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NR 446 Exam 1 Questions with Solution
1. Can an LPN hang electrolytes?: NO- requires assessment
2. Can an LPN hang TPN?: No
3. Can an LPN hang NS with K?: Yes - diluted
4. Can an LPN hang blood?: No
5. Can an LPN hang a bolus?: No
6. Can an LPN do an IV push?: No
7. UAP assignments: stable patients with chronic conditions
8. Who should UAP's not work with?: -no vitals on: acute cardiac, new patient - depending on status, post-op (not
stable patients), if RN is in room, UAP can help but RN needs to be in room
9. reactive planning: occurs after a problem exists, goal is just to get back to normal
10. inactivism: another type of conventional planning, seeks the status quo, not going to do anything, prevent change
from occurring, standing firm, slow incremental change
11. preactivism: utilize technology to accelerate change and are future oriented.
Unsatisfied with the past or present, preactivists do not value experience and believe that the future is always preferable to the present.
12. interactive or proactive planning: Planners who fall into this category consider the past, present, and future and
attempt to plan the future of their organization rather than react to it. Because the organizational setting changes often, adaptability is a key requirement for proactive planning. Proactive planning occurs, then, in anticipation of changing needs or to promote growth within an organization and is required of all leader-managers so that personal as well as organizational needs and objectives are met.
13. Forecasting: involves trying to estimate how a condition will be in the future.
14. SWOT analysis: identifying internal strengths (S) and weaknesses (W) and also examining external opportunities
(O) and threats (T) -need to have an objective first -subjective in nature
15. Strengths: internal attributes that help an organization achieve its objectives
16. Weaknesses: internal attributes resources that work against a successful out- come
17. Opportuninities: external and positive, national focused, evidence based prac- tice
18. Threats: external and negative
19. Planning Hierarchy: 1) Mission
2) Philosophy
3) Goals
4) Objectives
5) Policies
-limit setting, boundary setting
28. Implied policies: neither written nor expressed verbally, have usually developed over time and follow a precedent.
29. Expressed policies: delineated verbally or in writing
30. Procedures: how to get things done within that policy, instruct you how to do things
31. Rules: -define actions
-form policies and procedures -allow only once choice of action
32. strategic planning: Long-term planning that provides broad goals and direc- tions for the entire business.
33. Contemporary Adaptation of Lewins Model - Stages of Change MOdel: -
Stage 1: Pre-contemplation: no current intention to change Stage 2: Contemplation: individual considers making a change Stage 3: Preparation: there is intent to make a change in the near future Stage 4: Action: individual modifies behavior Stage 5: Maintenance: change in maintained and relapse is avoided
34. Rational Empirical Strategy: -using evidence, research, hard evidence
-ex: smoking causes lung cancer, why they need to do the change
35. normative-reeducative strategy: -social norms, groups norms and positive peer pressure to cause change
36. Power-coercive strategies: Change agent strategies based on the application of power by legitimate authority,
economic sanctions, or political clout. -using power to make change
37. Steps to time management: 1. Allow time for planning and establish priorities
2. complete the highest priority task whenever possible and finish one task before starting another
3. reprioritize based on the remaining tasks
38. three categories of prioritization - from a leader-manager: - dont do
- do later (part of a larger plan)
- do now (day to day operations)
39. cost containment: procedures used to control costs or expenses, efficiency, not having waste, provide care and still
yield a profit
40. cost effective: not the same as being inexpensive, producing good results for money spent, the product is worth
the price
41. The workforce or personnel budget: largest of budget expenditures, because health care is labor intensive,
42. operating budget: how the facility can operate, bills that need to get paid. supplies are a big expense
43. capital budget: plan for the purchase of buildings or major equipment, assets, big-ticket items, capital is another
word for investment, investment in "stuff"
44. incremental budgeting: flat percentage increase method, multiplying current year expenses by a certain figure,
usually the inflation rate or consumer price index, the budget for the coming year may be projected. Doesnt assess current coniditon of patient budget -giving a raise
45. Zero-based budget: justify budget every year, labor-intensive for nursing man- agers
-do the reimbursements for those who qualify -CMS sets qualities for reimbursements for hospitals, etc.
52. Prospective Payment System: the payment amount or reimbursement with a set rate for certain procedures is
known in advance -expected reimbursement based on DRG's
53. DRG's: -Diagnosis Related Groups
-begins idea of critical pathway -facility gets X amount of dollars
54. Patient Centered Medical Home: -a care delivery model whereby patient treat- ment is coordinated through their
primary care physician to ensure they receive the necessary care when and where they need it, in a manner they can understand -future of care -sending patients home earlier when it is safe to -keep chronically ill people out of hospital -preventative maintenance, proactive planning, education to prevent readmission to hospital
55. Where does decision making start?: yourself, values and beliefs
56. How do you come up with a decision?: generate alternatives
57. Decision making Tier: decision making -> problem solving -> critical thinking -> clinical reasoning
58. Decision making: making a snap decision
59. Problem solving: the process of finding solutions to difficult or complex issues, some analysis
60. Critical thinking: deeper than problem solving, analyzing the past, future, look- ing at everything, looking in 360
61. Clinical reasoning: critical thinking at the bedside
62. Management Functions: planning, organizing, staffing, directing, controlling
63. Theory X: assumes that workers are basically lazy, error-prone, and extrinsically motivated by money and, thus,
should be directed from above.
