CNL - Clinical Nurse Leader Certification Practice Exam with Complete Solutions 2023, Exams of Nursing

Download CNL - Clinical Nurse Leader Certification Practice Exam with Complete Solutions 2023 and more Exams Nursing in PDF only on Docsity! 1 Question 1 Question 2 Question 3 CNL - Clinical Nurse Leader Certification Practice Exam with Complete Solutions 2023 Patient satisfaction scores in the emergency department (ED) have shown a downward trend over the past three quarters. As a clinical nurse leader (CNL) in the ED, your focus is to: Create a script for the triage nurse in welcoming the patient Assign a volunteer to welcome patients to the hospital Compare desired outcomes with national and state standards Write a letter of apology to each dissatisfied patient A lack of compliance with deep vein thrombosis (DVT) prophylaxis has been identified in retrospective chart reviews of all ischemic stroke patients in your organization. As a CNL on the neurological unit, your primary goal will include: Challenging the guidelines on primary prevention of ischemic stroke written by the American Stroke Association Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient on your unit Developing an organization-wide educational program on DVT prophylaxis Developing a unit-based team of nursing personnel to investigate the problem Which of the following actions illustrates the CNL professional value of altruism? 2 Leading an interdisciplinary team looking at the remote cardiac monitoring process Sponsoring a meeting with the monitor technicians to understand their barriers in the cardiac monitoring process Flow mapping the admission process of the remote cardiac-monitored patient Editing the policy for the remote cardiac monitoring process Question 4 The results of a quarterly report identify an increase in patient falls on the telemetry unit. Your first action will be to: Implement hourly rounding Gain an understanding of patient care practices on the telemetry unit Assign patient personal alarms to all patients at risk Revise the current fall risk documentation form Question 5 Several near misses were identified by ICU nurses who had mistaken invasive lines for intravenous ports for medication administration. You have completed an analysis of the issue. Your recommendations include: A double-check system for medication administration To facilitate a critical incident reporting structure that fosters a “without blame” unit culture 5 Question 10 How can the CNL make the greatest impact on the health care organization? By representing the microsystem By representing the mesosystem By representing the patient and family By representing the nursing profession Question 11 The concept that an organization is in a continued state of change describes which organizational theory: systems theory classical theory contingency theory Chaos theory Question 12 Before beginning data collection, what is the primary key factor to determine? Personnel to collect data A secure database for holding data 6 Operational definitions of data A user-friendly collection method Question 13As 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? Visiting nursing for all patients All follow-up appointments scheduled prior to patient discharge Pharmacy to visit with each patient prior to discharge home to review medications All patients should be enrolled in a cardiac rehabilitation program Question 14 After careful review of unit processes, you have determined that the 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 the process? Develop an interdisciplinary team, including unit staff, nutritionist, diabetic educator, and meal service team members to investigate the self meal order program Have the nurse or nursing assistant order meals with patients; this way the nurse knows what time the patient orders meals When explaining the self meal order program to patients, instruct patients to notify staff when they order meals Have the meal service notify the unit secretary when meal orders are placed by patients Question 15 7 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? Tell the unit management which staff are documenting inappropriately Reeducate staff on the hospital documentation policy Remind staff of pain documentation during staff meetings and charge report Provide staff with a self-audit sheet as a way to review their own documentation during their shifts Question 16 You are listening to report with a novice nurse. As part of mentoring new staff and supporting clinical decision making, you ask the new nurse which patient she would like to assess first. Which patient should this nurse assess first? 