Effective Leadership & Management in Nursing, 9e (Sullivan)

Chapter 28 Imagining the Future

1) Having an adequate number of staff per client affects what factors?

1. Infections
2. Mortality
3. Length of stay
4. Charges
5. Fall rates
Answer: 1, 2, 3, 5
Explanation: 1. Having an adequate number of nurses per client affects the rate of infection,
mortality, length of stay, urinary tract infections, hospital-acquired pneumonia, and fall rates.
2. Having an adequate number of nurses per client affects the rate of infection, mortality, length
of stay, urinary tract infections, hospital-acquired pneumonia, and fall rates.
3. Having an adequate number of nurses per client affects the rate of infection, mortality, length
of stay, urinary tract infections, hospital-acquired pneumonia, and fall rates.
4. Having an adequate number of nurses per client affects the rate of infection, mortality, length
of stay, urinary tract infections, hospital-acquired pneumonia, and fall rates.
5. Having an adequate number of nurses per client affects the rate of infection, mortality, length
of stay, urinary tract infections, hospital-acquired pneumonia, and fall rates.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Resource Utilization
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

2) The ________ changed how healthcare is reimbursed.

Answer: Affordable Care Act
Explanation: The Affordable Care Act changed how healthcare is reimbursed. (This question
only has 1 answer for each blank, so you can use the heading Global rationale for it).
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

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3) What reforms did the Affordable Care Act (ACA) enact?
1. More affordable coverage
2. Stronger Medicare program
3. Stronger consumer rights and protections
4. Stronger Medicaid program
5. Less taxing for programs such as Medicaid
Answer: 1, 2, 3
Explanation: 1. The ACA enacted the following reforms: more affordable coverage, stronger
Medicare program, and stronger consumer rights and protections.
2. The ACA enacted the following reforms: more affordable coverage, stronger Medicare
program, and stronger consumer rights and protections.
3. The ACA enacted the following reforms: more affordable coverage, stronger Medicare
program, and stronger consumer rights and protections.
4. The ACA enacted the following reforms: more affordable coverage, stronger Medicare
program, and stronger consumer rights and protections.
5. The ACA enacted the following reforms: more affordable coverage, stronger Medicare
program, and stronger consumer rights and protections.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

4) One possible future includes which of the following wildcards?

1. Plausible occurrences
2. Unforeseen events
3. Probable future
4. Extension of the past
Answer: 2
Explanation: 1. A possible future includes wildcards, which are unforeseen events.
2. A possible future includes wildcards, which are unforeseen events.
3. A possible future includes wildcards, which are unforeseen events.
4. A possible future includes wildcards, which are unforeseen events.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-2: Evaluate predictions about society's future.

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5) What efforts have been made to improve relationships between clients and nurses?
1. Introduce self by name and role when first meeting
2. Wear all white
3. Perform as a handmaiden
4. Wear a visible RN name tag
5. Bedside report
Answer: 1, 4
Explanation: 1. Efforts to improve relationships between clients and nurses include introducing
oneself by name and role when first meeting and wearing a visible RN name tag.
2. Efforts to improve relationships between clients and nurses include introducing oneself by
name and role when first meeting and wearing a visible RN name tag.
3. Efforts to improve relationships between clients and nurses include introducing oneself by
name and role when first meeting and wearing a visible RN name tag.
4. Efforts to improve relationships between clients and nurses include introducing oneself by
name and role when first meeting and wearing a visible RN name tag.
5. Efforts to improve relationships between clients and nurses include introducing oneself by
name and role when first meeting and wearing a visible RN name tag.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 28-4: Critique opportunities for nurses in the future.

6) As a result of the Affordable Care Act, healthcare organizations are paid for the ________ of
their care.
1. quality
2. time used
3. amount
4. value
Answer: 4
Explanation: 1. As a result of the Affordable Care Act, healthcare organizations are paid for the
value of their care.
2. As a result of the Affordable Care Act, healthcare organizations are paid for the value of their
care.
3. As a result of the Affordable Care Act, healthcare organizations are paid for the value of their
care.
4. As a result of the Affordable Care Act, healthcare organizations are paid for the value of their
care.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

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7) Why have healthcare clinics relocated to retail stores?
1. More profit
2. For urgent care needs
3. One-stop shopping
4. Expanding services
5. Consumers' desire for quick, available service
Answer: 2, 5
Explanation: 1. Healthcare clinics have relocated to retail stores to provide for client's urgent
care needs and desire for quick, available service.
2. Healthcare clinics have relocated to retail stores to provide for client's urgent care needs and
desire for quick, available service.
3. Healthcare clinics have relocated to retail stores to provide for client's urgent care needs and
desire for quick, available service.
4. Healthcare clinics have relocated to retail stores to provide for client's urgent care needs and
desire for quick, available service.
5. Healthcare clinics have relocated to retail stores to provide for client's urgent care needs and
desire for quick, available service.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Resource Utilization
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

8) The average age of nurses in the United States is ________ years, and approximately
________% of the workforce is over the age of ________.
Answer: 46.8, 40, 50
Explanation: The average age of nurses in the United States is 46.8 years, and approximately
40% of the workforce is over the age of 50.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-4: Critique opportunities for nurses in the future.

