ANCC NE-BC Exam Questions

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1.

A nurse executive notices an increase in reported incidents of non-compliance with patient privacy laws. Which strategy is most effective in fostering a culture of compliance among the nursing staff?

  • Encouraging staff to report observed violations without fear of retaliation.

  • Instituting a system of penalties for breaches of patient privacy.

  • Limiting access to patient information as much as possible.

  • Recognizing that increased reporting indicates increased violations and requires increased staff education.

Correct answer: Encouraging staff to report observed violations without fear of retaliation.

Encouraging staff to report observed violations without fear of retaliation creates an environment where staff feel safe, and fosters a culture of transparency and compliance.

While penalties may deter non-compliance, they can also discourage the reporting of violations due to fear of punishment. Restricting information access may hinder necessary information flow for patient care and could affect patient outcomes. Increased reporting could indicate a positive shift toward greater awareness and a willingness to address compliance issues.

2.

A nurse executive is addressing a conflict between a patient's family wishes and the medical team's recommendations for care. According to the ANA Code of Ethics, the executive should first do which of the following?

  • Facilitate a meeting to discuss the patient's values and wishes, and the medical recommendations.

  • Support the medical team's recommendations so that the patient’s best interests are supported.

  • Defer to the patient's family's wishes.

  • Seek legal counsel to ensure the enforcement of what is in the patient’s best interests.

Correct answer: Facilitate a meeting to discuss the patient's values and wishes, and the medical recommendations.

Facilitating a dialogue aligns with the ANA Code of Ethics by respecting the patient's autonomy and values, as well as the collaborative nature of healthcare decision-making.

While the medical team's expertise is valuable, the ANA Code of Ethics emphasizes considering the patient's and family's values and wishes in care decisions. Automatically deferring to the family without considering medical advice or the patient's wishes can overlook the patient's autonomy and best interests. While legal options may need to be considered in some situations, the initial approach should focus on ethical deliberation and understanding, prioritizing patient-centered care.

3.

How can a nurse executive leverage diversity to improve the creativity and innovation of a nursing team?

  • Encouraging team members to embrace their diverse experiences when contributing ideas.

  • Encouraging conformity and team unity by discouraging deviations from traditional practices.

  • Assigning leadership roles based on seniority to avoid any perception of bias.

  • Providing education on how to avoid conflicts arising from diverse opinions.

Correct answer: Encouraging team members to embrace their diverse experiences when contributing ideas.

Encouraging team members to embrace their diverse experiences when contributing ideas utilizes the wide range of experiences and perspectives that diversity brings to foster creativity and innovative solutions.

Encouraging conformity and discouraging deviations from traditional practices stifles creativity and innovation by discouraging diversity. Assigning leadership roles based on seniority does not leverage the benefits of diversity in leadership roles. Avoiding conflicts arising from diverse opinions prevents the team from exploring innovative ideas through healthy debate and discussion.

4.

In the context of value-based purchasing, which of the following is most likely to be a potential challenge for healthcare providers?

  • Increased administrative workload to document quality metrics.

  • Decreased emphasis on patient satisfaction scores.

  • Reduced need for collaboration among healthcare professionals.

  • Lowered focus on preventive care practices.

Correct answer: Increased administrative workload to document quality metrics.

Documenting and reporting quality metrics can significantly increase the administrative burden on providers.

Value-based purchasing is likely to place a high emphasis on patient satisfaction scores as part of quality metrics. Value-based purchasing encourages collaboration among healthcare professionals to improve patient outcomes. Preventive care practices are emphasized in value-based purchasing to improve patient outcomes and reduce costs.

5.

What would be a transactional leader's primary method for improving patient satisfaction scores in a healthcare setting?

  • Setting clear patient satisfaction goals and linking staff bonuses to these outcomes.

  • Developing a detailed plan focusing on staff empowerment and engagement.

  • Facilitating workshops on empathy and communication skills for all healthcare staff.

  • Redefining the organizational vision to prioritize patient-centered care.

Correct answer: Setting clear patient satisfaction goals and linking staff bonuses to these outcomes.

Setting clear patient satisfaction goals and linking staff bonuses to these outcomes fits the transactional leadership model, which emphasizes setting specific goals and using rewards (or penalties) to motivate teams to achieve desired outcomes.

