CNL certification review, Exam (elaborations) (answered + rationales) 2023 Update

CNL certification review, Exam (elaborations) (answered + rationales) 2023 Update A team charter includes all except which of the following? A. Clearly defined goals B. Specific outcomes C. Team member roles D. Time allotted for each activity -Ans- D. Rationale: A team charter is an essential written agreement defining what the team is going to accomplish, how success will be measured, and defining team member roles. As a clinical nurse leader (CNL), you know a potential use of a patient's individual electronic health record is its use in A. Finding relevant evidence-based literature B. Performing a root cause analysis C. Implementing a best practice change D. Reviewing unit practice trends -Ans- B. Rationale: Each is a potential use of healthcare information technology, but only the root cause analysis involves the use of a patient's medical record. Lateral integration is based on the understanding of which of the following? A. Patient-specific healthcare needs B. The interdependency of all healthcare disciplines C. The variety of healthcare delivery settings D. Changes in patient care needs over time -Ans- B. Rationale: Lateral integration is based on the understanding that all disciplines of healthcare are interdependent and essential in providing complete care to the patient. When performing ongoing assessment of a process or system, the clinical nurse leader (CNL) should include all of the following, except: A. Efficacy B. Satisfaction C. Efficiency D. Ease of change -Ans- D. Rationale: Ease of change may be considered; however it should not prevent the CNL from taking action to improve a system or process that improves safety, efficacy, satisfaction, efficiency, or quality of care. As a clinical nurse leader (CNL) on an acute care floor, you recognize the importance of lateral integration. Which of the following examples of your role as a CNL illustrates the role of ongoing evaluation in lateral integration? A. Performing risk analysis to ensure client safety B. Assessing the appropriateness and relevancy of current or newly emerging healthcare information C. Synthesizing data to find a common goal D. Fostering rapport across professional boundaries -Ans- B. Rationale: Assessing new or current information is key to the process of ongoing evaluation. Performing a risk analysis to ensure client safety is part of the early coordination stages. Synthesizing data is the role of collaboration. Fostering rapport is a key aspect of communication. As a clinical nurse leader (CNL) on an acute care floor, you recognize the importance of lateral integration. Which of the following examples of your role as a CNL illustrates the role of collaboration in lateral integration? A. Monitoring the plan of care for specific patients and populations B. Clearly delegating tasks and responsibilities within a team C. Translating from discipline-specific language to a common message and goals D. Keeping all members of the team informed of current status and process -Ans- C. Rationale: Translating the message to form a common goal exemplifies collaboration within a team. Monitoring involves ongoing evaluation; clear delegation of tasks is an important aspect of coordination; updating on status is clear communication. clear delegation of tasks is an important aspect of . -Ans- coordination updating on status is clear . -Ans- communication Performing a risk analysis to ensure client safety is part of the early stages. -Ans- coordination In order to practice horizontal leadership, the clinical nurse leader (CNL) needs a "tool kit" of skills. These include all except which of the following? A. Vertical integration B. Use of feedback C. Healthcare outcomes D. Guiding EBP practice -Ans- A. Rationale: Critical skills in order to practice horizontal leadership include guiding evidence-based practice, healthcare outcomes, lateral integration, use of feedback, coaching, and leading teams. The clinical nurse leader (CNL) facilitates, coordinates, and oversees care provided by the healthcare team. This best describes which of the following roles? A. Risk anticipator B. Lateral integrator C. Team manager D. Outcomes manager -Ans- B. Rationale: Lateral integration of care involves the CNL as the leader of care; overseeing care provided by the healthcare team; identifying barriers; and working with the team to proactively manage potential problems. synthasizing data is -Ans- collaboration A male patient seen at your clinic says he has recently purchased a gym membership and requests information about what types of exercises he should start with when beginning. As the clinical nurse leader (CNL) for the clinic, you recognize this patient is most likely in which of Prochaska and DiClemente's Transtheoretical Model for stages of change: A. Contemplation B. Preparation C. Action D. Maintenance -Ans- B. Rationale: Based on Prochaska and DiClemente's Transtheoretical Model, this patient is in the preparation stage; he has taken some steps toward action showing he is seriously planning change in the near future through financial commitment and research. He has not yet reached the action phase because he has not yet modified the behavior Irene is a clinical nurse leader (CNL) in a small community hospital. Irene was tasked with leading an interdisciplinary team to improve the transition from emergency room (ER) to the medical unit. During a meeting, the ER nurses and the medical unit nurses argue over the cause of delays, blaming one another. The team is now disruptive and not focused on the goals of this group. Which of the following should the CNL do first to resolve this conflict? A. Define the problem. B. Develop plan of action. C. Evaluate underlying causes. D. Determine an approach. -Ans- A. Rationale: The first step in problem solving is to define the problem. Diane is a 43-year-old female who has been readmitted three times in the past 6 months with chronic obstructive pulmonary disease (COPD) exacerbations. Diane has been described as noncompliant with taking her medications and she continues to smoke half a pack of cigarettes daily. Which of the following best describes the first critical step when developing a plan of care for Diane? A. Refer Diane to a smoking cessation class. B. Coordinate with respiratory therapy to teach Diane correct technique for inhalers. C. Auscultate Diane's lungs to evaluate for wheezing. D. Ask Diane what she feels is causing her to come back to the hospital. -Ans- D. Rationale: Developing a therapeutic relationship is the first step in a clinical assessment. It is important to obtain information from the patient, including his or her perspective and goals. The clinical nurse leader (CNL) is asked to lead an interdisciplinary team in developing a pathway to help improve the discharge process. The CNL helps the team create an agreement that focuses on goals, outcomes, and team member