2020 EXAM #3 Combined

Clinical incompetence is a problem facing a nurse manager. Joyce, the nurse manager, is not aware of the problems of Sarah, a novice nurse. After she investigates, it is obvious that Sarah's peers are covering for her. Which of the following might Joyce include in her meeting with the nurses? a."It is a nurse's professional responsibility to maintain quality control." b."All instances of clinical incompetence are to be reported." c."It is not considered being disloyal when one nurse reports another for poor care." d."Patient care is the number one concern. Meeting standards is mandatory and necessary."

"It is a nurse's professional responsibility to... "All instances of clinical incompetence... "It is not considered being disloyal when... "Patient care is the number one concern...

Which of the following exemplifies a service orientation? a. Staff members on the unit are encouraged to chart details about family support networks. b. Chart audit reveals that details related to assessment of family history are missing. c. The palliative care unit organizes a "tree of light" fundraiser each year to highlight the importance of palliative care. d. A children's preoperative holding area is initiated in response to requests from families and nurses who care for them..

d. A children's preoperative holding area is initiated in response to requests from families and nurses who care for them.. ANS: D A service orntation needs to translate caring into appropriate, timely action that meets the needs of patients. Activities such as documentation of details or promotion of services may remain at the technical or conceptual level without a commitment to caring interactions. The institution of a holding area where families can be with children represents a caring action that arises out of interactions and knowledge of patient needs and thus, is service oriented.

11. As a new manager, you are shocked to learn that your unit is still using heparin in heparin locks. You are aware of evidence related to this practice and want to change this practice as quickly as possible on your unit. You are in which stage of Lewin's stages of change? a. Unfreezing b. Experiencing the change c. Integrating the change d. Refreezing

A

12. To engage your staff in awareness of their current practice and how it is affirmed or not by evidence, you plan a short series of learning presentations on evidence and use of heparin and saline to maintain IV patency. You meet with the educator to plan out the goals for each session with the overall purpose of increasing knowledge and awareness of staff in readiness to consider questions related to the IV practice. This learning approach is an example of which change management approach? a. Linear b. Nonlinear c. Facilitative d. Integrative

A

18. After speaking with Elizabeth, a few days later, you discover that she is now fine with the change but is concerned that other areas of the organization might resist the change because of perceptions related to patient safety and cost. She suggests that it is important to bring pharmacy on board as they have had previous concerns about the use of heparin. This type of campaign is best described as: a. Political. b. Marketing. c. Military. d. Cooptation.

A

3. The nurse manager frequently interacts with staff and other hospice facility employees. Communication was purposeful because the manager assessed current issues, such as specific satisfactions and dissatisfactions with the newly implemented computerized documentation system. Informally, the manager gathered available staff members to address similar learning needs. Many times, staff members were found coaching other staff about improving use of the new system. According to Senge (1990), the activities demonstrated in this example are: a. Dialogue, team learning. b. Resilience, personal mastery. c. Shared vision, systems thinking. d. Mental models, teachable moments.

A

5. Complex change situations require that the change leader promote ongoing visioning among staff members. One strategy is to: a. Consciously evaluate invisible mental models. b. Allow for individual outcomes. c. Encourage cooperative activities. d. Operate between order and disorder.

A

26. Which of the following are examples of application of the Leadership Rounding Tool? (Select all that apply.) a. "What is working well for you during bedside reporting?" b. "What has not worked for you today?" c. "Is there someone on your team who deserves special recognition for her efforts in the implementation?" d. "Did you have a good vacation?"

A, B, C, D

5. Sarah, a staff nurse on your unit, witnesses another nurse striking a patient. Sarah wants to remain friends with her colleague and worries that confrontation with her colleague or reporting her colleague will destroy their relationship. Sarah is experiencing which type of conflict? a. Intrapersonal b. Interpersonal c. Organizational d. Professional

ANS: A Intrapersonal conflict occurs within a person when confronted with the need to think or act in a way that seems at odds with one's sense of self. Questions often arise that create a conflict over priorities, ethical standards, and values. Some issues present a conflict over comfortably maintaining the status quo and taking risks to confront people when needed, which can lead to interpersonal conflict.

3. The nurse manager is aware that conflict is occurring on her unit; however, she is focused on preparing for a state health department visit, so she ignores the problem. A factor that can increase stress and escalate conflict is: a. The use of avoidance. b. An enhanced nursing workforce. c. Accepting that some conflict is normal. d. Managing the effects of fatigue and error.

ANS: A Purposeful avoiding is an appropriate strategy when the conflict is interpersonal and the individuals involved in the conflict have the necessary skills and insight to be able to own the problem and solve it themselves. When these conditions are not present and avoidance is not purposeful, then avoidance can increase stress and escalate conflict.

The nurse is presenting an in-service on the importance of collaborative communication. The nurse includes which critical event identified by the Joint Commission as an outcome of poor communication among health care team members? a. The occurrence of a patient event resulting in death or serious injury b. Decreased ability to document expenses of care provided c. Longer time to begin surgical cases d. Increased time to discharge patients to outpatient care

ANS: A The Joint Commission has identified that poor communication is the primary factor in the occurrence of sentinel events, or events resulting in unintended death or serious injury to patients. Lack of documentation, longer time to begin surgery, and increased delays in discharge all contribute to the management of health care, but do not result in critical patient outcomes.

7. After using a mediator to resolve a conflict between the nurse manager and two staff nurses, the chief nursing officer decides to: a. Observe to make sure the conflict has been resolved. b. Fire both staff nurses. c. Reassign both staff nurses. d. Reassign the nurse manager.

ANS: A The nurse leader should critically analyze organizational issues after a review of the evidence. Following up is important and necessary to maintain conflict resolution.

14. A nurse educator is giving a workshop on conflict. During the sessions, he makes various statements regarding conflict. All of the statements are true except: a. Conflict can decrease creativity, thus acting as a deterrent for the development of new ideas. b. Conflict can arise over the most trivial issues. c. A variety of definitions of conflict are known. d. All conflicts involve some level of disagreement.

ANS: A The opposite is true because research has shown that conflict, like change, increases creativity and allows for the development of new ideas.

2. Two staff nurses are arguing about working on holidays. In trying to resolve this conflict, the nurse manager understands that interpersonal conflict arises when: a. Risk taking seems to be unavoidable. b. People see events differently. c. Personal and professional priorities do not match. d. The ways in which people should act do not match the ways in which they do act.

ANS: B By definition, conflict involves a difference in perception between two or more individuals.

A nurse manager has recently overheard several negative comments made by nurses on the unit about other nurses on the unit. The manager recognizes that the nurses are exhibiting what type of behavior that is detrimental to collaboration? a. Vertical violence b. Lateral violence c. Descending violence d. Personal violence

ANS: B Lateral violence undermines collaboration and occurs nurse-to-nurse. Vertical or descending violence implies one participant has a higher status than another. Personal violence falls in a legal category, and while it will hinder collaboration, it is not specific to coworkers.

The management of a community hospital is trying to encourage a more collaborative environment among staff members. Which concept is most important for management to develop first? a. Post educational posters about how well collaboration is being performed b. Highlight that no single profession can meet the needs of all patients c. Provide meetings for each department on how their role affects patients d. Begin implementing evaluations of collaborative skills on annual performance reviews

ANS: B Recognizing that collaboration needs all professions to provide patient-centered care is an important first step to implementing a different philosophy in the hospital. Posting an evaluation of performance before education will not encourage participation. Collaboration requires an understanding of more than your own discipline. It is unfair to evaluate staff on a requirement that they have not been introduced to.

1. A group of staff nurses is dissatisfied with the new ideas presented by the newly hired nurse manager. The staff wants to keep their old procedures, and they resist the changes. Conflict arises from: a. Group decision-making options. b. Perceptions of incompatibility. c. Increases in group cohesiveness. d. Debates, negotiations, and compromises.

ANS: B The nurse manager should serve as a change agent, assisting others in understanding the importance, necessity, impact, and process of change.

6. The chief nursing officer plans a series of staff development workshops for the nurse managers to help them deal with conflicts. The first workshop introduces the four stages of conflict, which are: a. Frustration, competition, negotiation, and action. b. Frustration, conceptualization, action, and outcomes. c. Frustration, cooperation, collaboration, and action outcomes. d. Frustration, conceptualization, negotiation, and action outcomes.

ANS: B Thomas (1992) determined that conflict proceeds through these four stages in this particular order.

10. Two nurses on a psychiatric unit come from different backgrounds and have graduated from different universities. They are given a set of new orders from the unit manager. Each nurse displays different emotions in response to the orders. Nurse A indicates that the new orders include too many changes; Nurse B disagrees and verbally indicates why. This step in the process is which of the following in Thomas' Stages of Conflict? a. Frustration b. Conceptualization c. Action d. Outcomes

ANS: B Thomas' Stages of Conflict include conceptualization, which involves different ideas and emphasis on what is important or not or about what should occur

Which activities are appropriate for the nurse to collaborate with a patient? (Select all that apply.) a. Prescribing a new medication dose b. Health promotion activities c. End-of-life comfort decisions d. Interpreting laboratory results e. Lifestyle changes to improve health

ANS: B, C, E Nurses should include patients and their families when exploring health promotion activities, end-of-life decisions, lifestyle changes, and treatment options. Prescribed medication doses are initiated by educated professionals, although the patient gives feedback on the effectiveness of medications. Patients are not trained to interpret lab results, but patients rely on health professionals to explain results to them.

8. A nursing instructor is teaching a class on conflict and conflict resolution. She relates to the class that conflict in an organization is important, and that an optimal level of conflict will do the following: Generate: a. Creativity, a problem-solving atmosphere, a weak team spirit, and motivation of its workers. b. Creativity, a staid atmosphere, a weak team spirit, and motivation of its workers. c. Creativity, a problem-solving atmosphere, a strong team spirit, and motivation for its workers. d. A bureaucratic atmosphere, a strong team spirit, and motivation for its workers.

ANS: C Differences in ideas, perceptions, and approaches, when managed well, can lead to creative solutions and deepened human relationships. Work on conflict suggests that complete resolution of conflict is counterproductive to the achievement of organizational goals, organizational change, and cohesiveness of employees

9. Jane has transferred from ICU to CCU. She is very set in the way she makes assignments and encourages her new peers to adopt this method without sharing the rationale for why it is better. This is a good example of a process and procedure that creates ________ conflict. a. Organizational b. Intrapersonal c. Interpersonal d. Disruptive

ANS: C Interpersonal conflict transpires between and among nurses, physicians, members of other departments, and patients.

11. Mrs. Hill, aged 68, was hospitalized after a stroke. The speech therapist recommended that oral feeding be stopped because of her dysplasia. During visiting hours, Mr. Hill fed his wife some noodles. The nurse noticed this and stopped Mr. Hill from feeding his wife, telling him it was the doctor's decision. An hour later, the nurse returned and found Mr. Hill feeding his wife again. The nurse tried to stop him again. Mr. Hill refused and claimed that the clinical staff was trying to starve his wife; he also threatened to get violent with the nurse. The nurse decided to walk away and documented the event in Mrs. Hill's chart. According to Thomas' Four Stages of Conflict, in which stage could the nurse have been more effective? a. Frustration b. Conceptualizing c. Action d. Outcomes

ANS: C The nurse's actions did not include actions such as clarifying Mr. Hill's views on feeding his wife or on what is necessary to achieve good care for his wife and did not engage in dialogue with Mr. Hill, thus preventing identification of a common goal. The action stage involves a behavioral response such as clarification or dialogue.

The nurse is caring for a patient with a progressive, degenerative muscle illness. The patient states that she would like to remain in her home with her daughter as long as possible. What action should the nurse take? a. Teach the patient muscle strengthening and stretching exercises. b. Tell the patient to make plans to move to an assisted-living facility. c. Discuss resources to help the patient and make appropriate referrals. d. Ask the patient to come in for daily physical therapy.