46-year-old receiving IV antibiotic therapy 60-year-old s/p liver biopsy 56-year-old with pneumonia 10 barriers Question 21 A new nurse on the medical/surgical unit approaches you with concerns about one of her patients. She states the patient has not turned on the lights or television all day and did not order breakfast or lunch. She had to ask the patient what meal they wanted and 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 and it is Saturday. What is your best response to the nurse? “The patient is sick and needs extra support today” “The patient needs to be seen by the psychology team for an evaluation” “The patient may be following their religious practices and we need to support this” “The patient is depressed from being in the hospital” Question 22 When trying to implement a change in the outpatient family clinic, which group of staff should the CNL focus on more? Late majority Early majority Laggards Innovators Question 23 As the CNL on a medical unit, which of the following interventions would you support to reduce the readmission rate on your unit? 11 Keep patients one extra day to ensure they are prepared for discharge home Arrange for all patients to have at least 1 week of visiting nursing post discharge Review discharge instructions with the patient and one family member Begin discharge planning and teaching on the day of admission Question 24 Which type of evidence would you prefer to review and share with a team when trying to support whether an evidence-based intervention should be implemented on your unit? meta analysis quasi experimental experimental qualitative Question 25 Which group presents the highest challenge in attaining buy-in for a new innovation? early innovators early adopters late majority 12 laggards Question 26 There has been disagreement regarding the suggested adoption of a patient transfer blackout period during change of shift. Staff on the inpatient units favor a 30-minute blackout period, while emergency department staff favor no blackout period. A team of stakeholders from all areas recently agreed on a universal blackout period of 15 minutes during shift change. What type of solution does this represent? compromise collaboration accommodation confrontation Question 27 To confirm a scope of practice question, the CNL should consult which administrative body guidelines: The Joint Commission Centers for Medicare and Medicaid Services Hospital Policy and Procedure Manual 15 NDNQI Hospital Compare TJC NQF Question 33 What is the appropriate ending point of a root cause analysis (RCA)? When several possible reasons for the error have been identified When staff have identified what they think is the reason for the error When the list of causes is exhausted to no more possible causes The CNL can identify reasons for occurrence Question 34 When is an RCA performed? Prior to the initiation of a new treatment to anticipate possible problems During a process to evaluate ongoing problems As part of data analysis to understand why an intervention led to poor results After a serious safety event has occurred 16 Question 35 Your geriatric unit shows the highest average restraint episode duration in the hospital. You have been asked to lead an improvement project to reduce duration. What would be your first step? Obtain national restraint episode duration benchmark data Conduct a full assessment of your unit, including all restraint-related data and processes Conduct a literature search to obtain current best practices for geriatric patients in restraints Speak with staff and leadership of other units with lower restraint episode durations Question 36 What is the purpose of a fishbone diagram? To identify the cause and effect of multiple factors that lead to a result To identify the root cause of a serious safety event To aid in the development of an improvement project timeline To create the goals and objectives of an improvement project Question 37 A process improvement project charter or establishment of specific aims can help a project group to avoid which difficulty: Scope creep Meeting time confusion Budget constraints 17 Team communication problems Question 38 You have been charged with examining the heart failure 30-day readmission rate of your unit. In doing so, it is important for you to examine data from what other sources: National and state readmission rates National benchmarks Readmissions to other units in your hospital All of the above Question 39 One of the nurses on your unit was involved in a medication error. She revealed the error to both you and the nurse manager and documented the error in the online safety event reporting system. You meet with her and 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 laissez-faire culture A just culture A punitive culture A structural culture 20 Evidence-based practice poster presentations Evidence-based practice rounds All of the above Question 46 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: Case study Randomized controlled trial Expert opinion Nonrandomized controlled trial Question 47 In an effort to reduce central line infections, you have done some research and found evidence-based guidelines that you would like to implement at your organization. Your next step would be to: Gather data regarding central line infection rates at your institution Convene a team meeting to discuss the problem and impact of central line infections Run a PDSA of the new guidelines Share what you have found with the manager 21 Question 48 You have evaluated the fall rate for the previous 12 months on the medical– surgical unit where you work as a CNL. You find that your fall rate is above the national benchmark. Your next step is to: Implement a new fall