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1 UNC2 Practice Test 2 Select the correct response and jot down your rationale for choosing the answer. 1. If data are plotted over time, the resulting chart will be a (A) Run chart (B) Histogram (C) Pareto chart (D) Poisson distribution 2. The following diagram is best described as a: (A) Run chart (B) Flow chart (C) Control chart (D) Checklist 3. Using the diagram (in item number 2), which of the following statements is correct? (A) The purpose of this chart is to show how data in a process are distributed. (B) Steps in a highly complex process are outlined. (C) Only one decision can be made in this process. (D) Three potential activities or interventions can occur in this process.

2 4. Before selecting a vendor of a particular healthcare equipment or supply, the masters prepared nurse should do which of the following first? (A) Conduct vendor surveys. (B) Define departmental needs. (C) Determine which vendors are industry leaders. (D) Get feedback from team members about how various vendors and their supplies are performing. (E) Decide which vendor is most cost effective. 5. Which of the following is a priority for the MSN in planning quality improvement training? (A) Establishing specific training evaluation tools. (B) Developing short-term training plans. (C) Scheduling training for managers. (D) Connecting training to organizational needs. 6. To be effective, quality initiatives must be (A) Developed by stakeholders. (B) Free from cost and profit considerations. (C) An integral part of the overall organizational strategic plan. (D) A&C (E) All of the above 7. Which of the following is NOT an appropriate goal for quality improvement education of MSNs? (A) Develop an understanding of the fundamentals of quality. (B) Integrate quality into decision-making processes. (C) Define the chain of command for approving quality procedures. (D) Provide tools and information to help MSNs build and utilize quality systems and processes. 8. Rank order, from first to last, the following training design steps. 1. Prepare training materials. 2. Define training objectives. 3. Determine course structure and sequence. 4. Establish consensus on needs. (A) 2, 1, 4, 3 (B) 2, 4, 1, 3 (C) 4, 2, 3, 1 (D) 4, 3, 1, 2

3 9. An MSN wants to implement Leadership Rounds in the hospital, to include participation of the CEO. This initiative would provide an informal way for senior leaders to talk with front-line staff about safety issues in the organization and to encourage reporting of errors. All of the following are benefits of having the CEO involved in these rounds EXCEPT (A) Increased understanding by the CEO of the organization s state of affairs. (B) Improved motivation of subordinates through personal participation of the CEO. (C) Improved human relations between the CEO and front line staff. (D) Improved dissemination of information throughout the organization. 10. In order to be successful in the role of change agent, an MSN should do all but one of the following? (A) Understand and respect peoples needs. (B) Learn from previous unsuccessful efforts to transform the organization. (C) Maintain commitment to the mission and vision of the organization. (D) Communicate change initiatives only to senior management. 11. Which of the following is the first priority when starting a quality improvement initiative? (A) Assign team goals. (B) Develop strategies. (C) Identify an aim. (D) Make sweeping organizational changes to support quality. 12. Which of the following is the LEAST effective safety approach for a patient-centered healthcare organization to take? (A) Urge employees to do it right the first time. (B) Establish a quality council that includes patients. (C) Implement team-building throughout the organization. (D) Examine processes and establish controls to increase efficiency, reliability, and safety. 13. Which of the following is one advantage of team decision-making? (A) Ease of arriving at a decision. (B) Reduced potential for conflict. (C) Increased acceptance of decisions. (D) Increased productivity. 14. The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for which type of group? (A) Family health (B) Extended family health (C) Population health (D) Individual health

4 15. In interpreting the run chart below, all of the following are true EXCEPT (A) More than a year of data is represented in the chart. (B) The highest rate of infection reported was about 8%. (C) The data points in red indicate a rise in infection rates from April through December. (D) The data points in green indicate a decrease in infection rates over two separate time periods. (E) The green dotted line is located at about a 4.5% infection rate; this is the target or benchmark. (F) The blue dotted line is located at about a 3% infection rate; this is the target or benchmark. 16. A primary care provider refers a patient to a specialist. The specialist treats the patient and then sends the patient with a report back to the primary care provider. A manual (paper-based) system was used in this referral process. Which of the following statements about manual systems is true? Manual systems for referrals or other transitions in care: (A) Decrease the complexity of the referral process and reduce opportunities for human error. (B) Often result in more efficient work-flow processes. (C) Never result in missed appointments and lost revenue. (D) Are known to reduce delays in patient care. (E) Often involve no agreement on who is responsible for closing the loop (ensuring that referral information is exchanged provider-to-provider). 17. A patient's right to make informed decisions includes all of the following except: (A) Right to participate in the development of his/her plan of care. (B) Right to consent to treatment. (C) Right to refuse to consent to treatment. (D) Right to receive care that is not medically necessary. (E) Right to participate in planning for post-hospitalization care.

