CLINICAL NURSE LEADER (CNL) CERTIFICATION QUESTIONS WITH CORRECT AND VERIFIED ANSWERS., Exams of Nursing

Download CLINICAL NURSE LEADER (CNL) CERTIFICATION QUESTIONS WITH CORRECT AND VERIFIED ANSWERS. and more Exams Nursing in PDF only on Docsity! CLINICAL NURSE LEADER (CNL) CERTIFICATION QUESTIONS WITH CORRECT AND VERIFIED ANSWERS. GRADED A+ 6-year boy named Braden is pt in microsystem. He is terrified of shots he has to get BID for next 3 weeks. It is most therapeutic med route for his illness & becomes hysterical every time the med is due & must be held down by two people while RN gives injection. They will not have 3 people at home to do this. Working on discharge planning, what should you do? A) Plan on Braden being in hospital for next 3 weeks to receive his injections B) Obtain restraints for the parents to use at home in order to give the injection C) Talk with MD to prescribe a pill instead D) Work with child specialist & sit down with Braden to find out what scares him about the injections CORRECT ANSWER D) Work with child specialist & sit down with Braden to determine what scares him about injections Rationale: Working with interdisciplinary team to provide patient best treatment is ideal. Encouraging the child to become involved in his care & letting him help enables him to cooperate & feel more secure. A 5Ps assessment was completed by each NCL in the hospital. As A CNL you know this is an assessment of: A) Microsystem B) Mesosystem C) Macrosystem D) Health care system CORRECT ANSWER A) Microsystem Rationale: A 5Ps assemsnet is an analysis fo the microsystem. It consists of analyzing the purpose, patients, professionals, processes, & patterns of the microsystem. A 65 years man with hx of chest palpitations was seen by his cardiologist for new onset palpitations & put on a beta-blocker & told to return for a follow up in 1 week after taking a stress test. The beta blocker's action includes: A) Increasing the consistency of the heart rate B) Deceasing the ability of the heart muscle to contract C) Decreasing the change of dysrythmias D) Increasing contractility & decreasing heart rate CORRECT ANSWER D) Increasing contractility & decreasing heart rate A CNL on an ortho floor notice legs on several of walkers are not secure. She immediately calls medical equipment to replace walkers on the floor & puts defective stickers on current walkers. This is an example of: A) Health promotion B) Injury prevention C) Health care informatics D) Delegation CORRECT ANSWER B) Injury prevention Rationale: Providing safe care is one of the primary goals of CNL & this scenario prevented injury by ensuring safe equipment. A fellow staff nurse is struggling to understand the use of a clinical decision support system (CDSS) in the management of her septic patient. Your initial teaching strategy includes: A) Sharing the latest clinical research B) An understanding of expected & actual outcomes C) Defining the purpose of CDSS D) Exploring challenges, risks, & benefits CORRECT ANSWER C) Defining the purpose of CDSS Rationale: CDSS supports a safe patient culture & should be designed to help providers A Korean patient is admitted who speaks little English. An example of culturally competent care is: A) Finding a nurse who speaks some Korean B) Transferring that patient to a floor that has a Korean-speaking secretary C) Calling the patient's family to see if they can speak any English CORRECT ANSWER B) Learn more about the policy & why your organization supports it. Rationale: You should know how your professional organization stands -- we need to support each other & have on voice as nurses. A new nurse on the med-surg unit approaches you with concerns about one of her patients. She states the patient has not turned on the lights or TV all day & did not order breakfast or lunch. She had to sk the patient what meal they wanted & place the order. This nurse states she is concerned about the change in the patient's behavior. Looking at the patient's chart, you realize this patient is Jewish & it is Saturday. What is the best response to the nurse? A) "The pt is sick & needs extra support today" B) "The pt needs to be seen by the psychology team for an evaluation" C) The pt may be following their religious practices & we need to support this D) Begin being in the hospital CORRECT ANSWER C) "The patient may be following their religious practices & we need to support this" Rationale: We need to support patients' religious practices whenever possible in the hospital. onsidering it is Saturday & this patient is Jewish means the patient is recognizing the Sabbath. This means the patient will not use any electrical devices or ask to use them. The staff would have to ask whether a patient wants the TV on or the lights turned on/off, & so on. Patients will also not use the phone or call bell system during the Sabbath. Staff need to be sensitive to patient needs & try to accommodate cultural & spiritual practices whenever possible. A notifies you that her patient is c/o chest pain. As you enter the room, the patient becomes unresponsive. Upon verification that a pulse I absent, the cardiac monitor reveals the patient is in VFib. The nurse begins CPR. As a CNL you anticipate the need for which treatment next? A) Amiodarone B) Labetolol C) Defibriliation D) Cardiac catheterization CORRECT ANSWER C) Defibrillation A nurse approaches you & expresses her knowledge deficit regarding the difference between s/s of L & R sided heart failure. You explain the physiology between two types of heart failure & identify which of the following as a primary symptom of R-sided heart failure? A) SOB on exertion B) Heart murmur & distended veins C) Peripheral edema D) Cool extremities & weak peripheral pulses CORRECT ANSWER C) Peripheral edema Rationale: R-sided heart failure leads to congestion of systemic capillaries. This generates excess fluid accumulation int eh body & usually affects the dependent parts of the body first. A nurse called you into a room with a patient who is newly admitted to your unit with a dx of UTI. The pt is 86yo, VS reveal temp of 97.8, RR 24, HR 115, BP 75/48. The nurse has called MD & received orders to bolus pt with IVF that the pt is currently receiving. The patient is becoming increasingly confused. What is the most appropriate response to delegate to the RN while you stay with the patient? A) Recheck the vital signs in 15min to ensure BP is rising B) Call pt's family to obtain a full med hx C) Ask RN to call MD & notify him of need to evaluate the patient for a higher level of care D) Give pt a PRN dose of Ativan to help pt with confusion CORRECT ANSWER C) Ask RN to call MD & notify him of need to evaluate the patient for higher level of care Rationale: Pt is displaying signs of sepsis though temp is normal. Temp is unreliable in elderly as a sign of infection, however, tachypnea, tachycardia, and hypotension and change in mental status indicate infection. A nurse on the unit comes to you & says that every shift he works day or night he finds at least one of his patients without an identification band in place. He is very concerned about patient safety & feels a harmful mistake could occur in the near future if the practice on the unit is not improved. What do you do as the CNL? A) Perform daily audits on all patients & report results to management B) Have the unit secretary make new ID bands for all patients daily so the charge nurse can place new bands on the patients daily C) Research a new style of patient ID bands since the current product does not stay on the patient properly D) Provide support to the nurse on the unit who determines the problem & help him identify areas in the process to improve pt ID CORRECT ANSWER D) Provide support to the nurse on the unit who determines the problem & help him identify areas in the process to improve patient ID Rationale: Part of the CNL's role is to provide staff with education, support, & the tools needed to improve practice. This nurse is already concerned about improving a process. As a CNL it is important to foster leadership & ownership instead of providing solutions to problems A patient admitted to the hospital in a hypertensive crisis is now receiving care at what level of prevention: A) Primary B) Secondary C) Tertiary D) None of these CORRECT ANSWER C) Tertiary Rationale: The patient already has a severe medical problem that now requires treatment; this is tertiary level of prevention focused on maximizing the patient's health, despite the presence of illness. A patient asks the CNL about the regulations on abortion in NC. What should the CNL do? A) Tell pt you can't answer that because it's an ethical situation B) let the MD know the pt is asking about abortion C) Inform pt care RN D) Look up regulations in NC & share them with the patient CORRECT ANSWER D) Look up regulations in NC & share them with the patient Rationale: Being able to look up policies & regulations is an important role fo the CNL, along with educating patients. Giving the policy does not cross any ethical barriers, it is only providing facts. D) Practice CORRECT ANSWER B) Population After careful review of unit processes, you have determined that self meal order program was introduced 3 months ago. With this program, patients have the ability to order meals when they are ready to eat rather than eating at predetermined times set by the hospital. This change has altered the timing of medications previously given with meals. What does the CNL do to improve this process? A) Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, and meal service team members to investigate the self meal order program B) Have the nurse or nursing assistant order meals with patients; this way the