prevention tool Review the literature Review current hospital policy and find out what fall prevention strategies are currently being used on the unit Assemble a team from the unit to brainstorm ideas to reduce the fall rate Question 49 The manager of the medical unit where you work has just shared some data with you. She is concerned because the 30-day readmission rate for COPD patients is 15%. Your next step should be to: Schedule a meeting with the staff to discuss the problem Compare your hospital’s 30-day readmission rate with other like hospitals on the CMS website Perform a literature review in preparation for making changes to the current COPD pathway at your hospital Monitor the data over the next 6 months to see if there really is a problem Question 50 A patient who has been diagnosed with colon cancer remarks that since his diagnosis, many people he knows have mentioned someone they know who 22 has colon cancer. Most of these people live nearby. The patient asks you if colon cancer rates in the area have been increasing recently. The patient is asking about what type of measure: Incidence Prevalence Mortality Correlation Question 51 Your hospital has just completed a study comparing outcomes in rehospitalization rates for CHF patients who either received predischarge teaching from an APRN with those who received predischarge teaching from an RN. In the analysis of data, what resulting p-value would indicate that the intervention had a significant result? <.05 <0.8 <.10 <.22 Question 52 You are trying to reduce admission time to your unit from the emergency department. You have completed several PDSA cycles and have reduced 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? 25 Pay-for-performance model Private insurance model Advantage care model Question 58 Which most demonstrates advocacy toward a patient? Led interdisciplinary rounds on a group of patients Consulted a diabetic instructor for a patient who was found to have an HgB A1C of 13.1 Met with the trauma team of physicians to update patient plans of care Conducted an in-service with the nursing staff on how to reduce falls for the unit Question 59 A Korean patient is admitted who speaks little English. An example of culturally competent care is: Finding a nurse who speaks some Korean Transferring that patient to a floor that has a Korean-speaking secretary Calling the patient’s family to see if they speak any English Obtaining a Korean translator 26 Question 60 While admitting a patient for COPD, a nurse notices the patient has had two other admissions this month for the same diagnosis and is homeless. A key part of this admission is: Consult a social worker on admission Notify the physician Consult a clinical case manager upon discharge Consult financial counseling Question 61 B.L. is a 91-year-old male who was transferred to a skilled nursing facility from an acute care hospital. Upon transfer, the patient’s Lasix for CHF was not transferred with the patient. Once the medication error is found and restarted, it is the CNL’s job to: Notify the hospital of the error Notify the skilled nursing facility of the error Go back through all pathways and find where the error in this transfer process occurred Notify the family 27 Question 62 One of your patients, a widow, is reaching end of life. The physician has adamantly suggested to the patient’s family to plan for death and to make the decision to remove life support, as he feels it is futile at this point and most likely causing more agony to the patient. The patient has three children, and they cannot agree on a decision. The oldest daughter feels that they should abide by the doctor, as he knows best. The middle child does not agree with “killing” his mother. The youngest child just wants to be with her mother and cannot make a decision. You decide the best thing to do now is hold a patient-care conference. Whom do you invite? The family, the team of physicians, the primary nurse, the case manager, the chaplain, an ethics committee member, and the social worker The family, the team of physicians, the primary nurse, the nurse manager, the chaplain, the respiratory therapist, and the nutritionist The team of physicians, the primary nurse, the nurse manager, the case manager, the chaplain, an ethics committee member, and the social worker The team of physicians, the primary nurse, the chaplain, the respiratory therapist, and the nutritionist Question 63 You are the CNL on a busy medical–surgical unit. One of your patients, Mr. Thompson, a Type 2 diabetic, has been on your unit for 5 days following a right foot amputation due to necrosis. He has been on IV antibiotics and has now been afebrile for 24 hours. Mr. Thompson, 67 years old, lives alone, but his son lives two miles away and says he will be able to check on his dad at least daily once he is discharged home. In preparation for discharge, you realize Mr. Thompson will need someone to assist him with his dressing changes and to check his vital signs for several days. You think he will also need outpatient physical therapy. You discuss with the physician your thoughts on discharging Mr. Thompson home with home 30 readmitted to your unit within the last year Implement the Systems Theory to evaluate individual risks to each patient population on your unit Implement the Systems Theory to evaluate individual risks to each patient population on your unit Utilize the Complexity Theory to make the needed changes to the defective systems Question 68 Sam is a homeless 59-year-old male admitted with CHF. He arrives alone and crying. His vitals are BP 173/96, HR 83, O2 86%, and temperature 98.9°F. During your assessment, you notice multiple bruises and lacerations. His clothes are torn and soiled. According to Maslow’s Hierarchy of Needs, what should you do first? Inquire about his bruises and lacerations Call the social worker regarding shelter placement Ask why he is crying Apply oxygen Question 69 Jen is an obese patient admitted with COPD and CHTN. Part of her social history is that she smokes 2 ppd. Her CNL, Erika, makes a goal for her to decrease by one cigarette a day until there are no more by August 1. This goal will not work because: There is not a measurable outcome Jen should decrease by two cigarettes a day The patient has COPD 31 Jen should help make the goal Question 70 All of the following are components of evidence-based practice and clinical decision making except: Clinical expertise Information about patient preferences and values Research utilization Evidence from research and theories Question 71 Julie, a CNL, hears that another hospital does hourly rounding and thinks this is a great idea to reduce falls on her unit. She meets with her interdisciplinary team and they decide to try this on their unit. She informs the rest of the staff and makes a start date. What did Julie forget to do? Look at the latest evidence/literature review Ask her nurse manager Ask other units if they do hourly rounding Get data from the other hospital 32 Question 72 Carey, a CNL, thinks utilizing volunteers in a microsystem will benefit the staff and the patients. She performs a literature review and does not find much literature evaluating volunteers being effective in a health care setting. She decides to go ahead and implement a volunteer program and collects data to see whether this is an effective change. Should Carey have implemented this? No, there was no evidence volunteers would be beneficial Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective Yes, if there is no literature on a topic, data should be collected to evaluate the change to see whether it is effective Yes, it is always good to try something new Question 73 You are trying to get literature on using music to relieve pain. One research article uses methods you forget how to interpret. You should: Not use this article Google the methods to try and figure it out Look at the conclusion and just use that information Ask a mentor to assist you, so you understand the data Question 74 What is the first essential key to implementing a change in a microsystem? A clear vision of what outcomes are to be accomplished A strategic plan 35 You have evaluated the fall rate for the 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: Implement a new fall prevention tool review the literature review current hospital policy and find out what fall prevention strategies are currently being used on the unit assemble a team from teh unit to brainstorm ideas to reduce the fall rate Question 81 The manager of the med surg unit where you work has just shared some data with you. She is concerned because the 30-day readmission rate for COPD patients is 15%. Your next step should be to: schedule a meeting with the staff to discuss the problem compare your hospital's 30 day readmission rate with other like hospitals on the CMS website perform a literature review in preparation for making changes to the current COPD pathway at your hospital monitor the data over the next 6 months to see if there really is a problem Question 82 Your geriatric unit shows the highest average restraint episode duration in the hospital. You have been asked to lead an improvement project to reduce duration. What would be your first step? obtain national restraint episode duration benchmark data conduct a full assessment of your unit, including all restraint-related data and processes conduct a literature search to obtain current best practices for geriatric patients in restraints speak with staff and leadership of other units with lower restrain episode durations 36 Question 83 What is the purpose of a fishbone diagram? to identify the cause and effect of multiple factors that lead to a result to identify the root cause of a serious safety event to aid in the development of an improvement project timeline to create the goals and objectives of an improvement project Question 84 What is the appropriate ending point of a root cause analysis (RCA)? when several possible reasons for the error have been identified when staff have identified what they think is the reason for the error when the list of causes is exhausted to no more possible causes the CNL can identify reasons for occurrence Question 85 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, and children are often off schedule. How can teh clinic best address this issue to