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Certified Nurses Executive Administrator Board Certification Set 3
Terms in this set (25)
Which aspect of outcomes evaluation refers to
continuing treatment while still monitoring and
C: Outcomes evaluation includes the following:
Monitoring occurs during the course of treatment and involves careful observation and record keeping that notes the patient's progress. Supporting laboratory and radiographic evidence is documented.
Evaluating results includes reviewing records as well as current research to determine if the outcomes are within acceptable parameters.
Sustaining involves continuing treatment, but also continuing to monitor and evaluate.
Improving means to continue the treatment but with additions or modifications in order to improve outcomes.
Replacing the treatment with a different treatment must be done if outcomes evaluation indicates that current treatment is ineffective.
A sentinel event occurs when an 80-year-old postoperative patient develops a Clostridium difficile infection and dies as a result of the infection. The first step in preventing further cases is to:
a. conduct a root cause analysis.
b. develop an action plan.
c. close the unit for extensive cleaning.
d. educate staff about infection control measures
A: Each case must be dealt with individually. If defined as a sentinel event, a root cause analysis that defines the problem through gathering evidence to identify what contributed to the problem must be performed. Once a root cause has been determined, an action plan that identifies all the different elements that contributed to the problem is recommended and instituted. The theory is that finding the root cause can eliminate the problem rather than just treating it. Thus, finding the source of an infection would be more important than just treating the infection.
When conducting a stakeholder analysis as part of
long-term planning, the initial step is to:
a. evaluate stakeholders.
b. map stakeholder relationships.
c. identify important stakeholders.
d. classify stakeholders as either primary or
C: The initial step in stakeholder analysis is to identify those stakeholders important to the organization by surveying key stakeholders and looking to see with whom they identify. Once a list is compiled, then surveys ask respondents to evaluate and rate the relative power of each of the stakeholders. Next, stakeholder mapping is usually done to show the relationships among the stakeholders. Stakeholders may be further classified as those who are primary (essential), secondary (nonessential), internal (within the organization), or external (outside the organization but interacting with it).
The Hospital Compare Internet site provided by
Medicare allows for the comparison of how many
different hospitals at one time?
B: The Hospital Compare website allows people to compare up to 3 hospitals at a time. A search is conducted by zip code, city and state, or state alone. Results show distance from search parameter (such as distance from the zip code), availability of emergency services, and hospital type. Available information includes general information (address and types of services), patient survey results, timely and effective care in specified areas (heart attack, heart failure, pneumonia, surgical, ED, preventive care, and children's asthma), readmission complications and deaths, the use of medical imaging, Medicare payment, and number of Medicare patients.
When reviewing data provided by the CMS Hospital
Quality Initiative, the nurse executive notes that 83% of
patients admitted through the emergency department with pneumonia had a blood culture test prior to the first dose of antibiotics. The most appropriate initial response is to:
a. commend the staff for exceeding national
b. reprimand the staff for substandard care.
c. institute staff training regarding appropriate
d. question the accuracy of the results
C: The most appropriate initial response is to institute staff training regarding appropriate pneumonia care as the national average is 97%. While 83% represents less than optimal care, taking positive steps is more likely to bring about change than punitive steps. Data are provided at Hospital Compare as percentages, allowing comparison for up to 3 hospitals at a time. Data is shown for the selected hospitals as well as for state and national averages.
Under the Joint Commission's National Patient
Safety Goals, which of the following is generally
acceptable as one of two required identifiers?
a. Place of birth
b. Date of birth
c. Place of employment
d. An armband taped to bedside stand
B: The Joint Commission requires two identifiers to ensure that the correct individual is receiving care and that the care is intended for that individual. Identifiers must be specific to the patient. The first identifier is usually the patient's name, often found on the wristband, and the second can be the birthdate, patient ID number, or telephone number. Birthplace is usually too non-specific as is place of employment. If an armband is used as an identifier, it must be placed on the patient's body and cannot be simply placed at the bedside or taped to a bedside stand.