nurse knows what time the patient orders meals C) When explaining the self meal order program to patients, instruct patients to notify staff when they order meals D) Have the meal service notify the unit secretary when meal orders are placed by patients CORRECT ANSWER A) Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, & meal service team members to investigate the self meal order program. Rationale: Having an interdisciplinary team look at the entire process of the self meal order program will provide the team with innovative solutions to the problem. After completing unit audits, you have noticed the nurses are not completing AIR cycles documentation with pain management (AIR: assessment, intervention, reassessment). What should be done to improve documentation?: A) Tell the unit management which staff are documenting inappropriately B) Reeducate staff on the hospital documentation policy C) Remind staff of pain documentation during staff meetings & charge report D) Provide staff with a self-audit sheet as a way to review their own documentation during their shifts. CORRECT ANSWER D) Provide staff with a self-audit sheet as a way to review their own documentation during their shifts. Rationale: Giving staff a checklist will assist them in staying organized during their busy day. This will provide them a way to double check all their documentation before ending a shift. It also empowers staff to take ownership of their work. All are part of the data necessary for a CNL to fully understand & assess his or her clinical unit except: A) The organization financial statement B) The target population & age distribution C) The percentage of FTEs D) Rate of nosocomial infections E) Fall rates CORRECT ANSWER A) The organization financial statement Rationale: A comprehensive assessment of the clinical unit is a foundation for the work of the CNL but does not include the financial statement of the organization. In comprehending the "big picture" of the organization, the CNL should have an understanding of the financial health of the institution. All of the following are component of EBP & clinical decision making except: A) Clinical expertise B) Info about pt preferences & values C) Research utilization D) Evidence from research & theories CORRECT ANSWER C) Research utilization Rationale: Research utilization uses knowledge typically based on only one study, whereas EBP looks at evidence from research, EBtheories, opinion leaders/expert panels, evidence from patient assessment & hx, clinical expertise & information about pt preference & values All of the following are found to be an effective use of self except? A) Managing group processes B) Communicating with other disciplines C) Dictating to other staff D) Negotiating CORRECT ANSWER C) Dictating to other staff Rationale: Delegating is a role, NEVER dictating All of the following are steps of EBP except: A) Integrating evidence with clinical expertise, patient preferences, & values when making a decision or change B) Asking the question in a PICO format C) Obtaining informed consent from patients involved in the practice change D) Critically appraising the evidence CORRECT ANSWER C) Obtaining informed consent from patients involved in the practice change Rationale: EBP changes don't require consents An 88yo lady suffers a stroke in the nursing home & develops pneumonia & is transferred to the hospital. She continues to decline & is having trouble breathing, & become unconscious with little hope of recovery or quality of life. She has no family & no health care proxy, living will, or directions about whether she wants to be intubated or not. The MD wants to intubate the patient. The staff RN strongly believes the patient would not ant to be intubated, as she had cared for her before the lady became unconscious. What is the BEST thing for the CNL to do first? A) Take a vote among staff RN B) Call for an ethics consult C) Ask social worker to make a recommendation or decision D) Do a lit review on quality of life of elderly patients with pneumonia CORRECT ANSWER B) Call for an ethics consult Rationale: Pt has not declared his/her wishes & there is no family or documentation & there is a dispute, then there is an ethical issue & the best choice is to ask for an ethic consult. An example of true advocacy is: A) Telling dietary staff if the patient has any concerns with her food B) Calling a patient's family to give them updates on a patient's health C) Establishing goals to promote patient health Rationale: Lantus provides a consistent basal rate that doesn't respond to the body's needs for increased basal demands throughout the day while the insulin pump will provide the capability of increasing basal rates dependent on that patient's needs throughout the day. As a CNL you know that the most important nursing intervention to monitor a patient with CHF includes which of the following? A) Assessing pt's knowledge of the disease B) Encouraging coughing & deep breathing C) Encouraging frequent ambulation D) Monitoring fluid intak e& output CORRECT ANSWER D) Monitoring fluid intake & output Rationale: In heart failure, compensatory mechanisms cause retention of fluid & sodium As a member of the interdisciplinary team, the CNL is effective in all the following except: A) Maintaining & updating the POC B) Collaborating with other members of the team for the care delivery C) Delegating to other staff D) Taking charge of all patient care CORRECT ANSWER D) Taking charge of all patient care Rationale: CNL is a member of team & NEVER is in charge; the interdisciplinary team is a process that involves multiple people, not just one. As the CNL on a Cardiothoracic step-down unit, what is the one recommendation you would make to decrease the chance of readmission of your patient population? A) Visiting nursing for all patients B) All follow-up appointments scheduled prior to patient discharge C) Pharmacy to visit with each patient prior to discharge home to review medications D) All patients should be enrolled in a cardiac rehab program CORRECT ANSWER D) All patients should be enrolled in a cardiac rehab program Rationale: All patients should be enrolled in a cardiac rehab program to assist the patient with making permanent lifestyle changes required to improve their health, well-being, & success after their illness. Because these programs provide ongoing support, teaching & monitoring of health, it is the best choice. As the CNL on a Med-Surg unit, you are asked to participate in a RCA of a group of sentinel events that have occurred recently throughout the hospital. Your team determines that a lack of effective communication in emergent situations is the root problem. Now what? A) Lead the team in researching EBP improvements to implement a better way of communicating during emergencies B) Submit your findings to the administration that assigned you this task C) Share the findings with the units that had these sentinel events & instruct them to come up with better, research-based communication techniques D) Take the findings directly to the individuals involved int he sentinel events & show them what they need to improve to prevent the adverse outcomes CORRECT ANSWER A) Lead the team in researching EBP improvements to implement a better way of communicating Rationale: Once you discover what ht problem is, a solution needs to be created. This is something that should be non punitive & benefit the whole hospital. Focusing on individuals will not be beneficial to the big picture. As the CNL on a med-surg unit, you have noticed a trend over the last 3 months with patients having high blood glucose before lunch & after dinner. What is the best way to address this problem? A) Investigate whether the blood glucose monitors on the unit are accurate B) Provide an educational in-service about diabetes to the staff C) Ensure all patients with diabetes receive a consultation with the nutritionist D) Determine what other changes in processes have occurred on the unit in the past 3 months that could influence this trend CORRECT ANSWER D) Determine what other changes in processes have occurred on the unit in the past 3 months that could influence this trend. Rationale: While checking the accuracy of blood glucose meters, providing education to staff & patients is important. Other processes on the unit that have changed need to be further evaluated to determine their influence on patient outcomes. As the CNL on medical unit, which of the following interventions would you support to reduce the readmission rate on your unit? A) Keep patients one extra day to ensure they are prepared for discharge home B) Arrange for all patients to have at least 1 week of visiting nursing post-discharge C) Review discharge instructions with the patient and one family member D) Begin discharge planning & teaching on the day of admission CORRECT ANSWER D) Begin discharge planning & teaching on the day of admission Rationale: Using every opportunity to communicate to & educate the patient & family on their care & planning for discharge will better prepare the patient & family for returning home. As the CNL you have identified that post-op pneumonia has been a frequent occurrence within your unit. Your manager approaches you & identifies hat each occurence of post-op pneumonia costs the unit $5K. You develop a respiratory program that includes frequent IS use, ambulation TID minimal, & frequent mouth care, if warranted. You are able to reduce the unit's occurrent of post-op pneumonia by 75%. What is this an example of? A) Conceptual analysis & implementation fo the CNL role B) Knowledge management C) Effective use of self D) Horizontal leadership CORRECT ANSWER B) Knowledge management Rationale: Knowledge management improves clinical & cost outcomes As the CNL, you know that one of the first steps in building a team is to: A) Build trust B) Assign roles to each member C) Designate a mission of the team Rationale: Operational definitions clearly define what is to be collected & avoid confusion for those collecting the data. Clear operational definitions also helps those who are interpreting the data. Failure to determine operational definitions may result in data that are inaccurate. By leading which unit initiative can the CNL directly impact the financial health of the entire institution? A) Reducing readmissions B) Recruitment of new nursing staff C) Improving documentation compliance D) Encouraging staff to report safety events and near misses CORRECT ANSWER A) Reducing readmissions Rationale: Medicare reimbursement rates include a penalty to those health care institutions with 30-day readmission rates that are higher than national benchmamrks. C.W. is a 92yo male who is a DNR. There is no family to visit this patient, & the patient's status has declined over the past 24hr. The patient's breathing is labored & the MD tells the staff there is nothing else to do. What is an effective use of the CNL? A) Spend time talking with staff on their views of the dying process B) Call bed management & let them know there will be a bed available soon for a post-op patient C) Consult pastoral care to come with the patient D) Call dietary & tell them to stop bringing the patient food CORRECT ANSWER C) Consult pastoral care to come with the patient Rationale: It is within the scope of practice of nursing to get pastoral care involved Capstone project for CNL immersion experience focused on wound infections & readmission rates. Conduced a lit review on best way to provide education on surgical patients, reduce surgical infections & prevent readmissions. ON basis of lit review & EBP she developed a protocol for this patient population. What key principle did Marie use by incorporating this protocol? A) Team coordinations B) Risk reduction & prevention management C) Lateral integration of care D) Information management CORRECT ANSWER B) Risk reduction & prevention management Rationale: Marie uses evidence to keep an illness or injury from occurring early in its course & preventing further deterioritation by focusing on health promotion, disease prevention, risk reduction, & prevention management. Carey, a CNL, thinks utilizing volunteers in a microsystem will benefit staff & patients. She performs a lit review & doesn't find much literature evaluating volunteers being effective in a health care setting. She decides to go ahead & implement a volnteer program & collects data to see whether this is an effective change. Should Carey have implemented this? A) No, there was no evidence volunteers would be beneficial B) No, she should hav waited until there were data on this topic C) Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective D) Yes, it is always good to try something new. CORRECT ANSWER C) Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective Rationale: If sufficient lit/evidence isn't found for a particular group, it can still be implemented if done correctly & if data are collected to see whether the change should coninue or not. Cassidy, a CNL at an outpatient setting sees an increase of Japanese patients. This is a culture she doesn't know much about & does n't have much education materials to give to patients in this language. She goes online to valid websites & learns more about the culture & their health care practices. She also discovers a site within her heath care system that translates information & has handouts in 12 different languages. Cassidy demonstrated knowledge of: A) Team coordination B) Injury reduction C) Health care informatics D) Health care policy CORRECT ANSWER C) Health care informatics Rationale: Health care informatics applies using technology to improve patient care. Chloe, a CNl, walks into a patient's room & notices she has labored respirations & is pale. She immediately takes her vitals & calls the patient care nurse. Her vitals are bP 183/101, HR 121, RR 28, T 98.1, O2 90%. What should Chloe do? A) Call the doctor B) Lay the pt down & recheck the VS in 30min C) Give labetalol 20mg IVP D) Instruct patient care nurse to call MD CORRECT ANSWER D) Instruct patient care RN to call MD Rationale: Delegate the nurse to call the physician for further orders CNL focus on projects within a clinical microsystem. A clinical microsystem can be best described as: A) A department-wide program focused on improving continuity of care & patient satisfaction B) Trending the post-op care on all surgical units C) The clinical & business processes of a single unit within an organization D) All medical & surgical units guided by a chief nursing officer CORRECT ANSWER C) The clinical & business processes of a single unit within an organization Rationale: The microsystem is described by the AACN White Paper as the practice level of the CNL. Currently Medicare is moving from a fee-for-service model to a: A) Managed care model B) Pay-for-performance model C) Private insurance model D) Advantage care model CORRECT ANSWER B) Pay-for-performance model Rationale: Increasingly medicare is adjusting reimbursement rates to providers on the basis fo their patient outcomes. D.M. is admitted for a hip fracture, a fall from standing. As a CNL, you would know such a fracture obtained this way is best found from what? A) Osteomyelitis D) Share what you have found with the manager CORRECT ANSWER B) Convene a team meeting to discus the problem & impact of central line infections Rationale: The team needs to be involved in the whole change process In assessing your organization for EBP environmental readiness, you would evaluate all of the following except: A) Do advance practice nurse & educators model EBP? B) Are the nurses expressing an interest in EBP? C) Are the librarians available to assist nurses with EBP research? D) Are computers readily accessible to staff? CORRECT ANSWER B) Are the nurses expressing an interest in EBP Rationale: The organization is assessing environmental readiness, not interest In order to complete a thorough assessment of a 55yo male beginning an exercise program, the CNL should include the following in the instructions; A) Begin an exercise program of a minimum of 60 minutes of vigorous exercise each day B) Keep a daily written log of exercise & include the type of exercise, time of exercise & intensity of exercise C) Avoid drinking more than 8oz of water per day when exercising D) Side effects are common when beginning exercising & should be ignored CORRECT ANSWER B) Keep a daily written log of exercise & include the type of exercise, time of exercise, & intensity of exercise Rationale: When starting a new regimen, it is important to keep this important to keep this information to determine what the patient can tolerate at baseline before increasing the exercise plan. In order to generate ideas aimed at designing an implementation plan, a team reviews the topic & members verbalize solution ideas in a random fashion. This is an example of which of the following strategies: A) Multivoting B) Process mapping C) Brainstorming D) Nominal group technique CORRECT ANSWER C) Brainstorming Rationale: Brainstorming is creative, interactive, & unstructured, as team members suggest possible ideas in a free-flow format without regard to the details of the suggested solutions. In what way can the CNL serve as an advocate for the patient through other nurses? A) Delegate to other members of the profession B) Serve as an advocate for the profession of nursing C) Advocate for the staff to have better hours D) Research best practice methods for your unit CORRECT ANSWER B( Serve as an advocate for the profession of nursing Rationale: As an advocate for your profession, you can foster a sense of commitment to learning on your unit & with your staff. In your role as a CNL, you have implemented some practice changes on your unit that have resulted in an overall reduced LOS for the pneumonia patients. The cost savings will be reflected in which budget: A) Operating budget B) Capital budget C) Cash-flow budget D) Long-term budget CORRECT ANSWER A) Operating budget Rationale: Operating budget reflects the revenue & expenses for the nursing unit. The capital budget refers to larger purchases that may be planned over long periods Individual consults by many different health disciplines represent which type of approach: A) Multidisciplinary B) Interdisciplinary C) Team D) Intradisciplinary CORRECT ANSWER A) Multidisciplinary Rationale: A multidisciplinary approach is composed of individual consults, occurring independently of each other. Typically the disciplines do not meet to work toward a common goal as in an interdisciplinary approach. Jen is an obese pt admitted with COPD 7 CHTN. Part of her social hx is that she smokes 2ppd. Her CNL, Erika, makes a goal for her to decrease by one cigarette a day until there are no more by Aug 1. This goal will not work because: A) There I snot a measurable outcome B) Jen should decrease by two cigarettes a day C) The patient has COPD D) Jen should help make the goal CORRECT ANSWER D) Jen should help make the goal Rationale: In order for a goal to be effective & the patient to be compliant, it should be mutually set by the CNL & the patient. Julie, a NL, hears another hospital does hourly rounding & thinks this is a great idea to reduce falls on her unit. She meets her interdisciplinary team & decide to try this on their unit. She informs the rest of the staff and makes a start date. What did Jule forget to do? A) Look at latest evidence/lit