meet the needs of their patient populations? educate families on immunizations, their purpose, and their children's schedule provide reminder phone calls to families the day before a scheduled appointment if possible, offer extended clinic hours 1 to 2 nights a week, so parents can come in after work use the clinic data to determine why families are not coming in to appointments 37 Question 86 The result of a workflow diagram of a clinician illustrates an excessive amount of walking to obtain supplies. Reducing the waste of motion adds value-added time that ultimately benefits: the patient the clinician documentation none of the above Question 87 Survey results of the nursing staff reflect poor perceptions and a discomfort with addressing spiritual issues with patients. The ultimate success of focused staff education can be measured by: trending quarterly patient satisfaction scores pertaining to spiritual care during hospitalization a follow-up survey of the staff after the education to solicit feedback an open discussion of how the nurse would address spiritual care in a given scenario feedback shared during discharge phone calls Question 88 By leading which unit initiative can the CNL directly impact the financial health of the entire institution? reducing admissions recruitment of new nursing staff improving documentation compliance 40 Study Question 95 You are working with a team to reduce patient waiting time for transport to diagnostic imaging. An effective goal would be to: Decrease waiting time during the evening shift Increase monthly patient satisfaction Improve communication between the ED and DI departments Decrease waiting time for diagnostic imaging by 5% Question 96 When incorporating evidence-based practice interventions into your health care setting, it would be best to: Do what everyone else is doing Do what you think would work in your setting Choose the interventions you think would work for your setting and perform a rapid cycle test to evaluate the impact Do everything the literature suggests to improve your chances of a good outcome Question 97 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? Tell the charge nurse to discharge patients in the morning Ask the manager to staff an extra nurse on day shift to be the discharge nurse Use process mapping to determine all the possible factors that contribute to patient discharge and what barriers there are to discharge Don't worry about the number; your unit meets the other hospital goals, so it is 41 okay to miss one Question 98 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 and identify which has the strongest evidence based research in preventing patient falls. This tool is later standardized throughout the hospital. What is this an example of? Applying tools for risk analysis Patient advocacy Gathering, analyzing, and synthesizing data to risk reduction and patient safety Demonstrating accountability for the delivery of high quality care Question 99 You are working in a unit that has recently seen an influx of patients with substance related disorders. The nurses on the unit are complaining that frequently these patients are "drug seeking" and often signing out against medical advice in order to receive drugs elsewhere. What is an intervention that a CNL may implement to improve the treatment for this patient population? Educate the staff on not labeling the patients as drug seekers because they often require higher doses of pain medications to achieve an acceptable level of comfort Provide an in service to the staff about patients' withdrawal symptoms Follow each patient that comes in with a diagnosis of a substance related disorder in order to identify trends in mistreatment Research on whether the hospital uses an evidence based tool that may help with the assessment of patients for alcohol addiction and/or withdrawal Question 100 A patient asks the CNL about the regulations on abortion in North Carolina. What should the CNL do? Tell the patient you cannot answer that because it is an ethical situation Let the doctor know the patient is asking about an abortion 42 Inform the patient care nurse Look up the regulation in North Carolina and share them with the patient Question 101 You are trying to get literature on using music to relieve pain. One research article uses methods you forget how to interpret. You should: not use this article google the methods to try and figure it out look at the conclusion and just use that information ask a mentor to assist you, so you understand the data Question 102 Julie, a CNL, hears that another hospital does hourly rounding and thinks this is a great idea to reduce falls on her unit She meets with her interdisciplinary team and they decide to gry this on their unit. She informs the rest of the staff and makes a start date. What did Julie forget to do? Look at the latest evidence/literature review Ask her nurse manager Ask other units if they do hourly rounding Get data from the other hospital Question 103 All of the following are components of evidence based practice and clinical decision making except: clinical expertise information about patient preferences and values research utilization