Clinical Nurse Leader (CNL) Quiz Sample

1. Several near misses were identified by ICU nurses who had mistaken invasive lines for intravenous ports for medication administration. You have completed an analysis of the issue. Your recommendations include:

A visual signal on all ports not intended for intravenous drugs

A double-check system for medication administration

To facilitate a critical incident reporting structure that fosters a “without blame” unit culture

All of the above

Only C

The CNL should support the staff to identify all opportunities for improving
safety in this situation.

Explanation

The CNL should support the staff to identify all opportunities for improving
safety in this situation.

2. The results of a quarterly report identify an increase in patient falls on the telemetry unit. Your first action will be to:

Implement hourly rounding

Gain an understanding of patient care practices on the telemetry unit

Assign patient personal alarms to all patients at risk

Revise the current fall risk documentation form

Assessment includes gathering information about the health status of the client and analyzing and synthesizing those making judgments about nursing interventions on the basis of findings, evaluation, and managing of individual care outcomes.

Explanation

Assessment includes gathering information about the health status of the client and analyzing and synthesizing those making judgments about nursing interventions on the basis of findings, evaluation, and managing of individual care outcomes.

3. Patient satisfaction scores in the emergency department (ED) have shown a downward trend over the past three quarters. As a clinical nurse leader (CNL) in the ED, your focus is to:

Create a script for the triage nurse in welcoming the patient

Assign a volunteer to welcome patients to the hospital

Compare desired outcomes with national and state standards

Write a letter of apology to each dissatisfied patient

Client care outcomes are a measure of quality practice. CNLs must know how to compare desired outcomes that will improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client centered.

Explanation

Client care outcomes are a measure of quality practice. CNLs must know how to compare desired outcomes that will improve safety, effectiveness, timeliness, efficiency, quality, and the degree to which they are client centered.

4. The result of a workflow diagram of a clinician illustrates an excessive amount of walking to obtain supplies. Reducing the waste of motion adds value-added time that ultimately benefits:

The patient

The clinician

Documentation

None of the above

Process improvement enhances patient safety and nursing time at the bedside for the patient and family.

Explanation

Process improvement enhances patient safety and nursing time at the bedside for the patient and family.

5. You have been asked to lead the telemetry fall prevention committee. Which combination of team members would best suit the initial phase of this group?

A behavioral health APRN

A staff nurse

A physical therapist

The nurse manager

All of the above

Only A, B, and D are needed

Health promotion and disease prevention knowledge includes methods to keep an illness or injury from occurring, diagnosis, and treating a disease in its early course. CNLs need to work with an interdisciplinary team to make ethical decisions, develop, and monitor comprehensive, holistic plans of care. There is a strong correlation between patient falls and delirium. Exercise programs focused on strength, functional performance, and balance training are effective steps in reducing inpatient falls.

Explanation

Health promotion and disease prevention knowledge includes methods to keep an illness or injury from occurring, diagnosis, and treating a disease in its early course. CNLs need to work with an interdisciplinary team to make ethical decisions, develop, and monitor comprehensive, holistic plans of care. There is a strong correlation between patient falls and delirium. Exercise programs focused on strength, functional performance, and balance training are effective steps in reducing inpatient falls.

6. You are a CNL on the telemetry unit and orienting a newly graduated nurse. Critical thinking is best demonstrated when:

The CNL discusses with the physician the rationale for discontinuing cardiac monitoring in the hospice patient

Drawing the scheduled cardiac enzymes every 8 hours

Reviewing the patient care guidelines and protocols related to hourly rounding

The CNL balances both the charge role and the preceptor role simultaneously

Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity.

Explanation

Critical thinking underlies independent and interdependent decision making. Critical thinking includes questioning, analysis, synthesis, interpretation, inference, inductive and deductive reasoning, intuition, application, and creativity.

