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RNSG 2221: Modules 7-12 Exam
Questions With Complete Solutions
Discuss the difference between leadership & management. - ANSWER Leader = SELECTS and ASSUMES a role
- effective at influencing others
- Leadership is a way of behaving; it is the ability to cause others to respond, not because they have to, but because they want to Manager = is ASSIGNED or APPOINTED to a role
- Management is a problem-oriented process with similarities to the nursing process
- responsibility for organizational goals & the performance of organizational tasks such as budget preparation & scheduling
- supervise a team of people who are working to help pts achieve their defined outcomes Discuss Patient classification systems - ANSWER Aka acuity systems; used to determine the number of nurses needed on a unit at any one time. Patient acuity is the measure of categorizing pts based on nursing care requirements. Can be used to 1) improve pt care outcomes, 2)ID appropriate staffing, 3) track budget compliance/costs, 4) maintain nurse retention through their ability to impact staffing through assessment of pt's conditions Disease management - how do we manage patients with regard to their diagnosis - ANSWER Goal is to support patients with chronic disease who may receive services from various levels of care.
- Teaches pt how to manage a particular chronic disease
- pts learn to take responsibility for understanding how to take care of themselves to avoid potential prolems or worsening of their health condition
- May include: teaching pts about the disease so they will understand their symptoms & implement preventive strategies What are the 3 responsibilities of fiscal responsibility. - ANSWER 1) financial resources of the pt to maximize the patients health benefit
- financial resources of the employer to maximize organizational cost-effectiveness
- financial resources of the payer by using knowledge & efficiency
Describe strategies for fiscally responsible clinical practice as a nurse. - ANSWER - provides quality nursing care that prevents complications
- understand Medicare/ Medicaid insurance coverage
- makes conscious decisions about the allocation of professional nursing time
- shares info w/ pt/ family about costs of care & alternatives
- Assigns assistive personnel to help w/ care & recognizes the nurse is ultimately responsible
- begins discharge planning on or before admission
- completes charge slips for patient supplies
- avoids burnouts by taking breaks, meal times & vacations Type of budget: the beginning point of a budget. Hospital administrators typically ask departments for a list of items that their area will need to purchase in the coming year. Each manager must rank such requests for the unit & write a justification for the necessity of each item
- includes items that are durable (should last at least 1 year) and cost a substantial amount of money (usually over $5,000) - ANSWER Capital budget Type of budget: includes a statement of the expected expenses of the unit for a period, usually 1 year. Begins with a statement of volume projections, the nurse manager projects how much patient care will be provided in the coming year. May ask "how many patient days of care will be provided in the coming year?". Will typically look first at the previous year to help gather data.
- Small supplies needed for daily operations are included in this budget (ex: Linens & rolling BP cuffs) - ANSWER Operating budget Type of budget: Largest part of the unit expenses. Engages in a series of calculations such as : Hours per patient day (HPPD), Full time equivalent (FTE), Productive time, non productive time.
- ANSWER Personnel Budget Describe primary nursing. What is it designed to do? - ANSWER Nurse plans & directs care of patient over 24-hour period
- "Relationship-based practice" is new name for primary nursing — RN manages & coordinates patient's care in hospital and patient's discharge plan
Encourages nurses to join coalitions - ANSWER referent/ mentor power source of power: Weakest power base Nurses know about health and nursing care This is used most by nurses, but it is the weakest of the power bases - ANSWER expert/ informational power What is a political action committee (PAC)? Give an example. - ANSWER A mechanism whereby individuals can pool their resources and collectively support a candidate for national offices ex: ANA What are core measures? (Name them) - ANSWER Developed by the Joint Commission to improve quality of health care by implementing a national standardized performance measurement system. Measures are focused on patients with the following medical diagnoses: Acute myocardial infarction Congestive heart failure Community-acquired pneumonia Surgical infection prophylaxis Pregnancy-related conditions Deep vein thrombosis
Types of law: a) most common type of law affecting nurses ex: Nurse Practice Acts
b) law made by administrative agencies that have been given authority to pass rules and regulations and render opinions of state statutes on a particular subject area (rules & regulations passed by boards of nursing) ex: Nursing advisory opinions - ANSWER a) statutory law b) administrative law
Types of law: c) refers to rights, privileges, and responsibilities as set forth by the U.S. Constitution (the Bill of Rights) d) decisions made by judges in court cases e) composed of decisions rendered in court cases by appeals courts - ANSWER c) constitutional law d) common law e) case law
What is a tort? What is the most common? - ANSWER plaintiff files lawsuit to seek compensation for damages suffered from perceived wrong (intentional or unintentional)
Most common = malpractice claim (unintentional)
what are the 4 basic elements of malpractice? - ANSWER 1) You must have a duty (in other words, there must be a professional nurse-patient relationship)
- You must have breached that duty (in other words, you must have fallen below the standard of care for a nurse)
- Your breach of duty must have been a foreseeable cause of the patient's injury
- Damages or injury must have occurred
What 3 defenses might be available in malpractice claims? - ANSWER 1) Statute of limitations (usually 18yrs old if they are minors)
- Assumption of the risk
- Contributory negligence
What are 7 things that can lead to a malpractice claim but can be avoided? - ANSWER 1) med errors
- not providing a safe environment
informed decisions & BEFORE the procedure is performed.