ANS: C To honor the patient's request to stay at home the nurse should make appropriate referrals for needed evaluation and assistance. Most nurses will not have the expertise to teach appropriate exercises for degenerative illness. Asking the patient to move to an assisted-living facility does not account for the patient's request. The patient has not been assessed for the need of daily therapy, and it is not likely that a patient with a degenerative illness will be able to make daily appointments for treatment as the illness progresses.

A newly licensed nurse is assigned to an experienced nurse for training on a medical unit of a hospital. What type of nurse-to-nurse collaboration does this assignment demonstrate? a. Interprofessional collaboration b. Shared governance collaboration c. Interorganizational collaboration d. Mentoring collaboration

ANS: D Mentoring is a collaborative partnership between a novice nurse and an expert nurse to help transition a nurse through career development, personal growth, and socialization into the profession. Interprofessional collaboration is working with several disciplines. Shared governance is a type of management for nursing. Interorganizational collaboration often includes teams from inside and outside an organization to meet a common goal.

Which statement correctly describes the nurses' role in collaboration? a. State boards of nursing mandate that collaboration can only occur in hospitals. b. Collaboration should occur only with physicians. c. Collaboration occurs only between nurses with the same level of education. d. Collaboration may occur in health-related research.

ANS: D Nurses collaborate with many different persons, including patients, managers, educators, and researchers. Collaboration does not occur only with physicians or nurses of equivalent educational background, but with anyone who is working towards meeting patient goals. Collaboration occurs in any health care setting as well as community and home settings.

A nurse manager understands that the typical first step in handling an employee with a disciplinary problem is a: a. Verbal reprimand. b. Written reprimand. c. Reminder of employment standards. d. Day off without pay.

Reminder of employment standards.

Which patient scenario describes the best example of professional collaboration? a. The nurse, physician, and physical therapist have all visited separately with the patient. b. The nurse, physical therapist, and physician have all developed separate care plans for the patient. c. The nurse mentions to the physical therapist that the patient may benefit from a muscle strengthening evaluation. d. The nurse and physician discuss the patient's muscle weakness and initiate a referral for physical therapy.

ANS: D Professional collaboration includes team management and referral to needed providers to meet patient needs. Each discipline retains responsibility for their own scope of practice but recognizes the expertise of other providers. Working separately does not develop a comprehensive plan of care. Casual mentioning of patient needs does not follow professional communication channels and frequently delays needed interventions.

12. In Question 11, the outcome as depicted by Thomas' conflict stages can be considered to be: a. Compromising. b. Confronting. c. Constructive. d. Destructive.

ANS: D Resolution was absent because the nurse did not have time to effectively deal with the issues in the conflict, leading to escalation of the conflict.

13. Jill is the head nurse on a unit in a large hospital. Two of the staff nurses are constantly arguing and blaming each other, and a resolution has not occurred in months. To solve the existing conflict, which is the most desirable conflict resolution? a. Avoiding b. Competing c. Compromising d. Collaborating

ANS: D The collaboration technique has both sides in the conflict working together to develop an optimal outcome. This results in a win-win solution.

4. The nurse manager decides to use a mediator to help resolve the staff's conflict. A basic strategy for truly addressing this conflict is to: a. Identify the conflicting facts. b. Be determined to resolve the conflict. c. Schedule a meeting time for resolution. d. Have a clear understanding of the differences between the parties in conflict.

ANS: D The manager must determine if a conflict is constructive or destructive. In this situation, the manager has determined that the conflict is destructive and does not want the conflict to escalate, so has engaged a mediator.

A patient has been admitted to an acute care hospital unit. The nurse explains the hospital philosophy that the patient be an active part of planning their care. The patient verbalizes understanding of this request when they make which statement? a. "I will have to do whatever the physician says I need to do." b. "Once a plan is developed, it cannot be changed." c. "My insurance will not pay if I don't do what you want me to do." d. "We can work together to adjust my plan as we need to."

ANS: D Treatment plans need to be developed, evaluated, and adapted as needed based on the patient status and willingness to complete the prescribed care. Stating that the patient has to do whatever the care provider prescribes does not include the principle of collaboration. Care plans can be altered based on patient status. Insurance providers do not determine a patient's ability to complete prescribed care, although they do reimburse for standard care given.

The most important approach that a nurse manager can take with an emotionally troubled employee is to: a.Act as a therapist for the employee. b.Adjust the standard of care to assist the employee. c.Assist the employee in obtaining professional help. d.Adjust the employee's work schedule to decrease stress

Assist the employee in obtaining professional help.

1. When goals/outcomes are somewhat unclear in early preparation for a complex change, the manager and the change management team develop several acceptable goals/outcomes. This change in management approach is termed: a. Unfreezing. b. Nonlinear. c. Cybernetic. d. Linear.

B

10. An example of one strategy used to improve participation in the change process by staff fitting the behavioral description of innovators and early adopters is to: a. Repeat the benefits of the change. b. Share change experiences early in the process. c. Initiate frequent interactions among staff. d. Provide select information to the staff.

B

13. In Question 12, staff nurses who gain information on current IV therapy practices are engaging in which phase of Rogers' decision-making process? a. Persuasion b. Knowledge c. Confirmation d. Decision

B

19. Based on Elizabeth's insights and suggestions, you involve pharmacy, only to discover that the change in practice involves practice committees, a medical practice committee, and concerns from administration about potential costs and safety of the proposed change to the IV protocols. The change process at this point is: a. Linear. b. Nonlinear. c. Sabotaged. d. Neutralized.

B

16. Which of the following would be the most effective response to Elizabeth (Question 14)? a. "I understand how you feel, but you are going to have to change." b. "It is unfortunate that you feel this way. Others seem quite excited about the new information." c. "It is difficult sometimes to change what we know very well. Sometimes it can be frightening." d. "Perhaps I can arrange some more information sessions for you, so you can see just how important this change is to patient safety."