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9) Medicare reimbursement is based on what factor?
1. Physician fees
2. Client satisfaction
3. Accreditation reviews
4. State board of hospital reviews
Answer: 2
Explanation: 1. Medicare reimbursement is based on client satisfaction.
2. Medicare reimbursement is based on client satisfaction.
3. Medicare reimbursement is based on client satisfaction.
4. Medicare reimbursement is based on client satisfaction.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

10) Today, various generations work together to provide care. In order to be successful and work
as cohesive teams, what must these nurses do?
1. Place staff in positions fitting their character
2. Demonstrate active and assertive communication
3. Have opposing views
4. Recognize individual skill sets of each generation
5. Work with tension
Answer: 1, 2, 4
Explanation: 1. To be successful, nurses must place individuals in positions that fit their
character, demonstrate active and assertive communication, and recognize individual skill sets of
other generations.
2. To be successful, nurses must place individuals in positions that fit their character,
demonstrate active and assertive communication, and recognize individual skill sets of other
generations.
3. To be successful, nurses must place individuals in positions that fit their character,
demonstrate active and assertive communication, and recognize individual skill sets of other
generations.
4. To be successful, nurses must place individuals in positions that fit their character,
demonstrate active and assertive communication, and recognize individual skill sets of other
generations.
5. To be successful, nurses must place individuals in positions that fit their character,
demonstrate active and assertive communication, and recognize individual skill sets of other
generations.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

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11) The Institute of Medicine's (IOMs) recommendations for nursing include which of the
following?
1. Implement nurse residency programs
2. Expand opportunities for nurses to lead
3. Prepare and enable nurses to lead change to advance health
4. Ensure nurses engage in lifelong learning
5. Ensure full accessibility to all part of the organization
Answer: 1, 2, 3, 4
Explanation: 1. The IOMs recommendations for nursing include the following: remove scope-
of-practice barriers, expand opportunities for nurses to lead and diffuse collaborative
improvement efforts, implement nurse residency programs, increase the proportion of nurses
with a baccalaureate to 80% by 2020, double the number of nurses with a doctorate by 2020,
ensure that nurses engage in lifelong learning, prepare and enable nurses to lead change to
advance health, and build an infrastructure for the collection and analysis of interprofessional
healthcare workforce data.
2. The IOMs recommendations for nursing include the following: remove scope-of-practice
barriers, expand opportunities for nurses to lead and diffuse collaborative improvement efforts,
implement nurse residency programs, increase the proportion of nurses with a baccalaureate to
80% by 2020, double the number of nurses with a doctorate by 2020, ensure that nurses engage
in lifelong learning, prepare and enable nurses to lead change to advance health, and build an
infrastructure for the collection and analysis of interprofessional healthcare workforce data.
3. The IOMs recommendations for nursing include the following: remove scope-of-practice
barriers, expand opportunities for nurses to lead and diffuse collaborative improvement efforts,
implement nurse residency programs, increase the proportion of nurses with a baccalaureate to
80% by 2020, double the number of nurses with a doctorate by 2020, ensure that nurses engage
in lifelong learning, prepare and enable nurses to lead change to advance health, and build an
infrastructure for the collection and analysis of interprofessional healthcare workforce data.
4. The IOMs recommendations for nursing include the following: remove scope-of-practice
barriers, expand opportunities for nurses to lead and diffuse collaborative improvement efforts,
implement nurse residency programs, increase the proportion of nurses with a baccalaureate to
80% by 2020, double the number of nurses with a doctorate by 2020, ensure that nurses engage
in lifelong learning, prepare and enable nurses to lead change to advance health, and build an
infrastructure for the collection and analysis of interprofessional healthcare workforce data.
5. The IOMs recommendations for nursing include the following: remove scope-of-practice
barriers, expand opportunities for nurses to lead and diffuse collaborative improvement efforts,
implement nurse residency programs, increase the proportion of nurses with a baccalaureate to
80% by 2020, double the number of nurses with a doctorate by 2020, ensure that nurses engage
in lifelong learning, prepare and enable nurses to lead change to advance health, and build an
infrastructure for the collection and analysis of interprofessional healthcare workforce data.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-4: Critique opportunities for nurses in the future.