- NEVER obtain a consent to a procedure that has not been fully explained
Describe the Joint Commission. - ANSWER - Primary agency for hospital accreditation
- Hospitals must meet certain quality standards to pass inspection
- Mandates continuous quality improvement (CQI)
- Endorses plan-do-study-act (PDSA) cycle for process improvement
- Major accrediting body for health care institutions that are Medicare/ Medicaid-funded
- Addresses patient safety issues
- Requires error reduction and design of safe patient care processes
- The Joint Commission mandates specific quality outcome measures for all hospitals
Why does the Joint Commission exist? How does it affect healthcare? - ANSWER Set standards for healthcare organizations (licensure/ certifications)
- sends out a team of experts for a review of every health care organization that wishes to be certified
- issues National patient safety goals every year that include standards to improve safe identification of pts & their medications, prevent infections using proven guidelines & improved communication among care providers
Describe CQI. What is the purpose? - ANSWER Continuous quality improvement = CQI
Process or activities used to monitor, evaluate, and control services, providing some measure of quality to consumers
Includes incident and/or variance reports that track progress and serve as a guide for risk management and QI departments to make system improvements (ex: Med errors, lack of drug knowledge, rule violations, misuse of infusion pumps)
How do we monitor quality? - ANSWER QI department receives data, analyzes trends, & recommends actions for improvement.
Should also be a continuous quality improvement (CQI) council, quality circles, and service lines that collaborate to improve patient care.
Describe QSEN. What is the purpose? - ANSWER Quality and Safety Education for Nurses - QSEN
Developed to help prepare future nurses who will be needed in their health care environments to improve patient safety.Idea is to teach student nurses how always to be thinking about how to improve care for patients.
- AACN (American association of college nursing) says nurses today need to begin their nursing careers w/ knowledge about how to create and continuously improve systems of care
Name some reputable websites. Describe CARS in relation to evaluating a website. - ANSWER Confine your Internet searches to well-known & reputable sites:
- Office of the Surgeon General
- National Human Genome Research Institute (NHGRI)
- Centers for Disease Control and Prevention (CDC)
- Agency for Healthcare Research and Quality (AHRQ)
- Health Resources and Services Administration (HRSA)
CARS = tool designed to help you evaluate a website: Credibility--authoritative source? Accuracy — correct today? Reasonableness — engages subject thoughtfully, reasonably, truthfully? Support — triangulated sources?
Use the following steps to answer clinical questions:
- systematic research for the most relevant evidence to the question (what is the most relevant evidence?)
- critical evaluation of the evidence found (is the evidence logical & valid?)
- your own clinical experience (does your experience fit with the evidence?)
- patient preferences & values (will your patients accept the recommendations drawn from the evidence?)
(EBP) Evidence on which nursing practice is based is derived from: (5 things) - ANSWER
- Synthesis of knowledge from research
- Data analyzed from medical record
- Quality improvement
- Risk data
- Infection control data
What are the steps involved in applying evidence-based practice? - ANSWER Step 1: Define the problem Step 2: Identify, review, and evaluate the data applicable to the problem:
- Consider research design used
- Quantitative method
- Qualitative method
- Mixed methods Step 3: Design a practice change based on data Step 4: Implement the change in nursing practice
Describe EHR (electronic health record) - ANSWER EHR is part of CIS: Web-based system & Handheld or wireless system
EHR is different from electronic medical record (EMR)
Focus on TOTAL health of the patient:
- Goes beyond standard clinical data collected during a single visit to the hospital or physician's office
- Intended to share information with other providers involved in the patient's care
Describe EMR. How is it different from EHR? - ANSWER Comprised of data from multiple software applications used by a facility, such as a hospital or provider officer, to order, document, and store patient information, just as a paper medical record did in the past
Considered a digital version of the patient's chart.
More difficult to transport to other providers involved in the patient's care (i.e., hospital medical record of patient being transferred to patient's primary care physician).
Violence - where does it occur? - ANSWER intentional use of physical force with likelihood of causing injury or death
- Co-workers
- Patients
- Families
- Visitors
How do you deal with violence? What is "code white"? - ANSWER Crisis intervention programs
- Recognize signs of escalating anger.
- Strategies to de-escalate situation
"Code white"
- Signals a potentially violent situation
college educational programs in nursing. This mission is to serve the public interest by assisting deans & directors in improving & advancing nursing education, research, and practice.
Define & describe ANCC - ANSWER American Nurses Credentialing Center (ANCC)
Responsible for judging whether hospitals achieve their status (Magnet hospitals)
Magnet Hospitals: What is it? What does it mean? How is it achieved? - ANSWER Magnet hospitals are known for their success in attracting and keeping nurses and delivering high-quality nursing care.
"Forces of Magnetism" = objectives that exemplify excellence in nursing
Ergonomics - what is this? How can you conform to proper ergonomics at a working stations? - ANSWER designing & arranging things so people can use them easily & safely
Chair: Ensure proper padding and lumbar support Desk: Large enough for CPU and writing Monitor, keyboard, and mouse Monitor height should be 18 to 22 inches above desk surface Keyboard aligned to center of user's body Mouse placed on side of dominant hand
Why is ergonomics so important? - ANSWER Major safety risk for nurses = musculoskeletal injuries (back injury = most common)
Describe Rule 224 and 225 of the Texas Administrative Code - ANSWER 224: DELEGATION OF NURSING TASKS BY REGISTERED PROFESSIONAL NURSES TO
UNLICENSED PERSONNEL FOR CLIENTS WITH ACUTE CONDITIONS OR IN ACUTE
CARE ENVIRONMENTS
- applies when the client has an acute health condition that is unstable or unpredictable
225: RN DELEGATION TO UNLICENSED PERSONNEL & TASKS NOT REQUIRING DELEGATION IN INDEPENDENT LIVING ENVIRONMENTS FOR CLIENTS WITH STABLE AND PREDICTABLE CONDITIONS
What Is a Political Action Committee (PAC)? - ANSWER -A mechanism whereby individuals can pool their resources and collectively support a candidate -American Nurses Association (ANA) national PAC is called ANA-PAC -There are state-level PACs