64. Theory Y: The assumption that employees like work, are creative, seek respon- sibility, and can exercise self-
direction. Worker will do a good job.
65. Theory Z: everybody is in right spot, everyone will work together, everyone trusts what is going on
66. Human Capital: the investment in human knowledge and skills for future profit ex: formal educational attainment
generally increases human capital because the returns are in the form of wage, salary, or other compensation.
67. Code of Ethics: written by the ANA(professional organization), tells us how we should act but is not legally
binding
68. Breach of Duty: board of nursing sets standards for reasonable and prudent behavior, nursing scope of practice
69. decison making: a complex, cognitive process often defined as choosing a particular course of action.
70. problem solving: part of decision making and is a systematic process that focuses on analyzing a difficult situation.
Problem solving always includes a de- cision-making step. Many educators use the terms problem solving and decision making synonymously, but there is a small, yet important, difference between the two. Although decision making is the last step in the problem-solving process, it is possible for decision making to occur without the full analysis required in problem solving. Because problem solving attempts to identify the root problem in situations, much time and energy are spent on identifying the real problem.
-Leaders often do not have delegated authority but obtain their power through other means, such as influence. -Leaders have a wider variety of roles than do managers. -Leaders may or may not be part of the formal organization. -Leaders focus on group process, information gathering, feedback, and empowering others. -Leaders emphasize interpersonal relationships. -Leaders direct willing followers. -Leaders have goals that may or may not reflect those of the organization.
76. The Management process: planning, organizing, staffing, directing, controlling
77. Authoritarian: -Strong control is maintained over the work group.
-Others are motivated by coercion. -Others are directed with commands. -Communication flows downward. -Decision making does not involve others. -Emphasis is on difference in status ("I" and "you"). -Criticism is punitive.
78. Laissez-faire: -Takes a hands-off approach.
-Is permissive, with little or no control. -Motivates by support when requested by the group or individuals. -Provides little or no direction. -Uses upward and downward communication between members of the group. -Disperses decision making throughout the group. -Places emphasis on the group. -Does not criticize.
79. Democratic: -Less control is maintained.
-Economic and ego awards are used to motivate. -Others are directed through suggestions and guidance. -Communication flows up and down. -Decision making involves others. -Emphasis is on "we" rather than I and you. -Criticism is constructive.
80. Servant Leader: put serving others, including employees, customers, and the community, as the number one
priority.
1. The ability to listen on a deep level and to truly understand
2. The ability to keep an open mind and hear without judgment
3. The ability to deal with ambiguity, paradoxes, and complex issues
4. The belief that honestly sharing critical challenges with all parties and asking for their input is more important than
personally providing solutions
5. Being clear on goals and good at pointing the direction toward goal achievement without giving orders
6. The ability to be a servant, helper, and teacher first and then a leader
7. Always thinking before reacting
8. Choosing words carefully so as not to damage those being led
9. The ability to use foresight and intuition
10. Seeing things whole and sensing relationships and connections
90. Justice: seeks fairness; treats "equals" equally and treats "unequals" according to their differences
91. Veracity: obligation to tell the truth
92. Fidelity: Need to keep promises, faithfulness
93. Confidentiality: keep privileged information private
94. ANA Code of Ethics: -written by the ANA
-outlines the important general values, duties, and responsibilities that flow from the specific role of being a nurse. Although not legally binding, the code functions as a guide to the highest ethical practice standards for nurses and as an aid for moral thinking.
95. 4 Strategies of Ethical Behavior: 1. Separate legal and ethical issues.
2. Collaborate through ethics committees.
3. Use institutional review boards appropriately.
4. Foster an ethical work environment.
96. The constitution: The highest law in the United States; interpreted by the U.S. Supreme Court; gives authority to
other three sources of the law
97. Statutes: Also called statutory law or legislative law; laws that are passed by the state or federal legislators and that
must be signed by the president or governor
98. Administrative Agencies: The rules and regulations established by appointed agencies of the executive branch of
the government (governor or president) -ex: state board of nursing
99. Court Decisions: Also called tort law; this is court mode law, and the courts interpret the statutes and set
precedents; in the United States, there are two levels of court: trial court and appellate court
100. Criminal Cases: -beyond a reasonable doubt
-Consequences: incarceration, probation, and fines
101. Civil Cases: -Based on a preponderance of the evidence
-Consequences: Monetary damages
102. Administrative Cases: -Clear and convincing standard
-Consequences: Suspension or loss of licensure
103. Components of Professional Negligence: 1. Duty to use due care (defined by the standard of care)
2. Failure to meet standard of care (breach of duty)
3. Foreseeability of harm
4. A direct relationship between failure to meet the standard of care (breach) and injury can be proved.
5. Injury
104. Duty to Use Care: A nurse should give medications accurately, completely, and on time.
105. Failure to Meet Standard of Care: A nurse fails to give medications accurately, completely, or on time.
106. forseeability of harm: The drug handbook specifies that the wrong dosage or route may cause injury.