review B) Ask her RN manage C) Ask other units if they do hourly rounding D) Get data from the other hospital CORRECT ANSWER A) Look at latest evidence/lit review Rationale: When making a change it is important to look at EBP by performing a lit review & then decide whether there is sufficient evident to make the change or whether there is not much lit on the topic to collect data to see if the change is effective. Leah, a CNL on an obstetrical high-risk unit, looked at the evidence regarding women taking folic acid during pregnancy. Because it shows evidence to prevent neural tube defects in the fetus, she recommends this be included on the order set for antepartum patients. This is an example of which of the following: A) Health promotion B) Health literacy C) Qualitative Review exact timing info & the MD should agree to allow the pt to eat since delivery will not be within the next 8 hours. Also, once you call MD & report situation, he should agree to start IVF. Nurses on your unit have complained that equipment kept on the unit is not readily available. They have indicated that is often takes a considerable amount of time to locate. You realize that this is a waste of valuable human work resources. An effective process to utilize in solving this problem is the ______________ principle. A) 5P B) SIPOC C) FMEA D) 5S CORRECT ANSWER D) 5S Rationale: The 5S (sort, set in order, shine, standardize, & sustain) LEAN technique can be used to organize equipment, resulting in an orderly workplace. "A place for everything & everything in its place" Of the following choices, what is the best way that you, the CNL, could have an environmentally positive impact? A) Incorporate the importance of the environment into your teaching with each of your patients B) Institute a recycling program into your hospital C) When teaching patients & families, make sure they know how two properly dispose of their medical waste D) Have patients start calling their physicians instead of going to their appointments to save on gas & time CORRECT ANSWER B) Institute a recycling program into your hospital Rationale: Every hospital probably uses an extraordinary amount of products that could be recycled One morning as you, the CNL, are walking into the nurses' lounge, you hear a lot of talk about a nurse who has called out sick that day. The nurses are griping about how this nurse always calls out, especially on Fridays. The best response is to: A) sympathize with your team, saying you have no idea how she does not get in trouble or fired. This kind of behavior should not be tolerated B) Tell the nurses to stop talking about one of their teammates, especially in front of a new employee C) Listen to what the nurses are saying, & notify the manager to address it D) Listen to what the nurses have to say, & then address that it is not our business to discuss someone else's personal life. That nurse's sick days & disciplinary action are up to that nurse & the manager. Ensure they have adequate staffing to make up for the sick call/help to adjust assignments CORRECT ANSWER D) Listen, address it is not our business to discuss someone else's personal life. The nurse's sick days & disciplinary action are up to that nurse & magenment. Ensure that the staff is adequately provided for in adjusting assignments as necessary Rationale: It is good to show empathetic ear, but not helpful for a team to speak badly about one of the teammates. Adequate staffing is a big concern for the team, so ensure that this is addressed. One of the nurses on your unit was involved in a medication error. She revealed the error to both you and the nurse manager & documented the error in the online safety event reporting system. You meet with her & begin the process of identifying causes that led to this event, so the risk for future medication errors can be minimized. As evidenced by these actions, what is the culture of your hospital? A) A laissez-faire culture B) A just culture C) A punitive culture D) A structural culture CORRECT ANSWER B) A just culture Rationale: A just culture recognizes that human are fallible, & errors may happen in systems that are flawed. A non punitive culture fosters patient safety principles, encouraging practitioners to report errors & near misses, which in our enables organizations to address & correct flawed processes & systems. Errors that result from willfully negligent behavior are not a part of a just culture. One of your patients, a widow, is reaching end of life. The MD has adamantly suggested to the patient's family to plan for death & to make the decision to remove life support, as he feels it is futile at this point & most likely causing more agony to the patient. The patient has three children, & they can't agree on a decision. the Oldest feels that they should abide by the MD, as he knows best. Th middle doesn't agree with "killing" his mother. The youngest just wants to be with her mother & can't make a decision. You decide the best thing to do now is to hold a patient-care conference. Whom do you invite? A) The family, the team of MDs, the primary RN, the case manager, the chaplain, an ethics committee member, & the social worker B) The family, the team of MDs, the primary nurse, the nurse manager, the chaplain, the RT, & the nutritionist C) The team of MDs, the primary RN, the nurse manager, the case manager, the CORRECT ANSWER A) Family, team of MD, primary RN, case manager, Chaplin, ethics committee member, & social worker Rationale: Family/pt is necessary for a patient-care conference; the team of MD will be able to talk about prognosis & medical care; primary nurse can address how patient is responding on daily basis; case manager & social worker can help family with funeral/End of Life care planning; chaplain can be support to family & staff; ethic member can ensure ethical decision is being made. Opportunities that reflect human diversity include: A) Promoting effective communication for injured veterans B) Stressing the importance of family health history C) Standardizing the discharge process D) Decreasing the admission lead time to the pediatric unit CORRECT ANSWER A) Promoting effective communication for injured veterans Rationale: Human diversity includes understanding the ways cultural, ethnic, socioeconomic, linguistic, religious, & lifestyle variations are expressed. Over the past few weeks, nurses on the 30-ed medical unit have been complaining the MD orders related to O2 don't match what the patient is receiving. Often the patient has more than one O2 order at the same time. This leads to confusion for nursing & respiratory care staff & could harm the patient. How can the CNL improve the practice? A) Using the informatics team as support, create a hard stop in the computer that does not allow the physician to activate a new O2 order without discontinuing the previous order B) Tell the nurses they need to remind the doctors to keep orders up to date & have the nurses review orders at rounds with the team C) Meet with the unit hospitalist to make a plan to address the problem D) Do nothing since CNLs can't write patient care orders CORRECT ANSWER A) Using the informatics team as support, create a hard stop in the computer that does not allow the physician to activate a new O2 order without discontinuing the previous order A) A visual signal on all ports not intended for IV drugs B) A double-check system for medication administration C) To facilitate a critical incident reporting structure that fosters a "without blame) unit culture D) All of the Above E) Only C CORRECT ANSWER D) All of the above Rationale: The CNL should support the staff to identify all opportunities for improving safety in this situation. Strategies for advancing EBP in health care settings include: A) Skill-building workshops B) EBP poster presentations C) EBP rounds D) All of the above CORRECT ANSWER D) All of the above Rationale: All of these are good strategies for promoting EBP Survey results of the nursing staff reflect poor perceptions & a discomfort with addressing spiritual issues with patients. The ultimate success of focused staff education can be measured by: A) Trending quarterly patient satisfaction scores pertaining to spiritual care during the hospitalization B) A follow-up survey of the staff after the education to solicit feedback C) An open discussion of how the nurse would address spiritual care in a given scenario D) Feedback shared during discharge phone calls CORRECT ANSWER A) Trending quarterly patient satisfaction scores pertaining to spiritual care during hospitalization Rationale: Application of knowledge that impacts patient outcomes is the most significant indicator. Sustaining process improvement requires the use of appropriate learning principles & strategies. The CNL function that best utilizes this competency is: A) Advocate B) Educator C) Clinician D) Information manager CORRECT ANSWER B) Educator Rational: CNL competencies are described in the AACN White Paper Team coordination skills can help avoid all but: A) Undefined team member roles B) Poor membership involvement C) Member conflict D) Confusion regarding next steps CORRECT ANSWER C) Member conflict Rationale: In most working groups, conflict arises at some point. In addition to sound team coordination skills, the CNL must also possess effective conflict management skills. The CNL can effectively design fiscally efficient patient care using which of the following strategies: A) Division of tasks & responsibilities among all team members B) Delegation of responsibilities according to job roles C) Seeking team members' input regarding their strengths & desired responsibilities D) Using input from the manager for job assignments CORRECT ANSWER B) Delegation of responsibilities according to job roles Rationale: The CNL must delegate responsibilities to the appropriate team member according to job description. Each team member should function at the highest level according to licensure. This will help to avoid wasting human resources & will preserve fiscal efficiency. The CNL is performing rounds with the physician team on a patient that has a chest tube placed for a collapsed lung. Which is a priority in telling the medical team first? A) The patient has continued pain where the chest tube was placed B) There is no diet ordered for this patient C) The patient's incentive spirometer results decreased from 1500 to 750 D) The patient c/o a sore throat CORRECT ANSWER C) The patient's IS results decreased from 1500 to 750 Rationale: With CT placed, there is already a decrease in lung capacity; a decrease in results of IS could be a signal the lung trauma is worsening The concept that an organization is in a continued state of change describes which organizational theory: A) systems theory B) Classic theory C) Contingency theory D) Chaos theory CORRECT ANSWER D) Chaos theory Rationale: The chaos theory is based on the principle that a system can maintain itself only if change is occurring somewhere in the organization all the time. Chaos & change are seen as means of survival. The hospital has a goal for patient transfers from ICU to be completed by 12 noon. Your unit has a very low percentage for meeting this hospital goal. How can you best address this problem as the CNL? A) Tell the charge RN to discharge patients in the morning B) Ask the manager to staff an extra nurse on day shift to be the discharge nurse C) Use process mapping to determine all the possible factors that contribute to patient discharge & what barriers there are to discharge D) Don't worry about the number; your unit meets the other hospital goals, so it's okay to miss one CORRECT ANSWER C) Use process mapping to determine all the possible factors that contribute to pt discharge & what barriers there are to discharge Rationale: Process mapping is a tool to provide the team with an objective view of the problem being investigated. This view will help everyone to determine the barriers to transfer. Once the barriers are determined through process mapping, each barrier can be broken down further to determine solutions. The hospital is looking to utilize cardiac monitor watchers. Your analysis includes all of the following except: A) A review of an online ECG monitoring education program B) Identifying a clinical issue with a focus on a specific population C) Conducting a trend analysis of outcome data D) Confrontation CORRECT ANSWER B) Collaboration Rationale: Collaboration involves all parties working together to design optimal outcomes using mutually agreed upon solutions. Tim is a 31yo admitted for pneumonia. During hospitalization you discovered he smokes cigarettes 1ppd. You provided handouts on smoking cessation & gave him a helpline number. At discharge yo made a follow up appointment with PCP for pneumonia & smoking cessation. What did you forget to do? A) Ask B) Advise C) Assist D) Arrange CORRECT ANSWER B) Advise Rationale: It is always important to advise people to stop smoking on each visit Tim, a CNL in clinic setting begins seeing a lot more Hispanic patients with high blood pressure and/or diabetes & many with a lack of knowledge on nutrition. They often say someone in their family has the same proems. He knows the best way to educate them is to: A) set aside extra time at each appointment to focus on educaton B) set up educational posters a t local hispanic supermarket C) Set up health fair with bilingual educators at a local highly populated park in Hispanic neighborhood D) Make up handouts to be given to patients at their appointments to take home CORRECT ANSWER C) Set up health fair Rationale: Health fair would reach the most people to educate & they feel comfortable in their own setting. Many clinics do not have extra time to make appointments longer & many people do not even go to the clinic, so a health fair would reach largest amount of people for this setting. To be culturally competent as a CNL is best found to be an example of which form of nursing leadership? A) Lateral integration of care services B) Horizontal leadership C) Advocacy D) Vertical leadership CORRECT ANSWER C) Advocacy Rationale: An effective advocacy is needed during assessment, intervention, evaluate, & teaching to use cultural competence for communication to be effective To confirm a scope of practice question, the CNL should consult which administrative body guidelines: A) The Joint Commission B) Centers for Medicare & Medicaid Services C) Hospital Policy & Procedure Manual D) State Nursing Practice Act CORRECT ANSWER D) State Nurse Practice Act Rationale: Scope of practice is defined according to each individual state. The CNL must have a full understanding of licensure standards of practice according to role before delegation of tasks. To demonstrate active listening, the CNL would exhibit which behavior: A) Avoid making any facial expressions B) Preserve at least 3 feet between the parties C) Lean slightly forward D) Fold hands in the lap CORRECT ANSWER C) Lean slightly forward Rationale: Leaning slightly forward indicates desire to concentrate on the interaction at hand & relays openness & attention to the talker. To help patients maintain healthy skin while in the hospital, all of the following should be considered except: A) Provide patient with Q2h positioning/turning if patient is unable to self-position B) Ensure adequate protein intake C) Use bed surfaces known to prevent skin complications D) Allow patient to refuse bathing for days if uninterested, as the pt has the right to refuse care CORRECT ANSWER D) Allow patients to refuse bathing for days if uninterested, as the patient has the right to refuse care Rationale: While the patient does have the right to refuse care, a patient who would disengage with personal grooming for multiple days should draw the attention of the staff & CNL. Further investigation into the refusal & disinterest in self-care needs would be required to determine the underlying causes resulting in the patient's behavior & lack of care for self needs. Vaccinations are considered what level of prevention: A) Primary B) Secondary C) Tertiary D) None of these CORRECT ANSWER A) Primary Rationale; Vaccines are preventative & therefore considered primary level of prevention What is considered to be the highest form of knowledge worker? A) Data gatherer B) Knowledge builder C) Knowledge user D) Information user CORRECT ANSWER B) Knowledge Builder Rationale: Nurses will transition from knowledge users to knowledge builders when they can examine data & trends across patient groups What is the appropriate ending point of a root cause analysis (RCA)? A) When several possible reasons for the error have been identified B) When staff have identified what they think is the reason for the error C) When the list of causes is exhausted to no more possible causes D) The CNL can identify reasons for occurrence CORRECT ANSWER C) When the list of causes is exhausted to no more possible causes Rationale: When performing an RCA, the CNL must ask "why to saturation", or until there are no more contributing root causes. This often consists of asking why 5 or more times. What is the best way for the CNL to analyze systems & outcome datasets to anticipate individual client risk & improve quality care? Rationale: Cough is one of the paramount symptoms to help diagnose pneumonia. When conducting a lit review, the publication that would provide a comprehensive summary of research on that topic would be: A) Non experimental B) Experimental C) Case study D) Meta-analysis CORRECT ANSWER D) Meta-analysis Rationale: A meta-analysis includes an analysis of multiple studies on that topic When incorporating EBP interventions into your health care setting, it would be best to: A) Do what everyone else is doing B) Do what you think would work in your setting C) Choose the interventions you think would work for your setting & perform a rapid cycle test to evaluate the impact D) Do everything the literature suggests to improve your chances of a good outcome CORRECT ANSWER C) Choose the interventions you think would work for your setting & perform a rapid cycle test to evaluate the impact Rationale: Incorporating EP & then performing rapid cycle tests will give you feedback on whether the changes are working well in your setting When is an RCA performed? A) Prior to the initiation of a new treatment to anticipate possible problems B) During a process to evaluate ongoing problems C) As part of data analysis to understand why an intervention led to poor results D) After a serious safety event has occurred. CORRECT ANSWER D) After a serious injury has occurred Rationale: An RCA is performed as a way to gain insight into the factors that led to a serious safety event. It is a reactive activity with the intention of proactively designing solutions to processes that led to a program. When trying to implement a change in the outpatient family clinic, which group of staff should the CNL focus on more? A) Late majority B) Early majority C) Laggards D) Innovators CORRECT ANSWER A) Late majority Rationale: The innovators & early majority are going to be supportive of change & become champions for the project. The laggards make up a minority portion of the group & will be the last to adopt change. However, the late majority, which makes up a large percentage of the group, is the percentage that will need the most support during a change & they will be resistant Which