5 18. Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs provide financial incentives for the Meaningful Use of certified EHR technology. To receive payment, providers have to show that they are meaningfully using this technology by meeting certain measurement thresholds. In Stage 1, 18 out of a total of 22 Meaningful Use objectives must be met. Stage 1 requirements must be met for a 90-day period in the 1st year of Meaningful Use and for a full year in the 2nd year of Meaningful Use. Stage 2 requirements must then be met for two full years. Below is a table outlining the two incentive programs. Medicare EHR Incentive Program Medicaid EHR Incentive Program Run by CMS Run by Your State Medicaid Agency Maximum incentive amount is $44,000 Maximum incentive amount is $63,750 Payments over 5 consecutive years Payments over 6 years, does not have to be consecutive Payment adjustments will begin in No payment adjustments for providers who are only 2015 for providers who are eligible but eligible for the Medicaid program decide not to participate Providers must demonstrate Meaningful Use every year to receive incentive payments. In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate Meaningful Use in the remaining years to receive incentive payments. An MSN practice manager is trying feverishly to meet the Meaningful Use requirements for a newly implemented EHR system for the practice. She is behind on her work. Which approach is best for solving this problem? (A) Seek vendor input on how to optimally manage this transition period for implementing the EHR and meeting the Meaningful Use requirements. (B) Re-prioritize her own workload since she knows what to do and can do it all herself. (C) Meet with the medical director of the practice, explain the situation, and ask for help in selecting priorities. (D) Meet with the medical director of the practice, explain the situation, and request additional short-term help since the deadlines for attestation and reporting periods in this incentive program are fixed. 19. Historically, which group is closely aligned with the financial success of healthcare organizations and therefore is designated the leader for most clinically-based innovations? (A) Nurses (B) Administration (C) Physicians (D) Admitting 20. In reflecting on the role of MSN mentor, which of the following statements is not true? (A) The mentor nurtures and develops the mentee s capacity for self-reflection and self-direction.

6 (B) Mentoring relationships are task focused; when the tasks are completed the relationship comes to a close. (C) A mentor who understands how to provide vision and how to support and challenge the mentee can help the mentee grow and develop. (D) The mentoring relationship is a learning partnership that focuses on developing the mentee s abilities and thinking. (E) Some preceptors are also mentors; being a mentor is not dependent on being a preceptor. 21. By focusing on the patient, we can achieve the IHI Triple Aim. The Triple Aim is, simply stated, to create: (A) better outcomes, great patient experiences, and reduced costs (B) higher revenues, reduced turnover, and lower costs (C) lower revenues, higher costs, and lower patient satisfaction (D) better outcomes, reduced costs, and higher revenues UNC2 Practice Test 2 Select the correct response and jot down your rationale for choosing the answer. 1. If data are plotted over time, the resulting chart will be a (A) Run chart (B) Histogram (C) Pareto chart (D) Poisson distribution Improvement takes place over time. Determining whether an improvement has actually happened and if it has been sustained requires observing data to determine patterns over time. Run charts typically use a line graph to show data over time. The run chart below depicts a baseline measurement and the response to steps in the improvement process:

7 Pareto charts and Histograms (the next two graphs shown below) look very similar. Both typically involve bar graphs and help depict the frequency or distribution of data.

