ANCC NE-BC Exam Questions

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181.

A nurse executive evaluating the impact of leadership styles on nursing staff turnover intends to use evidence-based practice. Which of the following research designs would provide the most comprehensive evidence?

  • A systematic review of mixed-methods studies.

  • A single qualitative study.

  • A cross-sectional quantitative survey.

  • A longitudinal cohort study.

Correct answer: A systematic review of mixed-methods studies.

A systematic review of mixed-methods studies combines the strengths of qualitative and quantitative research, providing a comprehensive overview of the evidence on leadership styles and staff turnover.

A single qualitative study can provide in-depth insights but may not offer comprehensive evidence on the impact of leadership styles. A cross-sectional quantitative survey can indicate correlations at a specific point in time, but it lacks the depth and temporal perspective to fully understand turnover dynamics. A longitudinal cohort study can track changes over time but may not capture the complex, multifaceted nature of the issue.

182.

A healthcare system is planning to implement a remote monitoring program for hypertension management. Which factor is most important to consider for the success of the program?

  • Integration of patient-generated data with provider workflows.

  • The comfort of the blood pressure monitoring devices.

  • Compatibility of the devices with different smartphone models.

  • Educational materials provided for patient self-management.

Correct answer: Integration of patient-generated data with provider workflows.

The seamless integration of remote monitoring data into provider workflows is essential for timely and effective clinical responses, directly influencing the success of hypertension management programs.

While design and comfort may affect patient satisfaction and improve adherence, it does not impact the program's success in managing hypertension. Compatibility expands access but is not as crucial as effective use of the data in clinical decision-making. Education is important for engagement and compliance but secondary to the clinical integration of data for managing hypertension.

183.

A nurse executive is leading a quality improvement team to reduce medication errors on a medical-surgical unit. Which of the following steps should the team take first according to the PDSA cycle?

  • Analyze medication error reports from the past six months.

  • Implement a standardized medication administration protocol.

  • Begin a training program to improve current staff knowledge regarding medication safety.

  • Review and assess the effectiveness of the new protocol after three months.

Correct answer: Analyze medication error reports from the past six months.

The Plan-Do-Study-Act (PDSA) cycle is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a process or product, involving planning the test or change, implementing it, observing and studying the results, and acting on what is learned to make further improvements. Analyzing current errors provides insight into problem areas, guiding the planning phase.

Implementation of changes like a standardized medication administration protocol comes after planning and analysis. Improving staff knowledge is likely to be part of the “Do” or “Act” phase. Reviewing the protocol's effectiveness is part of the "Study" phase, and comes after implementation.

184.

Following a serious safety event involving a patient falling, what is the most appropriate initial action by the nurse executive?

  • Organize a debrief session with the staff involved to discuss the event openly.

  • Immediately suspend the staff involved pending an investigation.

  • Issue a memo to all staff highlighting the consequences and potential legal risks of negligence.

  • Update the facility's fall prevention protocols as soon as possible to prevent similar incidents.

Correct answer: Organize a debrief session with the staff involved to discuss the event openly.

Organizing a debrief allows for open discussion and learning from the event, and supports a non-punitive approach to safety.

Immediate suspension of staff involved can foster a culture of blame rather than improvement. The focus should be on improving processes that caused the fall, not assigning blame. Highlighting the consequences of the fall can contribute to a blame culture and does not focus on improving and mitigating risk factors. Updating protocols prior to analyzing the root cause of the event is incorrect.

185.

During a meeting on technology integration, a nurse executive discusses the implementation of a telehealth program. What is the primary goal of introducing telehealth services in a healthcare facility?

  • Enhancing access to care for patients.

  • Improving the adoption and integration of technology in care.

  • Increasing the facility's revenue.

  • Decreasing the workload of healthcare staff.

Correct answer: Enhancing access to care for patients.

The primary goal of introducing telehealth services is to enhance access to care, especially for patients in remote locations or with mobility issues.

Improving the adoption and integration of technology in care will be an outcome of introducing telehealth services, but this is not the primary goal. Increased revenue can result from telehealth services, however, the main goal is to improve patient care accessibility. Decreasing the workload of healthcare staff is a potential benefit, but the primary aim is to expand care access.

186.

To align with budgetary constraints, a nurse executive plans to adjust the HPPD target for a geriatric unit. Which consideration is most critical to ensure patient care is not adversely affected?

  • The unit's current staffing mix and competencies.

  • The current patient satisfaction scores.

  • The average length of stay on the unit.

  • The national benchmarks for HPPD in similar units.

Correct answer: The unit's current staffing mix and competencies.

Understanding the existing staffing mix and competencies is crucial to ensure that any adjustments to Nursing Hours Per Patient Day (HPPD) do not compromise the quality of patient care.

While important, patient satisfaction scores do not directly inform the appropriate HPPD for safe staffing levels. The average length of stay provides context for planning but is not the most critical factor in adjusting HPPD. National benchmarks offer a reference point but must be balanced with specific unit needs and staff capabilities to maintain patient care standards.

187.

Which reimbursement model is designed to cover all of a patient's healthcare needs for a predetermined period in exchange for a fixed payment?

  • Capitation

  • Fee-for-service

  • Bundled payments

  • Diagnosis-related group

Correct answer: Capitation

Capitation pays a set amount for each enrolled person assigned to them, per period of time, whether or not that person seeks care.

Fee-for-service reimburses individual services and does not provide a fixed payment covering all needs. Bundled payments are for expected costs of clusters of services during a healthcare event or for a specific condition. Diagnosis-related group is a system to classify hospital cases into groups that are expected to have similar hospital resource use.

188.

In response to a sudden increase in patient volume, a nurse executive must quickly adapt the staffing schedule. What is the best strategy to quickly ensure adequate staffing without increasing burnout?

  • Offer incentive pay for extra shifts.

  • Double the nurse-to-patient ratio.

  • Use agency nurses to fill gaps.

  • Implement cross-training for all staff.

Correct answer: Offer incentive pay for extra shifts.

Offering incentive pay for extra shifts provides an immediate solution to staffing needs while motivating staff to volunteer for extra shifts without mandating overtime.

Doubling the nurse-to-patient ratio is not a plan for addressing immediate staffing needs. Using agency nurses could be a viable option but may not be as immediate or cost-effective as offering incentive pay. While cross-training is beneficial for flexibility, it does not address the immediate need for more staff and will take time to be an effective intervention.

189.

A nurse executive notices a significant increase in staff burnout and turnover rates in the pediatric unit. Which of the following actions aligns best with servant leadership principles to address this issue?

  • Organizing a series of workshops and support groups where staff can express their concerns and suggest improvements.

  • Implementing a strict policy to minimize absenteeism and enforce discipline among the staff.

  • Assigning additional administrative tasks to senior staff members to closely monitor team performance and workflow efficiency.

  • Increasing the nurse-patient ratio to reduce workload without consulting the nursing staff for their input.

Correct answer: Organizing a series of workshops and support groups where staff can express their concerns and suggest improvements.

Organizing a series of workshops and support groups for staff reflects the core of servant leadership, focusing on serving the needs of staff members to improve their well-being and job satisfaction.

Imposing strict policies without addressing the root causes of burnout does not align with servant leadership, which emphasizes understanding and supporting the team's needs. Adding administrative tasks without addressing the underlying issues of burnout and turnover is likely to be counterproductive and does not demonstrate a commitment to serving the team's needs. Although reducing workload is positive, failing to consult the nursing staff disregards the principle of involving team members in decision-making, a key aspect of servant leadership.

190.

A healthcare facility is deciding whether to pay their nurse managers on an hourly or salaried basis. In considering the Fair Labor Standards Act (FLSA) regulations, which factor is most critical in determining if these nurse managers should be eligible for overtime pay?

  • The amount of autonomy and decision-making authority the nurse managers have.

  • The number of hours the nurse managers are expected to work each week.

  • The educational level of the nurse managers.

  • The method of payment, whether hourly or salary.

Correct answer: The amount of autonomy and decision-making authority the nurse managers have.

The key factor in determining exempt status under the FLSA is the nature of the job duties, particularly the level of autonomy and decision-making authority, which indicates an executive, administrative, or professional exemption.

While the number of hours worked can affect whether overtime is due, it does not determine exempt status. Educational level alone does not determine exempt status under the FLSA. The method of payment (hourly vs. salary) is less critical than the nature of the job duties in determining exempt status.

191.

A nurse executive is reviewing the performance of a nursing team that has recently shown a decline in patient satisfaction scores. Which action by the nurse executive is most likely to identify the underlying issues affecting team performance?

  • Conducting a team meeting to discuss the recent patient satisfaction scores.

  • Implementing an open-door policy for team members to discuss issues privately.

  • Assigning an external consultant to assess team dynamics and report findings.

  • Increasing the frequency of performance appraisals for all team members.

Correct answer: Conducting a team meeting to discuss the recent patient satisfaction scores.

Conducting a team meeting to discuss the recent patient satisfaction scores directly addresses the issue in a collective setting, encouraging open communication and collaboration toward identifying problems and developing solutions.