accreditation body is responsible for overseeing medical, mental health, & adult care facilities; emergency medical services, & local jails? A) IOM B) The joint commission C) Division of health service regulation D) CMS CORRECT ANSWER C) Division of health service regulation Which accrediting body is an independent nonprofit organization that works outside of government to provide unbiased & authoratative advice to decision makers & the public/ A) CMS B) IOM C) Institute for safe medication practices D) Division of Health Service regulation CORRECT ANSWER B) IOM Rationale: Institute of medicine is an indecent, nonprofit organization that works outside of the govn't to provide unbiased & authoritative advice to decision makers & the public Which CNL role from the White Paper best describes advocacy? A) Delegating & managing the care team B) Using appropriate teaching strategies when teaching clients C) Making sure that patients & families are well informed D) Using information to achieve the best outcomes for patients CORRECT ANSWER C) Making sure the patients & families are well informed Rationale: As clearly defined in the White paper, the CNL makes sure he or she is informed to be a resource for patients, families, & the interdisciplinary teams. Which group presents the highest challenge in attaining buy-in for a new innovation? A) Early innovators B) Early adopters C) Late majority D) Laggards CORRECT ANSWER C) Late majority Rationale: Members of the late majority approach any new initiative with a high degree of skepticism & require a large amount of information before adopting change. They will adopt change only in the late stages. laggards historically will not adopt change. Which group represents the single largest health profession in the US? A) RN B) MD C) Nursing assistants D) Clinical case managers CORRECT ANSWER A) RN Which is not considered an activity of daily living necessary for coverage of insurance? A) Bathing B) Dressing C) Taking medications D) Going to the park CORRECT ANSWER D) Going to the park Rationale: Other three are necessary for daily life functions Which level depicts a nurse with basic computer technology skills? A) Informatic innovator D) Participating in community event that focuses on cholesterol screening CORRECT ANSWER C) Presenting to your unit's staff a comparison of your institution & unit fall rates against national benchmarks Rationale: Knowledge management includes the CNL using institutional & unit data for comparison against national benchmarks Which of the following is an example of transcultural nursing? A) Maintaining eye contact with an Asian family B) Reporting the MD that you are unsure your American Indian patient understands his POC because he stares at the floor when you talk to him C) Male nursing giving his Hispanic female pt a huge D) Alerting the MD to write for a pork-free diet for you Islamic pt CORRECT ANSWER D) Alerting the MD to write for a pork-free diet for your Islamic pt Rationale: The goal of transcultural nursing is to improve & to provide culturally congruent care to people that is beneficial, will fit with, & will be useful to the client, family, or group healthy life ways. Which of the following is not part of the PDSA change model? A) Plan B) Assess C) Do D) Study CORRECT ANSWER B) Assess Which of the following may be beneficial tool for an interdisciplinary team to use to focus many ideas for improvement of patient satisfaction scores? A) Root cause analysis B) Multi-voting C) Development of a subcommittee D) None of the above; the group should work on all the ideas generated by the group CORRECT ANSWER B) Multivoting Rationale: To have effective outcomes, the group should focus on the most significant priorities related to the issue. Multivoting can give members a voice in the process. It is not practical or an effective use of resources to purse all ideas. Which of these actions can a CNL take to help protect a patient admitted for suicide? A) Call to have a screen placed on the window B) Call dietary to have only plastic utensils delivered on meal trays C) Move the patient close to the nursing desk for more frequent monitoring D_ Order a psych consult CORRECT ANSWER D) Order a psych consult Rationale: It is out of the nursing scope of practice to order a physician consults. The CNL may call & ask a physician to do this. Which type of evidence would you prefer to review & share with a team when trying to support whether an Evidence-based intervention should be implemented on your unit? A) Meta-analysis B) Quasi-experimental C) Experimental D) Qualitative CORRECT ANSWER C) Experimental Rationale: Experimental research is quantitative research, which is a formal, objective, rigorous, & systematic process for generating information about the world. Experimental research is an objective, highly controlled investigation for the purpose of predicting & controlling phenomena in nursing practice. While admitting a patient for COPD< a nurse notices the patient has had two other admission this month for the same diagnosis & is homeless. A key part of this admission is: A) Consult a social worker on admission B) Notify the physician C) Consult a clinical case manager upon discharge D) Consult financial counseling. CORRECT ANSWER A) Consult a social worker on admission Rationale: As a CNL it is important to notice any reoccurring admissions & patterns -- the social worker will be able to start working with the patient on day one for supportive services, to help the patient decrease the change of this happening again. While admitting a patient to the unit after a car accident, the patient informs you that she has been off her psych meds Seroquel & Celexa due to the cost & no longer has a doctor. As an advocate you would talk with the physician in hopes of obtaining what two consults? A) Medicine & clinical case manager b) Psychiatry & social worker C) Clinical case manager & social worker D) Medicine & psychiatry CORRECT ANSWER B) Psychiatry & social worker Rationale: Without a MD to monitor results of pt withdrawing herself from these two meds, the result could be detrimental. This consult can also help get the pt back with psychiatrist upon discharge. The social worker would assist with any social issues upon discharge, such as affording medications Who can function as an important ally to the CNL in engaging frontline staff in a major initiative? A) Content expert B) Unit champion C) Initiative sponsor D) Senior leadership CORRECT ANSWER B) Unit champion Rationale: Unit champions are individuals who work along frontline staff and have earned the respect and trust of their coworkers. Staff will follow their lead. the use of a physician champion is an especially useful strategy for engaging physicians in an initiative. Senior leadership and sponsors must also be engaged, especially financially, but are not as effective at the microsystem level as a unit champion. You are a CNL on the tele unit & orienting a newly graduated nurse. Critical thinking is best demonstrated when: A) The CNL discusses with the physician the rationale for discontinuing cardiac monitoring in the hospice patient B) Drawing the scheduled cardiac enzymes q8h Rationale: HF symptoms are often not well evaluated, as clients remain relatively inactive while in the hospital. Activities such as walking in the hall provide an opportunity for objective evaluation fo dyspnea, fatigue & gait issues. You are considering using a new type of Foley catheter in your setting when the sales representative mentions a study that the manufacturer conducted that showed a reduction of catheter-associated infections with the use of the new device. Which type of study would be most convincing of this new product's potential value: A) Case study B) Randomized controlled trial C) Expert opinion D) Nonrandomized controlled trial CORRECT ANSWER B) Randomized controlled trial Rationale: Type of study would provide highest level of evidence You are discharging a young patient dx with UTI. To help prevent future UTI you instruct the patient to do the following: A) Urinate forcefully to clear bacteria from the tract B) urinate before sexual intercourse to limit transmission C) Wear cotton underwear to prevent moisture D) Pat dry after urinating to prevent infection CORRECT ANSWER C) Wear cotton underwear to prevent moisture Rationale: Cotton absorbs moisture & pulls it away from the skin. Bacteria thrive in moist environments. You are helping a new nurse with admission of pt with dx of COPB exacerbation. You explain differences between two types of COPD. Together you review the finding that you would expect to asses on pt with chronic bronchitis vs. emphysema. Which of the following would not be an expected finding on a patient with chronic bronchitis? A) Wheezing & bronchi upon lung field auscultation B) Dry cough with little sputum production C) Cyanotic D) Hypercapnia & respiratory acidosis CORRECT ANSWER B) Dry cough with little sputum production Rationale: A pt with chronic bronchitis will have a chronic cough with production of large amounts of thick, tenacious mucus. You are leading a palliative care team in the ICU. Ethical competence is best defined as: A) The ability to recognize potential & actual ethical issues arising from the clinical practice B) The collaboration with a multicultural workforce C) The understanding of the physical, emotional, & spiritual health parameters of the ICU patient D) The skill set to define, design, & implement culturally competent health care providers. CORRECT ANSWER A) The ability to recognize potential & actual ethical issues arising from clinical practice Rationale: The CNL's role in ethics is highlighted in AACN's White Paper You are listening