ANCC NE-BC Exam Questions

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21.

During a departmental meeting, a nurse executive discusses the vision for enhancing the quality of patient care through interdisciplinary collaboration. The executive encourages the team to share innovative ideas and commit to personal and professional growth. This approach exemplifies which type of leadership?

  • Transformational leadership

  • Servant leadership

  • Bureaucratic leadership

  • Democratic leadership

Correct answer: Transformational leadership

Transformational leadership is characterized by motivating and inspiring followers to achieve extraordinary outcomes and by facilitating personal and professional growth. This type of leadership is illustrated by the encouragement to share innovative ideas.

Servant leadership emphasizes serving the needs of others first, which, while important, does not directly relate to inspiring innovation and a shared vision. Bureaucratic leadership is based on fixed official duties under a hierarchy of authority, applying a systematic set of rules for management; it does not typically inspire innovation. Democratic leadership involves making decisions based on the input of each team member, but it does not inherently focus on inspiring or motivating change and innovation.

22.

Following the introduction of a standardized handoff protocol in the emergency department, a nurse executive wishes to evaluate its effectiveness. What is the most direct measure of success for this initiative?

  • A decrease in adverse events related to miscommunication.

  • The number of staff complaints about the handoff process.

  • A reduction in patient wait times.

  • Feedback from patient satisfaction surveys about the discharge process.

Correct answer: A decrease in adverse events related to miscommunication.

A decrease in adverse events directly attributable to miscommunication demonstrates the protocol's effectiveness in enhancing patient safety.

Staff complaints can provide insight into the protocol's acceptance but do not measure effectiveness in improving patient safety. Patient wait times are influenced by many factors and are not directly related to the quality of handoffs. While patient feedback is important, it may not specifically address the effectiveness of the handoff protocol as well as measuring communication-related adverse events.

23.

In implementing a team nursing model in a pediatric unit, what is the primary role of the RN?

  • Coordinator of care for a group of patients.

  • Direct care provider for all patients.

  • Supervisor for LPNs and nursing aides.

  • Being solely responsible for medication administration and assessments, but not for other tasks.

Correct answer: Coordinator of care for a group of patients.

In a team nursing model, the RN coordinates care among team members, ensuring that each patient's care plan is implemented effectively.

While RNs provide direct care, it is not their only role in a team nursing model. Supervision is part of the role, but the primary role is coordinating care, not just supervision. In a team nursing model, RNs are responsible for coordinating care among team members and ensuring that all patient care tasks are completed. They are not solely responsible for certain tasks but for the overall care delivered, whether that care is delivered by them personally or delegated.

24.

A nurse manager is scheduling staff for the upcoming week and decides to mandate overtime for several nurses due to unexpected staff shortages. According to the Fair Labor Standards Act (FLSA), which statement is true regarding overtime pay?

  • Overtime pay must be at least one and a half times the nurse's regular rate of pay for hours worked beyond 40 in a workweek.

  • Overtime pay is not required for nurses because they are considered essential workers.

  • Nurses can opt out of overtime pay if they agree to compensatory time off instead.

  • Overtime pay is only required for hourly employees, not for salaried nurse managers.

Correct answer: Overtime pay must be at least one and a half times the nurse's regular rate of pay for hours worked beyond 40 in a workweek.

The FLSA mandates that non-exempt employees receive overtime pay at a rate of at least one and a half times their regular rate of pay for all hours worked over 40 in a workweek.

The FLSA requires that an employee classified as non-exempt, including many nurses, receive overtime pay for hours worked over 40 in a workweek, regardless of being an essential worker or not. The FLSA does not allow employees to waive their right to overtime pay in exchange for compensatory time off in private sector jobs. The determination of eligibility for overtime is not based solely on being salaried or hourly but on the employee's specific job duties and salary.

25.

A nurse executive wants to improve patient satisfaction in the outpatient surgery center. Which lean tool is most appropriate for gathering input directly from patients to understand their experiences and identify improvement areas?

  • Gemba Walk

  • Kaizen Event

  • Kano Model Analysis

  • SIPOC Diagram

Correct answer: Gemba Walk

A Gemba Walk, which involves going to the actual place where work is done to observe and understand the process, is the most appropriate lean tool for gathering direct input from patients.

A Kaizen Event is a short-duration event focused on making rapid changes and improvements but does not specifically focus on gathering patient input. Kano Model Analysis is used for product development and understanding customer (patient) satisfaction, but it is not a direct observation tool. SIPOC Diagrams are useful for understanding a process from a high-level perspective but do not involve direct interaction with patients for feedback.

26.

A nurse executive is analyzing the hospital's performance on core measures. Which of the following would be considered a core measure for assessing the effectiveness of heart failure management?