C

17. Elizabeth is an example of a(n): a. Early adopter. b. Late adopter. c. Laggard. d. Resister.

C

2. The home health agency hired an expert in financial management to evaluate and propose a plan for reversing growing expenses and decreasing revenues. The expert is well respected, both personally and professionally, by members living in this small community. To be effective, staff will need to perceive this change agent as: a. Trusted, quiet. b. Flexible, informal. c. Credible, legitimate. d. Communicative, personable.

C

21. As the unit manager on the unit that is leading changes to heparin locks, you find that Elizabeth is very valuable in terms of her observations about other units and her knowledge of organizational processes, and now in discussing the new procedure with others. Elizabeth might be considered an: a. Engager. b. Innovator. c. Informal change agent. d. Informant.

C

23. The situation in Question 22 is best captured in which theory of change? a. Chaos b. Planned change c. Cybernetics d. Innovation-decision process

C

25. Edith has been vocal about her negative concerns related to a new charting system and frequently expresses the view that keeping the "old system" would have been just fine. In facilitating change, your best approach to Edith would be to: a. Put her in the pilot planning group for the change. b. Determine if she has considered retirement. c. Schedule her work assignment so that it coincides with those of two staff members who are confident with technology and the change. d. Avoid discussion of the change, and trust that with sufficient training and information, she will change.

C

4. The clinical coordinator expects the position description of the new wound care specialist to change nurses' responsibilities in caring for clients with skin integrity problems. The best approach to address this need for change, yet to have the best outcomes for clients, staff nurses, and the organization, is to: a. Select one of the change models. b. Use Lewin's model and principles of change. c. Apply both planned and nonlinear approaches. d. Form a task force of nursing staff and wound care specialists.

C

8. The oncology clinic manager and the educational coordinator asked nursing staff to complete a brief written survey to assess their attitudes and knowledge related to having used the new infusion equipment for 6 weeks. The stage of change in this situation is: a. Developing awareness. b. Experiencing the change. c. Integrating the change. d. Perceiving awareness.

C

The unit manager discusses absenteeism with the unit clerk. She indicates that it is a serious problem on the unit. Which of the following points would they have likely discussed? a. Employee morale is at a high level. b. Care will suffer and standards will be lo-wered. c. Existing staff have experienced little ef-fect from the absenteeism. d. Replacement staff usually needs little su-pervision. e. Unit costs have increased because of staff replacements and overtime.

Care will suffer and standards will be lowered. Unit costs have increased because of staff replacements and overtime.

Nurses generally experience difficulty in identifying behaviors and actions that could signal chemical dependency in a co-worker. Which of the following is not a behavioral change that occurs with chemical dependency? a. Personality and behavioral changes b. Job performance changes c. Changes in educational involvement and pursuit d. Absenteeism

Changes in educational involvement and pursuit

14. Elizabeth, an RN with approximately 15 years of service on your unit (Question 11), walks away from one of the learning sessions on IV care, and you overhear her telling a colleague that she thought the session was a waste of time because "the unit has been using heparin for years and there has never been any adverse effect." According to Havelock (1973), this comment may originate from failure in which phase of the six phases of planned change? a. Generating self-renewal b. Choosing the solution c. Diagnosing the problem d. Building a relationship

D

15. You follow up with Elizabeth (Question 14) and discover that she is really quite angry about the information sessions because she feels that you are implying that "what she has been doing all these years means that she is incompetent and doesn't care about her patients." Your response to her indicates that: a. Elizabeth will never adopt the change. b. Elizabeth is insecure in her practice. c. Elizabeth requires more information about the practice. d. Change involves emotions rather than intellect.

D

20. Resistance is most likely when change: a. Is not well understood. b. Involves many layers in an organization. c. Involves nonprofessional workers. d. Threatens personal security.

D

22. As the unit manager, you spend a day performing direct patient care and work with a new system that is designed to capture patient documentation at the bedside. During discussions with staff while giving care, you discover that the number of screens that need to be opened during documentation makes charting more complex and time-consuming than traditional manual charting approaches. On the basis of this feedback, you: a. Assume that the system is doing what it needs to do. b. Provide reassurance to staff that the unit has achieved its goals in implementation of the system. c. Ask some of the staff if they have had similar experiences with the system. d. Consult chart audit data and end user consultation reports to determine if errors and problems are occurring.

D

24. Sarah, RN, is one of your most enthusiastic staff and has been to a workshop on preparing educational materials for patients. On the basis of this workshop, she would like to develop an information website for patients who are being admitted to the ward. An appropriate response to Sarah's suggestion would be: a. "That is a great suggestion, but we have no resources for such an expensive undertaking right now." b. "Perhaps you can keep that in mind as we redesign our charting system." c. "We have too many seniors as patients, and you know that they don't use technology." d. "There is a great group here that meets to look at technology pilots. Let's see if you can join them and discuss your idea further."

D

6. To effectively achieve a change goal/outcome in a change situation, the wound care specialist will: a. Preserve the status quo. b. Diminish facilitators and reinforce barriers. c. Weigh the strength of forces. d. Strengthen facilitating forces.

D

7. The wound care nurse decided to involve those to be affected by change early in the change management process. This can positively result in: a. Coordination. b. Resistance. c. Anticipation. d. Participation.

D

9. An example of one strategy to improve participation in the change process by staff fitting the behavioral descriptions of laggards, early majority, late majority, and rejectors is to: a. Encourage teamwork. b. Transfer to a different unit. c. Require attendance at staff meetings. d. Delegate the roles and tasks of change.

D

During unit staff meetings, you observe that Marg rolls her eyes and snorts whenever Julia makes a comment. Your first response as a unit manager is to: a. Discuss what you have observed with Marg. b. File immediate documentation in Marg's personnel file. c. Ask Julie to monitor Marg's behavior during meetings. d. Ignore the behavior, as Marg is one of your strongest nurses.