Developing a detailed plan focusing on staff empowerment and engagement would be more indicative of a transformational leadership style. Workshops on empathy and communication would be a good approach, but they represent a more transformational or developmental strategy rather than transactional. Redefining organizational vision is a strategic move typically associated with transformational leadership, which aims to inspire change at a foundational level.

6.

A nurse executive is evaluating the cost-effectiveness of a new wound care product. Which of the following metrics would be most important in determining its resource utilization?

  • The average healing time for wounds using the product.

  • The product's purchase price per unit.

  • The percentage of patients satisfied with the product.

  • The number of staff required to apply the product.

Correct answer: The average healing time for wounds using the product.

Shorter healing times can indicate higher efficiency and better resource utilization by potentially reducing the length of stay and associated care costs.

While the purchase price is important, it doesn't provide complete information on cost-effectiveness or overall resource utilization. Patient satisfaction is important but does not directly measure cost-effectiveness or resource utilization. Staffing requirements are a factor in resource utilization but are secondary to the impact on patient outcomes and, except for in extreme or unusual situations, overall cost-effectiveness.

7.

What is the minimum number of employees a private sector employer must have for the Family and Medical Leave Act (FMLA) to apply?

  • 50 employees within a 75-mile radius

  • One employee

  • 100 employees within a 100-mile radius

  • 200 employees nationwide

Correct answer: 50 employees within a 75-mile radius

FMLA applies to private sector employers with 50 or more employees within a 75-mile radius.

Other less restrictive options are incorrect. An employer with only one employee is not obligated to provide FMLA.

8.

During a performance review, a high-performing nurse expresses feeling overwhelmed by their workload and states that it is impacting their performance. What is the most appropriate response by the nurse executive?

  • Reassigning some of the nurse’s responsibilities.

  • Suggesting time management training.

  • Ignoring the complaint as an excuse for poor performance.

  • Encouraging the nurse to take personal leave to recover.

Correct answer: Reassigning some of the nurse’s responsibilities.

Reassigning responsibilities can directly address the issue of being overwhelmed, potentially improving performance and job satisfaction.

Time management training may not address the root cause if the workload is objectively too high, which is more probable in a high-performing nurse with this complaint. Ignoring concerns dismisses the employee’s experience and may exacerbate performance issues. Encouraging leave does not solve the underlying problem of an excessive workload and may impact team staffing levels.

9.

A nurse leader is made aware of a long-standing conflict between two staff nurses that is affecting patient care delivery. What is the first step in addressing this issue?

  • Facilitate a mediated discussion between the two nurses.

  • Provide immediate feedback to both nurses individually.

  • Organize a team-building meeting for the whole department.

  • Terminate the two nurses to avoid further safety risks.

Correct answer: Facilitate a mediated discussion between the two nurses.

Facilitating a mediated discussion between the two nurses directly addresses the conflict by facilitating communication between the involved parties, aiming for a resolution that acknowledges both perspectives.

Providing immediate feedback to both nurses individually might be necessary but does not address the interpersonal conflict directly. Organizing a team-building meeting for the whole department is a good long-term strategy but doesn't address the immediate conflict. Terminating the two nurses should be a last resort as it does not foster a culture of resolution and understanding.

10.

A nurse has received negative feedback from patients regarding their bedside manner. What is the most effective strategy for the nurse executive to improve this situation?

  • Mandating enrollment in a communication and empathy training program.

  • Immediate suspension to send a strong message to other staff.

  • Public reprimand to deter similar behavior in others.

  • Transfer to a non-clinical department.

Correct answer: Mandating enrollment in a communication and empathy training program.

Providing education and training on communication and empathy can directly address the feedback and support the nurse in developing the necessary skills.

Immediate suspension may be punitive and does not provide an opportunity for improvement. Public reprimand can create a culture of fear and does not address the root cause of the issue. Transferring the nurse avoids the issue rather than addressing it and supporting the nurse's development.

11.

A nurse leader observes a recurring conflict between the day shift and night shift nurses over incomplete tasks and communication breakdowns. What strategy should the nurse leader employ to improve shift transitions?

  • Implement a standardized shift-change checklist and communication protocol.

  • Increase the number of staff on each shift to reduce workload.

  • Organize separate meetings with each shift to discuss their concerns.

  • Encourage informal shift handover discussions to improve relationships.

Correct answer: Implement a standardized shift-change checklist and communication protocol.