  • Percentage of heart failure patients given discharge instructions.

  • Satisfaction scores of heart failure patients.

  • Nurse-to-patient ratio in the cardiac unit.

  • Number of staff training sessions on heart failure management.

Correct answer: Percentage of heart failure patients given discharge instructions.

Discharge instructions for heart failure patients are a recognized core measure, reflecting the hospital's commitment to patient education and self-management of their condition.

Patient satisfaction is important but it does not directly measure the clinical management of heart failure. The nurse-to-patient ratio affects overall care but is not a specific core measure for heart failure management. Staff training is crucial for quality care but it is not a direct core measure of how heart failure patients are managed upon discharge.

27.

A nurse manager observes that after implementing a new Electronic Health Record (EHR) system, there is a spike in medication errors. The best initial response to address this issue while promoting a culture of safety would be to do which of the following?

  • Conduct an assessment to identify and address gaps in EHR usage.

  • Identify and retrain the staff members who made the errors.

  • Recognize that the spike is a temporary adjustment issue and monitor to ensure that error rates return to the baseline quickly.

  • Remove the new EHR system and revert to the previous method to maintain patient safety.

Correct answer: Conduct an assessment to identify and address gaps in EHR usage.

Conducting a further assessment to identify gaps in EHR usage directly tackles the problem's root cause, and allows for interventions to be developed that are more likely to be effective.

Disciplining or retraining staff may be necessary, but does not necessarily address the root cause of the errors; further assessment is warranted first. Ignoring the issue does not solve the underlying problem or promote a safe environment. Removing the new system could be necessary, but should not be done without first gaining a good understanding of the root cause of the issue.

28.

What is the key factor a nurse executive should consider when implementing a new barcode medication administration system?

  • The potential for the system to reduce medication errors.

  • The system's compatibility with existing software and hardware.

  • The training required for nursing staff to use the system.

  • The potential for the system to improve nursing workflows.

Correct answer: The potential for the system to reduce medication errors.

The primary consideration should be the system's potential to reduce medication errors as this directly impacts patient safety and care quality.

Compatibility with existing systems is important for logistical implementation, but not the key factor for clinical impact. Training will be necessary for effective use but it is a secondary consideration when compared to the system's impact on patient safety. The impact of the system on nursing workflows is an important consideration but it is not as important as the impact it will have on patient safety.

29.

To address ethical dilemmas in patient care, a nurse executive plans to form an ethics committee. Which stakeholders should be prioritized for inclusion according to the ANA Nursing Administration Scope and Standards of Practice?

  • Clinical nurses and nurse managers.

  • Financial officers and legal counsel.

  • Patients and their family members.

  • External ethics consultants.

Correct answer: Clinical nurses and nurse managers.

Including clinical nurses and nurse managers ensures that the committee is grounded in the practical and ethical concerns of nursing practice, aligning with ANA standards for collaborative problem-solving.

While financial and legal perspectives are important, they do not directly address clinical ethical dilemmas and do not involve direct stakeholders. Patient and family involvement is important but should complement, not prioritize, the clinical perspective. External consultants can offer valuable insights, but prioritizing internal stakeholders ensures that approaches are relevant and applicable to the organization's specific context.

30.

Nurses at a healthcare facility are attempting to form a union. The facility's management responds by increasing surveillance in areas where nurses commonly discuss unionization efforts. According to the National Labor Relations Act (NLRA), which of the following is correct about this response?

  • Illegal, as it may constitute an unfair labor practice by creating a chilling effect on union activities.

  • Legal, as employers have the right to monitor employee activities on company property.

  • Legal, if the surveillance is part of the company's standard security measures.

  • Illegal, unless the increased surveillance is disclosed to employees in advance.

Correct answer: Illegal, as it may constitute an unfair labor practice by creating a chilling effect on union activities.

Increasing surveillance with the intent of monitoring union activities specifically can be seen as creating a chilling effect on those activities, violating employees' rights under the NLRA.

While employers have the right to monitor activities to some extent, targeted surveillance aimed at union activities can be considered an unfair labor practice. Even if surveillance is part of standard security measures, targeting or increasing it due to union activities without a legitimate business justification can still be considered illegal. Disclosure does not legalize the act if the intent is to intimidate or monitor employees engaged in protected concerted activities.

31.

A nurse executive is leading a quality improvement project aimed at reducing Hospital-Acquired Infections (HAIs) in the surgical unit. Which initial step best applies the principles of continuous process improvement?

  • Conduct a root cause analysis of recent HAI cases.

  • Implement a new sterilization technology across the unit.

  • Increase the frequency of hand hygiene audits.

