NE-BC practice questions for unit and department leaders

A nurse executive asks whether joining a coalition that lobbies for expanded health coverage is appropriate professional activity. Which statement BEST reflects the ANA Code of Ethics?

1. Nurses should stay politically neutral in their role
   The Code does not ask nurses to stay out of policy; it treats advocacy for just health policy as part of professional practice.
2. Policy work belongs to nursing organizations, not individuals
   Provision 9 names "nurses and their professional organizations," so the duty rests on individual nurses as well, not on associations alone.
3. Advocacy duties cover only patients in the nurse's care
   Limiting advocacy to current patients ignores the Code's duties toward communities and populations in Provisions 8 and 9.
4. Nurses have a duty to advance social justice through policy
   Provision 9 of the 2025 Code commits nurses and their professional organizations to work through practices, policies and legislation for social justice and health equity; joining a coverage coalition fits that duty.

Which provision of the ANA Code of Ethics most directly addresses the nurse's duty to advocate for and protect the patient's rights, health, and safety?

1. Provision 4
   Provision 4 covers nurses' authority over, and accountability for, their own practice.
2. Provision 3
   In the 2025 Code, Provision 3 says the nurse establishes a trusting relationship and advocates for the rights, health and safety of recipients of nursing care.
3. Provision 7
   Provision 7 covers advancing the profession through knowledge development, professional standards and policy.
4. Provision 5
   Provision 5 addresses the nurse's duties to self, including a safe workplace, integrity and competence.

A Six Sigma team is reducing surgical site infections using DMAIC. Which activity belongs to the Analyze phase?

1. Test which variables are tied to rising SSI rates
   In the Analyze phase the team uses data to identify and verify the root causes of variation, such as which factors are linked to infections.
2. Collect baseline SSI rates for all procedure types
   Collecting baseline data is the Measure phase.
3. Pilot a new skin-preparation protocol in two ORs
   Piloting a solution belongs to the Improve phase, after the causes are confirmed.
4. Write the project charter and define the scope
   The charter and scope belong to the Define phase at the start of the project.

When grading the strength of evidence for a practice change, which source is considered the WEAKEST?

1. A large multi-site cohort study
   A cohort study is observational but still stronger than opinion, because it collects data systematically.
2. A single expert's opinion
   Expert opinion sits at the bottom of evidence hierarchies because it rests on personal experience rather than systematic study.
3. A systematic review of multiple trials
   A systematic review of randomized trials sits at the top of the hierarchy as the strongest evidence.
4. A well-conducted randomized controlled trial
   A well-designed RCT is strong experimental evidence, just below a systematic review.

A unit restricts family visiting to set hours, and families ask to be present around the clock. Which policy BEST supports patient- and family-centered care?

1. Open family presence as defined by the patient
   Patient- and family-centered care lets the patient decide who counts as family and when they are present, instead of limiting visits to set hours.
2. Visits allowed only after the physician approves them
   Physician gatekeeping makes family presence a privilege granted by staff, the opposite of partnership.
3. Extended visiting hours from 8 a.m. to 10 p.m.
   Longer hours are still a restriction set by the unit, not the patient's choice.
4. Family presence limited to one person at a time
   A fixed head count is another unit-imposed rule that ignores what the patient wants.

In the emergency management cycle, which activity belongs to the MITIGATION phase?

1. Activating the hospital incident command system
   Activating incident command is a response-phase action, taken once an event occurs.
2. Restoring elective services after the event
   Bringing services back is recovery, the phase after the response.
3. Installing flood barriers around the generator room
   Mitigation reduces a hazard's impact before it happens, such as protecting critical utilities from flooding.
4. Running a tabletop exercise for the incident command team
   Exercises build readiness and belong to the preparedness phase.

A health system is launching a hospital-at-home program for acutely ill patients. Which requirement is MOST important for patient safety?

1. Daily video visits in place of all in-person nursing visits
   The CMS acute hospital care at home program requires in-person visits every day; video cannot replace them for acutely ill patients.
2. Defined escalation pathways with rapid in-person response
   Acute care at home is safe only when deterioration triggers a reliable, rapid escalation to in-person care or transfer.
3. Enrollment of any patient who prefers care at home
   Preference alone is not enough; patients must meet clinical and home-safety criteria.
4. Using the same staffing model as the inpatient medical unit
   Home care needs a model built around travel, remote monitoring and response times; copying the inpatient model does not fit.

Thirty percent of a unit's RNs will be eligible to retire within three years. Which strategy BEST addresses this workforce risk?

1. Offering early retirement incentives to reduce costs
   Early-retirement incentives speed up the very loss of experience the unit is trying to manage.
2. Posting positions only after each retirement occurs
   Waiting until each nurse leaves creates vacancies and loses the chance for overlap and knowledge transfer.
3. Phased retirement with roles that transfer knowledge
   Phased retirement keeps experienced nurses longer on flexible schedules and uses them to pass knowledge to newer staff, which lowers the risk of a sudden expertise gap.
4. Hiring travel nurses to replace retirees as they leave
   Travel nurses fill gaps at premium cost and do not carry the unit's knowledge forward.

In a cost-benefit analysis for a new robotic surgery program, which benefit is INTANGIBLE, meaning it is hard to express in dollars?

1. Shorter average length of stay for robotic cases
   Shorter stays have a measurable cost per day, so the benefit is tangible.
2. Lower blood product use per surgical case
   Blood product savings can be priced per unit, a tangible benefit.
3. Fewer surgical site infections and their costs
   Infection costs can be counted, which makes this tangible even though it is also a quality outcome.
4. Better surgeon recruitment and reputation
   Recruitment and reputation are real benefits but hard to put a dollar value on, which makes them intangible.

An audit finds that supplies used in bedside procedures are often never billed to the patient's account. Which step of the revenue cycle is failing?

1. Charge capture
   Charge capture records billable supplies and services to the patient's account at the point of use; supplies that never get billed show it is failing.
2. Patient registration
   Registration collects demographic and insurance data at the start; it does not record what was used.
3. Medical coding
   Coding turns documented diagnoses and procedures into codes; supplies that were never charged never reach coding.
4. Claims submission
   Submission sends the claim to the payer and can only send charges that were captured.

Three surgical units use five different brands of IV start kits. Which approach BEST reduces supply cost without compromising care?

1. Reduce par levels for IV kits on all units by 20%
   Lower par levels change how much stock sits on the shelf, not what each kit costs or how many brands are bought.
2. Let each unit keep its preferred brand to avoid pushback
   Keeping five brands preserves the variation that drives up cost and gives up purchasing leverage.
3. A clinician-led value analysis to standardize the kit
   Value analysis brings clinicians and supply chain together to choose one product on evidence, outcomes and cost, which cuts price and variation without risking care.
4. Switch all units to the lowest-priced kit this month
   Choosing on price alone, without clinician review, risks a product that fails in use and costs more in waste and restarts.

A grouped set of three to five evidence-based practices applied together to prevent a specific harm is called a:

1. Never event
   A never event is a serious, largely preventable harm event that should never occur, not a set of practices.
2. Care bundle
   A care bundle is a small set of evidence-based practices that improve outcomes more when performed together than separately.
3. Balancing measure
   A balancing measure checks whether an improvement causes problems elsewhere in the system.
4. Clinical pathway variance
   A pathway variance is a departure from the expected course of care on a clinical pathway.

A nurse executive adds the 30-day mortality rate to the unit's quality dashboard. Which Donabedian category does this measure represent?

1. Structure measure
   Structure measures describe the setting and resources of care, such as staffing or equipment.
2. Process measure
   Process measures track whether recommended care was delivered, such as giving a recommended medication on time.
3. Balancing measure
   A balancing measure comes from improvement science, not Donabedian, and tracks unintended effects of a change elsewhere in the system.
4. Outcome measure
   Outcome measures capture the results of care for patients, and death within 30 days is such a result.

Tension is rising between veteran nurses and newly hired younger nurses over communication and technology use. Which strategy should the nurse manager implement?

1. Hold a mandatory seminar on generational characteristics
   A seminar on generational traits risks stereotyping and does not change how people work together.
2. Schedule shifts so that each has similar age groups
   Separating shifts by age deepens the divide and removes the chance to learn from each other.
3. Form mixed-generation teams that share skills both ways
   Mixed teams with two-way skill sharing, clinical experience one way and technology fluency the other, build respect and use each group's strengths.
4. Adopt one standard communication style for all unit staff
   Forcing one style ignores real differences in preference and does not build working relationships.

A reliable nurse is late for the first time with no prior issues. Following progressive discipline, what is the manager's MOST appropriate first step?

1. Hold a verbal coaching conversation and document the discussion
   Progressive discipline starts with the least severe step, so a first, isolated lateness calls for a documented verbal conversation.
2. Suspend the nurse for one shift to reinforce the attendance policy
   Suspension is a late step for repeated or serious problems, far out of proportion for a first lateness.
3. Place the nurse on a final-warning performance improvement plan
   A final warning skips every earlier step and signals that termination is next.
4. Issue a formal written warning placed in the personnel file
   A written warning is the second step, used when a verbal conversation has not corrected the behavior.

A non-exempt staff nurse works 45 hours in one workweek. Under the FLSA, how must the 5 additional hours be paid?

