RN Registered Nurse: Management Care 5 — Questions and Answers
Question 1: A nurse manager is informed that a staff nurse has been witnessed accessing a patient's electronic health record without a clinical reason. The FIRST action should be:
- Immediately terminate the employee
- Conduct a preliminary investigation and place the nurse on administrative leave pending findings (Correct answer)
- Reassign the nurse to non-patient care duties and take no further action
- Report directly to the state board of nursing before investigating
Correct answer: Conduct a preliminary investigation and place the nurse on administrative leave pending findings
A fair and thorough investigation is required before disciplinary action to determine intent and gather all facts, consistent with HIPAA breach response protocols.
Question 2: Which budgeting approach requires each department to justify ALL expenditures from zero each fiscal year, regardless of prior year spending?
- Incremental budgeting
- Zero-based budgeting (Correct answer)
- Fixed budgeting
- Capital budgeting
Correct answer: Zero-based budgeting
Zero-based budgeting requires justification for every line item from scratch, promoting cost-consciousness and elimination of unnecessary spending.
Question 3: A nursing unit has a high turnover rate among new graduates in their first year. Which retention strategy is MOST evidence-based?
- Increasing starting salary alone
- Implementing a structured nurse residency program with mentorship and gradual acuity progression (Correct answer)
- Reducing orientation length to promote rapid independence
- Assigning new graduates to the most challenging patients to accelerate skill development
Correct answer: Implementing a structured nurse residency program with mentorship and gradual acuity progression
Nurse residency programs with mentorship and gradual acuity exposure have the strongest evidence base for improving first-year retention.
Question 4: Under the National Labor Relations Act, which nurse manager behavior during a union organizing campaign is PROHIBITED?
- Explaining the current benefits package to staff
- Threatening to close the unit if staff vote to unionize (Correct answer)
- Meeting with staff in groups to answer questions
- Reminding staff of an open-door policy
Correct answer: Threatening to close the unit if staff vote to unionize
Threatening reprisals or unit closure to discourage union activity is an unfair labor practice prohibited by the NLRA.
Question 5: A charge nurse is preparing the staffing plan for the evening shift and must prioritize which patients require RN-level care. This decision is based on which principle?
- Scope of practice and patient acuity (Correct answer)
- Seniority of available nursing staff
- Patient preference for nurse assignment
- Physician recommendation for staffing
Correct answer: Scope of practice and patient acuity
RN-level task assignment is determined by scope of practice and the clinical complexity of individual patients, ensuring safe and appropriate care.
Question 6: A sentinel event occurs on the unit. After immediate patient stabilization, which process does The Joint Commission require the organization to undertake?
- A peer review by the state nursing board
- A root cause analysis (RCA) to identify system-level contributing factors (Correct answer)
- Immediate public disclosure to all patients on the unit
- Termination of the nurse directly involved
Correct answer: A root cause analysis (RCA) to identify system-level contributing factors
TJC mandates a root cause analysis following sentinel events to identify systemic failures and implement corrective actions to prevent recurrence.
Question 7: Which of the following best exemplifies the 'just culture' model in nursing management?
- Disciplining any nurse who makes a medication error regardless of context
- Distinguishing between human error, at-risk behavior, and reckless behavior when responding to mistakes (Correct answer)
- Publicly reporting all staff errors to maintain transparency
- Exempting senior nurses from disciplinary review when errors occur
Correct answer: Distinguishing between human error, at-risk behavior, and reckless behavior when responding to mistakes
Just culture differentiates unintentional errors (system fixes), risky behaviors (coaching), and reckless actions (accountability) to promote safety reporting.
RN Registered Nurse: Management Care 5
A nurse manager is informed that a staff nurse has been witnessed accessing a patient's electronic health record without a clinical reason.
The FIRST action should be: