Patient satisfaction scores in emergency department have shown a
downward trend over the past three quarters. As a clinical nurse
leader in ED focus is to:
A) Create a script for triage nurse in welcoming the patient
B) Assign a volunteer to welcome patients to the hospital
C) Compare desired outcomes with national & state standards
D) Write a letter of apology to each dissatisfied patient - answer C)
Compare desired outcomes with national & State standards
Rationale: Client care outcomes are a measure of quality practice.
CNLs must know how to compare desired outcomes that will
improve safety, effectiveness, timeliness, efficiency, quality, and the
degree to which they are client centered.
Which of the following actions illustrates the CNL professional value
of altruism?
A) Leading an interdisciplinary team looking at the remote cardiac
monitoring process
B) Sponsoring a meeting with the monitor technicians to understand
their barriers in the cardiac monitoring process
C) Flow mapping the admission process of the remote cardiac-
monitored patient
D) Editing the policy for the remote cardiac monitoring process. -
answer B) Sponsoring a meeting with the monitor technicians to
understand their barriers in the cardiac monitoring process
Rationale: Altruism is a concern for the welfare & well-being of
others. In professional practice, altruism is reflected by the CNL's
,concern for the welfare of clients, other nurses, and other health
care providers.
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
Reviewing the patient care guidelines & protocols related to hourly
rounding
D) The CNL balances both the charge role & the preceptor role
simultaneously - answer A) The CNL discusses with the physician
the rationale for discontinuing cardiac monitoring in the hospice
patient
Rationale: Critical thinking underlies independent & interdependent
decision making. Critical thinking includes questioning, analysis,
synthesis, interpretation, inference, inductive & deductive
reasoning, intuition, application, & creativity.
You are a CNL selected to lead a team focused on implementing a
multidisciplinary clinical pathway for acute ischemic stroke &
transient ischemic attack. The risk assessment tool that you have
adopted identifies all of the following as independent stroke risk
factors except:
A) Age
B) Systolic BP
C) Liver dysfunction
D) Current smoking
E) Diabetes mellitus - answer C) Liver Dysfunction
Rationale: Independent stroke predictors include age, systolic BP,
hypertension, diabetes mellitus, current smoking, established
cardiovascular disease (any one of myocardiac infarction, angina,
coronary insufficiency, congestive heart failure, or intermittent
claudication), Afib, & left ventricular hypertrophy on ECG.
,A lack of compliance with 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:
A) Challenging the guidelines on primary prevention of ischemic
stroke written by the American Stroke Association
B) Gaining an understanding of how DVT prophylaxis is initiated on
each stroke patient on your unit
C) Developing an organization-wide educational program on DVT
prophylaxis
D) Developing a unit-based team of nursing personnel to investigate
the problem. - answer B) Gaining an understanding of how DVT
prophylaxis is initiated on each stroke patient on your unit.
Rationale:
White Paper: One competency is that of a systems analyst. A CNL
participates in a system review & conducts a microsystem analysis,
identifying a clinical issue with a focus on a particular population.
You are working on improving the patient discharge process. Which
of these targets would best reflect clinical microsystem outcomes?
A) Hospital length of stay
B) Time of discharge order for all medical patients to the actual time
the patient left
C) Number of discharge orders on your unit entered before 11am
D) Total number of discharged patients leaving by llam - answer C)
Number of discharge orders on your unit entered before 11am
Rationale: A CNL as an outcomes manager uses data to change
practice & to improve outcomes. Selecting the most appropriate
goals & targets will provide meaningful information.
Electronic nursing documentation has recently been instituted in
organization. Select a response that best defines a clinical decision
support:
, A) A reminder to save & sign your admission assessment
B) A visual red-alert when a patient's potassium is 6..8 mEq/L
C) A pop-up to initiate the discharge instruction sheet with every
physician discharge order
D) An electronic nursing care plan - answer C) A pop-up to initiate
the discharge instruction sheet with every physician discharge
order.
Rationale: CDS is a computer-based program designed to assist
clinicians in making clinical decisions by filtering & integrating vast
amounts of information & providing suggestions for clinical
intervention.
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 -
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.
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 - answer A) The organization financial statement
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