Implementing a standardized shift-change checklist provides a structured approach to improving communication and ensuring task completion, addressing the root cause of the conflict.

Increasing the number of staff on each shift might help with workload but does not directly improve communication. Organizing separate meetings with each shift could be useful for gathering information but it is not an intervention that provides an immediate solution. Encouraging informal shift handover discussions might improve relationships but lacks the structure needed to ensure consistent communication.

12.

A staff nurse requests FMLA leave to care for her spouse, who has a serious health condition. What documentation should the nurse executive require to best support the FMLA leave request?

  • A medical certification from a healthcare provider.

  • A note from the spouse's social worker.

  • A signed affidavit from the employee.

  • A court order compelling the staff member to care for their spouse.

Correct answer: A medical certification from a healthcare provider.

FMLA regulations require medical certification from a healthcare provider to support the need for leave due to a serious health condition.

A note from a social worker does not constitute medical certification. An affidavit from the employee is not a substitute for medical certification. While a court order compelling the staff member to care for their spouse could support the FMLA leave request, obtaining this documentation would be burdensome and unnecessary except in very rare situations.

13.

In an effort to enhance safety, a nurse executive introduces a monthly safety huddle where staff can discuss safety concerns and successes. This initiative should primarily aim to do which of the following?

  • Improve communication and team collaboration on safety issues.

  • Decrease the hospital's liability and insurance costs.

  • Increase staff accountability and individual performance metrics.

  • Punish those responsible for errors in a public forum.

Correct answer: Improve communication and team collaboration on safety issues.

Monthly safety huddles are designed to improve communication and collaboration, encouraging a shared responsibility for safety.

The primary aim should not be financial but focused on safety culture improvement. The initiative should aim to foster safety improvements through collaboration, not focus on individual metrics. The aim should be to foster an open, nonpunitive environment for discussing safety, not to punish individuals.

14.

After implementing a new Electronic Health Record (EHR) system, a nurse executive notes an increase in conflict among staff due to varying levels of tech-savviness. What is the most effective approach to address this issue?

  • Organize training sessions tailored to different skill levels.

  • Revert to the previous EHR system to avoid further conflict.

  • Assign tech-savvy staff to assist less experienced colleagues.

  • Encourage and incentivize self-learning to improve tech skills among the staff.

Correct answer: Organize training sessions tailored to different skill levels.

Organizing training sessions tailored to different skill levels acknowledges the diversity in staff's technological proficiency and provides a structured way to improve skills and reduce conflict.

Reverting to the previous EHR system ignores the benefits of the new system and the opportunity for staff development. Assigning tech-savvy staff to assist less experienced colleagues could be part of the solution but may not address the underlying need for formal training. Encouraging and incentivizing self-learning places the burden on individuals without offering support.

15.

When interviewing candidates for a nursing position, which question would be considered a violation of the Americans with Disabilities Act (ADA)?

  • Do you have any conditions that would prevent you from performing the job duties?

  • Can you perform the essential functions of this job with or without reasonable accommodation?

  • What skills or experiences do you bring to this position?

  • Are you available to work the schedule required by this position?

Correct answer: Do you have any conditions that would prevent you from performing the job duties?

Asking about medical conditions the interviewee may have is a violation of the ADA because it inquires into the candidate's medical conditions.

Asking if they can perform the essential functions of this job with or without reasonable accommodation directly relates to the candidate's ability to perform job-related functions, which is allowed under the ADA. Asking what skills or experiences they bring to the position pertains to the candidate's qualifications, not their medical status or disabilities. Asking about the candidate's availability does not encroach on the topic of their medical status or disabilities.

16.

After resolving a heated dispute between several team members, a nurse leader wants to rebuild team cohesion and trust. What is the most effective strategy to accomplish this goal?

  • Organize team-building activities that require collaboration and communication.

  • Move on from the past conflicts and focus solely on future team goals.

  • Implement new rules on team interactions to prevent future conflicts.

  • Encourage the team members who were not part of the conflict to improve team unity.

Correct answer: Organize team-building activities that require collaboration and communication.

Team-building activities can help mend relationships by improving communication and trust while fostering a positive team environment.

