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Nursing Executive Administrator Advanced - Board Certification Set 5
Prep work for CNEA exams
Terms in this set (55)
An employee who was fired for reporting unsafe staffing conditions at a healthcare fa- cility files a whistleblower lawsuit against his former employer. Which of the following would be used by the judicial system in upholding a charge of whistleblowing from the employee?
a. Did the employee threaten to release information about unsafe conditions to the media?
b. Had the employee reported the complaint, in writing, to the administration?
c. Had the facility followed their policies of 3 attempts as progressive discipline before ter- minating the employee?
d. Had the employee attempted to organize a work stoppage by the union?
Correct Answer: B. The only item of interest to the court regarding a whistleblowing complaint would be whether or not the employee had given the administrators of the or- ganization fair, written notice of her concerns. The Whistleblower protection Act prohibits employers from interfering with the efforts of whistleblowers to disclose information. Employees who report violations internally to their employer can receive protection, depend- ing upon circumstances may be eligible for a reward, and are protected by law.
A nurse manager, who works on a unit with a large number of elderly patients has re- cently attended a conference on a restraint-free care environment. She enthusiastically shares this new information with her staff who are less than enthusiastic about recom- mended changes, feeling that their current practices are satisfactory. An effective way for the manager to facilitate change would be:
a. Informing staff that their current practices are outdated and that continuing traditional re- straint policies would pose a legal liability
b. Informing the unit charge nurses that the restraint policies must be changed and insisting that all staff comply
c. Asking staff members to assist in gathering data about the outcomes of their current re- straint policies to compare with results of others utilizing a restraint-free environment
d. Writing a new restraint policy over the weekend and distributing it to co-workers for im- mediate implementation on Monday morning
Correct Answer: C. The most effective application of change theory is to involve staff in the process. Failure to do so will undermine the success of the initiative, decrease com- pliance and create negative feelings among the staff. The remaining choices also fail to ob- tain buy-in from staff, impede the change process and will undermine leadership position of the manager.
A task force has been charged by the nurse executive to make recommendations for a new patient care staffing model. The task force has assessed the driving and restraining forces of the recommended change, thoroughly examined the needs of stakeholders and formulated an action plan to implement their recommendations. What is the next step in the process?
a. Hold meetings with staff, managers, patients, and families to update them on the team's progress
b. Develop a policy that once the new staffing pattern is implemented, use of the prior staffing pattern will not be permitted under any circumstances
c. Develop an evaluation plan to evaluate the impact and effectiveness of the new staffing model
d. Reassess the restraining forces to make sure nothing was missed
Correct Answer: C. The team has successfully completed all steps in the change pro- cess and has developed a recommendation. The next step will be to develop a plan for evaluating the impact and effectiveness of the change. Holding future meetings with stakeholders before completing the plan is premature. Even after a new model is accepted and implemented, there must be contingency plans (including the prior staffing model) available to staff in the case of extreme extenuating circumstances which compromise ef- fectiveness of the new staffing model.
Below is a portion of a monthly operating statement for the medical-surgical units of your hospital.
ACTUAL vs BUDGETED
Patient Days: 2,269 vs 2, 335
Total Revenue: $646,665 vs $665,475
Regular Salaries and Wages with Overtime: $135, 309 vs $137, 830
Contract: $1,760 vs $10,000
Total Salary and Wages: $137, 069 vs $147, 830
Overtime Premium: $4,675 vs $2,027
Inservice and Orientation: $7,529 vs $9,648
Vacation, Holiday, Sick Time: $24,258 vs $24,258
Total Nonproductive Dollars: $36,462 vs $35,993
Taxes and Other Benefits: $31,393 vs $31,357
Total Salary ($ & Benefits): $204,924 vs $215,120
Total Other Expenses: $5,603 vs $6,726
Gross Profit (Loss): $436,138 vs $443,629
Based on this report; what feedback would you give to the nurse managers of these units?
a. "Congratulations on running under budget!"
b. "Consider using more contract employees."
c. "What were your alternatives to using overtime?"
d. "What policies and practices are you using to schedule vacation time?"
Correct Answer: C. Even though in the aggregate the unit was running under budget, client days and revenue were down so one would question why overtime was greater than that budgeted.
You are an evening shift nursing supervisor. A medical-surgical unit is staffed as fol- lows:
RN = 2
LPN = 1
Nursing Assistant = 2
Unit Secretary = 1
Census = 28
II = 8
III = 10
IV = 8
Note: A Classification of l is the least intense case; a classification of lV would be the most intense case.