1. At double the regular rate for all hours beyond forty
   The FLSA requires time and a half, not double time; double time is a contract or policy choice.
2. At one and a half times the nurse's regular rate of pay
   Non-exempt employees earn at least 1.5 times their regular rate for hours over 40 in a workweek; hospitals may instead use the 8-and-80 system by agreement.
3. At the regular hourly rate with compensatory time off
   Comp time in place of overtime pay is allowed only for public employers; a private hospital must pay overtime in cash.
4. At the regular rate because staff nurses are overtime-exempt
   Exemption depends on salary basis and duties; this nurse is stated to be non-exempt, so overtime applies.

Before evaluating an accommodation request under the ADA, what should the nurse executive determine FIRST?

1. Whether coworkers agree with the requested change
   Coworker opinion is not part of the ADA analysis.
2. The dollar cost of every possible accommodation option
   Cost matters only for an undue-hardship defense, which comes after identifying what the job needs and what would work.
3. The essential functions of the position in question
   An accommodation is judged against what the job fundamentally requires, so the essential functions must be clear before options are weighed.
4. The employee's complete medical and treatment history
   The employer may ask only for documentation needed to confirm the disability and the need; a full medical history goes beyond that.

During a union organizing campaign, which management action is an unfair labor practice under the NLRA?

1. Sharing factual information about the collective-bargaining process
   Employers may share facts and opinions about unionization when they contain no threats or promises of benefit.
2. Threatening to reduce benefits if the nurses vote to unionize
   Threats of reprisal for unionizing interfere with employees' Section 7 rights and are an unfair labor practice under Section 8(a)(1) of the NLRA.
3. Continuing to address staff concerns through normal channels
   Keeping normal practices in place is lawful; changing them to sway the vote would be the problem.
4. Enforcing an existing no-solicitation policy consistently
   A lawful no-solicitation rule applied evenly, not only to union talk, is permitted.

The Age Discrimination in Employment Act (ADEA) protects which employees?

1. Workers age 50 and older at employers with 50 or more staff
   Fifty employees is an FMLA figure, and protection begins at 40, not 50.
2. Workers of any age at employers with 15 or more staff
   Fifteen employees is the Title VII and ADA threshold, and the ADEA does not protect workers under 40.
3. Workers age 40 and older regardless of the employer's size
   The age-40 threshold is right, but the ADEA covers only employers with 20 or more employees.
4. Workers age 40 and older at employers with 20 or more staff
   The ADEA protects employees and applicants aged 40 and over from age discrimination at employers with 20 or more employees.

Under a typical collective bargaining agreement, what is usually the FIRST step when a nurse files a grievance?

1. An informal talk with the immediate supervisor
   Most grievance procedures in a collective bargaining agreement start at the lowest level, with the employee and steward raising the issue with the immediate supervisor.
2. A formal written appeal to executive leadership
   Appeals to senior leadership are middle steps, reached when the supervisor level does not settle the grievance.
3. A complaint filed with the labor relations board
   A grievance is a contract dispute handled inside the agreement's procedure; a charge to the labor board is a separate route for unfair labor practices.
4. Binding arbitration with a neutral third party
   Arbitration is the final step, used only when the earlier steps fail to resolve the grievance.

Which nurse action is NOT protected concerted activity under the NLRA?

1. Employees acting together to petition for safer workloads
   A joint petition about workloads is classic protected concerted activity.
2. A single nurse's complaint about a personal schedule
   Concerted activity means employees acting together, or one acting with or for others, about shared working conditions; a purely personal gripe is not protected.
3. Nurses discussing their pay rates with one another
   Discussing wages with coworkers is protected, and rules that ban it violate the NLRA.
4. A group of nurses jointly raising staffing concerns
   Group complaints about staffing are protected whatever the size of the group.

Which practice most improves a hospital's actual disaster readiness over time?

1. Recurring drills with structured debriefs
   Readiness improves through practice: repeated drills expose gaps, and debriefs turn them into fixes to the plan and training.
2. A detailed written disaster plan reviewed each year
   A plan that is never exercised stays untested; drills show whether people can carry it out.
3. Assigning disaster readiness to the safety officer
   Readiness is a shared, organization-wide responsibility; one person cannot prepare every unit.
4. A larger stockpile of emergency supplies
   Supplies help only if staff know how to use them in a coordinated response; a stockpile does not test the plan.

A hospital adds virtual nurses who work remotely alongside bedside teams. Which step MOST protects continuity of care?

1. Give virtual and bedside nurses identical duties
   Identical duties waste the model's strength; virtual nurses take the tasks that need no hands-on presence.
2. Train virtual nurses only on the technology
   Technical training alone leaves out the communication and role clarity that continuity depends on.
3. Define role scopes and a shared communication workflow
   Clear scopes and one shared workflow for handoffs and messages keep virtual and bedside nurses from duplicating or dropping tasks.
4. Let virtual nurses manage their own patient lists independently
   Working in parallel without coordination fragments care; the model depends on tight links with the bedside team.