8 A Poisson distribution can help us look at recurring events over a fixed timeframe:

9 2. The following diagram is best described as a: (E) Run chart (F) Flow chart (G) Control chart (H) Checklist A flow chart is basically an illustration of the steps in a process. It can help us better understand all the factors (human, environmental, organizational, etc.) that are involved. We ve already see a run chart in question #1. A checklist is essentially a list of prompts that serve as a reminder of the critical elements that must be completed in a process. A control chart is a special kind of run chart that helps us determine if a process is out of control or not. The chart below includes upper and lower control limits (UCL & LCL):

10 3. Using the diagram (in item number 2), which of the following statements is correct? (E) The purpose of this chart is to show how data in a process are distributed. (F) Steps in a highly complex process are outlined. (G) Only one decision can be made in this process. (H) Three potential activities or interventions can occur in this process. Again, the purpose of a flow chart is to outline or illustrate the steps in a process and will not help us see how data are distributed. This flow chart is not very complex and contains 2 decisions (indicated by the diamond shapes). The interventions are illustrated by the green rectangular shapes. 4. Before selecting a vendor of a particular healthcare equipment or supply, the masters prepared nurse should do which of the following first? (A) Conduct vendor surveys. (B) Define departmental needs. (C) Determine which vendors are industry leaders. (D) Get feedback from team members about how various vendors and their supplies are performing (E) Decide which vendor is most cost effective. Determining needs (or to think about it this way determining the aim) is necessary before attending to any of the other activities until we know what the department needs; we can t determine who (which vendor) can meet those needs. 5. Which of the following is a priority for the MSN in planning quality improvement training? (A) Establishing specific training evaluation tools. (B) Developing short-term training plans. (C) Scheduling training for managers. (D) Connecting training to organizational needs. Again, we start with needs (the aim) before any training is actually planned, scheduled, or evaluated.

11 6. To be effective, quality initiatives must be (A) Developed by stakeholders. (B) Free from cost and profit considerations. (C) An integral part of the overall organizational strategic plan. (D) A&C (E) All of the above The IHI is one organization that states that quality and safety must occupy a prominent place in the strategic plans of health care organizations. What we want to avoid is a long list of worthwhile projects and measures that are not well coordinated, or that are not capable of achieving system-level results. Having the stakeholders (people who have a vested interest in the systems that are being improved or that are in need of improvement) involved in quality initiatives is a great way to help ensure success. Quality improvement is not free from cost and profit considerations. In fact, improvement initiatives should seek to improve efficiency and reduce costs. 7. Which of the following is NOT an appropriate goal for quality improvement education of MSNs? (A) Develop an understanding of the fundamentals of quality. (B) Integrate quality into decision-making processes. (C) Define the chain of command for approving quality procedures. (D) Provide tools and information to help MSNs build and utilize quality systems and processes. Responses a, b, and d are reasonable goals for QI education of MSNs. Individual healthcare organizations and settings have their own mechanisms for initiating QI activities and providing approval. 8. Rank order, from first to last, the following training design steps. 1. Prepare training materials. 2. Define training objectives. 3. Determine course structure and sequence. 4. Establish consensus on needs. (A) 2, 1, 4, 3 (B) 2, 4, 1, 3 (C) 4, 2, 3, 1 (D) 4, 3, 1, 2 Determining needs (the aim) is the first step again. After that, we can define objectives, develop the course structure, and then prepare the training materials. 9. An MSN wants to implement Leadership Rounds in the hospital, to include participation of the CEO. This initiative would provide an informal way for senior leaders to talk with front-line staff about safety issues in the organization and to encourage reporting of errors. All of the following are benefits of having the CEO involved in these rounds EXCEPT (A) Increased understanding by the CEO of the organization s state of affairs.

12 (B) Improved motivation of subordinates through personal participation of the CEO. (C) Improved human relations between the CEO and front line staff. (D) Improved dissemination of information throughout the organization. Leadership Rounds are basically an opportunity for senior leaders, like the CEO, to demonstrate their organization s commitment to building a culture of safety by engaging in direct communication with frontline staff it is not an optimal method for disseminating information. For more information, see the IHI website: In order to be successful in the role of change agent, an MSN should do all but one of the following? (A) Understand and respect peoples needs. (B) Learn from previous unsuccessful efforts to transform the organization. (C) Maintain commitment to the mission and vision of the organization. (D) Communicate change initiatives only to senior management. Dissemination of information in a change initiative should not be limited to senior management. Responses a through c will help ensure success of the project as well as success of the change agent. 11. Which of the following is the first priority when starting a quality improvement initiative? (A) Assign team goals. (B) Develop strategies. (C) Identify an aim. (D) Make sweeping organizational changes to support quality. We first need to develop a time-specific, measurable aim or goal. For more see: Which of the following is the LEAST effective safety approach for a patient-centered healthcare organization to take? (A) Urge employees to do it right the first time. (B) Establish a quality council that includes patients. (C) Implement team-building throughout the organization. (D) Examine processes and establish controls to increase efficiency, reliability, and safety. Response a is not a systems approach to improving patient safety the focus should not be on individuals. Response b is good because it includes patients as a stakeholder. Team-building and examining processes are good approaches to improving systems. 13. Which of the following is one advantage of team decision-making? (A) Ease of arriving at a decision (B) Reduced potential for conflict (C) Increased acceptance of decisions (D) Increased productivity