The LPN called in sick. If all of the following are possible options (i.e., assuming compe- tency of possible replacements, conditions will be safe on the unit from which you pull a replacement, and contracts for agency use are in place), your best option is to:
a. Not replace the LPN on the unit
b. Reassign an LPN from a low-census, low-acuity unit
c. Obtain an LPN from a contract agency
d. Reassign a nursing assistant from a low-census, low-acuity unit
Correct Answer: B. Because 8 clients are categorized as Level IV and 10 clients cate- gorized as Level III, the safest and most cost-effective option would be to reassign an LPN from a low-census, low-acuity unit.
The agency that could be notified by an employee regarding age discrimination is:
a. The U.S. Department of Health and Human Services
b. The Equal Employment Opportunity Commission (EEOC)
c. The Occupational Safety and Health Administration
d. The Labor Board
Correct Answer: B. Age discrimination and sexual harassment is addressed by the Equal Employment Opportunity Commission (EEOC).
Power derived from one's position within an organization is termed:
a. Legitimate power
b. Reference power
c. Expert power
d. Coercive power
Correct Answer: A. Legitimate power is power that one derives from their own job position within the organization.
When would zero-based budget be used?
a. Projecting the next fiscal year's capital expenditures
b. Projecting the next year's staffing budget
c. Projecting expenses for anticipated increased client volume
d. As a check and balance on the organization's historical budget
Correct Answer: D. Zero-based budgets are generally used for 3 things: a brand new service; a major paradigm shift in healthcare reimbursement; and as a check and balance on an organization's historical budget.
Which law protects client's in forma ion in their medical records?
a. Whistleblower Protection Act
b. Health Insurance Portability and Accountability Act
c. Fair La bor Stand ards Act
d. Title VII of the Civil Rights Act
Correct Answer: B. The Health Insurance Portability and Accountability Act protects client's information in their medical record by prohibiting its release to anyone not directly involved in their care without their permission.
Which system of care was adopted nationally by the Medicare Program for reimbursement of acute-care services using a case rate of reimbursement?
a. Per-diem system
d. DRG system
Correct Answer: D. The DRG system was adopted nationally by Medicare for reimbursement of acute-care hospital services.
A nurse manager is concerned that lateral violence may be present in her unit. Some of the recently hired new nurses report feeling bullied by the more experienced staff and that what they perceive to be a hostile work environment is undermining their self-confidence and transition to nursing roles. Which of the following would be the most appropriate first step in resolving the problem?
a. Suspend the bullying nurses for harassment
b. Reassign all of the new nurses to different mentors
c. Clarify the roles of each nurse on the unit regarding their responsibilities in orienting new nurses
d. Interview all of the nurses to gain a better understanding of the problem
Correct Answer: D. The first step for the manager is to identify the scope and source of the problem. While a zero tolerance for lateral violence is appropriate, immediate suspen- sion of those accused would only serve to increase hostility. Randomly reassigning the new nurses to different mentors would cause greater uncertainty for the new nurses and may ac- tually upset any positive professional mentoring relationships that may have been formed. Simply restating expectations modifying the unit culture will not be effective.
Which of the following is mandatory for a research design to be considered as a true experimental design?
a. Convenience sample
b. No control group
c. No experimental group
d. Random sample
Correct Answer: D. An experimental design must have a random sample.
A nurse manager must implement a $20,000 cut in operational expenses of the nursing unit. She has been told that, unless she can develop an effective alternative, mandatory staffing cuts will be implemented to decrease unit expenses. Which approach demonstrates the manager's commitment to a participative leadership style?
a. Allow the staff to develop the most appropriate course of action without direction or support from the manager
b. Inform the staff of budget cuts in a series of meeting and accept their ideas in writing
c. Agree to the decrease in staffing and inform staff that the decision has already been made by superiors
d. Discuss guidelines for the budget cuts with staff, and developing recommendations with those who participate
Correct Answer: D. Persons who subscribe to a participative philosophy believe that employees are internally motivated to achieve the goals of the organization. However, op- tions A and B do not provide adequate information, dialogue, or support needed for the de- velopment of sound recommendations. Choice C indicates a lack of understanding, owner- ship, and accountability for the basic tenets of leadership.
The Framingham Heart Study and the Nurses' Health Study are conducted over many years' time on the same subjects and are examples of which type of study design?
b. Grounded theory
c. Longitudinal study
d. Single case study
Correct Answer: C. Longitudinal studies are studies conducted over a long period of time.