7. Clinical nurse leaders focus on projects within a clinical microsystem. A clinical microsystem can be best described as:

A department-wide program focused on improving continuity of care and patient satisfaction

Trending the postoperative care on all surgical units

The clinical and business processes of a single unit within an organization

All medical and surgical units guided by a chief nursing officer

The microsystem is described by the AACN White Paper as the practice level of the CNL.

Explanation

The microsystem is described by the AACN White Paper as the practice level of the CNL.

8. You are a CNL selected to lead a team focused on implementing a multidisciplinary clinical pathway for acute ischemic stroke and transient ischemic attack. The risk assessment tool that you have adopted identifies all of the following as independent stroke risk factors except:

Age

Systolic blood pressure

Liver dysfunction

Current smoking

Diabetes mellitus

Independent stroke predictors include age, systolic blood pressure, hypertension, diabetes mellitus, current smoking, established cardiovascular disease (any one of myocardial infarction, angina or coronary insufficiency, congestive heart failure, or intermittent claudication), atrial fibrillation, and left ventricular hypertrophy on ECG.

Explanation

Independent stroke predictors include age, systolic blood pressure, hypertension, diabetes mellitus, current smoking, established cardiovascular disease (any one of myocardial infarction, angina or coronary insufficiency, congestive heart failure, or intermittent claudication), atrial fibrillation, and left ventricular hypertrophy on ECG.

9. In 2008, the Centers for Medicaid and Medicare Services (CMS) collaboratively with the Centers for Disease Control and Prevention enacted a new payment provision related to eight hospital-acquired conditions. Hospital falls and traumas occurring during a hospital stay will not receive CMS reimbursement. Health promotion, risk reduction, and disease prevention are core competencies of the clinical nurse leader. As a CNL on the telemetry unit, you have recognized the importance of this issue. Which level within a system does this issue affect?

Microsystem

Mesosystem

Macrosystem

All of the above

One concept of health care systems involves three levels of building together to make up complex organizations.

Explanation

One concept of health care systems involves three levels of building together to make up complex organizations.

10. All are part of the data necessary for a CNL to fully understand and assess his or her clinical unit except:

The organization financial statement

The target population and age distribution

The percentage of full-time equivalents (FTEs)

Rate of nosocomial infections

Fall rates

A comprehensive assessment of the clinical unit is a foundation for the work of the CNL but does not include the financial statement of the organization. In comprehending the “big picture” of the organization, the CNL should have an understanding of the financial health of the institution.

Explanation

A comprehensive assessment of the clinical unit is a foundation for the work of the CNL but does not include the financial statement of the organization. In comprehending the “big picture” of the organization, the CNL should have an understanding of the financial health of the institution.

11. Which of the following actions illustrates the CNL professional value of altruism?

Leading an interdisciplinary team looking at the remote cardiac monitoring process

Sponsoring a meeting with the monitor technicians to understand their barriers in the cardiac monitoring process

Flow mapping the admission process of the remote cardiac-monitored patient

Editing the policy for the remote cardiac monitoring process

Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the CNL’s concern for the welfare of clients, other nurses, and other health care providers.

Explanation

Altruism is a concern for the welfare and well-being of others. In professional practice, altruism is reflected by the CNL’s concern for the welfare of clients, other nurses, and other health care providers.

12. A fellow staff nurse is struggling to understand the use of a clinical decision support system (CDSS) in the management of her septic patient. Your initial teaching strategy includes:

Sharing the latest clinical research

An understanding of expected and actual outcomes

Defining the purpose of CDSS

Exploring challenges, risks, and benefits

CDSS supports a safe patient culture and should be designed to help providers.

Explanation

CDSS supports a safe patient culture and should be designed to help providers.

13. A lack of compliance with deep vein thrombosis (DVT) prophylaxis has been identified in retrospective chart reviews of all ischemic stroke patients in your organization. As a CNL on the neurological unit, your primary goal will include:

Challenging the guidelines on primary prevention of ischemic stroke written by the American Stroke Association

Gaining an understanding of how DVT prophylaxis is initiated on each stroke patient on your unit

Developing an organization-wide educational program on DVT prophylaxis

Developing a unit-based team of nursing personnel to investigate the problem

White Paper: One competency is that of a systems analyst. A CNL participates in a system review and conducts a microsystem analysis, identifying a clinical issue with a focus on a particular population.