to report with a novice nurse. As part of mentoring new staff & supporting clinical decision making, you ask the new nurse which patient she would like to assess first. Which patient should this nurse assess first? A) 46yo receiving IV antibiotics therapy B) 60yo s/p liver biopsy C) 56yo with pneumonia D) 72yo hip replacement impatiently waiting for discharge CORRECT ANSWER B) 60yo s/p liver biopsy Rationale: Post-op liver biopsy patients have an increased risk of bleeding & need close monitoring after the procedure. The question does not indicate how recently the biopsy was done & therefore this is the best choice based on the information provided. You are providing discharge education to a patient who was diagnosed with Parkinson's disease. The patient is being discharge with a hone health nurse & PT. Which of the following statements by the patient's wife identifies a need for more education? A) I am afraid my husband will fall B) I am uncertain that I will be able to provide the right care for my husband C) My husband enjoys watching TV for long periods of time D) I may ask my daughter to stay with us for the next couple of weeks CORRECT ANSWER C) MY husband enjoys watching TV for long periods of time Rationale: Pneumonia is the most frequent COD in patients with Parkinson's disease. You are providing discharge instructions to a young patient with sickle cell anemia. What statement made by the patient would concern you the most fo the potential of this patient readmitting to the hospital? A) I am scared about my pain being kept under control B) I will need to find someone to take me to my hematology follow up appointment C) My mother helps me manage my pain meds D) I get tired throughout the day & often have to take naps CORRECT ANSWER B) I will need to find someone to take me to my hematology follow up appointment Rationale: Studies have shown that no outpatient hematology follow up appointment within 30 days of hospitalization is the greatest risk factor for hospital readmission. You are reviewing a patient's morning lab values. Pt's Hgb dropped from 12.5 to 7.3. The RN has called MD & received orders for 2units of PRBCs to be transfused. Pt was admitted for diabetic ketoacidosis. What is the next step you should perform? A) Research whether the pt has ever had a history of any anemia or GI bleeding B) Assess pt for s/s of bleeding C) Call MD & inform him to redraw the labs D) Review rest of pt's lab values CORRECT ANSWER B) Assess pt for s/s of bleeding Rationale: If the significant decrease in Hgb is unexpected & lab error is suspected, the clinician must first assess pt to ensure no s/s of bleeding are present. You are the CNL at an outpatient care clinic providing care to families in the area. You have noticed it is difficult to get families to bring their children in for their immunizations, & children are often off schedule. How can the clinic best address this issue to meet the needs of their patient populations? A) Educate families on immunizations, their purpose, & their children's schedule so you consult the case manager to set up home health 7 outpatient PT. You also consult with the PT for recommendations on home needs. You assist with making follow-up appointments for MR T. Mr T is able to be discharged home the next day. This is an example of which CN CORRECT ANSWER A) Lateral integration of care Rationale: Lateral integration of care involves delivering & coordination of care using a multidisciplinary approach You are the CNL on a busy medical unit. You get a new patient, Mrs G, admitted through the ED for abd pain. Mrs G is a 37yo Spanish-speaking woman. She has her 12yo son with her, who has been translating for the medical staff in the ED. Mrs G is clearly in a lot of pain, but you can't give her any pain meds until she is admitted into the system. Your next steps are to: A) Allow the son to translate enough to get Mrs G admitted so you may give her some pain meds & then get an interpreter to complete her admission hx B) Ask Mrs G through her son, if it's okay with her to use her son as the interpreter. You explain to her this will expedite her pain relief & she agrees C) Request an interpreter to come ASAP & tell Mrs G through her son that you will make her comfortable ASAP. Notify the primary RN who will be caring for her. D) Explain to Mrs G that you are unable to give her medicine until she is admitted & that you ne CORRECT ANSWER D) Explain MRs G unable to give medicine until admitted but will give med ASAP. Stay with her until interpreter gets there & try to relieve pain with nonpharm therapies Rationale: Establishes & maintains effective working relationships within an interdisciplinary team to make ethical decisions regarding application of technologies & acquisition of data; practice in collaboration with a multicultural workforce. You are the CNL on a geriatric unit. When walking down the hall, you notice a high-risk fall patient attempting to get out of bed alone. After assisting the patient & ensuring safety, what should you do? A) Report the incident to nursing management B) Identify the patient's nurse & nursing assistant & confront them with the incident C) Develop a new fall prevention policy & post it in the unit conference room for all staff to view D) Obtain the fall statistics & present them at the next unit staff meeting & develop a team to look at revising a fall prevention committee CORRECT ANSWER D) Obtain the fall statistics & present them at the next unit staff meeting & develop a team to look at revising a fall prevention committee Rationale: Using objective data to determine the trends on the unit will allow the CNL to determine a baseline fall rate for the unit. Starting a fall prevention committee will empower frontline staff to determine with evidence-based research which implementation will best meet the needs of the patient population & the staff. You are the CNL on a postpartum unit. You have noticed that lately you have had an increased number of patients readmitted with wound infections. You know that the most appropriate next step is to: A) Perform a failure mode & effects analysis B) Ask the MDs why their patients are getting so many infections lately C) Perform a root cause analysis D) Consult the wound-ostomy care nurses CORRECT ANSWER C) Perform a RCA Rationale: RCA addresses a systems issue. It is a broad, retrospective qualitative process that looks past the individual to enable development of an overall action plan. You are trying to encourage nurses on your unit to become more active in utilizing research in practice & to learn more about EBP. What would be a good activity to promote your idea? A) Leave a few nursing journals on the unit B) Make a point of discussing research articles you have read with nurses on the unit C) Form a journal club on the unit D) Email the nurses articles to read CORRECT ANSWER C) Form a journal club on the unit Rationale: This will encourage the nurses to read articles relevant to their practice & to evaluate them critically You are trying to get literature on using music to relieve pain. One research article uses methods you forget how to interpret. You should: A) Not use this article B) Google the methods to try & figure it out C) Look at the conclusion & just use that information D) Ask a mentor to assist you so you can understand the data CORRECT ANSWER D) Ask a mentor to assist you so you can understand the data Rationale: It might be a valid study so its important to ask fo resistance with understanding the data. Having mentors is important to maintain in your career. You are trying to reduce admission time to your unit from the ED. You have completed several PDSA cycles & have reduce the time by 21 minutes. But in the most recent PDSA the time actually increased by 6 minutes. What stage of the PDSA cycle should the team go to in order to plan the next steps? A) Act B) Plan C) Do D) Study CORRECT ANSWER D) Study Rationale: The information at this stage should tell you where the barriers are Plan --> Do --> Study (Study the DO results) --> Act (Enact change) You are using failure mode & effect analysis (FMEA) to anticipate the risk of medication errors in the ICU related to invasive lines. You begin your FMEA analysis with: A) The effects of each failure B) The potential cause of each failure C) Process mapping D) Specific defects & delays in the medication administration process CORRECT ANSWER C) Process mapping Rationale: Utilizing tools for process improvement can provide new insights into routine practices. You are working in unit that has recently seen influx of patient with substance-related disorders. The nurse on the unit are complaining that these patients are drug seeking & often signing out AMA to receive drugs elsewhere. What is an intervention that a CNL may implement to improve the treatment for this patient? A) Educate staff on not labeling pt's as drug seekers because they often require higher doses of pain meds to achieve an acceptable level of comfort The CNL can then resource share with other areas to gain insight into best practices & pre- existing initiatives at the microsystem, hospital, state, & national levels. You have done some research & found a new fall prevention tool that you would like to trial on your unit. The tool was recently developed & tested at a large city hospital with a population of open heart patients. You are not sure that this tool can be effectively implemented in your small community hospital. You are questioning the tool's: A) Relative risk B) External validity C) Transportability C) Casal association CORRECT ANSWER B) External Validity Rationale: External validity is the degree to which the results of the original study are