An open-door policy is beneficial for individual concerns but might not reveal collective dynamics affecting performance. It is also a more passive approach used for recognizing new issues and is not ideal for addressing existing issues. Assigning an external consultant could help, but it might not be the most immediate or engaging approach for the team. Increasing the frequency of performance appraisals focuses on individual assessment rather than team dynamics and could fail to address the underlying issues.

192.

A nurse executive is developing a policy to address end-of-life care. Which of the following actions best aligns with the ANA Code of Ethics?

  • Ensuring the policy supports patient autonomy and informed decision-making.

  • Reducing family involvement to reduce confusion and streamline patient-centered care.

  • Prioritizing cost-effectiveness in end-of-life care options.

  • Implementing a standard care protocol for all end-of-life patients to ensure equitable, unbiased care.

Correct answer: Ensuring the policy supports patient autonomy and informed decision-making.

Ensuring the policy supports patient autonomy and informed decision-making aligns with the ANA Code of Ethics by respecting patients' values and decisions, thus promoting autonomy and informed consent.

The ANA Code of Ethics emphasizes the importance of including the patient and their family in care decisions, recognizing their values and needs; reducing their involvement is incorrect. While cost-effectiveness is important, it should not override ethical considerations like patient autonomy and the delivery of compassionate, appropriate care. The ANA Code of Ethics advocates for personalized care that respects each patient's unique preferences and needs, rather than a one-size-fits-all approach.

193.

What type of sexual harassment would best describe a situation in which a nurse is denied a promotion because of refusal of their manager's sexual demands?

  • Quid pro quo

  • Hostile work environment

  • Verbal

  • Implied

Correct answer: Quid pro quo

Quid pro quo is a favor or an advantage that is given in return for something. This is an example of quid pro quo because it is linked to an employee benefit.

A hostile work environment describes sexual harassment that creates an unpleasant work environment. Sexual harassment may be verbal or implied; however, quid pro quo best describes sexual harassment that involves an offer to trade sexual favors for material benefits. Sexual harassment is a form of illegal discrimination and is not tolerated in the workplace. Steps should be taken to prevent sexual harassment from occurring, including providing training that increases employee awareness of how serious it is in the workplace. In addition, an effective grievance process should be in place in the case of employee complaints.

194.

A nurse executive aims to enhance the professional development opportunities for nursing staff in a long-term care facility. Which initiative best represents a servant leadership approach?

  • Offering a diverse array of professional development opportunities and allowing nurses to choose based on their interests and career goals.

  • Mandating participation in a predefined set of professional development courses for all nursing staff.

  • Designating senior nursing staff to select appropriate professional development courses that will best serve their juniors.

  • Implementing an annual performance review system to identify areas for mandatory training for each nurse.

Correct answer: Offering a diverse array of professional development opportunities and allowing nurses to choose based on their interests and career goals.

Offering a diverse array of professional development opportunities and allowing nurses to choose based on their interests and career goals aligns with servant leadership by supporting the growth and development of staff members according to their own aspirations and needs. This approach best demonstrates a commitment to staff’s personal and professional well-being.

While professional development is important, mandating a one-size-fits-all approach does not cater to individual needs or interests and is contrary to servant leadership principles. Although involving senior staff in decision-making can be valuable, this does not ensure that the individual needs and goals of all nursing staff are considered, as servant leadership would dictate. Performance reviews are useful, but using them to mandate training does not fully embrace the empowerment and support for individual growth at the heart of servant leadership.

195.

In attempting to improve hand hygiene compliance, a nurse executive applies the PDSA cycle. Which step corresponds to analyzing the effectiveness of newly installed hand sanitizer dispensers?

  • Study

  • Plan

  • Do

  • Act

Correct answer: Study

The Plan-Do-Study-Act (PDSA) cycle is a systematic series of steps for gaining valuable learning and knowledge for the continual improvement of a process or product, involving planning the test or change, implementing it, observing and studying the results, and acting on what is learned to make further improvements. The "Study" phase involves analyzing the results and effectiveness of the interventions made during the "Do" phase. Analyzing the effectiveness of newly installed hand sanitizer dispensers to improve hand hygiene compliance falls directly under this phase.

The “Plan” phase involves identifying the problem and devising strategies to address it, not analyzing the effectiveness of implemented solutions. The "Do" phase involves the implementation of the planned actions, such as installing new hand sanitizer dispensers, rather than evaluating their impact. In the "Act" phase, decisions are made based on the analysis from the "Study" phase, which might include expanding the project or making adjustments, but it is not where effectiveness is analyzed.

196.

A nurse manager is developing a staffing plan for the upcoming year. To comply with the Family and Medical Leave Act (FMLA), they must ensure which of the following?