Under EMTALA, who may perform the required medical screening examination in the emergency department?

1. The registration clerk during patient intake
   A clerk is not qualified medical personnel, and registration is not a screening exam.
2. Only a licensed physician in every case
   EMTALA does not require a physician; the hospital may designate other qualified personnel.
3. Any clinical staff member available at the time
   Screening must be done by personnel the hospital has formally designated as qualified, not whoever is free.
4. Personnel the bylaws designate as qualified
   EMTALA lets the hospital designate qualified medical personnel, such as physicians, NPs, PAs or specially trained RNs, in its bylaws or rules to perform the screening exam.

When a hospital policy conflicts with patient welfare, what does the ANA Code of Ethics direct a nurse executive to do?

1. Seek a policy change through proper channels
   The Code calls on nurses to raise concerns about practices that put patients at risk through appropriate channels, and on leaders to work to change the policy.
2. Quietly permit staff to ignore the policy
   Informal workarounds leave the harmful policy in place and expose staff to inconsistent practice.
3. Refer it to the legal department and take no action
   Handing the matter to legal and stepping away abandons the duty to advocate.
4. Enforce the existing policy without change
   Enforcing a policy known to harm patients puts organizational order above patient welfare.

Which publicly reported CMS survey measures the inpatient experience and is tied to reimbursement?

1. The Magnet appraisal
   Magnet appraisal is ANCC's review of nursing excellence; it is not a patient survey that CMS uses for payment.
2. The HCAHPS survey
   HCAHPS is the CMS-required, publicly reported survey of inpatients' care experience, and its scores feed the Hospital Value-Based Purchasing program.
3. The AHRQ SOPS survey
   The AHRQ SOPS asks staff about safety culture, not patients about their experience.
4. The NDNQI RN survey
   The NDNQI RN survey asks nurses about their work environment, not patients.

Which action best honors patient self-determination in care planning?

1. Relying on the family's preference by default
   Families speak for the patient only when the patient cannot, and then through the patient's known wishes or a designated surrogate.
2. Deferring care-planning decisions to the physician
   Physician-led planning without the patient's input is paternalism, not self-determination.
3. Carrying out the patient's advance directive
   Self-determination means the patient's own informed choices guide care, and an advance directive records those choices for times the patient cannot speak.
4. Applying a standard plan to all similar cases
   A standard plan ignores the individual preferences that self-determination protects.

In an emergency-response plan, which nursing-staffing element most prevents role confusion during a surge?

1. Predefined assignments and a labor-pool plan
   Assigning roles in advance and running a labor pool tell each nurse where to report and what to do, which prevents confusion when demand spikes.
2. A plan focused on buying surge equipment
   Equipment does not tell staff who does what; role clarity is a staffing element.
3. A general plan that leaves roles to the day of the event
   Leaving roles to be sorted out during the event creates the very confusion the plan should prevent.
4. Assigning all surge staffing to the ED manager
   One manager cannot coordinate staff across the hospital, and the plan still has no defined roles.

A unit assigns an RN to lead a group of LPNs and aides caring together for a set of patients. Which care delivery model is this?

1. Functional nursing
   Functional nursing divides tasks across the unit, such as one nurse giving all medications, instead of assigning a team to a patient group.
2. Primary nursing
   Primary nursing makes one RN accountable for a patient's care across the whole stay.
3. Total patient care
   Total patient care has one nurse provide all of a patient's care for the shift, without a team.
4. Team nursing
   In team nursing an RN team leader directs LPNs and assistive staff who together care for a group of patients during a shift.

A unit expects 7,300 patient days at 6.0 worked hours per patient day. The average RN wage is $40 an hour, and benefits add 25% to wage cost. What is the projected labor cost of these worked hours, including benefits?

1. $438,000
   $438,000 is the benefit cost by itself (25% of wages), not the total labor cost.
2. $1,752,000
   $1,752,000 is wages alone; the 25% benefit load has not been added.
3. $2,190,000
   Hours = 7,300 × 6.0 = 43,800; wages = 43,800 × $40 = $1,752,000; adding 25% for benefits gives $1,752,000 × 1.25 = $2,190,000.
4. $1,401,600
   This divides wages by 1.25 instead of multiplying, which takes the benefit load out instead of adding it.

A unit's supply expense is 10% over budget. Patient days and supply use per patient day were on budget, but the vendor raised prices 10%. What type of variance is this?

1. A quantity (use) variance
   A quantity variance comes from using more or less per patient day than planned, and use was on budget.
2. A volume variance
   A volume variance comes from more or fewer patient days than budgeted, and volume was on budget.
3. A price (rate) variance
   A rate variance arises when the price paid per unit differs from budget; with volume and use per patient day on budget, the 10% vendor increase explains the whole gap.
4. A timing variance
   A timing variance comes from when spending is recorded, such as an invoice posted in another month, not from a price change.