applicable to a population other than the one initially targeted. You have evaluated the fall rate for previous 12 months on the med-surg unit where you work as a CNL. You find that your fall rate is above the national benchmark. Your next step is to: A) implement a new fall prevention tool B) Review the literature C) Review current hospital policy & find out what fall prevention strategies are currently being used on the unit D) Assemble a team from the unit to brainstorm ideas to reduce the fall rate. CORRECT ANSWER C) Review current hospital policy & find out what fall prevention strategies are currently being used on the unit Rationale: CNL needs to know current policy & processes before making changes & improvements You have noticed that on your unit many elderly patients are unable to return home with their family members due to loss/decrease of their functional abilities. You research & implement a toll that scores a patient's functional ability when they enter the hospital & once upon discharge. You use this data to share with staff & create ideas to improve maintenance of an elderly patient's functional ability. What is this an example of? A) Interpreting & using quantitative data B) Interepteting & using qualitative data C) Risk analysis D) Using evidence to identify & modify interventions to meet specific client needs CORRECT ANSWER A) Interpreting & using quantitative data Rationale: Quantitative research collects information in the form of numbers You have recently recounted many people in you community who have been sick from drinking park water. As a CNL, which of the following actions would have the greatest impact for your community? A) Inform your local new station B) Participate in a petition to send to legislators C) Research whether this has become a national problem D) Do nothing CORRECT ANSWER B) Participate in a petition to send to legislators Rationale: Collaborate with the community to appear in front of legislators to promote & preserve healthy communities. As a CNL you are responsible to influence regulatory, legislative, & public policy in private & public arenas to promote & preserve health communities. You have reviewed the most recent pressure ulcer prevalence data for your unit. Although your unit's pressure ulcer rates are below national benchmarks, they have been steadily climbing over the past year. Your net step should be to: A) Make sure you assess all patients' skin daily B) Schedule brief in-services for the staff on the unit to review the pressure ulcer prevention policy & strategies C) Evaluate the pressure ulcer prevention policy D) Assess the bed surface on your unit CORRECT ANSWER B) Schedule brief in-service for the staff on unit to review the pressure ulcer prevention policy & strategies Rationale: Sometimes simply reviewing policy & strategies with staff will help them remember what they need to do You know teaching was effective to a cardiac patient & his wife with the following statement: A) "I can still have a burger & fries on to two times a week" B) "It is okay for my wife to bring in a pizza while I'm here; after all the hospital food is not that good" C) "I should limit my salt intake & increase fiber in my diet" D) "If my husband wants fried shrimp, it's okay because it's seafood" CORRECT ANSWER C) "I should limit my salt intake & increase fiber in my diet" Rationale: Cardiac patients should be on a sodium-restricted diet. Fried foods & high-fat foods should be very limited & /or excluded from the diet. You know that regulatory agencies' purpose is to: A) Stress out hospital employees B) Decrease fragmentation & medical errors resulting in deaths C) Give the public a source of standards for health care facilities D) Make the public feel safe & give them guidelines to follow with lawsuits CORRECT ANSWER B) Decrease fragmentation & medical errors resulting in deaths You want to do some research for a potential policy change. All of the following are excellent resources, except: A) CDC B) Wikipedia C) American Diabetes Association D) WebMD CORRECT ANSWER B) Wiki You work in the ED at a major public hospital. You have noticed that you see the same diabetic patients regularly. They are indigents & do not have PCP. They never check their blood sugars at home because they do not have glucometer, so by the time they get to the ED their blood sugars are well into the 300s & 400s. Usually the POC involves treating the blood sugars, instructing them to follow up at the clinics & giving them a snack for the road. What would be a positive change in the POC from the CNL perspective? A) Set up a program to give free glucometers to these patients who do not have one & schedule the follow up appointments for them before they leave the ED, sending them home with information B) Admit patients to the hospital so they can get instruction on diabetes care, including diet, exercise, insulin administration, & blood glucose monitoring Rationale: A value less than 0.05 is a significant statistical finding in research Your manager has approached you regarding her need to decrease the unit's budget. Which of the following would hav the greatest impact on decreasing the unit's budget? A) Exploring why staff is not leaving on time & creating overtime B) Eliminating unused supplies on the unit C) Increasing nurse to patient ratio D) Deciding not to update the unit's computers CORRECT ANSWER A) Exploring why staff is not leaving on time & creating overtime Rationale: Nurses' salaries are very costly; to help decrease a unit's budget, get rid of contract RNs &/or overtime. Your pt was recently dx with non-small-cell cancer to the lung. Postradiation she reports to the RN that she has a sore throat. The nurse approaches you indicating that he is unaware of what to do. You explain the nurse that mucositis is a common side effect for patients receiving radiation treatment. What will you instruct the nurse to do next? A) Asses pt's oral mucosa for swelling & redness with ulcerations B) Call physician & obtain an order for an antiseptic mouthwash C) Instruct pt to rinse her mouth before & after meals with a solution of salt & sodium bicarb D) use a soft-bristled toothbrush to clean her teeth & tongue CORRECT ANSWER A) Assess pt's oral mucosa for swelling & redness with ulcerations Rationale: Swelling & redness with ulcerations in oral mucosa are consistent with mucositis. Your team is looking at the delays in the discharge process. Your cause & effect diagram includes: A) A run chart B) A Gannt chart C) A fishbone diagram D) A high-level flowchart CORRECT ANSWER C) A fishbone diagram Rationale: A fishbone diagram is a useful tool to identify themes of clinical issues. Categories such as equipment, personnel, communication, & so on can be identified. Your unit has recently been participating in a study to evaluate the use of new, more affordable gloves. You have noticed that many of the nurses are complaining that the gloves are cheap & tearing easily. You present this to your unit manager & discuss the risk of infection. What is this example of? A) Patient advocacy B) EBP C) Team coordination D) Knowledge management CORRECT ANSWER D) Knowledge management Rationale: Knowledge managment includes anticipating risks when new technology, equipment, treatment regimens, or medication therapies are introduced Your unit has recently been relocated to the new hospital wing. This area is more spacious & modern than the unit's previous environment. Patient satisfaction scores in the area of "physical environment of care" have improved significantly. The added distance that staff must walk to answer call lights has resulted in decreased patient satisfaction scores in the area of "Call bell answered immediately" Based on this, the hospital budget was realigned to build an additional nurses station at the midpoint of the unit. What is the relationship between these two measures? A) Confounding measures B) Balancing measures C) Opposing measures D) Concurrent measures CORRECT ANSWER B) Balancing measures Rationale: Balancing measures demonstrate whether improvement in one area is at the expense of another area. When designing initiatives and improvements, it is important to achieve a balance among all areas. Organizational balancing measures are aligned with strategic goals. Your unit has recently had an increase in fall rates. When you compare what other units in your department are doing, you identify that each unit is using a different fall risk assessment tool. You research each tool & identify which one has the strongest evidence based research in preventing patient falls. This tool is later standardized thought the hospital. What is this an example of? A) Applying tools for risk analysis B) Patient advocacy C) Gathering, analyzing, & synthesizing data related to risk reduction & patient safety D) Demonstrating accountability for the delivery of high-quality care CORRECT ANSWER A) Applying tools for risk analysis Rationale: Researching & presenting evidence-based data apply to tools for prevention of falls (risk analysis) Your unit has worked hard to maintain a very low fall rate. There has now been a sharp increase over the past 2 months. In looking at control chart data related to falls, you see that all of these falls occur on the night shift. What is the most likely reason for this shift? A) A common cause B) A special cause C) A coincidence D) A trend CORRECT ANSWER B) A special cause Rational: A special cause occurs outside of a stable process & is attributed to a factor that is not commonly part of the process. The CNL would need to investigate whether there are special circumstances that are present on the night shift that have resulted in the increasing number of falls.