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12) The first year as a nurse will be challenging. What can the nurse do in the first year to ensure
success?
1. Build effective relationships
2. Manage a good impression
3. Appraise other job prospects
4. Adopt the right attitudes
5. Master skills and knowledge of the position
Answer: 1, 2, 4, 5
Explanation: 1. In the first year, the novice nurse can ensure success by building effective
relationships, manage a good impression, develop organizational savvy, adopt the right attitudes,
adjust expectations, and master skills and knowledge of the position.
2. In the first year, the novice nurse can ensure success by building effective relationships,
manage a good impression, develop organizational savvy, adopt the right attitudes, adjust
expectations, and master skills and knowledge of the position.
3. In the first year, the novice nurse can ensure success by building effective relationships,
manage a good impression, develop organizational savvy, adopt the right attitudes, adjust
expectations, and master skills and knowledge of the position.
4. In the first year, the novice nurse can ensure success by building effective relationships,
manage a good impression, develop organizational savvy, adopt the right attitudes, adjust
expectations, and master skills and knowledge of the position.
5. In the first year, the novice nurse can ensure success by building effective relationships,
manage a good impression, develop organizational savvy, adopt the right attitudes, adjust
expectations, and master skills and knowledge of the position.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-4: Critique opportunities for nurses in the future.

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13) Health Care Reform includes which of the following changes?
1. Free preventive services for women
2. Standardized reporting of healthcare coverage so that consumers can compare plans
3. Support for transitional care
4. Assurance that everyone can afford care at the level that they need care
5. Creation of medical homes that bridge the gap from hospital to home care
Answer: 1, 2, 3, 5
Explanation: 1. Health Care Reform includes prohibition of insurance cancellation if the person
is ill, eliminating preexisting condition clauses and prohibiting lifetime limits; creation of state
health insurance exchanges; support for nursing education/students; nurse-managed clinics;
school-based health centers; support for transitional care and chronic disease management;
creation of accountable care organizations and medical homes that bridge the gap between
services and home care; free preventive services for women; and standardized reporting of
healthcare coverage so that consumers can compare plans.
2. Health Care Reform includes prohibition of insurance cancellation if the person is ill,
eliminating preexisting condition clauses and prohibiting lifetime limits; creation of state health
insurance exchanges; support for nursing education/students; nurse-managed clinics; school-
based health centers; support for transitional care and chronic disease management; creation of
accountable care organizations and medical homes that bridge the gap between services and
home care; free preventive services for women; and standardized reporting of healthcare
coverage so that consumers can compare plans.
3. Health Care Reform includes prohibition of insurance cancellation if the person is ill,
eliminating preexisting condition clauses and prohibiting lifetime limits; creation of state health
insurance exchanges; support for nursing education/students; nurse-managed clinics; school-
based health centers; support for transitional care and chronic disease management; creation of
accountable care organizations and medical homes that bridge the gap between services and
home care; free preventive services for women; and standardized reporting of healthcare
coverage so that consumers can compare plans.
4. Health Care Reform includes prohibition of insurance cancellation if the person is ill,
eliminating preexisting condition clauses and prohibiting lifetime limits; creation of state health
insurance exchanges; support for nursing education/students; nurse-managed clinics; school-
based health centers; support for transitional care and chronic disease management; creation of
accountable care organizations and medical homes that bridge the gap between services and
home care; free preventive services for women; and standardized reporting of healthcare
coverage so that consumers can compare plans.
5. Health Care Reform includes prohibition of insurance cancellation if the person is ill,
eliminating preexisting condition clauses and prohibiting lifetime limits; creation of state health
insurance exchanges; support for nursing education/students; nurse-managed clinics; school-
based health centers; support for transitional care and chronic disease management; creation of
accountable care organizations and medical homes that bridge the gap between services and
home care; free preventive services for women; and standardized reporting of healthcare
coverage so that consumers can compare plans.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
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Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

14) The ________ future includes anything that could happen, including ________, which are
unforeseen events that have far-reaching effects.
Answer: possible, wildcards
Explanation: The possible future includes anything that could happen including wildcards,
which are unforeseen events that have far-reaching effects.
Cognitive Level: Applying
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-2: Evaluate predictions about society's future.