Discuss what you have observed with Marg.

The unit manager on 4E is concerned about the performance of Jean, a staff nurse. She is not involved directly with Jean, so she has not been able to determine whether the problem is one of motivation, ability, or both. If Jean lacks ability, which of the following strategies might the head nurse use? a. Dismiss or transfer Jean. b. Document all problem areas and then discuss them with Jean. c. Develop appropriate solutions and make recommendations to Human Resources. d. Smooth over the problems if they are minor in nature.

Document all problem areas and then discuss them with Jean.

Ellen is a novice nurse on your unit. Even though she has come to you highly recommended, as her supervisor, you have noticed some knowledge and skill deficiencies. These deficiencies have been noticed by her peers as well, who cover for her because she is new and they like her. Which of the following is likely to be the greatest asset to Ellen in improving her performance? a. Ignore Ellen's errors until she has more experience. b. Instruct staff to avoid working with Ellen until she learns to how do things herself. c. Ask Ellen to complete a self-assessment, using a standard skills checklist. d. Encourage staff to report every behavior of Ellen's that is different from theirs.

Encourage staff to report every behavior of Ellen's that is different from theirs.

All of the following are grounds for immediate dismissal except: a. Failing to pursue further medical help for a patient; patient dies. b. Selling narcotics obtained from the unit supply of narcotics. c. Restraining a patient in bed for 7 hours, unsupervised, as punishment for hitting a staff member. d. Grabbing the unit manager and threatening further physical harm after a poor performance appraisal.

Failing to pursue further medical help for a patient; patient dies.

The chief nursing officer understands that clinical incompetence is best prevented by a: a. Flexible protocol for evaluating competency skills. b. Standardized clinical skills checklist. c. Administration of personality tests and competency assessments at point of hire. d. Formalized competency program with established standards for practice.

Formalized competency program with established standards for practice.

A nurse manager must be familiar with the agency's policies regarding termination. Termination procedures include which of the following? a. Following specific procedures from other organizations b. Having an attorney present at the termination meeting c. Having adequate written documentation to support the action d. Having a friend present during the termination meeting

Having adequate written documentation to support the action

In keeping with guidelines of the organization, the nurse manager documents staff problems. Documentation of disciplinary problems should: a.Include a plan to correct them and to prevent future occurrences. b.State a detailed history of past problems that are related to the current one. c. Be written at the convenience of the manager. d. Accumulate until the evaluation period begins

Include a plan to correct them and to prevent future occurrences.

Nathan has been on the cardiac unit for 6 months and has found it difficult to adjust to the expectations of his team. Which of the following behaviors would most likely signal that Nathan is intending to resign from his position on the unit? a. Increased absenteeism over the past month b. Increased attempts to discuss his concerns with his colleagues c. Testing of workplace guidelines d. Frequent defensiveness

Increased absenteeism over the past month

Before terminating an employee, a nurse manager must: a.Be an expert in all legal aspects of termination and discipline practices. b.Know the organization's specific policies for addressing disciplinary problems and termination. c.Function as a counselor for problem employees. d.Do everything to assist and protect the employee by adjusting standards and policies.

Know the organization's specific policies for addressing disciplinary problems and termination.

Susan, a new graduate, is upset that so many staff have been absent lately from the unit. She declares to you that all absenteeism could be eliminated with proper management. Your response is based on understanding that: a. Not all absenteeism is voluntary. b. High personal control contributes to absenteeism. c. Direct discussions with employees who have high levels of absenteeism are not recommended. d. All absenteeism is related to personal issues and needs.

Not all absenteeism is voluntary.

A nurse manager understands that the second step in handling an employee with a disciplinary problem is to document the incident. Which of the following is best for documentation of personnel problems? a. Use of the performance appraisal on an annual basis b. Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up c. A tally sheet of medication errors and other specific problems that will be used at annual review d. Copies of reports, placed in his or her file, of all unusual occurrences involving the employee

Notes made immediately after an incident that include a description of the incident, actions taken, plans, and follow-up

The education consultant for the hospital is presenting a workshop titled "Documentation: A Manager's Responsibility." Which of the following points would she not include in her PowerPoint presentation? Documentation: a. Cannot be left to memory. A notation must be placed in the personnel file. b. Should avoid discussion of the problem. c. Should include what was done about the problem when it occurred. d. Needs to include date, time, and place.

Should avoid discussion of the problem.

The nursing director calls a meeting with one of the new unit managers. She is very concerned about a report of substance abuse on the manager's unit, and she reviews the procedures involved in dealing with chemically dependent staff. Which of the following statements would not be included in the discussion?

Should realize that the nurse is a professional embarrassment and should be kept out of sight of other staff."

The chief nursing officer reviews the policy about "progressive discipline process." The progressive discipline process includes which of the following? The manager: a. Is a counselor and friend to the employee. b. Should reprimand and suspend the employee as a last resort. c. Should rehire the employee after a reasonable length of time. d. Should terminate the employee if the problem persists.

Should terminate the employee if the problem persists.

When progressive discipline is used, the steps are followed progressively only for repeated infractions of the same rule. On some occasions, rules that are broken are so serious that the employee is: a. Transferred to another unit. b. Suspended indefinitely. c. Asked to attend a union grievance meeting. d. Terminated after the first infraction.

Terminated after the first infraction.

Incivility is a disruptive behavior or communication that creates a negative environment and interferes with quality patient care and safety. The manager can implement steps that help to alleviate uncivil behavior on a unit. Which of the following would NOT be an appropriate first step? a. Suspending the staff member from work b. Providing written admonishment that is discussed and placed in the employee's file c. Providing verbal admonishment d. Terminating the staff member

Terminating the staff member

The nurse manager places a staff member on probation because of reports of chemical dependency. The nurse manager should be aware that which of the following statements is true regarding chemical dependency? a. The chemically dependent employee usually hides any changes in behavior. b. When confronted with the issue, the affected employee is usually relieved to have someone to talk to about the problem. c. The chemically impaired nurse affects the entire healthcare organization. d. Hospital policy, state laws, and nurse practice acts address procedures for the chemically dependent employee in the most general terms

The chemically impaired nurse affects the entire healthcare organization.