An ambulatory clinic's visits peak from 8 to 11 a.m. and from 3 to 6 p.m., with a lull at midday. Which staffing plan BEST controls labor cost while meeting demand?

1. Staffing every hour to the average hourly volume
   An average leaves the clinic short in both peaks and overstaffed at midday.
2. Staggered shifts aligned to hourly visit volume
   Staggered start times put staff on duty when visits peak and fewer during the midday lull, matching labor to demand.
3. Staffing every hour to the peak-hour visit volume
   Staffing to the peak all day pays for idle staff during the lull.
4. Equal staffing across the day on 8-hour shifts
   Flat staffing overstaffs the lull and understaffs the peaks.

A director plans to build an internal float pool to reduce agency use. Which data BEST supports deciding how many FTEs the pool needs?

1. Total agency spending for the last fiscal year
   Agency dollars show the cost of the gaps, not their size or timing, and rates vary by contract.
2. Number of current staff willing to float
   Willingness to float shows who might staff the pool, not how many FTEs the demand requires.
3. Current vacancy rate across the nursing units
   Vacancies are one cause of gaps, but sick calls, leaves and census swings also create them.
4. Daily gaps between needed and scheduled hours
   Sizing a float pool starts from the pattern of daily gaps between hours needed and hours scheduled across units, which shows how many FTEs the pool must cover.

Compliance with the CMS severe sepsis and septic shock measure (SEP-1) is scored as all-or-none. What does this mean for a patient case?

1. The case passes only if every element is met on time
   In all-or-none scoring a case counts as compliant only when every required element of the measure is completed within its time window.
2. Only the antibiotic timing element determines the score
   Antibiotic timing is one element among several, and missing any element fails the case.
3. The case passes if most required elements are completed
   Completing most elements still fails the case under all-or-none scoring.
4. Each element is scored and the results are averaged
   Averaging elements is composite scoring, which gives partial credit; all-or-none gives none.

Which element is most essential to an effective corporate compliance program?

1. A program limited to billing and coding issues
   Compliance programs cover billing and also privacy, conflicts of interest, quality and other legal risks.
2. Automatic severe penalties for each reported violation
   Automatic harsh penalties discourage reporting; the guidance calls for consistent, proportionate discipline.
3. A confidential reporting channel with no retaliation
   OIG compliance program guidance treats a confidential reporting route with protection from retaliation as a core element, because problems surface only when staff can report safely.
4. Compliance training for managers and supervisors only
   All workforce members need training, because frontline staff see most compliance risks first.

Which nursing practice most reliably reduces call-light use and falls by proactively meeting patient needs?

1. Purposeful hourly rounding on the 4 Ps
   Scheduled rounds that address pain, potty, position and possessions anticipate the needs that drive call lights and unassisted attempts to get up.
2. Rounding only during daytime hours
   Many falls happen at night, so rounding only by day leaves the riskiest hours uncovered.
3. Responding only when patients call
   Reacting to call lights is the pattern purposeful rounding is meant to replace.
4. Rounding once per shift to complete charting
   A single round for documentation does not anticipate needs often enough to prevent falls.

Which single practice most reliably catches post-discharge problems in the vulnerable first week home?

1. Discharging the patient earlier in the day
   The time of discharge does nothing to detect problems after the patient gets home.
2. A structured follow-up call within 72 hours
   An early structured call catches medication confusion, new symptoms and missed appointments in the first days home, when post-discharge problems peak.
3. A longer printed instruction booklet
   More printed material does not confirm understanding or catch new problems at home.
4. A satisfaction survey mailed after discharge
   A survey measures experience weeks later; it does not find or fix clinical problems.

A pregnant RN brings a note from the nurse's clinician recommending no lifting over 20 pounds for eight weeks. Which action by the nurse manager is appropriate?

1. Also remove the nurse from caring for infectious patients
   Adding restrictions the clinician did not ask for is paternalistic and can be discriminatory under Title VII and the PWFA.
2. Place the nurse on leave until the restriction is lifted
   The PWFA bars requiring leave when another reasonable accommodation would let the employee keep working.
3. Deny the change because light duty is for work injuries
   A policy limiting light duty to work injuries cannot justify denying an accommodation the PWFA requires.
4. Modify the nurse's assignments within those limits
   The Pregnant Workers Fairness Act requires reasonable accommodation of known pregnancy-related limitations, and adjusting assignments is a modest accommodation.

A unit often runs out of IV tubing on weekends yet has expired dressing supplies on its shelves. Which approach BEST addresses both problems?

1. Order every item daily regardless of use
   Daily ordering without regard to use raises cost and does nothing about expired items.
2. Raise all par levels on the unit by 25%
   A blanket increase fixes the shortages by adding more stock that expires.
3. Switch to a new vendor for IV tubing
   The shortage comes from how pars are set, not from the vendor, and a new vendor does nothing about expiring dressings.
4. Reset par levels from actual usage data
   Par levels based on real use stock enough of fast movers like IV tubing and less of slow movers that expire.

