Assessment Information Set (OASIS) is a data set used by home health agencies (HHA) to measure outcomes and risk factors within a specified time frame. Minimum data set (MDS) contains elements to review for a comprehensive assessment of patient function. The MDS currently in use is MDS 3.0.
The primary purpose of sending a request for information (RFI) to multiple vendors is to:
a. aid in the elimination and selection process.
b. meet regulatory requirements.
c. eliminate the need for a request for quote (RFQ).
d. complete a cost-utility analysis.
A: The primary purpose of sending an RFI to a variety of vendors is to help in the elimination and selection process. Topics for questions may include:
- History and financial status of company.
- Lists of current users of company's product.
- Information about system architecture.
- Hardware/software requirements.
- User support.
- Equipment support/maintenance.
- Ability of equipment to integrate with other systems.
Requests for information (RFI) are used early in system analysis to gather information from various vendors, often in conjunction with requests for proposal (RFP) and requests for quote (RFQ).-
The first step to knowledge discovery in a database (KDD) is:
a. data mining.
b. data selection.
c. pre-processing data.
d. transforming data
B: The first step to knowledge discovery in database (KDD) is data selection. Other steps include preprocessing (assembling target data set and cleaning data of noise), transforming data, data mining, and interpreting results. KDD is a method to identify patterns and relationships in large amounts of data, such as the identification of risk factors or effectiveness of interventions. KDD may utilize data perturbation, the hiding of confidential information while maintaining the basic information in the database, and data mining.
According to the Health Information Technology for Economic and Clinical Health Act (HITECH) security provisions, a breach in security of personal health information requires notification of:
b. the physician.
c. the US Department of Health and Human Services (HHS).
d. the individuals impacted and US Department of Health and Human Services (HHS).
D: The American Recovery and Reinvestment Act (2009) (ARRA) included the Health Information Technology for Economic and Clinical Health Act (HITECH). Security provisions include:
Individuals and HHS must be notified of a breach in security of personal health information.
- Business partners must meet security regulations or face penalties.
- The sale/marketing of personal health information is restricted.
- Individuals must have access to personal electronic health information.
- Individuals must be informed of disclosures of personal health information.
HITECH provides incentive payments to Medicare practitioners to adopt EHRs. Additionally, HITECH provides penalties in the form of reduced Medicare payments for those who do not adopt EHRs, unless otherwise exempted.
Which of the following is an example of intelligent risk taking when a nurse executive is faced with the need to cut costs?
a. Switching to an acuity-based nursing care model to reduce overtime costs.
b. Reducing nursing staff across the board in all departments.
c. Reducing support staff by 50%.
d. Hiring all part-time staff to avoid paying benefits.
A: Switching to an acuity-based nursing care model to reduce overtime costs represents intelligent risk-taking because it stands a good chance of being successful, but failure is not likely to make things worse. Reducing nursing staff across the board in all departments is rarely a successful approach because the intensity of care needs often varies widely, increasing the risk of errors. Reducing support staff by 50% increases the burden on licensed staff and can result in costly problems. Hiring all part-time staff to avoid paying benefits often results in increased staff turnover and decreased engagement, both of which can be costly in the long-run.
The communication theory that describes communication as an exchange system in which people attempt to negotiate a return on their "investment" in much the same way that people engage in commerce is:
a. Social Penetration Theory (Altman and Taylor).
b. Communication Accommodation Theory (Giles).
c. Spiral of Science Theory (Noelle-Neuman).
d. Social Exchange Theory (Homans, Thibaut, and Kelley).
D: Social Exchange Theory describes communication as an exchange system in which people attempt to negotiate a return on their "investment." Social Penetration Theory describes the manner in which people use communication to develop closeness to others, proceeding from superficial communication to more explicit self-disclosure. Communication Accommodation Theory explains why people alter their communication styles. Individuals may practice convergence or divergence. Spiral of Science Theory looks at the role that mass media has in influencing communication. It suggests that people fear isolation so they conform to public opinions as espoused by mass media and mute dissent.
Which of the following serves as the guide for tracer methodology?
a. Patient surveys
b. Patient medical records
c. Staff surveys
d. Accreditation reports
B: Tracer methodology uses a selected patient's medical record as a guide to assess the continuum of care that a patient receives from admission to post-discharge. Tracer methodology uses the experience of this patient to evaluate the processes in place through documents and interviews. For example, if a patient received physical therapy, nursing and transport services, they would all be reviewed to determine how they received orders, carried out processes (including length of time and methods), and noted progress. Each step is traced and evaluated.
The primary purpose of knowledge management is to: a. increase organizational effectiveness.
b. widely disseminate information.
c. provide safeguards to prevent unauthorized access to information.
d. codify and transmit data.
A: The primary purpose of knowledge management is to increase organizational effectiveness by ensuring that information reaches those who need it in an efficient and easily accessible manner. Knowledge includes that which is explicit and can be codified and transmitted through databases as well as tacit knowledge based on an individual's experience. An infrastructure must be in place to capture, create, and share content, including best practices, as well as expertise and experience (intellectual capital).
The Leapfrog Safe Practices score is used as a basis for: a. Promoting evidence-based practice through the funding of 14 Evidence-based Practice Centers (EPCs). b. Providing collaborative training within the network related to safe clinical practice.
c. Providing fellowships to help professionals gain experience and expertise in health-related fields.
d. Assessing progress a healthcare organization is making on 30 safe practices.