Which of the following is the most reliable indicator of increased employee engagement?
a. Increased staff retention
b. Increased job satisfaction (according to staff
c. Decreased staff complaints
d. Anecdotal reports of staff
A: Increased staff retention is the most reliable indicator of increased employee engagement because it demonstrates a commitment to the organization, which is a critical element in engagement. Engaged employees are often more loyal and more productive. Employees can have high rates of job satisfaction without being engaged or actively trying to improve the organization, so surveys alone cannot measure engagement. Increased job satisfaction (with or without increased engagement) can lead to decreased complaints, but so can an intimidating environment in which employees are afraid to complain.
When conducting SWOT analysis, which of the
following is generally considered to be an external factor?
a. Human resources
c. Physical resources
D: With SWOT analysis, strengths (S) and weaknesses (W) usually refer to internal factors, such as human resources, financial resources, physical resources, and processes. Opportunities (O) and threats (T) are more focused on external factors, which can include trends, sources of finances, rules and laws, the general economy, and national and international events. Because SWOT analysis evaluates the effect that internal and external factors have on work, it is sometimes referred to as an Internal/External Analysis. SWOT analysis is useful for both brainstorming and more in depth planning.
Which of the following is an appropriate method for
assessing the driving and restraining forces when doing
a. Conducting a force field analysis.
b. Establishing a task list.
c. Conducting an events and causal factors analysis.
d. Completing an affinity diagram.
A: Force field analysis (Lewin) was designed to analyze both the driving forces (leaders, incentives, and competition) and the restraining forces (poor attitudes, hostility, inadequate equipment, and insufficient funds) for change. Steps include: List the proposed change at the top and then create two subgroups (driving forces and restraining forces) below, separated by a horizontal line. Brainstorm and list driving forces and opposed restraining forces. (When driving and restraining forces are in balance, this is usually a state of equilibrium or the status quo.) Discuss the value of the proposed change. Develop a plan to diminish or eliminate restraining forces.
A nurse executive whose responsibilities include
acting as the company compliance officer finds what
appears to be a long-standing pattern of fraudulent billing
practices by the organization. Which of the following
initial actions is most appropriate?
a. Notify the appropriate regulatory agencies
b. Notify the board.
c. c. Consult an attorney.
d. d. Notify the police.
C: Anyone in the position of potentially being a whistleblower needs to consult an attorney who specializes in whistle blowing before taking action. There are numerous federal and state laws and regulations about whistle blowing. Even more confusing is that they are often contradictory with different laws related to different professions and types of fraudulent actions. While whistleblowers are protected by many federal and state laws, the reality is that whistle blowing often results in loss of job, being ostracized or excluded, and/or civil action, so the person must fully understand the implications of their actions.
Which of the following is the best preparation for
dealing with an internal disaster?
a. Establishing a disaster management plan.
b. Training staff in preventive measures.
c. Advising staff to call 9-1-1 for crisis
d. Having regular fire drills
A: The best preparation for dealing with an internal or external disaster is to have a disaster management plan in place with all staff members thoroughly trained to understand their roles. The disaster plan should include procedures for fires, natural disasters (earthquakes, tornadoes, hurricanes, floods), chemical spills, communicable diseases, bomb threats, and utility failures. Emergency telephone numbers should be available and a telephone tree established. Plans for a command center should be outlined as well as lines of responsibility.
When developing a nursing professional practice
model, what would the nurse executive generally expect
to find at the center of the model?
b. Care standards
c. The patient and his/her family
d. Professional values
C: In most professional practice models, the patient/family is placed at the center of the model since the general goal of nursing is to provide excellent care for both the patient and his/her family. In some facilities, the practice model may focus on a slogan, such as "Patients first" or "Patient-centered care." Other aspects of the model are then developed to show how the caring environment is demonstrated. The professional practice model illustrates the role and responsibilities of the nurse and usually includes emphasis on clinical quality care, professional development and professional values.
Who or what is responsible for outlining a nurse's
scope of practice?
a. The American Nurses Association
b. The American Nurses Credentialing Center
c. Each state's Board of Nursing and Nurse Practice Act
d. The American Academy of Nurse Practitioners
C: The state board of nursing and the Nurse Practice Act determines the nurse's scope of practice. Advance practice nurses, such as nurse practitioners or certified nurse specialists, are those who have completed additional education in an accredited nursing program (usually at a Master's level) and have received certification with a national certifying organization, like the American Nurse's Credentialing Center. The American Nurse's Association and the American Academy of Nurse Practitioners are professional organizations that may help to set standards but do not have legal authority to determine scope of practice.
