Grohar-Murray TIF
Chapter 9: Special Responsibilities of the Manager
Learning Objective 1:
Define key terms associated with standards.
1. Which statement is an example of the overall goal of quality management in today’s health
care activities?
1. The administrator walks around making a list of potential problems.
2. The nurse wipes up a spilled drink before clients are allowed to enter.
3. The Human Resources Department lets nonproductive employees go.
4. The nurse manager realizes a policy was ineffective in reducing incidents.
2. The nursing manager is comparing data on average length of client hospital stay for a total hip
replacement between two hospitals in order to promote quality improvement. This comparison is
an example of which process or step?
1. A process standard
2. An outcome standard
3. Benchmarking
4. An indicator
3. A collaborative work group composed of members of the interdisciplinary health care team
develops a set of goals and research-based standardized practice guidelines. Of which concept is
this an example?
1. Quality improvement
2. Outcomes management
3. Risk management
4. Disease management
4. If a nurse wishes to become certified as having expertise in a particular area of nursing, which
action is the nurse’s first priority?
1. Work in the area for at least 5 years.
2. Arrange to take the certification exam.
3. Determine the specific requirements.
4. Obtain a letter of recommendation.
5. Which statement most appropriately describes why a nurse obtaining certification is required
to work in the specialty area, pass an examination, and recertify at specified intervals?
1. The certification board must ensure that the nurse knows the specialty well
enough to avoid being found guilty of negligence.
2. The certifying agency requires the standards to ensure that the nurse has mastered
the knowledge and skills required in the specialty.
3. The National League for Nursing Accrediting Commission (NLNAC) requires
certifying agencies to set these standards.
4. Working in the area, testing, and recertifying allow the nurse to have additional
credentials to increase earning potential.
6. If a nurse manager is discussing certification with nursing staff, which statement would be
omitted?
1. “Specialty organizations use their own practice guidelines in order to certify
nurses in that area.”
2. “There are five main areas of nursing in which nurses can obtain certification by
successfully passing the exam.”
3. “Only nurses with at least 5 years of nursing experience with the specialty can
become certified, regardless of the years in nursing.”
4. “Specialty area certification is an example of a structure standard, since it deals
with personnel qualifications.”
Learning Objective 3:
Identify the federal health insurance programs that led to the review of appropriate and effective
care.
7. Which appropriately describes the difference in nursing practice before and after the Social
Security Act Amendments of 1983?
1. Nursing practice changed from focusing mostly on the client to focusing more on
efficiency.
2. Nursing administrators finally were able to bill Medicare for nursing services.
3. Nurses at the beside had to discharge clients even if they were unstable.
4. Nursing practice did not change; only reimbursement for hospital services
changed.
8. If a nurse is working in a state agency that is not providing efficient care while striving for
continuous quality improvement, what is the most likely outcome? Select all that apply.
1. Agency administrators will receive increased complaints from clients.
2. Government reimbursements from Medicare will decrease.
3. The agency will encounter an influx of care providers seeking employment.
4. The nursing staff will be named in an increased number of negligence lawsuits.
5. Nurse managers will experience more difficulty staffing the units.
Cognitive Level: Application
9. Which statement indicates that a nurse manager understands the significance of the National
Health Planning and Resource Development Act (NHPRA) of 1974?
1. “The focus of the NHPRA was on establishing hospital systems specializing in
certain specialty practices.”
2. “The Medicare system was established by the legislation included in the
NHPRA.”
3. “The NHPRA closed down facilities that were old, and some people were left
with no access to health care.”
4. “The NHPRA helped to ensure equal access of small communities to health care
facilities.”
Learning Objective 4:
Discuss the relationship between clinical practice guidelines and outcome standards.
10. The nurse admits a client with insulin-dependent diabetes mellitus. When documenting,
which of the statements by the nurse is an outcome standard?
1. “The client will maintain a HbA1C of <6.5%.”
2. “Limit carbohydrates to 30 g for meals and 15 g for snacks.”
3. “Check glucose levels before administering ordered insulin.”
4. “Monitor glucose levels more frequently during illness.”
11. Which statement correctly describes the relationship between practice guidelines and
outcome standards?
1. Practice guidelines help to focus care management for a condition, while outcome
standards reflect a desired status for the client to reach.
2. Practice guidelines help determine which procedures and tests are indicated, while
outcome standards are statements of the end goals expected for a particular
condition.
3. Practice guidelines help steer the nurse’s practice, while outcome standards are
those goals a nurse can expect to achieve if the practice guidelines are followed.
4. Practice standards are the nursing actions required for the nurse, while the
outcomes standards are the goals a client can reach with a particular condition.
12. If the nurse admits a client with chronic asthma with status asthmaticus, which chart notation
is the practice guideline?
1. “The client will maintain oxygen saturations above 93%.”
2. “The client will identify asthma triggers before discharge.”
3. “Obtain a chest x–ray now and tomorrow morning.”
4. “The client’s family will describe needed changes in home environment.”
Learning Objective 5:
List the conditions that must be met to claim injury due to negligence.
13. Nurses are working a night shift on a rehabilitation floor. During the shift, a client falls and
breaks a hip. This client sues the nurses working on the shift, claiming negligence. Which
condition(s) still need(s) to be met in order for the client to win the case against the nurses?
Select all that apply.
1. Proof that the broken hip was directly caused by the nurses’ actions
2. Proof that the standard of care was not met
3. Proof that the client suffered an injury
4. Proof that the nurses on the shift were responsible for the client’s care
5. Proof that the nurses’ failure to act put the client at risk for injury
14. A client is receiving home health care to complete intravenous antibiotics. The nurse is
scheduled to visit every other day to check the site and make sure the client’s wife is
administering the medications safely and correctly. Both the client and his wife verbalize
understanding of the symptoms of an infiltration, and the importance of reporting it immediately.
With a scheduled visit 2 days later, the nurse finds the site red and swollen and the client’s arm
tender. There is no indication that the client or his wife notified the nurse or home health agency.
The lack of which condition will make it difficult to prove negligence on the nurse’s part?
1. The nurse owed a duty to the client.
2. The standard of care was not met.
3. The action or inaction of the nurse directly caused the injury.
4. Failure to act would cause harm to the client.
15. During an Intensive Care Unit hospitalization, a client undergoes an emergency surgery to
repair an aneurysm. The nurses caring for the client postoperatively repeatedly report changes in
vital signs, indicating deterioration, but the care provider does not evaluate the client for 3 hours.
The client’s brain herniates, and the client dies. The family files a lawsuit against the nurses, the
care provider, and the hospital. Given that the physician and the nurses are employees of the
hospital, who is at risk of being found guilty of negligence? Select all that apply.
1. The care provider on call at the time the nurses reported vital sign changes
2. The hospital, because of the employee/employer relationship
3. The nurses assigned to the client during the hospitalization
4. The administrators employed by the hospital
5. Only the nurse on duty at the time the client herniated