The independent variable in a quantitative research study is termed the:
a. Manipulated variable
b. Outcome variable
c. Study variable
d. Research variable
Correct Answer: A. The independent variable is often called the manipulated variable. It is the intervention in a quantitative research study.
The dependent variable in a quantitative research study is termed the:
a. Manipulated variable
b. Outcome variable
c. Study variable
d. Research variable
Correct Answer: B. The dependent variable is the measurement of outcome in a study.
Which one of the following serves as the basis for creating a research design?
b. Literature reviews
d. Physical measures
Correct Answer: B. Unlike the other options, the literature review is not an example of data collection. The purpose of the literature review is to assess what research has been done prior to the study.
The people who provide data in a research investigation are collectively referred to as the:
a. Research producers
d. Research assistants
Correct Answer: C. The sample is participants who meet the criteria of the study and are available to be in the study. The data are collected on the sample population in the research study.
The overall plan developed by the researcher to obtain answers to the question being studied is called the:
a. Coding plan
b. Problem statement
d. Research design
Correct Answer: D. Any research study needs to have a study design. One of the major purposes of the study design is to control for bias in the research study.
A researcher's expectations about the outcomes of a quantitative study are generally expressed in the form of a:
c. Criterion variable
d. Research problem
Correct Answer: A. Two types of hypotheses are stated in a quantitative research study. One is the null hypothesis, in which there is no difference in outcomes between the control group and the experimental group. The other is the alternate hypothesis in which the re- searcher describes the expected outcome of the study.
The purpose of an operational definition in a quantitative study is to:
a. Assign numeric values to variables
b. Specify how a variable will be defined and measured
c. State the expected relationship between the variables under investigation
d. Designate the overall plan by which the data will be collected
Correct Answer: B. Different words can have multiple meanings. When measuring something in a research study, it is vital to define what the variable is and how it is meas- ured.
What is the dependent variable in the hypothesis, "Baccalaureate degree-prepared nurses will practice more rehabilitative nursing measures on a client in an ICU than will associate degree-prepared nurses"?
a. Associate-degree-prepared nurses
b. Baccalaureate degree-prepared nurses
c. Rehabilitative nursing measures
d. Type of educational background of the nurse
Correct Answer: C. This study is examing whether baccalaureate-prepared nurses will practice more rehabilitative nursing measures, the outcome of this study.
The dependent variable(s) in the research question, "What is the effect of noise levels on postoperative pain or blood pressure fluctuations in ICU clients?"
a. Blood pressure
b. Postoperative pain
c. Noise levels
d. Blood pressure and postoperative pain
Correct Answer: D. The dependent variable is the outcome variable, the result of what happens with an intervention. In this particular study, the outcomes are postoperative pain and blood pressure.
The independent variable(s) in the research question, "Is the job performance of nurses affected by salary or perceived job autonomy?"
a. Job performance
c. Perceived job autonomy
d. Both salary and perceived job autonomy
Correct Answer: D. Salary and job autonomy would be the variables that are the inter- vention in this particular study. The intervention is known as the independent variable.
An intervention study that trialed a new medication to lower blood pressure and pulse rate was implemented at a community hospital. The measurement of pulse rate is:
a. A dependent variable
b. An independent variable
c. Not a variable
A categorical variable
The measurement of an intervention is known as the dependent or outcome variable.
Which of the following is true of non-verbal communication:
a. Is consistent across cultures
b. Should be minimized to avoid confusion between sender and receiver
c. Is a significant part of the communication when it is incongruent with the verbal message
d. Is given more credence than verbal communication when the two are inconsistent
30. Correct Answer: D. Nonverbal messages can easily differ between cultures and ethnic
groups. However, it is impossible to minimize or eliminate non-verbal communication in face-to face
encounters. It is generally accepted that non-verbal communication is given
more credence that verbal communication when the two are inconsistent.
1. Focusing on a person's strengths is best exemplified by which theorist?
a. Peter Senge
b. Marcus Buckingham
c. Stephen Covey
d. Abraham Maslow
Correct Answer: B. Marcus Buckingham is most noted for his work on focusing on a
1. During your rounds as evening shift supervisor, you are told by the orthopedic surgery unit charge nurse that she thinks Mr. B.'s cast is too tight. She reports that the resident on call has not responded to repeated pages. To prevent risk of negligence in this situation, you:
a. Tell her to document the resident's failure to respond in the client's medical record and contact the administrator on call.
b. Tell her to document her observations and report the situation to the night charge nurse during the change-of-shift report.
c. Assess the client; document your assessment findings in the client's medical record; if you agree with her assessment, contact the chief of surgery.