roles. Which of the following best describes the team leader tool the CNL is creating? A. Team agenda B. Team ground rules C. Team charter D. Team evaluation -Ans- C. Rationale: team charter is an essential written agreement defining what the team is going to accomplish, how success will be measured, and defining team member roles. There are three dimensions of safety: safety climate (compliance with rules and no-fault error reporting); teamwork climate (collaboration and communication); and which of the following? A. Employee climate (teamwork and engagement) B. Positive perceptions of management (working conditions, opinions of management) C. Positive perceptions of coworkers (engagement and low turn-over rates) D. Caring climate (values, ethics, and patient experience) -Ans- B. Rationale: Hudson et al identified position perception of management as the third dimension. A 24-bed critical care unit has experienced an increase in ventilator-associated pneumonia (VAP) within the past year. The clinical nurse leader (CNL) is asked to facilitate a workgroup focused on developing a plan to prevent VAP. Which of the following best exhibits how the CNL promotes communication within the team? A. Assigns each member a role, ensuring everyone understands his or her job. B. Engages the team in shared decision making before finalizing a plan. C. Shares clear goals, messages, and plans with the team throughout the process. D. Synthesizes the input from the team to find common themes and goals. -Ans- C. Rationale: The CNL communicates within a team by fostering the flow of information and serving as a translator. The CNL actively solicits input and shares information with the team. Which of the following defines horizontal leadership? A. It is a leadership style that depends on high levels of communication from management to meet goals. B. Managers and team members set predetermined goals together, and employees agree to follow the direction and leadership of the manager to accomplish those goals. C. It values the input of team members and peers, but the responsibility of making the final decision rests with the participative leader. D. It is a philosophy of organizational leadership whereby the structure promotes equality and an "open-door policy." -Ans- D. Rationale: It allows team members to voice their opinions and to provide feedback freely. As a clinical nurse leader (CNL), it is important to share outcomes and disseminate findings. Which of the following do you recognize as the most appropriate outlet for your findings? A. Journal and conferences only B. Founder of journal and conference C. Journal, conference, TV, and radio D. Journal, conference, founder of journal, TV, and radio -Ans- D. Rationale: All of the above are appropriate places to disseminate results. Which of the following are Hallmarks of a Healthy Work Environment? A. Skilled communication, true collaboration, meaningful recognition, and authentic leadership B. Autonomy, patient- and self-advocacy, collaborative teamwork, and professional communication C. Transformational leadership, efficient decision making, high staffing, and at least 80% of nurses having a BSN degree and/or certification D. Meaningful recognition, transformational leadership, collaborative teamwork, and professional communication -Ans- A. Rationale: The six American Association of Colleges of Nursing (AACN) Hallmarks of a Healthy Work Environment are: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition, and authentic leadership. LATERAL INTEGRATION & THE CNL ROLE Seeking input from other members of the healthcare team is -Ans- collaboration LATERAL INTEGRATION & THE CNL ROLE Ensuring role identity is . -Ans- coordination LATERAL INTEGRATION & THE CNL ROLE evaluation As a clinical nurse leader (CNL) on an acute care floor, you recognize the importance of lateral integration. Which of the following examples of your role as a CNL illustrates the role of communication in lateral integration? A. Seeking other members of the healthcare team to provide their input on a new nursing process B. Ensuring that each member of the interdisciplinary team knows his or her role and workflow C. Asking questions to clarify and restate information D. Evaluating communication strategies and processes within a team -Ans- C.Rationale: Clarifying verbal and nonverbal messages is a major aspect of communication. Seeking input from other members of the healthcare team is collaboration; ensuring role identity is coordination; while evaluating processes is part of ongoing evaluation. Alex, a clinical nurse leader (CNL) in a pediatric clinic, is conducting a gap analysis in order to compare best practices with the current processes. After determining the state of the microsystem, Alex should do which of the following next? A. Determine desired state based on benchmark data. B. Prioritize needs and determine importance. C. Analyze the gap between the current state and desired state. D. Identify potential solutions and opportunities for improvement -Ans- A. Rationale: A gap analysis is conducted by determining the state of the microsystem and then determining the desired state based upon benchmark data. As you begin to investigate the sentinel event, what is one way you can present a GRAPHICAL representation of the different factors that contributed to the issue? A. an RCA B. a fishbone diagram C. a concept map D. a cinical decision tree -Ans- B. a fishbone diagram The team wants to implement the process change and observe what happens, but they are unsure what method to use. What method do you suggest? A. 5S B. 5P C. FMEA D. PDSA -Ans- D. PDSA Ans- HCAHPS HCAHPS, the "A" stands for . -Ans- Assessment Provider HCAHPS, the "H" stand for . -Ans- Hospital A new graduate nurse, Jenny, approaches you and states she needs help removing a PICC line. Which of the following is the best response when acting as a horizontal leader? A. Remove the PICC line yourself B. Tell Jenny to find the policy and then remove the PICC C. Help Jenny find the policy and review it with her. Coach Jenny while she removes the PICC line and provide feedback D. Help Jenny find the policy and refer her to a nurse with 12 years of experience for assistance -Ans- C. Rantional: horizontal leadership What organizational theory is used with rapid, unpredictable, and constant change? A. Systems theory B. Chaos Theory C. Change Theory D. Traditional Theory -Ans- B. Rationale: suitable for healthcare systems Your hospital is currently trialing the integration of the CNL role. At the end of the trial implementation period how can you, as the CNL, best illustrate the effectiveness of your role during this trial? A. Refer to increased patient satisfaction scores over the course of the trial B. Present data that demonstrates the effect of the CNL and outcomes over the course of the trial C. Present a list of projects and tasks completed over the course of the trial D. Refer to your performance