A high-census unit has fixed costs of $200,000 a month and variable costs of $150 per patient day. What is the total cost for a 30-day month with an average daily census of 80?

1. $360,000
   $360,000 is the variable cost alone; the $200,000 fixed cost is missing.
2. $6,360,000
   This multiplies the monthly fixed cost by 30 days as if it were daily: $6,000,000 + $360,000.
3. $560,000
   Patient days = 80 × 30 = 2,400; variable cost = 2,400 × $150 = $360,000; total = $200,000 + $360,000 = $560,000.
4. $212,000
   This adds only one day's variable cost (80 × $150 = $12,000) to the fixed cost.

A director is developing a newly hired nurse manager who has strong clinical skills but no budgeting experience. Which approach BEST reflects effective coaching?

1. Let the manager build the budget alone to learn by doing it
   Learning alone without feedback risks errors and is abdication, not coaching.
2. Have the manager draft the budget with scheduled reviews
   Coaching builds skill through real work with guidance: the manager does the task, and the director reviews it and gives feedback along the way.
3. Prepare the budget for the manager for the first year
   Doing the work for the manager builds dependence instead of skill.
4. Enroll the manager in a healthcare finance course
   A course teaches general finance; coaching is guided practice on the manager's own budget.

On a high-performing unit, newer nurses defer to senior nurses even when they see a safety problem. Which strategy should the nurse manager use to change this team dynamic?

1. Remind newer nurses to use the chain of command for issues
   The chain of command is slow for an immediate safety problem, and it does nothing about the reluctance to challenge.
2. Assign newer nurses only to shifts led by senior mentors
   More senior oversight reinforces the deference hierarchy instead of changing it.
3. Ask senior nurses to check newer nurses' work each shift
   Extra checks by senior nurses deepen dependence and do nothing to empower newer nurses.
4. Teach all staff scripted phrases to voice safety concerns
   Scripted speak-up phrases that every nurse learns give newer nurses a shared, expected way to raise a safety concern, so seniority no longer decides whether the concern is heard.

An RN tells the nurse manager that more than a week off will be needed to care for a parent after surgery. Under the FMLA, what is the employer's next obligation?

1. Give an eligibility notice within 5 business days
   Once the employer learns that leave may be FMLA-qualifying, it must tell the employee about eligibility within five business days, absent extenuating circumstances (29 CFR 825.300(b)).
2. Wait for the RN to submit a formal FMLA leave form
   The employee need not request FMLA by name or use a form; the employer must act once it has notice of a possibly qualifying reason.
3. Provide FMLA information only if the RN asks for it
   The duty to notify is triggered by the employer's knowledge, not by the employee's request.
4. Decide within 30 days whether the leave will qualify
   There is no 30-day decision window; the designation notice follows within five business days of having enough information.

A CNO wants nurse managers to learn how their leadership is experienced by their staff, peers, and physician partners. Which appraisal method BEST meets this goal?

1. A forced-distribution ranking of managers
   Forced ranking compares managers with one another; it says nothing about how staff and partners experience each one.
2. A graphic rating scale completed by the CNO
   A rating by the CNO alone gives one viewpoint, the opposite of multi-source feedback.
3. A 360-degree feedback review
   360-degree feedback gathers ratings from staff, peers, physicians and the manager's own leader, showing how leadership is experienced from every direction.
4. A management-by-objectives review
   MBO measures results against agreed goals, not how others experience the manager's behavior.

Which EMTALA requirement helps ensure patients know their right to a screening exam regardless of ability to pay?

1. Screening insured patients ahead of all others
   Ordering care by insurance status is discriminatory and violates EMTALA.
2. Posting signs that explain emergency-care rights
   EMTALA requires conspicuous signs in the emergency department telling patients of their right to screening and stabilizing care regardless of ability to pay.
3. Verifying insurance coverage at registration
   Insurance checks are allowed only when they do not delay screening, and they tell the patient nothing about their rights.
4. Collecting a deposit from each patient before triage
   Asking for payment before screening delays care and is prohibited.

Which policy best manages conflict-of-interest risk when nurse leaders interact with device and drug vendors?

1. Required disclosure and documentation of vendor ties
   Conflict-of-interest risk is managed by requiring leaders to disclose vendor relationships and document interactions under a written policy that compliance reviews.
2. Accepting vendor gifts that seem minor
   "Minor" is undefined without a policy, and even small gifts create a sense of obligation; limits have to be set and documented.
3. An outright ban on meeting with any device or drug vendor
   A total ban blocks legitimate product evaluation and education; the risk is managed through disclosure, not prohibition.
4. Leaving vendor contacts to each manager's judgment
   Individual discretion produces inconsistent standards and leaves no record for compliance review.