Ignoring past conflicts without addressing underlying issues or rebuilding trust may leave residual tension. While rules are important and may influence behaviors, they alone cannot rebuild trust or cohesion after a conflict. Additionally, rules affecting team interactions can disrupt team unity and cohesion. Excluding certain team members from interventions can create further division and resentment. Increasing the involvement of team members who were not part of the conflict can expand the issue further than it needs to be.

17.

During a literature review on strategies to improve patient satisfaction in outpatient clinics, a nurse executive finds a systematic review that includes several randomized controlled trials. What is the significance of this finding for evidence-based practice?

  • It indicates a high level of evidence that can guide practice improvements.

  • It suggests that patient satisfaction can be objectively measured across different settings.

  • It implies that the strategies are cost-effective and easy to implement.

  • It shows that the strategies have been widely adopted.

Correct answer: It indicates a high level of evidence that can guide practice improvements.

A systematic review that includes Randomized Controlled Trials (RCTs) provides a high level of evidence, summarizing and synthesizing findings from multiple studies to guide practice improvements effectively.

While patient satisfaction can be measured, the significance of finding a systematic review with RCTs is not directly related to its measurability across settings. The cost-effectiveness and ease of implementation of the strategies are not directly indicated by the presence of a systematic review with RCTs. The widespread adoption of the strategies is not directly indicated by the presence of a systematic review with RCTs.

18.

The Emergency Department (ED) is experiencing high levels of stress due to a recent influx of patients. As a servant leader, how should the nurse executive respond to improve the situation?

  • Facilitate a meeting with the ED team to identify their needs and collaboratively develop a plan to manage the patient influx.

  • Enforce mandatory overtime for all ED nurses to ensure patient care needs are met.

  • Direct the hiring of temporary staff without discussing the current situation with the ED team.

  • Delegate the responsibility of managing the patient influx to the ED manager.

Correct answer: Facilitate a meeting with the ED team to identify their needs and collaboratively develop a plan to manage the patient influx.

Facilitating a meeting with the ED team to identify their needs and collaboratively plan, embodies servant leadership by prioritizing the needs of the team, encouraging their involvement in decision-making, and addressing both staff well-being and patient care quality.

Mandatory overtime might address immediate patient care needs but does not consider the well-being of the staff, which is a key concern of servant leadership. While hiring additional staff could be beneficial, making such decisions without team input does not foster a servant leadership environment that values collaboration and input. Delegating responsibility is important but disengaging from the process fails to demonstrate the commitment to serving and supporting the team's needs, an important characteristic of servant leadership.

19.

To support a culture of continuous improvement in patient care, a nurse executive introduces a new program encouraging staff to report near-misses and safety concerns. Which of the following features should be included in this program to ensure its effectiveness?

  • Anonymity for those reporting incidents to encourage openness without fear of retribution.

  • A detailed reporting system that thoroughly documents each incident.

  • Punitive measures for staff involved in near-misses and for those who do not report them.

  • A focus on high-severity incidents only to prioritize resources for the most critical areas.

Correct answer: Anonymity for those reporting incidents to encourage openness without fear of retribution.

Anonymity encourages staff to report incidents by reducing fear of blame or retribution, fostering an environment where safety concerns can be openly discussed and addressed.

A complex system may deter staff from reporting due to the time and effort required to navigate it. Punitive measures can lead to underreporting of incidents as staff may fear punishment or blame. It can also have the opposite effect if non-reported is punished, causing an over-reporting of errors to avoid punishment. Focusing only on high-severity incidents overlooks the importance of learning from near-misses, which can prevent more serious incidents from occurring.

20.

When implementing a new Electronic Health Record (EHR) system, what should a nurse executive prioritize to ensure high-quality patient care?

  • Comprehensive staff training on the EHR system.

  • Phasing the rollout of the new EHR system based on provider roles.

  • Reducing the number of patients seen during the transition period.

  • Increasing the nurse-to-patient ratio.

Correct answer: Comprehensive staff training on the EHR system.

Effective training ensures that staff can use the EHR system efficiently, reducing errors and improving patient care quality.

While a phased rollout may be necessary, this is best done by phasing it based on certain patient populations or units, not by provider type, as this can affect the coordination of interdisciplinary care. Reducing the number of patients might decrease workload during the transition, but it doesn't ensure the long-term success of the EHR system in improving patient care and may not be practical. Although important, increasing the nurse-to-patient ratio does not address the direct need for effective use of the new EHR system.