review over the course of the trial -Ans- B. rationale: present effects and outcomes A CNL evaluates a 17-year old patient who has been sexually assaulted. The patient has visible bruising and head laceration. After the CNL's assessment, law enforcement officials have contacted the CNL requesting information regarding the attack and the visible injuries. The CNL knows the priority is to take what initial action? A. The pictures and complete the rape kit B. Provide law enforcement with a record as requested C. Call the patient's parents first D. Explain to the patient in order to obtain consent for release of records -Ans- D. rationale: HIPPA A CNL in the NICU is collecting data on the hours worked weekly by the staff nurses. The CNL wants to see if there is a normal distribution of hours worked. What techniques is the best to display the distribution of the data collected? A. Run chart B. Fishbone chart C. FMEA chart D. Histogram chart -Ans- D. Rationale: graphic illustation for distribution of data without timelines (run chart) or sentinel events (fishbone) The CNL is performing RCA for spike in number of CAUTIs over the last 6 months. Realizing CMS operates on a pay-for-performance basis, you develop a CAUTI task force in an effort to reduce costs. This is an example of A. Implementing cost reduction and savings B. Anticipating risk and designing plans of care to Improve outcomes C Evaluating the effect of the health care financing on care access and patient outcomes D. Applying basic business and economic principles to the microsystem -Ans- B. rationale core competencies The CNL notices increased number of CLBSI on your unit. You conduct a literature search and, after critiquing and synthesizing the available evidence, you find that central line bundles have been shown to decrease CLBSI. You want to implement this bundle on your unit, and plan to evaluate the effect of this change. Which of the following best describes this process? A. PDSA B. Research C. QI D. EBP -Ans- D. Rationale: EBP involves applying research evidence to clinical practice in order to improve patient outcomes The CNL successfully implemented an EBP project utilizing music therapy to help with pain control in sickle cell patients on a medical-surgical unit. The CNL was asked by the CNO to implement the project within the medical division. What system will the CNL be working in? A. mesosystem B. macrosystme C. microsystem D. unit-based system -Ans- A. rationale: multiple microsystems A mother presents to ED with 8-month infant who has the following symptoms: coughing, recurring respiratory infections, fatty stools, and failure to thrive. Upon examination, the infants vitals are as follows: T 99.4 HR 150, RR 65, BP 88/50. A CNL in the ED receives a phone call from the lab stating that Staphylococcus aureus was found coloniezed in the patient's airway. A As the CNL in the ED, you associate the patients condition with which following disease? A. Asthma B. Lobar pneumonia C. Cystic fibrosis D. Croup -Ans- C. rationale: respiratory infections, FFT, and fatty stools What is the best tool utilized by the CNL to implement change? A. research study B. Meta-analysis C. PDSA D. SDSA -Ans- C. quickly test ideas A group composed of unit-based council members was put on a task force to improve discharge planning b/c pts reported feeling rushed and unprepared at discharge. A decision was made to create a discharge planning nurse position to educate patients the night before the discharge. Even though the new nurses did not like this solution, they deferred to the senior nurses of this group who were adamant about implementing this posiiton. Which barrier to effective teamwork does this exemplify? A. Physical threats B. Groupthink C. Team dysfunction D. Authority gradient -Ans- B. rationale: phenomenon that occurs when group members try to minimize conflict and reach consensus too ealry without fully vetting all ideas and consequences While QI efforts can yield many benefits in health care, as the CNL you recognize which of the following to be the most important potential effect of a nursing QI effort? A. Increased hospital cash flow/decreased expense B. Increased competitiveness with other facilities C. Reduction in lawsuits/liability D. Improvement of nursing quality indicators -Ans- D. patient-centered Team coordination skills can help avoid all of the following except: A. Undefined team member roles B. Poor membership involvement C. Member conflict D. Confusion regarding next steps -Ans- C. conflict usually arises in groups at some point The CNL of the heart failiure unit encourages the staff to earn advanced degrees, obtain certifications, and present and publish EBP projects. The CNL exhibitis which type of leadership style? A. Relational B. Transactional C. Situational D. Transformational -Ans- D. motivates to higher performance You are a CNL on a busy surgical unit. Recently, several nurses reported confusion regarding their patient's discharge process. The nurses stated that they often were unaware of all communications between interprofessional care team. As a result, the nurses were often unaware of their patient discharge plans. As a CNL, how can you best improve this process? A. Educate nurses on how to access progress notes from other providers within the current electronic health record (EHR). B. Discuss with each health care team member the clinical issue regarding the discharge process and suggest the creation of a daily interdisciplinary team meeting C. Communicate to the surgeons the nurses' concerns, and advocate for the nurses' needs for communication in their role D. Assume responsibility for the coordination of all discharge needs for patients on the unit -Ans- B. advocate for the role of the nurse as an equal part of the interprofessional team How can the CNL best provide and educate staff on giving culturally competent care within the unit? A. Educate staff on assessment questions/phrases in the most common secondary language present In the community or seen within the hospital B. Educate staff on varying cultural perceptions and beliefs surrounding the concepts of health C. Provide an in-service on accessing patient education and handouts in another language D. Ensure that nurses are assigned to the most culturally appropriate patients currently on the unit -Ans- B. ideal is intervention as education on cultural differences A 40-year old postpartum patient with chronic HTN and GDM who is gravida 5 para 4 is transferred from labor and delivery to the postpartum unit with lactated Ringer's at 125 mL/hr. Upon assessment of the patient, the nurse notices the patient's fundus is three finger breaths above umbilicus and to the right of midline and her bladder is palpable. The nurse also notes moderate to heavy bleeding and a full bladder and notifies the CNL. As a CNL, what is the most important intervention? A. Encourage the nurse to massage the fundus and heplock the patient B. Encourage