  • Employees who have worked for the hospital for at least 12 months, for a minimum of 1,250 hours, are eligible for up to 12 weeks of unpaid, job-protected leave.

  • All employees, regardless of their employment period, are eligible for up to 12 weeks of unpaid leave.

  • Only full-time employees who have worked for the hospital for at least 12 months are eligible for up to 12 weeks of unpaid leave.

  • Employees who have worked for the hospital for at least 6 months are eligible for up to 12 weeks of unpaid, job-protected leave.

Correct answer: Employees who have worked for the hospital for at least 12 months, for a minimum of 1,250 hours, are eligible for up to 12 weeks of unpaid, job-protected leave.

According to FMLA requirements, employees are eligible for up to 12 weeks of unpaid, job-protected leave if they have worked for the employer for at least 12 months and for a minimum of 1,250 hours during those 12 months.

FMLA eligibility requires employees to have worked for the employer for at least 12 months and is not irrespective of their employment period. Part-time employees can meet the eligibility criteria based on hours worked. The minimum employment period to qualify for FMLA benefits is 12 months, not 6 months.

197.

After receiving feedback about the lack of professional development opportunities, a nurse executive plans to enhance the nursing team's skills and knowledge. Which approach would best achieve this goal?

  • Developing a mentorship program that pairs experienced nurses with newer staff members.

  • Mandating participation in external continuing education courses.

  • Offering a one-time workshop on a relevant topic.

  • Requiring nurses to independently find and complete online courses that meet specific requirements.

Correct answer: Developing a mentorship program that pairs experienced nurses with newer staff members.

Developing a mentorship program that pairs experienced nurses with newer staff members provides personalized, ongoing professional development and fosters a supportive learning environment.

Mandating external courses may not meet individual or team needs and lacks personalization. A one-time workshop can be informative but doesn’t offer continuous development. Requiring independent study places the burden on individuals without organizational support or guidance.

198.

A nurse executive is developing a new policy to enhance compliance with corporate compliance standards. Which approach should be prioritized to effectively integrate these standards into daily nursing practice?

  • Incorporating compliance standards into job descriptions and performance evaluations.

  • Implementing an annual training session for all nursing staff on corporate compliance.

  • Posting corporate compliance standards on the hospital Intranet.

  • Sending monthly emails to staff highlighting different aspects of corporate compliance.

Correct answer: Incorporating compliance standards into job descriptions and performance evaluations.

Embedding compliance standards into job descriptions and evaluations ensures that adherence to these standards is seen as part of staff duties and is assessed regularly, promoting ongoing compliance.

While annual training sessions are valuable, they are not as effective as the continuous integration of compliance standards into everyday responsibilities. Simply posting standards may increase awareness but it does not ensure active engagement with the postings or adherence by staff. Monthly emails can provide reminders but lack the direct impact on daily practice and accountability that incorporating standards into evaluations and descriptions offers.

199.

A nurse executive is leading a team in a pediatric ward that is implementing a new, evidence-based approach to patient care. The nurse executive wants to inspire the team to adopt this change and see the value in improving patient outcomes. Which leadership style would be most effective in this scenario?

  • Transformational leadership

  • Transactional leadership

  • Autocratic leadership

  • Laissez-faire leadership

Correct answer: Transformational leadership

Transformational leadership involves inspiring and motivating employees to put aside their own self-interest for the good of the group and is ideal for implementing new evidence-based practices.

Transactional leadership focuses on routine, supervision, and performance to earn rewards, which is less effective for inspiring change and innovation. Autocratic leadership involves making decisions without input from the team, which may not foster a supportive environment for embracing new approaches. Laissez-faire leadership involves minimal direct supervision, which might not provide the necessary guidance and motivation for adopting a new care approach.

200.

A nurse executive is reviewing incident reports from the past month. Which of the following actions best demonstrates an enhanced culture of safety?

  • Implementing a no-blame policy for reporting near misses and incidents, even if primarily one individual was involved.

  • Retraining staff involved in medication errors to deter future mistakes.

  • Increasing surveillance of staff to promptly identify and correct unsafe practices, but in a way that does not assign blame.

  • Focus improvement efforts on errors that resulted in patient harm.

Correct answer: Implementing a no-blame policy for reporting near misses and incidents, even if primarily one individual was involved.

A no-blame policy encourages reporting of incidents and near misses, which is essential for identifying and addressing systemic issues, thereby improving safety. While an individual may be involved, efforts that focus on system errors that affect that individual are most important.

Punishing staff through mandatory retraining can create a culture of fear, leading to the underreporting of incidents. Increased surveillance may also contribute to a culture of fear rather than encouraging open communication about mistakes. Focusing on errors that resulted in patient harm misses important potential areas for improvement.