D: The Leapfrog Safe Practices Score assesses the progress a healthcare organization is making on 30 safety practices that Leapfrog has identified as reducing the risk of harm to patients. Leapfrog is a consortium of healthcare purchasers/employers and has developed a number of initiatives to improve safety. Leapfrog encourages voluntary public reporting and provides an annual Hospital and Quality Safety Survey to assess progress and release regional data. Leapfrog has instituted the Leapfrog Hospital Rewards Program (LHRP) as a pay-for-performance program to reward organizations for
The employee assistance program's critical incident stress management (CISM) plan is initiated after a severe explosion and fire brings dozens of critically injured patients to the hospital. When should the defusing sessions begin?
a. As soon as possible during or after the event
b. Two to three days after the event
c. One week after the event
d. Within 2 weeks after the event
A: Critical incident stress management (CISM) helps people cope with stressful events and in reducing the incidence of PTSD. Defusing sessions: Very early, sometimes during or immediately after a stressful event to educate those actively involved about what to expect over the next few days and to provide guidance in handling feelings and stress. Debriefing sessions: In 1-3 days after the incident and as needed for those directly and indirectly involved. People are encouraged to express their feelings and emotions. Six phases: introduction, fact sharing, discussing feelings, describing symptoms, teaching, and reentry. Follow-up is done at the end of the process, usually after about a week.
A nurse executive's span of control refers to:
a. the type of governance.
b. the number of patients.
c. the number of subordinate staff who report to her.
d. the number of departments she manages.
C: Span of control is a business term that refers specifically to the number of subordinate staff a nurse executive (or any person) has and generally includes those subordinates the person personally supervises. Span of control is most important in a hierarchical organization where lines of authority are clearly delineated. The span of control may vary widely depending on the skills of the nurse and the skills of subordinates. Each subordinate, such as a unit supervisor, may also have a span of control.
The National Quality Forum's safe practices, specifically regarding medication management, includes:
a. the need to document care properly.
b. implementing a computerized prescriber order entry (CPOE) system.
c. informing patients of medication side effects and risks.
d. providing discharge planning.
B: National Quality Forum's safe practices include managing medications by implementing a computerized prescriber order entry (CPOE) system, using standardizing abbreviations, maintaining updated medication lists for patients, and including pharmacists in medication management to identify high alert drugs and dispense drugs in unit doses. Additional safe practices include considering patient's rights and responsibilities, managing information and care, preventing healthcareassociated infections, providing safe practices for surgery, and providing procedures and ongoing assessment to prevent site-specific or treatment-specific adverse events.
In a database, the type of data that is usually used to represent a count of something is:
B: National Quality Forum's safe practices include managing medications by implementing a computerized prescriber order entry (CPOE) system, using standardizing abbreviations, maintaining updated medication lists for patients, and including pharmacists in medication management to identify high alert drugs and dispense drugs in unit doses. Additional safe practices include considering patient's rights and responsibilities, managing information and care, preventing healthcare associated infections, providing safe practices for surgery, and providing procedures and ongoing assessment to prevent site-specific or treatment-specific adverse events.
When brainstorming as part of action planning, which of the following is the first step?
a. Establish the purpose of and the time frame to brainstorm.
b. List every suggested idea.
c. Discuss items and clarify issues.
d. Decide on a structured or unstructured approach.
A: Brainstorming is used to generate ideas about problems, processes, solutions, or other criteria in a short time frame. There are 5 primary steps:
- Establish the purpose of and time frame for the brainstorming session.
- Decide on a structured or unstructured approach.
- Allow time for general discussion or individual thought.
List ideas according to the approach. Ideas may be written on a white board or flip chart or projected from a computer so that the group can look at the list.
- Discuss items, clarify, and combine like items as the group agrees.
Which of the following legal procedures authorizes disclosure of patient personal health information?
b. Subpoena duces tecum
d. Court order
D: A court order authorizes disclosure of a patient's personal health information. In some cases, this court order may cover only restricted information rather than an entire health record. A subpoena is issued to advise a person that he or she must give testimony in court or in a deposition. A subpoena duces tecum is similar but requires that the person bring specific documents to court. A warrant authorizes an action, such as a search.
The nurse executive would find Workers' Compensation data most useful when researching which of the following?
a. Tracking occupational illness.
b. Determining safety measures.
c. Estimating frequency of particular occupational injuries.
d. Reducing costs of work-related injuries
C: Workers' Compensation data are not available on a national basis. Criteria for data collection may vary from state to state along with state regulations, but even limited (statewide) data may provide an estimate of the frequency and severity of particular occupational injuries as well as their associated costs. The data may help guide the institution of work safety measures and development of safety training. Occupational illness data are less useful because injuries tend to be similar across industries while illnesses tend to show more variation
The four necessary elements of all negligence claims are:
a. Duty to care, harm, liability, and residual damages.
b. Onset, duration, cause, and injury.
c. Victim, perpetrator, injury, and residual damages.
d. Duty of care, breach of duty, damages, and causation.
D: When screening for medical cases for plaintiffs, the four necessary elements of negligence must be identified:
- Duty of care: The defendant had a duty to provide adequate care and/or protect the plaintiff's safety.
- Breach of duty: The defendant failed to carry out the duty to care, resulting in danger, injury, or harm to the plaintiff.
- Damages: The plaintiff experienced illness or injury as a result of the breach of duty.
- Causation: The plaintiff's illness or injury is directly caused by the defendant's negligent breach of duty.
According to von Bertalanffy's Systems Theory, which of the following is an example of throughput?
a. Raw materials
b. Planning processes
d. Accreditation reports
B: Planning processes is an example of throughput. Components of Systems Theory include:
Input: Includes those things going into a system in terms of energy and materials, such as money, raw materials, effort, and time.
Throughput: Processes that transform the input, such as brainstorming, planning, meeting, and sharing resources and information.
Output: Resulting product, such as laws, rule, financial gain, materials, and programs.
Evaluation: Monitoring success or failure, such as through
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