the nurse to call the physician stat to order Methergine C. Encourage the nurse to monitor the patient over the next hour b/c there are no risk factors for a postpartum hemorrhage D. Encourage the nurse to straight catherize the patient to decrease the likelihood of a postpartum hemorrhage -Ans- D. multipara and full bladder are risk factors for postpartum hemorrhage A 6-year-old boy is in critical condition following a car accident. The patient has head trauma and internal bleeding. The patient's parents have stated multiple times that they are Jehovah's Witnesses and do not want their son to receive blood. The CNL knows that the blood transfusion is needed immediately and could save the boy's life. Which of the following statements is the best thing for the CNL to do? A Listen to the parents, as US minors have no legal rights and remain under parental jurisdiction B. Obtain court order in the best interest of the child to receive blood, based on the avoidance of physical harm C. Based on religious beliefs, do not give blood D. Follow the physician's decision to give blood since the physician's decision overrides the parental decision -Ans- B. Rationale: child's interests as well as state policies outweigh the parental rights; a court order is needed to override parent's decision Which stage of Lewin's change theory involves explaining that the current situation must change? A. Unfreezing B. Adoption C. Evaluation D. Change -Ans- A. rationale: method of letting go of counterproductive patterns 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 -Ans- B. rationale: a champion will advocate and support the initiative and the CNL What type of chart is used in QI and uses step-by-step symbols to plan projects and describe a process? A. Flowchart/process mapping B. Pareto chart C. Control chart D. Run chart -Ans- A. rationale: mapping is graphic illustration of steps in a process The CNL completed an assessment of the community and identified a need for a public health program. Which of the following would have the potential for the greatest impact on the community? A. Implement a small pilot program at the local hospital B. Write a proposal to make the change and send it to the legislators to build their support for the change B. Research and analyze public health programs in other communities D. Write an article for the local paper discussing the need for the program -Ans- B. rationale: The CNL is responsibile for inflencing regulatory, legislative, and public policy to promote and preserve healthy communities. The CNL is advocating for a healthy community by writing to legislators The CNL works with high-risk obstetric patients both inpatient at the hospital and outpatient in the local health clinic. The CNL follows each patient throughout his or her episodes of care, ensuring the patient receives streamlined, comprehensive care. Which critical component of lateral integration best desribes what Lisa is demonstrating? A. Coordination B. Communication C. Collaboration D. Evaluation -Ans- A. Rationale: the CNL coordinates care my managing the care of clients across settings and episodes of care A 28-year-old patient with asthma is requesting the pneumococcal vaccine. Which of the following conditions are appropriate for receiving the pneumococcal vaccine? A. CHF, HIV, DM, pregnancy B. CHF, HIV, DM, sickle cell disease C. DM, chemotherapy, sickle cell disease, pregnancy D. Pregnancy, CHF, DM, chemotherapy -Ans- B. Rationale: all of these medical conditions require the patient to receive the pneumococcal vaccination A CNL on a medical unit is following up with patients on warfarin therapy postdischarge and concludes that patients are not receiving adequate education on medication administration. The CNL formulates an action plan and develops a team to improve warfarin discharge education. What competency was portrayed by the CNL? A. Lifelong learner B. Delegator C. Lateral integration D. Risk Anticipator -Ans- D. Rationale: Risk anticipation is critically evaluating and identifying potential threats to client safety A small group has been formed on the medical-surgical unit to implement change. Team members have had struggles over decision making and clarity of purpose. What stage of the Tuckman and Jensen's model is represented by members communicating their feelings but still viewing themselves as individuals rather than part of the team? A. Performing B. Norming C. Forming D. Storming -Ans- D. Rationale: this phase is where competition and conflict are at their highest FMEA is best used as follows: A. In response to a critical or sentinel event B. Prior to a process implementation or change C. As part of a random audit process D. In response to malfunctioning tools or equipment -Ans- B. rationale: tool for risk anticipation How can the CNL help determine the meaningful use of the EHR within his or her microsystem? A. Identify data that should be collected and managed, and note how that data should be shared for improving client outcomes B. Coordinate with physiciians to identify which clinical information would be meaningful for the patients under their care C. Discuss with unit leader and stakeholders what data could provide meaningful use fo the EHR within the unit D. Review the available client data currently in the EHR and assess for meaningfulness in improving patient outcomes -Ans- A. Rationale: the CNL should be able to identify meaningful data, as we as its collection and managment, and use that data to improve clinical outcomes on the unit Regarding information technology, how can the CNL improve the identification of meaningful data? A. Clarify with nurses what vendor-related terms may be used in their documentation B. Develop a tool to identify relevant nursing clinical data and its location within the EHR C. Advocate for standardized nursing terminology within the EHR D. Coordinate with the informatics the best way to document care for efficieint data retrieval -Ans- C. Rationale: standardization of nursing terminology within the EHR is the best way to identify relevant data The diabetes liason on an adult medsurg unit informed the team that the unit was only 45% compliant with checking blood sugars within 15 minutes after a hypoglycemic event. The team decided to implement a process change to ensure the blood sugar recheck is completed within 15 minutes. The change was implemented and there was an increase to 85% compliance of hypoglycemic rechecks. What is the next step for the team in the PDSA cycle? A. Plan B. Do C. Study D. Act -Ans- D. Rationale: After analysis of the results of the trial (also known as study), the team will then act by devising the next steps based on the analysis. A patient presents with severe pain in the upper right abdomen after eating a fatty meal. These symptoms lead you to suspect cholecystitis. Which assessment finding is most likely to be associated with this condition? A. Positive Homan's sign B,. Positive Psoas