The primary benefit of instituting a yearlong
mentoring program as part of new staff orientation is:
a. increased staff retention.
b. increased job satisfaction.
c. decreased orientation costs.
d. decreased need for supervision.
A: A mentoring program is a critical element in improving staff retention. Some orientation programs are primarily classroom based with reviews of policies, procedures, and equipment. As a result, many nurses feel overwhelmed when orientation ends, especially new graduates who may lack the experience necessary to work autonomously. An ongoing mentoring program provides support for new nurses and the opportunity to benefit and learn from the experience of others. Formal mentoring programs usually establish one-on-one relationships rather than the more informal mentoring that occurs when one nurse assists another
Which of the following types of research would
require review by the Institutional Review Board?
a. Research comparing the effectiveness of standard
orientation program vs orientation plus mentoring
b. Research involving the use of existing data
without identifying subjects
c. Research involving the evaluation of the
effectiveness of different inservice delivery systems
d. Research involving comparison of two different
therapeutic approaches for the same disorder
D: Research involving the comparison of two different therapeutic approaches for the same disorder would require review by the Institutional Review Board (IRB); an independent group that monitors research to ensure it is ethical. The Department of Health and Human Services, Title 45 Code of Federal Regulations, part 46 provides guidance for IRBs and outlines requirements for those involved in research. Institutions engaged in nonexempt research must submit an assurance of compliance document to the Office of Human Research Protection (OHRP), agreeing to comply with all requirements for research projects.
When faced with the need to cut costly programs,
which of the following is an example of lateral thinking?
a. Reduce nursing and support staff and institute a
b. Reduce benefits for new hires and increase the use
of part-time help.
c. Develop a community-action plan to attract "sponsors" of various programs.
d. Close satellite clinic sites and reduce onsite clinic
C: Vertical or rational thinking involves picking the "logical" solution to problems. In the case of the need to cut costs, this usually entails cutting back on staff or services. Lateral thinking looks at a problem from a different perspective and attempts to find a creative solution to a problem, considering all possible alternatives. When faced with the need to cut costs, the nurse executive utilizing lateral thinking might consider developing a community-action plan to attract "sponsors" of various programs. This is an innovative way to involve the community in cost-saving programs.
When conducting literature research, which of the
following has the most validity?
a. An article in the New York Times.
b. An article in The Reader's Digest.
c. The transcript of a 60 Minutes (CBS) television
d. An article in the New England Journal of
D: While all of these sources may, in fact, provide valid information, sources with the most authority are journals whose articles are peer-reviewed, such as the New England Journal of Medicine. Articles in the popular press undergo a much less rigorous review process. Besides considering the source, other important factors to consider when evaluating a source include the author's credentials, the strength of the thesis, how the article is organized, the evidence supporting or refuting the thesis, and the author's interpretation and analysis of the data.
When conducting internal research to determine if
staff turnover is higher in the critical care unit than the
general medicine unit, which of the following is the
a. Turnover rate
b. Staff assignments
c. Staff gender
d. Staff certification
A: The dependent variable is that which the researcher is trying to understand or explain, which in this case is the turnover rate. You can also think of the dependent variable as the presumed effect of something or some action. An independent variable is the presumed cause. In this type of research, besides looking at raw figures to determine the turnover rates in the two departments, the researcher would also attempt to identify other independent variables (such as the assignments, staff gender, and staff certification) to determine if they could also affect the dependent variable or turnover rates.
Which ethical system states that ethical decisions
should be made to benefit the most people?
d. Act utilitarianism
D: The four major ethical decision making systems are as follows:
Act Utilitarianism - Ethical decisions are those that benefit the most people, regardless of personal feelings or laws. In Rule Utilitarianism, ethical decisions must take laws and fairness into consideration.
Deontology - When confronted with an ethical dilemma, people should adhere to obligations and duties.
Rights - Protects and supports the rights set up by society, such as those permitted by tradition or law. Individuals may also grant rights to others.
Virtue - When one's ethical decisions are questionable, then the person's morals and motivation (virtues) should be taken into account.