Explanation

White Paper: One competency is that of a systems analyst. A CNL participates in a system review and conducts a microsystem analysis, identifying a clinical issue with a focus on a particular population.

14. You are using failure mode and effect analysis (FMEA) to anticipate the risk of medication errors in the ICU related to invasive lines. You begin your FMEA analysis with:

The effects of each failure

The potential cause of each failure

Process mapping

Specific defects and delays in the medication administration process

Utilizing tools for process improvement can provide new insights into routine practices.

Explanation

Utilizing tools for process improvement can provide new insights into routine practices.

15. The hospital is looking to utilize cardiac monitor watchers. Your analysis includes all of the following except:

A review of an online ECG monitoring education program

Identifying a clinical issue with a focus on a specific population

Conducting a trend analysis of outcome data

Analyzing barriers and facilitators with the organization

Systems analysis and risk anticipation are the competencies of the CNL.

Explanation

Systems analysis and risk anticipation are the competencies of the CNL.

16. Data reported by the ICU quality committee reflect challenges in the management of the septic patient. As a CNL in the ICU, all of the following are first steps in evaluating the delivery of client care except:

Knowledge of sepsis guidelines

Critical care clinicians staffing ratios

Use of clinical decision support systems

Differentiating sepsis from systemic inflammatory response syndrome (SIRS)

Nursing leadership and advocacy reviews and evaluates care guidelines and protocols.

Explanation

Nursing leadership and advocacy reviews and evaluates care guidelines and protocols.

17. As a CNL in the ICU, you have observed several prolonged and fragmented processes of starting an intravenous line in a critically ill patient. All of the following considerations are necessary in identifying a theme for your improvement process except:

A thorough review of the clinical unit

The manager’s mandate for change

The alignment with the organization’s strategic priorities

Input from the patient’s family

Specific mandates for change would be considered as the team “drills down” for further information.

Explanation

Specific mandates for change would be considered as the team “drills down” for further information.

18. Electronic nursing documentation has recently been instituted in your organization. Select a response that best defines a clinical decision support:

A reminder to save and sign your admission assessment

A visual red alert when a patient’s potassium is 6.8 mEq/L

A pop-up to initiate the discharge instruction sheet with every physician discharge order

An electronic nursing care plan

CDS is a computer-based program designed to assist clinicians in making clinical decisions by filtering and integrating vast amounts of information and providing suggestions for clinical intervention.

Explanation

CDS is a computer-based program designed to assist clinicians in making clinical decisions by filtering and integrating vast amounts of information and providing suggestions for clinical intervention.

19. Your colleagues have identified challenges in the process of inserting an intravenous line. To gain a better understanding of what this process entails, you:

Directly observe the intravenous line insertion process and time each step of the process

Create a workflow diagram tracing the path of the nurse during the line insertion process

Engage the IV team to reeducate the nurses

All of the above

A and B

Proper assessment of a clinical situation can expose issues of policy, compliance, or the need for education.

Explanation

Proper assessment of a clinical situation can expose issues of policy, compliance, or the need for education.

20. You are working on improving the patient discharge process. Which of these targets would best reflect clinical microsystem outcomes?

Hospital length of stay

Time of discharge order for all medical patients to the actual time the patient left

Number of discharge orders on your unit entered before 11 a.m.

Total number of discharged patients leaving by 11 a.m.

A CNL as an outcomes manager uses data to change practice and to improve outcomes. Selecting the most appropriate goals and targets will provide meaningful information.

Explanation

A CNL as an outcomes manager uses data to change practice and to improve outcomes. Selecting the most appropriate goals and targets will provide meaningful information.

Clinical Nurse Leader (Cnl) Quiz Sample