sign C. Murphy's sign D. Aaron's sign -Ans- C. Rationale: positive Murphy's sign is identified when the patient inhales and feels pain due to the inflamed gallbladder pushing into the palpating hand. A CNL using Roger's diffusion of innovation theory realizes while implementing a new health information management (HIM) system that when dealing with a member of the health care team she should: A. Spend a majority of time educating the laggards to become supporters of change B. Spend a majority of time on innovators because they will need a lot of convincing to make a change C. Spend a lot of time with early and late adopters because when they support the change it will be successful. D. Spend very little time with early majority adopters because they arae not adaptable to change -Ans- C. Rationale: early and late adopters each hold 34% on Roger's bell curve Heather, a nurse for 7 years, recently attained her MSN-CNL. She is very passionate about being involved in her local community. She volunteers frequently at a community center for underprivileged children. During her time there, she noticed that obesity is a concern with this population. What step best describes Heather's advocating for this local community center? A. Heather collaborates with the community center leaders to get donations from local health food corporations to ensure a healthy meal is provided for the children B. Heather collaborates with another CNL and plans to do a literature review on obesity C. Heather discusses her concern of obesity with the community center leaders D. Heather calls other community centers for underprvileged children to inquire about obesity in their populaiton -Ans- A. Rationale: the CNL operates by building partnerships wit community organizations to identify and address health disparities A nurse prepares to administer a patient's morning dose of metformin. After scanning the patient and the medication, a clinical alert appears on the computer screen warning of a possible interaction between the metformin and the CT contrast dye the patient received the day before. Based on this warning, the nurse chooses to hold the metformin and alert the pharmacy that this medication should ge scheduled as held for 72 hours after receiving the contrast. This is an example of a: A. Clinical decision support system B. Health information technology C. Clinical alert warning system D. Decision tree -Ans- A. Rationale: automated warnings within the EHR are an example of a clinical decision support system The health care team determines that the discharge process is ineffective and must be changed. The team determines the stakeholders and utilizes a force field analysis to weigh the pros and cons of the change. This was then used to motivate other team members and encourage buy in. Utilizing Lewin's theory of change, what stage is the team in? A. Sustaining B. Moving C. Refreezing D. Unfreezing -Ans- D. Rationale: the first step in Lewin's change model include battling resistance to change and includes a role for the CNL to assess readiness to change and motivate others to see the reason for change A Native-American patient is admitted with sepsis from a UTI. The patient tells the CNL that she is very discouraged and feels that she is not able to get better because she is unable to touch "mother earth" with her feet. The CNL gathers some dirt, grass, and flowers from outside the hospital and places it in a bucket. The CNL brings the bucket in the patient's room and helps her to stand on the dirt. Which of the following best describes what the CNL is demonstrating? A. Cultural knowledge B. Cultureal awareness C. Cultural skills D. Cultural management -Ans- C. Rationale: defined as ability to identify, assess, and incorporate the values, beliefs, and cultural customs of client A nurse comes to you with a concern about a telephone order she received from a doctor. The doctor told her to review a physician's order for life-sustaining treatment (POLST) form with a client, then sign and place it in his chart. The nurse is uncertain if this is in her scope of practice. You advice the nurse to: A. Complete the form as ordered by the MD B. Review the hospital's policy and procedure manual, and handle per policy C. Review the State Board of Nursing Scope of Practice and handle according to your scope of practice D. All of the above. -Ans- C. Rationale: The State Board of Nursing is the correct source of any scope of practice questions How can a CNL help to identify the general discharge needs of patients on his or her unit? A. Coordinate outpatient care and follow-up appointments B. Assess protective and predictive factors of patients health C. Discuss with each team's doctors the anticipated discharge needs of their patients D. Approach staff nurses about their patients' discharge needs -Ans- B. Rationale: assessing protective and predictive factors is the best way the CNL can identify potential needs with patient discharges Lisa, a CNL, is educating the staff on the effects of long-term bed rest. A majority of these patients have been on bed rest with a shortened cervix since 25 wks gestation. Which of the following statements is true? A. Bed rest is psychologically healthy B. Music therapy can ease the psychological effects of bed rest C. Bed rest prevents DVT D. Bed rest has been proved to prevent preterm labor -Ans- B. Rationale: Currently, there is no evidence that bed rest prevents preterm labor B.F. is a 52-year-old femaile patient recently placed with the palliative care team. The CNL makes sure the BF is transferred to another unit with a specific palliative care section. How is this a demonstration of advocacy? A. Physicians understand when to transfer patients B. It ensures that the system meets the needs of the population C. It advocates for the professional nurse D. It applies ethics toward patient care -Ans- B. Rationale: focus on patient placement to optimize outcome A nurse on the CNL's unit asks about accessing patient education materials via the EHR, as well as the availability of education on Cambodia. As the CNL guides the nurse in locating these materials, she recognizes this as an effective use of: A. Health care informatics B. Research utilization C. Clinical knowledge D. Evidence-based research -Ans- A. Rationale: health care informatics enables nurses to locate and provide materials The CNL works in a small primary care practice and has identified that several patients have missed appointments. After investigating why the patients were not going to appointments, the CNL determines that the patients made the appointments so far in advance that they forgot them. The CNL discusses these findings with the team and they decide to implement a program with reminder calls 2 days prior to the appointment. The CNL wants to be sure to identify aspects that may positively or negatively affect the project, so the CNL suggests the team utilize which of the following? A. 5P (persons, patients, professionals, processes, patterns) B. PDSA C. SWOT (strengths, weaknesses, opportunities, and threats) analysis D. 5S -Ans- C. Rationale: SWOT is vital tool for planning successful interventions You are the unit-based council chair for shared governance of a high-acuity progressive care unit. You notice that the staff is not aware of new evidence in caring for this patient population. You discuss this with the management team and the CNL to determine what can be done to increase the staff awareness and knowledge of EBP. What strategy can best be used to increase evidence into practice? A. Start a jounal club B. Learn how to determine if an article is peer-reviewed C. Encourage nurses to conduct research D. Discuss the importance of EBP in staff meeting -Ans- A. Rationale: other examples of increasing evidence into practice include 1) ensure policies/procedures are based upon the latest literature 2) grand rounds 3) update staff on latest evidence in short gatherings 4) link quality indicators in EBP 5) mentor staff to complete EBP activities The CNL recognizes the imortance of Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores in driving hospital reimbursement. These scores measure: A. Core measures and patient experience B. Core measures, patient experience, and clinical outcomes C. Core measures, patient experience, clinical outcomes, and readmission rates D. Patient experience, clinical outcomes, and readmission rates -Ans- A. Rationale: HCAHPS measure only core measures and patient experience. They do NOT measure patient mortality, clinical outcomes, or readmission rates In order to be successful while utilizing Kotter's change theory, you realize it is vital to spend time on the first step. Which of the following best represents the first step in Kotter's change theory? A. Having celebrations for short-term wins B. Communicating the change vison C. Consolidating gains and producing more change D. Obtaining buy-in and creating a sense of urgency for change -Ans- D. Rationale: Kotter's theory emphasizes adequate time spend on the 1st step of change, which is establishing a sense of urgency in order ot have enough buy-in from stakeholders The primary focus of the CNL is best defined as: A. Delivery of high quality, evidence-based, culturally competent care a tthe patient's bedside B. Educating and mentoring peers to improve clinical competence C. Providing patient care management and leadership of the interdisciplinary team meetings D. Evaluating and supporting evidence-based practice (EBP) decisions to ensure best possible outcomes -Ans- D. Rationale: CNL focus is to ensure outcomes by evaluating and implementing evidence-based research Use of EHRs can aid the CNL to conduct QI efforts in which of the following ways? A. Allow rapid access to informatics data, provide way of ongoing montioring, organize data into meaningful groups, and aid in the dedication of errors B. Allow rapid access to informatics data, ensure all staff follow protocols and policies, add second checks to medication administration, and aid in the detection of errors C. Provide a way of ongoing monitoring, ensure all staff follow protocols and policies, add second checks to medication administration, organize data into meaningful groups, and aid in the detection of erros -Ans- A. Rationale: QI efforts cannot ensure people act within established policies/procedures. And QI efforts do not depend on safety checks, such as additional safeguards to medication administration The CNLs noticed that the supply room was cluttered and often times supplies had expired. They created a team and conducted a 5S to organize the supply bins and reduce waste. Where will the CNLs see the cost savings with supplies refeclted? A. Capital budget B. Cashflow budget C. Cost-effectiveness analysis D. Operating budget -Ans- D. Rationale: supplies effects operating budget Recently, your unit replaced all of its current beds with air beds, designed to help prevent skin breakdown in your patients. Using informatics, what is the best way to evaluate the effectiveness of this intervention? A. Review the EHR for new pressure ulcer incidence since the new beds were utilized B. Complete a pressure ulcer prevalence study on all currently admitted patients c. Gather data on all patient Bradenscale scores since implementation D. Review all nurse skin integrity assessments since implementation -Ans- A. Rationale: before/after data regarding pressure ulcers incidences is the only meaningful information As a CNL, you recognize a sentinel event as which of the following? A. Any unintended event that results in ANY harm, physical or psychological, to a patient B. Any unintended event that has the POTENTIAL to result in ANY harm, physical or psychological, to a patient C. Any unintended event that results in SIGNIFICANT harm, physical or psychological, to a patient D. Any unintended event that has the POTENTIAL to result in significant harm, physical or psychological, to a patient -Ans- C. Rationale: sentinel event only occurs if the event reaches and significantly harms a patient You are a CNL working in a very busy 980-bed tertiary hospital. The hospital only has one MRI machine. This often causes delays in patient care. You write a proposal for the administrative team to advocate for more MRI scanners. If the proposal is approved, the money will come out of which budget? A. Capital budget B. Cash flow budget C. Operating budget D. Revenue -Ans- A. Rationale: capitol budget deals with large dollar amounts and long- term investments like equipment A patient who has been diagnosed with colon cancer remarks that since his diagnosis, many people he knows have mentioned someone they know who 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? A. Incidence B. Prevalence C. Mortality D. Correlation -Ans- Rationale: incidence measures new cases in a specific area in a specific time period Which of the following is not a part of the National Patient Safety Goals (NPSG)? A. Improve the accuracy of patient identification B. Reduce the risk of health care-associated infections C. Improve patient satisfaction D. Prevent health care-associated pressure ulcers -Ans- C. Rationale: not directly related to safety During the 5P assessment, you find out the 64% of patients have Medicare, 18% have Medicaid, 16% have private insurance, and 2% have no insurance. You can conclude that the majority of your patients are what type of payer source? A. First-party payer B. Second-party payer C.Fourth-party payer D. Third-party payer -Ans- D. Rationale: 3rd-party payers include government and private insurance organizations A staff nurse is performing a literature review on the best tool for determining health literacy for diabetic patients. When analyziing and appraising the literature, what methods can the nurse use to determine if the study is flawed? A. Are the results of the literature reliable and critical? B. Are the results