Nurse Stacey is a self-admitted drug addict and has been a heavy abuser of codeine. Stacey and the unit manager decide that changes have to occur. Stacey enrolls in an addiction program, and the manager has her transferred to a drug-free area. What other strategies might be appropriate? a. The manager could refer Stacey to the Human Resources Department. b. The manager could assist in monitoring Stacey's progress. c. The manager could counsel Stacey if Stacey has formed a trusting relationship with her. d. Stacey needs to be asked not to involve her family in the recovery program because this is a work-related situation.

The manager could assist in monitoring Stacey's progress.

The nurse and physician are explaining the home care that will be needed by a patient after discharge. The patient's spouse states angrily that it will not be possible to provide the care recommended. What is the best response by the nurse? a. "Let me review what is needed again." b. "It is important that you do what the physician has prescribed." c. "What concerns do you have about the prescribed care?" d. "I can come back after you talk with your spouse about the care."

The patient needs to be the focus of developing care plans, and communication is an important part of collaboration with the patient to discover barriers for the patient to follow recommendations. It is important to either provide solutions to the barriers or present other options. Reviewing the care again does not demonstrate willingness to have the patient be part of the team. Insisting that the patient do what is prescribed is autocratic and does not recognize the role the patient has in their care. Leaving the patient and spouse with the situation unresolved fosters distrust and more anger.

The nurse manager knows that the most serious effect that absenteeism has on the nursing unit is that: a.Using replacement personnel with new ideas may be beneficial. b.Salary costs are lower because personnel are fewer, and outcome is favorable. c.Absence on the part of the rest of the staff is decreased. d.Unacceptable patient care may result.

Unacceptable patient care may result.

In orienting new staff nurses to a pediatric intensive care unit, the nurse manager asks the staff nurses to answer the following question: "What is an important consideration in providing information to parents of a critically ill child?" a. Making sure that they receive complete information during each encounter with a member of the nursing staff b. Assessing parents' preferences for the amount of information desired c. Allowing parents to observe key aspects of their child's nursing care d. Making sure that patient education brochures explaining ICU protocols are readily available

b. Assessing parents' preferences for the amount of information desired Consultation with the parents regarding the amount of information that they desire reflects a service orientation, in which preferences and needs of the consumer are placed first. The other answers reflect nurse-directed decisions in which the nurse decides what information and how much information is needed and how it is to be delivered.

Based on data from the patient satisfaction survey, the nurse manager decides that a change should be made in communication with family members. What would be important for a nurse manager to consider when instituting a change to improve customer service? a. Assess the perceptions of the nursing staff regarding the particular service problem. b. Include community representatives on a planning committee to address the change. c. Involve physicians, other healthcare professionals, and ancillary staff. d. Review all patient complaints with the nursing staff.

a. Assess the perceptions of the nursing staff regarding the particular service problem. Nurses are the healthcare providers who spend the most time with the consumer and are in an opportune position to understand the issues, structures, and processes that affect patients. The nurse acts as the primary person to be alert to circumstances that may prevent a successful outcome for the patient and to intervene on the patient's behalf. As a nurse manager, it is important to support staff in their use of power to be in control and to make decisions at the consumer-staff level of interaction.

As a nurse manager, you see an opportunity for patients to be well serviced through the medical home concept. You recognize that the concept of medical homes: a. Currently does not include nurses in its vision of multifaceted primary care. b. Includes nurses as part of an interdisciplinary and multidisciplinary team. c. Restricts nurses to services related to direct care and procedures. d. Cannot encompass nurses within this framework.

a. Currently does not include nurses in its vision of multifaceted primary care. The concept of medical homes encompasses the idea of multifaceted medical homes that provide a usual source of health care. Current discussions have focused on physician-directed care even though nurses in advanced practice are well suited to lead teams in this model.

The nurse manager understands that the three Ps associated with client education are philosophy, priority, and performance. Effective client education programs start with a shared philosophy that such programs are worth the investment. Evidence of a philosophic commitment to client teaching is best represented by: a. Investing time and energy in teaching clients. b. Developing teaching skills among the nursing staff. c. Assuming that clients lack the knowledge they need. d. Having a teaching checklist on clients' charts.

a. Investing time and energy in teaching clients. A philosophy that patient education is an investment with a significant positive return is one of the three Ps of a successful consumer education focus. Money invested in teaching is money well spent.

The chief nursing officer is pleased with the nurse manager's strategy of improving patient satisfaction in the pediatric intensive care unit. She decides to implement these changes throughout the hospital. What would be important to consider in implementing a new program focused on improving relationships with consumers? a. Recognition of the nursing staff for excellence in promoting consumer relationships b. Holding the staff accountable for resolving patient complaints c. Selecting a staff nurse leader to implement the program d. Identifying key staff members who have already demonstrated excellence in consumer relationships

a. Recognition of the nursing staff for excellence in promoting consumer relationships The nurse leader should allow professionals more influence over their practice;give staff opportunities to learn new and varied skills; give recognition and reward for success and support and consolation for lack of success; and foster motivation and belief in the importance of each individual and the value of his or her contribution.

Which of the following activities would represent a customer-friendly approach in a healthcare setting? (Select all that apply.) a. Using a local anesthetic before inserting a needle into a child's arm b. Repeating patient history information to the admitting clerk, the admitting nurse, and the ultrasound technician c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma

a. Using a local anesthetic before inserting a needle into a child's arm c. Ensuring that birthing preferences are on file and available when a laboring mother comes in d. Providing support to families when a family member is brought into trauma ANS: A, C, D A service orientation means delivering services in a manner that is least disruptive. When possible, services should come to the patient and should be as easy, comfortable, pleasant, and effective as possible. Meeting the emotional, psychosocial, and spiritual needs of the patient is important.