A director compares two capital projects with similar total savings, but one delivers most of its savings in the first two years. Which measure accounts for the timing of future cash flows?

1. Break-even volume
   Break-even volume is the activity level at which revenue covers cost; it says nothing about the timing of savings.
2. Net present value
   NPV discounts each future cash flow to today's value, so savings that arrive earlier count for more.
3. Average accounting return
   Accounting return averages profit over the project's life without considering when the money arrives.
4. Simple payback period
   Payback counts how long until savings equal the cost, but it does not discount cash flows and ignores savings after payback.

As a unit's monthly patient days increase, what happens to its fixed cost PER patient day?

1. It rises with each additional patient day
   Rising with each patient day describes a variable cost in total, not a fixed cost per unit.
2. It stays the same at any volume of patients
   The total fixed cost stays the same; the cost per patient day changes with volume.
3. It changes only when the budget is revised
   Budget revisions change the plan, but per-day fixed cost moves with actual volume every month.
4. It falls as patient volume rises
   A fixed cost stays the same in total, so spreading it over more patient days lowers the fixed cost per patient day.

A hospital uses the FLSA 8-and-80 system by prior agreement. A non-exempt RN works four 12-hour shifts in week 1 and three 8-hour shifts in week 2 of the 14-day period. How many overtime hours are owed?

1. 16
   Under 8-and-80, overtime is due for hours over 8 in a workday or over 80 in the 14-day period, whichever is greater: four shifts × 4 hours over 8 = 16, while the 72 total hours stay under 80.
2. 0
   This applies only the 80-hour test; the 8-hour daily test still makes the extra 4 hours of each 12-hour shift overtime.
3. 32
   This counts every hour beyond 40 across the two weeks combined (72 − 40), which neither overtime method uses.
4. 8
   This uses the standard 40-hour workweek (48 − 40 in week 1) instead of the 8-and-80 system the hospital adopted.

An RN starts 10 weeks of unpaid FMLA leave and has 3 weeks of accrued vacation. What may the hospital require under the FMLA?

1. That the FMLA leave stay unpaid with vacation saved
   Keeping vacation in reserve is the employee's choice only if the employer does not require substitution; it is not a requirement the employer can impose.
2. That the RN forfeit the vacation while on FMLA leave
   Taking FMLA leave cannot cost an employee accrued benefits; forfeiting earned vacation would interfere with FMLA rights.
3. That the vacation be used only after the FMLA leave ends
   Requiring vacation afterward would stretch the absence beyond the entitlement; the rule lets paid leave run at the same time.
4. That the paid vacation run concurrently with the FMLA leave
   The FMLA lets the employer require, or the employee choose, substitution of accrued paid leave, so the vacation is used during the 12-week entitlement rather than added to it.

A patient repeatedly makes sexual comments to a female RN, who reports it to her manager. What is the hospital's obligation under Title VII?

1. Act only if the RN files a written grievance first
   The duty starts when the employer knows of the harassment; a verbal report to a manager is enough.
2. Take prompt corrective action to stop the harassment
   An employer is responsible for harassment by non-employees such as patients when it knows or should know and fails to take prompt, appropriate corrective action.
3. Reassign the RN without addressing the patient's conduct
   Moving the RN alone can penalize the person who reported and leaves the patient free to repeat the conduct with others.
4. None, because the harasser is a patient, not an employee
   Title VII reaches harassment by patients and visitors; who the harasser is affects the remedy, not the duty to act.

An RN requests FMLA leave for a serious health condition, and the hospital asks for medical certification. How long does the RN generally have to provide it?

1. Within 2 business days of the employer's request
   Two days is far shorter than the rule; the regulations give the employee at least 15 calendar days.
2. Only if the leave lasts longer than two weeks
   Any leave for a serious health condition can require certification, whatever its length.
3. At least 15 calendar days after the employer's request
   The employee must provide certification within 15 calendar days of the request, unless that is not practicable despite diligent, good-faith efforts.
4. Within 30 days after the leave has ended
   Certification supports the request before or early in the leave; it is not deferred until the leave is over.

An audit shows that an RN opened the chart of a coworker who was admitted, without any care role. How should the nurse manager view this?

1. As acceptable, if the RN did not share what was seen
   Viewing without a need is itself the violation; no further disclosure is needed for it to count.
2. As a matter for the coworker to raise personally
   The hospital must act on the audit finding itself; it cannot leave enforcement to the affected coworker.
3. As acceptable, since the RN works for the same hospital
   Employment does not authorize access; access follows the care or work role, not the employer.
4. As a privacy violation that requires sanction under policy
   Access to PHI is limited to what a job requires; looking at a chart out of curiosity is an impermissible use, and the Privacy Rule requires sanctions under the hospital's policy.