107. A direct relationship between failure to meet the standard of care (breach) and injury can be proved.:
113. Battery: an intentional and wrongful physical contact with a person that entails an injury or offensive touching
114. False Imprisonment: occurs when a person (who doesn't have legal authority or justification) intentionally
restrains another person's ability to move freely
115. Informed Consent: The person(s) giving consent must fully comprehend
1. The procedure to be performed
2. The risks involved
3. Expected or desired outcomes
4. Expected complications or side effects that may occur as a result of treatment
5. Alternative treatments that are available
Consent may be given by:
- A competent adult
2. A legal guardian or an individual holding durable power of attorney
3. An emancipated or married minor
4. A mature minor (varies by state)
5. A parent of a minor child
6. A court order
116. Advanced Directives: written instructions regarding desired end-of-life care. Most ADs address the use of
dialysis and respirators; if you want to be resuscitated if breathing or heartbeat stops; tube feeding; and organ or tissue donation
117. durable power of attorney: Names healthcare proxy
118. Healthcare Proxy: someone you trust to make health decisions if you are unable to do so
119. Good Samaritan Law: suggest that health-care providers are typically protect- ed from potential liability if they
volunteer their nursing skills away from the workplace (generally limited to emergencies), if actions taken are not grossly negligent, and if the health-care worker does not exceed his or her training or scope of practice in performing the emergency services.
120. Patient Bill of Rights: This document had three key goals: (a) to help patients feel more confident in the US
health-care system, (b) to stress the importance of a strong relationship between patients and their health-care providers, and (c) to stress the key role patients play in staying healthy by laying out rights and responsibilities for all patients and health-care providers
121. Subordinate Advocacy: suggests that nurse administrators should advocate for other health-care providers
(including subordinates) as well as patients, espe- cially when this is related to health and safety.
122. workplace advocacy: In this type of advocacy, the manager assures the work environment is both safe and
conducive to professional and personal growth for subordinates. For example, managers should assure that Occupational Safety and Health Administration (OSHA) guidelines for worker safety are followed. Educating
make decisions with few guidelines or structures
- CEO -high level nursing administrator
131. Middle level managers: coordinate the efforts of lower levels of the hierarchy and are the conduit between lower
level and top level managers -unit supervisor -department head
132. First level managers: concerned with specific units workflow, deal with imme- diate problems in their unit's
daily operations -charge nurse -primary nurse -team leader
133. Centralized Decision Making: occurs when key decisions are made by top management, little input, tend to
occur fast, authoritarian
134. decentralized decision making: occurs when important decisions are made by middle and lower level managers,
problems solved at the level at which they occur, laissez faire/democratic, theory y, decisions take longer
135. Stakeholders: entities in an organizations environment that play a role in the organizations health and
performance or that are effected by the organization -internal: physically in the building (patient's, employees, physicians, volunteers, families, administration) -external: who comes into the building throughout the day (vendors, ambulance services, educational institutions, local government, insurance companies)
136. Organizational Culture: the set of values, ideas, attitudes, and norms of behavior that is learned and
shared among the members of an organization
137. Subcultures: subgroups within the larger, or national, culture with unique values, ideas, and attitudes
138. Organizational Climate: feelings
139. Shared governance: a method that aims to distribute decision making among a group of people
140. Power: that which enables one to accomplish goals
141. What affects and individuals perception and acceptance of power?: how power was viewed in the family
unit. gender
142. Reward Power: obtained by the ability to grant favors or reward others with whatever they value. The arsenal
of rewards that a manager can dispense to get employees to work toward meeting organizational goals is very broad. Positive leadership through rewards tends to develop a great deal of loyalty and devotion toward leaders.
143. Punishment or Coercive Power: the opposite of reward power, is based on fear of punishment if the manager's
expectations are not met. The manager may obtain compliance through threats (often implied) of transfer, layoff, demotion, or dismissal. The manager who shuns or ignores an employee is exercising power through punishment, as is the manager who berates or belittles an employee.
144. legitamate power: Position power, Authority is also called legitimate power. It is the power gained by a title or
official position within an organization. Legitimate power has inherent in it the ability to create feelings of obligation or responsibility. The socialization and culture of subordinate employees will influence to some degree how much power a manager has due to his or her position.
145. Expert Power: gained through knowledge, expertise, or experience. Having critical knowledge allows a manager
to gain power over others who need that knowledge. This type of power is limited to a specialized area. For example, someone with vast expertise in music would be powerful only in that area, not in another specialization. When Florence Nightingale used research to quantify the need for nurses in the Crimea (by showing that when nurses were present,