13 Team work is not always easy and does not guarantee a reduction in conflict. In fact, storming is one of the early phases in team development (phases are form-storm-norm-perform). We hope that team decision-making will eventually increase our productivity, but finding time to participate in team meetings or other activities often does the opposite (at least in the short term). C is the best response. 15. The wide scale collection of patient weight into a large dataset is primarily used to measure and improve healthcare for which type of group? (E) Family health (F) Extended family health (G) Population health (H) Individual health The keywords here are wide-scale and large dataset. C is the best response the others (involving a single family or individual) are too limited. 15. In interpreting the run chart below, all of the following are true EXCEPT (G) More than a year of data is represented in the chart. (H) The highest rate of infection reported was about 8%. (I) The data points in red indicate a rise in infection rates from April through December. (J) The data points in green indicate a decrease in infection rates over two separate time periods. (K) The green dotted line is located at about a 4.5% infection rate; this is the target or benchmark. (L) The blue dotted line is located at about a 3% infection rate; this is the target or benchmark. Response e is located at about the 4.5% infection rate, but this is the mean or average of the values presented in the chart. The blue line at the 3% mark is the actual target rate the rate that helps to describe the aim of this project. Only four data points are on or below the target rate.

14 16. A primary care provider refers a patient to a specialist. The specialist treats the patient and then sends the patient with a report back to the primary care provider. A manual (paper-based) system was used in this referral process. Which of the following statements about manual systems is true? Manual systems for referrals or other transitions in care: (F) Decrease the complexity of the referral process and reduce opportunities for human error. (G) Often result in more efficient work-flow processes. (H) Never result in missed appointments and lost revenue. (I) Are known to reduce delays in patient care. (J) Often involve no agreement on who is responsible for closing the loop (ensuring that referral information is exchanged provider-to-provider). Paper-based systems for referral often do the opposite of responses a through d. Closing the loop is a significant problem, not only for referrals, but for other transitions in care that involve hand-offs between providers of different healthcare institutions. 18. A patient's right to make informed decisions includes all of the following except: (F) Right to participate in the development of his/her plan of care. (G) Right to consent to treatment. (H) Right to refuse to consent to treatment. (I) Right to receive care that is not medically necessary. (J) Right to participate in planning for post-hospitalization care. Most healthcare organizations issue a notification to patients of their rights and responsibilities upon admission or initial contact. While these may differ somewhat in content, the right to make informed decisions is included universally. However, while obtaining adequate information to make a decision about care that is not medically necessary is important, receipt of such care is not considered a right. In fact, most healthcare insurance companies will not cover the costs of care deemed medically unnecessary. 18. Medicare and Medicaid Electronic Health Care Record (EHR) Incentive Programs provide financial incentives for the Meaningful Use of certified EHR technology. To receive payment, providers have to show that they are meaningfully using this technology by meeting certain measurement thresholds. In Stage 1, 18 out of a total of 22 Meaningful Use objectives must be met. Stage 1 requirements must be met for a 90-day period in the 1st year of Meaningful Use and for a full year in the 2nd year of Meaningful Use. Stage 2 requirements must then be met for two full years. Below is a table outlining the two incentive programs. Medicare EHR Incentive Program Medicaid EHR Incentive Program Run by CMS Run by Your State Medicaid Agency Maximum incentive amount is $44,000 Maximum incentive amount is $63,750 Payments over 5 consecutive years Payments over 6 years, does not have to be consecutive Payment adjustments will begin in 2015 for providers who are eligible but No payment adjustments for providers who are only eligible for the Medicaid program