A medical unit's CAUTI rate has risen for two quarters. Which practice MOST directly lowers it?

1. Prophylactic antibiotics for patients with catheters
   Routine antibiotics do not prevent CAUTI and promote resistance.
2. A nurse-driven protocol to remove catheters no longer indicated
   Catheter days drive CAUTI risk, so a protocol that lets nurses remove catheters once they no longer meet criteria lowers infections most directly.
3. Routine catheter changes every 7 days for each patient
   Changing catheters on a fixed schedule is not recommended and adds insertion risk without lowering infections.
4. Daily antiseptic cleaning around the catheter insertion site
   Routine antiseptic meatal cleaning is not recommended; ordinary hygiene is enough and it does not shorten catheter use.

A patient falls on the unit without serious injury. What should the team do before the end of the shift?

1. Add a bed alarm and close the event once it is reported
   A single device chosen without analysis may not fit the cause, and closing the event stops the learning.
2. Wait for the monthly falls committee to review the case
   A monthly review comes too late to protect this patient, and details fade by then.
3. Hold a post-fall huddle to find causes and update the plan
   A huddle soon after the fall, with the patient and staff involved, captures what happened while it is fresh and changes the plan to prevent a repeat.
4. Have the assigned nurse write a statement explaining the fall
   An individual statement treats the fall as one nurse's fault instead of looking at the factors behind it.

An RN who has worked three 12-hour shifts in the past 5 days asks to pick up a fourth and a fifth this week. Under ANA's position on nurse fatigue, what should the manager do?

1. Approve one shift and ask the RN to rest before the next
   One extra shift still brings the week to 48 hours, beyond the 40-hour limit.
2. Approve, because the RN volunteered for the shifts
   Volunteering does not reduce fatigue; the risk to patients and the nurse is the same.
3. Approve, if the RN takes a short break on each shift
   Breaks within a shift help, but they do not offset accumulated hours across the week.
4. Decline, because it would exceed 40 hours in 7 days
   ANA's fatigue position calls for limits of 12 hours in 24 hours and 40 hours in 7 days, because fatigue raises the risk of errors and injury.

Back injuries among nurses on a medical unit have doubled in a year. Which intervention MOST effectively reduces them?

1. Annual training on proper body mechanics for all staff
   Body-mechanics training alone has not been shown to reduce injuries; the loads remain too heavy to lift safely by hand.
2. Lift equipment with training and a no-solo-lift policy
   Injuries fall when manual lifting is replaced by mechanical lift equipment, with training and a policy that no one lifts alone.
3. Back belts for staff who lift patients often
   Back belts have no proven benefit in preventing lifting injuries.
4. Two-person manual lifts for every heavy patient
   A second person still leaves both lifting a load beyond safe limits; manual lifting stays the hazard.

Several assaults on a unit came from patients with a known history of violence. Which step MOST directly reduces this risk?

1. Flag these patients in the chart and share a safety plan
   OSHA's guidelines call for identifying patients with a history of violence in the record and sharing a care plan, so every staff member knows the risk and the approach before contact.
2. Post zero-tolerance signs at the unit entrance
   Signs set expectations for visitors but do not tell staff which patients pose a risk.
3. Add security cameras in the unit hallways
   Cameras record incidents in hallways, while most assaults by patients happen during direct care.
4. Restrain patients early when they become agitated
   Early restraint escalates aggression and injures patients and staff; it is a last resort, not prevention.

A patient at high risk for suicide is admitted to a medical unit while awaiting a psychiatric bed. Which unit action MOST directly reduces the risk of self-harm?

1. Check the room and remove ligature points and hazardous items
   Medical rooms are full of cords, tubing and fixtures; an environmental check that removes them, with appropriate observation, addresses the means of self-harm directly.
2. Place the patient in a room close to the nurses' station
   Proximity helps staff notice problems but does not remove the means of self-harm in the room.
3. Schedule the patient for a psychiatric consult the next day
   A next-day consult delays the safety measures the patient needs from the moment of admission.
4. Ask the family to stay with the patient overnight
   Family presence is not trained observation, and it leaves the hazards in the room.

A device vendor offers to pay for a unit's holiday party if the unit keeps using the vendor's infusion pumps. Which law does this offer MOST directly raise?

1. The Stark Law
   Stark covers physician self-referral to entities in which the physician or family has a financial relationship; no physician referral is involved here.
2. The HIPAA Privacy Rule
   HIPAA protects health information; a gift from a vendor raises no privacy question.
3. The Anti-Kickback Statute
   The AKS bars offering or accepting anything of value to induce the purchase or ordering of items paid for by federal health programs, which includes a party tied to continued pump use.
4. EMTALA
   EMTALA governs emergency screening and stabilization, not vendor relationships.