Validate her assessment; contact the resident's immediate supervisor.
Correct Answer: D. You want to validate her assessment and then contact the resident's immediate supervisor so action can be taken immediately to correct the situation. This is also an example of following proper chain of command.
Dr. Peter Senge is most noted for his work and beliefs about which of the following?
a. Organizations are in a constant learning mode
b. Change is inherent in organizations
c. Quality circles
d. Theory X management
Correct Answer: D. Dr. Peter Senge wrote The Fifth Discipline. His idea is that organizations must be in a constant learning mode because of constant change.
1. Which one of the following stages involves the organization sensing a need for change?
a. Freezing stage
b. Refreezing stage
c. Unfreezing stage
d. Change agent
Correct Answer: C. Kurt Lewin is most noted for his theory about change. He describes 3 stages of change, the first if which is the unfreezing stage when the organization senses a need for change.
Which of the following is the best example of implied consent?
a. A 45-year-old man is brought to the emergency department (ED) in full cardiac arrest
b. A 45-year-old man scheduled for an elective herniorrhaphy
c. An 18-year-old woman presents to the office for her scheduled gynecological exam
d. A 75-year-old, competent man scheduled for an elective cataract surgery
Correct Answer: A. Implied consent occurs when one cannot consent to a procedure. In this example it is implied that the client brought to the ED would be resuscitated.
Concern for the least advantaged is an underlying principle of which of the following ethical theories?
Correct Answer: D. This theory was developed by John Rawls, a Harvard social justice philosopher.
The ethical theory of utilitarianism involves which of the following principles?
a. Utmost rationality
c. The greatest good for the greatest number of people
Correct Answer: C. Utilitarianism's focus is the greatest good for the greatest number
of people. An example would be opposing an organ transplant because the money to cover its high costs could be allocated to improve birth outcomes in many people in a particular community.
Which of the following best describes case management?
a. A system in which inpatient cases are reviewed by a utilization review manager so reimbursement is maximized.
b. A nursing care delivery model in which the case manager treats each case on a continuum, for example, visiting the client prehospital, intra-hospital, and post-discharge to insure quality care.
c. A transport system for instrumentation transfer from the CPD to the Operating Room.
d. A multidisciplinary method and approach to client care.
Correct Answer: B. Karen Zander best described case management as a continuum of care from prehospital, intrahospital, and postdischarge.
Three major issues affect health care in the United States: quality, cost, and which of the following?
d. Access to care
Correct Answer: D. Many Americans had no health insurance so their access to care
was limited before implementation of the Patient Protection and Affordable Care Act of 2010, which created insurance exchanges where people not covered by employer-provided insurance or
Medicare could buy compare and buy affordable plans or enroll in Medicaid
regardless of preexisting conditions
Research can be most effective in a home health setting when:
a. The results of research can be applied to improve practice.
b. The results of research can be reviewed but not applied.
c. There is no place for research in the home health setting.
d. The client can participate in the research study.
Correct Answer: A. The use of research evidence in nursing is to improve client care by providing care that is based on evidence.
The best example of a procedural statement is which of the following?
a. Surgery personnel with draining skin lesions shall not enter sterile work areas.
b. Soak instruments in 2% glutaraldehyde for 20 minutes.
c. Clean all instruments with detergent, then place them in bags for CPD to pick up.
Correct Answer: B. Unlike policies, which are broad statements written by administration to guide behavior, procedures are very detailed and explain each step in a sequence of exactly what to do.
Bureaucratic leaders assume that that their subordinates are motivated by:
a. An internal locus of control
b. A complex matrix of intervening variables
c. External sources
d. Socialization over time
Correct Answer: C. Autocratic and bureaucratic leaders assume that external
motivators will cause subordinates to change behavior. Democratic and Laissez-faire leaders believe that behavior change is internally inspired (i.e., Internal locus of control)
One of the best methods you can use to develop your communication skills is:
a. Practice by signing up for a lot of speaking engagements
b. Develop your listening skills
c. Practice being more aggressive with your communication style
d. Take a Dale Carnegie course
Correct Answer: B. The most significant problem in communication is poor listening skills. Dr. Stephen Covey lists "empathetic listening" as his 5th habit in The 7 Habits of Highly Effective People.
Capitation is a payment methodology in which risks are largely shifted to the provider and reimbursement is based on:
a. A per-diem rate established and paid to the practice
b. A per-member, per-month rate paid to the provider, whether the client uses services or not
c. A rate established for each potential diagnosis and paid to the provider based on docu- mentation in the medical record
d. The client paying 20% of the cost to the provider and the insurance carrier paying the remaining balance
This answer best describes capitation from a reimbursement stand-point.