  • Mandate additional infection control training for all surgical staff.

Correct answer: Conduct a root cause analysis of recent HAI cases.

A root cause analysis is a fundamental first step to continuous process improvement and will help identify the underlying causes of HAIs, allowing for targeted interventions.

Implementing a new sterilization technology would be premature without understanding specific causes. Increasing the frequency of hand hygiene audits and providing additional infection control training are potential actions, but they should be based on findings from the analysis to ensure they address the root issues effectively.

32.

In the context of team performance management, how should a nurse executive respond to a team member consistently underperforming?

  • Immediately provide targeted support and development opportunities to address specific areas of underperformance.

  • Take the difficult step of terminating their employment to maintain team standards.

  • Give the issue time to resolve spontaneously, recognizing that it may improve given more time.

  • Publicly reprimand the team member to deter others from underperforming.

Correct answer: Immediately provide targeted support and development opportunities to address specific areas of underperformance.

Offering support and development opportunities can improve performance and demonstrate a commitment to team member growth.

Termination as an initial response does not address potential underlying issues or support team member development. Termination can lead to the loss of a team member who would be valuable if correctly supported. Ignoring the issue can lead to a further decline in performance and lead to more issues, such as decreased team morale which will be harder to address. Public reprimand can harm morale and does not constructively address the issue.

33.

A group of nurses at a small clinic have successfully formed a union and are in the early stages of collective bargaining. The clinic's owner threatens to close the clinic if the nurses do not abandon their union activities. According to the National Labor Relations Act (NLRA), which of the following best describes the owner's threat?

  • Illegal, as it constitutes a threat of reprisal for engaging in protected union activities.

  • Legal, as business owners have the right to make decisions regarding the closure of their business.

  • Legal, but only if the clinic is experiencing financial difficulties that justify considering closure.

  • Illegal, but only if the clinic remains profitable and the threat is deemed a coercive tactic.

Correct answer: Illegal, as it constitutes a threat of reprisal for engaging in protected union activities.

Threatening to close the clinic as a reprisal for union activities is considered an unfair labor practice, as it aims to intimidate employees exercising their rights.

While business owners can make decisions about their business, threatening closure specifically as a response to union activities is an unfair labor practice under the NLRA. Even if the clinic is facing financial difficulties, using the threat of closure as leverage against union activities is illegal. The legality of the threat does not depend on the clinic's profitability but on the intent to intimidate or coerce employees in relation to their protected rights.

34.

A nurse executive is reviewing their facility's policies to ensure compliance with the Joint Commission's standards. Which of the following actions is most important for aligning with patient safety goals?

  • Implementing a standardized approach to handoff communications.

  • Conducting regular staff meetings to discuss incident reports.

  • Increasing the frequency of Healthcare-Associated Infection (HAI) screenings.

  • Mandating annual training for emergency preparedness.

Correct answer: Implementing a standardized approach to handoff communications.

The Joint Commission emphasizes effective communication among caregivers, particularly during handoffs, as a critical component of patient safety, making this the most crucial action for compliance.

While discussing incident reports is important for quality improvement, it does not align with the Joint Commission's specific patient safety goals as well as improved handoff communications. Although Healthcare-Associated Infection (HAI) screenings are important for patient safety, they are not an intervention to reduce HAIs proactively. Improving handoff communications is more likely to enhance alignment with patient safety goals than the screening of HAIs. Annual training for emergency preparedness is essential, but it does not address the specific focus of standardized communication protocols outlined by the Joint Commission's patient safety goals.

35.

A nurse manager is reviewing the hospital's policy on patient privacy with the nursing staff. Which action best represents compliance with Health Insurance Portability and Accountability Act (HIPAA) regulations?

  • Only discussing patient information in a secured area where unauthorized personnel cannot overhear.

  • Only sharing patient details with colleagues not involved in the patient's care, and if it is specifically for educational purposes and the colleagues have a HIPAA agreement with the facility.

  • Only allowing immediate family members to access patient records and only permitting access if they have signed a HIPAA agreement or waiver.

  • Permitting staff to post about challenging patient cases on social media on the condition that names and personal identifiers are not included.

Correct answer: Only discussing patient information in a secured area where unauthorized personnel cannot overhear.

Ensuring discussions about patient information take place in secure areas minimizes the risk of unauthorized access, aligning with HIPAA’s requirement to protect patient privacy.

Sharing patient details for educational purposes without direct involvement in care or without patient consent violates HIPAA privacy rules. Allowing family members to access patient records without explicit consent for the patient breaches patient confidentiality and HIPAA regulations. Posting patient cases on social media, even without names or personal identifiers, can still potentially identify the patient and violates HIPAA privacy standards.