When developing research questions, which of the
follow is a complex hypothesis with multiple dependent
a. Senior nurses are less likely to support the
expanding role of nurses than new graduates.
b. Patients assigned a case manager have a more
positive perception of nursing care than those
without a case manager.
c. Patients who are catheterized postoperatively
develop more postoperative infections than those
who are not catheterized.
d. A structured plan for post-operative pain control is
more effective than an unstructured plan in reducing
patient complaints of pain and requests for pain
D: A complex hypothesis predicts a relationship between an independent variable (a structured plan for post-operative pain control) and multiple dependent variables (perceptions of pain and requests for pain medication). Complex hypotheses are often more realistic than a simple hypothesis, which predicts the relationship between one independent variable and one dependent variable. A directional hypothesis predicts the direction of the relationship between the independent and dependent variable while a non-directional hypothesis predicts a relationship but not the direction
For which of the following would qualitative research
be more appropriate than quantitative research?
a. Determining if an intervention decreases rehospitalization
b. Evaluating patient response to two different
c. Determining whether an electronic medication
dispensing cart decreases medicine errors
d. Assessing health beliefs of a particular culture
D: While quantitative research is an objective empirical approach with clear steps, qualitative research is a much broader approach that allows researchers to generate theories and problems from subjective input, such as about health beliefs. Qualitative research can include field studies and historical research. Research is not data driven but instead depends on observation (as in field studies) and interviews. The researcher does not limit his analysis to relate to specific variables but attempts to find useful patterns in information
When conducting quantitative research with human
subjects, at what point in the process must Institutional
Review Board (IRB) approval be obtained?
a. Immediately after identification of the problem
b. Immediately after the collection of data
c. Immediately before the collection of data
d. Immediately before selection of the research
C: IRB approval must be obtained immediately before beginning to collect any data. However, the research plan must be complete because this is what is reviewed by the IRB. They can approve, deny, or exempt the research proposal based on the content of the plan. Steps to the research process include:
- Identifying the problem and stating the purpose.
- Reviewing appropriate literature.
- Describing the theoretical framework.
- Defining relevant terms.
- Stating the hypothesis or hypotheses.
- Selecting the research design, including population and sample size.
- Obtaining IRB approval.
- Collecting data.
- Analyzing/Interpreting data.
- Publishing results/recommendations.
What type of functioning is assessed by the CMS
Minimum Data Set (MDS)?
a. Nursing staff competency and accuracy
b. Patient physical, psychological, and psychosocial
c. Administrative functioning, including Nurse
Executive and Board of Directors
d. Financial management, including budget and
B: The CMS Minimum Data Set is a tool used to assess the physical, psychological, and psychosocial functioning of patients in long-term care facilities. The MDS applies to all long-term care facilities that are certified by CMS and must be used to assess all patients, even those not covered by Medicare or Medicaid. The tool helps to identify a patient's functional status and identify problems that must be addressed. Information is transmitted electronically to the state and then to the national CMS database.
Which of the following is based on the strategic plan
and provides performance measures in relation to the
facility mission, vision statement, and goals/objectives?
a. Pareto diagram
d. Balanced scorecard
D: The balanced scorecard (Kaplan and Norton) is based on the strategic plan and provides performance measures in relation to the mission and vision statement and goals and objectives. A balanced scorecard includes not only the traditional financial information but also data about customers, internal processes, and education. Each organization can select measures that help to determine if the organization is on track to meeting its goals. If the scorecard is adequately balanced, it will reflect both the needs and priorities of the organization itself and also those of the community and customers
The hospital has collected and transmitted ORYX® data for 4 core measure sets. How many non-core measures are also required?
A: Hospitals must collect and transmit data for at least four core measure sets or a combination of fewer core measure sets and non-core measures. The only exception to this is free-standing children's hospitals, which must collect data on the core measure set, Children's Asthma care, and 9 non-core measures. This is because most core measure sets apply only to adults. Core measure sets include: Acute Myocardial Infarction, Heart Failure, Pneumonia, Perinatal Care, Hospital-Based Inpatient Psychiatric Services, Surgical Care Improvement Project, Hospital Outcome Measures, Venous Thromboembolism, Stroke, Emergency Department, Tobacco Treatment, Immunizations and Substance Abuse.
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