In analyzing bar graphs of the past 2 years, a nurse practitioner who manages a hospital service observes that the client visits peak every January and June. Being fiscally accountable and responsible, the nurse practitioner should do which of the following?
a. Limit vacation time taken by employees during January and June.
b. Continue to allow employees to take scheduled vacation time during January and June.
c. Not do anything, because this year the census pattern may change.
Correct Answer: A. Nurse executives practice in a cost-competitive and focused environment today. The most prudent action to take cost-wise is limiting vacation time during peak months of operation.
A structure standard is best defined by which of the following?
a. An employee's job description
b. The hospital's mission statement
c. A surgical client who leaves the hospital without a nosocomial pneumonia
d. A nurse turning an older adult client every 2 hours
Correct Answer: B. Implicit in a structure standard is "foundation," where no action
occurs. This is best illustrated through a mission statement that provides structure for the organization.
Which of the following legal concepts applies to an employer being responsible for his or her employee's actions?
a. Res judicata
b. Respondeat superior
c. Stare decisis
d. Comparable worth
Correct Answer: B. Respondeat superior is the concept that implies "let the master
Which of the following is a wrongful act?
c. Broken contract
Correct Answer: B. A tort is a wrongdoing other than a breach of contract.
A computer is an example of which type of budget item?
a. Operational item
b. Capital equipment item
c. Real estate item
d. Fixed equipment item
Correct Answer: B. A computer is an example of a piece of major movable equipment, which is relegated to the capital budget.
Which type of system's theory best describes business and healthcare organizations?
a. Circumscribed systems theory
b. Open systems theory
c. Closed systems theory
d. Differentiated systems theory
Correct Answer: B. Most systems are open systems. Health care is an open system because it interacts with its environment, such as payors, regulators, medical staff, clients, and so forth.
Contingency leadership theory involves the interaction of three variables: power, task structure, and which of the following?
c. Leader-member relationships
Correct Answer: C. The third variable is leader-member relationships and how the leader leads subordinates. The interaction of these 3 variables is how this particular theory is operationalized.
Changing leadership style according to varying circumstances is most characteristic of which of the following leadership theories?
a. Transformational theory
b. Transactional theory
c. Situational theory
d. Great man theory
Correct Answer: C. Situational theory describes leading according to the situation at hand, thus changing the leader's style dependent upon the situation.
Which one of the following would be a conflict of interest for a hospital board member??
a. Management of day-to-day operations
b. Review of fiscal budgets
c. Medical staff credentialing
d. Overall responsibility for CQI
Correct Answer: A. Governing bodies hire an executive team to run day-to-day operations, which is the role of management, not the governing body. The governing body's main purpose is oversight.
Of the following types of business organizations, only one receives approval by a state, thus shielding the shareholders from liability.
c. Limited partnership
d. Sole proprietor
Correct Answer: B. Once a business incorporates, the shareholders and board of directors are shielded from liability.
A nurse preceptor folds her arms across her chest and rolls her eyes after a new nurse in orientation poses a clinical question to her. What best describes this preceptor's action?
a. Nurse bullying
b. Sexual harassment
d. A normal response
Correct Answer: A. The incident described is an example of nurse bullying, which ulti-
mately could lead to a negative client outcome.
Journal clubs are used in some facilities to encourage nursing staff to:
a. Develop a research mentorship program
b. Select articles of interest to discuss and present
c. Provide a short personal story of something that happened on a nurse's unit
d. Read, evaluate, and appraise articles that have been published in scientific and professional journals
Correct Answer: D. The main purpose of a journal club is to get attendees familiar with how to critically appraise research articles.
What best defines an experimental research design?
a. A control group and an experimental group
b. A control group
c. An experimental group
d. An open-ended interview
Correct Answer: A. A true experimental design, at a minimum, must have at least one control group and one experimental group.
When rating research evidence, which of the following levels would best correlate to a rigorous controlled clinical trial?
a. Level I
b. Level ll
c. Level lll
d. Level IV
Correct Answer: A. A rigorous controlled clinical trial is Level I in evidence rating
In the protection of human subjects consenting to a research study, which of the follow- ing statements is most accurate:
a. If paid, the subject must complete the research project.
b. The subject must write to the IRB requesting to withdraw from the study if so desired.
c. The subject may withdraw from the study at any time.
d. The subject must participate in the research study until its completion because he or she already consented to do so.
Correct Answer: C. Subjects in a research study may withdraw at any time without being penalized.
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