36.

A nurse executive is evaluating different staffing models to address fluctuations in patient volume in an acute care unit. Which staffing model allows the most flexibility to adjust nursing staff based on actual patient needs?

  • Patient acuity-based staffing

  • Fixed staffing

  • Ratio staffing

  • Centralized staffing

Correct answer: Patient acuity-based staffing

Patient acuity-based staffing adjusts the number and qualifications of nursing staff based on the acuity level of patients, providing flexibility to meet actual patient needs.

Fixed staffing does not adjust based on patient volume or acuity, leading to potential under or overstaffing. Ratio staffing strictly adheres to a set nurse-to-patient ratio, which may not accurately reflect patient needs. Centralized staffing focuses on the allocation of staff from a central point and does not inherently adjust for patient acuity or volume.

37.

A nurse leader observes a communication breakdown between the nursing and pharmacy departments regarding medication orders. What initial step should the nurse leader take to facilitate effective interdepartmental communication?

  • Organizing a joint meeting between the departments to discuss communication issues.

  • Requesting mandatory training for the nursing staff on medication orders.

  • Implementing a new electronic ordering system to facilitate clearer communication.

  • Ask the pharmacy department to provide a communication plan to improve interdepartmental communications.

Correct answer: Organizing a joint meeting between the departments to discuss communication issues.

A joint meeting allows both departments to voice concerns, understand each other's challenges, and collaboratively develop solutions, fostering better communication.

While training might be beneficial, it will not address the root cause of the interdepartmental communication breakdown or create a better understanding of the foundational issues. Training should also involve both departments, not just nursing staff. Implementing a new system prior to gaining stakeholder input may not address the specific issues and could lead to further resistance or confusion. Focusing efforts on one department can create hostility and does not contribute to a solution.

38.

A nurse manager is addressing a conflict between two team members about the adherence to new infection control protocols. One member is resistant to change, while the other is aggressively advocating for the new protocols. How should the nurse manager facilitate conflict resolution?

  • Organize a team meeting to discuss the importance of the new infection control protocols and address concerns.

  • Provide a formal warning to resistant team members for not adhering to the new protocols.

  • Ask the team to decide on the adherence to new protocols through a majority vote.

  • Allow the conflict to continue without intervention to promote autonomous conflict resolution.

Correct answer: Organize a team meeting to discuss the importance of the new infection control protocols and address concerns.

Organizing a meeting to discuss and address concerns promotes understanding, encourages adherence through knowledge, and demonstrates leadership in conflict resolution.

Disciplining the resistant team member does not address the reasons behind the resistance and can create further conflict. Deciding through a majority vote may not address the specific concerns of the resistant member, can lead to further division, and will not necessarily lead to the best long-term decision. Ignoring the conflict does not foster a supportive environment for change and can undermine the implementation of important protocols.

39.

Which of the following is the most appropriate method for a nurse executive to use when disseminating evidence-based guidelines on infection control to a multidisciplinary team?

  • Organize a workshop that includes case studies and Q&A sessions.

  • Email blast to all team members with attached guidelines.

  • Publish an article in the hospital newsletter.

  • Send printed copies of the guidelines via internal mail.

Correct answer: Organize a workshop that includes case studies and Q&A sessions.

A workshop facilitates interactive learning, discussion, and clarification of how to implement the guidelines in practice, making it more effective. It is also likely to have a broad reach with the audience the nurse executive is trying to reach.

Email is efficient but may not ensure understanding or engagement with the material. A newsletter article raises awareness but lacks interactive elements necessary for effective implementation. Printed copies ensure access to the information but do not provide opportunities for engagement or clarification.

40.

A nursing unit has been cited for non-compliance with hand hygiene protocols. As part of the remediation process, what should the nurse executive prioritize to ensure long-term compliance?

  • Conducting a root cause analysis to understand barriers to compliance.

  • Identifying and correcting specific staff members who were non-compliant.

  • Increasing the number of hand sanitizer dispensers throughout the unit.

  • Increasing training on the importance of adherence to hand hygiene protocols and how to best comply with existing policies.

Correct answer: Conducting a root cause analysis to understand barriers to compliance.

A root cause analysis helps identify underlying problems that lead to non-compliance, allowing for targeted interventions that address specific issues.

Assigning blame and corrective measures may create a culture of fear and does not address underlying issues or promote a solution-oriented approach. While increasing access to hand sanitizer is helpful, it does not address the reasons behind non-compliance. Increasing training on the importance of adherence to hand hygiene protocols and how to comply with existing policies may be an appropriate response, but a root cause analysis should first be conducted to direct further interventions and ensure their efficacy.