15) The Institute of Medicine (IOM) has recommended aims for improving quality in healthcare.
The IOM suggests that healthcare should be what?
1. Timely
2. Patient-centered
3. Effective
4. Inequitable
5. Safe
Answer: 1, 2, 3, 5
Explanation: 1. The IOM recommends that healthcare should be safe, effective, patient-centered,
timely, efficient, and equitable.
2. The IOM recommends that healthcare should be safe, effective, patient-centered, timely,
efficient, and equitable.
3. The IOM recommends that healthcare should be safe, effective, patient-centered, timely,
efficient, and equitable.
4. The IOM recommends that healthcare should be safe, effective, patient-centered, timely,
efficient, and equitable.
5. The IOM recommends that healthcare should be safe, effective, patient-centered, timely,
efficient, and equitable.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

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16) What are the future trends that are expected to affect nurses and the care they provide?
1. Increasing quality improvement and safety issues
2. Aging of the workforce
3. Increased cost-cutting
4. Aging of the baby-boomer generation
5. Physician's performing house calls
Answer: 1, 2, 3, 4
Explanation: 1. Future trends expected to affect nurses and the care they provide include
continued aging of the workforce, aging of the baby boomer generation, integration of evidence-
based practice into nursing education programs, efforts to ensure client safety(including
reduction of nosocomial infections, medication errors, failure to rescue, and other serious
adverse events), increased quality improvement efforts, use of electronic health records as
standard practice, acceptance of alternative/complementary approaches by many members of the
public and integrated into medical/nursing practice, focus on care transitions, care moving from
hospital to community, continued decrease of reimbursement from Medicare/Medicaid;
continued cost cutting, and improved communication and increased travel increasing exposure to
disease.
2. Future trends expected to affect nurses and the care they provide include continued aging of
the workforce, aging of the baby boomer generation, integration of evidence-based practice into
nursing education programs, efforts to ensure client safety(including reduction of nosocomial
infections, medication errors, failure to rescue, and other serious adverse events), increased
quality improvement efforts, use of electronic health records as standard practice, acceptance of
alternative/complementary approaches by many members of the public and integrated into
medical/nursing practice, focus on care transitions, care moving from hospital to community,
continued decrease of reimbursement from Medicare/Medicaid; continued cost cutting, and
improved communication and increased travel increasing exposure to disease.
3. Future trends expected to affect nurses and the care they provide include continued aging of
the workforce, aging of the baby boomer generation, integration of evidence-based practice into
nursing education programs, efforts to ensure client safety(including reduction of nosocomial
infections, medication errors, failure to rescue, and other serious adverse events), increased
quality improvement efforts, use of electronic health records as standard practice, acceptance of
alternative/complementary approaches by many members of the public and integrated into
medical/nursing practice, focus on care transitions, care moving from hospital to community,
continued decrease of reimbursement from Medicare/Medicaid; continued cost cutting, and
improved communication and increased travel increasing exposure to disease.
4. Future trends expected to affect nurses and the care they provide include continued aging of
the workforce, aging of the baby boomer generation, integration of evidence-based practice into
nursing education programs, efforts to ensure client safety(including reduction of nosocomial
infections, medication errors, failure to rescue, and other serious adverse events), increased
quality improvement efforts, use of electronic health records as standard practice, acceptance of
alternative/complementary approaches by many members of the public and integrated into
medical/nursing practice, focus on care transitions, care moving from hospital to community,
continued decrease of reimbursement from Medicare/Medicaid; continued cost cutting, and
improved communication and increased travel increasing exposure to disease.

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5. Future trends expected to affect nurses and the care they provide include continued aging of
the workforce, aging of the baby boomer generation, integration of evidence-based practice into
nursing education programs, efforts to ensure client safety(including reduction of nosocomial
infections, medication errors, failure to rescue, and other serious adverse events), increased
quality improvement efforts, use of electronic health records as standard practice, acceptance of
alternative/complementary approaches by many members of the public and integrated into
medical/nursing practice, focus on care transitions, care moving from hospital to community,
continued decrease of reimbursement from Medicare/Medicaid; continued cost cutting, and
improved communication and increased travel increasing exposure to disease.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Leadership
Learning Outcome: 28-3: Assess changes affecting the future in healthcare.

17) The Institute of Medicine (IOM) report on the Future of Nursing states which of the
following?
1. Society must promote rights for nurses.
2. The view of nursing should be positive and realistic.
3. Nurses need to be permitted to use their educational skills in the healthcare environment.
4. Nursing should be advanced in the interest of the public.
Answer: 3
Explanation: 1. The IOM Future of Nursing report states: Nurses need to be permitted to use
their educational skills in the healthcare environment.
2. The IOM Future of Nursing report states: Nurses need to be permitted to use their educational
skills in the healthcare environment.
3. The IOM Future of Nursing report states: Nurses need to be permitted to use their educational
skills in the healthcare environment.
4. The IOM Future of Nursing report states: Nurses need to be permitted to use their educational
skills in the healthcare environment.
Cognitive Level: Analyzing
Client Need: Safe Effective Care Environment
Client Need Sub: Management of Care
Nursing/Int Conc: Nursing Process: Evaluation/Education
Learning Outcome: 28-4: Critique opportunities for nurses in the future.

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