of the literature effective and modifiable? C. Are the results of the literature valid and reliable? D. Are the results of the literature valid and modiable? -Ans- C. Rationale: 3 questions to consider when apprasing any study: Are the results for the study valid? Are the results reliable? Will the results be applicable to study? A nurse on your unit has a question about required documentation for a patient with a NG tube to wall suction. You guide her to what resource? A. The unit charge nurse B. Hospital policy/procedure manual C. The State Board of Nursing Scope of Practice D. The Joint Comission website -Ans- B. Rationale: hospital policy is best source for required documentation Elizabeth, an 87-year-old female, is admitted to the orthopedic unit with a fractured hip. Elizabeth lives at home alone, but her retired son lives just 2 hours away and comes to visit her often. The PT recommeds patient go to rehab center prior to returning home. Elizabeth becomes visibly upset with this plan and refuses to go. Utilizing an interprofessional approach, you ask the social worker, case manager, doctor, and PT to help create a plan for Elizabeth. Which of the following is the best plan for Elizabeth? A. Convince Elizabeth to go to a rehabilitation facility where she will receive 24-hr care and 3 hours of PT a day B. Keep Elizabeth in the hospital until she has fully recovered, then discharge her home C. Discharge Elizabeth home and arrange for a physical therapist to come to her house once a week D. Contact Elizabeth's son, inform him of Elizabeth's refusal of the rehabilitation facility, and have him help develop an alternative to the original plan for her discharge -Ans- D. Rationale: The best option if for her to go home to her son's house where she can be monitored and safe while receiving home health services Which method of payment accounts for only 5% of the US population? A. Out-of-pocket payments B. Employment-based private insurance C. Government financing D. Individual private insurance -Ans- D. Rationale: 1st-party payer Judy completed an EBP study that resulted in a 25% reduction in noise on the unit and increased patient satisfaction to 100% for patients always saying it is quiet at night. Utilizing the EBP process, what would Judy's next step be? A. Apply for a poster-presentation for a national conference B. Compare results to a similar unit in her hospital C. Identify stakeholders within her organization D. Conduct a literature search and assess validity -Ans- A. Rationale: the final step in EBP is to disseminate findings via presentations or publications The nurse manager of a regional home health services company allows the employees to determine solutions for change, and always considers their opinions, suggestions, and concerns. What type of leadership style is the manager demonstrating? A. Autocratic B. Laissez-faire C. Consultative D. Democratic -Ans- D. Rationale: involves the whole group in the decision-making process You are using 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 and delays in the medication administration process -Ans- C. Rationalize: 1st step in FMEA-tool for process improvement can provide new insights into routine practice Sustaining process improvement requires the use of appropriate learning priniciples and strategies. The CNL function that best utilizes this competency is: A. Advocate B. Educator C. Clinician D. Information manager -Ans- B. Rationale: AACN describe educator core competency as using appropriate learning principles and strategies. Before beginning data collection, what is the primary key factor to determine? A. Personnel to collect data B. A secure database for holding data C. Operational definitions of data D. A user-friendly collection method -Ans- C. Ratinale: This is the first step in data collection A 65-year-old with a history of chest palpittions was seen by his cardiologist for new onset palpitations. He was put on a beta-blocker and 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. Decreasing the ability of the heart muscle to contract C. Decreasing the chance of dysrhymia D. Increasing contractility and decreasing heart rate -Ans- D. Rationale: this is the MOA of BB To demonstrate active-listening, the CNL would exhibit which behavior? A. Avoid making any facial expressions B. Preserve at least 3 ft between the parties C. Lean slightly forward D. Fold hands in the lap -Ans- C. Rationale: this indicates desire to concentrate 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? A. National and state readmission rates B. National benchmarks C. Readmissions to other units In your hospital D. All of the above -Ans- D. Rationale: The needs broad perspective of admisison rates across multiple settings. The CNL can then resource share with other areas to gain insight into best practices and pre=existing initiatives at the microsystem, hospital, state, and national levels. You have done some research and found a new fall prevention tool that you would like to trial on your unit. The tool was recently developed and 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 D. Causal association -Ans- B. Rationale: this is the degree to which the results of the original study are applicable to a population other than the one initially targeted. Medicaid covers which population? A. Employed B. Underinsured C Unemployed D. Poor and Disabled -Ans- D. Rationale: publicly funded insurance provided to poor & diabled of each state An 80-year-old is admitted for a hip fracture, caused by a fall from standing. As a CNL, you would know a fracture obtained this way is typically found from what? A. Osteomyelitis B. Osteoporosis C. Anemia D. Rheumatoid arthritis -Ans- B. Rationale: this is paramount sign of the dx You are caring for Sara, a 76-year-old grandmother recovering from heart failure. You know that she is ready to go home because: A. Her ECG is normal, her SpO2 is normal, and she has a supportive family to help care for her at home B. She tells you she is ready to go hom C. You observe her ambulating in the hallway, free from dyspnea D. She says she is free froom dyspnea and fatigue, she has a follow-up appointment set up for the following Monday morning, and her daughter said she can drive her to the appointment -Ans- C. Rationale: HF sx are often not well evaluated, as clients remain relatively inactive while in the hospital. Ambulating provides objective data A new health policy is being voted on in Congress. Your professional organization supports this policy and is recruiting nurses to go to DC to help promote their view and to have a bigger voice. You do not support this policy. Your manager wants you to go as a leader and represent your unit. What should you do? A. You should go, as you need to stick together with your professional organization and yield to your manager B. You should learn more about the policy and why your organization supports it C. You should politely decline, as you do not