15 decide not to participate Providers must demonstrate Meaningful Use every year to receive incentive payments. In the first year providers can receive an incentive payment for adopting, implementing, or upgrading EHR technology. Providers must demonstrate Meaningful Use in the remaining years to receive incentive payments. An MSN practice manager is trying feverishly to meet the Meaningful Use requirements for a newly implemented EHR system for the practice. She is behind on her work. Which approach is best for solving this problem? (E) Seek vendor input on how to optimally manage this transition period for implementing the EHR and meeting the Meaningful Use requirements. (F) Re-prioritize her own workload since she knows what to do and can do it all herself. (G) Meet with the medical director of the practice, explain the situation, and ask for help in selecting priorities. (H) Meet with the medical director of the practice, explain the situation, and request additional short-term help since the deadlines for attestation and reporting periods in this incentive program are fixed. A practice manager is a leadership role that an MSN might fill. A practice manager administers the business and financial activities of a medical practice. While a vendor could provide great information about implementation of an EHR, they should not be relied upon as a subject matter expert on the meaningful use requirements. Ultimately, the vendor will not hold any responsibility (or liability) for a failure to meet these requirements. Response b is basically continuing to do what has already been done (and probably getting the same results). It should additionally be noted that re-prioritization (either self-directed or directed by someone else) may not cure the problems of inadequate time or resources. Response c is potentially a strategy to shift responsibility for failure onto, and is a decision that will likely result in relinquishing some authority to the medical director who may not have the knowledge base or motivation to correctly select priorities for the practice manager. So will the practice manager be the subordinate or the equal of the medical director if response c is chosen? D is the best response the practice manager is alerting the medical director to the problem and suggesting a solution. This decision places the practice manager in the best possible light, retains decision-making authority, and will help create a culture conducive to teamwork. For more information on requirements and incentives for the Meaningful Use of certified EHR technology, see this site: Guidance/Legislation/EHRIncentivePrograms/Getting_Started.html 19. Historically, which group is closely aligned with the financial success of healthcare organizations and therefore is designated the leader for most clinically-based innovations? (E) Nurses (F) Administration

16 (G) Physicians (H) Admitting Administration & admitting can be eliminated as having no direct clinical role they might assume a leadership role in business innovations. Nurses typically don t earn the revenue; providers do (although this is changing somewhat). 20. In reflecting on the role of MSN mentor, which of the following statements is not true? (F) The mentor nurtures and develops the mentee s capacity for self-reflection and self-direction. (G) Mentoring relationships are task focused; when the tasks are completed the relationship comes to a close. (H) A mentor who understands how to provide vision and how to support and challenge the mentee can help the mentee grow and develop. (I) The mentoring relationship is a learning partnership that focuses on developing the mentee s abilities and thinking. (J) Some preceptors are also mentors; being a mentor is not dependent on being a preceptor. The preceptor relationship is task focused (not the mentor relationship). A mentor typically holds an unofficial role as a new nurse s trusted advisor. The mentor supports and nurtures the new nurse, usually checking in frequently to see how he/she is progressing. But there are no specific milestones or deadlines that must be met. The mentor is concerned about the nurse becoming an asset to the nursing profession as a whole, more than becoming an asset to any specific organization, unit, or job. A preceptor typically has an assigned duty of monitoring the training and evaluating the performance of a new nurse. A preceptor works with the new nurse for a defined period of time to assist the novice in acquiring new competencies required for safe, ethical and quality practice on a particular unit or for a particular type of job. At the end of the defined period of time, the preceptor is usually asked to help evaluate the novice and determine whether the individual is ready to work independently or needs additional time to train and prepare (as in an extension of the probationary time for a new job). When things go well, a preceptor may become a mentor to the new nurse (assuming that a relationship of trust has developed). 21. By focusing on the patient, we can achieve the IHI Triple Aim. The Triple Aim is, simply stated, to create: 1. better outcomes, great patient experiences, and reduced costs 2. higher revenues, reduced turnover, and lower costs 3. lower revenues, higher costs, and lower patient satisfaction 4. better outcomes, reduced costs, and higher revenues For more, see:

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