In designing a program for young adults regarding safe sexual practices, which of the following might reach the greatest number in your target group? a. Web-based applications b. Print-based media such as newspapers c. Television advertisements d. Brochures in kiosks in malls

a. Web-based applications Mobile technology is changing the digital divide, with young adults, minorities, those with no college experience, and those with lower household incomes being more likely to indicate that phones are their main source of Internet access (Zickuhr & Smith).

A 27-year old woman is admitted to your ICU in a coma, following an accident. The family of the patient, who is a Native American, places a medicine pouch in the bed with the young woman. As the nurse in this situation, it is important to: a. Explain to the family that the medicine pouch may contain herbs that may bother other patients. b. Ask the family about the significance of the medicine pouch for them. c. Remove the pouch when the family is not present. d. Put the medicine pouch on the shelf beside the bed.

b. Ask the family about the significance of the medicine pouch for them. Diversity encompasses more than differences in nationality or ethnicity and may include a variety of ways that patients are different from their healthcare providers. Nurses need to recognize the culture of their work setting, realizing that it may differ markedly from the culture of the consumer, and move beyond ethnocentrism to provide culturally competent care. This competence includes cultural knowledge, which involves actively learning about a community; cultural sensitivity, which entails valuing and respecting beliefs, norms, and practices of the people being served; and collaboration within a community (Flaskerud, 2007). In this instance, it is important to understand the meaning of the pouch for the family; removal from the bed without discussion does not demonstrate respect for the values and beliefs of this family.

The chief nursing officer decides to establish a client advocacy position in an oncology unit. Advocacy is best represented by: a. Establishing private and professional networking systems. b. Asking social services to handle clients' concerns. c. Identifying community support groups. d. Empowering others by promoting self-determination.

d. Empowering others by promoting self-determination. Advocacy involves empowering and promoting self-determination in others.

As a head nurse, you are concerned about the service orientation on your unit. Which of the following findings and approaches might provide useful information for you? a. Patients find nurses friendly and accessible; data are aggregated for the institution as a whole. b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. c. Specific questions related to management of comfort are included for the institution as a whole. d. The survey asks for a range of responses for the unit and the organization, with a focus on facilities, such as cleanliness and responsiveness of administrative services.

b. Data indicate that nurses are responsive to requests for assistance; data are available for the unit and the institution. The National Database of Nursing Quality Indicators (NDNQI®) is a national repository for unit-based quality data that can be used by organizations to benchmark the outcomes of care against those of other institutions (ANA, n.d.). Unit-based quality indicators, including satisfaction with nursing care, are a key feature of the NDNQI®. In addition to hospitals being provided with their own and comparison data, researchers are able to access de-identified data in order to answer important questions about nursing care quality. Pain management, the discharge process, and post-discharge patient callbacks are specific areas where nurses can make significant improvement in patient satisfaction. Because patients and nurses may differ in what they see as factors that produce satisfaction, total reliance on nursing perceptions of patient satisfaction may not provide a complete picture.

John is an older adult patient who comes regularly to the multigroup practice in which you are a nurse practitioner. He says that he doesn't understand what he is supposed to be doing about his medications, because every time he comes to the clinic, he sees someone else who has different ideas. John's experience represents what aspect of the current consumer experience? a. Nurses are well-trusted members of the healthcare team. b. Fragmentation of care results in lack of respect and trust. c. Care providers often have conflicting ideas about care. d. The public does not trust care providers other than nurses.

b. Fragmentation of care results in lack of respect and trust. When consumers visit a multigroup practice, they do not have the option of selecting a specific healthcare provider, and thus, there is less opportunity to build a trusting relationship with a provider.

The nurse manager has to develop a patient satisfaction survey. What is one of the critical elements in selecting a patient satisfaction instrument? a. Being able to use the same instrument for all clinical units b. Including items that are important from the patient's perspective c. Being able to administer the instrument before a patient's discharge from the hospital d. Being sure that the reading level is no higher than third grade

b. Including items that are important from the patient's perspective Because satisfaction is a measure of service and service is a measure of perception of what matters to the patient, to measure satisfaction, surveys must include items that reflect the perspective of the patient. The quality of human contacts becomes the measure by which the consumer forms perceptions and judgments about nursing and the health agency. Consumers may not be able to evaluate the quality of interventions, but they always can evaluate the quality of the relationship with the person delivering the service.

The nurse manager analyzes the data from the patient satisfaction surveys. What can a nurse manager do to strengthen service recovery and improve consumer relationships? a. Post comparisons of patient satisfaction scores with those of other units on a monthly basis. b. Involve the staff in resolving consumer issues quickly and effectively. c. Ensure that staff members apologize to patients when they complain about services. d. Ask that patients with complaints about services place them in a written format.

b. Involve the staff in resolving consumer issues quickly and effectively. Consumers need to be treated with fairness, given explanation, and provided with information about how errors will be prevented in the future. Staff can be assisted to respond to patient concerns through scripting, support, and an atmosphere that places an emphasis on learning and solutions rather than on blaming.

Technology is integral to a cardiac ICU. Sue, the nurse manager, implements a patient-centered approach that focuses on the meaning of the experience for the patient and family, primary nursing, and a health literacy approach. Sue is: a. Using high-tech-low-touch approaches. b. Using high-tech-high-touch approaches. c. Providing products. d. Providing tangible products of satisfaction.

b. Using high-tech-high-touch approaches. The provision of humanistic care within a high-tech environment is characteristic of high tech-high touch approaches and reflects the idea that the more that high-tech is used, the more patients also desire high-touch.

Which of the following actions best exemplifies advocacy? a. Developing a list of agencies that will provide free services for the homeless b. Working in a needle exchange program for individuals in an inner-city environment c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee d. Working in a free clinic for immigrant workers

c. Acting on behalf of a patient to promote end-of-life wishes to an ethics committee Advocacy means making known and defending and protecting the rights and interests of others, as well as ensuring the dignity and respect due to others. Simply being employed in an environment where this might be a focus of practice does not necessarily ensure that advocacy is actually occurring.