agree with the policy D. You should go, but rally against the policy since you do not agree with it. This is America and you are exercising your freedom of speech -Ans- B. Rationale: we need to support each other and have one voice as nurses The team has a vision and a strategy on how to approach this process change. They decide to create a pneumonia pathway with a comprehensive, streamlined plan of care including evidence-based nursing tasks, education from respiratory therapist, and discharge follow-up home health visits. The team shares the plan with the unit through presentations and e-mails. The staff expresses enthusiasm about the new changes. Utilizing Kotter's theory of change, what step is the team demonstrating now? A. Anchor new approaches in the culture B. Generate short-term wins C. Consolidate gains and produce more change D. Communicate the change vision -Ans- D. Rationale: The team is telling the unit the plan and how the process change will be implemented As a trial CNL, whose buy-in will be the most important in fully implementing the CNL role in the hospital? A. The chief nursing officer (CNO) B. The unit manager C. The members of the interdisciplinary team D. The staff affected by your outcomes -Ans- A. Rationale: CNO has the most influence on the implementation of the CNL role in the hospital The patient is a 36-year-old Latina with two previous births. One previous birth was 7 lb 5 oz stillborn at 36 weeks and the other was 9 lb 5 oz at 38 weeks. She is 5'2" and her BMI is 40.2. Her blood pressure is 140/80 and she had a cesarean. What are risk factors for developing GDM? A. Obesity, advanced maternal age B. Previous infant with birth weight greater than 9 lb., stillbirth, hypertension, and proteinuria. C. Obesity, advanced maternal age, Hispanic/Latina, previous infant with birth weight greater than 9 lb., and stillbirht D. HIspanic/Latinia, stillbirth, proteinuria. -Ans- C. Rationale: risk factors include obesity, age > 25 yo, nonwhite race, stillbirth, previous birth weight > 9 lb The patient presents to the clinic after recently arriving in the US at 32 weeks gestation with complaints of headache, blurred vision, lethargy, and diaphoresis. The patient arrives with no record of her prenatal care. The following lab results are from today's visit: Urine dipstick 3+ glycosuria and no proteinuria, fasting blood sugar of 58 mg/dL, and a biophysical profile of 8/10. An oral glucose tolerance test (OGTT) was also done today with a result of 150 mg/dL. Which of the following interventions is appropriate for the nurse to tell the CNL? A. The patient is experiencing hyperglycemia and should be given a protein snack. B, The patient is experiencing hyperglycemia and should be given insulin and juice. C. The patient is experiencing hypoglycemia and should be given insulin and juice D. The patient is experiencing hypoglycemia and should be given juice. -Ans- D. Rationale: fasting blood glucose <60 mg/dL plus sx are HA, blurred vision, lethargy, and diaphoresis What does the result of the 150 mg/dL from the OGTT signify? A. Based on a value greater than 140 mg/dL, the patient should have 3-hour 100-g OGTT within 1 week B The results are within normal limits and do not meet the threshold of the diagnosis of GDM C. A fasting blood sugar should be checked as soon as possible D. Based on this abnormal value, the 3-hour OGTT is not required -Ans- A. Rationale: if OGTT is > 140 mg/dL then the next step is a 3-hour OGTT. The 3-hour OGTT determines the GDM diagnosis In you role as CNL, the hospital leadership has asked for you to temporarily work on a new unit to investigate an issue and offer solutions to improve practice. The clinical incident involved a postoperative patient on patient-controlled analgesia (PCA) with a low-dose continuous infusion who became extremely oversedated during the night. When the nurse discovered the patient, they had a respiration rate of 5 rpm, SpO2. in the 60s, and appeared grossly cyanotic. How do you begin orienting to this new unit and the situation? A. Perform a 5P assessment (purpose, patients, professionals, processes, patterns) of the unit B. Review hospital policy and procedure related to PCA use C. Perform a root cause analysis (RCA) D. Create an interdisciplinary team to address this issue -Ans- A. Rationale: 1st step is to assess and evaluate the new microsystem You question the appropriateness of the PCA orders given the risks and patient's comorbidities. What information do you gather next? A. Discuss with the surgeons their rationale behind the order B. Review the current evidence of PCA use and oversedation C. Contact a peer in the sleep center to discuss risks and benefits of OSA and PCA. D. Examine the current hospital policy and procedure manual -Ans- B. Rationale: reviewing current evidence is the priority for the CNL to inform an investigation of a clinical issue. Ms Jones has now been in the hospital for 2 months, and she develops shortness of breath and pain in her right leg. Your patient has developed a PE, which requires an admission to the ICU. As a CNL, what would be the most appropriate intervention after assuring quality care is provided for this patient? A. Form a multidisciplinary team to review the patient's plan of care and gather whether anything can be done to prevent this from occurring B. Perform a RCA C. Review this case with your nurse manager D. Review the chart to see if Ms. Jones was mobile during her hospital stay -Ans- B. Rationale: RCA is performed to eliminate hidden problems within the system that contribute to adverse events You are a CNL student contemplating a topic for your capstone project. You believe that patients transferred from the medical ICU (MICU) to your medical unit are frequently transferred back to the MICU due to multiple rapid response team (RRT) calls. You want to look further into whether this is truly a concern for your unit. What first step should you take as a CNL student? A. Assess the current rate of RRTs and transfers back; collect data to see how many patients are transfer-backs to the MICU B. Implement a process to reduce transfers back to the MICU C. Perform a literature review on RRTs and transfers back D. Design a study to decrease RRTs and transfers back to MICU -Ans- A. Rationale: 1st step is to assess to identify the problem; assessing current numbers and collecting appropriate data are the 1st step in identifying the problem After assessing you unit population, you find that the rate of RRTs and transfers back to the MICU are higher than the national mean. What should be your next step? A. Design a study and implement the best practice B. Perform a literature review and create a team C. Design a study and perform a literature review D. Identify the problem and create a PICOT question -Ans- D, Rationale: The 1st step to the EBP process is to identify a clinical problem. Creating a PICOT question will help the CNL in performing a literature review