During review of a patient's progress, the healthcare team determines that a patient requires treatment that is generally accepted at that time in the usual illness trajectory of a patient. The patient is unable to pay. As the head nurse, you persist in ensuring that this patient receives the treatment. You are: a. Empowering the patient. b. Avoiding litigation. c. Advocating for the patient. d. Supporting the clinical pathway.

c. Advocating for the patient. Advocacy means defending the rights and interests of others and, in this situation, the right of a patient to receive care, as determined by standards utilized in a critical pathway.

As part of performance appraisal, the nurse manager designs strategies to acknowledge staff members. What practices by the nurse manager best acknowledge staff accountability and contribution? a. Providing new and varied learning experiences for staff members b. Fostering group cohesiveness through standardization of unit activities c. Allowing professionals greater influence over their practices d. Giving recognition for success and support for failure to staff members

c. Allowing professionals greater influence over their practices Facilitating greater control over practices implies trust and acknowledges expertise and performance.

The complexity of the healthcare environment for consumers is increased by: a. Falling levels of education among the public. b. Increased levels of poverty. c. Complex compensatory systems and a variety of delivery systems. d. Increased numbers of uninsured or underinsured.

c. Complex compensatory systems and a variety of delivery systems. The complexity of options in health care and the processes and policies involved in funding health services for patients, as well as fragmented relationships with a growing variety of healthcare providers, contribute to the complexity of the system for patients, especially for those who might need it most, such as the poor, uninsured or underinsured, and homeless.

A nurse is admitted to a psychiatric unit. The staff expresses frustration with her because they have explained several times her medication regimen, and yet, when she goes on passes, she fails to follow it. The staff believe that, as a nurse, she should be able to understand what is expected. The nurse's failure to follow the regimen indicates: a. Early cognitive impairment. b. Lack of motivation. c. Lack of health literacy. d. Worsening health state.

c. Lack of health literacy. What is evident from the response is that she lacks health literacy or the capacity to obtain, process, and understand basic health information and services. Using a Health Literate Care Model involves weaving health literacy strategies into care by assuming that patients do not understand their health conditions or what to do about them, and then, subsequently assessing patients' understanding (Koh, Brach, Harris, & Parchman, 2013). For example, a nurse who is an expert clinician in a specialty practice area, when diagnosed with a serious chronic illness, may not have the appropriate background to make informed healthcare decisions.

In writing the patient satisfaction survey, the nurse manager is aware of the education levels of the families. What is the most critical element in the concept of health literacy? a. Providing instructional materials at appropriate reading levels b. Facilitating access to translators for persons with language barriers c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made d. Knowing that most people have limited health literacy skills

c. Obtaining, processing, and understanding basic health information so appropriate decisions can be made The definition of health literacy used by the federal government is "the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions" (U.S. Department of Health and Human Services, 2010).

Corrine, a student nurse, often hears that nurses are gatekeepers and wonders what that term means. As a nurse leader, you explain that this is a reference to the: a. Assessment and admission of patients into care. b. Orientation of patients to services once they are admitted. c. Function of controlling which patients see the physician and which do not. d. Coordination of care, services, advocacy, and access for patients within the healthcare system.

d. Coordination of care, services, advocacy, and access for patients within the healthcare system. As gatekeepers to the system, nurses advocate for and coordinate care, services, and access for patients across all providers, settings, and levels of care.

You are involved in designing a clinic for women in an inner-city neighborhood. A goal of this clinic might be: a. Development of services that are identified in various studies as important for this target group. b. Partnership with area city councilors and health professionals to provide services that are consistent with their vision and funding sources. c. Provision of immunization and addictions services and health screening services for women in the area. d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care.

d. Development of services that have been identified by the women and neighborhood advocates as necessary for their health care. ANS: D Involvement of persons in their own health care is a cornerstone of healthcare reform and is important for improving health outcomes and patient experiences. While studies and partnership with key informants are important sources of information in the design of services, engagement of the women through their neighborhood advocates may increase activation and resulting behavior. Patient activation refers to patients' willingness and ability to take independent actions to manage their health and care.

A nurse makes a medication error that is not serious and does not cause harm to the patient. As the head nurse, your best action would be to: a. Call attention to it by posting the critical incidents report at the nursing station. b. Include the mistake on the nurse's performance appraisal. c. Apologize to the patient for the error, and indicate that discipline has occurred. d. Educate the nurse on how to provide an apology to the patient.

d. Educate the nurse on how to provide an apology to the patient. ANS: D Service recovery ensures responsiveness to the patient, and as part of service recovery, it is important to address an error in the most productive way, which also includes the nurse who made the error offering an apology to the patient.

An example of a factor that would impede a patient's learning is: a. Poverty. b. Limited health insurance. c. Being an older adult. d. Heavy sedation.

d. Heavy sedation. ANS: D Nurses need to be sensitive to the teaching needs of those at risk for disparities in health care: persons of a different race or ethnic group, women, children, older adults, rural residents, and those with limited or no health insurance, low health literacy, and/or low socioeconomic status. It is important that lower expectations for persons who are disadvantaged, have a low literacy level, or have limited English proficiency are not unintentionally communicated.

The nurse manager on a pediatric intensive care unit wants to evaluate patient satisfaction. The nurse manager understands that ultimately, positive relationships with consumers of care are evaluated by the: a. Cultural sensitivity of staff. b. Cost-effectiveness of care delivery. c. Economic value of service. d. Outcomes for clients and their perceptions of care.

d. Outcomes for clients and their perceptions of care. ANS: D Trend-setting organizations such as MagnetTM organizations need to demonstrate excellence in outcome data such as patient satisfaction. Patient satisfaction and perception of the quality of care are affected by the quality of the nurse-patient relationship. Valid measurement of patient satisfaction is an evolving science; nurses do not always accurately gauge what factors are most important to patients. Satisfaction measures are often skewed in a positive direction with scores clustered at the top of the scale.